Author: Catherine Rochefort

As more and more individuals are surviving cancer, interventions to promote mental health and quality of life in cancer survivors are growing. It is well established that physical activity is an appropriate intervention for preventing and treating depression in cancer survivors, who are frequently at risk of developing multiple depressive episodes following treatment. Unfortunately, the interplay between depression and physical activity in cancer survivors is unknown. Specifically, it is unclear whether physical activity buffers against depression or whether depression leads to low physical activity. Perhaps both are true. By answering this question, researchers can help determine whether targeting depression before physical activity (or physical activity before depression) can benefit cancer survivors’ quality of life. Ultimately, understanding this phenomenon will enhance the effectiveness of mental and physical health interventions for this growing population.

In a longitudinal observational study involving 201 female breast cancer survivors, the women completed measures of depression and wore a physical activity monitor to measure daily physical activity at five time points. A few methodological strengths are apparent in this study, including the longitudinal design and the objectively measured physical activity level. Longitudinal designs are considered strong research designs because they allow researchers to determine the temporal order of associations between variables. In addition, using an activity monitor to measure physical activity instead of using self-reported activity levels allows researchers to avoid biases in participants’ recall of their own activity level.

Brunet et al. (2018) found unexpected results. Mainly, previous depression did not predict future physical activity, and previous physical activity did not predict future depression. In addition, these effects did not vary across the multiple time points. These findings are counter-intuitive because previous research has shown predictive associations between depression and physical activity. But given that the researchers did not necessarily expect any change in physical activity or depression over time (i.e., there was no intervention), it is possible that the study did not include a large enough sample to detect subtle changes. Greater statistical power (which is typically achieved by including more participants) would allow researchers to detect smaller effects.

Given that physical activity has been shown to reduce depression in community and cancer survivor samples, it will be important to determine why these associations have been found and in what ways these associations may be different in cancer survivors. In order to prevent and treat depression in cancer survivors, clarifying the barriers to physical activity that these individuals face during their transition to survivorship will inform intervention development. Ultimately, physical activity and depression interventions may need to be artfully combined in order to enhance quality of life for cancer survivors.

Reference: Brunet, J., O’Loughlin, J. L., Gunnell, K. E., & Sabiston, C. M. (2018). Physical activity and depressive symptoms after breast cancer: Cross-sectional and longitudinal relationships. Health Psychology, 37(1), 14-23.

Inadequate physical activity levels are associated with a shorter lifespan because inadequate physical activity can increase an individual’s risk of developing chronic illnesses, like diabetes. Although the evidence is clear that increasing physical activity levels is important for preventing illness and premature mortality across the lifespan, do individual’s perceptions of their physical activity levels compared to others influence mortality? Prior work suggests that individual’s perceptions of their own health behaviors influences actual health behavior engagement leading to health outcomes.

A study recently published in Health Psychology examined whether adults’ perceptions of their physical activity levels predicted mortality. Data for this study came from the National Center for Health Statistics (NCHS), and included 61,141 participants across three nationally representative samples with follow-up time points up to 21 years later. One of the most important advantages of analyzing data from large-scale epidemiological studies is greater confidence in the accuracy of results by reducing the likelihood for error. Participants were asked to rate whether they perceived themselves as a lot more active, a little more active, as active, a little less active, and a lot less active than other people their same age. In addition, participants provided data on their actual physical activity levels via self-report or an accelerometer. Mortality was measured as death from any cause collected from the 2011 National Death Index. The authors chose to control for demographics variables, perceived health, number of illnesses, disability, mental health, smoking, body mass index, and actual physical activity levels in analyses to rule out alternative explanations for the effect.

This study found that, even after controlling for many variables influencing mortality, those who perceived themselves as a little more active or as active as others had an 8% increased likelihood of having died than those who perceived themselves as a lot more active than others. In addition, those who perceived themselves as a lot less active had an 18% increased likelihood of having died than those who perceived themselves as a lot more active. These results replicated in two additional samples, which provides evidence that these findings were not due to chance.

Taken together, this study supports a growing body of evidence that an individual’s perception of their own physical activity levels compared to others influences mortality. The authors suggest that perceptions predict mortality by influencing actual physical activity engagement. Future research will need to examine this mechanism. Given that physical activity interventions focus on increasing actual rates of physical activity, this study suggests that interventions may also want to target individual’s perceptions of their physical activity levels by informing people of their actual physical activity levels compared to others. Future research will need to assess the reasons why perceptions and social comparisons influence behavior.

Reference: Zahrt, O.H., & Crum, A.J. (2017). Perceived physical activity and mortality: Evidence from three nationally representative US samples. Health Psychology, 36, 1017-1025.

The American Cancer Society estimates that 10,000 people a year will die from melanoma, a deadly form of skin cancer primarily caused by sun exposure. First-degree relatives of melanoma patients, such as parents and children, are at particularly high risk for developing melanoma themselves. One would imagine that with higher risk of developing skin cancer, first-degree relatives of melanoma patients would be more likely to engage in sun protective behaviors than others. However, is this actually the case?

A study recently published in Health Psychology examined the use of four sun-protective behaviors: sunscreen usage, shade-seeking, hat wearing, and protective clothing use among first-degree relatives of melanoma patients. The researchers assessed these behaviors twice a day in 59 participants over 14-days using an automated phone call system. Data collected from daily surveys over multiple days allows researchers to examine and understand behavior in real-time, and allows for exploring changes in behavior within individual participants that increases confidence in the reliability and robustness of the findings.

Among the four behaviors examined, sunscreen use was most frequent, followed by shade seeking, wearing hats, and wearing protective clothing. However, the majority of participants reported inconsistent use of these behaviors meaning most participants used each sun protection behavior less than 80% of the time. In addition, the study found that the factors leading to sun protective behaviors were different for different participants. This means that different environmental factors, such as time of day and level of sun exposure, influenced individual’s use of sun protection behaviors. This finding is important because it indicates that sun protection interventions may need to target people’s own reasons for using sun protection behavior.

Taken together, sun protection behaviors are inconsistently used in individuals at increased risk of developing skin cancer. Moreover, factors leading to sun protective behaviors vary for different individuals. Future research should examine associations between multiple sun protection behaviors, and develop personally tailored interventions to increase individuals’ use of sun protection behaviors.

Reference: Hay, J.L., Shuk, E., Schofield, E., Loeb, R., Holland, S., Burkhalter, J., & Li, Y. (2017). Real-time sun protection decisions in first-degree relatives of melanoma patients. Health Psychology, 36, 907-915.

About half of American adults don’t meet recommended exercise guidelines and a quarter of American adults don’t exercise at all. Although the various benefits of exercise are well known, why do individuals avoid exercise altogether?

Our research group has begun examining experiential avoidance as one of the reasons why individuals avoid exercise. Experiential avoidance is the tendency to avoid thoughts, feelings, or sensations, even when this avoidance leads to negative outcomes. For example, the physical experiences associated with exercise, like increased heart rate and sweating, can be particularly uncomfortable for some individuals, and are thus experiences to be avoided. However, avoiding exercise also leads to unhealthy outcomes, such as difficulty maintaining a healthy weight, limited physical mobility, and increased disease risk. To understand any psychological phenomenon, it is critical to have an accurate measure of it.

One of the challenges in conducting experiential avoidance research is that measuring experiential avoidance has been difficult. Our research group has recently published a study in the journal Behavior Therapy highlighting the measurement issues associated with experiential avoidance measures. In this large-scale study, we used a series of statistical analyses and found consistent evidence that the two most popular self-report measures of experiential avoidance, the Action and Acceptance Questionnaire-II (AAQ-II) and the Multidimensional Experiential Avoidance Questionnaire (MEAQ), were measuring different things. The AAQ-II was unintentionally measuring the personality trait neuroticism—a proneness to experience negative thoughts and feelings— whereas the MEAQ was measuring it’s intended construct, experiential avoidance. Therefore, the MEAQ is an accurate measure of experiential avoidance.

After determining that the MEAQ is an accurate measure of experiential avoidance, we used it to study why individuals avoid exercise. Because the extent to which an individual enjoys exercise is a marker of how pleasant the experience is for them, we tested the idea that individuals who are high in experiential avoidance who also report low exercise enjoyment would be most likely to avoid exercise. Our results supported this idea. These findings suggest reducing individual’s experiential avoidance could be beneficial for increasing exercise rates.

Taken together, improved measurement of experiential avoidance has allowed our research group to better understand reasons why individuals do not engage in healthy behaviors. This will allow more effective interventions to be developed to target the specific characteristics of an individual to help that individual successfully change their behavior. Future directions include examining experiential avoidance in more health contexts with the goal of incorporating experiential avoidance reduction techniques into health behavior interventions.

Reference: Rochefort, C., Baldwin, A.S., & Chmielewski, M. (2017). Experiential avoidance: An examination of the construct validity of the AAQ-II and MEAQ. Behavior Therapy.

With improvements in cancer treatment, more and more individuals will be cancer
survivors. Many of these survivors will face unique physical and mental health challenges after cancer treatment. A recent study published in Annals of Behavioral Medicine suggests that optimism and self-affirmation – the tendency to actively think about the positive aspects of oneself – may promote health in cancer survivors.

Spontaneous self-affirmation refers to actively thinking about the positive traits of oneself when faced with difficult situations, such as having cancer. Optimism is a related personality construct that is characterized by the tendency to view the future positively. In this study, researchers looked at the relation between optimism, spontaneous self-affirmation, and various physical and mental health outcomes, such as cognitive decline, current affect, and information seeking. They used a national sample of cancer survivors from the Health Information National Trends Survey (HINTS). Analysis of large, national datasets allows for more general conclusions to be drawn about cancer survivors.

The main result of this study was that survivors who spontaneously self-affirmed showed greater hopefulness and had a greater likelihood of seeking cancer information. Of note, these relations were still present when controlling for optimism, which suggests that the effect is not simply due to people who self-affirm being more optimistic. Additionally, self-affirming women with a breast cancer diagnosis showed greater confidence in seeking health information, while this was not shown for women with non-breast cancer or men with cancer.

The take home message from this study is that self-affirmation may be beneficial for the mental and physical health of cancer survivors. Although optimism is considered stable across time, self-affirmation may be more amenable to change, and thus can be targeted in interventions to improve the overall health of cancer survivors. Future directions include determining who is likely to self-affirm after a cancer diagnosis and determining whether self-affirmation could lead to increased self-efficacy for managing health.

Reference: Taber, J. M., Klein, W. M., Ferrer, R. A., Kent, E. E., & Harris, P. R. (2015). Optimism and Spontaneous Self-affirmation are Associated with Lower Likelihood of Cognitive Impairment and Greater Positive Affect among Cancer Survivors. Annals of Behavioral Medicine, 50(2), 198-209.

Imagine a physician told you that you had a genetic predisposition for obesity. Would you
improve your diet and exercise in order to overcome your predisposition, or would you
decide to not even bother to change your behavior? An article published this year in Annals of Behavioral Medicine suggests that the answer to that question depends on your emotional state. Emotions influence how we interpret and react to information. In medical situations relating to chronic illness, emotions can run high.

In this experiment, researchers looked at the effects of negative emotions on beliefs about the causes of obesity and intentions to change diet and exercise after receiving messages delivered by an online, virtual physician. Participants included overweight women, who were randomized to one of six conditions that varied emotional states and information about the origins of obesity. Randomization is a method used to maximize similarity between groups and helps to rule-out existing differences in participants as an explanation for results.

Negative emotions were induced by asking participants to write about either a fear- or anger-inducing situation they experienced. This method of emotion induction is effective because the emotional situations are personally relevant to the participant. Those in the control condition wrote about a room in their house. Afterwards, participants watched videos of a virtual physician describing the origins of obesity as either genetic or behavioral. Finally, participants completed measures of their beliefs about the causes of obesity and their intentions to improve diet and exercise.

The women who heard the message about genetic predispositions for obesity reported lower intentions to change their diet and exercise, but only when they had written about a fear-inducing experience. For women who wrote about other experiences, the genetic message had no effect on their intentions to change.

The take away message from this study is that the combination of receiving genetic information from a physician while in a fearful state may uniquely lead to reduction of healthy diet and exercise behaviors. Fear can be a common emotion patients experience while interacting with physicians, and this fearful state can lead to unintended behavioral consequences after receiving medical information. Future directions include the need to determine how physicians can attend to patient emotions during encounters to improve behavioral outcomes.

Reference: Persky, S., Ferrer, R. A., & Klein, W. M. (2016). Genomic Information may Inhibit Weight-Related Behavior Change Inclinations Among Individuals in a Fear State. Annals of Behavioral Medicine, 1-8.