Look at the Audience? A Randomized Controlled Study of Shifting Attention From Self-Focus to Nonsocial vs. Social External Stimuli During Virtual Reality Exposure to Public Speaking in Social Anxiety

Background: Enhanced self-focused attention plays a central role in the maintenance and treatment of Social Anxiety and is targeted in contemporary cognitive behavioral therapy. Actual developments use Virtual Reality (VR) for behavioral training. However, no VR attention training combining exposure to public speaking with shifting attention from self-focus to external focus has been investigated, and no experimental evidence exists on different kinds of external cues as targets of attention. Therefore, we investigated the effects of an attention training during public speaking in VR and examined differential effects of an external focus on nonsocial vs. social stimuli.Methods: In this randomized controlled study, highly socially anxious participants were instructed to focus on either objects or the audience within a virtual speech task. We assessed the pre-post effects on affective reactions, self-perception, and attentional processes during public speaking as well as general Social Anxiety using subjective, physiological, and eye-tracking measures. Repeated-measures analyses of variance (ANOVAs) were calculated to detect changes from pretest to posttest over both groups, and time × group interaction effects.Results: Within the analysis sample (n = 41), anxiety during public speaking and fear of negative evaluation significantly decreased, with no significant differences between groups. No significant time effect, but a significant time × group effect, was found for the looking time proportion on the audience members' heads. Follow-up tests confirmed a significant increase in the social-focus group and a significant decrease in the nonsocial-focus group. For all other variables, except external focus and fear of public speaking, significant improvements were found over both groups. Further significant time x group effects were found for positive affect during public speaking, with a significant increase in the social focus, and no significant change in the nonsocial-focus group.Conclusion: Our findings suggest that attention training to reduce self-focus can be successfully conducted in VR. Both training versions showed positive short-term effects in the highly socially anxious, with particular advantages of an external social focus concerning eye contact to the audience and positive affect. Further research should investigate whether social focus is even more advantageous long term and if reinterpretations of dysfunctional beliefs could be achieved by not avoiding social cues.

INTERSTAARS: Attention training for infants with elevated likelihood of developing ADHD: A proof-of-concept randomised controlled trial

Attention-deficit/hyperactivity disorder (ADHD) is first diagnosed during middle childhood, when patterns of difficulty are often established. Pre-emptive approaches that strengthen developing cognitive systems could offer an alternative to post-diagnostic interventions. This proof-of-concept randomised controlled trial (RCT) tested whether computerised gaze-based attention training is feasible and improves attention in infants liable to develop ADHD. Forty-three 9- to 16-month-old infants with a first-degree relative with ADHD were recruited (11/2015–11/2018) at two UK sites and randomised with minimisation by site and sex to receive 9 weekly sessions of either (a) gaze-contingent attention training (intervention; n = 20); or (b) infant-friendly passive viewing of videos (control, n = 23). Sessions were delivered at home with blinded outcome assessments. The primary outcome was a composite of attention measures jointly analysed via a multivariate ANCOVA with a combined effect size (ES) from coefficients at baseline, midpoint and endpoint (Registration: ISRCTN37683928). Uptake and compliance was good but intention-to-treat analysis showed no significant differences between 20 intervention and 23 control infants on primary (ES −0.4, 95% CI −0.9 to 0.2; Complier-Average-Causal Effect ES −0.6, 95% CI −1.6 to 0.5) or secondary outcomes (behavioural attention). There were no adverse effects on sleep but a small increase in post-intervention session fussiness. Although feasible, there was no support for short-term effects of gaze-based attention training on attention skills in early ADHD. Longer-term outcomes remain to be assessed. The study highlights challenges and opportunities for pre-emptive intervention approaches to the management of ADHD.

The Effect of Combining Attention Training Program into Language-based Treatment of Anomia on Word Retrieval: A Case Report

Introduction: The present study is a case report of a 50-year-old man (SM) with aphasia whose word retrieval was severely impaired. The aim of the study was to compare the effect of a combined treatment program (attention training and language treatment) and a single program (language treatment alone) on the naming picture materials. Materials and Methods: This case was affected by a hemorrhagic cerebrovascular accident in the territory of Middle Cerebral Artery branches of the left hemisphere. Two naming treatments, i.e. the single and combined treatments sequentially, were provided for SM; during each of them a 50-item wordlist was practiced (Lists A and B). 12 treatment sessions were implemented for him during each treatment program. These two lists along with another list (List C), left for assessment of generalization of treatments to untrained items, were probed 6 times during and after each program. The whole picture set was normalized in another study described in the text. Results: Our patient’s naming ability progressed during the treatment programs. However, this progression was more salient in combined treatment program. More specifically, List B had the mean score of 34.25 in combined treatment program that was higher than mean of List A in single treatment program (14.5). The slope of List B scores was also higher than that of List A (3.7 vs 1.2). List C showed more generalization of combined treatment to untrained items than single treatment based on its mean scores (27 vs 18.5). Conclusion: the observed improvements of naming ability were felt to be the result of combining attention training into the language treatment which is lead to sustained attention, less distraction and more concentration.

Optimizing Performance and Mental Skills With Mindfulness-Based Attention Training: Two Field Studies With Operational Units

ABSTRACT Introduction Mental skills such as focusing attention and managing emotions are essential for optimal performance in high-stress occupations. Studies with military samples have demonstrated that mindfulness training (MT) led to improved computer-based cognitive performance. Materials and Methods To examine the impact of MT on operational performance, mental skills, and psychological health, a short-form program, Mindfulness-Based Attention Training (MBAT), was delivered to active duty soldiers as part of two randomized trials. Participants in study 1 (n = 121) and study 2 (n = 77) were randomized to one of three conditions: MT with proctored practice, MT with unproctored practice, or a waitlist control. Weekly 2-hour MBAT sessions were offered to participants in both MT conditions for 4 weeks. Beyond these sessions, participants also engaged in mindfulness practice that was proctored (within the occupational context) or unproctored (left up to the individual) for four subsequent weeks. Results Overall, the frequency of mindfulness practice was generally associated with better performance and improvements in mental skills. In study 1, those who practiced 3 or more days per week performed better on marksmanship under physical stress and reported fewer attentional lapses, less emotion regulation difficulties, greater mental toughness, and higher self-reported mindfulness compared to those who did not practice. In study 2, the frequency of mindfulness practice was associated with fewer attentional lapses and emotion regulation difficulties. Conclusions Consistent with prior findings, results suggest that regular engagement in MT practice may help to optimize operational performance and improve mental skills in military cohorts.

COVID-19 pandemic and its impact on emergency surgical services: A mini-review

Background: The global COVID-19 spread is unquestionably one of the leading obstacles of every healthcare system, patient, and healthcare professionals. This leading pandemic has immeasurable effects on every healthcare domain, including surgical care, especially surgical demand for emergency settings. Methods: An extensive data search was done from two leading databases Medline (PubMed) and Google Scholar, by using different keywords. The literature search was done both using individual and combination of keywords. All relevant data published from December 2019 to April 2021 were included and narratively analyzed. Results: Thirteen articles were selected based on COVID-19 and its consequences on emergency Surgical Services including recommendations, guidelines, prioritization, and reporting of surgical case reduction. Conclusion: This global COVID-19 pandemic had influenced all domains of surgery, including emergency surgery, which required urgent surgical attention. Training and multidisciplinary support are necessary for the surgical teams to perform in this critical situation.