"Life Without Symptoms" or "Being Able to Enjoy Life": What does it Mean to be "Well" After Cancer?

OBJECTIVE: To achieve wellness in cancer survivorship, researchers and clinicians need a better understanding of what it means to live "well", from the perspective of cancer survivors themselves. METHODS: Australian and UK cancer survivors (N = 376) diagnosed in the previous five years, were asked "What does it mean to be well?", with an open-ended text response. Responses were coded using content analysis. Demographics, time since diagnosis, coping style and symptom level were also assessed. RESULTS: Descriptions of what it meant to be "well" were coded as absence-focused (living without negative impacts of illness, 32.7%) or presence-focused (living with health, function, or wellbeing, 37.8%). A further 29.5% of responses contained both elements. Lower symptom level and higher use of a fatalism coping style were associated with presence-focused definitions of being well. CONCLUSIONS: More meaningful conversations with cancer survivors about their goals for care would be facilitated by a better understanding of what it means to them to be "well". As symptoms change over the course of survivorship, it may be necessary to re-examine each survivor's goals of care.

The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space and Nature Connection to Mental Health.

BACKGROUND: Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population. METHODS: Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic. RESULTS: Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

Developing habit-based health behaviour change interventions: twenty-one questions to guide future research.

OBJECTIVE: Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours. METHODS: Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour. RESULTS: In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions). CONCLUSIONS: While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change.

How and Why the Choice of Success Criteria Can Impact Therapy Service Delivery: A Worked Example From a Psychological Therapy Service for Anxiety and Depression.

Background: Well-defined measures of therapeutic benefit are essential for evaluating therapies and services. However, there is no single gold standard for defining 'successful' outcomes. We therefore examined the potential impact of adopting different success criteria. Method: We analysed data for 7,064 patients undergoing psychological therapy in a single UK IAPT (Increasing Access to Psychological Therapy) Service, each patient being assessed for depression (PHQ-9) and anxiety (GAD-7) both at the start and end of treatment. Predictors of successful outcomes based on these measures were analysed separately for three different success criteria: based either on assessing clinically significant change, or reliable change, in depression and anxiety. Results: The choice of criteria had little bearing on which variables predicted successful outcomes. However, the direction of the relationship between initial PHQ-9 or GAD-7 score and outcome success reverses when the criteria used to judge success are changed: successful outcomes are less probable under clinically significant change criteria for patients entering the service with more severe depression and/or anxiety but are more probable for such patients under reliable change criteria. Conclusion: Relevant for clinicians, researchers, and policymakers, the choice of success criteria adopted can substantially change the incentives for patient selection into a therapy service. Our analysis highlights how the methods used to evaluate treatment outcomes could impact the priorities and organisation of therapeutic services, which could then impact on who is offered treatment. We recommend further investigations of success criteria in other conditions or treatments to determine the reproducibility of the effects we found.

Psychological benefits of outdoor physical activity in natural versus urban environments: A systematic review and meta-analysis of experimental studies.

The impact of environmental context on the psychological benefits derived from physical activity has attracted research attention in recent years. Previous reviews have compared effects of indoor versus outdoor exercise. This review compares the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological health outcomes in adult general populations. An electronic literature search identified 24 experimental studies meeting the inclusion criteria. Results were analysed via narrative synthesis (n = 24) and meta-analysis (n = 9) of effect on six outcomes. Narrative synthesis found in favour of the natural environment for anxiety, anger/hostility, energy, affect and positive engagement. Post-intervention effect sizes suggested duration and social context as potential moderators. The meta-analyses revealed large or moderate effects in favour of the natural environment for anxiety, fatigue, positive affect and vigour, and a small effect for depression. Results were subject to high risk of bias and heterogeneity. Physical activity undertaken outdoors in natural environments is more beneficial for a range of psychological outcomes compared with urban environments. The various effect sizes evident in the meta-analyses may be explained by differing mechanisms through which psychological gains are experienced during physical activity in nature.

Attitudes, Habits, and Behavior Change.

Efforts to guide peoples' behavior toward environmental sustainability, good health, or new products have emphasized informational and attitude change strategies. There is evidence that changing attitudes leads to changes in behavior, yet this approach takes insufficient account of the nature and operation of habits, which form boundary conditions for attitude-directed interventions. Integration of research on attitudes and habits might enable investigators to identify when and how behavior change strategies will be most effective. How might attitudinally driven behavior change be consolidated into lasting habits? How do habits protect the individual against the vicissitudes of attitudes and temptations and promote goal achievement? How might attitudinal approaches aiming to change habits be improved by capitalizing on habit discontinuities and strategic planning? When and how might changing or creating habit architecture shape habits directly? A systematic approach to these questions might help move behavior change efforts from attitude change strategies to habit change strategies.

The common sense model of illness self-regulation: a conceptual review and proposed extended model.

The common sense model of illness self-regulation outlines the dynamic processes by which individuals perceive, interpret, and respond to health threats and illness-related information. An extended version of the model is proposed, which specifies additional constructs and processes to explain how lay perceptions of health threats impact coping responses and health-related outcomes. The extended model provides detail on: (a) the mediating process by which individuals' illness representations relate to illness outcomes through adoption of coping procedures; (b) how illness representations are activated by presentation of health-threatening stimuli; (c) behavioral and treatment beliefs as determinants of coping procedures and illness outcomes alongside illness representations; and (d) effects of moderators of relations between cognitive representations, coping procedures, and illness outcomes. The extended model sets an agenda for future research that addresses knowledge gaps regarding how individuals represent and cope with health threats, and may inform effective illness-management interventions. We identify the kinds of research required to provide robust evidence for the extended model propositions. We call for research that employs incipient illness samples, utilizes designs that capture dynamic processes in the model such as cross-lagged panel and intervention designs, and adopts illness-specific measures of coping procedures rather than relying on generic instruments.

The Impact of Illness Perceptions and Coping Strategies on Use of Supportive Care for Cancer.

Despite evidence that survivorship support programmes enhance physical and psychosocial wellbeing, cancer patients and survivors often do not use these supportive care services. This study investigated the utility of the Common Sense Model of Self-Regulation for predicting supportive care use following cancer, and the mediating role of coping strategies. Cancer patients and survivors (n = 336 from Australia, n = 61 from the UK; 191 males, 206 females) aged 20-83 years (Mean (M) = 62.73, Standard Deviation (SD) = 13.28) completed an online questionnaire. Predictor variables were cognitive and emotional representations of cancer, as measured by the Illness Perception Questionnaire-Revised (IPQ-R), and problem- and emotion-focused coping strategies, as measured by the Brief-Coping Orientation to Problems Experienced inventory (Brief-COPE). The outcome variable was survivorship support programme use within the preceding month. Perceived personal control over cancer predicted supportive care use, but cancer-related emotional distress did not. Coping was an inconsistent mediator of the relationships. Problem-focused coping mediated the relationship between personal control and supportive care use; emotion-focused coping did not mediate between emotional responses to cancer and the uptake of survivorship support programmes. The Common Sense Model provides a useful framework for understanding survivorship support programme use. However, more clarity around the relationship between illness beliefs and coping is required.

Patterns of Genital Sexual Arousal in Transgender Men.

Most men show genital sexual arousal to one preferred gender. Most women show genital arousal to both genders, regardless of their sexual preferences. There is limited knowledge of whether this difference is driven by biological sex or gender identity. Transgender individuals, whose birth sex and gender identity are incongruent, provide a unique opportunity to address this question. We tested whether the genital responses of 25 (female-to-male) transgender men followed their female birth sex or male gender identity. Depending on their surgical status, arousal was assessed with penile gauges or vaginal plethysmographs. Transgender men's sexual arousal showed both male-typical and female-typical patterns. Across measures, they responded more strongly to their preferred gender than to the other gender, similar to (but not entirely like) 145 cisgender (nontransgender) men. However, they still responded to both genders, similar to 178 cisgender women. In birth-assigned women, both gender identity and biological sex may influence sexual-arousal patterns.

Effect of information on reducing inappropriate expectations and requests for antibiotics.

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians' decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n1  = 402; n2  = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.

Loosening the GRIP (Gender Roles Inhibiting Prosociality) to Promote Gender Equality.

Prosociality is an ideal context to begin shifting traditional gender role stereotypes and promoting equality. Men and women both help others frequently, but assistance often follows traditional gender role expectations, which further reinforces restrictive gender stereotypes in other domains. We propose an integrative process model of gender roles inhibiting prosociality (GRIP) to explain why and how this occurs. We argue that prosociality provides a unique entry point for change because it is (a) immediately rewarding (which cultivates positive attitude formation), (b) less likely to threaten the gender status hierarchy, and therefore less susceptible to social backlash (which translates into less restrictive social norms), and (c) a skill that can be learned (which leads to stronger beliefs in one's own ability to help). Using the GRIP model, we derive a series of hypothesized interventions to interrupt the self-reinforcing cycle of gender role stereotyping and facilitate progress toward broader gender equality.

Psychometric properties of the stress control mindset measure in university students from Australia and the UK.

INTRODUCTION: Beliefs about the consequences of stress, stress mindsets, are associated with health and performance outcomes under stress. This article reports the development and examination of the psychometric properties of a measure of stress mindset: The Stress Control Mindset Measure (SCMM). The measure is consistent with theory on mindsets about self-attributes and conceptualizes stress mindset as the extent to which individuals endorse beliefs that stress can be enhancing. METHODS: The study adopted a correlational cross-sectional survey design in two student samples. Undergraduate students from an Australian university (Sample 1, N = 218) and a UK university (Sample 2, N = 214) completed the SCMM and measures of health and well-being outcomes. RESULTS: Confirmatory factor analyses supported a four-factor structure and strict measurement invariance across samples (ΔCFI < 0.01). Reliability, convergent validity, discriminant validity, and concurrent validity of the overall SCMM were supported in both samples. Incremental validity was supported for most outcomes, accounting for significantly more variance (between 2.2% and 5.9%) in health and well-being outcomes than an existing measure. CONCLUSIONS: Current data provide preliminary support for the SCMM as a reliable and valid measure with good psychometric properties and theoretically consistent relations with health outcomes under stress. Findings provide initial evidence supporting the potential utility of the SCMM in future research examining relations between stress mindsets and health and performance outcomes.

Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial.

TRIAL REGISTRATION: The authors confirm that all ongoing and related trials for this intervention are registered. The studies reported in this manuscript are registered as clinical trials at ISRCTN: Pilot ID- ISRCTN15325073 RCT ID- ISRCTN59395217.

Action bias in the public's clinically inappropriate expectations for antibiotics.

Clinical guidelines recommend that physicians educate patients about illnesses and antibiotics to eliminate inappropriate preferences for antibiotics. We expected that information provision about illnesses and antibiotics would reduce but not eliminate inappropriate preferences for antibiotics and that cognitive biases could explain why some people resist the effect of information provision. In 2 experiments, participants (n1 = 424; n2 = 434) either received incomplete information (about the viral etiology of their infection) or complete information (about viral etiology and the ineffectiveness and harms of taking antibiotics), before deciding to rest or take antibiotics. Those in the complete information conditions responded to items on 4 biases: action bias, social norm, source discrediting, and information neglect. In 2 follow-up experiments (n1 = 150; n2 = 732), we aimed to counteract the action bias by reframing the perception of the resting option as an action. Complete information provision reduced but did not eliminate inappropriate preferences for antibiotics. Around 10% of people wanted antibiotics even when informed they are harmful and offer no benefit and even when the alternative option (i.e., rest) was framed as an active treatment option. Results suggest an action bias underpins this preference but appears challenging to counteract. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Treatment preferences in fibromyalgia patients: A cross-sectional web-based survey.

BACKGROUND: Therapeutic approaches to fibromyalgia (FM) are shifting towards a combined multi-treatment approach to tackle the variety of symptoms experienced in FM. Importantly, little is known about FM patients' attitude towards the available treatments. METHODS: A cross-sectional web survey obtained responses from 464 individuals who satisfied diagnostic criteria for FM. Respondents were asked to report which treatments they adopted in their past, present and intend to adopt in the future. They also rated their level of well-being, depression, anxiety and pain catastrophizing. RESULTS: Data revealed a predominantly combined multi-treatment approach in a sample characterized by middle-aged, Caucasian women. Respondents reported pervasive use of pharmacological therapy but had also adopted non-pharmacological treatment in the past. Future intentions clustered on alternative treatment or no treatment. Regression analyses revealed that pharmacological treatment in the past was predictive of both pharmacological and non-pharmacological treatments in the present. However, use of non-pharmacological treatment in the past was uniquely predictive of its reuse in the present and future. This pattern was also accounted for by individual differences in pain magnification and well-being in the past. CONCLUSIONS: Treatment preferences of FM individuals reveal an ambivalent combination of heavy reliance on pharmacological treatment with lower but consistent reliance on non-pharmacological treatment for those individuals who used it in the past and present. This finding may inform longitudinal research into the relationship between pharmacological and non-pharmacological treatment preference in FM patients, which could in turn inform guidelines for individualized therapeutic plans for clinicians. SIGNIFICANCE: Individuals with fibromyalgia reported the use of non-pharmacological and pharmacological treatments in the past but a predominant use of a pharmacological approach overall. Patterns of treatment experienced in the past were differentially related to future preferences. Pharmacological treatment in the past was likely to lead to both pharmacological and non-pharmacological choices in the present. However, non-pharmacological treatment in the past was more likely to be chosen again in the present and future, but unlikely to lead to a pharmacological choice.

'Always take your doctor's advice': Does trust moderate the effect of information on inappropriate antibiotic prescribing expectations?

Objectives To reduce overprescribing, health campaigns urge physicians to provide people with information regarding appropriate antibiotic use and encourage the public to trust their physicians' prescribing decisions. We test (1) whether providing individuals with complete information about the viral aetiology of an illness and the ineffectiveness of antibiotics will reduce inappropriate antibiotic expectations, (2) whether individuals with greater trust in their physician will have lower expectations, and (3) whether individuals with greater trust in their physician will benefit more from the complete information provision and have lower expectations. Design Experiment 1 features a between-subjects design (information provision: baseline vs. complete information) with a general measure of participants' trust in their physician. Experiment 2 features a 2 (physician trustworthiness: low vs. high) × 2 (information provision: baseline vs. complete information) between-subjects design. Methods In Experiment 1, participants (n = 366) reported their trust in their physician, read a vignette describing a hypothetical consultation with a physician for a viral cold and then expressed their expectations for antibiotics. In Experiment 2, participants (n = 380) read a vignette of a consultation with a physician for a viral ear infection then expressed their expectations for antibiotics. Results In both experiments, the provision of complete information significantly reduced inappropriate expectations for antibiotics. Greater trust in physicians was associated with higher antibiotic expectations in Experiment 1, but lower expectations in Experiment 2. In both experiments, trust in physicians appeared to facilitate the effect of information provision, but this effect was weak and inconsistent. Conclusion Providing information about viral aetiology and the ineffectiveness and side effects of antibiotics reduces inappropriate antibiotic expectations. Further research into the effect of trust in physicians as a moderator of the effect information provision is required, particularly given the recent increase in trust-based antibiotic campaigns. Statement of contribution What is already known Inappropriate expectations for antibiotics encourage overprescribing in primary care. To reduce inappropriate expectations, interventions often aim to educate people about antibiotics and encourage them to trust their physician. What does this study add Causal evidence that clinical information provision reduces but does not eliminate inappropriate antibiotic expectations. We find that increased trust in physicians is not always associated with lower expectations for antibiotics. Although increased trust seemed to boost the effect of information provision, this effect was weak and inconsistent.

The intuitive use of contextual information in decisions made with verbal and numerical quantifiers.

Verbal and numerical formats (e.g., verbal: "low fat," or numerical: "20% fat") are used interchangeably to communicate nutritional information. However, prior research implies that verbal quantifiers are processed more intuitively than numerical ones. We tested this hypothesis in two pre-registered experiments measuring four indicators of processing style: (a) response time, (b) decision performance, (c) reliance on irrelevant contextual information, which we inferred from participants' decision patterns, and (d) the level of interference from a concurrent memory task. Participants imagined they had consumed a given amount of a nutrient (represented in a pie chart) and decided whether a new quantity (either verbal or numerical) could be eaten within their guideline daily amount (GDA). The experiments used a mixed design varying format (verbal or numerical), concurrent memory load (no load, easy, and hard load in Experiment 1; no load and hard load in Experiment 2), nutrient (fat and minerals), quantity (low, medium, and high in Experiment 1; low and high in Experiment 2), and the assigned correct response for a trial (within and exceeding limits). Participants were faster and made fewer correct decisions with verbal quantifiers, and they relied more on contextual information (i.e., the identity of the nutrient involved). However, memory load did not impair decisions with verbal or numerical quantifiers. Altogether, these results suggest that verbal quantifiers are processed intuitively, slightly more so than numerical quantifiers, but that numerical quantifiers do not require much analytical processing to reach simple decisions.

Automatic processes and self-regulation of illness.

Research on the Commonsense Self-Regulation Model has emphasised reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline, and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients' self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatise coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.

Correction to: Finger Length Ratios of Identical Twins with Discordant Sexual Orientations.

Readers should note that the confidence intervals for the effect of sexual orientation on 2D:4D in the left hand of female twins are incorrectly reported in Table 1 of this article. In particular, the upper limit of the confidence intervals is missing a minus sign.

Sexual Arousal Patterns of Identical Twins with Discordant Sexual Orientations.

Genetically identical twins can differ in their self-reported sexual orientations. However, whether the twins' subjective reports reflect valid differences in their sexual orientations is unknown. Measures of sexual orientation, which are free of the limitations of self-report, include genital arousal and pupil dilation while viewing sexual stimuli depicting men or women. We examined these responses in 6 male twin pairs and 9 female twin pairs who reported discordant sexual orientations. Across measures, heterosexual male twins responded more strongly to women than to men. Their homosexual co-twins showed an opposite pattern. Heterosexual female twins responded equally to both sexes, whereas their homosexual co-twins responded somewhat more to women than men. These differences within pairs were similar to differences between unrelated heterosexual and homosexual males and females. Our study provides physiological evidence confirming twins' discordant sexual orientations, thereby supporting the importance of the non-shared environment for the development of sexual orientation and sexual arousal.