The role of the communicated treatment rationale on treatment outcome: study protocol for a randomized controlled trial.

BACKGROUND: Placebo effects are a well-established phenomenon in the treatment of depression. However, the mechanism underlying these effects are not fully understood. Treatment expectations are considered one explanation for why placebos work. Treatment expectations are likely to be affected by clinician-patient interactions. This study aims to investigate the role of the communicated treatment rationale in modulating treatment expectations and its effects on the treatment outcomes of a pharmacological and a psychological active placebo intervention for depression. In this study, treatment expectations are modulated by presenting illness models that are either congruent or incongruent with the treatment intervention that follows. METHODS: This 2 × 2 randomized controlled trial will involve patients with major depression. Participants will either receive a biological or a psychological illness model from a clinician. Following this, they are randomly assigned to receive either a pharmacological or a psychological active placebo intervention. The illness model and the treatment are either congruent or incongruent with each other, resulting in four groups. In addition, a natural course control group will be included. DISCUSSION: This study will provide insights into the mechanism of expectation modulation in active placebo treatments for major depression. The results may provide insights for clinicians to improve their communication with patients by focusing on treatment expectations. By identifying the factors that contribute to placebo effects, this study has the potential to improve the effectiveness of existing depression treatments and reduce the burden of this highly prevalent mental health condition. TRIAL REGISTRATION: This trial has been registered prospectively at ClinicalTrials.gov under the identifier: NCT04719663. Registered on January 22, 2021.

Low mindfulness is related to poor sleep quality from middle adolescents to emerging adults: a process model involving resilience and emotional dysfunction.

OBJECTIVES: Transitions from middle adolescence into merging adulthood, a life stage between age 15-25, has a high prevalence of sleep problems. Mindfulness is a trait defined as being attentive to the present moment which positively relates to sleep quality. In this study, we aimed to investigate how resilience and emotional dysfunction may influence the relationship between trait mindfulness and sleep quality. METHODS: The Five Facet Mindfulness Questionnaire, Connor-Davidson Resilience Scale, Pittsburgh Sleep Quality Index and Depression Anxiety Stress Scales were used to measure the key variables through an online survey of 497 participants between middle adolescence and emerging adults (317 females, mean age 18.27 ± 0.76 years). A process model was built to investigate the mediating roles of resilience and emotional dysfunction in the impact of trait mindfulness on sleep quality, together with the relationships between their specific components. RESULTS: We found a positive association between mindfulness and sleep quality through resilience and through emotional dysfunction, and through the sequential pathway from resilience to emotional dysfunction. Of note, acting with awareness (mindfulness facet) showed significant indirect effects on sleep quality, mediated by resilience and emotional dysfunction. CONCLUSIONS: Our findings may unveil the underlying mechanisms of how low mindfulness induces poor sleep quality. The findings indicate that conceiving mindfulness as a multifaceted construct facilitates comprehension of its components, relationships with other variables, and underscores its potential clinical significance given its critical implications for mental health.

The role of mindfulness and dysexecutive functioning in the association between depression and COVID-19-related stress: cross-sectional and longitudinal analyses.

Background: Since the COVID-19 outbreak, the severity of college student's mental health has increased, with depression being the most prominent. This study's primary purpose was to explore (1) whether the perceived stress of COVID-19 was associated with depression through sequential mediation of mindfulness and dysexecutive function and also (2) the temporal association among mindfulness, dysexecutive function and depression.Methods: We performed two studies to evaluate dysexecutive function as a mechanism through which mindfulness impacts depression under the stress of the COVID-19 pandemic. Study 1 used a sequential mediation model to test the mediating role of mindfulness and dysexecutive function between the perceived stress of COVID-19 and depression based on 1,665 emerging adults. Study 2 used a random-effect, cross-lagged panel model (RE-CLPM) to test the directionality among mindfulness, dysexecutive function, and depression based on 370 emerging adults.Results: The cross-sectional study showed that perceived stress of COVID-19 was positively associated with depression through the sequential mediation of mindfulness and dysexecutive function (effect: 0.08, 95%CI = [0.07, 0.10]), also through the mediation of mindfulness (effect: 0.05, 95%CI = [0.03, 0.06]) and dysexecutive function (effect: 0.08, 95%CI = [0.06, 0.10]) separately. The RE-CLPM study indicated that dysexecutive function mediates the reciprocal relation between mindfulness and depression at the within-person level.Conclusion: These results suggest that dysexecutive function is an intermediate psychological mechanism that exacerbates depression under pandemic-related stress. Mindfulness can predict dysexecutive function and subsequently improve depression. As depression under pandemic-related stress can weaken the mindful state, long-term mindfulness practices are needed to maintain mental health during COVID-19.

Dysexecutive function is a potential cognitive risk factor of depression under pandemic stress using cross-sectional data.The random effect cross-lagged panel model (RE-CLPM) demonstrated temporal association among mindfulness, dysexecutive functions, and depression.Long-term mindfulness practices are needed to maintain mental health under COVID-19 stress.

Motor imagery and engagement favour spatial reasoning.

Based on the assumption that spatial reasoning relies on the construction of mental models of the states of affairs described in the premises, and on evidence that sensory-motor imagery can enhance cognitive abilities, we hypothesised that imagining moving the objects mentioned in the premises to the specific spatial locations should favour spatial reasoning. The results of Experiment 1 confirmed the prediction: when participants imagined moving the objects mentioned in the premises (dynamic-engagement condition), they drew accurate inferences faster compared with participants who merely read the premises (static-non-engagement condition). Experiment 2 was in part a replication of Experiment 1 but included two additional experimental conditions to control for possible effects of self-engagement in reasoning: in one condition, participants imagined that someone else was moving the objects (dynamic-non-engagement condition), and in the other condition, participants imagined that they were observing the objects (static-engagement condition). The results revealed an interaction between motor imagery and engagement in decreasing response times to spatial problems. We discuss the practical implications of the current results.

Untangling the role of social relationships in the association between caregiver burden and caregiver health: an observational study exploring three coping models of the stress process paradigm.

BACKGROUND: Caregivers health is often at risk due to the detrimental effects of caregiver burden. It is therefore vital to identify strategies and resources, which ensure the safeguarding of caregivers' health, whilst also enabling caregivers to continue providing high quality long-term care to care-receivers. The objective of this study is therefore to examine the moderating and mediating role of different social relationship constructs (social networks, social support, relationship quality, and loneliness) in the relationship between subjective caregiver burden and health, by exploring different coping models of the stress process paradigm, namely the stress buffering, social deterioration and counteractive models. METHODS: Longitudinal survey data from 133 couples of caregiving romantic partners and persons with spinal cord injury, living in Switzerland were used. We employed multivariable regression analysis with the inclusion of interaction terms to explore moderation effects of social relationships (i.e. stress buffering model), and path analysis to explore mediation effects (i.e. social deterioration vs. counteractive model) of social relationships on the association between subjective caregiver burden and health. Health was operationalised using the following outcomes: mental health, vitality, bodily pain and general health. RESULTS: Social support and relationship quality were found to buffer the negative effects of subjective caregiver burden on mental health. Mediating effects of social relationships were observed for mental health (indirect effect -0.25, -0.42- -0.08) and vitality (indirect effect -0.20, -0.37- -0.03), providing support for the deterioration model. Loneliness was found to be a particularly important construct on the pathway from caregiver burden to health. CONCLUSION: Our study highlights the potential of social support and relationship quality to override the negative consequences of caregiver burden on mental health and vitality. Our evidence thus supports the advance of interventions that seek to improve qualitative aspects of social relationships, especially in caregivers experiencing a high subjective caregiver burden.

How Daily Mindfulness Predicts Life Satisfaction: From the Perspective of Mindfulness Coping Model.

Previous studies have explored the effect of mindfulness on life satisfaction, but the mechanism has not been explored in terms of daily mindfulness. Therefore, based on the mindfulness coping model, this study uses a daily diary method to examine whether individuals' daily mindfulness could predict life satisfaction and whether this relationship was mediated by rumination. In this study, 178 adults who had not received mindfulness training completed the same diary for continuous 14 days, in which their mindfulness and rumination at state level were measured. Besides, mindfulness, rumination, and life satisfaction at dispositional level were measured before and after the daily reporting process. Hierarchical linear models showed that daily mindfulness is a significant predictor of daily rumination. In addition, both the latent growth curve model and structural equation model showed that the change of daily mindfulness can influence life satisfaction through the change of rumination, and this relationship was also confirmed at the dispositional level. These findings are not only valuable for understanding how mindfulness is linked to rumination and life satisfaction according to the mindfulness coping model, but also contribute to the development of psychological intervention programs aimed at improving individual life satisfaction.

The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis.

BACKGROUND: Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. OBJECTIVE: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. METHODS: A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. RESULTS: A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. CONCLUSIONS: Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT.

Mindful awareness as a mechanism of change for natural childbirth in pregnant women with high fear of childbirth: a randomised controlled trial.

BACKGROUND: Mindfulness-Based Childbirth and Parenting (MBCP) is effective in increasing natural childbirth in pregnant women with high fear of childbirth (FOC) as compared to enhanced care as usual (ECAU). We aimed to examine through which pathway of action MBCP reaches this effect, based on a model of approaching or avoiding the challenges related to childbirth. METHODS: One hundred eleven pregnant women with high FOC were measured pre- and post-intervention on FOC (emotion pathway), catastrophic beliefs about labour pain (cognition pathway) and mindful awareness (attention pathway). A multiple mediation model was used to examine through which pathway the mechanism of change operated in relation to approach (i.e., natural childbirth) versus avoidance (i.e., self-requested caesarean section). RESULTS: It was found that greater mindful awareness (18% R2 = 0.18, F[1107] = 22.77, p < 0.0001) was the only significant mechanism of change operating through the attentional pathway leading to natural childbirth. More specifically, nonreactivity to inner experience (a facet of mindful awareness) showed to be the strongest mechanism of change. More extensive meditation practice was positively associated with natural childbirth; however, the number of completed MBCP sessions was not associated with the outcome. CONCLUSIONS: An increase in mindful awareness was the strongest mechanism of change for better adaptation to the challenges of childbirth. Decreases in neither FOC nor catastrophic beliefs about labour pain were identified as mechanisms of change. Additionally, the more one meditated, the more one was inclined towards a natural childbirth. MBCP enhances adaptation to the challenges of childbirth and less use of obstetric interventions in the presence of high FOC. TRIAL REGISTRATION: The Netherlands Trial Register (NTR; 4302 ).

Leaving hypnosis behind?

Our consciousness and our practice of hypnosis co-evolve. From earliest civilizations to the present, we can think of the source of our abilities and knowledge, along with our self-awareness, as progressing from external and imperative to internal and autonomous. This perspective aligns with Jaynes' thesis on the origin of consciousness and its trajectory from a bicameral mind, to increasing self-efficacy, and on toward higher consciousness. With the ongoing emergence of our subjective and narrative consciousness comes shifting and multiplying resources for rational, shared, compassionate, and creative self-determination. However, the formal practice of therapeutic hypnosis - especially within reductive and diagnosis-based biomedical and psychological models - has lagged behind the evolution of consciousness. Most of the history of hypnosis has adhered to the bicameral paradigm. We have reserved a place for the authority of an externalized, revered entity whom we credit nonconsciously with our innate and extraordinary abilities. The creative applications of hypnosis by Erickson and the expansion of that work by Rossi signaled a fundamental emergence from that paradigm that encourages self-authorization and moves hypnosis practice toward a more evocative, systematic, and numinous horizon.

Nonlinear visuoauditory integration in the mouse superior colliculus.

Sensory information from different modalities is processed in parallel, and then integrated in associative brain areas to improve object identification and the interpretation of sensory experiences. The Superior Colliculus (SC) is a midbrain structure that plays a critical role in integrating visual, auditory, and somatosensory input to assess saliency and promote action. Although the response properties of the individual SC neurons to visuoauditory stimuli have been characterized, little is known about the spatial and temporal dynamics of the integration at the population level. Here we recorded the response properties of SC neurons to spatially restricted visual and auditory stimuli using large-scale electrophysiology. We then created a general, population-level model that explains the spatial, temporal, and intensity requirements of stimuli needed for sensory integration. We found that the mouse SC contains topographically organized visual and auditory neurons that exhibit nonlinear multisensory integration. We show that nonlinear integration depends on properties of auditory but not visual stimuli. We also find that a heuristically derived nonlinear modulation function reveals conditions required for sensory integration that are consistent with previously proposed models of sensory integration such as spatial matching and the principle of inverse effectiveness.

[What Did You Like About the Therapy? - A Qualitative Study on the Evaluation of Mentalization-Based Treatment for Adolescents with Conduct Disorder]. / Was hat dir an der Therapie gefallen? ­ Eine qualitative Studie zur Evaluation der Mentalisierungsbasierten Therapie für Jugendliche mit Störungen des Sozialverhaltens.

Psychotherapeutic treatment for adolescents with conduct disorder (CD) is considered difficult for various reasons. On the one hand, patients frequently lack psychological strain, and striving for autonomy is part of typical adolescent development. On the other hand, therapists can react aversively to delinquent and violent behavior, and insufficient psychological models explaining aetiology and maintenance of symptoms can impede treatment of adolescents with CD. Mentalization-Based Therapy for adolescents with CD (MBT-CD) was developed with the aim of addressing these difficulties and improving psychotherapeutic treatment for this patient group. MBT-CD focuses on the promotion of the adolescents' autonomy by increasing their scope of action via an improvement of mentalizing ability. The aim of this qualitative study is to investigate the acceptance of MBT-CD by the adolescents in terms of their experience with MBT-CD and thus obtain information about aspects which enhance therapy motivation for this group of patients. For this purpose, we conducted semi-structured interviews with twelve adolescents after completion of therapy assessing their subjective therapy evaluation. Qualitative content analysis was used to analyze the data. The results show both helpful and hindering aspects of the mentalization-based interventions. In addition, the monthly family sessions included in the therapy were regarded as important. Adolescents also regarded emotion regulation strategies as helpful. Implications for the treatment of adolescents with CD are discussed.

Financial difficulties in bipolar disorder part 2: psychological correlates and a proposed psychological model.

OBJECTIVES: A number of psychological variables have been shown to be prominent in bipolar disorder. However, no research has looked at the relationship between financial difficulties and psychological factors in bipolar disorder. AIMS: This study aims to look at the relationship between financial difficulties and psychological factors in bipolar disorder. METHOD: Fifty-four participants with diagnosis of bipolar disorder in an adult secondary care NHS mental health service completed the questionnaire pack which included measures examining financial variables including difficulty paying bills and perceived financial wellbeing. Questionnaires measured self-esteem, impulsivity, mindfulness and dysfunctional attitudes. RESULTS: Financial difficulties cross-sectionally were related to a number of psychological variables such as mindfulness and impulsivity. Over time, the strongest effects were for compulsive spending which was increased over time by higher dependency and achievement cognitions, lower mindfulness and lower self-esteem. Poor perceived financial wellness lower self-esteem over time. A psychological model incorporating these and related findings is presented. CONCLUSION: Psychological factors appear to be related to financial difficulties in bipolar disorder. Future research is needed to confirm the model presented here and develop interventions.

Effect of motor imagery on enjoyment in knee-injury prevention and rehabilitation training: A randomized crossover study.

OBJECTIVES: The novel MOTor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS) model takes a uniquely holistic approach by integrating mental and physical aspects into current training programs. The aim of this trial was to evaluate enjoyment of MOTIFS training as compared to Care-as-Usual (CaU) knee injury and/or rehabilitation training. The primary hypothesis was that enjoyment would be greater following MOTIFS training than CaU training. DESIGN: Block-randomized 2×2 cross-over trial. METHODS: Thirty athletes (18-31years, 50% women) currently or previously active in team ball sports, with no pain or injury preventing jump and/or directional changes. MOTIFS training integrates sport-specific experiences and equipment into physical exercises to increase individualized realism and meaning. The CaU condition included solely physical exercise. The main outcome was the Physical Activity Enjoyment Scale (PACES). Secondary outcomes included Self-Assessment Manikin (SAM; subscales Valence, Arousal, Dominance), Perceived exertion, pulse, duration, and movement quality. RESULTS: PACES scores were better following MOTIFS training than CaU (point estimate 24.67; 95% CI: 19.0; 30.3). Between-groups differences in SAM Valence (median 2, quartiles 1;3), Arousal (median 1, quartiles 0;2.25), and Dominance (median 0.5, quartiles 0;2), and RPE (median 1, quartiles -0.3;2), training duration (mean 5.34, 95% CI: -0.17; -0.73), and pulse (median 7.50, quartiles 0.25;16.75) were higher following MOTIFS training than CaU training. CONCLUSIONS: Results suggest that the MOTIFS model, which integrates simultaneous physical and psychological interventions, is a clinically plausible method of influencing enjoyment and other psychological outcomes. Further studies may explore effects of the MOTIFS principles on injury prevention and rehabilitation training.

A trait emotional intelligence perspective on schema modes.

Schema modes (or modes) are a key concept in the theory underlying schema therapy. Modes have rarely been related to established models of personality traits. The present study thus investigates the associations between trait emotional intelligence (TEI) and 14 modes, and tests a global TEI-mode factors-general psychological distress mediation model. The study draws on self-report data from 173 inpatients from a German clinic for psychosomatic medicine. Global TEI correlated positively with both healthy modes (happy child and healthy adult) and negatively with 10 maladaptive modes. When modes were regressed on the four TEI factors, six (emotionality), five (well-being), four (sociability), and four (self-control) significant partial effects on 10 modes emerged. In the parallel mediation model, the mode factors internalization and compulsivity fully mediated the global TEI-general psychological distress link. Implications of the results for the integration of modes with traits in general and with TEI in particular as well as implications of low TEI as a transdiagnostic feature of personality malfunctioning are discussed.

Attachment processes following traumatic loss: A mediation model examining identity distress, shattered assumptions, prolonged grief, and posttraumatic growth.

OBJECTIVE: Sudden or violent death of a loved one poses unique challenges for the bereaved. Research has found such losses to be associated with higher levels of chronic psychological distress. The present study explored underlying mechanisms and risk and protective factors for both prolonged grief and posttraumatic growth, considering both human and divine attachment. METHOD: In a mixed college and community sample of 374 traumatically bereaved adults, we examined associations between adult attachment to close others, adult attachment to God, identity distress, and shattered assumptions with the outcome variables of prolonged grief and posttraumatic growth. RESULTS: Correlations indicate that religious individuals' attachment patterns in close adult relationships were partially mirrored in their relationship with God. Regression analyses indicate a curvilinear relationship between prolonged grief and posttraumatic growth. Path analyses indicate significant associations between insecure attachment strategies and prolonged grief symptoms through the mediators of identity distress and shattered assumptions. Specifically, attachment anxiety in relation to close others and God, and attachment avoidance in relation to close others, were indirectly associated with prolonged grief. Attachment avoidance in relation to God was negatively associated with prolonged grief and posttraumatic growth, but there was no evidence for mediation. CONCLUSION: Faced with the traumatic loss of a loved one, the ability and desire to effectively access relationships facilitating emotional processing and cognitive reorganization is predicated on survivors' internal working model of attachment. These results inform the assessment and treatment of individuals bereaved through sudden or violent means. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Subtly encouraging more deliberate decisions: using a forcing technique and population stereotype to investigate free will.

Magicians' forcing techniques allow them to covertly influence spectators' choices. We used a type of force (Position Force) to investigate whether explicitly informing people that they are making a decision results in more deliberate decisions. The magician placed four face-down cards on the table in a horizontal row, after which the spectator was asked to select a card by pushing it forward. According to magicians and position effects literature, people should be more likely to choose a card in the third position from their left, because it can be easily reached. We manipulated whether participants were reminded that they were making a decision (explicit choice) or not (implicit choice) when asked to select one of the cards. Two experiments confirmed the efficiency of the Position Force-52% of participants chose the target card. Explicitly informing participants of the decision impairs the success of the force, leading to a more deliberate choice. A range of awareness measures illustrates that participants were unaware of their stereotypical behaviours. Participants who chose the target card significantly underestimated the number of people who would have chosen the same card, and felt as free as the participants who chose another card. Finally, we tested an embodied-cognition idea, but our data suggest that different ways of holding an object do not affect the level of self-control they have over their actions. Results are discussed in terms of theoretical implications regarding free will, Wegner's apparent mental causation, choice blindness and reachability effects.

When enhanced awareness threatens: Interactive effects of domain-specific awareness and acceptance manipulations on cardiovascular indices of challenge and threat.

Mindfulness includes acceptance and awareness subcomponents, and emerging theories imply that cultivating both acceptance and awareness may benefit health by diminishing stress reactivity. Yet, no prior work has examined the effects of mindful acceptance and awareness on cardiovascular markers of threat and challenge-cardiac output and total peripheral resistance-despite the unique insights these indices yield into stress-related evaluations and motivation. The current research integrates Monitor and Acceptance Theory with the Biopsychosocial Model of Challenge and Threat to elucidate how an awareness manipulation and a brief acceptance training are associated with cardiovascular stress responses underlying states of challenge and threat. Healthy young adults (N = 202) were enrolled in a 2 × 2 between-subjects experimental design manipulating both awareness (enhanced awareness vs. no enhanced awareness) and acceptance (acceptance training vs. no acceptance training) of physiological responses to a social-evaluative cold pressor test. Cardiovascular indices were recorded throughout. The combination of enhanced awareness and acceptance training led to higher cardiac output and lower total peripheral resistance (indexing greater challenge, less threat) to the cold pressor test than the combination of enhanced awareness and no acceptance training. However, the combination of no enhanced awareness and no acceptance training also led to higher cardiac output and lower total peripheral resistance than the combination of enhanced awareness and no acceptance training. These results add to a growing body of work suggesting that mindful awareness and acceptance subcomponents interact to influence stress reactivity and imply that enhanced stressor awareness without acceptance may lead to increased threat.

Lifestyle and Health Behavior Change in Traditional Acupuncture Practice: A Systematic Critical Interpretive Synthesis.

Introduction: Behavioral factors are the leading cause of ill-health worldwide. Diet, physical activity, smoking, and alcohol consumption are the focus of public health targets on promotion of healthy behavior. The science of behavior change is rapidly growing and has largely evolved within mainstream health care treatments. Traditional Chinese Medicine includes self-care practices that encourage healthy behavior alongside treatments such as acupuncture. Exploring behavior change within traditional acupuncture could potentially highlight new techniques and approaches, and contribute to developing models of behavior change. Aims: In this review, the authors aimed to critically appraise research exploring health behavior change within traditional acupuncture, to highlight gaps in the field, identify questions, and enable theory development. Design/Method: The authors were guided by a critical interpretive synthesis (CIS) method to explore a diverse mixture of research including qualitative and quantitative articles. Eight databases were searched up to October 2017 for articles published in English. Eleven thousand four hundred eighty-eight articles were identified (7,149 after deduplication). Titles and abstracts were screened by one reviewer (10% by a second reviewer). Eligible articles were selected using a Population, Intervention, Comparison, Outcome framework. CIS methods, including purposive sampling of eligible articles and a reflexive, dialectic process of critiquing evidence and theory, were used to synthesize the evidence. Results: Several articles examined the prevalence and patterns of behavior change and support for change, although methods varied and reliability of results was limited. There was more evidence concerning diet/exercise than alcohol/smoking. Aspects of acupuncturists' work identified as potential key elements for promoting behavior change included: individualized advice based on symptoms; holistic/biopsychosocial explanations; therapeutic relationship; simultaneous treatment of behavior-limiting symptoms; and patients' physical involvement with intervention. A logic model of the process of behavior change was developed, proposing that perceived support, mutual understanding, and active participation may facilitate change. Possible moderators included: single/multicomponent acupuncture; setting; patient/practitioner characteristics; treatment experience; timing; and treatment duration. Conclusion: These findings suggest behavior change work is a significant part of traditional acupuncture practice, although more reliable evidence is needed to understand the effectiveness, prevalence, and patterns of this work (in particular the patterns suggesting acupuncturists are more likely to work on changes to diet and physical activity than alcohol and smoking behaviors, and more likely to support changes in long-term compared with acute conditions). The proposed model of behavior change should be developed and tested with a view to refining the model and elaborating the suggested links with a wider theory of behavior and behavior change. This review was preregistered with PROSPERO as "Health behaviour change in traditional acupuncture treatment: a protocol for a critical interpretive synthesis": CRD42018099766.

Testing a Proactive Model of Successful Aging Among Older Adults in Costa Rica and Spain.

The purpose of this study is to examine successful aging among Spanish-speaking older adults in Costa Rica and in Spain using the proactive framework proposed by Kahana et al. (2014). More specifically, we hypothesized that older adults' life satisfaction would be positively associated with the frequency and perceived level of social support, spirituality/having purpose in life, and the use of proactive physical, cognitive, and social self-care behaviors. Our results confirmed these hypotheses, not only for the overall group of participants, but also separately for older adults in Costa Rica and in Spain. The present study contributes to the literature of successful aging among older adults, by examining the protective factors associated with life satisfaction among Spanish speaking older adults in Costa Rica and in Spain. It identifies specific protective factors (spirituality/purpose in life, social support, and self-care) associated with the values and preferences held by participants in the study.

Social Media Exposure and College Students' Mental Health During the Outbreak of COVID-19: The Mediating Role of Rumination and the Moderating Role of Mindfulness.

In response to reports of people experiencing varying levels of anxiety and depression during the outbreak of COVID-19, researchers have argued that exposure to related information on social media is a salient contributing factor. Based on the integrated model of ruminative response style and the diathesis-stress model, it has been suggested that incorporating rumination and mindfulness may elucidate the potential mechanism underlying the aforementioned association. This study aimed to examine the mediating role of rumination and the moderating role of mindfulness in the association between social media exposure (SME) to COVID-19 information and psychological distress. The results from online questionnaire responses of 439 college students from two universities in Wuhan, Hubei Province, showed that rumination mediated the association between SME and psychological distress. Furthermore, mindfulness was revealed as a protective factor that buffered the adverse effect of SME on psychological distress through rumination. These findings advance a better understanding of the formation process of psychological symptoms during the COVID-19 pandemic and provide insights regarding effective interventions for adverse mental health consequences in college students.