The relationship between internal experiences and physical activity and the moderating role of acceptance-based psychological processes in people with overweight and obese BMIs

Rationale: There are low rates of physical activity in adults with overweight and obese BMIs. Internal experiences may be an important and under-addressed determinant of physical activity behavior, however they have not been measured with objectively measured physical activity in people with overweight or obese BMIs; therefore this study’s first aim is to address this gap. The study’s second aim is to examine a new approach to physical activity promotion that is based in acceptance, which has preliminary evidence in interventions but the theoretical model has not been directly tested. Methods: Adults (n=320) rated their internal experiences during a treadmill walking task at baseline of a behavioral weight loss trial. Participants also completed measurements of physical activity (accelerometer) and acceptance-based psychological processes (self-report) at baseline. Accelerometer measurement of physical activity was repeated six months after initial behavioral weight loss. Compound poisson linear models were utilized to test the relationships between internal experiences, acceptance-based psychological processes, and physical activity. Results: Higher ratings of energetic and strength were both separately positively associated with concurrent physical activity. Discomfort tolerance moderated the relationship between ratings of weak/strong and physical activity, and perceived exertion and physical activity. Other significant moderation models yielded results contrary to hypotheses, such that acceptance-based psychological processes had a larger effect at positive internal experiences. No model significantly predicted physical activity at six months. Conclusions: Results from the first aim suggest that there is divergence in the relationships between different internal experiences and physical activity, and it may be clinically helpful to include more specific measurement of internal experiences in future studies. Results from the second aim suggest that discomfort tolerance may be a key skill in physical activity promotion. However, overall acceptance-based psychological processes had a larger effect on positive internal experiences, suggesting that a positive affective experience may be necessary to create an environment conducive to skill utilization. Additionally, no models significantly predicted physical activity at six-months, suggesting that other factors such as the changes during weight loss may be more salient to physical activity engagement at six-months. Limitations in methodology and measurement of the internal experience and acceptance-based psychological processes are discussed. This study is the first to examine internal experiences, acceptance-based psychological processes, and objectively measured physical activity in adults with overweight or obese BMIs. Future studies should address the limitations of this study to further investigate the theoretical model of acceptance-based interventions for physical activity.M.S., Psychology -- Drexel University, 201

Psychosocial Predictors of Non-Adherence and Treatment Failure in a Large Scale Multi-National Trial of Antiretroviral Therapy for HIV: Data from the ACTG A5175/PEARLS Trial

Background: PEARLS, a large scale trial of antiretroviral therapy (ART) for HIV (n = 1,571, 9 countries, 4 continents), found that a once-daily protease inhibitor (PI) based regimen (ATV+DDI+FTC), but not a once-daily non-nucleoside reverse transcriptase inhibitor/nucleoside reverse transcriptase inhibitor (NNRTI/NRTI) regimen (EFV+FTC/TDF), had inferior efficacy compared to a standard of care twice-daily NNRTI/NRTI regimen (EFV+3TC/ZDV). The present study examined non-adherence in PEARLS. Methods: Outcomes: non-adherence assessed by pill count and by self-report, and time to treatment failure. Longitudinal predictors: regimen, quality of life (general health perceptions = QOL-health, mental health = QOL-mental health), social support, substance use, binge drinking, and sexual behaviors. “Life-Steps” adherence counseling was provided. Results: In both pill-count and self-report multivariable models, both once-a-day regimens had lower levels of non-adherence than the twice-a-day standard of care regimen; although these associations attenuated with time in the self-report model. In both multivariable models, hard-drug use was associated with non-adherence, living in Africa and better QOL-health were associated with less non-adherence. According to pill-count, unprotected sex was associated with non-adherence. According to self-report, soft-drug use was associated with non-adherence and living in Asia was associated with less non-adherence. Both pill-count (HR = 1.55, 95% CI: 1.15, 2.09, p<.01) and self-report (HR = 1.13, 95% CI: 1.08, 1.13, p<.01) non-adherence were significant predictors of treatment failure over 72 weeks. In multivariable models (including pill-count or self-report nonadherence), worse QOL-health, age group (younger), and region were also significant predictors of treatment failure. Conclusion: In the context of a large, multi-national, multi-continent, clinical trial there were variations in adherence over time, with more simplified regimens generally being associated with better adherence. Additionally, variables such as QOL-health, regimen, drug-use, and region play a role. Self-report and pill-count adherence, as well as additional psychosocial variables, such QOL-health, age, and region, were, in turn, associated with treatment failure

Learning to address multiple syndemics for people living with HIV through client perspectives on CBT

Objective: The mental health burden among people living with HIV/AIDS (PLWHA) is high and often involves multiple comorbid psychological and substance use-related psychosocial problems. These co-occurring problems, or syndemics, additively impair engagement in HIV disease management. Existing psychotherapies for mental health and HIV health have generally focused on a single psychosocial problem and little research exists to guide future psychotherapies that address multiple mental health issues. Method: To address this gap in understanding, we conducted qualitative interviews with multiply comorbid PLWHA (N = 30) who completed cognitive-behavioural therapy (CBT) for depression and medication adherence. Results: Themes emerged regarding participants' perspectives on how overlapping substance use and mood disorders interacted to reduce the benefit of CBT. Substance use was a dominant theme compared to other syndemics, highlighting the need for integrated mental health and substance use interventions. Interviews also suggested modifications of which psychosocial concerns participants felt should be prioritized in treatment delivery. Finally, participants described content they would want in a psychotherapy intervention, including intimacy and sexual health. Conclusions: Future psychotherapeutic interventions for syndemic problems and HIV self-care will need to comprehensively address complex concerns, including issues salient to the overall well-being of PLWHA. This may improve client engagement and, ultimately, mental, and physical health outcomes. Clinical or methodological significance of this article: Although mental health comorbidity is common and often complex among clients living with HIV, little research exists to guide psychotherapy for such intricate mental health concerns. The current study used content analysis of in-depth qualitative interviews with clients living with HIV and multiple mental health comorbidities who had recently completed cognitive-behavioural therapy. Recommendations based on these findings suggest strategies for clinicians working with similar clients to consider and offers suggestions for future treatment development research

Task Shifting and Delivery of Behavioral Medicine Interventions in Resource-Poor Global Settings: HIV/AIDS Treatment in sub-Saharan Africa

sub-Saharan Africa is home to almost three-quarters of all individuals living with HIV/AIDS in the world. Yet, sub-Saharan Africa also has one of the most severe shortages of trained medical and behavioral health care workers in the world to tackle the needs of the huge epidemic. This gap between HIV-related treatment needs and staff resources has presented the need for “task shifting” or “task sharing,” defined as delegating tasks to less specialized health care workers, and/or considering ways of sharing tasks across a clinical team. Task shifting has been a key implementation strategy for increasing access to antiretroviral therapy (ART) to treat HIV/AIDS across sub-Saharan Africa. For behavioral medicine, task shifting can be used for the delivery of behavioral health interventions for HIV medication adherence and co-occurring mental health problems. In this chapter, we aim to demonstrate how the efforts to use task shifting for rolling out ART programs in sub-Saharan Africa can inform behavioral medicine task shifting efforts to expand access to evidence-based ART adherence counseling and mental health interventions in HIV care in sub-Saharan Africa. We focus specifically on examples of task shifting cognitive behavioral therapy (CBT) for ART adherence, depression, and substance use among individuals living with HIV/AIDS in sub-Saharan Africa. Although there have been few examples to date of task shifting CBT in the context of HIV care in sub-Saharan Africa, we use these promising early examples to inform future considerations for adapting and implementing CBT using a task shifting model in this population

Pilot Trial of an Acceptance-Based Behavioral Intervention to Promote Physical Activity Among Adolescents

Prior interventions have shown limited efficacy in increasing the number of adolescents engaging in adequate physical activity (PA). Preliminary evidence suggests acceptance-based behavioral treatments (ABTs) may increase PA; however, this approach has not been tested in adolescents. This was a nonrandomized experimental pilot study that examined feasibility, acceptability, and treatment outcomes of a school-based, acceptance-based behavioral intervention for PA. Adolescents (n = 20) with low activity received a PA tracking device and were allocated to device use only or device use plus 10-weeks of ABT. PA, cardiovascular fitness, and physiological outcomes were measured pre- and postintervention. The intervention was found to be feasible and acceptable. PA, cardiovascular fitness, and physiological outcomes improved over time in the intervention group, but not in the comparison condition. This study demonstrated feasibility, acceptability, and preliminary treatment efficacy based on effect sizes for an acceptance-based behavioral intervention to increase PA in adolescents

Cascade of engagement in care (N = 986).

<p>Attending ≥ 8 groups sessions = completion of early recovery; Complete full 16 week program = completion of relapse prevention.</p

Correlates of treatment completion (N = 129).

<p>Correlates of treatment completion (N = 129).</p

Correlates of a negative urine toxicology result in last two weeks of treatment (N = 304).

<p>Correlates of a negative urine toxicology result in last two weeks of treatment (N = 304).</p