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Sherman SA, Quinn TD, Bock BC, Braun TD, Unick JL. Perceived delivery of essential yoga properties within in-person and remote weight loss maintenance interventions. PLoS One 2024; 19:e0300105. [PMID: 38451990 PMCID: PMC10919620 DOI: 10.1371/journal.pone.0300105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES While previous research has utilized remote delivery of yoga interventions, no research has specifically interrogated the effectiveness of remote yoga intervention delivery. In this secondary analysis of weight-maintenance trial data, we examined participant perceptions of essential yoga properties across in-person and remote formats, hypothesizing that perceptions would not differ following remote delivery. METHODS 24 women with overweight or obesity (34.6±4.1 kg/m2, 48.2±9.9 years) received a 12-week Iyengar yoga intervention (2x/week) following a 3-month behavioral weight loss program. Of 23 participants who completed follow-up questionnaires, 12 received the planned in-person intervention and 11 received a remote intervention (delivered live) due to the COVID-19 pandemic. The Essential Properties of Yoga Questionnaire (EPYQ) was completed online by participants and by the instructors to measure the perceptions of the relative emphasis placed on the essential components of the yoga intervention via 14 subscales. Linear regression models were used to compare perceptions of each EPYQ dimension across in-person and remote delivery methods, as well as between participants and instructors, independent of delivery method. RESULTS 13 of the 14 subscales did not differ between delivery modalities (p>0.05). Participants perceived more individual attention within in-person yoga (p = 0.003). For both delivery methods, instructors perceived breathwork, restorative postures, and body locks to be incorporated to a lesser degree compared to participants (β = -1.28, p = 0.003; β = -1.57, p = 0.019; β = -1.39, p = 0.036; respectively). No other significant differences across the participant and instructor scores were observed. CONCLUSIONS Findings provide preliminary support for the use of live remote delivery of yoga, effectively communicating most essential yoga properties when compared to in-person classes. However, participants perceived more individual attention with in-person versus remote delivery; thus, future remote-based yoga interventions may benefit from providing additional individualized feedback.
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Affiliation(s)
- Sally A. Sherman
- Department of Health and Human Development, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Tyler D. Quinn
- Department of Epidemiology and Biostatistics, West Virginia University, Morgantown, WV, United States of America
| | - Beth C. Bock
- Department of Psychiatry and Human Behavior, Department of Behavioral and Social Sciences, Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Brown University, Providence, RI, United States of America
| | - Tosca D. Braun
- Department of Psychiatry and Human Behavior, Centers for Behavioral and Preventative Medicine, The Miriam Hospital, Brown University, Providence, RI, United States of America
| | - Jessica L. Unick
- Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, The Miriam Hospital, Brown University, Providence, RI, United States of America
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Braun TD, Bhuptani PH, O’Keefe B, Abrantes AM, Marsh E, Holzhauer CG. Mindful self-compassion for veteran women with a history of military sexual trauma: feasibility, acceptability, potential benefits, and considerations. Eur J Psychotraumatol 2024; 15:2301205. [PMID: 38349003 PMCID: PMC10866049 DOI: 10.1080/20008066.2023.2301205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 12/08/2023] [Indexed: 02/15/2024] Open
Abstract
Background: Military sexual trauma (MST) is reported by up to 74% of women veterans in the United States and is a driver of poor behavioural and physical health. Self-compassion is a transdiagnostic, protective factor linked with improved posttraumatic stress disorder (PTSD), depression, and health behaviours. Thus, Mindful Self-Compassion training (MSC) may help ameliorate MST-related impacts. However, MSC can also temporarily increase distress (i.e. backdraft). Delivering it with elective trauma-informed yoga (TIY), which regulates acute distress, may help address this issue.Objective: This VA quality improvement project examined feasibility, acceptability, and reported benefits and challenges of a manualized 8-week MSC including within non-randomized subgroups: MSC (n = 4) and MSC+ elective TIY classes (MSC+; n = 4).Methods: Nine women veterans with a history of MST at a Vet Center in the Northeastern U.S.A. enrolled; eight completed, excluding one MSC+ participant. Measures included attrition (n = 9), attendance (n = 8), weekly (n = 8) and posttreatment acceptability (n = 6), validated symptom severity assessments (n = 7), and an exit interview (n = 8).Results: Among completers, MSC attendance was excellent (89%) and higher among in MSC+ vs. MSC (94% vs. 84% sessions completed). On average across the two groups, depressive and PTSD symptom severity decreased by 21% and 30%, respectively. In exit interviews, participants across groups described improved coping with distress and psychiatric symptoms, reduced stress, and improved self-care and health behaviours. Although women in both groups reported backdraft during the programme, MSC+ also reported healthier coping and improved emotional processing.Conclusion: The results of this programme evaluation infer MSC may be feasible, acceptable, and beneficial for women survivors of MST in one Vet Center in the Northeastern USA. Further, temporary elevations in MSC-related distress may be ameliorated with adjunctive TIY. Given requests of women veterans in the USA. for additional complementary and integrative health treatment options, formal research on these approaches is warranted.
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Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
- VA Central Western Massachusetts, Leeds, MA, USA
| | - Prachi H. Bhuptani
- Alpert Medical School of Brown University, Providence, RI, USA
- Rhode Island Hospital, Providence, RI, USA
| | | | - Ana M. Abrantes
- Alpert Medical School of Brown University, Providence, RI, USA
- Butler Hospital, Providence, RI, USA
| | | | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, Leeds, MA, USA
- University of Connecticut School of Medicine, Farmington, CT, USA
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Uebelacker LA, Braun TD, Taylor LE, Saper R, Baldwi M, Abrantes A, Tremont G, Toribio A, Kirshy S, Koch R, Lorin L, Van Noppen D, Anderson B, Roseen EJ, Stein MD. Evaluation of intervention components to maximize yoga practice among people with chronic pain taking opioid agonist therapy: A factorial experiment using the multiphase optimization strategy framework. Contemp Clin Trials 2024; 137:107411. [PMID: 38103784 PMCID: PMC10922864 DOI: 10.1016/j.cct.2023.107411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/01/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Chronic pain affects up to half of individuals taking opioid agonist therapy (OAT; i.e., methadone and buprenorphine) for opioid use disorder (OUD), and yoga-based interventions may be useful for decreasing pain-related disability. Whereas more yoga practice (i.e., higher "dosage") may improve pain-related outcomes, it can be challenging for people with chronic pain taking OAT to attend class regularly and sustain a regular personal yoga practice. Therefore, we plan to optimize a yoga-based intervention (YBI) package in order to support class attendance and personal practice, thus maximizing the yoga dose received. STUDY DESIGN Using the Multiphase Optimization Strategy (MOST) framework, we will conduct a factorial experiment to examine four intervention components that may be added to a weekly yoga class as part of a YBI. Components include: 1) personal practice videos featuring study yoga teachers, 2) two private sessions with a yoga teacher, 3) daily text messages to inspire personal practice, and 4) monetary incentives for class attendance. The primary outcome will be minutes per week engaged in yoga (including class attendance and personal practice). We plan to enroll 192 adults with chronic pain who are taking OAT for OUD in this 2x2x2x2 factorial experiment. CONCLUSION Results of the study will guide development of an optimized yoga-based intervention package that maximizes dosage of yoga received. The final treatment package can be tested in a multisite efficacy trial of yoga to reduce pain interference in daily functioning in people with chronic pain who are taking OAT. TRIAL REGISTRATION Pre-registration of the study was completed on ClinicalTrials.gov (identifier: NCT04641221).
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Affiliation(s)
- Lisa A Uebelacker
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America.
| | - Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America.
| | - Lynn E Taylor
- University of Rhode Island, Kingston, RI, United States of America
| | - Robert Saper
- Cleveland Clinic, Cleveland, OH, United States of America
| | - Marielle Baldwi
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Ana Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States of America; Butler Hospital, Providence, RI, United States of America
| | - Geoffrey Tremont
- Alpert Medical School of Brown University, Providence, RI, United States of America; The Boston University School of Public Health, Boston, MA, United States of America
| | - Alisha Toribio
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | - Shannon Kirshy
- Butler Hospital, Providence, RI, United States of America
| | - Ryan Koch
- Butler Hospital, Providence, RI, United States of America
| | - Lucy Lorin
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
| | | | | | - Eric J Roseen
- Boston University Chobanian & Avedision School of Medicine, Boston, MA, United States of America; Boston Medical Center, Boston, MA, United States of America
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Unick JL, Dunsiger SI, Bock BC, Sherman SA, Braun TD, Hayes JF, Goldstein SP, Wing RR. A randomized trial examining the effect of yoga on dietary lapses and lapse triggers following behavioral weight loss treatment. Obes Sci Pract 2023; 9:484-492. [PMID: 37810521 PMCID: PMC10551112 DOI: 10.1002/osp4.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/12/2023] [Accepted: 04/16/2023] [Indexed: 10/10/2023] Open
Abstract
Background Dietary lapses can hinder weight loss and yoga can improve self-regulation, which may protect against lapses. This study examined the effect of yoga on dietary lapses, potential lapse triggers (e.g., affective states, cravings, dietary temptations), and reasons for initiating eating following weight loss treatment. Methods Sixty women with overweight/obesity (34.3 ± 3.9 kg/m2) were randomized to a 12 week yoga intervention (2x/week; YOGA) or contact-matched control (cooking/nutrition classes; CON) following a 12-week behavioral weight loss program. Participants responded to smartphone surveys (5x/day) over a 10-day period at baseline, 12, and 24 weeks to assess lapses and triggers. Results At 24 weeks, YOGA and CON differed on several types of lapses (i.e., less eating past full, eating more than usual, loss of control when eating, self-identified overeating, difficulty stopping eating in YOGA), and YOGA was less likely to eat to feel better or in response to stress (ps < 0.05). YOGA also reported less stress and anxiety and more positive affect (ps < 0.01); dietary temptations and cravings did not differ from CON. Conclusion Yoga resulted in fewer dietary lapses and improved affect among women with overweight/obesity following weight loss. While preliminary, findings suggest that yoga should be considered as a potential component of weight loss treatment to target dietary lapses.
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Affiliation(s)
- Jessica L. Unick
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | - Shira I. Dunsiger
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
| | - Beth C. Bock
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
- Department of Behavioral and Social SciencesBrown University School of Public HealthProvidenceRhode IslandUSA
- Behavioral Medicine and Addictions Research GroupButler HospitalProvidenceRhode IslandUSA
| | - Sally A. Sherman
- Department of Health and Human DevelopmentSchool of EducationUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Tosca D. Braun
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
- Behavioral Medicine and Addictions Research GroupButler HospitalProvidenceRhode IslandUSA
| | - Jacqueline F. Hayes
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | - Stephanie P. Goldstein
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
| | - Rena R. Wing
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Department of Psychiatry and Human BehaviorWarren Alpert Medical School at Brown UniversityProvidenceRhode IslandUSA
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Meshesha LZ, Magri TD, Braun TD, Sillice MA, Nguyen MD, Suren V, Abrantes AM. Patient Perspective on the Role of Substance-Free Activities During Alcohol Use Disorder Treatment: A Mixed-Method Study. Alcohol Treat Q 2023; 41:309-321. [PMID: 37519928 PMCID: PMC10373861 DOI: 10.1080/07347324.2023.2204815] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Behavioral economic theory of addiction proposes that substance use often takes place in environments with limited substance-free reinforcement. While increasing substance-free reinforcement is known to reduce substance use, systematic efforts to boost substance-free reinforcement is not often a focus of most alcohol treatment programs. Participants (N=21) with alcohol use disorder participated in virtual focus group sessions. Qualitative content analysis was conducted on participants' verbatim responses. Substance-free activities were also assessed with a 66-item modified pleasant activity list specifying activity engagement frequency and enjoyment. All participants reported introduction to substance-free activity engagement as part of their treatment, although those in group therapy (relative to individual) reported less consistent support. While motives for initial activity engagement were reported as stemming from external sources (i.e., therapist), activity maintenance was linked to intrinsic motives (i.e., personal interest). All participants identified substance-free activities as a key aid to successful recovery. Types of most helpful activities were ones related to self-care, social connections, acts of service, and creative outlets. Findings are consistent with theories of behavior change and suggest participants believe substance-free activity engagement is an important component of their recovery, however they are not receiving consistent support during the pivotal early recovery period.
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Affiliation(s)
- Lidia Z. Meshesha
- Department of Psychology, University of Central Florida, Orlando, FL, 32816
| | - Tatiana D. Magri
- Department of Psychology, University of Central Florida, Orlando, FL, 32816
| | - Tosca D. Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906
- Behavioral Medicine and Addiction Research, Butler Hospital; Providence, RI, 02906
| | - Marie A. Sillice
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Minh D. Nguyen
- Department of Psychology, University of Central Florida, Orlando, FL, 32816
| | - Vaishnavi Suren
- Department of Psychology, University of Central Florida, Orlando, FL, 32816
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI 02906
- Behavioral Medicine and Addiction Research, Butler Hospital; Providence, RI, 02906
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Braun TD, Green Z, Meshesha LZ, Sillice MA, Read J, Abrantes AM. Self-compassion buffers the internalized alcohol stigma and depression link in women sexual assault survivors who drink to cope. Addict Behav 2023; 138:107562. [PMID: 36463606 PMCID: PMC10184311 DOI: 10.1016/j.addbeh.2022.107562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/01/2022] [Accepted: 11/21/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Depression is strongly implicated in drinking to cope and the development of alcohol use disorders (AUD) in women, particularly among women with a history of sexual assault victimization (SAV). Alcohol use in women is heavily stigmatized, and substance use stigma is associated with depression. This study examined the link between internalized alcohol stigma (AS) and depression and tested whether self-compassion buffered (i.e., moderated) this association in a sample of women with a history of SAV and unhealthy drinking to cope. METHOD Women sexual assault survivors (N = 288; 82 % White, 91.2 % Non-Hispanic, 20.2 % sexual minority) reporting unhealthy drinking (Alcohol Use Disorders Inventory Test-C ≥ 4) and drinking to cope (Drinking Coping Motives Questionnaire-Revised ≥ 2) completed online self-report surveys. Hierarchical regression analyses tested associations between internalized-AS and self-compassion with depression after controlling for covariates (age, income, education, AUD symptoms, and posttraumatic stress disorder) and then, whether self-compassion moderated the Internalized-AS and depression link. RESULTS Internalized-AS accounted for 1.4 % of variance in depression (p < .01); self-compassion accounted for added variance when subsequently modeled (8.2 %, p < .001). Moderation analyses revealed self-compassion to buffer the internalized-AS and depression link. Among participants reporting high levels of self-compassion, there was no association between internalized-AS and depression (p = .894). DISCUSSION While findings are modest, they align with the previously observed link between internalized-AS and depression and extend these findings to women with a history of SAV endorsing elevated coping motives and unhealthy drinking. Self-compassion may protect against this link, pending further research sampling greater diversity of participants and longitudinal and controlled designs.
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Affiliation(s)
- Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Zoë Green
- University of Connecticut Health Center, Farmington, CT, United States
| | - Lidia Z Meshesha
- Department of Psychology, University of Central Florida, Orlando, FL, United States
| | - Marie A Sillice
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States
| | - Jennifer Read
- Department of Psychology, University at Buffalo, Buffalo, NY, United States
| | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
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Braun TD, Olson K, Panza E, Lillis J, Schumacher L, Abrantes AM, Kunicki Z, Unick JL. Internalized weight stigma in women with class III obesity: A randomized controlled trial of a virtual lifestyle modification intervention followed by a mindful self-compassion intervention. Obes Sci Pract 2022; 8:816-827. [PMID: 36483124 PMCID: PMC9722463 DOI: 10.1002/osp4.616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/11/2022] [Accepted: 05/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background Internalized weight stigma (Internalized-WS) is prevalent among individuals with severe obesity, particularly women, and is associated with shame, disordered eating, and weight gain. Effective, accessible interventions that address both severe (Class-III) obesity and Internalized-WS are needed. This randomized pilot trial evaluated the feasibility, acceptability, and preliminary efficacy of a fully-remote lifestyle modification intervention (LM) followed by mindful self-compassion training (MSC) or control. Methods Twenty-eight women with Class-III obesity (46.6 ± 3.7 kg/m2) and elevated Internalized-WS were randomized to a virtually-delivered 4-month LM followed by a 2-month MSC or cooking/dietary education (CON). Psychosocial measures/weight were assessed at baseline, 4-(post-LM), 6-(post-MSC/CON), and 9-month (follow-up). Results Improvements in Internalized-WS, shame, and self-compassion were observed with LM. Mean 4-month weight loss was 6.3 ± 3.7%. MSC had lower attendance and usefulness ratings versus CON. Post-MSC/CON, MSC yielded significant and/or meaningful improvements in Internalized-WS, self-compassion, and intuitive eating relative to CON. Weight loss did not differ by group at 6-month, and at 9-month trended lower in MSC versus CON. Conclusion Virtual LM is feasible, acceptable, and leads to significant weight loss among women with severe obesity; MSC led to further improved Internalized-WS, self-compassion, and intuitive eating. Continued work is needed to elucidate effects of self-compassion training on Internalized-WS, its mechanisms, and linkages to cardiometabolic health and long-term weight loss.
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Affiliation(s)
- Tosca D. Braun
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Centers for Behavioral and Preventive MedicineThe Miriam HospitalProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Kayloni Olson
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Emily Panza
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Jason Lillis
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Leah Schumacher
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
| | - Ana M. Abrantes
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Butler HospitalProvidenceRIUSA
| | - Zachary Kunicki
- Quantitative Sciences ProgramBrown UniversityProvidenceRIUSA
| | - Jessica L. Unick
- Alpert Medical School of Brown UniversityProvidenceRIUSA
- Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRIUSA
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Altman BR, Braun TD, Battle CL, Iacoi S, Stein MD, Abrantes AM. The indirect effect of negative emotionality via alcohol craving on abstinence self-efficacy among women in alcohol treatment. Addict Behav 2022; 132:107347. [PMID: 35561632 PMCID: PMC10260287 DOI: 10.1016/j.addbeh.2022.107347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 04/13/2022] [Accepted: 04/26/2022] [Indexed: 01/26/2023]
Abstract
Women with alcohol use disorder (AUD) often present to treatment with heightened negative emotionality, including negative affect, anxiety, stress, and depression. Negative emotionality might impact women's alcohol abstinence self-efficacy (AASE), or confidence in their ability to remain sober, which is an important predictor of treatment outcomes. It is also plausible that other variables, such as alcohol craving, influence AASE. The present work examined the indirect effect of negative emotionality on AASE via alcohol craving as a mediator cross-sectionally among a sample of women enrolled in AUD treatment reporting co-occurring depressive symptoms (N = 73). Participants completed baseline measures of negative emotionality (e.g. anxiety and depression symptoms, stress, negative affect), alcohol craving, and AASE. All indices of negative emotionality were positively correlated with each other and alcohol craving (r's ranging from 0.244 to 0.671) and all but depression were inversely associated with AASE (r's ranging from -0.341 to -0.234; p <.05). In separate simple mediation models, we found that alcohol craving mediated the association of each of the four measures of negative emotionality with AASE. Further longitudinal and experimental work is necessary to determine if teaching skills to cope with alcohol craving in the context of co-occurring negative emotionality might lead to better therapeutic outcomes.
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Affiliation(s)
- Brianna R Altman
- Alpert Medical School of Brown University, Providence, RI, United States
| | - Tosca D Braun
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States
| | - Cynthia L Battle
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States; Women & Infants Hospital of Rhode Island, Providence, RI, United States
| | | | | | - Ana M Abrantes
- Alpert Medical School of Brown University, Providence, RI, United States; Butler Hospital, Providence, RI, United States.
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Braun TD, Puhl RM, Quinn DM, Gorin A, Tishler D, Papasavas P. Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery. Surg Obes Relat Dis 2022; 18:1066-1073. [PMID: 35811291 PMCID: PMC9797255 DOI: 10.1016/j.soard.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. OBJECTIVE Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. SETTING Teaching hospital and surgical weight loss center in the United States. METHODS A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). RESULTS After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR2 = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR2 = .12 and .13, respectively; overall model R2 =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms. CONCLUSIONS Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Centers of Preventive Medicine, The Miriam Hospital, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island,Correspondence: Tosca D. Braun, Ph.D., Alpert Brown Medical School, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. (T.D. Braun)
| | - Rebecca M. Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut
| | - Diane M. Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Amy Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
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Braun TD, Unick JL, Abrantes AM, Dalrymple K, Conboy LA, Schifano E, Park CL, Lazar S. Intuitive eating buffers the link between internalized weight stigma and body mass index in stressed adults. Appetite 2022; 169:105810. [PMID: 34813916 PMCID: PMC9434977 DOI: 10.1016/j.appet.2021.105810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 11/05/2021] [Accepted: 11/14/2021] [Indexed: 02/03/2023]
Abstract
Internalized weight stigma (IWS) is independently associated with less intuitive eating (i.e., eating based on endogenous hunger/satiety cues) and higher Body Mass Index (BMI), and intuitive eating training is commonly conceptualized as protective against the effects of IWS on poor behavioral health. The 3-way relationship between IWS, intuitive eating, and BMI has yet to be examined, and it is unclear whether the link between IWS and BMI is buffered by high intuitive eating. This secondary preliminary analysis examined baseline data of stressed adults with poor diet (N = 75, 70% female, 64.1% White, 42.7% with overweight/obesity) in a parent clinical trial that tested the effects of yoga on diet and stress. Validated self-report surveys of IWS and intuitive eating were analyzed with objectively-assessed BMI. Moderated regression analyses using the SPSS PROCESS macro tested whether intuitive eating moderated the IWS-BMI link. The analysis revealed IWS was positively associated with BMI except among people with high intuitive eating. Results extend observational findings linking intuitive eating to lower BMI, and offer preliminary support for the hypothesis that this link may hold even among those with greater IWS. It's possible that individuals with lower BMI and greater IWS may gravitate more towards intuitive eating than those with greater BMI, and/or intuitive eating may be an important target for ameliorating the adverse association of IWS with behavioral and physical health indicators linked to BMI. Continued work is warranted in larger, more generalizable samples using causal and prospective designs.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020,Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Jessica L. Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Weight Control and Diabetes Research Center, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Kristy Dalrymple
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine at Brown University,Lifespan Physician’s Group, 146 West River Street, Suite 11B, Providence, RI 02904
| | - Lisa A. Conboy
- Department of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston MA 02215,New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences
| | - Elizabeth Schifano
- Department of Statistics, University of Connecticut, 215 Glenbrook Road U4120, Storrs, CT 06269
| | - Crystal L. Park
- Department of Psychological Sciences, University of Connecticut, 406 Babbidge Road, Storrs, CT 06269-1020
| | - Sara Lazar
- Department of Psychiatry, Massachusetts General Hospital, 55 Fruit St., Boston, MA,Department of Psychology, Harvard Medical School
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11
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Braun TD, Riley KE, Kunicki ZJ, Finkelstein-Fox L, Conboy LA, Park CL, Schifano E, Abrantes AM, Lazar SW. Internalized weight stigma and intuitive eating among stressed adults during a mindful yoga intervention: associations with changes in mindfulness and self-compassion. Health Psychol Behav Med 2021; 9:933-950. [PMID: 34868736 PMCID: PMC8635578 DOI: 10.1080/21642850.2021.1992282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Purpose Internalized weight stigma (IWS) is common in the United States of America across body weight categories, and is implicated in the development of distress and unhealthy eating behaviors (e.g. overeating, disordered eating) that can foster poor cardiometabolic health. While emerging intervention research shows early promise in reducing IWS, long-term efficacy is unclear and novel strategies remain needed. This analysis examined whether participation in a mindful yoga intervention was associated with reduced IWS and increased intuitive eating, an adaptive eating behavior, and whether these changes correlated with each other or with changes in mindfulness and self-compassion. Methods Participants were stressed adults with low fruit and vegetable intake (N = 78, 64.1% White, M. Body Mass Index 25.59 ± 4.45) enrolled in a parent clinical trial of a 12-week mindful yoga intervention. Validated self-report measures of IWS, intuitive eating, mindfulness, and self-compassion were administered at pre-treatment, mid-treatment (8 weeks), post-treatment (12 weeks), and 4-month follow-up (24 weeks). Results Linear mixed modeling revealed significant improvements in IWS and intuitive eating across the four timepoints (p < .001). Reduced IWS correlated with increased intuitive eating pre- to post-treatment (p = .01). Improved self-compassion and mindfulness correlated with intuitive eating (both p = . 04), but not IWS (p = .74 and p = .56, respectively). Conclusion This study offers preliminary support for the hypothesis that mindful yoga may promote intuitive eating and reduce IWS among stressed adults with poor diet, and suggests that changes in these factors may co-occur over time. Further investigation with controlled designs is necessary to better understand the temporality and causality of these relationships.Trial registration: ClinicalTrials.gov identifier: NCT02098018.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine, Brown University, Providence, RI, USA.,Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.,Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Kristen E Riley
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
| | - Zachary J Kunicki
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | - Lucy Finkelstein-Fox
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, USA
| | - Lisa A Conboy
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Crystal L Park
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, USA
| | | | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Medicine, Brown University, Providence, RI, USA.,Behavioral Medicine and Addictions Research, Butler Hospital, Providence, RI, USA
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychology, Harvard Medical School, Boston, MA, USA
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12
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Braun TD, Schifano ED, Finkelstein-Fox L, Park CL, Conboy LA, Deshpande R, Riley KE, Lazar SW. Yoga participation associated with changes in dietary patterns and stress: A pilot study in stressed adults with poor diet. Complement Ther Clin Pract 2021; 45:101472. [PMID: 34530181 PMCID: PMC8898640 DOI: 10.1016/j.ctcp.2021.101472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/18/2021] [Accepted: 08/03/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Stress contributes to dietary patterns that impede health. Yoga is an integrative stress management approach associated with improved dietary patterns in burgeoning research. Yet, no research has examined change in dietary patterns, body mass index (BMI), and stress during a yoga intervention among stressed adults with poor diet. MATERIALS AND METHODS Objectively-measured BMI and a battery of self-report questionnaires were collected at four time points during and following a 12-week yoga intervention (N = 78, 71% women, mean BMI = 25.69 kg/m2±4.59) - pre-treatment (T1), mid-treatment (6 weeks; T2), post-treatment (12 weeks; T3), and at 3-month follow-up (24 weeks; T4). RESULTS T1 to T3 fruit and vegetable intake, BMI, and stress significantly declined in the overall sample. Reduction in vegetable intake was no longer significant after accounting for reductions in caloric intake, and reduction in caloric intake remained significant after accounting for reductions in stress. CONCLUSION Findings may be interpreted as yoga either encouraging or adversely impacting healthy dietary patterns (i.e., minimizing likelihood of future weight gain vs. decreasing vegetable intake and overall caloric intake among individuals who may not need to lose weight, respectively). Continued research is warranted, utilizing causal designs.
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Affiliation(s)
- Tosca D Braun
- Department of Psychological Sciences, University of Connecticut, USA; Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI, USA; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA.
| | | | | | - Crystal L Park
- Department of Psychological Sciences, University of Connecticut, USA.
| | - Lisa A Conboy
- Beth Israel Deaconess Medical Center, Harvard Medical School, USA; New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences, USA.
| | - Rina Deshpande
- Department of Psychiatry, Massachusetts General Hospital, USA.
| | - Kristen E Riley
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, USA.
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, USA; Department of Psychology, Harvard Medical School, USA.
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Braun TD, Kunicki ZJ, Blevins CE, Stein MD, Marsh E, Feltus S, Miranda R, Thomas JG, Abrantes AM. Prospective Associations between Attitudes toward Sweet Foods, Sugar Consumption, and Cravings for Alcohol and Sweets in Early Recovery from Alcohol Use Disorders. Alcohol Treat Q 2021; 39:269-281. [PMID: 34566252 DOI: 10.1080/07347324.2020.1868958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sweet liking (heightened preference for highly-sweet solutions) is linked to Alcohol Use Disorder (AUD) and relapse, as well as attitudes towards sweet foods - use of sugar to cope with negative affect (sweet-cope), and impaired control over sweets consumption (sweet-control). This prospective analysis of individuals with AUD (N=26) participating in an Alcohol and Drug partial hospitalization program observed increases in self-reported sugar consumption and sweet craving from Time 1 (T1) to Time 2 (T2; 4 weeks later). Sweet-cope (T1) predicted T2 sweet craving. In an exploratory cross-lagged panel model, sweet-cope predicted sugar consumption and sweet craving at T1 and T2, and alcohol craving at T2. This pattern of results suggests the hypothesis that use of sugar to regulate negative affect may prove a novel, modifiable risk mechanism of the association between sweet liking and relapse. Sweet-cope may also prove an intervention target for improving nutrition and weight-related factors in early recovery. Future research in larger sample sizes is needed.
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Affiliation(s)
- Tosca D Braun
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Zachary J Kunicki
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Claire E Blevins
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
| | - Michael D Stein
- Behavioral Medicine and Addictions Research, Butler Hospital.,Department of Health Law, Policy & Management, Boston University School of Public Health
| | - Eliza Marsh
- Behavioral Medicine and Addictions Research, Butler Hospital
| | - Sage Feltus
- Behavioral Medicine and Addictions Research, Butler Hospital.,Department of Psychology, Binghamton University
| | - Robert Miranda
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Center for Alcohol and Addiction Studies, Brown University
| | - John G Thomas
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Weight Control and Diabetes Research Center, The Miriam Hospital
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University.,Behavioral Medicine and Addictions Research, Butler Hospital
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Braun TD, Uebelacker LA, Ward M, Holzhauer CG, McCallister K, Abrantes A. "We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma. Complement Ther Med 2021; 59:102729. [PMID: 33965560 DOI: 10.1016/j.ctim.2021.102729] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/27/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST. DESIGN Collective case series (N = 7). SETTING New England Vet Center. INTERVENTIONS Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy. MAIN OUTCOME MEASURES Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2). RESULTS Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2. CONCLUSIONS TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.
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Affiliation(s)
- Tosca D Braun
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States; Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 196 Richmond St., Providence, RI, 02903, United States(1); Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States.
| | - Lisa A Uebelacker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Psychosocial Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
| | - Mariana Ward
- Memorial Sloan Kettering, Sloan Kettering Institute, 1275 York Ave., New York, NY, 10065, United States.
| | - Cathryn Glanton Holzhauer
- VA Central Western Massachusetts, 421 N. Main St., Leeds, MA, 01053, United States; Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave., North Worcester, MA, 01655, United States.
| | - Kelly McCallister
- West Springfield, MA Vet Center, 95 Ashley Ave., West Springfield, MA, 01089-1352, United States.
| | - Ana Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Box G-BH, 700 Butler Drive, Providence, RI, 02906, United States; Behavioral Medicine and Addictions Research, Butler Hospital, 345 Blackstone Blvd., Providence, RI, 02906, United States.
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15
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Braun TD, Gorin AA, Puhl RM, Stone A, Quinn DM, Ferrand J, Abrantes AM, Unick J, Tishler D, Papasavas P. Shame and Self-compassion as Risk and Protective Mechanisms of the Internalized Weight Bias and Emotional Eating Link in Individuals Seeking Bariatric Surgery. Obes Surg 2021; 31:3177-3187. [PMID: 33905070 DOI: 10.1007/s11695-021-05392-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/19/2021] [Accepted: 03/25/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Emotional eating in bariatric surgery patients is inconsistently linked with poor post-operative weight loss and eating behaviors, and much research to date is atheoretical. To examine theory-informed correlates of pre-operative emotional eating, the present cross-sectional analysis examined paths through which experienced weight bias and internalized weight bias (IWB) may associate with emotional eating among individuals seeking bariatric surgery. METHODS We examined associations of experienced weight bias, IWB, shame, self-compassion, and emotional eating in patients from a surgical weight loss clinic (N = 229, 82.1% female, M. BMI: 48 ± 9). Participants completed a survey of validated self-report measures that were linked to BMI from the patient medical record. Multiple regression models tested associations between study constructs while PROCESS bootstrapping estimates tested the following hypothesized mediation model: IWB ➔ internalized shame ➔ self-compassion ➔ emotional eating. Primary analyses controlled for adverse childhood experiences (ACE), a common confound in weight bias research. Secondary analyses controlled for depressive/anxiety symptoms from the patient medical record (n = 196). RESULTS After covariates and ACE, each construct accounted for significant unique variance in emotional eating. However, experienced weight bias was no longer significant and internalized shame marginal, after controlling for depressive/anxiety symptoms. In a mediation model, IWB was linked to greater emotional eating through heightened internalized shame and low self-compassion, including after controlling for depressive/anxiety symptoms. CONCLUSIONS Pre-bariatric surgery, IWB may signal risk of emotional eating, with potential implications for post-operative trajectories. Self-compassion may be a useful treatment target to reduce IWB, internalized shame, and related emotional eating in bariatric surgery patients. Further longitudinal research is needed.
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Affiliation(s)
- Tosca D Braun
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA. .,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA. .,Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA.
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, CT, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, CT, USA
| | - Jennifer Ferrand
- Institute of Living, Div. of Health Psychology, Hartford Hospital, Hartford, CT, USA
| | - Ana M Abrantes
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Behavioral Medicine and Addiction Research, Butler Hospital, Providence, RI, USA
| | - Jessica Unick
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.,Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Glastonbury, USA
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16
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Park CL, Finkelstein-Fox L, Sacco SJ, Braun TD, Lazar S. How does yoga reduce stress? A clinical trial testing psychological mechanisms. Stress Health 2021; 37:116-126. [PMID: 32797683 PMCID: PMC10159010 DOI: 10.1002/smi.2977] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/30/2020] [Accepted: 08/03/2020] [Indexed: 02/06/2023]
Abstract
Yoga interventions can reduce stress, but the mechanisms underlying that stress reduction remain largely unidentified. Understanding how yoga works is essential to optimizing interventions. The present study tested five potential psychosocial mechanisms (increased mindfulness, interoceptive awareness, spiritual well-being, self-compassion and self-control) that have been proposed to explain yoga's impact on stress. Forty-two participants (62% female; 64% White) in a yoga program for stress reduction completed surveys at baseline (T1), mid-intervention (T2) and post-intervention (12 weeks; T3). We measured two aspects of stress, perceived stress and stress reactivity. Changes were assessed with paired t-tests; associations between changes in mechanisms were tested in residual change models. Only stress reactivity decreased, on average, from T1 to T3. Except for self-compassion, all psychosocial mechanisms increased from T1 to T3, with minimal changes from T2 to T3. Except for self-control, increases in each mechanism were strongly associated with decreases in both measures of stress between T1 and T2 and decreases in perceived stress from T1 to T3 (all p's < 0.05). Increased psychosocial resources are associated with stress reduction. Yoga interventions targeting these resources may show stronger stress reduction effects. Future research should test these linkages more rigorously using active comparison groups and larger samples.
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Affiliation(s)
- Crystal L Park
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Lucy Finkelstein-Fox
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Shane J Sacco
- Department of Allied Health Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Tosca D Braun
- Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Sara Lazar
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
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17
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Braun TD, Quinn DM, Stone A, Gorin AA, Ferrand J, Puhl RM, Sierra J, Tishler D, Papasavas P. Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients. Obesity (Silver Spring) 2020; 28:1974-1983. [PMID: 32808737 PMCID: PMC8650800 DOI: 10.1002/oby.22920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert Medical School of Medicine, Brown University, Providence, Rhode Island, USA
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer Ferrand
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica Sierra
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
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18
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Greenberg J, Braun TD, Schneider ML, Finkelstein-Fox L, Conboy LA, Schifano ED, Park C, Lazar SW. Is less more? A randomized comparison of home practice time in a mind-body program. Behav Res Ther 2018; 111:52-56. [PMID: 30312895 DOI: 10.1016/j.brat.2018.10.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/01/2018] [Accepted: 10/03/2018] [Indexed: 01/24/2023]
Abstract
Home practice is a major component of mind-body programs, yet little is known about how to optimize the amount of prescribed home practice in order to achieve an effective "dose" of practice while minimizing participant burden. This study tested how varying the amount of home practice in a mind-body program impacts compliance and stress reduction, and whether prescribing a flexible home practice schedule increases compliance. Eighty-four stressed participants undergoing a 12-week yoga program were randomized to low, medium, and high home practice conditions. The medium condition allowed participants the flexibility to choose one of two amounts of practice each day. The low practice group exhibited the highest compliance (91%) compared to the medium and low practice groups (∼60%), but exhibited the lowest total practice time, and did not significantly reduce stress. The high practice group was the only group to achieve significant stress-reduction, which was maintained 12 weeks post program. Prescribing a flexible home practice schedule did not increase compliance. Results suggest that prescribing higher practice doses may maximize practice time and symptom reduction despite lower compliance.
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Affiliation(s)
- Jonathan Greenberg
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, USA.
| | - Tosca D Braun
- Department of Psychological Sciences, University of Connecticut, USA
| | | | | | - Lisa A Conboy
- Harvard Medical School, USA; Beth Israel Deaconess Medical Center, USA
| | | | - Crystal Park
- Department of Psychological Sciences, University of Connecticut, USA
| | - Sara W Lazar
- Department of Psychiatry, Massachusetts General Hospital, USA; Harvard Medical School, USA
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Park CL, Riley KE, Braun TD, Jung JY, Suh HG, Pescatello LS, Antoni MH. Yoga and Cognitive-behavioral Interventions to Reduce Stress in Incoming College Students: A Pilot Study. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/jabr.12068] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Riley KE, Park CL, Wilson A, Sabo A, Antoni MH, Braun TD, Harrington J, Reiss J, Pasalis E, Harris A, Cope S. Improving physical and mental health in frontline mental health care providers: Yoga-based stress management versus cognitive behavioral stress management. J Workplace Behav Health 2016; 32:26-48. [PMID: 33354168 DOI: 10.1080/15555240.2016.1261254] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The need for brief, low-cost, easily disseminable and effective interventions to promote healthy lifestyles is high. This is especially true for mental health providers. We developed two studies to compare the impacts of Cognitive Behavioral Stress Management (CBSM) and Yoga Based Stress Management (YBSM) interventions for healthcare professionals. Study 1 offered an 8-week YBSM intervention to 37 mental healthcare participants and collected health data pre and post. Study 2 offered YBSM and CBSM classes to 40 randomly assigned mental healthcare providers and collected mental and physical health data at four time points. In Study 1, using t-tests, the YBSM intervention affected a number of mental and physical wellbeing indices pre to post. In Study 2, using linear mixed modeling, both YBSM and CBSM groups improved significantly (p <.05) in fruit and vegetable intake, heart rate, alcohol consumption, relaxation and awareness, professional quality of life, compassion satisfaction, burnout, depression, and stress levels. There was a group by time effect for coping confidence (CBSM increased more, p<.05, F = 4.34), physical activity (YBSM increased more, p<.05, F = 3.47), overall mental health (YBSM increased more, p<.10, F =5.32), and secondary traumatic stress (YBSM decreased more, p<.10, F = 4.89). YBSM and CBSM appear to be useful for healthcare professionals' mental and physical health. YBSM demonstrates some benefit above and beyond the extremely well-studied and empirically supported CBSM, including increased physical activity, overall mental health, and decreased secondary traumatic stress benefits.
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Affiliation(s)
- K E Riley
- Memorial Sloan Kettering Cancer Center
| | | | - A Wilson
- Kripalu Center for Yoga & Health
| | - A Sabo
- Berkshires Medical Center
| | | | | | | | | | | | - A Harris
- Kripalu Center for Yoga & Health
| | - S Cope
- Kripalu Center for Yoga & Health
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Park CL, Riley KE, George LS, Gutierrez IA, Hale AE, Cho D, Braun TD. Assessing Disruptions in Meaning: Development of the Global Meaning Violation Scale. Cogn Ther Res 2016. [DOI: 10.1007/s10608-016-9794-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Braun TD, Park CL, Gorin A. Self-compassion, body image, and disordered eating: A review of the literature. Body Image 2016; 17:117-31. [PMID: 27038782 DOI: 10.1016/j.bodyim.2016.03.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 03/01/2016] [Accepted: 03/03/2016] [Indexed: 12/24/2022]
Abstract
Self-compassion, treating oneself as a loved friend might, demonstrates beneficial associations with body image and eating behaviors. In this systematic review, 28 studies supporting the role of self-compassion as a protective factor against poor body image and eating pathology are reviewed. Findings across various study designs consistently linked self-compassion to lower levels of eating pathology, and self-compassion was implicated as a protective factor against poor body image and eating pathology, with a few exceptions. These findings offer preliminary support that self-compassion may protect against eating pathology by: (a) decreasing eating disorder-related outcomes directly; (b) preventing initial occurrence of a risk factor of a maladaptive outcome; (c) interacting with risk factors to interrupt their deleterious effects; and (d) disrupting the mediational chain through which risk factors operate. We conclude with suggestions for future research that may inform intervention development, including the utilization of research designs that better afford causal inference.
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Affiliation(s)
- Tosca D Braun
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1030, United States.
| | - Crystal L Park
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1030, United States.
| | - Amy Gorin
- Department of Psychology, University of Connecticut, 406 Babbidge Road, Unit 1020, Storrs, CT 06269-1030, United States.
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Braun TD, Park CL, Gorin AA, Garivaltis H, Noggle JJ, Conboy LA. Group-Based Yogic Weight Loss with Ayurveda-Inspired Components: A Pilot Investigation of Female Yoga Practitioners and Novices. Int J Yoga Therap 2016; 26:55-72. [PMID: 27797660 DOI: 10.17761/1531-2054-26.1.55] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Overweight/obesity is a pressing international health concern and conventional treatments demonstrate poor long-term efficacy. Preliminary evidence suggests yoga and Ayurveda may be promising approaches, although recent NHIS estimates indicate rare utilization of Ayurveda in the US. Group-based curricula that integrate yoga and Ayurveda-inspired principles to attenuate overweight and obesity across individuals may prove a feasible, disseminable clinical adjunct to facilitate psychosocial health and weight loss and/or maintenance. AIMS Determine feasibility and preliminary effectiveness of a ten-week yoga - based, Ayurveda-inspired weight management curriculum (YWL) piloted in female yoga practitioners (Study 1) then refined and tailored for yoga naïves (Study 2), on self-reported psychosocial process variables and % of self-reported total body weight loss (%TBWL). METHODOLOGY Study 1 enrolled 22 yoga-experienced women (48.2 ± 14.3 years, BMI 30.8 ± 4.2 kg/m2) in a 10-week yoga-based program (YWL-YE). Study 2 enrolled 21 yoga- naïve women (49.4 ± 10.7 years, BMI 35.5 ± 6.8 kg/m2) in a revised 10-week program (YWL-YN). Self-reported weight and self-ratings of mindful eating behavior, body image disturbance, weight loss self-efficacy, body awareness, and self-compassion were collected at baseline, post-treatment (T2), and 3-month follow- up (T3). RESULTS YWL curricula was feasible in both studies. While attrition rates for both studies favorably compared to other weight management studies, attrition was higher for YWL-YN (28.6%) than YWL-YE (18.2%). In both studies, self-reported process variables and self-reported % TBWL changed in hypothesized directions at T2 and evidenced greater improvement at T3; effect sizes across all process variables were medium (-0.4) to large (-1.8). % TBWL reached clinical significance (>5%) only at T3 for the YWL-YE group. CONCLUSIONS The YWL curricula employed here appear to improve psychosocial health among both overweight/obese yoga-experienced and yoga- naïve women. Results must be interpreted with caution due to study design, self-report assessments, and other limitations. Nonetheless, hypotheses are generated for future investigation.
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Affiliation(s)
- Tosca D Braun
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | - Crystal L Park
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | - Amy A Gorin
- 1. University of Connecticut, Department of Psychology, Storrs, CT
| | | | - Jessica J Noggle
- 2. Emory University, Nell Hodgson Woodruff School of Nursing, Atlanta, GA
| | - Lisa A Conboy
- 3. Harvard Medical School, Osher Research Center, Department of Biomedicine, Boston, MA
- 4. New England School of Acupuncture, Newton, MA
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Jung JY, Suh H, Jensen C, Braun TD, Riley KE, Park CL, Pescatello LS. The Influence of Yoga and Stress Management Intervention on Physical Activity and Function among College Students. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000493971.24596.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Braun TD, Gutierrez IA, Park CL, Angelina H. Differential Relations Between Mindfulness, Self-Compassion, and Eating Behavior. J Altern Complement Med 2014. [DOI: 10.1089/acm.2014.5369.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Bayley PJ, Isaac L, Kong JY, Adamson MM, Ashford JW, Mahoney LA, Beltran M, Brown-Elhillali A, Held A, Ajayi A, Belcher H, Bond A, Mason H, Lemaster C, Shaw S, Mullin C, Holick E, Saper R, Braun TD, Riley KE, Park CL, Trehern AE, Davis MB, Mastronardi EL, Butzer B, Khalsa SBS, Shorter SM, Reinhardt KM, Cope S, Cheung C, Justice C, Wyman J, Cook-Cottone CP, Daly LA, Haden SC, Hagins M, Danhauer SC, Griffin LP, Avis NE, Sohl SJ, Lawrence J, Jesse MT, Addington EL, Messino MJ, Giguere JK, Lucas SL, Wiliford SK, Shaw E, de Manincor M, Bensoussan A, Smith C, Fahey P, Bourchier S, Desrochers DIM, Viswanathan S, Partharasathy BR, Doherty K, Moye J, Walsh C, Pokaski-Azar J, Gosian J, Chapman J, King K, Sohl S, Danhauer S, Dunbar E, Gabriel MG, Huebner M, Hofmann SG, Khalsa SBS, Gaskins RB, Jennings E, Thind H, Fava JL, Hartman S, Bock BC, Gramann P, Haaz S, Bingham CO, Bartlett SJ, Hagins M, States R, Selfe T, Innes K, Harris AR, Jennings PA, Abenavoli RM, Katz DA, Hudecek KM, Greenberg MT, Jeter PE, Nkodo AF, Haaz S, Dagnelie G, Keosaian JE, Lemaster CM, Chao M, Saper RB, King KD, Gosian J, Doherty K, Walsh C, Pokaski Azar J, Chapman J, Danhauer SC, Moye J, Kinser P, Bourguignon C, Taylor A, Mahoney LA, Bayley PJ, Collery LM, Menzies-Toman D, Nilsson M, Frykman V, Noggle JJ, Braun T, Khalsa SBS, Nosaka M, Okamura H, Fukatu N, Potts A, Weidknecht K, Coulombe S, Davies B, Ryan C, Day D, Reale J, Staples JK, Knoefel J, Herman C, Riley KE, Park CL, Bedesin EY, Stewart VM, Riley KE, Braun TD, Park CL, Pescatello LS, Davis MB, Trehern AE, Mastronardi EL, Rioux J, Rosen RK, Thind H, Gaskins R, Jennings E, Morrow K, Williams D, Bock B, Rousseau D, Jackson E, Schmid AA, Miller KK, Van Puymbroeck M, Debaun EL, Schalk N, Dierks TD, Altenburger P, Damush T, Williams LS, Selman L, Citron T, Howie-Esquivel J, McDermott K, Milic M, Donesky D, Shook A, Ruzic R, Galloway F, Van Puymbroeck M, Miller KK, Schalk N, Schmid AA, Ward LJ, Stebbings S, Sherman K, Cherkin D, Baxter GD, West JI, Duffy N, Liang B. 2013 SYR Accepted Poster Abstracts. Int J Yoga Therap 2013; 23:32-53. [PMID: 24016822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Braun TD, Park CL, Conboy LA. Psychological well-being, health behaviors, and weight loss among participants in a residential, Kripalu yoga-based weight loss program. Int J Yoga Therap 2012:9-22. [PMID: 23070668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
UNLABELLED The increasing prevalence of overweight and obesity in humans is a growing public health concern in the United States. Concomitants include poor health behaviors and reduced psychological well-being. Preliminary evidence suggests yoga and treatment paradigms incorporating mindfulness, self-compassion (SC), acceptance, non-dieting, and intuitive eating may improve these ancillary correlates, which may promote long-term weight loss. METHODS We explored the impact of a 5-day residential weight loss program, which was multifaceted and based on Kripalu yoga, on health behaviors, weight loss, and psychological well-being in overweight/obese individuals. Thirty-seven overweight/obese program participants (age 32-65, BMI<25) completed validated mind-fulness, SC, lifestyle behavior, and mood questionnaires at baseline, post-program, and 3-month follow-up and reported their weight 1 year after program completion. RESULTS Significant improvements in nutrition behaviors, SC, mindfulness, stress management, and spiritual growth were observed immediately post-program (n = 31, 84% retention), with medium to large effect sizes. At 3-month follow-up (n = 18, 49% retention), most changes persisted. Physical activity and mood disturbance had improved significantly post-program but failed to reach significance at 3-month follow-up. Self-report weight loss at 1 year (n = 19, 51% retention) was significant. CONCLUSION These findings suggest a Kripalu yoga-based, residential weight loss program may foster psychological well-being, improved nutrition behaviors, and weight loss. Given the exploratory nature of this investigation, more rigorous work in this area is warranted.
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