Randomized Controlled Trial of Aerobic Exercise for Smoking Cessation Among Individuals With Elevated Depressive Symptoms

INTRODUCTION

Adults with depression have higher rates of cigarette smoking and are more likely to relapse than those without depression. Pharmacological, psychological, and combined interventions have largely yielded small improvements in smoking outcomes for adults with depression. Aerobic exercise (AE) may facilitate smoking cessation in this subpopulation.

METHODS

This study was a 12-week two-arm randomized controlled trial that evaluated the effect of a moderate-intensity AE program compared to a health education contact (HEC) control on smoking cessation in adults with elevated depressive symptoms (mild to severe). Participants (n = 231) were randomized to AE or HEC and received smoking cessation treatment (telephone counseling and nicotine replacement therapy). Primary (biologically confirmed 7-day point prevalence abstinence) and secondary (depressive symptoms, objective and self-reported physical activity, and cardiorespiratory fitness) outcomes were assessed at baseline, 3, 6, and 12 months. Data were analyzed with mixed-effects generalized linear models controlling for age, gender, nicotine dependence, history of major depression disorder, and month of follow-up assessment.

RESULTS

There were no significant differences in primary or secondary outcomes between the AE and HEC groups.

CONCLUSIONS

The AE program was not superior to HEC in facilitating smoking cessation, increases in physical activity, or improved depressive symptoms. Given evidence for the positive acute effects of exercise on mood and smoking urges, future research should consider testing alternative exercise approaches for aiding smoking cessation beyond structured, AE programs.

IMPLICATIONS

This study found that an adjunctive aerobic exercise (AE) program was not superior to a health education contact control for adults with elevated depressive symptoms, all of whom also received standard smoking cessation treatment. This finding adds to the growing body of literature that structured AE programs for smoking cessation may have limited efficacy for cessation outcomes. Future research is needed to test alternative methods of integrating AE into smoking cessation treatment, such as strategically using exercise to manage cravings and low mood in the moment.

Evaluation of intervention components to maximize yoga practice among people with chronic pain taking opioid agonist therapy: A factorial experiment using the multiphase optimization strategy framework

BACKGROUND

Chronic pain affects up to half of individuals taking opioid agonist therapy (OAT; i.e., methadone and buprenorphine) for opioid use disorder (OUD), and yoga-based interventions may be useful for decreasing pain-related disability. Whereas more yoga practice (i.e., higher "dosage") may improve pain-related outcomes, it can be challenging for people with chronic pain taking OAT to attend class regularly and sustain a regular personal yoga practice. Therefore, we plan to optimize a yoga-based intervention (YBI) package in order to support class attendance and personal practice, thus maximizing the yoga dose received.

STUDY DESIGN

Using the Multiphase Optimization Strategy (MOST) framework, we will conduct a factorial experiment to examine four intervention components that may be added to a weekly yoga class as part of a YBI. Components include: 1) personal practice videos featuring study yoga teachers, 2) two private sessions with a yoga teacher, 3) daily text messages to inspire personal practice, and 4) monetary incentives for class attendance. The primary outcome will be minutes per week engaged in yoga (including class attendance and personal practice). We plan to enroll 192 adults with chronic pain who are taking OAT for OUD in this 2x2x2x2 factorial experiment.

CONCLUSION

Results of the study will guide development of an optimized yoga-based intervention package that maximizes dosage of yoga received. The final treatment package can be tested in a multisite efficacy trial of yoga to reduce pain interference in daily functioning in people with chronic pain who are taking OAT.

TRIAL REGISTRATION

Pre-registration of the study was completed on ClinicalTrials.gov (identifier: NCT04641221).

Adding online storytelling-based acceptance and commitment therapy to antidepressant treatment for primary care patients: a randomized clinical trial

Depression is most often treated in primary care, where the prevailing treatment is antidepressant medication. Primary care patients with depression are less likely to be exposed to psychosocial interventions, despite evidence suggesting many of these treatments are effective. An example is acceptance and commitment therapy (ACT), a behavioral treatment for depression with a growing evidence base. A self-guided ACT intervention with a peer narrative (i.e. storytelling) format was developed with the intention of creating a treatment option for primary care patients that was more accessible than traditional psychotherapy. Titled LifeStories, the online program features videos of real individuals sharing coping skills for depression based on lived experiences and key ACT principles. A total of 93 primary care patients taking antidepressants were randomized to either continued antidepressant treatment alone or antidepressant treatment plus LifeStories for 4 weeks. There were no differences over time on depression severity and psychological inflexibility. However, LifeStories led to greater improvements in quality of life and increased patients' interest in additional treatment compared to antidepressant medication alone.Clinical trial pre-registration: ClinicalTrials.gov (NCT04757961).

Strategies Used to Manage Chronic Pain in HIV-Disease: Comparing Persons Prescribed Opioids Versus Persons not Receiving Opioids

Chronic pain is common in people living with HIV (PLWH), causes substantial disability and is associated with limitations in daily activities. Opioids are commonly prescribed for pain treatment among PLWH, but evidence of sustained efficacy is mixed. There is little information available on how PLWH who have chronic pain use multimodal strategies in pain management. The current cross-sectional study examined background characteristics, self-reported pain, and the use of other pain treatments among 187 PLWH with chronic pain and depressive symptoms who were and were not prescribed opioids. Approximately 20.9% of participants reported using prescription opioids at the time of the study interview. These individuals were significantly more likely to report having engaged in physical therapy or stretching, strengthening or aerobic exercises in the previous 3 months, recent benzodiazepine use, and receiving disability payments. There were no significant differences in pain characteristics (pain-related interference, average pain severity, and worst pain severity) between the two groups. Those not prescribed opioids were more likely to report better concurrent physical functioning and general health, and fewer physical role limitations, but higher depression symptom severity. Our findings suggest that many PLWH with chronic pain and depressive symptoms express high levels of pain with deficits in physical function or quality of life despite their use of opioids. The high rate of co-use of opioids and benzodiazepines (30.8%) is a concern because it may increase risk of overdose. An integrated care approach that includes a variety of effective non-pharmacologic treatment strategies such as physical therapy may be beneficial in reducing the reliance on opioids for pain management.

Do yoga and meditation moderate the relationship between negative life events and depressive symptoms? Analysis of a national cross-sectional survey of Australian women

Objectives

This study aims to examine the role of yoga/meditation in the relationship between negative life events, stress and depression.

Methods

The Australian Longitudinal Study on Women's Health (ALSWH) surveyed 7,186 women aged 36-43 years (mean age 39.2 years; 57.2% university degree) in 2015. Mediation and moderation analyses were conducted to examine whether yoga/meditation practice moderated those relationships.

Results

Yoga/meditation was practiced by 27.5% of participants, 33.2% reported negative life events in the past 12 months, and 24% had clinical depression. Perceived stress partially mediated the association between negative life events and depressive symptoms (B = 6.28; 95%CI 5.65; 6.92). Social support (B = -0.38; 95%CI -0.54; -0.23) and optimism (B = -0.25;95%CI -0.31; -0.18) moderated the association between stress and depressive symptoms. Yoga/meditation practice moderated the direct association between negative life events and depressive symptoms (B = -0.92; 95%CI -1.67; -0.18).

Conclusion

Yoga/meditation use was a significant moderator of the relationship between negative life events and depression. Yoga/mediation use did not act via reducing perceived stress, but instead was found to dampen the influence of negative life events on depression directly. More research on how yoga has an impact on depression is warranted.

The Global Task Force for Chronic Pain in People with HIV (PWH): Developing a research agenda in an emerging field

Chronic pain is a common comorbidity in people with HIV (PWH), with prevalence estimates of 25-85%. Research in this area is growing, but significant gaps remain. A Global Task Force of HIV experts was organized to brainstorm a scientific agenda and identify measurement domains critical to advancing research in this field. Experts were identified through literature searches and snowball sampling. Two online questionnaires were developed by Task Force members. Questionnaire 1 asked participants to identify knowledge gaps in the field of HIV and chronic pain and identify measurement domains in studies of chronic pain in PWH. Responses were ranked in order of importance in Questionnaire 2, which was followed by a group discussion. 29 experts completed Questionnaire 1, 25 completed Questionnaire 2, and 21 participated in the group. Many important clinical and research priorities emerged, including the need to examine etiologies of chronic pain in PWH. Pain-related measurement domains were discussed, with a primary focus on domains that could be assessed in a standardized manner across various cohorts that include PWH in different countries. We collaboratively identified clinical and research priorities, as well as gaps in standardization of measurement domains, that can be used to move the field forward.

An examination of the effects of distress intolerance and rating of perceived exertion on changes in mood and anxiety following aerobic exercise among treatment-seeking smokers

Aerobic exercise is frequently used as an intervention for depression and smoking cessation because of its antidepressant and anxiolytic effects. Distress intolerance (DI) is a proposed individual difference factor that, coupled with a higher rating of perceived exertion during exercise, may significantly impact the acute mood and anxiolytic effects of exercise. The current study examined the interactive effect of maximum rating of perceived exertion (RPE) and DI on change in mood and anxiety. Treatment-seeking smokers (Mage = 45.32; 72% female) with elevated depressive symptoms completed a 1-mile treadmill walk at their preferred intensity and self-reported their RPE during the test. Analyses were conducted to examine whether there was an interactive effect of maximum RPE and DI on change in self-reported mood and anxiety from before to after the walk test. Findings indicate a significant moderating effect of RPE at lower ratings. Individuals reporting a low maximum RPE and higher DI exhibit a greater change in mood over the course of an exercise session, whereas individuals reporting a low maximum RPE and a lower DI exhibit smaller changes in mood. These results indicate that the subjective effects of exercise within a population of cigarette smokers could be improved by tailoring exercise intensity to individual characteristics. Mild to moderate-intensity exercise, as compared to high-intensity exercise, may result in greater changes in mood for individuals endorsing difficulty tolerating affective and physical distress.

Effects of a bout of exercise on mood in people with depression with and without physical pain

Physical and mental health symptoms can reduce participation in physical activity. The current study assessed the impact of a bout of exercise on mood state in depressed participants with and without current physical pain. We enrolled a community sample of 147 participants (Mage = 45.5; SD = 11.98; 87.1% female) with elevated depressive symptoms. Individuals rated their mood state, completed a 1-mile walk test on a treadmill, and rated their mood state again. Pairwise comparisons between pre- and post-exercise mood ratings were statistically significant (p < .001) and showed improved mood state. People with at least moderate pain showed greater decreases in sadness and irritability from pre- to post- exercise bout. A single bout of exercise was associated with decreased sadness, anxiety, and irritability, and increased energy in a sample of adults with depression. The changes in sadness and irritability were greatest in those who reported at least moderate physical pain.

HIV-PASS (Pain and Sadness Support): Randomized Controlled Trial of a Behavioral Health Intervention for Interference Due to Pain in People Living With HIV, Chronic Pain, and Depression

OBJECTIVE

This study aimed to determine whether HIV-Pain and Sadness Support (HIV-PASS), a collaborative behavioral health intervention based on behavioral activation, is associated with decreased pain-related interference with daily activities, depression, and other outcomes in people living with HIV.

METHODS

We conducted a three-site clinical trial ( n = 187) in which we randomly assigned participants to receive either HIV-PASS or health education control condition. In both conditions, participants received seven intervention sessions, comprising an initial in-person joint meeting with the participant, their HIV primary care provider and a behavioral health specialist, and six, primarily telephone-based, meetings with the behavioral health specialist and participant. The intervention period lasted 3 months, and follow-up assessments were conducted for an additional 9 months.

RESULTS

Compared with health education, HIV-PASS was associated with significantly lower pain-related interference with daily activities at the end of month 3 (our primary outcome; b = -1.31, 95% confidence interval = -2.28 to -0.34). We did not observe other differences between groups at 3 months in secondary outcomes that included worst or average pain in the past week, depression symptoms, anxiety, and perceived overall mental and physical health. There were no differences between groups on any outcomes at 12 months after enrollment.

CONCLUSIONS

A targeted intervention can have positive effects on pain interference. At the end of intervention, effects we found were in a clinically significant range. However, effects diminished once the intervention period ended.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02766751.

Assessing feasibility and acceptability of yoga and group CBT for adolescents with depression: A pilot randomized clinical trial

PURPOSE

Given increasing rates of depression in adolescents, there is a clear need for innovative treatments. In this pilot randomized clinical trial, we assessed acceptability and feasibility of two group-based interventions: yoga and cognitive-behavioral therapy (CBT). The goal of this work is to prepare for a future fully powered randomized trial to test the hypothesis that yoga is not inferior to an established adolescent depression treatment, namely, group CBT.

METHODS

We enrolled 42 adolescents with elevated depression symptoms. Participants were randomly assigned to a 12-week group-based intervention, yoga or CBT. We had a priori feasibility and acceptability targets, including for recruitment rate, retention rate, expectancy, credibility, program satisfaction, class attendance, engagement in home practice, and instructor/leader manual adherence. We assessed adverse events, and within-subject changes in outcomes (depression, anxiety, impairment, sleep disturbance) and possible mediators (mindfulness, self-compassion).

RESULTS

Both interventions met most acceptability and feasibility targets. The only target not met related to low engagement in home practice. Participants within each study arm showed decreased depression symptoms over time and increased self-compassion.

CONCLUSIONS

A yoga intervention appears to be acceptable and feasible to adolescents with depression. However, it may be challenging for this group to engage in unstructured home practice.

Project MOVE: A randomized controlled trial of Interventions for initiating and maintaining physical activity in depressed individuals

Objective

To test interventions for increasing aerobic exercise in depressed individuals.

Methods

We conducted a 3-arm randomized controlled trial aimed at increasing minutes of moderate-to-vigorous physical activity (MVPA) in depressed adults (N = 242). Each successive arm included an added component that might serve to increase and maintain physical activity. Arms were: 1) Brief advice (BA) to aerobic exercise; 2) BA + supervised and home-based aerobic exercise (SHE) + health education (HE); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining aerobic exercise (CBEX). HE was intended to serve as a control for CBEX. Assessments were conducted at baseline, Month 1.5, end of intervention (Month 3), Month 6, and Month 9. The primary outcome of MVPA was assessed via accelerometry. Secondary outcomes included self-reported MVPA, depression severity, and other aspects of mood and affect.

Results

At 3 months (the pre-designated primary outcome timepoint), the simple effect of treatment was statistically significant (F2, 569.0 = 4.17, p = .016), with BA+SHE+CBEX being superior to BA. We did not observe differences between BA+SHE+HE and either of the other arms. There were no statistically significant differences between treatment groups at 6- or 9-months. Treatment effects were not statistically significant for secondary outcomes.

Conclusions

Supervised and home-based exercise, when combined with a cognitive-behavioral exercise intervention, is effective in increasing aerobic exercise in depressed adults in the short-term, although the impact diminishes post-intervention period.

Anger and substance use in HIV-positive patients with chronic pain

Chronic pain increases the risk of substance use in people living with HIV (PLWH). Depression and anxiety have also been identified as risk factors for substance use among PLWH. Relatedly, other negative mood states, such as anger, may influence chronic pain among PLWH. The current cross-sectional study examined whether the distinct negative mood state of anger is associated with substance use among 187 PLWH who report chronic pain. Using negative binomial regression analyses, we found higher levels of anger were positively associated with alcohol use. Higher levels of anger were inversely associated with benzodiazepine use. No association was found between anger and marijuana use, and there were no significant interactions between anger and pain severity on substance use. Our findings suggest that anger is an independent risk factor for substance use among PLWH and chronic pain. Addressing anger may be useful when adapting behavioral therapies in the treatment of pain among PLWH.

The relationship between substance use and physical activity among people living with HIV, chronic pain, and symptoms of depression: a cross-sectional analysis

ABSTRACTChronic pain, depression, and substance use are common among people living with HIV (PLWH). Physical activity can improve pain and mental health. Some substances such as cannabis may alleviate pain, which may allow PLWH to participate in more physical activity. However, risks of substance use include poorer mental health and HIV clinical outcomes. This cross-sectional analysis examined the relationships of self-reported substance use (alcohol, cannabis, and nicotine use), gender, and age with self-reports of walking, moderate physical activity, and vigorous physical activity, converted to Metabolic Equivalent of Task Units (METs), among 187 adults living with HIV, chronic pain, and depressive symptoms in the United States. Women reported less walking, vigorous activity, and total physical activity compared to men. Individuals who used cannabis reported more vigorous physical activity relative to those who did not use cannabis. These findings were partially accounted for by substance use*gender interactions: men using cannabis reported more vigorous activity than all other groups, and women with alcohol use reported less walking than men with and without alcohol use. Research is needed to increase physical activity among women who use substances and to evaluate reasons for the relationship between substance use and physical activity among men.

Testing the Feasibility and Acceptability of an Acceptance and Commitment Therapy Intervention to Increase Physical Activity among Individuals with Depression: A Protocol Paper

Background

Engaging in regular physical activity (PA) is particularly important among individuals with depression, who are at heightened risk for a host of negative health outcomes. However, people with depression are 50% less likely to meet national guidelines for PA and face unique barriers to PA adherence, including lower distress tolerance and motivation for exercise. Acceptance and Commitment Therapy (ACT) may offer promise for increasing PA among adults with depressive symptoms due to its effects on distress tolerance and motivation. Therefore, we developed ACTivity, an ACT-based intervention designed to promote PA among low-active adults with elevated depressive symptoms. Prior to testing the efficacy of ACTivity in an RCT, an important first step is to conduct a preliminary trial to establish feasibility of study procedures for the ACTivity and comparison intervention programs, as well as to establish the credibility/acceptability of the intervention. The purpose of this paper is to describe the ACTivity intervention and the design of this feasibility trial.

Method/Design

We will conduct a feasibility RCT with two parallel groups and a 1:1 allocation ratio comparing ACTivity to a comparison intervention (relaxation training + PA promotion) among 60 low-active adults with elevated depressive symptoms. All study procedures will be conducted remotely.

Discussion

Results of this feasibility study will inform a subsequent RCT designed to test the efficacy of ACTivity. If shown to be efficacious, ACTivity will provide a treatment that can be widely disseminated to increase PA among adults with depressive symptoms and thereby decrease their risk for chronic disease.

Acceptance of chronic pain in depressed patients with HIV: correlations with activity, functioning, and emotional distress

Chronic pain is highly prevalent among persons with HIV (PWH), as is depression. Both comorbidities might contribute to, as well as be maintained by, avoidance-based coping. A promising alternative to avoidance-based coping is acceptance. Acceptance of pain is associated with improved functioning and quality of life in chronic pain patients, but this relationship has not been substantially explored among PWH. Cross-sectional data from 187 adult outpatients enrolled in a randomized trial for depressed PWH with chronic pain were analyzed. Controlling for pain severity and demographics, the relationships among pain acceptance and indicators of activity, functioning, and emotional distress (i.e., anxiety and anger) were assessed in seven regression models. No significant relationships were found between self-reported physical activity or objective measurement of mean steps/day with pain acceptance. Results revealed an inverse relationship between chronic pain acceptance and pain-related functional interference (by.x = -.52, p < .01) and a positive relationship with self-reported functioning (by.x = 7.80, p < .01). A significant inverse relationship with anxiety symptoms (by.x = -1.79, p < .01) and pain acceptance was also found. Acceptance of chronic pain can facilitate decreased emotional distress, improved well-being, and better functioning and quality of life. Further investigation of chronic pain acceptance among PWH could inform the development of acceptance-based interventions.

A pilot randomized clinical trial of tDCS for increasing exercise engagement in individuals with elevated depressive symptoms: Rationale, design, and baseline characteristics

Regular exercise protects against overweight/obesity as well as numerous chronic diseases. Yet, less than half of Americans exercise sufficiently. Elevated levels of depressive symptoms have been identified as an important correlate of physical inactivity as well as poor adherence to exercise programs. Individuals with depression are less sensitive to rewards and demonstrate an attentional bias toward negative stimuli. These, and other features of depression, may place them at increased risk for effectively managing the affective experience of exercise. Lower baseline levels of activation of the left (vs right) frontal cortex, an area implicated in affect regulation, have also been found in depression, potentially pointing to this region as a potential target for intervening on affect regulation during exercise. Transcranial direct current stimulation (tDCS) has shown promise in impacting a variety of cognitive and affective processes in a large number of individuals, including people with depression. Some findings have suggested that tDCS targeting the left dorsolateral prefrontal cortex (DLPFC), specifically, may improve emotion regulation. Transcranial direct current stimulation could theoretically be a novel and potentially promising approach to improving the affective experience of exercise, thereby increasing exercise adherence among individuals with depressive symptoms. Here we present the rationale, design, and baseline characteristics of a pilot randomized controlled trial of tDCS versus sham delivered 3x/week for 8 weeks in the context of supervised aerobic exercise (AE) program among 51 low-active individuals with elevated depressive symptoms (86.3% female; mean age = 49.5). Follow-up assessments were conducted at end of treatment, and three and six months after enrollment to examine changes in levels of objectively-measured moderate-to-vigorous physical activity (MVPA). If effective, this approach could have high public health impact on preventing obesity and chronic diseases among these at-risk individuals.

Improving functioning in HIV+ patients with chronic pain and comorbid depression: Protocol for a randomized clinical trial testing a collaborative behavioral health intervention based on behavioral activation

OBJECTIVE

Persons living with HIV (PWH) experience a disproportionate level of comorbid chronic pain and depression compared to individuals who do not have a diagnosis of HIV. Many PWH report pain that impairs daily function, is severe, and requires medical management. Depression alone is associated with HIV disease progression, medication non-adherence, and increased mortality. Given that numerous studies show that PWHs have chronic pain and depression despite pharmacologic treatment, there is a clear need for additional treatment modalities to address these conditions.

DESIGN

In this paper, we describe our protocol for a multisite, randomized controlled trial of the effectiveness of a collaborative behavioral intervention, called HIV-Pain and Sadness Support (HIVPASS), designed for PWH who endorse chronic pain and depressive symptoms, as compared to an attention matched Health Education (HE) condition. The HIVPASS intervention is based on Behavioral Activation and designed to target both pain and depression using an integrated model that promotes collaboration between HIV medical and psychological providers.

SETTING AND METHODS

We plan to (1) recruit PWH who endorse chronic pain and depression in three sites located in New England and the Midwestern United States and (2) compare our HIVPASS intervention to a full attention matched HE intervention with the primary outcome of pain interference, and secondary outcomes of depression, physical activity, HIV medication adherence, and health-related quality of life. Follow-up assessments will occur monthly for three months during the intervention phase and then during the post-intervention phase at months four, six, nine and twelve.

CONCLUSIONS

We provide descriptions of our protocol and interventions of our randomized controlled trial for comorbid chronic pain and depression in PWH.

TRIAL REGISTRATION

http://ClinicalTrials.govNCT02766751 https://clinicaltrials.gov/ct2/show/NCT02766751?term=stein%2C+michael&draw=2&rank=5.

Pharmacologic and Non-Pharmacologic Treatments for Chronic Pain Used by Patients with Pain, HIV, and Depression

The objective of this study was to understand pain treatment utilization, perceived efficacy, and differences in utilization by gender, clinic site, chronicity of pain, pain severity, and depression severity among people living with HIV (PLWH), chronic pain, and elevated depression symptoms. Participants included 187 PLWH at three HIV clinics in the U.S. Overall, 85% of participants reported taking a pain medication. One quarter (25%) reported non-pharmacological professional treatments for pain (e.g., massage, physical therapy), 60% reported mind-body treatments, including exercise, meditation, and yoga, and 62% reported other non-pharmacological self-administered treatments (e.g., heat/cold). Most pain treatments were considered "slightly helpful" or "moderately helpful." Non-pharmacological self-administered treatments were more commonly used among women than men and among individuals with constant vs. intermittent pain. Further research is needed to evaluate the efficacy of the preferred analgesic modalities of PLWH.

Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy for Depression: a Systematic Review of Cognitive Outcomes

Objectives

Summarize existing literature on cognitive outcomes of MBSR and MBCT for individuals with depression.

Methods

Following PRISMA (2021) guidance, we conducted a systematic review. We searched databases for studies published from 2000 to 2020 which examined cognitive outcomes of MBSR and MBCT in individuals with at least mild depressive symptoms. The search result in 10 studies (11 articles) meeting inclusion criteria.

Results

We identified five single armed trials and five randomized controlled trials. Results indicated that three studies did not show any improvements on cognitive outcomes, and seven studies showed at least one improvement in cognitive outcomes.

Conclusions

Overall, the review highlighted several inconsistencies in the literature including inconsistent use of terminology, disparate samples, and inconsistent use of methodology. These inconsistencies may help to explain the mixed results of MBSR and MBCT on cognitive outcomes. Recommendations include a more streamlined approach to studying cognitive outcomes in depressed individuals in the context of MBSR and MBCT.

Stress, coping and silver linings: How depressed perinatal women experienced the COVID-19 pandemic

BACKGROUND

Research on perinatal mental health during the COVID-19 pandemic has largely focused on data from community samples. This study sought to understand the experiences of pregnant and postpartum women with histories of clinically elevated symptoms of depression.

METHODS

Participants included 60 perinatal women who participated in wellness intervention trials for women with antenatal depression. We used a mixed methods approach, assessing depression, anxiety, stressors and coping behaviors, along with narrative responses to questions regarding COVID-specific effects on mental health.

RESULTS

Over three-fourths of the sample indicated a worsening of mental health during the pandemic, with 31.7% of women endorsing clinically elevated depression symptoms and 36.7% screening positive for anxiety. Women reported negative impacts on their emotional wellbeing, especially a resurgence of mental health symptoms. Participants also articulated positive experiences during the pandemic, including an appreciation for increased time with family, especially infants. Women detailed numerous, mostly adaptive, coping strategies they had used to mitigate stress; self-isolation and spending time outdoors were associated with having depression above or below the clinical cut off, respectively.

LIMITATIONS

The study had a small sample, and the generalizability of findings may be limited, given that participants were clinical trial completers.

CONCLUSIONS

Although the pandemic upended many aspects of life for perinatal women and raised mental health concerns, many also reported adaptive means of coping and positive experiences or 'silver linings' related to pandemic restrictions. Some coping strategies that were utilized, including wellness-based behaviors, may have helped to mitigate the impact of COVID-19 related stress.

Examining the effect of exercise on the relationship between affect and cravings among smokers engaged in cessation treatment

Cigarette smoking is associated with multiple adverse health outcomes. When smokers attempt to quit smoking, one of the leading predictors of relapse are cravings. Recent research shows a relationship between positive and negative affect, exercise, and cravings, but the exact nature of this relationship has yet to be understood. This study explored the relationships between positive and negative affect and cravings in a sample of participants with elevated levels of depressive symptoms (N = 202; 68.8% female; mean age = 46.1 years) who were enrolled in a smoking cessation trial to test the efficacy of a 12-week exercise intervention relative to a health education control on smoking outcomes. Data on affect and craving were gathered before weekly study intervention sessions, and data on cravings were gathered again after each session. The results showed that negative affect had a significant and positive association with cravings before an exercise or health education session. After the session, positive and negative affect were not significant predictors of changes in cravings from pre-session. However, regardless of level of positive or negative affect participants in the exercise condition showed greater reductions in craving pre- to post-class than those in the control condition. These findings suggest that negative affect is associated with cravings, but cravings can be mitigated by exercise.

Single-arm Pilot Trial of Hatha Yoga for Adolescents with Depression

The prevalence of adolescent depression is increasing, particularly among girls. Existing evidence-based treatments have limitations and/or may not be acceptable to all adolescents and parents. There is evidence that hatha yoga may be useful as an adjunctive treatment for depression in adults. The purpose of the current study was to assess acceptability and feasibility of hatha yoga for depression in teens. We conducted a single-arm pilot trial of 12 weeks of manualized yoga classes specifically targeted toward teens with elevated depression symptoms. We assessed acceptability and feasibility by several metrics and compared our results against a priori benchmarks. We also collected qualitative feedback on the classes. We enrolled 11 teens. We met a priori benchmarks for recruitment and retention rates, credibility of the yoga classes, satisfaction with classes, and (lack of) adverse events causally related to classes. Class attendance and amount of home practice fell below planned benchmarks. Qualitative feedback was positive from the majority, although not all, participants. Results from this study may be used to further refine yoga classes for depressed teens.

A Feasibility Study of a Peer-Facilitated Physical Activity Intervention in Methadone Maintenance

PURPOSE

While methadone maintenance treatment (MMT) has been effective in improving opioid use outcomes, most patients continue to engage in unhealthy lifestyles that lead to significant mental and physical health consequences. Interventions targeting increases in physical activity (PA) in MMT patients could have a significant impact on reducing the overall morbidity in these individuals. The purpose of this study was to assess acceptability and feasibility of a 12-week peer-facilitated PA intervention for MMT patients called TREC (Transforming Recovery with Exercise and Community).

METHOD

We developed and then pilot-tested TREC in 26 low-active MMT clients (73% female; mean age=41.2 years). TREC included: 1) an orientation session and intervention materials, 2) weekly PA discussion groups led by trained MMT clients, 3) peer-led walking groups and 4) a Fitbit activity tracker to facilitate self-monitoring of PA.

RESULTS

Participants attended 63% of eligible TREC sessions. Sixty-nine percent of the sample wore the Fitbit for at least 6 weeks (of the 12-week intervention). Participants reported that they enjoyed the group walks and that it was helpful to have a peer-facilitated PA group. There were small-to-moderate effect sizes for increases in PA, positive affect, and benefits of PA, and decreases in illicit opioid use and barriers to PA. No changes in depression, anxiety, and negative affect were observed from baseline to the end of the 12-week intervention.

CONCLUSION

Indicators of feasibility and acceptability suggest that a peer-facilitated PA intervention can be incorporated in the context of MMT. Low active, opioid dependent clients showed increases in PA during the 12-week intervention. A future randomized clinical trial is necessary to determine the efficacy of TREC on long-term maintenance of PA and ancillary mental health and substance use outcomes.

"We really need this": Trauma-informed yoga for Veteran women with a history of military sexual trauma

OBJECTIVES

Up to 70% of women service members in the United States report military sexual trauma (MST); many develop post-traumatic stress disorder (PTSD) and co-occurring disorders. Trauma-informed yoga (TIY) is suggested to improve psychiatric symptoms and shown feasible and acceptable in emerging research, yet no work has evaluated TIY in MST survivors. The current quality improvement project aimed to examine TIY's feasibility, acceptability, and perceived effects in the context of MST.

DESIGN

Collective case series (N = 7).

SETTING

New England Vet Center.

INTERVENTIONS

Extant TIY program (Mindful Yoga Therapy) adapted for Veteran women with MST in concurrent psychotherapy.

MAIN OUTCOME MEASURES

Attrition and attendance; qualitative exit interview; validated self-report measure of negative affect pre/post each yoga class, and symptom severity assessments and surveys before (T1; Time 1) and after the yoga program (T2; Time 2).

RESULTS

Feasibility was demonstrated and women reported TIY was acceptable. In qualitative interviews, women reported improved symptom severity, diet, exercise, alcohol use, sleep, and pain; reduced medication use; and themes related to stress reduction, mindfulness, and self-compassion. Regarding quantitative change, results suggest acute reductions in negative affect following yoga sessions across participants, as well as improved affect dysregulation, shame, and mindfulness T1 to T2.

CONCLUSIONS

TIY is both feasible and acceptable to Veteran women MST survivors in one specific Vet Center, with perceived behavioral health benefits. Results suggest TIY may target psychosocial mechanisms implicated in health behavior change (stress reduction, mindfulness, affect regulation, shame). Formal research should be conducted to confirm these QI project results.

Teens' perspectives on yoga as a treatment for stress and depression

OBJECTIVE

To understand adolescents' experiences and attitudes toward yoga, with a particular focus on acceptability and feasibility of a yoga intervention for depressed adolescents.

DESIGN

Qualitative analysis of data from three focus groups and eight individual interviews, for a total of 22 teen participants.

SETTING

Outpatient setting in a psychiatric hospital in the U.S.

MAIN OUTCOME MEASURES

Teens were asked about their own and their peers' attitudes toward, and experiences with, hatha yoga; reactions to a study-created yoga video; and opinions on class logistics.

RESULTS

Teens had both positive and negative attitudes toward, and experiences with, hatha yoga. They commented on "who does yoga;" many responses suggested a limited group (e.g., moms; people with money and time). Participants agreed that yoga could be potentially beneficial for depressed or stressed teens. Self-consciousness while being in a yoga class was a major concern. Overall, teens reacted favorably to the study-created yoga video. Teens had varied opinions about class logistics including class duration and size. Teens cited barriers to class, such as transportation, as well as barriers to home yoga practice.

CONCLUSIONS

Key points for developing a yoga class that might be appealing to depressed or stressed teens include: creating a class with variety that teens will find interesting; taking concrete steps to decrease teen self-consciousness; incorporating messages relevant for teens and consistent with yoga philosophy; and actively countering stereotypes about who practices yoga. Limitations of this study include the lack of data from male teens.

Benefits of Yoga on IL-6: Findings from a Randomized Controlled Trial of Yoga for Depression

The present research sought to examine whether hatha yoga, implemented as an adjunctive intervention for major depression, influences markers of inflammation. A subset of 84 participants who were enrolled in a randomized controlled trial (RCT) of hatha yoga vs. health education control provided blood samples at baseline (pre-treatment) and at 3-(during treatment) and 10-week (end of treatment) follow-up visits. To be eligible for the RCT, participants met criteria for a current or recent (past two years) major depressive episode, had current elevated depression symptoms, and current antidepressant medication use. Venous blood was drawn between 2 and 6 pm and following at least one hour of fasting, and inflammatory markers (IL-6, CRP, and TNF-α) were assayed. Effects of participation in yoga relative to health education on inflammatory markers over time were examined with latent growth analyses. We observed a significant reduction in IL-6 concentrations in the yoga treatment group relative to the health education control group as demonstrated by a negative interaction between treatment group and slope of IL-6. TNF-α and CRP did not evidence significant interactions of treatment group by mean slope or intercept. In addition to the benefits of hatha yoga as an adjunctive intervention for individuals who have shown inadequate response to antidepressant medications, our findings point to possible benefits of yoga on IL-6 in depressed populations. Further research is needed to explore the effects of hatha yoga on immune function over time.

Yoga v. health education for attentional processes relevant to major depressive disorder

Objectives

Research has shown that yoga may be an effective adjunctive treatment for persistent depression, the benefits of which may accumulate over time. The objectives of this study were to evaluate the following in a sample of persistently depressed individuals: whether yoga increases mindfulness and whether yoga attenuates rumination. Rumination and mindfulness both represent attentional processes relevant for onset and maintenance of depressive episodes.

Methods

One-hundred-ten individuals who were persistently depressed despite ongoing use of pharmacological treatment were recruited into an RCT comparing yoga with a health education class. Mindfulness and rumination were assessed at baseline and across 3 time points during the ten-week intervention.

Results

Findings demonstrate that, compared to health education, yoga was associated with higher mean levels of the observe facet of mindfulness relative to the control group during the intervention period (p =.004, d =0.38), and that yoga was associated with a faster rate of increase in levels of acting with awareness over the intervention period (p= .03, f² =0.027). There were no differences between intervention groups with respect to rumination.

Conclusions

Results suggest a small effect of yoga on components of mindfulness during a 10-week intervention period. Previous research suggests that continued assessment after the initial 10 weeks may reveal continued improvement. Future research may also examine moderators of the impact of yoga on mindfulness and rumination, including clinical factors such as depression severity or depression chronicity, or demographic factors such as age.

An adapted Delphi approach: The use of an expert panel to operationally define non-judgment of internal experiences as it relates to mindfulness

OBJECTIVES

There are several definitions of mindfulness throughout the literature, many of which suggest an attitude of non-judgmental awareness. However, the concept of "non-judgment" itself has not previously been systematically operationally defined. Our purpose was to use an expert panel to generate an operational definition of non-judgment of internal experiences, as it relates to mindfulness, to be used to inform the development of an implicit measure of the construct.

DESIGN

We utilized an adapted Delphi survey method consisting of three survey rounds.

SETTING

We employed in-person and online survey methods.

RESULTS

We used three survey rounds with an adapted Delphi approach. Expert review panelists consisted of 18 mindfulness researchers or clinicians. Each round of survey results was assessed and discussed among the core team. A consensus was reached among the core team for an operational definition of non-judgment of internal experiences: "acknowledging our thoughts, feelings, and sensations, as they are, without applying valence (e.g., good, bad, right, wrong) to them."

CONCLUSIONS

An expert panel review process informed the generation of an operational definition of non-judgment of internal experiences. Our operational definition provides a foundation for the future development of an implicit task of non-judgment of internal experiences, with the aim of using this task to assess change in response to mindfulness-based treatments. To our knowledge, this is the first systematic definition of non-judgment of internal experiences within the mindfulness literature.

A Novel Experiential Quality Improvement Training Program During Residency Improves Quality Improvement Confidence and Knowledge: a Prospective Cohort Study

OBJECTIVE

The Accreditation Council for Graduate Medical Education (ACGME) mandates resident quality improvement (QI) training to improve patient safety, cost control, and efficiency. Thus, understanding this topic is crucial for early career physicians. This manuscript describes an enhanced, experiential QI curriculum for psychiatry residents and its outcomes.

METHODS

Two cohorts of 12 third-year residents completed the curriculum, which included didactics, external resources, and expert guidance through small group project design, implementation, and analysis/presentation. A survey on resident confidence in QI principles and the quality improvement knowledge assessment tool-revised (QIKAT-R) was used before and after curriculum participation. Data were analyzed using parametric descriptive tests and repeated measures general linear models with Benjamini-Hochberg correction for multiple comparisons.

RESULTS

Resident confidence in performing seven of the ten steps of QI and QIKAT-R scores significantly improved for both cohorts (p = .011). Eighty-nine percent of residents felt that the curriculum met their goals.

CONCLUSIONS

The QI curriculum effectively improved resident QI confidence and knowledge. Residents reported that experiential engagement in the design, implementation, and analysis/presentation of their project was crucial to these achievements. This experiential QI curriculum with resident-generated QI projects addressed ACGME training requirements while integrating QI training directly into the residents' clinical activities, making the QI efforts relevant and meaningful while also achieving ACGME goals.

Combined intervention approaches for initiating and maintaining physical activity in depressed individuals: design and rationale of the Project MOVE randomized clinical trial

INTRODUCTION

Regular engagement in physical activity decreases risks for many chronic conditions, and may also improve depression symptoms. However, rates of physical activity and adherence to exercise interventions remain low among depressed individuals relative to non-depressed individuals.

METHODS

This is a study protocol for Project MOVE. This study is a theoretically-driven, 3-arm randomized controlled trial for increasing physical activity with depressed adults. Each successive arm includes an added component that may serve to increase and maintain physical activity. The arms are: 1) Brief advice (BA) to exercise alone (minimal treatment control condition); 2) BA + supervised and home-based exercise (SHE) + health education (HE; serves as contact control for CBEX); and 3) BA + SHE +cognitive-behavioral sessions focused on increasing and maintaining exercise (CBEX). The target sample size is 240. Assessments are conducted at baseline, Month 1.5, end of intervention (month 3), and at 6 and 9 months. The primary outcome is minutes of moderate-to-vigorous physical activity, assessed via an accelerometer. Secondary outcomes include cardiorespiratory fitness, body composition, and depression, and maintenance of moderate-vigorous physical activity through 6 and 9 month follow-ups. Mediators and moderators derived from behavior change theories, including the Health Behavior Model, Self-Determination Theory, and Social Ecological Theory, will be examined.

CONCLUSION

Project MOVE is designed to test primarily whether both a structured exercise program (SHE) and a cognitive-behavioral group (CBEX) increase physical activity in depressed adults during both a 3-month intervention period, and during the 6-months that follow.

Using behavioral psychotherapy techniques to address HIV patients' pain, depression, and well-being

For persons with HIV (PWH), aims of psychotherapy can extend beyond HIV-related topics. Issues such as HIV stigmatization and disclosure and HIV-related self-care including treatment adherence might be ongoing concerns, but patients often need support to develop skills to manage other problems, whether functional or psychiatric. In the context of an ongoing randomized clinical trial, we delivered an individual, behavioral activation-based intervention to PWH with comorbid chronic pain and depression. Our primary treatment target was to reduce pain-related interference in physical and psychosocial functioning. Throughout the course of the 7-session intervention, clinicians used 4 core strategies to help patients improve a variety of domains related to their health and well-being: (a) teaching value-based goal setting, (b) developing skills to be an activated and informed patient, (c) focusing on changing behavior despite discomfort, and, (d) facilitating access to care (e.g., flexible scheduling and primarily phone sessions). The application of these strategies to HIV-related and non-HIV-related problems are presented to illustrate how and when clinicians can utilize these strategies. These practical lessons will inform a flexible approach to helping PWH address a myriad of health and functional issues related to their overall well-being. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

A pilot study assessing acceptability and feasibility of hatha yoga for chronic pain in people receiving opioid agonist therapy for opioid use disorder

The purpose of this project was to assess the feasibility and acceptability of a hatha yoga program designed to target chronic pain in people receiving opioid agonist therapy for opioid use disorder. We conducted a pilot randomized trial in which people with chronic pain who were receiving either methadone maintenance therapy (n = 20) or buprenorphine (n = 20) were randomly assigned to weekly hatha yoga or health education (HE) classes for 3 months. We demonstrated feasibility in many domains, including recruitment of participants (58% female, mean age 43), retention for follow-up assessments, and ability of teachers to provide interventions with high fidelity to the manuals. Fifty percent of participants in yoga (95% CI: 0.28-0.72) and 65% of participants in HE (95% CI: 0.44-0.87) attended at least 6 of 12 possible classes (p = 0.62). Sixty-one percent in the yoga group reported practicing yoga at home, with a mean number of times practicing per week of 2.67 (SD = 2.37). Participant mood improved pre-class to post-class, with greater decreases in anxiety and pain for those in the yoga group (p < 0.05). In conclusion, yoga can be delivered on-site at opioid agonist treatment programs with home practice taken up by the majority of participants. Future research may explore ways of increasing the yoga "dosage" received. This may involve testing strategies for increasing either class attendance or the amount of home practice or both.

Community-Delivered Heated Hatha Yoga as a Treatment for Depressive Symptoms: An Uncontrolled Pilot Study

Objectives: There are no known studies of concurrent exposure to high temperature and yoga for the treatment of depression. This study explored acceptability and feasibility of heated (Bikram) yoga as a treatment for individuals with depressive symptoms. Design: An 8-week, open-label pilot study of heated yoga for depressive symptoms. Subjects: 28 medically healthy adults (71.4% female, mean age 36 [standard deviation 13.57]) with at least mild depressive symptoms (Hamilton Rating Scale for Depression [HRSD-17] score ≥10) who attended at least one yoga class and subsequent assessment visit. Intervention: Participants were asked to attend at least twice weekly community held Bikram Yoga classes. Assessments were performed at screening and weeks 1, 3, 5, and 8. Hypotheses were tested using a modified-intent-to-treat approach, including participants who attended at least one yoga class and subsequent assessment visit (N = 28). Results: Almost half of our subjects completed the 8-week intervention, and close to a third attended three quarters or more of the prescribed 16 classes over 8 weeks. Multilevel modeling revealed significant improvements over time in both clinician-rated HRSD-17 (p = 0.003; d_GLMM = 1.43) and self-reported Beck Depression Inventory (BDI; p < 0.001, d_GLMM = 1.31) depressive symptoms, as well as the four secondary outcomes: hopelessness (p = 0.024, d_GLMM = 0.57), anxiety (p < 0.001, d_GLMM = 0.78), cognitive/physical functioning (p < 0.001, d_GLMM = 1.34), and quality of life (p = 0.007, d_GLMM = 1.29). Of 23 participants with data through week 3 or later, 12 (52.2%) were treatment responders (≥50% reduction in HRSD-17 score), and 13 (56.5%) attained remission (HRSD score ≤7). More frequent attendance was significantly associated with improvement in self-rated depression symptoms, hopelessness, and quality of life. Conclusions: The acceptability and feasibility of heated yoga in this particular sample with this protocol warrants further attention. The heated yoga was associated with reduced depressive symptoms, and other improved related mental health symptoms, including anxiety, hopelessness, and quality of life.

African American women's relationship with their mobile phone, and what they want in a mobile delivered physical activity intervention: guidance for intervention development

BACKGROUND

Mobile phone text messaging is an emerging platform in physical activity (PA) interventions with African American (AA) women. Research on the relationship that AA women have with their mobile phone as well as their views about text messaging as a potentially viable platform to help them acquire and maintain regular PA is central in advancing this field of research. Both self-report measures and qualitative interviews may be helpful in this endeavor.

METHODS

In the current study, a sample of 42 generally physically inactive AA women (mean age =35, SD =10.25) completed the Mobile Phone Affinity Scale (MPAS), which consists of six subscales that represent both positive (Connectedness, Productivity, Empowerment) and negative (Continuous Use, Anxious Attachment, Addiction) cognitions and behaviors that are associated with mobile phone use patterns. A subgroup of twenty participants completed a semi-structured qualitative interview that explored their views of text messaging technology as a potential platform to help become and remain physically active. Quantitative analyses included frequency and analyses of variance (ANOVAs) and assessed mobile phone use patterns and demographic differences based on age, marital status and education on the MPAS. Qualitative content analysis was conducted on participants' verbatim responses.

RESULTS

Results indicated that participants overall endorsed the positive MPAS subscales at a higher frequency compared to the negative subscales. Demographic differences were noted only for age and marital status for some of the MPAS subscales. Younger participants reported higher mean scores for the MPAS subscales Connectedness (P=0.005), Empowerment/Safety (P=0.04), Continuous Use (P=0.04), and Addiction (P=0.004) in comparison to older participants. Significant results for marital status showed single participants were higher on the Connectedness (P=0.02) and Productivity (P=0.01) subscales compared to married participants. Qualitative data showed that 19 of the 20 participants (95%) viewed text messaging as an appealing platform to deliver daily motivational messages to increase PA engagement. Participants stated a text messaging PA intervention would be "convenient" and "motivating". However, most participants suggested that other mobile phone technology applications in addition to text messaging would facilitate self-monitoring PA behaviors (e.g., goal setting, activity tracking) in mobile phone delivered (mHealth) PA interventions targeting AA women.

CONCLUSIONS

The study findings provide guidance in the development of mHealth intervention approaches for PA promotion that are likely to appeal to AA women, increase engagement, and behavior change among this group.

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.

Weekly assessment of number of yoga classes and amount of yoga home practice: Agreement with daily diaries

OBJECTIVE

To evaluate a weekly yoga practice assessment instrument designed to assess number of classes attended in the previous week, number of times engaged in formal home yoga practice, total number of minutes engaged in formal home yoga practice in the past week, and number of times engaged in informal home yoga practice. "Informal" practice was defined as "in the middle of other activities, you spent a few moments engaged in asanas/postures, focus on breath, body awareness, or very brief meditation, for less than 5 min at a time." We assessed agreement between this weekly assessment and a daily home practice log.

DESIGN AND SETTING

Seventy-two community yoga practitioners completed online daily yoga logs for 28 days as well as the weekly yoga practice assessment four times over the 28 day period.

RESULTS

We examined agreement between the two methods on the four indices of amount of weekly yoga practice. We found acceptable agreement between the two methods for number of classes, number of times engaged in formal home practice, and total number of minutes engaged in formal home practice. Agreement was lower for number of times engaged in informal practice.

CONCLUSIONS

These data provide support for use of a weekly yoga practice assessment to assess number of classes attended and amount of formal but not informal home practice.

Treatment credibility, expectancy, and preference: Prediction of treatment engagement and outcome in a randomized clinical trial of hatha yoga vs. health education as adjunct treatments for depression

BACKGROUND

Hatha yoga may be helpful for alleviating depression symptoms. The purpose of this analysis is to determine whether treatment program preference, credibility, or expectancy predict engagement in depression interventions (yoga or a control class) or depression symptom severity over time.

METHODS

This is a secondary analysis of a randomized controlled trial (RCT) of hatha yoga vs. a health education control group for treatment of depression. Depressed participants (n = 122) attended up to 20 classes over a period of 10 weeks, and then completed additional assessments after 3 and 6 months. We assessed treatment preference prior to randomization, and treatment credibility and expectancy after participants attended their first class. Treatment "concordance" indicated that treatment preference matched assigned treatment.

RESULTS

Treatment credibility, expectancy, and concordance were not associated with treatment engagement. Treatment expectancy moderated the association between treatment group and depression. Depression severity over time differed by expectancy level for the yoga group but not for the health education group. Controlling for baseline depression, participants in the yoga group with an average or high expectancy for improvement showed lower depression symptoms across the acute intervention and follow-up period than those with a low expectancy for improvement. There was a trend for a similar pattern for credibility. Concordance was not associated with treatment outcome.

LIMITATIONS

This is a secondary, post-hoc analysis and should be considered hypothesis-generating.

CONCLUSIONS

Results suggest that expectancy improves the likelihood of success only for a intervention thought to actively target depression (yoga) and not a control intervention.

Addressing Unhealthy Substance Use in Primary Care

Unhealthy substance use is common in primary care populations and is a major contributor to morbidity and mortality. Two key strategies to address unhealthy substance use in primary care are the process of screening, brief intervention, and referral to treatment (SBIRT), and integration of treatment for substance use disorders into primary care. Implementation of SBIRT requires buy-in from practice leaders, careful planning, and staff and primary care provider training. Primary care-based treatment of opioid and alcohol use disorders can be effective; more data are needed to better understand the benefits of these models and identify means of treating other substance use disorders in primary care.

Effects of Negative Affect, Urge to Smoke, and Working Memory Performance (n-back) on Nicotine Dependence

BACKGROUND

Three key domains including negative emotionality, incentive salience, and executive function form the core functional elements of addictive behaviors. Variables related to these broader domains have been studied extensively in relation to one another; however, no studies to date, have examined models including variables from all three domains, in relation to nicotine dependence.

METHOD

Smokers (N = 117), 65.8% female, 78% white, mean age of 44.4 (SD = 10.8), enrolled in a smoking cessation program completed measures of negative affect (a component of negative emotionality), urge to smoke (incentive salience), and working memory (WM; a core executive function), during a baseline assessment period prior to initiating treatment.

RESULTS

Negative affect was associated with greater urge to smoke, and this elevated urge to smoke was associated with higher levels of nicotine dependence. Further, a significant moderated mediation indicated that WM moderated the relationship between increased urge to smoke and nicotine dependence. For those with low to average WM, urge to smoke was significantly related to nicotine dependence; however, for those with higher WM (+1 SD), urge to smoke stemming from negative affect was not associated with nicotine dependence.

CONCLUSIONS

To our knowledge, this is the first reported relationship between negative affect, urge to smoke, WM, and nicotine dependence. Although preliminary, results indicate that WM may moderate the relationship between urge to smoke associated with negative affect and nicotine dependence. Treatments targeting WM may be particularly useful for individuals with average to low WM who experience urge to smoke related to negative affect.

Yoga for Depression and Anxiety: A Review of Published Research and Implications for Healthcare Providers

(Reprinted with permission from Rhode Island Medical Journal, 20-22, 2016).

Development of a Storytelling Video Self-Help Intervention Based on Acceptance and Commitment Therapy for Major Depression: Open Trial Results

This study involved the initial development and testing of a video self-help intervention called LifeStories, which features real patients describing their use of coping strategies for depression based on Acceptance and Commitment Therapy. We conducted a baseline-controlled open trial (AB design) of 11 individuals diagnosed with major depressive disorder. Participants reported high levels of satisfaction and transportation (i.e., engagement) after watching LifeStories. No significant changes were observed during the 4-week baseline period in terms of interviewer-rated depression severity (primary outcome), but a significant and large effect size improvement was observed at Week 8 postintervention. The majority of participants (54.5%) showed a reliable and clinically significant posttreatment response. Significant improvements also were observed during the intervention period only for self-reported depressive symptoms and aspects of mindfulness (nonreactivity). Qualitative data analysis of participant interviews identified additional areas for improvement and refinement. Future testing in a randomized trial is warranted based on these encouraging results.

Adjunctive yoga v. health education for persistent major depression: a randomized controlled trial

BACKGROUND

The objective of this study was to determine whether hatha yoga is an efficacious adjunctive intervention for individuals with continued depressive symptoms despite antidepressant treatment.

METHOD

We conducted a randomized controlled trial of weekly yoga classes (n = 63) v. health education classes (Healthy Living Workshop; HLW; n = 59) in individuals with elevated depression symptoms and antidepressant medication use. HLW served as an attention-control group. The intervention period was 10 weeks, with follow-up assessments 3 and 6 months afterwards. The primary outcome was depression symptom severity assessed by blind rater at 10 weeks. Secondary outcomes included depression symptoms over the entire intervention and follow-up periods, social and role functioning, general health perceptions, pain, and physical functioning.

RESULTS

At 10 weeks, we did not find a statistically significant difference between groups in depression symptoms (b = -0.82, s.e. = 0.88, p = 0.36). However, over the entire intervention and follow-up period, when controlling for baseline, yoga participants showed lower levels of depression than HLW participants (b = -1.38, s.e. = 0.57, p = 0.02). At 6-month follow-up, 51% of yoga participants demonstrated a response (⩾50% reduction in depression symptoms) compared with 31% of HLW participants (odds ratio = 2.31; p = 0.04). Yoga participants showed significantly better social and role functioning and general health perceptions over time.

CONCLUSIONS

Although we did not see a difference in depression symptoms at the end of the intervention period, yoga participants showed fewer depression symptoms over the entire follow-up period. Benefits of yoga may accumulate over time.

Perceptions of hatha yoga amongst persistently depressed individuals enrolled in a trial of yoga for depression

OBJECTIVES

To understand depressed individuals' experiences in a 10-week hatha yoga program.

DESIGN

In a randomized controlled trial, participants were assigned to either 10 weeks of hatha yoga classes or a health education control group. This report includes responses from participants in yoga classes. At the start of classes, average depression symptom severity level was moderate.

MAIN OUTCOME MEASURES

After 10 weeks of yoga classes, we asked participants (n=50) to provide written responses to open-ended questions about what they liked about classes, what they did not like or did not find helpful, and what they learned. We analyzed qualitative data using thematic analysis.

RESULTS AND CONCLUSIONS

Elements of yoga classes that may increase acceptability for depressed individuals include having instructors who promote a non-competitive and non-judgmental atmosphere, who are knowledgeable and able to provide individualized attention, and who are kind and warm. Including depression-related themes in classes, teaching mindfulness, teaching breathing exercises, and providing guidance for translating class into home practice may help to make yoga effective for targeting depression. Participants' comments reinforced the importance of aspects of mindfulness, such as attention to the present moment and acceptance of one's self and one's experience, as potential mechanisms of action. Other potential mechanisms include use of breathing practices in everyday life and the biological mechanisms that underlie the positive impact of yogic breathing. The most serious concern highlighted by a few participants was the concern that the yoga classes were too difficult given their physical abilities.

The Role of Physical Activity Enjoyment on the Acute Mood Experience of Exercise among Smokers with Elevated Depressive Symptoms

PROBLEM

Depressive symptoms are consistently shown to be related to poor smoking cessation outcomes. Aerobic exercise is a potential treatment augmentation that, given its antidepressant and mood enhancing effect, may bolster cessation outcomes for smokers with elevated depressive symptoms. Lower enjoyment of physical activity may inhibit the acute mood enhancing effects of aerobic exercise. The current study investigated the associations between depressive symptoms, physical activity enjoyment and the acute mood experience from exercise among low-active smokers with elevated depressive symptoms.

METHOD

Daily smokers with elevated depressive symptoms (N=159; M_age = 45.1, SD = 10.79; 69.8% female) were recruited for a randomized controlled exercise-based smoking cessation trial. Participants self-reported levels of depressive symptoms, physical activity enjoyment, and rated their mood experience (assessed as "mood" and "anxiety") before and after a standardized aerobic exercise test.

RESULTS

Hierarchical regression analysis revealed that depressive symptom severity accounted for significant unique variance in physical activity enjoyment (R² =.041, t = -2.61, p = .010), beyond the non-significant effects of gender and level of tobacco dependence. Additionally, physical activity enjoyment was a significant mediator of the association between depressive symptom severity and acute mood experience ("mood" and "anxiety") following the exercise test.

CONCLUSIONS

Physical activity enjoyment may explain, at least in part, how depressive symptom severity is linked to the acute mood experience following a bout of activity. Interventions that target increasing physical activity enjoyment may ultimately assist in enhancing the mood experience from exercise, and therefore improve smoking cessation likelihood, especially for smokers with elevated depressive symptoms.

Implementation of an acceptance- and mindfulness-based group for depression and anxiety in primary care: Initial outcomes

INTRODUCTION

Depression and anxiety disorders are highly prevalent among primary care patients. Group visits provide a way of delivering interventions to multiple patients at the same time. Group visits for depression and anxiety present an opportunity to expand the reach of behavioral health services for primary care patients. The goal of the current study was to evaluate the implementation of an acceptance and mindfulness-based group for primary care patients with depression and anxiety.

METHODS

Adult family medicine patients with Patient Health Questionnaire-9 (PHQ-9) and/or Generalized Anxiety Disorder Scale-7 (GAD-7) scores > 5 were eligible for the group. The group was held biweekly in the family medicine practice with rolling enrollment. The PHQ-9 and GAD-7 were administered at every visit, and changes in depression and anxiety symptoms were analyzed using multilevel modeling. We evaluated feasibility, acceptability/satisfaction, penetration, and sustainability.

RESULTS

Over the course of 19 months, 50 patients were referred to the group, and 29 enrolled. The median number of visits attended was four among those who attended more than one group visit. Results revealed that depression and anxiety symptoms decreased significantly over the first four visits attended (d = -.26 and -.19, respectively). Patients who attended more than one group reported high satisfaction. The group was sustainable after the research funding ended; however, penetration was low.

DISCUSSION

A rolling enrollment group for patients with depression and anxiety that utilized mindfulness- and acceptance-based treatment principles is feasible to implement in a primary care setting but is not without challenges. Recommendations for ways to enhance implementation and future research are provided. (PsycINFO Database Record

Pilot Randomized Trial of Collaborative Behavioral Treatment for Chronic Pain and Depression in Persons Living with HIV/AIDS

In this pilot study, we assessed feasibility and acceptability of a behavior therapy intervention for pain and depressive symptoms in persons living with HIV/AIDS (PLWH). We randomly assigned 23 participants to HIV-PASS (HIV-Pain and Sadness Study) or a health education control arm for 3 months. On average, participants attended more than 5 sessions (of 7 possible) in both arms. Qualitative data suggest HIV-PASS participants understood key messages and made concrete behavioral changes. HIV-PASS was associated with effects in the expected direction for three of four outcomes, including the primary outcome (pain-related interference with functioning). Findings suggest that HIV-PASS is promising.

Differential endorsement of suicidal ideation and attempt in bipolar versus unipolar depression: a testlet response theory analysis

BACKGROUND

Published data concerning differences in suicide risk across the mood disorders spectrum remain mixed. The current study used testlet response theory methods to evaluate differences in the endorsement of suicidal ideation and attempt in an epidemiological sample of individuals with bipolar and unipolar depression.

METHOD

Participants with lifetime history of bipolar I (n=1154), bipolar II (n=494), and unipolar (n=5695) depression were drawn from the National Epidemiologic Survey on Alcohol and Related Conditions, which included 4 structured queries concerning suicidal ideation/attempt. We estimated differential item functioning between groups with a 2-pl parametric item response model.

RESULTS

Endorsement of suicide items increased as a function of underlying depression severity. Equating for severity, endorsement of suicidal ideation and attempt was generally more frequent in bipolar versus unipolar depression, and in bipolar I versus bipolar II depression. Yet findings were not consistent across all suicide items, and differences were small in magnitude.

LIMITATIONS

The NESARC relied upon lifetime endorsement of suicide items, and suicide risk was only evaluated within the context of a major depressive episode. Thus, this study could not evaluate endorsement of suicide items within the context of (hypo)manic or mixed states.

CONCLUSION

Although there were some group differences, patterns of item endorsement were more similar than different. These data support a transdiagnostic model of suicide that emphasizes underlying depression severity over mood disorder class.

Patients' Beliefs About Medications are Associated with Stated Preference for Methadone, Buprenorphine, Naltrexone, or no Medication-Assisted Therapy Following Inpatient Opioid Detoxification

Subsequent to initial opioid detoxification, people with opioid use disorder are typically advised to engage in follow-up treatment to prevent relapse. Medication-assisted treatments (MATs) - i.e., the opioid agonist methadone (MMT) or partial agonist/antagonist, buprenorphine/naltrexone (BUP) -- are the maintenance treatment options with the best research support for positive outcomes. A third MAT, injectable extended-release naltrexone (XR-NTX), was approved by the FDA for opioid dependence in 2010 and shows promise. However, relatively few eligible patients choose to initiate one of these MATs following initial detoxification treatment. Consistent with the health belief model, we hypothesized that beliefs about 1) efficacy of each MAT; 2) safety of each MAT; and 3) perceived consistency with being drug-free would predict stated patient preferences for a particular MAT or for no MAT. We also hypothesized that perceived structural barriers (e.g., time, transportation) would decrease the likelihood of stating a preference for a given MAT. To assess these hypotheses, we surveyed 372 people undergoing inpatient opioid detoxification treatment. Results supported hypotheses for all 3 sets of patient beliefs, with the patient group stating that they preferred a particular MAT having significantly more positive beliefs about that MAT relative to other groups (p<.001). The group that preferred "no MAT" had the most negative beliefs about all MATs. Perceived structural barriers were not related to stated preferences, except that people who preferred BUP were more likely to endorse barriers to MMT than any of the other 3 groups. Notably, a relatively high proportion (32%) of participants were most interested in XR-NTX despite a lack of prior experience with this medication. These results suggest that efforts to increase MAT enrollment following detoxification might benefit from including patient beliefs as one set of factors to assess and target for change.