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Grant SJ, Liu S, Rhodes RE. A web-based physical activity intervention targeting affect regulation: a randomized feasibility trial. Psychol Health 2024:1-23. [PMID: 38946146 DOI: 10.1080/08870446.2024.2372658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 06/20/2024] [Indexed: 07/02/2024]
Abstract
Early career professionals (ECPs) are a critical target for physical activity (PA) promotion. Affect contributes to an established PA intention-behaviour gap and is pertinent among ECPs. OBJECTIVE The purpose of this study was to examine the feasibility and acceptability of a web-based intervention and explore the effects on secondary outcomes (moderate-to-vigorous PA (MVPA), emotion regulation, multi-process action control constructs). METHODS Adults aged 25-44 who were employed at least part-time in a desk-based job and not meeting PA guidelines (<150 min MVPA) were recruited and randomized into a 6-week online intervention integrating acceptance and commitment principles and affect regulation strategies, or a control group. RESULTS Forty adults were recruited and randomized to the web-based intervention (n = 21) and waitlist control (n = 19). The recruitment rate was 29%, retention was 75%, engagement was 68%, and satisfaction was high in both quantitative and qualitative assessment. Participants allocated to the intervention improved MVPA (ηp2=0.30), emotion regulation (ηp2 =0.49), behavioural regulation (ηp2=0.53), affective attitude (ηp2=0.23), identity (ηp2=0.24), and constructs of mindfulness (ηp2=0.44), and valued living (ηp2=0.20). CONCLUSIONS Primary outcomes concerning feasibility were adequate and secondary outcomes improved, suggesting a full-scale randomized controlled trial is feasible with minor modifications. A large-scale study is warranted to establish intervention effectiveness.
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Affiliation(s)
- Stina J Grant
- Behavioural Medicine Lab, @bmedlab, University of Victoria, Victoria, BC, Canada
| | - Sam Liu
- Digital Health Lab, University of Victoria, Victoria, BC, Canada
| | - Ryan E Rhodes
- Behavioural Medicine Lab, @bmedlab, University of Victoria, Victoria, BC, Canada
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2
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Robertson MC, Cox-Martin E, Basen-Engquist K, Lyons EJ. Reflective Engagement With a Digital Physical Activity Intervention Among People Living With and Beyond Breast Cancer: Mixed Methods Study. JMIR Mhealth Uhealth 2024; 12:e51057. [PMID: 38335025 PMCID: PMC10891490 DOI: 10.2196/51057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/21/2023] [Accepted: 12/07/2023] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND People living with and beyond breast cancer can face internal barriers to physical activity (eg, fatigue and pain). Digital interventions that promote psychological acceptance and motivation may help this population navigate these barriers. The degree to which individuals (1) adhere to intervention protocols and (2) reflect on and internalize intervention content may predict intervention efficacy. OBJECTIVE The objective of this study was to characterize the nature of reflective processes brought about by an 8-week acceptance- and mindfulness-based physical activity intervention for insufficiently active survivors of breast cancer (n=75). Furthermore, we explored the potential utility of a metric of reflective processes for predicting study outcomes. METHODS Of the intervention's 8 weekly modules, 7 (88%) included an item that asked participants to reflect on what they found to be most useful. Two coders conducted directed content analysis on participants' written responses. They assessed each comment's depth of reflection using an existing framework (ranging from 0 to 4, with 0=simple description and 4=fundamental change with consideration of social and ethical issues). The coders identified themes within the various levels of reflection. We fit multiple linear regression models to evaluate whether participants' (1) intervention adherence (ie, number of modules completed) and (2) the mean level of the depth of reflection predicted study outcomes. RESULTS Participants were aged on average 57.2 (SD 11.2) years, mostly non-Hispanic White (58/75, 77%), and mostly overweight or obese (54/75, 72%). Of the 407 responses to the item prompting personal reflection, 70 (17.2%) were rated as reflection level 0 (ie, description), 247 (60.7%) were level 1 (ie, reflective description), 74 (18.2%) were level 2 (ie, dialogic reflection), 14 (3.4%) were level 3 (ie, transformative reflection), and 2 (0.5%) were level 4 (ie, critical reflection). Lower levels of reflection were characterized by the acquisition of knowledge or expressing intentions. Higher levels were characterized by personal insight, commentary on behavior change processes, and a change of perspective. Intervention adherence was associated with increases in self-reported weekly bouts of muscle-strengthening exercise (B=0.26, SE 0.12, 95% CI 0.02-0.50) and decreases in sleep disturbance (B=-1.04, SE 0.50, 95% CI -0.06 to -2.02). The mean level of reflection was associated with increases in psychological acceptance (B=3.42, SE 1.70, 95% CI 0.09-6.75) and motivation for physical activity (ie, integrated regulation: B=0.55, SE 0.25, 95% CI 0.06-1.04). CONCLUSIONS We identified a useful method for understanding the reflective processes that can occur during digital behavior change interventions serving people living with and beyond breast cancer. Intervention adherence and the depth of reflection each predicted changes in study outcomes. Deeper reflection on intervention content was associated with beneficial changes in the determinants of sustained behavior change. More research is needed to investigate the relations among digital behavior change intervention use, psychological processes, and intervention efficacy.
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Affiliation(s)
- Michael C Robertson
- Department of Family and Preventive Medicine, TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | | | - Karen Basen-Engquist
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism & Rehabilitation Sciences, University of Texas Medical Branch at Galveston, Galveston, TX, United States
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3
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Wingood M, Criss MG, Irwin KE, Bamonti PM, Harris R, Phillips EL, Vincenzo JL, Chui KK. Examining physical activity participation barriers among adults 50 years and older: a scoping review. PHYSICAL THERAPY REVIEWS 2023; 28:195-210. [PMID: 38348467 PMCID: PMC10859686 DOI: 10.1080/10833196.2023.2265767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 09/12/2023] [Indexed: 02/15/2024]
Abstract
Background Addressing physical activity (PA) barriers is essential for increasing PA levels in middle-aged and older adults. However, there are no recommendations on selecting PA barrier assessment tools. Objectives Thus, we aimed to identify and provide clinimetric properties on PA barrier assessment tools that healthcare providers, exercise experts, and public health officials can use to examine potential barriers faced by community-dwelling adults 50 years and older. Methods We performed a systematic search of the following databases: PubMed, PsycINFO, CINAHL, and Web of Science. Articles were included if they presented clinimetric data on a PA participation barrier assessment tool for community-dwelling participants with a mean age of 50 years and older. The 561 identified articles underwent multiple rounds of blinded reviews. Included articles underwent data extraction for participant characteristics, scoring, constructs, reference tests, and clinimetric properties. Results The 35 included articles reported on 33 different PA participation barrier assessment tools. Eighteen articles reported on participants with cardiovascular, musculoskeletal, or neurological diagnoses, diabetes, hemodialysis, history of cancer, or mobility limitations. Tools with two or more supporting publications included the Exercise Benefits/Barrier Scale (EBBS), Episode-Specific Interpretations of Exercise Inventory (ESIE), and Inventory of Physical Activity and Barriers (IPAB). Due to differences in methodologies, across-tool comparison was not possible. Conclusion The EBBS, ESIE, and IPAB are promising tools for community-dwelling adults 50 years and older. However, additional research is warranted to identify the best PA barrier assessment tool among adults 50 years and older.
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Affiliation(s)
- Mariana Wingood
- Department of Implementation Science, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
- Sticht Center for Healthy Aging and Alzheimer’s
Prevention, Internal Medicine, Gerontology and Geriatric Medicine, Wake Forest
University School of Medicine, Winston-Salem, NC, USA
| | - Michelle G. Criss
- Doctor of Physical Therapy Program, Chatham University,
Pittsburgh, PA, USA
| | - Kent E. Irwin
- Department of Physical Therapy, Midwestern University,
Downers Grove, IL, USA
| | - Patricia M. Bamonti
- Research & Development, Veterans Affairs Boston
Healthcare System, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston,
MA, USA
| | - Rebekah Harris
- New England Geriatric Education and Clinical Center,
Veterans Affairs Boston Healthcare System, Boston, MA, USA
- Physical Medicine and Rehabilitation, Harvard Medical
School, Boston, MA, USA
| | | | - Jennifer L. Vincenzo
- Department of Implementation Science, University of
Arkansas for Medical Sciences, Fayetteville, AR, USA
| | - Kevin K. Chui
- Department of Physical Therapy, Radford University,
Roanoke, VA, USA
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4
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Bricker JB, Mull KE, Sullivan BM, Forman EM, Lillis J, McTiernan A, Santiago-Torres M. Telehealth acceptance and commitment therapy for weight loss: Protocol of the WeLNES full scale randomized controlled trial. Contemp Clin Trials 2023; 126:107091. [PMID: 36682490 PMCID: PMC9998365 DOI: 10.1016/j.cct.2023.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 01/05/2023] [Accepted: 01/17/2023] [Indexed: 01/22/2023]
Abstract
Behavioral interventions delivered via one-on-one telephone coaching (hereafter referred to as telehealth) for weight loss have had great population-level reach but to date limited efficacy. Acceptance and Commitment Therapy (ACT) has promise to improve behavioral weight loss treatment efficacy by addressing the fundamental challenges of weight loss and maintenance: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues. Here we describe the Weight Loss, Nutrition, and Exercise Study (WeLNES) randomized controlled trial that is testing the efficacy of an ACT-based telehealth coaching intervention for weight loss in comparison to a Standard Behavioral Therapy (SBT)-based telehealth coaching intervention. A total of 398 adults with overweight or obesity are being recruited and randomized to either ACT or SBT telehealth coaching. Participants in both arms are offered twenty-five telehealth coaching sessions in year one and nine booster sessions in year two. All participants receive a Bluetooth-enabled scale to self-monitor weight and a Fitbit Inspire + Fitbit app for tracking diet and physical activity. The primary aim is to determine whether a greater proportion of ACT participants will achieve a clinically significant weight loss of ≥10% compared with SBT participants at 12-months. Secondary outcomes include change in weight from baseline to 6, 12, and 24-months. Whether the effect of ACT on weight loss is mediated by ACT processes and is moderated by baseline factors will also be examined. If ACT proves efficacious, ACT telehealth coaching will offer an effective, broadly scalable weight loss treatment-thereby making a high public health impact.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington, Department of Psychology, Seattle, WA, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Brianna M Sullivan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA
| | - Evan M Forman
- Center for Weight, Eating and Lifestyle Science, Drexel University, Philadelphia, PA, USA
| | - Jason Lillis
- Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI, USA; College of Psychology, California Northstate University, Elk Grove, CA, USA
| | - Anne McTiernan
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Seattle, WA, USA; University of Washington School of Public Health, Department of Epidemiology, USA; University of Washington School of Medicine, Department of Medicine, USA
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5
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Barley EA, Bovell M, Bennett-Eastley K, Lee JT, Lee-Baggley D, Skene SS, Tai MZ, Brooks S, Scholtz S. Addressing a critical need: A randomised controlled feasibility trial of acceptance and commitment therapy for bariatric surgery patients at 15-18 months post-surgery. PLoS One 2023; 18:e0282849. [PMID: 37098049 PMCID: PMC10128967 DOI: 10.1371/journal.pone.0282849] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 02/17/2023] [Indexed: 04/26/2023] Open
Abstract
Bariatric surgery is an effective treatment for obesity. However, around one in five people experience significant weight regain. Acceptance and Commitment Therapy (ACT) teaches acceptance of and defusion from thoughts and feelings which influence behaviour, and commitment to act in line with personal values. To test the feasibility and acceptability of ACT following bariatric surgery a randomised controlled trial of 10 sessions of group ACT or Usual Care Support Group control (SGC) was delivered 15-18 months post bariatric surgery (ISRCTN registry ID: ISRCTN52074801). Participants were compared at baseline, 3, 6 and 12 months using validated questionnaires to assess weight, wellbeing, and healthcare use. A nested, semi-structured interview study was conducted to understand acceptability of the trial and group processes. 80 participants were consented and randomised. Attendance was low for both groups. Only 9 (29%) ACT participants completed > = half of the sessions, this was the case for 13 (35%) SGC participants. Forty-six (57.5%) did not attend the first session. At 12 months, outcome data were available from 19 of the 38 receiving SGC, and from 13 of the 42 receiving ACT. Full datasets were collected for those who remained in the trial. Nine participants from each arm were interviewed. The main barriers to group attendance were travel difficulties and scheduling. Poor initial attendance led to reduced motivation to return. Participants reported a motivation to help others as a reason to join the trial; lack of attendance by peers removed this opportunity and led to further drop out. Participants who attended the ACT groups reported a range of benefits including behaviour change. We conclude that the trial processes were feasible, but that the ACT intervention was not acceptable as delivered. Our data suggest changes to recruitment and intervention delivery that would address this.
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Affiliation(s)
- Elizabeth A Barley
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Marie Bovell
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Kate Bennett-Eastley
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - John Tayu Lee
- School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
| | | | - Simon S Skene
- School of Biosciences and Medicine, University of Surrey, Guildford, United Kingdom
| | - Michael Z Tai
- Department of Psychiatry, St Charles Hospital, London, United Kingdom
| | - Sue Brooks
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Samantha Scholtz
- Division of Diabetes, Endocrinology and Metabolism, Imperial College, London, United Kingdom
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6
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LaRowe LR, Bohlen LC, Gaudiano BA, Abrantes AM, Butryn ML, Dunsiger SI, Griffin E, Loucks EB, Uebelacker LA, Williams DM. Testing the Feasibility and Acceptability of an Acceptance and Commitment Therapy Intervention to Increase Physical Activity among Individuals with Depression: A Protocol Paper. Ment Health Phys Act 2022; 23:100475. [PMID: 37649877 PMCID: PMC10465112 DOI: 10.1016/j.mhpa.2022.100475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Engaging in regular physical activity (PA) is particularly important among individuals with depression, who are at heightened risk for a host of negative health outcomes. However, people with depression are 50% less likely to meet national guidelines for PA and face unique barriers to PA adherence, including lower distress tolerance and motivation for exercise. Acceptance and Commitment Therapy (ACT) may offer promise for increasing PA among adults with depressive symptoms due to its effects on distress tolerance and motivation. Therefore, we developed ACTivity, an ACT-based intervention designed to promote PA among low-active adults with elevated depressive symptoms. Prior to testing the efficacy of ACTivity in an RCT, an important first step is to conduct a preliminary trial to establish feasibility of study procedures for the ACTivity and comparison intervention programs, as well as to establish the credibility/acceptability of the intervention. The purpose of this paper is to describe the ACTivity intervention and the design of this feasibility trial. Method/Design We will conduct a feasibility RCT with two parallel groups and a 1:1 allocation ratio comparing ACTivity to a comparison intervention (relaxation training + PA promotion) among 60 low-active adults with elevated depressive symptoms. All study procedures will be conducted remotely. Discussion Results of this feasibility study will inform a subsequent RCT designed to test the efficacy of ACTivity. If shown to be efficacious, ACTivity will provide a treatment that can be widely disseminated to increase PA among adults with depressive symptoms and thereby decrease their risk for chronic disease.
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Affiliation(s)
- Lisa R. LaRowe
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Lauren Connell Bohlen
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Brandon A. Gaudiano
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - Meghan L. Butryn
- Department of Psychological and Brain Sciences, Drexel University, Philadelphia, PA, 19104, USA
| | - Shira I. Dunsiger
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Elizabeth Griffin
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Eric B. Loucks
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
| | - Lisa A. Uebelacker
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, 02903, USA
- Butler Hospital, Providence, RI, 02906, USA
| | - David M. Williams
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02903, USA
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7
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Webb JB, Padro MP, Thomas EV, Davies AE, Etzel L, Rogers CB, Heredia NI. Yoga at Every Size: A Preliminary Evaluation of a Brief Online Size-Inclusive Yoga and Body Gratitude Journaling Intervention to Enhance Positive Embodiment in Higher Weight College Women. Front Glob Womens Health 2022; 3:852854. [PMID: 35720811 PMCID: PMC9199427 DOI: 10.3389/fgwh.2022.852854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/11/2022] [Indexed: 11/19/2022] Open
Abstract
The present pilot randomized controlled trial (RCT) evaluated the feasibility, acceptability, and preliminary efficacy of a 4-week online yoga and body gratitude journaling intervention for strengthening positive embodiment among racially-diverse higher weight college women. Seventy-five participants were initially randomized to either the yoga condition (n = 36) or to a wait-list control (n = 39). Participants completed measures of positive and negative body image, weight bias internalization, self-compassion, drive for leanness, and physical activity acceptance at both baseline and post. Preliminary results among the 42 analyzed completers (mean age = 20.9, SD = 2.4; 30% Black or African American) revealed acceptable feasibility given the low-intensity nature of the intervention reflected in a 36% attrition rate. Self-reported adherence was strong for the yoga component with 81% of participants indicating that they practiced with the videos ≥3–4 times per week as suggested. Although 71% reported completing the body gratitude journal ≥1–2 times per week, daily adherence was minimal. Acceptability was also high among participants randomized to the yoga condition as indicated by 86% expressing at least moderate levels of satisfaction with the overall program. Qualitative feedback from participants further supported the acceptability of the program and pointed to important areas in further refining the protocol in the future. Preliminary efficacy was supported by significant reductions in internal body shame and gains in body appreciation, functional body appreciation, functional body satisfaction, functional body awareness, and behavioral commitment to physical activity engagement among the yoga vs. wait-list control participants. These promising findings once replicated in larger, higher-powered trials may have important implications for extending the reach and accessibility of mind-body wellness practices like yoga to benefit racially-/ethnically-diverse college women of higher weight. This research is further responsive to the growing need for efficacious remotely-delivered, and scalable behavioral health interventions in the ongoing era of the COVID-19 pandemic. However, additional research is warranted to explore ways of enhancing engagement of participants with lower levels of positive embodiment and to further incentivize the journaling component of the intervention.
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Affiliation(s)
- Jennifer B. Webb
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, United States
- *Correspondence: Jennifer B. Webb
| | - Meagan P. Padro
- Department of Education, UNC Chapel Hill, Chapel Hill, NC, United States
| | - Erin Vinoski Thomas
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, United States
| | - Alexandria E. Davies
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Lena Etzel
- Department of Psychology, University of North Carolina at Charlotte, Charlotte, NC, United States
| | | | - Natalia I. Heredia
- Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States
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Robertson MC, Cox-Martin E, Shegog R, Markham CM, Fujimoto K, Durand CP, Brewster A, Lyons EJ, Liao Y, Flores SA, Basen-Engquist KM. The Acceptability of an Electronically Delivered Acceptance- and Mindfulness-Based Physical Activity Intervention for Survivors of Breast Cancer: One-Group Pretest-Posttest Design. JMIR Cancer 2022; 8:e31815. [PMID: 35486425 PMCID: PMC9107061 DOI: 10.2196/31815] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 12/14/2021] [Accepted: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of breast cancer can face internal barriers to physical activity, such as uncertainty and frustration stemming from physical limitations, decreased physical functioning, fatigue, and pain. Interventions that draw from the principles of Acceptance and Commitment Therapy (ACT) may help survivors of breast cancer overcome some of the internal barriers associated with physical activity. Objective The primary aim of this study was to investigate the acceptability of an electronically delivered physical activity intervention for survivors of breast cancer, centered on ACT processes. Methods This study used a 1-group pretest-posttest design. We recruited 80 insufficiently active female survivors of breast cancer using a web-based recruitment strategy. The 8-week intervention consisted of weekly modules that featured didactic lessons and experiential exercises targeting key ACT processes in the context of physical activity promotion (namely, values, committed action, acceptance, defusion, and contacting the present moment). We determined intervention acceptability according to study retention (≥70%), adherence rates (≥75% of the participants completing ≥50% of the modules), and posttest survey scores reflecting the perceived ease of use, perceived usefulness, and interest and enjoyment of the intervention (≥5 on a 7-point Likert-type scale). We also evaluated changes in self-reported aerobic and muscle strengthening–physical activity, physical activity acceptance, physical activity regulation, and health-related outcomes. Results The retention rate (61/80, 76%), adherence rate (60/80, 75%), average perceived ease of use (6.17, SD 1.17), perceived usefulness (5.59, SD 1.40), and interest and enjoyment scores (5.43, SD 1.40) met the acceptability criteria. Participants increased their self-reported aerobic physical activity (Cohen d=1.04), muscle strengthening–physical activity (Cohen d=1.02), physical activity acceptance (cognitive acceptance: Cohen d=0.35; behavioral commitment: Cohen d=0.51), physical activity regulation (identified regulation: Cohen d=0.37; integrated regulation: Cohen d=0.66), increased their ability to participate in social roles and activities (Cohen d=0.18), and reported less fatigue (Cohen d=0.33) and sleep disturbance (Cohen d=0.53). Conclusions Electronically delivered acceptance- and mindfulness-based interventions may be useful for promoting physical activity in survivors of breast cancer. Further research is needed to refine these approaches and evaluate their effectiveness.
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Affiliation(s)
- Michael C Robertson
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States.,Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States.,Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | | | - Ross Shegog
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Christine M Markham
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Kayo Fujimoto
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Casey P Durand
- Health Promotion & Behavioral Sciences, University of Texas School of Public Health, Houston, TX, United States
| | - Abenaa Brewster
- Department of Clinical Cancer Prevention, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Elizabeth J Lyons
- Department of Nutrition, Metabolism, and Rehabilitation Sciences, The University of Texas Medical Branch, Galveston, TX, United States
| | - Yue Liao
- College of Nursing and Health Innovation, The University of Texas, Arlington, TX, United States
| | - Sara A Flores
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, United States
| | - Karen M Basen-Engquist
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
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9
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Burton Murray H, Zhang F, Manasse SM, Forman EM, Butryn ML, Juarascio AS. Validation of the food craving Acceptance and action questionnaire (FAAQ) in a weight loss-seeking sample. Appetite 2022; 168:105680. [PMID: 34487734 PMCID: PMC8671291 DOI: 10.1016/j.appet.2021.105680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The Food Craving Acceptance and Action Questionnaire (FAAQ) was developed to measure psychological flexibility around food-related internal experiences (e.g., thoughts, feelings, urges) and has two subscales, acceptance and willingness. However, the FAAQ factor structure has not yet been systematically validated with a clinically relevant sample. METHODS Two weight-loss treatment seeking samples (total N = 462; 80.4% female) ages 18 to 70 (M = 52.6, SD = 9.8) completed the FAAQ before and after group-based treatment of overweight or obesity. RESULTS Confirmatory factor analysis on the FAAQ's previously observed two-factor model produced poor model fit. An alternative 7-item model removing specific items that contributed to poor fit and were conceptually relevant to remove provided good model fit. The resulting revised 7-item FAAQ (items 1,3,6 removed) had adequate internal consistency and significant predictive validity for the Total score and subscales, and showed initial construct validity for the Total score. CONCLUSIONS Results from this study suggest researchers and clinicians should now use the 7-item FAAQ-II, which retains the Willingness and Acceptance subscales. Future research is needed with other relevant samples to confirm the FAAQ-II's factor structure and psychometric properties.
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Affiliation(s)
- Helen Burton Murray
- Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Neurointestinal Health, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
| | - Fengqing Zhang
- Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA
| | - Stephanie M Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA
| | - Evan M Forman
- Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA
| | - Meghan L Butryn
- Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA
| | - Adrienne S Juarascio
- Department of Psychology, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA; Center for Weight, Eating, and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton 226, Philadelphia, PA, 19104, USA
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10
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Lillis J, Schumacher LM, Bond DS. Preliminary Evaluation of a 1-Day Acceptance and Commitment Therapy Workshop for Increasing Moderate-to-Vigorous Physical Activity in Adults with Overweight or Obesity. Int J Behav Med 2021; 28:827-833. [PMID: 33598781 PMCID: PMC9917958 DOI: 10.1007/s12529-021-09965-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Novel strategies to help adults with overweight/obesity increase motivation for becoming active are needed. This single-arm trial aimed to test the feasibility, acceptability, and preliminary efficacy of a 4-h acceptance and commitment therapy (ACT)-based workshop intervention for increasing moderate-to-vigorous physical activity (MVPA) among insufficiently active adults with overweight/obesity. METHODS Participants (N = 41) received a 1-day 4-h ACT workshop followed by weekly e-mails and monthly phone calls for 3 months. The primary outcome was change in accelerometer-measured MVPA minutes/day at 3 and 6 months. Process variables (i.e., autonomous motivation, PA acceptance) through which the ACT intervention was hypothesized to increase MVPA were assessed via questionnaires. RESULTS Participants completed 91% of phone calls and 75% of e-mail surveys. Acceptability ratings were > 4.5 out of 5 for "understandable," "useful," and "intent-to-use" on all intervention components. Participants on average achieved significant increases in bouted and total MVPA at 3 months that were maintained at 6 months. Participants also reported significant increases in physical activity acceptance and autonomous motivation, the latter of which related to MVPA changes. CONCLUSION Results support the feasibility and acceptability of the ACT workshop intervention for promoting MVPA changes among insufficiently active adults with overweight/obesity. Rigorous testing of this approach as a low-intensity standalone or add-on intervention to increase MVPA is warranted.
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Affiliation(s)
- Jason Lillis
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI, 02903, USA.
| | - Leah M. Schumacher
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI 02903, USA
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University/The Miriam Hospital, Weight Control and Diabetes Research Center, Providence, RI 02903, USA
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11
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Wooldridge JS, Herbert MS, Dochat C, Afari N. Understanding relationships between posttraumatic stress disorder symptoms, binge-eating symptoms, and obesity-related quality of life: the role of experiential avoidance. Eat Disord 2021; 29:260-275. [PMID: 33459212 PMCID: PMC8285449 DOI: 10.1080/10640266.2020.1868062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Obesity, binge-eating symptoms, and PTSD symptoms commonly co-occur. Avoidance, a key feature of PTSD and proposed mechanism of binge-eating, is one potential mechanism for explaining this clinical overlap. The purpose of the current study was to: 1) examine the associations between PTSD symptoms (PTSD Checklist-Civilian; PCL-C) and measures of bingeeating symptoms (Binge Eating Scale; BES) and obesity-related quality of life (Obesity Related Well-Being Questionnaire-97; ORWELL-97) in a sample of veterans with overweight or obesity (N = 89), and 2) determine whether experiential avoidance (The Acceptance and Action Questionnaire-II; AAQ-II) explains the relationship between PTSD symptoms and binge-eating symptoms, and PTSD symptoms and obesity-related quality of life, respectively. Scores on the PCL-C, BES, ORWELL-97, and AAQ-II were all significantly correlated. Linear regression analyses indicated that higher PCL-C scores were related to higher scores on the BES and ORWELL-97 after controlling for potentially confounding factors (BMI and race). Effect sizes were in the medium-large range. Further, AAQ-II mediated the relationship between PCL-C and ORWELL-97, but did not mediate the relationship between PCL-C and BES. These findings suggest that experiential avoidance should be considered in interventions addressing co-occurring PTSD, binge-eating, and poor obesity-related well-being. Longitudinal research is needed to better understand directionality of these relationships and changes over time.
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Affiliation(s)
- Jennalee S Wooldridge
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Matthew S Herbert
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
| | - Cara Dochat
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology, California, San Diego, USA
| | - Niloofar Afari
- VA San Diego Healthcare System, San Diego, California, USA.,Department of Psychiatry, University of California, San Diego, California, USA.,Center of Excellence for Stress and Mental Health (CESAMH), San Diego, California, USA
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12
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Uimonen M, Repo JP, Grönroos K, Häkkinen A, Walker S. Validity and reliability of the motivation for physical activity (RM4-FM) questionnaire. J Exerc Rehabil 2021; 17:103-111. [PMID: 34012936 PMCID: PMC8103190 DOI: 10.12965/jer.2142194.097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/25/2021] [Indexed: 11/22/2022] Open
Abstract
There is a lack of validated instruments measuring motivation for physical activity (RM4-FM) in the Finnish language. The study examined the translated RM4-FM instrument's psychometric properties in a sample of healthy, older Finnish adults. RM4-FM was translated and linguistically validated adhering to published guidelines. 65-75-year olds (n=102), completed the RM4-FM, the physical activity acceptance questionnaire (PAAQ) and sociodemographic characteristics questionnaires electronically. The RM4-FM was readministered one month after the initial assessment. RM4-FM translated well into Finnish. Motivation dimension scores were skewed towards high internal and low external motivation. A floor effect was confirmed in the external regulation dimension and a ceiling effect was confirmed in the identified regulation dimension. Confirmatory factor analysis indicated inadequacy of the four-dimension model. Separate assessment of each of the four motivation dimensions with Exploratory factor analysis showed unidimensionality for all dimensions. Exploratory factor analysis provided a best-fit model of three factors (influence of other people, intention of well-being and emotional aspect of motivation). Readministration of the instruments showed good test-retest reliability in all motivation dimensions. Female gender, higher education, and higher PAAQ score were associated with higher internal motivation and lower external motivation scores. The Finnish version of the RM4-FM instrument provides valid and reliable scores in assessing motivation for physical activity in healthy, older Finnish adults. The score distributions suggested shortages in the scale when evaluating internal motivation. The three-factor model of the RM4-FM provided more favorable structural validity compared to the original version.
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Affiliation(s)
- Mikko Uimonen
- Department of Surgery, Central Finland Health Care District, Jyväskylä, Finland
| | - Jussi P Repo
- Department of Surgery, Central Finland Health Care District, Jyväskylä, Finland
| | - Kiira Grönroos
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Arja Häkkinen
- Health Sciences, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.,Department of Physical Medicine, Central Finland Health Care District, Jyväskylä, Finland
| | - Simon Walker
- NeuroMuscular Research Center, Faculty of Sport and Health Sciences, University of Jyväskylä, Finland
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13
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The effect of acceptance and commitment training on improving physical activity during the COVID-19 pandemic. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Hooke MC, Neumann J, Tucker CA. Testing the Child PROMIS Physical Activity Measurement in Youth Attending a Large Community Event. Pediatr Phys Ther 2021; 33:32-36. [PMID: 33337772 DOI: 10.1097/pep.0000000000000760] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The study's purpose was to evaluate the concurrent validity of the Child Patient-Reported Outcomes Measurement Information System (PROMIS) PA with the Youth Activity Profile (YAP) and examine its relationship to PROMIS measures of sedentary behavior and fatigue. The PROMIS Pediatric Activity (PA) measure is a newly developed, valid instrument used to collect data on children's lived experiences of short bouts of moderate to rigorous physical activity. METHODS Participants were ages 8 to 20 years attending a state fair. Child PROMIS measures-PA, Sedentary Behavior, and Fatigue-and the YAP were completed on an iPad. RESULTS The PROMIS PA and YAP had a positive correlation. The PROMIS PA was not associated with sedentary behavior or fatigue measurements. CONCLUSION As expected, the PROMIS PA and YAP measure-related PA constructs, the YAP focuses on energy expended while the PROMIS PA indicates perceived response to activity.
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Affiliation(s)
- Mary C Hooke
- University of Minnesota School of Nursing (Dr Hooke), Minneapolis, Minnesota; Aurora St Luke's Medical Center (Ms Neumann), Milwaukee, Wisconsin; Temple University College of Public Health (Dr Tucker), Philadelphia, Pennsylvania
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15
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Tucker CA, Bevans KB, Becker BD, Teneralli R, Forrest CB. Development of the PROMIS Pediatric Physical Activity Item Banks. Phys Ther 2020; 100:1393-1410. [PMID: 32313952 PMCID: PMC7439224 DOI: 10.1093/ptj/pzaa074] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/17/2020] [Accepted: 02/11/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to develop self-report and parent-proxy measures of children's physical activity for clinical research and practice and to demonstrate a valid and reliable instrument of children's lived experience of physical activity as reported by the children themselves or their parent proxies. METHODS This study involved qualitative development of item pools followed by 2 cross-sectional validity and reliability studies. The National Institutes of Health Patient Reported Outcome Measurement Information System (PROMIS) instrument development standards were applied to create child self-report and parent-proxy physical activity instruments from previously developed, content-valid pools of physical activity items. Each item used a 7-day recall period and had 5 response options. Item bank calibration was based on national samples totaling 3033 children aged 8 to 17 years and 2336 parents of children aged 5 to 17 years. Quantitative analyses included reliability assessments, factor analyses, item response theory calibration, differential item functioning, and construct validation. RESULTS The final item banks comprised 10 items each. The items were selected based on content and psychometric properties. The item banks appeared to be unidimensional and free from differential item functioning. They showed excellent reliability and a high degree of precision across the range of the latent variable. Child-report and parent-proxy 4- and 8-item fixed-length instruments were specified. The instruments showed moderate correlation with existing self-report measures of physical activity. CONCLUSION The PROMIS Pediatric Physical Activity instruments provide precise and valid measurement of children's lived experiences of physical activity. IMPACT The availability of the PROMIS Pediatric Physical Activity instruments will support advances in clinical practice and research that require measurement of pediatric physical activity by self- and parent-proxy report.
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Affiliation(s)
- Carole A Tucker
- Department of Health & Rehabilitation Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Room 634, Philadelphia, PA 19122 (USA)
| | | | - Brandon D Becker
- Patient Reported Outcomes, GlaxoSmithKline USA, Philadelphia, Pennsylvania
| | - Rachel Teneralli
- Health Services Research, Janssen Pharmaceutical Companies of Johnson and Johnson, Titusville, New Jersey
| | - Christopher B Forrest
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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16
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Manchón J, Quiles M, León E, López-Roig S. Acceptance and Commitment Therapy on physical activity: A systematic review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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17
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Jenkins M, Hargreaves EA, Hodge K. Examining the Relationships Among Cognitive Acceptance, Behavioral Commitment, Autonomous Extrinsic Motivation, and Physical Activity. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2020; 42:177-184. [PMID: 32150726 DOI: 10.1123/jsep.2018-0276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 06/10/2023]
Abstract
This study examined the relationships among cognitive acceptance, behavioral commitment, psychological need satisfaction, autonomous extrinsic motivation (EM) for physical activity (PA), and PA behavior. Participants (N = 456, M age = 40.7 years) completed online measures of these variables, and data were analyzed using structural equation modeling. Results indicated a direct pathway from behavioral commitment to autonomous EM, plus indirect effects via autonomy, competence, and relatedness. There was no direct pathway from cognitive acceptance to autonomous EM, but there were indirect effects via competence and autonomy satisfaction. There was a direct pathway from cognitive acceptance to self-reported PA plus indirect effects via autonomous EM. There was no direct pathway from behavioral commitment to self-reported PA, but there were indirect effects via autonomous EM. Cognitive acceptance and behavioral commitment potentially support the development of autonomous EM for PA. Future research using longitudinal and intervention-based research designs is required to determine the causal relationships among these variables.
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18
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Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation. Curr Opin Organ Transplant 2019; 24:705-713. [PMID: 31689261 DOI: 10.1097/mot.0000000000000712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk. RECENT FINDINGS Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors. SUMMARY Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.
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19
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Jenkins M, Hargreaves EA, Hodge K. The Role of Psychological Flexibility in Physical Activity Maintenance. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 2019; 41:185-193. [PMID: 31319399 DOI: 10.1123/jsep.2018-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/23/2019] [Accepted: 05/13/2019] [Indexed: 06/10/2023]
Abstract
The purpose of this study was to investigate the role of the constituent processes of psychological flexibility (contact with the present moment, acceptance, cognitive defusion, self-as-context, value clarification, and committed action) in supporting physical activity (PA) maintenance. A total of 9 physically active participants were interviewed using the Scanlan collaborative interview method. Participants were asked to discuss their strategies for maintaining PA, before being asked whether the 6 psychological flexibility processes played a role in their PA behavior. Data were analyzed using a combination of deductive and inductive thematic analyses. Acceptance, cognitive defusion, value clarification, and committed action played a role in participants' experiences of maintaining PA. Contact with the present moment and self-as-context were reported to be relatively unimportant to participants' PA maintenance. Cultivating acceptance of PA-related discomfort, defusion from unhelpful thoughts, clarifying the value of PA, and encouraging commitment to PA would likely benefit individuals' efforts to maintain PA.
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20
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Schneider J, Malinowski P, Watson PM, Lattimore P. The role of mindfulness in physical activity: a systematic review. Obes Rev 2019; 20:448-463. [PMID: 30468299 DOI: 10.1111/obr.12795] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/28/2018] [Accepted: 09/30/2018] [Indexed: 02/05/2023]
Abstract
Despite continued public health campaigns to promote physical activity, a majority of the population is inactive. In recent years, mindfulness-based approaches have been used in health and lifestyle interventions for physical activity promotion. We conducted a systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to investigate the evidence for the potential of mindfulness-based approaches for physical activity. We searched electronic databases for papers that met eligibility criteria and identified 40 studies for inclusion. Evidence from cross-sectional studies (n = 20) indicated a positive relationship between dispositional mindfulness and physical activity, particularly with psychological factors related to physical activity. Five studies found that the mindfulness-physical activity relationship was mediated by stress, psychological flexibility, negative affect and shame, satisfaction and state mindfulness. Evidence from mindfulness-based interventions (n = 20) suggested positive between-subjects effects on physical activity, but interventions varied in duration, session length, group size, delivery, content and follow-up. Mindfulness-based interventions were more likely to be successful if they were physical activity-specific and targeted psychological factors related to physical activity. The body of research shows a need for more methodologically rigorous studies to establish the effect of mindfulness on physical activity and to identify potential mechanisms involved in the mindfulness-physical activity relationship reliably.
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Affiliation(s)
- J Schneider
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Malinowski
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P M Watson
- Research Institute for Sport and Exercise Sciences, Faculty of Science, Liverpool John Moores University, Liverpool, UK
| | - P Lattimore
- School of Natural Sciences and Psychology, Faculty of Science, Liverpool John Moores University, Liverpool, UK
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21
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Schumacher LM, Godfrey KM, Forman EM, Butryn ML. Change in Domain-specific but not General Psychological Flexibility Relates to Greater Weight Loss in Acceptance-Based Behavioral Treatment for Obesity. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2019; 12:59-65. [PMID: 33101889 DOI: 10.1016/j.jcbs.2019.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Acceptance-based approaches have demonstrated promise for improving outcomes in behavioral treatments for obesity, but few studies have examined processes of change in these treatments. It is critical to identify mechanisms of action in treatment to further optimize this approach, refine theory, and inform future research. This study examined change in several domain-specific and general measures of psychological flexibility in a randomized controlled trial of an acceptance-based behavioral weight loss treatment. The relationships between change in these measures and weight loss outcomes were also examined. Adults (N = 283) were randomized to receive 12 months of acceptance-based (ABT) or non-acceptance-based (non-ABT) behavioral treatment and completed measures of general and weight control-specific psychological flexibility at months 0, 6, and 12. Participants in ABT demonstrated greater increases in psychological flexibility related to eating and physical activity experiences during treatment compared to participants in non-ABT, and changes in these processes were correlated with better weight loss. Parallel mediation analyses further revealed that psychological flexibility related to eating and physical activity experiences partially mediated the relationship between treatment condition and 12-month weight loss. Participants across conditions also experienced small increases in general psychological flexibility, but general psychological flexibility was not meaningfully related to weight loss outcomes. These findings indicate that domain-specific (versus general) psychological flexibility may be most impacted by ABT and most relevant to weight loss outcomes. Results also provide partial support for the theoretical model of ABT for weight management.
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Affiliation(s)
- Leah M Schumacher
- The Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA.,Department of Psychology, Drexel University, Philadelphia, PA
| | - Kathryn M Godfrey
- The Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA.,Department of Psychology, Drexel University, Philadelphia, PA
| | - Evan M Forman
- The Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA.,Department of Psychology, Drexel University, Philadelphia, PA
| | - Meghan L Butryn
- The Center for Weight, Eating, and Lifestyle Sciences (WELL Center), Drexel University, Philadelphia, PA.,Department of Psychology, Drexel University, Philadelphia, PA
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22
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McLean DC, Nakamura J, Csikszentmihalyi M. Reconsidering the experience machine: Self-reported versus objective measures of physical activity to increase positive affect. J Health Psychol 2018; 25:2428-2439. [PMID: 30246550 DOI: 10.1177/1359105318801939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
This article tests the utility of self-report and objective assessment of physical activity to predict increased positive affect. Participants wore Fitbit activity trackers and responded to single-item assessments of momentary affect and self-reported physical activity following an experience sampling method protocol. A test of the within-person mediation indicated that, on average, 63 percent of the relationship between objective physical activity and affect was accounted for by self-reported physical activity. This research adds to the body of literature demonstrating the benefits of physical activity and discusses the utility of perceived over actual assessments of physical activity in naturalistic settings.
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23
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Schneider M. Intrinsic Motivation Mediates the Association Between Exercise-Associated Affect and Physical Activity Among Adolescents. Front Psychol 2018; 9:1151. [PMID: 30104987 PMCID: PMC6077231 DOI: 10.3389/fpsyg.2018.01151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 06/15/2018] [Indexed: 11/18/2022] Open
Abstract
American adolescents overwhelmingly engage in insufficient physical activity (PA). Attention has turned to the role of affect in shaping PA, raising questions as to whether the impact of affect on PA is direct/automatic or cognitively mediated ("Type 1" or "Type 2" in the dual-process model). This study examines whether intrinsic motivation (IM) mediates the association between affect and PA. Adolescents (N = 142, 48% Male, 20% non-Latino White, mean age = 11.04 years, mean VO2 = 37.19 ml/kg/min, mean BMI = 63.19) completed assessments of cardiorespiratory fitness, affective response to exercise on a stationary cycle, IM, preferred exercise intensity, and moderate-to-vigorous PA (MVPA; ActiGraph). Fitness, exercise intensity and MVPA assessments were repeated 5 months later. Tests for mediation showed that affect predicted PA at baseline and 5 months, and IM mediated the relationship between affect and PA both cross-sectionally (CI = 0.03, 0.17) and longitudinally (CI = 0.04, 0.18). Results suggest a cognitively mediated pathway from affect to behavior. Adolescent PA may be increased either by enhancing IM or by tailoring interventions to accommodate individuals with a predisposition to respond to exercise with negative affect. This study is registered with Clinicaltrials.gov (ID # NCT01876602).
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Affiliation(s)
- Margaret Schneider
- Department of Urban Planning and Public Policy, School of Social Ecology, University of California, Irvine, Irvine, CA, United States
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24
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Bradley LE, Forman EM, Kerrigan SG, Goldstein SP, Butryn ML, Thomas JG, Herbert JD, Sarwer DB. Project HELP: a Remotely Delivered Behavioral Intervention for Weight Regain after Bariatric Surgery. Obes Surg 2017; 27:586-598. [PMID: 27586525 DOI: 10.1007/s11695-016-2337-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Weight regain following bariatric surgery is common and potentially compromises the health benefits initially attained after surgery. Poor compliance to dietary and physical activity prescriptions is believed to be largely responsible for weight regain. Patients may benefit from developing specialized psychological skills necessary to engage in positive health behaviors over the long term. Unfortunately, patients often face challenges to physically returning to the bariatric surgery program for support in developing and maintaining these behaviors. Remotely delivered interventions, in contrast, can be conveniently delivered to the patient and have been found efficacious for a number of health problems, including obesity. To date, they have received little attention with bariatric surgery patients. The study aimed to evaluate a newly developed, remote acceptance-based behavioral intervention for postoperative weight regain. METHODS Patients at least 1.5 years out from surgery who experienced postoperative weight regain were recruited to receive the 10-week intervention. Participants were assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up. RESULTS Support for the intervention's feasibility and acceptability was achieved, with 70 % retention among those who started the program and a high mean rating (4.7 out of 5.0) of program satisfaction among study completers. On average, weight regain was reversed with a mean weight loss of 5.1 ± 5.5 % throughout the intervention. This weight loss was maintained at 3-month follow-up. Significant improvements in eating-related and acceptance-based variables also were observed. CONCLUSIONS This pilot study provides initial support for the feasibility, acceptability, and preliminary efficacy of a remotely delivered acceptance-based behavioral intervention for postoperative weight regain.
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Affiliation(s)
- Lauren E Bradley
- Department of Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd. Suite 400, Chicago, IL, 60625, USA.
| | - Evan M Forman
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | | | | | - Meghan L Butryn
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - J Graham Thomas
- Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - David B Sarwer
- Center for Obesity Research and Education, Temple University, Philadelphia, PA, USA
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25
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A Pilot Study of an Acceptance-Based Behavioral Intervention for Weight Regain After Bariatric Surgery. Obes Surg 2017; 26:2433-41. [PMID: 26964997 DOI: 10.1007/s11695-016-2125-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Tens of thousands of bariatric surgery patients each year experience sub-optimal weight loss, significant regain, or both. Weight regain can contribute to a worsening of weight-related co-morbidities, and for some, leads to secondary surgical procedures. Poor weight outcomes have been associated with decreased compliance to the recommended postoperative diet. Decreased compliance may be partially due to a lack of psychological skills necessary to engage in healthy eating behaviors over the long term, especially as the effects of surgery (on appetite, hunger, and desire for food) decrease. Many behavioral interventions do not sufficiently address these challenges and often have limited effectiveness. The study aimed to evaluate the feasibility, acceptability, and preliminary effectiveness of a novel 10-week acceptance-based behavioral intervention to stop postoperative weight regain. METHODS A sample of bariatric surgery patients (n = 11) who regained at least 10 % of their maximum lost postoperative weight was recruited. All participants received the intervention, which emphasized psychological skills thought to be integral to successful weight control post-surgery. RESULTS The intervention was shown to be feasible and acceptable, with 72 % retention and high mean rating (4.25 out of 5.00) of program satisfaction among completers. Weight regain was stopped, and even reversed, with a mean total body weight loss of 3.58 ± 3.02 % throughout the 10-week intervention. There were also significant improvements in eating-related and acceptance-related variables. CONCLUSIONS These findings provide initial support for the use of a psychological acceptance-based intervention for weight regain in bariatric surgery patients.
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Martin E, Galloway-Williams N, Cox M, Winett R. Pilot testing of a mindfulness- and acceptance-based intervention for increasing cardiorespiratory fitness in sedentary adults: A feasibility study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2015; 4:237-245. [PMID: 27104134 PMCID: PMC4834715 DOI: 10.1016/j.jcbs.2015.10.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Vigorous physical activity (PA) has been promoted for improving cardiorespiratory fitness (CRF). However, therapeutic techniques designed to engage participants in vigorous PA have fallen short; one reason for this may be the unpleasant physical sensations associated with vigorous exercise (e.g., temporary shortness of breath and mild muscle soreness). Mindfulness and acceptance-based therapies such as Acceptance and Commitment Therapy (ACT) may be helpful at improving adherence to vigorous PA levels. In this open clinical trial, we sought to demonstrate the feasibility and acceptability of a mindfulness- and acceptance-based intervention for increasing CRF in sedentary adults and to generate initial outcomes data. DESIGN Participants (N=24) engaged in a 10-week fitness walking program while attending regular group sessions based on ACT. MAIN OUTCOME MEASURES AND RESULTS The feasibility and acceptability of the intervention were demonstrated through high levels of walking adherence (89.30%) and group session attendance (85.50%). A large significant decrease in total 1-mile walk test time [t(18)=4.61, p=.0002, d=.64] and a moderate significant increase in estimated VO2max [t(18)=-4.05, p=.0007, d=-.43] were observed. Analyses indicated a large significant increase in exercise-related experiential acceptance [t(18)=-9.19, p <.0001, d=-2.09]. CONCLUSION This study demonstrates the feasibility and acceptability of an ACT-based intervention for supporting participation in vigorous PA in sedentary individuals.
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Affiliation(s)
- E.C. Martin
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | | | - M.G. Cox
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Unit 1330, PO Box 301439, Houston, TX 77230-1439, USA
| | - R.A. Winett
- Department of Psychology, Virginia Tech, USA
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Spatola CAM, Cappella EAM, Goodwin CL, Baruffi M, Malfatto G, Facchini M, Castelnuovo G, Manzoni GM, Molinari E. Development and initial validation of the Cardiovascular Disease Acceptance and Action Questionnaire (CVD-AAQ) in an Italian sample of cardiac patients. Front Psychol 2014; 5:1284. [PMID: 25452737 PMCID: PMC4231832 DOI: 10.3389/fpsyg.2014.01284] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 10/23/2014] [Indexed: 11/20/2022] Open
Abstract
Psychological inflexibility refers to the attempt to decrease internal distress even when doing so is inconsistent with life values, and has been identified as a potential barrier to making and maintaining health behavior changes that are consistent with a heart-healthy lifestyle. Disease- and behavior-specific measures of psychological inflexibility have been developed and utilized in treatment research. However, no specific measure has been created for patients with heart disease. Thus, the CardioVascular Disease Acceptance and Action Questionnaire (CVD-AAQ) was developed. The present study is aimed to evaluate the psychometric properties of the CVD-AAQ and to explore its association with measures of psychological adjustment and cardiovascular risk factors in an Italian sample of 275 cardiac patients. Exploratory factor analysis showed a structural one-factor solution with satisfactory internal consistency and test-retest reliability. The relation with other measures was in the expected direction with stronger correlations for the theoretically consistent variables, supporting convergent and divergent validity. CVD-AAQ scores were associated with general psychological inflexibility, anxiety and depression and inversely correlated with psychological well-being. Moreover, the results showed that CVD-AAQ scores are associated with two relevant risk factors for cardiac patients, namely low adherence to medication and being overweight. In sum, results suggest that the CVD-AAQ is a reliable and valid measure of heart disease-specific psychological inflexibility with interesting clinical applications for secondary prevention care.
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Affiliation(s)
- Chiara A. M. Spatola
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Emanuele A. M. Cappella
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | | | - Matteo Baruffi
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gabriella Malfatto
- Cardiology Division, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
| | - Mario Facchini
- Cardiology Division, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Faculty of Psychology, eCampus UniversityNovedrate, Como, Italy
| | - Enrico Molinari
- Psychology Research Laboratory, Istituto Auxologico Italiano – Istituto di Ricovero e Cura a Carattere ScientificoMilan, Italy
- Department of Psychology, Catholic University of MilanMilan, Italy
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