A systematic review of behavioral headache interventions with an aerobic exercise component.

BACKGROUND: Behavioral approaches have been found to be effective in managing chronic headache. Recently, attention has been given to the role of exercise in chronic headache management, although much of the literature addresses it as a monotherapy. The current review assesses the effectiveness of exercise as an adjunct to other behavioral treatments for chronic headache. OBJECTIVE: To evaluate the methodology and outcomes of studies using behavioral headache interventions with an aerobic exercise component. METHODS: A systematic literature review was conducted on PubMed and PsychInfo to identify studies that offered or recommended aerobic exercise as part of a multicomponent treatment for headaches. The search included only those articles that were written in English and published in academic journals. RESULTS: Nine studies met inclusion criteria, of which 2 were randomized controlled trials. Despite methodological limitations, results of existing studies suggest that the behavioral headache interventions that include aerobic exercise may be associated with positive outcomes for headache variables. Four single-group studies reported statistically significant improvements in at least 1 headache variable at the end of treatment. Both randomized controlled trials and 1 non-randomized trial reported statistically significant post-treatment improvement in at least 1 headache outcome variable in the intervention group compared with control groups. CONCLUSIONS: Incorporating exercise into behavioral headache treatments appears to be promising, but as studies to date have not evaluated the individual contribution of exercise, its role in managing headache symptoms is unclear. Further work is needed to evaluate the unique role of exercise in such treatment programs. Recommendations for future research include adhering to published guidelines for clinical trial design and reporting, adhering to existing guidelines for headache research (such as reporting outcome data for multiple headache variables), developing exercise prescriptions based on public health recommendations, and reporting all aspects of exercise prescriptions.

The Smoking-Related Weight and Eating Episodes Test (SWEET): development and preliminary validation.

INTRODUCTION: Many smokers believe that smoking helps them to control their weight, and concerns about weight gain can interfere with smoking cessation. As researchers typically assess general weight concerns, a measure specific to smoking-related weight concerns is needed. METHODS: The Smoking-related Weight and Eating Episodes Test (SWEET) was created by generating items from 4 content domains: Hunger, Craving, Overeating, and Body Image. Female undergraduate smokers (N = 280) rated their postcessation weight gain concern and completed the SWEET, Fagerström Test for Nicotine Dependence, Brief Smoking Consequences Questionnaire-Adult, Eating Attitudes Test (EAT)-26, Bulimia Test-Revised (BULIT-R), and Body Shape Questionnaire. RESULTS: Factor analysis of the initial items suggested a 4-factor solution, suggesting 4 subscales: Smoking to suppress appetite, smoking to prevent overeating, smoking to cope with body dissatisfaction, and withdrawal-related appetite increases. Based on these results, the SWEET subscales were revised and shortened. The resulting 10-item SWEET showed excellent internal consistency (total α = .94; mean α = .86) and evidence of validity by predicting smoking frequency, eating pathology, and body image concerns (ps < .05). Smoking frequency, eating pathology, and body image concerns were significantly predicted by the SWEET while controlling for existing measures of postcessation weight gain concern. CONCLUSIONS: The SWEET appears to be a reliable and valid measure of tendencies to smoke in response to body image concern and nicotine withdrawal and as a way to control appetite and overeating.

Clarifying the linguistic signature: measuring personality from natural speech.

In this study, we examined the viability of measuring personality using computerized lexical analysis of natural speech. Two well-validated models of personality were measured, one involving trait positive affectivity (PA) and negative affectivity (NA) dimensions and the other involving a separate behavioral inhibition motivational system (BIS) and a behavioral activation motivational system (BAS). Individuals with high levels of trait PA and sensitive BAS expressed high levels of positive emotion in their natural speech, whereas individuals with high levels of trait NA and sensitive BIS tended to express high levels of negative emotion. The personality variables accounted for almost a quarter of the variance in emotional expressivity.

Fear of fatness and drive for thinness in predicting smoking status in college women.

Recent research has identified fear of fatness (FF) as a related yet distinct construct from drive for thinness (DT). Whereas DT may be associated with need for approval and an "approach" tendency, FF may be more strongly related to avoidance of disapproval and an avoidant problem-solving style. Although no research has directly compared the influence of FF vs. DT with regard to smoking behavior, FF and DT might represent distinct motivations for smoking. We predicted that both FF and DT would be significantly associated with cigarette smoking, but that FF would be a stronger predictor of smoking behavior, even after controlling for variables such as body mass index (BMI) and nicotine dependence. Participants (N=289) were female college undergraduate students. Daily smokers had the highest scores on measures of DT and FF, followed sequentially by infrequent smokers, "triers," and never smokers. More frequent smokers also reported greater levels of body dissatisfaction and eating pathology than less frequent and never-smokers. Hierarchical regression analyses showed that greater DT predicted higher likelihood of smoking on a daily basis; however, higher FF predicted fewer cigarettes smoked per day. FF and DT may each play a role in the relationship between eating pathology and smoking, but they might be differentially related to specific smoking patterns. Both FF and DT and their coinciding coping styles should be further researched in the role of smoking initiation and maintenance.

Smoking relapse and weight gain prevention program for postmenopausal weight-concerned women: A pilot study.

OBJECTIVE: Postmenopausal women have substantial concerns about weight gain when quitting smoking, which may contribute smoking relapse. There is a need for smoking cessation and weight gain prevention programs effective in this population. METHODS: Two formats of a smoking cessation/weight gain prevention follow-up intervention in postmenopausal weight concerned women were compared: a minimally-tailored group format and a highly tailored, multidisciplinary individual format. Effects on sustained abstinence and postcessation weight gain were assessed. Postmenopausal smokers received 6 sessions of behavioral counseling over a 2-week period, 8weeks of the nicotine transdermal patch, and subsequent random assignment to receive follow-up relapse prevention sessions at 1, 3, 8, and 16weeks postcessation in either group or individual format. RESULTS: The sample (N=98) was 67% Caucasian and 33% African-American. Age: m=52.3 (7.8) years, follicle stimulating hormone: m=42.6 (25.7), body mass index (BMI): m=27.4 (6.2), daily smoking rate: m=20.3 (11.5), for m=29.4 (10.7) years, Fagerström Test for Nicotine Dependence (FTND): m=6.4 (2.1), and carbon monoxide: m=23.8 (13.0) ppm. Abstinence rates in the group condition were significantly higher at 8weeks posttreatment. Group format significantly predicted abstinence rates at 8 and 16weeks posttreatment, even while controlling for age, race, BMI, CPD, years smoking, FTND, and weight concern. Weight concern predicted postcessation weight gain at 8 and 16weeks posttreatment. CONCLUSIONS: Results indicate that smoking cessation programs for postmenopausal women may best be delivered in a group format and that postcessation weight concerns be dealt with prior to a quit date.

Disordered eating and body image in Chinese and Caucasian students in the United States.

OBJECTIVE: This study evaluated the roles of exposure to Western culture and language choice and gender differences in disordered eating symptoms in Chinese and Caucasian students. METHOD: 796 Caucasian and 194 Chinese students completed measures of eating disorder symptoms, body image, and body esteem. Participants chose their survey language (English or Chinese). RESULTS: Caucasian women had higher levels of body dissatisfaction than Chinese women. Women of both ethnicities reported more disordered eating symptoms and body dissatisfaction than men; these differences were smaller for the Chinese group. Differences emerged on certain dimensions of body esteem between Chinese women who responded in Chinese and those who responded in English. CONCLUSIONS: There were few differences between ethnicities, suggesting that mechanisms other than Western culture play a role. Cultural variables may account for the degree of intra-ethnic gender differences. Individuals who complete studies in their native language may differ from their English-responding counterparts in areas of body esteem.

Tobacco use and substance use disorders as predictors of postoperative weight loss 2 years after bariatric surgery.

Although evaluations of tobacco and substance use disorders (SUDs) are required before bariatric surgery, the impact of these factors on postsurgical outcomes is unclear. This study describes (1) the prevalence of tobacco and SUDs in 61 veterans undergoing bariatric surgery, (2) associations between presurgical tobacco use and postsurgical weight loss, and (3) relationships between presurgical SUDs and postsurgical weight loss. Height, weight, tobacco, and SUDs were assessed from medical charts at presurgery and 6, 12, and 24 months postsurgery. Thirty-three patients (55%) were former or recent tobacco users; eight (13%) had history of SUDs. All patients who quit smoking within 6 months before surgery resumed after surgery, which was associated with increased weight loss at 6 and 12 months. Presurgical SUDs were related to marginally worse weight loss at 12 and 24 months. Bariatric surgery candidates with history of smoking and/or SUDs might benefit from additional services to improve postsurgical outcomes.

Craving and physiological reactivity to trauma and alcohol cues in posttraumatic stress disorder and alcohol dependence.

The high comorbidity of posttraumatic stress disorder (PTSD) and alcohol dependence (AD) has been firmly established. Although laboratory studies have examined self-reported craving in response to trauma and alcohol cues, no studies have reported on alcohol-related physiological responding in response to trauma cues in PTSD-AD individuals. Using a cue reactivity paradigm, this study examined the impact of personalized trauma-image cues and in vivo alcohol cues on alcohol-related responding (e.g., salivation, craving) in individuals with PTSD and AD (n = 40). Participants displayed reactivity to both trauma and alcohol cues when compared to neutral cues, including increased self-reported craving and distress, as well as greater salivation. These findings suggest that through repeated pairings of trauma memories and alcohol consumption, salivation may become classically conditioned to trauma cues. Moreover, the fact that the trauma-alcohol cue combination elicited greater alcohol craving, salivary responding, distress, and arousal than either the trauma-neutral or neutral-alcohol cue combinations suggests that effects of the trauma and alcohol cues were additive in nature. Evidence that AD individuals with PTSD report increased alcohol craving and display greater salivation in response to trauma memories, supplements prior research indicating that PTSD-related negative emotion and trauma-related alcohol craving may play an important role in the maintenance of AD.

Cigarette smoking is associated with body shape concerns and bulimia symptoms among young adult females.

Elevated rates of cigarette smoking have been reported among individuals with Bulimia Nervosa. However, little is known about eating disorder symptoms within non-clinical samples of smokers. The purpose of the present study was to compare the eating disorder symptoms of young adult female smokers (n=184) and non-smokers (n=56), to determine whether smokers were more likely to endorse bulimic symptoms and report greater body shape concern than non-smokers. Analyses indicated that smokers scored significantly higher than non-smokers on the Body Shape Questionnaire, p=.03, and the Bulimia Test-Revised, p=.006. In addition, a higher proportion of smokers than non-smokers scored > or = 85 on the Bulimia Test-Revised, p=.05, suggesting the possibility that Bulimia Nervosa diagnoses were more prevalent among smokers. No differences were found between smokers and non-smokers on other measures of eating behavior. Overall, findings suggest that smoking is specifically associated with symptoms of Bulimia Nervosa and body shape concern among young adult females.

The effect of food deprivation on cigarette smoking in females.

Food deprivation is associated with increased self-administration of nicotine and other substances in laboratory animals, although little is known about the effects of food deprivation on substance use in humans. A within-subjects design was utilized to test the primary hypotheses that smoking rate and expired carbon monoxide (CO) levels would be greater among 15 female participants following a 24-hour fasting period than when participants were not food-deprived. Food-deprived participants were also expected to endorse greater negative mood, smoking urges, and pleasure from smoking, as well as less positive mood. Analyses indicated that CO levels were significantly greater in the food-deprived condition than in the non-deprived condition (p=.05), although no differences were found in the number of cigarettes smoked during the laboratory session. Participants reported significantly lower Vigor-Activity in the food-deprived condition (p=.02). No differences were found between conditions in urges to smoke or pleasure from smoking. Findings suggest that nicotine intake may increase among females during acute food deprivation.