Sleep quality, valence, energetic arousal, and calmness as predictors of device-based measured physical activity during a three-week mHealth intervention

Physical inactivity is known to be a risk factor for several noncommunicable diseases and has a high prevalence in today’s society. Therefore, it is crucial to understand the psychological factors associated with physical activity (PA). Recent developments in the field of ambulatory assessment and technological advances are promising to enhance our understanding of this relationship by analyzing longitudinal data within- and between-persons. These analyses can reveal important factors to design behavior change interventions to enhance PA. Therefore, this study used an ecological momentary assessment during the 3-week intervention period in the SMARTFAMILY2.0 trial and aimed to investigate whether valence, calmness, energetic arousal, and sleep quality predict daily steps and moderate to vigorous PA. Overall, 49 adults (35–60 years) and 40 children (5–19 years) were included in this analysis and self-rated their mental state within our smartphone application while also wearing a hip-worn accelerometer for 21 consecutive days (996 days included) during the intervention period. Multilevel analyses were conducted to predict daily PA while considering covariables (e.g., child/adult and non-wear time) both within- and between-persons. The results indicated that higher than average ratings of a person’s valence and energetic arousal on one day predicted increased PA while higher than average calmness predicted decreased PA at the same day within this person. Sleep quality and between-person effects of the affective states showed no clear associations to PA. Overall, these results showed that within- person associations of valence, calmness, and energetic arousal should be considered when designing PA interventions for both children and adults. The influence of sleep quality, as well as between-person effects, should be further explored by future studies

Sleep quality, valence, energetic arousal, and calmness as predictors of device-based measured physical activity during a three-week mHealth intervention – An ecological momentary assessment study within the SMARTFAMILY trial = Schlafqualität, Valenz, energetische Erregung und Ruhe als Prädiktoren für gerätegestützt gemessene körperliche Aktivität während einer dreiwöchigen mHealth-Intervention – Eine ökologische Momentaufnahme-Studie im Rahmen der SMARTFAMILY-Studie

Physical inactivity is known to be a risk factor for several noncommunicable diseases and has a high prevalence in today’s society. Therefore, it is crucial to understand the psychological factors associated with physical activity (PA). Recent developments in the field of ambulatory assessment and technological advances are promising to enhance our understanding of this relationship by analyzing longitudinal data within- and between-persons. These analyses can reveal important factors to design behavior change interventions to enhance PA. Therefore, this study used an ecological momentary assessment during the 3‑week intervention period in the SMARTFAMILY2.0 trial and aimed to investigate whether valence, calmness, energetic arousal, and sleep quality predict daily steps and moderate to vigorous PA. Overall, 49 adults (35–60 years) and 40 children (5–19 years) were included in this analysis and self-rated their mental state within our smartphone application while also wearing a hip-worn accelerometer for 21 consecutive days (996 days included) during the intervention period. Multilevel analyses were conducted to predict daily PA while considering covariables (e.g., child/adult and non-wear time) both within- and between-persons. The results indicated that higher than average ratings of a person’s valence and energetic arousal on one day predicted increased PA while higher than average calmness predicted decreased PA at the same day within this person. Sleep quality and between-person effects of the affective states showed no clear associations to PA. Overall, these results showed that within-person associations of valence, calmness, and energetic arousal should be considered when designing PA interventions for both children and adults. The influence of sleep quality, as well as between-person effects, should be further explored by future studies

A just-in-time adaptive intervention to enhance physical activity in the SMARTFAMILY2.0 trial

Just-in-time adaptive interventions (JITAIs) are a promising technology-based approach for health behavior change. This examination aimed to evaluate whether a JITAI after a period of inactivity can enhance physical activity in the subsequent hour depending on whether the JITAI has been answered ("engaged" condition) compared to when the trigger was not answered ("not engaged" condition). Data of the three-week intervention period of the SMARTFAMILY2.0 trial was used for analysis. A total of 80 participants (n = 47 adults, 23 female; n = 33 children, 15 female) with 907 JITAI triggers were included in this examination. A JITAI was sent when the participant has been inactive for at least 60 minutes as indicated by accelerometry. Two multilevel models were calculated for metabolic equivalents (MET) and step count with measurements (level 1) nested in participants (level 2) under consideration of the covariates weekday/weekend, time of the day, and adult/child. Results indicated significantly higher MET (β = 0.08, p = .014) and step (β = 0.08, p = .022) counts in the subsequent hour for the engaged condition compared to the not engaged condition within-persons (level 1). Engagement with the JITAI implemented in the SMARTFAMILY2.0 trial yielded promising results concerning physical activity enhancement in the subsequent hour. Here, the inclusion of further constraining factors like the availability of the participant or the inclusion of affective and contextual variables into the design of a JITAI might enhance the engagement in future studies

Fragebogen zur Erfassung der nahrungsbezogenen Inhibitionskontrolle : Entwicklung und Pilotstudie

Eine fehlende nahrungsbezogene Inhibitionskontrolle ist mit ungünstigem Essverhalten assoziiert und stellt einen aufrechterhaltenden Faktor für Adipositas dar. Um diesen bereichsspezifischen Einfluss differenzierter untersuchen zu können, ist es notwendig, die Facetten der nahrungsbezogenen Inhibitionskontrolle valide und verlässlich abzubilden. Bisher werden zur Erfassung überwiegend behaviorale Maße eingesetzt. Ziel dieser Arbeit ist es, ein Fragebogeninstrument zu entwickeln und zur Erprobung in einer nicht-klinischen Stichprobe einzusetzen. Es wurde eine Literaturrecherche zur allgemeinen und nahrungsbezogenen Inhibitionskontrolle bei Adipositas durchgeführt. Darauf basierend wurden Items formuliert und hinsichtlich Sprache, Verständnis und Redundanz revidiert. Aktuell werden die 40 Items in einer Online-Befragung an einer nicht-klinischen Stichprobe pilotiert. Die Ergebnisse sollen hinsichtlich testtheoretischer Konstrukte ausgewertet und in Zusammenhang mit gewichtsassoziierten Maßen (BMI, Essverhalten) gebracht werden. Es gilt zu überprüfen, ob die entwickelten Items die Facetten der nahrungsbezogenen Inhibitionskontrolle (Handlungsunterdrückung, Handlungsunterbrechung, impulsives Entscheidungsverhalten) abbilden. Zum jetzigen Zeitpunkt haben 326 Personen (28.61±12.51 Jahre, 80.67% weiblich, BMI: 24.40±20.18 kg/m2) an der Befragung teilgenommen. Im Vortrag im März 2020 werden die Ergebnisse der Faktorenanalyse, die zur Bestimmung der faktoriellen Struktur des Fragebogens berechnet wird, vorgestellt. In einem nächsten Schritt soll der Fragebogen in einer klinischen Stichprobe bei Personen mit Adipositas hinsichtlich seiner Güte geprüft und überarbeitet. Die Ergebnisse könnten das Verständnis für den Zusammenhang zwischen der nahrungsbezogenen Inhibitionskontrolle und Adipositas erweitern. Ein ökonomisches Fragebogeninstrument, welches die distinkten Facetten valide und verlässlich abbildet, kann eine gezielte Bearbeitung der individuellen Beeinträchtigungen in der Therapie ermöglichen

Differential effects of the individualized gender-sensitive mHealth intervention I-GENDO on eating styles in individuals with overweight and obesity : a randomized controlled trial

Background: Addressing cognitive behavioral factors is associated with a favorable development of eating styles (i.e., increased levels of restrained eating, decreased levels of external and emotional eating) in individuals with overweight and obesity. Research suggests that the use of digital interventions that consider gender aspects regarding prevalence, comorbidities, and weight-related behaviors could enhance existing treatment options. This randomized controlled trial aimed to evaluate the effectiveness of the self-guided gender-sensitive mobile health intervention I-GENDO on restrained, emotional and external eating, body mass index, and physical activity at the end of the intervention, and at a 9- and 15-month follow-up. Methods: Two hundred thirteen individuals (67% female, body mass index: 33.35 ± 3.79 kg/m2) were randomly assigned to the intervention or control group. Multilevel models were calculated to investigate differences between groups. I-GENDO offered interactive modules addressing psychological content associated with obesity. Users were able to self-tailor intervention content based on their individual needs and life realities. Results: Restrained eating was higher in the intervention group after the intervention (95% CI: 0.20, 0.36) and at 9-months (95% CI: 0.07, 0.24). At 9-months, emotional eating among women was lower in the intervention group compared to the control group (95% CI: -0.44, -0,19). In the intervention group, external eating was lower after the intervention, which remained significant for women at 9 (95% CI: -0.40, -0.19) and 15-months (95% CI: -0.34, -0.13). Body mass index of men in the intervention group was 1.44 lower at 15-months than in the control group. No significant effects on physical activity were found. Conclusions: The I-GENDO intervention was effective in changing restrained eating of both women and men in the long-term, suggesting that a self-guided, gender-sensitive approach is promising. However, the differential effects on the outcome measures indicate that more research is warranted to examine distinct gender-sensitive mechanisms of digital psychological interventions (i.e., dose–response relationship, blended counselling). Trial registration: ClinicalTrials.gov identifier: NCT04080193, 06–09-2019

A cognitive behavioural mHealth intervention for families in the postpartum period to enhance weight management, mental well-being and resilience : a study protocol for a randomised controlled trial (I‑PREGNO) : [version 1; peer review: awaiting peer review]

Introduction: The postpartum period goes along with an increased risk of unhealthy weight gain and numerous physical and psychological challenges, which are associated with mental well-being and resilience. Given the individual circumstances and the accompanying time constraints, evidence-based mHealth interventions may be useful for flexible, spot-on complementary care. Thus, the mHealth app I-PREGNO aims to enhance mental well-being and resilience by offering cognitive-behavioural and behaviour change skills training to prevent unhealthy weight development in this vulnerable life episode. In a randomised controlled trial, we will examine its effectiveness and acceptance. Protocol: Parents of infants between 0 and 12 months will be randomised to the intervention or control group. Both groups will take part in a baseline survey (t0) and further assessments after 12 weeks (intervention duration, t1), and 6 months (t2). The intervention group will use the self-guided mHealth app after t0 and both groups will get unlimited access after t2. The primary outcomes will be i) weight (difference of weight in kg after the intervention and pre-pregnancy); ii) mental well-being assessed through the Edinburgh-Postnatal-Depression-Scale and Parenting Stress Index; iii) resilience assessed through the General Self-Efficacy Scale and Difficulties in Emotion Regulation Scale. Secondary outcomes will be sociodemographic variables, eating behaviour, physical activity, relationship experiences, childhood trauma, postpartum bonding, regulatory disorders, and app usability. Gender differences between mothers and fathers will be considered. Conclusion: Positive effects on weight development in the postpartum period, mental well-being, and resilience due to the I-PREGNO intervention will support parental health in the critical postpartum phase. The study results will contribute to the growing field of evidence-based, highly scalable, low-cost, geographically independent, just-in-time mobile support for a target group that is restricted in time and resources. Trial registration: The trial has been registered at the German Clinical Trials Register (DRKS00031067) in January 2023 prospectively

I-PREGNO – prevention of unhealthy weight gain and psychosocial stress in families during pregnancy and postpartum using an mHealth enhanced intervention: a study protocol of two cluster randomized controlled trials

Background The transition to parenthood represents a critical life period with psychosocial, and behavioral changes and challenges for parents. This often increases stress and leads to unhealthy weight gain in families, especially in psychosocially burdened families. Although universal and selective prevention programs are offered to families, specific support often fails to reach psychosocially burdened families. Digital technologies are a chance to overcome this problem by enabling a low-threshold access for parents in need. However, there is currently a lack of smartphone-based interventions that are tailored to the needs of psychosocially burdened families. Aims The research project I-PREGNO aims to develop and evaluate a self-guided, smartphone-based intervention in combination with face-to-face counseling delivered by healthcare professionals for the prevention of unhealthy weight gain and psychosocial problems. The intervention is specifically tailored to the needs of psychosocially burdened families during the pregnancy and postpartum period. Methods In two cluster randomized controlled trials in Germany and Austria (N = 400) psychosocially burdened families will be recruited and randomized to i) treatment as usual (TAU), or ii) I-PREGNO intervention (self-guided I-PREGNO app with counseling sessions) and TAU. We expect higher acceptance and better outcomes on parental weight gain and psychosocial stress in the intervention group. Discussion The intervention offers a low cost and low-threshold intervention and considers the life situation of psychosocially burdened families who are a neglected group in traditional prevention programs. After positive evaluation, the intervention may easily be implemented in existing perinatal care structures in European countries such as Germany and Austria. Trial registration Both trials were registered prospectively at the German Clinical Trials Register (Germany: DRKS00029673; Austria: DRKS00029934) in July and August 2022

Neural correlates of cue‐induced changes in decision‐making distinguish subjects with gambling disorder from healthy controls

In addiction, there are few human studies on the neural basis of cue-induced changes in value-based decision making (Pavlovian-to-instrumental transfer, PIT). It is especially unclear whether neural alterations related to PIT are due to the physiological effects of substance abuse or rather related to learning processes and/or other etiological factors related to addiction. We have thus investigated whether neural activation patterns during a PIT task help to distinguish subjects with gambling disorder (GD), a nonsubstance-based addiction, from healthy controls (HCs). Thirty GD and 30 HC subjects completed an affective decision-making task in a functional magnetic resonance imaging (fMRI) scanner. Gambling-associated and other emotional cues were shown in the background during the task. Data collection and feature modeling focused on a network of nucleus accumbens (NAcc), amygdala, and orbitofrontal cortex (OFC) (derived from PIT and substance use disorder [SUD] studies). We built and tested a linear classifier based on these multivariate neural PIT signatures. GD subjects showed stronger PIT than HC subjects. Classification based on neural PIT signatures yielded a significant area under the receiver operating curve (AUC-ROC) (0.70,p= 0.013). GD subjects showed stronger PIT-related functional connectivity between NAcc and amygdala elicited by gambling cues, as well as between amygdala and OFC elicited by negative and positive cues. HC and GD subjects were thus distinguishable by PIT-related neural signatures including amygdala-NAcc-OFC functional connectivity. Neural PIT alterations in addictive disorders might not depend on the physiological effect of a substance of abuse but on related learning processes or even innate neural traits

Cue‐induced effects on decision‐making distinguish subjects with gambling disorder from healthy controls

While an increased impact of cues on decision‐making has been associated with substance dependence, it is yet unclear whether this is also a phenotype of non‐substance‐related addictive disorders, such as gambling disorder (GD). To better understand the basic mechanisms of impaired decision‐making in addiction, we investigated whether cue‐induced changes in decision‐making could distinguish GD from healthy control (HC) subjects. We expected that cue‐induced changes in gamble acceptance and specifically in loss aversion would distinguish GD from HC subjects. Thirty GD subjects and 30 matched HC subjects completed a mixed gambles task where gambling and other emotional cues were shown in the background. We used machine learning to carve out the importance of cue dependency of decision‐making and of loss aversion for distinguishing GD from HC subjects. Cross‐validated classification yielded an area under the receiver operating curve (AUC‐ROC) of 68.9% (p = .002). Applying the classifier to an independent sample yielded an AUC‐ROC of 65.0% (p = .047). As expected, the classifier used cue‐induced changes in gamble acceptance to distinguish GD from HC. Especially, increased gambling during the presentation of gambling cues characterized GD subjects. However, cue‐induced changes in loss aversion were irrelevant for distinguishing GD from HC subjects. To our knowledge, this is the first study to investigate the classificatory power of addiction‐relevant behavioral task parameters when distinguishing GD from HC subjects. The results indicate that cue‐induced changes in decision‐making are a characteristic feature of addictive disorders, independent of a substance of abuseDFG, 103586207, GRK 1589: Sensory Computation in Neural System

Patterns of Alcohol Consumption Among Individuals With Alcohol Use Disorder During the COVID-19 Pandemic and Lockdowns in Germany

Importance Alcohol consumption (AC) leads to death and disability worldwide. Ongoing discussions on potential negative effects of the COVID-19 pandemic on AC need to be informed by real-world evidence. Objective To examine whether lockdown measures are associated with AC and consumption-related temporal and psychological within-person mechanisms. Design, Setting, and Participants This quantitative, intensive, longitudinal cohort study recruited 1743 participants from 3 sites from February 20, 2020, to February 28, 2021. Data were provided before and within the second lockdown of the COVID-19 pandemic in Germany: before lockdown (October 2 to November 1, 2020); light lockdown (November 2 to December 15, 2020); and hard lockdown (December 16, 2020, to February 28, 2021). Main Outcomes and Measures Daily ratings of AC (main outcome) captured during 3 lockdown phases (main variable) and temporal (weekends and holidays) and psychological (social isolation and drinking intention) correlates. Results Of the 1743 screened participants, 189 (119 [63.0%] male; median [IQR] age, 37 [27.5-52.0] years) with at least 2 alcohol use disorder (AUD) criteria according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) yet without the need for medically supervised alcohol withdrawal were included. These individuals provided 14 694 smartphone ratings from October 2020 through February 2021. Multilevel modeling revealed significantly higher AC (grams of alcohol per day) on weekend days vs weekdays (β = 11.39; 95% CI, 10.00-12.77; P < .001). Alcohol consumption was above the overall average on Christmas (β = 26.82; 95% CI, 21.87-31.77; P < .001) and New Year’s Eve (β = 66.88; 95% CI, 59.22-74.54; P < .001). During the hard lockdown, perceived social isolation was significantly higher (β = 0.12; 95% CI, 0.06-0.15; P < .001), but AC was significantly lower (β = −5.45; 95% CI, −8.00 to −2.90; P = .001). Independent of lockdown, intention to drink less alcohol was associated with lower AC (β = −11.10; 95% CI, −13.63 to −8.58; P < .001). Notably, differences in AC between weekend and weekdays decreased both during the hard lockdown (β = −6.14; 95% CI, −9.96 to −2.31; P = .002) and in participants with severe AUD (β = −6.26; 95% CI, −10.18 to −2.34; P = .002). Conclusions and Relevance This 5-month cohort study found no immediate negative associations of lockdown measures with overall AC. Rather, weekend-weekday and holiday AC patterns exceeded lockdown effects. Differences in AC between weekend days and weekdays evinced that weekend drinking cycles decreased as a function of AUD severity and lockdown measures, indicating a potential mechanism of losing and regaining control. This finding suggests that temporal patterns and drinking intention constitute promising targets for prevention and intervention, even in high-risk individuals