Remediation of elevated delay discounting in mid-life individuals: A phase-II trial

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Abstract Early-life disadvantage impedes normal developmental trajectories and confers elevated risk for poor health, personal, and financial consequences that are particularly pronounced for individuals in mid-life. This is a significant public health issue in impoverished communities that disproportionately suffer aging-related negative outcomes. Unfortunately, current interventions target single primary clinical outcomes rather than a target mechanism of various aging-related consequences, and are thus limited. This competing renewal application seeks to leverage (1) the work completed during the initial funding period and (2) new relationships established with community partners in the underserved communities of Baltimore, MD to continue and expand a project targeting elevated delay discounting (DD), a core mechanism for negative consequences in mid-life. Indicative of exaggerated preference for immediate rewards, elevated DD is associated with a wide spectrum of health-compromising behaviors and negative outcomes observed in mid-life of individuals with early-life disadvantage. Using a computerized executive function (EF) training intervention in a context of a Phase-II RCT design, this proposal seeks to experimentally examine changes in EF and DD in a sample of mid-life individuals who have experienced early-life disadvantage. Primary Aims are to examine initial and maintained (3-month and 6-month) effects of EF training on both EF and DD, in comparison to a matched control training condition and a no training condition. We expect EF improvement and reductions in DD immediately and at 3-months and 6-months following the active training condition but not in the control or no training conditions. We will examine whether improvement in EF is a mechanism of intervention effects on DD. We expect that reductions in DD will be mediated by improvement in EF. An exploratory aim is examination of whether the active training condition improves health behaviors and outcomes. The proposed research may illuminate an innovative approach that may be particularly applicable to impoverished communities and broadly impact the health and wellness of mid-life individuals with increased risk for poor consequences due to early-life disadvantage.