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BACKGROUND: The ecological momentary assessment method may collect more accurate data about a patient's symptoms and functioning during the patient's normal daily life than does a retrospective measurement method such as the standardized Asthma Quality of Life Questionnaire (AQLQ-S), which relies on the patient's recollections of symptoms and functioning. OBJECTIVE: To determine how well the AQLQ-S predicts actual asthma symptoms and functional limitations in patients' daily lives. METHODS: With 91 patients with asthma, we measured quality of life at baseline with the AQLQ-S. Each participant then carried a palm-top computer for 1 week, which signaled the patient 5 times a day to complete a momentary assessment of his or her asthma symptoms, mood, activities, and peak expiratory flow. Once a day, upon awakening, the participants were asked to enter data on their sleep and nocturnal asthma symptoms. RESULTS: The AQLQ-S scores were strongly associated with the momentary assessments of asthma symptoms and patient functioning. The unstandardized slope value indicates, for each 1-unit increase in quality of life, the corresponding change in the outcome variable (in the original units of measurement). Specifically, each 1-unit increase in quality of life was associated with better ambulatory outcomes (assessed on a 7-point scale): fewer coughing and wheezing symptoms (unstandardized slope = -0.44, P < .001); less symptom interference with sleep (unstandardized slope = -0.48, P < .001); less negative affect (unstandardized slope = -0.65, P = .04); and fewer activity restrictions (unstandardized slope = -0.54, P < .001). An increase in quality of life did not significantly predict peak expiratory flow (unstandardized slope = 11.53 L/min, P = .10). CONCLUSIONS: With ecological momentary assessment we found that the AQLQ-S is a valid tool for assessing asthma symptoms and functional limitations. The AQLQ-S scores correctly predicted asthma symptoms, mood, sleep-interference, and activity restrictions in asthma patients' daily lives over a 1-week interval. These data support the AQLQ-S in the clinical management of asthma. [ABSTRACT FROM AUTHOR]

Self-esteem has been demonstrated to predict health and well-being in a number of samples and domains using retrospective reports, but little is known about the effect of self-esteem in daily life. A community sample with asthma (n = 97) or rheumatoid arthritis (n = 31) completed a self-esteem measure and collected Ecological Momentary Assessment (EMA) data 5x/day for one week using a palmtop computer. Low self-esteem predicted more negative affect, less positive affect, greater stress severity, and greater symptom severity in daily life. Naturalistic exploration of mechanisms relating self-esteem to physiological and/or psychological components in illness may clarify causal relationships and inform theoretical models of self-care, well-being, and disease management. [ABSTRACT FROM AUTHOR]

Objective: Some information on the prevalence of adverse life experiences is available for the general population and college students, but the extent, nature, and severity of these events is unclear. Participants: The authors recruited undergraduate college students (N = 6,053) from diverse academic settings (public and private schools) and geographic locations. Methods: They examined the prevalence, nature, severity, and disclosure of adverse events, in addition to reports of posttraumatic stress disorder (PTSD) symptomatology within the sample. Results: Across multiple studies, prevalence rates of adverse events ranged from 55.8% to 84.5%, replicating previous findings in larger samples. In a subset of undergraduate students (n = 97) who the authors interviewed in greater depth, 9% reported symptoms of clinical PTSD and an additional 11% reported subclinical symptoms. Conclusions: Research using college samples for the study of stressful life events is a useful and reasonable strategy. The authors discuss implications for research, as well as screening and referral services at universities. [ABSTRACT FROM AUTHOR]

OBJECTIVES: This study investigates the boundary conditions (feasibility, safety, and efficacy) of an expressive writing intervention for individuals with post-traumatic stress disorder [PTSD]. DESIGN: Randomized trial with baseline and 3-month follow-up measures of PTSD severity and symptoms, mood states, post-traumatic growth, and (post-only) cortisol reactivity to trauma-related stress. METHODS: Volunteers with a verified diagnosis of PTSD (N=25) were randomly assigned to an experimental group (writing about their traumatic experience) or control group (writing about time management). RESULTS: Expressive writing was acceptable to patients with PTSD and appeared safe to utilize. No changes in PTSD diagnosis or symptoms were observed, but significant improvements in mood and post-traumatic growth were observed in the expressive writing group. Finally, expressive writing greatly attenuated neuroendocrine (cortisol) responses to trauma-related memories. CONCLUSIONS: The present study provides insight into several boundary conditions of expressive writing. Writing did not decrease PTSD-related symptom severity. Although patients continue to exhibit the core features of PTSD, their capacity to regulate those responses appears improved following expressive writing. Dysphoric mood decreased after writing and when exposed to traumatic memories, participants' physiological response is reduced and their recovery enhanced. [ABSTRACT FROM AUTHOR]

In the past decade, universities and colleges across the USA have attempted to develop a profile of college student drinkers in order to develop programs and policies for combating high-risk drinking. Most of these studies have relied on the Core Alcohol and Drug Survey in which students self-report drinking and behaviors associated with drinking. While the Core survey has undergone multiple validity checks, few researchers have employed official data to validate items in the survey, particularly self-reported official trouble. The present study employed municipal alcohol-related arrest reports to determine whether the correlates of arrest resembled correlates associated with self-reported official trouble from drinking. Overall, group membership patterns from the self-report item resembled the patterns of alcohol-related arrest. Further tests using internal Core survey criteria revealed additional validity support for the self-reported official trouble item. [ABSTRACT FROM AUTHOR]

Context: Nonpharmacological treatments with little patient cost or risk are useful supplements to pharmacotherapy in the treatment of patients with chronic illness. Research has demonstrated that writing about emotionally traumatic experiences has a surprisingly beneficial effect on symptom reports, well-being, and health care use in healthy individuals.Objective: To determine if writing about stressful life experiences affects disease status in patients with asthma or rheumatoid arthritis using standardized quantitative outcome measures.Design: Randomized controlled trial conducted between October 1996 and December 1997.Setting: Outpatient community residents drawn from private and institutional practice.Patients: Volunteer sample of 112 patients with asthma (n = 61) or rheumatoid arthritis (n = 51) received the intervention; 107 completed the study, 58 in the asthma group and 49 in the rheumatoid arthritis group.Intervention: Patients were assigned to write either about the most stressful event of their lives (n = 71; 39 asthma, 32 rheumatoid arthritis) or about emotionally neutral topics (n = 41; 22 asthma, 19 rheumatoid arthritis) (the control intervention).Main Outcome Measures: Asthma patients were evaluated with spirometry and rheumatoid arthritis patients were clinically examined by a rheumatologist. Assessments were conducted at baseline and at 2 weeks and 2 months and 4 months after writing and were done blind to experimental condition.Results: Of evaluable patients 4 months after treatment, asthma patients in the experimental group showed improvements in lung function (the mean percentage of predicted forced expiratory volume in 1 second [FEV1] improved from 63.9% at baseline to 76.3% at the 4-month follow-up; P<.001), whereas control group patients showed no change. Rheumatoid arthritis patients in the experimental group showed improvements in overall disease activity (a mean reduction in disease severity from 1.65 to 1.19 [28%] on a scale of 0 [asymptomatic] to 4 [very severe] at the 4-month follow-up; P=.001), whereas control group patients did not change. Combining all completing patients, 33 (47.1%) of 70 experimental patients had clinically relevant improvement, whereas 9 (24.3%) of 37 control patients had improvement (P=.001).Conclusion: Patients with mild to moderately severe asthma or rheumatoid arthritis who wrote about stressful life experiences had clinically relevant changes in health status at 4 months compared with those in the control group. These gains were beyond those attributable to the standard medical care that all participants were receiving. It remains unknown whether these health improvements will persist beyond 4 months or whether this exercise will prove effective with other diseases. [ABSTRACT FROM AUTHOR]

Few studies have measured components of stress responses in real time-an essential step in designing just-in-time interventions targeting moments of risk. Using ecological momentary assessment (EMA), we characterised stress response components to everyday stressors, including reactivity (the response following a stressor), recovery (the return towards baseline), and pile-up (the accumulation of stressors) (RRPs) by quantifying the dynamics of response indicators (i.e., subjective stress, negative affect, and perseverative cognition). To determine the utility of these novel measures in capturing and characterising acute moments of the stress response, this study evaluated the proportion of variance in RRPs attributed to (1) between-person, (2) between-days, and (3) within-day (momentary) levels. Healthy adults (n = 123; aged 35-65, 79% women, 91% non-Hispanic White) participated in a 14-day study assessing stress response via EMA 6 times a day. RRPs were constructed from 10,065 EMA reports. Multilevel models with moments nested within days nested within persons were used to partition variance in the RRPs. Reactivity and recovery indicators captured the most variation within-days (i.e., across moments; range 76%-80% and 87%-89%, respectively), with small amounts of variance between-person. For pile-up, variation was mostly observed between-days (range 60%-63%) and between-persons (range 27%-31%). In contrast, raw measures of stress response reflected substantial between-person (range 32%-54%) and within-day (range 34%-53%) variance. These results demonstrated that a person-specific approach to measuring stress response components (i.e., RRPs) can capture the dynamic within-person variation in stress response, as it occurs in real time, making it well-suited for use in novel just-in-time interventions targeting moments of risk., (© 2024 The Author(s). Stress and Health published by John Wiley & Sons Ltd.)

Heightened delay discounting has been linked to adverse smoking cessation outcomes, including among light cigarette users. Few studies have evaluated delay discounting's proposed mechanism, preference reversal (concurrent increases in valuation of/craving for desired objects), and none have done so in naturalistic settings. We examined how person-level delay discounting moderated the within-person association between cigarette valuation and craving among very light daily cigarette users who were financially incentivized to abstain. Forty participants completed a baseline delay-discounting task and intermittent ratings of cigarette valuation and craving during the incentivized abstinence attempt. Subjects earned monetary rewards for abstinence on a descending schedule (e.g., $20 on Days 1 and 2 and $2.50 on Days 9 and 10). Consistent with preference reversals, there was a positive association between cigarette valuation and craving. This relation was moderated by delay discounting (stronger among those with low discounting rates) and by monetary reinforcement amount (stronger on days with low reinforcement). Additionally, subjects were more likely to report stronger cravings on days with high monetary reinforcement, with this effect moderated by delay discounting (stronger among those with low discounting rates). The results suggest that heightened delay discounting may not confer risk for preference reversal among very light daily cigarette users who are attempting abstinence., (© 2024 The Author(s). Journal of the Experimental Analysis of Behavior published by Wiley Periodicals LLC on behalf of Society for the Experimental Analysis of Behavior.)

Background: Emerging evidence suggests a positive association between relevant aspects of one's psychological identity and physical activity engagement, but the current understanding of this relationship is primarily based on scales designed to assess identity as a person who exercises, leaving out essential aspects of physical activities (eg, incidental and occupational physical activity) and sedentary behavior., Objective: The goal of this study is to evaluate the validity of a new physical activity and sedentary behavior (PA/SB) identity scale using 2 independent samples of US adults., Methods: In study 1, participants answered 21 candidate items for the PA/SB identity scale and completed the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Study 2 participants completed the same PA/SB identity items twice over a 1-week interval and completed the IPAQ-SF at the end. We performed factor analyses to evaluate the structure of the PA/SB identity scale, evaluated convergent validity and test-retest reliability (in study 2) of the final scale scores, and examined their discriminant validity using tests for differences in dependent correlations., Results: The final PA/SB identity measure was comprised of 3 scales: physical activity role identity (F1), physical activity belief (F2), and sedentary behavior role identity (F3). The scales had high test-retest reliability (Pearson correlation coefficient: F1, r=0.87; F2, r=0.75; F3, r=0.84; intraclass correlation coefficient [ICC]: F1: ICC=0.85; F2: ICC=0.75; F3: ICC=0.84). F1 and F2 were positively correlated with each other (study 1, r=0.76; study 2, r=0.69), while both were negatively correlated with F3 (Pearson correlation coefficient between F1 and F3: r=-0.58 for study 1 and r=-0.73 for study 2; F2 and F3: r=-0.46 for studies 1 and 2). Data from both studies also demonstrated adequate discriminant validity of the scale developed. Significantly larger correlations with time in vigorous and moderate activities and time walking and sitting assessed by IPAQ-SF with F1, compared with F2, were observed. Significantly larger correlations with time in vigorous and moderate activities with F1, compared with F3, were also observed. Similarly, a larger correlation with time in vigorous activities and a smaller correlation with time walking were observed with F2, compared with F3., Conclusions: This study provided initial empirical evidence from 2 independent studies on the reliability and validity of the PA/SB identity scales for adults., (©Cheng K Fred Wen, Stefan Schneider, Doerte U Junghaenel, Meynard John L Toledo, Pey-Jiuan Lee, Joshua M Smyth, Arthur A Stone. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.10.2024.)

Mechanistically targeted behavioral interventions are a much-needed strategy for improving outcomes in depression, especially for vulnerable populations with comorbidities such as obesity. Such interventions may change behavior and outcome by changing underlying neural circuit function. However, it is unknown how these circuit-level modifications unfold over intervention and how individual differences in early circuit-level modifications may explain the heterogeneity of treatment effects. We addressed this need within a clinical trial of problem-solving therapy for participants with depression symptoms and comorbid obesity, focusing on the cognitive control circuit as a putative neural mechanism of action. Functional magnetic resonance imaging was applied to measure the cognitive control circuit activity at five time points over 24 months. Compared with participants who received usual care, those receiving problem-solving therapy showed that attenuations in cognitive control circuit activity were associated with enhanced problem-solving ability, which suggests that this circuit plays a key role in the mechanisms of problem-solving therapy. Attenuations in circuit activity were also associated with improved depression symptoms. Changes in cognitive control circuit activity at 2 months better predicted changes in problem-solving ability and depression symptoms at 6, 12, and 24 months, with predictive improvements ranging from 17.8 to 104.0%, exceeding baseline demographic and symptom characteristics. Our findings suggest that targeting the circuit mechanism of action could enhance the prediction of treatment outcomes, warranting future model refinement and improvement to pave the way for its clinical application.

High levels of stress during pregnancy can have lasting effects on maternal and offspring health, which disproportionately impacts families facing financial strain, systemic racism, and other forms of social oppression. Developing ways to monitor daily life stress during pregnancy is important for reducing stress-related health disparities. We evaluated the feasibility and acceptability of using mobile health (mHealth) technology (i.e., wearable biosensors, smartphone-based ecological momentary assessment) to measure prenatal stress in daily life. Fifty pregnant women (67% receiving public assistance; 70% Black, 6% Multiracial, 24% White) completed 10 days of ambulatory assessment, in which they answered smartphone-based surveys six times a day and wore a chest-band device (movisens EcgMove4) to monitor their heart rate, heart rate variability, and activity level. Feasibility and acceptability were evaluated using behavioral meta-data and participant feedback. Findings supported the feasibility and acceptability of mHealth methods: Participants answered approximately 75% of the surveys per day and wore the device for approximately 10 hours per day. Perceived burden was low. Notably, participants with higher reported stressors and financial strain reported lower burden associated with the protocol than participants with fewer life stressors, highlighting the feasibility of mHealth technology for monitoring prenatal stress among pregnant populations living with higher levels of contextual stressors. Findings support the use of mHealth technology to measure prenatal stress in real-world, daily life settings, which shows promise for informing scalable, technology-assisted interventions that may help to reduce health disparities by enabling more accessible and comprehensive care during pregnancy., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Cigarette smoking puts individuals with or at risk for developing cardiovascular disease (CVD) in jeopardy of experiencing a major cardiovascular event. Contingency management (CM) for smoking cessation is an intervention wherein financial incentives are provided contingent on biochemically verified smoking abstinence. Conventional CM programs typically require frequent clinic visits for abstinence monitoring, a potential obstacle for patients with medical comorbidities who may face barriers to access. This preliminary study examined the feasibility and comparative efficacy of (a) usual care (UC; advice to quit smoking, self-help materials, quitline referral) versus (b) UC plus home-based CM for smoking cessation (UC + HBCM). HBCM entailed earning monetary-based vouchers contingent on self-reported 24-hr smoking abstinence biochemically verified by a breath carbon monoxide (CO) sample ≤ 6 ppm. Participants were 20 outpatients with a CVD diagnosis or qualifying CVD risk factor randomly assigned 1:1 to the two conditions. Intervention participants received 14 in-home abstinence visits over 6 weeks. Voucher monetary value started at $10 and escalated by $2.50 for each subsequent negative sample (maximum earnings: $367.50). Positive samples earned no vouchers and reset voucher value to $10, but two negative samples following a positive allowed participants to continue earning vouchers at the prereset value. Primary outcome was point-prevalence smoking abstinence at Week 6 assessment. More participants assigned to UC + HBCM than UC were smoking abstinent at that Week 6 assessment (90% vs. 30%), χ ²(1, N = 20) = 7.5, p < .01. These results provide initial evidence that HBCM can effectively promote smoking abstinence in CVD outpatients. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Objective: Test whether frequent protective behavioral strategies (PBS) users report (a) fewer alcohol-related consequences and (b) less risky alcohol intoxication dynamics (measured via transdermal alcohol concentration [TAC] sensor "features") in daily life., Method: Two hundred twenty-two frequently heavy-drinking young adults ( M age = 22.3 years) wore TAC sensors for 6 consecutive days. TAC features peak (maximum TAC), rise rate (speed of TAC increase), and area under the curve (AUC) were derived for each day. Negative alcohol-related consequences were measured in the morning after each self-reported drinking day. Past-year PBS use was measured at baseline., Results: Young adults reporting more frequent baseline PBS use showed (a) fewer alcohol-related consequences and (b) lower intoxication dynamics on average (less AUC, lower peaks, and slower rise rates). Limiting/stopping and manner of drinking PBS showed the same pattern of findings as the total score. Serious harm reduction PBS predicted fewer negative alcohol-related consequences, but not TAC features. Multilevel path models showed that TAC features peak and rise rate partially explained associations between PBS (total, limiting/stopping, and manner of drinking) and consequences. Independent contributions of PBS subscales were small and nonsignificant, suggesting that total PBS use was a more important predictor of risk/protection than the specific types of PBS used., Conclusions: Young adults using more total PBS may experience fewer alcohol-related consequences during real-world drinking episodes in part through less risky intoxication dynamics (TAC features). Future research measuring PBS at the daily level is needed to formally test TAC features as day-level mechanisms of protection from acute alcohol-related consequences. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This study examined the cardiovascular disease (CVD) risk profiles of male law enforcement officers (LEOs) and civilians. CVD risk profiles were based on data collected using traditional objective (e.g., resting BP, cholesterol), novel objective (e.g., ambulatory BP) and self-report measures (e.g., EMA social vigilance). A subset of male LEOs ( n = 30, M age = 41.47, SD = 8.03) and male civilians ( n = 120, M age = 40.73, SD = 13.52) from a larger study were included in analyses. Results indicated LEOs had significantly higher body mass index [BMI], 31.17 kg/m 2 versus 28.87 kg/m 2 , and exhibited significantly higher trait and state social vigilance across multiple measures, whereas perceived stress was higher among civilians. Findings highlight the need for future research examining CVD risk associated with occupational health disparities, including attributes of individuals entering certain professions as well as experiential and environmental demands of the work., Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Loneliness influences how people experience and respond to stressors, which may account for its role as a risk factor for morbidity and mortality. The present study was motivated by emerging evidence that affective responses to minor daily events have long-term implications for health and well-being. Specifically, we evaluated how individual differences in loneliness relate to the frequency of everyday stressors and stressor-related negative emotions. A diverse community sample of 255 adults (age 25-65 years) completed ecological momentary assessments (EMA), during which they reported recent stressors and current negative affect (NA) five times a day for 14 days. Multilevel logistic analyses indicated that there was a quadratic association between loneliness and likelihood of reporting stressors, controlling for demographics, social isolation, depressive symptoms, and context (current activities, current location). Multilevel regression indicated that loneliness was unrelated to the concurrent effect of stressors on NA but significantly larger lagged stressor effects were observed among individuals in the low and high ranges of loneliness. These findings suggest that individuals with high levels of loneliness are more likely to experience everyday stressors and have prolonged emotional responses following stressors., (© 2023 The Authors. Stress and Health published by John Wiley & Sons Ltd.)

Interest in just-in-time adaptive interventions (JITAI) has rapidly increased in recent years. One core challenge for JITAI is the efficient and precise measurement of tailoring variables that are used to inform the timing of momentary intervention delivery. Ecological momentary assessment (EMA) is often used for this purpose, even though EMA in its traditional form was not designed specifically to facilitate momentary interventions. In this article, we introduce just-in-time adaptive EMA (JITA-EMA) as a strategy to reduce participant response burden and decrease measurement error when EMA is used as a tailoring variable in JITAI. JITA-EMA builds on computerized adaptive testing methods developed for purposes of classification (computerized classification testing, CCT), and applies them to the classification of momentary states within individuals. The goal of JITA-EMA is to administer a small and informative selection of EMA questions needed to accurately classify an individual's current state at each measurement occasion. After illustrating the basic components of JITA-EMA (adaptively choosing the initial and subsequent items to administer, adaptively stopping item administration, accommodating dynamically tailored classification cutoffs), we present two simulation studies that explored the performance of JITA-EMA, using the example of momentary fatigue states. Compared with conventional EMA item selection methods that administered a fixed set of questions at each moment, JITA-EMA yielded more accurate momentary classification with fewer questions administered. Our results suggest that JITA-EMA has the potential to enhance some approaches to mobile health interventions by facilitating efficient and precise identification of momentary states that may inform intervention tailoring., (© 2023. The Author(s).)

A core feature of autism involves difficulty perceiving and interpreting eye gaze shifts as nonverbal communicative signals. A hypothesis about the origins of this phenotype is that it emerges from developmentally different social visual attention (SVA). We developed Social Games for Autistic Adolescents (SAGA; Scherf et al. BMJ Open 8(9):e023682, 2018) as a serious game intervention for autistic individuals to discover the significance of eye gaze cues. Previously, we demonstrated the effectiveness of SAGA to improve the perception and understanding of eye gaze cues and social skills for autistic adolescents (Griffin et al. JCPP Adv 1(3):e12041, 2021). Here, we determine whether increases in social visual attention to faces and/or target gazed-at objects, as measured via eye tracking during the same Gaze Perception task in the same study sample, moderated this improvement. In contrast to predictions, SVA to faces did not differentially increase for the treatment group. Instead, both groups evinced a small increase in SVA to faces over time. Second, Prior to the SAGA intervention, attention to faces failed to predict performance in the Gaze Perception task for both the treatment and standard care control groups. However, at post-test, autistic adolescents in the treatment group were more likely to identify the object of directed gaze when they attended longer to faces and longer to target objects. Importantly, this is the first study to measure social visual attention via eye tracking as a treatment response in an RCT for autism. NCT02968225., (© 2024. The Author(s).)

Background: Lifestyle Africa is an adapted version of the Diabetes Prevention Program designed for delivery by community health workers to socioeconomically disadvantaged populations in low- and middle-income countries (LMICs). Results from the Lifestyle Africa trial conducted in an under-resourced community in South Africa indicated that the programme had a significant effect on reducing haemoglobin A1c (HbA1c)., Objective: To estimate the cost of implementation and the cost-effectiveness (in cost per point reduction in HbA1c) of the Lifestyle Africa programme to inform decision-makers of the resources required and the value of this intervention., Methods: Interviews were held with project administrators to identify the activities and resources required to implement the intervention. A direct-measure micro-costing approach was used to determine the number of units and unit cost for each resource. The incremental cost per one point improvement in HbA1c was calculated., Results: The intervention equated to 71 United States dollars (USD) in implementation costs per participant and a 0.26 improvement in HbA1c per participant., Conclusions: Lifestyle Africa reduced HbA1c for relatively little cost and holds promise for addressing chronic disease in LMIC. Decision-makers should consider the comparative clinical effectiveness and cost-effectiveness of this intervention when making resource allocation decisions., Trial Registration: Trial registration is at ClinicalTrials.gov (NCT03342274).

Advances in biomedical engineering continue to produce innovative wearable health sensors capable of real-time ambulatory assessments (e.g., of physiology, the environment), holding great potential for advancing precision monitoring and interventions through the integration of such devices and data into eHealth systems. As with any novel device, however, user views on acceptability and concerns about the technology must be evaluated to facilitate widespread implementation and user adoption of such devices. One factor that may strongly influence user views is the potential relevance to, and need for, self-care for chronic disease management. We examined if acceptability and concerns regarding innovative wearable devices differed between individuals living with or without chronic disease. A U.S. adult sample ( N  = 448; 20-70 yrs.; 34 % Female; 60 % White, 35 % Hispanic) completed a web-based survey regarding their thoughts/opinions related to innovative wearable sensors. Two-thirds (67 %, N  = 298) reported at least one chronic disease; one-third (33 %, N  = 150) reported no chronic health conditions. Participants viewed learning modules about two innovative devices: a watch to detect environmental gases for respiratory health, and a chest-patch monitoring real-time ECG. For each device, participants rated acceptability across multiple dimensions, and then rated potential concerns (including general concerns and specific worries about negative health impacts). Respondents with and without chronic disease differed in education, race, and ethnicity. Controlling for these differences, individuals with chronic disease reported significantly higher acceptability for the watch and for the chest-patch. Healthy participants reported significantly higher general concerns about technology. However, when concern questions were asked specifically about the potential negative impacts of the two study devices on physical health and well-being, participants with chronic disease reported significantly higher concerns. Overall, results show that living with chronic disease influences acceptability and concerns associated with adoption of innovative sensors. These findings suggest it is essential to take potential users' health status into account when studying the design and implementation of innovative wearable sensors. Dissemination strategies may benefit from emphasizing the beneficial features of these devices, addressing hesitations, and customizing implementation approaches by user group., Competing Interests: Both authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (© 2023 The Authors.)

Background: The quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools., Objective: This study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both., Methods: In a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant's voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response., Results: Participants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (P trend =.001) and GAD-7 scores (P trend =.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=-0.02 to -0.46) and GAD-7 (r=0.03 to -0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=-1.13, 95% CI -2.16 to -0.10) and GAD-7 (β=-1.17, 95% CI -2.13 to -0.20) scores., Conclusions: The participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy., Trial Registration: ClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104., (©Nan Lv, Thomas Kannampallil, Lan Xiao, Corina R Ronneberg, Vikas Kumar, Nancy E Wittels, Olusola A Ajilore, Joshua M Smyth, Jun Ma. Originally published in JMIR Human Factors (https://humanfactors.jmir.org), 06.11.2023.)

There has been slow progress in the development of interventions that prevent and/or reduce mental-health morbidity and mortality. The National Institute of Mental Health (NIMH) launched an experimental-therapeutics initiative with the goal of accelerating the development of effective interventions. The emphasis is on interventions designed to engage a target mechanism. A target mechanism is a process (e.g., behavioral, neurobiological) proposed to underlie change in a defined clinical endpoint and through change in which an intervention exerts its effect. This article is based on discussions from an NIMH workshop conducted in February 2020 and subsequent conversations among researchers using this approach. We discuss the components of an experimental-therapeutics approach such as clinical-outcome selection, target definition and measurement, intervention design and selection, and implementation of a team-science strategy. We emphasize the important contributions of different constituencies (e.g., patients, caregivers, providers) in deriving hypotheses about novel target mechanisms. We highlight strategies for target-mechanism identification using published and hypothetical examples. We consider the decision-making dilemmas that arise with different patterns of results in purported mechanisms and clinical outcomes. We end with considerations of the practical challenges of this approach and the implications for future directions of this initiative.

Objectives: Recent work suggests that views of aging (VOA; a meta-construct reflective of individuals' aging-related thoughts, beliefs, feelings, and experiences) fluctuate within persons in day-to-day life. This study characterized the extent of daily variability in VOA and explored differences in variability patterns based on measure to enhance understanding of the dynamic nature of VOA., Methods: An online sample of 122 adults aged 26-78 years completed multiple measures of VOA (subjective age, age group identity, aging attitudes, implicit theories of aging, awareness of age-related losses or gains) on each of 7 consecutive days. We partitioned variance in responses to each measure at the person level and day level to assess between-person and within-person variability, respectively., Results: Between-person variability accounted for most of the total observed variation in VOA, whereas within-person variability accounted for a smaller amount. Different measures exhibited different ratios of between-person to within-person variation, with the lowest ratios observed for subjective age. Exploration of potential differences between age groups also suggests lower ratios in younger compared to older adults., Discussion: Analyses suggest relative stability in daily measures of VOA over a 1-week period. Further study of measures (and age groups) showing greater within-person variability (evidenced by lower ratios of between-person to within-person variation) can increase understanding about constructs with greater sensitivity to fluctuating contexts. It can also inform future work linking VOA to other phenomenon in daily life., (© The Author(s) 2023. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To present the design, development, and pilot testing of Connections , an empirically derived cooperative card game intervention to reduce loneliness and enhance connection. Materials and Methods: Theory and empirical evidence from domains such as self-disclosure, interpersonal closeness, and serious games informed the design of this game. Iterative design was used to develop the intervention, followed by feasibility and preliminary efficacy pilot testing. Results: Pilot testing showed that participants felt confident playing the game and found Connections to be enjoyable, interesting, and helpful in building connections with others, and would recommend the game to others. Preliminary evaluation found statistically significant benefits across multiple domains after playing the game. Participants reported decreases in loneliness, depressed mood, and anxiousness ( ps  < 0.02). Additionally, participants reported increases in looking forward to forming new connections with others in the future, the degree to which they felt like opening up and talking to others, and the amount they felt like they had in common with others ( ps  < 0.05). Conclusion: Pilot testing of Connections demonstrated feasibility and preliminary impact among a community sample. Future development plans include minor revisions to the game instructions followed by more rigorous testing of the feasibility, usability, and efficacy of Connections among various settings and populations, with large samples and controlled trials.

The prevalence of non-communicable diseases, such as diabetes and cardiovascular disease, is rising in low- and middle-income countries (LMICs). Health behavior change (HBC) interventions such as the widely used Diabetes Prevention Program (DPP) are effective at reducing chronic disease risk, but have not been adapted for LMICs. Leveraging mobile health (mHealth) technology such as text messaging (SMS) to enhance reach and participant engagement with these interventions has great promise, yet we lack evidence-informed approaches to guide the integration of SMS specifically to support HBC interventions in LMIC contexts. To address this gap, we integrated guidance from the mHealth literature with expertise and first-hand experience to establish specific development steps for building and implementing SMS systems to support HBC programming in LMICs. Specifically, we provide real-world examples of each development step by describing our experience in designing and delivering an SMS system to support a culturally-adapted DPP designed for delivery in South Africa. We outline eight key SMS development steps, including: 1) determining if SMS is appropriate; 2) developing system architecture and programming; 3) developing theory-based messages; 4) developing SMS technology; 5) addressing international SMS delivery; 6) testing; 7) system training and technical support; and 8) cost considerations. We discuss lessons learned and extractable principles that may be of use to other mHealth and HBC researchers working in similar LMIC contexts.Trial registration Clinicaltrials.gov, NCT03342274 . Registered 10 November 2017., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Consumer-based voice assistants have the ability to deliver evidence-based treatment, but their therapeutic potential is largely unknown. In a pilot trial of a virtual voice-based coach, Lumen, delivering problem-solving treatment, adults with mild-to-moderate depression and/or anxiety were randomized to the Lumen intervention (n = 42) or waitlist control (n = 21). The main outcomes included changes in neural measures of emotional reactivity and cognitive control, and Hospital Anxiety and Depression Scale [HADS] symptom scores over 16 weeks. Participants were 37.8 years (SD = 12.4), 68% women, 25% Black, 24% Latino, and 11% Asian. Activation of the right dlPFC (neural region of interest in cognitive control) decreased in the intervention group but increased in the control group, with an effect size meeting the prespecified threshold for a meaningful effect (Cohen's d = 0.3). Between-group differences in the change in activation of the left dlPFC and bilateral amygdala were observed, but were of smaller magnitude (d = 0.2). Change in right dlPFC activation was also meaningfully associated (r ≥ 0.4) with changes in self-reported problem-solving ability and avoidance in the intervention. Lumen intervention also led to decreased HADS depression, anxiety, and overall psychological distress scores, with medium effect sizes (Cohen's d = 0.49, 0.51, and 0.55, respectively), compared with the waitlist control group. This pilot trial showed promising effects of a novel digital mental health intervention on cognitive control using neuroimaging and depression and anxiety symptoms, providing foundational evidence for a future confirmatory study., (© 2023. The Author(s).)

The use of repeated, momentary, real-world assessment methods known as the Experience Sampling Method and Ecological Momentary Assessment (EMA) has been broadly embraced over the last few decades. These methods have extended our assessment reach beyond lengthy retrospective self-reports as they can capture everyday experiences in their immediate context, including affect, behavior, symptoms, and cognitions. In this review we evaluate nine conceptual, methodological, and psychometric issues about EMA with the goal of stimulating conversation and guiding future research on these matters: the extent to which participants are actually reporting momentary experiences, respondents' interpretation of momentary questions, the use of comparison standards in responding, efforts to increase the EMA reporting period beyond the moment to longer periods within a day, training of EMA study participants, concerns about selection bias of respondents, the impact of missing EMA assessments, the reliability of momentary data, and for which purposes EMA might be considered a gold standard for assessment. Resolution of these issues should have far-reaching implications for advancing the field.

Although the use of nondrug rewards (e.g., money) to facilitate smoking cessation is widespread, recent research has found that such rewards may be least effective when people who smoke cigarettes are tempted to do so. Specifically, among people who smoke, the neural response to nondrug rewards appears blunted when access to cigarettes is anticipated, and this blunting is linked to a decrease in willingness to refrain from smoking to earn a monetary incentive. Accordingly, methods to enhance the value of nondrug rewards may be theoretically and clinically important. The current proof-of-concept study tested if real-time fMRI neurofeedback training augments the ability to upregulate responses in reward-related brain areas relative to a no-feedback control condition in people who smoke. Adults (n = 44, age range = 20-44) who reported smoking >5 cigarettes per day completed the study. Those in the intervention group (n = 22, 5 females) were trained to upregulate brain responses using feedback of ongoing striatal activity (i.e., a dynamic "thermometer" that reflected ongoing changes of fMRI signal intensity in the striatum) in a single neurofeedback session with three training runs. The control group (n = 22, 5 females) underwent a nearly identical procedure but received no neurofeedback. Those who received neurofeedback training demonstrated significantly greater increases in striatal BOLD activation while attempting to think about something rewarding compared to controls, but this effect was present only during the first training run. Future neurofeedback research with those who smoke should explore how to make neurofeedback training more effective for the self-regulation of reward-related brain activities., (© 2023. The Psychonomic Society, Inc.)

Objective: There is reason to believe that introversion may relate to different patterns of negative and positive experiences in everyday life ("hassles" and "uplifts"), but there is little evidence for this based on reports made in daily life as events occur. We thus extend the literature by using data from ecological momentary assessments to examine whether introversion is associated with either the frequency or intensity of hassles and uplifts., Method: Participants (N = 242) were community-dwelling adults (63% Black, 24% Hispanic; ages 25-65; 65% women) who completed baseline measures of personality and mental health, followed by reports of hassles and uplifts 5x/day for 14 days. We present associations between introversion and hassles/uplifts both with and without controlling for mood-related factors (neuroticism, recent symptoms of depression, and anxiety)., Results: Introversion was associated with reporting less frequent and less enjoyable uplifts, but not with overall hassle frequency or unpleasantness; exploratory analyses suggest associations with specific types of hassles., Conclusions: Our results expand understanding of the role of introversion in everyday experiences, suggesting an overall association between introversion and uplifts (but not hassles, broadly) in daily life. Better understanding of such connections may inform future research to determine mechanisms by which introversion relates to health., (© 2022 Wiley Periodicals LLC.)

Although the potential for participant selection bias is readily acknowledged in the momentary data collection literature, very little is known about uptake rates in these studies or about differences in the people that participate versus those who do not. This study analyzed data from an existing Internet panel of older people (age 50 and greater) who were offered participation into a momentary study (n = 3,169), which made it possible to compute uptake and to compare many characteristics of participation status. Momentary studies present participants with brief surveys multiple times a day over several days; these surveys ask about immediate or recent experiences. A 29.1% uptake rate was observed when all respondents were considered, whereas a 39.2% uptake rate was found when individuals who did not have eligible smartphones (necessary for ambulatory data collection) were eliminated from the analyses. Taking into account the participation rate for being in this Internet panel, we estimate uptake rates for the general population to be about 5%. A consistent pattern of differences emerged between those who accepted the invitation to participate versus those who did not (in univariate analyses): participants were more likely to be female, younger, have higher income, have higher levels of education, rate their health as better, be employed, not be retired, not be disabled, have better self-rated computer skills, and to have participated in more prior Internet surveys (all p < .0026). Many variables were not associated with uptake including race, big five personality scores, and subjective well-being. For several of the predictors, the magnitude of the effects on uptake was substantial. These results indicate the possibility that, depending upon the associations being investigated, person selection bias could be present in momentary data collection studies., Competing Interests: AAS is a Senior Scientist with the Gallup Organization and a consultant with CiVi Pharmaceuticals. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Stone et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Individuals with greater affect variability (i.e., moment-to-moment fluctuations possibly reflecting emotional dysregulation) are at risk for greater systemic inflammation, which is associated with cardiovascular disease. Some evidence suggests that affect variability is linked with poorer health indicators only among those with higher average levels of affect, particularly for positive affect (PA), and that associations may be non-linear. The present study sought to examine whether links between both PA and negative affect (NA) variability and inflammation are moderated by average level of affect., Methods: Participants (N = 300, 50 % female, ages 21-70, 60 % non-Hispanic White, 19 % Hispanic, 15 % non-Hispanic Black) completed a lab assessment and provided a blood sample to measure systemic inflammation (i.e., TNF-α, IL-6, CRP). Affect was collected via a two-day ecological momentary assessment protocol where reports were collected about every 45-min during waking hours. Momentary affect ratings were averaged across both days (i.e., iM), separately for PA and NA, for each participant. Affect variability was calculated as the person-specific SD (i.e., iSD) of affect reports, separately for PA and NA. Linear and quadratic interactions were tested. Models included covariates for sex, race, and body mass index., Results: There were significant interactions between NA iM and NA iSD predicting TNF-α (b = 6.54; p < 0.05) and between PA iM and PA iSD predicting IL-6 (b = 0.45; p < 0.05). Specifically, the association between these affect variability indicators and inflammatory markers were suggestive of a positive association among those with higher average affect but a negative association among those with lower average affect. There was no evidence of non-linear associations between affect and inflammation., Discussion: Incorporating interactive effects between affect variability and average affect may be an important consideration in understanding affective-inflammatory associations., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Very light daily smoking (1-5 cigarettes/day) is associated with adverse consequences and is prevalent among young adults. Evidence suggests that perceived smoking opportunity modulates links between affect and craving in adults with heavier smoking patterns (e.g., > 10 cigarettes per day), but there is a lack of similar data in young adults with very light daily smoking patterns. This study addresses this gap by investigating the associations between affect and craving as a function of perceived smoking opportunity under naturalistic conditions., Methods: Forty-one young adults aged 18-25 (M=21.03, SD=1.75) who reported smoking 1-5 cigarettes per day (M=3.2, SD=1.2) completed intermittent ratings of momentary affective valence and arousal, smoking craving, and perceived smoking opportunity on smartphones five times per day for seven days., Results: Multilevel analyses suggested that when participants felt more pleasant or unpleasant, they were likely to report more intense craving. When smoking opportunity was perceived as high, affective arousal was positively associated with craving; this association was not observed when opportunity to smoke was perceived as low., Conclusions: These findings indicate that higher momentary intensity of affective valence (both negative and positive) is linked to stronger momentary craving in young adults who report very light daily smoking. Anticipating an opportunity to satisfy craving by smoking may strengthen the association between reported affective arousal and craving in this population. These results highlight the potential benefits of coping with craving (e.g., by regulating affect) for those who engage in light tobacco use, especially in environments with high cigarette availability., Competing Interests: Conflict of Interest None of the author has any conflicts of interest to disclose., (Copyright © 2022 Elsevier B.V. All rights reserved.)

To advance understanding of doctoral student experiences and the high attrition rates among Science, Technology, Engineering, and Mathematics (STEM) doctoral students, we developed and examined the psychological profiles of different types of doctoral students. We used latent class analysis on self-reported psychological data relevant to psychological threat from 1,081 incoming doctoral students across three universities and found that the best-fitting model delineated four threat classes: Lowest Threat, Nonchalant, Engaged/Worried, and Highest Threat. These classes were associated with characteristics measured at the beginning of students' first semester of graduate school that may influence attrition risk, including differences in academic preparation (e.g., amount of research experience), self-evaluations and perceived fit (e.g., sense of belonging), attitudes towards graduate school and academia (e.g., strength of motivation), and interpersonal relations (e.g., perceived social support). Lowest Threat students tended to report the most positive characteristics and Highest Threat students the most negative characteristics, whereas the results for Nonchalant and Engaged/Worried students were more mixed. Ultimately, we suggest that Engaged/Worried and Highest Threat students are at relatively high risk of attrition. Moreover, the demographic distributions of profiles differed, with members of groups more likely to face social identity threat (e.g., women) being overrepresented in a higher threat profile (i.e., Engaged/Worried students) and underrepresented in lower threat profiles (i.e., Lowest Threat and Nonchalant students). We conclude that doctoral students meaningfully vary in their psychological threat at the beginning of graduate study and suggest that these differences may portend divergent outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Stevens et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background/objectives: Although cortisol levels increase during normal pregnancy, particularly high levels of cortisol or stress have been associated with adverse maternal/child outcomes. Obesity is associated with altered cortisol metabolism, but there is limited information on pregnancy-related changes in cortisol in pregnant women with overweight/obesity. The objective of this study was to examine weekly measures of urinary cortisol and perceived stress throughout ~10-36 weeks gestation, if levels differ by pre-pregnancy BMI categories, and whether concurrent measures of urinary cortisol and perceived stress are associated., Methods: Longitudinal observational data from Healthy Mom Zone, a gestational weight management intervention, and an ancillary fetal growth study were combined. Pregnant women with normal (n=7), overweight (n=11), or obese (n=14) pre-pregnancy BMI were recruited at >8 weeks gestation. Overnight urinary cortisol and Perceived Stress Scale were measured weekly from ~10-36 weeks gestation., Results: Higher pre-pregnancy BMI was associated with overall lower urinary cortisol throughout gestation, but rate of increase in urinary cortisol across pregnancy was similar across weight status groups. Women with obesity reported higher levels of overall perceived stress than normal weight women. Regardless of weight status, perceived stress was not associated with gestational age or cortisol., Conclusions: Although women with obesity reported higher perceived stress, they had lower urinary cortisol than women with normal BMI, and gestation-related increases in cortisol were similar across weight groups and unrelated to perceived stress, suggesting that physiological factors that drive increases in cortisol as pregnancy may outweigh effects of stress and adiposity., Clinical Trial Registration: https://clinicaltrials.gov/ct2/show/NCT03945266, identifier (NCT03945266)., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hohman, Smyth, McNitt, Pauley, Symons Downs and Savage.)

Repeated assessments in everyday life enables collecting ecologically valid data on dynamic, within-persons processes. These methods have widespread utility and application and have been extensively used for the study of stressors and stress responses. Enhanced conceptual sophistication of characterizing intraindividual stress responses in everyday life would help advance the field. This article provides a pragmatic overview of approaches, opportunities, and challenges when intensive ambulatory methods are applied to study everyday stress responses in "real time." We distinguish between three stress-response components (i.e., reactivity, recovery, and pileup) and focus on several fundamental questions: (a) What is the appropriate stress-free resting state (or "baseline") for an individual in everyday life? (b) How does one index the magnitude of the initial response to a stressor (reactivity)? (c) Following a stressor, how can recovery be identified (e.g., when the stress response has completed)? and (d) Because stressors may not occur in isolation, how can one capture the temporal clustering of stressors and/or stress responses (pileup)? We also present initial ideas on applying this approach to intervention research. Although we focus on stress responses, these issues may inform many other dynamic intraindividual constructs and behaviors (e.g., physical activity, physiological processes, other subjective states) captured in ambulatory assessment.

Anticipatory stress can prospectively and negatively influence diverse outcomes, including cognitive performance and emotional well-being. It has been suggested that perseverative cognitions (e.g., worry, rumination) during the anticipation period constitute a key mechanism driving these effects. The present study investigated the temporal dynamics among stressor anticipation, perseverative cognitions, and affective well-being. To accurately test the suggested mechanism, we focused on how these dynamics unfold within individuals over time. To that end, we analyzed data from an ecological momentary assessment study in an ethnically diverse sample ( N = 243, 25-65 year olds, 68.7% Hispanic or non-Hispanic Black; 14 days, 5 measurement occasions per day) using dynamic structural equation modeling. Anticipating an upcoming stressor was linked to higher levels of perseverative cognitions approximately 3 hours later. At times when individuals reported higher levels of recent perseverative cognitions than typical for them, they also reported higher levels of negative affect and lower levels of positive affect. Mediational modeling indicated that perseverative cognitions accounted for the persistent effects of previous stressor anticipation on negative as well as positive affect several hours later. These findings suggest that perseverative cognitions may play an important role in explaining the detrimental effects of anticipatory stress on subsequent emotional well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Background: Artificial intelligence has provided new opportunities for human interactions with technology for the practice of medicine. Among the recent artificial intelligence innovations, personal voice assistants have been broadly adopted. This highlights their potential for health care-related applications such as behavioral counseling to promote healthy lifestyle habits and emotional well-being. However, the use of voice-based applications for behavioral therapy has not been previously evaluated., Objective: This study aimed to conduct a formative user evaluation of Lumen, a virtual voice-based coach developed as an Alexa skill that delivers evidence-based, problem-solving treatment for patients with mild to moderate depression and/or anxiety., Methods: A total of 26 participants completed 2 therapy sessions-an introductory (session 1) and a problem-solving (session 2)-with Lumen. Following each session with Lumen, participants completed user experience, task-related workload, and work alliance surveys. They also participated in semistructured interviews addressing the benefits, challenges and barriers to Lumen use, and design recommendations. We evaluated the differences in user experience, task load, and work alliance between sessions using 2-tailed paired t tests. Interview transcripts were coded using an inductive thematic analysis to characterize the participants' perspectives regarding Lumen use., Results: Participants found Lumen to provide high pragmatic usability and favorable user experience, with marginal task load during interactions for both Lumen sessions. However, participants experienced a higher temporal workload during the problem-solving session, suggesting a feeling of being rushed during their communicative interactions. On the basis of the qualitative analysis, the following themes were identified: Lumen's on-demand accessibility and the delivery of a complex problem-solving treatment task with a simplistic structure for achieving therapy goals; themes related to Lumen improvements included streamlining and improved personalization of conversations, slower pacing of conversations, and providing additional context during therapy sessions., Conclusions: On the basis of an in-depth formative evaluation, we found that Lumen supported the ability to conduct cognitively plausible interactions for the delivery of behavioral therapy. Several design suggestions identified from the study including reducing temporal and cognitive load during conversational interactions, developing more natural conversations, and expanding privacy and security features were incorporated in the revised version of Lumen. Although further research is needed, the promising findings from this study highlight the potential for using Lumen to deliver personalized and accessible mental health care, filling a gap in traditional mental health services., (©Thomas Kannampallil, Corina R Ronneberg, Nancy E Wittels, Vikas Kumar, Nan Lv, Joshua M Smyth, Ben S Gerber, Emily A Kringle, Jillian A Johnson, Philip Yu, Lesley E Steinman, Olu A Ajilore, Jun Ma. Originally published in JMIR Formative Research (https://formative.jmir.org), 12.08.2022.)

Stress and sleep are related, but the nature and time course of this relation is not well understood. We explored the within-person associations of three components of emotional responses to everyday stressors, indexed by negative affect, reactivity (initial response to a stressor), recovery (persistence of the post-stressor response), and pile-up (accumulation of stress episodes), with sleep indicators. We conducted coordinated analyses of data in several studies employing ecological momentary assessments, which captured naturally occurring, self-reported stress and sleep. We defined proximal reactivity as the emotional response to the stressor moment in question compared to an immediate pre-stressor state, and distal reactivity as the emotional response to the stressor moment in question compared to a typical stressor-free state for that person. Results in two of three studies showed that people reported significantly lower sleep quality following days on which they experienced higher levels of distal reactivity to stressors. Days with greater distal reactivity also predicted significantly more difficulty falling asleep in one of two studies. There was no clear association between proximal reactivity and subsequent sleep. Associations of recovery or pile-up with subsequent sleep emerged only in single studies. Poorer sleep quality was significantly related to higher next day levels of negative affect in all three studies, but there were no consistent relations between sleep and next day stress reactivity, recovery, or pile-up. These exploratory analyses suggest that distal reactivity is associated with a heightened risk of experiencing poor sleep quality the following night, and as such the former may serve as a candidate for potential targets for the remediation of the negative effects of stress on sleep., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Ostracism is associated with poor outcomes, but it is unclear if online versus in-person ostracism elicits divergent psychological and physiological responses. Participants ( N  = 54) were randomly assigned to online or in-person ostracism, and provided pre- and post-ostracism measures of affect, self-esteem, self-feelings, and salivary cortisol. No significant changes in negative affect, self-esteem, or self-feelings emerged, nor were there differences by ostracism condition. Both ostracism conditions decreased positive affect (stronger online) and lowered cortisol. Extending prior work, ostracism appears to reliably decrease positive affect (especially online) but may not be threatening to the self; moreover, ostracism may reliably elicit acute cortisol declines.

Response bias characterized by decreases in self-reported subjective states when measured repeatedly over short time-frames is a potential concern in social science. Recent work suggests that this initial elevation bias (IEB) is pronounced among young adult students' self-reports of affect when using ambulatory methods, but it is unclear if such bias extends broadly across samples, designs, and constructs. We examined the conditions wherein reliable and robust IEB may manifest by conducting a coordinated analysis of seven ecological momentary assessment (EMA) studies with diverse lifespan samples to test the generalizability of IEB across study designs and affective constructs (momentary negative and positive affect). Overall, evidence for substantial IEB across studies was weak. No reliable evidence emerged for IEB in negative affect, with evidence for a small magnitude IEB for positive affect when comparing initial reports with reports made 1 week later, although the latter was not evident in other comparisons and was attenuated to nonsignificance when controlling for temporal factors. The magnitude and direction of IEB varied, but in mostly nonsystematic ways, as a function of study design and affective valence. Meta-analytic summary revealed consistently low combined effect sizes (Cohen's d s ranging from -.05 to .14). We found little evidence that IEB in momentary affect is sufficiently reliable, robust, or generalizable across designs and constructs to pose broad and/or serious concerns for EMA studies. Nonetheless, we recommend systematically examining the potential for IEB across study designs and constructs to help identify the conditions/contexts where IEB may or may not manifest. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Objective: To examine the association between COVID-19 impact and clinical outcomes of an integrated collaborative care intervention for adults with obesity and comorbid depression., Methods: Latent class analysis identified clusters of self-reported COVID-19 impact. Cluster characteristics were examined using Fishers' least significant difference method and canonical discriminant analysis. Intervention vs. usual care effects on primary (body mass index [BMI], depressive symptoms) and secondary (anxiety symptoms and other psychosocial) outcomes stratified by cluster were examined using linear mixed models., Results: Three clusters were identified: mental health and sleep impact (cluster 1, n = 37), economic impact (cluster 2, n = 18), and less overall impact (cluster 3, n = 20). Clusters differed in age, income, diet, and baseline coping skills. The intervention led to improvements across several health outcomes compared with usual care, with medium to large effects on functional impairments (standardized mean difference, -0.7 [95% CI: -1.3, -0.1]) in cluster 1, depressive symptoms (-1.1 [95% CI: -2.0, -0.1]) and obesity-related problems (-1.6 [95% CI: -2.8, -0.4]) in cluster 2, and anxiety (-1.1 [95% CI: -1.9, -0.3]) in cluster 3., Conclusions: People with obesity and comorbid depression may have varied intervention responses based on COVID-19 impact. Interventions tailored to specific COVID-19 impact clusters may restore post-pandemic health., (Copyright © 2022 Asia Oceania Association for the Study of Obesity. Published by Elsevier Ltd. All rights reserved.)

Background: Low- and middle-income countries (LMICs) are experiencing major increases in diabetes and cardiovascular conditions linked to overweight and obesity. Lifestyle interventions such as the United States National Diabetes Prevention Program (DPP) developed in high-income countries require adaptation and cultural tailoring for LMICs. The objective of this study was to evaluate the efficacy of "Lifestyle Africa," an adapted version of the DPP tailored for an underresourced community in South Africa compared to usual care., Methods and Findings: Participants were residents of a predominantly Xhosa-speaking urban township of Cape Town, South Africa characterized by high rates of poverty. Participants with body mass index (BMI) ≥ 25 kg/m2 who were members of existing social support groups or "clubs" receiving health services from local nongovernmental organizations (NGOs) were enrolled in a cluster randomized controlled trial that compared Lifestyle Africa (the intervention condition) to usual care (the control condition). The Lifestyle Africa intervention consisted of 17 video-based group sessions delivered by trained community health workers (CHWs). Clusters were randomized using a numbered list of the CHWs and their assigned clubs based on a computer-based random allocation scheme. CHWs, participants, and research team members could not be blinded to condition. Percentage weight loss (primary outcome), hemoglobin A1c (HbA1c), blood pressure, triglycerides, and low-density lipoprotein (LDL) cholesterol were assessed 7 to 9 months after enrollment. An individual-level intention-to-treat analysis was conducted adjusting for clustering within clubs and baseline values. Trial registration is at ClinicalTrials.gov (NCT03342274). Between February 2018 and May 2019, 782 individuals were screened, and 494 were enrolled. Participants were predominantly retired (57% were receiving a pension) and female (89%) with a mean age of 68 years. Participants from 28 clusters were allocated to Lifestyle Africa (15, n = 240) or usual care (13, n = 254). Fidelity assessments indicated that the intervention was generally delivered as intended. The modal number of sessions held across all clubs was 17, and the mean attendance of participants across all sessions was 61%. Outcome assessment was completed by 215 (90%) intervention and 223 (88%) control participants. Intent-to-treat analyses utilizing multilevel modeling included all randomized participants. Mean weight change (primary outcome) was -0.61% (95% confidence interval (CI) = -1.22, -0.01) in Lifestyle Africa and -0.44% (95% CI = -1.06, 0.18) in control with no significant difference (group difference = -0.17%; 95% CI = -1.04, 0.71; p = 0.71). However, HbA1c was significantly lower at follow-up in Lifestyle Africa compared to the usual care group (mean difference = -0.24, 95% CI = -0.39, -0.09, p = 0.001). None of the other secondary outcomes differed at follow-up: systolic blood pressure (group difference = -1.36; 95% CI = -6.92, 4.21; p = 0.63), diastolic blood pressure (group difference = -0.39; 95% CI = -3.25, 2.30; p = 0.78), LDL (group difference = -0.07; 95% CI = -0.19, 0.05; p = 0.26), triglycerides (group difference = -0.02; 95% CI = -0.20, 0.16; p = 0.80). There were no unanticipated problems and serious adverse events were rare, unrelated to the intervention, and similar across groups (11 in Lifestyle Africa versus 13 in usual care). Limitations of the study include the lack of a rigorous dietary intake measure and the high representation of older women., Conclusions: In this study, we found that Lifestyle Africa was feasible for CHWs to deliver and, although it had no effect on the primary outcome of weight loss or secondary outcomes of blood pressure or triglycerides, it had an apparent small significant effect on HbA1c. The study demonstrates the potential feasibility of CHWs to deliver a program without expert involvement by utilizing video-based sessions. The intervention may hold promise for addressing cardiovascular disease (CVD) and diabetes at scale in LMICs., Trial Registration: ClinicalTrials.gov NCT03342274., Competing Interests: The authors have declared that no competing interests exist.