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Engelkamp JE, Hartmann AS, Petrowski K, Herhaus B, Fegert JM, Sachser C, Kropp P, Müller B, Brähler E, Hilbert A. Health behavior and psychological treatment utilization in adults with avoidant/restrictive food intake disorder symptoms. J Eat Disord 2024; 12:88. [PMID: 38926791 PMCID: PMC11200871 DOI: 10.1186/s40337-024-01049-1] [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] [Received: 12/30/2023] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Avoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with weight and shape concerns, results in nutrient or energy deficiencies related with further health consequences and a pronounced need for specialized treatment. These interventions need to be tailored to individual health behavior. However, research about health behavior and treatment utilization in ARFID is scarce, particularly in adults, as ARFID is more common in children despite occurring across the lifespan. One important aspect of health behavior is the individual's health regulatory focus (i.e., health prevention and health promotion). Additionally, symptoms of eating disorders have generally been associated with various health risk behaviors, such as smoking, drinking, or unhealthy physical (in)activity. Therefore, the present study aimed to investigate health behavior and psychological treatment utilization in adults with symptoms of ARFID. METHODS A representative adult population sample (N = 2415) completed several self-report questionnaires assessing symptoms of eating disorders and health behavior. Differences between groups (symptoms of ARFID vs. no symptoms of ARFID) were tested with analysis of variance, Mann-Whitney-U-tests, and binary logistic regression. RESULTS Individuals with symptoms of ARFID (n = 20) did not differ in their health regulatory focus, smoking status, physical activity or psychological treatment utilization from individuals without symptoms of ARFID (n = 2395). However, they reported higher alcohol misuse than individuals without symptoms of ARFID. CONCLUSION The findings suggest a relevance of further exploration of the relationship between alcohol misuse and ARFID, given the preliminary nature of these results. This exploration could inform treatment strategies for addressing potential comorbid substance misuse. Furthermore, the low psychological treatment utilization in adults with symptoms of ARFID suggest a need for more specialized psychological treatment services, public education about ARFID being an indication for psychological treatment, and further research about treatment barriers.
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Affiliation(s)
- Julia Enya Engelkamp
- Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Konstanz University, Universitätstr. 10, 78464, Konstanz, Germany.
| | - Andrea Sabrina Hartmann
- Department of Psychology, Clinical Psychology and Psychotherapy of Childhood and Adolescence, Konstanz University, Universitätstr. 10, 78464, Konstanz, Germany
| | - Katja Petrowski
- Department of Medical Psychology and Medical Sociology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Benedict Herhaus
- Department of Medical Psychology and Medical Sociology, University Medical Centre of the Johannes Gutenberg University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Jörg Michael Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Krankenhausweg 3, 89075, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Krankenhausweg 3, 89075, Ulm, Germany
| | - Peter Kropp
- Institute of Medical Psychology and Medical Sociology, University Medical Center Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Britta Müller
- Institute of Medical Psychology and Medical Sociology, University Medical Center Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany
| | - Elmar Brähler
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Anja Hilbert
- Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Stephanstr. 9a, 04103, Leipzig, Germany
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Pfeffer I, Lach L, Sanchez X. Self-regulation and healthy lifestyles: considering the future may increase current physical activity levels. PSYCHOL HEALTH MED 2023; 28:2825-2831. [PMID: 36082937 DOI: 10.1080/13548506.2022.2121973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
The present study examined whether people's consideration of consequences (future vs. immediate consequences; CFC) can predict physical activity behaviour (PAB) and, to explore key mechanisms that may underline such association. To that end, participants (N = 128) filled in standardised measures of CFC and PAB, and questionnaires of health regulatory focus, attitude and intention as mediators of the CFC-PAB association. Regression analysis revealed that CFC-immediate was negatively associated with PAB, and that health regulatory promotion focus and intention were both positively associated with PAB. Mediation analysis revealed a significant effect of CFC-future via health promotion focus, attitude, and intention on PAB. Findings are discussed considering both susceptibility and buffering hypotheses. CFC-future buffers against self-control failure because it is associated with a promotion focus and with both more positive attitudes and stronger intentions towards PAB. Interventions promoting a physically active lifestyle should foster people to value and become aware of the future consequences of their actual PAB.
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Affiliation(s)
- Ines Pfeffer
- Department of Pedagogy, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
- Medical School Hamburg, ICAN Institute of Cognitive and Affective Neurosciences, Hamburg, Germany
| | - Larissa Lach
- Department of Pedagogy, Faculty of Human Sciences, Medical School Hamburg, Hamburg, Germany
| | - Xavier Sanchez
- Complexité, Innovation et Activités Motrices et Sportives (CIAMS), Université d'Orléans, Orléans, France
- Complexité, Innovation et Activités Motrices et Sportives (CIAMS), Université Paris-Saclay, Orsay, France
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Lyu X, Yang T, Fan Y, Hong H, Fu C. Evaluation of the reliability and validity of the health regulatory focus scale in Chinese samples. Front Psychol 2023; 14:1215209. [PMID: 37941753 PMCID: PMC10628087 DOI: 10.3389/fpsyg.2023.1215209] [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: 06/07/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023] Open
Abstract
This study sought to validate the psychometric properties of the Health Regulatory Focus Scale (HRFS), emphasizing its manifestation and association with personality traits in a Chinese context. Originally developed by Ferrer, the HRFS gauges individuals' inclinations either to avoid negative health outcomes (prevention focus) or achieve positive health outcomes (promotion focus). Our cross-sectional analysis involved a diverse sample of 652 Chinese participants, averaging 39.6 years in age (SD = 9.39). Data were analyzed using SPSS and AMOS, and both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed to assess the HRFS's factor structure. Additionally, we evaluated convergent and discriminant validity, criterion-related validity, internal consistency reliability, and test-retest reliability. The CFA results (CFI = 0.985, TLI = 0.971, RMSEA = 0.059, and SRMR = 0.047), combined with McDonald's omega value (0.916) and the test-retest correlation coefficient (0.78) for the HRFS, underscore its robust construct validity and reliability. Furthermore, the promotion dimension of the HRFS exhibited significant positive correlations with all dimensions of the Chinese Adjectives Short Scale of Big-Five Factor Personality (BFFP-CAS-S). In conclusion, the HRFS's Chinese adaptation offers a reliable and valid instrument for assessing health regulatory focus.
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Affiliation(s)
- Xiaokang Lyu
- Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Tingting Yang
- Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Yanqin Fan
- Songjiang District Central Hospital, Shanghai, China
| | - Haijuan Hong
- Songjiang District Central Hospital, Shanghai, China
| | - Chunye Fu
- Zhou Enlai School of Government, Nankai University, Tianjin, China
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Rodrigues DL, Zoppolat G, Balzarini RN, B Slatcher R. Security motives and negative affective experiences during the early months of the COVID-19 pandemic. Psychol Health 2022; 37:1605-1625. [PMID: 35510649 DOI: 10.1080/08870446.2022.2067332] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Self-regulation can help individuals cope during stressful events, but little is known about why and when this might occur. We examined if being more focused on prevention was linked to negative affective experiences during the COVID-19 pandemic. We also examined possible underlying mechanisms for this association, and whether social support buffered it. DESIGN Pre-registered longitudinal study, with surveys every 2 weeks over one month (N = 1269). MAIN OUTCOME MEASURES Regulatory focus and worry for health (T1), adherence to self-isolation and preventive health behaviours (T2), negative affective experiences, positive affect, frequency of online interactions, and perceived social support (T3). RESULTS Prevention focus was associated with health worries at baseline and linked to greater adherence to preventive health behaviours (T2). Only adherence to self-isolation was linked to more negative affective experiences (T3). Exploratory analyses showed that prevention focus was linked to more negative affective experiences (T3), but only for participants with fewer online interactions with their family and less perceived social support from family and friends. CONCLUSIONS Prevention motives in threatening times can be a double-edged sword, with benefits for health behaviours and consequences for negative affective experiences. Having a strong social network during these times can alleviate these consequences.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | - Giulia Zoppolat
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Zhao L, Lyu X, Jiang H, Gao X. Musicokinetic and exercise therapies decrease the depression level of elderly patients undergoing post-stroke rehabilitation: The moderating effect of health regulatory focus. Front Psychol 2022; 13:889510. [PMID: 36046420 PMCID: PMC9421369 DOI: 10.3389/fpsyg.2022.889510] [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: 03/04/2022] [Accepted: 07/15/2022] [Indexed: 11/23/2022] Open
Abstract
This study aims to investigate the impact of musicokinetic and exercise therapies on the depression level of elderly patients undergoing post-stroke rehabilitation and its possible moderators, the promotion focus (i.e., achieve gains) and prevention focus (i.e., avoid losses or non-gains), which are the two motivational orientations of health regulatory focus. An eight-week randomized controlled trial was employed. Sixty-five elderly patients undergoing post-stroke rehabilitation in a hospital in Shanghai, China. Patients were randomly assigned to the musicokinetic (n = 32) therapy group or the exercise (n = 33) therapy group. The Mini-mental State Examination Scale measuring the patients’ cognitive functions was used to screen participants. The Hamilton Depression Rating Scale and the Health Regulatory Focus Scale were applied to assess their levels of depression and health regulatory focus on weeks 0, 4, and 8, respectively. The musicokinetic therapy had a significantly better effect than the exercise therapy for individuals who had a lower level of prevention focus, whereas the exercise therapy had a significantly better effect than the musicokinetic therapy for individuals who had a higher level of prevention focus. Musicokinetic therapy and exercise therapy were both effective in decreasing post-stroke depression for elderly patients. But it is important to choose an appropriate type of therapy per the health regulatory focus of elderly patients with post-stroke rehabilitation.
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Affiliation(s)
- Li Zhao
- Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Xiaokang Lyu
- Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - He Jiang
- Zhou Enlai School of Government, Nankai University, Tianjin, China
| | - Xinhai Gao
- Shibei Hospital, Shanghai, China
- *Correspondence: Xinhai Gao,
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Schmalbach B, Zenger M, Brähler E, Petrowski K. Norm values and psychometric properties for the German health regulatory focus scale - results of a representative survey. BMC Med Res Methodol 2020; 20:51. [PMID: 32122330 PMCID: PMC7053077 DOI: 10.1186/s12874-020-00927-x] [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: 08/31/2018] [Accepted: 02/17/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The health regulatory focus is an application of Higgins' regulatory focus theory to a health-specific context. It explains individual differences in health motivation, strategies, and behavior. Previous research found the Health Regulatory Focus Scale (HRFS) to be a reliable and valid measure for the construct. However, an evaluation of the HRFS in a representative sample has not been performed as of yet. Neither are there any normative values available. METHODS We collected a representative sample from the German general population to perform a confirmatory factor analysis, an analysis of measurement invariance, and to calculate norm values. RESULTS A two-factor model evinced good model fit with a good reliability for the two subscales. We found evidence for strict invariance across gender groups and partial strict invariance across age groups. In addition, we are presenting normative values for the general population. CONCLUSIONS The findings of the present study are in line with previous research in confirming the HRFS as a valid and reliable tool suitable for the assessment of the health regulatory focus. The reported normative values allow for comparisons of individuals with their respective sociodemographic group.
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Affiliation(s)
- Bjarne Schmalbach
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany.
| | - Markus Zenger
- Faculty of Applied Human Studies, University of Applied Sciences Magdeburg-Stendal, Osterburger Str. 25, 39576, Stendal, Germany.,Integrated Research and Treatment Center AdiposityDiseases - Behavioral Medicine, Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Philipp-Rosenthal-Straße 27, 04103, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Untere Zahlbacher Str. 8, 55131, Mainz, Germany
| | - Katja Petrowski
- Medical Psychology & Medical Sociology, University Medical Center of the Johannes Gutenberg University Mainz, Saarstraße 21, 55099, Mainz, Germany
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Laroche M, Roussel P, Cury F. Identifying a motivational process surrounding adherence to exercise and diet among adults with type 2 diabetes. PHYSICIAN SPORTSMED 2020; 48:68-74. [PMID: 31213112 DOI: 10.1080/00913847.2019.1632154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives: This paper aims to provide physicians with knowledge about the motivational processes surrounding exercise and diet for patients with type 2 diabetes and to offer patient support measures to favor self-management. To respond to this objective, the links between two kind of motivators (i.e., promotion and prevention foci), the Selection, Optimization and Compensation (SOC) self-management strategy, and adherence to exercise and diet of patients with type 2 diabetes were investigated for the first time in the literature.Method: A cross-sectional study was conducted with 491 French volunteer participants with type 2 diabetes diagnosed for at least 3 months (Age = 61.66 ± 9.63; BMI = 29.8 ± 5.9). Participants completed an online self-report survey measuring SOC strategy, promotion and prevention foci, and adherence to exercise and diet.Results: The main results of path and bootstrapping analysis demonstrated that promotion focus was positively related with SOC strategy (β = .69, p < .001) whereas prevention focus was not (β = -.01, ns.). On the other hand, SOC strategy was positively related with exercise (β = .20, p < .05), general diet (β = .49, p < .001), fruit and vegetable consumption (β = .27, p < .001), and spacing of carbohydrates (β = .40, p < .001), and mediated the positive link between promotion focus and these behaviors (bootstrapped 95% CI: [.11; .40], [.52; .81], [.22; .54], [.37; .70], respectively).Conclusion: This paper addresses a gap in previous research by evidencing a motivator that promotes self-management for exercise and diet among patients with type 2 diabetes. Our results suggest that physicians should privilege an interaction with patients oriented toward promotional motivation so as to favor their patients' self-management regarding exercise and diet.
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Affiliation(s)
- Manon Laroche
- Factulty of Sports Sciences, Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Peggy Roussel
- Factulty of Sports Sciences, Aix Marseille Univ, CNRS, ISM, Marseille, France
| | - Francois Cury
- Factulty of Sports Sciences, Aix Marseille Univ, CNRS, ISM, Marseille, France.,UFR STAPS, University of Toulon, Toulon, France
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Laroche M, Roussel P, Cury F, Boiché J. Understanding the dynamics of physical activity practice in the health context through Regulatory Focus and Self-Determination theories. PLoS One 2019; 14:e0216760. [PMID: 31443106 PMCID: PMC6707789 DOI: 10.1371/journal.pone.0216760] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 07/10/2019] [Indexed: 11/19/2022] Open
Abstract
This research aimed to associate for the first time in the literature Regulatory Focus and Self-Determination theories to understand the dynamics of physical activity practice in the health context. Two cross-sectional studies were conducted with 603 (Study 1) and 395 (Study 2) French volunteer participants aged from 18 to 69 and 19 to 71 respectively, who were healthy or concerned by a health condition. The main results of structural equation modeling analyses demonstrated that across the two studies, health promotion focus was positively associated with intrinsic motivation (.44 < β < .74, p < .001), integrated regulation (.47 < β < .72, p < .001), identified regulation (.40 < β < .69, p < .001) and introjected regulation (.41 < β < .53, p < .001), whereas health prevention focus was positively related with external regulation (.31 < β < .45, p < .001) and amotivation (.32 < β < .38, p < .001). Bootstrapping analyses main results in Study 2 showed that health promotion focus was indirectly associated with physical activity through intrinsic motivation (95% CI [.02 to .11]), integrated regulation (95% CI [.00 to .08]), identified regulation (95% CI [.00 to .09]) and introjected regulation (95% CI [.04 to .12]), whereas health prevention focus was indirectly associated with physical activity through external regulation (95% CI [.00 to .12]). These studies reveal meaningful associations between Regulatory Focus and Self-Determination theories' variables which support the relevance of associating these two models to understand the processes underlying the physical activity practice.
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Affiliation(s)
| | | | | | - Julie Boiché
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA, Montpellier, France
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Health Regulatory Focus, Selection Optimization and Compensation Strategy and Sports Practice: A Mediational Analysis. THE SPANISH JOURNAL OF PSYCHOLOGY 2019; 22:E18. [PMID: 31006416 DOI: 10.1017/sjp.2019.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study aimed to investigate associations of health promotion and prevention regulatory foci with sports practice, and examined the Selection, Optimization and Compensation (SOC) process behind the positive relationship between health promotion focus and sports practice. A cross-sectional study was conducted with 513 French volunteer sports participants aged from 18 to 82. Participants completed an online self-report survey measuring health regulatory foci, SOC strategy, Amount of Sports Practice (ASP), health condition, and educational level. Path analysis main results (χ2 = 16.64; df = 5; p < .01; RMSEA = 0.067; CFI = 0.98; R2 = .24) demonstrated that ASP was positively related with health promotion focus (β = .13, p < .01), SOC strategy (β = .28, p < .001) and negatively related with health prevention focus (β = -.20, p < .001). SOC strategy was positively related with health promotion focus (β = .39, p < .001) and bootstrapping analyses revealed that this strategy partially mediated the positive relationship between health promotion focus and ASP, 95% CI [.13, .29]. Finally, additional analyses showed that it was specifically the elective selection, optimization and compensation sub-components of SOC strategy which played mediating roles in this link, [.13, .29] < 95% CI < [.13, .29]. For the first time in the literature, these results evidenced direct links between health regulatory foci and sports practice, and a mechanistic pathway between health promotion focus and sports practice. The theoretical and applied implications of these results for sports promotion are discussed.
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