Bodily Experience in Depression: Using Focusing as a New Interview Technique.

INTRODUCTION: Research on body aspects in depression primarily focuses on somatic complaints, while phenomenologists emphasize the pre-reflective bodily experience of depression as relevant for the psychopathology of it. Despite this increasing acknowledgement of the subjective body's impact on depression, empirically, it remains rarely studied. METHODS: Relying on the psychotherapy method of Focusing (Gendlin, 1982), interviews were developed, which enable participants with depression to get in contact with pre-reflective bodily experiences through turning inward, attentively observing all bodily feelings that arise, and finding symbolizations for these feelings. RESULTS: In 501 codings of the conducted interviews, the theme of passivity emerged on a continuum ranging from inhibition of drive to lack of drive. It can be split into 5 components (heaviness, emptiness, paralysis, blockage, and alienation), which were felt in the head or the whole body. Moreover, participants reported active, pressuring feelings in the chest and stomach areas, which were associated with specific emotions in some participants. DISCUSSION: In conclusion, through focusing, participants were able to take note of their pre-reflective bodily feelings and described feelings of passivity, active, pressuring feelings, and an ambivalence between these two parts. Results support the notion that depression is associated with specific pre-reflective bodily experiences and lay a foundation for future research.

Combining app-based behavioral therapy with electronic cigarettes for smoking cessation: a study protocol for a single-arm mixed-methods pilot trial.

BACKGROUND: Cigarette smoking remains a leading cause of preventable illness and death, underscoring the need for effective evidence-based smoking cessation interventions. Nuumi, a novel smoking cessation program integrating a digital behavioral therapy and an electronic cigarette, may provide a solution. OBJECTIVE: To investigate the initial efficacy, acceptability and psychological outcomes of an evidence-based smoking cessation intervention comprised of a mobile phone app and an electronic cigarette among adults who smoke and who are motivated to quit. METHODS: A prospective 6-month single-arm mixed-methods pilot study will be conducted. Seventy adults who smoke and who are motivated to quit will be recruited via web-based advertisements and flyers. Participants receive access to an app and an electronic cigarette with pods containing nicotine for temporary use of at least 3 months. The electronic cigarette is coupled with the app via Bluetooth, allowing for tracking of patterns of use. The behavioral therapy leverages evidence-based content informed by cognitive behavioral therapy and mindfulness-informed principles. Web-based self-report surveys will be conducted at baseline, at 4 weeks, at 8 weeks, at 12 weeks, and at 24 weeks post-baseline. Semi-structured interviews will be conducted at baseline and at 12 weeks post-baseline. Primary outcomes will be self-reported 7-day point prevalence abstinence from smoking at 12 weeks and 24 weeks. Secondary outcomes will include other smoking cessation-related outcomes, psychological outcomes, and acceptability of the nuumi intervention. Descriptive analyses and within-group comparisons will be performed on the quantitative data, and content analyses will be performed on the qualitative data. Recruitment for this study started in October 2023. DISCUSSION: As tobacco smoking is a leading cause of preventable morbidity and mortality, this research addresses one of the largest health burdens of our time. The results will provide insights into the initial efficacy, acceptability, and psychological outcomes of a novel mobile health intervention for smoking cessation. If successful, this pilot may generate an effective intervention supporting adults who smoke to quit smoking. The results will inform feasibility of a future randomized controlled trial. Trial Registration German Clinical Trials Register DRKS00032652, registered 09/15/2023, https://drks.de/search/de/trial/DRKS00032652 .

The foundations of mind-body medicine: Love, good relationships, and happiness modulate stress and promote health.

Although stress is an everyday fact of life, it can lead to poor health outcomes, particularly when intense or prolonged. However, humans have unique cognitive abilities and thus may be able to combat stress by engaging critical psychological defence mechanisms. In this review, we discuss the field of mind-body medicine, which focuses on improving our understanding of the mechanisms underlying this response and developing interventions that might be used to limit the effects of chronic stress. We review the findings of past and current research in this field that has focused on the impact of psychological, emotional, and behavioural factors, including love, social connectedness, and happiness on human health and the amelioration of pain as well as other signs and symptoms of disease. While these studies have not yet led to confirmed, quantifiable conclusions, the overall weight of evidence suggests that happiness (defined as a personal sense of well-being) may be directly associated with improved health parameters and reductions in debilitating symptoms. Collectively, these findings suggest that interventions designed to promote stress mitigation, notably those that encourage social activity, may lead to significant improvements in human health.

Understanding health behavior change by motivation and reward mechanisms: a review of the literature.

The global rise of lifestyle-related chronic diseases has engendered growing interest among various stakeholders including policymakers, scientists, healthcare professionals, and patients, regarding the effective management of health behavior change and the development of interventions that facilitate lifestyle modification. Consequently, a plethora of health behavior change theories has been developed with the intention of elucidating the mechanisms underlying health behavior change and identifying key domains that enhance the likelihood of successful outcomes. Until now, only few studies have taken into account neurobiological correlates underlying health behavior change processes. Recent progress in the neuroscience of motivation and reward systems has provided further insights into the relevance of such domains. The aim of this contribution is to review the latest explanations of health behavior change initiation and maintenance based on novel insights into motivation and reward mechanisms. Based on a systematic literature search in PubMed, PsycInfo, and Google Scholar, four articles were reviewed. As a result, a description of motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) and their role in health behavior change processes is presented. Three central findings are discussed: (1) motivation and reward processes allow to distinguish between goal-oriented and stimulus-driven behavior, (2) approach motivation is the key driver of the individual process of behavior change until a new behavior is maintained and assertion motivation takes over, (3) behavior change techniques can be clustered based on motivation and reward processes according to their functional mechanisms into facilitating (= providing external resources), boosting (= strengthening internal reflective resources) and nudging (= activating internal affective resources). The strengths and limitations of these advances for intervention planning are highlighted and an agenda for testing the models as well as future research is proposed.

Mindfulness-Based and Mindfulness-Informed Interventions at the Workplace: A Systematic Review and Meta-Regression Analysis of RCTs.

Objectives: Positive effects of mindfulness-based interventions (MBIs) on occupational health have been demonstrated by several systematic review studies during the last two decades. So far, existing reviews excluded mindfulness-informed interventions (MIIs) that build on informal approaches or mixed techniques aiming at improving mindfulness indirectly. To address this research gap, the present comprehensive meta-analysis synthesizes the results of RCTs of MBIs and MIIs conducted in various workplace settings. Method: A systematic literature search was conducted in five electronic databases complemented by manual search. Random-effects models were used to synthesize standardized mean differences (SMDs) for 25 outcomes and seven overarching categories of outcomes, and to detect various temporal effects. Meta-regressions were run to elucidate average SMDs between mindfulness intervention types and intervention and population characteristics, with the goal of detecting sources of heterogeneity and help guide the selection of the most appropriate mindfulness intervention type. Results: Based on 91 eligible studies (from 92 publications), including 4927 participants and 4448 controls, the synthesis shows that MBIs and MIIs significantly improve mindfulness (SMD = 0.43; 95%-CI [0.33;0.52]), well-being (SMD = 0.63; 95%-CI [0.34;0.93]), mental health (SMD = 0.67; 95%-CI [0.48;0.86]), stress (SMD = 0.72; 95%-CI [0.54;0.90]), resilience (SMD = 1.06; 95%-CI [-0.22;2.34]), physical health (SMD = 0.45; 95%-CI [0.32;0.59]), and work-related factors (SMD = 0.62; 95%-CI [0.14;1.10]). Sensitivity analyses demonstrate a tendency towards smaller effect sizes due to extreme outliers. Effect sizes are stable in short-term follow-up assessments (1-12 weeks) for most outcomes, but not for long-term follow-up assessments (13-52 weeks). Meta-regressions suggest that observable intervention characteristics (e.g., online delivery) and population characteristics (e.g., age of participants), as well as study quality, do not explain the prevalence of heterogeneity in effect sizes. Conclusions: Generally effective, mindfulness interventions are a useful tool to enhance aspects of employee health. However, because of heterogeneity and risk of bias, studies aiming at high-quality data collection and thorough reporting are necessary to draw firm conclusions. Preregistration: A protocol of this systematic review was registered with PROSPERO (Registration-No. CRD42020159927). Supplementary Information: The online version contains supplementary material available at 10.1007/s12671-023-02130-7.

Artificial Intelligence: Deciphering the Links between Psychiatric Disorders and Neurodegenerative Disease.

Artificial Intelligence (AI), which is the general term used to describe technology that simulates human cognition [...].

Functional Mechanisms of Health Behavior Change Techniques: A Conceptual Review.

Background: Health behavior change is among the top recommendations for improving health of patients with lifestyle-related chronic diseases. An array of behavior change techniques (BCTs) have been developed to support behavior change initiation and maintenance. These BCTs often show limited success when they are not informed by theory, leading to a mismatch between the intention of the BCT and patients' needs or expectations. Previous studies have identified a number of resources (domains) which patients may require to initiate and maintain health behavior change. Indeed, not yet well established is how BCTs address these resources, i.e., the functional mechanisms of BCTs. Purpose: Provide a theoretical framework of the functional mechanisms of BCTs for developing and implementing successful interventions for health behavior change. Methods: Conceptual review, including literature analysis and synthesis as well as conceptualization of a new model based on the synthesis. Results: Through the integration of dual-process models as well as reward and motivation proceeding, i.e., affective, emotional, or intuitive neurobiological cues, into the rational framework of rather linear cognitive or task-related decision progress, we categorize previously identified resources into three distinct sets: external, internal reflective, and internal affective resources. Based on this triad, we classify BCTs according to their functional mechanisms into facilitating (=providing external resources), boosting (=strengthening internal reflective resources), and nudging (=activating internal affective resources). Consequently, we present a simplified Behavior Change Resource Model (BCRM) that is centered on patients' resources. Conclusion: The model can be applied to develop health behavior change interventions, which promote engagement and empowerment. Future studies should aim at testing the applicability and practicality of the BCRM.

The U-Curve of Happiness Revisited: Correlations and Differences in Life Satisfaction Over the Span of Life-An Empirical Evaluation Based on Data From 1,597 Individuals Aged 12-94 in Germany.

Background: Subjective wellbeing (SWB) is a research topic of growing interest for different disciplines. Based on a cross-sectional survey with 1,597 participants aged 12-94, this study investigated life satisfaction and momentary happiness, two important dimensions of SWB. We examined their relationship, shape, and correlates across individuals of different ages and interpreted the results in the light of a neurobiological model of motivation systems. Methods: Statistical analyses were performed using multiple linear regression. First, we examined how life satisfaction is associated with selected socio-demographic variables across four age groups. Second, we analyzed the association between life satisfaction and age, and lastly, we examined the extent to which happiness is a prerequisite for life satisfaction in each age group. Results: Our analyses show that life satisfaction correlates negatively with poor health and financial worries, and positively with partnership, grandchildren, and religiosity. However, the inverse relationship with poor health is stronger in younger than in older individuals, while the inverse association with financial worries is strongest in late midlife (50-69 years). We identified gender-specific differences concerning the relationship between life satisfaction and age, with males displaying a U-shape trend with its lowest point between the ages of 30 and 49, whereas females' life satisfaction increases stepwise with age. Although momentary happiness correlates strongly with life satisfaction, this relationship decreases with age. Conclusion: The results suggest that individuals adjust or even grow beyond their perceptions of a "good life" over time. Neurobiological processes of adaptation and personal growth could play an important role in these developments.

Effects of a Mindfulness Intervention Comprising an App, Web-Based Workshops, and a Workbook on Perceived Stress Among Nurses and Nursing Trainees: Protocol for a Randomized Controlled Trial.

BACKGROUND: Previous research has found digitally supported mindfulness interventions to be effective when used for stress management among workers in high-stress occupations. Findings on digitally supported mindfulness interventions among nurses working in acute inpatient care settings are heterogeneous, lack long-term follow-up, and do not assess adherence and acceptability. OBJECTIVE: This study aimed to investigate the effectiveness and efficacy of a digitally supported mindfulness intervention designed to improve health- and work-related outcomes among nurses and nursing trainees working in acute inpatient care settings. METHODS: We will conduct a multicenter randomized controlled trial using a wait-list control group design. Randomization will be stratified by hospital and job status (nurse or nursing trainee). Recruitment will take place on the web and offline during the working hours of nurses and nursing trainees. The intervention group will receive a digitally supported mindfulness intervention, which will comprise an app, 2 web-based workshops, and a workbook, whereas the wait-list control group will be scheduled to receive the same intervention 14 weeks later. The 2 web-based workshops will be led by a certified mindfulness-based stress reduction trainer. Nurses will use the app and the workbook independently. Self-report web-based surveys will be conducted on the web at baseline, at 10 weeks after allocation, at 24 weeks after allocation, and at 38 weeks after allocation. Outcomes of interest will include perceived stress (primary outcome), health- and work-related variables, and variables related to adherence and acceptability of the digitally supported mindfulness intervention. We will perform intention-to-treat and per-protocol analyses. RESULTS: Data collection will be completed by the beginning of August 2022. Data analyses will be completed by December 2022. CONCLUSIONS: Our study design, including long-term follow-up and the investigation of variables related to adherence and acceptability, will ensure rigorous evaluation of effectiveness and efficacy. Relative to costly in-person intervention efforts, this program may present a cost-effective and potentially highly scalable alternative. Findings regarding effectiveness, efficacy, adherence, and acceptability will inform stakeholders' decisions regarding the implementation of similar interventions to promote the well-being of nurses and nursing trainees, which may, in turn, alleviate detrimental stress-related outcomes (eg, burnout) because of work-related demands. TRIAL REGISTRATION: German Clinical Trials Register DRKS00025997; https://tinyurl.com/433cas7u. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/37195.

Motivation and reward mechanisms in health behavior change processes.

With increasing prevalence of lifestyle-related chronic diseases worldwide, understanding health behavior change and the development of successful interventions to support lifestyle modification is gaining increasing interest among politicians, scientists, therapists and patients alike. A number of health behavior change theories have been developed aiming at explaining health behavior change and understanding the domains that make change more likely. Until now, only few studies have taken into account automatic, implicit or non-cognitive aspects of behavior, including emotion and positive affect. Recent progress in the neuroscience of motivation and reward systems can provide further insights into the relevance of such domains. In this integrative review, we present a description of the possible motivation and reward systems (approach/wanting = pleasure; aversion/avoiding = relief; assertion/non-wanting = quiescence) involved in behavior change. Therefore, based on established theories encompassing both initiation and maintenance of behavior change, we create a flexible seven-stage behavior change process with three engagement phases (non-engagement, motivational engagement, executive engagement) and relate the motivation and reward systems to each of these stages. We propose that either appetitive (preferably) or aversive motivational salience is activated during motivational engagement, that learning leads to continued behavior and that assertive salience prevails when the new behavior has become habitual. We discuss under which circumstances these mechanisms and reward-motivation pathways are likely to occur and address potential shortcomings of our proposed theoretical framework. We highlight implications for future interventions aiming at lifestyle modification.

An Empirical Investigation of the Relationship Between Spirituality, Work Culture, and Burnout: The Need for an Extended Health and Disease Model.

Apart from biological, psychological, and social factors, recent studies indicate that spirituality and work culture also play an important role in the onset of burnout. Hence, the commonly applied bio-psycho-social model of health and disease might not be sufficient to comprehensively explain and describe burnout. This study empirically investigates the relationship between spirituality (operationalized by perceived meaningfulness of work) and work culture (operationalized by sense of homeliness of the working environment) with burnout risk and work engagement. For this purpose, an anonymous cross-sectional data collection with fully standardized questionnaires and selected socio-demographic and work-related items was conducted among working adults (n = 439) from different industries via social media and local health service centers. For all scales and subscales, we found significant moderate to strong correlations. Furthermore, positive meaning within the perceived meaningfulness of work scale was the largest beta coefficient for burnout (ß = -0.65) and work engagement (ß = 0.62). Within sense of homeliness, the largest beta coefficient for burnout was needs fulfillment (ß = -0.34) and work engagement emotional connection (ß = 0.36). The strong associations suggest that the current health and disease model needs to be expanded to a bio-psycho-socio-spirito-cultural model to be able to sufficiently describe burnout. The perceived meaningfulness of work and a sense of homeliness should be adequately considered when examining the onset of burnout, describing burnout as a concept, and explaining work engagement.

Bio-Psycho-Socio-Spirito-Cultural Factors of Burnout: A Systematic Narrative Review of the Literature.

Background: Burnout is a widespread, multifactorial, and mainly psychological phenomenon. The pathogenesis of burnout is commonly described within the bio-psycho-social model of health and disease. Recent literature suggests that the phenomenon of burnout may be broader so that the three dimensions might not reflect the multifaceted and complex nature of the syndrome. Consequently, this review aims to identify the diversity of factors related to burnout, to define overarching categories based on these, and to clarify whether the bio-psycho-social model adequately describes the pathogenesis of burnout-holistically and sufficiently. Method: Five online databases (PubMed, PubPsych, PsychARTICLES, Psychology and Behavioral Sciences Collection, and Google Scholar) were systematically searched using defined search terms to identify relevant studies. The publication date was set between January 1981 and November 2020. Based on the selected literature, we identified factors related to burnout. We aggregated these factors into a comprehensible list and assigned them to overarching categories. Then, we assigned the factors to the dimensions of an extended model of health and disease. Results: We identified a total of 40 burnout-related factors and 10 overarching categories. Our results show that in addition to biological, psychological, and socio-environmental factors, various factors that can be assigned to a spiritual and work cultural dimension also play an important role in the onset of burnout. Conclusion: An extended bio-psycho-socio-spirito-cultural model is necessary to describe the pathogenesis of burnout. Therefore, future studies should also focus on spiritual and work cultural factors when investigating burnout. Furthermore, these factors should not be neglected in future developments of diagnosis, treatment, and prevention options.