Feasibility of a Self-Determination Theory-based exercise intervention promoting Healthy at Every Size with sedentary overweight women: Project CHANGE

ObjectivesTo examine feasibility, acceptability and preliminary results of a Self-Determination Theory (SDT) -based exercise intervention with a Healthy at Every Size (HAES) orientation for sedentary overweight/obese women.DesignProject CHANGE was an 8-week randomized controlled trial with follow-up at 4-week.MethodTwenty-five sedentary, overweight women (BMI = 25–34.9) were randomized to either the SDT-based intervention with a HAES orientation (S/H) or exercise only (EX) intervention. The S/H group received exercise training and a weekly behavioral intervention while the EX group received only traditional supervised exercise training. Information about acceptability and feasibility was collected from process evaluation (i.e., participants' satisfaction and feedback) and objective data (e.g., retention, attendance, adherence to the PA goal). Assessments of PA participation and physical/psychological variables were obtained at baseline, post-intervention, and 4-week follow-up.ResultsParticipants reported high levels of satisfaction. Participation in the S/H group averaged 95%. Retention was high for both groups (S/H = 83.3% vs. EX = 84.6%), while adherence to the PA goal was better for the S/H group at follow-up (S/H = 60% vs. EX = 36.4%). The S/H intervention also resulted in larger effect sizes for changes in key motivational variables, including self-determination, autonomy, as well as goal-setting, planning and scheduling self-efficacy.ConclusionThe 8-week SDT-based intervention promoting Healthy at Every Size is feasible and acceptable and may result in better exercise adherence and improvements in motivational variables relative to traditional supervised exercise. These results support conducting additional research to determine the efficacy of this approach for promoting PA in sedentary, overweight women.     

Preventing children's aggression: Outcomes of an early intervention

Mothers of medically at-risk infants were randomly assigned to a Healthy Start intervention (HV) or a cognitive reframing intervention (HV+). Outcome measures were taken at the conclusion of the intervention (1 year) and at the 3-year follow-up visit. At age 3, children in the HV+ condition (in comparison with those in the HV condition) showed fewer aggression problems (as measured by the Child Behavior Checklist). Maternal emotional unavailability (as measured by combined scores on the Beck Depression Inventory and avoidance items on the Conflict Tactics Scale) at the 1-year visit mediated the effects of the intervention on children's aggression at age 3. Findings suggest that an early, cognitively based intervention may lead to reduced child aggression as a result of increased maternal social-emotional availability within the caregiving relationship. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Diagnostic differences in social anhedonia: a longitudinal study of schizophrenia and major depressive disorder

This study examined the hypothesis that, in schizophrenia, elevated trait social anhedonia (SA) is a stable individual difference, whereas in depression, increased SA is a reflection of a current clinical state that will diminish with recovery. Differences in trait Negative Affect (NA) and Positive Affect (PA) were also examined. Individuals with schizophrenia (n = 55) and depression (n = 34) were evaluated at baseline during hospitalization and compared with nonpsychiatric control participants (n = 41). Participants were assessed again at a 1-year follow-up. At baseline, compared with control participants, individuals with schizophrenia and depression were both characterized by elevated SA, greater NA, and lower PA. In schizophrenic individuals, elevated SA remained stable over the follow-up. However, in recovered depressed patients, SA declined over the follow-up period. Group differences remained in NA and PA over the 1-year follow-up. These results support the view that elevated SA is enduring in schizophrenia but that elevated SA is transiently related to clinical status in depression.     

A self-regulation-based intervention to increase physical activity in cancer patients

The study examined whether a behavior-change intervention focusing on self-regulatory strategies and emphasizing role model support increases physical activity (PA) among insufficiently active (not meeting PA guidelines of 150 min/week) cancer patients. Ambulatory cancer patients [N = 72; 54% female; M = 56 years, SD = 12.34; most with breast or colon cancer (34, 15%)] were enrolled in the MOTIVACTION-study, a 4-week intervention (1-hr counseling, followed by weekly phone calls), with pretest (T1), posttest (T2) and a 10-week follow-up (T3). Participants were randomized to either an exercise or to a stress management intervention (active control). The exercise intervention emphasized self-regulatory strategies (e.g. action- and coping planning and self-monitoring); patients were also encouraged to contact a physically active same-sex role model as a potential exercise partner. The active control condition consisted of coping and relaxation techniques. Sixty-seven patients remained in the study and completed the SQUASH assessment of PA and a measure of perceived stress. PA was validated by Actigraph accelerometry. At T2, 46% of the patients in the exercise group and 19% of stress management patients increased their activity levels to meet PA guidelines (>150 min/week; χ²(1) = 5.51, p = .019). At T3, participants in the exercise intervention maintained their exercise level (46%), but also 31% of the stress management patients met the guidelines. All patients reported reductions in perceived stress. Additional analyses comparing patients in the exercise group by role model contact (63% realized contact) revealed that those who had contact with their role model were significantly more likely to adhere to the recommended guidelines (T2:50%; T3:64%) compared to those who did not have contact with a role model (T2:39%; T3:15%), suggesting the potential of mobilizing role model support to facilitate PA. In sum, cancer patients may not only benefit from an exercise intervention emphasizing self-regulation, but also from stress management, regarding both reducing stress and increasing PA.     

Motivational interviewing as a way to promote physical activity in obese adolescents: A randomised-controlled trial using self-determination theory as an explanatory framework

Using self-determination theory (SDT) as an explanatory framework, this randomised-controlled study evaluates the effect of a motivational interviewing (MI)-based intervention as an addition to a standard weight loss programme (SWLP) on physical activity (PA) practice in obese adolescents over a six-month period. Fifty-four obese adolescents (mean age?=?13?years, mean BMI?=?29.57?kg/m²) were randomly assigned to an SWLP group (n?=?28) or SWLP?+?MI group (n?=?26). Both groups received two SWLP sessions, supplemented for the SWLP?+?MI group, by six MI sessions. Perceived autonomy support, perceived competence, motivational regulations, PA and BMI were assessed at baseline, three and six months (i.e. the end of the programme). MLM analyses revealed that compared to SWLP, the SWLP?+?MI group had a greater BMI decrease and a greater PA practice increase over time. Moreover, the SWLP?+?MI group reported greater autonomy support from medical staff at the end of the programme, greater increase in integrated and identified regulations and a stronger decrease in amotivation. MI appears as an efficient counselling method as an addition to an SWLP to promote PA in the context of pediatric obesity.     

Reduced substance use as a secondary benefit of an indicated cognitive-behavioral adolescent depression prevention program

Our first aim was to test whether a group cognitive-behavioral (CB) depression prevention program reduces substance use escalation over 2-year follow-up relative to two active comparison interventions and a brochure assessment control. Our second aim examined whether reductions in depressive symptoms mediate intervention effects, as posited by the affect-regulation model of substance use. In this indicated prevention trial, 341 high school adolescents at risk for depression because of the presence of elevated depressive symptoms were randomized to a Group CB intervention, group supportive-expressive group intervention, CB bibliotherapy, or educational brochure control condition. Participants in Group CB had significantly lower rates of substance use compared with brochure control participants at both 1- and 2-year follow-up and lower substance use at 2-year follow-up relative to bibliotherapy participants; no other condition differences were significant. Mediational analyses suggested that reductions in depressive symptoms from baseline to posttest accounted for changes in substance use over 2 years for participants in Group CB relative to brochure control participants but did not mediate effects relative to those receiving bibliotherapy. Results suggest that a secondary benefit of this CB group indicated depression prevention program is lower rates of long-term substance use. Findings supported the hypothesis that, relative to a nonactive comparison condition, reductions in depressive symptoms mediated the effects of Group CB prevention on substance use escalation. (PsycINFO Database Record (c) 2012 APA, all rights reserved).     

Testing mediator variables in a physical activity intervention for women with type 2 diabetes

ObjectivesA limited understanding of the mechanisms of behavior change has hindered the development of more effective interventions. The aim of this study was to identify potential mediators of objectively measured physical activity (PA) behavior change in women with type 2 diabetes (T2DM).DesignMediation test of a randomized controlled trial.MethodWomen with T2DM (n = 93) from the control group (standard PA materials, n = 44) and the full intervention group (control + stage-matched printed material and telephone counseling, n = 49) of a larger PA intervention trial were included. PA outcomes were minutes of MET weighted moderate and vigorous PA/week (self-report) and steps/3-days (objective) recorded at baseline and 12-months. Social-cognitive constructs were measured and tested in a mediating variable framework.ResultsPerceived behavioral control and barrier self-efficacy mediated intervention effects on objective PA (proportion of intervention effect mediated = 18% and 24% respectively). Intention was a mediator of objective PA (23%).ConclusionPerceived behavior control, barrier self-efficacy, and intention are effective mechanisms of PA behavior change in women with T2DM.     

Motivational interviewing and self-determination theory in a web-based computer tailored physical activity intervention: A randomized controlled trial

Objective: This study explores whether a web-based physical activity (PA) intervention grounded in self-determination theory (SDT) and motivational interviewing (MI) is more effective and better appreciated than a traditional web-based PA intervention.

Design: A randomized controlled trial was conducted, comparing (1) I Move; a web-based PA intervention based on SDT and MI, (2) Active Plus; a traditional web-based PA intervention and (3) a waiting list control condition.

Main outcome measures: Weekly minutes of moderate to vigorous PA and weekly days with ≥30 min PA were measured through self-report at baseline and at 3 and 6 months from baseline.

Results: I Move achieved a small, but significant increase in weekly minutes of moderate to vigorous PA, while Active Plus did not have a significant impact on this outcome. Both interventions were effective in increasing weekly days with ≥30 min PA, whereas Active Plus yielded a greater effect on this outcome.

Conclusion: Overall, the web-based PA intervention grounded in SDT and MI did not outperform the traditional web-based PA intervention. Further research should reveal whether this type of intervention is profitable for long-term maintenance of PA levels.     

Long-term effects of educational and peer discussion group interventions on adjustment to breast cancer.

The authors report a 3-year follow-up of the effects of 8-week support group interventions on the quality of life of women with early stage breast cancer. Shortly after diagnosis, women were randomly assigned to 1 of 4 conditions: control, education, peer discussion, and education plus peer discussion. The education group intervention focused on providing information to enhance control over the illness experience, whereas the peer discussion group intervention focused on providing emotional support through the expression of feelings. Consistent with the results that emerged 6 months after the interventions (V. S. Helgeson, S. Cohen, R. Schulz, & J. Yasko, 1999), the authors found that the benefits of the education intervention were maintained over a 3-year period (N=252), although effects dissipated with time. The authors continued to find no benefits of the peer discussion intervention, either alone or in combination with education.     

Psychosocial mediation of fruit and vegetable consumption in the body and soul effectiveness trial.

In this study the authors examined psychosocial variables as mediators for fruit and vegetable (FV) intake in a clustered, randomized effectiveness trial conducted in African American churches. The study sample included 14 churches (8 intervention and 6 control) with 470 participants from the intervention churches and 285 participants from the control churches. The outcome of FV intake and the proposed mediators were measured at baseline and at 6-month follow-up. Structural equation modeling indicated that the intervention had direct effects on social support, self-efficacy, and autonomous motivation; these variables also had direct effects on FV intake. Applying the M. E. Sobel (1982) formula to test significant mediated effects, the authors confirmed that social support and self-efficacy were significant mediators but that autonomous motivation was not. Social support and self-efficacy partially mediated 20.9% of the total effect of the intervention on changes in FV intake. The results support the use of strategies to increase social support and self-efficacy in dietary intervention programs.     

A growth mindset intervention to improve mental health in adolescents during COVID-19

COVID-19 poses a considerable threat to adolescent mental health. We investigated depression rates in teens from pre to post-COVID. We also explored if leveraging a growth mindset intervention (“Healthy Minds”) could improve adolescent mental health outcomes during the pandemic, especially for adolescents experiencing the most distress. In Study 1, we recruited youth from schools in a rural southern community (N = 239) and used a pre-post design. In Study 2, we recruited an online sample (N = 833) and used a longitudinal randomized control trial design to test the effectiveness of Healthy Minds. Across both studies, there is evidence of higher rates of depression in youth during COVID-19, relative to pre-pandemic numbers. In Study 1, the intervention effectively changed psychological and behavioral processes related to mental health, especially for adolescents experiencing greater COVID-19 stress. However, in Study 2, the intervention failed to impact depression rates or symptoms at follow-up.     

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.     

Randomized Face-to-face vs. Home exercise interventions in pregnant women with gestational diabetes

ObjectivesEvaluate effects of a theoretically-based, semi-intensive (Face-to-Face; F2F) exercise intervention and minimum-contact (Home) exercise intervention to the standard care (Control) on exercise, its motivational determinants, blood glucose levels, and insulin use of pregnant women with gestational diabetes mellitus (GDM).DesignRandomized control trial with two intervention arms and control (standard care).MethodParticipants (N = 65) were randomized to a Control (standard prenatal care/GDM dietary counseling), Home (standard care + phone education/support + home exercise), or F2F (standard care + on-site education/support + guided exercise with instructor on 2 days/week) group from ∼20 weeks gestation to delivery. Assessments of exercise and motivational determinants were obtained at baseline (20-weeks gestation) and follow-up (32-weeks gestation). Blood glucose levels (fasting/postprandial mg/dL) and insulin use were extrapolated from medical records.ResultsAt the 32-week follow-up, the F2F group had significantly higher exercise min, pedometer steps/day, and motivational determinants (attitude, subjective norm, perceived control, intention) than controls (p's < 0.05) and significantly higher exercise min and subjective norm than the Home group (p's < 0.05); these effect sizes were medium-large (η² = 0.11-0.23). There was a medium effect (η² = 0.13) on postprandial blood glucose at 36-weeks gestation with the F2F group having lower values than controls. Although not significant, the F2F group started insulin later (33 weeks gestation) than the Home (27 weeks) and Control (31 weeks) groups.ConclusionA theoretically-based, F2F exercise intervention has multiple health benefits and may be the necessary approach for promoting exercise motivation and behavior among GDM women.     

Effects of cognitive-behavioural therapy on anxiety,depression and condom use in people with HIV in Mexico City: a pilot study

Anxiety and depression in people living with HIV (PLWH) are negatively associated with healthy sexual behaviours. We pilot-tested a Cognitive-Behavioural Therapy (CBT)-based intervention to reduce anxiety and depression, aimed to increase serostatus disclosure to sexual partners, quality of sexual life (QoSL) and condom use. The study had a single-case experimental design (AB) with follow-up measures. Eleven PLWH with moderate/severe anxiety/depression received six-module CBT intervention delivered in ten one-hour individual weekly sessions. Anxiety, depression, consistent/correct condom use and QoSL were measured. Depression and anxiety decreased after the intervention (depression baseline [BL] Mdn = 21, final [F] Mdn = 3, z = -2.934, p = .003; anxiety BL Mdn = 30, F Mdn = 4, z = -2.941, p = .003). QoSL improved (BL Mdn = 28, F Mdn = 13, z = -2.625, p = .009), along with participants’ ability to use condoms (57.14 vs.100, z = -2.937, p = .003). Effect size was large, changes were maintained at follow-up measurements. The CBT intervention had positive effects in reducing anxiety and depression, which could facilitate the acquisition of healthy sexual behaviours. Further studies are important to clarify the benefits of targeting emotional variables to improve wellbeing and prevention behaviours in PLWH.     

Kinaesthetic imagery ability moderates the effect of an AO+MI intervention on golf putt performance: A pilot study

BackgroundPrevious research has established that motor imagery (MI) and action observation (AO) independently enhance the performance and learning of motor skills. Recent studies have demonstrated that combining AO and MI (AO + MI) elicits increased activity in motor regions of the brain and enhances performance more than either AO or MI alone. Kinesthetic imagery (KI) ability refers to the ease with which one can sense their own body and imagine how a movement feels during a task (Malouin et al., 2007). KI ability may be of particular importance when engaging with AO + MI as the provision of an external visual stimulus through AO renders the visual component of MI redundant.ObjectiveThe current study aims to add to the emerging body of behavioural evidence demonstrating the performance benefits of AO + MI by exploring the effect of an AO + MI intervention on golf putting performance, as well as exploring the role that KI ability represents in AO + MI effectiveness.MethodRight-handed male golfers (N = 44) of varying skill level performed twenty 15-foot putts before and after a 3.5 min AO + MI intervention (AO + MI group; mean handicap = 7.5, SD = 4.3) or a similarly timed passive reading task (Control group; mean handicap = 11.5, SD = 5.4). Using the MIQ-3 questionnaire, participants in both experimental groups were classified according to kinesthetic imagery ability where: a mean score ≥6 were classified as good imagers. Performance accuracy was measured using mean radial error (MRE), precision was quantified via bivariate error (BVE) and putter kinematics were recorded by SAM Puttlab.ResultsResults from a series of ANCOVAs indicate that good kinesthetic imagers who received the AO + MI intervention were significantly more precise (BVRE) on the putting task than good kinesthetic imagers in the Control group (p = 0.041, d = 0.678). Good kinesthetic imagers in the intervention group also significantly outperformed good kinesthetic imagers in the control group on a measure of speed control (SD of error scores along the axis of progression) in golf putting (p = 0.041).ConclusionsOur results suggest that the presence of AO with MI increases the relevance of kinesthetic cues, that good kinesthetic imagers are able to utilise for subsequent performance benefits during the putting task. We discuss the increased importance of kinesthetic awareness/feel following the intervention as an explanation for such improvements in performance.     

Do government brochures affect physical activity cognition? A pilot study of Canada's physical activity guide to healthy active living

Health Canada has published national physical activity (PA) guidelines, which are included in their 26-page Physical Activity Guide to Healthy Active Living (CPAG). To date, the use of CPAG as a motivational instrument for PA promotion has not been evaluated. The purpose of this study was to determine whether reading CPAG 1) increased motivational antecedents to engage in regular PA, and 2) increased regular PA intention and behaviour over 1 month. Participants included 130 randomly sampled Canadian adults (18 years or older) who were randomly mailed pack ages consisting of either 1) a questionnaire and a copy of CPAG, or 2) a questionnaire. Questionnaire items pertained to participants' sociodemographics, previous PA behaviours (Godin Leisure-Time Questionnaire) and PA motivation (theory of planned behaviour). Participants were then sent a follow-up questionnaire pertaining to their PA behaviours throughout the previous month. Results revealed significant interactions between the guide condition and previous activity status on instrumental behavioural beliefs about strength activities and subjective norms about endurance activities (p < 0.05), but all other factors were not significantly different. It was concluded that among previously inactive people, receiving this guide may change some informational/motivational constructs, but key motivational antecedents (affective attitude, perceived behavioural control) and outcomes (intention, behaviour) seem unaffected.     

Transfer from discrimination under hunger to discrimination under thirst: The role of expectancy and habit

The experimental group (Group HA-TA) received food (F) and water (W) rewarded trials in an alternating sequence under hunger in Phase 1 and under thirst in Phase 2. Group HA-TA ran faster on F than on W trials in Phase 1, and faster on W than on F trials in Phase 2. Early in Phase 2 the difference between speeds on W and F trials was larger for Group HA-TA than for a group which received no runway training in Phase 1 (Group HO-TA), but later in Phase 2 this difference was larger for Group HO-TA than for Group HA-TA. Also in Phase 2 the difference between speeds on W and F trials was larger for Group HA-TA than for a group which received a random sequence of F and W trials under hunger in Phase 1, and smaller for Group HA-TA than for a group which received alternating F and W trials under thirst in both phases. To interpret these results it was assumed that for Group HA-TA the expectancies of reward formed in Phase 1 facilitated development of alternation performance in Phase 2, but that the S-R associative connections formed in Phase 1 inhibited ultimate development of alternation performance in Phase 2.     

Internalized weight stigma mediates and moderates physical activity outcomes during a healthy living program for women with high body mass index

ObjectivesTo investigate the influence of internalized weight stigma (IWS) on physical activity (PA) outcomes among women with body mass index (BMI) over 30 kg/m².Design and methodData were drawn from an RCT that included 80 primarily inactive women (94% non-Hispanic/Latina white; mean age = 39.6, SD = 4.1, range = 30.0 to 45.0; mean BMI = 38.0 kg/m², SD = 3.9, range = 30.2–44.8 kg/m². Participants completed a 6 month weight-neutral, health-at-every-size or weight-loss-focused group-based healthy living program. PA enjoyment and engagement in moderate-intensity PA (MI-PA) (at least 30 minutes most days of the week) were assessed at baseline and immediately post-intervention. We used intention-to-treat linear mixed-effects modeling to test IWS as a moderator of changes in MI-PA engagement. We also tested a model whereby the positive effects of participating in the program on engagement in MI-PA would be serially mediated by a reduction in IWS and a concomitant increase in MI-PA enjoyment.ResultsThe weight-neutral and weight-loss-focused data were combined for all analyses. The moderation hypothesis was supported with a significant interaction between IWS and time. Participants had significant gains overall in MI-PA engagement from baseline to post-intervention; however, those with high IWS had an attenuated response. The serial mediation model was also supported. The positive effect of the program on engagement in MI-PA occurred through decreased IWS and increased MI-PA enjoyment.ConclusionsSelf-directed stigma and holding negative attitudes about one's weight interferes with positive changes in PA outcomes. Healthy living programs may be less effective for those most vulnerable unless we aim to reduce IWS.     

Impulsivity: core aspect of borderline personality disorder

This prospective follow-up study addresses whether impulsivity versus other aspects of borderline personality disorder (BPD) are (1) stable over a 7-year follow-up period; (2) able to predict the persistence versus remittance of BPD over 7 years of follow-up, and (3) more predictive of the level of borderline psychopathology on follow-up than other aspects of the disorder. When the cohort was assembled, 88 of 130 subjects scored seven or higher on the Diagnostic Interview for Borderlines (DIB), indicating a definite diagnosis of BPD. The cohort was reassessed at 2 and 7 years after the index admission. At the 7-year follow up, 81(62.3%) of the original cohort were re-examined, two (1.6%) were deceased, six (4.6%) suicided, 36 (27.7%) refused to participate and five (3.8%) could not be located. The results indicated that the initial impulse action subscale score was highly correlated with the 7-year follow-up score (r = 0.53). Using a stepwise multiple regression technique, the impulse action subscale score from the DIB best predicted borderline psychopathology at the 7-year follow up, with an r2 of 0.24, F = 24.84, p < 0.001. This prospective study of subjects with BPD indicates that impulsivity is stable over time and highly predictive of borderline psychopathology over 7 years follow up. These results suggest the treatment of impulsivity may impact the course of BPD.