Using Microtrials to Test Preventive Intervention Components for Stabilizing Positive Change, Based on Dynamic Systems Extensions of Intervention Action Theory

When and why do prevention programs have lasting effects? Studies of mediation show that program effects on proximal targets do continue over longer periods for some participants but not for others. We are guided in the design of prevention programs by theories of action, often more implicit than explicit, concerning our best guesses as to how we can change the behavior and thinking of individuals and families in ways that have long-term impact. Our action theories often provide more guidance on how to bring about immediate change than on what is necessary to maintain that change once it has occurred. In this presentation we advance and explore the notion of self-stabilization, a concept derived from dynamic systems theory, and how it might be applied to extend action theories that guide intervention development. We then discuss how microtrial designs may be used to test whether intervention components for enhancing self-stabilization are likely to prove effective, and whether these effects vary for individuals with different risk profiles. We take as an example prevention programs designed to reduce risk for depression in adults facing loss of employment and precipitous economic decline. These programs include two key elements that appear important for long-term effects: strategies for inoculation against setbacks and components for developing coherent action plans that can be used for future episodes of job change or job loss. Inoculation against setbacks attempts to stabilize motivation to continue job search activities in the face of initial failures through training in self-priming techniques that block the activation of helplessness schemas, while the development of action plans attempts to build broad active coping schemas that will be re-activated should job loss recur. Placing these in a dynamic systems framework, we discuss the results of a recent microtrial designed to test whether positive expectancies stabilize as a result of a brief inoculation intervention and whether these effects vary for people with different levels of impulsivity, as an illustration of how microtrial designs can be used to test for stabilization effects and provide guidance for enhancing the next generation of prevention programs in this area.