Aerobic Exercise Exposure Targeting Anxiety Sensitivity: Effects on Associated Health Behaviors in Young Adults

Anxiety sensitivity (AS) is associated with health behaviors such as low rates of physical activity, overeating, alcohol use, and poor sleep; however, interventions targeting AS via exercise-based interoceptive exposure have not assessed these as outcomes. In addition, previous studies are limited by brief follow-up periods. This study aimed to replicate previous aerobic exercise interoceptive exposures with an extended (6-week) follow-up and measurement of health behaviors. Participants were 44 sedentary young adults with elevated AS randomized to intervention (6 20-minute sessions of moderate-intensity treadmill walking) or assessment-only control. Assessments took place at baseline, week 2 (post-treatment), week 4, and week 8 with measurements of AS (ASI-3), physical activity (7-Day PAR), sleep (ISI), binge eating, alcohol use, depression (PHQ-8), anxiety (GAD-7), and stress (PSS-4). The intervention condition demonstrated a marginally significant reduction in AS compared to control at week 4 which eroded by week 8. There were no significant between-group differences for health behavior change. The intervention condition demonstrated decreases in depression, general anxiety, and perceived stress compared to control, but these effects eroded by week 4. There was no difference in findings for participants with BMI\u3c25 vs. those with BMI\u3e=25. Findings indicate that a brief intervention might not be sufficient to produce lasting changes in AS without additional treatment. Intervention effects were not as strong in this study compared to previous reports, which may be due to the size and greater racial/ethnic diversity of the current sample. Future research should objectively measure physical activity and explore individual variability in treatment response

The Impact of a Primary Care Psychology Training Program on Medical Utilization in a Community Sample

Mental illness and psychological distress is associated with higher rates of medical service usage and treatment of these issues results in more appropriate medical utilization rates. Little research has been conducted in an integrated care clinic, wherein health psychologists or behavioral health specialists work together with physicians to provide patient care. The current study examines the effects of brief behavioral and mental health interventions on patient medical utilization in this setting with care delivered by medical residents and doctoral psychology trainees. Access to the health system’s electronic billing records allowed for objective measures of annual healthcare utilization in terms of inpatient, outpatient, and emergency department use. A quasi-control group was constructed using propensity score matching in order to compare patients who had received a primary care psychology intervention to those who had not. Rates of inpatient utilization decreased significantly among treated patients overall as well as among treated patients identified as frequent attenders; there was no change in inpatient utilization among patients in the control group overall nor among frequent attenders in the control group, indicating that there is likely an effect of behavioral and mental health treatment on rates of inpatient visits. Rates of emergency department use and specialty outpatient visits were comparable between treated and control group patients, suggesting the lack of a treatment effect in these areas. Strengths, limitations, possible mechanisms, and implications for future research are discussed

Screening for Cognitive Impairment in Primary Brain Tumor Patients: A Preliminary Investigation with the MMSE and RBANS

Introduction: The prevalence of mild cognition impairment (MCI) among older adults (≥65) is estimated to range between 10-20% (Langa & Levine, 2014). Integrated primary care allows opportunities for interdisciplinary consultation, screening, and intervention. The aim of this study is to explore the percentage of older adults reporting cognitive concerns during their first primary care psychology visits. It is hypothesized that these rates will mirror prevalence rates in other older adult community dwelling samples in primary care settings. Methods: A patient sample of older adults (≥60) was introduced to services following a referral from their primary care physician. Clinicians then identified problems that were discussed in session, including “cognitive concerns.” Descriptive statistics will be used to assess the percentage of older adults with “cognitive concerns” in this sample, compared to other community dwelling samples. Results: 267 older adults were identified within a larger sample of patients who received primary care psychology services. The percentage of older adults who were referred for “cognitive concerns” was 10.5% (n = 28), with 12.7% (n = 34) reporting “cognitive concerns” during their visit. Interestingly of the 28 older adults referred by their provider for “cognitive concerns,” less than 50% (n = 13) of those patients reported “cognitive concerns” as one of their problems in session. Discussion: This sample of older adults reported cognitive concerns in primary care psychology sessions at a rate that falls within the range identified in other community dwelling samples. Future research could further improve upon identification and screening of older adults with cognitive concerns by psychologists in primary care settings, as intervention for MCI can improve quality of life and may delay progression of dementia (Campbell et al., 2018; Eshkoor et al., 2015).https://scholarscompass.vcu.edu/gradposters/1088/thumbnail.jp

Secondary data analysis from a randomized trial examining the effects of small financial incentives on intrinsic and extrinsic motivation for weight loss

The purpose of this study was to examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation “crowd out” intrinsic motivation for weight control. Participants (N = 153, 80.4% female; body mass index [BMI] = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL + $). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9-month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire (TSRQ), with questions added to specifically target extrinsic motivation related to incentives. Compared to WBWL alone, WBWL +$ had better weight loss and higher levels of both extrinsic and intrinsic motivation for weight management (p-values ≤ .02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL + $ (p = .58). Extrinsic motivation was not a significant mediator of treatment outcomes. These results suggest that modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions. Clinicaltrials.gov number: NCT01560130

Study protocol for Cognitive Behavioral Therapy for Insomnia in patients with primary brain tumor: A single-arm phase 2a proof-of-concept trial

Background: Sleep disturbance is among the most common symptoms endorsed by patients with primary brain tumor (PwPBT), with many reporting clinically elevated insomnia and poor management of their sleep-related symptoms by their medical team. Though Cognitive Behavioral Therapy for Insomnia (CBT-I) remains the front-line treatment for sleep disturbance, CBT-I has yet to be evaluated in PwPBT. Thus, it is unknown whether CBT-I is feasible, acceptable, or safe for patients with primary brain tumors. Methods: PwPBT (N = 44) will enroll and participate in a six-week group-based CBT-I intervention delivered via telehealth. Feasibility will be based on pre-determined metrics of eligibility, rates and reasons for ineligibility, enrollment, and questionnaire completion. Acceptability will be measured by participant retention, session attendance, satisfaction ratings, and recommendation to others. Safety will be assessed by adverse event reporting. Sleep will be measured both objectively via wrist-worn actigraphy and subjectively via self-report. Participants will also complete psychosocial questionnaires at baseline, post-intervention, and three-month follow-up. Conclusion: CBT-I, a non-pharmacological treatment option for insomnia, has the potential to be beneficial for an at-risk, underserved population: PwPBT. This trial will be the first to assess feasibility, acceptability, and safety of CBT-I in PwPBT. If successful, this protocol will be implemented in a more rigorous phase 2b randomized feasibility pilot with the aim of widespread implementation of CBT-I in neuro-oncology clinics

A scalable, virtual weight management program tailored for adults with type 2 diabetes: effects on glycemic control

Abstract Background The objective was to test the efficacy of a scalable, virtually delivered, diabetes-tailored weight management program on glycemic control in adults with type 2 diabetes (T2D). Methods This was a single arm, three-site clinical trial. Participants had baseline HbA1c between 7–11% and BMI between 27–50 kg/m2. Primary outcome was change in HbA1c at 24 weeks. Secondary outcomes were changes in body weight, waist circumference, the Diabetes Distress Scale (DDS), quality of life (IWQOL-L), and hunger (VAS). Generalized linear effects models were used for statistical analysis. Results Participants (n = 136) were 56.8 ± 0.8 y (Mean ± SEM), 36.9 ± 0.5 kg/m2, 80.2% female, 62.2% non-Hispanic white. Baseline HbA1c, weight, and total DDS score were 8.0 ± 0.09%, 101.10 ± 1.47 kg, and 2.35 ± 0.08, respectively. At week 24, HbA1c, body weight, and total DDS decreased by 0.75 ± 0.11%, 5.74 ± 0.50%, 0.33 ± 0.10 units, respectively (all p < 0.001). Also, at week 24, quality of life increased by 9.0 ± 1.2 units and hunger decreased by 14.3 ± 2.4 units, (both p < 0.0001). Conclusions The scalable, virtually delivered T2D-tailored weight management program had favorable and clinically meaningful effects on glycemic control, body weight, and psychosocial outcomes