The relationship between personality and bullying among primary school children: the mediation role of trait emotion intelligence and empathy

Background/Objectives: Several studies have shown that personality traits are a benchmark in research field of bullying prevention, while others have highlighted that the socio-emotional skills are important to prevent a wide range of maladjusted behaviors, suggesting that the investment in their developing may mediate the effects of personality dispositions. The present study aims to clarify if socio-emotional attitudes can mediate the relationships between personality traits and bullying. Methods: Five sequential mediation models are tested using the Big Five personality traits as focal predictors, bullying as the outcome, and trait emotional intelligence and empathy as causally chained mediators, involving 199 primary school children (8-10 years) through the Bullying Prevalence Questionnaire, the Big Five Questionnaire for children, the Emotional Intelligence Index and the Empathy-Teen Conflict Survey. Results: Data showed that openness, conscientiousness, and agreeableness were inversely related to bullying, and that the causal chain of TEI-empathy negatively and completely mediated the relationship between emotional instability and bullying and negatively and partially mediated the relationship between openness and bullying. Conclusions: These results suggest that TEI and empathy mediate the relationship between personality traits and bullying, reducing the risk of being involved in bullying perpetration. (AU)

Mind-stimulating leisure activities: Prospective associations with health, wellbeing, and longevity.

Introduction: This study examines prospective associations within a 6-year perspective between three mind-stimulating leisure activities (relaxed and solitary: reading; serious and solitary: doing number and word games; serious and social: playing cards and games) and 21 outcomes in (1) physical health, (2) wellbeing, (3) daily life functioning, (4) cognitive impairment, and (5) longevity domains. Methods: Data were obtained from 19,821 middle-aged and older adults from 15 countries participating in the Survey of Health, Ageing, and Retirement in Europe (SHARE). Temporal associations were obtained using generalized estimating equations. All models were controlled for prior sociodemographic, personality, lifestyle factors, health behaviors, and pre-baseline leisure activity values and all outcome variables. The Bonferroni correction was used to correct for multiple testing. E-values were calculated to examine the sensitivity of the associations to unmeasured confounding. Secondary analyses (1) under the complete case scenario, (2) after excluding respondents with health conditions, and (3) using a limited set of covariates were conducted to provide evidence for the robustness of the results. Results: The relaxed solitary activity of reading almost daily was prospectively associated with a lower risk of depression, experiencing pain, daily functioning limitations, cognitive impairment, lower loneliness scores, and more favorable wellbeing outcomes. Engaging in serious solitary leisure activities almost daily was prospectively associated with a lower risk of depression, feeling full of energy, and a lower risk of death by any cause. Occasionally engaging in these activities was prospectively associated with greater optimism and a lower risk of cognitive impairment. Engaging in serious social activities was prospectively associated with greater happiness, lower scores on the loneliness scale, a lower risk of Alzheimer's disease, and an increased risk of cancer. Additionally, occasionally engaging in serious social activities was associated with greater optimism and lower risk of depression, pain, and mobility limitations. These associations were independent of demographics, socioeconomic status, personality, history of diseases, and prior lifestyle. The sensitivity analyses provided substantial evidence for the robustness of these associations. Discussion: Mind-engaging leisure activities can be considered a health and wellbeing resource. Practitioners may consider them tools that help middle-aged and older adults maintain their health and quality of life.

Individual personality predicts social network assemblages in a colonial bird.

Animal personalities manifest as consistent individual differences in the performance of specific behavioural expressions. Personality research has implications for zoo animal welfare, as it can further our understanding of how captive individuals may differ in their resource use and provide insight into improving individual and group social health. For group living species, personality may enable assortment based on similar behaviour and influence an individual's interactions with conspecifics (e.g. social support). This research aimed to document how personality traits (aggressive, exploratory, submissive) influenced the social network structure of highly social animals in a captive environment. Data were collected from separate flocks of captive Caribbean (Phoenicopterus ruber) and Chilean flamingos (Phoenicopterus chilensis) to identify relationships between birds and examine opportunities for social support. The flocks associated non-randomly, and in both cases, personality was a substantial predictor of network structure. Personality also predicted key elements of Caribbean flamingo social role (degree, betweenness and average association strength) conflict outcome, and propensity to provide social support, however these patterns were not replicated within the Chilean flamingo network. While both species appear to assort by personality, the broader relationship between personality and social role may vary depending on species and context.

Mindfulness may be associated with less prosocial engagement among high intelligence individuals.

This study examined the role of dispositional mindfulness in the association between intelligence and prosocial behavior. A total of 759 college students (mean age is 22.03; 477 females) participated in exchange for extra credit in psychology course. The results confirmed a positive relationship between intelligence and prosocial behavior as revealed by many studies, with empathy serving as a potential mediator. Mindfulness negatively moderated all the hypothesized pathways between research variables. Specifically, with the increase of the levels of dispositional mindfulness, (1) the intelligence-prosociality association changed from positive to negative, (2) the intelligence-empathy association changed from positively significant to insignificant, (3) the empathy-prosociality association changed from stronger to weaker. These findings may suggest some limitations of mindfulness. That is, present moment awareness and acceptance of the status quo may result in reduced arousal when witnessing others suffering, thereby preventing high intelligence individuals from helping the sufferers to get rid of trouble.

Sensitive liberals and unfeeling conservatives? Interoceptive sensitivity predicts political liberalism.

The stark divide between the political right and left is rooted in conflicting beliefs, values, and personality-and, recent research suggests, perhaps even lower-level physiological differences between individuals. In this registered report, we investigated a novel domain of ideological differences in physiological processes: interoceptive sensitivity-that is, a person's attunement to their own internal bodily states and signals (e.g., physiological arousal, pain, and respiration). We conducted two studies testing the hypothesis that greater interoceptive sensitivity would be associated with greater conservatism: one laboratory study in the Netherlands using a physiological heartbeat detection task and one large-scale online study in the United States employing an innovative webcam-based measure of interoceptive sensitivity. Contrary to our predictions, we found evidence that interoceptive sensitivity may instead predict greater political liberalism (versus conservatism), although this association was primarily limited to the American sample. We discuss implications for our understanding of the physiological underpinnings of political ideology.

Sex-specific effects of a parasite on stress-induced freezing behavior in a natural beetle-nematode system.

Some animals react to predation threats or other stressors by adopting a freezing posture in an attempt to avoid detection, and the duration of this behavior usually corresponds with individual personality, such that timid individuals freeze longer. Despite decades of research on this or related behaviors (thanatosis), never has the impact of parasitism been considered. Parasites could prolong the duration, if hosts are less motivated to move (i.e. lethargic), or they could reduce it, if hosts are motivated to forage more to compensate for energy drain. We examined this behavior within a natural beetle-nematode system, where hosts (horned passalus beetles, Odontotaenius disjunctus) are parasitized by a nematode, Chondronema passali. We exposed beetles (n = 238) to four stressors in our lab, including noise, vibration, light and inversion, and recorded how long they adopt a frozen stance. Afterward, we determined nematode burdens, which can range from dozens to hundreds of worms. Beetles tended to freeze for 20 seconds on average, with some variation between stressors. We detected no effect of beetle mass on the duration of freezing, and this behavior did not differ in beetles collected during the breeding or non-breeding season. There was a surprising sex-based difference in the impact of nematodes; unparasitized females remained frozen twice as long as unparasitized males, but for beetles with heavy nematode burdens, the opposite was true. From this we infer that heavily parasitized females are more bold, while males with heavy burdens would be more timid. The explanation for this finding remains elusive, though we can rule out many possibilities based on prior work on this host-parasite system.

Post-truth epistemic beliefs rooted in the Dark Factor of Personality are associated with higher COVID-19 vaccination refusal.

A substantial number of people refused to get vaccinated against COVID-19, which prompts the question as to why. We focus on the role of individual worldviews about the nature and generation of knowledge (epistemic beliefs). We propose a model that includes epistemic beliefs, their relationship to the Dark Factor of Personality (D), and their mutual effect on the probability of having been vaccinated against COVID-19. Based on a US nationally representative sample (N = 1268), we show that stronger endorsement of post-truth epistemic beliefs was associated with a lower probability of having been vaccinated against COVID-19. D was also linked to a lower probability of having been vaccinated against COVID-19, which can be explained by post-truth epistemic beliefs. Our results indicate that the more individuals deliberately refrain from adhering to the better argument, the less likely they are vaccinated. More generally, post-truth epistemic beliefs pose a challenge for rational communication.

Exploring effectiveness of CBT in obese patients with binge eating disorder: personality functioning is associated with clinically significant change.

BACKGROUND: Binge eating disorder (BED), as the most prevalent eating disorder, is strongly related to obesity and other somatic and psychiatric morbidity. Despite evidence-based treatments a considerable number of BED patients fail to recover. There is preliminary evidence for the association between psychodynamic personality functioning and personality traits on treatment outcome. However, research is limited and results are still contradictory. Identifying variables associated with treatment outcome could improve treatment programs. The aim of the study was to explore whether personality functioning or personality traits are associated with Cognitive Behavioral Therapy (CBT) outcome in obese female patients with BED or subthreshold BED. METHODS: Eating disorder symptoms and clinical variables were assessed in 168 obese female patients with DSM-5 BED or subthreshold BED, referred to a 6-month outpatient CBT program in a pre-post measurement design. Personality functioning was assessed by the Developmental Profile Inventory (DPI), personality traits by the Temperament and Character Inventory (TCI). Treatment outcome was assessed by the Eating Disorder Examination-Questionnaire (EDE-Q) global score and self-reported binge eating frequency. According to the criteria of clinical significance, 140 treatment completers were categorized in four outcome groups (recovered, improved, unchanged, deteriorated). RESULTS: EDE-Q global scores, self-reported binge eating frequency and BMI significantly decreased during CBT, where 44.3% of patients showed clinically significant change in EDE-Q global score. Treatment outcome groups showed significant overall differences on the DPI Resistance and Dependence scales and the aggregated 'neurotic' scale. Significant overall differences were found between groups on TCI Harm avoidance, although post hoc t-tests were non-significant. Furthermore, multiple logistic regression analysis, controlling for mild to moderate depressive disorder and TCI harm avoidance showed that 'neurotic' personality functioning was a significant negative predictor of clinically significant change. CONCLUSION: Maladaptive ('neurotic') personality functioning is significantly associated with a less favorable outcome after CBT in patients with binge eating. Moreover, 'neurotic' personality functioning is a predictor of clinically significant change. Assessment of personality functioning and personality traits could support indication for more specified or augmented care, tailored towards the patients' individual strengths and vulnerabilities. TRIAL REGISTRATION: This study protocol was retrospectively evaluated and approved on 16-06-2022 by the Medical Ethical Review Committee (METC) of the Amsterdam Medical Centre (AMC). Reference number W22_219#22.271.

Evaluation of international guidance for the community treatment of 'personality disorders': A systematic review.

BACKGROUND: Guidelines for the treatment and management of 'personality disorders' have been introduced to provide guidance on best practice based on evidence and views of key stakeholders. However, guidance varies and there is yet to be an overall, internationally recognised consensus on the best mental health care for people with 'personality disorders'. AIMS: We aimed to identify and synthesise recommendations made by different mental health organisations from across the world on community treatment for people with 'personality disorders'. METHODS: This systematic review consisted of three stages: 1. systematic literature and guideline search, 2. quality appraisal, and 3. data synthesis. We combined a search strategy involving both systematic searching of bibliographic databases and supplementary search methods of grey literature. Key informants were also contacted to further identify relevant guidelines. Codebook thematic analysis was then conducted. The quality of all included guidelines was assessed and considered alongside results. RESULTS: After synthesising 29 guidelines from 11 countries and 1 international organisation, we identified four main domains, with a total of 27 themes. Important key principles on which there was consensus included continuity of care, equity of access, accessibility of services, availability of specialist care, taking a whole systems approach, trauma informed approaches, and collaborative care planning and decision making. CONCLUSIONS: Existing international guidelines shared consensus on a set of principles for the community treatment of 'personality disorders'. However, half of the guidelines were of lower methodological quality, with many recommendations not backed by evidence.

Abnormal Brain Circuits Characterize Borderline Personality and Mediate the Relationship between Childhood Traumas and Symptoms: A mCCA+jICA and Random Forest Approach.

Borderline personality disorder (BPD) is a severe personality disorder whose neural bases are still unclear. Indeed, previous studies reported inconsistent findings concerning alterations in cortical and subcortical areas. In the present study, we applied for the first time a combination of an unsupervised machine learning approach known as multimodal canonical correlation analysis plus joint independent component analysis (mCCA+jICA), in combination with a supervised machine learning approach known as random forest, to possibly find covarying gray matter and white matter (GM-WM) circuits that separate BPD from controls and that are also predictive of this diagnosis. The first analysis was used to decompose the brain into independent circuits of covarying grey and white matter concentrations. The second method was used to develop a predictive model able to correctly classify new unobserved BPD cases based on one or more circuits derived from the first analysis. To this aim, we analyzed the structural images of patients with BPD and matched healthy controls (HCs). The results showed that two GM-WM covarying circuits, including basal ganglia, amygdala, and portions of the temporal lobes and of the orbitofrontal cortex, correctly classified BPD against HC. Notably, these circuits are affected by specific child traumatic experiences (emotional and physical neglect, and physical abuse) and predict symptoms severity in the interpersonal and impulsivity domains. These results support that BPD is characterized by anomalies in both GM and WM circuits related to early traumatic experiences and specific symptoms.

Personality variation is eroded by simple social behaviours in collective foragers.

The movement of groups can be heavily influenced by 'leader' individuals who differ from the others in some way. A major source of differences between individuals is the repeatability and consistency of their behaviour, commonly considered as their 'personality', which can influence both position within a group as well as the tendency to lead. However, links between personality and behaviour may also depend upon the immediate social environment of the individual; individuals who behave consistently in one way when alone may not express the same behaviour socially, when they may be conforming with the behaviour of others. Experimental evidence shows that personality differences can be eroded in social situations, but there is currently a lack of theory to identify the conditions where we would expect personality to be suppressed. Here, we develop a simple individual-based framework considering a small group of individuals with differing tendencies to perform risky behaviours when travelling away from a safe home site towards a foraging site, and compare the group behaviours when the individuals follow differing rules for aggregation behaviour determining how much attention they pay to the actions of their fellow group-members. We find that if individuals pay attention to the other members of the group, the group will tend to remain at the safe site for longer, but then travel faster towards the foraging site. This demonstrates that simple social behaviours can result in the repression of consistent inter-individual differences in behaviour, giving the first theoretical consideration of the social mechanisms behind personality suppression.

Self-selection biases in psychological studies: Personality and affective disorders are prevalent among participants.

Respondents select the type of psychological studies that they want to participate in consistence with their needs and individual characteristics, which creates an unintentional self-selection bias. The question remains whether participants attracted by psychological studies may have more psychological dysfunctions related to personality and affective disorders compared to the general population. We investigated (N = 947; 62% women) whether the type of the invitation (to talk about recent critical or regular life events) or the source of the data (either face-to-face or online) attracts people with different psychopathology. Most importantly, participants who alone applied to take part in paid psychological studies had more symptoms of personality disorders than those who had never before applied to take part in psychological studies. The current results strongly translate into a recommendation for either the modification of recruitment strategies or much greater caution when generalizing results for this methodological reason.

Troll story: The dark tetrad and online trolling revisited with a glance at humor.

Internet trolling is considered a negative form of online interaction that can have detrimental effects on people's well-being. This pre-registered, experimental study had three aims: first, to replicate the association between internet users' online trolling behavior and the Dark Tetrad of personality (Machiavellianism, narcissism, psychopathy, and sadism) established in prior research; second, to investigate the effect of experiencing social exclusion on people's motivation to engage in trolling behavior; and third, to explore the link between humor styles and trolling behavior. In this online study, participants were initially assessed on their personality, humor styles, and global trolling behavior. Next, respondents were randomly assigned to a social inclusion or exclusion condition. Thereafter, we measured participants' immediate trolling motivation. Results drawn from 1,026 German-speaking participants indicate a clear correlation between global trolling and all facets of the Dark Tetrad as well as with aggressive and self-defeating humor styles. However, no significant relationship between experiencing exclusion/inclusion and trolling motivation emerged. Our quantile regression findings suggest that psychopathy and sadism scores have a significant positive effect on immediate trolling motivation after the experimental manipulation, whereas Machiavellianism and narcissism did not explain variation in trolling motivation. Moreover, being socially excluded had generally no effect on immediate trolling motivation, apart from participants with higher immediate trolling motivation, for whom the experience of social exclusion actually reduced trolling motivation. We show that not all facets of the Dark Tetrad are of equal importance for predicting immediate trolling motivation and that research should perhaps focus more on psychopathy and sadism. Moreover, our results emphasize the relevance of quantile regression in personality research and suggest that even psychopathy and sadism may not be suitable predictors for low levels of trolling behavior.

Divergent responses to local diversity: Outgroup differences and the impact of personality.

Research has shown that differences in personality can help explain attitudes towards immigration. Personality may also moderate the impact of local immigrant levels. Using attitudinal measures from the British Election Study, this research confirms the importance of all Big Five personality traits in predicting immigration attitudes in the UK and finds consistent evidence of an interaction between extraversion and local immigrant concentrations. In areas with high levels of immigrants, extraverted individuals are associated with more supportive immigration attitudes. Moreover, this study shows that the response to local immigrant levels varies by immigrant group. Levels of nonwhite immigrants and immigrants from predominantly Muslim countries are associated with greater levels of immigration hostility, whereas this is not the case for white immigrants or immigrants from Western and Eastern Europe. These findings demonstrate that an individual's response to local immigration levels depends on both their personality and the immigrant group in question.

Exploring the Functioning of Online Self-Organizations during Public Health Emergencies: Patterns and Mechanism.

With the increasing use of social media, online self-organized relief has become a crucial aspect of crisis management during public health emergencies, leading to the emergence of online self-organizations. This study employed the BERT model to classify the replies of Weibo users and used K-means clustering to summarize the patterns of self-organized groups and communities. We then combined the findings from pattern discovery and documents from online relief networks to analyze the core components and mechanisms of online self-organizations. Our findings indicate the following: (1) The composition of online self-organized groups follows Pareto's law. (2) Online self-organized communities are mainly composed of sparse and small groups with loose connections, and bot accounts can automatically identify those in need and provide them with helpful information and resources. (3) The core components of the mechanism of online self-organized rescue groups include the initial gathering of groups, the formation of key groups, the generation of collective action, and the establishment of organizational norms. This study suggests that social media can establish an authentication mechanism for online self-organizations, and that authorities should encourage online interactive live streams about public health issues. However, it is important to note that self-organizations are not a panacea for all issues during public health emergencies.

Personality Determinants of Exercise-Related Nutritional Behaviours among Polish Team Sport Athletes.

A proper diet increases the effectiveness of training and accelerates post-workout regeneration. One of the factors determining eating behaviour are personality traits, including those included in the Big Five model, i.e., neuroticism, extraversion, openness, agreeableness, and conscientiousness. The aim of this study was to analyse the personality determinants of peri-exercise nutritional behaviours among an elite group of Polish athletes practicing team sports. The study was conducted in a group of 213 athletes, using the author's validated questionnaire of exercise-related nutrition behaviours and the NEO-PI-R (Neuroticism Extraversion Openness-Personality Inventory-Revised). A statistical analysis was performed using Pearson's linear correlation and Spearman's rank correlation coefficients as well as a multiple regression analysis, assuming a significance level of α = 0.05. It has been shown that the level of the overall index regarding normal peri-exercise eating behaviours decreased with increasing neuroticism (r = -0.18) and agreeableness (r = -0.18). An analysis of the relationship between the personality traits (sub-scales) of the Big Five model demonstrated that the overall index of proper peri-exercise nutrition decreased with the intensification of three neuroticism traits, i.e., hostility/anger (R = -0.20), impulsiveness/immoderation (R = -0.18), and vulnerability to stress/learned helplessness (R = -0.19), and four traits of agreeableness, i.e., straightforwardness/morality (R = -0.17), compliance/cooperation (R = -0.19), modesty (R = -0.14), and tendermindedness/sympathy (R = -0.15) (p < 0.05). A multiple regression analysis exhibited that the full model consisting of all the analysed personality traits explained 99% of the variance concerning the level of the proper peri-exercise nutrition index. In conclusion, the index of proper nutrition under conditions of physical effort decreases along with the intensification of neuroticism and agreeableness among Polish athletes professionally practicing team sports.

Personality and Nomophobia: The Role of Dysfunctional Obsessive Beliefs.

BACKGROUND: The development of new technologies (ICTs), and specifically the invention of smartphones, has offered users enormous benefits. However, the use of this technology is sometimes problematic and can negatively affect people's lives. Nomophobia has been defined as the fear of being unreachable by means of a smartphone and is considered a disorder of the modern world. The present study aims to provide additional evidence of the relationship between personality traits and nomophobia. Moreover, this research explores dysfunctional obsessive beliefs as another possible antecedent. Finally, this study also examines the effect of the combination of these antecedents on nomophobia. METHOD: The study sample was comprised of Spanish workers (males: 44.54%; females: 55.46%) in the city of Tarragona and its surroundings. RESULTS: Our results showed that nomophobia is directly related to personality traits such as extraversion, and that dysfunctional obsessive beliefs play a role in the development of nomophobia. Moreover, our study confirms that the combination of personality traits and dysfunctional obsessive beliefs can affect the degree of nomophobia experienced. DISCUSSION AND CONCLUSIONS: Our study contributes to the body of literature that examines how psychological variables of personality can be predictors of nomophobia. Additional research is needed to better understand the determinants of nomophobia.

Regardless of personality, males show similar levels of plasticity in territory defense in a Neotropical poison frog.

Animal personality traits are sometimes linked to an individual's degree of plasticity, with certain personality types being more plastic than others. In territorial species, consistently high levels of aggression might increase the risk of harmful fights, while consistently low aggression might lead to the loss of a territory. Consequently, reacting plastically with an appropriate territorial response should be beneficial to avoid these risks. An integrative investigation of both personality traits and plasticity can help us better understand the dynamics of aggressive interactions during male-male competition. Here, we used a free-ranging Neotropical poison frog population to investigate the role of plasticity in male territorial aggression towards intruders. We conducted repeated standardized territorial intrusion experiments mimicking frogs of different body sizes via playback calls with different peak frequencies. We found individual repeatability for the latency to reach and approach a simulated intruder and observed that both aggressive and less aggressive males decreased their level of aggression towards big intruders. However, our results do not support a correlation between personality and plasticity in the context of male territory defense during the breeding season. We discuss how such a correlation between personality and plasticity might be conditional on the costs and benefits across contexts.

A predictive model for understanding the role of emotion for the formation of presence in virtual reality.

Users' emotions may influence the formation of presence in virtual reality (VR). Users' expectations, state of arousal and personality may also moderate the relationship between emotions and presence. An interoceptive predictive coding model of conscious presence (IPCM) considers presence as a product of the match between predictions of interoceptive emotional states and the actual states evoked by an experience (Seth et al. 2012). The present paper aims to test this model's applicability to VR for both high-arousal and low-arousal emotions. The moderating effect of personality traits on the creation of presence is also investigated. Results show that user expectations about emotional states in VR have an impact on presence, however, expression of this relationship is moderated by the intensity of an emotion, with only high-arousal emotions showing an effect. Additionally, users' personality traits moderated the relationship between emotions and presence. A refined model is proposed that predicts presence in VR by weighting emotions according to their level of arousal and by considering the impact of personality traits.

Effect of health education-based yoga & naturopathy lifestyle interventions on personality of patients with non-communicable diseases: A randomized controlled trial.

BACKGROUND: Personality traits play a role in the progression and management of chronic diseases. However, a change in personality is seldom considered an outcome in the management of chronic diseases. The present study explored if a health education-based yoga & naturopathy lifestyle intervention group (HYNLG) can induce change in the personality traits, vitality, quality of life (QoL), and satisfaction in patients with non-communicable diseases compared to a therapy-centric yoga & naturopathy lifestyle intervention (TYNLG). METHODS: This randomized control trial included 56 participants who were equally randomized into the HYNLG and TYNLG groups. Both groups received a 10-day inpatient regimen that included hydrotherapy, mud therapy, diet therapy, supervised fasting, sunbathing, acupressure, and massage therapy. Additionally, HYNLG received a 10-day orientation (1 h/d) on concepts centered around belief systems, lifestyle changes, and their impact on health. Vedic Personality Inventory, SF-12 QoL questionnaire, visual analog scale, Hamilton Anxiety Inventory, and Visit-Specific Patient Satisfaction Questionnaire were used as outcome measures. The changes between the time points were analyzed using parametric and non-parametric tests, and Pearson correlation was used to investigate the association between the variables. RESULTS: The Sattva (balance and stability) personality trait has significantly increased in HYNLG, while the Rajas (activity and imbalance) and Tamas (inertia and dullness) personalities have decreased. HYNLG also demonstrated a significant improvement in mental QoL, vitality, anxiety reduction, and patient satisfaction when compared to TYNLG. CONCLUSION: These findings may have serious clinical and public health implications as they provide insights on the usefulness of introducing a health education component into lifestyle modification programs.