The effects of a real-life lifestyle program on physical activity and objective and subjective sleep in adults aged 55+ years.

STUDY OBJECTIVES: Age related changes in sleep result in an increasing prevalence of poor sleep in mid-aged and older adults. Although physical activity has shown to benefit sleep in studies in controlled settings, this has not yet been examined in a real-life lifestyle program. The aims of this study were to: 1) examine the effects of a lifestyle program on moderate-to-vigorous physical activity and objective and subjective sleep in adults aged 55+ years; and 2) examine if the effects differed between good and poor sleepers. METHODS: This controlled pretest-posttest trial examined the effects of the 12-week group-based real-life lifestyle program 'Lekker Actief' on moderate-to-vigorous physical activity (measured using accelerometers) and sleep (measured using accelerometers and the Pittsburgh Sleep quality Index, PSQI). The main component of the program was a 12-week progressive walking program, complemented by an optional muscle strengthening program and one educational session on healthy nutrition. Of the 451 participants who were tested pre-intervention, 357 participants completed the posttest assessment (200 in the intervention group and 157 in the control group). Effects on moderate-to-vigorous physical activity and on objective sleep (sleep efficiency, total sleep time, wake time after sleep onset (WASO) and number of awakenings) as well as subjective sleep (sleep quality) were examined in crude and in adjusted multiple regression models. An interaction term between program (control versus intervention) and sleep category (good and poor) was included in all models. RESULTS: Moderate-to-vigorous physical activity levels significantly increased in the intervention group compared with the control group (43,02 min per day; 95%CI: 12.83-73.22; fully adjusted model). The interaction terms revealed no differences between good and poor sleepers regarding the effect of the intervention on moderate-to-vigorous physical activity. There were no significant effects on sleep, except for good sleepers who showed an increase in number of awakenings/night by 1.44 (CI 95% 0.49; 2.24). CONCLUSIONS: Although this program was effective in increasing physical activity, it did not improve sleep. Lifestyle programs should be promoted to increase physical activity, but more is needed to improve sleep as well. This trial was registered at ClinicalTrials.gov (Trial registration NCT03576209).

Effects of physical activity programs on sleep outcomes in older adults: a systematic review.

BACKGROUND: One in two older adults report sleep problems, which not only cause fatigue, but also negatively affect general functioning, activities of daily living, and physical and mental health. Although it is known that physical activity is positively associated with sleep in older adults, the effects of physical activity programs on sleep in older adults has not been reviewed. The aim of this systematic review was to systematically review the effects of physical activity programs on sleep in generally healthy older adults aged 60+ years. METHODS: Searches were performed in PubMed, Embase, Web of Science, SPORTDiscus, PEDro and CINAHL. The methodological quality of the included studies was rated using the 'Quality Assessment Tool for Quantitative Studies'. Only studies of moderate and strong quality were included. This review was registered in PROSPERO (CRD42018094007). RESULTS: Fourteen studies met the inclusion criteria (six randomised controlled trials and eight pretest-posttest studies). Of these studies, five were moderate and nine were strong quality studies. Mean age of study samples ranged from 64 to 76 years. Exercise programs included various activities aimed at improving mobility, endurance and strength. Intervention duration ranged from 2 weeks to 12 months. Eleven studies used subjective measures of sleep, two used objective measures and one used both. Sixteen different sleep outcomes were reported. All but one study, found at least one significant improvement on sleep outcomes. No significantly detrimental effects were reported. Effect sizes, calculated in ten studies, ranged from 0,34-1,55 and were substantial (≥0,8) in four studies. CONCLUSIONS: This systematic review suggests that exercise programs positively affect various aspects of sleep in generally healthy older adults. More specifically, moderate intensity exercise programs, with a frequency of three times per week and a duration of 12 weeks up to 6 months, showed the highest number of significant improvements in different sleep outcomes in older adults. Furthermore, programs that offered single exercise types, such as Baduanjin, Tai chi and the silver yoga program, or a combination of exercises showed the highest proportion of significant versus reported effects on sleep outcomes.

Repeated traumatic experiences in eating disorders and their association with eating symptoms.

OBJECTIVE: This study aimed to analyze the association between traumatic experiences (TEs) and eating symptoms and their severity in a healthy group (HG) of students and an eating disorder group (EDG). METHOD: The HG (N=150) comprised first- and secondyear undergraduate psychology students, the EDG (N=150) day hospital patients. EDG patients were evaluated consecutively when they entered the Day Hospital Eating Disorder Unit. Information on TEs was collected via an ad hoc questionnaire, a semi-structured interview and the first part of The Dissociation Questionnaire (Part I). The Bulimic Investigatory Test Edinburgh was used to evaluate eating symptoms and their severity. RESULTS: Emotional abuse was the most frequent TE in both groups. In the EDG, TEs occurred more in patients with purging behavior (anorexia nervosa of the binge-eating/purging type, AN-P; and bulimia nervosa of the purging type, BN-P) than in those with AN-R (anorexia nervosa of the restricting type). In patients with purging behavior, TEs often begin in childhood and are repeated. When the severity of eating symptoms in patients with EDs who had suffered repeated TEs was compared with those who had suffered an isolated TE, a tendency towards greater severity of eating symptoms associated with TE repetition was observed. CONCLUSIONS: The results obtained with respect to the presence and type of TEs in EDs concurred with those of other studies. However, unlike other studies, we found high percentages of childhood TEs in ED subtypes with purging behavior. In these ED subtypes, TEs tended to be more repeated than in ED subtypes with restrictive behavior. Further studies are required to draw conclusions on the effect of the different TEs and their repetition on eating symptoms and their severity.

[The importance of movement-directed interventions in the multidisciplinary treatment of binge eating disorder: an overview]. / Bewegingsgerichte interventies in de multidisciplinaire behandeling van eetbuistoornissen; een literatuuronderzoek.

BACKGROUND: More than three out of four persons with binge eating disorder do not get enough physical exercise. AIM: To collect scientific evidence of the effects and benefits that movement and physical exercise can have on persons with a binge eating disorder. METHOD: PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Physiotherapy Evidence Database, the Dutch Journal of Psychiatry (Tijdschrift voor Psychiatrie), het Tijdschrift voor Vaktherapie and Actual Themata derived from psychomotor therapy were screened for the period January 1994 to August 2011. The methodological quality of the studies was determined on the basis of a checklist. Evidence for the effectiveness of the interventions was summarised by best-evidence synthesis. RESULTS: Eight studies met the inclusion and exclusion criteria. Strong evidence was found for: 1) significant weight-loss after movement interventions; 2) fewer symptoms of depression after a combination of both movement and cognitive behavioural therapy (CBT) than after CBT on its own. There was only limited evidence for 1) the fact that the combination of movement and CBT leads to less eating disorder pathology than does CBT alone; 2) the beneficial effects of yoga on weight-loss as well as on the reduction of eating disorder pathology.There are indications that walking can be helpful in reducing of eating disorder pathology. CONCLUSIONS: Activities involving movement and physical exercise deserve to play an important role in the multidisciplinary treatment of binge eating disorders.

Alexithymia in patients with alopecia areata: educational background much more important than traumatic events.

BACKGROUND: Recent studies suggest a higher prevalence of alexithymia in patients with alopecia areata (AA). Some authors link alexithymia with the presence of early traumatic events, such as dysfunctional parent-child relationships. However, until today, no studies have been carried out on the association of alexithymia and early traumatic events in AA patients. OBJECTIVE: The primary aim of this study was to explore if an association exists between the presence of traumatic childhood experiences and alexithymia in AA patients. A secondary aim was to confirm earlier observations indicating that the occurrence and/or degree of alexithymia is higher in patients with AA compared with individuals from the general population. METHODS: We enrolled 90 patients with AA. Data on alexithymia and traumatic events were collected with two self-report questionnaires: the Toronto Alexithymia Scale-20 and the Traumatic Experiences Checklist. These data were compared with data obtained from control patients without AA randomly selected from patients presenting for dermatological surgery. RESULTS: In adult AA patients, we found no evidence for a significant association between Toronto Alexithymia Scale (TAS) scores and emotional neglect or childhood traumatic experiences. We found a significant association with educational level, higher levels of education being associated with lower TAS-20 scores (P = 0.002). The mean TAS-20 score of 51.22 (SD 11.90) in our adult AA patient group was significantly higher compared with control patients from the same setting (44.00, SD 10.33, P < 0.001). CONCLUSION: In adult AA patients, higher levels of education are significantly associated with lower alexithymia scores. Somewhat unexpectedly, we found no association between alexithymia score and emotional neglect or childhood traumatic experiences. Our results also confirm that alexithymia scores are significantly higher in adult patient with AA compared with control patients.

Body experience assessment in non-clinical male and female subjects.

INTRODUCTION: Body image is an important feature in the quality of life of clinical and non-clinical subjects. Therefore, the evaluation of different instruments for measuring body image is necessary. More and more attention is also given to the body image of males. This study addresses the body image of non-clinical males in comparison to females by using well-know questionnaires. METHOD: Four widely used questionnaires are evaluated: The Body Attitude Test, The Eating Disorder Inventory, The Body Shape Questionnaire and the Body Attitude Questionnaire. Psychometric properties of these questionnaires are investigated in 427 males and 389 female subjects. Normative values for a Flemish population are provided. RESULTS AND CONCLUSIONS: All questionnaires have good psychometric properties. To separate males from females all four questionnaires can be used. The four questionnaires are able to differentiate between individuals who are and who are not suffering from body image concerns.

Be kind to your eating disorder patients: the impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders.

OBJECTIVE: Lack of self-esteem may play an important role in the development of eating disorders (ED). This study investigated the differential impact of positive and negative feedback on implicit and explicit self-esteem in women with an ED (N=25) as compared to women without an ED (N=29). METHOD: False feedback (positive or negative) was given on participant's performance on a specifically developed intellectual test. Before and after the performance, explicit and implicit self-esteem was measured. RESULTS: On the explicit measure ED patients reacted congruently with the nature of the feedback. On the implicit measure only ED patients responded to the positive feedback with an improvement of self-esteem, with no effect for negative feedback. The control group was unaffected by either feedback. Furthermore, no correlation was observed between the explicit and implicit measures, a finding suggesting that these measurements tap different constructs. CONCLUSION: Positive feedback affects implicit self-esteem of female patients with eating disorders. The results underline the importance of positively approaching women with ED.

[Dissociative phenomena: relationship to present and past stress]. / Dissociatieve verschijnselen: verband met stress uit heden én verleden.

BACKGROUND: Up till now research into dissociation has paid little attention to the relationship between current stress and family variables on the one hand and dissociative phenomena on the other hand. By contrast, however, many studies have investigated the link between traumatic experiences in the past and dissociative phenomena. AIM: To investigate, in a clinical population, whether dissociation is linked to current stress (within and outside the family) and to traumatic experiences in the past. METHOD: Dissociation was predicted on the basis of current stress (within and outside the family) and trauma by means of a multiple regression conducted on a population of patients with an eating disorder. RESULTS: Results indicated a clear link between current stress and dissociation. Patients with particularly high dissociation scores reported significantly more stress both on the measures of current stress and on the list of trauma. CONCLUSION: Dissociation is associated with stressful experiences, but not only with sexual trauma. Dissociation is also linked to stress experienced in current living conditions. Therefore the simple model that links dissociative experiences directly with trauma needs to be revised. This finding demonstrates that more attention should be given to stress factors in the treatment of dissociative phenomena.

Which elements in the treatment of eating disorders are necessary 'ingredients' in the recovery process?--A comparison between the patient's and therapist's view.

BACKGROUND: Little is known about which therapeutic 'ingredients' in the treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED)) are needed for recovery. Remarkably, most studies on this topic have neglected the patient's view. METHOD: In this study, a large sample of eating disorder patients (n = 132) was invited to evaluate which elements in the treatment they consider to be helpful and effective in their recovery process. These results were compared to the view of 49 eating disorder experts. RESULTS: Following the patient's view, 'improving self-esteem', 'improving body experience' and 'learning problem solving skills', were considered as core elements in their treatment. No major differences were found between the different patient samples when comparing the patient's and therapist's view. DISCUSSION: The findings suggest that therapists and patients share more or less the same view about the basic and effective elements in the treatment.

Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury.

The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.

Laparoscopic cholecystectomy in the third trimester of pregnancy.

Laparoscopic cholecystectomy has become the method of choice for symptomatic cholelithiasis. Laparoscopic cholecystectomy during pregnancy is also becoming more accepted, as illustrated by several recent publications on this subject. In the third trimester, however, laparoscopic cholecystectomy has been less commonly attempted, with only a few case reports. We present a series of four patients who underwent laparoscopic cholecystectomy during the third trimester of pregnancy without complication. We describe a safe and effective technique for this procedure, and review the literature on this topic.

Which factors do provoke binge-eating? An exploratory study in female students.

To study the different factors (external, emotional, cognitive, and physiological) which may trigger binge-eating in young females. A total of 110 female students (between 14 and 25 years of age) filled out the Eating Disorder Inventory (EDI) and the Binge Eating Trigger Checklist (BETCH), a new screening device to evaluate the type of situations (and their experienced discomfort) which subjects identify as antecedents of a binge-eating episode. Approximately 41% of the female students reported binge-eating and 15% admitted they have daily binges. The binge-eating triggers most frequently reported and at the same time having the highest level of discomfort were emotional triggers (feeling bored, depressed, anxious, tense, and sad) and physiological triggers (being hungry and feeling an urge to eat sweets). Fewer food-related cues have been reported whereas dysfunctional cognitions were rarely mentioned as antecedents of binge-eating. Binge-eating, as perceived and reported by female students, seems to be provoked by a combination of different antecedents, both emotional and physiological.

The use of hypnosis in the treatment of bulimia nervosa.

Promising research data, relating hypnotizability and the possible presence of a dissociative mechanism in bulimic individuals, stimulated the present authors to incorporate hypnosis in their directive and multidimensional treatment of bulimic patients. Important strategies and how and when they can be applied in the different phases of treatment are described. In many cases, hypnotherapeutic techniques may enhance the effectiveness of cognitive behavioral and interactional strategies in the treatment of bulimic patients. In other instances, the incorporation of hypnosis may help both the therapist and patient to discover new pathways to facilitate the therapeutic process.

Assessment of hypnotic processes and responsiveness in a clinical context.

The present study was designed to investigate in a clinical situation whether differences in measured hypnotizability validly reflect differences in hypnotic processes and to what extent factors deemed extraneous to hypnosis--such as resistance--influence hypnotic responding. To answer this question, Dutch versions of relevant scales had to first be developed. The factorial validity and reliability of a Dutch translation of the Resistance Toward Hypnosis Scale (DRHS) and a shortened Dutch version of the Phenomenology of Consciousness Inventory (DPCI) were investigated in a sample of 205 psychiatric patients. The DRHS proved to be factorially valid and reliable, and two subscales, Trance and Reality Orientation, derived empirically from the DPCI showed good to satisfactory reliability. In a second study with a subsample of 99 psychiatric patients, hypnotizability as measured by the Stanford Hypnotic Clinical Scale for Adults was strongly and positively related to DPCI Trance scores and moderately and negatively related to DPCI Reality Orientation and DRHS Resistance scores. It is concluded that hypnotizability as measured in a clinical context under standard conditions is strongly related to hypnotic experiences over and above the moderate effects of resistance toward hypnosis and hypnotic suggestions. Standard hypnotizability assessments appear to be similar in their meaning in an experimental and clinical context.

The (limited) possibilities of hypnotherapy in the treatment of obesity.

In this paper we review the possibilities and limitations of hypnotherapeutic techniques in the treatment of obesity. In spite of some promising reports, the findings and opinions about the effectiveness of hypnosis in the treatment of obesity vary greatly. We provide a brief overview of specific hypnotherapeutic techniques--such as teaching relaxation, increasing self-control, encouraging physical exercise, altering self-esteem and body image, strengthening motivation, and exploring ambivalence for change--that can be involved in a multidimensional approach to obesity. Case reports illustrate the use of these techniques.

Dissociative and hypnotic experiences in eating disorder patients: an exploratory study.

Hypnotizability, subjective experiences during hypnotizability assessment, and dissociation were studied in 53 eating disorder patients in order to explore the relationship between these phenomena. Dissociation was measured with a newly developed self-reporting Dissociation-Questionnaire (DIS-Q), level of hypnotizability was assessed with the Stanford Hypnotic Clinical Scale (SHCS), subjective experiences during hypnosis with the Dutch Phenomenology of Consciousness Inventory (DPCI), and the Dutch Resistance to Hypnosis Scale (DRHS). Compared with normals, eating disorder patients scored significantly higher on the DIS-Q and SHCS. Compared with restricting anorexics, anorexics of the mixed type as well as bulimics report higher scores on both the DIS-Q and SHCS, but a significant difference was found only for the DIS-Q subscale loss of control. Although positive correlations between the DIS-Q and SHCS were found, the magnitude of the correlations shows that both instruments probably are measuring different constructs. Some implications of these findings are discussed.

[The Dissociation Questionnaire DIS-Q: preliminary results with a French-speaking Swiss population]. / Le questionnaire de dissociation DIS-Q: résultats préliminaires dans une population suisse francophone.

Vanderlinden and his collegues (1993) proposed a first european clinical scale to assess dissociative symptoms, the DIS-Q. The DIS-Q was studied in a psychiatric (n = 154) and a control (n = 65). Swiss French speaking sample. Our results reflected that The Dissociation Questionnaire (DIS-Q) has a good criterion-related validity since it discriminates between patients (Axes I and II of the DSM IV classification) and controls. Statistical comparisons indicated significant differences between three subgroups (axis I only, n = 60; axis II only, n = 24; axes I et II together, n = 70), and controls (n = 65). The total DIS-Q score was the highest for the patients with axes I and II together. About 12% of the psychiatric sample studied obtained DIS-Q score > or = 2.5, suggesting the presence of pathological dissociative symptoms. Our results seem not to be influenced by cultural factors.

Perception of changes in eating disorder patients during group treatment.

The evolution of 53 eating disorder patients during inpatient group treatment has been studied by comparing the perception of changes by the patients themselves, the group members, and the therapeutic team. Remarkable differences were found between the judgments of these three groups. Patients tend to deny problems or to evaluate their progress rather optimistically, whereas fellow patients and staff members are much alike in their sceptical evaluations. It is concluded that the evaluation procedure may have more value as a therapeutic tool than as an assessment method.

Guidelines for the family therapeutic approach to eating disorders.

After a brief historical overview of the literature on family therapy in eating disorders, the authors' own clinical experience is summarized in some practical guidelines: give the family therapist a central position within the team, engage the family and/or spouse as co-therapist, explore the message of the eating disorder on different levels, neutralize the symptoms outside of the family interaction, promote direct communication, facilitate the separation-individuation process, and be available for a long time. Finally some special issues are discussed: sexual and/or physical abuse in the family, broken-home situations and single-parent families, married and chronic patients.

The significance of body size estimation in eating disorders: its relationship with clinical and psychological variables.

OBJECTIVE: To assess the relationship between body size estimation on the one hand and clinical and psychological variables on the other. METHOD: Body size estimation was tested with the video distortion method on a life-size screen in normal women (n = 45) and compared to a total of 189 female eating disorder patients (100 with restricting anorexia nervosa, 41 with binging/purging anorexia nervosa, 48 with bulimia nervosa). The subjects' cognitive responses (what they think they really look like), affective responses (what they feel they look like), and optative responses (what they want to look like) were correlated with clinical parameters (including body composition) and with the scores on a series of self-report questionnaires assessing general psychological well-being and body experience. RESULTS: No significant relationship was found between the body size estimations and the clinical variables. The cognitive and affective responses showed a moderate relationship with self-reported body attitude. Body dissatisfaction was negatively correlated with the optative response (desired body size). DISCUSSION: This study contributes to the construct validity of the video distortion method. Body size estimation includes more than just a perceptual task. Hence, the narrow notion of body image should be replaced by the more complex construct of "body experience," the multidimensionality of which should be addressed in both research and treatment of eating-disordered patients.