Long-term efficacy of exercise across diagnostically heterogenous mental disorders and the mediating role of affect regulation skills

BackgroundExercise interventions are efficacious in reducing disorder-specific symptoms in various mental disorders. However, little is known about long-term transdiagnostic efficacy of exercise across heterogenous mental disorders and the potential mechanisms underlying treatment effects.MethodsPhysically inactive outpatients, with depressive disorders, anxiety disorders, insomnia or attention deficit hyperactivity disorder were randomized to a standardized 12-week exercise intervention, combining moderate exercise with behavior change techniques (BCTs) (n = 38), or a passive control group (n = 36). Primary outcome was global symptom severity (Symptom Checklist-90, SCL-90-R) and secondary outcomes were self-reported exercise (Physical Activity, Exercise, and Sport Questionnaire), exercise-specific affect regulation (Physical Activity-related Health Competence Questionnaire) and depression (SCL-90-R) assessed at baseline (T1), post-treatment (T2) and one year after post-treatment (T3). Intention-to-treat analyses were conducted using linear mixed models and structural equations modeling.ResultsFrom T1 to T3, the intervention group significantly improved on global symptom severity (d = −0.43, p = .031), depression among a depressed subsample (d = −0.62, p = .014), exercise (d = 0.45, p = .011) and exercise-specific affect regulation (d = 0.44, p = .028) relative to the control group. The intervention group was more likely to reveal clinically significant changes from T1 to T3 (p = .033). Increases in exercise-specific affect regulation mediated intervention effects on global symptom severity (ß = −0.28, p = .037) and clinically significant changes (ß = −0.24, p = .042).ConclusionsThe exercise intervention showed long-term efficacy among a diagnostically heterogeneous outpatient sample and led to long-lasting exercise behavior change. Long-term increases in exercise-specific affect regulation within exercise interventions seem to be essential for long-lasting symptom reduction.     

A pilot study exploring the use of a telephone-assisted planning intervention to promote parental support for physical activity among children and youth with disabilities

Parent support is an important contributor to physical activity (PA) among children and youth with disabilities (CYD). Although many parents of CYD are motivated to provide parent PA support, CYD remain insufficiently active. The multi-process action control model has been applied to understand parent PA support and highlights behavioral regulation strategies such as action and coping planning as critical for translating intentions into behavior. Parents may struggle to create and carryout planning without support. There is no known research examining telephone support as a tool to promote planning and subsequent parent PA support behavior.MethodParents (43 mothers and 6 fathers) of CYD (child M_age = 12.53 years ± 5.53; 75% male; 38.6% developmental disability) completed a baseline questionnaire and were subsequently randomized to a telephone-assisted planning experimental group twice over four weeks (n = 23) or a control group who had access to planning tools but no telephone assistance (n = 26).ResultsNo significant main or interaction effects emerged for parent PA support behavior. However, a significant time × condition interaction was found for behavioral regulation strategies (i.e., action and coping planning and self-monitoring; F(1,44) = 5.05, p = 0.03) indicating a significant increase in the use of behavioral regulation strategies for parent PA support from baseline, for parents assigned to the telephone-assisted intervention.ConclusionThese findings suggest potential for planning support as a tool to enhance behavioral regulation strategies related to parent PA support among parents of CYD.     

Daily Posttraumatic Stress Disorder Symptom Accommodation and Relationship Functioning in Military Couples

Romantic partners’ accommodation of trauma survivors’ posttraumatic stress disorder (PTSD) symptoms (e.g., taking on tasks, survivors avoid participating in social withdrawal) is associated with lower relationship satisfaction for both partners and survivors. Little is known about associations of partner accommodation with other aspects of relationship functioning, like intimacy. Sixty‐four male military veterans with at least subclinical PTSD and their partners participated in a 2‐week daily diary study. Veterans completed nightly measures of PTSD symptoms, while female partners completed nightly measures of accommodating behaviors performed that day. Both partners reported feelings of intimacy each night. Multilevel models revealed that accommodation was significantly, negatively associated with feelings of intimacy, with stronger effects for partners (t = ?8.70) than for veterans (t = ?5.40), and stronger effects when veterans had lower (t = ?7.43) rather than higher (t = ?5.20) levels of daily PTSD symptoms. Therapists should consider accommodating behaviors as a potential impediment to relationship intimacy, particularly when veterans have less severe symptoms of PTSD. Accommodating behaviors are an ideal treatment target in behavioral couple therapies.     

A randomized controlled trial evaluating the efficacy of Triple P Online with parents of children with early-onset conduct problems

ObjectiveThis study examined the efficacy of Triple P Online (TPOL), an eight-module intensive online positive parenting program for parents of children with early-onset disruptive behavior problems.MethodOne hundred and sixteen parents with 2–9-year-old children displaying early-onset disruptive behavior difficulties were randomly assigned to either the intervention condition (N = 60) or an internet-use-as-usual control group (N = 56).ResultsAt post-intervention assessment, parents receiving the internet intervention TPOL had significantly better outcomes on measures of problem child behavior, dysfunctional parenting styles, parents’ confidence in their parenting role, and parental anger. At 6-month follow-up assessment intervention gains were generally maintained, and in some cases enhanced. Consumer satisfaction ratings for the program were high.ConclusionsInternet-delivered self-help parenting programs appear to make a valuable contribution to a comprehensive public health approach to parenting support.     

Promoting parent academic expectations predicts improved school outcomes for low-income children entering kindergarten

This study explored patterns of change in the REDI (Research-based Developmentally Informed) Parent program (REDI-P), designed to help parents support child learning at the transition into kindergarten. Participants were 200 prekindergarten children attending Head Start (55% European-American, 26% African American, 19% Latino, 56% male, M_age = 4.45 years, SD = 0.29) and their primary caregivers, who were randomized to a 16-session home-visiting intervention (REDI-P) or a control group. Extending beyond a prior study documenting intervention effects on parenting behaviors and child kindergarten outcomes, this study assessed the impact of REDI-P on parent academic expectations, and then explored the degree to which intervention gains in three areas of parenting (parent-child interactive reading, parent-child conversations, parent academic expectations) predicted child outcomes in kindergarten (controlling for baseline values and a set of child and family characteristics). Results showed that REDI-P promoted significant gains in parent academic expectations, which in turn mediated intervention gains in child emergent literacy skills and self-directed learning. Results suggest a need to attend to the beliefs parents hold about their child's academic potential, as well as their behavioral support for child learning, when designing interventions to enhance the school success of children in low-income families.     

Parental Efficacy Moderates the Association Between Empathy and Burden Among Parents of Children Admitted to a Psychiatric Ward

Empathy is considered a positive aspect of caregiving, although in certain circumstances, being empathic might increase the burden of caregivers. The current study assessed the associations between empathy, parental efficacy, and family burden among parents of children who were hospitalized in a psychiatric unit. Specifically, we examined whether the association between empathy and family burden was moderated by the parents’ sense of self-efficacy. Seventy parents of children with psychiatric disorders, hospitalized in an inpatient psychiatric unit, filled out questionnaires of empathy, parental efficacy, and family burden. Results supported a moderating role of parental efficacy between empathy and family burden (interaction effect: β = −1.72, p = .0406). Specifically, empathy was positively related to family burden among parents with low self-efficacy (conditional effect = 0.70, p = .032) and negatively related to family burden among parents with high self-efficacy (conditional effect = −0.39, p = N.S). Implications for practice include the importance of self-efficacy and address the possible negative implications of empathy among parents of children treated in a psychiatric hospital.     

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.     

The impact of COVID-19 and socioeconomic status on psychological distress in cancer patients

ObjectiveWe aimed to investigate the impact of the COVID-19 pandemic on psychological symptom burden against the socioeconomic background of cancer patients using data from routine assessments before and during the pandemicMethodIn this cross-sectional study, standardised assessment instruments were applied in N = 1,329 patients to screen for symptoms of anxiety, depression, post-traumatic stress, and fatigue from 2018 to 2022. Two MANOVAs with post-hoc tests were computed. First, only time was included as predictor to examine the isolated impact of the pandemic. Second, income level and education level were included as further predictors to additionally test the predictive power of socioeconomic factorsResultsIn the final model, only income had a significant impact on all aspects of psychological symptom burden, with patients with low income being highly burdened (partial η² = .01, p = .023). The highest mean difference was found for depressive symptoms (MD = 0.13, CI = [0.07; 0.19], p < .001). The pandemic had no further influence on psychological distressConclusionsAlthough the pandemic is a major stressor in many respects, poverty may be the more important risk factor for psychological symptom burden in cancer outpatients, outweighing the impact of the pandemic.     

The Association between Symptom Accommodation and Emotional Coregulation in Couples with Binge Eating Disorder

Intense negative emotions and maladaptive behavioral strategies to reduce emotional distress occur not only in patients with various forms of psychopathology but also in their committed partners. One common strategy to reduce distress is for partners to accommodate to the symptoms of the disorder, which reduces distress short term but maintains symptoms long term. Accommodation is believed to be motivated by the partner reacting behaviorally to the patient's emotions, but the emotions of the partner in this context have yet to be examined. This pilot study examined how partner accommodation related to specific patterns of emotional coregulation between patients with binge eating disorder (BED) and their partners, before and after a couple‐based intervention for BED. Vocally encoded emotional arousal was measured during couples’ (n = 11) conversations about BED. As predicted, partners’ emotional reactivity to patients’ emotional arousal was associated with high accommodation before treatment. Thus, partners may use accommodation as a strategy to reduce both the patients’ and their own distress. After treatment, partners’ arousal was no longer associated with the patients’ emotional arousal; instead, partners showed greater emotional stability over time, specifically when accommodation was low. Additionally, patients were less emotionally aroused after treatment. Therefore, treatment may have decreased overall emotionality of patients and altered the association between accommodation and partners’ emotional reactivity. If replicated, this understanding of the emotional context associated with accommodation in BED can inform couple‐based treatment by targeting specific emotional precipitants of behaviors that maintain symptoms.     

The effects of an authentic coaching intervention on athlete outcomes: A pilot randomised controlled trial

ObjectivesAuthentic leadership has been found to be related to promising outcomes in sport. However, no intervention designed to increase coaches' authentic leadership exists. The aim of this study was to develop and evaluate such an intervention.DesignThe study was a pilot randomised controlled trial. We used a mixed design with Group (Intervention, Control) as between- and Time (pre, post) as within-participants factors.MethodA total of 18 coaches (M_age = 37.89; 83% males) and their athletes (N = 153; M_age = 20.48; 50.3% females) were randomly allocated, via block randomisation, into either an intervention (coaches n = 9, athletes n = 90) or a control group (coaches n = 9, athletes n = 63). The coaches in the intervention group received a 2-h-long workshop and completed weekly coaching logs. Data were collected via questionnaires, which were administered to both the coaches and their athletes prior to the workshop and two months after the workshop.ResultsThe results revealed that the intervention group reported higher authentic leadership compared to the control group. A mixed-design analysis of variance indicated that athletes in the intervention group reported significantly higher enjoyment and prosocial behaviour from pre- to post-intervention compared to the control group.ConclusionsThe findings suggest that an authentic coaching intervention can be effective in improving coaches' authentic behaviours and promoting positive athlete outcomes.     

Comparing the efficacy (RCT) of learning a dance choreography and practicing creative dance on improving executive functions and motor competence in 6–7 years old children

ObjectivesThis study examined the effect of two different dance curriculums on executive functions and motor competence in 6–7 years old primary-school children across an 8-week period. One dance curriculum was underscored by creativity and the other was based on a choreographed dancing curriculum with high cognitive challenge.DesignRandomised-controlled trial.MethodsSixty-two primary-school children (6.6 ± 0.5 years old; 47% females) participated for a control period in the regular school PE lessons, after which they were randomly assigned to two experimental groups – choreography dance group or creative dance group. The two experimental groups practiced dance for 8 weeks, twice a week, learning either a choreographed dance sequence with high cognitive challenge or creating their own dance sequence in a creative dance curriculum. Executive functions (working memory capacity, inhibition, and flexibility) and motor competence were assessed at three time points – baseline, pre-intervention and post-intervention.ResultsThere was a time effect for inhibitory control (p < 0.01), with a high improvement during the intervention (d = 0.76) than baseline (d = 0.46); for working memory capacity (p < 0.01), with a higher improvement during intervention (d = 0.43) than baseline (d = 0.31) in the high challenging task; and for motor competence (p < 0.01), with a higher improvement during baseline (d = 1.7) than intervention (d = 0.75); no other significant effects. Group differences revealed weak evidence that the choreography group improved inhibitory control and working memory more than the creative dance group. However, a check for pedagogy fidelity revealed that the creative-dance curriculum was not adopted as planned (i.e., high volume of teacher's instruction and small use of music).ConclusionsAn 8-week dance intervention improved inhibitory control and potentially working memory capacity in grade one and two primary-school children. Contrary to prediction, the dance intervention did not improve motor competence beyond typical development. Discrepancy between the planned and adopted creative-dance curriculum suggests caution in interpreting results. This study provides new insights into the exercise-cognition relationship.     

Refreshing Older Adults’ Driving Skills (ROADSkills): A randomized controlled trial examining the effect of video feedback

ObjectivesThis study evaluated the effectiveness of a personalized video-based driver training program on the behind-the-wheel skills of community-dwelling older adults.MethodIn this randomized controlled trial (RCT), 80 older drivers [mean age (SD) = 71.0 (3.9)] were randomly assigned to view one of two educational videos: 1) personalized video feedback on their driving (n = 40) or 2) a generic video on aging-in-place (n = 40). The primary outcome, the total number of errors accrued in a 30-minute standardized on-road evaluation, was analyzed at baseline and 4 weeks after watching the assigned video. On-road evaluations were video-recorded and scored by a blinded rater. Self-report measures of driving abilities, behaviors, and comfort were also compared.ResultsAt the 4-week follow-up, the mean difference in the number of on-road performance errors [mean (95% CI) = -12.0 (-16.6, −7.4), p < 0.001] favored the intervention group compared to controls, with significant improvements across multiple domains: vehicle control [mean (95% CI) = -4.8 (-8.1, −1.5), p < 0.01], observing the roadway [mean (95% CI) = -5.5 (-8.4, −2.6), p < 0.001], and compliance with traffic rules [mean (95% CI) = -1.3 (-2.3, −0.2), p < 0.05]. Within-group change on behind-the-wheel errors was significant for the intervention group [mean (95% CI) = -10.3 (-13.5, −7.1), p < 0.001], but not for the control group [mean (95% CI) = 1.7 (-1.6, 4.9), p > 0.05]. No significant differences were found on the self-report measures.DiscussionA novel, video-based approach that provided personalized feedback to older drivers significantly reduced behind-the-wheel errors 4-weeks post-intervention. Changes in self-reported driving behaviors and abilities were not significant. Future research will examine the long-term effects of this approach on older adults’ actual and perceived driving abilities.     

The Effect of Holy Qur’an Recitation on Depressive Symptoms in Hemodialysis Patients: A Randomized Clinical Trial

Patients with advanced renal failure often face considerable sociopsychological stress as a result of lifestyle changes due to the disease and its treatment. The aim of the present study is to examine the effect of the Holy Qur’an recitation on depressive symptoms in hemodialysis patients. In this clinical trial, 54 hemodialysis patients were randomized to either an experimental (n = 27) or a control (n = 27) group. Patients completed the Beck Depression Inventory-II (BDI-II) at baseline and at 1 month after the intervention. Participants in the experimental group listened to recitation of the Holy Qur’an, while those in the control group received no intervention. The mean BDI-II score at baseline was 33.6 (±6.7) for the experimental group and 29.3 (±9.0) for the control group; at the end of treatment, BDI-II scores in the experimental and control groups were 14.5 (±4.8) and 31.6 (±9.2), respectively. Results from the repeated-measures general linear model controlling for baseline differences indicated a significant treatment effect (F = 9.30, p = 0.004, Cohen’s d = 0.85). Holy Qur’an recitation has a significant effect on lowering depressive symptoms in hemodialysis patients. Holy Qur’an recitation is an easy-to-implement and cost-effective strategy that may be used to supplement the treatment of depression in this setting in Iran.

     

Implementation of a mindfulness-based stress reduction (MBSR) program to reduce stress,anxiety, and depression and to improve psychological well-being among retired Iranian football players

ObjectivesTo test whether a mindfulness-based stress reduction (MBSR) program could reduce symptoms of anxiety, stress, and depression, and increase psychological well-being among retired Iranian football players compared to an active control group.DesignRandomized controlled trial, with an 8-week MBSR intervention (16 group sessions, 90 min each) and an active control group. Three data assessments were performed at baseline, eight weeks later after completion of the intervention, and again twelve weeks later at follow-up.MethodsForty male retired football players (M_age = 34.05, SD = 1.72) were randomly assigned either to the MBSR intervention or the active control condition. All participants completed questionnaires on perceived stress, anxiety, depression, and psychological well-being. Repeated measures analyses of variance were used to assess time by group interactions.ResultsSignificant time by group interaction effects were found for all outcomes. In the MBSR group, psychological well-being improved and symptoms of stress, anxiety, and depression decreased over time from baseline to intervention completion and to follow-up. In the active control group, the outcomes remained relatively stable across time.ConclusionsThe present findings suggest that among male retired Iranian football players, a MBSR intervention has the potential to reduce symptoms of stress, anxiety, and depression, and to increase their psychological well-being. Potential (underlying) mechanisms were not assessed in the present study. In future investigations, researchers should try to gain a deeper understanding of the mechanisms which may explain the observed effects.     

Effects of a self-regulation intervention on exercise are moderated by depressive symptoms: A quasi-experimental study

This study investigated whether a computer-based self-regulation intervention increases physical exercise in individuals with or without depressive symptoms. A total of 361 individuals in orthopedic rehabilitation, 36 of them with depressive symptoms, were recruited in Germany. In a quasi-experimental study, individuals were allocated to either a computer-based self-regulation intervention or an online questionnaire. Exercise was measured at the beginning of rehabilitation and six weeks after rehabilitation. Depressive symptoms were assessed at the end of rehabilitation. An analysis of covariance was conducted, controlling for exercise baseline, sex, and phase of assessment. A main effect for depressive symptoms (p = .005) and intervention group (p = .011), as well as a marginal interaction of intervention x depressive symptoms were found (p = .076). Results indicate that the self-regulation exercise intervention in an orthopedic rehabilitation setting seem to be only effective in non-depressed individuals. Future research should examine how health behavior change programs can be designed more effectively for individuals with depressive symptoms.     

Effects of a teacher training program to promote physically active play among preschoolers with autism spectrum disorders

Wellness Enhancing Physical Activity for Young Children (WE PLAY) is an intervention intended to promote physical activity (PA) among typically-developing preschool children in child care settings. It was adapted for use by teachers who educate children with Autism Spectrum Disorders (ASD). This study used a multiple baseline design across participants to evaluate the impact of WE PLAY-Autism on teachers' PA facilitating behaviors and on the PA levels of children with ASD. Visual analysis and effect size estimates indicated that two of the three teachers increased their PA facilitating behavior, although this was insufficient to demonstrate a functional relation. Children's (n = 5) PA was measured daily during school hours using accelerometry. Visual analysis, which was further supported by effect size calculations, indicated higher average levels of moderate-to-vigorous PA (MVPA) among preschoolers with ASD in the intervention phase (Tau-U_{A vs. B} = 0.53, p < .001, Hedges' g = 0.99, 95% CI [0.56, 1.43]) and post-training phase (Tau-U_{A vs. B} = 0.55, p < .001, Hedges' g = 1.17, 95% CI [0.73, 1.60]) in comparison to the baseline phase. WE PLAY-Autism is an intervention deserving of further investigation given its meaningful impact on the MVPA of preschoolers with ASD paired with its potential for broad implementation in preschools.     

The gap between athletes’ and parents’ perceptions of parental practices: The role of gender

ObjectivesThe present study explored the differences between athletes’ and parents’ perceptions of parental practices (i.e., active involvement, directive, pressure, praise, and understanding behaviours implemented by parents in the context of their child’s sport) by considering athletes’ and parents’ gender.Designcross-sectional study.MethodParents (N = 352) and athletes (N = 256, M = 14.72 years) completed a questionnaire to measure their perceptions of parental practices in sport. Zero-order correlations were computed for the entire sample and each sub-group (i.e., father-daughter, father-son, mother-daughter, and mother-son). One-level multilevel model (level 1: respondent) was computed to measure the influence of the respondent on the perceptions of parental practices. Two-level multilevel model (level 1: respondent, level 2: dyad) estimated the impact of the athletes’ gender, parents’ gender, and their interaction on the differences in perceptions.ResultsCorrelations highlighted relatively modest concordance between perceptions of parents and adolescents. Multilevel models showed that compared to athletes, parents reported significantly less frequent use for directive behaviours (β = −0.29) and more frequent use for active involvement (β = −0.18) and praise and understanding (β = 0.27). Correlations and multilevel models showed that the differences between athletes’ and parents’ perceptions of parental practices differed according to gender. The differences in perceptions of the directive behaviours (β = −0.22) and active involvement (β = 0.22) were higher when the father was involved in the dyad compared to the mother.     

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.