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How Social Learning Theory Works

Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

Core Concepts of Social Learning Theory

• Key Factors
• Applications

Social learning theory, introduced by psychologist Albert Bandura , proposed that learning occurs through observation, imitation, and modeling and is influenced by factors such as attention, motivation, attitudes, and emotions. The theory accounts for the interaction of environmental and cognitive elements that affect how people learn.

The theory suggests that learning occurs because people observe the consequences of other people's behaviors. Bandura's theory moves beyond behavioral theories , which suggest that all behaviors are learned through conditioning, and cognitive theories, which consider psychological influences such as attention and memory.

According to Bandura, people observe behavior either directly through social interactions with others or indirectly by observing behaviors through media. Actions that are rewarded are more likely to be imitated, while those that are punished are avoided.

Basic Principles of Social Learning Theory

What is social learning theory.

During the first half of the 20th-century, the behavioral school of psychology became a dominant force. The behaviorists proposed that all learning was a result of direct experience with the environment through the processes of association and reinforcement.   Bandura's theory believed that direct reinforcement could not account for all types of learning.

For example, children and adults often exhibit learning for things with which they have no direct experience. Even if you have never swung a baseball bat in your life, you would probably know what to do if someone handed you a bat and told you to try to hit a baseball. This is because you have seen others perform this action either in person or on television. 

While the behavioral theories of learning suggested that all learning was the result of associations formed by conditioning, reinforcement, and punishment, Bandura's social learning theory proposed that learning can also occur simply by observing the actions of others.  

His theory added a social element, arguing that people can learn new information and behaviors by watching other people. Known as observational learning, this type of learning can be used to explain a wide variety of behaviors, including those that often cannot be accounted for by other learning theories.

There are three core concepts at the heart of social learning theory. First is the idea that people can learn through observation. Next is the notion that internal mental states are an essential part of this process. Finally, this theory recognizes that just because something has been learned, it does not mean that it will result in a change in behavior.

"Learning would be exceedingly laborious, not to mention hazardous, if people had to rely solely on the effects of their own actions to inform them what to do," Bandura explained in his 1977 book Social Learning Theory .  

Bandura goes on to explain that "Fortunately, most human behavior is learned observationally through modeling: from observing others one forms an idea of how new behaviors are performed, and on later occasions, this coded information serves as a guide for action."

Let's explore each of these concepts in greater depth.

People Can Learn Through Observation

One of the best-known experiments in the history of psychology involved a doll named Bobo. Bandura demonstrated that children learn and imitate behaviors they have observed in other people.

The children in Bandura’s studies observed an adult acting violently toward a Bobo doll. When the children were later allowed to play in a room with the Bobo doll, they began to imitate the aggressive actions they had previously observed.  

Bandura identified three basic models of observational learning:

• A live model, which involves an actual individual demonstrating or acting out a behavior.
• A symbolic model, which involves real or fictional characters displaying behaviors in books, films, television programs, or online media.
• A verbal instructional model, which involves descriptions and explanations of a behavior.

As you can see, observational learning does not even necessarily require watching another person to engage in an activity. Hearing verbal instructions, such as listening to a podcast, can lead to learning. We can also learn by reading, hearing, or watching the actions of characters in books and films.  

It is this type of observational learning that has become a lightning rod for controversy as parents and psychologists debate the impact that pop culture media has on kids. Many worry that kids can learn bad behaviors such as aggression from violent video games, movies, television programs, and online videos.

Mental States Are Important to Learning

Bandura noted that external, environmental  reinforcement  was not the only factor to influence learning and behavior. And he realized that reinforcement does not always come from outside sources.  Your own mental state and motivation play an important role in determining whether a behavior is learned or not.

He described  intrinsic reinforcement  as a form of internal rewards, such as pride, satisfaction, and a sense of accomplishment.   This emphasis on internal thoughts and cognitions helps connect learning theories to cognitive developmental theories. While many textbooks place social learning theory with behavioral theories, Bandura himself describes his approach as a 'social cognitive theory.'

Learning Does Not Necessarily Lead to Change

So how do we determine when something has been learned? In many cases, learning can be seen immediately when the new behavior is displayed. When you teach a child to ride a bicycle, you can quickly determine if learning has occurred by having the child ride his or her bike unassisted.

But sometimes we are able to learn things even though that learning might not be immediately obvious. While behaviorists believed that learning led to a permanent change in behavior, observational learning demonstrates that people can learn new information without demonstrating new behaviors.  

Key Factors for Social Learning Success

It is important to note that not all observed behaviors are effectively learned. Why not? Factors involving both the model and the learner can play a role in whether social learning is successful. Certain requirements and steps must also be followed.

The following steps are involved in the observational learning and modeling process:  

• Attention: In order to learn, you need to be paying  attention . Anything that distracts your attention is going to have a negative effect on observational learning. If the model is interesting or there is a novel aspect of the situation, you are far more likely to dedicate your full attention to learning.
• Retention: The ability to store information is also an important part of the learning process. Retention can be affected by a number of factors, but the ability to pull up information later and act on it is vital to observational learning.
• Reproduction: Once you have paid attention to the model and retained the information, it is time to actually perform the behavior you observed. Further practice of the learned behavior leads to improvement and skill advancement.
• Motivation: Finally, in order for observational learning to be successful, you have to be motivated to imitate the behavior that has been modeled. Reinforcement and  punishment  play an important role in motivation. While experiencing these motivators can be highly effective, so can observing others experiencing some type of reinforcement or punishment. For example, if you see another student rewarded with extra credit for being to class on time, you might start to show up a few minutes early each day.

Real-World Applications for Social Learning Theory

Social learning theory can have a number of real-world applications. For example, it can be used to help researchers understand how aggression and violence might be transmitted through observational learning. By studying media violence, researchers can gain a better understanding of the factors that might lead children to act out the aggressive actions they see portrayed on television and in the movies.

But social learning can also be utilized to teach people positive behaviors. Researchers can use social learning theory to investigate and understand ways that positive role models can be used to encourage desirable behaviors and to facilitate social change.

A Word From Verywell

In addition to influencing other psychologists, Bandura's social learning theory has had important implications in the field of education. Today, both teachers and parents recognize how important it is to model appropriate behaviors. Other classroom strategies such as encouraging children and building  self-efficacy  are also rooted in social learning theory.

As Bandura observed, life would be incredibly difficult and even dangerous if you had to learn everything you know from personal experience. Observing others plays a vital role in acquiring new knowledge and skills. By understanding how social learning theory works, you can gain a greater appreciation for the powerful role that observation plays in shaping the things we know and the things we do.

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By Kendra Cherry, MSEd Kendra Cherry, MS, is a psychosocial rehabilitation specialist, psychology educator, and author of the "Everything Psychology Book."

How do pressure impact attention control in precision sports: attentional engagement or attentional disengagement?

• Published: 15 June 2024

Cite this article

• Lixin Ai   ORCID: orcid.org/0000-0002-4492-5668 1 , 2 &
• Liwei Zhang   ORCID: orcid.org/0000-0001-6072-2484 2  

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The present research aimed to examine the effect of time pressure and reward-punishment pressure on attention control in two distinct processes: attentional engagement and attentional disengagement. Study 1 employed a dart-throw task to explore the effects of time pressure (Experiment 1) and reward-punishment pressure (Experiment 2) on attention control. The findings revealed that (a) time pressure did not significantly impact attentional engagement or attentional disengagement toward either task-relevant nor task-irrelevant targets; (b) reward/punishment pressure resulted in reduced attentional engagement towards task-irrelevant targets; and (c) compared to punishment pressure, reward pressure led to longer attentional disengagement from task-irrelevant targets. In Study 2, two virtual reality shooting tasks (Experiment 3 and Experiment 4) were conducted using the same design as Study 1, with a repetition rate of 50%. The findings showed that (a) time pressure did not impact attentional engagement, but led longer attentional disengagement; (b) attentional disengagement from the scoreboard was longer in the TP condition than in the NTP condition, while attentional disengagement from the target was shorter; (c) reward pressure induced attentional disengagement from both task-relevant and task-irrelevant targets. Through a mini meta-analysis that synthesized the results, it was determined that the impairment of attention control was primarily manifested through attentional disengagement. This study provides empirical support for attention control theory in the field of sports and offers a direct measurement method for assessing attention in sporting contexts.

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Ai, L., Zhang, L. How do pressure impact attention control in precision sports: attentional engagement or attentional disengagement?. Curr Psychol (2024). https://doi.org/10.1007/s12144-024-06139-6

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Prior experience with target encounter affects attention allocation and prospective memory performance

Affiliations.

• 1 Oklahoma State University, 116 Psychology Building, Stillwater, OK, 74078, USA. [email protected].
• 2 216 Memorial Hall, Department of Psychological Sciences, University of Arkansas, Fayetteville, AR, 72701, USA.
• 3 210 McAlester Hall, Department of Psychological Sciences, University of Missouri, Columbia, MO, USA.
• 4 Oklahoma State University, 116 Psychology Building, Stillwater, OK, 74078, USA.
• PMID: 35524866
• PMCID: PMC9077979
• DOI: 10.1186/s41235-022-00385-7

We examined how prior experience encountering targets affected attention allocation and event-based prospective memory. Participants performed four color match task blocks with a difficult, but specified prospective memory task (Experiment 1) or an easier, but unspecified prospective memory task (Experiment 2). Participants were instructed to search for targets on each block. Participants in the prior experience condition saw targets on each block, participants in the no prior experience condition only saw targets on the fourth block, and, in Experiment 2, participants in the mixed prior experience condition encountered some of the targets on the first three blocks, and saw all the targets on the fourth block. In Experiment 1, participants in the no prior experience condition were less accurate at recognizing targets and quicker to respond on ongoing task trials than participants in the prior experience condition. In Experiment 2, we replicated the effect of prior experience on target accuracy, but there was no effect on ongoing trial response time. The mixed experience condition did not vary from the other conditions on either dependent variable, but their target accuracy varied in accordance with their experience. These findings demonstrate that prospective memory performance is influenced by experience with related tasks, thus extending our understanding of the dynamic nature of search efforts across related prospective memory tasks. This research has implications for understanding prospective memory in applied settings where targets do not reliably occur such as baggage screenings and missing person searches.

Keywords: Expectations; Experience; Frequency; Meta-cognition; Prevalence; Prospective memory.

© 2022. The Author(s).

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Example of trial types by block and condition in Experiment 1. Note: The…

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Ongoing task response time across blocks by experience condition in Experiment 1

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Target accuracy by experience condition and category in the mixed experience condition

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Attention Training as a Low Intensity Treatment for Concerning Anxiety in Clinic-Referred Youth

Jeremy w. pettit.

a Department of Psychology and Center for Children and Families, Florida International University, Miami, FL, USA

Carla E. Marin

b Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA

Michele Bechor

Eli r. lebowitz, michael w. vasey.

c Department of Psychology, The Ohio State University, Columbus, OH, USA

James Jaccard

d Silver School of Social Work, New York University, New York, NY, USA

e Section on Development and Affective Neuroscience, Emotion and Development Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, MD, USA

Daniel S. Pine

Yair bar-haim.

f School of Psychological Sciences and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel

Wendy K. Silverman

Although youth anxiety treatment research has focused largely on severe and impairing anxiety levels, even milder anxiety levels including levels that do not meet full criteria for a diagnosis can be impairing and cause for concern. There is need to develop and test viable treatments for these concerning anxiety levels to improve functioning and reduce distress. We present findings from a randomized controlled efficacy trial of attention bias modification treatment (ABMT) and attention control training (ACT) for youths with concerning anxiety levels. Fifty-three clinic-referred youths (29 boys; M age=9.3 years, SD age=2.6) were randomized to either ABMT or ACT. ABMT and ACT consisted of attention-training trials in a dot-probe task presenting angry and neutral faces; probes appeared in the location of neutral faces in 100% of ABMT trials and 50% of ACT trials. Independent evaluators provided youth anxiety severity ratings; youths and parents provided youth anxiety severity and global impairment ratings; and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and two-month follow-up. In both arms, anxiety severity and global impairment were significantly reduced at posttreatment and follow-up. At follow-up, anxiety severity and global impairment were significantly lower in ACT compared with ABMT. Attention control, but not attention bias to threat, was significantly improved at follow-up in both arms. Changes in attention control and attention focusing were significantly associated with changes in anxiety severity. Findings support the viability of attention training as a low intensity treatment for youth with concerning anxiety levels, including levels that do not meet full criteria for a diagnosis. Superior anxiety reduction effects in ACT highlight the critical need for mechanistic research on attention training in this population.

The youth anxiety randomized controlled treatment literature is dominated by samples of severe and diagnosable cases, which has significantly advanced knowledge about treating anxiety disorders in children and adolescents (hereon “youth”) ( Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016 ; Silverman, Pina, & Viswesvaran, 2008 ). Far less advancement has occurred in treating less severe yet concerning levels of youth anxiety. Emanating from the anxiety stepped care literature, in this article for brevity we use the term “concerning anxiety” to refer to such levels ( Kendall et al., 2016 ; Silverman, Pettit, & Lebowitz, 2016 ). Concerning anxiety includes mild to moderate anxiety levels that meet for diagnosis, as well as mild to moderate levels that do not meet the number, duration, and/or severity of symptoms required for diagnosis. Concerning anxiety, too, is associated with impairment and distress and is the focus of the current treatment study.

Angold, Costello, Farmer, Burns, and Erkanli (1999) were among the first to shine a light on these understudied though prevalent “impaired but undiagnosed” youth with concerning anxiety. Additional supportive data from large U.S. and European samples have since appeared ( Balàzs et al., 2013 ; Roberts, Fisher, Turner, & Tang, 2015 ). In a sample of 4,975 youths in the U.S., the Teen Health 2000 Study found about a three-fold rate of concerning anxiety cases that did not meet full criteria for a diagnosis (5.9%) compared with diagnosable anxiety cases (2.0%) ( Roberts et al., 2015 ). Close to 40% (37.8%) of these cases were highly impaired -- a sizable proportion given 49.6% of diagnosable cases were highly impaired. In 12,395 youths, the Saving and Empowering Young Lives in Europe Study also showed high rates of concerning anxiety, high impairment, and increased disease burden and suicide risk ( Balàzs et al., 2013 ).

Using Attention Training as a Low Intensity Treatment Approach to Target Attention Bias

With the cumulative knowledge concerning prevalence, impairment, and increased disease burden and suicide risk, there is need for evidence-based treatments that can allay concerning anxiety. A key consideration for such treatment is access and use of mental health services. Access and use of services are key because only 22% of anxiety disorder cases access services, lowest of all psychiatric disorders ( Costello, He, Sampson, Kessler, & Merikangas, 2014 ). When youth with anxiety disorders and their families do access mental health services, they attend on average four sessions and up to 50% drop out of treatment ( de Haan, Boon, de Jong, Hoeve, & Vermeiren, 2013 ; Harpaz-Rotem, Leslie, & Rosenheck, 2004 ).

Given the above, attention bias modification treatment (ABMT) seems like an especially viable low intensity treatment for youth with concerning anxiety. This is because ABMT is inexpensive (does not require skilled clinicians), brief (8 15-minute sessions), and can allay participants’ privacy, stigma, and personal disclosure concerns ( Yeguez, Page, Rey, Silverman, & Pettit, 2020 ). ABMT is based on converging behavioral and neuroscience research establishing that attention processes among anxious individuals, including youth with concerning anxiety, are characterized by perturbations in attention allocation to threat ( Abend et al., 2018 ; Dudeney, Sharpe, & Hunt, 2015 ). Although low intensity prevention programs show small positive effects for nonreferred youth at risk for anxiety (e.g., Waters et al., 2019 ; Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017 ), it is unknown whether these or other low intensity treatment approaches are efficacious for clinic-referred anxious youth who do not meet full criteria for a diagnosis. Having such treatments available has the potential to improve early intervention and stepped care approaches.

In ABMT, attention perturbations are targeted directly as participants complete hundreds of computer-based training trials of a dot-probe task. In each trial, a pair of threatening and neutral stimuli is presented simultaneously, followed immediately by a probe. The probe always appears in the location of the neutral stimulus, establishing a contingency between the neutral stimulus and probe location, facilitating reductions in attention allocation to threat. Studies demonstrate feasibility and acceptability and largely demonstrate significant ABMT effects in adults and youth with anxiety disorders and youth at temperamental risk for anxiety ( Chang et al., 2019 ; Eldar et al., 2012 ; Liu, Taber-Thomas, Fu, & Perez-Edgar, 2018 ; Price et al., 2016 ). Of note, not all studies find superior effects for ABMT relative to comparator attention training arms, as we elaborate in the following section ( de Voogd, Wiers, & Salemink, 2017 ; Fodor et al., 2020 ; Grist, Croker, Denne, & Stallard, 2019 ).

Using Attention Control Training as a Comparator to Target Attention Focusing and Shifting

The most widely used comparator in youth and adult ABMT randomized controlled trials is Attention Control Training (ACT) ( Price et al., 2016 ). In ACT, participants complete the same dot-probe task as in ABMT, with the key exception that the probe appears with equal frequency in the locations of the neutral stimulus and threatening stimulus. By having no contingency between stimulus valence and probe location, ACT is designed to control for nonspecific effects on focusing and shifting attention. Although designed as a comparator control, data from samples of youth and adults with anxiety disorders show significant anxiety-reduction effects in both ABMT and ACT ( Heeren, Mogoase, McNally, Schmitz, & Philippot, 2015 ; Pergamin-Hight, Pine, Fox, & Bar-Haim, 2016 ; Pettit et al., 2020 ). Data from youth and adults with anxiety disorders further show that ABMT and ACT both significantly increase attention control, the ability to focus strategically and shift attention voluntarily ( Heeren et al., 2015 ; Linetzky, Pettit, Silverman, Pine, & Bar-Haim, 2020 ; Pettit et al., 2020 ). Whether this is true with concerning anxiety in youth is unknown; our examining this issue is therefore another important contribution of our study.

Our study further contributes and extends past research by evaluating attention training’s effects on attention control components, focusing and shifting. Focusing refers to maintaining attention on a stimulus; shifting refers to redirecting attention from one stimulus to another. By evaluating attention control as well as its components, our study is an important step in developing more nuanced understanding of mechanisms of anxiety reduction effects found in ABMT and ACT.

Present Study

Based on the conceptualization that reducing attention bias to threat is critical to the anxiety-reduction effects of attention training (e.g., MacLeod & Clarke, 2015 ), we designed our randomized controlled trial to test the hypotheses that ABMT would result in significantly lower levels of attention bias to threat and anxiety severity at posttreatment and at the follow-up evaluation two months after treatment, compared with ACT. Under this conceptualization, decreases in attention bias to threat would be associated with decreases in anxiety severity. However, as our summary reveals, it cannot be taken for granted that ABMT will produce superior outcome compared with ACT. Based on data suggesting that increases in attention control may be critical to the anxiety-reduction effects of attention training ( Heeren et al., 2015 ; Linetzky et al., 2020 ; Pettit et al., 2020 ), it is plausible that levels of attention control would be significantly higher, and levels of anxiety severity significantly lower at posttreatment and follow-up relative to pretreatment in both ABMT and ACT, and that increases in attention control would be associated with decreases in anxiety. Given that youth with concerning anxiety are impaired despite not necessarily meeting full criteria for a diagnosis of an anxiety disorder ( Angold et al., 1999 ), we evaluated youth global impairment as well. We expected that findings for global impairment would parallel those for anxiety severity.

Participants

Participants were 53 clinic-referred youths ages 7 to 15 years (mean age = 9.3 years, SD = 2.6; 54.7% boys; 66.0% Hispanic; see Table 1 ) recruited from two university-based anxiety disorder specialty clinics, one at Florida International University and the other at Yale University. We recruited from anxiety specialty clinics because, as noted, concerning anxiety is impairing and prompts parents to seek clinical intervention. Inclusion criteria were either youths or parents endorsing concerning anxiety, defined as (a) the presence of at least 3 anxiety symptoms across the most common youth anxiety disorders, generalized anxiety disorder, separation anxiety disorder, and social anxiety disorder, and (b) global anxiety impairment ratings of either 4 or 5 (mild to moderate) on the 0–8 point scale on the Anxiety Disorder Interview Schedule for Children-IV: Child and Parent Versions (ADIS-IV: C/P; Silverman & Albano, 1996 ). Global anxiety impairment ratings were obtained by asking parents and children to provide an overall severity rating based on all anxiety symptoms endorsed across all diagnostic modules on the ADIS-IV: C/P. We derived a composite rating for each participant using the highest overall severity rating from the youth and parent interviews. These inclusion criteria ensured all participants experienced anxiety-related impairment. Of note, baseline attention bias to threat was not an inclusion criterion because there is insufficient evidence that it either predicts or moderates ABMT outcome (e.g., Pergamin-Hight et al., 2016 ; Shechner et al., 2014 ). Exclusion criteria were global impairment ratings of 6 or higher, developmental disabilities, psychosis, or current involvement in another treatment; all can be ruled in/out with the ADIS-IV: C/P.

Participant Sociodemographic and Diagnostic Characteristics at Pretreatment

Note. ABMT = attention bias modification treatment; ACT = attention control training.

As shown in Figure 1 , 74 youths were recruited for this study. Of these 74, 53 (71.6%) parents provided informed consent and youths provided informed assent. After we obtained consent/assent, participants were then enrolled. All 53 participants met criteria for concerning anxiety as defined above; of these 53, 20 (37.7%) met for an anxiety disorder diagnosis and 33 (62.2%) experienced impairing anxiety that did not meet full criteria for a diagnosis (see Table 1 ). Four participants (2 in ABMT; 2 in ACT) met criteria for Attention Deficit /Hyperactivity Disorder (ADHD), Combined Type and were on a stable dose of medication for ADHD.

CONSORT Diagram

Materials and Task

All measures described below have been validated and used widely in samples of youth ages 7 to 15 years.

Diagnostic Interview.

We administered the ADIS-IV: C/P ( Silverman & Albano, 1996 ) to youths and parents, respectively. The ADIS-IV: C/P yields retest reliability kappas between .80 and .92 for diagnoses, interrater reliability kappas between .57 and .86 for specific anxiety diagnoses, and significant associations with youth anxiety ratings ( Silverman, Saavedra, & Pina, 2001 ).

Pediatric Anxiety Rating Scale (PARS; RUPP Anxiety Study Group, 2002 ).

We measured primary outcome using independent evaluator (IE) ratings of youth anxiety symptom severity on the six-item version of the PARS. Using information obtained in separate interviews with youths and parents, an IE masked to participants’ assigned study arm scored each of 50 anxiety symptoms as either present or absent during the past week. IEs then rated endorsed symptoms on six dimensions of global severity and impairment. A clinical cutoff for the six-item PARS has not been established. To characterize the study’s sample, we compared scores on the six-item PARS with established clinical cutoffs for the five-item PARS (11.5) and the seven-item PARS (17.5) ( Ginsburg, Keeton, Drazdowski, & Riddle, 2011 ). The PARS has adequate coefficient alphas (between .64 and .91) and interrater reliability (intraclass correlation coefficients between .78 and .97), treatment sensitivity, and convergent validity through significant correlations with youth self-ratings and parent ratings on youth anxiety scales ( RUPP Anxiety Study Group, 2002 ). In this sample, the omega coefficient was .83 ( Revelle & Condon, 2019 ).

Screen for Child Anxiety Related Emotional Disorders – Child and Parent versions (SCARED-C/P; Birmaher et al., 1997 ).

We measured secondary outcomes using youth self-ratings and parent ratings of youth anxiety symptom severity on the SCARED-C/P. The SCARED-C/P consists of 41 items on which youth or parents rate youth anxiety symptoms. A score of 25 or higher indicates clinical levels of anxiety severity. The SCARED-C/P has adequate test-retest reliability (ranging from .70 to .90) and convergent and divergent validity through expected patterns of correlations with other screening scales ( Birmaher et al., 1997 ). In this sample, the omega coefficient was .93 for the SCARED-C and .94 for the SCARED-P.

Columbia Impairment Scale – Child and Parent versions (CIS-C/P; Bird et al., 1993 ).

We also measured secondary outcomes using youth self-ratings and parent ratings of youth global impairment on the CIS-C/P. The CIS-C/P consists of 13 items on which youth or parents rate youth global impairment on a 5-point Likert scale, ranging from “no problem” to “very bad problem.” Higher scores indicate greater impairment, with scores above 15 indicating “high” impairment ( Bird et al., 1993 ). The CIS has adequate test-retest reliability (ranging from .63 to .89) and convergent validity through significant correlations with other measures of impairment ( Winters, Collett, & Myers, 2005 ). In this sample, the omega coefficient was .78 for the CIS-C and .88 for the CIS-P.

Attention Bias to Threat.

Consistent with past studies on attention training for anxiety (e.g., Price et al., 2016 ), we used the standardized emotional faces dot-probe task from the Tel Aviv University – National Institute of Mental Health ABMT Initiative ( http://people.socsci.tau.ac.il/mu/anxietytrauma/research/ ) to measure attention bias to threat ( Abend, Pine, & Bar-Haim, 2014 ). In each of 120 trials, a white fixation cross appeared for 500 milliseconds (ms) in the center of the screen, followed by a pair of faces (one neutral, one angry) appearing for 500 ms. Immediately following the faces, a probe (“<” or “>”) appeared in the location of one of the faces. Participants indicated the orientation of the probe by clicking the left or right mouse button (left for “<”, right for “>”). Responses on the dot-probe task were used to calculate attention bias scores. Trials in which the probe replaced the angry face were considered congruent trials; trials in which the probe replaced the neutral face were considered incongruent trials. Bias scores were computed as reaction time differences of incongruent minus congruent trials. Positive attention bias scores indicate a bias toward angry faces (i.e., threat) and negative scores indicate a bias away from threat. Inaccurate responses, trials with response latencies shorter than 150 ms and longer than 1,200 ms, and trials with response latencies plus or minus 2.5 SDs from the participant’s mean were excluded ( Abend et al., 2018 ; Eldar, Yankelevitch, Lamy, & Bar-Haim, 2010 ).

Attentional Control Scale for Children (ACS-C; Muris, de Jong, & Engelen, 2004 ).

We measured youth attention control using a 15-item version of the ACS-C ( Melendez, Bechor, Rey, Pettit, & Silverman, 2017 ; van Son et al., 2021 ). The original ACS-C consists of 20 items on which youth rate their ability to maintain attentional focus on a stimulus and shift attention from one stimulus to another. Multiple independent validation studies in anxious youth support a 15-item version that excludes 5 poorly performing items from the original version ( Melendez et al., 2017 ; van Son et al., 2021 ). On the 15-item version, 9 items comprise a Focusing subscale and 6 items comprise a Shifting subscale. The 15-item ACS-C total scale score and subscale scores have demonstrated good psychometric properties and concurrent validity through significant correlations with anxiety and depression severity ( Melendez et al., 2017 ; van Son et al., 2021 ). In this sample, the omega coefficient was .74 for the total scale, .79 for Focusing, and .73 for Shifting.

The present study received approval from the universities’ institutional review boards ( ClinicalTrials.gov identifier: {"type":"clinical-trial","attrs":{"text":"NCT02410967","term_id":"NCT02410967"}} NCT02410967 ). The study was conducted at Florida International University and Yale University from April 2015 to June 2018. All measures were completed at pretreatment (PRE), posttreatment (POST), and a follow-up (Follow-Up) evaluation two months after POST. Following PRE, participants were randomized in equal proportion to ABMT or ACT. Participants and researchers were masked to study arm assignment. Six masters- and doctoral-level graduate students served as IEs and administered ABMT and ACT sessions. Before conducting interviews, IEs received extensive training in administering and scoring the protocol and met reliability criteria on five video-recorded youth–parent assessments. Supervision was provided by a licensed clinical psychologist at weekly meetings. For each participant, one IE administered the PRE evaluation and a different IE administered the POST and Follow-Up evaluations.

Consistent with past attention training studies and following the standardized Tel Aviv University – National Institute of Mental Health ABMT Initiative ( http://people.socsci.tau.ac.il/mu/anxietytrauma/research/ ), youths completed two weekly sessions of ABMT in the clinic over four weeks, for a total of eight sessions (e.g., Pergamin-Hight et al., 2016 ; Pettit et al., 2020 ). At each session, participants completed 160 trials of the ABMT protocol, for a total of 1,280 trials. Trials of the ABMT protocol were identical to trials of the attention bias to threat assessment task except that a unique set of faces was used (i.e., different from those used in the assessment task) and the probe replaced the neutral face on 100% of the trials. Data demonstrate that this standardized ABMT protocol, including stimuli, number of sessions, and number of trials, produces anxiety-reduction effects ( Pergamin-Hight et al., 2016 ; Price et al., 2017 ).

ACT was identical to the ABMT protocol except for the frequency with which the probe replaced the neutral face. Eighty percent of trials included one neutral face and one angry face. On these trials, angry face location, probe location, and actor were fully counterbalanced. Probe type appeared with equal probability for angry face location, probe location, and actor. The other 20% of trials included neutral-neutral face pairs.

Statistical Analysis

We used power analyses to determine sample size. With alpha at .05 and power at 0.80, we introduced covariates (age, study site, and the PRE-score on the outcome variable) to reduce within-subject error and thus increase the precision of estimated between-group differences ( Belin & Normand, 2009 ; Pocock, Assmann, Enos, & Kasten, 2002 ). This allowed us to detect medium-sized effects between treatment arms, which is in line with meta-analyses that show small to medium effects (e.g., Hakamata et al., 2010 ; Price et al., 2016 ).

To examine the influence of treatment on anxiety, impairment, and attention, we used two-way analyses of covariance in a structural equation modeling (SEM) framework ( Rausch, Maxwell, & Kelley, 2003 ). We used a maximum likelihood estimator with robust standard errors (MLR) as implemented in the MPlus 6.12 statistical software program. In each model, participant age, study site, and the PRE-score on the outcome variable were included as covariates. Robust likelihood ratio tests were used to examine differences between PRE and POST mean scores and POST and Follow-Up mean scores (collapsing across treatment arms). We calculated reliable change indices for primary and secondary anxiety outcomes, with RCIs greater than or equal to 1.96 indicating clinically significant change at p < 0.05 (RCI; Jacobson & Truax, 1991 ).

To examine the associations between changes in anxiety variables and changes in attention variables, we used fixed effects regression analyses for panel data at PRE, POST, and Follow-Up ( Allison, 2009 ). This approach regressed anxiety variables onto attention variables on a within-person basis, documenting how much anxiety changed given a one-unit change in attention variables.

Complete data were obtained from 90.6% of participants at POST and 71.7% at Follow-Up. To examine missing-data bias, a dummy variable was created that indicated the presence or absence of missing data on each variable in the analyses. Associations between the dummy variables and other study variables were examined. No meaningful bias was observed and the extent of missing data did not differ between study arms. Missing data were accommodated using full information maximum likelihood for the two-way analyses of covariance ( Enders, 2010 ). For the fixed effects regressions, missing data were accommodated using multiple imputation (chained equations) ( Van Buuren, 2007 ). Across all analyses, significant effects were detected at α < 0.05. All tests were two-sided.

We present a CONSORT diagram in Figure 1 . Attrition did not differ significantly between study arms at POST or Follow-Up. Forty-eight (90.6%) participants completed all 8 training sessions as scheduled, supporting the feasibility and acceptability of the attention training protocols in this sample of youths with concerning anxiety. There were no statistically significant differences between study completers and non-completers at PRE on any study variables. Outcome analyses included all participants (study completers and non-completers), allowing intent-to-treat analyses. We determined maintenance of masked assignment to study arm by asking youths and their parents at Follow-Up to indicate to which study arm the youth was assigned (ABMT or ACT). Youths’ and parents’ ability to identify study arm assignment did not exceed chance.

Outcomes Analyses

We present means and standard deviations on anxiety variables, impairment, and attention variables for each study arm in Table 2 . Relative to prior RCTs of attention training for youth with anxiety disorders (see Hang, Zhang, Wang, Zhang, & Liu, 2021 ), the current sample’s mean anxiety severity levels at PRE were lower according to clinician ratings on the PARS, which typically were above 16 in prior RCTs, and similar according to youth and parent ratings on the SCARED-C/P, which typically were between 25 and 30 in prior RCTs. Mean IE ratings of youth anxiety on the PARS were below clinical cutoff at PRE, POST, and Follow-Up. Mean youth and parent ratings of youth anxiety on the SCARED-C/P were above clinical cutoff at PRE, indicating they rated youth anxiety severity at clinical levels. Mean youth and parent ratings on the SCARED-C/P were below cutoff at POST and Follow-Up. Mean youth and parent ratings of youth global impairment on the CIS-C/P were slightly below the “high” cutoff at PRE and substantially below the cutoff at POST and Follow-Up.

Means and Standard Deviations for Anxiety Symptoms, Impairment, and Attention Variables at Pretreatment, Posttreatment, and Two-Month Follow-Up

Note. ABMT = attention bias modification treatment; ACT = attention control training; PARS = Pediatric Anxiety Rating Scale; SCARED – C = Screen for Child Anxiety and Related Disorders – Child Version; SCARED-P = Screen for Child Anxiety and Related Disorders – Parent Version; CIS-C = Columbia Impairment Scale – Child Version; CIS-P = Columbia Impairment Scale – Parent Version; ACS-C = Attentional Control Scale for Children. Means and standard deviations of Attention bias to threat are presented in milliseconds.

Primary Outcome.

The Time x Study Arm interaction effect was statistically significant for IE ratings of youth anxiety on the PARS; youth in ACT had significantly lower PARS scores at Follow-Up than youth in ABMT, controlling for scores at POST ( z = 1.99, p < .05; Cohen’s d = 0.44). The difference between study arms at POST for the PARS was not statistically significant ( z = −.47, p = .64; Cohen’s d = 0.07). Collapsing across study arms, mean scores on the PARS were significantly lower at POST than PRE ( z = 3.70, p < .001; Cohen’s d = 0.51) and mean scores at POST were not significantly different from mean scores at Follow-Up. RCI analyses indicated significant reliable PRE to POST change on the PARS in 29.3% of participants.

Secondary Outcomes.

The Time x Study Arm interaction effects were statistically significant for youth self-ratings of anxiety on the SCARED-C and parent ratings of youth impairment on the CIS-P, but not parent ratings of youth anxiety on the SCARED-P or youth self-ratings of impairment on the CIS-C. Youth in ACT had significantly lower youth SCARED-C ( z = 2.29, p < .05; Cohen’s d = 0.72) and CIS-P ( z = 2.50, p < .05; Cohen’s d = 0.69) scores at Follow-Up than youth in ABMT, controlling for scores at POST. The differences between study arms at POST was not statistically significant for the SCARED-C ( z = −.37, p = .71; Cohen’s d = 0.17), SCARED-P ( z = −.32, p = .75; Cohen’s d = 0.13), CIS-P ( z = −.02, p = .98; Cohen’s d = 0.01), or CIS-C ( z = −.02, p = .98; Cohen’s d = 0.04). Collapsing across study arms, mean scores were significantly lower at POST than PRE for the SCARED-C ( z = 4.33, p < .001; Cohen’s d = 0.66), SCARED-P ( z = 5.05, p < .001; Cohen’s d = 0.96), CIS-C ( z = 4.78, p < .001; Cohen’s d = 0.88) and CIS-P ( z = 3.57, p < .001; Cohen’s d = 0.49). Mean scores at POST were not significantly different from mean scores at Follow-Up. RCI analyses indicated significant reliable PRE to POST change on the SCARED-C in 46.7% of participants and on the SCARED-P in 39.1% of participants.

Attention Bias and Attention Control Analyses

Mean levels of attention bias to threat and attention control were similar to those in prior trials of attention training in anxious youth (e.g., Pergamin-Hight et al., 2016 ; Pettit et al., 2020 ). The Time x Study Arm interaction effect was not statistically significant for attention bias scores at POST ( z = .34, p = .73; Cohen’s d = 0.22) or Follow-Up ( z = −.28, p = .78; Cohen’s d = 0.29), indicating no significant differences between study arms. Collapsing across study arms, mean attention bias scores did not significantly differ between PRE and POST, nor between POST and Follow-Up. In fixed effects panel regression analyses, changes in attention bias scores were not significantly associated with changes in anxiety severity.

The Time x Study Arm interaction effect was not statistically significant for total attention control, Attention Focusing, or Attention Shifting scores at POST or Follow-Up, indicating no significant differences between study arms. Collapsing across study arms, mean total attention control scores were significantly higher at Follow-Up than PRE ( z = 4.24, p < .001; Cohen’s d = 0.73) and POST ( z = 2.38, p < .05; Cohen’s d = 0.37). Collapsing across study arms, mean Attention Focusing scores were significantly higher at Follow-Up than PRE ( z = 2.71, p = .007; Cohen’s d = −0.52) and POST ( z = 2.50, p = .012; Cohen’s d = −0.29), and the Attention Shifting scores were significantly higher at Follow-Up than PRE ( z = 2.00, p = .045; Cohen’s d = −0.29) but not POST ( z = .76, p = .45; Cohen’s d = 0.13).

In fixed effects panel regression analyses, changes in total attention control (coefficient = −0.52, z = 2.91, p < .01) and Attention Focusing (coefficient = −0.69, z = 3.26, p = .001), but not Attention Shifting, were significantly associated with changes in anxiety severity on the SCARED-C. These coefficients indicate that SCARED-C scores decreased on average by 0.52 units for every one unit increase in attention control and by 0.69 units for every one unit increase in Attention Focusing. Changes in total attention control, Attention Focusing, or Attention Shifting scores were not significantly associated with changes in anxiety severity on the PARS or SCARED-P.

In this sample of clinic-referred youths with concerning anxiety, we found statistically significant reductions in anxiety severity and global impairment from PRE to POST in both ABMT and ACT, with medium to large effect sizes for independent evaluator ratings, youth self-ratings, and parent ratings and reliable change in 29% to 47% of participants. These reductions were maintained at a two-month Follow-Up. Contrary to hypotheses, we found significantly greater reductions in youth anxiety severity and global impairment at Follow-Up in ACT compared with ABMT, again with medium to large effect sizes. These data therefore reveal successful anxiety reduction effects using low intensity treatment in clinic-referred youths with concerning anxiety.

These data and revelation are important because they support the viability of attention training, a low intensity treatment, to reduce concerning youth anxiety levels – impairing problems that have been sorely under-researched. We acknowledge though that our data raise tantalizing questions that require further research. We highlight these questions below and suggest possible answers. We hope this discussion will spark increased “attention on attention training” approaches and enhance conceptual understanding of these treatments including mechanisms of action, and lead to more efficacious and efficient treatments.

Two tantalizing and intertwined questions relate to the optimal contingencies to use in attention training for concerning anxiety in youth and the mechanisms by which attention training reduces concerning anxiety in youth. The current findings raise the possibility that the 50% neutral training contingency in ACT may produce superior effects compared with the 100% neutral training contingency in ABMT. These findings were statistically significant using youth self-ratings of anxiety and parent ratings of youth impairment, although the pattern of lower anxiety and impairment in ACT was present across all informants (albeit not always statistically significant). When a threat appears, it is adaptive to rapidly orient attention to the threat to evaluate for potential relevance and initiate cognitive-affective processes related to defense or escape, as needed. If the threat is not relevant, attention control is needed to disengage attention from the threat, shift attention to back task-relevant stimuli, and maintain attentional focus on task-relevant stimuli ( Shi, Sharpe, & Abbott, 2019 ). The balanced contingency in ACT may train more flexible deployment of attention by requiring participants to maintain focus on task-relevant stimuli and ignore distracting threatening stimuli that are irrelevant to efficient completion of the task ( Badura-Brack et al., 2015 ; Lazarov et al., 2019 ), possibly resulting in more reductions in anxiety and related impairment.

Our finding that the focusing component of attention control was associated with reductions in anxiety severity is also consistent with this possibility that sustaining attention in the presence of a distracting threat is a key mechanism in attention training’s anxiety-reducing effects. Our finding that total attention control and focusing, but not shifting, were significantly associated with reductions in anxiety severity represents an important and initial step in developing mechanistic understanding of attention training’s anxiety-reduction effects. For example, improvements in the ability to maintain focus on task-relevant stimuli in the presence of distracting threats may be central to anxiety reductions. Further research is needed to test this idea.

Overall, the current findings contribute to the growing evidence supporting attention control as critical to the anxiety-reduction effects of attention training, dampening the earlier conceptualization of decreases in attention bias to threat as a key mechanism to anxiety reductions ( Heeren et al., 2015 ; Linetzky et al., 2020 ; Pettit et al., 2020 ). The lack of significant effects of treatment arm on attention control, however, is consistent with findings of some prior RCTs in youth with anxiety disorders, highlighting the need for further mechanistic research before concluding attention control is indeed a key mechanism of anxiety reduction ( de Voogd et al., 2016 ; Linetzky et al., 2020 ; Pettit et al., 2020 ).

Overall, these findings highlight the need for more research on the optimal attention training schedules for enhancing attention control and its components among youth with concerning anxiety. This includes research that systematically manipulates both the training contingencies (e.g., 10% neutral versus 50% neutral vs. 90% neutral), and the presence versus absence of distracting threat stimuli to test whether balanced contingencies result in more flexible deployment of attention, and whether effects on attention are most salient in the presence of a distracting threat.

Another tantalizing question pertains to what the optimal approach to help clinic-referred youth with concerning anxiety might be, especially when considered within the context of the observed effect sizes. The medium to large effect sizes for reductions in anxiety severity and impairment support the viability of low intensity treatment. The size of anxiety- and impairment-reduction effects is encouraging given the resource-light features (e.g., time, personal investment) of attention training. Also encouraging is that over 90% of participants attended all 8 training sessions, further supporting the viability of low intensity treatment. As we noted earlier, identifying efficacious, resource-light treatments is critical given data showing only 22% of youths with diagnosable anxiety disorders access mental health services ( Costello et al., 2014 ). Lengthy, resource-heavy treatments perhaps could be reserved for severe cases and/or for youths with concerning anxiety who have completed but not benefited from attention training. Importantly, our prior research supports not only the promise but also the cost-effectiveness of attention training as a low intensity treatment in a stepped care approach in youths with anxiety disorders, with higher intensity cognitive behavioral therapy delivered to the subset of youth who did not benefit from attention training ( Pettit et al., 2017 ; Yeguez et al., 2020 ). Further development and evaluation of this and other strategies for leveraging attention training to treat concerning anxiety is warranted to improve efforts to reduce youth’s distress and impairment while using limited resources efficiently. As such development and evaluation work progresses, a key consideration will be ensuring access to treatment without compromising anxiety-reduction effects. Recent efforts to deliver attention training in schools and remotely under clinician supervision represent promising steps in this direction ( Alon, Azriel, Pine, & Bar-Haim, 2022 ; Waters et al., 2019 ).

This study has several strengths and limitations. Strengths include the double-blind, randomized controlled design, the multi-informant assessment approach, the use of independent evaluators, and the assessment of global impairment. Another strength is our focus on clinic-referred youths with concerning anxiety, as noted a prevalent and understudied population. Further, the high representation of Hispanic/Latino youth in this sample (66%) is a strength given the longstanding underrepresentation of such youth in anxiety treatment research in general ( Pina, Polo, & Huey, 2019 ; Pina, Silverman, Fuentes, Kurtines, & Weems, 2003 ) and attention training research specifically. We know of only two prior trials of attention training in predominantly Hispanic/Latino youth samples with anxiety disorders, both of which supported attention training’s anxiety-reducing effects ( Pettit et al., 2020 ; Pettit et al., 2017 ). We were unable to examine the influence of youth ethnicity on response to attention training in this study, although others have noted it is possible the use of non-linguistic training stimuli (i.e., faces) may make it amenable to youth from diverse ethnic and linguistic backgrounds ( Amir, Taylor, & Donohue, 2011 ).

A study limitation is the absence of a no treatment control arm and an alternative comparison arm. Only three trials of attention training for youth anxiety have included a no treatment control arm; each trial evaluated a remotely-administered visual search for positive stimuli training task, two among youth with anxiety disorders ( Waters et al., 2015 , 2016 ) and one among unselected youth ( de Voogd et al., 2017 ). The two trials among youth with anxiety disorders found significantly enhanced anxiety reductions in the active arms compared with the no treatment control arm; the trial among unselected youth found comparable anxiety reductions in all arms. As noted by others ( Chang et al., 2019 ; Mogg, Waters, & Bradley, 2017 ), a no treatment control arm would have allowed us to parse out effects due to repeated assessment, regression to the mean, and spontaneous remission in this sample of clinic-referred youth with concerning anxiety. An alternative comparator arm that did not target attention control would allow for firmer inferences about whether enhancements in attention control accounts for reductions in anxiety severity ( Linetzky et al., 2020 ). Additional limitations include the relatively small sample, which hindered statistical power to detect small effects, an absence of an independent measure of attention to threat that does not use the dot-probe paradigm, and a reliance on a rating scale to measure attention control. In an ongoing trial of attention training ( ClinicalTrials.gov Identifier: {"type":"clinical-trial","attrs":{"text":"NCT03932032","term_id":"NCT03932032"}} NCT03932032 ), we supplement rating scales with other tasks (e.g., antisaccade; Cardinale et al., 2019 ) and methods (e.g., electroencephalography; Bechor et al., 2019 ; Thai, Taber-Thomas, & Perez-Edgar, 2016 ) to measure attention control and attention allocation to threat. With the cumulation of data from multiple tasks and methodologies, researchers will be positioned to advance theory and treatment development by mapping patterns of attention onto neural circuitry and behavioral phenotypes of anxiety ( Pettit & Silverman, 2020 ).

In summary, the current study supports the viability of low intensity treatments that involve attention training for youth with concerning anxiety. These novel data provide the impetus for further efforts to help this population of youth while maximizing use of limited treatment resources effectively and efficiently. This demonstration of anxiety reduction in a clinic setting also supports investigation of attention training in community or school settings where there are higher numbers of youth with concerning anxiety (e.g., de Voogd et al., 2017 ; Waters et al., 2019 ). The data further set the stage for additional mechanistic research on attention training protocols, using alternative comparison arms and investigating optimal training contingencies for targeting attention control.

• Tested attention training for concerning anxiety in youth
• Attention training led to reductions in anxiety severity and global impairment
• Changes in attention control were associated with changes in anxiety
• Findings support the viability of attention training for concerning anxiety

Acknowledgements:

We gratefully acknowledge Deepika Bose, MS, Victor Buitron, PhD, Yesenia Martinez, LMHC, Alyssa Martino, MS, Raquel Melendez, PhD, and Daniella Vaclavik, MS for their assistance in administering attention training sessions and collecting data.

Declarations:

This research was supported by National Institutes of Health grant UH MH101470 and NIMH-IRP Project ZIA-MH002781. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors report no financial interests or conflicts of interest.

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Healthy and pathological neurocognitive aging: spectral and functional connectivity analyses using magnetoencephalography.

• Gianluca Susi , Gianluca Susi Complutense University of Madrid; Technical University of Madrid, Center for Biomedical Technology (CTB); University of Rome “Tor Vergata”
• Jaisalmer de Frutos-Lucas , Jaisalmer de Frutos-Lucas Universidad Autonoma de Madrid, Center for Biomedical Technology (CTB)
• Guiomar Niso , Guiomar Niso Technical University of Madrid, Center for Biomedical Technology, Biomedical Research Networking Centre on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN)
• Su Miao Ye-Chen , Su Miao Ye-Chen Complutense University of Madrid, Center for Biomedical Technology (CTB)
• Luis Antón Toro , Luis Antón Toro Complutense University of Madrid, Center for Biomedical Technology (CTB)
• Brenda Nadia Chino Vilca Brenda Nadia Chino Vilca Universidad Nacional de San Agustin de Arequipa; Universidad Catolica San Pablo
•  and  Fernando Maestú Fernando Maestú Complutense University of Madrid, Center for Biomedical Technology (CTB), Biomedical Research Networking Centre on Bioengineering, Biomaterials, and Nanomedicine (CIBER-BBN)
• https://doi.org/10.1093/acrefore/9780190236557.013.387
• Published online: 26 March 2019

Oscillatory activity present in brain signals reflects the underlying time-varying electrical discharges within and between ensembles of neurons. Among the variety of non-invasive techniques available for measuring of the brain’s oscillatory activity, magnetoencephalography (MEG) presents a remarkable combination of spatial and temporal resolution, and can be used in resting-state or task-based studies, depending on the goals of the experiment.

Two important kinds of analysis can be carried out with the MEG signal: spectral a . and functional connectivity (FC) a . While the former provides information on the distribution of the frequency content within distinct brain areas, FC tells us about the dependence or interaction between the signals stemming from two (or among many) different brain areas.

The large frequency range combined with the good resolution offered by MEG makes MEG-based spectral and FC analyses able to highlight distinct patterns of neurophysiological alterations during the aging process in both healthy and pathological conditions. Since disruption in spectral content and functional interactions between brain areas could be accounted for by early neuropathological changes, MEG could represent a useful tool to unveil neurobiological mechanisms related to the cognitive decline observed during aging, particularly suitable for the detection of functional alterations, and then for the discovery of potential biomarkers in case of pathology.

The aging process is characterized by alterations in the spectral content across the brain. At the network level, FC studies reveal that older adults experience a series of changes that make them more vulnerable to cognitive interferences.

While special attention has been dedicated to the study of pathological conditions (in particular, mild cognitive impairment and Alzheimer’s disease), the lack of studies addressing the features of FC in healthy aging is noteworthy. This area of research calls for future attention because it is able to set the baseline from which to draw comparisons with different pathological conditions.

• functional connectivity
• magnetoencephalography
• Alzheimer’s disease

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Cognitive Secrets: The Science Behind Attention

Attention is a fundamental cognitive process that enables us to navigate and make sense of the world. From focusing on a conversation in a noisy room to driving a car in heavy traffic, our ability to direct and sustain attention is crucial for everyday functioning. But what exactly is it, how does it work, and why is it so essential? This article will delve into the science behind attention, exploring its mechanisms, types, and factors influencing it.

If you haven’t read the other articles in this series, read about 1) the science behind memory and 2) the science behind decision-making .

Understanding Attention

Attention is the mental process that allows us to concentrate on specific information while selectively ignoring other stimuli. It acts as a filter, helping us focus on what is relevant and important at any moment. Without it, our minds would be overwhelmed by the sheer volume of sensory information we encounter every second.

The Neuroscience of Attention

Attention involves a complex network of brain regions working together to process and prioritize information. Key areas involved in attention include:

Types of Attention

• Selective Attention : This type lets us focus on a single task or stimulus while filtering out irrelevant information. For example, selective attention lets us listen to one person speaking at a crowded party.
• Sustained Attention: Also known as vigilance, this is the ability to maintain focus on a task or stimulus over an extended period. This is crucial for activities that require continuous monitoring, such as studying for an exam or keeping watch over a security feed.
• Divided Attention : This type refers to the ability to focus on multiple tasks simultaneously. While true multitasking is largely a myth, divided attention allows us to switch between tasks quickly and efficiently, such as cooking dinner while talking on the phone.
• Alternating Attention : Alternating attention is the capacity to switch focus between different tasks or stimuli. This is essential for tasks that require frequent shifts, like driving a car while responding to navigation instructions.

Internal Factors

• Arousal Levels : Optimal attention requires a balance in arousal levels. Too much arousal (e.g., anxiety) or too little (e.g., fatigue) can impair attention.
• Motivation : High motivation and interest in a task can enhance attention. Conversely, tasks perceived as boring or irrelevant can lead to lapses in focus.
• Mental Health : Conditions such as ADHD, anxiety, and depression can affect attention. Individuals with ADHD, for instance, often struggle with sustaining attention and managing distractions.

External Factors

• Environment : A cluttered or noisy environment can be distracting and hinder attention. Creating a quiet, organized space can help improve focus.
• Task Complexity : Simple tasks are generally easier to focus on, while complex tasks that require more cognitive resources can be more challenging to maintain attention.
• Multitasking : Attempting to multitask can divide attention and reduce the quality of performance on individual tasks. It is generally more effective to focus on one task at a time.

The Role of Attention in Root Cause Analysis

In the context of RCA, attention is vital for several reasons:

• Detailed Examination : Effective RCA requires scrutinizing every aspect of an incident, from the immediate causes to the underlying systemic issues. Sustained attention ensures that no critical detail is overlooked.
• Information Processing : Attention helps organize and integrate information from various sources. This includes gathering data, interviewing stakeholders, and reviewing documentation. A focused mind can better synthesize this information into a coherent analysis.
• Identifying Patterns : Detecting patterns and correlations within the data is essential for identifying root causes. Attention enables analysts to notice these patterns, which might be missed if the focus is scattered.

Despite its importance, maintaining attention throughout the RCA process can be challenging. Attentional lapses and multitasking are common pitfalls that can compromise the quality of the analysis. These lapses can lead to:

• Missed Details : Critical information might be overlooked, leading to incomplete analysis.
• Erroneous Conclusions : Inaccurate or incomplete data can incorrectly identify root causes.
• Reduced Reliability : Frequent lapses reduce the overall reliability and credibility of the analysis.

As mentioned, the human brain is not designed to multitask effectively, especially for complex cognitive tasks. Multitasking can lead to:

• Cognitive Overload : The brain becomes overloaded with information, leading to errors and omissions.
• Divided Attention : Attention is split between tasks, reducing the ability to focus deeply on any single task.
• Increased Stress : The mental strain of multitasking can increase stress levels, further impairing cognitive function.

Strategies to Maintain Focus and Attention

To conduct thorough and accurate RCAs, it is essential to implement strategies that enhance and maintain attention throughout the investigative process. Here are some effective approaches:

Prioritize and Plan

• Structured Approach : Develop a structured plan for the RCA process, breaking it down into manageable steps. This helps maintain focus on one task at a time.
• Task Prioritization : Prioritize tasks based on their importance and urgency. Focus on high-priority tasks when your attention is at its peak.

Minimize Distractions

• Controlled Environment : Conduct RCAs in a quiet, controlled environment where distractions are minimized.
• Digital Hygiene : Limit electronic devices and notifications during the analysis to reduce interruptions.

Use Attention-Enhancing Techniques

• Mindfulness and Meditation : Practicing mindfulness and meditation can improve attention span and focus.
• Breaks and Rest : Take regular breaks to rest and recharge. Short, frequent breaks can prevent cognitive fatigue and maintain high levels of attention.

Collaborative Efforts

• Team Analysis : Conduct RCAs as a team, distributing tasks among team members. Collaborative efforts can help maintain focus and cross-verify findings.
• Peer Review : Have another team member review the analysis to catch any missed details or errors.

Training and Tools

• Attention Training : Provide training on attention management and techniques to improve focus.
• Analytical Tools : Utilize tools and software designed to assist in the RCA process, helping to organize information and maintain focus.

If you haven’t attended a TapRooT® Root Cause Analysis course, I encourage you to find a course location that interests you here !

Attention is a vital cognitive process that underpins our ability to function effectively. By understanding the science behind attention and the factors that influence it, we can employ effective strategies to enhance focus and boost productivity, leading to improved cognitive performance and overall well-being.

For more insightful content and updates, please connect with me on  LinkedIn .

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Rogers, R. D., & Monsell, S. (1995). Costs of a predictable switch between simple cognitive tasks. Journal of Experimental Psychology: General, 124 (2), 207-231. https://doi.org/10.1037/0096-3445.124.2.207

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Sarter, M., Givens, B., & Bruno, J. P. (2001). The cognitive neuroscience of sustained attention: Where top-down meets bottom-up. Brain Research Reviews, 35 (2), 146-160. https://doi.org/10.1016/S0165-0173(01)00044-3

Smallwood, J., & Schooler, J. W. (2006). The restless mind. Psychological Bulletin, 132 (6), 946-958. https://doi.org/10.1037/0033-2909.132.6.946

Yerkes, R. M., & Dodson, J. D. (1908). The relation of strength of stimulus to rapidity of habit-formation. Journal of Comparative Neurology and Psychology, 18 (5), 459-482. https://doi.org/10.1002/cne.920180503

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Why Your Brain Loves Good Storytelling

• Paul J. Zak

Studying the neuroscience of compelling communication.

It is quiet and dark. The theater is hushed. James Bond skirts along the edge of a building as his enemy takes aim. Here in the audience, heart rates increase and palms sweat.  I know this to be true because instead of enjoying the movie myself, I am measuring the brain activity of a dozen viewers. For me, excitement has a different source: I am watching an amazing neural ballet in which a story line changes the activity of people’s brains.

• Paul J. Zak is the founding director of the Center for Neuroeconomics Studies and a professor of economics, psychology, and management at Claremont Graduate University, and the CEO of Immersion Neuroscience. He is the author of Trust Factor: The Science of Creating High-Performance Companies .

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Convergent Attention, Divergent Consciousness

Since consciousness is private, attention is needed for communication..

Updated June 5, 2024 | Reviewed by Monica Vilhauer

• Understanding Attention
• Find counselling to help with ADHD
• Phenomenal consciousness cannot be the sole source of intelligent capacities.
• Attention is required for creating a common world, or communicative background.
• The divergence of conscious experiences, however, can offer a diversity of perspectives and creativity.

In this blog series, for the last 9 years, we have explored the implications of the differences between consciousness and attention . One difference is about the divergent paths taken by species towards intersubjective communication (fueled by competition , cooperation , and joint attention ) and towards a radical kind of subjectivity that eventually led to cognitive individuality and uniqueness, at least in humans (and perhaps close relatives of humans).

While cognitive uniqueness (what in philosophy is called “phenomenal consciousness” or “what it is like” to be you, from the point of view of your awareness) naturally builds on organismic autonomy, it is in considerable tension with cognition and intelligence in general, because of the radically private nature of consciousness. For instance, the set of possible kinds of radical subjectivity are less constrained by the environment than the constraints on the types of attention routines that animals can use.

The evolution of complex communication, in particular, enriches attention in ways that allow for marked increases in intelligence. On the other hand, consciousness makes subjects diverge from a common or standard type of mentality. The difference between consciousness and attention is, therefore, more complicated than the simple necessity or sufficiency claims that are frequently discussed in the literature, namely, whether attention is necessary or necessary and sufficient for consciousness (or other combinations of this relation). So-called “access consciousness”, or the reportable kind of consciousness we use in action and decision-making , may just be attention, while phenomenal consciousness may be a graded phenomenon, some aspects of it more homeostatic than others, others more formatted through language (e.g., introspection).

A consequence of the difference between consciousness and attention for future research is that we need to focus on how consciousness radically diverges among individuals, and how this phenomenal divergence is modulated and tempered by the convergence of joint attention and language (or not, as might be the case of introspection and inner narrative). This is a dynamic relation, rather than a static dependence relation. We call this thesis: “divergent consciousness, convergent attention.”

Views that propose that consciousness is fundamental and immediate, and that it provides a unique kind of knowledge, get something right, which is that consciousness is a unique connection that brings familiarity to our cognitive capacities. But these views are wrong in proposing that this is our only way to connect with the world and, in particular, to communicate. For this, attention is needed. An implication of this conclusion, which we have explored in other posts, is that consciousness is not the same as intelligence, including artificial intelligence . Attention is essential for intelligence, which is a publicly available good and stands in contrast to your private conscious awareness, which is uniquely valuable to you.

With respect to contemporary theories of consciousness, the Integrated Information Theory (IIT) has the consequence that radical divergence (unique to an individual) is compatible with convergence with other individuals, through evolution (this seems to be a unique feature of IIT). But more needs to be said about how attention is involved here. Other theories of consciousness, such as the Global Neuronal Network Theory (GNWT) may explain convergence simply through information processing and neural activation, but might find it difficult to explain radical divergence. Is this the main difference between access and phenomenal consciousness? Is GNWT better suited at explaining access consciousness and IIT better suited at explaining phenomenal consciousness?

This point is so important that it can be made independently of the empirical literature, which favors the dissociation between consciousness and attention . If phenomenal intelligence is radically private, then it cannot be publicly assessable or communicable. Since phenomenal consciousness is radically private, we cannot create a common world through it alone. Phenomenal consciousness cannot be the sole source of intelligent capacities. Thus, phenomenal consciousness is not necessarily a source of convergence.

A slightly stronger claim is that phenomenal consciousness is a source of divergence. When combined with language, for instance, the contribution of language as conscious inner dialogue is divergent. Spontaneous and intrusive thoughts or memories can become a source of divergence. In this way, one could even classify certain costs of consciousness, such as inner distraction through introspection, and an obsession with inner language.

With regard to attention, the environment itself is not sufficient to explain the whole range of intersubjective coordination. Agents with capacities for attention are crucial to explain salient constancies for the action perception loop. Phenomenal consciousness itself is not sufficient to explain success in communication and action. Therefore, phenomenal consciousness is not a source of convergence. Attention is needed to explain convergence, both in the form of binding properties mapped from external information and also in terms of intersubjective attention that allows for communication and joint action. If phenomenal consciousness is a source of convergence, it is very important to explain how something radically private could achieve this without the involvement of the convergence functions of attention.

Are there advantages to being conscious? Clearly there are! Dreams are radical departures from environmental constraints, and provide fertile ground for the exploration of artistic and spiritual experiences. Art, our familiarity with the world, the immediacy of our biological needs, and our sense of embodiment, they all seem to depend fundamentally on phenomenal consciousness.

It is perhaps through this divergence of conscious experience that we find diversity in perspectives and creativity . The question now emerges: is this divergence an evolutionary advantage for conscious complex organisms? Or is this divergence detrimental to the survival of species with extreme versions of it?

Carlos Montemayor, Ph.D. , is an Associate Professor of Philosophy at San Francisco State University.

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Summary across measurement domains of comparisons of meditation programs with nonspecific active controls (efficacy analysis) (A) and specific active controls (comparative effectiveness analysis) (B). CAD indicates coronary artery disease; CHF, congestive heart failure; CSM, clinically standardized meditation (a mantra meditation program); MA, meta-analysis; PA, primary analysis; PO, number of trials in which this was a primary outcome for the trial; and TM, transcendental meditation (a mantra meditation program). Direction is based on the relative difference in change analysis. ↑ Indicates the meditation group improved relative to the control group (with a relative difference generally ≥5% across trials); ↓, the meditation group worsened relative to the control group (with a relative difference generally ±5% across trials); Ø, a null effect (with a relative difference generally <5% across trials); and ↑↓, inconsistent findings (some trials reported improvement with meditation [relative to control], whereas others showed no improvement or improvement in the control group [relative to meditation]). Magnitude is based on the relative difference in the change score, a relative percent difference, using the baseline mean in the meditation group as the denominator. For example, if the meditation group improves from 10 to 19 on a mental health scale and the control group improves from 11 to 16 on the same scale, the relative difference between groups in the change score is: {[(19 − 10) − (16 − 11)]/10} × 100 = 40%. The interpretation is a 40% relative improvement on the mental health scale in the meditation group compared with the control group. Improvement in all scales is indicated in the positive direction. A positive relative percent difference means that the score improved more in the intervention group than in the control group. The meta-analysis figure (far right) shows the Cohen d statistic with the 95% CI. a Summary effect size is not shown owing to concern about publication bias for this outcome. b Negative affect combines the outcomes of anxiety, depression, and stress/distress and is thus duplicative of those outcomes. c We did not perform an MA on this outcome because it would duplicate the anxiety MA for mantra. Anxiety and depression are indirect measures of negative affect and therefore resulted in a lower strength of evidence than that for the outcome of mantra on anxiety.

a Total exceeds the number in the exclusion box because reviewers were allowed to mark more than 1 reason for exclusion.

• Meditation Intervention Reviews JAMA Internal Medicine Comment & Response July 1, 2014 Thomas Rutledge, PhD; Paul Mills, PhD; Robert Schneider, MD
• Meditation Intervention Reviews JAMA Internal Medicine Comment & Response July 1, 2014 Harald Walach, PhD; Stefan Schmidt, PhD; Tobias Esch, MD
• Meditation Intervention Reviews JAMA Internal Medicine Comment & Response July 1, 2014 Eric B. Loucks, PhD
• Meditation Intervention Reviews—Reply JAMA Internal Medicine Comment & Response July 1, 2014 Madhav Goyal, MD, MPH; Eric B. Bass, MD, MPH; Jennifer A. Haythornthwaite, PhD
• Evidence-Based Complementary Care JAMA Internal Medicine Invited Commentary March 1, 2014 Allan H. Goroll, MD

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Goyal M , Singh S , Sibinga EMS, et al. Meditation Programs for Psychological Stress and Well-being : A Systematic Review and Meta-analysis . JAMA Intern Med. 2014;174(3):357–368. doi:10.1001/jamainternmed.2013.13018

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Meditation Programs for Psychological Stress and Well-being : A Systematic Review and Meta-analysis

• 1 Department of Medicine, The Johns Hopkins University, Baltimore, Maryland
• 2 Department of Pediatrics, The Johns Hopkins University, Baltimore, Maryland
• 3 Department of Psychiatry and Behavioral Services, The Johns Hopkins University, Baltimore, Maryland
• 4 Department of Health Policy and Management, Johns Hopkins School of Public Health, Baltimore, Maryland
• Invited Commentary Evidence-Based Complementary Care Allan H. Goroll, MD JAMA Internal Medicine
• Comment & Response Meditation Intervention Reviews Thomas Rutledge, PhD; Paul Mills, PhD; Robert Schneider, MD JAMA Internal Medicine
• Comment & Response Meditation Intervention Reviews Harald Walach, PhD; Stefan Schmidt, PhD; Tobias Esch, MD JAMA Internal Medicine
• Comment & Response Meditation Intervention Reviews Eric B. Loucks, PhD JAMA Internal Medicine
• Comment & Response Meditation Intervention Reviews—Reply Madhav Goyal, MD, MPH; Eric B. Bass, MD, MPH; Jennifer A. Haythornthwaite, PhD JAMA Internal Medicine

Importance   Many people meditate to reduce psychological stress and stress-related health problems. To counsel people appropriately, clinicians need to know what the evidence says about the health benefits of meditation.

Objective   To determine the efficacy of meditation programs in improving stress-related outcomes (anxiety, depression, stress/distress, positive mood, mental health–related quality of life, attention, substance use, eating habits, sleep, pain, and weight) in diverse adult clinical populations.

Evidence Review   We identified randomized clinical trials with active controls for placebo effects through November 2012 from MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, the Cochrane Library, and hand searches. Two independent reviewers screened citations and extracted data. We graded the strength of evidence using 4 domains (risk of bias, precision, directness, and consistency) and determined the magnitude and direction of effect by calculating the relative difference between groups in change from baseline. When possible, we conducted meta-analyses using standardized mean differences to obtain aggregate estimates of effect size with 95% confidence intervals.

Findings   After reviewing 18 753 citations, we included 47 trials with 3515 participants. Mindfulness meditation programs had moderate evidence of improved anxiety (effect size, 0.38 [95% CI, 0.12-0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03- 0.62]) and low evidence of improved stress/distress and mental health–related quality of life. We found low evidence of no effect or insufficient evidence of any effect of meditation programs on positive mood, attention, substance use, eating habits, sleep, and weight. We found no evidence that meditation programs were better than any active treatment (ie, drugs, exercise, and other behavioral therapies).

Conclusions and Relevance   Clinicians should be aware that meditation programs can result in small to moderate reductions of multiple negative dimensions of psychological stress. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress. Stronger study designs are needed to determine the effects of meditation programs in improving the positive dimensions of mental health and stress-related behavior.

Many people use meditation to treat stress and stress-related conditions and to promote general health. 1 , 2 To counsel patients appropriately, clinicians need to know more about meditation programs and how they can affect health outcomes. Meditation training programs vary in several ways, including the type of mental activity promoted, the amount of training recommended, the use and qualifications of an instructor, and the degree of emphasis on religion or spirituality. Some meditative techniques are integrated into a broader alternative approach that includes dietary and/or movement therapies (eg, ayurveda or yoga).

Meditative techniques are categorized as emphasizing mindfulness, concentration, and automatic self-transcendence. Popular techniques, such as transcendental meditation, emphasize the use of a mantra in such a way that it transcends one to an effortless state where focused attention is absent. 3 - 5 Other popular techniques, such as mindfulness-based stress reduction, emphasize training in present-focused awareness or mindfulness. Uncertainty remains about what these distinctions mean and the extent to which these distinctions actually influence psychosocial stress outcomes. 5 , 6

Reviews to date report a small to moderate effect of mindfulness and mantra meditation techniques in reducing emotional symptoms (eg, anxiety, depression, and stress) and improving physical symptoms (eg, pain). 7 - 26 These reviews have largely included uncontrolled and controlled studies, and many of the controlled studies did not adequately control for placebo effects (eg, waiting list– or usual care–controlled studies). Observational studies have a high risk of bias owing to problems such as self-selection of interventions (people who believe in the benefits of meditation or who have prior experience with meditation are more likely to enroll in a meditation program and report that they benefited from one) and use of outcome measures that can be easily biased by participants’ beliefs in the benefits of meditation. Clinicians need to know whether meditation training has beneficial effects beyond self-selection biases and the nonspecific effects of time, attention, and expectations for improvement. 27 , 28

An informative analogy is the use of placebos in pharmaceutical trials. A placebo is typically designed to match nonspecific aspects of the “active” intervention and thereby elicit the same expectations of benefit on the part of the provider and patient in the absence of the active ingredient. Office visits and patient-provider interactions, all of which influence expectations for outcome, are particularly important to control when the evaluation of outcome relies on patient reporting. In the situation when double-blinding has not been feasible, the challenge to execute studies that are not biased by these nonspecific factors is more pressing. 28 To develop evidence-based guidance on the use of meditation programs, we need to examine the specific effects of meditation in randomized clinical trials (RCTs) in which the nonspecific aspects of the intervention are controlled.

The objective of this systematic review is to evaluate the effects of meditation programs on negative affect (eg, anxiety, stress), positive affect (eg, well-being), the mental component of health-related quality of life, attention, health-related behaviors affected by stress (eg, substance use, sleep, eating habits), pain, and weight among persons with a clinical condition. We include only RCTs that used 1 or more control groups in which the amount of time and attention provided by the control intervention was comparable to that of the meditation program.

We searched the following databases for primary studies: MEDLINE, PsycINFO, EMBASE, PsycArticles, Scopus, CINAHL, AMED, and the Cochrane Library through June 2013. We developed a MEDLINE search strategy using PubMed medical subject heading terms and the text words of key articles that we identified a priori. We used a similar strategy in the other electronic sources. We reviewed the reference lists of included articles, relevant review articles, and related systematic reviews to identify articles missed in the database searches. We did not impose any limits based on language or date of publication. The protocol for this systematic review is publicly available. 29

Two trained investigators independently screened titles and abstracts, excluding those that both investigators agreed met at least 1 of the exclusion criteria ( Table 1 ). For those studies included after the first review, a second dual independent review of the full-text article occurred, and differences regarding article inclusion were resolved through consensus.

We included RCTs in which the control group was matched in time and attention to the intervention group. We also required that studies include participants with a clinical condition. We defined a clinical condition broadly to include mental health/psychiatric conditions (eg, anxiety or stress) and physical conditions (eg, lower back pain, heart disease, or advanced age). In addition, because stress is of particular interest in meditation studies, we also included trials that studied stressed populations, although they may not have had a defined medical or psychiatric diagnosis.

We used systemic review software (DistillerSR, 2010; Evidence Partners) to manage the screening process. For each meditation program, we extracted information on measures of intervention fidelity, including dose, training, and receipt of intervention. We recorded the duration and maximal hours of structured training in meditation, the amount of home practice recommended, description of instructor qualifications, and description of participant adherence, if any. Because numerous scales measured negative or positive affect, we chose scales that were common to the other trials and the most clinically relevant to make comparisons more meaningful.

To display outcome data, we calculated the relative difference in change scores (ie, the change from baseline in the treatment group minus the change from baseline in the control group, divided by the baseline score in the treatment group). We used the relative difference in change scores to estimate the direction and approximate magnitude of effect for all outcomes. We were unable to calculate a relative difference in change score for 6 outcomes owing to incompletely reported data for statistically insignificant findings. We considered a 5% relative difference in change score to be potentially clinically significant because these studies examined short-term interventions and relatively low doses of meditation.

For the purpose of generating an aggregate quantitative estimate of the effect of an intervention and the associated 95% confidence interval, we performed random-effects meta-analyses using standardized mean differences (effect size [ES]; Cohen d ). We also used these analyses to assess the precision of individual studies, which we factored into the overall strength of evidence. For each outcome, ES estimates are displayed according to the type of control group and the duration of follow-up. Trials did not give enough information to conduct a meta-analysis on 16 outcomes. We display the relative difference in change scores along with the ES estimates from the meta-analysis so that readers can see the full extent of the available data ( Figure 1 and Supplement [eFigures 1 to 34]).

We classified the type of control group as a nonspecific active or specific active control ( Table 1 ). The nonspecific active comparison conditions (eg, education or attention control) control for the nonspecific effects of time, attention, and expectation. Comparisons against these controls allow for assessments of the specific effectiveness of the meditation program beyond the nonspecific effects of time, attention, and expectation. This comparison is similar to a comparison against a placebo pill in a drug trial. Specific active controls are therapies (eg, exercise or progressive muscle relaxation) known or expected to change clinical outcomes. Comparisons against these controls allow for assessments of comparative effectiveness similar to those of drug trials that compare one drug against another known drug. Because these study designs are expected to yield different conclusions (efficacy vs comparative effectiveness), we separated them in our analyses.

We assessed the quality of the trials independently and in duplicate based on the recommendations in the Methods Guide for Conducting Comparative Effectiveness Reviews . 30 We supplemented these tools with additional assessment questions based on the Cochrane Collaboration’s risk-of-bias tool. 31 , 32 Two reviewers graded the strength of evidence for each outcome using the grading scheme recommended by the Methods Guide for Conducting Comparative Effectiveness Reviews. 33 This grading was followed by a discussion to review and achieve consensus on the assigned grades. In assigning evidence grades, we considered the following 4 domains: risk of bias, directness, consistency, and precision. We classified evidence into the following 4 basic categories: (1) high grade (indicating high confidence that the evidence reflects the true effect and that further research is very unlikely to change our confidence in the estimate of the effect), (2) moderate grade (indicating moderate confidence that the evidence reflects the true effect and that further research may change our confidence in the estimate of the effect and may change the estimate), (3) low grade (indicating low confidence that the evidence reflects the true effect and that further research is likely to change our confidence in the estimate of the effect and is likely to change the estimate), and (4) insufficient grade (indicating that evidence is unavailable or inadequate to draw a conclusion).

We screened 18 753 unique citations ( Figure 2 ) and 1651 full-text articles. Forty seven trials met our inclusion criteria. 34 - 80

Most trials were short-term but ranged from 3 weeks to 5.4 years in duration ( Table 2 ). Not all trials reported the amount of training or home practice recommended. Quiz Ref ID Mindfulness-based stress reduction programs typically provided 20 to 27.5 hours of training during 8 weeks. The other mindfulness meditation trials provided about half this amount. Transcendental meditation trials were estimated to provide 16 to 39 hours in 3 to 12 months, whereas other mantra meditation programs provided about half this amount. Only 5 of the trials reported the trainers’ actual meditation experience (ranging from 4 months to 25 years), and 6 reported the trainers’ actual teaching experience (ranging from 0-15.7 years). Fifteen trials studied psychiatric populations, including those with anxiety, depression, stress, chronic worry, and insomnia. Five trials studied smokers and alcoholics, 5 studied populations with chronic pain, and 16 studied populations with diverse medical problems, including those with heart disease, lung disease, breast cancer, diabetes mellitus, hypertension, and human immunodeficiency virus infection.

The strength of evidence concerning the outcomes is shown in Figure 1 . We found it difficult to draw comparative effectiveness conclusions owing to the large heterogeneity of type and strength of the many comparators. Therefore, we present our results first for all the comparisons with nonspecific active controls (efficacy) and then for those with specific active controls (comparative effectiveness).

The direction and magnitude of effect is derived from the relative difference between groups in the change score. In our efficacy analysis ( Figure 1 A), we found low evidence of no effect or insufficient evidence that mantra meditation programs had an effect on any of the psychological stress and well-being outcomes we examined. Quiz Ref ID Mindfulness meditation programs had moderate evidence of improved anxiety (ES, 0.38 [95% CI, 0.12- 0.64] at 8 weeks and 0.22 [0.02-0.43] at 3-6 months), depression (0.30 [0.00-0.59] at 8 weeks and 0.23 [0.05-0.42] at 3-6 months), and pain (0.33 [0.03-0.62]) and low evidence of improved stress/distress and mental health–related quality of life. Quiz Ref ID We found low evidence of no effect or insufficient evidence of an effect of meditation programs on positive mood, attention, sleep, and weight. We also found insufficient evidence that meditation programs had an effect on health-related behaviors affected by stress, including substance use and sleep.

In our comparative effectiveness analyses ( Figure 1 B), Quiz Ref ID we found low evidence of no effect or insufficient evidence that any of the meditation programs were more effective than exercise, progressive muscle relaxation, cognitive-behavioral group therapy, or other specific comparators in changing any outcomes of interest. Few trials reported on potential harms of meditation programs. Of the 9 trials reporting this information, none reported any harms of the intervention.

We could not conduct any quantitative tests (eg, funnel plots) for publication bias because few studies were available for most outcomes, and many were excluded from the meta-analysis owing to missing data. We reviewed the clinicaltrials.gov registration database to identify trials completed 3 or more years ago that prespecified our outcomes of interest and did not publish at all or did not publish all prespecified outcomes. We found 5 trials that appeared to have been completed before January 1, 2010, that did not publish all the outcomes they had prespecified and 9 trials for which we could not find an associated publication. Because only 6 outcomes were excluded from the analyses of the relative difference in change scores between groups, whereas 16 outcomes were excluded from the meta-analyses, our findings from the primary analyses are less likely than the meta-analyses to be affected by publication bias.

Our review indicates that meditation programs can reduce the negative dimensions of psychological stress. Mindfulness meditation programs, in particular, show small improvements in anxiety, depression, and pain with moderate evidence and small improvements in stress/distress and the mental health component of health-related quality of life with low evidence when compared with nonspecific active controls. Mantra meditation programs did not improve any of the outcomes examined, but the strength of this evidence varied from low to insufficient. Although meditation programs generally seek to improve the positive dimensions of health, the evidence from a small number of studies did not show any effects on positive affect or well-being for any meditation program. We found no evidence of any harms of meditation programs, although few trials reported on harms. One strength of our review is the focus on RCTs with active controls, which should give clinicians greater confidence that the reported benefits are not the result of nonspecific effects (eg, attention and expectations) that are seen in trials using a waiting list or usual-care control condition.

Anxiety, depression, and stress/distress are different components of negative affect. When we combined each component of negative affect, we saw a small and consistent signal that any domain of negative affect is improved in mindfulness programs when compared with a nonspecific active control. The ESs were small but significant for some of these individual outcomes and were seen across a broad range of clinical conditions ( Table 2 ). During the course of 2 to 6 months, the mindfulness meditation program ES estimates ranged from 0.22 to 0.38 for anxiety symptoms and 0.23 to 0.30 for depressive symptoms. These small effects are comparable with what would be expected from the use of an antidepressant in a primary care population but without the associated toxicities. In a study using patient-level meta-analysis, Fournier et al 81 found that for patients with mild to moderate depressive symptoms, antidepressants had an ES of 0.11 (95% CI, −0.18 to 0.41), whereas for those with severe depression, antidepressants had an ES of 0.17 (−0.08 to 0.43) compared with placebo.

Among the 9 RCTs 43 , 44 , 47 , 54 , 55 , 63 , 64 , 73 , 74 evaluating the effect on pain, we found moderate evidence that mindfulness-based stress reduction reduces pain severity to a small degree when compared with a nonspecific active control, yielding an ES of 0.33 from the meta-analysis. This effect is variable across painful conditions and is based on the results of 4 trials, of which 2 were conducted in patients with musculoskeletal pain, 55 , 64 1 trial in patients with irritable bowel syndrome, 43 and 1 trial in a population without pain. 44 Visceral pain had a large and statistically significant relative 30% improvement in pain severity, whereas musculoskeletal pain showed 5% to 8% improvements that were considered nonsignificant.

Overall, the evidence was insufficient to indicate that meditation programs alter health-related behaviors affected by stress, and low-grade evidence suggested that meditation programs do not influence weight. Although uncontrolled studies have usually found a benefit of meditation, very few controlled studies have found a similar benefit for the effects of meditation programs on health-related behaviors affected by stress. 17 - 19

In the 20 RCTs examining comparative effectiveness, 34 , 36 , 37 , 40 , 45 , 46 , 48 , 49 , 51 , 53 , 54 , 57 , 61 - 63 , 66 , 70 , 71 , 73 - 75 , 77 , 80 mindfulness and mantra programs did not show significant effects when the comparator was a known treatment or therapy. A lack of statistically significant superiority compared with a specific active control (eg, exercise) only addresses the question of equivalency or noninferiority if the trial is suitably powered to detect any difference. Sample sizes in the comparative effectiveness trials were small (mean size of 37 per group), and none appeared adequately powered to assess noninferiority or equivalence.

A number of observations provide context to our conclusions. First, very few mantra meditation programs met our inclusion criteria. This lack significantly limited our ability to draw inferences about the effects of mantra meditation programs on psychological stress–related outcomes, which did not change when we evaluated transcendental meditation separately from other mantra training.

Second, differences may exist between trials for which the outcomes are a primary vs a secondary focus, although we did not find any evidence of this. The samples included in these trials resembled a general primary care population, and there may not be room to measure an effect if symptom levels of the outcomes are low to start with (ie, a floor effect). This limitation may explain the null results for mantra meditation programs because 3 transcendental meditation trials 47 , 59 , 65 enrolled patients with cardiac disease, whereas only 1 enrolled patients with anxiety. 69

Third, the lack of effect on stress-related outcomes may relate to the way the research community conceptualizes meditation programs, the challenges in acquiring such skills or meditative states, and the limited duration of RCTs. Historically, meditation was not conceptualized as an expedient therapy for health problems. 3 , 6 , 82 Meditation was a skill or state one learned and practiced over time to increase one’s awareness and through this awareness to gain insight and understanding into the various subtleties of one’s existence. Training the mind in awareness, in nonjudgmental states, or in the ability to become completely free of thoughts or other activity are daunting accomplishments. The interest in meditation that has grown during the past 30 years in Western cultures comes from Eastern traditions that emphasize lifelong growth. The translation of these traditions into research studies remains challenging. Long-term trials may be optimal to examine the effect of meditation on many health outcomes, such as those trials that have evaluated mortality. 65 However, many of the studies included in this review were short term (eg, 2.5 h/wk for 8 weeks), and the participants likely did not achieve a level of expertise needed to improve outcomes that depend on mastery of mental and emotional processes.

Finally, none of our conclusions yielded a high strength-of-evidence grade for a positive or null effect. Thus, further studies in primary care and disease-specific populations are indicated to address uncertainties caused by inconsistencies in the body of evidence, deficiencies in power, and risk of bias.

Some of the trials we reviewed were implemented before modern standards for clinical trials were established. Thus, many did not report key design characteristics to enable an accurate assessment of the risk of bias. Quiz Ref ID Most trials were not registered, did not standardize training using trainers who met specified criteria, did not specify primary and secondary outcomes a priori, did not power the trial based on the primary outcomes, did not use CONSORT recommendations for reporting results, or did not operationalize and measure the practice of meditation by study participants. 83

We could not draw definitive conclusions about effect modifiers, such as dose and duration of training, because of the limited details provided in the publications of the trials. Despite our focus on RCTs using active controls, we were unable to detect a specific effect of meditation on most outcomes, with the majority of our evidence grades being insufficient or low. These evidence grades were mostly driven by 2 important evaluation criteria: the quality of the trial and inconsistencies in the body of evidence. Trials primarily had the following 4 biases: lack of blinding of outcome assessment, high attrition, lack of allocation concealment, and lack of intention-to-treat analysis. The reasons for inconsistencies in the body of evidence may have included the differences in the particular clinical conditions and the type of control groups the studies used. Another possibility is that the programs had no real effect on many of the outcomes that had inconsistent findings.

Despite the limitations of the literature, the evidence suggests that mindfulness meditation programs could help reduce anxiety, depression, and pain in some clinical populations. Thus, clinicians should be prepared to talk with their patients about the role that a meditation program could have in addressing psychological stress.

Future research in meditation would benefit by addressing the remaining methodological and conceptual issues. All forms of meditation, including mindfulness and mantra, imply that more time spent meditating will yield larger effects. Most forms, but not all, present meditation as a skill that requires expert instruction and time dedicated to practice. Thus, more training with an expert and practice in daily life should lead to greater competency in the skill or practice, and greater competency or practice would presumably lead to better outcomes. However, when compared with other skills that require training, such as writing, the amount of training or the dose afforded in the trials was quite small, and generally the training was offered during a fairly short period. These 3 components—trainer expertise, amount of practice, and skill—require further investigation. We were unable to examine the extent to which trainer expertise influences clinical outcome because teacher qualifications were not reported in detail in most trials. Trials need to document the amount of training instructors provide and patients receive and the amount of home practice patients complete. These measures will allow future investigators to examine questions about dosing related to outcome.

Accepted for Publication: October 4, 2013.

Corresponding Author: Madhav Goyal, MD, MPH, Department of Medicine, The Johns Hopkins University, 2024 E Monument St, Ste 1-500W, Baltimore, MD 21287 ( [email protected] ).

Published Online: January 6, 2014. doi:10.1001/jamainternmed.2013.13018.

Author Contributions: Dr Goyal had full access to all the data and takes full responsibility for the completeness and integrity of the data.

Study concept and design: Goyal, Singh, Sibinga, Rowland-Seymour, Sharma, Berger, Ranasinghe, Bass, Haythornthwaite.

Acquisition of data: Goyal, Singh, Sibinga, Gould, Rowland-Seymour, Sharma, Berger, Maron, Shihab, Ranasinghe, Linn.

Analysis and interpretation of data: Goyal, Sibinga, Gould, Rowland-Seymour, Berger, Sleicher, Shihab, Ranasinghe, Linn, Saha, Bass, Haythornthwaite.

Drafting of the manuscript: Goyal, Singh, Sibinga, Gould, Rowland-Seymour, Sharma, Berger, Sleicher, Maron, Ranasinghe, Haythornthwaite.

Critical revision of the manuscript for important intellectual content: Goyal, Sibinga, Rowland-Seymour, Berger, Shihab, Ranasinghe, Linn, Saha, Bass, Haythornthwaite.

Statistical analysis: Goyal, Singh, Berger, Saha.

Obtained funding: Goyal, Bass.

Administrative, technical, and material support: Goyal, Gould, Sharma, Maron, Shihab, Linn, Bass.

Study supervision: Goyal, Sharma, Bass.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grant HHSA 290 2007 10061 from the Agency for Healthcare Research and Quality (AHRQ).

Role of the Sponsor: The funding source had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The funding source approved assertion of copyright by the authors, as noted in a letter from the AHRQ Contracting Officer.

Disclaimer: The authors are responsible for the contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of AHRQ or of the US Department of Health and Human Services.

Additional Contributions: Shilpa H. Amin, MD, provided support for this review in her capacity as the Task Order Officer assigned by the AHRQ for the work done under this task order. We received thoughtful advice and input from our key informants and members of a technical expert panel, who were offered a small honorarium in appreciation of their time. Swaroop Vedula, MBBS, PhD, helped to conduct the meta-analysis and was compensated for his time. Manisha Reuben, BS, Deepa Pawar, MD, MPH, Oluwaseun Shogbesan, MBBS, MPH, and Yohalakshmi Chelladurai, MBBS, MPH, helped to review studies included in the review and were compensated for their time.

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The Molecular Bioscience Laboratory is dedicated for understanding the important biological processes at the molecular level – with the goal of using this knowledge to tackle major problems in human health and disease. The Molecular Biosciences laboratory is an exclusive facility which focuses on the molecular basis of Yogic practices. The techniques that are pioneered in our laboratory include DNA sequencing, microarrays, flow cytometry, fluorescent microscopy, high performance liquid chromatography, chemiluminescence, and 2D electrophoresis to name a few. The Molecular Bioscience group is working to understand the influence of Yoga at the biochemical, genomic and proteomic levels in states of health and various diseases especially Non- Communicable diseases with special interest to type 2 Diabetes Mellitus and Cancer. This work is likely to lead to a better understanding of the Yoga practices which we hope to involve in the regulation of genes and interactions of proteins inside the cell.

In the past years, this laboratory has added a lot to the understanding of autonomic modulations following yoga practices, evaluating the functions of autonomic nervous system in various mental states, meditation and breathing practices. To name a few key contributions, an overall parasympathetic predominance and a considerable reduction in metabolic rate & oxygen consumption in Yoga practitioners were demonstrated from this lab. Also, the capability of the autonomic nervous system to respond to stressful stimuli without getting stressed following yoga practices reported from this laboratory has gained great attention. Currently, researchers at this lab are working on understanding autonomic modulations following different yoga techniques.

The cognitive neuroscience laboratory (CNL) through its multidisciplinary approach studies the neural underpinnings of human behaviour, primarily using 128 channel dense EEG, and Evoked Potentials, functional Near Infrared Spectroscopy (fNIRS). The cognitive neuroscience research group targets to ascertain the role of yoga as a mind body intervention in regulating the neural processes influencing cognition pertaining to various mental states. Recent studies from this group with f-MRI & dense array EEG has identified increased activity of cortical areas associated with working memory, and attention following cyclic meditation

Psychology lab attempts at standardizing tools and designing theoretical frameworks from traditional knowledge, to address the specific needs of Yoga research. The laboratory hosts a spectrum of facilities to assess cognition, physical abilities, professional skills using computerized tests. The laboratory has shown evidences to bring out the efficacy of yoga in performance, and cognitive abilities, following traditional Indian systems of education. Recently implicit tools were used to study inherent attitudes and preferences in yoga population. The laboratory is working further to develop specific tools for assessment for Yoga research integrating the western methodologies and the concepts of Indian psychology.

The Bio-Energy laboratory explores subtle energy aspects of biological and inanimate systems. The facilities of the lab include Electrophotonic Imaging a Kirlian principle based system for subtle energy measurements; Acugraphaelectrodermal assessment based on Chinese traditional medicine system; Nadi Tarangini- an indigenous pulse based diagnostic system for assessment of tridosha (vata, pitta, kapha) based on Ayurveda principle and Random Event Generator to study the influence of human mind on the hypothetical consciousness field & power of intention of individuals. Recognizing the need for standardization of subtle energy measuring instruments, initial work of the Laboratory involved experiments to validate these instruments to meet the scientific standards. Using these tools later research showed effect of Yoga in organism’s regulation at subtler levels. Evidence from these experiments supports the existence of subtler dimensions like pranamaya kosa. Effects of various traditional rituals have also been shown on the consciousness field. Future directions of the lab include developing ability to assess a person’s state of health using non-invasive subtle energy tools, complementing the modern methods of diagnosis, resulting in early detection of manifestation of diseases.

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Mindfulness

5 ways to find focus in the age of distractions, unplug and embrace single-tasking in a multitasking world..

Posted May 25, 2024 | Reviewed by Tyler Woods

• What Is Mindfulness?
• Find a mindfulness-based therapist
• Constant screen use overwhelms us, reducing our capacity for real-life interactions.
• Hyper-connectivity leads to anxiety, loneliness, and increased self-harm among youth.
• Embrace single-tasking, mindfulness, and digital detox to counteract digital distractions and improve focus.

Clients, friends, and colleagues face similar challenges, a pervasive sense of feeling overwhelmed and anxious, a sentiment I attribute to our collective struggle with our screen usage obsession. Our lives have been drastically altered by the constant presence of digital technology, which has fundamentally shifted how we interact with each other and our environment. Despite our constant tethering to technology, paradoxically, we find ourselves increasingly disconnected from both ourselves and those around us. While some may argue that their overwhelm is mainly a result of real-life matters, I would argue that we have less capacity for real-life issues as a result of our energy being scattered across so many fronts. Our minds resemble computers, with numerous tabs open simultaneously. While multitasking was once renowned as a skill, it now subtly reshapes the very framework of our brains. The true art lies in single-tasking—in mastering the ability to remain fully present.

From dawn to dusk, we are bombarded with an endless stream of digital stimuli. Our smartphones serve as gateways to a virtual realm where emails, messages, social media notifications, and news updates compete for our attention . As we strive to keep pace with this relentless flow of information and tasks, it is all too easy to feel overwhelmed.

It is apparent that this hyper-connected lifestyle may not be sustainable. The rise in diagnoses of anxiety and overdiagnoses of ADHD , coupled with concerning trends such as a decline in empathy among college students and a rise in narcissistic behavior, highlight the negative consequences of our screen-centric lives.

Jonathan Haidt's research shows that the arrival of social media accessibility on smartphones precipitated a 90 percent rise in suicides among boys, alongside a notable increase in feelings of loneliness and challenges with self-esteem . He found a 150 percent surge in anxiety and depressive disorders among youth, and a 188 percent increase in emergency room visits for self-harm among girls.

I recall a friend labeling me as strict for prohibiting my young children from using devices. While her argument for teaching balance is valid, I believe that absence during these formative years can foster healthier habits. As adults struggling to regulate our own screen time , it's unrealistic to expect children to do any better. In my experience, the key lies in modeling behavior.

Reflecting on the past, it's evident that our modes of interaction have undergone a dramatic change. Gone are the days of genuine face-to-face meetings and the anticipation of waiting for a friend's arrival without the convenience of instant communication. Even simple pleasures like dining out have transformed into digital distractions, with us glued to screens instead of engaging in real-life interactions. We no longer endure commercials or immerse ourselves in meaningful one-on-one interactions or activities. During spa days and trips, I've observed friends so engrossed in capturing every moment digitally that they forget to truly experience and savor the present. Instead, we constantly multitask, overstimulating our brains and perpetuating a cycle of relentless activity and the pursuit of more. The key difference is our unfamiliarity with the art of boredom and learning how to slow down.

Here are a few challenges for you to consider:

• Single Task : Single-tasking involves focusing on one task at a time, as opposed to multitasking. This can enhance productivity and quality of work.
• Mindfulness Practices : Engage in mindfulness meditation or exercises to train your mind to focus on the present moment, allowing you to give your full attention to the task at hand without being pulled in multiple directions by digital distractions.
• Time Block : Allocate specific blocks of time for different tasks throughout your day. Commit to focusing solely on one task during each block without allowing interruptions from digital devices.
• Digital Detox : Schedule regular periods of time where you intentionally disconnect from digital devices and platforms. Use this time to engage in offline activities that promote deep focus and relaxation.
• Set Clear Goals and Priorities : Clarify your goals and priorities for each day or week to better focus your attention on the most important tasks and avoid getting distracted by less meaningful activities. Break down larger tasks into smaller, manageable steps to make them easier to tackle one at a time.

Carrie James, Katie Davis, Linda Charmaraman, Sara Konrath, Petr Slovak, Emily Weinstein, Lana Yarosh; Digital Life and Youth Well-being, Social Connectedness, Empathy, and Narcissism. Pediatrics November 2017; 140 (Supplement_2): S71–S75. 10.1542/peds.2016-1758F.

Haidt, J. The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness . Penguin Press. 2024; (1-400).

Anita Owusu, MSW, RSW , is a registered social worker and psychotherapist based in Toronto.

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Ethical Principles of Psychologists and Code of Conduct

Effective date June 1, 2003 with amendments effective June 1, 2010 and January 1, 2017. Copyright © 2017 American Psychological Association. All rights reserved.

The American Psychological Association's (APA) Ethical Principles of Psychologists and Code of Conduct (hereinafter referred to as the Ethics Code) consists of an Introduction, a Preamble , five General Principles  (A-E) and specific Ethical Standards . The Introduction discusses the intent, organization, procedural considerations, and scope of application of the Ethics Code. The Preamble and General Principles are aspirational goals to guide psychologists toward the highest ideals of psychology. Although the Preamble and General Principles are not themselves enforceable rules, they should be considered by psychologists in arriving at an ethical course of action. The Ethical Standards set forth enforceable rules for conduct as psychologists. Most of the Ethical Standards are written broadly, in order to apply to psychologists in varied roles, although the application of an Ethical Standard may vary depending on the context. The Ethical Standards are not exhaustive. The fact that a given conduct is not specifically addressed by an Ethical Standard does not mean that it is necessarily either ethical or unethical.

This Ethics Code applies only to psychologists' activities that are part of their scientific, educational, or professional roles as psychologists. Areas covered include but are not limited to the clinical, counseling, and school practice of psychology; research; teaching; supervision of trainees; public service; policy development; social intervention; development of assessment instruments; conducting assessments; educational counseling; organizational consulting; forensic activities; program design and evaluation; and administration. This Ethics Code applies to these activities across a variety of contexts, such as in person, postal, telephone, Internet, and other electronic transmissions. These activities shall be distinguished from the purely private conduct of psychologists, which is not within the purview of the Ethics Code.

Membership in the APA commits members and student affiliates to comply with the standards of the APA Ethics Code and to the rules and procedures used to enforce them. Lack of awareness or misunderstanding of an Ethical Standard is not itself a defense to a charge of unethical conduct.

The procedures for filing, investigating, and resolving complaints of unethical conduct are described in the current Rules and Procedures of the APA Ethics Committee . APA may impose sanctions on its members for violations of the standards of the Ethics Code, including termination of APA membership, and may notify other bodies and individuals of its actions. Actions that violate the standards of the Ethics Code may also lead to the imposition of sanctions on psychologists or students whether or not they are APA members by bodies other than APA, including state psychological associations, other professional groups, psychology boards, other state or federal agencies, and payors for health services. In addition, APA may take action against a member after his or her conviction of a felony, expulsion or suspension from an affiliated state psychological association, or suspension or loss of licensure. When the sanction to be imposed by APA is less than expulsion, the 2001 Rules and Procedures do not guarantee an opportunity for an in-person hearing, but generally provide that complaints will be resolved only on the basis of a submitted record.

The Ethics Code is intended to provide guidance for psychologists and standards of professional conduct that can be applied by the APA and by other bodies that choose to adopt them. The Ethics Code is not intended to be a basis of civil liability. Whether a psychologist has violated the Ethics Code standards does not by itself determine whether the psychologist is legally liable in a court action, whether a contract is enforceable, or whether other legal consequences occur.

The modifiers used in some of the standards of this Ethics Code (e.g., reasonably, appropriate, potentially) are included in the standards when they would (1) allow professional judgment on the part of psychologists, (2) eliminate injustice or inequality that would occur without the modifier, (3) ensure applicability across the broad range of activities conducted by psychologists, or (4) guard against a set of rigid rules that might be quickly outdated. As used in this Ethics Code, the term reasonable means the prevailing professional judgment of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time.

In the process of making decisions regarding their professional behavior, psychologists must consider this Ethics Code in addition to applicable laws and psychology board regulations. In applying the Ethics Code to their professional work, psychologists may consider other materials and guidelines that have been adopted or endorsed by scientific and professional psychological organizations and the dictates of their own conscience, as well as consult with others within the field. If this Ethics Code establishes a higher standard of conduct than is required by law, psychologists must meet the higher ethical standard. If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to this Ethics Code and take steps to resolve the conflict in a responsible manner in keeping with basic principles of human rights.

Psychologists are committed to increasing scientific and professional knowledge of behavior and people's understanding of themselves and others and to the use of such knowledge to improve the condition of individuals, organizations, and society. Psychologists respect and protect civil and human rights and the central importance of freedom of inquiry and expression in research, teaching, and publication. They strive to help the public in developing informed judgments and choices concerning human behavior. In doing so, they perform many roles, such as researcher, educator, diagnostician, therapist, supervisor, consultant, administrator, social interventionist, and expert witness. This Ethics Code provides a common set of principles and standards upon which psychologists build their professional and scientific work.

This Ethics Code is intended to provide specific standards to cover most situations encountered by psychologists. It has as its goals the welfare and protection of the individuals and groups with whom psychologists work and the education of members, students, and the public regarding ethical standards of the discipline.

The development of a dynamic set of ethical standards for psychologists' work-related conduct requires a personal commitment and lifelong effort to act ethically; to encourage ethical behavior by students, supervisees, employees, and colleagues; and to consult with others concerning ethical problems.

This section consists of General Principles. General Principles, as opposed to Ethical Standards, are aspirational in nature. Their intent is to guide and inspire psychologists toward the very highest ethical ideals of the profession. General Principles, in contrast to Ethical Standards, do not represent obligations and should not form the basis for imposing sanctions. Relying upon General Principles for either of these reasons distorts both their meaning and purpose.

Principle A: Beneficence and Nonmaleficence Psychologists strive to benefit those with whom they work and take care to do no harm. In their professional actions, psychologists seek to safeguard the welfare and rights of those with whom they interact professionally and other affected persons, and the welfare of animal subjects of research. When conflicts occur among psychologists' obligations or concerns, they attempt to resolve these conflicts in a responsible fashion that avoids or minimizes harm. Because psychologists' scientific and professional judgments and actions may affect the lives of others, they are alert to and guard against personal, financial, social, organizational, or political factors that might lead to misuse of their influence. Psychologists strive to be aware of the possible effect of their own physical and mental health on their ability to help those with whom they work.

Principle B: Fidelity and Responsibility Psychologists establish relationships of trust with those with whom they work. They are aware of their professional and scientific responsibilities to society and to the specific communities in which they work. Psychologists uphold professional standards of conduct, clarify their professional roles and obligations, accept appropriate responsibility for their behavior, and seek to manage conflicts of interest that could lead to exploitation or harm. Psychologists consult with, refer to, or cooperate with other professionals and institutions to the extent needed to serve the best interests of those with whom they work. They are concerned about the ethical compliance of their colleagues' scientific and professional conduct. Psychologists strive to contribute a portion of their professional time for little or no compensation or personal advantage.

Principle C: Integrity Psychologists seek to promote accuracy, honesty, and truthfulness in the science, teaching, and practice of psychology. In these activities psychologists do not steal, cheat or engage in fraud, subterfuge, or intentional misrepresentation of fact. Psychologists strive to keep their promises and to avoid unwise or unclear commitments. In situations in which deception may be ethically justifiable to maximize benefits and minimize harm, psychologists have a serious obligation to consider the need for, the possible consequences of, and their responsibility to correct any resulting mistrust or other harmful effects that arise from the use of such techniques.

Principle D: Justice Psychologists recognize that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists. Psychologists exercise reasonable judgment and take precautions to ensure that their potential biases, the boundaries of their competence, and the limitations of their expertise do not lead to or condone unjust practices.

Principle E: Respect for People's Rights and Dignity Psychologists respect the dignity and worth of all people, and the rights of individuals to privacy, confidentiality, and self-determination. Psychologists are aware that special safeguards may be necessary to protect the rights and welfare of persons or communities whose vulnerabilities impair autonomous decision making. Psychologists are aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status, and consider these factors when working with members of such groups. Psychologists try to eliminate the effect on their work of biases based on those factors, and they do not knowingly participate in or condone activities of others based upon such prejudices.

1.01 Misuse of Psychologists' Work If psychologists learn of misuse or misrepresentation of their work, they take reasonable steps to correct or minimize the misuse or misrepresentation.

1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights.

1.03 Conflicts Between Ethics and Organizational Demands   If the demands of an organization with which psychologists are affiliated or for whom they are working are in conflict with this Ethics Code, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights.

1.04 Informal Resolution of Ethical Violations When psychologists believe that there may have been an ethical violation by another psychologist, they attempt to resolve the issue by bringing it to the attention of that individual, if an informal resolution appears appropriate and the intervention does not violate any confidentiality rights that may be involved. (See also Standards 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority , and 1.03, Conflicts Between Ethics and Organizational Demands .)

1.05 Reporting Ethical Violations If an apparent ethical violation has substantially harmed or is likely to substantially harm a person or organization and is not appropriate for informal resolution under Standard 1.04, Informal Resolution of Ethical Violations , or is not resolved properly in that fashion, psychologists take further action appropriate to the situation. Such action might include referral to state or national committees on professional ethics, to state licensing boards, or to the appropriate institutional authorities. This standard does not apply when an intervention would violate confidentiality rights or when psychologists have been retained to review the work of another psychologist whose professional conduct is in question. (See also Standard 1.02, Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority .)

1.06 Cooperating with Ethics Committees Psychologists cooperate in ethics investigations, proceedings, and resulting requirements of the APA or any affiliated state psychological association to which they belong. In doing so, they address any confidentiality issues. Failure to cooperate is itself an ethics violation. However, making a request for deferment of adjudication of an ethics complaint pending the outcome of litigation does not alone constitute noncooperation.

1.07 Improper Complaints Psychologists do not file or encourage the filing of ethics complaints that are made with reckless disregard for or willful ignorance of facts that would disprove the allegation.

1.08 Unfair Discrimination Against Complainants and Respondents Psychologists do not deny persons employment, advancement, admissions to academic or other programs, tenure, or promotion, based solely upon their having made or their being the subject of an ethics complaint. This does not preclude taking action based upon the outcome of such proceedings or considering other appropriate information.

2.01 Boundaries of Competence (a) Psychologists provide services, teach, and conduct research with populations and in areas only within the boundaries of their competence, based on their education, training, supervised experience, consultation, study, or professional experience.

(b) Where scientific or professional knowledge in the discipline of psychology establishes that an understanding of factors associated with age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status is essential for effective implementation of their services or research, psychologists have or obtain the training, experience, consultation, or supervision necessary to ensure the competence of their services, or they make appropriate referrals, except as provided in Standard 2.02, Providing Services in Emergencies .

(c) Psychologists planning to provide services, teach, or conduct research involving populations, areas, techniques, or technologies new to them undertake relevant education, training, supervised experience, consultation, or study.

(d) When psychologists are asked to provide services to individuals for whom appropriate mental health services are not available and for which psychologists have not obtained the competence necessary, psychologists with closely related prior training or experience may provide such services in order to ensure that services are not denied if they make a reasonable effort to obtain the competence required by using relevant research, training, consultation, or study.

(e) In those emerging areas in which generally recognized standards for preparatory training do not yet exist, psychologists nevertheless take reasonable steps to ensure the competence of their work and to protect clients/patients, students, supervisees, research participants, organizational clients, and others from harm.

(f) When assuming forensic roles, psychologists are or become reasonably familiar with the judicial or administrative rules governing their roles.

2.02 Providing Services in Emergencies In emergencies, when psychologists provide services to individuals for whom other mental health services are not available and for which psychologists have not obtained the necessary training, psychologists may provide such services in order to ensure that services are not denied. The services are discontinued as soon as the emergency has ended or appropriate services are available.

2.03 Maintaining Competence Psychologists undertake ongoing efforts to develop and maintain their competence.

2.04 Bases for Scientific and Professional Judgments Psychologists' work is based upon established scientific and professional knowledge of the discipline. (See also Standards 2.01e, Boundaries of Competence , and 10.01b, Informed Consent to Therapy .)

2.05 Delegation of Work to Others Psychologists who delegate work to employees, supervisees, or research or teaching assistants or who use the services of others, such as interpreters, take reasonable steps to (1) avoid delegating such work to persons who have a multiple relationship with those being served that would likely lead to exploitation or loss of objectivity; (2) authorize only those responsibilities that such persons can be expected to perform competently on the basis of their education, training, or experience, either independently or with the level of supervision being provided; and (3) see that such persons perform these services competently. (See also Standards 2.02, Providing Services in Emergencies ; 3.05, Multiple Relationships ; 4.01, Maintaining Confidentiality ; 9.01, Bases for Assessments ; 9.02, Use of Assessments ; 9.03, Informed Consent in Assessments ; and 9.07, Assessment by Unqualified Persons .)

2.06 Personal Problems and Conflicts (a) Psychologists refrain from initiating an activity when they know or should know that there is a substantial likelihood that their personal problems will prevent them from performing their work-related activities in a competent manner.

(b) When psychologists become aware of personal problems that may interfere with their performing work-related duties adequately, they take appropriate measures, such as obtaining professional consultation or assistance, and determine whether they should limit, suspend, or terminate their work-related duties. (See also Standard 10.10, Terminating Therapy .)

3.01 Unfair Discrimination In their work-related activities, psychologists do not engage in unfair discrimination based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, socioeconomic status, or any basis proscribed by law.

3.02 Sexual Harassment Psychologists do not engage in sexual harassment. Sexual harassment is sexual solicitation, physical advances, or verbal or nonverbal conduct that is sexual in nature, that occurs in connection with the psychologist's activities or roles as a psychologist, and that either (1) is unwelcome, is offensive, or creates a hostile workplace or educational environment, and the psychologist knows or is told this or (2) is sufficiently severe or intense to be abusive to a reasonable person in the context. Sexual harassment can consist of a single intense or severe act or of multiple persistent or pervasive acts. (See also Standard 1.08, Unfair Discrimination Against Complainants and Respondents .)

3.03 Other Harassment Psychologists do not knowingly engage in behavior that is harassing or demeaning to persons with whom they interact in their work based on factors such as those persons' age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, or socioeconomic status.

3.04 Avoiding Harm (a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable. 

(b) Psychologists do not participate in, facilitate, assist, or otherwise engage in torture, defined as any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person, or in any other cruel, inhuman, or degrading behavior that violates 3.04(a).

3.05 Multiple Relationships 

(a) A multiple relationship occurs when a psychologist is in a professional role with a person and (1) at the same time is in another role with the same person, (2) at the same time is in a relationship with a person closely associated with or related to the person with whom the psychologist has the professional relationship, or (3) promises to enter into another relationship in the future with the person or a person closely associated with or related to the person.

A psychologist refrains from entering into a multiple relationship if the multiple relationship could reasonably be expected to impair the psychologist's objectivity, competence, or effectiveness in performing his or her functions as a psychologist, or otherwise risks exploitation or harm to the person with whom the professional relationship exists.

Multiple relationships that would not reasonably be expected to cause impairment or risk exploitation or harm are not unethical.

(b) If a psychologist finds that, due to unforeseen factors, a potentially harmful multiple relationship has arisen, the psychologist takes reasonable steps to resolve it with due regard for the best interests of the affected person and maximal compliance with the Ethics Code.

(c) When psychologists are required by law, institutional policy, or extraordinary circumstances to serve in more than one role in judicial or administrative proceedings, at the outset they clarify role expectations and the extent of confidentiality and thereafter as changes occur. (See also Standards 3.04, Avoiding Harm , and 3.07, Third-Party Requests for Services .)

3.06 Conflict of Interest Psychologists refrain from taking on a professional role when personal, scientific, professional, legal, financial, or other interests or relationships could reasonably be expected to (1) impair their objectivity, competence, or effectiveness in performing their functions as psychologists or (2) expose the person or organization with whom the professional relationship exists to harm or exploitation.

3.07 Third-Party Requests for Services When psychologists agree to provide services to a person or entity at the request of a third party, psychologists attempt to clarify at the outset of the service the nature of the relationship with all individuals or organizations involved. This clarification includes the role of the psychologist (e.g., therapist, consultant, diagnostician, or expert witness), an identification of who is the client, the probable uses of the services provided or the information obtained, and the fact that there may be limits to confidentiality. (See also Standards 3.05, Multiple relationships , and 4.02, Discussing the Limits of Confidentiality.)

3.08 Exploitative Relationships Psychologists do not exploit persons over whom they have supervisory, evaluative or other authority such as clients/patients, students, supervisees, research participants, and employees. (See also Standards 3.05, Multiple Relationships ; 6.04, Fees and Financial Arrangements ; 6.05, Barter with Clients/Patients ; 7.07, Sexual Relationships with Students and Supervisees ; 10.05, Sexual Intimacies with Current Therapy Clients/Patients ; 10.06, Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients ; 10.07, Therapy with Former Sexual Partners ; and 10.08, Sexual Intimacies with Former Therapy Clients/Patients .)

3.09 Cooperation with Other Professionals When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately. (See also Standard 4.05, Disclosures .)

3.10 Informed Consent (a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research ; 9.03, Informed Consent in Assessments ; and 10.01, Informed Consent to Therapy .)

(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual's rights and welfare.

(c) When psychological services are court ordered or otherwise mandated, psychologists inform the individual of the nature of the anticipated services, including whether the services are court ordered or mandated and any limits of confidentiality, before proceeding.

(d) Psychologists appropriately document written or oral consent, permission, and assent. (See also Standards 8.02, Informed Consent to Research ; 9.03, Informed Consent in Assessments ; and 10.01, Informed Consent to Therapy .)

3.11 Psychological Services Delivered to or Through Organizations (a) Psychologists delivering services to or through organizations provide information beforehand to clients and when appropriate those directly affected by the services about (1) the nature and objectives of the services, (2) the intended recipients, (3) which of the individuals are clients, (4) the relationship the psychologist will have with each person and the organization, (5) the probable uses of services provided and information obtained, (6) who will have access to the information, and (7) limits of confidentiality. As soon as feasible, they provide information about the results and conclusions of such services to appropriate persons.

(b) If psychologists will be precluded by law or by organizational roles from providing such information to particular individuals or groups, they so inform those individuals or groups at the outset of the service.

3.12 Interruption of Psychological Services Unless otherwise covered by contract, psychologists make reasonable efforts to plan for facilitating services in the event that psychological services are interrupted by factors such as the psychologist's illness, death, unavailability, relocation, or retirement or by the client's/patient's relocation or financial limitations. (See also Standard 6.02c, Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work .)

4.01 Maintaining Confidentiality Psychologists have a primary obligation and take reasonable precautions to protect confidential information obtained through or stored in any medium, recognizing that the extent and limits of confidentiality may be regulated by law or established by institutional rules or professional or scientific relationship. (See also Standard 2.05, Delegation of Work to Others .)

4.02 Discussing the Limits of Confidentiality (a) Psychologists discuss with persons (including, to the extent feasible, persons who are legally incapable of giving informed consent and their legal representatives) and organizations with whom they establish a scientific or professional relationship (1) the relevant limits of confidentiality and (2) the foreseeable uses of the information generated through their psychological activities. (See also Standard 3.10, Informed Consent .)

(b) Unless it is not feasible or is contraindicated, the discussion of confidentiality occurs at the outset of the relationship and thereafter as new circumstances may warrant.

(c) Psychologists who offer services, products, or information via electronic transmission inform clients/patients of the risks to privacy and limits of confidentiality.

4.03 Recording Before recording the voices or images of individuals to whom they provide services, psychologists obtain permission from all such persons or their legal representatives. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research ; 8.05, Dispensing with Informed Consent for Research ; and 8.07, Deception in Research .)

4.04 Minimizing Intrusions on Privacy (a) Psychologists include in written and oral reports and consultations, only information germane to the purpose for which the communication is made.

(b) Psychologists discuss confidential information obtained in their work only for appropriate scientific or professional purposes and only with persons clearly concerned with such matters.

4.05 Disclosures (a) Psychologists may disclose confidential information with the appropriate consent of the organizational client, the individual client/patient, or another legally authorized person on behalf of the client/patient unless prohibited by law.

(b) Psychologists disclose confidential information without the consent of the individual only as mandated by law, or where permitted by law for a valid purpose such as to (1) provide needed professional services; (2) obtain appropriate professional consultations; (3) protect the client/patient, psychologist, or others from harm; or (4) obtain payment for services from a client/patient, in which instance disclosure is limited to the minimum that is necessary to achieve the purpose. (See also Standard 6.04e, Fees and Financial Arrangements .)

4.06 Consultations When consulting with colleagues, (1) psychologists do not disclose confidential information that reasonably could lead to the identification of a client/patient, research participant, or other person or organization with whom they have a confidential relationship unless they have obtained the prior consent of the person or organization or the disclosure cannot be avoided, and (2) they disclose information only to the extent necessary to achieve the purposes of the consultation. (See also Standard 4.01, Maintaining Confidentiality .)

4.07 Use of Confidential Information for Didactic or Other Purposes Psychologists do not disclose in their writings, lectures, or other public media, confidential, personally identifiable information concerning their clients/patients, students, research participants, organizational clients, or other recipients of their services that they obtained during the course of their work, unless (1) they take reasonable steps to disguise the person or organization, (2) the person or organization has consented in writing, or (3) there is legal authorization for doing so.

5.01 Avoidance of False or Deceptive Statements (a) Public statements include but are not limited to paid or unpaid advertising, product endorsements, grant applications, licensing applications, other credentialing applications, brochures, printed matter, directory listings, personal resumes or curricula vitae, or comments for use in media such as print or electronic transmission, statements in legal proceedings, lectures and public oral presentations, and published materials. Psychologists do not knowingly make public statements that are false, deceptive, or fraudulent concerning their research, practice, or other work activities or those of persons or organizations with which they are affiliated.

(b) Psychologists do not make false, deceptive, or fraudulent statements concerning (1) their training, experience, or competence; (2) their academic degrees; (3) their credentials; (4) their institutional or association affiliations; (5) their services; (6) the scientific or clinical basis for, or results or degree of success of, their services; (7) their fees; or (8) their publications or research findings.

(c) Psychologists claim degrees as credentials for their health services only if those degrees (1) were earned from a regionally accredited educational institution or (2) were the basis for psychology licensure by the state in which they practice.

5.02 Statements by Others (a) Psychologists who engage others to create or place public statements that promote their professional practice, products, or activities retain professional responsibility for such statements.

(b) Psychologists do not compensate employees of press, radio, television, or other communication media in return for publicity in a news item. (See also Standard 1.01, Misuse of Psychologists' Work .)

(c) A paid advertisement relating to psychologists' activities must be identified or clearly recognizable as such.

5.03 Descriptions of Workshops and Non-Degree-Granting Educational Programs To the degree to which they exercise control, psychologists responsible for announcements, catalogs, brochures, or advertisements describing workshops, seminars, or other non-degree-granting educational programs ensure that they accurately describe the audience for which the program is intended, the educational objectives, the presenters, and the fees involved.

5.04 Media Presentations When psychologists provide public advice or comment via print, Internet, or other electronic transmission, they take precautions to ensure that statements (1) are based on their professional knowledge, training, or experience in accord with appropriate psychological literature and practice; (2) are otherwise consistent with this Ethics Code; and (3) do not indicate that a professional relationship has been established with the recipient. (See also Standard 2.04, Bases for Scientific and Professional Judgments .)

5.05 Testimonials Psychologists do not solicit testimonials from current therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence.

5.06 In-Person Solicitation Psychologists do not engage, directly or through agents, in uninvited in-person solicitation of business from actual or potential therapy clients/patients or other persons who because of their particular circumstances are vulnerable to undue influence. However, this prohibition does not preclude (1) attempting to implement appropriate collateral contacts for the purpose of benefiting an already engaged therapy client/patient or (2) providing disaster or community outreach services.

6.01 Documentation of Professional and Scientific Work and Maintenance of Records Psychologists create, and to the extent the records are under their control, maintain, disseminate, store, retain, and dispose of records and data relating to their professional and scientific work in order to (1) facilitate provision of services later by them or by other professionals, (2) allow for replication of research design and analyses, (3) meet institutional requirements, (4) ensure accuracy of billing and payments, and (5) ensure compliance with law. (See also Standard 4.01, Maintaining Confidentiality .)

6.02 Maintenance, Dissemination, and Disposal of Confidential Records of Professional and Scientific Work (a) Psychologists maintain confidentiality in creating, storing, accessing, transferring, and disposing of records under their control, whether these are written, automated, or in any other medium. (See also Standards 4.01, Maintaining Confidentiality , and 6.01, Documentation of Professional and Scientific Work and Maintenance of Records .)

(b) If confidential information concerning recipients of psychological services is entered into databases or systems of records available to persons whose access has not been consented to by the recipient, psychologists use coding or other techniques to avoid the inclusion of personal identifiers.

(c) Psychologists make plans in advance to facilitate the appropriate transfer and to protect the confidentiality of records and data in the event of psychologists' withdrawal from positions or practice. (See also Standards 3.12, Interruption of Psychological Services , and 10.09, Interruption of Therapy .)

6.03 Withholding Records for Nonpayment Psychologists may not withhold records under their control that are requested and needed for a client's/patient's emergency treatment solely because payment has not been received.

6.04 Fees and Financial Arrangements (a) As early as is feasible in a professional or scientific relationship, psychologists and recipients of psychological services reach an agreement specifying compensation and billing arrangements.

(b) Psychologists' fee practices are consistent with law.

(c) Psychologists do not misrepresent their fees.

(d) If limitations to services can be anticipated because of limitations in financing, this is discussed with the recipient of services as early as is feasible. (See also Standards 10.09, Interruption of Therapy , and 10.10, Terminating Therapy .)

(e) If the recipient of services does not pay for services as agreed, and if psychologists intend to use collection agencies or legal measures to collect the fees, psychologists first inform the person that such measures will be taken and provide that person an opportunity to make prompt payment. (See also Standards 4.05, Disclosures ; 6.03, Withholding Records for Nonpayment ; and 10.01, Informed Consent to Therapy .)

6.05 Barter with Clients/Patients Barter is the acceptance of goods, services, or other nonmonetary remuneration from clients/patients in return for psychological services. Psychologists may barter only if (1) it is not clinically contraindicated, and (2) the resulting arrangement is not exploitative. (See also Standards 3.05, Multiple Relationships , and 6.04, Fees and Financial Arrangements .)

6.06 Accuracy in Reports to Payors and Funding Sources In their reports to payors for services or sources of research funding, psychologists take reasonable steps to ensure the accurate reporting of the nature of the service provided or research conducted, the fees, charges, or payments, and where applicable, the identity of the provider, the findings, and the diagnosis. (See also Standards 4.01, Maintaining Confidentiality ; 4.04, Minimizing Intrusions on Privacy ; and 4.05, Disclosures .)

6.07 Referrals and Fees When psychologists pay, receive payment from, or divide fees with another professional, other than in an employer-employee relationship, the payment to each is based on the services provided (clinical, consultative, administrative, or other) and is not based on the referral itself. (See also Standard 3.09, Cooperation with Other Professionals .)

7.01 Design of Education and Training Programs Psychologists responsible for education and training programs take reasonable steps to ensure that the programs are designed to provide the appropriate knowledge and proper experiences, and to meet the requirements for licensure, certification, or other goals for which claims are made by the program. (See also Standard 5.03, Descriptions of Workshops and Non-Degree-Granting Educational Programs .)

7.02 Descriptions of Education and Training Programs Psychologists responsible for education and training programs take reasonable steps to ensure that there is a current and accurate description of the program content (including participation in required course- or program-related counseling, psychotherapy, experiential groups, consulting projects, or community service), training goals and objectives, stipends and benefits, and requirements that must be met for satisfactory completion of the program. This information must be made readily available to all interested parties.

7.03 Accuracy in Teaching (a) Psychologists take reasonable steps to ensure that course syllabi are accurate regarding the subject matter to be covered, bases for evaluating progress, and the nature of course experiences. This standard does not preclude an instructor from modifying course content or requirements when the instructor considers it pedagogically necessary or desirable, so long as students are made aware of these modifications in a manner that enables them to fulfill course requirements. (See also Standard 5.01, Avoidance of False or Deceptive Statements .)

(b) When engaged in teaching or training, psychologists present psychological information accurately. (See also Standard 2.03, Maintaining Competence .)

7.04 Student Disclosure of Personal Information Psychologists do not require students or supervisees to disclose personal information in course- or program-related activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment, and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing them from performing their training- or professionally related activities in a competent manner or posing a threat to the students or others.

7.05 Mandatory Individual or Group Therapy (a) When individual or group therapy is a program or course requirement, psychologists responsible for that program allow students in undergraduate and graduate programs the option of selecting such therapy from practitioners unaffiliated with the program. (See also Standard 7.02, Descriptions of Education and Training Programs .)

(b) Faculty who are or are likely to be responsible for evaluating students' academic performance do not themselves provide that therapy. (See also Standard 3.05, Multiple Relationships .)

7.06 Assessing Student and Supervisee Performance (a) In academic and supervisory relationships, psychologists establish a timely and specific process for providing feedback to students and supervisees. Information regarding the process is provided to the student at the beginning of supervision.

(b) Psychologists evaluate students and supervisees on the basis of their actual performance on relevant and established program requirements.

7.07 Sexual Relationships with Students and Supervisees Psychologists do not engage in sexual relationships with students or supervisees who are in their department, agency, or training center or over whom psychologists have or are likely to have evaluative authority. (See also Standard 3.05, Multiple Relationships .)

8.01 Institutional Approval When institutional approval is required, psychologists provide accurate information about their research proposals and obtain approval prior to conducting the research. They conduct the research in accordance with the approved research protocol.

8.02 Informed Consent to Research (a) When obtaining informed consent as required in Standard 3.10, Informed Consent, psychologists inform participants about (1) the purpose of the research, expected duration, and procedures; (2) their right to decline to participate and to withdraw from the research once participation has begun; (3) the foreseeable consequences of declining or withdrawing; (4) reasonably foreseeable factors that may be expected to influence their willingness to participate such as potential risks, discomfort, or adverse effects; (5) any prospective research benefits; (6) limits of confidentiality; (7) incentives for participation; and (8) whom to contact for questions about the research and research participants' rights. They provide opportunity for the prospective participants to ask questions and receive answers. (See also Standards 8.03, Informed Consent for Recording Voices and Images in Research ; 8.05, Dispensing with Informed Consent for Research ; and 8.07, Deception in Research .)

(b) Psychologists conducting intervention research involving the use of experimental treatments clarify to participants at the outset of the research (1) the experimental nature of the treatment; (2) the services that will or will not be available to the control group(s) if appropriate; (3) the means by which assignment to treatment and control groups will be made; (4) available treatment alternatives if an individual does not wish to participate in the research or wishes to withdraw once a study has begun; and (5) compensation for or monetary costs of participating including, if appropriate, whether reimbursement from the participant or a third-party payor will be sought. (See also Standard 8.02a, Informed Consent to Research .)

8.03 Informed Consent for Recording Voices and Images in Research Psychologists obtain informed consent from research participants prior to recording their voices or images for data collection unless (1) the research consists solely of naturalistic observations in public places, and it is not anticipated that the recording will be used in a manner that could cause personal identification or harm, or (2) the research design includes deception, and consent for the use of the recording is obtained during debriefing. (See also Standard 8.07, Deception in Research .)

8.04 Client/Patient, Student, and Subordinate Research Participants (a) When psychologists conduct research with clients/patients, students, or subordinates as participants, psychologists take steps to protect the prospective participants from adverse consequences of declining or withdrawing from participation.

(b) When research participation is a course requirement or an opportunity for extra credit, the prospective participant is given the choice of equitable alternative activities.

8.05 Dispensing with Informed Consent for Research Psychologists may dispense with informed consent only (1) where research would not reasonably be assumed to create distress or harm and involves (a) the study of normal educational practices, curricula, or classroom management methods conducted in educational settings; (b) only anonymous questionnaires, naturalistic observations, or archival research for which disclosure of responses would not place participants at risk of criminal or civil liability or damage their financial standing, employability, or reputation, and confidentiality is protected; or (c) the study of factors related to job or organization effectiveness conducted in organizational settings for which there is no risk to participants' employability, and confidentiality is protected or (2) where otherwise permitted by law or federal or institutional regulations.

8.06 Offering Inducements for Research Participation (a) Psychologists make reasonable efforts to avoid offering excessive or inappropriate financial or other inducements for research participation when such inducements are likely to coerce participation.

(b) When offering professional services as an inducement for research participation, psychologists clarify the nature of the services, as well as the risks, obligations, and limitations. (See also Standard 6.05, Barter with Clients/Patients .)

8.07 Deception in Research (a) Psychologists do not conduct a study involving deception unless they have determined that the use of deceptive techniques is justified by the study's significant prospective scientific, educational, or applied value and that effective nondeceptive alternative procedures are not feasible.

(b) Psychologists do not deceive prospective participants about research that is reasonably expected to cause physical pain or severe emotional distress.

(c) Psychologists explain any deception that is an integral feature of the design and conduct of an experiment to participants as early as is feasible, preferably at the conclusion of their participation, but no later than at the conclusion of the data collection, and permit participants to withdraw their data. (See also Standard 8.08, Debriefing .)

8.08 Debriefing (a) Psychologists provide a prompt opportunity for participants to obtain appropriate information about the nature, results, and conclusions of the research, and they take reasonable steps to correct any misconceptions that participants may have of which the psychologists are aware.

(b) If scientific or humane values justify delaying or withholding this information, psychologists take reasonable measures to reduce the risk of harm.

(c) When psychologists become aware that research procedures have harmed a participant, they take reasonable steps to minimize the harm.

8.09 Humane Care and Use of Animals in Research (a) Psychologists acquire, care for, use, and dispose of animals in compliance with current federal, state, and local laws and regulations, and with professional standards.

(b) Psychologists trained in research methods and experienced in the care of laboratory animals supervise all procedures involving animals and are responsible for ensuring appropriate consideration of their comfort, health, and humane treatment.

(c) Psychologists ensure that all individuals under their supervision who are using animals have received instruction in research methods and in the care, maintenance, and handling of the species being used, to the extent appropriate to their role. (See also Standard 2.05, Delegation of Work to Others .)

(d) Psychologists make reasonable efforts to minimize the discomfort, infection, illness, and pain of animal subjects.

(e) Psychologists use a procedure subjecting animals to pain, stress, or privation only when an alternative procedure is unavailable and the goal is justified by its prospective scientific, educational, or applied value.

(f) Psychologists perform surgical procedures under appropriate anesthesia and follow techniques to avoid infection and minimize pain during and after surgery.

(g) When it is appropriate that an animal's life be terminated, psychologists proceed rapidly, with an effort to minimize pain and in accordance with accepted procedures.

8.10 Reporting Research Results (a) Psychologists do not fabricate data. (See also Standard 5.01a, Avoidance of False or Deceptive Statements .)

(b) If psychologists discover significant errors in their published data, they take reasonable steps to correct such errors in a correction, retraction, erratum, or other appropriate publication means.

8.11 Plagiarism Psychologists do not present portions of another's work or data as their own, even if the other work or data source is cited occasionally.

8.12 Publication Credit (a) Psychologists take responsibility and credit, including authorship credit, only for work they have actually performed or to which they have substantially contributed. (See also Standard 8.12b, Publication Credit .)

(b) Principal authorship and other publication credits accurately reflect the relative scientific or professional contributions of the individuals involved, regardless of their relative status. Mere possession of an institutional position, such as department chair, does not justify authorship credit. Minor contributions to the research or to the writing for publications are acknowledged appropriately, such as in footnotes or in an introductory statement.

(c) Except under exceptional circumstances, a student is listed as principal author on any multiple-authored article that is substantially based on the student's doctoral dissertation. Faculty advisors discuss publication credit with students as early as feasible and throughout the research and publication process as appropriate. (See also Standard 8.12b, Publication Credit .)

8.13 Duplicate Publication of Data Psychologists do not publish, as original data, data that have been previously published. This does not preclude republishing data when they are accompanied by proper acknowledgment.

8.14 Sharing Research Data for Verification (a) After research results are published, psychologists do not withhold the data on which their conclusions are based from other competent professionals who seek to verify the substantive claims through reanalysis and who intend to use such data only for that purpose, provided that the confidentiality of the participants can be protected and unless legal rights concerning proprietary data preclude their release. This does not preclude psychologists from requiring that such individuals or groups be responsible for costs associated with the provision of such information.

(b) Psychologists who request data from other psychologists to verify the substantive claims through reanalysis may use shared data only for the declared purpose. Requesting psychologists obtain prior written agreement for all other uses of the data.

8.15 Reviewers Psychologists who review material submitted for presentation, publication, grant, or research proposal review respect the confidentiality of and the proprietary rights in such information of those who submitted it.

9.01 Bases for Assessments (a) Psychologists base the opinions contained in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, on information and techniques sufficient to substantiate their findings. (See also Standard 2.04, Bases for Scientific and Professional Judgments .)

(b) Except as noted in 9.01c , psychologists provide opinions of the psychological characteristics of individuals only after they have conducted an examination of the individuals adequate to support their statements or conclusions. When, despite reasonable efforts, such an examination is not practical, psychologists document the efforts they made and the result of those efforts, clarify the probable impact of their limited information on the reliability and validity of their opinions, and appropriately limit the nature and extent of their conclusions or recommendations. (See also Standards 2.01, Boundaries of Competence , and 9.06, Interpreting Assessment Results .)

(c) When psychologists conduct a record review or provide consultation or supervision and an individual examination is not warranted or necessary for the opinion, psychologists explain this and the sources of information on which they based their conclusions and recommendations.

9.02 Use of Assessments (a) Psychologists administer, adapt, score, interpret, or use assessment techniques, interviews, tests, or instruments in a manner and for purposes that are appropriate in light of the research on or evidence of the usefulness and proper application of the techniques.

(b) Psychologists use assessment instruments whose validity and reliability have been established for use with members of the population tested. When such validity or reliability has not been established, psychologists describe the strengths and limitations of test results and interpretation.

(c) Psychologists use assessment methods that are appropriate to an individual's language preference and competence, unless the use of an alternative language is relevant to the assessment issues.

9.03 Informed Consent in Assessments (a) Psychologists obtain informed consent for assessments, evaluations, or diagnostic services, as described in Standard 3.10, Informed Consent, except when (1) testing is mandated by law or governmental regulations; (2) informed consent is implied because testing is conducted as a routine educational, institutional, or organizational activity (e.g., when participants voluntarily agree to assessment when applying for a job); or (3) one purpose of the testing is to evaluate decisional capacity. Informed consent includes an explanation of the nature and purpose of the assessment, fees, involvement of third parties, and limits of confidentiality and sufficient opportunity for the client/patient to ask questions and receive answers.

(b) Psychologists inform persons with questionable capacity to consent or for whom testing is mandated by law or governmental regulations about the nature and purpose of the proposed assessment services, using language that is reasonably understandable to the person being assessed.

(c) Psychologists using the services of an interpreter obtain informed consent from the client/patient to use that interpreter, ensure that confidentiality of test results and test security are maintained, and include in their recommendations, reports, and diagnostic or evaluative statements, including forensic testimony, discussion of any limitations on the data obtained. (See also Standards 2.05, Delegation of Work to Others ; 4.01, Maintaining Confidentiality ; 9.01, Bases for Assessments ; 9.06, Interpreting Assessment Results ; and 9.07, Assessment by Unqualified Persons .)

9.04 Release of Test Data (a) The term test data refers to raw and scaled scores, client/patient responses to test questions or stimuli, and psychologists' notes and recordings concerning client/patient statements and behavior during an examination. Those portions of test materials that include client/patient responses are included in the definition of test data . Pursuant to a client/patient release, psychologists provide test data to the client/patient or other persons identified in the release. Psychologists may refrain from releasing test data to protect a client/patient or others from substantial harm or misuse or misrepresentation of the data or the test, recognizing that in many instances release of confidential information under these circumstances is regulated by law. (See also Standard 9.11, Maintaining Test Security .)

(b) In the absence of a client/patient release, psychologists provide test data only as required by law or court order.

9.05 Test Construction Psychologists who develop tests and other assessment techniques use appropriate psychometric procedures and current scientific or professional knowledge for test design, standardization, validation, reduction or elimination of bias, and recommendations for use.

9.06 Interpreting Assessment Results When interpreting assessment results, including automated interpretations, psychologists take into account the purpose of the assessment as well as the various test factors, test-taking abilities, and other characteristics of the person being assessed, such as situational, personal, linguistic, and cultural differences, that might affect psychologists' judgments or reduce the accuracy of their interpretations. They indicate any significant limitations of their interpretations. (See also Standards 2.01b and c, Boundaries of Competence , and 3.01, Unfair Discrimination .)

9.07 Assessment by Unqualified Persons Psychologists do not promote the use of psychological assessment techniques by unqualified persons, except when such use is conducted for training purposes with appropriate supervision. (See also Standard 2.05, Delegation of Work to Others .)

9.08 Obsolete Tests and Outdated Test Results (a) Psychologists do not base their assessment or intervention decisions or recommendations on data or test results that are outdated for the current purpose.

(b) Psychologists do not base such decisions or recommendations on tests and measures that are obsolete and not useful for the current purpose.

9.09 Test Scoring and Interpretation Services (a) Psychologists who offer assessment or scoring services to other professionals accurately describe the purpose, norms, validity, reliability, and applications of the procedures and any special qualifications applicable to their use.

(b) Psychologists select scoring and interpretation services (including automated services) on the basis of evidence of the validity of the program and procedures as well as on other appropriate considerations. (See also Standard 2.01b and c, Boundaries of Competence .)

(c) Psychologists retain responsibility for the appropriate application, interpretation, and use of assessment instruments, whether they score and interpret such tests themselves or use automated or other services.

9.10 Explaining Assessment Results Regardless of whether the scoring and interpretation are done by psychologists, by employees or assistants, or by automated or other outside services, psychologists take reasonable steps to ensure that explanations of results are given to the individual or designated representative unless the nature of the relationship precludes provision of an explanation of results (such as in some organizational consulting, preemployment or security screenings, and forensic evaluations), and this fact has been clearly explained to the person being assessed in advance.

9.11 Maintaining Test Security The term test materials refers to manuals, instruments, protocols, and test questions or stimuli and does not include test data as defined in Standard 9.04, Release of Test Data . Psychologists make reasonable efforts to maintain the integrity and security of test materials and other assessment techniques consistent with law and contractual obligations, and in a manner that permits adherence to this Ethics Code.

10.01 Informed Consent to Therapy (a) When obtaining informed consent to therapy as required in Standard 3.10, Informed Consent , psychologists inform clients/patients as early as is feasible in the therapeutic relationship about the nature and anticipated course of therapy, fees, involvement of third parties, and limits of confidentiality and provide sufficient opportunity for the client/patient to ask questions and receive answers. (See also Standards 4.02, Discussing the Limits of Confidentiality , and 6.04, Fees and Financial Arrangements .)

(b) When obtaining informed consent for treatment for which generally recognized techniques and procedures have not been established, psychologists inform their clients/patients of the developing nature of the treatment, the potential risks involved, alternative treatments that may be available, and the voluntary nature of their participation. (See also Standards 2.01e, Boundaries of Competence , and 3.10, Informed Consent .)

(c) When the therapist is a trainee and the legal responsibility for the treatment provided resides with the supervisor, the client/patient, as part of the informed consent procedure, is informed that the therapist is in training and is being supervised and is given the name of the supervisor.

10.02 Therapy Involving Couples or Families (a) When psychologists agree to provide services to several persons who have a relationship (such as spouses, significant others, or parents and children), they take reasonable steps to clarify at the outset (1) which of the individuals are clients/patients and (2) the relationship the psychologist will have with each person. This clarification includes the psychologist's role and the probable uses of the services provided or the information obtained. (See also Standard 4.02, Discussing the Limits of Confidentiality .)

(b) If it becomes apparent that psychologists may be called on to perform potentially conflicting roles (such as family therapist and then witness for one party in divorce proceedings), psychologists take reasonable steps to clarify and modify, or withdraw from, roles appropriately. (See also Standard 3.05c, Multiple Relationships .)

10.03 Group Therapy When psychologists provide services to several persons in a group setting, they describe at the outset the roles and responsibilities of all parties and the limits of confidentiality.

10.04 Providing Therapy to Those Served by Others In deciding whether to offer or provide services to those already receiving mental health services elsewhere, psychologists carefully consider the treatment issues and the potential client's/patient's welfare. Psychologists discuss these issues with the client/patient or another legally authorized person on behalf of the client/patient in order to minimize the risk of confusion and conflict, consult with the other service providers when appropriate, and proceed with caution and sensitivity to the therapeutic issues.

10.05 Sexual Intimacies with Current Therapy Clients/Patients Psychologists do not engage in sexual intimacies with current therapy clients/patients.

10.06 Sexual Intimacies with Relatives or Significant Others of Current Therapy Clients/Patients Psychologists do not engage in sexual intimacies with individuals they know to be close relatives, guardians, or significant others of current clients/patients. Psychologists do not terminate therapy to circumvent this standard.

10.07 Therapy with Former Sexual Partners Psychologists do not accept as therapy clients/patients persons with whom they have engaged in sexual intimacies.

10.08 Sexual Intimacies with Former Therapy Clients/Patients (a) Psychologists do not engage in sexual intimacies with former clients/patients for at least two years after cessation or termination of therapy.

(b) Psychologists do not engage in sexual intimacies with former clients/patients even after a two-year interval except in the most unusual circumstances. Psychologists who engage in such activity after the two years following cessation or termination of therapy and of having no sexual contact with the former client/patient bear the burden of demonstrating that there has been no exploitation, in light of all relevant factors, including (1) the amount of time that has passed since therapy terminated; (2) the nature, duration, and intensity of the therapy; (3) the circumstances of termination; (4) the client's/patient's personal history; (5) the client's/patient's current mental status; (6) the likelihood of adverse impact on the client/patient; and (7) any statements or actions made by the therapist during the course of therapy suggesting or inviting the possibility of a posttermination sexual or romantic relationship with the client/patient. (See also Standard 3.05, Multiple Relationships .)

10.09 Interruption of Therapy When entering into employment or contractual relationships, psychologists make reasonable efforts to provide for orderly and appropriate resolution of responsibility for client/patient care in the event that the employment or contractual relationship ends, with paramount consideration given to the welfare of the client/patient. (See also Standard 3.12, Interruption of Psychological Services .)

10.10 Terminating Therapy (a) Psychologists terminate therapy when it becomes reasonably clear that the client/patient no longer needs the service, is not likely to benefit, or is being harmed by continued service.

(b) Psychologists may terminate therapy when threatened or otherwise endangered by the client/patient or another person with whom the client/patient has a relationship.

(c) Except where precluded by the actions of clients/patients or third-party payors, prior to termination psychologists provide pretermination counseling and suggest alternative service providers as appropriate.

The American Psychological Association’s  Council of Representatives  adopted this version of the APA Ethics Code during its meeting on Aug. 21, 2002. The Code became effective on June 1, 2003. The Council of Representatives amended this version of the Ethics Code on Feb. 20, 2010, effective June 1, 2010, and on Aug. 3, 2016, effective Jan. 1, 2017.  Inquiries concerning the substance or interpretation of the APA Ethics Code should be addressed to the Director, Office of Ethics, American Psychological Association, 750 First St. NE, Washington, DC 20002-4242. The standards in this Ethics Code will be used to adjudicate complaints brought concerning alleged conduct occurring on or after the effective date. Complaints will be adjudicated on the basis of the version of the Ethics Code that was in effect at the time the conduct occurred.

The APA has previously published its Ethics Code as follows:

American Psychological Association. (1953). Ethical standards of psychologists . Washington, DC: Author.

American Psychological Association. (1959). Ethical standards of psychologists. American Psychologist , 14 , 279-282.

American Psychological Association. (1963). Ethical standards of psychologists. American Psychologist , 18 , 56-60.

American Psychological Association. (1968). Ethical standards of psychologists. American Psychologist , 23 , 357-361.

American Psychological Association. (1977, March). Ethical standards of psychologists. APA Monitor , 22-23.

American Psychological Association. (1979). Ethical standards of psychologists . Washington, DC: Author.

American Psychological Association. (1981). Ethical principles of psychologists. American Psychologist , 36 , 633-638.

American Psychological Association. (1990). Ethical principles of psychologists (Amended June 2, 1989). American Psychologist , 45 , 390-395.

American Psychological Association. (1992). Ethical principles of psychologists and code of conduct. American Psychologist , 47 , 1597-1611.

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist , 57 , 1060-1073.

American Psychological Association. (2010). 2010 amendments to the 2002 “ Ethical Principles of Psychologists and Code of Conduct. ” American Psychologist , 65 , 493.

American Psychological Association. (2016). Revision of ethical standard 3.04 of the “ Ethical Principles of Psychologists and Code of Conduct ” (2002, as amended 2010). American Psychologist , 71 , 900.

Request copies of the APA's Ethical Principles of Psychologists and Code of Conduct from the APA Order Department, 750 First St. NE, Washington, DC 20002-4242, or phone (202) 336-5510.

2010 Amendments

Introduction and Applicability If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to this Ethics Code and take steps to resolve the conflict in a responsible manner . If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing authority in keeping with basic principles of human rights.

1.02 Conflicts Between Ethics and Law, Regulations, or Other Governing Legal Authority If psychologists’ ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists clarify the nature of the conflict , make known their commitment to the Ethics Code, and take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code . If the conflict is unresolvable via such means, psychologists may adhere to the requirements of the law, regulations, or other governing legal authority. Under no circumstances may this standard be used to justify or defend violating human rights .

1.03 Conflicts Between Ethics and Organizational Demands If the demands of an organization with which psychologists are affiliated or for whom they are working are in conflict with this Ethics Code, psychologists clarify the nature of the conflict, make known their commitment to the Ethics Code, and to the extent feasible, resolve the conflict in a way that permits adherence to the Ethics Code. take reasonable steps to resolve the conflict consistent with the General Principles and Ethical Standards of the Ethics Code. Under no circumstances may this standard be used to justify or defend violating human rights .

2016 Amendment

3.04 Avoiding Harm (a) Psychologists take reasonable steps to avoid harming their clients/patients, students, supervisees, research participants, organizational clients, and others with whom they work, and to minimize harm where it is foreseeable and unavoidable. 

Additional Resources

2018 APA Ethics Committee Rules and Procedures (PDF, 197KB)

Revision of Ethics Code Standard 3.04 (Avoiding Harm) 

APA Ethical Principles of Psychologists and Code of Conduct (2017) (PDF, 272KB)

2016 APA Ethics Committee Rules and Procedures

Revision of Ethical Standard 3.04 of the “Ethical Principles of Psychologists and Code of Conduct” (2002, as Amended 2010) (PDF, 26KB)

2010 Amendments to the 2002 "Ethical Principles of Psychologists and Code of Conduct" (PDF, 39KB)

Compare the 1992 and 2002 Ethics Codes

Contact APA Ethics Office

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Business transactions take widely varying forms—from multibillion-dollar corporate mergers to patent licenses to the signing of an all-star quarterback. Yet every deal shares the same goal, or at least should: to maximize the joint value created and to distribute that value among the parties. Building on decades of experience teaching and advising on business deals, Michael Klausner and Guhan Subramanian show how to accomplish this goal through rigorous attention to designing incentives, conveying information, and specifying parties’ rights and obligations.

Business transactions take widely varying forms—from multibillion-dollar corporate mergers to patent licenses to the signing of an all-star quarterback. Yet every deal shares the same goal, or at least should: to maximize the joint value created and to distribute that value among the parties. Building on decades of experience teaching and advising...

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Immigrants contribute disproportionately to entrepreneurship in many countries, accounting for a quarter of new employer businesses in the US. We review recent research on the measurement of immigrant entrepreneurship, the traits of immigrant founders, their economic impact, and policy levers. We provide updated statistics on the share of US...

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In fall 2023, the Food Program of Met Council—America’s largest Jewish charity dedicated to fighting poverty—completed the rollout of the newest version of its digital pantry platform to twelve food pantries in the Met Council food pantry network. The digital initiative coincided with a shift from food pantries’ traditional “pre-packed” model—in...

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