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Background: Executive functioning (EF) is an important concept in cognitive psychology that has rarely been studied in people with intellectual disabilities (IDs). The aim of this study was to examine the validity of two test batteries and the structure of EF in this client group. Methods: We administered the children's version of the Behavioural Assessment of the Dysexecutive Syndrome (BADS-C) and the Cambridge Executive Functioning Assessment (CEFA) for people with ID, to 40 participants who attended day centres for people with mild to moderate learning disabilities [mean full-scale intelligence quotient (IQ) = 59]. The BADS-C consists of six EF subtests while the CEFA contains eight EF (including two executive memory) subtests and four memory subtests. IQ and receptive language ability were also assessed. The results were subjected to principal components analysis, and regression analysis was used to examine the relationship of the ensuing factors to other cognitive variables. Results: Scores on both sets of EF tests were only weakly related to receptive language ability, and even more weakly related to IQ. Scores on the BADS-C were substantially lower than predicted from the published norms for people in higher IQ ranges, and many participants scored zero on three of the six subtests. This potential floor effect was less evident with scores on the CEFA. Principal components analyses produced one usable factor for the BADS-C, and two factors for the CEFA that differed in both the extent of involvement of working memory and the predominant sensory modality. A combined analysis of the subtests retained from both analyses produced three factors that related uniquely to aspects of IQ and memory. Conclusions: The CEFA is suitable for use with people with mild to moderate learning disabilities, whereas the BADS-C is at the lower limit of usability with this client group. The lower-than-expected scores observed on the BADS-C may indicate that people known to learning disability services may be more impaired than people of comparable IQ not known to services. The structure of EF seen in people with IDs closely resembles a model of EF in the general population that has received a broad level of support.

The present study undertook an updated citation analysis of Skinner's (1957) "Verbal Behavior". All articles that cited "Verbal Behavior" between 1984 and 2004 were recorded and content analyzed into one of five categories; four empirical and one nonempirical. Of the empirical categories, studies that employed a verbal operant from Skinner's analysis were assigned to either basic, applied, or observational categories. Empirical studies that did not employ a verbal operant were categorized as other-empirical. The total number of citations remained stable across the review period and averaged just over 52 per year. Of these, 80% were from nonempirical articles, 13.7% were from other-empirical articles, 4% were from applied articles, 1.4% were from basic articles, and 0.9% were from observational articles. An "obliteration" analysis was also conducted to identify articles that employed Skinner's verbal operant terms but did not cite "Verbal Behavior". This analysis identified 44 additional articles, suggesting that a degree of obliteration had occurred in the half century since the publication of "Verbal Behavior". In particular, the analysis suggests that the verbal operant of manding has sufficient presence in the applied empirical literature to render citation of "Verbal Behavior" redundant. Overall, "Verbal Behavior" continues to make an important contribution to the psychological literature. (Contains 3 figures, 1 table, and 1 footnote.)

Climatic conditions exert important control over the growth, productivity, and distribution of forests, and characterizing these relationships is essential for understanding how forest ecosystems will respond to climate change. We used dendrochronological methods to develop climate-growth relationships for two dominant species, Populus tremuloides (quaking aspen) and Pinus resinosa (red pine), in the upper Great Lakes region to understand how climate and water availability influence annual forest productivity. Trees were sampled along a topographic gradient at the Marcell Experimental Forest (Minnesota, USA) to assess growth response to variations in temperature and different water availability metrics (precipitation, potential evapotranspiration (PET), cumulative moisture index (CMI), and soil water storage). Climatic variables were able to explain 33-58% of the variation in annual growth (as measured by ring-width increment) for quaking aspen and 37-74% of the variation for red pine. Climate-growth relationships were influenced by topography for quaking aspen but not for red pine. Annual ring growth for quaking aspen decreased with June CMI on ridges, decreased with temperature in the November prior to the growing season on sideslopes, and decreased with June PET on toeslopes. Red pine growth increased with increasing July PET across all topographic positions. These results indicate the sensitivity of both quaking aspen and red pine to local climate and show several vulnerabilities of these species to shifts in water supply and temperature because of climate change. Copyright © 2015 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Anaphylaxis is a clinical diagnosis with no gold-standard test. Recent case definitions have attempted to provide objective criteria for diagnosis. The aim of this study was to compare the diagnostic concordance of the Brighton Collaboration case definition (the 'Brighton' case definition) to the consensus case definition from the Second Symposium on the Definition and Management of Anaphylaxis (the 'Symposium' definition). The study setting was a hospital-based emergency department in the UK. We identified cases of anaphylaxis by physicians' discharge diagnoses over a 2-year period from 2005 to 2006, and used randomly selected cases of allergic reaction, asthma and urticaria as a control group. Data was extracted by clinicians (who were unaware of the content of either case definition), and the two case definitions were applied by Boolean operators in a Microsoft Excel spreadsheet. Concordance between the case definitions was measured using Cohen's kappa (kappa) statistic. We reviewed 128 sets of notes, with 47 cases of anaphylaxis. Brighton and Symposium definitions had sensitivities of 0.681 and 0.671, respectively, and specificities of 0.790 and 0.704, respectively. A discordant result was found in 36/128 cases (28.1%; kappa = 0.414 [95% CI 0.253, 0.574]), which represents a moderate level of agreement between case definitions. The Brighton case definition has a similar diagnostic concordance to the Symposium case definition. It does not seem to over- or underestimate cases and is sufficiently unique that the identification of an allergic trigger does not have to form part of the case definition. This will be important in the recognition of anaphylaxis resulting from the administration of drug and vaccines, where causality should be examined separately from case ascertainment. [ABSTRACT FROM AUTHOR]

Research on the emergence of human avoidance behavior in the absence of direct contact with an aversive event is somewhat limited. Consistent with work on derived relational responding, the present study sought to investigate the transformation of avoidance response functions in accordance with the relational frames of Same and Opposite. Participants were first exposed to nonarbitrary and arbitrary relational training and testing in order to establish Same and Opposite relations among arbitrary stimuli. The training tasks were; Same-A1-B1, Same-A1-C1, Opposite-A1-2, Opposite-A1-C2. Next, all possible combinatorially entailed (i.e., B-C and C-B) relations were tested. During the avoidance-conditioning phase, one stimulus (B1) from the relational network signaled a simple avoidance response that cancelled a scheduled presentation of an aversive image and sound. All but one of the participants who met the criteria for conditioned avoidance also demonstrated derived avoidance by emitting the avoidance response in the presence of C1 and the nonavoidance response in the presence of C2. Control participants who were not exposed to relational training and testing did not show derived avoidance. Implications of the findings for understanding clinically significant avoidance behavior are discussed. [ABSTRACT FROM AUTHOR]

Across three experiments, the transformation of consequential functions in accordance with a seven-member relational network (A-B-C-D-E-F-G) was investigated. In this network, the relational rankings ranged from A, ranked the least, to G, ranked the most. In the first phase, contextual cues for more-than and less-than were established by training participants across multiple exemplars to select comparisons containing larger quantities in the presence of the former cue, and fewer quantities in the presence of the latter cue. Participants then were trained in six conditional discriminations (i.e., AD, F>E, and G>F) with the contextual cues as samples and nonsense words as comparisons, and all possible derived relations were tested (e.g., B

Fear and anxiety are rarely confined to specific stimuli or situations. In fear generalisation, there is a spread of fear responses elicited by physically dissimilar generalisation stimuli (GS) along a continuum between danger and safety. The current study investigated fear generalisation with a novel online task using COVID-19-relevant stimuli (i.e., busy or quiet shopping street/mall scenes) during pandemic lockdown restrictions in the United Kingdom. Participants (N = 50) first completed clinically relevant trait measures before commencing a habituation phase, where two conditioned stimuli (CSs; i.e., a busy or quiet high street/mall scene) were presented. Participants then underwent fear conditioning where one conditioned stimulus (CS+) was followed by an aversive unconditioned stimulus (US; a loud female scream accompanied by a facial photograph of a female displaying a fearful emotion) and another (CS-) was not. In a test phase, six generalisation stimuli were presented where the US was withheld, and participants provided threat expectancy and fear ratings for all stimuli. Following successful conditioning, fear generalization was observed for both threat expectancy and fear ratings. Trait worry partially predicted generalised threat expectancy and COVID-19 fear strongly predicted generalised fear. In conclusion, a generalisation gradient was evident using an online remote generalisation task with images of busy/quiet streets during the pandemic. Worry and fear of COVID-19 predicted fear generalisation., (© 2024. The Author(s).)

Objectives: Little is known about whether distress tolerance and anxiety mediate the relationship between comorbid complex posttraumatic stress disorder (CPTSD) and alcohol use among military veterans. Here, we investigated the contribution of distress tolerance and anxiety on the strength of the CPTSD and alcohol use association. We hypothesized that the impact of a two-factor model of CPTSD derived from subscale scores on the International Trauma Questionnaire (ITQ)-namely ITQ PTSD and ITQ Disturbances in Self Organization (DSO; e.g., issues with affective regulation/self-belief and shame)-on alcohol use severity would be mediated by anxiety but not by distress tolerance., Methods: Participants included 403 community-dwelling United Kingdom (UK) veterans (91.64% male, M age  = 51.15 years, SD = 12.48) recruited as part of a larger, online study., Results: Findings indicated that the influence of CPTSD symptoms on alcohol use severity was mediated by anxiety, not by distress tolerance, with greater relative impact due to ITQ DSO status than ITQ PTSD status., Conclusions: We identified the mediational influence of anxiety and distress tolerance on the association between CPTSD subscales and alcohol use in UK veterans. Interventions for anxiety may be adapted for reducing problematic alcohol use and the impact of CPTSD symptoms in veterans with comorbid PTSD and alcohol use disorder., (© 2023 The Authors. Journal of Clinical Psychology published by Wiley Periodicals LLC.)

Background: Alcohol misuse is common in the United Kingdom Armed Forces (UKAF), with prevalence significantly higher than in the general population. To date, digital health initiatives to support alcohol misuse have focused on male individuals, who represent approximately 89% of the UKAF. However, female veterans drink disproportionally more than female members of the public., Objective: This 2-arm participant-blinded (single-blinded) confirmatory randomized controlled trial (RCT) aims to assess the efficacy of a brief alcohol intervention (DrinksRation) in reducing weekly self-reported alcohol consumption between baseline and a 3-month follow-up (day 84) among women who have served in the UKAF., Methods: In this 2-arm single-blinded RCT, a smartphone app that includes interactive user-focused features tailored toward the needs of female veterans and designed to enhance participants' motivations to reduce the amount of alcohol they consume is compared with the UK Chief Medical Officer guidance on alcohol consumption. The trial will be conducted among women who have served at least 1 day of paid service in the UKAF. Recruitment, consent, and data collection will be carried out automatically through the DrinksRation app or the BeAlcoholSmart platform. The primary outcome is change in self-reported weekly alcohol consumption between baseline (day 0) and the 3-month follow-up (day 84) measured using the Timeline Follow Back for alcohol consumption. The secondary outcome is the change in the Alcohol Use Disorders Identification Test score measured at baseline and 3-month follow-up between the control and intervention groups. The process evaluation measures include (1) app use and (2) usability ratings as measured by the mHealth App Usability Questionnaire., Results: RCT recruitment will begin in January 2024 and last for 5 months. We aim to complete all data collection, including interviews, by May 2024., Conclusions: This study will assess whether a smartphone app tailored to the needs of women who have served in the UKAF is efficacious in reducing self-reported alcohol consumption. If successful, the digital therapeutics platform could be used not only to support women who have served in the UKAF but also for other conditions and disorders., Trial Registration: ClinicalTrials.gov NCT05970484; https://www.clinicaltrials.gov/study/NCT05970484., International Registered Report Identifier (irrid): PRR1-10.2196/51531., (©Grace Williamson, Ewan Carr, Nicola T Fear, Simon Dymond, Kate King, Amos Simms, Laura Goodwin, Dominic Murphy, Daniel Leightley. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.12.2023.)

Competing Interests: SD sits on the Executive Committee of the Academic Forum for the Study of Gambling (AFSG) for which he receives an annual honorarium. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Background: Whilst some research has explored the impact of COVID-19 on gambling behaviour, little is yet known about online search behaviours for gambling during this period. The current study explored gambling-related online searches before, during and after the outbreak of the COVID-19 pandemic in the UK. We also assessed whether search trends were related to Gambling Commission behavioural data over the same period., Methods: Google Trends™ search data, covering thirty months from January 2020 to June 2022, for five gambling activities and five gambling operators were downloaded. Graphical displays of the weekly relative search values over this period were then produced to visualise trends in search terms, with key dates in COVID-19 policy and sporting events highlighted. Cross-correlations between seasonally adjusted monthly search data and behavioural indices were conducted., Results: Sharp increases in internet searches for poker, slots, and bingo were evident during the first lockdown in the UK, with operator searches sharply decreasing over this period. No changes in gambling activity searches were highlighted during subsequent lockdowns, although small increases in operator-based searches were detected. Strong positive correlations were found between search data and industry data for sports betting and poker but not for slots., Conclusions: Google Trends™ data may act as an indicator of population-level gambling behaviour. Substitution of preferred gambling activities for others may have occurred during the first lockdown when opportunities for sports betting were limited. Further research is needed to assess the effectiveness of internet search data in predicting gambling-related harm.

Research into self-directed methods for reducing problematic and harmful gambling is still in its infancy. One strategy that individuals use to prevent gambling involves voluntary self-exclusion (VSE) programs. For example, VSE programs can make it challenging to access betting sites or enable banks to block gambling-related transactions. Although individual VSEs can be helpful when used alone, it is unclear whether their efficacy is enhanced when combined. Furthermore, it is unknown how VSE compliance can be improved. We propose that contingency management (CM), an evidence-based strategy to incentivise abstinence, could encourage continued VSE use, promoting long-lasting recovery from problematic or harmful gambling. Here, we conducted exploratory analyses on VSE use and CM for gambling in two populations (members of the UK general population recruited and students). Participants responded favourably regarding combined VSE use. They felt that providing vouchers exchangeable for goods/services could incentivise gambling abstinence during VSE. However, some were concerned about people potentially "gaming" the system. Participants believed supplementing VSE and CM with social support could encourage abstinence. These attitudes, and recent research on treatment providers' opinions on CM for gambling, suggest that experimental evidence should be sought to determine the efficacy of combined VSE use and CM for gambling.

Introduction: Military veterans are at heightened risk of problem gambling. Little is known about the costs of problem gambling and related harm among United Kingdom (UK) Armed Forces (AF) veterans. We investigated the social and economic costs of gambling among a large sample of veterans through differences in healthcare and social service resource use compared with age-matched and gender-matched non-veterans from the UK AF Veterans' Health and Gambling Study., Methods: An online survey measured sociodemographic characteristics, gambling experience and problem severity, mental health and healthcare resource utilisation. Healthcare provider, personal social service and societal costs were estimated as total adjusted mean costs and utility, with cost-consequence analysis of a single timepoint., Results: Veterans in our sample had higher healthcare, social service and societal costs and lower utility. Veterans had greater contacts with the criminal justice system, received more social service benefits, had more lost work hours and greater accrued debt. A cost difference of £590 (95% CI -£1016 to -£163) was evident between veterans with scores indicating problem gambling and those reporting no problems. Costs varied by problem gambling status., Conclusions: Our sample of UK AF veterans has higher healthcare, social service and societal costs than non-veterans. Veterans experiencing problem gambling are more costly but have no reduction in quality of life., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Maladaptive avoidance of safe stimuli is a defining feature of anxiety and related disorders. Avoidance may involve physical effort or the completion of a fixed series of responses to prevent occurrence of, or cues associated with, the aversive event. Understanding the role of response effort in the acquisition and extinction of avoidance may facilitate the development of new clinical treatments for maladaptive avoidance. Despite this, little is known about the impact of response effort on extinction-resistant avoidance in humans. Here, we describe findings from two laboratory-based treatment studies designed to investigate the impact of high and low response effort on the extinction (Experiment 1) and return (Experiment 2) of avoidance. Response effort was operationalised as completion of fixed-ratio (FR) reinforcement schedules for both danger and safety cues in a multi-cue avoidance paradigm with behavioural, self-report, and physiology measures. Completion of the FR response requirements cancelled upcoming shock presentations following danger cues and had no impact on the consequences that followed safety cues. Both experiments found persistence of high response-effort avoidance across danger and safety cues and sustained (Experiment 1) and reinstated (Experiment 2) levels of fear and threat expectancy. Skin conductance responses evoked by all cues were similar across experiments. The present findings and paradigm have implications for translational research on maladaptive anxious coping and treatment development.

The COVID-19 pandemic continues to impact global psychological wellbeing. To investigate the sustained impact of COVID-19 on wellbeing, the current study longitudinally assessed fear of COVID-19, anxiety, depression, intolerance of uncertainty, worry, sleep quality, loneliness and alcohol use during the pandemic in the United Kingdom. Timepoint 1 (T1; N  = 445) took place in February 2021 following the highest number of pandemic-related deaths in the UK. Timepoint 2 (T2, N  = 198) took place in June 2021 when pandemic-related deaths had declined considerably, and many had been vaccinated. At T1, COVID-19 fear predicted elevated levels of anxiety, depression, intolerance of uncertainty, worry, sleep quality and loneliness. At T2, we observed that levels of COVID-19 fear, depression, loneliness and sleep quality decreased. However, COVID-19 fear continued to predict elevated intolerance of uncertainty, worry and impaired sleep quality. These findings demonstrate the longitudinal impact of COVID-19 fear on psychological wellbeing.

Background and Objectives: In counterconditioning, a conditioned aversive stimulus (CS) is paired with an appetitive stimulus to reduce fear and avoidance. Findings are, however, mixed on the relative impact of counterconditioning versus standard extinction, where the CS is presented in the absence of the aversive event. This analogue treatment study investigated the impact of counterconditioning relative to standard extinction on threat expectancy, fear, and persistent avoidance with an online fear-conditioning task conducted with COVID-19-relevant appetitive stimuli during the pandemic., Methods: Following habituation, in which two CSs (male faces wearing face-coverings) were presented in the absence of the unconditioned stimulus (US; a loud female scream), participants (n = 123) underwent threat-conditioning where one stimulus (CS+) was followed by the US and another (CS-) was not. In avoidance learning, the US could be prevented by making a simple response in the presence of the CS+. Next, participants received either counterconditioning in which trial-unique positively rated images of scenes from before the COVID-19 pandemic and its associated restrictions (e.g., hugging others and holding hands) were presented with the CS + or no-counterconditioning (i.e., extinction). In the final test phase, avoidance was available, and all US deliveries were withheld., Results: Counterconditioning led to diminished threat expectancy and reduced avoidance relative to no-counterconditioning. Fear ratings did not differ between groups., Limitations: No physiological measures were obtained., Conclusions: Implemented online during the pandemic with COVID-19-relevant appetitive stimuli, counterconditioning was effective at reducing persistent avoidance and threat expectancy., Competing Interests: Declaration of competing interest The authors have no interests to declare., (Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Strategies to reduce antibiotic overuse in hospitals depend on prescribers taking decisions to stop unnecessary antibiotic use. There is scarce evidence for how to support these decisions. We evaluated a multifaceted behaviour change intervention (ie, the antibiotic review kit) designed to reduce antibiotic use among adult acute general medical inpatients by increasing appropriate decisions to stop antibiotics at clinical review., Methods: We performed a stepped-wedge, cluster (hospital)-randomised controlled trial using computer-generated sequence randomisation of eligible hospitals in seven calendar-time blocks in the UK. Hospitals were eligible for inclusion if they admitted adult non-elective general or medical inpatients, had a local representative to champion the intervention, and could provide the required study data. Hospital clusters were randomised to an implementation date occurring at 1-2 week intervals, and the date was concealed until 12 weeks before implementation, when local preparations were designed to start. The intervention effect was assessed using data from pseudonymised routine electronic health records, ward-level antibiotic dispensing, Clostridioides difficile tests, prescription audits, and an implementation process evaluation. Co-primary outcomes were monthly antibiotic defined daily doses per adult acute general medical admission (hospital-level, superiority) and all-cause mortality within 30 days of admission (patient level, non-inferiority margin of 5%). Outcomes were assessed in the modified intention-to-treat population (ie, excluding sites that withdrew before implementation). Intervention effects were assessed by use of interrupted time series analyses within each site, estimating overall effects through random-effects meta-analysis, with heterogeneity across prespecified potential modifiers assessed by use of meta-regression. This trial is completed and is registered with ISRCTN, ISRCTN12674243., Findings: 58 hospital organisations expressed an interest in participating. Three pilot sites implemented the intervention between Sept 25 and Nov 20, 2017. 43 further sites were randomised to implement the intervention between Feb 12, 2018, and July 1, 2019, and seven sites withdrew before implementation. 39 sites were followed up for at least 14 months. Adjusted estimates showed reductions in total antibiotic defined daily doses per acute general medical admission (-4·8% per year, 95% CI -9·1 to -0·2) following the intervention. Among 7 160 421 acute general medical admissions, the ARK intervention was associated with an immediate change of -2·7% (95% CI -5·7 to 0·3) and sustained change of 3·0% (-0·1 to 6·2) in adjusted 30-day mortality., Interpretation: The antibiotic review kit intervention resulted in sustained reductions in antibiotic use among adult acute general medical inpatients. The weak, inconsistent intervention effects on mortality are probably explained by the onset of the COVID-19 pandemic. Hospitals should use the antibiotic review kit to reduce antibiotic overuse., Funding: UK National Institute for Health and Care Research., Competing Interests: Declaration of interests MJL, DWC, LY, TEAP, and ASW declare funding from the National Institute for Health Research (NIHR) for the ARK-Hospital programme. ASW is an NIHR Senior Investigator. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Background: PTSD and gambling disorder (GD) are frequently comorbid. Gambling may provide escape-based coping for the emotions experienced by PTSD sufferers. Military personnel may be at increased risk of PTSD and/or GD. Acceptance and Commitment Therapy (ACT) has been found to improve both PTSD and GD outcomes, yet research into the potential effectiveness of ACT for PTSD and/GD in veterans is scarce. Objective: This review aimed to systematically assess and describe the evidence relating to the use of ACT and acceptance-based therapy for military populations with PTSD and/or GD. Method: Six databases were searched. Selection criteria included studies that featured the armed forces/military, delivered ACT/acceptance-based therapy, and aimed to improve PTSD and/or GD outcomes. A narrative synthesis approach was adopted. Results: From 1,117 results, 39 studies were fully screened and 14 met inclusion criteria. All studies originated from the USA and 9 were associated with United States Department of Veterans Affairs. Therapy use within each study produced an improvement in PTSD and/or GD, yet only one study examined GD and no studies considered comorbid PTSD/GD. The broad range of study designs made it difficult to compare the findings or make generalisations from the collective results. It is unclear which method of ACT delivery is superior (app-based, telehealth, face-to-face, groups, one-to-one, manualised, or unstructured), or what the true effect size is of ACT for PTSD and/or GD. Conclusions: These preliminary findings are promising, yet more research is needed on the delivery format and content of ACT sessions, and whether findings generalise beyond USA-recruited military samples. The cost-effectiveness of remote-based ACT also warrants investigation. HIGHLIGHTS Among veterans, psychological interventions such as Acceptance and Commitment Therapy (ACT) may be effective for Post-Traumatic Stress Disorder (PTSD) and/or Gambling Disorder (GD).There is a paucity of evidence on ACT approaches for treating PTSD and GD in veterans.Further work is needed on context-specific delivery (in-person vs. group), method of ACT intervention (manualised vs unstructured, digital therapeutics) with non-US samples.

Introduction: In military personnel are vulnerable to gambling problems, yet many are reluctant to seek help. The aim of the current study was to explore the lived experience of problem gambling and help-seeking among serving members of the United Kingdom Armed Forces., Methods: Seventeen individuals from a larger, cross-sectional survey of gambling and wellbeing in the Royal Air Force (RAF) completed semi-structured interviews. Interview questions focused on personal experiences, the context of the RAF and its influence, knowledge and experiences of treatment and support services, and the impact of COVID-19., Results: Reflexive thematic analysis revealed four themes: (1) harmful and protective occupational factors; (2) socio-cultural and personal influences; (3) organizational attitudes toward mental health and help-seeking, and (4) current support pathways and provision., Discussion: Findings also indicated that gambling and alcohol use are common within the RAF, and that personnel are actively coping with mental health challenges., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Champion, Pritchard, Dighton and Dymond.)

Low levels of treatment access and poor retention among those with gambling problems suggests a need to improve treatment. Contingency management (CM) is a behavioural intervention involving the identification of target behaviours and the provision of incentives when targets are met. There exists a substantial evidence base for CM increasing abstinence and attendance in substance misuse treatment, but this has not been widely extended to gambling treatment setting. This study sought to explore the views of clients about CM for the treatment of problematic and disordered gambling. We conducted semi-structured interviews with 25 gambling treatment clients who were, or had previously been, engaged in treatment in Great Britain. Participants were provided with an explanation of CM, two hypothetical scenarios, and two structured questionnaires to facilitate discussion. Thematic analysis was used to interpret findings. Some participants felt that clients could manipulate CM while in treatment to obtain money to gamble, and that mechanisms of CM could trigger recovering clients into relapse. Participants also identified potential benefits of CM to achieve treatment goals, by enhancing motivation and engagement while in treatment, and helping bring people into treatment earlier. Gambling treatment clients broadly supported the use of incentives for treatment. CM is seen as a facilitator of extended engagement in treatment, and an encouragement for clients to make progress in the treatment process.

Fear conditioning paradigms are critical to understanding anxiety-related disorders, but studies use an inconsistent array of methods to quantify the same underlying learning process. We previously demonstrated that selection of trials from different stages of experimental phases and inconsistent use of average compared to trial-by-trial analysis can deliver significantly divergent outcomes, regardless of whether the data is analysed with extinction as a single effect, as a learning process over the course of the experiment, or in relation to acquisition learning. Since small sample sizes are attributed as sources of poor replicability in psychological science, in this study we aimed to investigate if changes in sample size influences the divergences that occur when different kinds of fear conditioning analyses are used. We analysed a large data set of fear acquisition and extinction learning (N = 379), measured via skin conductance responses (SCRs), which was resampled with replacement to create a wide range of bootstrapped databases (N = 30, N = 60, N = 120, N = 180, N = 240, N = 360, N = 480, N = 600, N = 720, N = 840, N = 960, N = 1080, N = 1200, N = 1500, N = 1750, N = 2000) and tested whether use of different analyses continued to produce deviating outcomes. We found that sample size did not significantly influence the effects of inconsistent analytic strategy when no group-level effect was included but found strategy-dependent effects when group-level effects were simulated. These findings suggest that confounds incurred by inconsistent analyses remain stable in the face of sample size variation, but only under specific circumstances with overall robustness strongly hinging on the relationship between experimental design and choice of analyses. This supports the view that such variations reflect a more fundamental confound in psychological science-the measurement of a single process by multiple methods., Competing Interests: The authors have declared that no competing interests exist.

Gambling in the modern era is pervasive owing to the variety of gambling opportunities available, including those that use technology (eg, online applications on smartphones). Although many people gamble recreationally without undue negative effects, a sizeable subset of individuals develop disordered gambling, which is associated with marked functional impairment including other mental health problems, relationship problems, bankruptcy, suicidality, and criminality. The National UK Research Network for Behavioural Addictions (NUK-BA) was established to promote understanding of, research into, and treatments for behavioural addictions including gambling disorder, which is the only formally recognised behavioural addiction. In this Health Policy paper, we outline the status of research and treatment for disordered gambling in the UK (including funding issues) and key research that should be conducted to establish the magnitude of the problem, vulnerability and resilience factors, the underlying neurobiology, long-term consequences, and treatment opportunities. In particular, we emphasise the need to: (1) conduct independent longitudinal research into the prevalence of disordered gambling (including gambling disorder and at-risk gambling), and gambling harms, including in vulnerable and minoritised groups; (2) select and refine the most suitable pragmatic measurement tools; (3) identify predictors (eg, vulnerability and resilience markers) of disordered gambling in people who gamble recreationally, including in vulnerable and minoritised groups; (4) conduct randomised controlled trials on psychological interventions and pharmacotherapy for gambling disorder; (5) improve understanding of the neurobiological basis of gambling disorder, including impulsivity and compulsivity, genetics, and biomarkers; and (6) develop clinical guidelines based on the best contemporary research evidence to guide effective clinical interventions. We also highlight the need to consider what can be learnt from approaches towards mitigating gambling-related harm in other countries., Competing Interests: Declaration of interests HB is the director of the National Problem Gambling clinic and the national centre for gaming disorders. These clinics have received funding from NHS England, CNWL NHS Trust, and GambleAware. HB is the President of the Psychiatry Section at the Royal Society of Medicine and sits on several national and international Boards. HB has been on research teams funded by the Medical Research Council, the Wellcome Trust, and the Wolfson Family Trust. SRC's role in this paper was funded by a Clinical Fellowship from the Wellcome Trust (reference 110049/Z/15/Z & 110049/Z/15/A). SRC consults for Promentis on work unrelated to the content of this paper. SRC also receives stipends from Elsevier for editorial work at Comprehensive Psychiatry, and at Neuroscience & Biobehavioral Reviews. JEG has received research grants from Biohaven, Promentis, and Otsuka Pharmaceuticals. JEG receives yearly compensation from Springer Publishing for acting as Editor in Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Norton Press, and McGraw Hill. SC declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health, Canadian ADHD Alliance Resource, British Association of Pharmacology, and Healthcare Convention for educational activity on ADHD. OC has received royalties from Routledge, Springer, and Elsevier for editorial duties and advises the UK Parliament and the United Nations on addiction-related matters. OC held various research grants from the European Union, World Anti-Doping Agency, and University of Hertfordshire. SAT has received royalties from Elsevier and research grants from the National Health and Medical Research Council, Australian Research Council, and the Victorian and Australian Governments. SD has received funding from GambleAware and is the Director of the Gambling Research, Education and Treatment Network Wales, which is funded by the Welsh Government through Health and Care Research Wales. BJS consults for Cambridge Cognition, Greenfield Bioventures, and Cassava Sciences. BJS's research is funded by Eton College and the Wallitt Foundation, and is conducted within the National Institute for Health Research (NIHR) MedTech and in-vitro diagnostic Co-operative, and the NIHR Cambridge Biomedical Research Centre Mental Health Theme. In the past 3 years NAF has held research or networking grants from the European College of Neuropsychopharmacology (ECNP), UK NIHR, EU H2020 (COST), Medical Research Council, and University of Hertfordshire. In the past 3 years NAF has accepted travel and hospitality expenses from the British Association for Pharmacology, ECNP, Royal College of Psychiatrists, CINP, International Forum of Mood and Anxiety Disorders, World Psychiatric Association, Indian Association for Biological Psychiatry, and Sun. In the past 3 years NAF has received payment from Taylor and Francis and Elsevier for editorial duties and has accepted paid speaking engagements sponsored by Abbott and Sun. Previously, NAF has accepted paid speaking engagements in symposia supported by various pharmaceutical companies and has recruited patients for various pharmaceutical industry-sponsored studies in the field of obsessive compulsive disorder (OCD) treatment. NAF leads an NHS treatment service for OCD and holds Board membership for various registered charities linked to OCD. NAF gives expert advice on psychopharmacology to the UK Medicines and Healthcare products Regulatory Agency. NAD reports research funding from multiple sources, including government departments (through hypothecated taxes from gambling revenue), and is the recipient of a Deakin University Faculty of Health Mid-Career Fellowship. TWR consults for Cambridge Cognition, Takeda, Greenfield Bioventures, Cassava, Shionogi, Heptares, Arcadia. TWR reports grants from GlaxoSmithKline, Shionogi Royalties, and Cambridge Cognition; and Editorial Honoraria from Springer Nature and Elsevier. The rest of the authors declared no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

International evidence indicates that currently serving and former military personnel may be at heightened vulnerability to problem gambling. The aim of the present study was to undertake the first survey of gambling experience and potential problems among serving United Kingdom Royal Air Force (RAF) personnel. Our objectives were to survey the frequency of gambling problems, types of gambling activities, examine mental health, alcohol use, and COVID-19-related associations with gambling, and identify potential risk factors for problem gambling among RAF personnel. A cross-sectional online survey was distributed to all serving RAF personnel in January 2021 and the final dataset consisted of n = 2119 responses. The Problem Gambling Severity Index (PGSI) identified gambling severity, the Patient Health Questionnaire (PHQ-9) assessed depression, the Generalized Anxiety Disorder assessment (GAD-7) measured anxiety, and alcohol use was assessed with the Alcohol Use Disorders Identification Test (AUDIT). Questions relating to COVID-19 asked whether the pandemic had impacted one's gambling, mental health, and alcohol use. Findings indicated that 12.5% of personnel reported gambling problems, which included 8.0% with PGSI scores indicating low-risk gambling (1-2), 2.9% with moderate-risk gambling scores (3-4), and 1.6% with scores indicating problem gambling (≥8). Most personnel had no symptoms of depression or anxiety, and most experienced lower risk drinking levels. The likelihood of any gambling problem (PGSI ≥ 1) in RAF personnel was associated with age (18-24 years old), male gender, and Non-Commissioned ranks. Most participants reported a deterioration in their mental health due to COVID-19 and increased risky gambling. These findings indicate that gambling problems and associated harms are significant concerns for serving RAF personnel., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: There is a need to improve retention and outcomes for treatment of problem gambling and gambling disorder. Contingency management (CM) is a behavioural intervention involving identification of target behaviours (such as attendance, abstinence, or steps towards recovery) and the provision of incentives (such as vouchers or credits towards the purchase of preferred items) contingent on objective evidence of these behaviours. Contingency management for abstinence and attendance in substance misuse treatment has a substantial evidence base but has not been widely adopted or extended to other addictive behaviours such as gambling. Potential barriers to the widespread adoption of CM may relate to practitioners' perceptions about this form of incentive-based treatment. The present study sought to explore United Kingdom (UK) gambling treatment providers' views of CM for treatment of problem gambling and gambling disorder., Methods: We conducted semi-structured interviews with 30 treatment providers from across the UK working with people with gambling problems. Participants were provided with an explanation of CM, several hypothetical scenarios, and a structured questionnaire to facilitate discussion. Thematic analysis was used to interpret findings., Results: Participants felt there could be a conflict between CM and their treatment philosophies, that CM was similar in some ways to gambling, and that the CM approach could be manipulated and reduce trust between client and therapist. Some participants were more supportive of implementing CM for specific treatment goals than others, such as for incentivising attendance over abstinence due to perceived difficulties in objectively verifying abstinence. Participants favoured providing credits accruing to services relevant to personal recovery rather than voucher-based incentives., Conclusions: UK gambling treatment providers are somewhat receptive to CM approaches for treatment of problem gambling and gambling disorder. Potential barriers and obstacles are readily addressable, and more research is needed on the efficacy and effectiveness of CM for gambling., (© 2022. The Author(s).)

Diversity and nitrogen addition have positive relationships with plant productivity, yet climate-induced changes in water availability threaten to upend these established relationships. Using long-term data from three experiments in a mesic grassland (ranging from 17 to 34 yr of data), we tested how the effects of species richness and nitrogen addition on community-level plant productivity changed as a function of annual fluctuations in water availability using growing season precipitation and the Standardized Precipitation-Evapotranspiration Index (SPEI). While results varied across experiments, our findings demonstrate that water availability can magnify the positive effects of both biodiversity and nitrogen addition on productivity. These results suggest that productivity responses to anthropogenic species diversity loss and increasing nitrogen deposition could depend on precipitation regimes, highlighting the importance of testing interactions between multiple global change drivers., (© 2021 by the Ecological Society of America.)