Effort is a ubiquitous feature in the decision-making literature. Increasing numbers of studies examine the effect of effort requirements on behavior using a discounting framework, assessing the process by which the subjective value of an outcome decreases as the effort required to obtain it increases. Therefore, a review of methodological approaches, findings, and issues is timely. Accordingly, in this systematic review, we identified research studies examining effort discounting to explore how choice architecture factors used in delay discounting and other experimental manipulations affected effort discounting, and the mathematical descriptors used to summarize the relationship between subjective value and effort requirements. Our analysis suggests an area ripe for future research and identifies important knowledge gaps. These gaps are attributable to the use of divergent definitions of effort, as well as highly heterogeneous methodologies, which limit our ability to generate strong conclusions about the intersection between effort and delay discounting processes.

Background: Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in lowincome minority women, but the mechanism remains unclear. Objective: We tested whether diabetes group medical visits (GMVs) reduced hemoglobin A1c(HbA1c) by mitigating diabetes distress (DD), an emotional response affecting nearly half of adults with type 2 diabetes in community settings. Methods: We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed that both technology-enabled and in-person diabetes GMVs improve HbA1c. We tested whether DD mediated the relationship between diabetes GMV engagement and reductions in HbA1c. We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. Diabetes GMV engagement was measured using the Group Climate Questionnaire. The mediator, DD, was measured using the Diabetes Distress Screening Scale. The outcome was the 6-month change in HbA1c. Social support was measured using the Medical Outcomes Study Social Support Survey. Results: DD mediated the relationship between engagement and 6-month HbA1c. Specifically, group engagement affected HbA1c by reducing distress associated with the regimen of diabetes self-management (P=.04), and possibly the emotional burden of diabetes (P=.09). The relationship between engagement and 6-month HbA1c was moderated by depressive symptoms (P=.02), and possibly social support (P=.08). Conclusions: Engagement in diabetes GMVs improved HbA1c because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and possibly related to its emotional burden, and especially for women without depressive symptoms and possibly for women who lacked social support. Trial Registration: ClinicalTrials.gov NCT02726425; https://clinicaltrials.gov/study/NCT02726425

Most cigarette smokers say that they want to quit, but few attempts at smoking cessation are successful. To examine factors predicting the ability to quit, researchers have examined various behaviors. Heightened delay discounting, preference for smaller, sooner rewards over larger, later rewards, has been associated with a heightened probability of relapse. The current study examined whether this extended to short-term laboratory-based smoking lapse protocols, and whether probability discounting (preference for smaller, certain rewards over larger, uncertain rewards) showed similar effects. Participants were 32 adult smokers contemplating cessation, who attended two experimental sessions. Tasks required participants to choose between money available now and either $25 available later (0-365 days) or with less certainty (0-100%). Participants were then given a 2-hour window when they could either smoke or receive progressively more money over time. Time before smoking was recorded as their “lapse time”. Steeper delay discounting predicted shorter lapse times, while probability discounting was unrelated. These data suggest that delay discounting may be related to the inability to maintain abstinence over short time periods not just days and weeks during smoking cessation, thereby contributing to heightened smoking associated with heightened delay discounting. They also support the independence of probability discounting from substance use phenotypes.

Delay discounting refers to the behavioral tendency to devalue rewards as a function of their delay in receipt. Heightened delay discounting has been associated with substance use disorders and multiple co-occurring psychopathologies. Human and animal genetic studies have established that delay discounting is heritable, but only a few associated genes have been identified. We aimed to identify novel genetic loci associated with delay discounting through a genome-wide association study (GWAS) using Heterogeneous Stock (HS) rats, a genetically diverse outbred population derived from eight inbred founder strains. We assessed delay discounting in 650 male and female HS rats using an adjusting amount procedure in which rats chose between smaller immediate sucrose rewards or a larger reward at various delays. Preference switch points were calculated and both exponential and hyperbolic functions were fitted to these indifference points. Area under the curve (AUC) and the discounting parameter k of both functions were used as delay discounting measures. GWAS for AUC, exponential k, and one indifference point identified significant loci on chromosomes 20 and 14. The gene Slc35f1, which encodes a member of the solute carrier family, was the sole gene within the chromosome 20 locus. That locus also contained an eQTL for Slc35f1, suggesting that heritable differences in the expression might be responsible for the association with behavior. Adgrl3, which encodes a latrophilin subfamily G-protein coupled receptor, was the sole gene within the chromosome 14 locus. These findings implicate novel genes in delay discounting and highlight the need for further exploration.

Organisms must regulate their behavior flexibly in the face of environmental challenges. Failure can lead to a host of maladaptive behavioral traits associated with a range of neuropsychiatric disorders, including attention deficit hyperactivity disorder, autism, and substance use disorders. This maladaptive dysregulation of behavior is influenced by genetic and environmental factors. For example, environmental enrichment produces beneficial neurobehavioral effects in animal models of such disorders. The present study determined the effects of environmental enrichment on a range of measures related to behavioral regulation using a large cohort of male, outbred heterogeneous stock (HS) rats as subjects to mimic the genetic variability found in the human population. Subjects were reared from late adolescence onwards either in pairs in standard housing with minimal enrichment (n=200) or in groups of 16 in a highly enriched environment consisting of a large multi-level cage filled with toys, running wheels, and shelters (n=64). Rats were subjected to a battery of tests, including: (i) locomotor response to novelty, (iI) light reinforcement, (iii) social reinforcement, (iv) reaction time, (v) a patch-depletion foraging test, (vi) Pavlovian conditioned approach, (vii) conditioned reinforcement, and (viii) cocaine conditioned cue preference. Results indicated that rats housed in the enriched environment were able to filter out irrelevant stimuli more effectively and thereby regulate their behavior more efficiently than standard-housing rats. The dramatic impact of environmental enrichment suggests that behavioral studies using standard housing conditions may not generalize to more complex environments that may be more ethologically relevant.

Background: Serious illness communication is a key element of high-quality care, but it is difficult to implement in practice. The Serious Illness Care Program (SICP) is a multifaceted intervention that contributes to more, earlier, and better serious illness conversations and improved patient outcomes. This qualitative study examined the organizational and implementation factors that influenced improvement in real-world contexts.Methods: The authors performed semistructured interviews of 30 health professionals at five health systems that adopted SICP as quality improvement initiatives to investigate the organizational and implementation factors that appeared to influence improvement.Results: After SICP implementation across the organizations studied, approximately 4,661 clinicians have been trained in serious illness communication and 56,712 patients had had an electronic health record (EHR)-documented serious illness conversation. Facilitators included (1) visible support from leaders, who financially invested in an implementation team and champions, expressed the importance of serious illness communication as an institutional priority, and created incentives for training and documenting serious illness conversations; (2) EHR and data infrastructure to foster performance improvement and accountability, including an accessible documentation template, a reporting system, and customized data feedback for clinicians; and (3) communication skills training and sustained support for clinicians to problem-solve communication challenges, reflect on communication experiences, and adapt the intervention. Inhibitors included leadership inaction, competing priorities and incentives, variable clinician acceptance of EHR and data tools, and inadequate support for clinicians after training.Conclusion: Successful implementation appeared to rely on multilevel organizational strategies to prioritize, reward, and reinforce serious illness communication. The insights derived from this research may function as an organizational road map to guide implementation of SICP or related quality initiatives.

OBJECTIVE:Communication about patients' values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations.METHODS:Qualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions.RESULTS:We completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians' beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from 'end-of-life planning' to 'knowing and honoring what matters most to patients;' improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician's job; discomfort managing emotions; lack of reliable processes.CONCLUSIONS:Aspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.

BACKGROUND:Studies in animals and humans suggest that greater levels of sensation seeking and alcohol use are related to individual differences in drug-induced dopamine release. However, it remains unclear whether drug-induced alterations in the functional synchrony between mesostriatal regions are related to sensation seeking and alcohol use.METHODS:In this within-subject masked-design study, 21-year-old participants (n = 34) underwent functional magnetic resonance imaging to measure ventral tegmental area (VTA) resting-state functional connectivity to the striatum after receiving alcohol (target blood alcohol concentration 0.08 g/dL) or placebo. Participants also completed the UPPS-P Impulsive Behavior Scale to assess sensation seeking, the Young Adult Alcohol Consequences Questionnaire, and self-reported patterns of alcohol and drug use.RESULTS:Voxel-wise analyses within the striatum demonstrated that during the alcohol condition (compared with placebo) young adults had less connectivity between the VTA and bilateral caudate (p < 0.05 corrected). However, young adults exhibiting smaller alcohol-induced decreases or increases in VTA-left caudate connectivity reported greater sensation seeking.CONCLUSION:These findings provide novel information about how acute alcohol impacts resting-state connectivity, an effect that may be driven by the complex pre and postsynaptic effects of alcohol on various neurotransmitters including dopamine. Further, alcohol-induced differences in VTA connectivity represent a plausible mechanistic substrate underlying sensation seeking.

The stability of delay discounting across time has been well-established. However, limited research has examined the stability of probability discounting, and no studies of the stability of effort discounting are available. The present study assessed the steady-state characteristics of delay, probability, and effort discounting tasks across time with hypothetical rewards in humans, as well as whether response characteristics suggested a common discounting equation. Participants completed delay, probability, and effort discounting tasks on three occasions. We found moderate relative stability of delay and probability tasks, and similar evidence for absolute stability across time for all tasks. The interclass correlations coefficient showed some correspondence across time points and tasks, and higher levels of between subject variability, especially for the effort discounting task, suggesting trait level variables has a stronger influence on performance than state level variables. Performance on the delay and probability tasks were moderately correlated and similar mathematical functions fit choice patterns on both tasks (hyperbolic), suggesting that delay and probability discounting processes shared some common elements. Lower correlations and different function fits suggested that effort discounting involves more unique features.

Zusammenfassen is a German word that means “to summarize”, but its parts add up to more than its whole. Fassen means to take hold of; and Zusammen means bring together. We bring together in this special issue papers that take hold of parts of the legacy of Howard Rachlin. But there is no way to summarize his work. It is too diverse, too protean, too creative. Perusing these articles, as enriching as that will be, cannot tell you why its authors and so many others revere Howard Rachlin for his seminal contributions, and for himself. It cannot tell you why, in our esteem, he is noble. But it will give you an idea. Figure 1 pictures him and his lifelong partner Nahid, whose love may have given him his first inkling of an extended self. Rachlin made pioneering contributions in behavioral economics, choice and decision-making, self-control, delay-, probability-, and social-discounting, along with his early work on aversive control. He threw new light on social dilemmas. All of these find resonance in this special issue. In the last half of his life, Rachlin recognized that the proper study of behavior is the study of extended patterns of stimuli and responses: a symphony, not a C#; framing a house, not swinging a hammer. This insight led to his teleological behaviorism (TeB). Rather than deny the importance of mind, he embodied it as extended patterns of behavior, around which the more molecular components were organized. The term telos means aim, or goal. For Rachlin the telos of the C# was a Beethoven symphony. The telos of the papers in this collection is a symphony composed of his works and the extended patterns of his life. Another under-hyphenated German word is Festschrift. This special issue constitutes a written (Schrift) celebration (Fest)—a commemoration—of Rachlin. We celebrate Howie Rachlin, a gentle force of nature, who spent his life attempting to unravel the behavioral enigmas that we still confront. Howie's contribution to this Fest has been his new perspectives on behavior writ large, leading to a radically novel conception of behavior as a whole. What we acolytes bring to this celebration are echoes of his ideas, reshaped as they resonated in our life, and in that of our intellectual community. The first contributions to this Schrift are pictures of the man himself, in his own words, from an interview given by Carsta Simon a decade ago; and a satellite's image of the landscape of Rachlin's intellectual life taken by Matt Locey, taken just now. Intellectual contributions and extensions are often too rarefied to give a sense of the human behind the work. We lead with these articles to bring the soul of Rachlin (another extended pattern, of course) to bear on all of the subsequent papers. The epigraph to Rachlin's last book, Escape of the Mind, was an observation of Wittgenstein's, one that provides a synopsis, both of the book's major point, and of Rachlin's philosophy of behavior: If one sees the behavior of a living thing, one sees its soul. What is particularly special about the interview is how one can almost hear Rachlin's voice, can almost touch his soul. To construe how the pieces in this Schrift fit into the pattern of Rachlin's scientific life, you will find no better map than the one provided by Matt Locey. Locey divides that life into four epochs, each with their characteristic patterns, moving from empirical work on matching, punishment, and self-control, through behavioral economics and philosophy, to social discounting and Rachlin's capstone theory, TeB. Locey's is a most evocative and illuminating read. It includes a beautiful tree of students and colleagues, extended to their students, and to theirs in turn. This is a fitting companion piece to Simon's, with hers giving a personal in-depth picture, and Matt's giving a grand overview and evaluation of Howard's scientific oeuvre. It has been said that God is in the details. It has been said that the Devil is in the details. Somehow, in those tight spaces, they manage to avoid each other. As scientists, however, we engage both of these dual aspects of details—of data. Grand theories and philosophies can be beautiful things, but as scientists we seek their grounding in data, without which they are at best art; estimable, but entertainment only. We find salvation in data, and in theories based on data, which organize and possibly explain them. But here is where we are likely to trip over the Devil: Theories and models must be simpler than the data they explain. What is left out of their accounts may be unimportant, idiosyncratic; or may come to be recognized as a Devil's work, a fatal flaw for that account. Empiricists, and especially those mapping their data to models, execute a fine balancing act, from experimental question, its context, experimental design, data selection, analysis, to interpretation. This requires both skill and sweat. It is what makes science more than entertainment. Rachlin excelled both at the hard work of the laboratory, and the pensive work of the study. This Schrift will illuminate these dual aspects of his contributions. == Behaviorists sometimes find themselves in the shadow of giants from nearby fields. Daniel Kahneman, a cognitive psychologist, won the Nobel Prize in Economic Sciences for his and Amos Tversky's work in behavioral economics and decision-making. They showed that decisions are often illogical, and even irrational, by current standards of logic and rationality (Lewis, 2017). The contribution by McKerchar and Mazur gets at least one of our feet out of that shadow. In replicating some of Tversky and Kahneman's classic work, their systematic use of the discounting paradigm generated data that ruled out explanation of the framing effects as explicable by either absolute or relative accounting. They were able to bring a nonstandard theory to bear on their data, which provided an excellent description of them. This extrapolation of Kahneman and Tversky's results also addressed the crucial issue of opportunity cost, which as one might expect, plays an important role in decisions. The Devil enters, stage-left. Research on delay discounting is often characterized by stories such as “A person confronts a choice between another slice of pie/another cigarette/another cocktail/unprotected sex/all of the above, versus a longer/healthier/happier life.” This frames the decision as between two positive goods. It is conceivable, is it not, that the participants interpret the question as a choice between an immediate good and a delayed bad? “Longer/healthier/happier” are vague concepts (unless of course they mean endless pie, booze and sex, a lusty Viking large-late heaven). Many people have given up cigarettes, not to get “a healthier life”—but because of the fear of lung cancer or associated calamities (Premack, 2017); they have given up overindulgence, facing the specter of the obese, diabetic, alcoholic with STD they could be in Christmas Future. Does this reframing—from a diffuse delayed positive, to a concrete delayed negative—change anything? You bet it does (Tversky & Kahneman, 1981). The Washington University team, here led by Sarah Estle, untangles this interaction, and shows that a small immediate gain associated with a delayed loss (think cig now + emphysema later) significantly changes the operating characteristics of that loss. If you indulge in any of the Viking goods, you should read this article. Among Rachlin's most innovative offerings was his demonstration that the amount of money a person would provide to another individual varied as a hyperbolic function of the social distance between the two: A person will provide more to a close relative than a distant acquaintance. Battaglia and Romanowich extended Rachlin's social distance research to show that the propensity to share different types of personal information, such as one's finances or health, varied as a similar function of social distance. The researchers conclude that Rachlin's social discounting task can assess the propensity to share computer-based personal information. This is an important generalization of Rachlin and students' original extension of discounting to the social realm, adding another extension—from money to the commodity called information. Not unimportant in this media-modulated world, we suspect. Marshmallow tests for rats!!! Haynes and colleagues consider the following question. According to the standard hyperbolic model of intertemporal choice, once the larger later (LL) is chosen, animals should stick with it. But if given the opportunity to defect and eat the marshmallow, many often will. How to account for that? Rachlin's hypothesis was that the animal's sense of the delay to the LL was not fixed, but rather that it was sampled from a distribution around the true delay from any point in the interval. So sometimes it could seem farther way—and thus defection is sensible. If that is true, then pretraining with temporal intervals to reduce the variance around the expected delay through the interval should reduce the number of defections. Will it? No marshmallows here—turn to the article for a more nutritious read. Rachlin later fundamentally reconceptualized how we might think about self-control. He recognized that choices in the world involve far greater complexity and nuance than are captured by the binary options we offer our subjects. It's not the particular choice of whether or not to smoke that cigarette at that moment that matters, but rather the pattern of choices over time. We may be able to produce successful, long-term effective control of current behavior by their enduring consequences if we can weave that behavior into a pattern. Arfer took the challenge, extending the patterning hypothesis from delay to risky choice. Does the beautiful theory survive experimental test? Take bets and wait to see! To Match or to Maximize, that is the Question! … Strange question, though, isn't it? But as Gene Heyman shows us, it is a critical question when contemplating one of the causes of the parlous state of our world, overconsumption. Heyman shows, counterintuitively, that the Matching Law can lead to overconsumption. The regnant economic models involve bundling of commodities, which make other predictions. Heyman's analysis helps explain why efforts to increase consumption are so often more effective than those to constrain it. Read the article to know what drives your behavior; where it drives it; and how you might get off of that highway. One needs to take the good with the bad, they say. Rachlin's innovative and theoretically significant work on punishment was evident in his early publications, where pigeons had to take the bad with the good. Rachlin argued persuasively that punishment was the opposite of reinforcement: That they were symmetrical operations. This was against a literature arguing that they were asymmetrical, with punishment, unlike reinforcement, having transient suppressive effects with a rebound in responses once it is removed. Which is it? Shahan and crew set out to determine. We encourage readers to understand this old question, one of current relevance, through this paper's review of the issues. In carefully designed conditions, the authors supported one of the positions. Which one? The results may shock you, but at the same time be quite rewarding. Theories are machines that put data into correspondence with models. They select the kinds of data that are relevant and the kinds of models that are kosher (Hestenes, 1992). They also typically offer a broad-brush account that is accessible to nonexperts. Theoreticians are often occupied creating and testing ways of representing the facts delivered by empiricists. In this section you will see theoreticians evaluating representations of selection, volition, and choice of delayed and probabilistic goods. All of these have roots in the work of Rachlin. == You know about artificial intelligence, artificial neural-nets, and may have heard about artificial life. Read McDowell and co-workers' article to learn about artificial behavior emitted by artificial organisms (AOs). The authors conducted experiments with AOs, so perhaps we should have slotted this as an empirical article. Since no IRB was involved, however, we decided that it was theoretical. Do not let artificial mislead you though; these are the real things, hand-made and high quality. In a long line of research, McDowell and students have shown that from simple rules of variation and selection and genetic mixing (as happens in the creation of new generations of animals by blending the genes of parents), surprising behavioral patterns emerge. This article replicates the conditions observed in published studies where VI and VR punishment schedules were superimposed on VI schedules of reinforcement; the AOs, surprisingly, replicate behavioral data. Why “surprisingly”? Because there was no tweaking of the basic program to get these results: They were “out of the box”. If this leaves some of you scratching your heads about their behavior, watch out! In a couple of years these AOs may be scratching theirs about your behavior! Volition has been a problematic term for philosophers, theologians, biologists, and deterministically oriented behaviorists. Operant behavior has itself been described as “voluntary,” in contrast with the more deterministic reflexes, both unconditioned and Pavlovian. Neuringer explores the voluntary nature of operant behavior from three perspectives: Skinner's emphasis on contingent reinforcers; Rachlin's broad patterns of responses, presented in terms of his theory of teleological behaviorism; and Neuringer's own reinforcement-of-variability research. The three provide cases where operant behaviors can be adequately described as voluntary; and other cases where operant responses and voluntary actions differ. You will read Neuringer's contribution voluntarily. Think about that. One of the signal contributions of Rachlin was the unification of delay and probability discounting. Here Killeen takes a beady-eyed look at the theoretical rationale for that unification. He finds some logical and empirical problems with it, and proposes an alternative treatment of probability discounting, which he integrates with delay discounting in a novel way. Watch out though; it uses equations! If deterred by them, just look at his pretty pictures. The inverse linear model of discounting called “hyperbolic” provides a good account of nonhuman data. It is systematically off in its attempts to map the human data. Rachlin had the insight that calendar months might not be the same as human months. A student of S.S. Stevens, he explored a power-function map from calendar time to human time. It worked. Raising the time variable to an exponent less than 1 provided an excellent fit to human discounting data, in a model subsequently called a hyperboloid. But is that good enough? It requires model mavens for a verdict; and here we have a stellar array of them. Franck and colleagues put the hyperboloid through the wringer. It comes out fit to use, clean and certified. Wear it, over and over! Life is not two dimensional, but most of our models of it are. At best. It is all most of us can do. Rzeszutek and associates do better. They have combined delay discounting data and behavioral economic demand—how consumption changes as a function of the price of the good. But how can one integrate the effects of price and the effects of delay? It takes some wizardry; and all of these authors are wizards. It was gratifying that Rachlin's model came out well in this extension. We very much need a unified account of these paradigms, and this article takes us a big step in that direction. Stahlman and Catania examine how Rachlin's conception of self-control operates in evolutionary and societal realms. In all three domains, interactions between short-term consequences and extended, often delayed, long-term patterns are dynamic; they may direct behavior in the same direction, or in opposite directions. Uncharacteristic for this journal, Ainslie, Rachlin, Green, Stahlman and Catania's work constitutes a scientific exegesis of Romans 7:18-19: “…will is present with me; but how to perform that which is good I find not. For the good that I would I do not: but the evil which I would not, that I do.” This can happen many ways, delay discounting chief amongst them. But as Stahlman and Catania clearly show, one needn't be a saint or sinner to fall into that trap. Peacocks do it; Irish Elk do it; patterns of communication and social influence often lead communities to do it. Viral memes do it. We have all heard of segments of our community who, in some eyes, consistently vote against their own long-term interests. The authors explore the universality of such short-term traps to long-term bliss. This is an important generalization of process across domains, much as Skinner's classic Selection by Consequences was. In the present case, however, a more apt title is Seduction by Consequences. How you look at it; that is what perspectives means. This gives license. These contributors all have a driver's license. They are certified to steer conversation in profitable ways, ones that get us closer to our destination of understanding behavior, and Rachlin's take on it. You will find all of that here, in these great final papers. == Ed Wasserman focusses on Rachlin's enduring attempt to equate mental events with overt behaviors. Rachlin's teleological behaviorism is compared to early comparative psychology approaches, as represented by George Romanes, and experimental psychology approaches, as represented by E. G. Boring. Wasserman uses behavioral interpretations of mental events (some of those provided by Keller and Schoenfeld), critically evaluating Rachlin's position with regard to them. This is a very important contribution to a task that largely lies before us: Reconciling the mental and behavioral. Rachlin's (1989, 2018; 2014) TeB does this, yet it may be difficult for some of us to fully understand or assent to. By showing us how other scientists have dealt with very similar issues, and with his thoughtful evaluation of TeB, Wasserman helps keep TeB on the table as a behavioral alternative to mentalism. Inspired by Rachlin and informed by an old issue of a philosophy journal entitled “Psychology: A Behavioral Interpretation”, Catania asks what such an issue might look like today. His sections: “Causation,” “Good and Evil,” “Freedom and Volition,” “Time,” “Words,” and “Mind” remind us of the essays of Montaigne, who mused over similar topics. Here, however, data, and Rachlin's synoptic world-view, enrich Catania's essays. This, like the other papers, are elegant intellectual sustenance. The drink pairings for the other articles on the table of this Fest lean toward coffee and tea; for Charlie's, we recommend a glass of wine, to be slowly savored and sipped, while you savor and sip and ponder and enjoy his many insights. Rachlin's influence was multifaceted and broad. One example is offered by researchers in São Paulo. João Lucas Bernardy and his colleagues directed a multiyear seminar anchored by Rachlin's work, with specific focus on his 1989 book (see references). Together with their students, the researchers analyzed Rachlin's position on such topics as self-control and altruism. The analyses led to empirical studies on social distancing and on randomness, directly motivated by Rachlin's writings. Their contribution reminds us that an important influence of leaders such as Rachlin is measured, not by citation impact factors, but by human impact factors. Few have contributed to both basic and translational research, to both clinical and applied interventions, and to different disciplines such as behavior analysis, psychology at large, economics, and philosophy. The next two papers validate Rachlin's elevation into such a pantheon. The work by Vuchinich and colleagues stands on its own as innovative and effective, while simultaneously making clear its debt to the insights of Rachlin. If we were to do an experimental test of the aphorism “standing on the shoulders of giants allows one to see farther”, these papers could constitute the results and discussion sections. Spoiler: We see the hypothesis validated. Well, now we have another long German word to learn—Weltanschauung—a comprehensive conception of the world from a particular viewpoint. Rachlin certainly had that, and Fisher draws it out. What makes his article most notable is that it: a) makes clear the revere held for Rachlin, and why; b) identifies key contributions, and how some of them enlighten us on philosophical issues (e.g., essentialism, category mistakes); c) shows how Rachlin's ideas have been applied to clinical and preventive interventions; and d) shows that important public health factors such as social support may be treated within Rachlin's world view. This is a good read. You will learn much from it, we promise. And you may even come out with the glimmer of a new Weltanschauung. Evidence of Howard Rachlin's substantial influence on our field is manifest in this Festschrift. His extended self reaches far beyond his personal self, as Locey so poignantly noted. A part of Ludwig Boltzmann's legacy—his equation for entropy—is inscribed on his gravestone. A part of of Howard Rachlin's legacy—his scientific innovations and those issuing from them—is inscribed in this Schrift. They are inscribed not in granite, however, but in a paradoxically more enduring cloud. That would have pleased Howie, a man who loved to formulate paradoxes, and then to solve them.

Choice behavior requires animals to evaluate both short- and long-term advantages and disadvantages of all potential alternatives. Impulsive choice is traditionally measured in laboratory tasks by utilizing delay discounting (DD), a paradigm that offers a choice between a smaller immediate reward, or a larger more delayed reward. This study tested a large sample of Heterogeneous Stock (HS) male (n = 896) and female (n = 898) rats, part of a larger genetic study, to investigate whether measures of reward maximization overlapped with traditional models of delay discounting via the patch depletion model using a Sequential Patch Depletion procedure. In this task, rats were offered a concurrent choice between two water "patches" and could elect to "stay" in the current patch or "leave" for an alternative patch. Staying in the current patch resulted in decreasing subsequent reward magnitudes, whereas the choice to leave a patch was followed by a delay and a resetting to the maximum reward magnitude. Based on the delay in a given session, different visit durations were necessary to obtain the maximum number of rewards. Visit duration may be analogous to an indifference point in traditional DD tasks. Males and females did not significantly differ on traditional measures of DD (e.g. delay gradient; AUC). When examining measures of patch utilization, females made fewer patch changes at all delays and spent more time in the patch before leaving for the alternative patch compared to males. Consistent with this, there was some evidence that females deviated from reward maximization more than males. However, when controlling for body weight, females had a higher normalized rate of reinforcement than males. Measures of reward maximization were only weakly associated with traditional DD measures and may represent distinctive underlying processes. Taken together, females performance differed from males with regard to reward maximization that were not observed utilizing traditional measures of DD, suggesting that the patch depletion model was more sensitive to modest sex differences when compared to traditional DD measures in a large sample of HS rats.

Resurgence refers to a behavioral process in which a recent response is extinguished (or reinforcement conditions worsen) and a previously extinguished response recurs. In previous research, resurgence has been reliably produced when the resurgence procedure is repeated. Changes in the degree of increase of the resurging response across iterations of the procedure have been inconsistent, however, with some studies showing increases and some showing no changes or decreases in resurgence magnitude. The present study examined the nature of resurgence across repeated iterations of the conventional resurgence procedure by exposing four pigeons to the resurgence procedure six times in succession. In the first condition of the resurgence procedure, pecks on one key (e.g., the left) were reinforced under a variable-interval (VI) 30-s schedule. In the second condition pecks on that key were extinguished, and pecks on another key (e.g., the right) were reinforced under the same schedule. In the final condition there were no programmed consequences for either response. Resurgence was observed in 21 of 24 opportunities (87.5%). Iteration-over-iteration increases in resurgence were observed in 15 of 20 opportunities (75.0%), and this increase was found to be statistically significant. These findings demonstrate that, under certain conditions, resurgence generally increases in magnitude with repeated exposure to the procedures that generate it.

Journal Article To minimize loss or maximize gain? That depends on sleep and gender Get access Suzanne H Mitchell, Suzanne H Mitchell Department of Behavioral Neuroscience and Psychiatry, Oregon Health & Science University, Portland, OR, USAOregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA Corresponding author. Suzanne H. Mitchell, Department of Behavioral Neuroscience, L470, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA. Email: mitchesu@ohsu.edu. https://orcid.org/0000-0002-0225-7200 Search for other works by this author on: Oxford Academic Google Scholar Steven A Shea Steven A Shea Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR, USA https://orcid.org/0000-0003-1949-0954 Search for other works by this author on: Oxford Academic Google Scholar Sleep, Volume 45, Issue 9, September 2022, zsac177, https://doi.org/10.1093/sleep/zsac177 Published: 23 July 2022 Article history Published: 23 July 2022 Corrected and typeset: 06 August 2022

Objective: We aim to explore how users' experience of presence in a virtual world (VW) learning environment enhanced patient engagement in DSME/S programs conducted in an online VW platform with minority women with type 2 diabetes.Methods: We conducted an embedded, mixed methods study, using a convergent study design to analyze qualitative field notes and interview data and quantitative survey data gathered from the Women in Control 2.0 (WIC2) clinical trial participants. The WIC2 clinical trial compared a diabetes group visit program delivered using an online VW platform versus an in-person approach.Result: We enrolled 158 VW participants, of which 144 completed baseline data, 124 completed the postintervention follow up survey, and 30 participated in key informant and focus group interviews. Overall, participants reported a sense of social (63.7%, mean 3.7/5.0), physical (63.1%, mean 3.6/5.0), and self (49.0%, mean 3.3/5.0) presence while engaged in VW group DSME/S. Three themes emerged from mixed methods analysis including, 1) Participants' identification with their avatars enhances a sense of self presence in a VW, 2) physical presence enables visualization and imaginative play modalities of social learning, and 3) social presence cultivates meaningful social support and psychological safety.Conclusion: Our research empirically supports the premise that participants' experience of three domains of presence (self, physical and social) in a VW environment enhances participant engagement in DSME/S programs.Practice implications: Further research is warranted to study optimal approaches to implementation and dissemination of this novel approach to patient education and engagement. (c) 2021 Published by Elsevier B.V.

PURPOSE:To determine if hospitalized patients with depressive symptoms will benefit from post-discharge depression treatment with care transition support.METHODS:This is a randomized controlled trial of hospitalized patients with patient health questionnaire-9 score of 10 or more. We delivered the Re-Engineered Discharge (RED) and randomized participants to groups receiving RED-only or RED for Depression (RED-D), a 12-week post-discharge telehealth intervention including cognitive behavioral therapy, self-management support, and patient navigation. Primary outcomes were hospital readmission and reutilization rates at 30 and 90 days post discharge.RESULTS:We randomized 709 participants (353 RED-D, 356 RED-only). At 90 days, 265 (75%) intervention participants had received at least 1 RED-D session (median 4). At 30 days, the intention-to-treat analysis showed no differences between RED-D vs RED-only in hospital readmission (9% vs 10%, incidence rate ratio [IRR] 0.92 [95% CI, 0.56-1.52]) or reutilization (27% vs 24%, IRR 1.14 [95% CI, 0.85-1.54]). The intention-to-treat analysis also showed no differences at 90 days in readmission (28% vs 21%, IRR 1.30 [95% CI, 0.95-1.78]) or reutilization (70% vs 57%, IRR 1.22 [95% CI, 1.01-1.49]). In the as-treated analysis, each additional RED-D session was associated with a decrease in 30- and 90-day readmissions. At 30 days, among 104 participants receiving 3 or more sessions, there were fewer readmissions (3% vs 10%, IRR 0.30 [95% CI, 0.07-0.84]) compared with the control group. At 90 days, among 109 participants receiving 6 or more sessions, there were fewer readmissions (11% vs 21%, IRR 0.52 [95% CI, 0.27-0.92]). Intention-to-treat analysis showed no differences between study groups on secondary outcomes.CONCLUSIONS:Care transition support and post-discharge depression treatment can reduce unplanned hospital use with sufficient uptake of the RED-D intervention.

Background The development of evidence-based care geared towards Black and Latina women living with uncontrolled type 2 diabetes is contingent upon their active recruitment into clinical interventions. Well-documented impediments to recruitment include a historical mistrust of the research community and socioeconomic factors that limit awareness and access to research studies. Although sociocultural and socioeconomic factors deter minorities from participating in clinical research, it is equally important to consider the role of stigma in chronic disease intervention studies. Objective We aim to share our discovery of diabetes-related stigma as an underrecognized impediment to recruitment for the Women in Control 2.0 virtual diabetes self-management education study. Methods Our initial recruitment plan used traditional strategies to recruit minority women with uncontrolled type 2 diabetes, which included letters and phone calls to targeted patients, referrals from clinicians, and posted flyers. After engaging a patient advisory group and consulting with experts in community advocacy, diabetes-related stigma emerged as a prominent barrier to recruitment. The study team reviewed and revised recruitment scripts and outreach material in order to better align with the lived experience and needs of potential enrollees. Results Using a more nuanced, community-centered recruitment approach, we achieved our target recruitment goal, enrolling 309 participants into the study, exceeding our target of 212. Conclusions There is a need for updated recruitment methods that can increase research participation of patients who experience internalized diabetes stigma. To address disparities in minority health, further research is needed to better understand diabetes-related stigma and devise strategies to avert or address it.