Revisiting self-regulatory techniques to promote physical activity in older adults: null-findings from a randomised controlled trial

Objective. A randomised controlled trial (RCT) was conducted to evaluate a three-hour face-to-face physical activity (PA) intervention in community-dwelling older German adults with four groups: The intervention group (IG) received behaviour change techniques (BCTs) based on the health action process approach plus a views-on-ageing component to increase PA. The second intervention group ‘planning’ (IGpl) contained the same BCTs, only substituted the views-on-ageing component against an additional planning task. An active control group received the same BCTs, however, targeting volunteering instead of PA. A passive control group (PCG) received no intervention.

Design. The RCT comprised 5 time-points over 14 months in N = 310 participants aged 64+.

Main outcome measures. Self-reported as well as accelerometer-assessed PA.

Results. Neither PA measure increased in the IG as compared to the other groups at any point in time. Bayes analyses supported these null-effects.

Conclusion. A possible explanation for this null-finding in line with a recent meta-analysis is that some self-regulatory BCTs may be ineffective or even negatively associated with PA in interventions for older adults as they are assumed to be less acceptable for older adults. This interpretation was supported by observed reluctance to participate in self-regulatory BCTs in the current study.     

Working mechanisms of a web-based self-management intervention for cancer survivors: a randomised controlled trial

Objective: The aim of this study was to investigate whether problem-solving skills and perceived personal control over cancer recovery mediated the intervention effects on depression and fatigue of a web-based computer-tailored intervention for cancer survivors – the Kanker Nazorg Wijzer (Cancer Aftercare Guide).

Design: Patients were recruited through 21 Dutch hospitals (November 2013–June 2014). The mediation model was tested in a randomised controlled trial with an intervention group (n = 231) and a waiting list control group (n = 231).

Main outcome measures: Hypothesised mediators problem-solving skills (SPSI-R) and personal control (IPQ-R) were measured at baseline and 3 months from baseline. Outcomes depression (HADS) and fatigue (CIS) were measured at baseline and 6 months from baseline.

Results: The intervention effects in decreasing depression and fatigue were mediated by personal control. Problem-solving skills did not mediate the intervention effects on depression and fatigue.

Conclusion: While personal control in the control group decreased in the first three months after baseline, levels of personal control within the intervention group were maintained. This effect partially explained the intervention effects on depression and fatigue. The results provide evidence for the relevance of addressing personal control in web-based interventions in order to improve psychosocial well-being in early cancer survivors.     

Book reviews and books received

Helping interventions John Heron: Helping the Client: a Creative Practical Guide. London: Sage, 1990. £9.95.

A person-centred perspective on school counselling John McGuiness: A Whole School Approach to Pastoral Care. London: Kogan Page, 1989. £8.95.

How to relate effectively Richard Nelson-Jones: Human Relationship Skills (2nd edition). London: Cassell, 1990. £11.95.

Ripe for research? Dave Mearns and Windy Dryden: Experiences of Counselling in Action. London: Sage, 1989. £9.95.

Issues in action Windy Dryden (ed.): Key Issues for Counselling in Action. London: Sage, 1989. £7.95.

The meaning of death Rosemary Dinnage: The Ruffian on the Stair: Reflections on Death. London: Viking, 1990. £14.99.

The empty cradle Irving G. Leon: When a Baby Dies: Psychotherapy for Pregnancy and Newborn Loss. London: Yale University Press, 1990. £20.

Children against themselves Israel Orbach: Children Who Don't Want to Live: Understanding and Treating the Suicidal Child. San Francisco: Jossey-Bass, 1988. £17.95.     

Book reviews and books received

Practical help for family therapists John Carpenter and Andy Treacher: Marital and Family Therapy. Oxford: Blackwell, 1989. €29.50 (hardback); €9.95 (paperback).

Survival for the guidance teacher W.P. Gothard and E. Goodhew: Guidance and the Changing Curriculum. London: Croom Helm, 1987. €22.50.

Second-class male Michael S. Kimmel (ed.): Changing Men: New Directions in Research on Men and Masculinity. London: Sage, 1987. €35 (hardback); €14.50 (paperback).

Analysing the analyst Rosemary Dinnage: One to One: Experiences of Psychotherapy. London: Viking, 1988. €12.95.

Practical counselling skills revisited Richard Nelson-Jones: Practical Counselling and Helping Skills. London: Cassell, 1988. €7.95.

Snakes and pyramids Jocelyn Chaplin: Feminist Counselling in Action. London: Sage, 1988. €7.95.

The person-centred approach: a key text Dave Mearns and Brian Thome: Person-Centred Counselling in Action. London: Sage, 1988. €7.95.     

Changes in physical activity among coronary and hypertensive patients: A longitudinal study using the Health Action Process Approach

Objectives: Physical activity (PA) is a key factor in cardiovascular disease prevention. Through the Health Action Process Approach (HAPA), the present study investigated the process of change in PA in coronary patients (CPs) and hypertensive patients (HPs).

Design: Longitudinal survey study with two follow-up assessments at 6 and 12 months on 188 CPs and 169 HPs.

Main outcome measures: Intensity and frequency of PA.

Results: A multi-sample analysis indicated the equivalence of almost all the HAPA social cognitive patterns for both patient populations. A latent growth curve model showed strong interrelations among intercepts and slopes of PA, planning and maintenance self-efficacy, but change in planning was not associated with change in PA. Moreover, increase in PA was associated with the value of planning and maintenance self-efficacy reached at the last follow-up

Conclusions: These findings shed light on mechanisms often neglected by the HAPA literature, suggesting reciprocal relationships between PA and its predictors that could define a plausible virtuous circle within the HAPA volitional phase. Moreover, the HAPA social cognitive patterns are essentially identical for patients who had a coronary event (i.e. CPs) and individuals who are at high risk for a coronary event (i.e. HPs).     

Book reviews

So you thought you had sorted out a Code of Ethics? Gavin Fairbairn and Susan Fairbaim: Ethical Issues in Caring. Aldershot: Avebury, 1988. £22.50.

The myth of positivism Celia Kitzinger: The Social Construction of Lesbianism. London: Sage, 1987. £8.95.

A family approach to art psychotherapy H. B. Landgarten: Family Art Psychotherapy: a Clinical Guide and Casebook. New York: Brunner/Mazel, 1987. $27.50.

Simple psychodynamics Michael Jacobs: Psychodynamic Counselling in Action. London: Sage, 1988.

Optimistic assumptions T. Haberle: Counselling and Curing. London: SPCK, 1987. £3.50.     

Explaining the effects of a decision intervention on mammography intentions: The roles of worry,fear and perceived susceptibility to breast cancer

Objective: This study examines the effects of a mammography decision intervention on perceived susceptibility to breast cancer (PSBC) and emotion and investigates how these outcomes predict mammography intentions.

Design: Randomised between-subjects online experiment. Participants were stratified into two levels of risk. Within each stratum, conditions included a basic information condition and six decision intervention conditions that included personalised risk estimates and varied according to a 2 (amount of information: brief vs. extended) × 3 (format: expository vs. untailored exemplar vs. tailored exemplar) design. Participants included 2465 US women ages 35–49.

Main Outcome Measures: PSBC as a percentage, PSBC as a frequency, worry, fear and mammography intentions.

Results: The intervention resulted in significant reductions in PSBC as a percentage for women in both strata and significant increases in worry and fear for women in the upper risk stratum. Of the possible mediators examined, only PSBC as a percentage was a consistent mediator of the effect of the intervention on mammography intentions.

Conclusion: The results provide insight into the mechanism of action of the intervention by showing that PSBC mediated the effects of the intervention on mammography intentions.     

Positive and negative affectivity,stress, and well-being in African-Americans: Initial demonstration of a polynomial regression and response surface methodology approach

Objective: The extent to which positive (PA) and negative (NA) affect conjointly impact well-being is not yet well understood. Additionally, research investigating the role of affectivity in maintaining well-being among ethnic and racial minorities is scant. The current research demonstrates how polynomial regression and response surface methodology (PR and RSM) may be used to better understand how PA and NA jointly influence stress and well-being.

Design: In Study 1, 291 African-American undergraduates (M_age = 22.91, SD = 6.91; 67% female) completed measures of affectivity and psychological well-being. In Study 2, a community sample of 117 African-Americans (M_age = 31.87, SD = 13.83; 69% female) completed affectivity measures and a laboratory-based social stressor task to assess links between affectivity and salivary cortisol reactivity.

Main outcome measures: Study 1 included life satisfaction, perceived stress and self-reported depressive symptoms. Study 2 included salivary cortisol reactivity.

Results: Across both studies, PA ascendency (i.e. high PA combined with low NA) was associated with better well-being, while NA ascendancy (i.e. high NA combined with low PA) was associated with poorer outcomes.

Conclusion: PR and RSM may provide new insight into the conjoint influence of PA and NA on health and well-being. We discuss potential implications for affectivity research, including race-related explorations.     

Book reviews and book received

The most practised, the least taught David S. Werman: The Practice of Supportive Psychotherapy. New York: Brunner/Mazel, 1984. $34.00.

Another load of research L.S. Greenberg and W.M. Pinsof (eds.): The Psychotherapeutic Process: a Research Handbook. New York: Guilford, 1986. £39.95.

Crisis of identity K. Yardley &; T. Honess (eds.): Self and Identity: Psychosocial Perspectives. Chichester: Wiley, 1987. £28.

A dig from the 'Rib' Sue O'Sullivan (ed.): Women's Health: a Spare Rib Reader. London: Pandora, 1987. £5.95.

'Weak on vision, hot on workshops' Zandy B. Leibowitz, Caela Farren and Beverley L. Kaye: Designing Career Development Systems. San Francisco: Jossey-Bass, 1986. £30.75.

Holland not neglected in Australia Jan J. Lokan and Keith F. Taylor (eds.): Holland in Australia: a Vocational Choice Theory in Research and Practice. Melbourne: Australian Council for Educational Research, 1986. $A24.95.

Need help getting a job? Elizabeth B. Yost and M. Anne Corbishley: Career Counseling: a Psychological Approach. San Francisco: Jossey-Bass, 1987. £24.

Children's health B. Mayall: Keeping Children Healthy. London: Allen &; Unwin, 1986. £6.95.

Educating about divorce Kathleen M. Cox and Martin Desforges: Divorce and the School. London: Methuen, 1987. £7.95.     

Self-efficacy versus perceived enjoyment as predictors of physical activity behaviour

Objective: Self-efficacy and physical activity (PA) enjoyment are related to PA behaviour, but it is unclear which is more important and how they interrelate. The purpose of this study was to examine how these two constructs interrelate to influence PA behaviour.

Design: Participants were low-active adults (n = 448) participating in a RCT examining the effect of a PA promotion intervention. Participants completed physical activity, enjoyment and self-efficacy measures at baseline, six and 12 months.

Results: Self-efficacy and enjoyment at both baseline and six months predicted PA at 12 months. However, enjoyment was a stronger predictor than self-efficacy, in that self-efficacy no longer predicted PA behaviour when included alongside enjoyment. In follow-up mediation analyses, enjoyment at six months did not mediate the effect of baseline self-efficacy on 12-month PA; however, six-month self-efficacy mediated the effect of baseline enjoyment on 12-month PA.

Conclusion: Our results indicate that interventions should perhaps initially focus on increasing enjoyment of physical activity. Greater PA enjoyment appears to influence individuals’ self-reported ability to engage in regular PA (i.e. higher self-efficacy ratings). Additional research is needed to better understand the interrelationships between self-efficacy and enjoyment and how these constructs affect PA.     

Book reviews and books received

Counselling and spirituality Lyall, D. 1995 Counselling in the Pastoral and Spiritual Context Buckingham, Open University Press ISBN 0-335-19162-2 £10.99

Career counselling Seligman, L. 1994 Developmental Career Counseling and Assessment (2nd ed.) London, Sage ISBN 0-8039-5804-8 £19.95

Women's careers Walsh, W.B. &; Osipow, S.H. (Eds), 1994 Career Counseling for Women Hove, Erlbaum ISBN 0-8058-1035-8 £53.50

Crisis? what crisis? Dattilio, F.M. &; Freeman, A. (Eds), 1994 Cognitive-Behavioral Strategies in Crisis Intervention New York, Guilford ISBN 0-89862-221-2 £25.00

Guidance on research methods McLeod, J. 1994 Doing Counselling Research London, Sage ISBN 0 8039 7804 9 £10.95

Barker, C. Pistrang, N. &; Elliott, R. 1994 Research Methods in Clinical and Counselling Psychology Chichester, Wiley ISBN 0-471-93612-X £29.95

Research into creative therapies Gilroy, T. &; Lee, C. (Eds), 1995 Art and Music Therapy and Research London, Routledge ISBN 0-415-10045-3 £37.50 (hardback); £15.99 (paperback)

Treating stress Palmer, S. &; Dryden, W. 1995 Counselling for Stress Problems London, Sage ISBN 0-8039-8863-X £12.95

Breast cancer Batt, S. 1994 Patient No More: the Politics of Breast Cancer London, Scarlet Press ISBN 1-85727-167-3 £10.99

Supervision Feltham, C. &; Dryden, W. 1994 Developing Counsellor Supervision London, Sage ISBN 0-8039-8939-3 £9.95     

Affect and between-meal snacking in daily life: the moderating role of gender and age

Objective: Affect-related energy intake from snacks remains relatively unexplored in daily life. This study examines the associations between momentary positive affect (PA) and momentary negative affect (NA) and subsequent energy intake from snacks. In addition, the moderating role of BMI, gender, age and level of education is investigated.

Design: Adults (N = 269), aged 20–50, participated in this study. Demographics were assessed in an online composite questionnaire. An experience sampling smartphone application was used to map momentary NA/PA and energy intake (kilocalories) from snacks in the context of daily life.

Main outcome measures: Energy intake from moment-to-moment self-reported snacks in real-life settings.

Results: A significant negative main effect of momentary NA on moment-to-moment energy intake was found. The higher the momentary NA, the lower the subsequent amount of kilocalories consumed. There was no main effect with regard to PA. Interaction analyses showed that men decreased their energy intake after experiencing NA, and increased their intake after experiencing PA. No associations were found in women. Additionally, young adults (20–30) increased their energy intake after experiencing PA. No associations were found in the other age groups.

Conclusion: Interventions aiming at reducing energy intake might also address PA-related snacking in young adults and men.     

Book reviews

Laughing Gods, Weeping Virgins: Laughter in the History of Religion. Ingvild Sæud Gilhus, 1997 London, New York: Routledge 173 pp., £45.00 (hb) ISBN 0–415–16197–5

Questioning the Secular State: The Worldwide Resurgence of Religion in Politics. David Westerlund, ed., 1996 London: Hurst & Companyμ xii +428 pp., £14.95 ISBN 1–85065–241–4 (pb.)

Religion and Resistance Politics in South Africa. Lyn S. Graybill, 1996 Westport, Connecticut: Praeger/Greenwood Press 157 pp., £44.95 (hb) ISBN 0–275–95141–3

Engaged Buddhism: Buddhist Liberation Movements in Asia Christopher S. Queen & Sallie B. King, eds., 1996 Albany, NY: State University of New York Press 446 pp., US$24.95 ISBN 0–7914–2844–3

Religious Pluralism and Christian Truth. Joseph S. O'Leary, 1996 Edinburgh: Edinburgh University Press xiii + 269 pp., £45.00 ISBN 0–7486–0727–7

Church, State and Religious Minorities. Tariq Modood, ed., 1997 London: Policy Studies Institute 96 pp., £10.95 ISBN 0 85374 724 5

The Coming Deliverer: Millennial Themes in World Religions. Fiona Bowie, ed., 1997 Cardiff: University of Wales Press 264 pp., £9.95 (pb) ISBN 0–7083–1338–8

Zoroastrians in Britain. John R. Hinnells, 1996 Oxford, Clarendon Press xiv + 336 pp., £42.00 (hb) ISBN 0–19–826193–4

From the Holy Mountain: A Journey in the Shadow of Byzantium. William Dalrymple, 1997 London, Harper Collins 484 pp., illustrated, £18.00 ISBN 0–0025–5509–3

Jerusalem Today: What Future for the Peace Process?. Ghada Karmi, edv 1996 Reading: Ithaca Press xix +191 pp., £25.00 ISBN 0–86372–204–0

Judaism Since Gender. Miriam Peskowitz & Laura Levitt, eds., 1997 London: Routledge 229 pp., £14.99 (pb), £45.00 (hb) ISBN 0–415–91461–2 (pb), ISBN 0–415–91460–4 (hb)

Muslim Communities in the New Europe. Gerd Nonneman, Tim Niblock & Bogdan Szajkowski, eds., 1996 Reading: Ithaca Press 346 pp, £35.00 (hb) ISBN 0–86372–192–3

Congregation and Community. Nancy Tatom Ammerman, 1997 New Brunswick: Rutgers University Press xvi + 434 pp., US$55.00 (hb), US$24.00 (pb) ISBN 0–81352–334–6 (hb), ISBN 0–81352–335–4 (pb)

Against the Stream: The Adoption of Traditional Christian Faiths by Young Adults. Richard P. Cimino, 1997 Lanham, Maryland: University Press of America & Religion Watch 128 pp., US$46,00 (hb), US$26,00 (pb) ISBN 0–7618–0574–5 (hb), ISBN 0–7618–0575–3 (pb)

Polygamous Families in Contemporary Society. Irwin Altman & Joseph Ginat, 1996 Cambridge: Cambridge University Press xv + 512 pp., £55.00 (hb), £19.95 (pb) ISBN 0–521–56169–8 (hb), 0–521–56731–9 (pb)

Fertility, Class and Gender in Britain: 1860–1940. Simon Szreter, 1996 Cambridge: Cambridge University Press 710 pp., £50.00 ISBN 0–521–34343–7

Implicit Religion in Contemporary Society. Edward I. Bailey, 1997 Kampen, Netherlands: Kok Pharos Publishing House; Weinheim, Germany: Deutscher Studien Verlag 302 pp., Dfl.69.00, £23.00 ISBN (Kok) 90–390–0581–8; ISBN (DSV) 3–89271–694–3

Geography of Religions in Russia. Alexei D. Krindatch, 1996 Decatur, Georgia: Glenmary Research Center 72 pp., 47 maps, US$29.95 (Paper/Spiral Bound) ISBN 0–914422–25–1

Believing in Australia: A Cultural History of Religions". Hilary M. Carey, 1996 St Leonards, N.S.W.: Allen & Unwin xviii + 270p., £16.95 (pb) ISBN 1–86373–950–5

Icelandic Spiritualism: Mediumship and Modernity in Iceland. William H. Swatos, jr. & Loftur Reímar Gíssurarson, 1997 New Brunswick: Transaction Publishers 269 pp., US$32.95 (hb) ISBN 1–56000–273–5

The Channeling Zone: American Spirituality in an Anxious Age. Michael F. Brown, 1997 Cambridge, Massachusetts & London, England: Harvard University Press 214 pp., £14.50 (hb) ISBN 0–674–10882–5

Listening People, Speaking Earth: Contemporary Paganism. Graham Harvey, 1997 London: Hurst & Co. 250 pp., £27.50 (hb), £9.95 (pb) ISBN 1–85065–271–6 (hb), ISBN 1–85065–272–4 (pb)     

Qualitative analysis of feedback on functional imagery training: A novel motivational intervention for type 2 diabetes

Objective: Effective motivational support is needed in chronic disease management. This study was undertaken to improve a novel type 2 diabetes motivational intervention, (functional imagery training, FIT) based on participant feedback and results from a self-management randomised controlled trial.

Design: Qualitative inductive thematic analysis of semi-structured interviews.

Main outcome measures: Open-ended questions on participant experiences of the FIT intervention content, process, most/least helpful features, suggestions for improvement and general feedback.

Results: Eight themes emerged. Participants thought FIT promoted autonomy and self-awareness. They found the intervention interesting and helpful in keeping their health on track through accountability provided by regular phone calls. However, boredom with repetitive use of imagery, feeling inadequately equipped to manage unhealthy cravings, and difficulty with the time commitment was reported by some. Supplementary written material was recommended.

Conclusion: Several well-received features of FIT overlapped with those from traditional motivational interviewing. FIT sessions should ensure content is regularly adapted to new health-enhancing goals. After self-management behaviour becomes habitual, imagery practice could be restricted to challenging contexts. Provision of a written rationale and use of mindfulness for cravings is recommended. With these improvements, the impact of FIT on diabetic control may be substantially enhanced.     

Book notes

Apocalyptic Bodies: The Biblical End of the World in Text and Image Tina Pippin, 1999 London, New York: Routledge 160 pp., £14.99 ISBN 0–415–18248–4

The Picture in Question: Mark Tansey and the Ends of Representation Marc C. Taylor, 1999 Chicago, London: University of Chicago Press 144 pp., US$30.00, £23.95 (hb), US$12.00, £9.50 (pb) ISBN 0–226–79128–9 (hb), ISBN 0–226–79129–7

Religion in the Twenty‐first Century Mary Pat Fisher, 1999 London: Routledge 128 pp., £6.99 (pb) ISBN 0–415–21166–2

Religion im Wandel der Kosmologien Religionswissenschaft Vol. 10 Dieter Zeixer, ed., 1999 Frankfurt a.M., Berlin, Berne, New York, Paris, Vienna: Peter Lang 305 pp., £33.00 (pb) ISBN 3–631–33138‐X

Pluralism and the Religions: The Theological and Political Dimensions John D'Arcy May, ed., 1998 London: Cassell 99 pp., £30 (hb), £9.99 (pb) ISBN 0–304–70258–7 (hb), ISBN 0–304–70259–5 (pb)

Sharing Shalom: A Process for Local Interfaith Dialogue between Christians and Jews Philip A. Cunningham & Arthur F. Starr, eds., 1998 New York; Mahwah, NJ: Paulist Press/Stimulus Books 120 pp., US$7.95 (pb) ISBN 0–8091–3835–2

What Price Prejudice? Christian Antisemitism in America Frank E. Eakin, Jr., 1998 New York; Mahwah, NJ: Paulist Press/Stimulus Books 208 pp., US$9.95 (pb) ISBN 0–8091–3822–0

Christian Theology: A Brief Introduction Gareth Jones, 1999 Oxford: Polity Press 178 pp., £45.00 (hb), £14.99 (pb) ISBN 0–7456–1062–5 (hb), ISBN 0–7456–1063–3 (pb)

Holy Smoke. Religion and Roots: A Personal Memoir LiBBY PURVES, 1998 London: Hodder & Stoughton 199 pp., £14.99 (pb) ISBN 0–340–72151–0

Animal Gospel: Christian Faith as though Animals Mattered Andrew Linzey, 1998 London: Hodder & Stoughton 212 pp., £6.99 (pb) ISBN 0–340–62150–8

Vocations in Kerala: A Study on the Changes in the Social Determinants of Vocations to Priesthood and Religious Life in the Catholic Community in Kerala Jose Kuriedath, 1998 Thevara, Kochi, India: Sacred Heart College 144 pp., Rs 50/‐ no ISBN indicated

Jim Bakker: Miscarriage of Justice? James A. Albert, 1997 Chicago; La Salle, Illinois: Open Court Publishing 532 pp., £31.95 (hb), £14.50 (pb) ISBN 0–8126–9369–8 (hb), ISBN 0–8126–9370–1 (pb)

Buddhism and the Mythology of Evil: A Study in Theravada Buddhism Trevor Ling, 1997 Oxford: Oneworld Publications 179 pp., £11.99 (pb) ISBN 1–85168–132–9

Jung on Mythology Robert A. Segal, ed., 1998 London: Routledge 275 pp., £15.99 (pb) ISBN 0–415–19944–1

Islam: A Concise Introduction Neal Robinson, 1999 Richmond, Surrey: Curzon 197 pp., £40.00 (hb), £14.99 (pb) ISBN 0–7007–1103–1 (hb), ISBN 0–7007–1100–7 (pb)

Der Koran: Zugänge und Lesarten Hans Zirker, 1999 Darmstadt: Primus Verlag 230 pp., DM 39.80, SFR 37.00, 6S 291.00 (pb) ISBN 3–89678–121–9

On Faith Nathan Rotenstreich/Paul Mendes‐Flohr, 1998 Chicago, London: University of Chicago Press xii +169 pp., £27.95, US$35.00 (hb), £11.95, US$15.00 (pb) ISBN 0–226–72875–7 (hb), ISBN 0–226–72876–5 (pb)

Hegel's Idea of a Phenomenology of Spirit Michael N. Forster, 1998 Chicago: University of Chicago Press 661 pp., £59.95, US$75 (hb), £23.95, US$30.00 (pb) ISBN 0–226–25740–1 (hb), ISBN 0–226–25742–8 (pb)

Cartesian Questions: Method and Metaphysics Jean‐Luc Marion, 1999 Chicago, London: University of Chicago Press 215 pp., US$25.00, £19.95 (pb) ISBN 0–226–50544–8     

Experiences and engagement with the design features and strategies of an internet-delivered treatment programme for generalised anxiety disorder: a service-based evaluation

Background: Outcome research has highlighted the efficacy of internet-based cognitive behavioural therapy (iCBT). Some process research has examined users experiences of iCBT. Understanding the user experience provides valuable feedback to developers of internet-delivered interventions.

Aim: The present study aimed to evaluate user's experiences and engagement with the design features of an internet-delivered treatment programme for anxiety.

Methods: Semi-structured interviews were conducted with 7 participant users of the Space from Anxiety programme. A thematic analysis framework was employed to analyse the data collected.

Results: Identified themes related to participants engagement and adherence with the programme material, participant's experience of personal development through interaction with the programme content and participants experience of the social features employed in the programme. Another theme investigated the various attributes or conditions necessary for internet-delivered therapy to be helpful to an individual.

Conclusion: Considering the experiences of users of online interventions provides insight into what works for whom both in terms of technological features and the various skills and strategies that may compose the treatment intervention. Knowing more about what design features and strategies/components of the intervention are attractive and keep users involved can only enhance the delivery of effective internet-delivered interventions for anxiety disorders.     

Thyroid chondroplasty: Smoothing the thyroid cartilage— A retrospective study of thyroid chondroplasty for feminine neck appearance

Background: Thyroid chondroplasty is a surgical intervention for reduction of the Adam's apple, performed in trans women to achieve a more feminine appearance of the neck. This procedure is necessary since hormonal therapy given as part of gender affirming medical interventions has no effect on the mature larynx.

Objectives: We aim to describe our thyroid chondroplasty surgical technique and outcome of all thyroid chondroplasties performed during the study period.

Methods: A retrospective chart review of all thyroid chondroplasty procedures performed in a tertiary referral center between 2006 and 2015. Patients' clinical characteristics and surgical outcome were recorded and analyzed.

Results: Twenty-seven trans women underwent thyroid chondroplasty in our institution. Post-operative complications included a single patient who suffered from false vocal fold (ventricular folds) hematoma that resolved spontaneously. Five other patients had an erythematous scar. No other complications were observed.

Conclusion: Thyroid chondroplasty is a safe procedure for achieving a feminine neck contour in trans women.     

Book notes

Religion, Society, and Psychoanalysis: Readings in Contemporary Theory Janet Liebman Jacobs & Donald Capps, eds., 1997 Boulder, CO., Oxford: Westview Press 282 pp., £48.50 (hb), £14.95 (pb) ISBN 0–8133–2647–8 (hb), ISBN 0–8133–2648–6 (pb)

On the Genealogy of Morals: A Polemic Friedrich Nietzsche/Douglas Smith, 1998 Oxford, New York: Oxford University Press xxxvii + 170 pp., £5.99, US$10.95 ISBN 0–19–283617‐X

Seeing through the Media: A Religious View of Communications and Cultural Analysis Michael Warren, 1997 Harrisburg, PA: Trinity Press International 213 pp., US$17.00 ISBN 1–56338–211–3

Citizens and Exiles: Christian Faith in a Plural World Michael Nazir‐Ali, 1998 London: SPCK 198 pp., £12.99 (pb) ISBN 0–281–05050–3

Historical Dictionary of Catholicism William J. Collinge, 1997 Lanham, Md., London: The Scarecrow Press 551 pp., £53.00 ISBN 0–8108–3233‐X

Calendars in the Dead Sea Scrolls: Measuring Time James C. Vanderkam, 1998 London, New York: Routledge 136 pp., £35.00 ISBN 0–415–16513‐X

The Explorer's Guide to Judaism Jonathan Magonet, 1998 London: Hodder & Stoughton 340 pp., £8.99 (pb) ISBN 0–340–70984–7

The Explorer's Guide to Christianity Marcus Braybrooke, 1998 London: Hodder & Stoughton 287 pp., £8.99 (pb) ISBN 0–340–71005–5     

A randomized controlled trial of expressive writing in breast cancer survivors with lymphedema

Objective: Breast cancer survivors who develop lymphedema report poorer quality of life (QoL) than those without lymphedema. Expressive writing is a potential intervention to address QoL.

Design: Adult women (N = 107) with breast cancer and chronic Stage II lymphedema were randomised to writing about thoughts and feelings specific to lymphedema and its treatment (intervention) or about daily activities (control) for four, 20-min sessions.

Main Outcome Measures: Outcome measures were several indicators of QoL assessed at baseline, one, three, and six months post-intervention (total scores and subscales of Upper Limb Lymphedema 27 and Functional Assessment of Cancer Therapy–Breast). Hypothesised moderators of change in QoL were dispositional optimism, avoidant behaviours, and time since lymphedema diagnosis.

Results: There was no statistically significant intent-to-treat main effects of expressive writing on QoL. Statistically significant moderating effects on change in different indicators of QoL were observed for all three moderators. Expressive writing was more effective for improving QoL in women who were higher on optimism, lower on avoidance and had less time since a lymphedema diagnosis.

Conclusion: These results provide further evidence that there are subsets of individuals for whom expressive writing is more effective. Future research may investigate targeting expressive writing based on identified moderators.