RESUMO
The sense of agency is a fundamental aspect of human self-consciousness, whose neural correlates encompass widespread brain networks. Research has explored the neuromodulatory properties of the sense of agency with noninvasive brain stimulation, which induces exogenous manipulations of brain activity; however, it is unknown whether endogenous modulation of the sense of agency is also achievable. We investigated whether the sense of agency can be self-regulated with electroencephalography-based neurofeedback. We conducted 2 experiments in which healthy humans performed a motor task while their motor control was artificially disrupted, and gave agency statements on their perceived control. We first identified the electrophysiological response to agency processing, and then applied neurofeedback in a parallel, sham-controlled design, where participants learnt to self-modulate their sense of agency. We found that behavioral measures of agency and performance on the task decreased with the increasing disruption of control. This was negatively correlated with power spectral density in the theta band, and positively correlated in the alpha and beta bands, at central and parietal electrodes. After neurofeedback training of central theta rhythms, participants improved their actual control over the task, and this was associated with a significant decrease in the frequency band trained via neurofeedback. Thus, self-regulation of theta rhythms can improve sensory-guided behavior.
Assuntos
Neurorretroalimentação , Humanos , Neurorretroalimentação/fisiologia , Controle Comportamental , Eletroencefalografia/métodos , Ritmo Teta/fisiologia , EncéfaloRESUMO
BACKGROUND: Women bodybuilders build their ideal physique by manipulating their diet, supplement, and exercise regimens to extreme levels. Excess protein intake and dietary supplement use is ubiquitous in women bodybuilders preparing for a competition, i.e., in-season competitors, however the impetus for these two dietary behaviors are relatively unknown. The Theory of Planned Behavior (TPB) has been used to explain dietary behaviors. The purpose of the study was to examine how the TPB can explain protein intake and dietary supplement use in in-season competitors. METHODS: Using a cross-sectional design, an online questionnaire was developed, validated, and administered to collect dietary supplement use, TPB variables, and other measures from 112 in-season competitors. Protein intake was assessed using multiple 24-h dietary recalls. Associations between TPB and protein intake and dietary supplement use were determined with multiple regression analysis while adjusting for confounders. RESULTS: For protein intake: attitude, subjective norm, and perceived behavioral control explained 8% of the variance in intention; subjective norm independently predicted intention. Behavioral beliefs predicted attitude; subjective norm was predicted by trainer/coach, workout partners, and social media influencers. For dietary supplement use: intention explained 5% of the variance in dietary supplement use; attitude, subjective norm, and perceived behavioral control together explained 38% of the variance in intention. Attitudes towards dietary supplements use were predicted by five factors (not a waste of money, help improve physique, sustain energy levels, provide enough calories, help with recovery). Primary determinants of subjective norm were fellow competitors, social media influencers, and trainer/coach. Perceived behavioral control was predicted by three factors (ease of purchase, affordability to purchase, availability to purchase). CONCLUSIONS: TPB predicted dietary supplement use in women bodybuilders during in-season but there was little evidence for the prediction of protein intake using the TPB. Health professionals should develop effective interventions using strategies that align health education messages with in-season competitors' outcome beliefs and collaborate with their referent others to influence safer and effective dietary supplement use.
Assuntos
Controle Comportamental , Teoria do Comportamento Planejado , Feminino , Humanos , Estudos Transversais , Suplementos Nutricionais , IntençãoRESUMO
The basal ganglia are known to control actions and modulate movements. Neuronal activity in the two efferent pathways of the dorsal striatum is critical for appropriate behavioral control. Previous evidence has led to divergent conclusions on the respective engagement of both pathways during actions. Using calcium imaging to evaluate how neurons in the direct and indirect pathways encode behaviors during self-paced spontaneous explorations in an open field, we observed that the two striatal pathways exhibit distinct tuning properties. Supervised learning algorithms revealed that direct pathway neurons encode behaviors through their activation, whereas indirect pathway neurons exhibit behavior-specific silencing. These properties remain stable for weeks. Our findings highlight a complementary encoding of behaviors with congruent activations in the direct pathway encoding multiple accessible behaviors in a given context, and in the indirect pathway encoding the suppression of competing behaviors. This model reconciles previous conflicting conclusions on motor encoding in the striatum.
Assuntos
Gânglios da Base , Corpo Estriado , Neostriado , Controle Comportamental , NeurôniosRESUMO
Anemia in pregnancy is a public health concern. It has been diagnosed in 27% of pregnant women in Malaysia and up to 40% of pregnant women globally. This study aimed to develop and evaluate the effectiveness of an intervention initiative based on the health belief model. The MyPinkMom program was disseminated through a mobile messaging application to pregnant women to educate them on the prevention of anemia in pregnancy. We conducted a two-arm cluster-assignment, single-blinded, randomized control trial at two government antenatal clinics in Selangor. One clinic was randomly chosen as the intervention group, and the other was chosen as the control group. Sixty pregnant women with anemia from the intervention group received the MyPinkMom intervention program in the form of six infographic video clips, and 60 pregnant women with anemia from the control group received routine counseling on anemia in pregnancy. Pregnant women who had anemia secondary to hemoglobinopathy or other chronic diseases were excluded from this study. MANOVA showed significant increases in hemoglobin, knowledge, attitude, subjective norms, and perceived behavioral control scores for adherence to iron supplements, dietary iron, and dietary vitamin C intake (p < 0.001) in the intervention group at week 6. A significant reduction also occurred in dietary tannin intake (p < 0.001) in the intervention group at week 6. The intervention group at week 6 showed a large effect on hemoglobin level increments (partial eta squared, È p2 0.268), dietary iron intake (È p2 0.213), knowledge of anemia in pregnancy (È p2 0.622), subjective norm scores for adherence to iron supplements (È p2 0.167), and reduction in dietary tannin intake (È p2 0.353). Similarly, repeated measures ANOVA showed that changes in hemoglobin levels were significantly different over time (i.e., at baseline, week 6, and week 12) between the intervention and control groups (p < 0.001). Hemoglobin increased rapidly over time among participants in the intervention group but gradually in the control group. To conclude, the newly developed MyPinkMom program that was delivered through a messaging application showed effectiveness in preventing anemia during pregnancy.
Assuntos
Anemia , Controle Comportamental , Gravidez , Feminino , Humanos , Anemia/prevenção & controle , Hemoglobinas , Ferro , MalásiaRESUMO
Due to the lack of trust in the builder and indeterminate benefits, it is a struggle for people in Taiwan to make up their minds to participate in urban renewal. This leads to the completion rate of urban renewal of fewer than one ten-thousandth of the new construction needed. This study investigated the perspective on the research variables for people in Taiwan and how those influence their intention to participate in urban renewal. Using the Theory of Planned Behavior, the research framework is designed with the trust of urban renewal project builders and the perceived benefits of public participation as the independent variables. Attitudes, subjective norms, and perceived behavioral control are the mediating variables, and the general public's intention to participate in urban renewal is the dependent variable. A total of 545 valid questionnaires were collected through the survey. The results showed that the respondents' trust in the builder of the urban renewal project positively and significantly influenced their perceived benefits of the project, and the respondents' trust in the builder significantly influenced their subjective norms. The perceived benefits positively and significantly affected their attitudes and subjective norms, and people's attitudes, subjective norms, and perceived behavioral control positively and significantly affected their intention to participate in urban renewal. People's perceived benefits in urban renewal projects affected their participation intention through attitudes and subjective norms. The variable perceived benefits most strongly influenced people's intention to participate in urban renewal in this study. This study provides practical suggestions for the government and builders to increase people's intention to participate in urban renewal. This study modeled two independent variables, trust in the builder and perceived benefits, under the urban renewal context in Taiwan. In future works, other factors could be included, such as tax incentives, floor area rewards, and fair appraisal.
Assuntos
Intenção , Reforma Urbana , Humanos , Controle Comportamental , Confiança , SugestãoRESUMO
Prethalamic nuclei in the mammalian brain include the zona incerta, the ventral lateral geniculate nucleus, and the intergeniculate leaflet, which provide long-range inhibition to many targets in the midbrain, hindbrain, and thalamus. These nuclei in the caudal prethalamus can integrate sensory and non-sensory information, and together they exert powerful inhibitory control over a wide range of brain functions and behaviors that encompass most aspects of the behavioral repertoire of mammals, including sleep, circadian rhythms, feeding, drinking, predator avoidance, and exploration. In this perspective, we highlight the evidence for this wide-ranging control and lay out the hypothesis that one role of caudal prethalamic nuclei may be that of a behavioral switchboard that-depending on the sensory input, the behavioral context, and the state of the animal-can promote a behavioral strategy and suppress alternative, competing behaviors by modulating inhibitory drive onto diverse target areas.
Assuntos
Controle Comportamental , Corpos Geniculados , Animais , Ritmo Circadiano , Corpos Geniculados/fisiologia , Mamíferos , Mesencéfalo , TálamoRESUMO
Insects' ethology is an important factor when it is desired to carry out pest management. This knowledge makes it possible to manipulate behavioral activities, repel, or attract insects according to needs and interests. The maize weevil Sitophilus zeamais (Mots., 1855) (Coleoptera: Curculionidae), one of the main stored grain pests, has been the target of studies of behavioral changes studies through natural substances due to its resistance to different insecticidal classes. Thus, this study aimed to evaluate the effect of sublethal concentrations of neem extract and copaiba oil on the locomotor behavior of S. zeamais. The behavioral characteristic considered were walking activity, the frequency of contact of insects with the treated grain mass, and the time spent for this behavior. The walking activity of the S. zeamais increased with exposure to Neem extract and Copaiba oil. In general, the Neem extract and Copaiba oil-induced more contact with grain mass than the control, suggesting an attractive effect on the insect, however more significant for the Neem oil. The insect's behavior was altered, presenting a specific path due to Copaiba oil and Neem extract stimuli. These results indicate that Copaiba oil and Neem extract can be a potential alternative for controlling S. zeamais on stored products since changes in this pests' behavior can reduce qualitative and quantitative grain damage. Thus, the development of products based on Copaiba oil and Neem extract may be helpful for storage pest management.
Assuntos
Controle de Insetos , Inseticidas , Óleos Voláteis , Extratos Vegetais , Gorgulhos , Animais , Controle Comportamental , Inseticidas/farmacologia , Melia/química , Óleos Voláteis/farmacologia , Extratos Vegetais/farmacologiaRESUMO
As barragens de rejeito de minério de ferro fazem parte do processo de mineração no Brasil. Trata-se de uma técnica antiga envolvendo diversas tecnologias para torná-la mais segura. A constante vigília e cuidado sobre essas estruturas tornaram-se uma rotina frequente das mineradoras para evitar possíveis rupturas dessas barragens. Após o rompimento da barragem de rejeitos de minério em Brumadinho-MG e Mariana-MG muitos discursos com elementos metafóricos acerca da sustentabilidade e a prática de uso de barragens de rejeitos foram sustentados por uma intencionalidade discursiva voltada para a crítica social. O objetivo deste estudo é identificar e analisar o uso de metáforas conceptuais presentes como elementos multimodais na argumentação textual, numa perspectiva sociocognitiva e interacional da linguagem. Para isso, adota-se uma pesquisa expo-facto. O viés teórico da intencionalidade discursiva na linha de Searle; o caráter de modelos mentais, representações sociais e conhecimento sociocultural tal com prevê Van Dijk, a visão sociosemiótica de Geeraerts para compreender como argumentação por meio do campo imagético das charges é construída e sustentada socialmente e o dialogismo na perspectiva de Meyer a partir da argumentação. Nessa perspectiva sociocognitiva e interacional, o texto é pensado como uma construção linguístico-discursiva na qual a intencionalidade está relacionada com os modelos mentais resultantes de representações construídas a partir da experiencia do sujeito em sociedade e das práticas interacionais. Nesse contexto, o texto contempla uma gama de operações cognitivas interligadas como direciona Marscuschi. Constitui-se um corpus de charges publicadas na mídia brasileira, orientadas para a temática do rompimento de barragens de rejeitos de minério de ferro para a análise do aparecimento de metáforas conceptuais. Conclui-se que as metáforas se constituem recursos multimodais na orientação argumentativa e revelam metáforas do medo e da lama envolvendo um discurso do horror sobre a tragédia das cidades de Brumadinho e Mariana.
Iron ore tailings dams are part of the mining process in Brazil. It is an old technique involving several technologies to make it more secure. Constant vigilance and care about these structures have become a frequent routine for mining companies to avoid possible failures of these dams. After the collapse of the ore tailings dam in Brumadinho (MG) and Mariana (MG) cities, many discourses with metaphorical elements about sustainability and the practice of using tailings dams were supported by a discursive intentionality focused on social criticism. The aim of this study is to identify and analyze the use of conceptual metaphors present as multimodal elements in textual argumentation, in a sociocognitive and interactional perspective of language. For this, it is adopted from expo-facto research. The theoretical bias of discursive intentionality along the lines of Searle; the character of mental models, social representations,and sociocultural knowledge as predicted by Van Dijk, the sociosemiotic vision of Geeraerts (2016) to understand how argumentation through the imagery field of cartoons is constructed and socially supported and dialogism in perspective of Meyer from the argumentation. In this sociocognitive and interactional perspective, the text is thought of as a linguistic-discursive construction in which intentionality is related to mental models resulting from representations built from the subject's experience in society and interactional practices. In this context, the text contemplates a range of interconnected cognitive operations as directed by Marscuschi. A corpus of cartoons published in the Brazilian media is constituted, oriented to the theme of breaking up iron ore tailings dams for the analysis of the appearance of conceptual metaphors. It is concluded that metaphors are multimodal resources in the argumentative orientation and reveal metaphors offear and mud involving a horror speech about the tragedy of the cities of Brumadinho and Mariana.
Assuntos
Humanos , Desastres Provocados pelo Homem , Cognição , Metáfora , Controle Comportamental , Meios de Comunicação de Massa , Mineração , Recursos Audiovisuais , Brasil , CompreensãoRESUMO
Pubertal male Syrian hamsters (Mesocricetus auratus) treated with anabolic/androgenic steroids (AASs) during adolescence (P27-P56) display a highly intense aggressive phenotype that shares many behavioral similarities with pathological aggression in youth. Anticonvulsant drugs like valproate that enhance the activity of the γ-aminobutyric acid (GABA) neural system in the brain have recently gained acceptance as a primary treatment for pathological aggression. This study examined whether valproate would selectively suppress adolescent AAS-induced aggressive behavior and whether GABA neural signaling through GABAA subtype receptors in the latero-anterior hypothalamus (LAH; an area of convergence for developmental and neuroplastic changes that underlie aggression in hamsters) modulate the aggression-suppressing effect of this anticonvulsant medication. Valproate (1.0-10.0 mg/kg, intraperitoneal) selectively suppressed the aggressive phenotype in a dose-dependent fashion, with the effective anti-aggressive effects beginning at 5 mg/kg, intraperitoneally. Microinfusion of the GABAA receptor antagonist bicuculline (7.0-700 ng) into the LAH reversed valproate's suppression of AAS-induced aggression in a dose-dependent fashion. At the 70 ng dose of bicuculline, animals expressed the highly aggressive baseline phenotype normally observed in AAS-treated animals. These studies provide preclinical evidence that the anticonvulsant valproate selectively suppresses adolescent, AAS-induced aggression and that this suppression is modulated, in part, by GABA neural signaling within the LAH.
Assuntos
Agressão , Androgênios , Controle Comportamental/métodos , Antagonistas GABAérgicos/farmacologia , Hipotálamo , Congêneres da Testosterona , Ácido Valproico/farmacologia , Adolescente , Agressão/efeitos dos fármacos , Agressão/fisiologia , Agressão/psicologia , Androgênios/metabolismo , Androgênios/farmacologia , Animais , Anticonvulsivantes/farmacologia , Comportamento Animal/efeitos dos fármacos , Relação Dose-Resposta a Droga , Humanos , Hipotálamo/efeitos dos fármacos , Hipotálamo/metabolismo , Mesocricetus , Plasticidade Neuronal/efeitos dos fármacos , Plasticidade Neuronal/fisiologia , Transdução de Sinais/efeitos dos fármacos , Congêneres da Testosterona/metabolismo , Congêneres da Testosterona/farmacologiaRESUMO
BACKGROUND: Several studies demonstrate that the provision of personalized lifestyle advice, based on genetics, can help motivate individuals to engage in greater nutrition and physical activity changes compared to the provision of population-based advice. The theoretical mechanism behind this phenomenon is poorly understood. The objective of this study was to determine the impact of providing genetically tailored and population-based lifestyle advice on key constructs of the Theory of Planned Behaviour (TPB). MATERIALS AND METHODS: A pragmatic, cluster randomized controlled trial (n = 140) took place at the East Elgin Family Health Team, in Aylmer, Ontario, Canada. Participants were primarily Caucasian females enrolled in a weight management program (BMI ≥ 25.0 kg/m2). Weight management program groups were randomized (1:1) to receive a population-based lifestyle intervention for weight management (Group Lifestyle Balance™ (GLB)) or a lifestyle genomics (LGx)-based lifestyle intervention for weight management (GLB+LGx). Attitudes, subjective norms and perceived behavioural control were measured at baseline, immediately after receiving a report of population-based or genetic-based recommendations and after 3-, 6- and 12-month follow-ups. Linear mixed models were conducted, controlling for measures of actual behavioural control. All analyses were intention-to-treat by originally assigned groups. RESULTS: Significant changes (p < 0.05) in attitudes, subjective norms, and perceived behavioural control tended to be short-term in the GLB group and long-term for the GLB+LGx group. Short-term and long-term between-group differences in measures of subjective norms were discovered, favouring the GLB+LGx group. CONCLUSIONS: The TPB can help provide a theoretical explanation for studies demonstrating enhanced behaviour change with genetic-based lifestyle interventions. CLINICAL TRIAL REGISTRATION: NCT03015012.
Assuntos
Atitude , Controle Comportamental , Terapia Nutricional , Adulto , Exercício Físico , Feminino , Humanos , Intenção , Estilo de Vida , Masculino , Motivação , Ontário , Teoria Psicológica , Inquéritos e QuestionáriosRESUMO
OBJECTIVE: This pilot randomized controlled trial (RCT) aimed at evaluating the feasibility and potential efficacy of a motivational interviewing (MI) intervention to increase physical activity (PA) behavior in cancer patients. METHODS: Participants were randomly assigned to an experimental group with standard care plus 12 MI sessions within 12 weeks or a control group with standard care only. The number of recruited participants and the modality of recruitment were recorded to describe the reach of the study. The acceptability of the study was estimated using the attrition rate during the intervention phase. The potential efficacy of the intervention was evaluated by analyzing the PA behavior. RESULTS: Twenty-five participants were recruited within the 16-month recruitment period (1.6 participants per month). Five participants (38.5%) from the experimental group (n = 13) and one participant (8.3%) from the control group (n = 12) dropped out of the study before the end of the intervention phase. No group by time interaction effect for PA behavior was observed at the end of the intervention. CONCLUSION: Due to the low recruitment rate and compliance, no conclusion can be drawn regarding the efficacy of MI to increase PA behavior in cancer patients. Moreover, the current literature cannot provide any evidence on the effectiveness of MI to increase PA in cancer survivors. Future RCTs should consider that the percentage of uninterested patients to join the study may be as high as 60%. Overrecruitment (30% to 40%) is also recommended to accommodate the elevated attrition rate.
Assuntos
Exercício Físico , Comportamentos Relacionados com a Saúde , Entrevista Motivacional/métodos , Neoplasias , Cooperação do Paciente , Acelerometria/métodos , Atitude Frente a Saúde , Controle Comportamental/métodos , Controle Comportamental/psicologia , Exercício Físico/fisiologia , Exercício Físico/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Neoplasias/fisiopatologia , Neoplasias/psicologia , Aptidão Física/psicologiaRESUMO
Within the domain of food consumption, we explore the antecedents and consequences of "guilty displeasures," or experiences that consumers should enjoy, but do not. Food is an emotionally charged stimulus, with consumption leading to both positive (e.g., joy) and negative (e.g., guilt) emotions. Individuals who are high in dietary restraint are particularly susceptible to experiencing negative emotions given their heightened state of arousal in the presence of indulgent food. We show that these negative emotions arise even when individuals simply imagine the food. Across one pilot study and three experiments, we provide evidence that restrained eaters actively dampen their enjoyment of indulgences (i.e., guilty displeasures). We manipulate guilt using imagery type, with outcome imagery leading to greater guilt than process imagery (study 1). We also demonstrate that individuals high, compared to low, in dietary restraint dampen their savoring of even a hypothetical indulgence when guilt is evoked (study 2). Finally, we show these effects within the context of actual food consumption (study 3). Our exploration shows that merely anticipating an indulgence can elicit guilt among consumers high in dietary restraint, thus resulting in the dampening of enjoyment during a subsequent consumption experience.
Assuntos
Controle Comportamental/psicologia , Comportamento Alimentar/psicologia , Culpa , Imaginação , Prazer , Adulto , Nível de Alerta , Dieta/psicologia , Emoções , Feminino , Felicidade , Humanos , Masculino , Projetos Piloto , Inquéritos e QuestionáriosRESUMO
ADHD is one of the most prevalent neuropsychiatric disorders of childhood, but symptoms vary considerably between individuals. Therefore, different ADHD subtypes can be distinguished. Yet, it is widely elusive whether the specific subtype is critical to consider when examining treatment effects. Based on theoretical considerations, this could be the case for EEG theta/beta neurofeedback. We examine the effects of such an intervention on rapid response execution and inhibition processes using a Go/Nogo task in the inattentive (ADD) and the combined (ADHD-C) subtype. We show that a single neurofeedback protocol affects opposing deficits depending on the ADHD subtype - namely the execution (in ADD) and inhibition of action (in ADHD-C). No changes occurred in the healthy controls. These findings are discussed in relation to overarching principles of neural oscillations, particularly in the beta frequency band. The data suggest that theta/beta neurofeedback trains a superordinate system strongly related to the function of neural beta frequency oscillations to tune neural networks important for the sampling of sensory information used for behavioral control.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Neurorretroalimentação , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Controle Comportamental , Criança , Cognição , HumanosRESUMO
Background: Mental health professionals (MHPs) often lack skills necessary to effectively manage suicide risk. Training designed to combat this deficiency tend to rely on passive techniques, despite research suggesting active methods may better facilitate skill development.Aim: This study examines the effect of a role-play training on MHPs' attitudes, subjective norms and perceived behavioral control surrounding suicide risk assessment behaviors.Methods: Two hundred and three MHPs participated in a 4.5 hour role-play training after participation in an online suicide risk assessment training. The training utilized active learning and behavioral modification strategies. MHPs completed questionnaires assessing attitudes, subjective norms, perceived behavioral control and training variables.Results: MHPs endorsed positive attitudes, social norms and perceived behavioral control in suicide risk assessment and management skills, especially in assessing/determining the severity of risk, establishing rapport, documenting risk assessment information and developing a treatment plan. Results also revealed support for the feasibility of disseminating role-play training utilizing active learning methods.Conclusion: Factors found to be associated with participation in the role-play training are discussed. Findings may inform future development and improvement of suicide risk assessment training and practices that target risk and protective factors to effectively reduce suicide-related behavior.
Assuntos
Atitude do Pessoal de Saúde , Controle Comportamental/psicologia , Pessoal de Saúde/educação , Medição de Risco/métodos , Desempenho de Papéis , Normas Sociais , Prevenção do Suicídio , Competência Clínica , Feminino , Humanos , Masculino , Serviços de Saúde MentalRESUMO
OBJECTIVE: Narcotics Anonymous (NA), a nonprofessional 12-step fellowship for people seeking recovery from addiction, reports 27,677 meetings in the USA, where it was founded, but there is limited literature on its adaptability cross-culturally. We studied NA within the Islamic Republic of Iran to ascertain its relative adaptation in a different cultural setting. METHOD: We surveyed 262 NA members in Iran, supplemented by member interviews, and compared demographic and substance use-related characteristics of members, and also the nature of their respective involvement in NA, to the survey results of a previous US survey (nâ=â527). RESULTS: NA in Iran reports 21,974 meetings. The Iranian respondents surveyed differed relatively little (dâ<â0.50) from US members on demographics and prior ambulatory substance use disorder treatment, but did have fewer female members (means for Iran and US: 42.4 vs 39.0 years; 77% vs 87%; 6% vs 28%, respectively). They were, however, more involved in the fellowship (dâ>â0.50) in terms of reporting service as sponsors, experience of spiritual awakening, and achievement of diminished craving (scores of 1-10) (85% vs 48%; 95% vs 84%; 1.03 vs 1.89, respectively). Surveyed NA members in Iran publicized the fellowship with public (36%) and religious (20%) figures, and systematically worked the 12 steps in large sponsor-led groups ((Equation is included in full-text article.)= 19 members). CONCLUSION: NA, a 12-step program developed in a Western, predominantly Christian-oriented country, was adapted widely in the Islamic Republic of Iran, a setting different in culture, language, ethnicity, and religious orientation. The growth in its membership derives, in part, from specific innovations that may have broader applicability in other settings.
Assuntos
Controle Comportamental/métodos , Comparação Transcultural , Grupos de Autoajuda/organização & administração , Espiritualidade , Transtornos Relacionados ao Uso de Substâncias/reabilitação , Adulto , Controle Comportamental/psicologia , Feminino , Humanos , Relações Interpessoais , Entrevista Psicológica , Irã (Geográfico) , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Grupos de Autoajuda/estatística & dados numéricos , Inquéritos e Questionários , Estados UnidosRESUMO
BACKGROUND: Chronic pain is one of the most common, disabling, and expensive public health problems in the United States. Interdisciplinary pain management treatments that employ behavioral approaches have been successful in helping patients with chronic pain reduce symptoms and regain functioning. However, most patients lack access to such treatments. We are conducting a pragmatic clinical trial to test the hypothesis that patients who receive an interdisciplinary biopsychosocial intervention, the Pain Program for Active Coping and Training (PPACT), at their primary care clinic will have a greater reduction in pain impact in the year following than patients receiving usual care. METHODS/DESIGN: This is an effectiveness-implementation hybrid pragmatic clinical trial in which we randomize clusters of primary care providers and their patients with chronic pain who are on long-term opioid therapy to 1) receive an interdisciplinary behavioral intervention in conjunction with their current health care or 2) continue with current health care services. Our primary outcome is pain impact (a composite of pain intensity and pain-related interference) measured using the PEG, a validated three-item assessment. Secondary outcomes include pain-related disability, patient satisfaction, opioids dispensed and health care utilization. An economic evaluation assesses the resources and costs necessary to deliver the intervention and its cost-effectiveness compared with usual care. A formative evaluation employs mixed methods to understand the context for implementation in the participating health care systems. DISCUSSION: This trial will inform the feasibility of implementing interdisciplinary behavioral approaches to pain management in the primary care setting, potentially providing a more effective, safer, and more satisfactory alternative to opioid-based chronic pain treatment. Clinical Trials Registration Number: NCT02113592.
Assuntos
Controle Comportamental/métodos , Dor Crônica , Dor Lombar , Qualidade de Vida , Adaptação Psicológica , Adulto , Analgésicos Opioides/administração & dosagem , Dor Crônica/diagnóstico , Dor Crônica/tratamento farmacológico , Dor Crônica/psicologia , Feminino , Humanos , Dor Lombar/diagnóstico , Dor Lombar/tratamento farmacológico , Dor Lombar/psicologia , Masculino , Manejo da Dor/métodos , Medição da Dor/métodos , Equipe de Assistência ao Paciente , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Recuperação de Função Fisiológica/efeitos dos fármacos , Resultado do TratamentoRESUMO
This paper argues against incorporating assessments of individual responsibility into healthcare policies by expanding an existing argument and offering a rebuttal to an argument in favour of such policies. First, it is argued that what primarily underlies discussions surrounding personal responsibility and healthcare is not causal responsibility, moral responsibility or culpability, as one might expect, but biases towards particular highly stigmatised behaviours. A challenge is posed for proponents of taking personal responsibility into account within health policy to either expand the debate to also include socially accepted behaviours or to provide an alternative explanation of the narrowly focused discussion. Second, a critical response is offered to arguments that claim that policies based on personal responsibility would lead to several positive outcomes including healthy behaviour change, better health outcomes and decreases in healthcare spending. It is argued that using individual responsibility as a basis for resource allocation in healthcare is unlikely to motivate positive behaviour changes, and is likely to increase inequality which may lead to worse health outcomes overall. Finally, the case of West Virginia's Medicaid reform is examined, which raises a worry that policies focused on personal responsibility have the potential to lead to increases in medical spending overall.
Assuntos
Atenção à Saúde/ética , Comportamentos Relacionados com a Saúde , Política de Saúde , Estilo de Vida , Obrigações Morais , Autonomia Pessoal , Responsabilidade Social , Controle Comportamental , Causalidade , Dissidências e Disputas , Equidade em Saúde , Gastos em Saúde , Humanos , Medicaid , Princípios Morais , Motivação , Alocação de Recursos , Comportamento Social , Justiça Social , Estados Unidos , West VirginiaRESUMO
Self-regulation is a broad construct representing the general ability to recruit cognitive, motivational and emotional resources to achieve long-term goals. This construct has been implicated in a host of health-risk behaviors, and is a promising target for fostering beneficial behavior change. Despite its clear importance, the behavioral, psychological and neural components of self-regulation remain poorly understood, which contributes to theoretical inconsistencies and hinders maximally effective intervention development. We outline a research program that seeks to define a neuropsychological ontology of self-regulation, articulating the cognitive components that compose self-regulation, their relationships, and their associated measurements. The ontology will be informed by two large-scale approaches to assessing individual differences: first purely behaviorally using data collected via Amazon's Mechanical Turk, then coupled with neuroimaging data collected from a separate population. To validate the ontology and demonstrate its utility, we will then use it to contextualize health risk behaviors in two exemplar behavioral groups: overweight/obese adults who binge eat and smokers. After identifying ontological targets that precipitate maladaptive behavior, we will craft interventions that engage these targets. If successful, this work will provide a structured, holistic account of self-regulation in the form of an explicit ontology, which will better clarify the pattern of deficits related to maladaptive health behavior, and provide direction for more effective behavior change interventions.
Assuntos
Controle Comportamental/métodos , Controle Comportamental/psicologia , Transtorno da Compulsão Alimentar/psicologia , Obesidade/psicologia , Sobrepeso/psicologia , Projetos de Pesquisa , Autocontrole/psicologia , Fumantes/psicologia , Transtorno da Compulsão Alimentar/complicações , Cognição , Humanos , Obesidade/complicações , Sobrepeso/complicaçõesRESUMO
BACKGROUND: While mindfulness-based interventions (MBIs) employ two distinct practices, focused attention (FA) and open monitoring (OM), the integrated delivery of these practices in MBIs precludes understanding of their practice-specific effects or mechanisms of action. The purpose of this study is to isolate hypothesized active ingredients and practice-specific mechanistic target engagement by creating structurally equivalent interventions that differ only by the active ingredient (meditation practice) offered and to test whether the hypothesized components differentially engage the mechanistic targets that they are purported to engage. METHODS: Participants were intended to be representative of American meditators and had mild to severe affective disturbances. Measures of structural equivalence included participant-level (sample characteristics), treatment-level (program structure and duration, program materials, class size, attendance, homework compliance, etc.), and instructor-level variables (training, ratings and adherence/fidelity). Measures of differential validity included analysis of program materials and verification of differential mechanistic target engagement (cognitive and affective skills and beliefs about meditation acquired by participants after the 8-week training). RESULTS: The results indicate successful creation of structurally equivalent FA and OM programs that were matched on participant-level, treatment-level, and instructor-level variables. The interventions also differed as expected with respect to program materials as well as mechanistic targets engaged (skills and beliefs acquired). CONCLUSIONS: These validated 8-week FA and OM training programs can be applied in future research to assess practice-specific effects of meditation.