Motivational Interviewing to Increase Physical Activity Behavior in Cancer Patients: A Pilot Randomized Controlled Trials.

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.

Guilty displeasures: How imagined guilt dampens consumer enjoyment.

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.

Examining the effects of role play practice in enhancing clinical skills to assess and manage suicide risk.

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.

Cross-cultural Applicability of the 12-Step Model: A Comparison of Narcotics Anonymous in the USA and Iran.

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 (n = 527). RESULTS: NA in Iran reports 21,974 meetings. The Iranian respondents surveyed differed relatively little (d < 0.50) 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 (d > 0.50) 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.

Applying novel technologies and methods to inform the ontology of self-regulation.

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.

Mentalization and Dialectical Behavior Therapy.

Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT) are two approaches to the treatment of borderline personality disorder (BPD). While DBT has the most empirical support, MBT has a small but significant evidence base. Dialectical behavior therapy synthesizes behaviorism, mindfulness, and dialectics, while MBT is conceptually anchored in psychoanalysis, attachment theory, cognitive neuroscience, and developmental psychopathology. While coming from strikingly different orientations, DBT and MBT therapists share more interventions and stances than one might suppose. The central purported active ingredient of MBT is the capacity to mentalize, which is crucial for the formation of secure attachment, and this ability is thought to be weak and unstable in individuals with borderline personality disorder. This article explores the question of whether or not mentalizing is already present in DBT practice, whether it would be compatible with DBT conceptually and practically, and whether a focus on mentalizing would be of use to the DBT therapists and their patients.

Resisting religious coercive control.

Religious coercive control refers to the use of religious beliefs and doctrine as means to coercively control intimate partners. Scholars have shown that some abusive partners use the Christian doctrine of submission as a means of religious coercive control. I explore how victims who experience the doctrine of submission qua religious coercive control actively resist it. I argue that victims' successful resistance of the doctrine is contingent on their religious capital-that is, the knowledge and mastery that people have of a particular religious culture-and interpretive confidence-that is, people's subjective confidence in their interpretations of religious culture-related to the doctrine.

Medical clowns facilitate nitrous oxide sedation during intra-articular corticosteroid injection for juvenile idiopathic arthritis.

BACKGROUND: Intra-articular corticosteroid injection (IACI), a common procedure in juvenile idiopathic arthritis, is usually associated with anxiety and pain. In a previous study, we concluded that nitrous oxide (NO2) provides effective and safe sedation for such procedures. Following the introduction of medical clowns in our hospital, we added them as an integral part of the team performing IACI. OBJECTIVES: To prospectively evaluate the effect of a medical clown on pain perception during intra-articular corticosteroid injection for juvenile idiopathic arthritis using NO2 conscious sedation. METHODS: Patients scheduled for IACI first met and interacted with the medical clown. During the procedure, the rheumatologist and the medical clown worked in parallel to create distraction. NO2 was administered. The patient, parent, physician, medical clown and nurse completed a visual analog scale (0-10) for pain. Change in heart rate ≥ 15% was recorded to evaluate physiologic response to pain and stress. RESULTS: A total of 46 procedures were performed in 32 children: 23 girls, 9 boys, with a mean age of 10.9 ± 3.6 years. The median visual analog scale pain score for the patients, parents, physicians, medical clown and nurses was 2, 2, 1, 1 and 1, respectively. Five patients had increased heart rate and experienced increased pain. CONCLUSIONS: Active participation of a medical clown during IACI with nitrous oxide for juvenile idiopathic arthritis further decreases pain and stress and results in a positive patient experience.

A chinese mind-body exercise improves self-control of children with autism: a randomized controlled trial.

Self-control problems commonly manifest as temper outbursts and repetitive/rigid/impulsive behaviors, in children with autism spectrum disorders (ASD), which often contributes to learning difficulties and caregiver burden. The present study aims to compare the effect of a traditional Chinese Chan-based mind-body exercise, Nei Yang Gong, with that of the conventional Progressive Muscle Relaxation (PMR) technique in enhancing the self-control of children with ASD. Forty-six age- and IQ-matched ASD children were randomly assigned to receive group training in Nei Yang Gong (experimental group) or PMR (control group) twice per week for four weeks. The participants' self-control was measured by three neuropsychological tests and parental rating on standardized questionnaires, and the underlying neural mechanism was assessed by the participants' brain EEG activity during an inhibitory-control task before and after intervention. The results show that the experimental group demonstrated significantly greater improvement in self-control than the control group, which concurs with the parental reports of reduced autistic symptoms and increased control of temper and behaviors. In addition, the experimental group showed enhanced EEG activity in the anterior cingulate cortex, a region that mediates self-control, whereas the PMR group did not. The present findings support the potential application of Chinese Chan-based mind-body exercises as a form of neuropsychological rehabilitation for patients with self-control problems. Chinese Clinical Trial Registry; Registration No.: ChiCTR-TRC-12002561; URL: www.chictr.org.

Spirituality-based recovery from drug addiction in the twelve-step fellowship of narcotics anonymous.

BACKGROUND: Narcotics Anonymous is a worldwide fellowship that employs the Twelve-Step model for members dependent on drugs of abuse. The spiritual orientation of its program of abstinence has not been subjected to empirical study. METHODS: Responses of 527 American Narcotics Anonymous meeting attendees to a structured questionnaire were evaluated for the roles of cognitive and psychosocial aspects of spirituality in their recovery. RESULTS: Respondents had last used drugs or alcohol on average 6.1 years previously. They were found to be more oriented toward a spiritual than a formally religious orientation than probability samples of the general population. Aspects of membership such as affiliation toward other members and the experience of spiritual awakening were associated with lower rates of drug or alcohol craving, whereas scores on depression were associated with higher craving scores. CONCLUSIONS: Spiritual renewal combined with an abstinence-oriented regimen in Narcotics Anonymous social context can play a role in long-term recovery from drug addiction.

Psychological management of unipolar depression.

OBJECTIVE: To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. METHOD: Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. RESULTS: Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. CONCLUSION: Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal.

Identifying with a process of change: a qualitative assessment of the components included in a smoking cessation intervention at antenatal clinics in South Africa.

INTRODUCTION: previous research has suggested that pregnant women prefer a person-centred approach for smoking cessation interventions. However few studies have illustrated the mechanism through which such an approach has an influence on quitting or reduction rates among pregnant women in resource poor settings. PURPOSE: to explore the role of different components included in a smoking cessation intervention delivered to disadvantaged pregnant women with high smoking rates attending public health antenatal clinics in South Africa. METHODS: a qualitative design consisting of focus-group discussion with women exposed to the intervention was used. Women were purposively selected from four antenatal clinics and one tertiary hospital to represent different experiences of the intervention. Focus group discussions with four groups of smokers and four groups of quitters were conducted and a total of 41 women were interviewed. Data were analysed using content analysis. MAIN FINDINGS: the main theme describing the intervention effect that emerged from the interviews was, 'Making identification with change possible'. The categories 'An impulse for change', 'An achievable recipe', 'A physical reminder' and 'A compassionate companion' further described how each intervention component was perceived by women and how it contributed to behaviour change. CONCLUSIONS: behaviour change interventions that are directly informed by the target population with regards to its design, content and delivery offer great opportunities for positive behaviour change. Women positively evaluated all the components employed in this intervention but rated the social support they received from peer-counsellors as the overriding aspect of the intervention.

Children's event reports: factors affecting responses to repeated questions in vignette scenarios and event recall interviews.

When adults repeat questions, children often give inconsistent answers. This study aimed to test the claim that these inconsistencies occur because children infer that their first answer was unsatisfactory, and that the adult expects them to change their answer. Children aged 4, 6, and 8 years (N= 134) were asked about vignettes in which an adult repeated a question, with manipulation of the adult's overt dissatisfaction (high vs. low pressure) and knowledge about the information sought. On a separate occasion, the children were given an unrelated event recall interview containing repeated questions. All age groups showed sensitivity to adult dissatisfaction, interpreting question repetition as an implicit request for answer change more frequently in the high than in the low-pressure vignettes. Overall, however, these 'change-expected' interpretations were least frequent in the younger children, who were the most prone to shifting. Also there was no evidence that these interpretations were associated with more frequent shifting in the recall interview. The results do not provide clear support for a simple conversational inference account of shifting, especially in younger children.

[Medical clowns--dream doctors as important team members in the treatment of young children with juvenile idiopathic arthritis].

Juvenile idiopathic arthritis (JIA) is the most common chronic rheumatic disease in children. An intra-articular corticosteroid injection (IAS), one of the cornerstones of treatment for this disease, is usuaLLy associated with anxiety and pain. A major part of the success in reducing the pain is associated with the level of the child's anxiety even before starting the procedure. This is a case study of a 5 year old girl with JIA, who has been treated with an intra-articular corticosteroid injection to her knee joint. The case study is presented from the point of view of the medical clown, who is an important integral part of the team of the IAS procedure. In this article we will discuss the participation of medical clowns in the treatment of children in general, and in the IAS procedure in particular. The importance of the subject stems from the fact that it has been proven that the presence of medical clowns significantly alleviates the children's anxiety and pain. This study, as well as others on this subject, shows that we should encourage medical clowns as an integraL part of the treatment of children.

Mindfulness training effects for parents and educators of children with special needs.

Parents and teachers of children with special needs face unique social-emotional challenges in carrying out their caregiving roles. Stress associated with these roles impacts parents' and special educators' health and well-being, as well as the quality of their parenting and teaching. No rigorous studies have assessed whether mindfulness training (MT) might be an effective strategy to reduce stress and cultivate well-being and positive caregiving in these adults. This randomized controlled study assessed the efficacy of a 5-week MT program for parents and educators of children with special needs. Participants receiving MT showed significant reductions in stress and anxiety and increased mindfulness, self-compassion, and personal growth at program completion and at 2 months follow-up in contrast to waiting-list controls. Relational competence also showed significant positive changes, with medium-to-large effect sizes noted on measures of empathic concern and forgiveness. MT significantly influenced caregiving competence specific to teaching. Mindfulness changes at program completion mediated outcomes at follow-up, suggesting its importance in maintaining emotional balance and facilitating well-being in parents and teachers of children with developmental challenges.

The contribution of behavioural science to primary care research: development and evaluation of behaviour change interventions.

Behavioural science is concerned with predicting, explaining and changing behaviour. Taking a personal perspective, this article aims to show how behavioural science can contribute to primary care research, specifically in relation to the development and evaluation of interventions to change behaviour. After discussing the definition and measurement of behaviour, the principle of compatibility and theories of behaviour change, the article outlines two examples of behaviour change trials (one on medication adherence and the other on physical activity), which were part of a research programme on prevention of chronic disease and its consequences. The examples demonstrate how, in a multidisciplinary context, behavioural science can contribute to primary care research in several important ways, including posing relevant research questions, defining the target behaviour, understanding the psychological determinants of behaviour, developing behaviour change interventions and selection or development of measures. The article concludes with a number of recommendations: (i) whether the aim is prediction, explanation or change, defining the target behaviour is a crucial first step; (ii) interventions should be explicitly based on theories that specify the factors that need to be changed in order to produce the desired change in behaviour; (iii) intervention developers need to be aware of the differences between different theories and select a theory only after careful consideration of the alternatives assessed against relevant criteria; and (iv) developers need to be aware that interventions can never be entirely theory based.

Alternatives for hand over mouth exercise after its elimination from the clinical guidelines of the american academy of pediatric dentistry.

PURPOSE: The purpose of this study was to survey the alternative behavior management techniques that might be utilized by pediatric dentists in place of hand over mouth exercise (HOME) after its elimination from the clinical guidelines of the American Academy of Pediatric Dentistry (AAPD). METHODS: A questionnaire was electronically mailed to 2,600 AAPD members. The survey included items related to HOME alternatives after the elimination, concerns with its use, and if the elimination had affected access to care for children. RESULTS: Seven hundred four respondents (30%) completed the survey. Voice control was the first alternative, and minimum/moderate sedation was the second most common. Three hundred fifty respondents (50%) believed that HOME is an acceptable behavior management technique, and 290 (41%) believed it should be continued to be recognized by the AAPD. Only 7% believed that HOME elimination affected access to care for some children. CONCLUSION: Advanced behavior management techniques will be utilized more by pediatric dentists after the elimination of the hand over mouth exercise from the American Academy of Pediatric Dentistry's clinical guidelines.