Driving environments that influence on-road outcomes in persons with Multiple Sclerosis

IntroductionDrivers with Multiple Sclerosis (MS) who demonstrate adjustment to stimuli and gap acceptance errors may be prone to fail a standardized on-road assessment. However, the complexity (e.g., traffic speed, volume of road users, flow of traffic, spaced interchanges) of driving environments, and their relationship to driving errors critical for failing, is not fully understood. This prospective research study determines the predictive validity of the total number of adjustment to stimuli and gap acceptance errors (modelled as one variable) in residential, suburban, city, or highway environments on drivers with MS failing (vs. passing) a standardized on-road assessment.MethodsCommunity-dwelling participants with MS (N = 35) completed a comprehensive driving evaluation consisting of clinical and on-road assessments, adhering to the regulations for assessing fitness to drive in Ontario, Canada.ResultsLogistic regression models indicated that, as sole predictors, the total number of adjustment to stimuli and gap acceptance errors made in suburban (OR = 0.43, 95% CI = [0.23, 0.83], p = .012) and city environments (OR = 0.34, 95% CI = [0.13, 0.89], p = .028) significantly increased the odds of participants failing the on-road assessment. Also, the total number of adjustment to stimuli and gap acceptance errors made in suburban (AUC = 0.84, SE = 0.11, p = .006, 95% CI = [0.63, 1.00]) and city environments (AUC = 0.74, SE = 0.12, p = .05, 95% CI = [0.51, 0.98]) predicted on-road outcomes. A cut-point of 4 or more adjustment to stimuli and gap acceptance errors made in suburban environments optimally predicted on-road outcomes with 71.4% sensitivity, 92.9% specificity, and 4 misclassifications; while a cut-point of 2 or more adjustment to stimuli and gap acceptance errors made in city environments optimally predicted on-road outcomes with 57.1% sensitivity, 92.9% specificity, and 5 misclassifications.ConclusionThe total number of adjustment to stimuli and gap acceptance errors made in suburban and city environments predict drivers with MS failing a standardized on-road assessment. Assessing adjustment to stimuli and gap acceptance errors in these environments are critical for informing fitness to drive decisions.     

Sexualization in Lyrics of Popular Music from 1959 to 2009: Implications for Sexuality Educators

This study analyzed sexualization in lyrics of popular music in the final year of six decades. The study sample was comprised of Billboard Hot 100 year-end songs from 1959, 1969, 1979, 1989, 1999, and 2009 (N = 600). Regression analysis was used to compare the presence of sexualized lyrics from 1959 with other study years. Male artists’ lyrics (OR = 2.163; p = .029; CI = 1.080–4.333), non-White artists’ lyrics in 1999 and 2009 (OR = 2.670; p < .001; CI = 1.554–4.586), and 2009 lyrics (OR = 3.439; p = .003; CI = 1.515–7.809), were significantly more likely to contain sexualization. Recent research associating sexual content in media with adolescent sexual activity together with findings demonstrating a connection between exposure to objectifying media and self-sexualized behavior make this study’s findings significant to sexuality educators desiring to improve sexual health outcomes and promote healthy adolescent sexual development. Sexuality educators should be cognizant of the recent significant trend toward the inclusion of sexualization in music lyrics and the probable impact such music may have on adolescent sexual behavior and attitudes.     

Impact of the telephone motivational interviewing on the colorectal cancer screening participation. A randomized controlled study

IntroductionWhile high participation rates ensure the cost-effectiveness of colorectal cancer screening programs, it is well known that postal requests do not achieve acceptable levels of participation.ObjectiveThis randomized controlled study aimed to test the impact of individualized phone counseling to prompt people aged 50 to 74 to take a colorectal cancer test.MethodTwo phone strategies were compared. The first involved computer-aided individualized counseling while the second was based on motivational interviewing. A total of 49,972 people were randomly assigned to a control group (CG) and to the individualized counseling (IC) and motivational interviewing (MI) telephone groups.ResultsA simple call doubled the participation rate per protocol (19.2% > 9.2%; p < .001; r = .131; OR = 2.374), and tripled it when the interview was conducted (30.4% > 9.2%; p < .001; r = .219; OR = 4.321). In an intention-to-treat analysis, the benefit of calling by phone remained even higher than postal requests (10% > 9.2%; p < .01; r = .014; OR = 1.103). However, there was no impact of the type of interview on participation rates.ConclusionThe results are discussed for future research.     

Impact of psychiatric illness upon asthma patients’ health care utilization and illness control. Are all psychiatric comorbidities created equal?

The impact of psychiatric illnesses upon asthma patients' functioning is not well understood. This study examined the impact of psychiatric comorbidity upon illness management in asthma patients using empirically-derived psychiatric comorbidity groups. Participants were a clinic sample of Greek-speaking asthma patients (N = 212) assessed using the Patient Health Questionnaire (PHQ) Somatoform, Depression, Panic Disorder (PD), Other Anxiety Disorder, Eating Disorder (ED) and Alcohol sub-scales. The associations between sub-scales were examined using multiway frequency analysis. The following groups were derived: Somatoform disorder and/or Any Depressive disorder (n = 63), Somatoform disorder and/or Other Anxiety disorder (n = 51), Somatoform disorder and/or Any ED (n = 60), and Any Anxiety group including PD and/or Other Anxiety disorder (n = 24). Across all groups, psychiatric illness was associated with significantly worse asthma control (p < .01). Participants in Any Anxiety group, OR = 4.61, 95% CI [1.90, 11.15], Somatoform and/or Any Depressive disorder, OR = 2.06, 95% CI [1.04, 4.09] and Somatoform and/or Other Anxiety disorder, OR = 2.75, 95% CI [1.35, 5.60] were at higher risk for asthma-related Emergency Room (ER) visits compared to controls. However only Somatoform and/or Any Depressive disorder, OR = 3.67, 95% CI [1.60, 8.72], Somatoform and/or Other Anxiety disorder, OR = 5.50, 95% CI [2.34, 12.74], and Somatoform and/or Any ED, OR = 4.98, 95% CI [2.14, 11.60] group membership were risk factors for asthma-related hospitalizations. Results suggest that while comorbid psychiatric disorders generally negatively impact asthma illness management, different psychiatric comorbidities appear to have disparate effects upon illness management outcomes.     

The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

ObjectiveWe aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemicMethodIn this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factorsResultsIn the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distressConclusionsAlthough the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.     

Body appreciation,sexual relationship status,and protective sexual behaviors in women

The relationship between body appreciation and sexual risk reduction behavior in women is under-explored. This cross-sectional study examined the relationships between body appreciation, male condom use, and sexually transmitted infection (STI) testing among a community-based sample of women (n = 285). Logistic regression results revealed that after controlling for age, BMI, and sexual orientation, having more than one sexual partner moderated body appreciation and current male condom use (OR = 4.21, p < .01, CI = 1.510–11.726). Body appreciation was not a significant predictor of STI testing in the previous 12 months. This suggests that women with higher body appreciation may be more likely to engage in some protective sexual health behaviors. Interventions that seek to improve body appreciation instead of body size change such as weight loss or gain may encourage certain protective sexual behaviors in women.     

Everyday tasks impair spatiotemporal variables of gait in older adults with Parkinson's disease

IntroductionAlthough it is known that individuals with Parkinson's disease (PD) have difficulties performing dual-task activities, most of the studies have verified the effect of dual tasks on gait using tasks that are uncommon to perform while walking. However, the realization of tasks involving gait that really represents the daily activities carried out by the participants, allow us to detect real fall risk situations of individuals with PD during their gait.ObjectiveOur aim was to verify the influence of daily-life dual-tasks on gait spatiotemporal variables of the older adults with PD.Methods20 older adults without PD and 20 older adults with PD participated in the study. Gait kinematic was analyzed under three different conditions: walking without dual task, walking carrying bags with weight, and walking talking on the cell phone.ResultsOlder adults with PD presented lower speed (p = .001), cadence (p = .039), and shorter step length (p = .028) than older adults without PD during walking without dual tasks. When walking while carrying bags with weight, older adults with PD had a lower speed (p < .001), cadence (p = .015), shorter step length (p = .008), and greater double support time (p = .021) compared with older adults without PD. During walking while talking on the cell phone, older adults with PD walked with lower speed (p < .001), cadence (p = .013), shorter step length (p = .001) and swing time (p = .013), and increased double support time (p = .008) and support time (p = .014) in relation to older adults without PD.ConclusionDaily-life dual tasks impair the spatiotemporal variables of gait in the older adults with PD, which was most evident during walking talking on the cell phone.     

Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BackgroundExercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.MethodsPhysically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.ResultsFrom T1 to T3, the intervention group significantly improved on global symptom severity (d = −0.43, p = .031), depression among a depressed subsample (d = −0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = −0.28, p = .037) and clinically significant changes (ß = −0.24, p = .042).ConclusionsThe exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.     

Effect of psychostimulant medications on static balance performance in adults with attention deficit hyperactivity disorder: Within-subjects repeated-measure study

ObjectiveThis study examined the effect of psychostimulant medications nPS) on balance and functional motor performance in adults with attention-deficit/hyperactivity disorder (ADHD).MethodsParticipants completed two sessions (off-medication and on-medication) in a within-subjects repeated-measure study design. There was a minimum of seven days between the two sessions. During both sessions, participants stood for 30 s per condition on a force platform. The conditions were: feet-apart with 1) eyes-open and 2) eyes-closed; feet-together with 3) eyes-open and 4) eyes-closed. Participants performed three trials of timed up and go (TUG) and lateral step-up test (LSUT) during both sessions. Outcome measures were sway area (SA [cm²]), average sway velocity (SV [cm/s]), TUG average time (s), and average number of LSUT repetitions. Data were analyzed using multivariate repeated measures analysis of variance and paired t-tests for examining PS effects on balance (SA and SV) and functional motor performance (TUG and LSUT), respectively.ResultsThe sample included 45 adults (35 females; mean age = 28.4 ± 6.3 years). The repeated-measures MANOVA indicated that PS was associated with better SA [F(1,44) = 9.6; p = 0.003;η_p² = 0.18] but not with SV [F(1,44) = 1.0; p = 0.319;η_p² = 0.02]. PS was associated with significantly better SA with decreasing base-of-support [F(1,44) = 9.9; p = 0.003;η_p² = 0.18]. Additionally, PS use was associated with better TUG [t(1,44) = 2.65; p = 0.014;Cohen's d = 0.39] but not LSUT performances [t(1,44) = −0.68; p = 0.499;Cohen's d = −0.10].ConclusionsPS was associated with better SA and TUG in adults with ADHD. Further studies are needed to investigate the effects of PS on balance performance using rigorous designs in this population.ImpactHealthcare providers should screen for PS status and balance when treating adults with ADHD to enhance safe motor performance.     

The effects of lemon taste on attention,perceived exertion,and affect during a stepping task

ObjectivesTo better understand the effects of taste cues on delaying the attention shift from an external focus (dissociative) towards an internal focus (associative) as exercise intensity increases.DesignA between subjects' experimental design with random assignment to three groups: taste (lemon-flavored mouth guards), placebo (unflavored mouth guards), or control group (no mouth guards) was used. Participants reported perceived exertion, affect (i.e., pleasantness and arousal), and attention allocation before, during, and after performing a weighted stepping task.ResultsPerforming the task resulted in a gradual increase of perceived exertion, F (1.87, 74.89) = 63.05, p < .05, η_p² = .61, along with a shift from dissociative to associative attention, F (2.17, 86.68) = 35.57, p < .05, η_p² = .47 across all conditions. Additionally, participants reported feeling less pleasant and more aroused after task completion in all conditions. The lemon-flavored mouth guard failed to affect attention, F (4.33, 86.68) = 1.41, p = .23, η_p² = .07, perceived exertion, F (3.74, 74.86) = .38, p = .81, η_p² = .02, pleasantness, F (2, 40) = .126, p = .88, η_p² = .01, and arousal, F (2, 40) = 2.40, p = .10, η_p² = .10, differently than the other two conditions.ConclusionsThe study was one of the first to examine the effects of taste during an exertive task. Despite the non-significant effects of using a lemon-taste mouth guard on various cognitive variables (perception of exertion, attention allocation, pleasantness, and arousal), more scientific effort is needed to explore the effects of other tastes (e.g., sweet, bitter) and delivery methods (e.g., sprays, drops).     

Motor skill learning in children with and without Developmental Coordination Disorder

ObjectiveThe question whether children with DCD have motor learning deficits is difficult to answer based on the current body of knowledge. The aim of this study was to examine the impact of practice on motor skill acquisition, retention and transfer in children with and without DCD using a variety of games in a virtual environment.MethodPerformance on a criterion task (Wii ski game) and MABC-2 balance subscore was compared between children with DCD (n = 33) and TD children (n = 28) following 10 weeks of playing active video games. Repeated measures ANOVA was used to compare changes in the two groups.ResultsThe children with DCD demonstrated lower performance on the criterion task than the TD group (p = 0.031). A time by group interaction indicated that the difference in performance on the criterion task became larger over time (p = 0.039). No differences were found in retention between groups. Large improvement (Cohen d 1.11) was observed for the children with DCD on the MABC-2 balance subscore.ConclusionBased on the criterion task results, typically developing children seem more proficient in learning new skills compared to children with DCD. More research is needed to confirm that children with DCD have a problem to transfer skills to other contexts.     

A randomized clinical trial of Behavioral Activation (BA) therapy for improving psychological and physical health in dementia caregivers: Results of the Pleasant Events Program (PEP)

Dementia caregiving is associated with elevations in depressive symptoms and increased risk for cardiovascular diseases (CVD). This study evaluated the efficacy of the Pleasant Events Program (PEP), a 6-week Behavioral Activation intervention designed to reduce CVD risk and depressive symptoms in caregivers. One hundred dementia family caregivers were randomized to either the 6-week PEP intervention (N = 49) or a time-equivalent Information-Support (IS) control condition (N = 51). Assessments were completed pre- and post-intervention and at 1-year follow-up. Biological assessments included CVD risk markers Interleukin-6 (IL-6) and D-dimer. Psychosocial outcomes included depressive symptoms, positive affect, and negative affect. Participants receiving the PEP intervention had significantly greater reductions in IL-6 (p = .040), depressive symptoms (p = .039), and negative affect (p = .021) from pre- to post-treatment. For IL-6, clinically significant improvement was observed in 20.0% of PEP participants and 6.5% of IS participants. For depressive symptoms, clinically significant improvement was found for 32.7% of PEP vs 11.8% of IS participants. Group differences in change from baseline to 1-year follow-up were non-significant for all outcomes. The PEP program decreased depression and improved a measure of physiological health in older dementia caregivers. Future research should examine the efficacy of PEP for improving other CVD biomarkers and seek to sustain the intervention's effects.     

The dopamine D4 receptor gene,birth weight,maternal depression,maternal attention,and the prediction of disorganized attachment at 36 months of age: A prospective gene × environment analysis

BackgroundEfforts to understand the developmental pathways for disorganized attachment reflect the importance of disorganized attachment on the prediction of future psychopathology. The inconsistent findings on the prediction of disorganized attachment from the dopamine D4 receptor (DRD4) gene, birth weight, and maternal depression as well as the evidence supporting the contribution of early maternal care, suggest the importance of exploring a gene by environment model.MethodsOur sample is from the Maternal Adversity, Vulnerability, and Neurodevelopment project; consisting of 655 mother–child dyads. Birth weight was cross-referenced with normative data to calculate birth weight percentile. Infant DRD4 genotype was obtained with buccal swabs and categorized according to the presence of the 7-repeat allele. Maternal depression was assessed with the Center for Epidemiologic Studies Depression Scale at the prenatal, 6-, 12-, and 24-month assessments. Maternal attention was measured at 6-months using a videotaped session of a 20-min non-feeding interaction. Attachment was assessed at 36-months using the Strange Situation Procedure.ResultsThe presence of the DRD4 7-repeat allele was associated with less disorganized attachment, β = −1.11, OR = 0.33, p = 0.0008. Maternal looking away frequency showed significant interactions with maternal depression at the prenatal assessment, β = 0.003, OR = 1.003, p = 0.023, and at 24 months, β = 0.004, OR = 1.004, p = 0.021, as at both time points, women suffering from depression and with frequent looking away behavior had an increased probability of disorganized attachment in their child, while those with less looking away behavior had a decreased probability of disorganized attachment in their child at 36 months.ConclusionsOur models support the contribution of biological and multiple environmental factors in the complex prediction of disorganized attachment at 36 months.     

Prevalence,correlates, and psychosocial outcomes of sport participation in young adult cancer survivors

Young adult cancer survivors (YACS) face unique challenges from their disease and treatments that may influence their sport participation choices as well as their psychosocial response.ObjectivesTo examine the prevalence, correlates, and psychosocial outcomes of sport participation in YACS.DesignA provincial, population-based mailed survey of 588 YACS in Alberta, Canada, was completed in May 2008 and included measures of sport participation, psychosocial health (depression, self-esteem, and stress), quality of life (QoL), and medical and demographic variables.ResultsOne third (32.5%) of YACS reported participating in a sport in the past month with the most common being golf (40.8%) and ice hockey (8.3%). YACS participating in sport reported an average frequency of 1.7 (SD = 1.0) days/week and an average duration of 119 min/session (SD = 68) for a total of 189 (SD = 164) min/week. Independent t-tests showed that YACS who participated in sport reported better psychosocial health and QoL including physical QoL (p < 0.001), mental QoL (p < 0.001), self-esteem (p < 0.001), depression (p < 0.001), and stress (p < 0.001). In multivariate regression analysis, 8.5% (p < 0.001) of the variance in sport participation was explained by being male (β = 0.17, p < 0.001), Caucasian (β = 0.15, p = 0.001), in better general health (β = 0.15, p < 0.001), and having a normal body mass index (β = ?0.10, p = 0.024).Discussion/conclusionsSport participation is associated with better psychosocial health and QoL in YACS but only a third participated in the past month. Randomized controlled trials examining sport as an intervention strategy to increase physical activity and improve health outcomes in YACS are warranted.     

Refreshing Older Adults’ Driving Skills (ROADSkills): A randomized controlled trial examining the effect of video feedback

ObjectivesThis study evaluated the effectiveness of a personalized video-based driver training program on the behind-the-wheel skills of community-dwelling older adults.MethodIn this randomized controlled trial (RCT), 80 older drivers [mean age (SD) = 71.0 (3.9)] were randomly assigned to view one of two educational videos: 1) personalized video feedback on their driving (n = 40) or 2) a generic video on aging-in-place (n = 40). The primary outcome, the total number of errors accrued in a 30-minute standardized on-road evaluation, was analyzed at baseline and 4 weeks after watching the assigned video. On-road evaluations were video-recorded and scored by a blinded rater. Self-report measures of driving abilities, behaviors, and comfort were also compared.ResultsAt the 4-week follow-up, the mean difference in the number of on-road performance errors [mean (95% CI) = -12.0 (-16.6, −7.4), p < 0.001] favored the intervention group compared to controls, with significant improvements across multiple domains: vehicle control [mean (95% CI) = -4.8 (-8.1, −1.5), p < 0.01], observing the roadway [mean (95% CI) = -5.5 (-8.4, −2.6), p < 0.001], and compliance with traffic rules [mean (95% CI) = -1.3 (-2.3, −0.2), p < 0.05]. Within-group change on behind-the-wheel errors was significant for the intervention group [mean (95% CI) = -10.3 (-13.5, −7.1), p < 0.001], but not for the control group [mean (95% CI) = 1.7 (-1.6, 4.9), p > 0.05]. No significant differences were found on the self-report measures.DiscussionA novel, video-based approach that provided personalized feedback to older drivers significantly reduced behind-the-wheel errors 4-weeks post-intervention. Changes in self-reported driving behaviors and abilities were not significant. Future research will examine the long-term effects of this approach on older adults’ actual and perceived driving abilities.     

Self-control exertion and caffeine mouth rinsing: Effects on cycling time-trial performance

ObjectivesThe exertion of self-control has been associated with impaired performance on subsequent physical tasks also requiring self-control. However, the effect in well-trained individuals, and of nutritional intervention strategies to reduce the impact of self-control exertion are unknown. This study, therefore, explored the effect of self-control exertion on endurance performance, and pacing strategies, in well-trained individuals. A further aim was to examine the potential for a caffeine mouth rinse to attenuate any decrements in performance due to self-control exertion.MethodFollowing familiarization, fifteen trained male cyclists completed four simulated 10 km cycling time-trials on a cycle ergometer. Prior to each time-trial, participants completed a congruent Stroop task, or an incongruent Stroop task, to manipulate self-control. They also received either a caffeine (containing 40 mg of dissolved caffeine) or placebo mouth-rinse prior to, and every 2 km during, the cycling time-trial. The participants' performance time, subjective measures (perceived pain, motivation, task importance, and RPE), heart rate, and blood lactate concentration were recorded throughout the time-trials. Data were analysed using three-way (self-control*caffeine*split time) repeated measures ANOVA.ResultsThere was no effect of self-control or caffeine on overall 10 km performance time (all p > 0.05). However, following self-control exertion, split time was significantly slower at 3 km (p = 0.031) and 5 km (p = 0.034), and tended to be slower at 1 km (p = 0.088) and 7 km (p = 0.078). There was no effect of the caffeine mouth rinse, nor did this interact with self-control, to affect split times (all p > 0.05). Prior self-control exertion and a caffeine mouth rinse did not influence perceptions of pain, motivation, and task importance in well-trained individuals (all p > 0.05).ConclusionsFindings suggest that prior self-control exertion affects self-regulatory pacing strategies during the first 7 km of a 10 km cycling time-trial, in well-trained individuals. However, caffeine mouth rinsing does not attenuate the effects of self-control exertion on subsequent endurance performance.     

Self-determination theory based instructional interventions and motivational regulations in organized physical activity: A systematic review and multivariate meta-analysis

This study aimed to provide a quantitative synthesis of the effect of Self-determination theory (SDT) based instructional interventions on the motivational regulations of participants in organized physical activity. We conducted a systematic review and meta-analysis on experimental studies conducted before December 2021. The search using the online databases PsychINFO, PsychARTICLES, ERIC, SportDISCUS, and ProQuest Dissertations and Theses, and Google Scholar and other supplementary search strategies yielded 7774 articles, with 38 articles (142 effects and 12,457 participants) meeting the inclusion criteria. The articles were analyzed using a meta-analytic multivariate model. The study showed that SDT-based instruction had a positive heterogeneous small effect on intrinsic motivation (g = 0.29; CI 95% [0.17, 0.41]) and identified regulation (g = 0.23; CI 95% [0.10, 0.35]) and a negative heterogeneous, small effect on external regulation (g = −0.16; CI 95% [-0.31, −0.00]) and amotivation (g = −0.14; CI 95% [-0.28, −0.01]). SDT-based instruction did not have an effect on integrated regulation (g = 0.08; CI 95% [-0.11, 0.28]) nor introjected regulation (g = 0.03; CI 95% [-0.7, 0.13]). Univariate categorical moderator analyses highlighted multiple variables that impacted the size of the effects on the outcomes, including type of intervention and control group, length of study, age of participants, and study quality. Findings from the moderator analyses challenge the practical implications of SDT-based instructional interventions in improving motivation in organized physical activity. High-quality experimental trials using careful and precise conceptualizations of need-supportive behaviors and strategies would benefit the discipline.     

Boredom,motivation, and perceptions of pain: Mechanisms to explain the effects of self-control exertion on subsequent physical performance

ObjectivesPrior self-control exertion has been shown to have a detrimental effect on subsequent physical performance. However, some potential underpinning mechanisms of the effect have yet to be examined. The present study explored whether exerting self-control reduces subsequent physical performance; and also examines the role of boredom, motivation, perceptions of pain, and sustained attention as mechanisms to explain these performance effects.MethodsIn a within-subjects order-balanced crossover design, 63 participants completed a self-control exertion task (incongruent Stroop) and non-self-control exertion task (congruent Stroop) for 4 min. Immediately after, participants completed a wall-sit task until volitional exhaustion. Task-specific boredom was measured following the Stroop task and following the wall-sit task. Participants’ perceptions of pain and motivation were measured every 30 s during the wall sit task. Upon completion of the wall-sit, participants completed a test of sustained attention.ResultsFollowing the self-control exertion task, participant’s wall-sit performance time was reduced (136 ± 62 s), compared to when they completed the non-self-control exertion task (144 ± 57 s, p = 0.05, d = 0.14). Participant’s task related boredom was significantly higher during the non-self-control exertion task (4.30 ± 1.23), compared to the self-control exertion task (3.82 ± 1.22) (p < 0.001, d = 0.39); but boredom was not different during the wall-sit task (p = 0.79). Prior self-control exertion also led to increased overall perceptions of pain (p = 0.02) and reduced overall (p = 0.01) and initial (p = 0.02) motivation during the wall-sit task. However, no differences in initial perceptions of pain (p = 0.16) or sustained attention (response time, p = 0.99; response accuracy, p = 0.78) were observed. Additional within-subjects mediation analysis revealed that differences in wall-sit performance time could not be explained by differences in task related boredom during the Stroop task, overall perceptions of pain, or overall and initial motivation (all p > 0.05).ConclusionsThe prior exertion of self-control resulted in a decrement in subsequent physical performance. Furthermore, individuals’ perceptions of task related boredom were higher during the non-self-control exertion (congruent Stroop) task, whilst overall perceptions of pain were higher, and initial and overall motivation were lower, following the self-control exertion (incongruent Stroop) task. However, mediation analysis revealed that these mechanisms did not explain the difference in wall sit performance time between the conditions.     

CBT/DBT-Informed Intensive Outpatient Treatment for Anxiety and Depression: A Naturalistic Treatment Outcomes Study

Anxiety and depression are highly prevalent and disabling mental health disorders, with comorbidity often posing as a barrier to successful treatment outcomes, thus creating a need for more intensive treatment options. Outpatient clinicians are more likely to refer patients with severe symptoms of anxiety and depression to inpatient hospitalizations rather than partial hospital programs (PHPs) or intensive outpatient programs (IOPs), despite evidence that inpatient hospitalization is associated with high costs and other risks following discharge. The present study reviews two case studies of patients who received cognitive-behavioral therapy/dialectical behavior therapy (CBT/DBT)-based IOP treatment in a private New York clinic. We evaluated treatment outcomes for 73 adult patients (50.7% female) with a mean age of 29.10 years (SD = 10.30). At intake, patients averaged 2.15 diagnoses (SD = 0.94, range = 4) and the majority (80.8%) were prescribed psychotropic medication. Treatment was structured and individually tailored, with patients receiving an average of 21.77 hours (SD = 15.06) of psychotherapy over 12.63 treatment sessions (SD = 9.76), across 12.21 days (SD = 9.61). We observed a clinically and statistically significant change in symptoms of anxiety (t = 6.24, p < .001), depression (t = 5.55, p < .001), and suicidality (t = 2.32, p < .05) over the course of the IOP. After completing treatment, 68.1% of participants tapered down to once-weekly treatment. The present study highlights the clinical utility of an IOP and suggests that this approach can be effective for adult patients presenting with severe symptoms of anxiety and/or depression.