Lilienfeld (2007, Psychological treatments that cause harm. Perspectives on Psychological Science, 2, 53) identified a list of potentially harmful therapies (PHTs). Given concerns regarding the replicability of scientific findings, we conducted a meta-scientific review of Lilienfeld's PHTs to determine the evidential strength for harm. We evaluated the extent to which effects used as evidence of harm were as follows: (a) (in)correctly reported; (b) well-powered; (c) statistically significant at an inflated rate given their power; and (d) stronger compared with null effects of ineffectiveness or evidence of benefit, based on a Bayesian index of evidence. We found evidence of harm from some PHTs, though most metrics were ambiguous. To enhance provision of ethical and science-based care, a comprehensive reexamination of what constitutes evidence for claims of harm is necessary. Public Health Significance StatementPsychological interventions designed to help people sometimes inadvertently harm them instead. In our examination-incorporating more than 70 reports-of treatments previously identified as potentially harmful, we found that the clinical trials often provided weak scientific evidence and are therefore difficult to interpret. However, some interventions showed stronger evidence for harm and only grief therapy showed promise of benefit; as such, the remaining treatments we examined require more compelling, reproducible, and replicable evidence of benefit to justify continued clinical use.

Objective Our previous research indicated that athletes scoring high in competitiveness were less likely to report sports-related concussion symptoms and withdraw from the game. The present study examined whether athletes’ desire to succeed (competitiveness motive), win (win orientation), and achieve personal goals (goal orientation) were related to the age of players. Method Participants included 161 athletes, ages 14–32 (M = 17.6 years; 33.2% female), recruited from a mid-sized Canadian city participating in low (rowing), moderate (soccer) and high (hockey, rugby, football) contact sports. Confirmatory factor analysis was first used to evaluate the structure of the Sports Orientation Questionnaire. Then, using SEM, athletes’ competitiveness, goal orientation, and win orientation were predicted by age. Results High internal consistency was obtained within each factor (.84–.93). The model demonstrated suboptimal fit for this sample (CFI = .84; χ2f/df ratio = 2.02; RMSEA = .087; 90% CI: .077–.097). All factors were significantly related to age, indicating that athletes’ desire to succeed (competitiveness motive; β = .18, p = .009), achieve personal goals (goal orientation; β = .26, p = .007), and win (win orientation; β = .30, p = .000) increases with age. Conclusion The small positive association between age and competitiveness, win, and goal orientation indicates that older athletes are more competitive than younger athletes. Given that competitiveness predicts athletes’ intention to report a concussion, clinicians and coaches should pay particular attention to senior athletes who demonstrate high levels of general competitiveness and who are driven by the desire to win and achieve personal goals. Therefore, interventions targeting the barriers to reporting concussions should evaluate subco.

Objective With some variability, research indicates that a high percentage (20–60%) of athletes do not report post-concussion symptoms, despite having sufficient concussion knowledge. Our study examined whether competitiveness and past reporting predicted future reporting intention in males participating in high contact sports. Method Participants included 92 male athletes (M = 19.35 years, SD = 4.35) recruited from a mid-sized Canadian city participating in high contact sports (American football, rugby, or hockey). Competitiveness was measured using the Sport Orientation Questionnaire. The Rosenbaum Concussion Knowledge and Attitudes Survey-Student Version was used to assess concussion knowledge and nondisclosure. Logistic regression was conducted to predict future intention of playing despite experiencing post-concussion symptoms. Age, knowledge, competitiveness, sport, and past history of concussion nondisclosure were included as predictors. Results Age, sport, and concussion knowledge were not significant predictors. Competitiveness was a significant predictor for the model, such that higher competitiveness predicted less likelihood to report post-concussion symptoms. Our findings also suggest that athletes who have not disclosed a concussion in the past are more likely to have higher intention to continue to play with symptoms of a concussion in the future. Over half (54%) of the athletes reported past history of concussion nondisclosure. Conclusions Interventions focusing on increasing general concussion knowledge are not adequate to prevent symptom nondisclosure. The results suggest that highly competitive athletes or athletes with a past history of nondisclosure are most vulnerable to future nondisclosure. These findings could help improve future interventions by targeting athletes at high-risk of concussion nondisclosure.

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Purpose Limited research examines how electrophysiological markers of reward sensitivity in athletes with concussion history may relate to corresponding executive behavior. Therefore, the present study aimed to examine the relationship between event-related brain potentials (ERPs) elicited during a reward-processing task, and self-report of emotional control and initiation problems in athletes with and without a history of concussion. Methods A total of 38 collegiate athletes (53% females, ages 18-27 years) completed a reward task in a “virtual T-maze” environment, as well as the BRIEF-A. The reward positivity (RewP), an ERP component associated with reward processing, was regressed on endorsement of emotional control and initiation problems in athletes with a history of concussion (n=16) and in athletes with no concussion history (n=22). Results A multiple regression analysis showed that in the concussion group, RewP peak amplitude explained a significant proportion of variance in emotional control, r2=.36, F(1,13)=6.76, p=.02, but did not for initiation, r2=.05, F(1,13)=.60, p>.05. For athletes with no history of concussion, RewP peak amplitude did not explain a significant proportion of variance in either emotional control, r2=.003, F(1,21)=.05, p>.05, or initiation, r2=.11, F(1,21)=2.49, p=.13. Conclusion Results indicate that for athletes with a history of concussion, a lower electrophysiological response to reward may predict greater problems concerning emotional control. Potential implications are discussed for how decision-making, an integral cognitive process driven by reward processing, might impact emotional regulation following concussion.