Engaging nursing students with a behaviour change intervention designed to improve their lifestyle.

BACKGROUND: In common with the general population, nursing students struggle to live a healthy lifestyle. AIMS: To recruit students in a behaviour change intervention, using the COM-B model of behaviour change to understand engagement. METHODS: Nursing students were invited to complete an online survey assessing height, weight, BMI, physical activity, lifestyle satisfaction, motivation for leading a healthy life, and quality of life. Those identified as overweight or not physically active were offered a webinar and social media site to support setting personal goals and boosting motivation to achieve a healthy lifestyle. FINDINGS: 25% of invited students engaged with the interventions, 19% attending a webinar and 19% joining the social media site. No statistically reliable differences between those who engaged and those who did not were identified. CONCLUSION: Current models of behaviour change do not predict engagement. Interventions may need to be integrated into the curriculum to elicit change.

Exploring barriers, motivators and solutions to achieve a healthy lifestyle among undergraduate student nurses.

BACKGROUND: Many preregistration student nurses tend to be overweight or obese and have unhealthy lifestyles. AIMS: This study aimed to quantify the prevalence of these issues, to identify barriers to adopting a healthy lifestyle as well as potential solutions, and to explore the use of smartphone health apps. METHODS: An online questionnaire examined diet and physical activity habits, general health and attitudes to eHealth. An in-class questionnaire with a new sample assessed current lifestyle, barriers to healthier living, support needed to achieve goals and the use of health apps. FINDINGS: Half of student nurses were overweight or obese and only 41% met the recommended levels of physical activity. An in-class questionnaire revealed that more than half of them wanted to have a better diet and to exercise more. CONCLUSION: Generally, student nurses were not satisfied with their current lifestyles. A lack of motivation and time were the most frequently reported barriers; an intervention focusing on motivational support could be an acceptable and effective means of achieving and sustaining positive behaviour change.

Functional imagery training versus motivational interviewing for weight loss: a randomised controlled trial of brief individual interventions for overweight and obesity.

OBJECTIVE: Functional Imagery Training (FIT) is a new brief motivational intervention based on the Elaborated Intrusion theory of desire. FIT trains the habitual use of personalised, affective, goal-directed mental imagery to plan behaviours, anticipate obstacles, and mentally try out solutions from previous successes. It is delivered in the client-centred style of Motivational Interviewing (MI). We tested the impact of FIT on weight loss, compared with time- and contact-matched MI. DESIGN: We recruited 141 adults with BMI (kg/m²) ≥25, via a community newspaper, to a single-centre randomised controlled trial. Participants were allocated to one of two active interventions: FIT or MI. Primary data collection and analyses were conducted by researchers blind to interventions. All participants received two sessions of their allocated intervention; the first face-to-face (1 h), the second by phone (maximum 45 min). Booster calls of up to 15 min were provided every 2 weeks for 3 months, then once-monthly until 6 months. Maximum contact time was 4 h of individual consultation. Participants were assessed at Baseline, at the end of the intervention phase (6 months), and again 12 months post-baseline. MAIN OUTCOME MEASURES: Weight (kg) and waist circumference (WC, cm) reductions at 6 and 12 months. RESULTS: FIT participants (N = 59) lost 4.11 kg and 7.02 cm of WC, compared to .74 kg and 2.72 cm in the MI group (N = 55) at 6 months (weight mean difference (WMD) = 3.37 kg, p < .001, 95% CI [-5.2, -2.1], waist-circumference mean difference (WCMD) = 4.3 cm, p < .001, 95% CI [-6.3,-2.6]). Between-group differences were maintained and increased at month 12: FIT participants lost 6.44 kg (W) and 9.1 cm (WC) compared to the MI who lost .67 kg and 2.46 cm (WMD = 5.77 kg, p < .001, 95% CI [-7.5, -4.4], WCMD = 6.64 cm, p < .001, 95% CI [-7.5, -4.4]). CONCLUSION: FIT is a theoretically informed motivational intervention which offers substantial benefits for weight loss and maintenance of weight reduction, compared with MI alone, despite including no lifestyle education or advice.

The Soothing Sea: A Virtual Coastal Walk Can Reduce Experienced and Recollected Pain.

Virtual reality (VR) distraction has become increasingly available in health care contexts and is used in acute pain management. However, there has been no systematic exploration of the importance of the content of VR environments. Two studies tested how interacting with nature VR influenced experienced and recollected pain after 1 week. Study 1 (n = 85) used a laboratory pain task (cold pressor), whereas Study 2 (n = 70) was a randomized controlled trial with patients undergoing dental treatment. In Study 1, nature (coastal) VR reduced both experienced and recollected pain compared with no VR. In Study 2, nature (coastal) VR reduced experienced and recalled pain in dental patients, compared with urban VR and standard care. Together, these data show that nature can improve experience of health care procedures through the use of VR, and that the content of the VR matters: Coastal nature is better than urban.

The Mini Alcohol Craving Experience Questionnaire: Development and Clinical Application.

BACKGROUND: Standardized alcohol craving scales are rarely used outside of research environments despite recognized clinical utility. Scale length is a key barrier to more widespread application. A brief measure of alcohol craving is needed to improve research and treatment of alcohol use disorders (AUDs). Grounded in the Elaborated Intrusion Theory of Desire, the Alcohol Craving Experience (ACE) Questionnaire comprises two 11-item self-report scales that assess past-week frequency and maximum strength of alcohol craving. This study aimed to create a brief version of the ACE while maintaining psychometric integrity and clinical utility. METHODS: Patients attending a university hospital alcohol and drug outpatient service for the treatment of AUD completed the ACE as part of a questionnaire battery. Three patient samples were utilized: 519 patients with pretreatment and outcome data, 228 patients with pretreatment data, and 66 patients who completed the ACE at treatment sessions 1 and 2. RESULTS: The Frequency scale of the ACE possessed greater clinical utility and predictive validity than the Strength scale. Revision of the Frequency measure produced a 5-item "Mini Alcohol Craving Experience" (MACE) Questionnaire. Satisfactory validity (construct, predictive, concurrent, convergent, and incremental) and reliability (internal and test-retest) were maintained. A 1 standard deviation increase in pretreatment MACE score was associated with a 54 percentage increase in the odds of patient lapse or dropout. CONCLUSIONS: The MACE provides a brief, theoretically, and psychometrically robust measure of alcohol craving suitable for use with AUD populations in time-limited clinical and research settings.

Assessment of Motivational Cognitions in Diabetes Self-Care: the Motivation Thought Frequency Scales for Glucose Testing, Physical Activity and Healthy Eating.

PURPOSE: There is a need for improved measurement of motivation for diabetes self-care. The Elaborated Intrusion Theory of Desire offers a coherent framework for understanding and identifying the cognitive-affective events that constitute the subjective experience of motivation and may therefore inform the development of such an instrument. Recent research has shown the resultant Motivation Thought Frequency scale (MTF) to have a stable factor structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) when applied to physical activity, excessive snacking or alcohol use in the general population. The current study aimed to confirm the four-factor structure of the MTF for glucose testing, physical activity and healthy eating in people with type 2 diabetes. Associations with self-reports of concurrent diabetic self-care behaviours were also examined. METHOD: Confirmatory factor analyses tested the internal structure, and multiple regressions assessed the scale's relationship with concurrent self-care behaviours. The MTF was completed by 340 adults with type 2 diabetes, and 237 from that sample also reported self-care behaviours. Separate MTFs assessed motivation for glucose testing, physical activity and healthy eating. Self-care was assessed using questions from the Summary of Diabetes Self-Care Activities. RESULTS: The MTF for each goal achieved an acceptable fit on all indices after selected errors within factors were allowed to intercorrelate. Intensity and Self-Efficacy Imagery provided the strongest and most consistent correlations with relevant self-care behaviours. CONCLUSION: Results provide preliminary support for the MTF in a diabetes sample. Testing of its sensitivity to change and its predictive utility over time is needed.

Functional Imagery Training to reduce snacking: Testing a novel motivational intervention based on Elaborated Intrusion theory.

Functional Imagery Training (FIT) is a new theory-based, manualized intervention that trains positive goal imagery. Multisensory episodic imagery of proximal personal goals is elicited and practised, to sustain motivation and compete with less functional cravings. This study tested the impact of a single session of FIT plus a booster phone call on snacking. In a stepped-wedge design, 45 participants who wanted to lose weight or reduce snacking were randomly assigned to receive a session of FIT immediately or after a 2-week delay. High-sugar and high-fat snacks were recorded using timeline follow back for the previous 3 days, at baseline, 2 and 4 weeks. At 2 weeks, snacking was lower in the immediate group than in the delayed group, and the reduction after FIT was replicated in the delayed group between 2 and 4 weeks. Frequencies of motivational thoughts about snack reduction rose following FIT for both groups, and this change correlated with reductions in snacking and weight loss. By showing that FIT can support change in eating behaviours, these findings show its potential as a motivational intervention for weight management.

Playing 'Tetris' reduces the strength, frequency and vividness of naturally occurring cravings.

Elaborated Intrusion Theory (EI) postulates that imagery is central to craving, therefore a visually based task should decrease craving and craving imagery. This study provides the first laboratory test of this hypothesis in naturally occurring, rather than artificially induced, cravings. Participants reported if they were experiencing a craving and rated the strength, vividness and intrusiveness of their craving. They then either played 'Tetris' or they waited for a computer program to load (they were told it would load, but it was designed not to). Before task completion, craving scores between conditions did not differ; after, however, participants who had played 'Tetris' had significantly lower craving and less vivid craving imagery. The findings support EI theory, showing that a visuospatial working memory load reduces naturally occurring cravings, and that Tetris might be a useful task for tackling cravings outside the laboratory. Methodologically, the findings show that craving can be studied in the laboratory without using craving induction procedures.

Brief guided imagery and body scanning interventions reduce food cravings.

Elaborated Intrusion (EI) Theory proposes that cravings occur when involuntary thoughts about food are elaborated; a key part of elaboration is affectively-charged imagery. Craving can be weakened by working memory tasks that block imagery. EI Theory predicts that cravings should also be reduced by preventing involuntary thoughts being elaborated in the first place. Research has found that imagery techniques such as body scanning and guided imagery can reduce the occurrence of food thoughts. This study tested the prediction that these techniques also reduce craving. We asked participants to abstain from food overnight, and then to carry out 10 min of body scanning, guided imagery, or a control mind wandering task. They rated their craving at 10 points during the task on a single item measure, and before and after the task using the Craving Experience Questionnaire. While craving rose during the task for the mind wandering group, neither the guided imagery nor body scanning group showed an increase. These effects were not detected by the CEQ, suggesting that they are only present during the competing task. As they require no devices or materials and are unobtrusive, brief guided imagery strategies might form useful components of weight loss programmes that attempt to address cravings.

Tell me all about it: Narrated memories are less emotional than imagined memories.

People often re-live memories by talking about them. Verbal thinking is usually less emotive than imagery-based thinking but it is not known if this finding generalises to recollection. We tested if narrating memories aloud reduces their affective charge compared with recollecting them using imagery. Participants were randomised to two conditions: imagery (recalling the memory silently as vividly as possible) or narration (describing the memory out loud as clearly as possible). After practicing with a neutral topic, they recalled three aversive (Experiments 1 and 2) or three happy (Experiment 3) memories using narration or imagery, and rated emotionality of the memory after each recall. Before and after the procedure, they completed the PANAS to measure effects on mood. Experiments 2 and 3 included a 24 h follow-up. Emotionality was consistently lower following narrated recollection than imaginal recollection: narrated M = 5.3, SD = 2.5; imaginal M = 7.2, SD = 2.0; effect size (difference in mean values divided by overall SD) = 0.78. Negative affect increased after recollection of aversive memories and positive affect decreased, but there were no effects of condition upon mood. Recalling a positive memory had no effect on mood. Follow-up data showed no lasting effects of recall mode on availability of memories or mood. We conclude that narration of emotional autobiographical memories reduces the emotionality of the recollection, but does not differentially change mood compared with image-based recall.

An attentional control task reduces intrusive thoughts about smoking.

INTRODUCTION: Attentional control tasks such as body scanning and following isometric exercise instructions have been shown to reduce smoking cravings, apparently by reducing stress (Ussher, M., Cropley, M., Playle, S., Mohidin, R., & West, R. [2009]. Effect of isometric exercise and body scanning on cigarette cravings and withdrawal symptoms. Addiction, 104, 1251-1257. doi:10.1111/j.1360-0443.2009.02605.x). Related work based upon elaborated intrusion theory (Kavanagh, D. J., Andrade, J., & May, J. [2005]. Imaginary relish and exquisite torture: The elaborated intrusion theory of desire. Psychological Review, 112, 446-467. doi:10.1037/0033-295X.112.2.446) has shown that similar tasks can reduce hungry participants' involuntary food-related thoughts (May, J., Andrade, J., Batey, H., Berry, L.-M., & Kavanagh, D. [2010]. Less food for thought: Impact of attentional instructions on intrusive thoughts about snack foods. Appetite, 55, 279-287. doi:10.1016/j.appet.2010.06.014). This study tests the effect of body scanning instructions upon smoking-related thoughts as well as craving. METHODS: Twenty-seven smokers took part in 2 counterbalanced sessions, on different days, having been asked to abstain from smoking for 2 hr. In each session, they followed audio instructions for three 10-min blocks during which their thoughts were probed 10 times. In the first and third blocks, they were instructed to let their mind wander; during the second block of the control session, they also let their mind wander, but in the experimental session, they followed body scanning instructions. "Smoking thought frequency" was assessed using thought probes; "Craving" was measured using Factor 1 of the Questionnaire on Smoking Urges (Tiffany, S. T., & Drobes, D. J. [1991]. The development and initial validation of a questionnaire on smoking urges. British Journal of Addiction, 86, 1467-1476. doi:10.1111/j.1360-0443.1991.tb01732.x). RESULTS: Participants reported fewer smoking-related thoughts and lower smoking cravings in the body scanning block of the experimental session, whereas they rose in the comparable mind-wandering block of the control session. The reduction in thoughts during the body scanning correlated with the corresponding reduction in craving. CONCLUSIONS: Body scanning reduces cravings and reduces the frequency or shortens the duration of smoking thoughts. Attentional control strategies may form a useful part of smoking cessation practices.

Use of a clay modeling task to reduce chocolate craving.

Elaborated Intrusion theory (EI theory; Kavanagh, Andrade, & May, 2005) posits two main cognitive components in craving: associative processes that lead to intrusive thoughts about the craved substance or activity, and elaborative processes supporting mental imagery of the substance or activity. We used a novel visuospatial task to test the hypothesis that visual imagery plays a key role in craving. Experiment 1 showed that spending 10 min constructing shapes from modeling clay (plasticine) reduced participants' craving for chocolate compared with spending 10 min 'letting your mind wander'. Increasing the load on verbal working memory using a mental arithmetic task (counting backwards by threes) did not reduce craving further. Experiment 2 compared effects on craving of a simpler verbal task (counting by ones) and clay modeling. Clay modeling reduced overall craving strength and strength of craving imagery, and reduced the frequency of thoughts about chocolate. The results are consistent with EI theory, showing that craving is reduced by loading the visuospatial sketchpad of working memory but not by loading the phonological loop. Clay modeling might be a useful self-help tool to help manage craving for chocolate, snacks and other foods.

Life Course Digital Twins-Intelligent Monitoring for Early and Continuous Intervention and Prevention (LifeTIME): Proposal for a Retrospective Cohort Study.

BACKGROUND: Multimorbidity, which is associated with significant negative outcomes for individuals and health care systems, is increasing in the United Kingdom. However, there is a lack of knowledge about the risk factors (including health, behavior, and environment) for multimorbidity over time. An interdisciplinary approach is essential, as data science, artificial intelligence, and engineering concepts (digital twins) can identify key risk factors throughout the life course, potentially enabling personalized simulation of life-course risk for the development of multimorbidity. Predicting the risk of developing clusters of health conditions before they occur would add clinical value by enabling targeted early preventive interventions, advancing personalized care to improve outcomes, and reducing the burden on health care systems. OBJECTIVE: This study aims to identify key risk factors that predict multimorbidity throughout the life course by developing an intelligent agent using digital twins so that early interventions can be delivered to improve health outcomes. The objectives of this study are to identify key predictors of lifetime risk of multimorbidity, create a series of simulated computational digital twins that predict risk levels for specific clusters of factors, and test the feasibility of the system. METHODS: This study will use machine learning to develop digital twins by identifying key risk factors throughout the life course that predict the risk of later multimorbidity. The first stage of the development will be the training of a base predictive model. Data from the National Child Development Study, the North West London Integrated Care Record, the Clinical Practice Research Datalink, and Cerner's Real World Data will be split into subsets for training and validation, which will be done following the k-fold cross-validation procedure and assessed with the Prediction Model Risk of Bias Assessment Tool (PROBAST). In addition, 2 data sets-the Early-Life Data Cross-linkage in Research study and the Children and Young People's Health Partnership randomized controlled trial-will be used to develop a series of digital twin personas that simulate clusters of factors to predict different risk levels of developing multimorbidity. RESULTS: The expected results are a validated model, a series of digital twin personas, and a proof-of-concept assessment. CONCLUSIONS: Digital twins could provide an individualized early warning system that predicts the risk of future health conditions and recommends the most effective intervention to minimize that risk. These insights could significantly improve an individual's quality of life and healthy life expectancy and reduce population-level health burdens. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/35738.

Understanding Public Attitudes to Hate: Developing and Testing a U.K. Version of the Hate Crime Beliefs Scale.

Against the backdrop of an increase in reported hate crimes, we present the development of a U.K.-focussed instrument designed to evaluate the nature of public beliefs about hate crime, legislation, offenders and victims. In Study 1, 438 participants completed an Anglicized version of the Hate Crime Beliefs Scale (HCBS). Factor analyses revealed three subfactors: Denial (high scores represent a denial of hate crime severity and need for legislation), Compassion (high score reflect compassion toward victims and affected communities) and Sentencing (higher scores reflect more punitive attitudes). In Study 2 (N = 134) we show that scores on Denial are positively associated with those on Right-Wing Authoritarianism (RWA) and Social Dominance Orientation (SDO), ideologies known to be associated with prejudice. Compassion was negatively associated with these ideologies. Mediation analyses showed that Big Five personality traits Openness to Experience and Conscientiousness predicted Denial and Compassion via RWA, whereas Agreeableness and Openness predicted scores via SDO, consistent with a dual-process motivation model of hate crime beliefs. Results are discussed in terms of the nature of hate crime beliefs and the importance of understanding public attitudes which may support undesirable social norms and influence jury decision making in trials of hate related offenses.

Less food for thought. Impact of attentional instructions on intrusive thoughts about snack foods.

Intrusive thoughts about food may play a role in unhealthy eating behaviours. Food-related thoughts that capture attention can lead to craving and further intrusive thoughts (Kavanagh, Andrade, & May, 2005). We tested whether diverting attention to mental images or bodily sensations would reduce the incidence of intrusive thoughts about snack foods. In two experiments, participants reported their thoughts in response to probes during three 10min periods. In the Baseline and Post-task period, participants were asked to let their mind wander. In the middle, Experimental, period, participants followed mind wandering (Control), thought diversion, or Thought Suppression instructions. Self-directed or Guided Imagery, Mindfulness-based Body Scanning, and Thought Suppression all reduced the proportion of thoughts about food, compared to Baseline. Following Body Scanning and Thought Suppression, food thoughts returned to Baseline frequencies Post-task, rather than rebounding. There were no effects of the interventions upon craving, although overall, craving and thought frequency were correlated. Thought control tasks may help people to ignore thoughts about food and thereby reduce their temptation to snack.

Say it aloud: Measuring change talk and user perceptions in an automated, technology-delivered adaptation of motivational interviewing delivered by video-counsellor.

Motivational Interviewing is a widely used counselling technique. A fundamental principle of this technique is that hearing oneself argue for change strengthens motivation. This study presents the first analysis of participants' dialogue with an automated motivational interviewer. The objective was to explore communication with, and perceptions of, a technology-delivered adaptation of motivational interviewing (TAMI) delivered by a pre-recorded video-counsellor. Eighteen participants undertook the video interview and evaluated it after one week. Interviews were scored for change and sustain talk. Participants' written evaluations were subjected to thematic analysis. Interviews lasted 10 min 30s (SD 3 min 0 s). Change talk was observed in a mean of 16 of 25 responses (SD 3.35, range 11-21). Sustain talk was less frequent (mean = 3.4 replies, SD = 2.5, range 0 to 8). Participants disliked seeing their own image in the webcam and desired a personalised interaction where each question depended on the answer given to the previous one. Positive appraisals included space to think about motivation and plans, and hearing themselves voicing goals. A brief, generic, automated TAMI elicited change talk and was perceived as motivating.

Neighbourhood greenspace and smoking prevalence: Results from a nationally representative survey in England.

OBJECTIVE: The current study investigated whether people are less likely to be smokers when they live in greener neighbourhoods, and whether such an association is attributable to lower rates of ever-smoking and/or higher rates of smoking cessation. METHOD: Using a representative sample of the adult population of England (N = 8,059), we investigated the relationships between neighbourhood greenspace and three inter-related smoking outcomes (current smoking, ever-smoking and smoking cessation). RESULTS: After controlling for a range of individual and area-level covariates, including socioeconomic status, income and education, living in the highest greenspace quartile was associated with a 20% lower prevalence of current smoking, compared to living in the lowest greenspace quartile (PR = 0.80, CI = 0.67, 0.96, p < .017). Neighbourhood greenspace was not significantly associated with ever-smoking. However, amongst ever-smokers, residing in the two highest quartiles of neighbourhood greenspace quartiles (vs. 1st quartile) was associated with a 10% and 12% higher prevalence of smoking cessation (PR = 1.10, CI = 1.02, 1.18, p = .012; PR = 1.12, CI = 1.02, 1.22, p = .016, respectively). This suggests that the association between greenspace and current smoking is due to a higher likelihood of smoking cessation, rather than lower rates of ever- smoking. The associations between greenspace, current smoking and smoking cessation were similar in magnitude to those of having high (vs. low) household income and were largely unmoderated by socioeconomic measures. IMPLICATIONS: Our findings advocate the need to protect and invest in local greenspaces, to maximise the public health benefits they may afford. Improving access to greenspace may constitute an overlooked public health strategy for reducing smoking prevalence.

The Motivational Thought Frequency Scales for increased physical activity and reduced high-energy snacking.

OBJECTIVES: The Motivational Thought Frequency (MTF) Scale has previously demonstrated a coherent four-factor internal structure (Intensity, Incentives Imagery, Self-Efficacy Imagery, Availability) in control of alcohol and effective self-management of diabetes. The current research tested the factorial structure and concurrent associations of versions of the MTF for increasing physical activity (MTF-PA) and reducing high-energy snacks (MTF-S). DESIGN: Study 1 examined the internal structure of the MTF-PA and its concurrent relationship with retrospective reports of vigorous physical activity. Study 2 attempted to replicate these results, also testing the internal structure of the MTF-S and examining whether higher MTF-S scores were found in participants scoring more highly on a screening test for eating disorder. METHODS: In Study 1, 626 participants completed the MTF-PA online and reported minutes of activity in the previous week. In Study 2, 313 participants undertook an online survey that also included the MTF-S and the Eating Attitudes Test (EAT-26). RESULTS: The studies replicated acceptable fit for the four-factor structure on the MTF-PA and MTF-S. Significant associations of the MTF-PA with recent vigorous activity and of the MTF-S with EAT-26 scores were seen, although associations were stronger in Study 1. CONCLUSIONS: Strong preliminary support for both the MTF-PA and MTF-S was obtained, although more data on their predictive validity are needed. Associations of the MTF-S with potential eating disorder illustrate that high scores may not always be beneficial to health maintenance.

Tests of the elaborated intrusion theory of craving and desire: Features of alcohol craving during treatment for an alcohol disorder.

OBJECTIVES: We tested predictions from the elaborated intrusion (EI) theory of desire, which distinguishes intrusive thoughts and elaborations, and emphasizes the importance of imagery. Secondarily, we undertook preliminary evaluations of the Alcohol Craving Experience (ACE) questionnaire, a new measure based on EI Theory. METHODS: Participants (N = 232) were in correspondence-based treatment trials for alcohol abuse or dependence. The study used retrospective reports obtained early in treatment using the ACE, and daily self-monitoring of urges, craving, mood and alcohol consumption. RESULTS: The ACE displayed high internal consistency and test - retest reliability and sound relationships with self-monitored craving, and was related to Baseline alcohol dependence, but not to consumption. Imagery during craving was experienced by 81%, with 2.3 senses involved on average. More frequent imagery was associated with longer episode durations and stronger craving. Transient intrusive thoughts were reported by 87% of respondents, and were more common if they frequently attempted to stop alcohol cognitions. Associations between average daily craving and weekly consumption were seen. Depression and negative mood were associated with more frequent, stronger and longer lasting desires for alcohol. CONCLUSIONS: Results supported the distinction of automatic and controlled processes in craving, together with the importance of craving imagery. They were also consistent with prediction of consumption from cross-situational averages of craving, and with positive associations between craving and negative mood. However, this study's retrospective reporting and correlational design require that its results be interpreted cautiously. Research using ecological momentary measures and laboratory manipulations is needed before confident inferences about causality can be made.

Natural environments and craving: The mediating role of negative affect.

This paper presents a novel investigation of a conceptual model, proposing that increased nature exposure may be associated with lower cravings, through reductions in negative affect. A cross-sectional online survey (N = 149) provided an initial exploration of the relationships between various aspects of nature exposure, craving and negative affect. Access to gardens/allotments and residential views incorporating more than 25% greenspace were both associated with reductions in the strength and frequency of cravings. These associations were mediated, to varying degrees, by reductions in negative affect. This novel link could have implications for public health and environmental protection programmes.