Protocol for a randomized controlled trial: exercise-priming of CBT for depression (the CBT+ trial)

BACKGROUND

Depression is a leading cause of disability worldwide, and treatments could be more effective. Identifying methods to improve treatment success has the potential to reduce disease burden dramatically. Preparing or "priming" someone to respond more effectively to psychotherapy (e.g., cognitive behavioral therapy [CBT]) by preceding sessions with aerobic exercise, a powerful neurobiological activator, could enhance the success of the subsequently performed therapy. However, the success of this priming approach for increasing engagement of working mechanisms of psychotherapy (e.g., increased working alliance and behavioral activation) has yet to be formally tested.

METHODS

The CBT + trial will be a parallel-arm randomized controlled trial that will recruit 40 adult participants with DSM-5 diagnosed depression (verified with clinical interview) via referrals, mass emails, local flyers, and social media posts. Participants will be randomized to an ActiveCBT or CalmCBT condition. The ActiveCBT group will receive an 8-week CBT intervention primed with 30 min of moderate-intensity aerobic exercise (cycling on a stationary bike at a 13 rating of perceived exertion). The CalmCBT group will receive the same 8-week CBT intervention while resting for 30 min before CBT (i.e., cycling vs no cycling is the only difference). The primary outcome measures will be mean working alliance (assessed with the client version of the Working Alliance Inventory-Short Revised) and mean behavioral activation (self-reported Behavioral Activation for Depression Scale) recorded at each of the 8 therapy sessions. Secondary outcomes include evaluation of state anhedonia and serum brain-derived neurotrophic factor before the active/calm conditions, between the condition and therapy, and after the therapy. Additional exploratory analyses will evaluate group differences in algorithm-generated ratings of therapist-participant interactions via the Lyssn platform.

DISCUSSION

The novel approach of priming CBT with moderate-intensity aerobic exercise evaluated in a randomized controlled trial (CBT + trial) has the potential to demonstrate the usefulness of exercise as an augmentation strategy that improves working mechanisms of therapy and overall treatment outcomes for adults with depression.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06001346 . Registered on August 21, 2023.

Past, present, and future of the Living Planet Index

As we enter the next phase of international policy commitments to halt biodiversity loss (e.g., Kunming-Montreal Global Biodiversity Framework), biodiversity indicators will play an important role in forming the robust basis upon which targeted, and time sensitive conservation actions are developed. Population trend indicators are one of the most powerful tools in biodiversity monitoring due to their responsiveness to changes over short timescales and their ability to aggregate species trends from global down to sub-national or even local scale. We consider how the project behind one of the foremost population level indicators - the Living Planet Index - has evolved over the last 25 years, its value to the field of biodiversity monitoring, and how its components have portrayed a compelling account of the changing status of global biodiversity through its application at policy, research and practice levels. We explore ways the project can develop to enhance our understanding of the state of biodiversity and share lessons learned to inform indicator development and mobilise action.

Sentiment analysis of the Twitter response to Netflix's Our Planet documentary

The role of nature documentaries in shaping public attitudes and behavior toward conservation and wildlife issues is unclear. We analyzed the emotional content of over 2 million tweets related to Our Planet, a major nature documentary released on Netflix, with dictionary and rule-based automatic sentiment analysis. We also compared the sentiment associated with species mentioned in Our Planet and a set of control species with similar features but not mentioned in the documentary. Tweets were largely negative in sentiment at the time of release of the series. This effect was primarily linked to the highly skewed distributions of retweets and, in particular, to a single negatively valenced and massively retweeted tweet (>150,000 retweets). Species mentioned in Our Planet were associated with more negative sentiment than the control species, and this effect coincided with a short period following the airing of the series. Our results are consistent with a general negativity bias in cultural transmission and document the difficulty of evoking positive sentiment, on social media and elsewhere, in response to environmental problems.

A content analysis of 32 years of Shark Week documentaries

Despite evidence of their importance to marine ecosystems, at least 32% of all chondrichthyan species are estimated or assessed as threatened with extinction. In addition to the logistical difficulties of effectively conserving wide-ranging marine species, shark conservation is believed to have been hindered in the past by public perceptions of sharks as dangerous to humans. Shark Week is a high-profile, international programming event that has potentially enormous influence on public perceptions of sharks, shark research, shark researchers, and shark conservation. However, Shark Week has received regular criticism for poor factual accuracy, fearmongering, bias, and inaccurate representations of science and scientists. This research analyzes the content and titles of Shark Week episodes across its entire 32 years of programming to determine if there are trends in species covered, research techniques featured, expert identity, conservation messaging, type of programming, and portrayal of sharks. We analyzed titles from 272 episodes (100%) of Shark Week programming and the content of all available (201; 73.9%) episodes. Our data demonstrate that the majority of episodes are not focused on shark bites, although such shows are common and many Shark Week programs frame sharks around fear, risk, and adrenaline. While criticisms of disproportionate attention to particular charismatic species (e.g. great whites, bull sharks, and tiger sharks) are accurate and supported by data, 79 shark species have been featured briefly at least once. Shark Week's depictions of research and of experts are biased towards a small set of (typically visual and expensive) research methodologies and (mostly white, mostly male) experts, including presentation of many white male non-scientists as scientific experts. While sharks are more often portrayed negatively than positively, limited conservation messaging does appear in 53% of episodes analyzed. Results suggest that as a whole, while Shark Week is likely contributing to the collective public perception of sharks as bad, even relatively small alterations to programming decisions could substantially improve the presentation of sharks and shark science and conservation issues.

How much Fear? Exploring the Role of Integral Emotions on Stated Preferences for Wildlife Conservation

Scientific evidence suggests that emotions affect actual human decision-making, particularly in highly emotionally situations such as human-wildlife interactions. In this study we assess the role of fear on preferences for wildlife conservation, using a discrete choice experiment. The sample was split into two treatment groups and a control. In the treatment groups the emotion of fear towards wildlife was manipulated using two different pictures of a wolf, one fearful and one reassuring, which were presented to respondents during the experiment. Results were different for the two treatments. The assurance treatment lead to higher preferences and willingness to pay for the wolf, compared to the fear treatment and the control, for several population sizes. On the other hand, the impact of the fear treatment was lower than expected and only significant for large populations of wolves, in excess of 50 specimen. Overall, the study suggests that emotional choices may represent a source of concern for the assessment of stable preferences. The impact of emotional choices is likely to be greater in situations where a wildlife-related topic is highly emphasized, positively or negatively, by social networks, mass media, and opinion leaders. When stated preferences towards wildlife are affected by the emotional state of fear due to contextual external stimuli, welfare analysis does not reflect stable individual preferences and may lead to sub-optimal conservation policies. Therefore, while more research is recommended for a more accurate assessment, it is advised to control the decision context during surveys for potential emotional choices.

Plastic Waste and the Environmental Crisis Industry

Our relationship with plastic is complex. While the societal benefits of plastic are undeniable, plastic has also come to occupy a central role within a culture of waste and disposable living that constitutes a significant problem for health and the natural environment. Public awareness of the harms asociated with plastic is high, thanks, in part, to a range of sustained media exposure. This, however, has so far failed to materialize in any significant global reduction in plastic pollution. Meaningful regulatory change that adressess the harms of plastic at the point of production is curiously absent, while some apparent gains have been rolled back-against a backdrop of a global pandemic and a rehabilitation of plastic. This article highlights the assemblage of media, government and corporate interests that performs the role of what we identify as the "Environmental Crisis Industry" ("ECI"), which perpetuates stasis in the face of environmental catastrphe. The ECI manages our anxieties through media discourses of precarity and danger, while at the same time, offering us attainable "solutions" that exist well within the logic of consumer capitalism-in effect, compelling us (at least morally) to become eco-consumers. In this way, the political energy of grassroots climate resistance is "pre-corporated," so to speak, into the product design of major corporations, dissipating the chance of real progressive change in favor of a new green spirit of capitalism.