Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis.

BACKGROUND: Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE: To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES: 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION: Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION: Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS: Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS: High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION: There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE: National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).

Exploring women's thoughts on self-weighing during pregnancy: results of the Self-Weighing in Pregnancy: Experiences (SWIPE) study.

BACKGROUND: Excess gestational weight gain is common and an important risk factor for adverse pregnancy outcomes. Regular weighing can be used to assess and manage weight gain, but NICE guidelines do not recommend routine weighing during antenatal care. Trials that have tested the effectiveness of self-weighing to manage GWG have been unsuccesful in engaging women in regular self-weighing, although the reasons for lack of engagement are not fully understood. This study aimed to understand why this lack of engagement occurred by exploring the naturally occurring thoughts and feelings of pregnant women (9 to 15 weeks gestational age) who were asked to weigh themselves at home. METHODS: Twenty-five women were recruited to take part. Participants completed short questionnaires at their first-trimester and 20-week scans. After recruitment, participants were asked to weigh themselves at roughly the same time each week for 8 weeks. Whilst they weighed themselves they were asked to audio-record their current weight and describe any thoughts or feelings that occurred as they weighed themselves. These audio recordings were then sent to researchers using a secure messaging service. RESULTS: Most of the recruited women (56%) were unaware of guidelines for gestational weight gain, and only 40% could identify the ideal rate of GWG for their BMI group. Thematic analysis of the think-aloud recordings resulted in three main themes: "understanding weight gain in pregnancy", "taking action to prevent weight gain" and "reactions to self-weighing". Overall, there was a relatively positive response to self-weighing and some participants used self-weighing to reflect on the reasons for weight gain and plan actions they could take to avoid excess gain. Negative emotional responses tended to be related to a lack of guidance about what level of weight gain or loss was "healthy", or to other worries about the pregnancy. Of the women recruited who submitted at least one think aloud recording (n 10), 80% found self-weighing to be useful, and said they would likely continue to self-weigh at home. CONCLUSIONS: Women had complex emotions about self-weighing during pregnancy but overall found it useful, suggesting it could be encouraged as part of self-regulatory interventions to control GWG. Clear guidelines about appropriate gestational weight gain could help to reduce anxiety. TRIAL REGISTRATION: The study was prospectively registered with ISRCTN ISRCTN10035244 .

Cognitive-behavioral and electrophysiological evidence of the affective consequences of ignoring stimulus representations in working memory.

Ignoring visual stimuli in the external environment leads to decreased liking of those items, a phenomenon attributed to the affective consequences of attentional inhibition. Here we investigated the generality of this "distractor devaluation" phenomenon by asking whether ignoring stimuli represented internally within visual working memory has the same affective consequences. In two experiments we presented participants with two or three visual stimuli and then, after the stimuli were no longer visible, provided an attentional cue indicating which item in memory was the target they would have to later recall, and which were task-irrelevant distractors. Participants subsequently judged how much they liked these stimuli. Previously-ignored distractors were consistently rated less favorably than targets, replicating prior findings of distractor devaluation. To gain converging evidence, in Experiment 2, we also examined the electrophysiological processes associated with devaluation by measuring individual differences in attention (N2pc) and working memory (CDA) event-related potentials following the attention cue. Larger amplitude of an N2pc-like component was associated with greater devaluation, suggesting that individuals displaying more effective selection of memory targets-an act aided by distractor inhibition-displayed greater levels of distractor devaluation. Individuals showing a larger post-cue CDA amplitude (but not pre-cue CDA amplitude) also showed greater distractor devaluation, supporting prior evidence that visual working-memory resources have a functional role in effecting devaluation. Together, these findings demonstrate that ignoring working-memory representations has affective consequences, and adds to the growing evidence that the contribution of selective-attention mechanisms to a wide range of human thoughts and behaviors leads to devaluation.

Relative toxicity of mood stabilisers and antipsychotics: case fatality and fatal toxicity associated with self-poisoning.

BACKGROUND: Bipolar and other psychiatric disorders are associated with considerably increased risk of suicidal behaviour, which may include self-poisoning with medication used to treat the disorder. Therefore, choice of medication for treatment should include consideration of toxicity, especially for patients at risk. The aim of this study was to estimate the relative toxicity of specific drugs within two drug categories, antipsychotics and mood stabilizers, using large-scale databases to provide evidence that could assist clinicians in making decisions about prescribing, especially for patients at risk of suicidal behaviour. METHOD: Two indices were used to assess relative toxicity of mood stabilisers and antipsychotics: case fatality (the ratio between rates of fatal and non-fatal self-poisoning) and fatal toxicity (the ratio between rates of fatal self-poisoning and prescription). Mood stabilisers assessed included lithium [reference], sodium valproate, carbamazepine, and lamotrigine, while antipsychotics included chlorpromazine [reference], clozapine, olanzapine, quetiapine and risperidone. Fatal self-poisoning (suicide) data were provided by the Office for National Statistics (ONS), non-fatal self-poisoning data by the Multicentre Study of Self-harm in England, and information on prescriptions by the Clinical Practice Research Datalink. The primary analysis focussed on deaths due to a single drug. Cases where the drug of interest was listed as the likely primary toxic agent in multiple drug overdoses were also analysed. The study period was 2005-2012. RESULTS: There appeared to be little difference in toxicity between the mood stabilisers, except that based on case fatality where multiple drug poisonings were considered, carbamazepine was over twice as likely to result in death relative to lithium (OR 2.37 95% CI 1.16-4.85). Of the antipsychotics, clozapine was approximately18 times more likely to result in death when taken in overdose than chlorpromazine (single drug case fatality: OR 18.53 95% CI 8.69-39.52). Otherwise, only risperidone differed from chlorpromazine, being less toxic (OR 0.06 95% CI 0.01-0.47). CONCLUSIONS: There was little difference in toxicity of the individual mood stabilisers. Clozapine was far more toxic than the other antipsychotics. The findings are relevant to prescribing policy, especially for patients at particular risk of suicidal behaviour.

Making Sense of an Unknown Terrain: How Parents Understand Self-Harm in Young People.

Self-harm is common in young people, and can have profound effects on parents and other family members. We conducted narrative interviews with 41 parents and other family members of 38 young people, aged up to 25, who had self-harmed. Most of the participants were parents but included one sibling and one spouse. This article reports experiences of the parent participants. A cross-case thematic analysis showed that most participants were bewildered by self-harm. The disruption to their worldview brought about by self-harm prompted many to undergo a process of "sense-making"-by ruminative introspection, looking for information, and building a new way of seeing-to understand and come to terms with self-harm. Most participants appeared to have been successful in making sense of self-harm, though not without considerable effort and emotional struggle. Our findings provide grounds for a deeper socio-cultural understanding of the impact of self-harm on parents.

Planning and optimising a digital intervention to protect older adults' cognitive health.

BACKGROUND: By 2050, worldwide dementia prevalence is expected to triple. Affordable, scalable interventions are required to support protective behaviours such as physical activity, cognitive training and healthy eating. This paper outlines the theory-, evidence- and person-based development of 'Active Brains': a multi-domain digital behaviour change intervention to reduce cognitive decline amongst older adults. METHODS: During the initial planning phase, scoping reviews, consultation with PPI contributors and expert co-investigators and behavioural analysis collated and recorded evidence that was triangulated to inform provisional 'guiding principles' and an intervention logic model. The following optimisation phase involved qualitative think aloud and semi-structured interviews with 52 older adults with higher and lower cognitive performance scores. Data were analysed thematically and informed changes and additions to guiding principles, the behavioural analysis and the logic model which, in turn, informed changes to intervention content. RESULTS: Scoping reviews and qualitative interviews suggested that the same intervention content may be suitable for individuals with higher and lower cognitive performance. Qualitative findings revealed that maintaining independence and enjoyment motivated engagement in intervention-targeted behaviours, whereas managing ill health was a potential barrier. Social support for engaging in such activities could provide motivation, but was not desirable for all. These findings informed development of intervention content and functionality that appeared highly acceptable amongst a sample of target users. CONCLUSIONS: A digitally delivered intervention with minimal support appears acceptable and potentially engaging to older adults with higher and lower levels of cognitive performance. As well as informing our own intervention development, insights obtained through this process may be useful for others working with, and developing interventions for, older adults and/or those with cognitive impairment.

The Active Brains Digital Intervention to Reduce Cognitive Decline in Older Adults: Protocol for a Feasibility Randomized Controlled Trial.

BACKGROUND: Increasing physical activity, improving diet, and performing brain training exercises are associated with reduced cognitive decline in older adults. OBJECTIVE: In this paper, we describe a feasibility trial of the Active Brains intervention, a web-based digital intervention developed to support older adults to make these 3 healthy behavior changes associated with improved cognitive health. The Active Brains trial is a randomized feasibility trial that will test how accessible, acceptable, and feasible the Active Brains intervention is and the effectiveness of the study procedures that we intend to use in the larger, main trial. METHODS: In the randomized controlled trial (RCT), we use a parallel design. We will be conducting the intervention with 2 populations recruited through GP practices (family practices) in England from 2018 to 2019: older adults with signs of cognitive decline and older adults without any cognitive decline. Trial participants were randomly allocated to 1 of 3 study groups: usual care, the Active Brains intervention, or the Active Brains website plus brief support from a trained coach (over the phone or by email). The main outcomes are performance on cognitive tasks, quality of life (using EuroQol-5D 5 level), Instrumental Activities of Daily Living, and diagnoses of dementia. Secondary outcomes (including depression, enablement, and health care costs) and process measures (including qualitative interviews with participants and supporters) will also be collected. The trial has been approved by the National Health Service Research Ethics Committee (reference 17/SC/0463). RESULTS: Results will be published in peer-reviewed journals, presented at conferences, and shared at public engagement events. Data collection was completed in May 2020, and the results will be reported in 2021. CONCLUSIONS: The findings of this study will help us to identify and make important changes to the website, the support received, or the study procedures before we progress to our main randomized phase III trial. TRIAL REGISTRATION: International Standard Randomized Controlled Trial Number 23758980; http://www.isrctn.com/ISRCTN23758980. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/18929.

Changes in parenting strategies after a young person's self-harm: a qualitative study.

BACKGROUND: When faced with the discovery of their child's self-harm, mothers and fathers may re-evaluate their parenting strategies. This can include changes to the amount of support they provide their child and changes to the degree to which they control and monitor their child. METHODS: We conducted an in-depth qualitative study with 37 parents of young people who had self-harmed in which we explored how and why their parenting changed after the discovery of self-harm. RESULTS: Early on, parents often found themselves "walking on eggshells" so as not to upset their child, but later they felt more able to take some control. Parents' reactions to the self-harm often depended on how they conceptualised it: as part of adolescence, as a mental health issue or as "naughty behaviour". Parenting of other children in the family could also be affected, with parents worrying about less of their time being available for siblings. Many parents developed specific strategies they felt helped them to be more effective parents, such as learning to avoid blaming themselves or their child for the self-harm and developing new ways to communicate with their child. Parents were generally eager to pass their knowledge on to other people in the same situation. CONCLUSIONS: Parents reported changes in their parenting behaviours after the discovery of a child's self-harm. Professionals involved in the care of young people who self-harm might use this information in supporting and advising parents.

The impact of self-harm by young people on parents and families: a qualitative study.

OBJECTIVES: Little research has explored the full extent of the impact of self-harm on the family. This study aimed to explore the emotional, physical and practical effects of a young person's self-harm on parents and family. DESIGN AND PARTICIPANTS: We used qualitative methods to explore the emotional, physical and practical effects of a young person's self-harm on their parents and family. We conducted a thematic analysis of thirty-seven semistructured narrative interviews with parents of young people who had self-harmed. RESULTS: After the discovery of self-harm, parents described initial feelings of shock, anger and disbelief. Later reactions included stress, anxiety, feelings of guilt and in some cases the onset or worsening of clinical depression. Social isolation was reported, as parents withdrew from social contact due to the perceived stigma associated with self-harm. Parents also described significant impacts on siblings, ranging from upset and stress to feelings of responsibility and worries about stigma at school. Siblings had mixed responses, but were often supportive. Practically speaking, parents found the necessity of being available to their child often conflicted with the demands of full-time work. This, along with costs of, for example, travel and private care, affected family finances. However, parents generally viewed the future as positive and hoped that with help, their child would develop better coping mechanisms. CONCLUSIONS: Self-harm by young people has major impacts on parents and other family members. Clinicians and staff who work with young people who self-harm should be sensitive to these issues and offer appropriate support and guidance for families.

Stimulus-category competition, inhibition, and affective devaluation: a novel account of the uncanny valley.

Stimuli that resemble humans, but are not perfectly human-like, are disliked compared to distinctly human and non-human stimuli. Accounts of this "Uncanny Valley" effect often focus on how changes in human resemblance can evoke different emotional responses. We present an alternate account based on the novel hypothesis that the Uncanny Valley is not directly related to 'human-likeness' per se, but instead reflects a more general form of stimulus devaluation that occurs when inhibition is triggered to resolve conflict between competing stimulus-related representations. We consider existing support for this inhibitory-devaluation hypothesis and further assess its feasibility through tests of two corresponding predictions that arise from the link between conflict-resolving inhibition and aversive response: (1) that the pronounced disliking of Uncanny-type stimuli will occur for any image that strongly activates multiple competing stimulus representations, even in the absence of any human-likeness, and (2) that the negative peak of an 'Uncanny Valley' should occur at the point of greatest stimulus-related conflict and not (in the presence of human-likeness) always closer to the 'human' end of a perceptual continuum. We measured affective responses to a set of line drawings representing non-human animal-animal morphs, in which each continuum midpoint was a bistable image (Experiment 1), as well as to sets of human-robot and human-animal computer-generated morphs (Experiment 2). Affective trends depicting classic Uncanny Valley functions occurred for all continua, including the non-human stimuli. Images at continua midpoints elicited significantly more negative affect than images at endpoints, even when the continua included a human endpoint. This illustrates the feasibility of the inhibitory-devaluation hypothesis and the need for further research into the possibility that the strong dislike of Uncanny-type stimuli reflects the negative affective consequences of cognitive inhibition.

Hot or not: response inhibition reduces the hedonic value and motivational incentive of sexual stimuli.

The motivational incentive of reward-related stimuli can become so salient that it drives behavior at the cost of other needs. Here we show that response inhibition applied during a Go/No-go task not only impacts hedonic evaluations but also reduces the behavioral incentive of motivationally relevant stimuli. We first examined the impact of response inhibition on the hedonic value of sex stimuli associated with strong behavioral-approach responses (Experiment 1). Sexually appealing and non-appealing images were both rated as less attractive when previously encountered as No-go (inhibited) than as Go (non-inhibited) items. We then discovered that inhibition reduces the motivational incentive of sexual appealing stimuli (Experiment 2). Prior Go/No-go status affected the number of key-presses by heterosexual males to view erotic-female (sexually appealing) but not erotic-male or scrambled-control (non-appealing) images. These findings may provide a foundation for developing inhibition-based interventions to reduce the hedonic value and motivational incentive of stimuli associated with disorders of self-control.

The affective consequences of cognitive inhibition: devaluation or neutralization?

Affective evaluations of previously ignored visual stimuli are more negative than those of novel items or prior targets of attention or response. This has been taken as evidence that inhibition has negative affective consequences. But inhibition could act instead to attenuate or "neutralize" preexisting affective salience, predicting opposite effects for stimuli that were initially positive or negative in valence. We tested this hypothesis by presenting trustworthy and untrustworthy faces (Experiment 1), strongly positive and negative photographs (Experiment 2), and monetary gain- and loss-associated patterns (Experiment 3) in a Go/No-Go task and assessing subsequent affective ratings. Evaluations of prior No-Go (inhibited) stimuli were more negative than of prior Go (noninhibited) stimuli, regardless of a priori affective valence. Ratings of No-Go stimuli also became increasingly negative (vs. increasingly neutral) when preexisting salience was increased via stimulus repetition (Experiment 4). Our results suggest inhibition leads to affective devaluation, not affective neutralization.

Manipulations of attention enhance self-regulation.

Successful goal-directed behavior requires self-regulation to override competing impulses. Emerging evidence suggests that attention may mediate such acts, but little is known about the specific operations through which attention might influence self-regulation. Here we test this often-implicit assumption by manipulating attention mechanisms in two ways: one controlling the inhibition of inappropriate responses; the other controlling the breadth of attention. Participants significantly improved their performance on a self-regulation task after practice on a response inhibition task (Experiment 1) and after the induction of a broad focus of attention in a visual discrimination task (Experiment 2). We propose that such manipulations enhance self-regulation by engaging mechanisms that enhance the salience of goal-related representations and reduce the activation of competing goal-irrelevant neural representations. By more efficiently resolving conflict among the signals vying to drive behavior, pre-engaging attention may also help to conserve resources needed for continued self-regulation.