Search

Suboptimal weight losses are partially attributable to lapses from a prescribed diet. We developed an app (OnTrack) that uses ecological momentary assessment to measure dietary lapses and relevant lapse triggers and provides personalized intervention using machine learning. Initially, tension between user burden and complete data was resolved by presenting a subset of lapse trigger questions per ecological momentary assessment survey. However, this produced substantial missing data, which could reduce algorithm performance. We examined the effect of more questions per ecological momentary assessment survey on algorithm performance, app utilization, and behavioral outcomes. Participants with overweight/obesity ( n = 121) used a 10-week mobile weight loss program and were randomized to OnTrack-short (i.e. 8 questions/survey) or OnTrack-long (i.e. 17 questions/survey). Additional questions reduced ecological momentary assessment adherence; however, increased data completeness improved algorithm performance. There were no differences in perceived effectiveness, app utilization, or behavioral outcomes. Minimal differences in utilization and perceived effectiveness likely contributed to similar behavioral outcomes across various conditions.

Only two trials have compared acceptance and commitment therapy (ACT) and traditional cognitive behavior therapy (tCBT) in the treatment of social anxiety disorder (SAD), with both finding no significant differences. These trials did not examine effects on observer-rated behavioral outcomes and did not explicitly quantify the dose of exposure therapy within each treatment. In a replication trial, one hundred and two individuals with SAD (per DSM-IV criteria) were randomized to 12 sessions of ACT (n = 49) or tCBT (n = 53) controlling for exposure dose and assessing behavioral outcomes. Assessments were completed at pre- and post-treatment using clinician-rated and self-report measures of social anxiety, quality of life, and overall functioning. Observer-rated behavioral measures of social performance were completed for a subsample of participants. Results indicated that participants across conditions received equivalent doses of exposure. Those who received tCBT evidenced greater improvements in self-reported social anxiety symptoms and overall functioning, which contrasts with prior studies finding no differences between tCBT and ACT in the treatment of social anxiety. Medium effect sizes, while not statistically significant, indicate that ACT participants may have had greater improvements in observer-rated social behavior than tCBT participants. The discrepancy between these symptom and behavioral outcomes, building upon prior literature, calls for more research to assess the differences between tCBT and ACT treatments in behavioral domains.

Objective Mindfulness-informed cognitive behavioral interventions for obesity are promising. However, results on the efficacy of such treatments are inconsistent which in part may be due to their substantially different methods of practice. This study is the first direct comparison of two theoretically distinct mindfulness-based weight loss approaches: increasing awareness of homeostatic/innate physiological cues versus hedonic/externally-driven cues for eating. Methods Overweight adults were randomized to one of three group-based workshops: Mindful Eating (ME; n = 21), Mindful Decision-Making (MD; n = 17), or active standard behavioral control (SC; n = 19). Outcome measures included percent weight change and reduction in caloric intake from baseline to 6 weeks. Results Differences in weight loss and calorie reduction did not differ significantly among groups. However, the difference in weight loss between the MD and ME groups trended towards significance, with medium-large effect sizes. Conclusions Results provide modest preliminary evidence for the utility of mindful decision-making strategies over mindful eating for short-term weight loss and calorie reduction.

College students report several barriers to exercise, highlighting a need for university-based programs that address these challenges. In contrast to in-person interventions, several web-based programs have been developed to enhance program engagement by increasing ease of access and lowering the necessary level of commitment to participate. Unfortunately, web-based programs continue to struggle with engagement and less-than-ideal outcomes. One explanation for this discrepancy is that different intervention modalities may attract students with distinctive activity patterns, motivators, barriers, and program needs. However, no studies have formally evaluated intervention modality preference (e.g., web-based or in-person) among college students. The current study sought to examine the relationship between intervention modality preference and physical activity programming needs. Undergraduate students (n = 157) enrolled in psychology courses at an urban university were asked to complete an online survey regarding current activity patterns and physical activity program preferences. Participants preferring web-based physical activity programs exercised less (p = .05), were less confident in their abilities to exercise (p = .01), were less likely to endorse the maintenance stage of change (p .01) and perceived more barriers to exercising (p .01) than those who preferred in-person programming. Findings suggest that students preferring web-based programming may require programs that enhance self-efficacy by fostering goal-setting and problem-solving skills. A user-centered design approach may enhance the engagement (and therefore effectiveness) of physical activity promotion programs for college students.

The present study examined the effect of a picture-picture evaluative conditioning (EC) procedure on soft drink (soda) outcomes, including negative implicit attitudes, consumption during a taste test, and real-world consumption reported during the week after the intervention. In the EC condition (n = 43), soda images were paired with disgust images and water images were paired with pleasant images, whereas in the control condition (n = 41), the same images were viewed without pairing. The EC condition showed a larger reduction in real-world soda consumption across the week following the intervention. However, individuals in the EC condition did not consume less soda during a taste test immediately following the intervention. EC only significantly increased negative implicit attitudes towards soda among individuals who already had relatively higher baseline negative attitudes. These findings generally favored the potential for EC to impact soda drinking habits, but suggest that a brief EC intervention may not be strong enough to change attitudes towards a well-known brand unless negative attitudes are already present.

Weight regain following bariatric surgery is common and potentially compromises the health benefits initially attained after surgery. Poor compliance to dietary and physical activity prescriptions is believed to be largely responsible for weight regain. Patients may benefit from developing specialized psychological skills necessary to engage in positive health behaviors over the long term. Unfortunately, patients often face challenges to physically returning to the bariatric surgery program for support in developing and maintaining these behaviors. Remotely delivered interventions, in contrast, can be conveniently delivered to the patient and have been found efficacious for a number of health problems, including obesity. To date, they have received little attention with bariatric surgery patients. The study aimed to evaluate a newly developed, remote acceptance-based behavioral intervention for postoperative weight regain. Patients at least 1.5 years out from surgery who experienced postoperative weight regain were recruited to receive the 10-week intervention. Participants were assessed at baseline, mid-treatment, post-treatment, and at 3-month follow-up. Support for the intervention’s feasibility and acceptability was achieved, with 70 % retention among those who started the program and a high mean rating (4.7 out of 5.0) of program satisfaction among study completers. On average, weight regain was reversed with a mean weight loss of 5.1 ± 5.5 % throughout the intervention. This weight loss was maintained at 3-month follow-up. Significant improvements in eating-related and acceptance-based variables also were observed. This pilot study provides initial support for the feasibility, acceptability, and preliminary efficacy of a remotely delivered acceptance-based behavioral intervention for postoperative weight regain.

A clinician who is poised to assist an individual with a particular psychological disorder will ideally have at her disposal clear, unambiguous guidelines pointing to which intervention strategies are most likely to lead to positive outcomes. Ideally, the national and private health care systems paying for care would also be able to make use of treatment guidelines in order to conserve precious resources, to hold clinicians accountable for delivering services with the greatest likelihood of positive impact, and to protect patients. Moreover, given the nonuniform application of efficacious treatments for psychological conditions, the consumer seeking treatment would ideally have access to straightforward recommendations for seeking out the treatments and clinicians most likely to benefit him. Unfortunately, the current state of affairs is radically different from this ideal. In fact, not only do consumers not know how to locate evidence-based psychotherapy, but even those who attempt to receive expert help from their physicians- who are the typical gateway to health services-are unlikely to receive it. For example, two surveys of Canadian family doctors revealed that most are unfamiliar with cognitive- behavioral therapy (Grenier, Chomienne, Gaboury, Ritchie, & Hogg, 2008), and very few would refer a patient with a discrete anxiety disorders to specialty treatment (Talbot, Clark, Yuzda, Charron, & McDonald, 2014).Evidence-Based Treatment RecommendationsWhile some researchers and clinicians are skeptical of or even antagonistic toward scientifically based practice (Lilienfeld, Ritschel, Lynn, Cautin, & Latzman, 2013), a steadily growing body of evidence supports the conclusion that treatments do actually differ in efficacy (Tolin, 2010; Weisz, Weiss, Han, Granger, & Morton, 1995). In 1993, the Society of Clinical Psychology (SCP; which is a division of the American Psychological Association [APA]) established a task force to identify (and promulgate) specific treatments that had empirical support (Chambless et al., 1993). For the first time, the field took the position that it was possible to issue and disseminate formalized treatment recommendations based on available scientific evidence of efficacy. A number of other approaches to guiding treatment selection followed suit in the United States, Canada, and other countries. However, the empirically-based guidance that has been developed to date appears to be having limited pragmatic impact such that individuals seeking treatment are unlikely to receive treatment that is based on the best available scientific evidence (Stewart, Chambless, & Baron, 2012). Below, we pragmatically review a number of major treatment guidance systems that have been developed, with an eye toward the impact each has had. (To keep the article focused, we deliberately ignore other important pieces of empirically based practice, such as assessment.) Following this review, we discuss some ideas for greatly increasing the impact of empirically based treatment guidance systems.Approaches for Guiding Treatment Decisions: Description and ConcernsEmpirically Supported Treatment ListsVarious groups have developed lists of empirically supported treatments (ESTs) over the years, the most prominent being the Chambless Task Force which evaluated the level of empirical support for treatments targeting specific psychological disorders or problems (Chambless & Hollon, 1998; Chambless & Ollendick, 2001). The task force formulated two levels of evidential support depending on the rigor and number of studies finding that a particular treatment was efficacious. Treatments were considered "probably efficacious" if the task force was able to identify, in the published literature, at least one "well-designed" study or a "small series" of single-case reports. Treatments were considered "wellestablished" if at least two independently conducted, welldesigned studies or a "large series" of well-designed and carefully controlled single case studies could be identified. …

We describe the development of a novel, Internet-based, self-help intervention for social anxiety disorder (SAD) in adults, and report data on the preliminary efficacy of the program when administered with minimal therapist support delivered via a common videoconferencing platform. Participants (n = 13) completed the intervention, which consists of 8 weekly modules and a brief weekly videoconferenced check-in with a therapist. The intervention program is derived from an acceptance-based CBT program that utilizes traditional behavioral interventions (e.g., exposure) within the context of a model emphasizing mindful awareness and psychological acceptance of distressing subjective experiences. Assessments revealed that participants experienced a significant reduction in SAD symptoms and improvements in psychosocial functioning, and that treatment gains were maintained over a 3-month follow-up period. The effect sizes for the main outcome measures were large to very large (d = 0.90 to 1.47), and comparable to other Internet-based treatment programs as well as in-person trials for SAD (e.g., Feske & Chambless, 1995; Tulbure, 2011). Participants also rated the treatment program as highly acceptable. This pilot study provides preliminary evidence that an Internet-based intervention grounded in basic behavioral and acceptance-based principles is effective for the treatment of SAD, and that videoconferenced therapist support may be useful in enhancing treatment compliance. Implications and future directions are discussed.

Mindfulness has become a fixture of both clinical treatment and popular culture. Much research and theoretical scholarship have operationalized “mindfulness” as clinicians use the term, yet no research has examined popular (i.e., lay) conceptions of mindfulness. Mindfulness trainings and interventions are now widely offered on college campuses. Thus, as a starting point for assessing lay conceptions of the construct, we examined how undergraduate college students at an urban university (N = 361) conceptualize mindfulness. In open-ended responses, participants linked mindfulness to awareness of external objects, internal sensations, or being in the present moment. When rating sentences on how well they represented mindfulness, participants strongly associated mindfulness with controlling emotions. In both the open-ended and sentence stem responses, mindfulness was rarely associated with psychological acceptance, which is notable because of the importance of acceptance in mindfulness-based clinical treatments. Implications and future directions are discussed.

Distress tolerance (DT) refers to an individual’s capacity to cope with aversive internal (e.g., physical, cognitive, emotional) states. A growing body of evidence suggests that there is a relationship between DT and the development and maintenance of problematic behavioral patterns. Despite emerging evidence for such associations, a number of issues remain unresolved. The results of recent studies suggest problems with the convergent validity of the primary measures used to assess DT, despite the fact that these measures are used interchangeably in the DT literature. In order to further examine the relationships among DT assessments, we evaluated intercorrelations among various self-report and behavioral measures of DT in an unselected undergraduate sample (n = 83). Results indicate that two self-report measures of DT were highly correlated with one another, but that neither measure was significantly correlated with the behavioral measures. The relationships among the behavioral measures and between self-report and behavioral measures were weak and non-significant. Correlations between self-report measures only were strong. The findings partially replicate prior research indicating weak correlations between certain, commonly used measures of DT, and raise questions about the current conceptualization of the construct.

Background: Individuals who adhere to dietary guidelines provided during weight loss interventions tend to be more successful with weight control. Any deviation from dietary guidelines can be referred to as a “lapse.” There is a growing body of research showing that lapses are predictable using a variety of physiological, environmental, and psychological indicators. With recent technological advancements, it may be possible to assess these triggers and predict dietary lapses in real time. The current study sought to use machine learning techniques to predict lapses and evaluate the utility of combining both group- and individual-level data to enhance lapse prediction. Methods: The current study trained and tested a machine learning algorithm capable of predicting dietary lapses from a behavioral weight loss program among adults with overweight/obesity (n = 12). Participants were asked to follow a weight control diet for 6 weeks and complete ecological momentary assessment (EMA; repeated brief surveys delivered via smartphone) regarding dietary lapses and relevant triggers. Results: WEKA decision trees were used to predict lapses with an accuracy of 0.72 for the group of participants. However, generalization of the group algorithm to each individual was poor, and as such, group- and individual-level data were combined to improve prediction. The findings suggest that 4 weeks of individual data collection is recommended to attain optimal model performance. Conclusions: The predictive algorithm could be utilized to provide in-the-moment interventions to prevent dietary lapses and therefore enhance weight losses. Furthermore, methods in the current study could be translated to other types of health behavior lapses.

There has recently been a renewed interest in philosophy among some psychologists, particularly those working within the modern behavior analytic framework known as contextual behavioral science. Functional contextualism (FC) has emerged as an alternative to the dominant mechanistic view – generally associated with epistemological realism—within psychology. The most controversial feature of FC has been its so-called “a-ontological” stance, in which it is argued that any statements about even the mere existence of a reality independent of human sensation are meaningless. We argue that FC in fact requires the assumption of the existence of such a “reality,” which we term an “independent, textured substratum,” if it is to serve as an orienting function for psychological science. Moreover, wholesale rejection of any reference to any ontological dimension is itself incommensurate with the analytic goals of FC in that it unnecessarily alienates scientists who might otherwise find value in the sensitivities of FC.