Effects of exercise self-regulation on subsequent eating self-regulation: Implications for depletion vs. improvement based on behavioral treatment foci

IntroductionAn improved understanding of individuals’ ability to self-regulate through barriers in the management of their weight-loss behaviors is important. Although self-regulation related to exercise might carry-over to increased eating-related self-regulation through the development of such skills, it also might be depleted because self-regulation is thought to be a limited resource. Additionally, mood might affect self-regulation change.ObjectiveThis field study aimed to determine if exercise-related self-regulation was associated with subsequent eating-related self-regulation, how treatment foci affected that relationship, and if mood change concurrently influenced self-regulation.MethodAn educational weight-loss treatment (n = 52) and a behaviorally based self-regulatory-focused treatment (n = 57) was administered to women with obesity via a community health-promotion setting. Baseline – Month 3 changes in their exercise self-regulation and overall negative mood, and Months 3–6 change in eating self-regulation, were assessed.ResultsImprovements were significantly greater in the self-regulation treatment group on exercise self-regulation, eating self-regulation, and mood. For the self-regulation group, there was a significant positive relationship between changes in exercise self-regulation and eating self-regulation, β = 0.27, p = 0.044. Conversely, the association of those variables was significant and inverse in the educational group, β = −0.29, p = 0.039. Reduction in negative mood was significantly related to increased exercise self-regulation, across groups, β = −0.32, p = 0.001.ConclusionWhen self-regulation was focused upon and rehearsed within an exercise context, its changes positively affected subsequent changes in eating self-regulation. However, when self-regulation was not targeted, self-regulation used for maintaining exercise depleted eating-focused self-regulation. Findings contributed to self-regulatory theory and had implications for the improvement of behavioral weight-loss treatments.     

Symptoms of Meares-Irlen/Visual Stress Syndrome in subjects diagnosed with Chronic Fatigue Syndrome

Several diagnostic symptoms of the visual-processing deficit Meares-Irlen/Visual Stress Syndrome are remarkably similar to symptom manifestations reported by individuals with chronic fatigue syndrome (CFS). We surveyed the specific incidences of nine widely-recognised symptoms of visual stress (VS) in a group of subjects (n = 20) previously diagnosed with CFS. The presence of each symptom of VS in the CFS group was compared to its respective presence in both an age and sex matched healthy comparison group (n = 46), and an age and sex matched group comprised of individuals (n = 14) diagnosed with VS. Results showed the frequencies of all nine VS symptoms in the CFS-diagnosed group to be significantly higher (p = .032 – p < .0005) than in the comparison group, with only two symptoms being statistically less frequent in the CFS group than in the VS-diagnosed group. The average number of VS symptoms reported by the CFS group was also significantly higher than the comparison group, yet not significantly different from the VS group. Thus, the occurrence of VS symptoms in subjects diagnosed with CFS appears to be far greater than previously reported, which in turn may indicate the interplay of some yet to be identified underlying factor(s) common to both conditions.     

Generalization of theory-based predictions for improved nutrition to adults with morbid obesity: Implications of initiating exercise

Exercise is a robust predictor of long-term success with weight loss, and research based on social cognitive theory suggests that exercise program-induced changes in self-regulation, mood, and self-efficacy transfer to improved eating. These relationships were tested in adults with morbid obesity (overall M_age = 43 years; 86% female; M_{body mass index} = 45 kg/m²) participating in a 6-month treatment of cognitive-behaviorally supported exercise paired with either standard nutrition education (n = 87) or cognitive-behavioral methods for controlled eating (n = 89). Based on multiple mediation analyses, improvements in self-regulation and self-efficacy were significantly associated with increased fruit and vegetable intake and reduced body mass index (BMI). The cognitive-behavioral nutrition methods were associated with greater improvements in fruit and vegetable intake and BMI, however, within both models, complete mediation was found after simultaneous entry of changes in self-regulation, mood, and self-efficacy, and exercise volume as mediators. Only the indirect effect of change in self-regulation was a significant (or marginally significant) independent mediator. Generalization of previously identified relationships between exercise program-induced improvements in psychosocial variables and improvements in nutrition and BMI were supported for individuals with morbid obesity. Based on these relationships, implications for behavioral treatments were discussed.     

Experiential avoidance in body dysmorphic disorder

Experiential avoidance (i.e., the attempt to avoid certain internal experiences including bodily sensations, thoughts, emotions, memories, and urges) has been studied in various psychological disorders. However, research examining experiential avoidance in individuals with body dysmorphic disorder (BDD) is limited and inconsistent. The present study compared experiential avoidance in individuals with primary BDD (n = 23) to healthy controls (n = 22). Standardized measures were used to assess baseline clinical characteristics as well as experiential avoidance. Compared to healthy controls, individuals with BDD presented with significantly greater experiential avoidance (p < .001, d = −2.51). In BDD, experiential avoidance was positively correlated with depressive symptoms (p < .01) and avoidant coping strategies (p < .01). Clinician sensitivity to experiential avoidance may serve to improve the course of treatment for BDD.     

The link between stress,well-being,and psychological flexibility during an Acceptance and Commitment Therapy self-help intervention

Background/Objective: Prolonged stress can overwhelm coping resources, leading people to seek mental health care. Acceptance and commitment therapy (ACT) is an intervention that enhances well-being and reduces distress, assumedly by means of increasing psychological flexibility (PF). We examined the association between a total increase in PF during an intervention and decreases in stress and increases in well-being during and after the intervention. Method: The intervention was a randomized controlled trial of an ACT-based self-help intervention. Participants were 91 individuals reporting elevated levels of work-related stress. Measurements were completed at preintervention, postintervention, and 3-month follow-up. Results: Structural equation models revealed that the total increase in PF during the intervention was negatively associated with a decrease in stress (b = -0.63, SE = 0.14, p < .001) and positively associated with an increase in well-being during the intervention (b = 0.48, SE = 0.11, p < .001), but not with a decrease in stress (b = 0.03, SE = 0.27, p > .05) and well-being (b = -0.04, SE = 0.39, p > .05) following the intervention. Conclusions: Our study provides empirical support for decreasing stress and promoting well-being through ACT and emphasizes the potential of PF in promoting well-being.     

A randomized controlled trial of strong minds: A school-based mental health program combining acceptance and commitment therapy and positive psychology

To date, most early intervention programs have been based on emotion regulation strategies that address dysfunctional cognitive appraisals, problem-solving skills, and rumination. Another emotion regulation strategy, ‘acceptance’ training, has largely been overlooked. To examine the efficacy of this strategy, a school-based mental health program combining positive psychology with acceptance and commitment therapy (Strong Minds) was evaluated in a randomized controlled trial with a sample of 267 Year 10 and 11 high-school students in Sydney, Australia. Mixed models for repeated measures examined whether the program led to reductions in symptoms amongst students who commenced the program with high depression, anxiety, and stress scores, and increased wellbeing scores amongst all students. Results demonstrated that compared to controls, participants in the Strong Minds condition with elevated symptom scores (n = 63) reported significant reductions in depression (p = .047), stress (p = .01), and composite depression/anxiety symptoms (p = .02) with medium to strong effect sizes (Cohen's d = 0.53, 0.74, and 0.57, respectively). Increased wellbeing (p = .03) in the total sample and decreased anxiety scores (p = .048) for students with elevated symptoms were significant for Year 10 students with medium effect sizes (Cohen's d = 0.43 and 0.54, respectively). This study tentatively suggests that including the emotion regulation strategy of acceptance in early intervention programs may be effective in reducing symptoms and improving wellbeing in high school students. Further research to investigate the generalizability of these findings is warranted.     

The effects of aerobic- versus strength-training on body image among young women with pre-existing body image concerns

This experiment compared the effects of aerobic-training (AT) versus strength-training (ST) on body image among young women with pre-existing body image concerns. Theory-based correlates of body image change were also examined. Participants were 46 women (M age = 21.5 years), randomly assigned to an 8-week AT or ST intervention consisting of supervised exercise 3 days/week. Multidimensional measures of body image were administered pre- and post-intervention, along with measures of physical fitness, perceived fitness, and exercise self-efficacy. Women in the AT condition reported greater reductions in social physique anxiety (p = .001) and tended to report greater improvements in appearance evaluation (p = .06) than women in the ST condition. Changes in perceived fatness, perceived aerobic endurance and aerobic self-efficacy were significantly correlated with body image change (ps < .003). Results provide direction for prescribing exercise to improve body image and advancing theory to account for the effects of exercise.     

Maternal postpartum depressive symptoms and infant externalizing and internalizing behaviors

Maternal postpartum depression has been shown to be one of the main predictors of externalizing and internalizing behaviors in toddlers and adolescents. Research suggests that presence of such behaviors can be observed as early as infancy. The current study uses longitudinal data from 247 mothers to examine the relationship between postpartum depressive symptoms at 8 weeks and the infant's externalizing and internalizing behaviors at 12 months. In unadjusted linear regression models, there were associations between postpartum depressive symptoms and infant externalizing behaviors (β = 0.082, SE = 0.032, p = 0.012) and internalizing behaviors (β = 0.111, SE = 0.037, p = 0.003). After controlling for potential confounding factors, including maternal age, race, education, home ownership, smoking status in the postpartum period, marital status, parenting stress, and happiness from becoming a parent, the associations between postpartum depressive symptoms and infant externalizing (β = 0.051, SE = 0.034, p = 0.138) and internalizing behaviors (β = 0.077, SE = 0.040, p = 0.057) were reduced and became non-significant. Furthermore, in these models the total amount of variance explained was 17.2% (p < 0.0001) for externalizing behaviors and 10.5% (p < 0.01) for internalizing behaviors; the only significant predictor of externalizing behaviors was maternal age (β = −0.074, SE = 0.030, p = 0.014), and of internalizing behaviors was white non-Hispanic ethnicity (β = −1.33, SE = 0.378, p = 0.0005). A combined effect of the confounding factors seems to explain the finding of no significant independent association between postpartum depressive symptoms and infant externalizing and internalizing behaviors.     

Depression mediates the relationship between social performance impairment and hostility

The goal of this study was to test depressive symptoms as a mediator between social difficulties and hostility in young adults. Hostility is often a reaction to both intrinsic and extrinsic factors; therefore a greater understanding of contributing factors is needed, especially among emerging adults. College students (n = 608; 408 females, 200 males) self-reported on social difficulties, depression, and hostility. Via exploratory factor analyses, two latent constructs related to social difficulty were identified: social performance and social motivation. Using structural equation modeling, the direct effects found that poor social performance was significantly positively associated with BPAQ Total (β = .44, p < .01). Social motivation was not associated with BPAQ Total (β = −.07, p = .21). Further, depression scores were found to partially mediate the relationship between social performance deficits (β = .34, p < .01; 95% CI = .05–.16), but not social motivation (β = −.06, p > .05; 95% CI = −.04 to .04), and overall aggression. Results are discussed in terms of the influence of negative affect and impaired emotion regulatory processes on hostility as a consequence of social performance deficits.     

The mediating role of self-esteem in the relationship between big five personality traits and depressive symptoms among Chinese undergraduate medical students

The objectives of this study were to examine the correlations between big five personality traits and depressive symptoms among Chinese undergraduate medical students, and to explore the mediating role of self-esteem on the correlations. Self-reported questionnaires, including Big Five Inventory, the Center for Epidemiologic Studies Depression Scale, Rosenberg’s Self-Esteem scale, and socio-demographic section were distributed to 2000 undergraduate medical students at four medical colleges and universities in Liaoning province, China, in June 2014. 1738 students became the final subjects. After adjustment for age and gender, agreeableness (β = −0.329) and openness (β = −0.096) were negatively related to depressive symptoms, while neuroticism (β = 0.245) was positively related to the symptoms. Self-esteem functioned as a mediator in the relationship between agreeableness (a * b = −0.154, 95% CI: −0.182, −0.127)/openness (a * b = −0.097, 95% CI: −0.124, −0.069)/neuroticism (a * b = 0.031, 95% CI: 0.007, 0.058) and depressive symptoms. Therefore, identifying at-risk students and undertaking appropriate intervention strategies that focus on both personality traits and self-esteem may be effective in preventing and reducing depressive symptoms among Chinese medical students.     

Rumination and depression in Chinese university students: The mediating role of overgeneral autobiographical memory

ObjectiveIn this study, we examined the mediator effects of overgeneral autobiographical memory (OGM) on the relationship between rumination and depression in 323 Chinese university students.Method323 undergraduates completed the questionnaires measuring OGM (Autobiographical Memory Test), rumination (Ruminative Response Scale) and depression (Center for Epidemiologic Studies Depression Scale).ResultsResults using structural equation modeling showed that OGM partially-mediated the relationship between rumination and depression (χ² = 88.61, p < .01; RMSEA = .051; SRMR = .040; and CFI = .91). Bootstrap methods were used to assess the magnitude of the indirect effects. The results of the bootstrap estimation procedure and subsequent analyses indicated that the indirect effects of OGM on the relationship between rumination and depressive symptoms were significant.ConclusionThe results indicated that rumination and depression were partially mediated by OGM.     

Assessing Decentering: Validation,Psychometric Properties,and Clinical Usefulness of the Experiences Questionnaire in a Spanish Sample

Decentering is defined as the ability to observe one’s thoughts and feelings in a detached manner. The Experiences Questionnaire (EQ) is a self-report instrument that originally assessed decentering and rumination. The purpose of this study was to evaluate the psychometric properties of the Spanish version of EQ-Decentering and to explore its clinical usefulness. The 11-item EQ-Decentering subscale was translated into Spanish and psychometric properties were examined in a sample of 921 adult individuals, 231 with psychiatric disorders and 690 without. The subsample of nonpsychiatric participants was also split according to their previous meditative experience (meditative participants, n = 341; and nonmeditative participants, n = 349). Additionally, differences among these three subgroups were explored to determine clinical validity of the scale. Finally, EQ-Decentering was administered twice in a group of borderline personality disorder, before and after a 10-week mindfulness intervention. Confirmatory factor analysis indicated acceptable model fit, _sbχ² = 243.8836 (p < .001), CFI = .939, GFI = .936, SRMR = .040, and RMSEA = .06 (.060–.077), and psychometric properties were found to be satisfactory (reliability: Cronbach’s α = .893; convergent validity: r > .46; and divergent validity: r < − .35). The scale detected changes in decentering after a 10-session intervention in mindfulness (t = − 4.692, p < .00001). Differences among groups were significant (F = 134.8, p < .000001), where psychiatric participants showed the lowest scores compared to nonpsychiatric meditative and nonmeditative participants. The Spanish version of the EQ-Decentering is a valid and reliable instrument to assess decentering either in clinical and nonclinical samples. In addition, the findings show that EQ-Decentering seems an adequate outcome instrument to detect changes after mindfulness-based interventions.     

Assessment of Person-Centered Care in Gerontology Services: A new tool for healthcare professionals

Background/Objective: Retirement homes and other gerontology services are frequently criticized due to their lack of flexibility and tailored attention, leading to homogeneous treatment which compromises patients’ control of their lives. This study aims to develop and validate the first Spanish instrument for healthcare professionals to assess the degree of person-centered attention delivered by senior care centers. Method: A total of 844 healthcare professionals (mean age = 39.94 years old; SD = 10.56) with a mean of 6.56 years (SD = 6.15) of work experience participated in the study. The psychometric properties of the questionnaire developed were analyzed using both classical test theory and item response theory models. Results: The internal structure was unidimensional with an explained variance of 55.23%. Reliability was outstanding: internal consistency (α = .96, ω = .96) and test-retest (r = .88; ICC = .93). The total score was significantly correlated with two similar questionnaires, with associated variance of 58.83% and 55.20% respectively. Conclusions: The new instrument allows healthcare professionals to assess the level of person-centered care provided by gerontology centers with excellent reliability and validity.     

Drive for leanness and health-related behavior within a social/cultural perspective

We examined relationships between drive for leanness and perceived media pressure to change appearance, internalization of an ideal physique, exercise frequency, and dieting. Men and women (N = 353) completed the Drive for Leanness Scale, the Sociocultural Attitudes Toward Appearance Questionnaire-3, the Eating Attitudes Test-26, and a demographic inventory. Drive for leanness was significantly correlated with athletic internalization (.52), pressure to attain an ideal physique (.25), exercise frequency (.36), and dieting (.25). Structural equation modeling revealed a good fitting model (χ² = 2.85, p < .241; CFI = .99; NNFI = .98; RMSEA = .04; SRMR = .02) with internalization predicting drive for leanness, which in turn predicted dieting and exercise. Results reveal social/cultural theory helps enhance the understanding of the drive for leanness and its relationship with health-related behavior.     

Transdiagnostic and Transcultural: Pilot Study of Unified Protocol for Depressive and Anxiety Disorders in Japan

Unified protocol (UP) is a transdiagnostic cognitive behavior therapy for emotional disorders. It remains unknown whether UP is applicable for use in non-Western countries and for depressive disorders. We therefore examined its feasibility for a Japanese clinical population using this clinical trial design, which is multicentered, open-labeled, and single-armed (Clinical registry: UMIN000008322). The primary outcome was severity of anxiety symptoms, as assessed using Structured Interview Guide for the Hamilton Anxiety Rating Scale. Secondary outcomes were depressive symptoms, clinical global impression, functioning, quality of life, affectivity, emotion regulation, and adverse events. Of the 28 prospective participants, 17 were eligible and enrolled (depressive disorders = 9, anxiety disorders = 8). Severity of anxiety symptoms, which decreased significantly after the intervention, remained low for 3 months (Hedges’ g = 1.29, 95% CI = 0.56–2.06). Similar tendencies were observed for secondary outcome measures. No severe adverse event occurred. Two participants dropped out of the intervention. High treatment adherence and interrater reliability were confirmed. Results suggest the feasibility of UP in the Japanese context sufficient to warrant a larger clinical trial.     

Predictors of aerobic physical activity and resistance training among Canadian adults with type 2 diabetes: An application of the Protection Motivation Theory

BackgroundIt is well established that both aerobic physical activity (PA) and resistance training are essential in the treatment and management of type 2 diabetes (T2D), but few studies have examined the determinants of both modes of PA in the same sample.PurposeThe main objective was to investigate the utility of the Protection Motivation Theory (PMT) in predicting aerobic PA and resistance training in a population sample of T2D adults.MethodsA total of 244 individuals completed self-report PMT constructs of vulnerability, severity, fear, response efficacy, self-efficacy and intention, and a 3-month follow-up that assessed aerobic PA and resistance training.ResultsPMT explained 19% (p < .001) and 20% (p < .001) of the variance respectively for aerobic PA and resistance training behaviour. Significant associations were found between self-efficacy (β = 0.45, p < .001) and gender (β = 0.15, p < .05) for aerobic PA, and self-efficacy (β = 0.48, p < .001) and age (β = 0.17, p < .05) for resistance training. PMT accounted for 43% (p < .001) and 56% (p < .001) of the variance respectively for aerobic PA and resistance training intentions. For aerobic PA, response efficacy (β = 0.14, p < .05) and self-efficacy (β = 0.59, p < .001) were significantly associated with intention, while response efficacy (β = 0.23, p < .001), self-efficacy (β = 0.64, p < .001) and age (β = 0.10, p < .05) were significantly related with resistance training intention.ConclusionsNone of the unique constructs of the PMT (i.e., perceived vulnerability, severity and fear) were significant with either aerobic and resistance training intention. These results may guide the development of effective PA interventions in people with T2D.     

Adolescents with and without a facial difference: The role of friendships and social acceptance in perceptions of appearance and emotional resilience

This study investigated the role of friendships and social acceptance in self-perceptions of appearance and depressive symptoms, comparing adolescents with and without a facial difference. Adolescents with a visible cleft (n = 196) were compared with adolescents with a non-visible cleft (n = 93), and with a comparison group (n = 1832). Boys with a visible difference reported significantly more positive perceptions of friendships and less depressive symptoms than the comparison group. These results were interpreted in the context of indicators of emotional resilience. The objective measure of facial difference did not explain levels of depressive symptoms, while subjective measures did. Subjective ratings of appearance mediated the association between social acceptance and depressive symptoms in all samples. Gender did not contribute in explaining the paths between friendships, appearance, and depressive symptoms. The associations between perceptions of social acceptance, appearance, and emotional distress, support the possible utility of strengthening social experiences in preventing and treating appearance-concerns.     

Real-time kinematic biofeedback improves scapulothoracic control and performance during scapular-focused exercises: A single-blind randomized controlled laboratory study

Emerging evidence suggests that scapular-focused therapeutic exercises hold promise for shoulder dynamic stability retraining. While recent findings show that therapeutic exercises can alter scapular neuromuscular function measured with muscle electromyography, no study has yet addressed the effects of kinematic biofeedback for improving scapulothoracic control and performance. The aim of this study was to assess the effectiveness of kinematic biofeedback on motor relearning transfer during shoulder flexion and a daily activity, on the quality of scapular-focused exercise performance, and on execution time. Thirty healthy young adults were randomly distributed into two groups. Skin mounted electromagnetic sensors were used to collect kinematic data of the thorax, scapula and humerus while subjects performed a shoulder flexion and a daily activity, prior to and after scapular-focused exercises. For both groups, the exercise execution error and the execution time determined the scapulothoracic control and performance. Significant statistical differences were found in the exercise execution error results within the experimental group (z = 5.313; p = 0.037) and between groups (u = 37.00; p = 0.001; u = 64.00; p = 0.024). This study’s results demonstrate that real-time kinematic biofeedback improves scapulothoracic control and performance during scapular-focused exercise execution.     

Effects of whole body vibration on spasticity and lower extremity function in children with cerebral palsy

AimThe aim of this study was to evaluate the effect of whole body vibration (WBV) on lower extremity spasticity and ambulatory function in children with cerebral palsy (CP) with a complete crossover design.MethodSixteen participants aged 9.8(2.3) years received a 20-min WBV and a control condition in a counterbalanced order on two separate days. Change scores of each outcome variable were used to show the improvement.ResultsRepeated-measures analyses revealed significant differences in condition scores among variables including active range-of-motion (active ROM, increased), relaxation index (RI, increased), Modified Ashworth Scale (MAS, decreased), timed up-and-go (TUG, decreased), and Six Minute Walk Test (6MWT, increased). Significant differences were also found in time change scores for MAS and 6MWT. Correlation results revealed that TUG was significantly correlated with RI (r = −.512, p = .042), and 6MWT (r = −.700, p = .003).InterpretationThis study suggested that WBV intervention can control the spasticity, enhance ambulatory performance and increase active ROM. Along with previous results, data from this study revealed the potential use of WBV in clinical rehabilitation in children with CP. Future investigations should focus on finding the combination of treatment frequency and duration to achieve an ideal result.     

The role of motion platform on postural instability and head vibration exposure at driving simulators

This paper explains the effect of a motion platform for driving simulators on postural instability and head vibration exposure. The sensed head level-vehicle (visual cues) level longitudinal and lateral accelerations (a_x,sensed = a_{x_head} and a_y,sensed = a_{y_head}, a_yv = a_{y_veh} and a_yv = a_{y_veh}) were saved by using a motion tracking sensor and a simulation software respectively. Then, associated vibration dose values (VDVs) were computed at head level during the driving sessions. Furthermore, the postural instabilities of the participants were measured as longitudinal and lateral subject body centre of pressure (X_CP and Y_CP, respectively) displacements just after each driving session via a balance platform. The results revealed that the optic-head inertial level longitudinal accelerations indicated a negative non-significant correlation (r = −.203, p = .154 > .05) for the static case, whereas the optic-head inertial longitudinal accelerations depicted a so small negative non-significant correlation (r = −.066, p = .643 > .05) that can be negligible for the dynamic condition. The X_CP for the dynamic case indicated a significant higher value than the static situation (t(47), p < .0001). The VDV_x for the dynamic case yielded a significant higher value than the static situation (U(47), p < .0001). The optic-head inertial lateral accelerations resulted a negative significant correlation (r = −.376, p = .007 < .05) for the static platform, whereas the optic-head inertial lateral accelerations showed a positive significant correlation (r = .418, p = .002 < .05) at dynamic platform condition. The VDV_y for the static case indicated a significant higher value rather than the dynamic situation (U(47), p < .0001). The Y_CP for the static case yielded significantly higher than the dynamic situation (t(47), p = .001 < 0.05).