A bayesian network meta-analysis to explore modifying factors in randomized controlled trials: what works for whom to reduce depression in nursing home residents?

BACKGROUND: Reviews of depression interventions in nursing home residents resulted in positive findings. However, because of the heterogeneity of the studies, it remains unclear what works for whom. Considering moderator effects may contribute to a comprehensive understanding of depression treatment in residents. Therefore, this study aims to review depression interventions, examining moderator effects of (1) residents' factors, and (2) components specific of interventions. METHODS: A Bayesian network meta-analysis of randomized controlled trials primarily aimed at reducing depressive symptoms among residents was conducted. First, intervention types, e.g., exercise interventions, were compared to care as usual. Second, meta-regression analyses were conducted for moderator effects of residents' factors (i.e., severity of depressive symptoms, physical dependency, and cognitive impairment) and components identified as specific to an intervention (e.g., music, creativity, positivity). RESULTS: Our search across six databases resulted in 118 eligible studies: 16 on neurobiological interventions, 102 on non-pharmacological interventions. Compared to care as usual, cognitive interventions, such as cognitive behavioral therapy and goal-oriented therapy, showed the strongest effects (MD = -1.00, 95% CrI [-1.40 to -0.66]). Furthermore, the severity of depressive symptoms moderated the effect of interventions (ƅ = -0.63, CrI 95% [-1.04 to -0.22]), while none of fifteen identified intervention-specific components did. In residents with a depression diagnosis, there were larger effect sizes for interventions including daily structure, psychoeducation, healthy food, creativity, positivity, and an activating/encouraging environment, whereas interventions focusing on distraction and relaxation had larger effect sizes in those residents without. CONCLUSIONS: By examining the moderator effects, we provided an integrative perspective on the observed variations in effects across different target groups, and components of depression interventions. This approach underscores the complex nature of interventions, emphasizing the need for continued transdisciplinary research, and the exploration of potential moderators. Future investigations should carefully assess residents' factors and choose interventions and their components accordingly.

Informal antidepressant strategies for nursing home residents: two group concept mapping studies.

OBJECTIVES: To identify and structure potential informal antidepressant strategies that can be used in daily practice for nursing home residents alongside formal treatments. METHODS: In a first Group Concept Mapping study, residents, relatives, and professional caregivers (N = 124) brainstormed on strategies residents could use to prevent or alleviate depression. In a second study, the same participants (N = 110) reported strategies for use by others. Furthermore, participants rated the expected effectiveness and feasibility of the suggested strategies. Simultaneously, all strategies were sorted by experts and clustered using multidimensional scaling and hierarchical cluster analysis. RESULTS: Six clusters emerged for strategies by residents themselves and five clusters for strategies by others. For residents' strategies, the clusters Being socially connected and Participating in activities were perceived as most effective, as was the cluster Offering personal attention for strategies by others. Participants perceived Creating a healthy living environment as the most feasible cluster executed by residents. Within strategies by others, the clusters Offering personal attention, Using positive treatment/approach, and Using or adapting the physical environment were perceived as the most feasible. CONCLUSION: The results indicated the importance of social connectedness, a personalized and positive approach by significant others, and tailored activity programs. The results also suggest that adaptations to the physical environment within nursing homes may be an easy applicable strategy to prevent or alleviate depression in residents. Although more research is needed, these findings may guide daily practice and the development of interventions that include informal strategies.Supplemental data for this article can be accessed online at https://doi.org/10.1080/13607863.2022.2057427 .

The Relation of Mood and Sexual Desire: An Experience Sampling Perspective on the Dual Control Model.

We investigated the effect of fluctuations in negative and positive affect on momentary sexual motivation in a sample of women and men in a steady relationship (n = 133). Sexual motivation was regarded as the aggregate of sexual desire, subjective sexual arousal and openness to sexual contact. Experience sampling methodology was used to collect up to 70 measurements per participant over a period of seven consecutive days of sexual motivation, and negative and positive affect. Using multilevel analysis, we investigated cross-level interactions between affect and trait measures as specified in the dual control model (DCM). This model postulates sexually excitatory and inhibitory mechanisms as relatively independent systems that together can explain individual differences in sexual motivation and behavior. Results implicated that any intensification of feelings, positive or negative, was associated with a momentary increase in sexual motivation for participants more prone to sexual excitation. In the lagged analysis, higher preceding negative affect, measured 1-2 h earlier, forecasted an increase in current sexual motivation for participants more prone to sexual excitation. The lagged analysis included the autoregressive effect or inertia of sexual motivation. Inertia reflects the extent to which sexual motivation lingers and persists at similar levels. Our findings showed that sexual motivation levels persisted less in individuals with higher sexual inhibition proneness due to threat of performance failure. This study demonstrated how experience sampling methodology can be used to extend research on associations between mood and sexual motivation and implicates that DCM factors moderate these associations.

Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study.

BACKGROUND: Digital health promotion programs tailored to the individual are a potential cost-effective and scalable solution to enable self-management and provide support to people with excess body weight. However, solutions that are widely accessible, personalized, and theory- and evidence-based are still limited. OBJECTIVE: This study aimed to develop a digital behavior change program, Choosing Health, that could identify modifiable predictors of weight loss and maintenance for each individual and use these to provide tailored support. METHODS: We applied an Intervention Mapping protocol to design the program. This systematic approach to develop theory- and evidence-based health promotion programs consisted of 6 steps: development of a logic model of the problem, a model of change, intervention design and intervention production, the implementation plan, and the evaluation plan. The decisions made during the Intervention Mapping process were guided by theory, existing evidence, and our own research-including 4 focus groups (n=40), expert consultations (n=12), and interviews (n=11). The stakeholders included researchers, public representatives (including individuals with overweight and obesity), and experts from a variety of relevant backgrounds (including nutrition, physical activity, and the health care sector). RESULTS: Following a structured process, we developed a tailored intervention that has the potential to reduce excess body weight and support behavior changes in people with overweight and obesity. The Choosing Health intervention consists of tailored, personalized text messages and email support that correspond with theoretical domains potentially predictive of weight outcomes for each participant. The intervention content includes behavior change techniques to support motivation maintenance, self-regulation, habit formation, environmental restructuring, social support, and addressing physical and psychological resources. CONCLUSIONS: The use of an Intervention Mapping protocol enabled the systematic development of the Choosing Health intervention and guided the implementation and evaluation of the program. Through the involvement of different stakeholders, including representatives of the general public, we were able to map out program facilitators and barriers while increasing the ecological validity of the program to ensure that we build an intervention that is useful, user-friendly, and informative. We also summarized the lessons learned for the Choosing Health intervention development and for other health promotion programs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2020-040183.

Trajectories of loneliness across adolescence: An empirical comparison of longitudinal clustering methods using R.

INTRODUCTION: In this study, we compare three different longitudinal clustering methods. As a case study, the comparison of the methods is conducted for the development of loneliness from middle childhood to young adulthood. The aim is to explore how two nonparametric longitudinal cluster methods compare with a model-based latent class mixture model approach. METHODS: The trajectories of loneliness of 130 young people between 9 and 21 years of age, were analyzed to find a set clusters within these trajectories. The data for this study were obtained from the Nijmegen Longitudinal Study on Infant and Child Development (The Netherlands). Loneliness was measured at four waves at the age of 9, 13, 16, and 21 years. The nonparametric methods are in the R-packages kml and traj, and the model-based in the lcmm package. RESULTS: All methods indicated that the optimal number of clusters to describe the heterogeneity across the trajectories was three. The kml and lcmm methods showed the most similarity in shape of all clusters and fitted the data relatively well, while the traj method yielded somewhat different shapes and didn't fit the data well. CONCLUSIONS: All three methods corroborate the literature in this field by finding that the largest portion of subjects experience stable and low levels of loneliness. However, the clustering methods also reveal that there is a portion of subjects that experience changes in loneliness during adolescence. By comparing the results of nonparametric clustering methods to the latent class mixture model, this study equips researchers with an example of how to implement these models and thereby contributes to the literature on longitudinal clustering in the social sciences. Altogether the analyses show that it might be useful to investigate different algorithms to identify the most robust solution.

Predicting Sexual Desire in Daily Life from an Attachment Perspective: An Experience Sampling study.

In the present study we investigated the temporal associations between emotional intimacy, daily hassles, and sexual desire of individuals in long-term relationships, and examined the direct and moderating effects of attachment orientation. We investigated these variables by reanalyzing an existing data set. Experience sampling methodology was used to collect data 10 times per day, across seven days. Attachment orientation was assessed with the Experiences in Close Relationships questionnaire. Age, gender, and relationship duration were added as predictors. Data of 134 participants (Nfemale = 87) were analyzed. Only one of the partners of a couple participated. Men overall reported higher sexual desire than women. Longer relationship duration was associated with lower sexual desire, but age was not associated with sexual desire. Increased level of intimacy predicted sexual desire across measurements with an average time interval of 90 min, but this effect was no longer significant when assessment points were 180 min apart. Daily hassles did not predict sexual desire at subsequent assessments. Avoidant and anxious attachment were not associated with sexual desire level. No interaction effects of gender, stress, intimacy and attachment orientation on sexual desire were found. Speculative explanations are offered for the absence of stress effects.

Development of 'learn to dare!': An online assessment and intervention platform for anxious children.

BACKGROUND: Many children and adolescents suffer from problematic levels of anxiety, but the multitude of these children do not receive an intervention. It is of importance to increase the accessibility and availability of child anxiety interventions, as to identify and treat anxious children early and successfully. Online platforms that include information, assessments and intervention can contribute to this goal. Interventions for child anxiety are frequently based on Cognitive Behavioral Therapy, because of its strong theoretical and empirical basis. However, the working mechanisms of Cognitive Behavioral Therapy in children are poorly studied. To our knowledge, mediation studies on child anxiety are non-existent regarding online Cognitive Behavioral Therapy. METHODS: We will aim at children aged 8-13 years with problematic anxiety. We recruit these children via the community setting, and refer them to our online platform 'Learn to Dare!' (in Dutch: 'Leer te Durven!'), https://leertedurven.ou.nl, where information about child anxiety and our research is freely accessible. After an active informed consent procedure, the participants can access the screening procedure, which will select the children with problematic anxiety levels. Thereafter, these children will be randomized to an online intervention based on Cognitive Behavioral Therapy (n = 120) or to a waitlist control (WL, n = 120). The intervention consists of 8 sessions with minimal therapist support and contains psycho-education, exposure (based on inhibitory learning), cognitive restructuring and relapse prevention. Child anxiety symptoms and diagnoses, cognitions, avoidance behavior and level of abstract reasoning are measured. Assessments are the same for both groups and are performed before and after the proposed working mechanisms are offered during the intervention. A follow-up assessment takes place 3 months after the final session, after which children in the waitlist control group are offered to take part in the intervention. DISCUSSION: This protocol paper describes the development of the online platform 'Learn to Dare!', which includes information about child anxiety, the screening procedure, anxiety assessments, and the online intervention. We describe the development of the online intervention. Offering easy accessible interventions and providing insight into the working mechanisms of Cognitive Behavioral Therapy contributes to optimizing Cognitive Behavioral Therapy for anxious youth.

The associations of intimacy and sexuality in daily life: Temporal dynamics and gender effects within romantic relationships.

The experience of emotional intimacy is assumed to play a particularly large role in maintaining sexual desire and partnered sexual activity in romantic relationships of longer duration. It is unclear whether the effect of intimacy on sexual contact between partners is direct or indirect, via its impact on sexual desire. Baumeister and Bratslavsky suggested that a certain increment in emotional intimacy causes a greater increment in sexual desire in men than in women. In the present study, we aimed to test the mediating role of sexual desire between perceived intimacy and sexual partner interaction and the gender effect as hypothesized by Baumeister and Bratslavsky. Experience sampling methodology in the participant's natural environment was used. At 10 quasi-random moments per day, during 7 consecutive days, 134 participants reported their feelings of emotional intimacy, sexual desire, and sexual activity. The direct effect of intimacy on sexual partner interaction was not significant, but an indirect effect via sexual desire was observed. The strength of the association between intimacy and sexual desire diminished over time, from the strongest effect when intimacy, sexual desire, and sexual activity were measured simultaneously to a very small, but significant effect at an average time lag of 3 hr. At still larger time gaps, no effects were found. Men reported a higher average level of sexual desire than women, but the strength of the link between (increases in) intimacy and sexual desire was not different between the genders. The present findings suggest that in both male and female partners in romantic, long-term relationships, higher levels of intimacy are associated with higher sexual desire, which is, in turn, associated with higher odds for partnered sexual activity to occur. The temporal association of increasing intimacy and subsequent sexual desire appears not to be different in women and men.

Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: a randomized controlled trial.

BACKGROUND: The number of cancer survivors is growing. Negative physical and psychosocial consequences of cancer treatment can occur during survivorship. Following healthy lifestyle recommendations is beneficial to increase quality of life and to reduce the risk of cancer recurrence and comorbidities. To meet individual needs, web-based interventions can supply a large population of cancer survivors with easily accessible and personalized information. Evidence concerning the long-term effects of web-based cancer aftercare interventions on lifestyle outcomes is limited. The present study evaluates the 12-month effects of a fully automated web-based cancer aftercare intervention. We investigated whether the previously determined 6-month effects on moderate physical activity and vegetable intake were maintained over 12 months. Possible moderator effects of using specific intervention modules, gender, age, and education were also explored. METHOD: A two-armed randomized controlled trial was conducted using online self-report questionnaires among survivors of various types of cancer (N = 462). The intervention group had access to the online intervention for 6 months, and the control group received access after 12-months. Multilevel linear regression analyses (complete cases and intention-to-treat) were conducted to explore 12- month effects. RESULTS: A significant intervention effect after 12 months was found for moderate physical activity (complete cases: B = 128.475, p = .010, d = .35; intention-to-treat: B = 129.473, p = .011). Age was the only significant moderator (p = .010), with the intervention being effective among participants aged younger than 57 years (B = 256.549, p = .000, d = .59). No significant intervention effect remained for vegetable consumption after 12 months (complete cases: B = 5.860, p = .121; intention-to-treat: B = 5.560, p = .132). CONCLUSION: The online cancer after care intervention is effective in increasing and maintaining moderate physical activity in the long term among early cancer survivors younger than 57 years. Short-term increases in vegetable consumption were not sustained in the long term. These findings indicate the value and potential of eHealth interventions for cancer survivors. Based on the study results, web-based self-management interventions could be recommended for younger cancer survivors (<57 years of age) as a possible method to increase physical activity. TRIAL REGISTRATION: Dutch Trial Register NTR3375 . Registered 29 March 2012.

Decline in physical activity during adolescence is not associated with changes in mental health.

BACKGROUND: The majority of studies investigating associations between physical activity and mental health in adolescents have been cross-sectional in design. Potential associations between physical activity and mental health may be better examined longitudinally as physical activity levels tend to decrease in adolescence. Few studies have investigated these associations longitudinally in adolescents and none by measuring physical activity objectively. METHODS: A total of 158 Dutch adolescents (mean age 13.6 years, 38.6% boys, grades 7 and 9 at baseline) participated in this longitudinal study. Physical activity, depressive symptoms and self-esteem were measured at baseline and at the 1-year follow-up. Physical activity was objectively measured with an ActivPAL3™ accelerometer during one full week. Depressive symptoms were measured with the Center for Epidemiologic Studies Depression Scale (CES-D) and self-esteem was assessed with the Rosenberg Self-Esteem Scale (RSE). Results were analysed using structural equation modelling. RESULTS: Physical activity levels decreased 15.3% over a 1-year period (p < .001), with significantly (p = .001) greater decreases during grade 7 (-20.7%) than during grade 9 (-5.0%). Overall, depressive symptoms decreased (-12.1%, p < .001) over a 1-year period, while self-esteem did not change significantly (+2.9%, p = .066). Higher levels of depressive symptoms at baseline predicted a greater decline in depressive symptoms (ß = -.51, p < .001) and higher levels of self-esteem at baseline predicted a smaller increase in self-esteem (ß = -.48, p < .001). The decline in physical activity did not appear to predict any change in depressive symptoms and self-esteem. CONCLUSION: The decline in physical activity over a 1-year period during adolescence is not associated with a change in mental health. Further studies in adolescents aiming to investigate whether a change in physical activity is associated with a change in mental health should control for baseline levels of mental health and academic year differences.

Implicit and Explicit Associations with Erotic Stimuli in Sexually Functional and Dysfunctional Men.

INTRODUCTION: Although conceptual models of sexual functioning have suggested a major role for implicit cognitive processing in sexual functioning, this has thus far, only been investigated in women. AIM: The aim of this study was to investigate the role of implicit cognition in sexual functioning in men. METHODS: Men with (N = 29) and without sexual dysfunction (N = 31) were compared. MAIN OUTCOME MEASURES: Participants performed two single-target implicit association tests (ST-IAT), measuring the implicit association of visual erotic stimuli with attributes representing, respectively, valence ('liking') and motivation ('wanting'). Participants also rated the erotic pictures that were shown in the ST-IAT on the dimensions of valence, attractiveness, and sexual excitement to assess their explicit associations with these erotic stimuli. Participants completed the International Index of Erectile Functioning for a continuous measure of sexual functioning. RESULTS: Unexpectedly, compared with sexually functional men, sexually dysfunctional men were found to show stronger implicit associations of erotic stimuli with positive valence than with negative valence. Level of sexual functioning, however, was not predicted by explicit nor implicit associations. Level of sexual distress was predicted by explicit valence ratings, with positive ratings predicting higher levels of sexual distress. CONCLUSIONS: Men with and without sexual dysfunction differed significantly with regard to implicit liking. Research recommendations and implications are discussed.

Effects of a music therapy and music listening intervention for nursing home residents with dementia: a randomized controlled trial.

Introduction: The aim of the present study was to evaluate the effects of an individual music therapy intervention and an individual music listening intervention on neuropsychiatric symptoms and quality of life in people with dementia living in a nursing home and on professional caregiver's burden to be able to make statements about their specific value of application in clinical practice. Methods: A multicenter single blind randomized controlled trial with three groups was performed: an individual music therapy intervention (IMTI) group (n = 49), an individual music listening intervention (IMLI) group (n = 56) and a control group (n = 53) receiving usual care. The interventions were given during three weeks, three times a week on non-consecutive days during 30-45 minutes for in total nine sessions. The endpoint of the study is the difference from baseline to interim (1,5 week), post-intervention (3 weeks) and follow-up (6 weeks) in reported scores of problem behaviour (NPI-NH) and quality of life (Qualidem) in people with dementia and occupational disruptiveness (NPI-NH) in care professionals. Results: In total 158 people with dementia were randomized to one of the two intervention groups or the control group. Multilevel analyses demonstrated that hyperactive behaviour assessed by the NPI-NH was significantly more reduced for the IMLI group at follow up and that restless behaviour assessed by the Qualidem was significantly more reduced for the IMTI group at post and follow-up measurement compared to the control group. No significant effects between groups were found in other NPI-NH clusters or Qualidem subscales. Conclusion: In conclusion, because we found no convincing evidence that the IMTI or IMLI is more effective than the other both interventions should be considered in clinical practice. For the future, we advise further research into the sustainability of the effects with alternative designs, like a single case experimental design.

The efficacy of online physical activity interventions with added mobile elements within adults aged 50 years and over: Randomized controlled trial.

Electronic health (eHealth) and mobile health (mHealth) could stimulate physical activity (PA) in a time-efficient and cost-effective way. This randomized controlled trial aims to investigate effects on moderate-to-vigorous PA (MVPA) of different combined computer- and mobile-based PA interventions targeted at adults aged 50 years and over. Participants (N = 954) were randomly allocated to a basic existing computer-based intervention (Active Plus [AP] or I Move [IM]) supplemented with one of three mobile elements being (1) activity tracker (AT), (2) ecological momentary intervention (EMI), or (3) chatbot (CB) or a control group (CG). MVPA was assessed via the SQUASH at baseline (T0), 3 months (T1), and 6 months (T2) and via accelerometers at T0 and T2. No intervention effects were found on objective (p = .502) and subjective (p = .368) MVPA for main research groups (AP/IM + AT, AP/IM + EMI, AP/IM + CB). Preliminary MVPA findings for subgroups (AP + AT, AP + EMI, AP + CB, IM + AT, IM + EMI, IM + CB) combined with drop-out data showed potential for the computer-based intervention AP with an integrated AT. Based on these preliminary findings, eHealth developers can be recommended to integrate ATs with existing computer-based PA interventions. However, further research is recommended to confirm the findings as a result of the exploratory nature of the subgroup analyses.

Choosing Health: acceptability and feasibility of a theory-based, online-delivered, tailored weight loss, and weight loss maintenance intervention.

Few weight loss and weight loss maintenance interventions are tailored to include factors demonstrated to predict the user's behavior. Establishing the feasibility and acceptability of such interventions is crucial. The aim of this study was to assess the acceptability and feasibility of a theory-based, tailored, online-delivered weight loss and weight loss maintenance intervention (Choosing Health). We conducted a mixed methods process evaluation of the Choosing Health tailored intervention, nested in a randomized controlled trial (N = 288) with an embedded N-of-1 study, investigating participants' and implementers' experiences related to intervention context, implementation, and mechanisms of impact. Measures included: (i) surveys, (ii) data-prompted interviews (DPIs) with study participants, (iii) semi-structured interviews with implementers, and (iv) intervention access and engagement data. Five themes described the acceptability of the intervention to participants: (i) monitoring behavior change and personal progress to better understand the weight management process, (ii) working collaboratively with the intervention implementers to achieve participants' goals, (iii) perceived benefits of non-judgmental and problem-solving tone of the intervention, (iv) changes in personal perception of the weight management process due to intervention tailoring, and (v) insufficient intervention content tailoring. The intervention delivery was feasible, however, emails and text messages differed in terms of accessibility and resources required to deliver the content. The use of Ecological Momentary Assessment as a technique to gather personal data for further tailoring was acceptable, and facilitated behavior change monitoring. Personalization of the intervention content above and beyond domain-specific issues, for example, by addressing participants' social roles may better match their needs. Support from the implementers and feedback on body composition changes may increase participants' engagement.

People with overweight and obesity can benefit from participating in behavior change programs that are individually adjusted to participants' psychological characteristics. It is important to provide knowledge of how to design acceptable and feasible, widely accessible, sustainable tailored interventions for weight loss, and weight loss maintenance. We designed Choosing Health­a tailored intervention that matched intervention content to psychological factors that were demonstrated to influence each participant's behavior. This study assessed whether the Choosing Health program was acceptable and feasible from the point of view of program participants and people who worked directly with the participants. The intervention tailoring supported participants in changing the way they thought about the weight loss process, and regular tailored messages served as a cue to maintain healthy habits. However, tailoring based on psychological characteristics was insufficient for many participants, as they would have preferred more personalized content. We provide guidance on good practices to gather data for tailored support, monitor behavior change progress, and for communicating with participants, to improve the acceptability of tailored interventions. We also compare how acceptable participants found methods of intervention delivery (SMS messages, emails, handbook) to advise which methods are the most acceptable and preferred by participants.

The effects of autobiographic sexual memory recall on the sexual response of sexually functional men.

In this experimental study, we investigated how recalling positive, negative, and affectively neutral autobiographic sexual experiences in their personal history affected the current sexual response of sexually functional male volunteers. Based on an attentional-capacity account of sexual arousal, we predicted that affectively charged autobiographic sexual memory recall, both with negative and positive valence, would negatively impact genital arousal, compared to recalling affectively neutral sexual experiences. We expected that subjective sexual arousal would not be differentially affected by emotional memory valence. We measured subjective and genital response to erotic video fragments in sexually functional volunteers (N = 24) in a within-subjects, repeated-measures design. For the memory manipulation, participants received instructions to visualize and mentally re-experience positive, negative, and neutral sexual episodes from autobiographic memory. Memory instructions were found to result in the expected affective states. As predicted, compared to recalling neutral memory, mean genital response was significantly lower during recalling positive and negative memory. However, contrary to prediction, subjective sexual arousal was affected, when multilevel analysis was performed, including a time effect. The implications of the findings were discussed with respect to the advancement of theory and therapeutic intervention.

Effectiveness and mechanisms of the arts therapies in forensic care. A systematic review, narrative synthesis, and meta analysis.

Introduction: Mental health care provided to offenders with psychiatric problems in forensic settings mainly consists of verbal oriented treatments. In addition, experience-based therapies are used such as (creative) arts therapies: (visual) art therapy, music therapy, drama therapy and dance (movement) therapy. There are indications for effectiveness of arts therapies, but a systematic overview of effect studies of all arts therapies in forensic care is lacking. Methods: First, we performed a systematic review. Second, Thematic Analysis was used to synthesize the qualitative narrative results and define the hypothesized mechanisms of change. Third, we performed a meta-analysis to investigate the effects of arts therapies in reducing psychosocial problems of offenders. Twenty-three studies were included in the review. Quality and risk of bias was assessed using EPHPP (Effective Public Health Practice Project). Results: The included studies were heterogeneous in type of outcome measures and intervention characteristics. Synthesis of mechanisms of change involved in the methodical use of the arts in arts therapies resulted in a description of regulatory processes which are stimulated in arts therapies: perceptive awareness (interoceptive and exteroceptive), the regulation of emotions, stress, impulses, cognitions, social regulation, and self-expression. These processes play a role in developing prevention, coping and self-management skills. Eighteen studies were included in the meta-analyses (11 RCTs/CCTs; 7 pre-post studies). The meta-analyses indicated significant effects on both risk factors (psychiatric symptoms and addiction) and protective factors for criminal behavior (social functioning and psychological functioning). Effects on criminal and/or antisocial behavior were not significant, but this outcome measure was scarcely used among the studies. Discussion: The analyses in this study should be considered explorative. More research is needed to gain more solid conclusions about effectiveness and mechanisms of change of arts therapies in forensic institutions. However, the results of this first systematic review, synthesis of mechanisms and meta-analysis in this field are promising and show effects of arts therapies on risk and protective factors in individuals in forensic institutions. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020217884, identifier: CRD42020217884.

Drug behaviors, sexually transmitted infection prevention, and sexual consent during chemsex: insights generated in the Budd app after each chemsex session.

Chemsex refers to the intentional use of drugs before or during sex in a specific context, typically involving prolonged sex sessions with multiple partners. Engaging in chemsex is associated with a wide range of health risks and related risk behaviors. We developed a mobile phone application ('Budd-app') to support and inform chemsex participants, reduce potential negative impacts associated with chemsex (e.g., physical, psychological and social health harms), and encourage more reasoned participation. During Budd's development process, 11 participants completed a survey after each chemsex session they attended. This data collection approach provided precise experiences on drug related behavior, prevention measures for sexually transmitted infection and sexual consent on 63 chemsex sessions. The mean duration of chemsex sessions was 17.5 h. Polydrug use was reported during 95% of chemsex sessions with an average of 3.5 agents per session. Unsafe dosing occurred at 49% of chemsex sessions, and 9/11 participants dosed unsafely at least once. Seven participants did not consistently take measures to prevent STI transmission. Nine had experienced peer pressure, both regarding drug use and sexual health. The same number reported sex without consent, not respecting others' boundaries as well as their own boundaries not being respected. Many participants experienced negative impact of their chemsex behavior during (7/9) and after (8/9) chemsex. Through participants' behavior assessment during multiple chemsex sessions, 'within-person' variability can be clarified. This clarification provides valuable insights in personal, emotional and contextual vulnerabilities. These insights can direct an individualized care and support trajectory aimed at addressing those vulnerabilities.

'A healthy lifestyle is a journey': exploring health perceptions and self-defined facilitators to health through photo-elicitation.

OBJECTIVE: The aim of this study was to explore health perceptions and self-defined facilitators to health in general population. An additional aim of the study was to assess if these perceptions were connected with the context of the Covid-19 pandemic. DESIGN: We applied photo-elicitation method by gathering original photographs and narratives (captions) via social media and e-mails. Participants (N = 50) were asked to answer the question: 'What does it mean to be healthy?'. Data were collected online in Poland. We generated and interpreted the main themes associated with common perceptions of health and self-defined facilitators to health using polytextual thematic analysis. RESULTS: The health perception themes were, health as: a 'long journey'; keeping balance; and self-acceptance. The main facilitators to health were: enjoyment of activities that are part of a healthy lifestyle; planning time for rest; contact with nature, and supportive relationships. Participants' perceptions of how Covid-19 impacted on their health differed. CONCLUSIONS: The findings provide evidence for individual health perceptions and self-defined facilitators to health and can support the development of future health interventions.

Emotionally focused couple therapy in cancer survivor couples with marital and sexual problems: a replicated single-case experimental design.

Objective: The current research examined the effect of Emotionally Focused Couples Therapy (EFCT) on perceived intimacy, affect, and dyadic connection in cancer survivor couples with relationship challenges. Method: In this longitudinal replicated single-case study, positive and negative affect, intimacy, partner responsiveness, and expression of attachment-based emotional needs were reported every 3 days before and during treatment. Thirteen couples, with one partner having survived colorectal cancer or breast cancer, participated for the full duration of the study. Statistical analysis of the data was performed using randomization tests, piecewise regression, and multilevel analyses. Results: Adherence to the therapeutic protocol was tested and found adequate. Compared with baseline, significant positive effects on affect variables were found during the therapeutic process. Positive affect increased and negative affect decreased. Partner responsiveness, perceived intimacy, and the expression of attachment-based emotional needs improved, but only in the later phase of treatment. Results at the group level were statistically significant, whereas effects at the individual level were not. Discussion: This study found positive group-level effects of EFCT on affect and dyadic outcome measures in cancer survivors. The positive results warrant further research, including randomized clinical trials, to replicate these effects of EFCT in cancer survivor couples experiencing marital and sexual problems.