Appraising negative experiences in ways that reduce associated distress is a key component of successful emotion regulation. In 4 studies, the authors examined the effects of systematically practicing appraisal skills using a computer-mediated cognitive bias modification (CBM) methodology. In Studies 1-3, healthy participants practiced applying appraisal themes linked to the idea of seeing the bigger picture to a series of distressing training films, either during each film (Study 1) or immediately after each film (Studies 2 and 3). Control participants watched the same films with no appraisal instructions. Participants who practiced appraisal, compared with controls, exhibited reduced levels of self-reported negative emotional (Studies 1-3) and electrodermal (Study 1) responses to a final test film that all participants were instructed to appraise. In Study 4, a comparable effect of appraisal practice was found using distressing autobiographical memories for participants with higher levels of negative affect. Appraisal practice also led to reduced intrusion and avoidance of the target memories in the week poststudy, compared with prestudy levels, and relative to the no-practice controls. The findings are discussed in terms of the broader literature on CBM.
Background: Online patient simulations (OPS) are a novel method for teaching clinical reasoning skills to students and could contribute to reducing diagnostic errors. However, little is known about how best to implement and evaluate OPS in medical curricula. The aim of this study was to assess the feasibility, acceptability and potential effects of eCRESTthe electronic Clinical Reasoning Educational Simulation Tool. Methods: A feasibility randomised controlled trial was conducted with final year undergraduate students from three UK medical schools in academic year 2016/2017 (cohort one) and 2017/2018 (cohort two). Student volunteers were recruited in cohort one via email and on teaching days, and in cohort two eCREST was also integrated into a relevant module in the curriculum. The intervention group received three patient cases and the control group received teaching as usual; allocation ratio was 1:1. Researchers were blind to allocation. Clinical reasoning skills were measured using a survey after 1 week and a patient case after 1 month. Results: Across schools, 264 students participated (18.2% of all eligible). Cohort two had greater uptake (183/833, 22%) than cohort one (81/621, 13%). After 1 week, 99/137 (72%) of the intervention and 86/127 (68%) of the control group remained in the study. eCREST improved students' ability to gather essential information from patients over controls (OR = 1.4; 95% CI 1.1-1.7, n = 148). Of the intervention group, most (80/98, 82%) agreed eCREST helped them to learn clinical reasoning skills. Conclusions: eCREST was highly acceptable and improved data gathering skills that could reduce diagnostic errors. Uptake was low but improved when integrated into course delivery. A summative trial is needed to estimate effectiveness.
IMPORTANCE New and expectant parents experience perinatal mood disorders, with consequences to parenting ability, bonding with the neonate, interpersonal relationships, and health and well-being of parents. Research shows that maternal and paternal perinatal mood disorders are associated, but no recent systematic review has addressed the prevalence of perinatal mood disorders in both mothers and fathers (parental dyad).
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