Patterns of relational responding and a healthy self in older adolescents

Evidence from Contextual Behavioral Science indicates that two patterns of relating facilitate a sense of self, namely, self-as-distinction and self-as-hierarchy. Although the latter has been associated with better mental health outcomes relative to self-as-distinction, to date these types of relating have not been examined directly at a baseline level, wherein manipulation has not occurred. The present study examined the relative contribution of self-as-distinction and self-as-hierarchy on depression, stress, and anxiety in a sample of 102 young people, while controlling for deictic ability and gender. The role of psychological flexibility was also examined using mediation analysis. While self-as-hierarchy emerged as a significant predictor of lower levels of stress and depression, psychological flexibility was not found to mediate this relationship. Self-as-distinction did not emerge as a significant predictor of any outcome variable. Suggestions for future research on the basis of these findings are discussed

Moderate-intensity aerobic and resistance exercise is safe and favorably influences body composition in patients with quiescent Inflammatory Bowel Disease: a randomized controlled cross-over trial

peer-reviewedBackground Overweight and metabolic problems now add to the burden of illness in patients with Inflammatory Bowel Disease. We aimed to determine if a program of aerobic and resistance exercise could safely achieve body composition changes in patients with Inflammatory Bowel Disease. Methods A randomized, cross-over trial of eight weeks combined aerobic and resistance training on body composition assessed by Dual Energy X-ray Absorptiometry was performed. Patients in clinical remission and physically inactive with a mean age of 25 ± 6.5 years and Body Mass Index of 28.9 ± 3.8 were recruited from a dedicated Inflammatory Bowel Disease clinic. Serum cytokines were quantified, and microbiota assessed using metagenomic sequencing. Results Improved physical fitness was demonstrated in the exercise group by increases in median estimated VO2max (Baseline: 43.41mls/kg/min; post-intervention: 46.01mls/kg/min; p = 0.03). Improvement in body composition was achieved by the intervention group (n = 13) with a median decrease of 2.1% body fat compared with a non-exercising group (n = 7) (0.1% increase; p = 0.022). Lean tissue mass increased by a median of 1.59 kg and fat mass decreased by a median of 1.52 kg in the exercising group. No patients experienced a deterioration in disease activity scores during the exercise intervention. No clinically significant alterations in the α- and β-diversity of gut microbiota and associated metabolic pathways were evident. Conclusions Moderate-intensity combined aerobic and resistance training is safe in physically unfit patients with quiescent Inflammatory Bowel Disease and can quickly achieve favourable body compositional changes without adverse effects. Trial registration The study was registered at ClinicalTrials.gov; Trial number: NCT02463916

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Genetic correlation between amyotrophic lateral sclerosis and schizophrenia

A. Palotie on työryhmän Schizophrenia Working Grp Psychiat jäsen.We have previously shown higher-than-expected rates of schizophrenia in relatives of patients with amyotrophic lateral sclerosis (ALS), suggesting an aetiological relationship between the diseases. Here, we investigate the genetic relationship between ALS and schizophrenia using genome-wide association study data from over 100,000 unique individuals. Using linkage disequilibrium score regression, we estimate the genetic correlation between ALS and schizophrenia to be 14.3% (7.05-21.6; P = 1 x 10(-4)) with schizophrenia polygenic risk scores explaining up to 0.12% of the variance in ALS (P = 8.4 x 10(-7)). A modest increase in comorbidity of ALS and schizophrenia is expected given these findings (odds ratio 1.08-1.26) but this would require very large studies to observe epidemiologically. We identify five potential novel ALS-associated loci using conditional false discovery rate analysis. It is likely that shared neurobiological mechanisms between these two disorders will engender novel hypotheses in future preclinical and clinical studies.Peer reviewe

The self, perspective-taking and adolescent mental health: a contextual behavioural science approach

Mental health concerns affect approximately 20% of adolescents worldwide, many of which can be linked to one’s sense of self. However, many psychological accounts of self have been shown to be poorly defined and lacking in strong theoretical foundations. The present thesis investigates the relationship between the self and adolescent mental health using evidence from Contextual Behavioural Science (CBS), which offers a coherent theory of self and identifies empirically testable units. Overall this body of research aims to empirically examine the theoretical assumptions of the CBS account of self at multiple levels of analysis and test the practical application of this with an adolescent population, while addressing issues identified across previous investigations. Study 1 tested the ability of a model of the three senses of self (self-as-content; self-as-process; self-as-context) to predict overall mental health in adolescents. A significant model emerged with all three predictor variables contributing significantly. Study 2, tested a clinical application of this theory through a brief school based intervention, targeting the development of a healthy sense of self as articulated by CBS. Study 2 results revealed no significant improvements following this intervention, compared to a theory of mind intervention and a no intervention control group. Study 3 examined these senses of self and other relevant behaviours (e.g. relating to others) in samples of adolescent textual responses using a qualitative behavioural measure. Consistent with Study 1, higher self-as-process was related to lower depression and lower anxiety for female participants, while lower rigid self-as-content was related to higher well being. Due to insufficient occurrences of self-as-context this relationship could not be examined reliably. Results also showed how one relates to others and ability to identify emotions have important implications for mental health, well-being, and psychological flexibility. Finally, study 4 involved a fine-grained investigation into the 2 types of self-as-context (distinction and hierarchy) at a naturally occurring level in a sample of older adolescents. Study results showed that self-as-hierarchy was significantly predictive of lower stress and depression, and that self-as-distinction was not predictive of mental health. Psychological flexibility was not found to mediate this relationship. Overall these findings make a unique and important contribution to the CBS literature. Findings are discussed in terms of theoretical and practical implications for how this body of evidence may serve to guide future empirical wor

The self, perspective-taking and adolescent mental health: a contextual behavioural science approach

Mental health concerns affect approximately 20% of adolescents worldwide, many of which can be linked to one’s sense of self. However, many psychological accounts of self have been shown to be poorly defined and lacking in strong theoretical foundations. The present thesis investigates the relationship between the self and adolescent mental health using evidence from Contextual Behavioural Science (CBS), which offers a coherent theory of self and identifies empirically testable units. Overall this body of research aims to empirically examine the theoretical assumptions of the CBS account of self at multiple levels of analysis and test the practical application of this with an adolescent population, while addressing issues identified across previous investigations. Study 1 tested the ability of a model of the three senses of self (self-as-content; self-as-process; self-as-context) to predict overall mental health in adolescents. A significant model emerged with all three predictor variables contributing significantly. Study 2, tested a clinical application of this theory through a brief school based intervention, targeting the development of a healthy sense of self as articulated by CBS. Study 2 results revealed no significant improvements following this intervention, compared to a theory of mind intervention and a no intervention control group. Study 3 examined these senses of self and other relevant behaviours (e.g. relating to others) in samples of adolescent textual responses using a qualitative behavioural measure. Consistent with Study 1, higher self-as-process was related to lower depression and lower anxiety for female participants, while lower rigid self-as-content was related to higher well being. Due to insufficient occurrences of self-as-context this relationship could not be examined reliably. Results also showed how one relates to others and ability to identify emotions have important implications for mental health, well-being, and psychological flexibility. Finally, study 4 involved a fine-grained investigation into the 2 types of self-as-context (distinction and hierarchy) at a naturally occurring level in a sample of older adolescents. Study results showed that self-as-hierarchy was significantly predictive of lower stress and depression, and that self-as-distinction was not predictive of mental health. Psychological flexibility was not found to mediate this relationship. Overall these findings make a unique and important contribution to the CBS literature. Findings are discussed in terms of theoretical and practical implications for how this body of evidence may serve to guide future empirical wor

An investigation into the relationship between the three selves (Self-as-Content, Self-as-Process and Self-as-Context) and mental health in adolescents

2018 Association for Contextual Behavioral Science. It is estimated that globally, 10-20% of young people experience a mental health disorder in a given year. The emergence of many issues in adolescence can be linked to a dysfunctional sense of self. Contextual Behavioral Science (CBS) suggests that there are three functionally distinct patterns of self discrimination, that is, Self-as-Content, Self-as-Process, and Self-as-Context, each of which has important implications for a healthy, functional sense of self. This study examines the relative predictive power of the three selves according to CBS to predict mental health in adolescents. A sample of 176 adolescents participated. Using hierarchical multiple regression a significant model emerged indicating that the three selves model is predictive of mental health in adolescents. Results are discussed in terms of implications for future research, such as development of interventions based on the CBS conceptualization of self

Delivering Cardiac Rehabilitation Exercise Virtually Using a Digital Health Platform (ECME-CR): Protocol for a Pilot Trial

BackgroundExercise-based cardiac rehabilitation is recognized as a core component of cardiovascular disease management and has been shown to reduce all-cause and cardiovascular mortality and reduce the risk of hospital readmission following a cardiac event. However, despite this, the uptake of and long-term adherence to cardiac rehabilitation exercise is poor. Delivering cardiac rehabilitation exercise virtually (ie, allowing patients to participate from their own homes) may be an alternative approach that could enhance uptake and increase adherence. ObjectiveThe aim of this study is to assess the feasibility of delivering a virtual cardiac rehabilitation exercise program supported by the Eastern Corridor Medical Engineering – Cardiac Rehabilitation (ECME-CR) platform. MethodsA convenience sample (n=20) of participants eligible to participate in community-based cardiac rehabilitation exercise will be recruited. Participants will be randomized to one of two study groups. Both study groups will perform the same exercise program, consisting of twice-weekly sessions of 60 minutes each, over an 8-week intervention period. Participants in the intervention group will partake in virtually delivered cardiac rehabilitation exercise classes in their own home. The virtual exercise classes will be delivered to participants using a videoconferencing platform. Participants in the control group will attend the research center for their cardiac rehabilitation exercise classes. Intervention group participants will receive the ECME-CR digital health platform for monitoring during the class and during the intervention period. Outcomes will be assessed at baseline and following the 8-week intervention period. The primary outcome will be exercise capacity as assessed using the 6-minute walk test. Other outcome measures will include heart rate, blood pressure, weight, percentage body fat, muscle strength, and self-reported quality of life. Semistructured interviews will also be conducted with a subset of participants to explore their experiences of using the digital platform. ResultsParticipant recruitment and data collection will begin in July 2021, and it is anticipated that the study results will be available for dissemination in spring 2022. ConclusionsThis pilot trial will inform the design of a randomized controlled trial that will assess the clinical effectiveness of the ECME-CR digital health platform. International Registered Report Identifier (IRRID)PRR1-10.2196/3185

Efficacy of a Digital Acceptance and Commitment Therapy Intervention for the Improvement of Self-management Behaviors and Psychological Flexibility in Adults With Cardiac Disease: Protocol for a Single Case Experimental Design

BackgroundResearch indicates that the management of distress levels in those with cardiac disease is not only important for improving quality of life and functioning but also critical for condition management; adherence to treatment; and, ultimately, disease prognosis and progression. Acceptance and commitment therapy (ACT) has consistently demonstrated positive long-term outcomes across a wide array of conditions, including chronic illness. However, most empirical investigations conducted to date have also involved in-person therapy, which can be difficult to access, particularly for those dealing with the demands of chronic disease. ObjectiveThe objective of our research is to evaluate a digital ACT intervention for improving self-management behaviors and distress levels in those with cardiac conditions. MethodsThe digital ACT intervention will be delivered via a digital health self-management platform over 6 sessions. This will involve a randomized, multiple baseline, single case experimental design with approximately 3 to 15 adults with cardiac disease. The independent variable for each participant will be the pre-post intervention phase. The dependent variables will be a daily self-report measure of psychological flexibility as well as objective measures of condition self-management (eg, blood pressure readings) and engagement with the app (eg, completing guided mindfulness). One-to-one qualitative interviews will also be conducted to further examine participants’ experiences with using the intervention and what factors contribute to or impede successful outcomes. ResultsParticipant recruitment and data collection began in October 2021, and it is projected that the study findings will be available for dissemination by spring 2022. ConclusionsThe findings will be discussed in terms of how a digital ACT intervention can best meet the needs of cardiac patients. International Registered Report Identifier (IRRID)PRR1-10.2196/3378