Having Trouble Staying Active? Try Increasing Your Psychological Well-Being First

We know exercise is good for our health yet most of us struggle to exercise regularly, especially as we get older. A recent paper published in the Annals of Behavioral Medicine suggests that increasing your psychological well-being may lead to increases in physical activity, even later in adulthood. Psychological well-being includes positive feelings, distress, life satisfaction, optimism, and purpose in life.

In this longitudinal study, researchers investigated if higher psychological well-being increases the likelihood of meeting recommended physical activity levels, defined as 150 minutes of moderate or 75 minutes of vigorous-intensity exercise a week by the Center for Disease Control and Prevention (2013). Almost 10,000 older adults (>50 years old) were followed and surveyed every 2 years for 11 years. Longitudinal studies gather data from the same individuals over a period of time and are strong designs because it allows researchers to follow change over time. Researchers measured psychological well-being, which included questions about distress, control, autonomy, pleasure and self-realization. Participants also completed measures of frequency and intensity of their physical activity.

The researchers found that higher psychological well-being was with higher physical activity over the period of 11 years. They also found that among those who were initially inactive, those with higher psychological well-being were more likely to start regular physical activity. In addition, researchers statistically controlled for the influence of other variables, such as health status and psychological distress, to rule out the possibility that it was these other variables influencing the results.

The findings suggest that higher levels of psychological well-being predict future increases in physical activity. Therefore, psychological well-being may be a potential target for intervention. Evidence from various studies suggests that some ways to increase psychological well-being include writing exercises about positive life events and best possible future outcomes, as well as exercises to enhance positive emotions and personal values.

Kim, E. S., Kubzansky, L. D., Soo, J., & Boehm, J. K. (2017). Maintaining healthy behavior: A prospective study of psychological well-being and physical activity. Annals of Behavioral Medicine, 51, 337-347.

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Experiential Avoidance: Measurement and Implications for Exercise

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.

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Can Self-Affirmation and Optimism Improve the Health of Cancer Survivors?

With improvements in cancer treatment, Survivor-wristband-ALT-IMAGE-PINK-TEAL-1200_1200more 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.

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Turning Intentions Into Behavior

How many times have you made plans to exercise or eat healthier, but not followed through? You may think “I’ll go to the gym right after work,” but when you get to the end of the day you go home instead. Often we struggle moving from forming intentions to act to actually performing behaviors. An article published this month in Health Psychology suggests that it is easier to turn intentions into behaviors when your intentions are based on how you expect to feel about the behavior.

In this study, researchers examined the relationship between intentions to act and various health behaviors (e.g. eating five servings of fruits and vegetables per day, exercising regularly). Researchers also considered other motives people have that might change this relationship such as how one feels about performing a behavior, or what one believes other think about their behavior. Participants in the UK completed questionnaires at three different times, spanning two months, that assessed their intentions, behaviors, and motives to change that might impact the relation between intentions and behaviors.  The researchers found that when people’s intentions to act are based on expecting to feel regret for not performing a behavior, people were more likely to follow through on their intentions. Despite looking at many possible motives, only the expected feelings of regret mattered in strengthening the relation between intentions and behavior.

The study had several strengths that make the findings particularly compelling.  First, several different health behaviors were examined, so the benefit of basing intentions in anticipated regret is not limited to one single behavior. Instead, the findings suggest anticipating regret strengthens the likelihood of acting for various behaviors. A second strength of the study was that the researchers looked at many potential motives for people’s intentions. Examining various motives strengthens the confidence one has in the finding that anticipated regret is particularly influential in the relation between intentions and behavior. Finally, the researchers were able to examine how anticipated emotions influence the relation between intentions formed at one time and behavior performed later (a prospective study). This aspect of the study design increases confidence that the researchers have identified a meaningful relationship.

These findings suggest that in order to ensure we follow through on our intentions, it may be helpful to base our intentions on how we expect to feel after the behavior rather than focusing on what we think we should do, or how we feel about the behavior. For example, it may be useful to consider the regret we may feel if we do not eat our daily servings of fruits and vegetables or do not exercise.

Reference. Conner, M.C., McEachan, R., Lawton, R., & Gardner, P. (2016). Basis of intentions as a moderator of the intention-health behavior relationship. Health Psychology, 35, 3, 219-227.

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Does Receiving Genetic Information About Obesity Change Diet and Exercise Intentions?

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.

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An Innovative Approach to HPV Vaccination

In 2006, the Food and Drug Administration (FDA) approved a vaccine for adolescent girls and young adult women that protects against the human papillomavirus (HPV) – a sexually transmitted virus that can cause several cancer types, including cervical cancer. In 2009, the FDA approved the vaccine for adolescent boys and young adult men.
The US government recommends an 80% vaccination rate by 2020, but current rates for the 3-dose series among US adolescents is well below this rate (39.7% for girls, 21.6% for boys), particularly among traditionally underserved adolescents seen in safety-net clinics (uninsured, low-income, and racial and ethnic minorities). Thus, low vaccination rates are an important public health issue.

In a paper our group recently published in the journal JMIR Research Protocols, we describe an innovative project designed to address the problem of suboptimal HPV vaccination rates in safety-net pediatric clinics. Self-persuasion, the process of generating one’s own arguments for engaging in a specific behavior, is an effective behavior change strategy. Moreover, it may be a particularly useful strategy for adolescent HPV vaccination because many parents of adolescents are undecided or ambivalent about the vaccine. Leveraging parents’ own arguments for the vaccine may help to address their indecision or ambivalence. However, it is not yet known how to develop and implement self-persuasion for HPV vaccination in a safety-net clinic setting.

In the paper, we describe the 3-stage project that is funded by the National Cancer Institute to develop and implement a self-persuasion intervention for adolescent HPV vaccination. In the intervention, we will use an iPad application we developed to help parents learn about HPV and the vaccine and to think about and verbalize their own reasons for why getting the vaccine is important. The three stages of the project all have a distinct purpose. In Stage 1, we have conducted formative studies to understand parents’ ability to generate their own arguments for HPV vaccination and to understand how parents and healthcare providers discuss the vaccine with one another. In Stage 2, we will conduct a randomized intervention to understand what aspects of self-persuasion (verbalization, choosing argument topics) are most effective and to identify the optimal approach to self-persuasion in this population. In Stage 3, we will conduct a pilot trial to establish the feasibility of using the iPad-based intervention before a clinic appointment and to determine its effect on parent-provider discussions about the vaccine.

This project is an excellent example of an integration of basic and applied behavioral science to address an important public health issue. From a basic science perspective, the project uses an effective behavior change approach in an innovative way. Plus, the findings from the study will add to our understanding which aspects of self-persuasion are most effective. From an applied science perspective, the project will result a feasible intervention that can be realistically implemented in pediatric clinics. This type of collaboration between basic and applied behavioral science is important to advancing our understanding of how best to address important health issues, like HPV vaccination.

Reference. Tiro, J.A., Lee, S.C., Marks, E.G., Persaud, D., Skinner, C.S., Street, R.L., Wiebe, D.J., Farrell, D., Bishop, W.P., Fuller, S., & Baldwin, A.S. (2016). Developing a tablet-based self-persuasion intervention promoting adolescent HPV vaccination: Protocol for a three-stage mixed-methods study. JMIR Research Protocols, 5, e19.

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Does Monitoring Goal Progress Promote Goal Attainment?

Most of us have tried tracking the foods we eat or used a FitBit in hopes of meeting our health goals. Have you wondered whether it was worth the trouble? Findings from a recent meta-analysis published in Psychological Bulletin suggest that it is.

Meta-analysis is a research methodology in which the findings from several studies on the same topic are combined and analyzed together. A well-conducted meta-analysis is considered the gold standard of evidence for an effect because idiosyncrasies that exist in any individual study that can affect its results are minimized when analyzing findings across studies. Thus, a meta-analysis provides a more precise and accurate estimate of an effect than any one study can.

In the recently published meta-analysis, researchers tested whether people who monitored their progress on goals were more likely to attain those goals. The studies included in the analysis covered a range of goals (e.g., weight loss, smoking cessation, physical activity, medication adherence, time management), although most were health related. The researchers also determined whether various factors influence the strength of the effect, such as whether the monitoring of goal progress is public (e.g., sharing step counts with friends via a social networking site) and whether it is physically recorded (e.g., using a smartphone). In addition, this meta-analysis is particularly valuable because the researchers only included experimental studies that randomly assigned participants to monitor goal progress or to a control group. Thus, the findings from this meta-analysis reflect how strongly monitoring goal progress actually has a causal effect on goal attainment – a critical piece to understanding the effect of monitoring goal progress.

The results of the meta-analysis included several interesting findings. First, goal monitoring interventions had strong effects on the frequency of progress monitoring, which led to consistent and reliable changes in goal attainment. Second, public monitoring and physically recording one’s progress both led to stronger effects on goal attainment. Third, the effect of goal monitoring was stronger when the focal behavior was the management of a specific medical condition (e.g., asthma, diabetes) compared to other health goals (e.g., weight loss, physical activity).

These findings are the most conclusive and definitive to date on the effect of goal monitoring progress. The findings clearly indicate that keeping track of the progress toward your goals will increase the likelihood you accomplish your goals. This is especially true if others can see your progress and you’re physically keeping track, like in a smartphone app. Moreover, the findings provide strong evidence to include goal monitoring as part of effective behavioral interventions aimed at changing behaviors such as physical activity.

Reference. Harkin, B., Webb, T. L., Chang, B. P., Prestwich, A., Conner, M., Kellar, I., Benn, Y., & Sheeran, P. (2016). Does monitoring goal progress promote goal attainment? A meta-analysis of the experimental evidence. Psychological Bulletin, 142, 198-229.

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