Annals of Behavioral Medicine (Ann Behav Med)

Publications in this journal

• Article: An Online Mindfulness Intervention Targeting Socioemotional Regulation in Fibromyalgia: Results of a Randomized Controlled Trial.

  Mary C Davis, Alex J Zautra
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  ABSTRACT: BACKGROUND: Patients with fibromyalgia (FM) experience pain as well as deficits in positive affect and social relations that are not explicitly addressed in most behavioral treatments. PURPOSE: The purpose of this study is to compare the effects of a 12-module online intervention targeting socioemotional regulation via mindful awareness/acceptance (MSER) with those of an attention-control treatment, healthy lifestyle tips (HT). METHODS: Seventy-nine FM patients were randomly assigned to MSER or HT, with outcomes assessed via online diary reports of pain, coping efficacy, affect, and social relations. Multilevel analyses revealed greater improvements in social functioning, positive affect, and coping efficacy for pain and stress (all ps < .05) in MSER versus HT across the 6-week trial. CONCLUSIONS: FM patients experience increases in self-efficacy for coping with pain and positive engagement in relationships, marginal increases in positive affect, and decreases in relationship stress from an automated online intervention that targets socioemotional regulation skills. Findings highlight the potential utility of widely accessible, low-cost intervention methods for fibromyalgia (Clinicaltrials.gov number NCT01748786).
  Annals of Behavioral Medicine 05/2013;
• Article: Improving Adherence to Medication in Stroke Survivors: A Pilot Randomised Controlled Trial.

  Ronan E O'Carroll, Julie A Chambers, Martin Dennis, Cathie Sudlow, Marie Johnston
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  ABSTRACT: BACKGROUND: Adherence to preventive medication is often poor, and current interventions have had limited success. PURPOSE: This study was conducted to pilot a randomised controlled trial aimed at increasing adherence to preventive medication in stroke survivors using a brief, personalised intervention. METHODS: Sixty-two stroke survivors were randomly allocated to either a two-session intervention aimed at increasing adherence via (a) introducing a plan linked to environmental cues (implementation intentions) to help establish a better medication-taking routine (habit) and (b) eliciting and modifying any mistaken patient beliefs regarding medication/stroke or a control group. Primary outcome was adherence to antihypertensive medication measured objectively over 3 months using an electronic pill bottle. RESULTS: Fifty-eight people used the pill bottle and were analysed as allocated; 54 completed treatment. The intervention resulted in 10 % more doses taken on schedule (intervention, 97 %; control, 87 %; 95 % CI for difference (0.2, 16.2); p = 0.048). CONCLUSIONS: A simple, brief intervention increased medication adherence in stroke survivors, over and above any effect of increased patient contact or mere measurement. ( http://controlled-trials.com , number ISRCTN38274953.).
  Annals of Behavioral Medicine 05/2013;
• Article: Classifying the Reasons Men Consider to be Important in Prostate-Specific Antigen (PSA) Testing Decisions: Evaluating Risks, Lay Beliefs, and Informed Decisions.

  Michelle E McDowell, Stefano Occhipinti, Suzanne K Chambers
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  ABSTRACT: BACKGROUND: Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test. PURPOSE: This study aims to identify classes of reasons guiding men's decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. METHODS: First-degree relatives of men with prostate cancer (n = 207) and men from the general population (n = 239) of Australia listed reasons they considered when deciding whether to have a PSA test. RESULTS: Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men. CONCLUSION: Understanding the reasons underlying men's screening decisions may lead to a more effective information provision and decision support.
  Annals of Behavioral Medicine 05/2013;
• Article: Using Mental Imagery to Deliver Self-Regulation Techniques to Improve Sleep Behaviors.

  Marisa H Loft, Linda D Cameron
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  ABSTRACT: BACKGROUND: Poor sleep habits and insufficient sleep represent significant workplace health issues. PURPOSE: Applying self-regulation theory, we conducted a randomized, controlled trial testing the efficacy of mental imagery techniques promoting arousal reduction and implementation intentions to improve sleep behavior. METHOD: We randomly assigned 104 business employees to four imagery-based interventions: arousal reduction, implementation intentions, combined arousal reduction and implementation intentions, or control imagery. Participants practiced their techniques daily for 21 days. They completed online measures of sleep quality, behaviors, and self-efficacy at baseline and Day 21; and daily measures of sleep behaviors. RESULTS: Participants using implementation intention imagery exhibited greater improvements in self-efficacy, sleep behaviors, sleep quality, and time to sleep relative to participants using arousal reduction and control imagery. CONCLUSIONS: Implementation intention imagery can improve sleep behavior for daytime employees. Use of arousal reduction imagery was unsupported. Self-regulation imagery techniques show promise for improving sleep behaviors.
  Annals of Behavioral Medicine 05/2013;
• Article: Conceptualizing and Examining the Role of Stress in Arthritis: a Comment on Harris et al.

  Perry M Nicassio, Taylor L Draper, Sarah R Ormseth
  Annals of Behavioral Medicine 05/2013;
• Article: Sources of Uncertainty and Their Association with Medical Decision Making: Exploring Mechanisms in Fanconi Anemia.

  Jada G Hamilton, Sadie P Hutson, Richard P Moser, Sarah C Kobrin, Amy E Frohnmayer, Blanche P Alter, Paul K J Han
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  ABSTRACT: BACKGROUND: Effects of different sources of medical uncertainty on people's health-related cognitions, emotions, and decision making have yet to be systematically examined. PURPOSE: The aim of this study is to examine how uncertainties arising from different sources are associated with decision making regarding stem cell transplantation in Fanconi anemia, a rare, inherited bone marrow failure syndrome that typically presents during childhood. METHODS: Data were collected through a cross-sectional survey of 178 parents of 126 Fanconi anemia patients. RESULTS: Two distinct sources of uncertainty were associated with decision outcomes: probability was associated with a lower likelihood of choosing stem cell transplantation, and ambiguity due to conflicting expert opinions was associated with greater decision-making difficulty. Concern about transplantation may mediate these associations. CONCLUSIONS: Different sources of uncertainty have different effects on Fanconi anemia treatment decisions, which may be mediated by parents' emotional reactions. Further research is needed to elucidate these effects and help Fanconi anemia families cope with uncertainty.
  Annals of Behavioral Medicine 05/2013;
• Article: Feasibility of an Online Mindfulness Program for Stress Management-A Randomized, Controlled Trial.

  Thomas J Morledge, Didier Allexandre, Emily Fox, Alex Z Fu, Mitchell K Higashi, Denise T Kruzikas, Sissi V Pham, Pat Ray Reese
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  ABSTRACT: BACKGROUND: Chronic stress affects many Americans. Stress management programs may be prohibitively expensive or have limited access. PURPOSE: This study aims to determine feasibility of an 8-week Internet-based stress management program (ISM) based on mindfulness principles in reducing stress in a 12-week, parallel, randomized, controlled trial. METHODS: Participants were randomly allocated to ISM, ISM plus online message board (ISM+), or control groups. Perceived stress, mindfulness, self-transcendence, psychological well-being, vitality, and quality of life were measured at baseline, week 8, and week 12 using standard validated questionnaires. RESULTS: ISM and ISM+ groups demonstrated statistically significant improvements compared with control on all measures except vitality and physical health. CONCLUSIONS: The ISM program effectively and sustainably reduced measures of stress. The magnitude of improvement is comparable to traditional mindfulness programs, although fewer participants were engaged. This feasibility study provides strong support for online stress management programs, which increase access at a fraction of cost of traditional programs.
  Annals of Behavioral Medicine 05/2013;
• Article: Effects of Anger Awareness and Expression Training versus Relaxation Training on Headaches: A Randomized Trial.

  Olga Slavin-Spenny, Mark A Lumley, Elyse R Thakur, Dana C Nevedal, Alaa M Hijazi
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  ABSTRACT: BACKGROUND AND PURPOSE: Stress contributes to headaches, and effective interventions for headaches routinely include relaxation training (RT) to directly reduce negative emotions and arousal. Yet, suppressing negative emotions, particularly anger, appears to augment pain, and experimental studies suggest that expressing anger may reduce pain. Therefore, we developed and tested anger awareness and expression training (AAET) on people with headaches. METHODS: Young adults with headaches (N = 147) were randomized to AAET, RT, or a wait-list control. We assessed affect during sessions, and process and outcome variables at baseline and 4 weeks after treatment. RESULTS: On process measures, both interventions increased self-efficacy to manage headaches, but only AAET reduced alexithymia and increased emotional processing and assertiveness. Yet, both interventions were equally effective at improving headache outcomes relative to controls. CONCLUSIONS: Enhancing anger awareness and expression may improve chronic headaches, although not more than RT. Researchers should study which patients are most likely to benefit from an emotional expression or emotional reduction approach to chronic pain.
  Annals of Behavioral Medicine 04/2013;
• Article: Towards Integrated Multiple Behavior Management for HIV and Chronic Conditions: a Comment on Blashill et al.

  Colleen A Redding
  Annals of Behavioral Medicine 04/2013;
• Article: Behavioral Impacts of Sequentially versus Simultaneously Delivered Dietary Plus Physical Activity Interventions: the CALM Trial.

  Abby C King, Cynthia M Castro, Matthew P Buman, Eric B Hekler, Guido G Urizar, David K Ahn
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  ABSTRACT: BACKGROUND: Few studies have evaluated how to combine dietary and physical activity (PA) interventions to enhance adherence. PURPOSE: We tested how sequential versus simultaneous diet plus PA interventions affected behavior changes. METHODS: Two hundred participants over age 44 years not meeting national PA and dietary recommendations (daily fruit and vegetable servings and percent of calories from saturated fat) were randomized to one of four 12-month telephone interventions: sequential (exercise first or diet first), simultaneous, or attention control. At 4 months, the other health behavior was added in the sequential arms. RESULTS: Ninety-three percent of participants were retained through 12 months. At 4 months, only exercise first improved PA, and only the simultaneous and diet-first interventions improved dietary variables. At 12 months, mean levels of all behaviors in the simultaneous arm met recommendations, though not in the exercise- and diet-first arms. CONCLUSIONS: We observed a possible behavioral suppression effect of early dietary intervention on PA that merits investigation.
  Annals of Behavioral Medicine 04/2013;
• Article: Six-Month Outcomes from Living Well with Diabetes: A Randomized Trial of a Telephone-Delivered Weight Loss and Physical Activity Intervention to Improve Glycemic Control.

  E G Eakin, M M Reeves, E Winkler, G N Healy, D W Dunstan, N Owen, A M Marshal, K C Wilkie
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  ABSTRACT: BACKGROUND: Intensive lifestyle intervention trials in type 2 diabetes contribute evidence on what can be achieved under optimal conditions, but are less informative for translation in applied settings. PURPOSE: Living Well with Diabetes is a telephone-delivered weight loss intervention designed for real-world delivery. METHODS: This study is a randomized controlled trial of telephone counseling (n = 151) versus usual care (n = 151); 6-month primary outcomes of weight, physical activity, HbA1c; secondary diet outcomes; analysis was by adjusted generalized linear models. RESULTS: Relative to usual care, telephone counseling participants had small but significantly better weight loss [-1.12 % of initial body weight; 95 % confidence interval (CI) -1.92, -0.33 %]; physical activity [relative rate (RR) = 1.30; 95 % CI, 1.08, 1.57]; energy intake reduction (-0.63 MJ/day; 95 % CI, -1.01, -0.25); and diet quality (3.72 points; 95 % CI, 1.77, 5.68), with no intervention effect for HbA1c (RR = 0.99; 95 % CI, 0.96, 1.01). CONCLUSIONS: Results are discussed in light of challenges to intervention delivery.
  Annals of Behavioral Medicine 04/2013;
• Article: Phone-Delivered Mindfulness Training for Patients with Implantable Cardioverter Defibrillators: Results of a Pilot Randomized Controlled Trial.

  Elena Salmoirago-Blotcher, Sybil L Crawford, James Carmody, Lawrence Rosenthal, Gloria Yeh, Mary Stanley, Karen Rose, Clifford Browning, Ira S Ockene
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  ABSTRACT: BACKGROUND: The reduction in adrenergic activity and anxiety associated with meditation may be beneficial for patients with implantable cardioverter defibrillators. PURPOSE: This study aims to determine the feasibility of a phone-delivered mindfulness intervention in patients with defibrillators and to obtain preliminary indications of efficacy on mindfulness and anxiety. METHODS: Clinically stable outpatients were randomized to a mindfulness intervention (eight weekly individual phone sessions) or to a scripted follow-up phone call. We used the Hospital Anxiety and Depression Scale and the Five Facets of Mindfulness to measure anxiety and mindfulness, and multivariate linear regression to estimate the intervention effect on pre-post-intervention changes in these variables. RESULTS: We enrolled 45 patients (23 mindfulness and 22 control; age, 43-83; 30 % women). Retention was 93 %; attendance was 94 %. Mindfulness (beta = 3.31; p = 0.04) and anxiety (beta = -1.15; p = 0.059) improved in the mindfulness group. CONCLUSIONS: Mindfulness training can be effectively phone-delivered and may improve mindfulness and anxiety in cardiac defibrillator outpatients.
  Annals of Behavioral Medicine 04/2013;
• Article: Childhood Socioeconomic Position and Blood Pressure Dipping in Early Adulthood: a Longitudinal Study.

  Tavis S Campbell, Jean R Séguin, Frank Vitaro, Richard E Tremblay, Blaine Ditto
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  ABSTRACT: BACKGROUND: The experience of low socioeconomic position in childhood may increase risk for adult cardiovascular disease above and beyond the effects of current socioeconomic position. One limitation of most previous research is that childhood socioeconomic position was assessed retrospectively. METHODS: Measures of ambulatory blood pressure, heart rate, and heart rate variability were obtained from 110 young men (22 years) who were enrolled in a long-term study of child development at age 6. RESULTS: Men who had lower childhood socioeconomic position had smaller decreases in systolic blood pressure (SBP) during sleep independent of current education, daytime SBP, and body mass index (BMI). They also displayed smaller decreases in low-frequency heart rate variability during sleep. Twenty-four-hour SBP was negatively associated with childhood socioeconomic position independent of current education and BMI. CONCLUSIONS: While the mechanisms are unclear, childhood socioeconomic position may influence blood pressure in early adulthood independent of current life circumstances.
  Annals of Behavioral Medicine 04/2013;
• Article: Nighttime Sleep and Daytime Stress-Tangled Bedfellows: a Comment on Williams et al.

  Kathi L Heffner
  Annals of Behavioral Medicine 04/2013;
• Article: Pain Fear Avoidance and Pain Acceptance: A Cross-Sectional Study Comparing Their Influence on Adjustment to Chronic Pain Across Three Samples of Patients.

  Rosa Esteve, Carmen Ramírez-Maestre
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  ABSTRACT: BACKGROUND: Prior studies found that pain fear avoidance and pain acceptance are significantly associated with adjustment to chronic pain. PURPOSE: The purpose of this study is to compare the influence of pain fear avoidance and pain acceptance on adjustment to chronic pain across three samples: patients with chronic back pain treated at primary care centres, patients with heterogeneous pain conditions treated at a pain clinic and patients with pain associated with inflammatory bowel disease. METHODS: Structural equation modelling was used to test for differences between groups in the linear relationships between variables. RESULTS: The model had the best fit for the group of patients with back pain. Three significant relationships were equal across the groups: experiential avoidance on pain fear avoidance, pain intensity on pain fear avoidance, and pain fear avoidance on negative mood. CONCLUSIONS: The associations between both pain fear avoidance and pain acceptance and adjustment to chronic pain vary depending on the pain condition and the type of health care centres where the patients are treated.
  Annals of Behavioral Medicine 04/2013;
• Article: Personality Factors, Emotional Triggers and Acute Cardiac Events: a Comment on Compare et al.

  J Denollet, W J Kop
  Annals of Behavioral Medicine 04/2013;
• Article: Night/Day Ratios of Ambulatory Blood Pressure Among Healthy Adolescents: Roles of Race, Socioeconomic Status, and Psychosocial Factors.

  Tanisha I Burford, Carissa A Low, Karen A Matthews
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  ABSTRACT: BACKGROUND: Elevated nighttime blood pressure (BP) predicts hypertension and its complications in adulthood. PURPOSE: This study aimed to assess the independent effects of race and family income on night/day BP among adolescents and to examine whether negative emotions, low positive resources, and unpleasant interactions during the day are also related. METHODS: Healthy African American and Caucasian high school students (N = 239) wore an ambulatory BP monitor for 48 h, recorded quality of ongoing interpersonal interactions, and completed questionnaires. RESULTS: African Americans and those with lower family income had higher night/day BP ratios. African Americans reporting greater negative emotions, lower positive resources, and more unpleasant interactions had higher night/day BP ratios. CONCLUSIONS: Racial differences in night BP emerge by adolescence, independent of family income. African Americans, especially those high in negative emotions and low in positive resources, may be at higher relative risk for hypertension later in life in part due to elevated night BP.
  Annals of Behavioral Medicine 04/2013;