Anxious Attachment Style Predicts Dietary Adherence 1-Year Post-bariatric Surgery.

PURPOSE: Adherence to dietary guidelines is critical for optimizing health and weight outcomes after metabolic and bariatric surgery, yet many patients have difficulty. The purpose of this study was to identify the types and frequency of post-surgery non-adherent dietary behaviors and to determine pre-surgery predictors of adherence at 1-year post-surgery. MATERIALS AND METHODS: We completed a prospective cohort study of 348 adults who underwent sleeve gastrectomy (n = 25) or Roux-en-Y gastric bypass (n = 323) at an academic medical center between 2013 and 2017. Pre- and post-surgery parameters were demographics, adherence to dietary recommendations and mental health symptoms. Descriptive statistics and regression analyses were used. RESULTS: Pre-surgery, 264 (75.9%) participants were classified as adherent to nutrition recommendations by a Registered Dietitian (RD). At 1-year post-surgery, 203 (58.3%) were adherent, a statistically significant decrease (p < 0.05). The three most frequent non-adherent eating behaviors were insufficient protein intake (32.4%), inadequate vitamin intake (26.1%), and grazing (21.1%). Pre-surgery predictors in the bivariate regression analysis were anxious attachment (p = 0.01), poorer emotion regulation (p = 0.01), poorer perceived social support (p = 0.01), and RD disposition of dietary adherence (p = 0.02). In the best subset multivariate regression analysis, anxious attachment emerged as the significant predictor. CONCLUSION: Several types of non-adherent eating behaviors were identified. Pre-surgery, anxious attachment style, dietary adherence, emotion regulation, and perceived social support were predictors of adherence to dietary guidelines 1-year post-surgery. These factors should be assessed and patients provided with relevant support and education.

A longitudinal approach to evaluating therapist and client contributions to alliance on outcomes in borderline personality disorder.

Methods for studying therapeutic alliance have primarily examined the impact of the early alliance on outcomes. This does not allow for an understanding of the contributions of client, therapist, and dyadic factors to the alliance. Also, the alliance may change over time, highlighting the need for longitudinal methods. Efforts have been made to develop approaches that decompose the contributing factors and their impact on outcomes, but these findings may not apply to clients with borderline personality disorder (BPD). Our study extends previous research by replicating Baldwin et al.'s (2007) approach to disentangling therapist versus client-therapist dyad effects while using a time-varying framework. Participants (n = 156) were individuals diagnosed with BPD randomized to 1 year of dialectical behavior therapy or general psychiatric management. Outcomes were general psychiatric severity and interpersonal functioning measured at baseline and every 4 months. Client-rated alliance was measured at these time points. Early alliance predicted interpersonal functioning (p = .0132) with a significant contribution from clients (p = .0248) but not therapists (p = .2854). In the time-varying analysis, client contribution to the alliance was significant (p = .0022). For general psychiatric severity, client contributions to the alliance were significant (p < .0001) but not therapist contributions (p = .6779). Client contribution to the alliance was significant (p = .0168) in the time-varying model. Results suggest that in a BPD sample, time-varying alliance is a better predictor of rate of change in outcomes compared with the alliance measured at a single time point. In contrast to other studies, client, not therapist, contributions to alliance were significant in predicting outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

HIV Risk and Protective Factors in the Context of Alcohol and Substance Use During Pride.

This investigation sought to identify HIV-risk and -protective factors among men-who-have-sex-with-men (MSM) who engaged in anal sex following alcohol or substance use during an international Pride Festival. MSM attending World Pride were surveyed regarding (1) alcohol, substance use, and sex during the past 24 h; and (2) HIV-risk and -protective factors. Valid data were provided by 1123 MSM. Anal sex was reported by 195 MSM, among whom the majority (n = 105) consumed alcohol or substances prior to sex. Among MSM aware of their HIV status who consumed alcohol or substances prior to sex (n = 99), those who engaged in serodiscordant condomless anal sex (n = 22) were more likely to be HIV+ (AOR = 10.14, 95% CI 1.48-69.35); report multiple sex partners (AOR = 9.05, 95% CI 1.70-48.12); and possess lower condom efficacy (AOR = 0.47, 95% CI 0.23-0.93) and social support (AOR = 0.08, 95% CI 0.01-0.46). Bolstering condom negotiation skills and social support could potentially reduce HIV acquisition/transmission-risk behavior, even when under the influence of alcohol or substances.