Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

Objective: A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n?=?63, aged 35–69). Design: Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email. Main Outcome Measures: Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect. Results: Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level. Conclusion: Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.     

Manic temporality

Time-consciousness has long been a focus of research in phenomenology and phenomenological psychology. We advance and extend this tradition of research by focusing on the character of temporal experience under conditions of mania. Symptom scales and diagnostic criteria for mania are peppered with temporally inflected language: increased rate of speech, racing thoughts, flight-of-ideas, hyperactivity. But what is the underlying structure of temporal experience in manic episodes? We tackle this question using a strategically hybrid approach. We recover and reconstruct three hypotheses regarding manic temporality that were advanced and modeled by two pioneers of clinical phenomenology: Eugène Minkowski (1885–1972) and Ludwig Binswanger (1881–1966). We then test, critique, and refine these hypotheses using heterophenomenological methods in an interview-based study of persons with a history of bipolar and a current diagnosis of acute mania. Our conclusions support a central hypothesis due to Minkowski and Binswanger, namely, that disturbance in the formal structure of temporal experience is a core feature of mania. We argue that a suitably refined variant of Binswanger’s model of disturbance in manic protention helps to explain a striking pattern of impaired insight and impaired reasoning in manic episodes.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications (‘apps’) and online trackers. A cross-sectional study (n = 276) was conducted to assess college students’ health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.     

Bedding down new words: Sleep promotes the emergence of lexical competition in visual word recognition

Lexical competition processes are widely viewed as the hallmark of visual word recognition, but little is known about the factors that promote their emergence. This study examined for the first time whether sleep may play a role in inducing these effects. A group of 27 participants learned novel written words, such as banara, at 8 am and were tested on their learning at 8 pm the same day (AM group), while 29 participants learned the words at 8 pm and were tested at 8 am the following day (PM group). Both groups were retested after 24 hours. Using a semantic categorization task, we showed that lexical competition effects, as indexed by slowed responses to existing neighbor words such as banana, emerged 12 h later in the PM group who had slept after learning but not in the AM group. After 24 h the competition effects were evident in both groups. These findings have important implications for theories of orthographic learning and broader neurobiological models of memory consolidation.     

Escape from rich‐to‐lean transitions: Stimulus change and timeout

Extended pausing during discriminable transitions from rich‐to‐lean conditions can be viewed as escape (i.e., rich‐to‐lean transitions function aversively). In the current experiments, pigeons’ key pecking was maintained by a multiple fixed‐ratio fixed‐ratio schedule of rich or lean reinforcers. Pigeons then were provided with another, explicit, mechanism of escape by changing the stimulus from the transition‐specific stimulus used in the multiple schedule to a mixed‐schedule stimulus (Experiment 1) or by producing a period of timeout in which the stimulus was turned off and the schedule was suspended (Experiment 2). Overall, escape was under joint control of past and upcoming reinforcer magnitudes, such that responses on the escape key were most likely during rich‐to‐lean transitions, and second‐most likely during lean‐to‐lean transitions. Even though pigeons pecked the escape key, they paused before doing so, and the latency to begin the fixed ratio (i.e., the pause) remained extended during rich‐to‐lean transitions. These findings suggest that although the stimulus associated with rich‐to‐lean transitions functioned aversively, pausing is more than simply escape responding from the stimulus.     

What's Context Got to Do with It? Comparative Difficulty of Test Questions Influences Metacognition and Corrected Scores for Formula‐scored Exams

Summary: On formula‐scored exams students receive points and penalties for correct and incorrect answers, respectively, but they can avoid the penalty by withholding incorrect answers. However, test‐takers have difficulty strategically regulating their accuracy and often set an overly conservative metacognitive response bias (e.g., Higham, 2007). The current experiments extended these findings by exploring whether the comparative difficulty of surrounding test questions (i.e., easy vs. hard)—a factor unrelated to the knowledge being tested—impacts metacognitive response bias for medium‐difficulty test questions. Comparative difficulty had no significant influence on participants' ability to choose correct answers for medium questions, but it did affect willingness to report answers and confidence ratings. This difference carried over to corrected scores (scores after penalties are applied) when comparative difficulty was manipulated within‐subjects: Scores were higher in the hard condition. Results are discussed in terms of implications for interpreting formula‐scored tests and underlying mechanisms of performance.Copyright © 2017 John Wiley & Sons, Ltd.     

Repressive coping and cardiovascular reactivity to novel and recurrent stress

Background and objectives: Repressors tend to report less negative emotion and to describe challenges as less stressful, yet tend to exhibit higher rates of cardiovascular disease. While repressive coping has been shown to be associated with exaggerated physiological reactivity to novel stress, we sought to establish if elevated responses persisted across repeated exposure.

Design and methods: In a sample of 86 healthy female adults, a verbal-autonomic response dissociation index of repressive coping was computed. Participants were exposed to two consecutive stress tasks, with analyses based on comparisons of consecutive stress responses.

Results: Analysis of covariance demonstrated significant differences across the study on diastolic blood pressure and cardiac output, as a function of repressive coping. Repressors showed elevated reactions to both stress tasks; however, cardiac output responses to the second task were more muted indicating that repressive coping was associated with successful adaptation to recurrent stress. Nevertheless, repressive copers maintained an exaggerated cardiovascular responses to recurrent stress.

Conclusions: The present study identifies that repressive coping may be associated with increased risk of cardiovascular disease development through elevated cardiovascular reactions to both novel and recurrent stress.