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This study tested whether a mindfulness-based intervention for obesity that included components aimed at emotion regulation and mindful eating improved psychological outcomes including stress, anxiety, positive emotion, and depression, during the intervention period and at longer-term follow-up.Adults with obesity (Participants randomized to the mindfulness arm had significant increases in positive emotions at all follow-up times compared to controls. There were statistically significant increases in mindfulness, psychological flexibility, and reflection, as well as decreases in anxiety and depressive symptoms at 12 months compared to control participants. These changes remained significant for psychological flexibility and reflection at 18 months. There were no significant differences in perceived stress. Among mindfulness participants, greater increases in mindfulness from 6-18 months was associated with greater positive emotions and psychological flexibility as well as lower perceived stress, anxiety, depressive symptoms, and rumination at 18 months, adjusting for 6-month values. Mediation analyses indicated that randomization to the mindfulness intervention arm was associated with 6-month increases in mindfulness, and these increases were in turn associated with improved psychological outcomes at 6 months and 18 months. Changes from baseline to 18 months did not mediate 18-month changes in psychological outcomes.Mindfulness training in emotion regulation and mindful eating may provide greater longer-term psychological well-being benefits in non-clinical populations with obesity compared to conventional diet-exercise interventions.

Objective People of color and lower socioeconomic groups have higher obesity prevalence, lose less weight compared with Whites and higher socioeconomic groups, and are underrepresented in randomized controlled trials of mindfulness-based interventions. We examined whether mindfulness approaches reduce disparities in weight loss interventions. Methods We analyzed data from a randomized controlled trial of 194 participants with obesity (41% participants of color, 36% without college degree) comparing a 5.5-month mindfulness-based weight loss intervention to an active-control with identical diet-exercise guidelines. We assessed attendance, 18-month attrition, and weight change at 6, 12, and 18 months by race/ethnicity and education level using linear mixed models, adjusting for baseline body mass index, age, and education or race/ethnicity, respectively. Results Participants without versus with a college degree attended fewer sessions and had higher attrition across interventions. Participants of color attended fewer intervention sessions in the mindfulness compared with the control intervention. Overall, participants of color lost significantly less weight at 12 and 18 months compared with Whites. However, during the 6- to 18-month maintenance period, we found an interaction of intervention arm, race/ethnicity, and time (p = .035), indicating that participants of color compared with Whites regained more weight in the control (0.33 kg/mo; p = .005) but not mindfulness intervention (0.06 kg/mo; p = .62). Participants without a college degree had greater initial weight loss in the mindfulness compared to control intervention from 0 to 6 months (-0.46 kg/mo; p = .039). Conclusions Although disparities persist, mindfulness approaches may mitigate some racial/ethnic and socioeconomic differences in weight loss compared with conventional diet-exercise programs. Trial registration Clinicaltrials.gov registration: NCT00960414.

Objective\ud This study aimed to adapt the Multidimensional Assessment of Interoceptive Awareness (MAIA) questionnaire for younger respondents.\ud \ud Method\ud The language of the MAIA was revised and children aged 7–10 years (n = 212) and adolescents aged 11–17 years (n = 217) completed the questionnaire.\ud \ud Results\ud The original eight‐factor model was tested for fit using confirmatory factor analysis. The model had an acceptable fit in the total sample and younger subsample and overall fit in the older subsample was adequate following modification. Internal consistency was good, except for the Noticing, Not‐Distracting and Not‐Worrying scales. Results also demonstrated a negative linear relationship between the trusting scale and age, suggesting that youths may lose trust in their body as they age.\ud \ud Conclusion\ud The adapted MAIA can be used with a younger population and, depending on the research question, individual MAIA scales may be selected. The survey is available at https://osher.ucsf.edu/maia.

Chapter 5 follows eighteenth- and nineteenth-century developments in astronomy, upon which modern theories of statistical inference were built in the 1920s and 1930s. Significance testing derived ultimately from the controversial use of probabilistic criteria for the rejection of discordant observations in astronomy. From an unelaborated remark of Jeffreys (Jeffreys H (1961) Theory of probability (3rd ed.). Clarendon Press, Oxford. (1st ed., 1939)), I believe I have identified the origin of the 5% criterion as a side consequence of the typical size of a batch of astronomical observations. Belgian astronomer and sociologist Adolphe Quetelet applied the normal curve to whole populations of different individuals. His work was quickly picked up by Francis Galton, who was working with the English biometricians to study the Darwinian hypothesis by means of the rates of change in natural populations. Francis Edgeworth (Transact Cambridge Philosophical Soc 14:138–169, 1885b) was the first to speak of a “significant difference,” drawing on the double meaning of significant as indicative (of a real difference in the population). Gosset, a statistician who worked for the Guinness brewers in Dublin, and was friends with the biometric group, derived the distribution of the z statistics for small samples and took the dubious step of applying the methods of the biometricians for normal populations to the yields of different fields of barley.

Chapter 1 introduces the problem autobiographically, tracing how I came to see the problem, and key influences on my thinking. Unique as my development has been, I suggest that it contains enough common themes to shed light on some of the reasons for the persistence of statistical inference. This personal account is one of three uses of history that I make. A second obviously is a history of the relevant concepts, back to their roots. Efforts at understanding that begin with the modern versions of these concepts are doomed from the start, in accepting conceptual packages that were seductive but ultimately irrelevant. A third use of history is a brief study of the ontogenesis of probability concepts, by way of illustrating the forgotten struggles we all went through in constructing these concepts. The dualistic concept of probability which arose in the seventeenth and eighteenth centuries predictably led to rival theories in succeeding centuries: the various frequency and “subjective” theories. Fisher, who formulated the first modern theory of statistical inference, attempted to straddle the theories in practice, while stoutly professing allegiance to the frequency theory. Psychologists’ confusion on significance testing owes much to their having learned primarily from Fisher.

This chapter explores the transformation of sixteenth- and seventeenth-century thought and culture, by way of sketching the context and conditions for the emergence of the modern concepts of probability and statistical inference in the seventeenth and eighteenth centuries, respectively. Philosophically, the profound changes at that time could be summarized as splitting and polarization, externalization and movement toward the surface, and an uprooting and decentering. Widespread monetization had implied that everything could be measured, that the world could be understood in mathematical terms, and that judgment might be replaced by calculation. As a self-sustaining, self-correcting system, the market lent plausibility to mechanistic theories of nature. Aristotelian causes could not be found by empirical methods, which could only determine the frequency of co-occurrence of signs; the connections between things were lost; entities became detachable from their attributes. The new awareness of finitude and epistemological aloneness entailed acute anxiety and an ensuing frantic search for a solid footing. In the midst of that trauma, the formation of the modern dualistic concept of probability at once gave expression to the crisis of knowledge and provided the key to its solution, in the mathematical formalization of all empirical knowledge by statistical inference.

Chapter 8 traces the other branch of probability theory, the epistemic theories. The logical theorists hold probability to be the degree of belief in a proposition logically warranted by a given body of evidence. There is naturally some question who is to say what that degree of belief is. The personalist Bayesians answer that question in terms of betting ratios: Probability is determined by how you would bet. But they also impose constraints—chiefly additivity—to make the resulting probabilities correspond to the traditional aleatory calculus. In doing so they force us to commit all our chips on every proposition, since knowledge, in this vision, is a matter of betting against a malevolent Nature, seeking to win against us, and we are forced to pay for incorrect guesses. There remains the disquieting peculiarity of making personal betting ratios fundamental to science. Bayesian statistical inference proceeds by specifying your beliefs prior to seeing the data then combining them with the data to yield your posterior beliefs. Bayesians claim as an advantage that they include the full inference process in their calculations; the frequentists can retort that science is not served by forcing nonformalizable aspects into a formula.

Chapter 9 explores the history of statistics in psychology, beginning with the development of the concept of psychological measurement, for which the impetus was clearly more commercial than scientific. It covers in detail the confusions arising from the difference between the Fisher and Neyman-Pearson theories, and the reaction to the Bayesian challenge. It concludes by noting that Bayesian statistics have made inroads in recent years, though not as a model of data analysis; rather, frequentists seeking to develop random effects (e.g., hierarchical) models found that Bayesian theorists had already shown the way. Predictably, the use of Bayesian methods by frequentists has involved less understanding on the part of practitioners than might be hoped. It seems to be seldom appreciated, for example, that the only reason multiple imputation of missing data is considered an intrinsically Bayesian procedure is that Bayesian (posterior) probabilities are intrinsically conditional and troublesome terms cancel out.

Chapter 3, after considering why the modern concept of probability didn’t emerge before the middle of the seventeenth century, traces its origin to insurance contracts covering maritime commerce. When the familiar calculus of games of chance was developed, it wasn’t called a calculus of probability for another 50 years, until Bernoulli (Bernoulli J (1713) Ars conjectandi [The art of conjecturing]. Thurneysen, Basel). Bernoulli recognized that two different scales were involved, but his attempts at evaluation were unsuccessful. Bernoulli himself wasn’t satisfied with his work, which was published 8 years after his death. Shafer (Arch History Exact Sci 19:309–370, 1978) has determined that the reason his concept was successful was that eulogies made it sound as though he had succeeded in integrating the two concepts; de Moivre and Montmort, writing mathematical textbooks in 1711 and 1718, respectively, then used Bernoulli’s term probability, thus sealing the conceptual package. That dualistic concept then made possible the mathematical formalization of all knowledge, in the form of statistical inference.

Bernoulli’s Theorem could be said to predict from cause (fair coin) to effect (distribution of outcomes). More often in application, interest lay in reasoning from observed effects (empirical series) to underlying causes, the problem of statistical inference. Bayes (Philosophical Transactions of the Royal Society of London 53:370–418, 1763) solved the problem with a two-stage experiment: having the probability p of a success on a trial itself determined as the outcome of a random process. Laplace (Laplace, P. S. Marquis de (1891). Memoire sur la probabilite des causes par les evenements [Memoir on the probability of causes from events]. Memoires de l’Academie Royale des Sciences de Paris, 1774, 6, 621–656. (Reprinted in Œuvres completes, Vol. 8, pp. 27–65)), on the other hand, merely stipulated that, if we know nothing of the value of p, we could assume all values between 0 and 1 equally likely. As a particular result Laplace was able to show (Rule of Succession) that if we had observed p successes and q failures on a binary trial, the probability of a success on the next trial was (p + 1)/(p + q + 2). Laplace’s celebrated example was in answer to Hume: If the world was created 5000 years ago, then the probability that the sun will rise tomorrow is 1,826,214/1,826,215. Application to surface characters like the color of swans gave it an appearance of plausibility; but the same calculation applied as well to intrinsic characters, such as whether a swan had a head.

Chapter 10 endeavors first to supply a fuller context for the evaluation of Bayesian claims by looking at both the philosophical and psychological literature on reasoning and inference. It also includes a brief study of the development of probability concepts in children. Then, some alternative approaches to probability and inference are presented: the propensity theory of probability, the likelihood theory of statistical inference, and Shafer’s theory of belief functions. The chapter also attempts to broaden the context for evaluation of Bayesian theory by looking at the nature of formalization, its purpose and limits, and at the relation between philosophy and psychology, between the epistemic and the psychological subject.

This chapter considers near-term possible paths for psychological research without statistical inference, before going on the deeper obstacles to change, including our attachment to rules. These include, on the one hand, a desperate denial of the subject, in pursuit of objectivity, and, on the other, frantic attempts at control, at assertion of the subject. Our only accredited methods are epidemiological, yet we know that psychological and biological processes don’t operate on random aggregates, but individuals. Our contemporary approach is biomedical research without a biomedical model. When physicists construct a linear plot of, say, solubility as a function of temperature, it is because physical theory predicts a linear relationship across the specified range. But when psychologists plot physical symptoms against depression, there is no psychological theory which says that these measurements should exhibit a linear relationship across different individuals; and the resulting plot exhibits almost nothing but error. Bill Powers (Behavior: The control of perception. Chicago, IL: Aldine, 1973; Psychological Review, 85:417–435, 1978) has developed a psychological theory based on individuals, which reconciles the concepts of mechanism and purpose; and the chapter concludes with a brief overview of his Perceptual Control Theory, as an indication of how the science of psychology might intelligently proceed.

This chapter traces one branch of theories of probability which bifurcated naturally from the dualistic concept of the eighteenth century: the frequency theories of Venn, Peirce, Mises, Reichenbach, and Popper. These theories failed on several counts. In defining probability as relative to a precisely defined kind of sequence, they made it inapplicable to the real world, to empirical series. And in defining probability as relative frequency, they removed all relevance to evidence or support, and Bernoulli’s Theorem became a tautology: The long-run relative frequency of an event approaches its long-run relative frequency. But the frequency theory, because of its empiricist ambitions, became the received theory among philosophers of science, and a design criterion for the next theory of statistical inference.

This chapter explores how Fisher, and then Neyman and Pearson, tried to build a theory of statistical inference from the frequency definition of probability. Fisher, despite his rejection of Laplacean inverse probability, remained with the epistemic tradition, and the fundamental tension in his theory was never resolved. Neyman and Pearson developed a more consistent theory, but Neyman’s commitment to the frequency theory led him inexorably to a theory of inductive behavior, to a theory of statistical decision-making. This approach found paradigmatic application to problems of quality control in manufacturing but had little relevance for basic research in psychology.

ObjectivesTo test effects of the Community of Voices choir intervention on the health, well-being, and health care costs of racial/ethnically diverse older adults.MethodTwelve Administration-on-Aging-supported senior centers were cluster randomized into two groups: the intervention group started the choir immediately and a wait-list control group began the choir 6 months later. The choir program was designed for community-dwelling adults aged 60 years and older. The multimodal intervention comprises activities that engage participants cognitively, physically, and socially. Outcome measures assessed these three domains as well as health care utilization and costs. The intention-to-treat comparison was at 6 months.ResultsThe sample (N = 390) had a mean age of 71.3 years (SD = 7.2); 65% were nonwhite. Six-month retention was 92%. Compared to controls, intervention group members experienced significantly greater improvements in loneliness (p = .02; standardized effect size [ES = 0.34] and interest in life (p = .008, ES = 0.39). No significant group differences were observed for cognitive or physical outcomes or for health care costs.DiscussionFindings support adoption of community choirs for reducing loneliness and increasing interest in life among diverse older adults. Further efforts need to examine the mechanisms by which engagement in choirs improves aspects of well-being and reduces health disparities among older adults, including potential longer-term effects.ClinicalTrials.gov RegistrationNCT01869179 registered January 9, 2013.

Author(s): Mason, Ashley E; Hecht, Frederick M; Daubenmier, Jennifer J; Sbarra, David A; Lin, Jue; Moran, Patricia J; Schleicher, Samantha G; Acree, Michael; Prather, Aric A; Epel, Elissa S | Abstract: OBJECTIVE:The aim of the study was to determine, within a weight loss clinical trial for obesity, the impact of intervention arm, weight change, and weight loss maintenance on telomere length (TL). METHODS:Adults (N = 194) with a body mass index between 30 and 45 were randomized to a 5.5-month weight loss program with (n = 100) or without (n = 94) mindfulness training and identical diet-exercise guidelines. We assessed TL at baseline and 3-, 6-, and 12-month postbaseline in immune cell populations (primarily in peripheral blood mononuclear cells [PBMCs], but also in granulocytes and T and B lymphocytes). We defined weight loss maintenance as having lost at least 5% or 10% of body weight (tested in separate models) from preintervention to postintervention, and having maintained this loss at 12 months. We predicted that greater weight loss and weight loss maintenance would be associated with TL lengthening. RESULTS:Neither weight loss intervention significantly predicted TL change nor did amount of weight change, at any time point. Across all participants, weight loss maintenance of at least 10% was associated with longer PBMC TL (b = 239.08, 95% CI = 0.92 to 477.25, p = .049), CD8+ TL (b = 417.26, 95% CI = 58.95 to 775.57, p = .023), and longer granulocyte TL (b = 191.56, 95% CI = -4.23 to 387.35, p = .055) at 12 months after accounting for baseline TL. Weight loss maintenance of 5% or more was associated with longer PBMC TL (b = 163.32, 95% CI = 4.00 to 320.62, p = .045) at 12 months after accounting for baseline TL. These tests should be interpreted in light of corrections for multiple tests. CONCLUSIONS:Among individuals with obesity, losing and maintaining a weight loss of 10% or more may lead to TL lengthening, which may portend improved immune and metabolic function. TL lengthening in this study is of unknown duration beyond 12 months and requires further study. TRIAL REGISTRATION:Clinicaltrials.govidentifierNCT00960414; Open Science Framework (OSF) preregistration: https://osf.io/t3r2g/.

OBJECTIVE: Mindfulness-based interventions have been found to reduce psychological and physiological stress reactivity. In obesity, however, stress reactivity is complex, with studies showing both exaggerated and blunted physiological responses to stressors. A nuanced view of stress reactivity is the “challenge and threat” framework, which defines adaptive and maladaptive patterns of psychophysiological stress reactivity. We hypothesized that mindfulness training would facilitate increased challenge-related appraisals, emotions, and cardiovascular reactivity, including sympathetic nervous system activation paired with increased cardiac output (CO) and reduced total peripheral resistance (TPR) compared to a control group, which would exhibit an increased threat pattern of psychophysiological reactivity to repeated stressors. METHODS: Adults (N=194) with obesity were randomized to a 5.5-month mindfulness-based weight loss intervention or an active control condition with identical diet-exercise guidelines. Participants were assessed at baseline and 4.5 months later using the Trier Social Stress Task. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during the speech and verbal arithmetic tasks to assess pre-ejection period (PEP), CO, and TPR reactivity. RESULTS: Mindfulness participants showed significantly greater maintenance of challenge-related emotions and cardiovascular reactivity patterns (higher CO and lower TPR) from pre to post-intervention compared to control participants, but groups did not differ in PEP. Findings were independent of changes in body mass index. CONCLUSIONS: Mindfulness training may increase the ability to maintain a positive outlook and mount adaptive cardiovascular responses to repeated stressors among persons with obesity though findings need to be replicated in other populations and using other forms of mindfulness interventions.

While negative emotions are associated with risk behaviors and risk avoidance among people with HIV, emerging evidence indicates that negative self-conscious emotions, those evoked by self-reflection or self-evaluation (e.g., shame, guilt, and embarrassment), may differentially influence health-risk behaviors by producing avoidance or, conversely, pro-social behaviors. Positive emotions are associated with beneficial health behaviors, and may account for inconsistent findings related to negative self-conscious emotions. Using multinomial logistic regression, we tested whether positive emotion moderated the relationships between negative emotion and negative self-conscious emotions and level of condomless sex risk: (1) seroconcordant; (2) serodiscordant with undetectable viral load; and (3) serodiscordant with detectable viral load [potentially amplified transmission (PAT)] among people recently diagnosed with HIV (n = 276). While positive emotion did not moderate the relationship between negative emotion and condomless sex, it did moderate the relationship between negative self-conscious emotion and PAT (AOR = 0.60; 95% CI 0.41, 0.87); high negative self-conscious and high positive emotion were associated with lower PAT risk. Acknowledgment of both positive and negative self-conscious emotion may reduce transmission risk behavior among people with HIV.

Objectives: To report intention-to-treat results of a pragmatic, cluster-randomized trial to examine the effect of Community of Voices, a multi-modal community choir intervention, on the health and well-being of racial/ethnically and socioeconomically diverse older adults. Method: Twelve Administration-on-Aging-supported senior centers were randomized to receive the choir intervention immediately or after a six-month delay. We recruited community-dwelling adults aged 60 and over. The choir intervention was culturally tailored around three engagement components (cognitive, physical, and psychosocial) and delivered at senior centers by community-based music professionals. The main randomized comparison was at 6 months (after 23 choir sessions). Results: The sample (N=390) had a mean age of 71.3 (SD=7.2); 65% were from non-white racial/ethnic backgrounds. Study retention was 92%. Intention-to-treat analyses found a significant group-by-time interaction effect for two of six psychosocial outcomes: participants in the choir intervention experienced significant improvements in loneliness and interest in life compared to the wait-list controls. No significant group differences were observed for cognitive or physical outcomes. Discussion: The finding that singing in a choir can reduce loneliness and increase interest in life in diverse older adults are important because of the relatively low-cost and cultural salience of the intervention. This supports further efforts to examine how engagement in the arts may improve health and well-being and reduce health disparities in diverse older adults.

Interoception, the process by which the nervous system senses, interprets, and integrates signals originating from within the body, has become major research topic for mental health and in particular for mind-body interventions. Interoceptive awareness here is defined as the conscious level of interoception with its multiple dimensions potentially accessible to self-report. The Multidimensional Assessment of Interoceptive Awareness (MAIA) is an 8-scale state-trait questionnaire with 32 items to measure multiple dimensions of interoception by self-report and was published in November 2012. Its numerous applications in English and other languages revealed low internal consistency reliability for two of its scales. This study’s objective was to improve these scales and the psychometrics of the MAIA by adding three new items to each of the two scales and evaluate these in a new sample. Data were collected within a larger project that took place as part of the Live Science residency programme at the Science Museum London, UK, where visitors to the museum (N = 1,090) completed the MAIA and the six additional items. Based on exploratory factor analysis in one-half of the adult participants and Cronbach alphas, we discarded one and included five of the six additional items into a Version 2 of the MAIA and conducted confirmatory factor analysis in the other half of the participants. The 8-factor model of the resulting 37-item MAIA-2 was confirmed with appropriate fit indices (RMSEA = 0.055 [95% CI 0.052–0.058]; SRMR = 0.064) and improved internal consistency reliability. The MAIA-2 is public domain and available (www.osher.ucsf.edu/maia) for interoception research and the evaluation of clinical mind-body interventions.

Objective To describe the recruitment and baseline results of the Community of Voices study that aims to examine the effect of a community choir intervention on the health and well-being of older adults from diverse racial/ethnic and socioeconomic backgrounds. Method Using community-based participatory research methods, we recruited adults age 60 and over from 12 Administration on Aging–supported senior centers in San Francisco into a 2-arm cluster-randomized controlled trial of the community choir intervention. Multiple outreach methods were used. We tracked outreach, screening, and recruitment metrics and collected demographics and baseline outcomes via community-based, interviewer-administered surveys and performance measures of cognition, physical function, and psychosocial variables. Results The study contacted 819 individuals, screened 636, and enrolled 390 diverse older adults over a 42-month, phased recruitment period. The mean age was 71.2 (SD = 7.3), and the majority were women. Two-thirds of the sample are non-white, and 20% of participants reported having financial hardship. Discussion Outreach and recruitment methods used in the Community of Voices trial facilitated enrollment of a large proportion of minority and lower-SES older adults in the final sample. Similar recruitment approaches could serve as a model for recruiting diverse racial/ethnic and socioeconomic older adults into research.

A diversity of scales capture facets of reward-related eating (RRE). These scales assess food cravings, uncontrolled eating, addictive behavior, restrained eating, binge eating, and other eating behaviors. However, these scales differ in terms of the severity of RRE they capture. We sought to incorporate the items from existing scales to broaden the 9-item Reward-based Eating Drive scale (RED-9; Epel et al., 2014), which assesses three dimensions of RRE (lack of satiety, preoccupation with food, and lack of control over eating), in order to more comprehensively assess the entire spectrum of RRE. In a series of 4 studies, we used Item Response Theory models to consider candidate items to broaden the RED-9. Studies 1 and 2 evaluated the abilities of additional items from existing scales to increase the RED-9's coverage across the spectrum of RRE. Study 3 evaluated candidate items identified in Studies 1 and 2 in a new sample to assess the extent to which they accounted for more variance in areas less well-covered by the RED-9. Study 4 tested the ability of the RED-13 to provide consistent coverage across the range of the RRE spectrum. The resultant RED-13 accounted for greater variability than the RED-9 by reducing gaps in coverage of RRE in middle-to-low ranges. Like the RED-9, the RED-13 was positively correlated with BMI. The RED-13 was also positively related to a diagnosis of type 2 diabetes as well as cravings for sweet and savory foods. In summary, the RED-13 is a brief self-report measure that broadly captures the spectrum of RRE and may be a useful tool for identifying individuals at risk for overweight or obesity.

Objective We conducted a randomized controlled trial to determine whether IRISS (Intervention for those Recently Informed of their Seropositive Status), a positive affect skills intervention, improved positive emotion, psychological health, physical health, and health behaviors in people newly diagnosed with HIV. Method One-hundred and fifty-nine participants who had received an HIV diagnosis in the past 3 months were randomized to a 5-session, in-person, individually delivered positive affect skills intervention or an attention-matched control condition. Results For the primary outcome of past-day positive affect, the group difference in change from baseline over time did not reach statistical significance (p = .12, d = .30). Planned secondary analyses within assessment point showed that the intervention led to higher levels of past-day positive affect at 5, 10, and 15 months postdiagnosis compared with an attention control. For antidepressant use, the between group difference in change from baseline was statistically significant (p = .006, d = -.78 baseline to 15 months) and the difference in change over time for intrusive and avoidant thoughts related to HIV was also statistically significant (p = .048, d = .29). Contrary to findings for most health behavior interventions in which effects wane over the follow up period, effect sizes in IRISS seemed to increase over time for most outcomes. Conclusions This comparatively brief positive affect skills intervention achieved modest improvements in psychological health, and may have the potential to support adjustment to a new HIV diagnosis. (PsycINFO Database Record

© Copyright 2017, Mary Ann Liebert, Inc. 2017. Background and Objective: Sleep disturbance is a common problem among adults with obesity. Mindfulness interventions have been shown to improve sleep quality in various populations but have not been investigated in adults with obesity. The aim of this study was to compare the effects of a mindfulness-based weight-loss intervention with an active control on self-reported sleep quality among adults with obesity. Method: This study was a secondary analysis of a randomized controlled trial and included 194 adults with a body mass index in the range 30-45 kg/m2. The treatment intervention included mindfulness-based eating and stress-management practices, and the active control intervention included training in progressive muscle relaxation (PMR). Both groups received identical diet and exercise guidelines in 17 group sessions conducted over 5.5 months that were matched for time, attention, and social support. The primary outcome of this analysis was between-group change in self-reported sleep quality, which was assessed using the Pittsburgh Sleep Quality Index (PSQI) global score at baseline and at 6, 12, and 18 months. Results: Between-group differences in mean PSQI change scores in the mindfulness group (n = 100) compared to the control group (n = 94) were -0.27 (-0.68, 1.22; p = 0.58) at 6 months, -0.57 (-0.35, 1.50; p = 0.22) at 12 months, and -0.50 (-0.53, 1.53; p = 0.34) at 18 months, all in the direction of more sleep improvement in the mindfulness group but none reaching statistical significance. In the mindfulness group, average weekly minutes of meditation practice time was associated with improved sleep quality from baseline to 6 months. Conclusions: No statistically significant evidence was found that a weight-loss program that incorporates mindfulness improves self-reported sleep quality compared to a control diet/exercise intervention that included PMR. Within the mindfulness group, average weekly minutes of mindfulness practice was associated with improved sleep quality.

Background: The novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in adolescent depression and framed within the National Institute of Mental Health Research Domain Criteria. TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills, and value-based committed action. Methods: We performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing depression and anxiety levels and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six adolescents (14–18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1), and 3 months after the end of TARA (T2). Results: Significant improvement was seen in depression symptoms (Reynolds Adolescent Depression Scale Second Edition) between T0–T1 (t-value = −3.56, p = 0.002, CI = −6.64, −1.77) and T0–T2 (t-value = −4.17, p < 0.001, CI = −11.20, −3.75) and anxiety symptoms (Multidimensional Anxiety Scale for Children) between T0–T1 (t-value = −2.26, p = 0.033, CI = −4.61, −0.21) and T0–T2 (t-value = −3.06, p = 0.006, 95% confidence interval = −9.02, −1.73). Significant improvements in psychological flexibility, sleep, and mindfulness skills were also found between T0 and T2. Limitations: The sample size was small without a control condition. The pilot design did not allow for testing the hypothesized brain changes and effect of TARA on relevant systemic biomarkers. Conclusion: TARA is feasible in a sample of clinically depressed and/or anxious adolescents and preliminary efficacy was demonstrated by reduced depression and anxiety symptoms. The specific symptom and behavioral outcomes corresponded well with the hypothesized mechanisms of change.

Many individuals with obesity report over eating despite intentions to maintain or lose weight. Two barriers to long-term weight loss are reward-driven eating, which is characterized by a lack of control over eating, a preoccupation with food, and a lack of satiety; and psychological stress. Mindfulness training may address these barriers by promoting awareness of hunger and satiety cues, self-regulatory control, and stress reduction. We examined these two barriers as potential mediators of weight loss in the Supporting Health by Integrating Nutrition and Exercise (SHINE) randomized controlled trial, which compared the effects of a 5.5-month diet and exercise intervention with or without mindfulness training on weight loss among adults with obesity. Intention-to-treat multiple mediation models tested whether post-intervention reward-driven eating and psychological stress mediated the impact of intervention arm on weight loss at 12- and 18-months post-baseline among 194 adults with obesity (BMI: 30-45). Mindfulness (relative to control) participants had significant reductions in reward-driven eating at 6 months (post-intervention), which, in turn, predicted weight loss at 12 months. Post-intervention reward-driven eating mediated 47.1% of the total intervention arm effect on weight loss at 12 months [β=-0.06, SE(β)=0.03, p=.030, 95% CI (-0.12,-0.01)]. This mediated effect was reduced when predicting weight loss at 18 months (p=.396), accounting for 23.0% of the total intervention effect, despite similar weight loss at 12 months. Psychological stress did not mediate the effect of intervention arm on weight loss at 12 or 18 months. In conclusion, reducing reward-driven eating, which can be achieved using a diet and exercise intervention that includes mindfulness training, may promote weight loss (clinicaltrials.gov registration: NCT00960414).

© 2015, Springer Science+Business Media New York. We evaluated changes in mindful eating as a potential mechanism underlying the effects of a mindfulness-based intervention for weight loss on eating of sweet foods and fasting glucose levels. We randomized 194 obese individuals (M age = 47.0 ± 12.7 years; BMI = 35.5 ± 3.6; 78 % women) to a 5.5-month diet-exercise program with or without mindfulness training. The mindfulness group, relative to the active control group, evidenced increases in mindful eating and maintenance of fasting glucose from baseline to 12-month assessment. Increases in mindful eating were associated with decreased eating of sweets and fasting glucose levels among mindfulness group participants, but this association was not statistically significant among active control group participants. Twelve-month increases in mindful eating partially mediated the effect of intervention arm on changes in fasting glucose levels from baseline to 12-month assessment. Increases in mindful eating may contribute to the effects of mindfulness-based weight loss interventions on eating of sweets and fasting glucose levels.

Many debilitating symptoms arise from cancer and its treatment that are often unrelieved by established methods. Pranayama, a series of yogic breathing techniques, may improve cancer-related symptoms and quality of life, but it has not been studied for this purpose.A pilot study was performed to evaluate feasibility and to test the effects of pranayama on cancer-associated symptoms and quality of life.This was a randomized controlled clinical trial comparing pranayama to usual care.The study was conducted at a university medical center.Patients receiving cancer chemotherapy were randomized to receive pranayama immediately or after a waiting period (control group).The pranayama intervention consisted of four breathing techniques taught in weekly classes and practiced at home. The treatment group received pranayama during two consecutive cycles of chemotherapy. The control group received usual care during their first cycle, and received pranayama during their second cycle of chemotherapy.Feasibility, cancer-associated symptoms (fatigue, sleep disturbance, anxiety, depression, stress), and quality of life were the outcomes.Class attendance was nearly 100% in both groups. Sixteen (16) participants were included in the final intent-to-treat analyses. The repeated-measures analyses demonstrated that any increase in pranayama dose, with dose measured in the number of hours practiced in class or at home, resulted in improved symptom and quality-of-life scores. Several of these associations--sleep disturbance (p=0.04), anxiety (p=0.04), and mental quality of life (p=0.05)--reached or approached statistical significance.Yoga breathing was a feasible intervention among patients with cancer receiving chemotherapy. Pranayama may improve sleep disturbance, anxiety, and mental quality of life. A dose-response relationship was found between pranayama use and improvements in chemotherapy-associated symptoms and quality of life. These findings need to be confirmed in a larger study.

Disclosing HIV status to friends, family, and sex partners is often stressful. However, HIV disclosure has been associated with improved physical health, psychological well-being, and improved health behaviors. The aim of this study was to address some of the gaps in the literature regarding the disclosure process by conducting a mixed-methods study of disclosure in people newly diagnosed with HIV and the relationship of disclosure to stigma and social support. The CHAI (Coping, HIV, and Affect Interview) Study was a longitudinal cohort study that followed individuals who were newly diagnosed with HIV. The study took place from October 2004 to June 2008 in the San Francisco Bay Area. This sample includes data from 50 participants who were interviewed 1, 3, and 9 months following diagnosis with HIV. We identified four main approaches to HIV disclosure that revealed distinct differences in how participants appraised disclosure, whether disclosure was experienced as stressful, and whether disclosure or nondisclosure functioned as a way of coping with an HIV diagnosis. Implications of these findings for disclosure counseling are discussed.

Stress has been shown to deplete the self-regulation resources hypothesized to facilitate effective role functioning. However, recent research suggests that positive affect may help to replenish these vital self-regulation resources. Based on revised Stress and Coping theory and the Broaden-and-Build theory of positive emotion, three studies provide evidence of the potential adaptive function of positive affect in the performance of roles for participants experiencing stress. Participants were students (Study 1), caregivers of ill children (Study 2), and individuals recently diagnosed with HIV (Study 3). In cross sectional analyses, using role functioning as an indicator of self-regulation performance, we found that positive affect was significantly correlated with better self regulation performance, independent of the effects of negative affect. The effects were not as strong longitudinally, however, and there was little evidence of a reciprocal association between increases in positive affect and improvements in role functioning over time. The results provide some modest support for hypotheses stemming from the Broaden and Build model of positive emotion and revised Stress and Coping theory, both of which argue for unique adaptive functions of positive affect under stressful conditions.

Background. Pediatric hematopoietic cell transplant (HCT) is a lifesaving treatment that often results in physical and psychological discomfort. An acupressure-massage intervention may improve symptom management in this setting.Methods. This randomized controlled pilot trial compared a combined massage-acupressure intervention to usual care. Children were offered three practitioner-provided sessions per week throughout hospitalization. Parents were trained to provide additional acupressure as needed. Symptoms were assessed using nurses' reports and two questionnaires, the behavioral affective and somatic experiences scale and the Peds quality of life cancer module.Results. We enrolled 23 children, ages 5 to 18. Children receiving the intervention reported fewer days of mucositis (Hedges' g effect sizeES=0.63), lower overall symptom burden (ES=0.26), feeling less tired and run-down (ES=0.86), having fewer moderate/severe symptoms of pain, nausea, and fatigue (ES=0.62), and less pain (ES=0.42). The intervention group showed trends toward increasing contentness/serenity (ES=+0.50) and decreasing depression (ES=−0.45), but not decreased anxiety (ES=+0.42). Differences were not statistically significant.Discussion. Feasibility of studying massage-acupressure was established in children undergoing HCT. Larger studies are needed to test the efficacy of such interventions in reducing HCT-associated symptoms in children.

STUDY DESIGN A prospective cohort study. OBJECTIVE To establish outcome measures for recovery and chronic pain for studies with patients who present with recent-onset acute low back pain (LBP) in primary care. SUMMARY OF BACKGROUND DATA Among back pain researchers, no consensus exists about outcome definitions or how to identify primary-care patients as not-recovered from an episode of LBP. Cut points for outcome scales have mostly been arbitrarily chosen. Theoretical models for establishing minimal important change values in studies of patients with LBP have been proposed and need to be applied to real data. METHODS A sample of 521 patients who presented with acute LBP (

The narrative responses of 32 people with AIDS or cancer with survival prognoses of 6 months to a year to monthly interview questions about their daily lives were analysed with a team-based qualitative methodology. Two groups emerged: (a) a Maintained Lifeworld Group characterised by one or more of the following: continued engagement with family, friends, and community; the ability to relinquish untenable goals and substitute new, realistic ones; engagement in spirituality and a spiritual practice; and, (b) a Lifeworld Interrupted Group characterised by one or more of the following: relocation just before or during the study, cognitive impairment, commitment to untenable goals, ongoing substance abuse. Understanding how people with a terminal illness can maintain a lifeworld and experience well-being while also managing the physical challenges of their illness could help inform the support offered by professional and family caregivers to improve care recipients' quality of life.

Thin-film Bi2Te3- and Sb2Te3-based superlattice (SL) thermoelectric (TE) devices are an enabling technology for high-power and low-temperature applications, which include low-noise amplifier cooling, electronics hot-spot cooling, radio frequency (RF) amplifier thermal management, and direct sensor cooling. Bulk TE devices, which can pump heat loads on the order of 10 W/cm2, are not suitable in these applications due to their large size and low heat pumping capacity. Recently, we have demonstrated an external maximum temperature difference, ΔTmax, as high as 58 K in an SL thin-film p–n couple. This state-of-the-art couple exhibited a cold-side minimum temperature, Tcmin, of −30.9°C. We regularly attain ΔTmax values in excess of 53 K, in spite of the many significant electrical and thermal parasitics that are unique to thin-film devices. These measurements do not use any complex thermal management at the heat sink to remove the heat flux from the TE device’s hot side. We describe here multistage SL cooling technologies currently being developed at RTI that can provide useful microcooling cold-side temperatures of 200 K. This effort includes a three-stage module employing independently powered stages which produced a ΔTmax of 101.6 K with a Tcmin of −75°C, as well as a novel two-wire three-stage SL cascade which demonstrated a Tcmin of −46°C and a ΔTmax of nearly 74 K. These RTI modules are only 2.5 mm thick, significantly thinner than a similar commercial three-stage module (5.3 mm thick) that produces a ΔTmax of 96 K. In addition, TE coolers fabricated from these thin-film SL materials perform significantly better than the extrapolated performance of similar thickness bulk alloy materials.

We examined the use of complementary and alternative medicine (CAM) at 3 US pediatric medical centers, comparing a group of children with inflammatory bowel disease (IBD) with children presenting with chronic constipation.Surveys were administered by postal mail and at pediatric IBD centers in San Francisco, Houston, and Atlanta from 2001 to 2003. A comparison group consisting of pediatric patients with chronic constipation also was surveyed. Data were analyzed by t tests and by exact tests of contingency tables.In all, 236 surveys were collected from the IBD group; 126 surveys were collected from the chronic constipation comparison group. CAM therapies were used by 50% in the IBD group and 23% in the chronic constipation group. The overall regional breakdown of CAM use in IBD revealed no differences, although the types of CAM therapy used varied by site. The most commonly used CAM therapies in the IBD group were spiritual interventions (25%) and nutritional supplements (25%). Positive predictors for CAM use in IBD include the patient's self-reported overall health, an increase in the number of side effects associated with allopathic medications, white ethnicity, and parental education beyond high school.This is the first US study to characterize CAM use in pediatric patients with IBD with another chronic gastrointestinal disorder. CAM use was twice as common with the IBD group compared with the chronic constipation group. Regional variations exist with the types of CAM therapy used. Practitioners should know that half of their pediatric patients with IBD may be using CAM in conjunction with or as an alternative to other treatments and that certain predictors can help identify those using CAM therapies.

Objectives: To determine whether new-onset clinical depression emerges over time, and whether positive and negative mood levels change among patients with terminal cancer. Methods: In this two-site study, 58 cancer patients seen at least twice were interviewed monthly until death or study termination. Major measures included the Patient Health Questionnaire—9, Holland System of Beliefs Inventory, and Positive and Negative Affect Schedule. Results: At study entry, 7% of patients had major depressive disorder; another 9% had depressive symptoms but no Axis I diagnosis. Twenty-two percent were taking antidepressants. During visits ranging from 2 to 21 per patient, 76% of patients never had a depression diagnosis, 3% were always depressed, and 14% became depressed for the first time, almost exclusively at their final visit before death. Scores on positive mood were equivalent to or higher than scores on negative mood and did not change over time. Cancer site, hospice, spiritual beliefs, income, and caregiver mood were unrelated to depression. Spiritual beliefs were, however, associated with positive mood, hope, and better quality of life. Conclusions: In this exploratory study, terminally ill patients approaching death experienced positive as well as negative mood although a significant minority met criteria for major depression at the last visit before death. The findings suggest that major depression is not an inevitable part of the dying process in patients with terminal cancer. Further, the appropriateness of classifying sadness, loss of interest and thoughts that one would be better off dead in the last days of life as psychopathology should be reconsidered. Copyright © 2008 John Wiley & Sons, Ltd.

Knowledge of effective ways of coping with HIV is critical to help individuals with HIV maintain the best possible psychological and physical well-being. The purpose of the present article is to determine, through meta-analysis, the strength of the evidence regarding 2 questions: (a) Which types of coping are related to psychological and physical well-being among people with HIV? and (b) Do contextual (pre?post introduction of highly active antiretroviral therapies [HAART]; time since diagnosis), measurement (HIV-related event vs. generic prompts for coping measurement), or individual (gender) variables affect the extent to which coping is related to physical and psychological well-being? The authors' analysis demonstrates that Direct Action and Positive Reappraisal were consistently associated with better outcomes in people coping with HIV across affective, health behavior, and physical health categories. In contrast, disengagement forms of coping, such as Behavioral Disengagement and Use of Alcohol or Drugs to Cope, were consistently associated with poorer outcomes. The findings also indicate that in some cases, coping effectiveness was dependent on contextual factors, including time since diagnosis and the advent of HAART.

Objective To determine whether positive affect predicts mortality among people with diabetes and among a comparison group of people with no chronic health conditions. Design Longitudinal cohort study. Main outcome measure Mortality. Results Positive affect was significantly associated with lower risk of all-cause mortality in people with diabetes (N = 715). Enjoyed life was associated with lower risk of mortality over and above the effects of negative affect or other significant predictors of mortality. In a comparison sample without chronic illness (N = 2,673), positive affect was not associated with mortality. However, when the analysis was restricted to those over the age of 65, specific positive affects, in particular hopeful and enjoyed life were significantly associated with lower risk of mortality, again independent of negative affect. Enjoyed life remained significantly predictive of lower risk of mortality in the older sample when other predictors of mortality were statistically controlled. Positive affect was particularly protective among those over the age of 65 who reported higher levels of stress. Conclusion These findings are discussed in light of possible stress-buffering functions of positive affect.

There are currently no commonly used or easily accessible ‘biomarkers’ of hedonic eating. Physiologic responses to acute opioidergic blockade, indexed by cortisol changes and nausea, may represent indirect functional measures of opioid-mediated hedonic eating drive and predict weight loss following a mindfulness-based intervention for stress eating. In the current study, we tested whether cortisol and nausea responses induced by oral ingestion of an opioidergic antagonist (naltrexone) correlated with weight and self-report measures of hedonic eating and predicted changes in these measures following a mindfulness-based weight loss intervention. Obese women (N = 88; age = 46.7 ± 13.2 years; BMI = 35.8 ± 3.8) elected to complete an optional sub-study prior to a 5.5-month weight loss intervention with or without mindfulness training. On two separate days, participants ingested naltrexone and placebo pills, collected saliva samples, and reported nausea levels. Supporting previous findings, naltrexone-induced cortisol increases were associated with greater hedonic eating (greater food addiction symptoms and reward-driven eating) and less mindful eating. Among participants with larger cortisol increases (+1 SD above mean), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b = −0.95, SE(b) = 0.40, 95% CI [−1.74, −0.15], p = .021. Naltrexone-induced nausea was marginally associated with reward-based eating. Among participants who endorsed naltrexone-induced nausea (n = 38), mindfulness participants (relative to control participants) reported greater reductions in food addiction symptoms, b = −1.00, 95% CI [−1.85, −0.77], p = .024, and trended toward reduced reward-based eating, binge eating, and weight, post-intervention. Single assessments of naltrexone-induced cortisol increases and nausea responses may be useful time- and cost-effective biological markers to identify obese individuals with greater opioid-mediated hedonic eating drive who may benefit from weight loss interventions with adjuvant mindfulness training that targets hedonic eating.

Background Providing home care for a child with a chronic illness can be stressful for the family. The purpose of this paper is to examine patterns of caregiving and the associated psychological impact on maternal caregivers of children with sickle cell disease (SCD). Procedure Fourteen maternal caregivers of children with SCD were interviewed as part of a larger study of maternal caregivers of children with chronic illness. Forty-four caregivers of children with HIV and 36 caregivers of healthy children were included as comparison groups. Interviews included questions regarding amount of time spent providing care for the child (technical care, non-technical care, health care management), hospitalization, emergency room visits, illness stigma, and mental health of the caregiver. Results Children with SCD had significantly lower functional status and significantly more hospitalizations in the previous 3 months than children with HIV. Caregivers of children with SCD were more likely to work full-time and had higher incomes than caregivers of children with HIV. The three caregiving groups did not differ significantly on amount of total care, although caregivers of children with SCD and caregivers of children with HIV both reported significantly more time spent in technical care than caregivers of healthy children. Despite lower functional status of the children in the SCD group, when group comparisons on caregiving time variables were adjusted for child's functional status, the differences between groups increased. This appeared to be due to the fact that caregivers in the HIV group spent more time in all caregiving categories except skin, crisis, and other care. In terms of caregiver mental health, caregivers of children with HIV and SCD had significantly higher depressive mood scores than caregivers of healthy children but the groups did not differ on caregiving burden. Conclusions The perceived care burden of caregivers of children with SCD may be related to the unpredictable nature of the crisis care they provide. Additional attention is warranted to developing adequate resources for caregivers of children with SCD to mitigate the stress of unexpected crises. Pediatr Blood Cancer 2007;48:64–71. © 2006 Wiley-Liss, Inc.

To examine the economic and psychologic costs of care provided by maternal caregivers to children with gastrostomy tube (GT) feedings.We conducted a 3-site study of primary maternal caregivers of 101 chronically ill children, with (n = 50) and without (n = 51) enteral nutrition support by GT to determine the time spent providing technical care, nontechnical care, and health care management and to assess depressive mood and quality of life. Associated costs were determined.Caregivers spent 339.7 +/- 34.1 (SEM) min/d to provide all care. Children with a GT required more than twice as much care time as children without a GT: 484.5 +/- 54.6 versus 197.8 +/- 30.6 min/d ( P.0001). The mean annual total value of home care by the primary caregiver for a child with a GT was 37,232 dollars, compared with 15,004 dollars for the child without a GT. Caregivers of children with GT were no more depressed or less satisfied with their lives than caregivers of children without GT.Use of a GT for enteral nutrition support is associated with significant increased care time by the primary caregiver but not at additional psychologic cost compared with caring for chronically ill children.

The purpose of the current study was to document the course and 1-month post-bereavement predictors of both positive and negative psychological states in bereaved gay male caregivers for 3 years following the death of their partners. The results show that although the patterns of post-bereavement depressive mood and positive psychological states were similar, some of their predictors differed. Given that the processes that produce positive psychological states are not the same as those that produce negative states, our findings support the inclusion of both positive and negative psychological states in studies of post-bereavement adjustment.

The reformulated learned helplessness (RLH) diathesis–stress model of depression (L. Y. Abramson, M. E. P. Seligman, & J. D. Teasdale, 1978) was tested using the explanatory style scores of 30 gay male caregivers. Scores were derived from interviews immediately following AIDS-related bereavement. Concurrently, questionnaire measures of depressive symptoms (CES-D) and stress (Daily Hassles Scale) were taken along with repeated measures of depressive symptoms at 3, 6, 9, and 12 months following bereavement. As predicted by RLH, the interaction between Explanatory Style and Stress scores predicted subsequent depressive symptoms, with initial stress and initial depressive symptoms assuming a more powerful role early in the recovery process. Implications for treatment and future research are discussed.

Why are some individuals more vulnerable to persistent weight gain and obesity than are others? Some obese individuals report factors that drive overeating, including lack of control, lack of satiation, and preoccupation with food, which may stem from reward-related neural circuitry. These are normative and common symptoms and not the sole focus of any existing measures. Many eating scales capture these common behaviors, but are confounded with aspects of dysregulated eating such as binge eating or emotional overeating. Across five studies, we developed items that capture this rewardbased eating drive (RED). Study 1 developed the items in lean to obese individuals (n = 327) and examined changes in weight over eight years. In Study 2, the scale was further developed and expert raters evaluated the set of items. Study 3 tested psychometric properties of the final 9 items in 400 participants. Study 4 examined psychometric properties and race invariance (n = 80 women). Study 5 examined psychometric properties and age/gender invariance (n = 381). Results showed that RED scores correlated with BMI and predicted earlier onset of obesity, greater weight fluctuations, and greater overall weight gain over eight years. Expert ratings of RED scale items indicated that the items reflected characteristics of reward-based eating. The RED scale evidenced high internal consistency and invariance across demographic factors. The RED scale, designed to tap vulnerability to reward-based eating behavior, appears to be a useful brief tool for identifying those at higher risk of weight gain over time. Given the heterogeneity of obesity, unique brief profiling of the reward-based aspect of obesity using a self-report instrument such as the RED scale may be critical for customizing effective treatments in the general population. © 2014 Epel et al.

Chronic stress has deleterious effects on immune function, which can lead to adverse health outcomes. However, studies investigating the impact of stress reduction interventions on immunity in clinical research have yielded divergent results, potentially stemming from differences in study design and genetic heterogeneity, among other clinical research challenges. To test the hypothesis that reducing glucocorticoid levels enhances certain immune functions, we administered influenza vaccine once (prime) or twice (boost) to mice housed in either standard control caging or environmental enrichment (EE) caging. We have shown that this approach reduces mouse corticosterone production. Compared with controls, EE mice had significantly lower levels of fecal corticosterone metabolites (FCMs) and increased splenic B and T lymphocyte numbers. Corticosterone levels were negatively associated with the numbers of CD19(+) (r(2) = 0.43, p = 0.0017), CD4(+) (r(2) = 0.28, p = 0.0154) and CD8(+) cells (r(2) = 0.20, p = 0.0503). Vaccinated mice showed nonsignificant differences in immunoglobulin G (IgG) titer between caging groups, although EE mice tended to exhibit larger increases in titer from prime to boost than controls; the interaction between the caging group (control versus EE) and vaccine group (prime versus boost) showed a strong statistical trend (cage-group*vaccine-group, F = 4.27, p = 0.0555), suggesting that there may be distinct effects of EE caging on primary versus secondary IgG vaccine responses. Vaccine-stimulated splenocytes from boosted EE mice had a significantly greater frequency of interleukin 5 (IL-5)-secreting cells than boosted controls (mean difference 7.7, IL-5 spot-forming units/10(6) splenocytes, 95% confidence interval 0.24-135.1, p = 0.0493) and showed a greater increase in the frequency of IL-5-secreting cells from prime to boost. Our results suggest that corticosterone reduction via EE caging was associated with enhanced secondary vaccine responses, but had little effect on primary responses in mice. These findings help identify differences in primary and secondary vaccine responses in relationship to stress mediators that may be relevant in clinical studies.

Tacit definitions of informal caregiving Aims of the study: This study describes three tacit definitions of informal caregiving and explores the extent to which differences in these tacit definitions explain variation in caregivers’ negative mood over time. Background/Rationale: There is a growing need to understand the sources of stress and gratification for informal caregivers. Tacit definitions of informal caregiving refer to caregivers’ understanding of what caregiving entails. These definitions are tacit because they arise from caregivers’ taken-for-granted understanding rather than formally articulated positions concerning caregiving. Design/Methods: A random sample of 60 men, all of whom were caregiving partners of men with acquired immunodeficiency syndrome (AIDS), was drawn from a larger cohort of 253 participants in the University of California San Francisco (UCSF) Coping Project (1990–1997). The caregivers were assessed bimonthly for 2 years with procedures that included a semi-structured interview focusing on a recent stressful event involving caregiving, and quantitative measures of well-being. Results/Findings: Interpretive phenomenological case studies of the narrative accounts of the 60 caregivers produced three tacit definitions of caregiving – engagement, conflict and distance. These three tacit definitions were distinguished by differences in learning about caregiving, involvement in health care decisions, caregiving activities and reported sources of stress. The three groups differed on measures of dyadic adjustment, depression, anger and anxiety. Conclusions: Better understanding of caregivers’ tacit definitions can facilitate and enhance effective support and interventions for caregivers.

Purpose We sought to determine whether propranolol has adverse effects on cognitive function, depressive symptoms, and sexual function in patients treated for diastolic hypertension. Subjects and methods We performed a placebo-controlled trial among 312 men and women, 22 to 59 years of age, who had untreated diastolic hypertension (90 to 104 mm Hg). Patients were randomly assigned to treatment with propranolol (80 to 400 mg/day) or matching placebo tablets. Thirteen tests of cognitive function were assessed at baseline, 3 months, and 12 months. Five tests measured reaction time to, or accuracy in, interpreting visual stimuli; one test measured the ability to acquire, reproduce, and change a set of arbitrary stimulus-response sets; and seven tests measured memory or learning verbal information. Depressive symptoms and sexual function were assessed by questionnaires at baseline and 12 months. Results There were no significant differences by treatment assignment for 11 of the 13 tests of cognitive function at either 3 or 12 months of follow-up. Compared with placebo, participants treated with propranolol had slightly fewer correct responses at 3 months (33 +/- 3 [mean +/- SD] versus 34 +/- 2, P = 0.02) and slightly more errors of commission at 3 months (4 +/-5 versus 3 +/- 3, P = 0.04) and at 12 months (4 +/- 4 versus 3 +/- 3, P = 0.05). At 12 months, depressive symptoms and sexual function and desire did not differ by treatment assignment. Conclusions Treatment of hypertension with propranolol had limited adverse effects on tests of cognitive function that were of questionable clinical relevance, and there were no documented adverse effects on depressive symptoms or sexual function. Selection of beta-blockers for treatment of hypertension should be based on other factors.

The objectives of the study were to compare different aspects of social support between caregiving partners of men with AIDS and partners of healthy men and to examine the association of social support with positive and negative mood. Data were collected in a longitudinal study of 244 gay male caregivers and 61 comparison gay male noncaregivers. Measures included perceived positive support; social conflict; sought support; amount, types, and sources of received support; relationships with family; and positive and negative mood. Cross-sectional analyses and changes between baseline and 2 years were examined. No significant differences were found between the caregivers and noncaregivers in most aspects of social support. Regression analyses showed (a) caregiver status was associated with positive and negative mood (caregivers reported lower positive mood and higher negative mood) at baseline, but not at 2 years; (b) perceived support was the only variable significantly associated with positive mood at baseline and at 2 years; and (c) social conflict (at both times) and perceived support, amount of received support, and having a family confidant (at one of the time periods) were associated with negative mood. The findings support the importance of distinguishing between perceptual and behavioral aspects of social support and their relation to both positive and negative mood.