An acceptance-based behavioral intervention for weight loss: a pilot study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6 months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age=52.2±7.6 years; baseline mean body mass index=32.8±3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0 kg (SE=1.4) after 6 months of treatment and 12.1 kg (SE=1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r=.64, p=.002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted.     

The effect of a psycho-educational intervention on weight management in obese military personnel

Obesity is a serious health problem for many population groups, including military personnel. Model-based health education programs have been shown to be effective in reducing weight. This study assessed the efficacy of an educational intervention based on a trans-theoretical model (TTM) targeting weight loss among active duty military. A single group experimental study using a before-after design was conducted in 49 military personnel with obesity. Constructs such as self-efficacy, decisional balance, stages of change, and processes of change as well as anthropometric measures including weight, waist circumference, and body mass index (BMI) were assessed at three times (baseline, 2 months after the intervention, and 4 months later). The intervention consisted of 10 educational sessions developed based on TTM constructs. At baseline, 30 (61%) and 19 (39%) persons were in the pre-action and action stages, respectively. By 2 months after the intervention, only 24 persons (49%) were in pre-action stages and 25 (51%) were in the action stages. Four months later, one (2%) and 43 (88%) were in pre-action and action stages. The mean changes in self-efficacy (25.7 ± 4.1 to 29.3 ± 2.4), decisional balance (9.2 ± 3.6 to 13.8 ± 1.9), total cognitive (74.7 ± 8.5 to 84.7 ± 6.3), and total behavioral change (60.8 ± 9.8 to 71.7 ± 7.8) were significantly different across the three time points. Reductions in weight (99.8 ± 10.4 to 93.0 ± 9.6), waist circumference (105.9 ± 14.2 to 100.2 ± 13.0), and BMI (32.5 ± 5.2 to 30.3 ± 4.5) from baseline to 4 months after the intervention were also significant (p < 0.05). An educational program based on TTM may be effective in reducing weight among obese military staff.     

The effect of prayer on physical health: Experimental evidence

There has been enough published scientific work on the direct effects of prayer upon physical health in the past thirty years to merit review. While experimental evidence has yet to reveal large direct effects of prayer on physical health, the effects which have been found are notable and encourage further study. In this article the authors review the major studies, discuss problems in their interpretation, and suggest considerations for future experimental study of prayer.     

Stability of physical self: Examining the role of chronic obstructive pulmonary disease

This observational study compared global self-esteem and physical self scores and their stability over a three-week period in patients with chronic obstructive pulmonary disease (COPD) and healthy adults, through the analysis of day-to-day time series. Two groups were formed: a COPD group of 27 patients with stable and moderate COPD, and a control group of 31 “healthy” adults. The results showed lower mean scores over the study period for global self-esteem, physical self-worth, and each of the physical self subdomains in COPD patients as compared with the “healthy” group. Moreover, the results showed less stability in global self-esteem, physical self-worth, and the physical self subdomains over the same period in these patients. Our principal findings support the assertion of Kernis and colleagues that unstable global self-esteem and physical self reflects a certain vulnerability to endogenous and exogenous events.     

The testing effect: The role of feedback and collaboration in a tertiary classroom setting

Successful retrieval on a test compared to just re‐studying material improves long‐term retention—a phenomenon called the ‘testing effect’. This study investigated the role of feedback and collaborative testing on the retention of course material in a tertiary educational setting. Tested material was better retained relative to non‐tested material (testing effect), and feedback facilitated correction of errors. Group testing produced higher performance on the initial, but not final test performance, compared to individual testing. This set of findings suggests that to encourage long‐term retention, educators should utilise individual formative testing with feedback; theoretical implications are also discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Testing motivational and self-regulatory mechanisms of action on device-measured physical activity in the context of a weight loss maintenance digital intervention: A secondary analysis of the NoHoW trial

BackgroundTo date, few digital behavior change interventions for weight loss maintenance focusing on long-term physical activity promotion have used a sound intervention design grounded on a logic model underpinned by behavior change theories. The current study is a secondary analysis of the weight loss maintenance NoHoW trial and investigated putative mediators of device-measured long-term physical activity levels (six to 12 months) in the context of a digital intervention.MethodsA subsample of 766 participants (Age = 46.2 ± 11.4 years; 69.1% female; original NoHoW sample: 1627 participants) completed all questionnaires on motivational and self-regulatory variables and had all device-measured physical activity data available for zero, six and 12 months. We examined the direct and indirect effects of Virtual Care Climate on post intervention changes in moderate-to-vigorous physical activity and number of steps (six to 12 months) through changes in the theory-driven motivational and self-regulatory mechanisms of action during the intervention period (zero to six months), as conceptualized in the logic model.ResultsModel 1 tested the mediation processes on Steps and presented a poor fit to the data. Model 2 tested mediation processes on moderate-to-vigorous physical activity and presented poor fit to the data. Simplified models were also tested considering the autonomous motivation and the controlled motivation variables independently. These changes yielded good results and both models presented very good fit to the data for both outcome variables. Percentage of explained variance was negligible for all models. No direct or indirect effects were found from Virtual Care Climate to long term change in outcomes. Indirect effects occurred only between the sequential paths of the theory-driven mediators.ConclusionThis was one of the first attempts to test a serial mediation model considering psychological mechanisms of change and device-measured physical activity in a 12-month longitudinal trial. The model explained a small proportion of variance in post intervention changes in physical activity. We found different pathways of influence on theory-driven motivational and self-regulatory mechanisms but limited evidence that these constructs impacted on actual behavior change. New approaches to test these relationships are needed. Challenges and several alternatives are discussed.Trial registrationISRCTN Registry, ISRCTN88405328. Registered December 16, 2016, https://www.isrctn.com/ISRCTN88405328.     

Cognitive dissonance and psychotherapy: The role of effort justification in inducing weight loss

The role of effort justification in psychotherapy was examined. It was hypothesized that the effort involved in therapy, plus the conscious decision to undergo that effort, leads to positive therapeutic changes through the reduction of cognitive dissonance. An experiment was conducted in which overweight subjects attempted to lose weight through one of two forms of “effort therapy”. These therapies were bogus in that they were based solely on the expenditure of effort on a series of cognitive tasks that were unrelated to any existing techniques or theory addressing weight loss. One of the therapies called for a high degree of effort while the degree of effort in the second therapy was low. A no-treatment control group was also included. It was predicted that greater weight loss would occur for high-effort than low-effort or control subjects, and that this weight loss would be maintained or increased over time. Results supported these predictions. Over an initial 3-week period, high-effort subjects lost slightly more weight than low-effort subjects or controls. A 6-month follow-up revealed that the effects of effort on weight loss had increased and were highly significant. Reliable differences remained even 1 year after the initial experimental sessions. Possible mechanisms mediating the dissonance effect were discussed, as were several alternative explanations.     

Pilot study testing the effects of a multicomponent intervention for increasing moderate-intensity physical exercise

Physical inactivity has been associated with several health problems, including diabetes, obesity, and heart disease. Although many of these health problems are preventable through regular exercise, a small percentage of the adult population engages in the recommended levels. Reinforcement-based interventions have been implemented successfully to promote physical activity, but studies targeting moderate or vigorous physical exercise using behavior-analytic interventions are scarce. The purpose of the current study was to investigate the feasibility of a multicomponent intervention that provided monetary incentives for increasing running, jogging, or brisk walking distance for five adults. The intervention lasted 6 weeks and comprised weekly goal setting, feedback, public posting, and group contingencies. The results of the study suggest that the intervention may be feasible and effective at increasing moderate physical activity to levels recommended by the federal guidelines, but further research is warranted.     

N-of-1 study of weight loss maintenance assessing predictors of physical activity,adherence to weight loss plan and weight change

Objective: Behaviour change interventions are effective in supporting individuals to achieve clinically significant weight loss, but weight loss maintenance (WLM) is less often attained. This study examined predictive variables associated with WLM.

Design: N-of-1 study with daily ecological momentary assessment combined with objective measurement of weight and physical activity, collected with wireless devices (Fitbit?) for six months. Eight previously obese adults who had lost over 5% of their body weight in the past year took part. Data were analysed using time series methods.

Main outcomes measures: Predictor variables were based on five theoretical themes: maintenance motives, self-regulation, personal resources, habits, and environmental influences. Dependent variables were: objectively estimated step count and weight, and self-reported WLM plan adherence.

Results: For all participants, daily fluctuations in self-reported adherence to their WLM plan were significantly associated with most of the explanatory variables, including maintenance motivation and satisfaction with outcomes, self-regulation, habit, and stable environment. Personal resources were not a consistent predictor of plan adherence.

Conclusion: This is the first study to assess theoretical predictions of WLM within individuals. WLM is a dynamic process including the interplay of motivation, self-regulation, habit, resources, and perceptions of environmental context. Individuals maintaining their weight have unique psychological profiles which could be accounted for in interventions.     

The role of self-regulation strategies and self-efficacy perceptions in successful weight loss maintenance

Abstract

The purpose of this study was to identify the self-regulatory strategies which people use to lose, maintain, or manage their weight, and to assess their self-efficacy perceptions to implement these strategies. Thirty-three (N = 33) undergraduate college students were divided into three groups based on their past weight loss experience and confirmed by their current Body Mass Index: (a) overweight participants who tried but failed to lose weight, (b) participants who used to be overweight but lost significant weight and kept it off for at least six months, and (c) participants with an optimal weight. All participants were interviewed using a structured questionnaire. Data were analyzed using a one-way ANOVA and correlation analyses. Participants who used self-regulatory strategies such as goal-setting, self-monitoring, self-evaluation, environmental structuring, time management, social assistance and information seeking were better able to maintain or lose weight. Overweight participants reported significantly less strategy use than participants who had lost weight or who had a healthy weight. In addition, overweight participants had lower self-efficacy perceptions about implementing strategies than did healthy weight participants or participants who had successfully lost weight. Finally, a path analysis revealed that participants who reported high self-efficacy perceptions and applied their strategies persistently in the face of difficulties were more likely to successfully manage their weight.     

The individual-oriented and social-oriented Chinese bicultural self: testing the theory

The author proposes a bicultural self theory for contemporary Chinese individuals, encompassing 2 main components: the individual-oriented self and the social-oriented self. The social orientation is rooted in traditional Chinese conceptualization of the self, whereas the individual orientation has evolved and developed under Western influences along with recent societal modernization. The author conducted a series of 5 studies to test the theory and relate the model to important issues in current personality and social psychological research, such as cultural individualism-collectivism, self-construals, motivation, cognition, emotion, and well-being. A total of 977 university students in Taiwan participated. The author found that contrasting self-aspects were differentially associated with the aforementioned constructs, as theoretically predicted. This evidence thus generally supported the bicultural self model.     

Effects of a physical education intervention programme for ninth-graders on physical activity-related health competence: Findings from the GEKOS cluster randomised controlled trial

The main purpose of this cluster randomised controlled trial was to investigate the effects of a physical education (PE) intervention programme combining theoretical and practical components on students' knowledge, skills, abilities and motivation related to competence for a healthy active lifestyle. The intervention used learning tasks to combine theory on health and physical fitness with either running/jumping activities or small-sided ball games and was compared to regular PE classes. Forty-eight PE classes were randomly assigned to intervention (IG-run, IG-game play; 27 classes) and control (CG-run, CG-game play; 21 classes) groups. Overall, 841 ninth-graders (51.1% girls, M_age = 14.20, SD = 0.51) were tested before and after the six-week intervention and in an eight-to-twelve-week follow-up. Students completed a health-related fitness knowledge test, questionnaires on control competence for physical training, health- and fitness-related interest and attitudes, and physical fitness tests. Regressions in structural equation models revealed positive treatment effects of the game play intervention on students' knowledge (β_StdY = 0.33, 99.6% CI [0.12, 0.55]) and control competence for physical training (β_StdY = 0.26, 99.6% CI [0.02, 0.50]) at the post-test. No significant effects were found at the follow-up test. Treatment effects were independent of gender. The results indicate the short-term effectiveness of learning tasks combining theory with ball games in order to develop knowledge and control competence for physical training in PE. Further studies have to clarify how to sustain effects over time and address students' physical fitness and health- and fitness-related interest and attitudes in interventions combining theory and practice.Trial registrationThis study was retrospectively registered with the German Clinical Trials Register (DRKS), DRKS-ID: DRKS00016349.     

Constructing a self: The role of self-structure and self-certainty in social anxiety

Current cognitive models stress the importance of negative self-perceptions in maintaining social anxiety, but focus predominantly on content rather than structure. Two studies examine the role of self-structure (self-organisation, self-complexity, and self-concept clarity) in social anxiety. In study one, self-organisation and self-concept clarity were correlated with social anxiety, and a step-wise multiple regression showed that after controlling for depression and self-esteem, which explained 35% of the variance in social anxiety scores, self-concept clarity uniquely predicted social anxiety and accounted for an additional 7% of the variance in social anxiety scores in an undergraduate sample (N = 95) and the interaction between self-concept clarity and compartmentalisation (an aspect of evaluative self-organisation) at step 3 of the multiple regression accounted for a further 3% of the variance in social anxiety scores. In study two, high (n = 26) socially anxious participants demonstrated less self-concept clarity than low socially anxious participants (n = 26) on both self-report (used in study one) and on computerised measures of self-consistency and confidence in self-related judgments. The high socially anxious group had more compartmentalised self-organisation than the low anxious group, but there were no differences between the two groups on any of the other measures of self-organisation. Self-complexity did not contribute to social anxiety in either study, although this may have been due to the absence of a stressor. Overall, the results suggest that self-structure has a potentially important role in understanding social anxiety and that self-concept clarity and other aspects of self-structure such as compartmentalisation interact with each other and could be potential maintaining factors in social anxiety. Cognitive therapy for social phobia might influence self-structure, and understanding the role of structural variables in maintenance and treatment could eventually help to improve treatment outcome.     

More than just body weight: The role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age = 21.5, SD = 4.9; mean BMI = 23.6, SD = 5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.     

The role of the self in mindblindness in autism

Since its inception the 'mindblindness' theory of autism has greatly furthered our understanding of the core social-communication impairments in autism spectrum conditions (ASC). However, one of the more subtle issues within the theory that needs to be elaborated is the role of the 'self'. In this article, we expand on mindblindness in ASC by addressing topics related to the self and its central role in the social world and then review recent research in ASC that has yielded important insights by contrasting processes relating to both self and other. We suggest that new discoveries lie ahead in understanding how self and other are interrelated and/or distinct, and how understanding atypical self-referential and social-cognitive mechanisms may lead to novel ideas as to how to facilitate social-communicative abilities in ASC.     

Changing eating behaviour vs. losing weight: the role of goal focus for weight loss in overweight women

A 6-week longitudinal study with N?=?126 overweight women participating in a weight-loss programme investigated the hypothesis that focusing on the process (dietary behaviours) rather than on the outcome of dieting (weight loss) is associated with more successful goal pursuit and achievement. As expected, process focus was related positively to subjective daily success in dieting as well as to actual weight loss, and negatively to deviations from the diet. In contrast, outcome focus had a negative impact on successful dieting: focusing on weight loss was marginally negatively related to actual weight loss and was associated with more disinhibition after lapses. Confirming hypotheses, self-regulation failure (i.e. deviations from the diet, disinhibition) was negatively related to daily affective well-being. Contrary to hypotheses, however, goal focus was not directly associated with affective well-being but only indirectly through self-regulation. Focusing on the process rather than on the outcome of dieting, then, might help achieving difficult health-related goals and support self-regulation but does not contribute directly to affective well-being.     

Posttraumatic stress and physical health among adults: The role of coping mechanisms

The purpose of the present study was to examine whether coping mechanisms predict physical health, after controlling for posttraumatic stress disorder (PTSD) symptom clusters in a non-clinical sample of adults. Data were collected from 483 adults through an online survey. Most of the participants (66.7%) reported lifetime exposure to at least one traumatic event. The final sample of this study included 319 trauma-exposed individuals. Results indicated that PTSD symptoms on the avoidance and hyperarousal clusters had significant positive relationships with self-reported physical health symptoms. After controlling for gender and PTSD, denial, behavioral disengagement, and self-blame significantly and positively predicted physical health symptoms.     

The role of self-aspects in emotions elicited by threats to physical health

In two studies, we examined the relationship between self-aspects and socially engaging and socially disengaging emotions elicited by imagined and real physical health problems. In Study 1, participants imagined themselves experiencing a health problem described in a hypothetical scenario and rated the extent to which they would experience a list of emotions. The experience of socially engaging emotions such as shame and embarrassment was predicted by the endorsement of collective self. In Study 2, participants recalled a past health problem and emotions they experienced during its course. Again, collective self predicted the extent to which people mentioned socially engaging emotions in their free recall of emotions. Independent self was not related to the imagined experience of socially disengaging emotions in Study 1 or the recollection of such emotions in Study 2.