The effect of visualisation and mindfulness-based decentering on chocolate craving.

According to the elaborated intrusion (EI) theory of desire, loading visual working memory should help prevent and reduce cravings because cravings occur when intrusive thoughts are elaborated upon in working memory, often as vivid mental images. Mindfulness-based decentering strategies may also help prevent and reduce cravings since they may divert attention away from craving-related thoughts and mental imagery. To compare the effects of visualisation versus decentering on cravings, participants (N = 108) were randomly assigned to one of three conditions: (a) decentering, (b) visualisation, (c) mind-wandering control. Participants in each condition received two audio exercises: (1) a 2-min exercise, preceding a craving induction but after initial deprivation and cue exposure, (2) a 4-min exercise, following a craving induction. The audios instructed participants to look at a plate of chocolate that was in front of them whilst either (a) decentering from their thoughts and feelings, (b) engaging in visualisation or (c) letting their mind wander. Participants were asked to rate the strength of their cravings at four time points (Time 1, baseline; Time 2, after the 2-min audio; Time 3, post-craving induction; Time 4, post-4 minute audio). Frequency of craving-related thoughts was also measured at Time 4. Compared to the control condition, results showed a significant reduction in strength of cravings for the decentering condition after both the 2-min audio and the 4-min audio. Decentering was superior to visualisation only after the 2-min audio. Participants in both the visualisation and decentering conditions also had significantly lower frequencies of craving-related thoughts compared to control participants. The findings support EI theory and suggest that mindfulness-based decentering strategies may be useful for both the prevention and reduction of cravings. Pre-registration: https://osf.io/jv3pq.

Psychological distress amongst immigration detainees: a cross-sectional questionnaire study.

OBJECTIVES: To compare levels of depression, anxiety, and post traumatic stress disorder (PTSD) amongst immigration detainees with a comparison group of asylum seekers living within the community. DESIGN: A cross-sectional questionnaire study. METHODS: Sixty-seven detained asylum seekers, 30 detainees who had previously been imprisoned within the UK for criminal offences, and 49 asylum seekers living in the community completed the hospital anxiety and depression scale (HADS) and the impact of event scale-revised (IES-R). Demographic information was collected. RESULTS: High levels of anxiety, depression, and PTSD symptoms were reported by all three groups. Detained asylum seekers had higher scores than asylum seekers living within the community for depression, anxiety, and PTSD symptoms. There was an interaction between length of detention period and prior exposure to interpersonal trauma (IP trauma) on depression scores. CONCLUSIONS: Immigration detainees are highly vulnerable to psychological distress. A review of detention policies is recommended in light of this. Immigration detention may have an independent adverse effect on mental health. It is also possible that individuals with mental health problems may be more likely to be detained. Further research is required to investigate this.

Towards an understanding of British public attitudes concerning human cloning.

The ability of scientists to apply cloning technology to humans has provoked public discussion and media coverage. The present paper reports on a series of studies examining public attitudes to human cloning in the UK, bringing together a range of quantitative and qualitative methods to address this question. These included a nationally representative survey, an experimental vignette study, focus groups and analyses of media coverage. Overall the research presents a complex picture of attitude to and constructions of human cloning. In all of the analyses, therapeutic cloning was viewed more favourably than reproductive cloning. However, while participants in the focus groups were generally negative about both forms of cloning, and this was also reflected in the media analyses, quantitative results showed more positive responses. In the quantitative research, therapeutic cloning was generally accepted when the benefits of such procedures were clear, and although reproductive cloning was less accepted there was still substantial support. Participants in the focus groups only differentiated between therapeutic and reproductive cloning after the issue of therapeutic cloning was explicitly raised; initially they saw cloning as being reproductive cloning and saw no real benefits. Attitudes were shown to be associated with underlying values associated with scientific progress rather than with age, gender or education, and although there were a few differences in the quantitative data based on religious affiliation, these tended to be small effects. Likewise in the focus groups there was little direct appeal to religion, but the main themes were 'interfering with nature' and the 'status of the embryo', with the latter being used more effectively to try to close down further discussion. In general there was a close correspondence between the media analysis and focus group responses, possibly demonstrating the importance of media as a resource, or that the media reflect public discourse accurately. However, focus group responses did not simply reflect media coverage.

Mutational analysis in UK patients with a clinical diagnosis of familial hypercholesterolaemia: relationship with plasma lipid traits, heart disease risk and utility in relative tracing.

As part of a randomised trial [Genetic Risk Assessment for Familial Hypercholesterolaemia (FH) Trial] of the psychological consequences of DNA-based and non-DNA-based diagnosis of FH, 338 probands with a clinical diagnosis of FH (46% with tendon xanthomas) were recruited. In the DNA-based testing arm (245 probands), using single-strand conformation polymorphism of all exons of the low-density lipoprotein receptor (LDLR) gene, 48 different pathogenic mutations were found in 62 probands (25%), while 7 (2.9%) of the patients had the R3500Q mutation in the apolipoprotein B (APOB) gene. Compared to those with no detected mutation, mean untreated cholesterol levels in those with the APOB mutation were similar, while in those with an LDLR mutation levels were significantly higher (None=9.15+/-1.62 vs LDLR=9.13+/-1.16 vs APOB=10.26+/-2.07 mmol/l p<0.001, respectively). Thirty seven percent of the detected mutations were in exon 3/4 of LDLR, and this group had significantly higher untreated cholesterol than those with other LDLR mutations (11.71+/-2.39 mmol/l vs 9.88+/-2.44 mmol/l, p=0.03), and more evidence of coronary disease compared to those with other LDLR or APOB mutations (36 vs 13% p=0.04). Of the probands with a detected mutation, 54 first-degree relatives were identified, of whom 27 (50%) had a mutation. Of these, 18 had untreated cholesterol above the 95th percentile for their age and gender, but there was overlap with levels in the non-carrier relatives such that 12% of subjects would have been incorrectly diagnosed on lipid levels alone. In the non-DNA-based testing arm (82 probands) only 19 of the 74 relatives identified had untreated cholesterol above the 95th percentile for their age and gender, which was significantly lower (p<0.0005) than the 50% expected for monogenic inheritance. These data confirm the genetic heterogeneity of LDLR mutations in the UK and the deleterious effect of mutations in exon 3 or 4 of LDLR on receptor function, lipids and severity of coronary heart disease. In patients with a clinical diagnosis of FH but no detectable mutation, there is weaker evidence for a monogenic cause compared with relatives of probands with LDLR mutations. This supports the usefulness of DNA testing to confirm diagnosis of FH for the treatment of hyperlipidaemia and for further cascade screening.

Public responses to precautionary information from the Department of Health (UK) about possible health risks from mobile phones.

Understanding public perceptions of health information is of increasing importance in the light of the growing imperatives upon regulators to communicate information about risk and uncertainty. Communicating the possible health risks from mobile telecommunications is a domain that allows consideration of both public perceptions of uncertain public health information and public responses to precautionary advice. This research reports the results of a nationally representative survey in the UK (n=1742) that explored public responses to a leaflet issued by the Department of Health (DoH) in 2000 providing information about the possible health risks of mobile phones. The aims of the study were two-fold: (a) to assess awareness of the leaflet and the extent to which participants could identify the precautionary advice that the leaflet contained as coming from the Government; and (b) to examine publics' responses to the current Government precautionary advice about mobile phone health risks; was this associated with increased concern or reassurance? The results indicate the importance of policy makers developing a clear understanding of the possible effects of communicating precautionary advice.

The influence of perceived control over causes and responses to health threats: a vignette study.

OBJECTIVES: To test the hypothesis that a disease caused by controllable, compared with uncontrollable, factors is more likely to result in negative emotions and less likelihood of disclosure to significant others. DESIGN AND METHODS: A between-participants design in which students (N=108) imagined they had just been diagnosed with either HIV or hypertension and where the cause for each was described as either controllable or uncontrollable. Anticipated emotional and behavioural responses by self and others were assessed by questionnaire. RESULTS: When the vignette represented a more controllable cause, participants thought they would have more negative feelings and that they would be less likely to disclose information about the disease to their family or an acquaintance than when the vignette represented a less controllable cause. The type of disease, but not the cause, influenced anticipated responses by others. CONCLUSIONS: Although greater perceived control over future outcomes is often psychologically adaptive, these findings suggest that the perception that the onset of a disease was controllable may be maladaptive, resulting in more negative feelings and a greater reluctance to disclose the diagnosis to others. In the light of the increasing use of medical technologies aimed at primary prevention of disease, together with a cultural shift toward individual responsibility for health, there is a need for greater understanding of how the perceived controllability of the cause of a disease affects subsequent adjustment.

Eliciting Causal Beliefs about Heart Attacks: A Comparison of Implicit and Explicit Methods.

Objective To compare beliefs about the importance of different factors in causing heart attacks, elicited by explicit questionnaire ratings and an implicit vignette task. Method In two separate studies: (1) 107 adults (aged 40-60 years); and (2) 134 students completed two tasks: (a) a questionnaire in which they explicitly rated the importance of a number of causes of heart attacks; and (b) a vignette task in which they implicitly used risk factor information to estimate a hypothetical man's likelihood of a heart attack. Results In both studies, family history was rated as a significantly less important cause than smoking or stress on the explicit questionnaire; in the implicit task, smoking and family history exerted a much greater influence on estimates of risk than did stress. Discussion The causal beliefs elicited by the two methods differ in important respects. The predictive validity of each measure, alone and in combination with other nonquestionnaire-based measures, needs to be determined.

Making sense of risk: an interpretative phenomenological analysis of vulnerability to heart disease.

This study investigates perceptions of familial hypercholesterolaemia (FH) and its genetic basis in patients diagnosed with, and receiving treatment for, FH. Semi-structured interviews were conducted with seven patients. Transcripts were analysed using interpretative phenomenological analysis (IPA). Participants reported engaging in an active process of seeking causes for their FH. FH was invariably attributed to genes. In some cases diet and stress were also considered as causes of FH. Causal attributions appear to be both a determinant and a result of behavioural strategies to reduce risk. On the whole, FH was perceived as unproblematic, a perception that appeared to reflect downward social comparison processes. Nonetheless, participants reported acting in ways consonant with the perception of an increased risk of heart attack, in particular, being vigilant to symptoms of a possible heart attack.

Does Pain Acceptance Predict Physical and Psychological Outcomes in Cancer Outpatients with Pain?

Pain acceptance has been associated with improved physical and psychosocial well-being in chronic non-malignant pain patients. However, its effects are unclear in cancer outpatients with pain. Our aim was to determine whether pain acceptance predicts reduced pain, pain interference with function, anxiety, and depression in cancer outpatients. We recruited 116 outpatients from a tertiary oncology center, with various types of cancer and pain levels. Patients completed the Brief Pain Inventory, the Hospital Anxiety and Depression Scale and the Chronic Pain Acceptance Questionnaire, the latter of which comprises activity engagement and pain willingness. We carried out multiple regression analyses, adjusting for patient characteristics and outcomes. Activity engagement and pain willingness significantly predicted pain interference with function (P=0.033 and P=0.041 respectively). However, only activity engagement predicted anxiety (P=0.001) and depression (P<0.001). These findings support the beneficial role of pain acceptance in patients' functional adaptation to cancer-related pain. Activity engagement in particular, shows promise in fostering psychological well-being. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain and whether it should be included in cancer pain management interventions. Further studies could confirm its role in reducing anxiety and depression in cancer patients with pain, and whether it should be included in cancer pain management interventions.

Individuals' experience of chronic fatigue syndrome/myalgic encephalomyelitis: an interpretative phenomenological analysis.

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a condition of unknown aetiology that consists of symptoms such as fatigue, muscle and joint pain, gastric problems and a range of neurological disturbances. Due to the fact that these symptoms are complaints that most individuals will experience to a varying degree, it seems pertinent to investigate the processes by which those with CFS/ME conceptualise their symptoms and the experience of reaching a diagnosis. Participants were recruited from local CFS/ME support groups. Eight semi-structured telephone interviews were conducted and transcribed, and the verbatim transcriptions were analysed according to interpretative phenomenological analysis (IPA). Six distinct themes were uncovered that illustrated the participants' experience and perception of their symptoms. These included symptomatology and illness course, interference with daily and working life, frequency of symptoms, external information, diagnosis and treatment. The findings were discussed in terms of internal and external cues related to symptom perception and the discovery that the possession of a diagnosis did not necessarily signify the end of the journey.

Fetal fibronectin test predicts delivery before 30 weeks of gestation in high risk women, but increases anxiety.

OBJECTIVE: To assess efficacy of cervico-vaginal fetal fibronectin as a predictor of spontaneous preterm birth in a high risk antenatal population, and to evaluate the psychological impact of fetal fibronectin testing. DESIGN: An observational study. SETTING: The antenatal clinic at a tertiary referral hospital. POPULATION: One hundred and forty-six pregnant women with known risk factors for spontaneous preterm birth. METHODS: Women designated as 'at risk' for preterm delivery by clinical history were screened for fetal fibronectin at 24 and again at 27 weeks of gestation. Anxiety levels were assessed by questionnaire and compared with anxiety levels of 206 low risk women also tested for fetal fibronectin. Fetal fibronectin results were disclosed to the woman and her clinician. MAIN OUTCOME MEASURES: Maternal anxiety and efficacy of the 24-week fetal fibronectin test to predict delivery before 30, 34 and 37 weeks of gestation. RESULTS: Maternal anxiety was higher pretesting in those at high risk compared with low risk women undergoing the test. Among the high risk women, anxiety was raised to clinically significant levels in those receiving a positive fetal fibronectin screening test result. In all women, 5%, 9% and 21% delivered <30, <34 or <37 weeks of gestation, respectively. Nine percent (n= 13) tested positive for fetal fibronectin at 24 weeks. Predictive power for fetal fibronectin (24 weeks) was greatest for delivery <30 weeks of gestation, with a likelihood ratio of 15 for a positive test (6/13 positive women delivered before 30 weeks). CONCLUSIONS: Fetal fibronectin was most efficient as a predictor of preterm spontaneous delivery <30 weeks of gestation, but was associated with high levels of anxiety.

Self-reported adherence to cholesterol-lowering medication in patients with familial hypercholesterolaemia: the role of illness perceptions.

BACKGROUND: The objectives of this study are to describe levels of adherence to cholesterol-lowering medication and to identify predictors of adherence in patients with familial hypercholesterolaemia (FH). DESIGN: Descriptive questionnaire study. METHODS: 336 adults patients with FH attending one of five outpatient lipid clinics in South East England underwent a clinical assessment by a nurse and completed a questionnaire. The questionnaire assessed self-reported adherence to cholesterol-lowering medication, anxiety, depression, and patient perceptions of heart disease. RESULTS: Overall, participants reported high levels of medication adherence, although 63% reported some level of non-adherence. Total medication adherence (never deviating from the regimen) was more likely to be reported by older participants, those with no formal educational qualifications, those with a personal history of cardiovascular disease, those with a lower total cholesterol level, and those with a greater difference between untreated cholesterol levels and current cholesterol levels. The illness perceptions associated with reported total adherence were lower perceived risk of raised cholesterol, perceiving greater control over FH, and perceiving genes and cholesterol to be important determinants of a heart attack. Emotional state was not associated with medication adherence. In logistic regression analysis, predictors of total medication adherence were having personal history of cardiovascular disease, having no formal qualifications, and perceiving genes to be important determinants of a heart attack. CONCLUSIONS: Both clinical factors and patients' illness perceptions were associated with self-reported cholesterol-lowering medication adherence. The association with illness perceptions was small and many of these associations may be a consequence, rather than a cause, of greater adherence. Given this, intervention strategies aimed at helping patients' to establish routines for medication taking may be more effective in increasing adherence than interventions designed to alter perceptions related to taking statins.

The structure of beliefs about the causes of heart attacks: A network analysis.

OBJECTIVES: To explore the structure of causal beliefs about heart attack, using network analysis, in particular to determine whether there is a consensual representation and, if so, which putative causes of heart attacks were perceived as being proximal or distal causes and which were perceived to mediate the effects of other causes. METHODS: A total of 107 adult respondents completed questionnaires, indicating the extent to which they perceived each of eight agents as causes of a heart attack, as well as whether they perceived that each of these eight causal agents, in turn, causally affects each of the other seven causal agents. RESULTS: A consensual representation was produced, indicating how these eight agents were perceived as causally relating to each other, and to heart attack. Three key features were evident. First, the type of work a person does was perceived to be a distal cause of heart attack, operating mainly through stress and high blood pressure. Second, the causal impact of stress on heart attack was not seen as mediated by behaviour, but mediated via blood pressure. Third, the causal impact of genes on heart attack was perceived as unmediated by behaviour or physiological processes. CONCLUSIONS: The general public appears to share a reasonably complex view of how different agents lead to heart attack. This complexity would not be elicited by standard methods, suggesting that the network analysis method may be usefully employed as either a process or an outcome measure in health-promotion research.

Understanding why negative genetic test results sometimes fail to reassure.

A proportion of those receiving negative results following predictive genetic testing desire future bowel screening. This is despite a negative result meaning a general population risk of 1:7500 and despite bowel screening being experienced as aversive and clinically unnecessary. This study aimed to investigate perceptions of risk, illness, and tests amongst those receiving negative results following predictive genetic testing. Interviews with nine people receiving negative genetic test results for familial adenomatous polyposis (FAP) were analyzed using the qualitative method, interpretative phenomenological analysis (IPA). Those not reassured by negative genetic test results perceived a continuing risk to themselves and to their children. Two sets of perceptions emerged that might explain this: (1). perceptions of the genetic basis of the condition (FAP). Although the condition was perceived to be genetic, genetic status was seen as transient, so a result today could not predict the future. The condition was also seen as caused by factors other than genes, so information about only one risk factor could not be reassuring. (2). Perceptions of the genetic test. There was a lack of conviction in the ability of the genetic test, based on a blood sample, to predict a disease located in the bowel. These results suggest that some individuals receiving negative test results are not reassured because of their representations of the cause of their condition and the nature of the tests they undergo. It may be that eliciting and, when appropriate, changing people's representations prior to testing may enable those receiving negative results to be more reassured about their residual risk.

Psychological impact of genetic testing for familial hypercholesterolemia within a previously aware population: a randomized controlled trial.

This trial tests the hypothesis that confirming a clinical diagnosis of familial hypercholesterolemia (FH) by finding a genetic mutation reduces patients' perceptions of control over the disease and adherence to risk-reducing behaviors. Three hundred forty-one families, comprising 341 hypercholesterolemia probands and 128 adult relatives, were randomized to one of two groups: (a) routine clinical diagnosis; (b) routine clinical diagnosis plus genetic testing (mutation searching in probands and direct gene testing in relatives). The main outcome measures were perceptions of control over hypercholesterolemia, adherence to cholesterol-lowering medication, diet, physical activity, and smoking. There was no support for the main hypothesis: finding a mutation had no impact on perceived control or adherence to risk-reducing behavior (all P-values > 0.10). While all groups believed that lowering cholesterol was an effective way of reducing the risk of a heart attack, participants in whom a mutation was found believed less strongly in the efficacy of diet in reducing their cholesterol level (P = 0.02 at 6 months) and showed a trend in believing more strongly in the efficacy of cholesterol-lowering medication (P = 0.06 at 6 months). In conclusion, finding a mutation to confirm a clinical diagnosis of FH in a previously aware population does not reduce perceptions of control or adherence to risk-reducing behaviors. The pattern of findings leads to the new hypothesis that genetic testing does not affect the extent to which people feel they have control over a condition, but does affect their perceptions of how control is most effectively achieved. Further work is needed to determine whether similar results will be obtained in populations with little previous awareness of their risks.