Background: Effective treatments for depression are available, yet many patients do not respond to treatment or experience relapse. Cognitive bias modification aims to ameliorate cognitive biases that contribute to the development and maintenance of the disorder.
Objective: This study examines the efficacy of a novel mobile approach-avoidance bias modification training with socioemotional cues for depression.
Methods: In this randomized clinical superiority trial, 75 inpatients with depression underwent 6 sessions of either active or sham approach-avoidance bias modification training with socioemotional cues over the course of 2 weeks alongside inpatient treatment as usual. The primary outcome was self-reported depressive symptoms, and the secondary outcomes included approach-avoidance bias based on reaction time and response force, anhedonia, and positivity. Outcomes were assessed before and after the training, and again at 2-week and 6-month follow-ups. The primary hypothesis was that active training would lead to a stronger decrease in symptoms of depression at the end of training.
Results: Both groups improved in depressive symptoms from baseline to the end-of-training assessment but did not differ in this regard (B=-1.14, 95% CI -5.65-3.41; t188.61=-0.47; P=.64; d=-0.09, 95% CI -0.46-0.28). Changes in anhedonia, positivity, and approach-avoidance bias were also not different between training groups, neither at end of training (P=.16) nor at the 2-week follow-up (P=.69). However, the active training group showed a significantly greater reduction in depressive symptoms from the baseline assessment to the 6-month follow-up (B=7.26, 95% CI 2.53-11.93; t190.54=2.95; P=.004; d=0.58, 95% CI 0.20-0.96). Permuted split-half reliability of the mobile assessment of approach-avoidance bias ranged from 0.77 to 0.94 for reaction times and from 0.81 to 0.93 for response force. Approach-avoidance bias was not altered by the training and did not mediate the training effects.
Conclusions: Mobile approach-avoidance bias modification training with socioemotional cues did not reduce depressive symptoms in the short term but did in the long term. Mobile training and assessment versions may be more feasible in the future, as they require no joystick setup and can be conducted on patients' smartphones. Future work needs to further examine short- and long-term efficacy and the mechanisms driving long-term symptom change in larger multicenter trials.
Background: The health impact of summer heat on older adults is a growing public concern, yet the physiological responses, particularly changes in resting heart rate (RHR), and the role of personal heat adaptation behaviors remain underexplored. Wearable devices offer an opportunity to objectively monitor physiological responses and evaluate the effectiveness of adaptation strategies in real-world settings.
Objective: This study aimed to quantify the short-term association between summer temperatures and RHR in older adults and to examine how individual heat adaptation behaviors modify this relationship, with additional consideration of personal characteristics such as age, sex, BMI, and chronic disease status.
Methods: We conducted a panel study among 83 community-dwelling older adults (≥65 y) in Taipei City during the summer of 2021 (May to September). Participants wore Garmin smartwatches to continuously monitor heart rate. Daily RHR was defined as the lowest 30-minute average heart rate. In September, heat adaptation behaviors were assessed via structured telephone interviews. Ambient temperature and relative humidity were obtained from a nearby monitoring station. Linear mixed-effect models were used to estimate temperature-RHR associations, and interaction terms were included to examine behavioral modifications. Subgroup analyses were conducted to explore effect modification by individual characteristics such as age, sex, BMI, and chronic disease status.
Results: Each 1 °C increase in daily mean temperature over lag days 0-1 was associated with a 0.11 (95% CI 0.07-0.15; P<.001) beats/min increase in RHR. After mutual adjustment for behaviors, several heat adaptation strategies showed significant protective effects, including reducing physical activity (β=-.15, P=.001), drinking cold beverages (β=-.24, P<.001), increasing naps or sleep duration (β=-.28, P=.003), drinking additional water ≥500 mL (β=-.10, P=.02), using air conditioner (AC) before (β=-.15, P=.002) and during sleep (β=-.13, P=.007), and using electric fans during sleep (β=-.12, P=.01). Subgroup analyses revealed stronger effects for certain behaviors in vulnerable populations: reduced physical activity was particularly beneficial for those with higher BMI; AC use and cold beverage intake were more effective in people with diabetes; increased naps yielded the largest benefits in individuals with hypertension; and the use of AC or fans during sleep was especially protective for older adults and females.
Conclusions: Summer heat is associated with elevated RHR in older adults, but this effect can be mitigated through targeted heat adaptation behaviors. Smartwatch monitoring provides a feasible and informative approach for capturing physiological changes, supporting the development of personalized heat-health recommendations for aging populations in a warming climate.
Background: Augmented reality (AR) superimposes virtual objects onto a real-world environment, allowing users to interact in real time. As AR has become widely used, its integration into smartphones or tablets has enabled mobile augmented reality (MAR) experiences. AR has been adopted in many industries, and the literature has highlighted its applications in academic and clinical settings, particularly in enhancing visualization, communication, and learning.
Objective: This study investigated the potential of MAR as a mobile health tool to enhance shared decision-making (SDM) in thoracic surgery by increasing patient understanding and engagement during medical consultations.
Methods: A randomized crossover clinical trial was conducted at the Tri-Service General Hospital in Taiwan. Participants scheduled for thoracic surgery were enrolled and randomized in a crossover design. The MAR intervention incorporated patient-specific 3D anatomical models that were reconstructed from computed tomography imaging to facilitate understanding and support SDM. The impact of each counseling approach on SDM was evaluated using postintervention questionnaires.
Results: A total of 47 participants were enrolled in this study. After analyzing the data, we found that patients in the MAR group showed significantly higher scores compared to those in the traditional counseling group (P<.001) during the SDM process. Moreover, patients reported higher satisfaction levels and found the visual objects helpful for understanding tumor location and surgical procedures.
Conclusions: This study demonstrated that MAR counseling significantly enhanced patients' comprehension of thoracic conditions and increased their active engagement in the SDM process (P<.001). The integration of patient-specific 3D anatomical models into MAR technology provided an intuitive method for critical medical information. This digital approach not only enhanced personalization in medical communication but also reinforced patient education about their health care conditions. These findings suggest that MAR counseling represents a promising approach for promoting patient-centered care in thoracic surgery and has potential applications across various clinical domains.
Trial registration: ClinicalTrials.gov NCT07062393; https://clinicaltrials.gov/study/NCT07062393.
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