Eating behavior dimensions and 9-year weight loss maintenance: a sub-study of the Finnish Diabetes prevention study.

BACKGROUND: Behavioral processes through which lifestyle interventions influence risk factors for type 2 diabetes (T2DM), e.g., body weight, are not well-understood. We examined whether changes in psychological dimensions of eating behavior during the first year of lifestyle intervention would mediate the effects of intervention on body weight during a 9-year period. METHODS: Middle-aged participants (38 men, 60 women) with overweight and impaired glucose tolerance (IGT) were randomized to an intensive, individualized lifestyle intervention group (n = 51) or a control group (n = 47). At baseline and annually thereafter until nine years body weight was measured and the Three Factor Eating Questionnaire assessing cognitive restraint of eating with flexible and rigid components, disinhibition and susceptibility to hunger was completed. This was a sub-study of the Finnish Diabetes Prevention Study, conducted in Kuopio research center. RESULTS: During the first year of the intervention total cognitive (4.6 vs. 1.7 scores; p < 0.001), flexible (1.7 vs. 0.9; p = 0.018) and rigid (1.6 vs. 0.5; p = 0.001) restraint of eating increased, and body weight decreased (-5.2 vs. -1.2 kg; p < 0.001) more in the intervention group compared with the control group. The difference between the groups remained significant up to nine years regarding total (2.6 vs. 0.1 scores; p = 0.002) and rigid restraint (1.0 vs. 0.4; p = 0.004), and weight loss (-3.0 vs. 0.1 kg; p = 0.046). The first-year increases in total, flexible and rigid restraint statistically mediated the impact of intervention on weight loss during the 9-year study period. CONCLUSIONS: Lifestyle intervention with intensive and individually tailored, professional counselling had long-lasting effects on cognitive restraint of eating and body weight in middle-aged participants with overweight and IGT. The mediation analyses suggest that early phase increase in cognitive restraint could have a role in long-term weight loss maintenance. This is important because long-term weight loss maintenance has various health benefits, including reduced risk of T2DM.

Predictors of changing patterns of adherence to containment measures during the early stage of COVID-19 pandemic: an international longitudinal study.

BACKGROUND: Identifying common factors that affect public adherence to COVID-19 containment measures can directly inform the development of official public health communication strategies. The present international longitudinal study aimed to examine whether prosociality, together with other theoretically derived motivating factors (self-efficacy, perceived susceptibility and severity of COVID-19, perceived social support) predict the change in adherence to COVID-19 containment strategies. METHOD: In wave 1 of data collection, adults from eight geographical regions completed online surveys beginning in April 2020, and wave 2 began in June and ended in September 2020. Hypothesized predictors included prosociality, self-efficacy in following COVID-19 containment measures, perceived susceptibility to COVID-19, perceived severity of COVID-19 and perceived social support. Baseline covariates included age, sex, history of COVID-19 infection and geographical regions. Participants who reported adhering to specific containment measures, including physical distancing, avoidance of non-essential travel and hand hygiene, were classified as adherence. The dependent variable was the category of adherence, which was constructed based on changes in adherence across the survey period and included four categories: non-adherence, less adherence, greater adherence and sustained adherence (which was designated as the reference category). RESULTS: In total, 2189 adult participants (82% female, 57.2% aged 31-59 years) from East Asia (217 [9.7%]), West Asia (246 [11.2%]), North and South America (131 [6.0%]), Northern Europe (600 [27.4%]), Western Europe (322 [14.7%]), Southern Europe (433 [19.8%]), Eastern Europe (148 [6.8%]) and other regions (96 [4.4%]) were analyzed. Adjusted multinomial logistic regression analyses showed that prosociality, self-efficacy, perceived susceptibility and severity of COVID-19 were significant factors affecting adherence. Participants with greater self-efficacy at wave 1 were less likely to become non-adherence at wave 2 by 26% (adjusted odds ratio [aOR], 0.74; 95% CI, 0.71 to 0.77; P < .001), while those with greater prosociality at wave 1 were less likely to become less adherence at wave 2 by 23% (aOR, 0.77; 95% CI, 0.75 to 0.79; P = .04). CONCLUSIONS: This study provides evidence that in addition to emphasizing the potential severity of COVID-19 and the potential susceptibility to contact with the virus, fostering self-efficacy in following containment strategies and prosociality appears to be a viable public health education or communication strategy to combat COVID-19.

Adolescents' stress and depressive symptoms and their associations with psychological flexibility before educational transition.

INTRODUCTION: Relatively little is known about individual differences in adolescent psychological flexibility and its associations with symptoms of stress and depression. This study examined different profiles of adolescent stress and depressive symptoms and their associations with developing psychological flexibility before the critical educational transition. METHODS: The data were derived from a general sample of 740 Finnish ninth-grade adolescents (Mage = 15.7 years, 57% female) who were assessed twice during the final grade of their basic education. The data were analyzed using growth mixture modeling. RESULTS: Four profiles of stress and depressive symptoms were identified during a school year: (1) no stress and no depressive symptoms (None; 69%); (2) mild and decreasing stress and depressive symptoms (Decreasing; 15%); (3) low but increasing stress and depressive symptoms (Increasing; 6%); and (4) high and stable levels of stress and depressive symptoms (High; 10%). The adolescents in these profiles differed from each other in their initial levels and changes of psychological flexibility. The initial level of psychological flexibility was highest in the no-symptom profile group. We observed simultaneous change trends in symptoms and psychological flexibility during a school year. When symptoms decreased, psychological flexibility increased, and when symptoms increased, psychological flexibility decreased. CONCLUSIONS: A bidirectional pattern of relationships between psychological flexibility and psychological symptoms was found. Despite initially high level of skills in psychological flexibility, some adolescents, unexpectedly, experienced increased symptoms of stress and depression during the school year. The results call for further studies to explore in-depth the developmental diversity in adolescents' well-being and its antecedents.

Supported Web-Based Acceptance and Commitment Therapy for Older Family Caregivers (CareACT) Compared to Usual Care.

OBJECTIVES: The objective of the present study was to investigate whether an acceptance and commitment therapy (ACT)-based web-intervention (Group 1, CareACT), or a standardized rehabilitation in a rehabilitation center (Group 2) was effective in enhancing the psychological well-being of family caregivers aged 60 and over compared to support provided by voluntary caregiver associations (Group 3). METHODS: Altogether, 149 family caregivers participated in this quasi-experimental study. Primary outcome measure was depression. Secondary outcomes included anxiety, sense of coherence, quality of life, psychological flexibility, experiential avoidance, and thought suppression. The questionnaires were administered at baseline, and four, and 10 months post-measurement. We investigated differences in the changes between the groups using Mplus modeling techniques. RESULTS: Regarding the main outcome of depression, the results suggest that the CareACT intervention was superior to standardized rehabilitation and to the support given by caregiver associations at four months, both showing a medium-sized difference between the groups. However, the change from four to 10 months post-intervention was not significantly different between these groups (d = 0.32-0.36). Thought suppression showed a significantly different change between the three groups from baseline to four months and to 10 months post-measurement (p = .038). CONCLUSIONS: Web-based ACT may have beneficial effects on depressive symptoms and thought suppression in older caregivers. CLINICAL IMPLICATIONS: Web-based ACT could be a feasible alternative to institutional rehabilitation and support provided by voluntary caregiver associations. Web-based ACT responds flexibly to the needs of caregivers and provides them an opportunity for learning new skills to promote well-being.

Finnish diabetes-related quality of life questionnaire for children and adolescents: Reliability and validity.

AIM: To study the psychometric properties, reliability and validity of the FinDiab quality-of-life questionnaire (FDQL), a strength-oriented quality-of-life (QOL) questionnaire for children and adolescents with type 1 diabetes (T1D). METHODS: Participants were 215 youths with T1D (aged 10-17 years). They completed FDQL and comparison questionnaires (KINDL-R and SDQ). Demographic and disease measures were collected from the participants' medical records. The questionnaire's psychometric properties were investigated. Construct validity was studied through principal component analysis using Promax rotation, reliability with alphas, and criterion and convergent validity with correlations between sum scale, subscales, demographic and disease factors, and comparison measures. RESULTS: FDQL demonstrated an adequate range of measurement and feasibility. The four-factor solution was found to be optimal, resulting in the subscales of flexibility with diabetes, well-being, social relations and health behaviour. The sum scale correlated significantly with glycaemic control and the psychosocial and QOL comparison measures. Construct, criterion and convergent validity of the subscales was also good. Children under 14 years of age reported better QOL than older adolescents. CONCLUSION: FDQL is a practical QOL assessment method focusing on strengths. The questionnaire has good validity and reliability and is easy to use as a clinical tool.

The Effects of Acceptance and Commitment Therapy (ACT) Intervention on Inflammation and Stress Biomarkers: a Randomized Controlled Trial.

BACKGROUND: Psychological processes can be manifested in physiological health. We investigated whether acceptance and commitment therapy (ACT), targeted on psychological flexibility (PF), influences inflammation and stress biomarkers among working-age adults with psychological distress and overweight/obesity. METHOD: Participants were randomized into three parallel groups: (1) ACT-based face-to-face (n = 65; six group sessions led by a psychologist), (2) ACT-based mobile (n = 73; one group session and mobile app), and (3) control (n = 66; only the measurements). Systemic inflammation and stress markers were analyzed at baseline, at 10 weeks after the baseline (post-intervention), and at 36 weeks after the baseline (follow-up). General PF and weight-related PF were measured with questionnaires (Acceptance and Action Questionnaire, Acceptance and Action Questionnaire for Weight-Related Difficulties). RESULTS: A group × time interaction (p = .012) was detected in the high-sensitivity C-reactive protein (hsCRP) level but not in other inflammation and stress biomarkers. hsCRP decreased significantly in the face-to-face group from week 0 to week 36, and at week 36, hsCRP was lower among the participants in the face-to-face group than in the mobile group (p = .035, post hoc test). Age and sex were stronger predictors of biomarker levels at follow-up than the post-intervention PF. CONCLUSION: The results suggest that ACT delivered in group sessions may exert beneficial effects on low-grade systemic inflammation. More research is needed on how to best apply psychological interventions for the health of both mind and body among people with overweight/obesity and psychological distress. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01738256, Registered 17 August, 2012.

Reducing Stress and Enhancing Academic Buoyancy among Adolescents Using a Brief Web-based Program Based on Acceptance and Commitment Therapy: A Randomized Controlled Trial.

Acceptance and commitment therapy programs have rarely been used as preventive tools for alleviating stress and enhancing coping skills among adolescents. This randomized controlled trial examined the efficacy of a novel Finnish web- and mobile-delivered five-week intervention program called Youth COMPASS among a general sample of ninth-grade adolescents (n= 249, 49% females). The intervention group showed a small but significant decrease in overall stress (between-group Cohen's d = 0.22) and an increase in academic buoyancy (d= 0.27). Academic skills did not influence the intervention gains, but the intervention gains were largest among high-stressed participants. The results suggest that the acceptance and commitment based Youth COMPASS program may be well suited for promoting adolescents' well-being in the school context.

The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: a randomized controlled trial.

BACKGROUND: Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. METHODS: Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants' (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. RESULTS: Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. CONCLUSIONS: ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted. TRIAL REGISTRATION: ClinicalTrials.gov ( NCT01738256 ), registered 17 August, 2012.

Cognitive behavioural therapy and mindfulness for stress and burnout: a waiting list controlled pilot study comparing treatments for parents of children with chronic conditions.

BACKGROUND: Parents of children with chronic conditions often experience a crisis with serious mental health problems for themselves as a consequence. The healthcare focus is on the children; however, the parents often worry about their children's health and future but are seldom offered any counselling or guidance. AIM: The aim of this study was to investigate the effectiveness of two group-based behavioural interventions on stress and burnout among parents of children with chronic conditions. DESIGN, PARTICIPANTS AND SETTING: After a waiting list control period (n = 28), parents were offered either a cognitive behavioural (CBT, n = 10) or a mindfulness program (MF, n = 9). RESULTS: Both interventions decreased significantly stress and burnout. The within-group effect sizes were large in both interventions (CBT, g = 1.28-1.64; MF, g = 1.25-2.20). CONCLUSIONS: Hence, the results of this pilot study show that treating a group using either CBT or mindfulness can be an efficient intervention for reducing stress levels and burnout in parents of children with chronic conditions.

Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions.

OBJECTIVE: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight. DESIGN: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings Data were collected in three Finnish towns. SUBJECTS: The participants were overweight or obese (n 219), reporting symptoms of perceived stress. RESULTS: The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups. CONCLUSIONS: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.

High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age.

Stress-related eating may be a potential factor in the obesity epidemic. Rather little is known about how stress associates with eating behavior and food intake in overweight individuals in a free-living situation. Thus, the present study aims to investigate this question in psychologically distressed overweight and obese working-aged Finns. The study is a cross-sectional baseline analysis of a randomized controlled trial. Of the 339 study participants, those with all the needed data available (n = 297, 84% females) were included. The mean age was 48.9 y (SD = 7.6) and mean body mass index 31.3 kg/m(2) (SD = 3.0). Perceived stress and eating behavior were assessed by self-reported questionnaires Perceived Stress Scale (PSS), Intuitive Eating Scale, the Three-Factor Eating Questionnaire, Health and Taste Attitude Scales and ecSatter Inventory. Diet and alcohol consumption were assessed by 48-h dietary recall, Index of Diet Quality, and AUDIT-C. Individuals reporting most perceived stress (i.e. in the highest PSS tertile) had less intuitive eating, more uncontrolled eating, and more emotional eating compared to those reporting less perceived stress (p < 0.05). Moreover, individuals in the highest PSS tertile reported less cognitive restraint and less eating competence than those in the lowest tertile (p < 0.05). Intake of whole grain products was the lowest among those in the highest PSS tertile (p < 0.05). Otherwise the quality of diet and alcohol consumption did not differ among the PSS tertiles. In conclusion, high perceived stress was associated with the features of eating behavior that could in turn contribute to difficulties in weight management. Stress-related way of eating could thus form a potential risk factor for obesity. More research is needed to develop efficient methods for clinicians to assist in handling stress-related eating in the treatment of obese people.

Towards a physically more active lifestyle based on one's own values: the results of a randomized controlled trial among physically inactive adults.

BACKGROUND: The high prevalence of physical inactivity has led to a search for novel and feasible interventions that will enhance physical activity, especially among the least physically active individuals. This randomized controlled trial aimed to determine the effectiveness of a value-based intervention to promote a physically more active lifestyle among physically inactive adults. The framework of the study was based on Acceptance and Commitment Therapy (ACT). METHODS: Physically inactive participants aged 30 to 50 years (n = 138) were randomly allocated to a feedback (FB, n = 69) or an acceptance- and commitment-based group (ACT + FB, n = 69). Both groups received written feedback about their objectively measured physical activity and were offered a body composition analysis. In addition, the participants in the ACT + FB group attended six group sessions and were given a pedometer for self-monitoring their physical activity during the nine-week intervention. The primary outcome was physical activity. In addition, participants' cognitions related to exercise and physical activity were evaluated at baseline and at three- and six-month follow-ups. The changes in mean physical activity level were analysed using multilevel random regression and rank order stability, using the structural equation model. RESULTS: Participants in both groups increased their objectively measured and self-reported physical activity with high individual differences. No difference was observed in the change of physical activity level between the FB and ACT + FB groups over time. However, the cognitions related to physical activity and exercise improved more in the ACT + FB group than in the FB group. In addition, after re-analyzing the data among the non-depressive participants, higher stability was observed in objectively measured physical activity at the individual level between the three- and six-month follow-ups in the ACT + FB group as compared to FB group. CONCLUSIONS: Acceptance- and commitment-based group intervention, combined with the self-monitoring of physical activity, was beneficial in supporting the cognition related to exercise and physical activity, and brought more stability to the individual level physical activity behaviour change, especially among the non-depressive participants. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT01796990. Registered in February 2013.

A four-session acceptance and commitment therapy based intervention for depressive symptoms delivered by masters degree level psychology students: a preliminary study.

BACKGROUND: Depressive symptoms are one of the main reasons for seeking psychological help. Shorter interventions using briefly trained therapists could offer a solution to the ever-rising need for early and easily applicable psychological treatments. AIMS: The current study examines the effectiveness of a four-session Acceptance and Commitment Therapy (ACT) based treatment for self-reported depressive symptoms administered by Masters level psychology students. METHOD: This paper reports the effectiveness of a brief intervention compared to a waiting list control (WLC) group. Participants were randomized into two groups: ACT (n = 28) and waiting list (n = 29). Long-term effects were examined using a 6-month follow-up. RESULTS: The treatment group's level of depressive symptoms (Beck Depression Inventory) decreased by an average of 47%, compared to an average decrease of 4% in the WLC group. Changes in psychological well-being in the ACT group were better throughout, and treatment outcomes were maintained after 6 months. The posttreatment "between-group" and follow-up "with-in group" effect sizes (Cohen's d) were large to medium for depressive symptoms and psychological flexibility. CONCLUSIONS: The results support the brief ACT-based intervention for sub-clinical depressive symptoms when treatment was conducted by briefly trained psychology students. It also contributes to the growing body of evidence on brief ACT-based treatments and inexperienced therapists.

Predictors of increase in physical activity during a 6-month follow-up period among overweight and physically inactive healthy young adults.

BACKGROUND/OBJECTIVE: The beneficial effects of physical activity (PA) are well known, but it remains challenging to increase PA among physically inactive and overweight young individuals. The present study aimed to examine how selected psychological and physical characteristics assessed at baseline predict the increase in total PA over a 6-month follow-up among 51 physically inactive and overweight adults (20 women, 31 men; age 26-40 years) who participated in a lifestyle counselling study without supervised PA sessions. METHODS: Baseline measurements included a questionnaire assessment of sense of coherence and psychological flexibility, heart rate monitoring-based stress/recovery from stress (stress%/recovery% during 24 hours), and body composition. PA volume was elicited through interview. Participants who increased their PA by ≥ 500 metabolic equivalent of task-minutes/week during the follow-up compared with their prebaseline PA level were regarded as able to increase PA. Logistic regression was used to analyze associations of baseline characteristics with PA increase. RESULTS: During the 6-month follow-up, 41% of the participants increased their total PA by ≥ 500 metabolic equivalent of task-minutes/week. The best predictors of the increase in PA were high meaningfulness subscores of the sense of coherence questionnaire (multivariate adjusted odds ratio 1.57, 95% confidence interval 1.04-2.35) and high recovery% during a day off (odds ratio 1.15, 95% confidence interval 1.02-1.30). CONCLUSION: A strong sense of meaningfulness and better recovery from stress predict an increase in PA among physically inactive and overweight young adults. Therefore, participants with a low sense of meaningfulness and low recovery from stress may require support from other interventions to be able to increase their PA.

The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.

BACKGROUND: Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes. METHODS/DESIGN: 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations. DISCUSSION: This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions. TRIAL REGISTRATION: Current Clinical Trials NCT01738256, Registered 17 August, 2012.

Metacognitive group training for forensic and dangerous non-forensic patients with schizophrenia: a randomised controlled feasibility trial.

BACKGROUND: In schizophrenia, the presence of certain cognitive biases has been established. Informed by this, metacognitive training (MCT) has been developed for schizophrenia. There is increasing evidence of its effectiveness with some patients, but its applicability to dangerous patients has not yet been demonstrated. AIMS: Our aim was to test the feasibility of a randomised controlled trial (RCT) of MCT for patients in a high-security hospital setting. METHODS: Twenty of 33 eligible and selected male in-patients with schizophrenia and a history of violence were randomised pairwise to eight sessions of MCT or treatment as usual. Symptom severity and reasoning, according to the jumping to conclusions paradigm, were measured before, immediately after treatment, and 3 and 6 months later. RESULTS: Men in both groups completed the trial, and those in the MCT arm, almost all of the group sessions. The MCT arm had a significant advantage in improvement of 'suspiciousness', greatest at 3 months, but then declining. No significant improvement in reasoning ability was achieved. CONCLUSIONS: Metacognitive training showed sufficient promise in this group for a full trial to be worthwhile, and the feasibility of an RCT methodology, even in a secure hospital, was established. The fact that the improvements faded during follow-up suggests that a useful modification to the treatment would be lengthening the protocol, repeating it, or both.

Online acceptance and commitment therapy (iACT) for adults with persistent physical symptoms - 3-month follow-up study of a randomized controlled trial.

OBJECTIVE: Persistent physical symptoms (PPS) represent a major health problem affecting daily functioning. This RCT aimed to examine whether a guided Internet-based treatment based on acceptance and commitment therapy (ACT) provided additional benefits compared to Treatment as Usual (TAU) in reducing somatic complaints and psychological distress in adults with PPS. METHODS: A total of 103 adults with PPS related to indoor environments, chronic fatigue or both conditions were assigned to receive either either a 14-week intervention (video-based case conceptualization + Internet-based ACT) combined with TAU (iACT + TAU; n = 50) or TAU alone (n = 53). Somatic symptoms, depression, anxiety, insomnia, and psychological flexibility were assessed from pre-intervention to a 3-month follow-up. Additionally, the association between changes in psychological flexibility from pre- to post-intervention and changes in symptoms from pre to 3-month follow-up was explored. Analyses were conducted using a multigroup method with full information maximum likelihood estimator. RESULTS: The results revealed a significant interaction effect, indicating reductions in somatic symptoms and symptoms of depression and anxiety with moderate to large between-group effects (d = 0.71-1.09). No significant interaction effect was observed in insomnia and measures of psychological flexibility. CONCLUSION: Internet-based ACT, when combined with Treatment as Usual, demonstrated efficacy for individuals with PPS associated with indoor environments and chronic fatigue. These findings are pertinent for primary healthcare providers, suggesting that the current treatment model could serve as a low-threshold first-line treatment option. THE CLINICAL TRIAL REGISTRATION NUMBER: NCT04532827.

Towards a physically more active lifestyle based on one's own values: study design of a randomized controlled trial for physically inactive adults.

BACKGROUND: This randomised controlled trial demonstrates the effectiveness of a value-based intervention program to encourage a physically more active lifestyle among physically inactive adults aged 30 to 50 years. The conceptual framework of the program is based on an innovative behavioural therapy called Acceptance and Commitment Therapy (ACT) that aims to increase an individual's psychological flexibility and support behaviour change towards a higher quality and more meaningful life. METHODS: Participants will be randomly allocated to a feedback group (FB) or an Acceptance and Commitment based (ACT+FB) group. Both the groups will receive written feedback about their objectively measured physical activity levels and offered an opportunity to attend a body composition analysis. In addition, the Acceptance and Commitment based group will attend six group sessions and be given a pedometer for self-monitoring of their daily physical activity throughout the 9-week intervention. The group sessions aim to clarify individual values and enhance committed actions towards the goal of achieving a more meaningful life. Participants will also be taught new skills to work on subjective barriers related to physical activity. Physical activity will be measured objectively by an accelerometer over seven consecutive days and by self-reported questionnaires at the baseline, as well as at 3, 6, 9 and 15 months after the baseline measures. In addition, psychological well-being will be measured through the questionnaires, which assess mindfulness skills, psychological flexibility, psychological distress and depressive symptoms. DISCUSSION: This study's objective is to demonstrate a research protocol for a randomized controlled study motivating a physically more active lifestyle based on one's own values among physically inactive adults. The aim of the study is to evaluate the feasibility and intervention efficacy on physical activity and psychological well-being, and discuss challenges in motivating physically inactive adults towards physically more active lifestyles. TRIAL REGISTRATION: ClinicalTrials.gov, number NCT01796990.

In the shadow of COVID-19: A randomized controlled online ACT trial promoting adolescent psychological flexibility and self-compassion.

Background: Although some adolescents managed to cope well with the challenges brought on by the COVID-19 pandemic, the well-being of many was adversely affected due to school closures, distance education, restrictions on gathering with friends, and limited access to mental health services. Many adolescents reported increased anxiety and depression as well as decreased psychological wellbeing due to the pandemic. Consequently, there is a need for psychological support that exceeds the strained resources available to schools to support young people during times of crisis and societal pressure. Objective: The present study aimed to explore the effects of an online-delivered ACT intervention to promote adolescent psychological flexibility and self-compassion and decrease psychological distress during the second wave of COVID-19 in the fall of 2020. Methods: A total of 348 adolescents aged 15-16 were randomly divided into three equal groups: 1) the iACT student coach + virtual coach group, n = 116; 2) the iACT virtual coach group, n = 116; and 3) the control group with no intervention, n = 116). Among these adolescents, 234 participated in a pre-measurement (iACT, n = 154; control, n = 80; intent-to-treat) and completed measures of psychological flexibility, self-compassion, anxiety, and depression. Results: An investigation of all the adolescents who participated in the pre-measurement (intent-to-treat analysis, n = 234) revealed no significant differences between the three groups with regard to psychological flexibility, self-compassion, and symptoms of anxiety and depression. However, upon combining the two intervention groups and examining the adolescents who completed at least 30% of the Youth Compass program (per-protocol analysis, n = 137), small but significant differences between the iACT intervention and control groups were found regarding the psychological flexibility subscale valued action, self-compassion, and anxiety in favor of the intervention group. Conclusions: Active use of an ACT-based online intervention under adverse circumstances may decrease symptoms of anxiety and increase psychological flexibility skills in adolescents.

Corrigendum: Illness perceptions of COVID-19 in Europe: predictors, impacts and temporal evolution.

[This corrects the article DOI: 10.3389/fpsyg.2021.640955.].