Texas is the land of professed public bootstraps, and very private suffering. There is not a family in Texas that has not been touched by the rising prevalence of mental, emotional, behavioral and related physical illnesses. In fact there is not a family in America that has not been so touched, based on the elegant epidemiological monitoring in the US.
So in the land of big hats, why cannot Texas take the lead in a very big idea that will save billions of dollars, improve health, increase the global economic competitiveness of the US, and improve our national security? All that sounds, well, frankly very patriotic and American. What is the really big idea?
First, virtually every mental, emotional, and behavioral disorder (including addictions) is preventable. How solid is that statement? Stamp on the ground ten times as hard as you can. Did you feel it? Well that is how solid the science is. You don’t hear it on your TV; you don’t hear that science in your newspaper or Time magazine; you don’t hear it from your health care provider; and people are not learning this at university. And absolutely nobody is lobbying the Texas Legislature or Governor about this science and possibility. I’ll wager you might not believe me, even though I am a pretty dang good scientist. So if you don’t believe me that the science exists, you can go to www.pubmed.gov and look every study or fact I site. After my talk, you will jabbering away at just about anybody who will listen.
Second, recovery from mental, emotional, and behavioral disorders—including very serious ones like schizophrenia and bipolar disorder—can go into remission. This remission and recovery is not dependent on medications. Now that is not a fact that you will hear on TV, or hear from the pharmaceutical detail people in your doctor’s office. Now I read almost everything I can on these problems, and I missed hearing about this science—until recently. That shows you how buried it is. At my plenary, you will hear about the practical science of recovery.
Third, there are ways to pay for all this using something called, “Social Impact Bonds.” So instead of Texas selling bonds for building another prison, bonds can be sold preventing or reducing the problems in the first place. Now there’s an idea. And, yes other countries are doing this.
The really big idea—a Texas big idea? Well, Texas could be the first place in America to do all this. That would change America, and all our futures.
1. Developing a Culture of
Prevention, Recovery &
Wellness for Our Futures NOW!
Dennis D. Embry, Ph.D., President/Senior
Scientist,PAXIS Institute
Keynote Presentation:
Texas Behavioral Health Institute, Austin, TX, July 17, 2012
1Wednesday, July 18, 12
2. What good things do the people of
Texas want to pack in the suitcase
for life of their children?
What heavy things do the people of
Texas NOT want to pack in the
suitcase for life of their children?
2Wednesday, July 18, 12
3. How many of you know…
2x
3Wednesday, July 18, 12
4. 35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
4Wednesday, July 18, 12
5. 35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
4Wednesday, July 18, 12
6. 35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
4Wednesday, July 18, 12
7. 35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Behavior
Mood
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
4Wednesday, July 18, 12
8. 35%
30%
25%
20%
15%
10%
5%
0%
4 5 6 7 8 9 10 11 12 13 14 15 16 17 18
Age in Years
Anxiety
Substance
Behavior
Mood
Merikangas et al., 2010
Lifetime Prevalence of Disorders in US Adolescents (N=10,123)
4Wednesday, July 18, 12
9. Nearly 3 out of 4 of United States 17- to 24-year-olds are
ineligible for military service for based on national
epidemiological data (not service entrance exams)
Medical/physical problems, 35
percent.
Illegal drug use, 18 percent.
Mental Category V (the lowest 10
percent of the population), 9
percent.
Too many dependents under age
18, 6 percent.
Criminal record, 5 percent.
Army Times, Nov 5, 2009 • www.missionreadiness.org/PAEE0609.pd
5Wednesday, July 18, 12
10. By 21 years of age,
61.1% of participants
had met criteria for a
well-specified psychiatric
disorder.
An additional 21.4% had
met criteria for a not
otherwise specified
disorder only, increasing
the total cumulative
prevalence for any
disorder to 82.5%.
Cumulative prevalence of psychiatric disorders by young adulthood
a prospective cohort analysis from the Great Smoky Mountains Study.
6Wednesday, July 18, 12
11. The US has
75 million
children and
teens.
40.4 million
are on
psychotropic
medications
Wall Street Journal, 12-28-2010
7Wednesday, July 18, 12
14. Depression Onset By Birth Cohort
Born 1986-1995?
Born 1996-2005?
8Wednesday, July 18, 12
15. Evolutionary bottleneck
1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈ ≈
Disease & War26,000 to 12,000 B.E. Extermination,
Marginalization,
& Suppression
The America’s First Peoples…
Residential
Schools;
Western Diet
9Wednesday, July 18, 12
16. Evolutionary bottleneck
1491 AD
OriginalHuman
Migrations to
North America
30,000,000
Souls in
North America
300,000
Souls≈ ≈
Today,
Historic
Disparities
Disease & War26,000 to 12,000 B.E. Extermination,
Marginalization,
& Suppression
The America’s First Peoples…
Residential
Schools;
Western Diet
9Wednesday, July 18, 12
17. Evolutionary bottleneck
Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Middle
Passage
Continuing
Trauma
Institution
of Slavery
Separation,
violence,
malnutrition
Jim
CrowAfrican Americans…
Exposure
to Toxins
&
Racism
The Great
Migration
North
10Wednesday, July 18, 12
18. Evolutionary bottleneck
Slavery
1500’s to
1863
Original Human
Populations in Africa
Capture
30% to
50% +
mortality
≈
Today,
historic
disparities
Middle
Passage
Continuing
Trauma
Institution
of Slavery
Separation,
violence,
malnutrition
Jim
CrowAfrican Americans…
Exposure
to Toxins
&
Racism
The Great
Migration
North
10Wednesday, July 18, 12
19. Epigenesis
Epigenetics are
heritable
changes in
gene expression
caused by
mechanisms
other than
changes in the
underlying DNA
sequence.
These changes
can pass
through multiple
generations.
Genesis
Social Biological
Environmental Inputs
Nurturing or Toxic
Environments,
Disease, or
Threats
Signaling
M
orphogensis
Phosphorlyation
Acetylation
Methylation
Histone Remodeling
Chromatin Stucture Changes
Development Immunity Stem Cell Changes Imprinting
Three
Generation
Effects
Parent,
1st Generation
Baby,
2nd Generation
Reproductive Cells,
3rd Generation
These
polygenes
can be
“added”,
“subtracted”,
“divided”, or
“multiplied.”
11Wednesday, July 18, 12
21. Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &
Elders
13Wednesday, July 18, 12
22. Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &
Elders
adults and elders invest in children
13Wednesday, July 18, 12
23. Humans are the only species with bi-directional
wealth and wellbeing transfer across generations
Our
Children
Our
Adults &
Elders
Youth return the favor as adults
adults and elders invest in children
13Wednesday, July 18, 12
24. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
14Wednesday, July 18, 12
25. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are living
longer though get
progressively sicker…
14Wednesday, July 18, 12
26. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are living
longer though get
progressively sicker…
Requiring more wealth transfer
14Wednesday, July 18, 12
27. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get
progressively sicker…
Requiring more wealth transfer
14Wednesday, July 18, 12
28. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
Who are less
and less able…
Who are living
longer though get
progressively sicker…
Requiring more wealth transfer
But elders voting to stop funds to kids
14Wednesday, July 18, 12
29. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
15Wednesday, July 18, 12
30. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
5-Year
Olds
65-Year
Olds
15Wednesday, July 18, 12
31. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
65-Year
Olds
15Wednesday, July 18, 12
32. We are the first civilization to abandon what
Mother Nature, Evolution & God gifted us…
15Wednesday, July 18, 12
34. Our Own Future and Our Own Children’s Future
17Wednesday, July 18, 12
35. Our Own & Our Children’s Future Rests On Other’s Futures
18Wednesday, July 18, 12
36. Our Own & Our Children’s Future Rests On Other’s Futures
depression
bipolar
drugs
tobacco
alcohol
ADHD
aggression
learning disabilities
stealing
suicide
depression
crime
violence
dangerous acts
asthma
obesity cancer
heart-disease
diabetes
hi-blood pressure
18Wednesday, July 18, 12
37. Key facts that predict our futures in America…
and, by the way, Texas…
19Wednesday, July 18, 12
38. Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.
19Wednesday, July 18, 12
39. Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.
Our current adults
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders among
the rich
democracies.
19Wednesday, July 18, 12
40. Key facts that predict our futures in America…
and, by the way, Texas…
Our children
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders
among the rich
democracies.
Our children
predicted to
have a shorter
lifespan and
worse morbidity
than their
parents or
grandparents.
Our bulge of
retiring
boomers have
high rates of
these same
problems plus
medical
problems of
aging.
Our current adults
have the highest
rates of mental,
emotional,
behavioral, and
related physical
disorders among
the rich
democracies.
19Wednesday, July 18, 12
42. What these trends this predict for small
businesses in America & Texas?
20Wednesday, July 18, 12
43. What these trends this predict for small
businesses in America & Texas?
What do these trends predict for US
global economic competitiveness?
20Wednesday, July 18, 12
44. What these trends this predict for small
businesses in America & Texas?
What do these trends predict for US
global economic competitiveness?
What do these trends predict for US
safety and security?
20Wednesday, July 18, 12
45. Who in Texas can act to protect our futures?
And how much could we reduce these problems?
21Wednesday, July 18, 12
49. Available at:
www.slideshare.net/drdennisembry
The Critical Role of Nurturing Environments for
Promoting Human Well-Being
Anthony Biglan Oregon Research Institute
Brian R. Flay Oregon State University
Dennis D. Embry PAXIS Institute
Irwin N. Sandler Arizona State University
The recent Institute of Medicine report on prevention (Na-
tional Research Council & Institute of Medicine, 2009)
noted the substantial interrelationship among mental, emo-
tional, and behavioral disorders and pointed out that, to a
great extent, these problems stem from a set of common
conditions. However, despite the evidence, current re-
search and practice continue to deal with the prevention of
mental, emotional, and behavioral disorders as if they are
unrelated and each stems from different conditions. This
article proposes a framework that could accelerate prog-
ress in preventing these problems. Environments that foster
successful development and prevent the development of
psychological and behavioral problems are usefully char-
acterized as nurturing environments. First, these environ-
ments minimize biologically and psychologically toxic
events. Second, they teach, promote, and richly reinforce
prosocial behavior, including self-regulatory behaviors
and all of the skills needed to become productive adult
members of society. Third, they monitor and limit oppor-
tunities for problem behavior. Fourth, they foster psycho-
logical flexibility—the ability to be mindful of one’s
thoughts and feelings and to act in the service of one’s
values even when one’s thoughts and feelings discourage
taking valued action. We review evidence to support this
synthesis and describe the kind of public health movement
that could increase the prevalence of nurturing environ-
ments and thereby contribute to the prevention of most
mental, emotional, and behavioral disorders. This article is
one of three in a special section (see also Mun˜oz Beardslee,
& Leykin, 2012; Yoshikawa, Aber, & Beardslee, 2012)
representing an elaboration on a theme for prevention
science developed by the 2009 report of the National Re-
The next big challenge is to translate this knowledge into
significant reductions in the incidence and prevalence of
multiple disorders.
Doing so requires us to accept two other conclusions
of the report: Psychological and behavioral disorders and
related problems co-occur (e.g., Biglan, Brennan, Foster, &
Holder, 2004; Donovan, Jessor, & Costa, 1993; Flay,
2002), and these problems stem largely from the same
conditions (Biglan et al., 2004; Flay, Snyder, & Petraitis,
Editor’s note. This article is one of three in a special section presented
in this issue of the American Psychologist (May–June 2012) representing
an elaboration on an important theme for prevention science developed by
the landmark report of the National Research Council and Institute of
Medicine (NRC & IOM, 2009). That report summarized the impressive
progress in prevention research that has occurred over the past two
decades with children and youth. The report also presented recommenda-
tions for the next generation of research and policy initiatives to translate
this progress into true improvements in the mental health of America’s
children and youth. One theme in the report concerns the power of
positive aspects of the social environment to promote positive develop-
ment and to prevent the development of disorder. The current article
develops a coherent, empirically based, theoretical framework for con-
ceptualizing the positive aspects of the social environment, which the
authors have labeled “nurturing environments.” The other articles in this
special section elaborate on two other themes in the NRC & IOM report,
one of which concerns the salient role of poverty as a pervasive risk factor
(Yoshikawa, Aber, & Beardslee, 2012) and the other of which concerns
the potential for preventing the incidence of depression, a major mental
disorder (Mun˜oz, Beardslee, & Leykin, 2012).
Authors’ note. Anthony Biglan, Promise Neighborhoods Research
Consortium, Oregon Research Institute, Eugene, Oregon; Brian R. Flay,
College of Public Health and Human Sciences, Oregon State University;
Dennis D. Embry, PAXIS Institute, Tucson, Arizona; Irwin N. Sandler,
25Wednesday, July 18, 12
50. Behavioral Vaccines and
Evidence-Based Kernels:
Nonpharmaceutical
Approaches for the
Prevention of Mental,
Emotional, and
Behavioral Disorders
Dennis D. Embry, PhD
KEYWORDS
Evidence-based kernels Behavioral vaccines Prevention
Public health
Available at:
www.slideshare.net/drdennisembry
26Wednesday, July 18, 12
51. Available at:
www.slideshare.net/drdennisembry
Evidence-based Kernels: Fundamental Units of Behavioral
Influence
Dennis D. Embry Æ Anthony Biglan
Ó The Author(s) 2008. This article is published with open access at Springerlink.com
Abstract This paper describes evidence-based kernels,
fundamental units of behavioral influence that appear to
underlie effective prevention and treatment for children,
adults, and families. A kernel is a behavior–influence
procedure shown through experimental analysis to affect a
specific behavior and that is indivisible in the sense that
removing any of its components would render it inert.
Existing evidence shows that a variety of kernels can
influence behavior in context, and some evidence suggests
that frequent use or sufficient use of some kernels may
produce longer lasting behavioral shifts. The analysis of
kernels could contribute to an empirically based theory of
behavioral influence, augment existing prevention or
treatment efforts, facilitate the dissemination of effective
prevention and treatment practices, clarify the active
ingredients in existing interventions, and contribute to
efficiently developing interventions that are more effective.
Kernels involve one or more of the following mechanisms
of behavior influence: reinforcement, altering antecedents,
changing verbal relational responding, or changing physi-
ological states directly. The paper describes 52 of these
kernels, and details practical, theoretical, and research
implications, including calling for a national database of
kernels that influence human behavior.
This paper presents an analysis of fundamental units of
behavioral influence that underlie effective prevention and
treatment. We call these units kernels. They have two
defining features. First, in experimental analysis,
researchers have found them to have a reliable effect on
one or more specific behaviors. Second, they are funda-
mental units of behavior influence in the sense that deleting
any component of a kernel would render it inert. Under-
standing kernels could contribute to an empirically based
theory of behavioral influence, facilitate dissemination of
effective prevention and treatment practices, clarify the
active ingredients in existing interventions, and contribute
to developing interventions that are more efficient and
effective. Subsequent sections of this paper expand on the
two essential features of evidence-based kernels, as well as
the origins of the idea and terminology.
The ultimate goals of treatment and prevention research
are a reduction of the prevalence of the most common and
costly problems of behavior and an increase in the preva-
lence of wellbeing. Current thinking about how to
accomplish this assumes that we will identify empirically
supported programs and, to a lesser extent, policies, and
will disseminate them widely and effectively. Although
substantial progress is occurring through this strategy, there
Clin Child Fam Psychol Rev
DOI 10.1007/s10567-008-0036-x
27Wednesday, July 18, 12
52. Physiological
influences trigger
adverse biological
mechanisms
Reinforcement
more for anti-social
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses
Multi-Inflammatory Brain Body Response
28Wednesday, July 18, 12
53. Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
Healing
Dysfunction
Physiological
influences trigger
adverse biological
mechanisms
Reinforcement
more for anti-social
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses
Multi-Inflammatory Brain Body Response
28Wednesday, July 18, 12
54. Mood
Instability
Inattention
Lo Reward
Delay
Lo Executive
Function
Lo Behavioral
Competencies
Poor
Motor
Skills
Immune-
Healing
Dysfunction
Physiological
influences trigger
adverse biological
mechanisms
Reinforcement
more for anti-social
than prosocial
behaviors
Antecedents
cue anti-social
acts and threats
Verbal Relations
occasion perceived
threats and related
reactions
Major Connected Ecologic Causes of the Adverse Trends Predicting MEBs Related Illnesses
Mental Illness
Substance
Abuse
Violence
Work
Problems
Obesity,
etc
CancerEarly
Sex
School
Failure
STD’s Special
EdMulti-Inflammatory Brain Body Response
28Wednesday, July 18, 12
55. Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
Addictions
New cultural trends predict new challenges and risks
29Wednesday, July 18, 12
56. Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
AddictionsOmega 3
Fatty Acid
Deficiency
Vitamin D
Deficiency
Reduced
Outdoor
Activities
Fear of
Violence
Crime
Increased
Electronic
Media Use
New cultural trends predict new challenges and risks
29Wednesday, July 18, 12
57. Rise in
Depression
Rates
Rise in
Aggression
Rates
Rise in
Obesity
Rates
Change in
Genes
Increased
Cancer
Increased
Autism
Increased
Schizo.
ATOD
AddictionsOmega 3
Fatty Acid
Deficiency
Vitamin D
Deficiency
Reduced
Outdoor
Activities
Fear of
Violence
Crime
Increased
Electronic
Media Use
Lower Rates
of Positive
Reinforcement
New cultural trends predict new challenges and risks
29Wednesday, July 18, 12
58. Four Types of Kernels
Antecedent
Kernel
Reinforcement
Kernel
Relational
Frame
Kernel
Physiological
Kernel
Happens BEFORE
the behavior
Happens AFTER the
behavior
Creates verbal
relations for the
behavior
Changes
biochemistry of
behavior
Embry, D. D., Biglan, A.
(2008). Evidence-Based
Kernels: Fundamental Units of
Behavioral Influence. Clinical
Child Family Psychology
Review, 39.
30Wednesday, July 18, 12
59. Physiological
influences trigger
protective biological
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation
Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults
Multi Anti-Inflammatory Brain Body Response
31Wednesday, July 18, 12
60. Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healing
Efficiency
Physiological
influences trigger
protective biological
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation
Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults
Multi Anti-Inflammatory Brain Body Response
31Wednesday, July 18, 12
61. Mood
Stability
Attention
Hi Reward
Delay
Hi Executive
Function
Hi Behavioral
Competencies
Good
Motor
Skills
Immune-
Healing
Efficiency
Physiological
influences trigger
protective biological
mechanisms
Reinforcement
more for prosocial
behaviors
Antecedents
cue prosocial
behaviors
Verbal Relations
occasion perceived
safety and
affiliation
Major Connected Ecologic Causes of the Positive Trends to Children, Youth and Adults
Mental health
Low
Addictions
Prosociality
Work
Success
Heart
Health
etc
Low
Cancer
Delayed
Sex
Hi Sch.
Grad
Low
Injuries
Higher
Ed
Multi Anti-Inflammatory Brain Body Response
31Wednesday, July 18, 12
62. Kernels are building
blocks of behavior change
Humans survive individually and collectively by
influencing the behavior or other humans
The 2008 paper by Embry and Biglan identifies
52 evidence based kernels that can be used to
design or or improve programs.
32Wednesday, July 18, 12
65. Muriel Saunders
PAX GBG: An Example Behavioral Vaccine
Read about multiple scientific studies on the “Good Behavior Game” at www.pubmed.gov
35Wednesday, July 18, 12
72. Timeline of Life Time Benefits…
More time for
teaching and learning
First Month
Less stress for
Staff Students
Better
Attendance
Better
Academics
Less
Illness
Fewer Service
Needs
Fewer
Referrals
First Year
Happier
Families
Less
Vandalism
2nd 3rd Years
ADHD
Averted
Oppositional
Defiance Averted
Special Education
Averted
5-15 Years
No
Tobacco
Less
Alcohol
Less Conduct
Disorders
Delayed
vaginal sex
Less Crime,
Violence, Suicide
High School
Grad University
37Wednesday, July 18, 12
73. How much might PAX GBG
save for Texans?
To do PAX GBG will cost about $150 to protect our children for
life from mental illnesses, behavioral problems, drug addictions,
becoming a criminal, trying suicide, dying from tobacco or
alcohol related illnesses. And, it increases their academic
success—including university entry.
PAX GBG pays back $4,636 to individuals, taxpayers, and
others per student exposed in First Grade over 15 years.
Assuming 40,000 First Graders each year, that saves
$186 million every First Grade cohort.
Cost
Savings
Source: Aos, S., Lee, S., Drake, E., Pennucci, A., Klima, T., Miller, M., et al. (2011). Return on Investment: Evidence-Based Options to Improve Statewide Outcomes. (July), 8. Retrieved from http://www.wsipp.wa.gov/rptfiles/11-07-1201.pdf
38Wednesday, July 18, 12
74. First graders
exposed to GBG
for one year had
these benefits at
age 21.
SOURCE: Kellam, S. G., Mackenzie, A. C., Brown, C. H., Poduska, J. M., Wang, W., Petras, H., Wilcox, H. C. (2011). The good behavior game and the future of prevention and treatment. Addict Sci Clin Pract, 6(1), 73-84.
Read this and other studies about the Good Behavior Game at www.pubmed.gov
OUTCOMES STUDENT GROUPS GBG CLASSROOM STANDARD CLASSROOM
Drug abuse and All males 19 percent 38 percent
dependence disorders
Highly aggressive males 29 percent 83 percent
Regular smoking All males 6 percent 19 percent
Highly aggressive males 0 percent 40 percent
Alcohol abuse and All males and females 13 percent 20 percent
dependence disorders
Antisocial personality Highly aggressive males 40 percent 100 percent
disorder (ASPD)
Violent and criminal Highly agressive males 34 percent 50 percent
behavior (and ASPD)
Service use for All males 25 percent 42 percent
problems with behavior,
emotions, drugs, or
alcohol
Suicidal thoughts All females 9 percent 19 percent
All males 11 percent 24 percent
39Wednesday, July 18, 12
75. Lifespan example of one kernel
for prevention, intervention and
treatment
Reinforcement
Kernel
Happens AFTER
the behavior
Available from Amazon.com for $45
40Wednesday, July 18, 12
76. Giggle Fest Giving Cuts in
Line
Mumble, Grumble
Gowl
Play Hangman
Jokester Making Faces
Nerf Toss or
Nerf Basket
Paper Airplane
Toss
Pencil Tapping Penny or Poker
Chip Flipping
possible in the time set. You can’t help but giggle.
Suggested Time: 10 to 20 seconds
Winning teams can give cuts to a friend for one set
time as determined by the teacher
Suggested Time: One lunch, or day only.
Suggested Time: 10 to 20 seconds
Winning teams get to mumble, grumble and growl as
much as possible during the set time.
Winning teams are allowed to play a game of hang-
man for a time set by the teacher.
Suggested Time: 1-2 minutes; more at day’s end
Suggested Time: 1-3 minutes, depending on joke book
A joke is read for each winning team. Teacher may
read them or team captains can read the jokes. (Teach-
er needs to have several joke books ready.)
Winning teams may make faces at each other or the
teacher.
Suggested Time: 10-30 seconds.
Suggested Time: About 1-2 mins, based on nerf balls
Winning teams get to line up and toss a nerf ball into a
box, bin or mini basketball hoop.
-
ing them. (Nice at the end of the day prize)
Suggested Time: A few minutes to make, then toss
Suggested Time: 10 seconds or so.
cups or jars. You can make some containers smalller
for more “points”.
Suggested Time: A minute or so
PAX TIP: Please cut out and select prizes appropriate for you. Start and stop the prizes with PAX Quiet.
Using prize bowl or mystery
motivator in prevention
41Wednesday, July 18, 12
77. Seine River Pilot Demonstration
April, 2011 – Principals and key
staff trained for two days for all
12 schools.
April, 2011 – First grade
classrooms then trained that
week
April through May – Each
successive month other grades
trained, including 8th grade
0
2
4
6
8
10
12
Before
(Baseline)
After
PAX GBG
Disruptions by All Seine River First Graders
RatePerHourPerChild
40.8%
Reduction
45%
42Wednesday, July 18, 12
78. An ancient inukshuk points the
way
0%
6%
12%
18%
24%
30%
Psychosis
Omega-3 Placeo
27.5%
4.9%
PercentagewithPsychosisat12months
Physiological
Kernel
Changes
biochemistry of
behavior
Brief Report
Omega-3 Fatty Acid Treatment of Women
With Borderline Personality Disorder:
A Double-Blind, Placebo-Controlled Pilot Study
Mary C. Zanarini, Ed.D.
Frances R. Frankenburg, M.D.
Objective: The purpose of this study was to compare the effi-
cacy of ethyl-eicosapentaenoic acid (E-EPA) and placebo in the
treatment of female subjects with borderline personality disorder.
Method: The authors conducted an 8-week, placebo-con-
trolled, double-blind study of E-EPA in 30 female subjects meet-
ing Revised Diagnostic Interview for Borderlines and DSM-IV cri-
teria for borderline personality disorder.
Results: Twenty subjects were randomly assigned to 1 g of E-
EPA; 10 subjects were given placebo. Ninety percent of those in
both groups completed all 8 weeks of the trial. Analyses that
used random-effects regression modeling and controlled for
baseline severity showed E-EPA to be superior to placebo in
diminishing aggression as well as the severity of depressive
symptoms.
Conclusions: The results of this study suggest that E-EPA may
be a safe and effective form of monotherapy for women with
moderately severe borderline personality disorder.
(Am J Psychiatry 2003; 160:167–169)
Borderline personality disorder is marked by notable
reactivity of mood and impulsive aggression. Because re-
sponse to antidepressants and mood stabilizers has typi-
cally been clinically modest in this patient group (1), the
identification of novel treatments is needed. Candidates
include omega-3 fatty acids, such as eicosapentaenoic
acid and docosahexaenoic acid, which are commonly
found in seafood and have beneficial effects and none of
the adverse side effects commonly associated with phar-
macotherapy. In cross-national studies, greater seafood
consumption was associated with lower rates of bipolar
disorder (30-fold range) and major depression (50-fold
range) (2). In placebo-controlled trials, a mixture of these
fatty acids was found to be an effective adjunctive agent
for patients suffering from bipolar disorder (3), and ethyl-
eicosapentaenoic acid (E-EPA) was found to have a bene-
ficial adjunctive effect for patients suffering from recur-
rent depression (4). Because of the shared symptoms of
borderline personality disorder and these mood disorders,
a double-blind, placebo-controlled trial of E-EPA seemed
warranted.
Method
Recruitment of women between the ages of 18 and 40 was ac-
complished through advertisements in Boston newspapers.
week, were actively abusing alcohol or drugs, or were acutely sui-
cidal.
Subjects were next invited to participate in face-to-face inter-
views. At that time, the study procedures were fully explained,
and written informed consent was obtained. Two semistructured
diagnostic interviews were then administered to each subject: the
Structured Clinical Interview for DSM-IV Axis I Disorders (6) and
the Revised Diagnostic Interview for Borderlines (DIB-R) (7). Two
observer-rated scales were also administered: the Modified Overt
Aggression Scale (8) and the Montgomery-Åsberg Depression
Rating Scale (9).
Subjects were included if they met both DIB-R and DSM-IV cri-
teria for borderline personality disorder. They were excluded if
they met current or lifetime criteria for schizophrenia, schizoaf-
fective disorder, or bipolar I or bipolar II disorder or were cur-
rently in the midst of a major depressive episode.
Study duration was 8 weeks. Subjects were seen every week for
the first month and then biweekly for the next month. Both psy-
chiatric rating scales were readministered at each subsequent
visit. Side effects were also assessed at these visits with a struc-
tured questionnaire.
Subjects received two capsules per day (beginning the day after
their baseline assessment); each capsule contained either 500 mg
of 97% E-EPA or a placebo (mineral oil). One gram was chosen as
the dose most likely to be effective on the basis of unpublished
studies in depression (David Horrobin, personal communication,
Feb. 1, 2001). Capsules were supplied by Laxdale Pharmaceuticals
(Stirling, U.K.).
Between-group baseline demographic variables and clinical
history variables were analyzed by using chi-square analyses for
categorical variables and Student’s t test for continuous variables.
Source: Archives of General PsychiatrySource: Am. Journal of Psychiatry
43Wednesday, July 18, 12
79. 0
0.25
0.50
0.75
1.00
Before supplementation During supplementation
RatioofDisciplinaryIncidentsSupplementation/Baseline
Active
Placebo
Reduced
Felony
Violent
Offenses
Among
Prisoners
with
recommended
daily
amounts
of
vitamins,
minerals
and
essen=al
fay
acids
UK
maximum
security
prison
-‐
338
offences
among
172
prisoners
over
9
months
treatment
in
a
compared
to
9
months
baseline.
Gesch
et
al.
Br
J
Psychiatry
2002,
181:22-‐28
Ac=ve
-‐37.0%
p
‹
0.005
Placebo
-‐10.1%
p
=
ns
Physiological
Kernel
44Wednesday, July 18, 12
80. Why not reproduce the rapid
results in the US to get a 37%
reduction in jail violence?
It cost the Brits 19¢ per day or $69.35 per year.
45Wednesday, July 18, 12
81. Omega-3 Status and US Military Suicide Deaths
Suicide Deaths of Active-Duty US Military and
Omega-3 Fatty-Acid Status: A Case-Control Comparison
Michael D. Lewis, MD; Joseph R. Hibbeln, MD; Jeremiah E. Johnson, RD;
Yu Hong Lin, PhD; Duk Y. Hyun, BS; and James D. Loewke, BS
ABSTRACT
Background: The recent escalation of US military
suicide deaths to record numbers has been
a sentinel for impaired force efficacy and has
accelerated the search for reversible risk factors.
Objective: To determine whether deficiencies
of neuroactive, highly unsaturated omega-3
essential fatty acids (n-3 HUFAs), in particular
docosahexaenoic acid (DHA), are associated with
increased risk of suicide death among a large
random sample of active-duty US military.
Method: In this retrospective case-control
study, serum fatty acids were quantified as
a percentage of total fatty acids among US
military suicide deaths (n=800) and controls
(n=800) matched for age, date of collection of
sera, sex, rank, and year of incident. Participants
were active-duty US military personnel
(2002–2008). For cases, age at death ranged
from 17–59 years (mean=27.3 years, SD=7.3
years). Outcome measures included death by
suicide, postdeployment health assessment
questionnaire (Department of Defense Form
2796), and ICD-9 mental health diagnosis data.
Results: Risk of suicide death was 14% higher per
SD of lower DHA percentage (OR=1.14; 95% CI,
1.02–1.27; P.03) in adjusted logistic regressions.
Among men, risk of suicide death was 62%
greater with low serum DHA status (adjusted
OR=1.62; 95% CI, 1.12–2.34; P.01, comparing
DHA below 1.75% [n=1,389] to DHA of 1.75%
and above [n=141]). Risk of suicide death was
52% greater in those who reported having seen
wounded, dead, or killed coalition personnel
(OR=1.52; 95% CI, 1.11–2.09; P.01).
Suicide rates among active-duty US military have increased to re-
cord numbers, doubling since the inception of Operation Enduring
Freedom (Afghanistan) and Operation Iraqi Freedom and rivaling the
battlefield in toll on the US military.1 Army Vice–Chief of Staff General
Peter W. Chiarelli described the record suicide rate as “horrible” and
voiced frustration that “the Army has not yet been able to identify any
causal links among the suicide cases.”2(pA2)
Deficiencies of nutrients critical for brain function may be a signifi-
cant contributing risk factor for psychiatric pathology, especially suicide
and stress-related psychiatric symptoms.3 Highly unsaturated omega-3
essential fatty acids (n-3 HUFAs), in particular docosahexaenoic acid
(DHA), are selectively concentrated in neural tissues and are required
for optimal neural function.4
These fatty acids cannot be made de novo
but are available only from dietary sources, with seafood being the richest
source. Nutritional deficiencies in n-3 HUFAs may increase vulnerabil-
ity to combat deployment stress, manifesting as psychiatric symptoms
including adjustment disorders, major depression, impulsive violence,
and suicide.5 In civilian populations, observational studies indicate that
low fish consumption is associated with increased risk of completed sui-
cides6,7
and greater suicidal ideation.8
Low DHA status was associated
with increased risk of past suicide attempts9
and future suicide attempts.10
In comparison to placebo, 2 grams per day of n-3 HUFA reduced suicidal
thinking and depressive symptoms and reduced the perception of stress
among subjects (n=49) with deliberate self-harm.11
These findings suggest that low DHA levels may be a contributing
factor for adverse psychiatric symptoms. In this study, we posited that
low DHA status would be associated with increased risk of suicide death
among military personnel. Prospectively collected serum and supporting
data were available from the Armed Forces Health Surveillance Center
(AFHSC) for a large number of active-duty suicide deaths (n=800) and
matched controls (n=800). To our knowledge, this is the largest study of
46Wednesday, July 18, 12
82. REVIEW Open Access
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids:
a novel preventive strategy for posttraumatic
stress disorder?
Yutaka Matsuoka1,2
Abstract
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless
of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric
condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially
important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity
to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence
and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and
proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting
hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of
injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately
after accidental injury can reduce subsequent PTSD symptoms.
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids: a novel
preventive strategy for posttraumatic stress disorder?
Matsuoka
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)
Omega-3 for PTSD symptoms could be used
routinely for the patients exposed to trauma
REVIEW Open Access
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids:
a novel preventive strategy for posttraumatic
stress disorder?
Yutaka Matsuoka1,2
Abstract
Not only has accidental injury been shown to account for a significant health burden on all populations, regardless
of age, sex and geographic region, but patients with accidental injury frequently present with the psychiatric
condition of posttraumatic stress disorder (PTSD). Prevention of accident-related PTSD thus represents a potentially
important goal. Physicians in the field of psychosomatic medicine and critical care medicine have the opportunity
to see injured patients in the immediate aftermath of an accident. This article first briefly reviews the prevalence
and associated factors of accident-related PTSD, then focuses on a conceptual model of fear memory and
proposes a new, rationally hypothesized translational preventive intervention for PTSD through promoting
hippocampal neurogenesis by omega-3 fatty acid supplementation. The results of an open-label pilot trial of
injured patients admitted to the intensive care unit suggest that omega-3 fatty acid supplementation immediately
after accidental injury can reduce subsequent PTSD symptoms.
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3
Clearance of fear memory from the hippocampus
through neurogenesis by omega-3 fatty acids: a novel
preventive strategy for posttraumatic stress disorder?
Matsuoka
Matsuoka BioPsychoSocial Medicine 2011, 5:3
http://www.bpsmedicine.com/content/5/1/3 (8 February 2011)
47Wednesday, July 18, 12
83. Omega-3 can improve school
grades and success
-2
-1
0
1
2
3
4
5
6
7
Reading Spelling
Omega 3 Placebo
These were gains in
academics after 3
months of exposure
to fish oil.
Before Omega 3
After Omega 3
See www.durhamtrial.org/
48Wednesday, July 18, 12
87. Wait for the Timer for tobacco
addictions with SMI/CMI
Antecedent
Kernel
Happens
BEFORE the
behavior
52Wednesday, July 18, 12
88. Beat the timer in school to
improve engagement
Antecedent
Kernel
Happens
BEFORE the
behavior
53Wednesday, July 18, 12
89. Trend-line for humorous warnings on binge drinking
by women of child-rearing age
No Warnings Humorous Warnings
Antecedent
Kernel
54Wednesday, July 18, 12
90. Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
0
4
8
12
16
20
Percentage
No Warnings Humorous Warnings
Antecedent
Kernel
54Wednesday, July 18, 12
91. Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
0
4
8
12
16
20
Percentage
No Warnings Humorous Warnings
Antecedent
Kernel
54Wednesday, July 18, 12
92. Trend-line for humorous warnings on binge drinking
by women of child-rearing age
1995 1997 1999 2001 2002 2003 2004 2005 2006 2007
0
4
8
12
16
20
Percentage
No Warnings Humorous Warnings
Antecedent
Kernel
54Wednesday, July 18, 12
99. Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30 40 50
Time in Months
Treatment Strategy #1 Treatment Strategy #2
Only 17% of the
discharged clients
of program #1 have
not relapsed,been
re-arrested,or
re-hospitalized by
48 months.
About 80% of the
discharged clients
of program #2
“survived”with
no relapse,
re-arrested,or
re-hospitalization by
48 months.
Do these two
evidence- based
strategies look
significantly
different at 20
days?
60Wednesday, July 18, 12
100. Thinking about and measuring recovery, relapse
and recidivism
0
50
100
0 10 20 30 40 50
Time in Months
0
50
100
0 10 20 30 40 50
Time in Months
Treatment Strategy #1 Treatment Strategy #2
Only 17% of the
discharged clients
of program #1 have
not relapsed,been
re-arrested,or
re-hospitalized by
48 months.
About 80% of the
discharged clients
of program #2
“survived”with
no relapse,
re-arrested,or
re-hospitalization by
48 months.
60Wednesday, July 18, 12
101. Percentage of patients in recovery during followup year.
Harrow M et al. Schizophr Bull 2005;31:723-734
Percentage of
patients in recovery
during followup year.
Note: SZ =
schizophrenia,
SZNIF =
schizophreniform,
OP = other
psychotic, NP =
nonpsychotic.
Non-psychotic
Other psychotic
Schizophreniform
Schizophrenia
61Wednesday, July 18, 12
102. Percent of Patients Ever in Recovery (5 Follow-ups Over 15 Years).
Harrow M et al. Schizophr Bull 2005;31:723-734
62Wednesday, July 18, 12
103. Percent of Nonmedicated Schizophrenia and Schizophreniform Patients in Recovery at 15-Year Follow-ups.
Harrow M et al. Schizophr Bull 2005;31:723-734
63Wednesday, July 18, 12
104. Recognition/Rewards
for Successs
Vaccine
Recipe Identify
Behaviors
Reduced
Identify
Behaviors
Increased
List local,
state and
national
policies
positively
impacted or
lled by
recipe
Psychinfo
www.pubmed.gov
ERIC
NTIS
User T
Local
State
National
Cite relevant
studies
Cite relevant
endorsements
or standards
Create policy
funding supports
(organizational,
local and/or state
Cultivate some
current or
prospective early
adopters for
testimonials Lo Hi
- A
catchy positive
name (meme)
-
What the
ts are
- Where/
how to get
recipe
- Relational framing
Support
Training
Daily, Weekly
or Monthly
Feedback
res
TH
cacy,
Adoption,
Implementation,
Maintenance
- What
the costs of use
are
Developmental stages
Multiple
Settings
Fam
ilies
Schools
Communities
Organiations
Birth Childhood Adolescence Adulthood
Intensity/reachlevels
High Intensity
Low reach
Low
Intensity
A
B
C
Hi
reach
Impacting Values
Evaluation
Outcome
Monitoring
Population Targeting
The path
from
research
findings
to public
health
policy
and
impact
64Wednesday, July 18, 12
106. Dennis D. Embry, Ph.D.
dde@paxis.org
520-299-6770
Business cards available
for follow up and copies
of papers presentations
66Wednesday, July 18, 12