"Pathways": A hope-enhancing intervention for patients undergoing treatment for advanced lung cancer.

OBJECTIVE: Observational data suggest hope is associated with the quality of life and survival of people with cancer. This trial examined the feasibility, acceptability, and preliminary outcomes of "Pathways," a hope intervention for people in treatment for advanced lung cancer. METHODS: Between 2020 and 2022, we conducted a single-arm trial of Pathways among participants who were 3-12 weeks into systemic treatment. Pathways consisted of two individual sessions delivered during infusions and three phone calls in which participants discussed their values, goals, and goal strategies with a nurse or occupational therapist. Participants completed standardized measures of hope and goal interference pre- and post-intervention. Feasibility was defined as ≥60% of eligible patients enrolling, ≥70% of participants completing three or more sessions, ≥70% of participants completing post-assessments, and mean acceptability ratings ≥7 out of 10 on intervention relevance, helpfulness, and convenience. Linear regression fixed effects models with covariates modeled pre-post changes in complete case analysis and multiple imputation models. RESULTS: Fifty two participants enrolled: female (59.6%), non-Hispanic White (84.6%), rural (75.0%), and with low educational attainment (51.9% high school degree or less). Except for enrollment (54%), feasibility and acceptability markers were surpassed (77% adherence, 77% retention, acceptability ratings ≥8/10). There was moderate improvement in hope and goal interference from pre-to post-intervention (d = 0.51, p < 0.05 for hope; d = -0.70, p < 0.005 for goal interference). CONCLUSIONS: Strong feasibility, acceptability, and patient-reported outcome data suggest Pathways is a promising intervention to increase hope and reduce cancer-related goal interference during advanced lung cancer treatment.

Seeing is believing: The effect of subtle communication in social media on viewers' beliefs about depression and anxiety symptom trajectories.

OBJECTIVE: One barrier to treatment seeking, uptake, and engagement is the belief that nothing can be done to reduce symptoms. Given the widespread use of social media to disseminate information about important issues, including psychological health, we sought to understand how the influence of social media communication regarding mental health impacts viewers' beliefs about psychopathology recovery. METHOD: Undergraduate participants from a large Midwestern university (N = 322) were randomized to view a series of Tweets characterizing psychopathology from a fixed mindset perspective, a growth mindset perspective, or, in the control condition, Tweets unrelated to psychopathology. Afterward, they completed a series of questionnaires designed to assess beliefs about recovery from depression and anxiety. RESULTS: Participants in the growth mindset condition endorsed less pessimistic beliefs about their ability (i.e., self-efficacy) to alleviate symptoms of depression and anxiety, and they believed these symptoms to be less stable and innate relative to those in the fixed mindset condition. CONCLUSION: Social media communication that characterizes psychopathology from a growth mindset perspective may be a viable intervention for improving beliefs around mental health self-efficacy and the malleable nature of mental illness, particularly depression and anxiety. Clinicians may be able to use social media platforms to promote functional beliefs around mental illness.

The Friends and Family for Mental Health Program: a pilot study of a cognitive behavioral therapy skills intervention for rural adults.

INTRODUCTION: Limited access to psychological treatment is a pressing problem in the US, especially in more rural areas. One potentially underutilized resource is informal care from friends and family members. Although those in rural areas rely on informal care more than those in urban areas, there is little to guide interested caregivers in how they can be most effective. METHODS: In this study, we conducted a pilot test of the Friends and Family for Mental Health Program, a mental health skills program we developed to enhance informal care and reduce psychological symptoms among informal caregivers. To provide an initial test of the potential benefits of this program, we evaluated the impact of the program on informal care skills, hope, psychological symptoms, and mental health skills. RESULTS: Informal care skills and hope improved. Participants also reported reduced anxiety. We considered intervention feedback to inform intervention development. DISCUSSION: Overall, findings provided preliminary support for the program and provide directions for future refinements. CONCLUSION: Though further research is needed, initial evidence suggests mental health skills programs directed at informal caregivers are both desired and beneficial in rural areas.

Defining the p-factor: an empirical test of five leading theories.

BACKGROUND: Despite statistical evidence of a general factor of psychopathology (i.e., p-factor), there is little agreement about what the p-factor represents. Researchers have proposed five theories: dispositional negative emotionality (neuroticism), impulsive responsivity to emotions (impulsivity), thought dysfunction, low cognitive functioning, and impairment. These theories have primarily been inferred from patterns of loadings of diagnoses on p-factors with different sets of diagnoses included in different studies. Researchers who have directly examined these theories of p have examined a subset of the theories in any single sample, limiting the ability to compare the size of their associations with a p-factor. METHODS: In a sample of adults (N = 1833, Mage = 34.20, 54.4% female, 53.3% white) who completed diagnostic assessments, self-report measures, and cognitive tests, we evaluated statistical p-factor structures across modeling approaches and compared the strength of associations among the p-factor and indicators of each of these five theories. RESULTS: We found consistent evidence of the p-factor's unidimensionality across one-factor and bifactor models. The p-factor was most strongly and similarly associated with neuroticism (r = .88), impairment (r = .88), and impulsivity (r = .87), χ2(1)s < .15, ps > .70, and less strongly associated with thought dysfunction (r = .78), χ2(1)s > 3.92, ps < .05, and cognitive functioning (r = -.25), χ2(1)s > 189.56, ps < .01. CONCLUSIONS: We discuss a tripartite definition of p that involves the transaction of impulsive responses to frequent negative emotions leading to impairment that extends and synthesizes previous theories of psychopathology.

Goal-Focused Emotion-Regulation Therapy (GET) in Young Adult Testicular Cancer Survivors: A Randomized Pilot Study.

BACKGROUND: Young adult testicular cancer survivors experience adverse impacts after treatment. We developed Goal-focused Emotion-regulation Therapy (GET) to improve distress symptoms, emotion regulation, and goal navigation skills. PURPOSE: This pilot study examined GET versus an active control intervention in young adult survivors of testicular cancer. METHODS: Seventy-five eligible survivors treated with chemotherapy were randomized to receive GET or Individual Supportive Listening (ISL). Study acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between arms. Preliminary efficacy was evaluated by effect sizes for between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention. RESULTS: Among the 38 men randomized to GET, 81.1% completed all study sessions compared with 82.4% of the 37 men assigned to ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance wassignificantly higher among those receiving GET versus ISL. Participants exhibited a medium group-by-time effect size with greater reductions in depressive (d = 0.45) and anxiety (d = 0.29) symptoms for those in GET versus ISL, with a similar pattern at 3 months for depressive (d = 0.46) and anxiety (d = 0.46) symptoms. CONCLUSIONS: GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults. Observed effect sizes preliminarily suggest meaningful change, though should be interpreted with caution in small samples. GET may be a developmentally-matched behavioral approach to improve psychosocial function in this cancer group. CLINICAL TRIAL INFORMATION: Clinicaltrials.gov, NCT04150848. Registered on October 28, 2019.

Young adult testicular cancer survivors experience adverse impacts after treatment. Goal-focused Emotion-regulation Therapy (GET) was developed to improve distress symptoms, emotion regulation, and goal navigation skills. The aim of this pilot study was to examine GET versus a control intervention in young adult survivors of testicular cancer. Seventy-five survivors were randomly assigned to GET or Individual Supportive Listening (ISL). Indictors of acceptability, engagement, and tolerability were examined, and intervention fidelity and therapeutic alliance were compared between groups. Between-group changes in primary (anxiety and depressive symptoms) and secondary (career confusion, goal navigation, and emotion regulation) outcomes from baseline to immediately and 3-month post-intervention were examined. Among GET participants, 81.1% completed all study sessions compared with 82.4% of those receiving ISL. Fidelity to the intervention was 87% in GET. Therapeutic alliance scores were significantly higher among those receiving GET. Participants exhibited greater reductions in depressive and anxiety symptoms for those in the GET versus ISL, with a similar pattern observed for changes at 3 months for depressive and anxiety symptoms. GET is a feasible and acceptable intervention for reducing adverse outcomes after testicular cancer for young adults.

Early and slow weight loss responders' perceptions of an adaptive diabetes prevention trial: A qualitative perspective.

Objective: Behavioural weight loss interventions demonstrate success on average, yet participants who respond more slowly may benefit from an augmented, tailored approach. Thus, an augmented intervention for early, slow weight loss responders was implemented. This qualitative analysis explored participants' perceptions of and experiences of the 12-month weight loss programme to inform future intervention development and implementation. Design: Individual interviews were conducted post-treatment. In-person, in-depth interviews were offered prior to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic; videoconferencing interviews were offered following the pandemic onset. Setting: A Midwestern US university workplace. Method: Adults ⩾21 years old with overweight or obesity and prediabetes (n = 39) were recruited and volunteered to participate in a semi-structured interview. Results: Content analysis identified recurring themes among early and early slow weight loss responders. Social support received during weekly group sessions was a critical intervention component. Some early slow responders expressed difficulty with self-regulatory strategies such as setting specific yet attainable goals, and requested additional contact prior to the maintenance study phase - treatment randomisation at month 5 disrupted group dynamics. Early slow responders who received the intervention via videoconferencing believed the format interfered with their ability to establish friendships with other participants and gain insight and support from others' lived experiences. Conclusion: Weight loss interventions may be more efficacious when considering participant heterogeneity during implementation of behavioural strategies. Findings suggest early slow weight loss responders may benefit from greater emphasis on goal setting and striving, agentic thinking, and social support. Future research is needed to examine the implications of these insights on intervention outcomes.

Framing an intervention as focused on one's strength: Does framing enhance therapeutic benefit?

INTRODUCTION: A capitalization approach to enhancing client skills in cognitive behavioral interventions is focused on enhancing skills that represent relative strengths. This approach may bolster outcomes because the targeted skills are those that clients can most effectively use to recover from negative moods. Alternatively, the benefits might be due to client attitudes about these skills, such as their confidence that they can use these skills effectively. METHODS: In an unselected sample of 616 undergraduates, we randomized to one of two brief interventions (a cognitive or mindfulness intervention) and one of two framing conditions (framing the intervention as focusing on a relative strength or a weakness), resulting in four conditions. Participants were then asked to use the skill targeted in their intervention to recover from a sad mood induction. RESULTS: Framing conditions did not differ on expectations of benefit from sustained use of an intervention but did differ on mood recovery. Participants told that the intervention focused on a strength recovered more quickly following the mood induction. There was no difference between the skill interventions. DISCUSSION: Our finding suggests intervention framing positively contributes to the effects of strengths focused treatments, though perhaps not by enhancing treatment expectations.

The therapeutic alliance and dropout in cognitive behavioral therapy of depression.

Identifying predictors of dropout is an important step in improving treatment outcomes. The alliance is the most frequently studied psychotherapy process variable, but its relation to dropout in cognitive behavioral therapy (CBT) of depression is not well understood.We evaluated the alliance at session one as reported by clients and therapists as predictors of dropout among 126 clients with major depressive disorder participating in CBT for depression.Over a similar time period, those who dropped out experienced less symptom change than those who did not. Client, but not therapist reported alliance was related to reduced risk for dropout. This relation remained significant even when clients' pre-treatment predictions of the alliance were included as a covariate. Concurrent use of medication did not moderate the alliance-dropout relation.Our findings are consistent with alliance being an important contributor to risk of dropout in CBT for depression. Future research should investigate intervention strategies that might promote the alliance as a means of reducing dropout.

Developing pathways, a hope-enhancing intervention for metastatic lung cancer patients receiving cancer treatment.

OBJECTIVE: Between 40% and 65% of lung cancer patients report concern about maintaining valued activities and roles, yet few interventions address this concern. Hope, a patient's perceived ability to generate goals and identify ways to pursue them, may be a promising intervention target to support function among lung cancer patients. The goal of this study was to assess metastatic non-small cell lung cancer (mNSCLC) patient interest and preferences for a hope-enhancing intervention. METHODS: We conducted a sequential mixed-methods (survey followed by semi-structured interviews) study with patients with mNSCLC. Surveys assessed patient interest in, perceived helpfulness of, and preferences for a hope intervention. A subset of 12 patients (and caregivers, when present) completed semi-structured interviews to elicit feedback on proposed intervention content and procedures. RESULTS: Survey data from 60 patients (40% male; Mean age = 62.5; SD = 9.3) suggested high perceived importance of pursuing personal goals during cancer treatment, moderate perceived helpfulness in discussing personal goals, and preference for a nurse-led intervention. Based on these data, a 5-session, nurse-led intervention protocol was drafted and reviewed with 12 patients. Interviewed patients and caregivers agreed working towards goals was beneficial, liked the intervention concept, and thought prompts and rating scales on handouts would facilitate discussion. The majority preferred nurse delivery during infusions. CONCLUSIONS: A nurse-led hope-enhancing intervention delivered primarily during infusions may be acceptable to mNSCLC patients. Future work should test feasibility and identify ways to incorporate caregivers and oncology providers into hope interventions.

Hope attenuates the negative impact of general psychological distress on goal progress.

OBJECTIVE: Symptoms of general psychological distress disrupt goal pursuit; however, not everyone is equally impacted by distress when pursuing goals. We tested whether hope, self-efficacy, and/or grit buffered the impact of symptoms of general psychological distress on longitudinal goal progress. METHOD: Undergraduate students reported on these constructs and, 2 months later, their progress toward five personal goals (N = 117). RESULTS: Although greater levels of baseline psychological distress predicted less goal progress, the impact of psychological distress on goal progress was moderated by hope, ß = .20, SE = 0.07, p < .01. More specifically, at higher hope, participants reported similar goal progress regardless of baseline distress symptoms, while at lower hope, baseline distress was negatively associated with goal progress. CONCLUSION: Hope may function as a buffer against the association between general psychological distress and impaired goal progress.

Hope-related goal cognitions and daily experiences of fatigue, pain, and functional concern among lung cancer patients.

PURPOSE: Cross-sectional research suggests that thinking about multiple ways to reach goals (hope pathways) and the belief that one can reach them (hope agency) may be adaptive for lung cancer patients. We examined the between-person and within-person associations among aspects of hope agency and pathways thinking, daily fatigue, pain, and functional concerns (e.g., sense of independence, usefulness) among lung cancer patients during active treatment. METHODS: Data from a daily diary study were used to examine relations among hope agency, hope pathways, fatigue, pain, and functional concern in 50 patients with advanced lung cancer. Participants were accrued from one outpatient cancer center and completed the study between 2014 and 2015. RESULTS: Adjusting for covariates and the previous day's symptoms or concern, patients who engaged in higher pathways thinking reported lower daily symptoms, whereas those who engaged in higher agency thinking reported less functional concern. Within-person increases in pathways thinking were associated with less daily fatigue, pain, and functional concern; within-person increases in agency thinking were associated with less daily fatigue and pain. Models examining symptoms and concerns as predictors of hope suggested within-person increases in functional concern and fatigue and pain were related to lower agency and pathways thinking the same day. Patients with higher fatigue and pain did not report lower agency or pathways thinking, but patients with more functional concern did. CONCLUSIONS: Increases in hope pathways thinking may be associated with lower symptoms and better functioning in lung cancer patients. This suggests that it is important to determine the efficacy of interventions that emphasize the pathways the component of hope.

More (of the right strategies) is better: disaggregating the naturalistic between- and within-person structure and effects of emotion regulation strategies.

Although people often use multiple strategies to regulate their emotions, it is unclear if using more strategies effectively changes emotional outcomes. This may be because there is no clear, data-driven structure to organise which strategies people use together, so strategies with opposing impacts are modelled together. We first conducted a multilevel factor analysis of negative- and positive-emotion regulation strategies among undergraduates (n = 92) completing ecological momentary assessment three times per day for 10 days. Solutions including 3-within/3-between factors were most interpretable. Using more between-person Adaptive Engagement strategies and within-person Adaptive Engagement, Enhancement, and Behavioural strategies predicted improved mood, whereas using more between-person Aversive Cognitive and within-person Aversive Cognitive and Disengagement strategies predicted worse mood, ps < .05. Using a greater quantity of strategies may thus promote better, or worse, emotional outcomes, depending on the class of strategies used.

Validation predicting premature drop-out from treatment provided in training clinics.

BACKGROUND: Therapist validation in treatment is theorized to be related to positive outcomes (Linehan, 1993), including keeping patients in therapy longer. AIMS: We sought to evaluate the role of therapist validation from both therapists' and clients' perspectives as a predictor of drop-out from psychotherapy in three cognitive behavioural training clinics. METHOD: Clients in psychotherapy (n = 50; 80% female; 82% Caucasian) and their trainee therapists (n = 22; 68% female; 86% Caucasian) rated validation by the therapist at each of four early sessions of therapy. RESULTS: After accounting for symptom severity, clients who reported greater therapist validation were less likely to drop out of treatment. Therapist ratings of their own validating behaviours were unrelated to client drop-out. Therapist experience moderated the relation between client-rated validation and drop-out, such that validation was unrelated to drop-out for more experienced therapists. CONCLUSIONS: Assessing and attending to client perceptions of validation by the therapist early in treatment, with brief self-report inventories, can alert therapists to clients at greater risk of drop-out.

Posttraumatic stress disorder in interstitial cystitis/bladder pain syndrome: Relationship to patient phenotype and clinical practice implications.

PURPOSE: The relationship between exposure to abuse and interstitial cystitis/bladder pain syndrome (IC/BPS) is well-documented. However, studies have yet to examine posttraumatic stress disorder (PTSD), which develops following exposure to trauma and worsens health outcomes in chronic pain. We aimed to assess the prevalence and impact of PTSD in patients with IC/BPS, including their relation to genitourinary symptom presentation and widespread pain phenotype. MATERIALS AND METHODS: We recruited 202 participants with chronic pain from an academic medical center and classified 64 individuals as IC/BPS based on validated epidemiological criteria. Participants completed self-reported questionnaires assessing trauma exposure, PTSD symptoms, emotional distress, pain, and urinary symptoms. Wilcoxon rank-sum tests assessed study aims comparing IC/BPS to other chronic pain. RESULTS: Although elevated, IC/BPS trauma exposure rates were equivalent to that of other chronic pain conditions in the sample. Despite this equivalence, in comparison, IC/BPS patients had significantly higher rates of PTSD symptoms, with 42% meeting provisional diagnostic criteria for PTSD. Among IC/BPS, those meeting provisional criteria for PTSD had significantly higher incidence of lifetime sexual abuse, childhood trauma, and presentations consistent with the widespread pain phenotype. In IC/BPS, there was no association between PTSD and genitourinary symptoms, but provisional PTSD was associated with more pain, emotional distress, and poorer quality of life. CONCLUSIONS: We recommend that patients with IC/BPS and widespread pain have ongoing screening and monitoring of PTSD. We recommend using trauma-informed care practices with these patients to increase trust and safety, which could improve treatment compliance and follow-up.

Literacy-Adapted Cognitive Behavioral Therapy Versus Education for Chronic Pain at Low-Income Clinics: A Randomized Controlled Trial.

Background: Chronic pain is common and challenging to treat. Although cognitive behavioral therapy (CBT) is efficacious, its benefit in disadvantaged populations is largely unknown. Objective: To evaluate the efficacy of literacy-adapted and simplified group CBT versus group pain education (EDU) versus usual care. Design: Randomized controlled trial. (ClinicalTrials.gov: NCT01967342). Setting: Community health centers serving low-income patients in Alabama. Patients: Adults (aged 19 to 71 years) with mixed chronic pain. Interventions: CBT and EDU delivered in 10 weekly 90-minute group sessions. Measurements: Self-reported, postintervention pain intensity (primary outcome) and physical function and depression (secondary outcomes). Results: 290 participants were enrolled (70.7% of whom were women, 66.9% minority group members, 72.4% at or below the poverty level, and 35.8% reading below the fifth grade level); 241 (83.1%) participated in posttreatment assessments. Linear mixed models included all randomly assigned participants. Members of the CBT and EDU groups had larger decreases in pain intensity scores between baseline and posttreatment than participants receiving usual care (estimated differences in change scores-CBT: -0.80 [95% CI -1.48 to -0.11]; P = 0.022; EDU: -0.57 [CI, -1.04 to -0.10]; P = 0.018). At 6-month follow-up, treatment gains were not maintained in the CBT group but were still present in the EDU group. With regard to physical function, participants in the CBT and EDU interventions had greater posttreatment improvement than those receiving usual care, and this progress was maintained at 6-month follow-up. Changes in depression (secondary outcome) did not differ between either the CBT or EDU group and the usual care group. Limitations: Participants represented a single health care system. Self-selection bias may have been present. Conclusion: Simplified group CBT and EDU interventions delivered at low-income clinics significantly improved pain and physical function compared with usual care. Primary Funding Source: Patient-Centered Outcomes Research Institute.

Emotions as context: Do the naturalistic effects of emotion regulation strategies depend on the regulated emotion?

Researchers have examined how several contexts impact the effectiveness of emotion regulation strategies. However, few have considered the emotion-to-be-regulated as a context of interest. Specific emotions are important contexts because they may require particular responses to internal and external stimuli for optimal regulation. Ninety-two undergraduates completed 10 days of ecological momentary assessment, reporting their current mood, recent emotions, and emotion regulation strategies three times per day. The frequency with which certain emotion regulation strategies were used (i.e., acceptance, positive refocusing, reappraisal, problem-solving, and other-blame) differed by the specific emotion experienced. Acceptance and positive refocusing were associated with better mood regardless of emotion, while substance use was associated with worse mood regardless of emotion. Reappraisal was associated with better mood in response to anger than anxiety or sadness, while emotional suppression and other-blame were associated with worse mood in response to anger. These results suggest some emotion regulation strategies exhibit emotion-invariant effects while others depend on the emotion-to-be-regulated.

Flexible, yet firm: A model of healthy emotion regulation.

We propose a model of healthy intentional emotion regulation that includes (1) a large repertoire of (2) adaptive strategies that (3) one persists with despite initial negative feedback. One hundred forty-four undergraduates (average age = 19.20 years; 68% female, 79% Caucasian) completed a novel performance task indicating what they would think or do to feel better in response to eleven stressful vignettes. After their initial response, participants indicated four more times how they would respond if their previous strategy was not working. Raters categorized each response as an emotion regulation strategy and coded the adaptiveness of each strategy. Participants self-reported Neuroticism, Extraversion, Conscientiousness, Borderline Personality Disorder (BPD) symptoms, and depressive symptoms. We regressed each personality dimension and psychopathology symptom on our model of healthy emotion regulation. Neuroticism was negatively associated with adaptiveness and persistence. Extraversion was positively associated with adaptiveness. Conscientiousness was positively associated with repertoire, adaptiveness, and persistence, while BPD symptoms were negatively associated with all three variables. Depressive symptoms were negatively associated with persistence. These preliminary findings suggest that people with larger repertoires of more adaptive emotion regulation strategies who persist with these strategies despite initial negative feedback report less personality pathology and psychological distress.

Assessing the Relation Between Flexibility in Emotional Expression and Symptoms of Anxiety and Depression: The Roles of Context Sensitivity and Feedback Sensitivity.

Expressive flexibility (EF), the ability to enhance and suppress emotional expressions, predicts decreases in anxiety and depression symptoms years later (Bonanno, Papa, Lalande, Westphal, & Coifman, 2004). Bonanno and Burton (2013) proposed that knowing the most appropriate strategy for a situation (context sensitivity; CS), and awareness of how well strategies are working (feedback sensitivity; FS), partially explain this effect. We conducted a conditional process analysis to test this theory. One hundred thirty-eight undergraduates completed a behavioral measure of EF and self-reported symptoms of anxiety and depression, CS, and FS over one month. CS moderated the effect of EF on one-month changes in symptoms of anxiety and depression (p = .03): EF only predicted decreased anxiety and depression symptoms among people low in CS. FS mediated the effect of EF (95% CI: -.10, -.01) on changes in anxiety and depression symptoms: higher baseline EF was associated with higher two-week FS, which predicted decreased one-month anxiety and depression symptoms. Results suggest EF and CS may be compensatory skills and FS may be necessary to experience the adaptive effects of emotion regulation flexibility.

Incorporating Resilience Factors Into the Interpersonal Theory of Suicide: The Role of Hope and Self-Forgiveness in an Older Adult Sample.

OBJECTIVES: The interpersonal theory of suicide posits that perceived burdensomeness and thwarted belongingness are risk factors for suicide ideation. To more comprehensively characterize this model, it is important to identify resilience factors. Forgiveness of oneself may attenuate the relation between perceived burdensomeness and suicide ideation. Similarly, hope might weaken the association between thwarted belongingness and suicide ideation. METHOD: We examined these relations cross-sectionally in a sample (N = 91) of older adults after including symptoms of depression and demographic variables in the models. RESULTS: Self-forgiveness moderated the relation between perceived burdensomeness and suicide ideation. Hope did not moderate the relation between thwarted belongingness and suicide ideation. CONCLUSIONS: These findings suggest that including resilience factors (i.e., self-forgiveness) in models of suicide ideation may result in better identification of those most at risk for suicide and may allow for more precise intervention targets.

Does intervention sequence impact self-regulatory and behavioral outcomes in an adaptive trial among adults with prediabetes?

Background: Lifestyle interventions can promote improvement in dietary intake and physical activity (PA), on average, by strengthening motivation, self-regulatory efforts, and commitment to behavioral change. However, maintenance of behavioral change is challenging, and slow responders during treatment often experience less overall success. Adaptive intervention sequences tailored to treatment response may be more effective in sustaining behavioral change. Methods: Adults ≥ 21 years old with prediabetes (n = 187) were stratified at week five to the standard Group Lifestyle Balance (GLB) intervention, if they achieved > 2.5% weight loss, or to the augmented intervention GLB Plus (GLB+) at week five, if they did not. At month five, each person in a matched pair was randomly assigned to GLB or GLB + for the extended intervention phase (months 5-12) followed by no study conduct (months 13-18). The primary comparison of interest was the change in outcomes between the standard (GLB followed by GLB) and augmented (GLB + followed by GLB+) intervention sequences post-intervention at 12 - and 18-months using linear mixed effect models. Results: The augmented GLB + intervention sequence reported a decline in the change in self-efficacy for reducing fat intake, self-efficacy for 'sticking to' healthy eating and exercise, and hopeful thought and planning compared to the standard GLB intervention sequence (all P < 0.0167) at 18-months. However, there were no significant differences between these intervention sequences at 18-months in the change in dietary intake or minutes of PA (all P > 0.05). Conclusions: No significant change in behavioral measures across intervention sequences occurred at study end. An 18-month decline in self-efficacy regarding diet and PA and hopeful thought and planning among slow responders following no intervention for six months indicates greater extended care is likely needed. The type of extended care that is most effective for slow treatment responders requires additional research.