Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = −2.06, p = .046, d = −0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement’s effects on physical and mental health.     

Treating Young Adult Depression With Text-Delivered Cognitive Behavioral Therapy: A Pilot Randomized Clinical Trial

Young adults (ages 18 to 25) in the U.S. suffer from the highest rates of past-year major depressive episode and are the least likely to receive treatment compared to other age groups. As such, we examined the feasibility, acceptability, and efficacy of a text-message delivered cognitive behavioral therapy: CBT-txt with young adults. The study was a 2-month pilot RCT to test a 4-week intervention for depression that contained 197 text messages (average 12 texts every other day). The sample, recruited via Facebook and Instagram, was 102 U.S. young adults who presented with at least moderate depressive symptomatology. Assessments occurred at baseline prior to randomization and at 1 and 2 months post enrollment. The primary outcome, severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Feasibility benchmarks were met and participants reported high levels of engagement with and acceptability of the intervention. Logistic regression indicated that treatment participants were three times as likely to have minimal or mild depression symptoms at 2 months compared to waitlist control participants. Latent change score modeling found that the strongest significant treatment effect appeared at the 1-month follow-up period, particularly for participants who began with severe depressive symptoms. Mediation analysis revealed significant indirect treatment effects of increases in behavioral activation on reducing depressive symptoms, suggesting a mechanism of change. Limitations were that the sample was relatively small and consisted of primarily women. These results provide initial evidence for the feasibility, acceptability, and efficacy of a text-delivered treatment for young adult depression.     

Efficacy of guided self-help behavioural activation and physical activity for depression: a randomized controlled trial

Behavioural activation and physical activity have received empirical support that highlight their efficacy in reducing depression. Even though both behavioural activation and physical activity share the common goal of reactivating the individual, limited research has directly compared these interventions, and more research is required to evaluate their efficacy when offered in low-intensity formats. The present study involves a randomized controlled clinical trial comparing the efficacy of two guided self-help interventions for the treatment of depression: behavioural activation and physical activity. Fifty-nine participants presenting mild-to-moderate symptoms of depression were randomized either to a behavioural activation intervention (n = 20), a physical activity intervention (n = 19) or a wait-list control group (n = 20). All participants completed symptom measure pre-, mid- and post-intervention, as well as at a two-month follow-up. Mixed-model analyses of variance revealed that both interventions were significantly more efficacious in reducing depressive symptoms in comparison with the control group. Physical activity involved significantly less time-investment compared to the behavioural activation condition (less than half the amount of time). These results indicate that physical activity and behavioural activation both effectively reduce depressive symptoms and are favourably applicable in low-intensity formats. Implications of these results and avenues for future research are discussed.     

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.     

Activity Level,Activity Enjoyment,and Weather as Mediators of Physical Health Risks in Seasonal and Nonseasonal Depression

Research suggests that depression has negative consequences on physical health. One of the mechanisms driving this link may be the decrease in physical activity characteristic of individuals before and during a depressive episode. However, the factors that influence changes in physical activity across the seasons remain unclear. For instance, weather has been proposed to play an important role in the frequency of activities and enjoyment derived from them. In addition, research has not investigated how weather variables influence activity levels across the seasons in individuals with seasonal versus nonseasonal depression. The present study compared patterns of activity level and enjoyment in samples of women with seasonal and nonseasonal depression and controls. Women with Major Depressive Disorder (MDD) and MDD with a seasonal pattern (Seasonal Affective Disorder, SAD) reported similar patterns of activity; engaging in less frequent activity and deriving less enjoyment from activities than controls across the entire year, most notably during the winter months. Women with SAD also reported being significantly impacted by the weather such that their mood and energy levels increased with warmer temperatures an increased sunshine. Results suggest that women with seasonal depression may be at similar health risks as women with nonseasonal depression and activity patterns may have implications for behavioral activation treatments for depression.     

Changes in physical activity and sedentary behavior associated with an exercise intervention in depressed adults

BackgroundExercise is beneficial for depression, but less is known about its impact on post-intervention physical activity and sedentary behavior. The aim of this paper was to determine the extent to which participation in light-, moderate- and vigorous-intensity exercise intervention influenced habitual physical activity and sedentary behavior patterns in depressed adults.MethodsAccelerometer data was collected pre- and post-intervention from depressed participants randomized to one of three 12-week intervention groups: light (n = 21), moderate (n = 25) and vigorous (n = 22) exercise. Mixed models examined changes in time spent sedentary and in light and moderate-to-vigorous physical activity (MVPA); time accumulated in sedentary and MVPA bouts; and, number of MVPA bouts and interruptions in sedentary time.ResultsOverall sedentary time decreased while light activity time increased across all intervention groups but not significantly so. The light exercise intervention group reduced MVPA minutes (−8.22, 95% CI: −16.44, −0.01), time in MVPA bouts (−8.44, 95% CI: −14.27, −2.62), and number of activity bouts (−0.43, 95% CI: −0.77, −0.09). The moderate exercise intervention group reduced time in MVPA bouts (−6.27, 95% CI: −11.71, −0.82) and number of sedentary interruptions (−6.07, 95% CI: −9.30, −2.84). No changes were observed for the vigorous exercise intervention group.ConclusionsThe exercise intervention led to an increase in overall light physical activity and decrease in sedentary time, though neither change was statistically significant. Participation in the light and moderate exercise intervention groups was associated with reductions of time in MVPA bouts, but this was not evident for the vigorous exercise intervention group.     

Cognitive,Behavioral and Goal Adjustment Coping and Depressive Symptoms in Young People with Diabetes: A Search for Intervention Targets for Coping Skills Training

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for young people with Type 1 (T1) diabetes. A wide range of coping techniques was studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 78 young people with T1 diabetes participated. They were contacted through a social networking website, several Internet sites, and flyers. A wide range of coping techniques appeared to be related to depressive symptoms. Especially the cognitive coping strategies self-blame, rumination, refocus positive, and other-blame, together with goal adjustment coping, were of importance. A large proportion of the variance of depressive symptoms could be explained (65 %). These findings suggest that these specific coping strategies should be part of coping skills trainings for young people with T1 diabetes.     

Adapting Homework for an Older Adult Client With Cognitive Impairment

There is growing evidence that psychosocial treatments incorporating behavioral intervention strategies can be effective in the treatment of depression in older adults with cognitive impairment. However, less work with such cases has focused on the use of cognitive interventions in tandem with these behavioral intervention strategies. This case study describes how cognitive behavioral intervention strategies and related homework assignments were tailored and integrated to successfully treat depressive symptoms in an older African American diagnosed with probable Alzheimer’s disease. Examples of the homework strategies utilized are introduced by phase of treatment. We also discuss ways to overcome barriers to homework completion as well as methods to incorporate the client’s sociocultural context and personal history into homework.     

The effects of a self-management treatment package on daily step count in university students with depressive symptoms

Research demonstrates that exercise can decrease depressive symptoms, yet it is infrequently prescribed as an intervention. Self-management techniques offer an effective and cost-efficient approach to increase engagement in physical activity. The purpose of this study was to evaluate the efficacy of goal setting, self-monitoring, and feedback for increasing daily step count in university students (N = 4) reporting depressive symptoms. The treatment was efficacious for increasing steps for three participants with varying levels of consistency. All participants showed a decrease in some depression symptoms on the University Student Depression Inventory. Expert ratings on the Clinical Global Impression Scale indicated improvement in global functioning for three participants. Additional research is needed to determine the efficacy of this intervention package for increasing daily steps and the relation to depression symptoms.     

Acceptance and Commitment Therapy and Implementation Intentions Increase Exercise Enjoyment and Long-Term Exercise Behavior Among Low-Active Women

The current study evaluated the long-term effectiveness of acceptance and commitment therapy (ACT) for promoting exercise behavior in comparison with planning in the form of implementation intentions (forming situational cues and action plans as to when, where, and how to incorporate exercise). We expected both interventions to increase exercise behavior (assessed using the Godin Leisure-Time Exercise Questionnaire; Godin and Shephard 1985) from baseline to 6-months post-intervention, but expected only ACT to also increase exercise enjoyment (assessed using the Physical Activity Enjoyment Scale; Kendzierski and DeCarlo 1991). A total of 32 women, randomized to receive a single session of either ACT training or instructions to form implementation intentions for exercise activities, took part in this study. The participants were contacted by email 6-months following the intervention to determine the amount of self-reported exercise. As expected, exercise amount increased in both groups. Contrary to our expectations, both groups also increased in exercise enjoyment. This study provides initial evidence that exercising can be increased through an ACT intervention. ACT and implementation intentions may both be effective and brief interventions for promoting exercise behavior and exercise-related enjoyment in low-active women. Future research needs to establish the psychosocial and personality factors that lead to the effectiveness of ACT and implementation intentions.     

Depression

Patients with myocardial infarction who suffer from a depression are at increased risk of dying of a subsequent heart attack or some other complication of coronary artery disease (CAD). A considerable body of research has provided evidence that a major depression, which is found in 16 to 23 percent of patients with CAD, but also subliminal depressive symptoms are independent risk factors for an unfavourable outcome of CAD. However, it is not yet clear whether depression is a causal risk factor having impact on the course of the heart disease or merely a prognostic marker that allows predicting the outcomes of interest, without any causal influence on them. Several pathways between depression and CAD have been discussed. These include behavioral mechanisms such as low compliance with both medical treatment and life style recommendations as well as neurobiological links. Much attention has been paid to the hypothalamic-pituitary-adrenocortical and sympathomedullary hyperactivity found in depression. Other possible links include diminished heart rate variability, stress-induced ischemia, platelet activation, and immunological dysregulation. To resolve the issue whether depression is a causal risk factor or only a prognostic marker, experimental studies are needed to evaluate interventions aimed at improving depression and test whether mortality is subsequently reduced. Such studies brought in the past mixed results. Whereas comprehensive intervention programs including risk factor management have produced a reduction in both coronary morbidity and mortality, a recent multicenter study providing either cognitive-behavioral therapy or usual care to depressed patients with CAD could not demonstrate a survival benefit among the participants of the intervention. Finally, results of evaluation studies regarding integrated disease management programs for patients with comorbid depression are presented.     

Enhanced Brief Motivational Intervention for College Student Drinkers With ADHD: Goal-Directed Activation as a Mechanism of Change

College students with attention-deficit/hyperactivity disorder (ADHD) are at risk for alcohol-related problems and disorders relative to their typically developing peers. Despite risk, the optimal therapeutic approach for reducing problem alcohol use in students with ADHD, and mechanisms of change underlying treatment effects in this population, are largely unknown. The current study evaluated putative mechanisms of change in a randomized controlled trial of two harm reduction interventions for college student drinkers with ADHD (N = 113; 49% male): brief motivational intervention plus supportive counseling (BMI + SC) versus brief motivational intervention plus behavioral activation (BMI + BA). Results showed that participants in the BMI + BA condition engaged in more goal-directed activation and less avoidant behavior over the course of treatment compared to those in the BMI + SC condition, in turn predicting reductions in alcohol-related negative consequences. Effects were more robust 1 month following intervention, and diminished by 3 months. Sensitivity analyses revealed a significant indirect effect of treatment condition on alcohol-related negative consequence via reductions in avoidance over treatment. Post hoc moderated mediations showed that BMI + BA engaged target mechanisms more robustly for students with more severe ADHD and depressive symptoms compared to BMI + SC. These findings support the application of BMI + BA intervention, particularly in targeting goal-directed activation and avoidance/rumination in at-risk student drinkers with ADHD.     

Physical Activity and Physical Self-Concept among Sedentary Adolescent Females; An Intervention Study

PROBLEM: Physical activity has been promoted as a means of enhancing self-concept, yet the evidence for this connection is far from compelling. In particular, experimental research investigating this association during adolescence, a period during which many youth struggle to maintain a positive self-image, is noticeably lacking. This study investigates the impact on self-concept of a 9-month physical activity intervention among sedentary adolescent females. METHOD: Female adolescents who were sedentary at baseline were assigned either to an exercise intervention or a comparison group as part of the controlled trial. The intervention was school-based, and assignment to groups was based on school attended. Intervention participants engaged in supervised activity 4 times per week and received didactic instruction promoting activity outside of school 1 day per week. Self-concept, physical activity participation, and cardiovascular fitness were assessed before, mid-way through, and after the 9-month intervention. RESULTS: The intervention had a significant positive impact on participation in vigorous activity and cardiovascular fitness. The intervention did not significantly influence any of the self-concept dimensions overall. There was, however, a three-way interaction such that there was an increase in global physical self-concept among those intervention participants who increased cardiovascular fitness. CONCLUSIONS: These findings indicate that a physical activity intervention among sedentary adolescent females enhanced global physical self-concept for a subset of intervention participants who manifested positive changes in fitness.     

Social Anxiety Disorder and Social Support Behavior in Friendships

Relationship quality is a strong predictor of health outcomes, and individuals with social anxiety disorder (SAD) report increased interpersonal impairment. However, there are few studies testing the effect of SAD on friendships and it is thus unclear whether there are behavioral differences that distinguish friendships in which a target individual has SAD from friendships in which the target individual does not have SAD. We tested for differences in the provision and receipt of support behaviors as a function of having a SAD diagnosis and accounting for comorbid depressive symptoms. Participants with SAD (n = 90) and their friends engaged in support conversations that were coded using the Social Support Interaction Coding System. Structural equation modeling revealed some differences between participants and friends when accounting for depression. Specifically, friends of participants with SAD and comorbid depression engaged in fewer positive helper behaviors than the friends of participants who did not have SAD or comorbid depression. Additionally, dyads in which the primary participant had SAD engaged in more off-task behaviors. Results suggest that SAD does not result in global interpersonal impairment, but that receipt of positive support behaviors from friends may differ as a function of SAD and comorbid depression. Interpersonal interventions aimed at increasing adaptive friendships and aspects of CBT that target subtle avoidance (e.g., safety behaviors) may be useful in facilitating more satisfactory relationships for these individuals.     

Mediation analyses of Internet-facilitated cognitive behavioral intervention for maternal depression

This study evaluated the putative mediating mechanisms of an Internet-facilitated cognitive-behavioral therapy (CBT) intervention for depression tailored to economically disadvantaged mothers of preschool-age children. The CBT mediators were tested across two previously published randomized controlled trials which included the same measures of behavioral activation, negative thinking, and savoring of positive events. Trial 1 included 70 mothers with elevated depressive symptoms who were randomized to either the eight-session, Internet-facilitated intervention (Mom-Net) or to treatment as usual. Trial 2 included 266 mothers with elevated depressive symptoms who were randomized to either Mom-Net or to a motivational interviewing and referral to services condition. Simple mediation models tested each putative mediator independently followed by tests of multiple mediation that simultaneously included all three mediators in the model to assess the salient contributions of each mediator. The pattern of results for the mediating effects were systematically replicated across the two trials and suggest that behavioral activation and negative thinking are salient mediators of the Mom-Net intervention; significant mediating effects for savoring were obtained only in the simple mediation models and were not obtained in the multiple mediation models.     

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).     

Negative life events and substance use moderate cognitive behavioral adolescent depression prevention intervention

Investigate factors that amplify or mitigate the effects of an indicated cognitive behavioral (CB) depression prevention program for adolescents with elevated depressive symptoms. Using data from a randomized trial (Registration No. NCT00183417; n?=?173) in which adolescents (M age =?15.5, SD =?1.2) were assigned to a brief cognitive behavioral prevention program or an educational brochure control condition, we tested whether elevated motivation to reduce depression and initial depressive symptom severity amplified intervention effects and whether negative life events, social support deficits, and substance use attenuated intervention effects. Hierarchical linear modeling (HLM) indicated differential intervention effects for two of the five examined variables: negative life events and substance use. For adolescents at low and medium levels of substance use or negative life events, the CB intervention produced declines in depressive symptoms relative to controls. However, at high levels of substance use or negative life events, the CB intervention did not significantly reduce depressive symptoms in comparison to controls. Results imply that high-risk adolescents with either high rates of major life stress or initial substance use may require specialized depression prevention efforts.     

Developing and Testing a Novel,Computerized Insomnia and Anxiety Intervention to Reduce Safety Aids Among an at-Risk Student Sample: A Randomized Controlled Trial

Anxiety and insomnia disorders are two of the most common and costly mental health conditions. They are frequently comorbid, but current treatments do not target both. To streamline treatment, we developed a computerized intervention targeting a transdiagnostic factor, safety aids (cognitive or behavioral strategies used to cope with distress that paradoxically exacerbate symptoms). We conducted a randomized controlled trial to determine the acceptability and efficacy of this brief one-session intervention. Young adult undergraduates (N = 61) with elevated subclinical anxiety and insomnia were randomized to receive the anxiety-insomnia intervention or a physical health control condition. Participants were followed for 1 month and completed self-report measures. Analyses indicated that participants found the intervention acceptable, credible, and engaging. Analyses revealed the active intervention reduced sleep- and anxiety-related safety aids, with medium to large effect sizes. Findings suggest that targeting safety aids for anxiety and insomnia is acceptable and effective in reducing the target mechanism, safety aids, as well as worry. Future research should replicate these findings within a clinical sample and with a longer-term follow-up.