Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

A latent profile analysis of coping responses to individuals’ most traumatic event: associations with adaptive and maladaptive mental health outcomes

ABSTRACT

Background & Objectives: This study explores how empirically-derived coping response patterns influence mental health.

Design: Emerging adults, currently enrolled in college and aged 18–24 (N?=?432; M_age?=?19.66; SD?=?1.65), completed self-report measures of trauma exposure, coping responses to self-selected most traumatic event (MTE), resilience, posttraumatic growth (PTG), depressive symptoms, and posttraumatic stress symptoms (PTSS).

Methods: Eight coping subscales were included as indicators in a latent profile analysis. Then, associations between established profiles and mental health outcomes were examined, covarying for demographic and trauma-related variables.

Results: Considering fit statistics, class size, profile patterns, and theory, the four-class model was deemed most appropriate: High Overall Coping (HCOPE; n?=?146, 34%), Low Overall Coping (LCOPE; n?=?92, 22%), High Engagement Coping (HENG; n?=?115, 27%), and High Disengagement Coping (HDIS; n?=?73, 17%). HENG participants endorsed above-average resilience and PTG, coupled with below-average depressive symptoms and PTSS. Compared to the sample average, HDIS participants endorsed lower resilience and PTG, coupled with higher depressive symptoms and PTSS. LCOPE participants endorsed low levels of all outcomes. HCOPE participants endorsed high levels of all outcomes.

Conclusions: Findings suggest that clinicians who promote engagement coping and discourage disengagement coping among trauma-exposed individuals may engender the most desirable constellation of mental health outcomes.     

A qualitative analysis of the role of emotions in different patterns of long-term weight loss

Objective: To explore participant perspectives of the impact emotions have on weight loss.

Design: A qualitative design gathered data through semi-structured interviews with participants in a weight management programme. The interview addresses the following research questions: (1) how do individuals working to lose weight perceive the impact emotions have on their long-term success, and (2) what strategies do more or less successful participants use to regulate their emotions? Researchers conducted and transcribed the interviews then completed content analysis to create and organise themes.

Results: Two broad themes emerged through the interviews with 21 participants: emotional impact and emotional regulation. Further subthemes captured emotions blocking action toward goals, strategies for regulating emotions (e.g. exercise, food) and the need for new strategies to regulate emotions. Themes were also split in to three groups based on weight outcomes: regainer, moderate success (3–6% loss) and large success (>7% loss). More successful participants, compared to regainers, shared being aware of the impact of their emotions and made efforts to develop healthy regulation strategies.

Conclusions: Emotional awareness and regulation play an important role in participant’s weight management experience. Taking time to build emotional awareness and strategies to manage emotions is important to participants in weight management.     

Do behavioural self-blame and stigma predict positive health changes in survivors of lung or head and neck cancers?

Survivors of lung or head and neck cancers often change tobacco and alcohol consumption after diagnosis, but few studies have examined other positive health changes (PHCs) or their determinants in these groups. The present study aims to: (a) document PHCs in survivors of lung (n?=?107) or head and neck cancers (n?=?99) and (b) examine behavioural self-blame and stigma as determinants of PHCs. We hypothesised that: (a) survivors would make a variety of PHCs; (b) behavioural self-blame for the disease would positively predict making PHCs; and (c) stigma would negatively predict making PHCs.

Methods: Respondents self-administered measures of PHC, behavioural self-blame, and stigma. Hierarchical multiple regression analysis tested the hypotheses.

Results: More than 65% of respondents reported making PHCs, the most common being changes in diet (25%), exercise (23%) and tobacco consumption (16.5%). Behavioural self-blame significantly predicted PHCs but stigma did not. However, both behavioural self-blame and stigma significantly predicted changes in tobacco consumption.

Conclusions: Many survivors of lung or head and neck cancers engage in PHCs, but those who do not attribute the disease to their behaviour are less likely to do so. Attention to this problem and additional counselling may help people to adopt PHCs.     

Transdiagnostic assessment of anxiety symptoms using the Anxiety Disorder Diagnostic Questionnaire – weekly version

Background: Norton and Robinson [2010. Development and evaluation of the anxiety disorder diagnostic questionnaire. Cognitive Behaviour Therapy, 39(2), 137–149. doi:10.1080/16506070903140430] developed the Anxiety Disorder Diagnostic Questionnaire (ADDQ) as a transdiagnostic assessment of fear and anxiety to address problems in using diagnosis-specific measures as well as limitations with the extant transdiagnostic measures of anxiety. The present study validated a weekly version of the ADDQ, the Anxiety Disorder Diagnostic Questionnaire – Weekly (ADDQ-W) allowing session-by-session transdiagnostic assessment of anxiety.

Method: Data were a secondary analysis of 49 treatment-seeking outpatient adults from a previous clinical trial. The ADDQ-W was administered weekly over the course of 12-group therapy sessions.

Results: The ADDQ-W was a valid weekly measure and neither scores, F(2, 37)?=?2.70, p?=?.08, nor trajectories of change, F(2, 37)?=?0.31, p?=?.73, differed by primary diagnosis, though power was limited. Rate of ADDQ-W change was predictive of change in both primary diagnosis severity, t?=?2.40, p?=?.02, β?=?0.32, and overall severity, t?=?3.01, p?<?.01, β?=?0.36, at post-treatment.

Conclusions: This study has established initial support for the use of the brief, easily scored, ADDQ-W for repeated assessment over treatment using a diagnostically heterogeneous clinical sample of treatment-seeking individuals.     

Examining the effects of perceived social support on momentary mood and symptom reports in asthma and arthritis patients

Objective: Social support has been linked to beneficial effects on health directly (main effect) and as a buffer to stress. Most research, however, has examined these relationships using global and retrospective assessments of health and stress, which may be subject to recall biases. This study used ambulatory ecological momentary assessment (EMA) methods to test the main and stress-buffering effects of social support on the daily health and well-being of asthma and rheumatoid arthritis (RA) patients.

Design: Community volunteers with asthma (n?=?97) or RA (n?=?31) responded to EMA prompts five times daily for one week.

Main outcomes: Baseline perceived social support was obtained, and then, participants reported mood, stress and symptoms using EMA. Multilevel mixed-modelling examined whether social support predicted mood and symptoms directly or via stress-reducing effects.

Results: Supporting a main effect, more perceived social support predicted decreased negative mood and stress severity. Supporting a stress-buffering effect, more perceived social support resulted in fewer reported symptoms when stress was present.

Conclusion: Results suggest perceived social support directly relates to better ambulatory status and dynamically buffers individuals against the negative effects of stressors, and highlight the importance of studying social support across different temporal and contextual levels.     

Type D personality and social relations in adults with diabetes: results from diabetes MILES – The Netherlands

Abstract

Objective: To examine whether individual differences in Type D personality (combination of negative affectivity (NA) and social inhibition (SI)) could explain heterogeneity in perceived social support and relationship adjustment (intimate partner relationship) among people living with diabetes.

Design: In the Diabetes MILES—The Netherlands survey, 621 adults with type 1 or type 2 diabetes (54% female, age: 56?±?14 years) completed measures of Type D personality (DS14), perceived social support and relationship adjustment. We used established DS14 cut-off scores to indicate Type D personality, high NA only, high SI only and reference groups.

Results: Participants from the Type D and NA only groups perceived lower levels of social support (Welch[3,259]?=?37.27, p?<?0.001), and relationship adjustment (Welch[3,191]?=?14.74; p?<?0.01) than those from the SI only and reference groups. Type D was associated with lower social support (lowest quartile; adjusted OR?=?8.73; 95%CI?=?5.05?～?15.09; p?<?0.001) and lower relationship adjustment (lowest quartile; adjusted OR?=?3.70; 95%CI?=?2.10?～?6.53; p?<?0.001). Type D was also associated with increased levels of loneliness.

Conclusion: Participants with Type D and participants with high NA only tend to experience less social support and less relationship adjustment. Type D personality was also associated with more loneliness. Experiencing lower social support and relationship adjustment may complicate coping and self-management in people with diabetes.     

Social anxiety and post-event processing among African-American individuals

Background: Social anxiety is among the most prevalent psychiatric conditions, yet little attention has been paid to whether putative cognitive vulnerability factors related to social anxiety in predominantly White samples are related to social anxiety among historically underrepresented groups.

Design: We tested whether one such vulnerability factor, post-event processing (PEP; detailed review of social event that can increase state social anxiety) was related to social anxiety among African-American (AA; n?=?127) persons, who comprise one of the largest underrepresented racial groups in the U.S. Secondarily, we tested whether AA participants differed from non-Hispanic White participants (n?=?127) on PEP and social anxiety and whether race moderated the relation between PEP and social anxiety.

Method: Data were collected online among undergraduates.

Results: PEP was positively correlated with social anxiety among AA participants, even after controlling for depression and income, pr?=?.30, p?=?.001. AA and White participants did not differ on social anxiety or PEP, β?=??1.57, 95% CI: ?5.11, 1.96. The relation of PEP to social anxiety did not vary as a function of race, β?=?0.00, 95% CI: ?0.02, 0.02.

Conclusions: PEP may be an important cognitive vulnerability factor related to social anxiety among AA persons suffering from social anxiety.     

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention.

Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n?=?101; IGVoA), and without ‘views-on-ageing’-component (n?=?30; IG), and active control intervention for volunteering (n?=?103; CG).

Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5?months after the intervention.

Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable.

Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.     

Emotion recognition and emotional theory of mind in chronic fatigue syndrome

Background: Difficulties with social function have been reported in chronic fatigue syndrome (CFS), but underpinning factors are unknown. Emotion recognition, theory of mind (inference of another's mental state) and ‘emotional’ theory of mind (eToM) (inference of another's emotional state) are important social abilities, facilitating understanding of others. This study examined emotion recognition and eToM in CFS patients and their relationship to self-reported social function.

Methods: CFS patients (n?=?45) and healthy controls (HCs; n?=?50) completed tasks assessing emotion recognition, basic or advanced eToM (for self and other) and a self-report measure of social function.

Results: CFS participants were poorer than HCs at recognising emotion states in the faces of others and at inferring their own emotions. Lower scores on these tasks were associated with poorer self-reported daily and social function. CFS patients demonstrated good eToM and performance on these tasks did not relate to the level of social function.

Conclusions: CFS patients do not have poor eToM, nor does eToM appear to be associated with social functioning in CFS. However, this group of patients experience difficulties in emotion recognition and inferring emotions in themselves and this may impact upon social function.     

The relationship between dietary restraint and deficits in reasoning about causes of obesity

Abstract

Objective: Increased levels of dietary restraint are associated with deficits on many cognitive tasks. Less is known about how individual differences in restraint influences complex cognition such as reasoning which is the focus of this research.

Design: Two experimental studies are reported. In study 1, participants (n?=?158) completed a causal conditional reasoning task with statements about weight-related and general causal relationships. Study 2 replicated and extended study 1. Participants (n?=?108) completed a causal conditional reasoning task focusing on behavioural causes of weight change or general statements.

Main outcome measure: Causal conditional reasoning task performance.

Results: In study 1, levels of dietary restraint were negatively associated with reasoning abilities for weight-related statements only. Study 2 replicated the negative association between dietary restraint and reasoning finding the effect in both weight-related, and general, causal judgements.

Conclusion: The novel findings show that individual differences in dietary restraint have a wider relationship with cognition than previously demonstrated. Results tentatively support theoretical explanations of a reduction in cognitive capacity, rather than differences in belief, explaining reasoning deficits. These findings open an interesting avenue for research and might have implications for effective decision making about personal health behaviours, such as food choice.     

Posttraumatic stress severity is associated with coping motives for alcohol use among in-patient and community recruited adolescents

Background and Objectives: A growing body of work suggests individuals with more severe post-traumatic stress symptoms (PTSS) are at higher risk for developing problematic alcohol use outcomes. Extending work from the adult literature, the present study was the first to examine the extent to which PTSS is related to drinking motives for alcohol use in both clinical and non-clinical samples of adolescents.

Design: Hierarchical regression analyses were used to predict coping motives for alcohol use from PTSS, above and beyond demographic variables, alcohol use frequency, and other alcohol use motives.

Methods: Trauma-exposed adolescents before entering treatment (Sample 1 n?=?41) and recruited from the local community (Sample 2 n?=?55) self-reported on PTSS and alcohol use motives.

Results: PTSS positively predicted coping motives for alcohol use after controlling for age, gender, and alcohol use frequency.

Conclusions: The current study highlights the need to consider both PTSS severity, as well as underlying cognitive mechanisms (e.g., motives), to better understand the etiology of problematic alcohol use among trauma-exposed youth. Future work focused on clarifying the trajectory of alcohol use motives and problems as a function of PTSS is needed.     

Weight maintenance: Self-regulatory factors underpinning success and failure

Objectives: To investigate the differences in the contributing factors involved in weight maintenance success and failure.

Design: Semi-structured interviews were conducted with both successful and unsuccessful weight maintainers. Eighteen participants were recruited (16 women), nine of who had lost 10% of their body weight and maintained this weight for a minimum of 12?months (Maintainers), and nine individuals who met the above criteria for weight loss but had subsequently regained their weight (Regainers). A thematic analysis was employed to compare the differences between the two groups.

Results and conclusions: Two main themes highlighted the differences between the two groups, these were: goal regulation and self-control. Within these overarching themes, successful weight maintenance was related to the following subthemes: long-term, realistic goal setting, consistent use of routines and self-monitoring, avoiding deprivation and effective coping skills. Unsuccessful maintenance was related to short-term unrealistic goal setting, inconsistent routines and self-monitoring, experiencing deprivation and poor coping skills. These factors are explained in terms of the interrelationships that they have on one another and their subsequent impact on weight maintenance success or failure.     

Combining total laparoscopic hysterectomy and bilateral salpingo-oophorectomy with subcutaneous mastectomy in trans men: The effect on safety outcomes

Abstract

Background: Masculinizing mastectomy is the most requested gender affirming surgery (GAS) in trans men, followed by genital GAS. Mastectomy and total laparoscopic hysterectomy, with or without bilateral salpingo-oophorectomy (TLH?±?BSO), can both be performed in one single operation session. However, data on complication rates of the combined procedure is scarce and no consensus exists on the preferred order of procedures.

Aims: To compare safety outcomes between mastectomy performed in a single procedure with those when performed in a combined procedure and assess whether the order of procedures matters when they are combined.

Methods: A retrospective chart review was performed of trans men who underwent masculinizing mastectomy with or without TLH?±?BSO in a combined session. The effects of the surgical procedure on complication and reoperation rate of the chest were assessed using logistic regression.

Results: In total, 480 trans men were included in the study. Of these, 212 patients underwent the combined procedure. The gynecological procedure was performed first in 152 (71.7%) patients. In the total sample, postoperative hematoma of the chest occurred in 11.3%; 16% in the combined versus 7.5% in the single mastectomy group (p?=?0.001). Reoperations due to hematoma of the chest were performed in 7.5% of all patients; 10.8% in the combined versus 4.9% in the single mastectomy group (p?=?0.017). The order of procedures in the combined group had no significant effect on postoperative hematoma of the chest (p?=?0.856), and reoperations (p?=?0.689).

Conclusion: Combining masculinizing mastectomy with TLH?±?BSO in one session was associated with significantly more hematoma and reoperations compared with separately performing mastectomy. This increased risk of complications after a combined procedure should be considered when deciding on surgical options. The order of procedures in a combined procedure did not have an effect on safety outcomes.     

Effects of perceived weight discrimination on willingness to adopt unhealthy behaviours: influence of genomic information

Objective: Weight-based discrimination negatively influences health, potentially via increased willingness to engage in unhealthful behaviours. This study examines whether the provision of genomic obesity information in a clinical context can lead to less willingness to engage in unhealthy eating and alcohol consumption through a mediated process including reduced perceptions of blame and discrimination.

Design: A total of 201 overweight or obese women aged 20–50 interacted with a virtual physician in a simulated clinical primary care environment, which included physician-delivered information that emphasised either genomic or behavioural underpinnings of weight and weight loss.

Main Outcome Measures: Perceived blame and weight discrimination from the doctor, and willingness to eat unhealthy foods and consume alcohol.

Results: Controlling for BMI and race, participants who received genomic information perceived less blame from the doctor than participants who received behavioural information. In a serial multiple mediation model, reduced perceived blame was associated with less perceived discrimination, and in turn, lower willingness to eat unhealthy foods and drink alcohol.

Conclusion: Providing patients with genomic information about weight and weight loss may positively influence interpersonal dynamics between patients and providers by reducing perceived blame and perceived discrimination. These improved dynamics, in turn, positively influence health cognitions.     

A psychometric comparison of anxiety-relevant attention measures

Background and Objectives: Preferential attention to threat, emotional response inhibition, and attentional control each purportedly play a key role in anxiety disorders. Divergent psychometric properties among attention measures may produce differential detection of anxiety-related associations and treatment-related changes. However, no studies have directly compared the psychometric properties of these attention measures in the same sample.

Design: Eighty-five young adults (M?=?19.41 years, SD?=?1.47, 48 Females) completed a cognitive task battery and a subset of 60 participants (M?=?19.42 years, SD?=?1.48, 33 Females) completed the task battery again approximately two weeks later.

Method: To assess preferential attention to threat, emotional response inhibition, and attentional control, the cognitive task battery included a dot-probe task, emotion and gender Stroop tasks, and a flanker task. Tasks varied in how attention was directed and if emotional stimuli were included. Internal consistency and test-retest reliability were compared across measures.

Results: Within the same sample, internal consistency and reliability differed across attention measures. Explicit attention measures (emotional Stroop and flanker) exhibited stronger internal consistency and greater test-retest reliability compared to implicit measures (dot-probe and gender Stroop).

Conclusions: These results inform clinical research using attention measures to assess anxiety-related differences and treatment response.     

Eating styles in the morbidly obese: Restraint eating,but not emotional and external eating,predicts dietary behaviour

Objectives : The research explored (1) the relationships between self-reported eating style (restraint, emotional and external eating) and dietary intake and (2) emotional eater status as a moderator of food intake when emotional, in a morbidly obese population.

Design : A sample of 57 obese participants (BMI: M?=?51.84, SD?=?8.66) completed a five-day food diary together with a reflective diary, which assessed eating style and positive and negative affect daily.

Main outcome measures : A dietician-scored food pyramid analysis of intake.

Results : Restraint eating was the only predictor (negative) of overall food intake and the variable most strongly associated with the consumption of top-shelf foods. Emotional and external eating were unrelated to food intake. Emotional eater status did not moderate food intake in response to positive and negative mood states.

Conclusion : The findings indicated largely analogous relationships between eating style and dietary intake in this obese sample compared with previous results from healthy populations. The lack of predictive validity for emotional eating scales (when emotional) raises questions over people’s ability to adequately assess their eating style and consequently, the overall validity of emotional eater scales.     

Optimism buffers the detrimental effect of negative self-perceptions of ageing on physical and mental health

Objectives: First, to replicate previous findings on the detrimental effect of negative self-perceptions of ageing (SPA) on physical health outcomes and to expand them to the prediction of mental health; second, to test whether an optimistic outlook to the future can buffer the effect of negative SPA on physical and mental health outcomes.

Design: Data for this study comes from the 2008 and 2011 waves of the German Ageing Survey (DEAS; n?=?6205), a population-based representative survey of adults aged 40–85?years. Mean age of the participants was 61.50 (±12.1), 49.5% were women.

Main Outcome Measures: Self-rated health, physical functioning and depressive symptoms.

Results: Multiple regression analyses indicated that negative SPA predicted deterioration in the three health outcomes over a three-year period, controlling for demographics and illnesses. The most remarkable finding is the interaction with optimism: People who were prepared for physical losses (negative SPA), and who were nevertheless optimistic, were better able to maintain better physical functioning, and lower depressive symptoms.

Conclusion: A multidimensional perspective on ageing, considering both gains and losses at the same time, seems to be best for the maintenance of good health. Individual and societal positive views of ageing should be encouraged.     

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.     

Automatic affective-motivational regulation processes underlying supportive dyadic coping: the role of increased implicit positive attitudes toward communal goals in response to a stressed relationship partner

Background and objectives: We examined the implicit affective mechanisms underlying provision of support in intimate dyads. Specifically, we hypothesized that in individuals with high relationship satisfaction, the perception that one’s partner is stressed leads to increased implicit positive attitudes toward communal goals. In turn, this change in implicit attitudes facilitates supportive behavior.

Design and methods: In two studies, we induced partner stress by instructing participants to either recall a situation where their partner was highly stressed (Study 1; N?=?47 university students) or imagine a specific stressful event (excessive workload; Study 2; N?=?85 university students). Subsequently, implicit attitudes toward communal goals were assessed with an Implicit Association Test.

Results: In both studies, we found that among participants with high relationship satisfaction partner stress increases preferences for communal goals. In addition, implicit preferences for communal goals predicted stronger inclinations to engage in supportive dyadic coping (Study 2).

Conclusions: The current findings provide important insights into the implicit cognitive-affective mechanics of dyadic coping. Moreover, they can explain how people manage to avoid experiencing motivational conflicts between partner-oriented and self-oriented goals in situations characterized by high partner stress.