Variant connective tissue (joint hypermobility) and its relevance to depression and anxiety in adolescents: a cohort-based case-control study.

OBJECTIVE: To test whether variant connective tissue structure, as indicated by the presence of joint hypermobility, poses a developmental risk for mood disorders in adolescence. DESIGN: Cohort-based case-control study. SETTING: Data from the Avon Longitudinal Study of Parents and Children (ALSPAC) were interrogated. PARTICIPANTS: 6105 children of the ALSPAC cohort at age 14 years old, of whom 3803 also were assessed when aged 18 years. MAIN OUTCOME MEASURES: In a risk analysis, we examined the relationship between generalised joint hypermobility (GJH) at age 14 years with psychiatric symptoms at age 18 years. In an association analysis, we examined the relationship between presence of symptomatic joint hypermobility syndrome (JHS) and International Classification of Diseases-10 indication of depression and anxiety (Clinical Interview Schedule Revised (CIS-R), Anxiety Sensitivity Index) at age 18 years. RESULTS: GJH was more common in females (n=856, 28%) compared with males (n=319, 11%; OR: 3.20 (95% CI: 2.78 to 3.68); p<0.001). In males, GJH at age 14 years was associated with depression at 18 years (OR: 2.10 (95% CI: 1.17 to 3.76); p=0.013). An index of basal physiological arousal, elevated resting heart rate, mediated this effect. Across genders, the diagnosis of JHS at age 18 years was associated with the presence of depressive disorder (adjusted OR: 3.53 (95% CI: 1.67 to 7.40); p=0.001), anxiety disorder (adjusted OR: 3.14 (95% CI: 1.52 to 6.46); p=0.002), level of anxiety (B=8.08, t(3278)=3.95; p<0.001) and degree of psychiatric symptomatology (B=5.89, t(3442)=5.50; p<0.001). CONCLUSIONS: Variant collagen, indexed by joint hypermobility, is linked to the emergence of depression and anxiety in adolescence, an effect mediated by autonomic factors in males. Recognition of this association may motivate further evaluation, screening and interventions to mitigate development of psychiatric disorders and improve health outcomes.

Vitamin D levels in children and adolescents with chronic tic disorders: a multicentre study.

This study investigated whether vitamin D is associated with the presence or severity of chronic tic disorders and their psychiatric comorbidities. This cross-sectional study compared serum 25-hydroxyvitamin D [25(OH)D] (ng/ml) levels among three groups: children and adolescents (3-16 years) with CTD (n = 327); first-degree relatives (3-10 years) of individuals with CTD who were assessed for a period of up to 7 years for possible onset of tics and developed tics within this period (n = 31); and first-degree relatives who did not develop tics and were ≥ 10 years old at their last assessment (n = 93). The relationship between 25(OH)D and the presence and severity of tics, as well as comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD), were analysed controlling for age, sex, season, centre, latitude, family relatedness, and comorbidities. When comparing the CTD cohort to the unaffected cohort, the observed result was contrary to the one expected: a 10 ng/ml increase in 25(OH)D was associated with higher odds of having CTD (OR 2.08, 95% CI 1.27-3.42, p < 0.01). There was no association between 25(OH)D and tic severity. However, a 10 ng/ml increase in 25(OH)D was associated with lower odds of having comorbid ADHD within the CTD cohort (OR 0.55, 95% CI 0.36-0.84, p = 0.01) and was inversely associated with ADHD symptom severity (ß = - 2.52, 95% CI - 4.16-0.88, p < 0.01). In conclusion, lower vitamin D levels were not associated with a higher presence or severity of tics but were associated with the presence and severity of comorbid ADHD in children and adolescents with CTD.

Mycoplasma pneumoniae IgG positivity is associated with tic severity in chronic tic disorders.

Infectious pathogens may represent an environmental risk factor for chronic tic disorders (CTD). This cross-sectional study aimed to determine whether Mycoplasma pneumoniae (M. pneumoniae) IgG positivity is associated with the presence or severity of tics. We compared M. pneumoniae IgG positivity across three groups: children and adolescents (3-16 years) with CTD (CTD group; n = 302); siblings (3-10 years) of people with CTD who developed tics within a seven-year follow-up period (tic onset group; n = 51); siblings (4-10 years) who did not develop tics within the study period and were ≥10-years-old at their last assessment (unaffected group; n = 88). The relationship between M. pneumoniae IgG positivity and the presence and severity of tics was analysed using multilevel models controlling for site, family relatedness, sex, age, presence of comorbid obsessive-compulsive and/or attention-deficit/hyperactivity disorder and use of psychotropic medication. M. pneumoniae IgG positivity was not associated with the presence of CTD, or the first onset of tics as compared to siblings who remained unaffected. M. pneumoniae IgG positivity was associated with a higher tic severity score within the CTD group (ß = 2.64, s.e. = 1.15, p = 0.02). It is possible that M. pneumoniae infection influences tic severity in CTD or, that having more severe tics, increases the risk of infection. However, it is more likely that the association observed in this study reflects a propensity toward enhanced immune responses in people with CTD and that, rather than a causal relationship, infection and greater tic severity are indirectly linked via shared underlying immune mechanisms.

Psychological and sociocultural influences on body image among midlife women with and without a history of breast cancer: Testing the Tripartite Influence Model of Body Image.

Body image concerns are common among breast cancer survivors and women in midlife. However, effective interventions are lacking for breast cancer survivors. This may be related to prior research having examined non-modifiable and medicalised influences on body image, instead of modifiable sociocultural and psychological influences. An adaptation of the 'Tripartite Influence Model of Body Image' was tested among women with (n = 169; mean age = 49.9) and without (n = 323; mean age = 47.6) a history of breast cancer, to investigate whether psychological and sociocultural influences on body image were similar between groups. Structural equation modelling revealed the model fit was satisfactory. Media pressure had an indirect effect on body image among both groups, and a direct effect among women treated for breast cancer. An additional influence of relevance only to women without breast cancer was pressure from friends. Overall, findings indicate common influences of media pressure and appearance comparisons on body image among both groups of women. This suggests that with some tailoring, existing evidence-based body image interventions designed for midlife women targeting these factors may also be relevant and beneficial for breast cancer survivors.

Physiological and perceptual correlates of masculinity in children's voices.

Low frequency components (i.e. a low pitch (F0) and low formant spacing (ΔF)) signal high salivary testosterone and height in adult male voices and are associated with high masculinity attributions by unfamiliar listeners (in both men and women). However, the relation between the physiological, acoustic and perceptual dimensions of speakers' masculinity prior to puberty remains unknown. In this study, 110 pre-pubertal children (58 girls), aged 3 to 10, were recorded as they described a cartoon picture. 315 adults (182 women) rated children's perceived masculinity from the voice only after listening to the speakers' audio recordings. On the basis of their voices alone, boys who had higher salivary testosterone levels were rated as more masculine and the relation between testosterone and perceived masculinity was partially mediated by F0. The voices of taller boys were also rated as more masculine, but the relation between height and perceived masculinity was not mediated by the considered acoustic parameters, indicating that acoustic cues other than F0 and ΔF may signal stature. Both boys and girls who had lower F0, were also rated as more masculine, while ΔF did not affect ratings. These findings highlight the interdependence of physiological, acoustic and perceptual dimensions, and suggest that inter-individual variation in male voices, particularly F0, may advertise hormonal masculinity from a very early age.

Perinatal mental health and risk of child maltreatment: A systematic review and meta-analysis.

BACKGROUND: Mental health problems in parents have been identified as a risk factor for child maltreatment. The perinatal period (from conception to 1 year) is a critical period but it is unclear whether perinatal mental health problems are also associated with increased risk. OBJECTIVE: To review evidence on perinatal mental health and risk of child maltreatment. METHODS: Searches were conducted on six databases and 24 studies reported in 30 papers identified. Studies were conducted in seven countries, mainly the USA (n = 14). Sample sizes ranged from 48-14,893 and most examined mothers (n = 17). Studies were conducted in community (n = 17) or high-risk (n = 7) samples. RESULTS: The majority of studies found a relationship between parental perinatal mental health problems and risk of child maltreatment, but inconsistent findings were observed between and within studies. The few studies that examined fathers (n = 6) all found a relationship between fathers' mental health and risk of child maltreatment. Meta-analysis of 17 studies (n = 22,042) showed perinatal mental health problems increased risk of child maltreatment by OR 3.04 (95% CI 2.29-4.03). This relationship was moderated by type of sample, with larger effects for risk of child maltreatment in high-risk samples. The relationship was not moderated by type of mental illness, child maltreatment; methodological or measurement factors. CONCLUSION: The association between perinatal mental health and risk of child maltreatment is similar to that observed at other times during childhood. Methodological heterogeneity and inconsistent findings mean conclusions are tentative and need to be considered alongside other individual, family and social/cultural risk factors.

Human roars communicate upper-body strength more effectively than do screams or aggressive and distressed speech.

Despite widespread evidence that nonverbal components of human speech (e.g., voice pitch) communicate information about physical attributes of vocalizers and that listeners can judge traits such as strength and body size from speech, few studies have examined the communicative functions of human nonverbal vocalizations (such as roars, screams, grunts and laughs). Critically, no previous study has yet to examine the acoustic correlates of strength in nonverbal vocalisations, including roars, nor identified reliable vocal cues to strength in human speech. In addition to being less acoustically constrained than articulated speech, agonistic nonverbal vocalizations function primarily to express motivation and emotion, such as threat, and may therefore communicate strength and body size more effectively than speech. Here, we investigated acoustic cues to strength and size in roars compared to screams and speech sentences produced in both aggressive and distress contexts. Using playback experiments, we then tested whether listeners can reliably infer a vocalizer's actual strength and height from roars, screams, and valenced speech equivalents, and which acoustic features predicted listeners' judgments. While there were no consistent acoustic cues to strength in any vocal stimuli, listeners accurately judged inter-individual differences in strength, and did so most effectively from aggressive voice stimuli (roars and aggressive speech). In addition, listeners more accurately judged strength from roars than from aggressive speech. In contrast, listeners' judgments of height were most accurate for speech stimuli. These results support the prediction that vocalizers maximize impressions of physical strength in aggressive compared to distress contexts, and that inter-individual variation in strength may only be honestly communicated in vocalizations that function to communicate threat, particularly roars. Thus, in continuity with nonhuman mammals, the acoustic structure of human aggressive roars may have been selected to communicate, and to some extent exaggerate, functional cues to physical formidability.

Impact of intranasal oxytocin on interoceptive accuracy in alcohol users: an attentional mechanism?

Interoception, i.e. the perception and appraisal of internal bodily signals, is related to the phenomenon of craving, and is reportedly disrupted in alcohol use disorders. The hormone oxytocin influences afferent transmission of bodily signals and, through its potential modulation of craving, is proposed as a possible treatment for alcohol use disorders. However, oxytocin's impact on interoception in alcohol users remains unknown. Healthy alcohol users (n = 32) attended two laboratory sessions to perform tests of interoceptive ability (heartbeat tracking: attending to internal signals and, heartbeat discrimination: integrating internal and external signals) after intranasal administration of oxytocin or placebo. Effects of interoceptive accuracy, oxytocin administration and alcohol intake, were tested using mixed-effects models. On the tracking task, oxytocin reduced interoceptive accuracy, but did not interact with alcohol consumption. On the discrimination task, we found an interaction between oxytocin administration and alcohol intake: Oxytocin, compared with placebo, increased interoceptive accuracy in heavy drinkers, but not in light social drinkers. Our study does not suggest a pure interoceptive impairment in alcohol users but instead potentially highlights reduced flexibility of internal and external attentional resource allocation. Importantly, this impairment seems to be mitigated by oxytocin. This attentional hypothesis needs to be explicitly tested in future research.

How Do Self-Assessment of Alexithymia and Sensitivity to Bodily Sensations Relate to Alcohol Consumption?

BACKGROUND: Alexithymia describes an abnormality of emotional experience that is commonly expressed among individuals with addiction and alcohol abuse disorders. Alexithymic individuals are characterized by difficulties in identifying and describing their emotions. This impairment is linked to the development and maintenance of addiction. Moreover, an emergent theory suggests alexithymia is itself secondary to a failure of interoception (sensitivity to internal bodily signals, including physiological arousal states). METHODS: This study tested for hypothesized contributory roles of alexithymia and dysfunctional interoception in the expression of social drinking. Alexithymia, subjective sensitivity to bodily sensations, and alcohol consumption scores were quantified using the Toronto Alexithymia Scale, the Body Perception Questionnaire, and the Alcohol Use Questionnaire, respectively, in a normative sample (N = 600). Regression and bootstrapping mediation analyses were used to test the hypothesis that alexithymia mediated the association between sensitivity to bodily sensations and alcohol consumption. RESULTS: Alexithymia was positively correlated with sensitivity to bodily sensations and with alcohol consumption. Mediation analysis revealed that alexithymia, and more precisely, difficulty in identifying feelings, mediated the relationship between sensitivity to bodily sensations and alcohol consumption, such that the predictive effect of sensitivity to bodily sensations on alcohol intake became nonsignificant when controlling for alexithymia. CONCLUSIONS: These results indicate that alexithymia is associated with subjective hypersensitivity to bodily sensations. Moreover, our findings support the theoretical proposal that alexithymia is an expression of impaired processing of bodily sensations including physiological arousal, which underpin the development of maladaptive coping strategies, including alcohol use disorders. Our observations extend a growing literature emphasizing the importance of interoception and alexithymia in addiction, which can inform the development of new therapeutic strategies.

"I just feel so guilty": The role of introjected regulation in linking appearance goals for exercise with women's body image.

Appearance goals for exercise are consistently associated with negative body image, but research has yet to consider the processes that link these two variables. Self-determination theory offers one such process: introjected (guilt-based) regulation of exercise behavior. Study 1 investigated these relationships within a cross-sectional sample of female UK students (n=215, 17-30 years). Appearance goals were indirectly, negatively associated with body image due to links with introjected regulation. Study 2 experimentally tested this pathway, manipulating guilt relating to exercise and appearance goals independently and assessing post-test guilt and body anxiety (n=165, 18-27 years). The guilt manipulation significantly increased post-test feelings of guilt, and these increases were associated with increased post-test body anxiety, but only for participants in the guilt condition. The implications of these findings for self-determination theory and the importance of guilt for the body image literature are discussed.

Voluntary temporary abstinence from alcohol during "Dry January" and subsequent alcohol use.

OBJECTIVE: Research suggests that temporary abstinence from alcohol may convey physiological benefits and enhance well-being. The aim of this study was to address a lack of information about: (a) correlates of successful completion of a planned period of abstinence, and (b) how success or failure in planned abstinence affects subsequent alcohol consumption. METHOD: 857 British adults (249 men, 608 women) participating in the "Dry January" alcohol abstinence challenge completed a baseline questionnaire, a 1-month follow-up questionnaire, and a 6-month follow-up questionnaire. Key variables assessed at baseline included measures of alcohol consumption and drink refusal self-efficacy (DRSE). RESULTS: In bivariate analysis, success during Dry January was predicted by measures of more moderate alcohol consumption and greater social DRSE at baseline. Multivariate analyses revealed that success during Dry January was best predicted by a lower frequency of drunkenness in the month prior to Dry January. Structural equation modeling revealed that participation in Dry January was related to reductions in alcohol consumption and increases in DRSE among all respondents at 6-month follow-up, regardless of success, but indicated that these changes were more likely among people who successfully completed the challenge. CONCLUSIONS: The findings suggest that participation in abstinence challenges such as Dry January may be associated with changes toward healthier drinking and greater DRSE, and is unlikely to result in undesirable "rebound effects": very few people reported increased alcohol consumption following a period of voluntary abstinence.

Incorporating Psychological Predictors of Treatment Response into Health Economic Simulation Models: A Case Study in Type 1 Diabetes.

BACKGROUND: . Health economic modeling has paid limited attention to the effects that patients' psychological characteristics have on the effectiveness of treatments. This case study tests 1) the feasibility of incorporating psychological prediction models of treatment response within an economic model of type 1 diabetes, 2) the potential value of providing treatment to a subgroup of patients, and 3) the cost-effectiveness of providing treatment to a subgroup of responders defined using 5 different algorithms. METHODS: . Multiple linear regressions were used to investigate relationships between patients' psychological characteristics and treatment effectiveness. Two psychological prediction models were integrated with a patient-level simulation model of type 1 diabetes. Expected value of individualized care analysis was undertaken. Five different algorithms were used to provide treatment to a subgroup of predicted responders. A cost-effectiveness analysis compared using the algorithms to providing treatment to all patients. RESULTS: . The psychological prediction models had low predictive power for treatment effectiveness. Expected value of individualized care results suggested that targeting education at responders could be of value. The cost-effectiveness analysis suggested, for all 5 algorithms, that providing structured education to a subgroup of predicted responders would not be cost-effective. LIMITATIONS: . The psychological prediction models tested did not have sufficient predictive power to make targeting treatment cost-effective. The psychological prediction models are simple linear models of psychological behavior. Collection of data on additional covariates could potentially increase statistical power. CONCLUSIONS: . By collecting data on psychological variables before an intervention, we can construct predictive models of treatment response to interventions. These predictive models can be incorporated into health economic models to investigate more complex service delivery and reimbursement strategies.

Modeling predictors of changes in glycemic control and diabetes-specific quality of life amongst adults with type 1 diabetes 1 year after structured education in flexible, intensive insulin therapy.

Few studies have identified determinants of glycemic control (HbA1c) and diabetes-specific quality of life (DSQoL) in adults with type 1 diabetes. To identify factors predicting outcomes following structured diabetes education. 262 participants completed biomedical and questionnaire assessments before, and throughout 1 year of follow-up. The proportion of variance explained ranged from 28 to 62 % (DSQoLS) and 14-20 % (HbA1c). When change in psychosocial variables were examined, reduced hypoglycemia fear, lower 'perceived diabetes seriousness', greater self-efficacy and well-being predicted QoL improvements from baseline to 3-months. Increased frequency of blood glucose testing predicted improvements in HbA1c from baseline to 6-months. Greater benefits may be achieved if programs focus explicitly on psychosocial factors. Self-care behaviours did not predict HbA1c suggesting existing assessment tools need refinement. Evaluation of treatment mechanisms in self-management programs is recommended.

Further evidence of the heterogeneous nature of impulsivity.

'Impulsivity' refers to a range of behaviours including preference for immediate reward (temporal-impulsivity) and the tendency to make premature decisions (reflection-impulsivity) and responses (motor-impulsivity). The current study aimed to examine how different behavioural and self-report measurements of impulsivity can be categorised into distinct subtypes. Exploratory factor analysis using full information maximum likelihood was conducted on 10 behavioural and 1 self-report measure of impulsivity. Four factors of impulsivity were indicated, with Factor 1 having a high loading of the Stop Signal Task, which measures motor-impulsivity, factor 2 representing reflection-impulsivity with loadings of the Information Sampling Task and Matching Familiar Figures Task, factor 3 representing the Immediate Memory Task, and finally factor 4 which represents the Delay Discounting Questionnaire and The Monetary Choice Questionnaire, measurements of temporal-impulsivity. These findings indicated that impulsivity is not a unitary construct, and instead represents a series of independent subtypes. There was evidence of a distinct reflection-impulsivity factor, providing the first factor analysis support for this subtype. There was also support for additional factors of motor- and temporal-impulsivity. The present findings indicated that a number of currently accepted tasks cannot be considered as indexing motor- and temporal-impulsivity suggesting that additional characterisations of impulsivity may be required.

How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies.

Given the extensive evidence base for the efficacy of mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT), researchers have started to explore the mechanisms underlying their therapeutic effects on psychological outcomes, using methods of mediation analysis. No known studies have systematically reviewed and statistically integrated mediation studies in this field. The present study aimed to systematically review mediation studies in the literature on mindfulness-based interventions (MBIs), to identify potential psychological mechanisms underlying MBCT and MBSR's effects on psychological functioning and wellbeing, and evaluate the strength and consistency of evidence for each mechanism. For the identified mechanisms with sufficient evidence, quantitative synthesis using two-stage meta-analytic structural equation modelling (TSSEM) was used to examine whether these mechanisms mediate the impact of MBIs on clinical outcomes. This review identified strong, consistent evidence for cognitive and emotional reactivity, moderate and consistent evidence for mindfulness, rumination, and worry, and preliminary but insufficient evidence for self-compassion and psychological flexibility as mechanisms underlying MBIs. TSSEM demonstrated evidence for mindfulness, rumination and worry as significant mediators of the effects of MBIs on mental health outcomes. Most reviewed mediation studies have several key methodological shortcomings which preclude robust conclusions regarding mediation. However, they provide important groundwork on which future studies could build.

Mediational role of parenting styles in emotional intelligence of parents and aggression among adolescents.

The present study was designed to examine the relationship between parents' emotional intelligence and adolescents' aggression, through the mediation of parenting styles. Two hundred and twenty five undergraduate students (113 boys & 112 girls; age 17-18 years), from four universities in Pakistan, participated with their parents. The Parenting Styles and Dimensions Questionnaire (Robinson, Mandleco, Olsen, & Hart, 1995), and the Scale of Emotional Intelligence (Batool & Khalid, 2011) were completed by parents. The Aggression Questionnaire (Buss & Perry, 1992) was completed by their adolescent offspring. Mediational path analysis supported our hypothesised model. Results indicate that emotional intelligence of parents indirectly links to aggression among offspring, through parenting styles. It was concluded that emotional intelligence training will help parents to improve their parenting styles, and it will lower the risk of aggression in their children.

The relationship between materialism and personal well-being: A meta-analysis.

This meta-analysis investigates the relationship between individuals' materialistic orientation and their personal well-being. Theoretical approaches in psychology agree that prioritizing money and associated aims is negatively associated with individuals' well-being but differ in their implications for whether this is invariably the case. To address these and other questions, we examined 753 effect sizes from 259 independent samples. Materialism was associated with significantly lower well-being for the most widely used, multifaceted measures (materialist values and beliefs, r = -.19, ρ = -.24; relative importance of materialist goals, r = -.16, ρ = -.21), more than for measures assessing emphasis on money alone (rs = -.08 to -.11, ρs = -.09 to -.14). The relationship also depended on type of well-being outcome, with largest effects for risky health and consumer behaviors and for negative self-appraisals (rs = -.28 to -.44, ρs = -.32 to -.53) and weakest effects for life satisfaction and negative affect (rs = -.13 to -.15, ρs = -.17 to -.18). Moderator analyses revealed that the strength of the effect depended on certain demographic factors (gender and age), on value context (study/work environments that support materialistic values and cultures that emphasize affective autonomy), and on cultural economic indicators (economic growth and wealth differentials). Mediation analyses suggested that the negative link may be explained by poor psychological need satisfaction. We discuss implications for the measurement of materialist values and the need for theoretical and empirical advances to explore underlying processes, which likely will require more experimental, longitudinal, and developmental research.

What makes a voice masculine: physiological and acoustical correlates of women's ratings of men's vocal masculinity.

Men's voices contain acoustic cues to body size and hormonal status, which have been found to affect women's ratings of speaker size, masculinity and attractiveness. However, the extent to which these voice parameters mediate the relationship between speakers' fitness-related features and listener's judgments of their masculinity has not yet been investigated. We audio-recorded 37 adult heterosexual males performing a range of speech tasks and asked 20 adult heterosexual female listeners to rate speakers' masculinity on the basis of their voices only. We then used a two-level (speaker within listener) path analysis to examine the relationships between the physiological (testosterone, height), acoustic (fundamental frequency or F0, and resonances or ΔF) and perceptual dimensions (listeners' ratings) of speakers' masculinity. Overall, results revealed that male speakers who were taller and had higher salivary testosterone levels also had lower F0 and ΔF, and were in turn rated as more masculine. The relationship between testosterone and perceived masculinity was essentially mediated by F0, while that of height and perceived masculinity was partially mediated by both F0 and ΔF. These observations confirm that women listeners attend to sexually dimorphic voice cues to assess the masculinity of unseen male speakers. In turn, variation in these voice features correlate with speakers' variation in stature and hormonal status, highlighting the interdependence of these physiological, acoustic and perceptual dimensions.

Combining self-affirmation with implementation intentions to promote fruit and vegetable consumption.

OBJECTIVE: The current study tested whether self-affirmation in the context of a threatening health message helps promote a health behavior (fruit and vegetable consumption) over a 3-month period, and whether adding a manipulation to support the translation of intentions into behavior (an implementation intentions induction) enhances the impact of self-affirmation. METHODS: Participants (N = 332, 71% women) reported their baseline consumption and were randomly assigned to condition in a 2 (self-affirmation: yes, no) × 2 (implementation intentions: formed, not formed) between-subjects factorial design. They completed a self-affirmation/control task and then read a health communication advising eating at least 5 portions of fruit and vegetables daily. Next participants reported intentions for behavior change, after which they formed/did not form relevant implementation intentions. Consumption was measured again 7 days and 3 months postintervention. RESULTS: Self-affirmed (vs. nonaffirmed) participants reported eating more fruit and vegetables at both follow-ups. Forming (vs. not forming) implementation intentions was also beneficial for consumption. At 7 days, there was also a significant self-affirmation × implementation intentions interaction: consumption was highest when self-affirmed participants also formed implementation intentions. CONCLUSIONS: The present study offers new evidence concerning the impact and durability of self-affirmation on health behaviors and the role of implementation intentions in enhancing the impact of self-affirmation.