Physical activity after cardiac rehabilitation: Evidence that different types of self-efficacy are important in maintainers and relapsers.

Objective: To test whether maintenance self-efficacy predicts physical activity among individuals who maintain an active lifestyle and whether recovery self-efficacy predicts physical activity among those who relapse to a less active lifestyle. Study Design and Participants: In a longitudinal study, data were collected from 114 participants 4-10 days after a myocardial infarction (MI), 2 weeks after rehabilitation (2 months after MI), and 8 months after MI. Results: In a subgroup of participants who maintained regular activity at 8 months after MI, maintenance self-efficacy predicted physical activity. Among participants who had relapsed by 8 months after MI, recovery self-efficacy predicted physical activity. Conclusions: Those who conduct interventions among cardiac rehabilitation patients should aim to increase recovery self-efficacy among those patients who are at risk for relapse and to increase maintenance self-efficacy among those patients who are likely to maintain their level of physical activity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

On becoming ready to pursue a goal you don't know you have: Effects of nonconscious goals on evaluative readiness.

Findings showed that the nonconscious activation of a goal in memory led to increased positive implicit attitudes toward stimuli that could facilitate the goal. This evaluative readiness to pursue the nonconscious goal emerged even when participants were consciously unaware of the goal-relevant stimuli. The effect emerged the most strongly for those with some skill at the goal and for those for whom the goal was most currently important. The effect of implicit goal activation on implicit attitudes emerged in both an immediate condition as well as a delay condition, suggesting that a goal rather than a nonmotivational construct was activated. Participants' implicit attitudes toward a nonconscious goal also predicted their goal-relevant behavior. These findings suggest that people can become evaluatively ready to pursue a goal whenever it has been activated--a readiness that apparently does not require conscious awareness or deliberation about either the goal or the goal-relevant stimuli. Theoretical implications of this type of implicit goal readiness are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conceptual-motor compatibility and homonegativity: Approaching and avoiding words associated with homosexuality.

Two studies explored conceptual-motor compatibility effects underlying attitudes toward gay men and lesbian women. In Study 1, we tested if attitudes toward gay men and lesbian women would influence whether or not participants chose to engage in, and how quickly they engaged in, approach or avoidance motor movements. Participants responded to homosexual and heterosexual words on a computer screen by choosing to push (avoidance movement) or pull (approach movement) a computer mouse. Findings indicated that participants who were high in prejudice chose to make more prejudice-compatible motor responses than did participants who were low in prejudice. In Study 2, participants were randomly assigned to a prejudice-compatible or prejudice-incompatible motor movements condition. Results indicated that highly prejudiced participants were faster to complete prejudice-compatible motor movements than were low prejudice participants. Implications for implicit attitudes and measuring prejudice toward gay men and lesbian women are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of music therapy on mood and social interaction among individuals with acute traumatic brain injury and stroke.

Objective: To investigate the efficacy of music therapy techniques as an aid in improving mood and social interaction after traumatic brain injury or stroke. Design: Eighteen individuals with traumatic brain injury or stroke were assigned either standard rehabilitation alone or standard rehabilitation along with music therapy (3 treatments per week for up to 10 treatments). Measures: Pretreatment and posttreatment assessments of participant self-rating of mood, family ratings of mood and social interaction, and therapist rating of mood and participation in therapy. Results: There was a significant improvement in family members' assessment of participants' social interaction in the music therapy group relative to the control group. The staff rated participants in the music therapy group as more actively involved and cooperative in therapy than those in the control group. There was a trend suggesting that self-ratings and family ratings of mood showed greater improvement in the music group than in the control group. Conclusions: Results lend preliminary support to the efficacy of music therapy as a complementary therapy for social functioning and participation in rehabilitation with a trend toward improvement in mood during acute rehabilitation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of a stage algorithm for physical activity in participants recruited from orthopedic and cardiac rehabilitation clinics.

Objective: For stage-matched interventions, individuals must be classified with respect to their previous behaviors and in conjunction with their future intentions. A novel procedure for the assessment of stages in physical activity was developed. For this, individuals' activity and their regarding intentions were compared with recommended levels of activity. The aim was to examine the psychometric properties. Design: In a cross-sectional study, stages were assessed in 366 study participants (84 in cardiac and 282 in orthopedic rehabilitation) in terms of their previous physical activity and their intention to perform recommended activity levels in the future. Main Outcome Measures: Stages of change were compared to self-reported behavior, intention, planning, self-efficacy, risk perception, pros, cons, and social support. Misclassification, sensitivity, specificity, receiver operating characteristic (ROC) curves, non-linear trends, and planned contrasts were computed. Results: In comparison to previous studies, sensitivity (44%–99%) was high and specificity was similar or low (3%–88%), depending on the type of validation outcome selected. When using less demanding criteria (i.e., less intensive activity), measurement quality decreased, although not always significantly. Applying contrast analyses, more than half of the predicted stage differences were confirmed. No main differences between orthopedic and cardiac, ambulant and stationary rehabilitation appeared and no interactions were found. Conclusion: The stage algorithm proved to have acceptable measurement qualities in study participants recruited in both cardiac and orthopedic rehabilitation. Especially in detecting Intenders and Actors the stage algorithm performed well. Mechanisms of adopting and maintaining recommended activity levels seem to operate equally in both groups. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A randomized trial of a lay person-led self-management group intervention for back pain patients in primary care

STUDY DESIGN: Randomized, controlled trial. OBJECTIVE: To evaluate a four-session self-management group intervention for patients with pain in primary care, led by trained lay persons with back pain. The intervention was designed to reduce patient worries, encourage self-care, and reduce activity limitations. BACKGROUND DATA: Randomized trials of educational interventions suggest that activating interventions may improve back pain outcomes. Expert opinion increasingly regards effective self-management of back pain as important in achieving good outcomes. In this study, an educational intervention designed to activate patients and support effective self-management was evaluated. METHODS: Six to 8 weeks after a primary care visit for back pain, patients were invited to participate in an educational program to improve back pain self-management. Those showing interest by returning a brief questionnaire became eligible for the study. Participants (n = 255) randomly were assigned to either a self-management group intervention or to a usual care control group. The effect of the intervention, relative to usual care, was assessed 3, 6, and 12 months after randomization, controlling for baseline values. The intervention consisted of a four-session group applying problem-solving techniques to back pain self-management, supplemented by educational materials (book and videos) supporting active management of back pain. The groups were led by lay persons trained to implement a fully structured group protocol. The control group received usual care, supplemented by a book on back pain care. RESULTS: Participants randomly assigned to the self-management groups reported significantly less worry about back pain and expressed more confidence in self-care. Roland Disability Questionnaire Scores were significantly lower among participants in the self-management groups relative to the usual care controls at 6 months (P = 0.007), and this difference was sustained at 12 months at borderline significance levels (P = 0.09). Among self-management group participants, 48% showed a 50% or greater reduction in Roland Disability Questionnaire Score at 6 months, compared with 33% among the usual care controls. CONCLUSIONS: Self-management groups led by trained lay persons following a structured protocol were more effective than usual care in reducing worries, producing positive attitudes toward self-care, and reducing activity limitations among patients with back pain in primary care.     

Antibody responses to tetanus toxoid and Haemophilus influenzae type b conjugate vaccines following autologous peripheral blood stem cell transplantation (PBSCT)

OBJECTIVE: Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury (SCI), there are little data to support this assertion. To date, reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation. DESIGN: The study employed a nonrandomized controlled trial, and measures were taken on three occasions: before, immediately after, and 12 months after treatment. SETTING, OUTCOME MEASURES, AND INTERVENTION: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation. CONTROLS: The intervention group's responses on the measures were compared with a control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization. RESULTS: There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury, compared to similar persons in the control group. CONCLUSIONS: While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT.     

Attitudes toward depression among rehabilitation participants with acute stroke: Evidence of an age cohort effect.

Purpose/Objective: Depression is commonplace after acute stroke and is associated with increased morbidity and mortality. No data exist regarding attitudes about depression among older persons with acute stroke and their potential impact on self-report of depressive symptoms. The objective of this study was to determine if attitudes toward depression affect depression symptom reporting. Research Method/Design: Cross-sectional using data from an inpatient rehabilitation unit. Seventy-two people with acute stroke were surveyed regarding their attitudes toward depression as part of a larger battery assessing their cognitive and emotional functioning. Results: Both age and cognitive status were significant predictors of attitudes toward depression. Older participants expressed significantly more negative attitudes about depression and seeking professional help compared with younger participants. Those with higher cognitive scores held more positive attitudes. However, attitudes about depression were unrelated to participants' responses on self-report measures of depression. Conclusions/Implications: Participants with stroke who were older were more likely to report negative attitudes about depressive symptoms than were younger participants. However, these attitudes do not appear to represent a barrier to their ability to accurately report the presence and severity of depressive symptoms. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Inpatient rehabilitation diabetes consult service: A rehabilitation psychology approach to assessment and intervention.

Problem: Diabetes clinical practice recommendations call for assessment and intervention on diabetes self-management during inpatient hospitalization. Although diabetes is prevalent in inpatient rehabilitation settings, diabetes self-management has not traditionally been a focus of inpatient rehabilitation psychology care. This is because diabetes is often a secondary diagnosis when an individual is admitted to rehabilitation for an acute event. Objectives: The authors provide a rationale for a role for rehabilitation psychologists in assessing and intervening on the psychosocial, behavioral, and functional self-management needs of individuals with diabetes within the rehabilitation setting. The development of a rehabilitation psychology Inpatient Rehabilitation Diabetes Consultation Service is described. Theoretical and empirical bases for compilation of the assessment and intervention materials are provided. Format and implementation of the service on a university-affiliated inpatient rehabilitation unit is described, with special consideration given to professional issues faced by rehabilitation psychologists and teams. Results: A flexible consultation model was implemented using a guided diabetes psychosocial assessment with brief educational handouts addressing selected key topics (i.e., hyperglycemia, hypoglycemia, blood sugar monitoring, nutrition, physical activity, medication, and, A1C and average blood sugar). The consultation service was feasible and well-accepted by treated individuals and the rehabilitation team. Conclusions: Rehabilitation psychologists are uniquely positioned to address the functional, psychosocial, and behavioral needs of individuals with diabetes. With further research to assess clinical outcomes, this approach may further address practice recommendations for inpatient diabetes care. Moreover, such a diabetes consultation model may be useful on an outpatient rehabilitation basis as well. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The efficacy and safety of exercise programs in cardiac rehabilitation

Physical activity performed by patients with coronary heart disease is a two-edged sword. A number of biological changes produced by regular exercise may reduce the risk of future cardiac events, while the increase in cardiac work produced by this same exercise can predispose the patient to sudden cardiac death. Data from observational studies as well as randomized clinical trials demonstrate a lower cardiac mortality rate for men participating in exercise rehabilitation programs vs nonparticipants. Overall, exercise program participants appear to experience a reduction of approximately 25% in cardiac and all-cause mortality, but no single study has provided definitive results. During medically supervised exercise, the risk of cardiac death based on reports of programs in the United States is approximately one event in every 60,000 participant-hours of exercise. At this rate, a typical rehabilitation program that has 95 patients exercising 3 h.wk-1 could expect a sudden cardiac death during an exercise session once every 4 yr. No data have been published on the morbidity or mortality benefits or risks of home-based exercise or for women participants. Also, the contribution of continuous electrocardiographic monitoring to the safety of exercise training of cardiac patients is yet to be defined.     

Profile of mood states and cardiac rehabilitation after acute myocardial infarction

Following an acute myocardial infarction, evaluation of a patient's own perceptions of health, including mood state, provides useful information about the efficacy of rehabilitation when data are available for patients randomized to both control and intervention. Data are presented on the Profile of Mood States (POMS) in 187 patients, with mild to moderate scores for Spielberger state anxiety and/or Beck depression, who were randomized within 6 wk of acute myocardial infarction to usual care or to brief cardiac rehabilitation lasting 8 wk and who were followed-up during the 12 months following the acute event. Repeated measures multivariate analysis of covariance identified significant main as well as time effects in POMS scores over 12 months. Repeated measures analysis of variance over the 12 months demonstrated significant improvement for both depression and anxiety in both groups. At 8 wk, improvement was greater in the rehabilitation patients than usual care patients but only in the tension-anxiety, depression-dejection and vigor-activity dimensions of POMS and only in anxiety in those patients with above mean anxiety scores. Overall, rehabilitation and control patients showed similar and significant improvements in anxiety, depression and in mood states over the duration of the 12-month trial.     

Stage of change in self-management of chronic diseases: Psychometric properties of the Chinese version of the University of Rhode Island Change Assessment (C-URICA) Scale.

Objective: The University of Rhode Island Change Assessment (URICA) Scale has been widely used to assess the readiness to change with regard to various health-related behaviors. The present study aimed to develop a Chinese version of the URICA (C-URICA) for measuring the readiness to change of Chinese participants with chronic diseases. Participants: A group of participants (N=101; 87 women and 14 men) in a chronic disease self-management program were asked to complete the C-URICA. Method: The C-URICA was conducted at the baseline, middle, and end of the 6-week program. Changes in self-management behaviors were also measured. Results: Factor analyses revealed a moderate item-to-subscale fit, indicating that structural validity was retained. Item analyses suggested a moderate item quality. The C-URICA subscales can differentially and effectively predict participants' gains in self-management behaviors at the completion of the intervention program. Conclusion: The C-URICA is suitable for use among Chinese patients with chronic diseases. Further studies should explore the generalizability of the results to different diagnostic groups and subgroups among Chinese populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of managers' attitudes toward change.

Correlated a measure of a general readiness to accept change and a measure of attitudes toward change in a specific area (promotions policy) with age, education, managerial rank, frustration-contentment, level of self-confidence, and extraversion and neuroticism (Maudsley Personality Inventory) in 258 managers. Older managers were more conservative than the younger managers, and the confident were more radical than the unconfident. Stable introverts and emotional extraverts tended to support innovation, while emotional introverts and stable extraverts did not. The relation between readiness to accept change and managerial status, education, and contentment depended on the type of change and was not always linear. Results support the notion of a general readiness for change underlying attitudes toward change in a specific area. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hepatic histidase gene expression responds to protein rehabilitation in undernourished growing rats

We studied the effect of nutritional rehabilitation with a 6, 18 or 50% casein diet in undernourished rats on histidase (Hal) expression. Undernutrition was induced by feeding rats a 0.5% casein diet for 5 wk. Over this period, growth, serum total proteins and insulin-like growth factor-I (IGF-I) levels were significantly lower than those of rats that freely consumed an 18% casein diet. During this period, undernutrition also significantly reduced Hal activity and Hal-mRNA concentration. Nutritional rehabilitation for 21 d with a 6% casein diet did not change any of these variables. Nutritional rehabilitation with an 18 or 50% casein diet for 1 d initiated the restoration of Hal activity and mRNA concentration. After 10 d of consuming 18 or 50% casein diets, Hal activity was 5- and 14-fold, and mRNA concentration was 8.5- and 23-fold higher, respectively, than in the protein-undernourished group (PU). During this period, body weight, total serum proteins and IGF-I levels were also significantly (P < 0.05) higher than those of the PU group. At the end of 21 d of rehabilitation with an 18 or 50% casein diet, Hal activity was 14- and 31-fold higher and Hal mRNA concentration was 10- and 24-fold higher, respectively, than in the PU group. In conclusion, our data showed that rehabilitation of undernourished rats with a 6% casein diet was not sufficient to re-establish growth indicators, Hal activity or gene expression, and that nutritional rehabilitation with an 18 or 50% casein diet effectively re-established body weight , biochemical variables and the capacity of histidase gene expression to eliminate the excess of protein.     

Characteristics of highly physically active smokers in a population of young adult military recruits

A substantial number of cigarette smokers are thought to engage in regular exercise. It is unclear why individuals who engage in a health-promoting activity such as exercising would simultaneously engage in a health-damaging behavior like smoking. Two possibilities are that (1) exercise serves as a "harm reduction" strategy to lessen the negative effects of smoking, or (2) that among weight conscious individuals, exercise and smoking are both used as weight control strategies. To examine these issues, smoking status, physical activity level, weight concerns, and several additional health behaviors and attitudes were assessed by questionnaire in a population of United States Air Force recruits (n=32,144). Multiple logistic regression analyses were used to compare characteristics of highly physically active smokers with both highly physically active never-smokers, and less active smokers. A substantial proportion of smokers reported being highly physically active (15.8%), although this proportion was significantly higher for never-smokers (22.7%). Active smokers were similar to active never-smokers across several health behaviors and attitudes, including diet, seatbelt use, and attitudes toward illegal drugs and condom use. Compared to less active smokers, active smokers consumed more fruits and vegetables, worried less about their weight, were less nicotine dependent, and had greater previous success at quitting smoking. These findings indicate that a substantial proportion of highly physically active young adults are regular cigarette smokers. Based on findings regarding general health behaviors and smoking history, this group may be particularly amenable to smoking cessation efforts.     

The role of homework in cognitive-behavioral therapy for cocaine dependence.

This study examines the effect of homework compliance on treatment outcome in 123 participants receiving cognitive-behavioral therapy (CBT) for cocaine dependence. Regression analyses revealed a significant relationship between homework compliance and cocaine use that was moderated by readiness to change. Homework compliance predicted less cocaine use during treatment but only for participants higher in readiness to change. For those lower in readiness to change, homework compliance was not associated with cocaine use during treatment. Homework compliance early in therapy was associated with better retention in treatment. Homework compliance was not predicted by participants' level of education or readiness to change. These findings support the use of homework during CBT for substance use disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use and effectiveness of self-regulation strategies for improving mood in a group of trainee teachers.

A field study investigated the ongoing use and effectiveness of self-regulation strategies for improving mood and the effects of a mood-regulation intervention. Thirty trainee teachers used pocket computers to complete ratings of their mood and their use of mood-regulation strategies every 2 hr during 2 weeks of a school placement. Cognitive distraction was the most frequently used strategy, but behavioral diversion and cognitive reappraisal were associated with the greatest improvements in reported mood. Neither avoidance nor venting was associated with mood improvements. Concurrent mood, mood awareness, and activity predicted the use of different regulation strategies. Half of the participants were instructed to use engagement strategies and the other half diversion strategies during the middle 6 days of the study. The engagement group reported significantly higher levels of cheerfulness during this intervention. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hypnotic discontinuation in chronic insomnia: Impact of psychological distress, readiness to change, and self-efficacy.

Objective: To compare individuals who were successful in discontinuing hypnotic medications against those who were not on measures of insomnia severity, medication withdrawal symptoms, psychological symptoms, perceived health, readiness to change and self-efficacy. Design: Secondary analyses of a randomized clinical trial comparing a hypnotic taper intervention with or without self-help treatment for insomnia. Main Outcome Measures: Self-report measures of insomnia severity, medication withdrawal symptoms, depression and anxiety symptoms, physical and mental health, stages of change, readiness to change, decisional balance, and general and situational self-efficacy. Results: There were no significant differences at baseline between medication-free individuals and those still using sleep medication at the end of a taper intervention. Group differences emerged midway through the 8-week withdrawal program and were accentuated after the intervention; participants who remained medication-free during the next six months had less severe insomnia and anxiety symptoms, a more positive perception of their health and higher self-efficacy to refrain from hypnotic use in various situations. Contrary to expectations, there were no differences between drug-free and nondrug-free participants on both readiness to change and stages of change. Conclusions: Chronic users of hypnotic medications entered a taper intervention with equal levels of psychological distress, health, self-efficacy, and readiness to change. Successful hypnotic discontinuation was associated with overall improvement of insomnia, anxiety and distress symptoms, perceived health and self-efficacy. More intensive and individualized therapeutic attention may be warranted for individuals experiencing worsening of insomnia symptoms, more withdrawal symptoms and psychological distress, and lower self-efficacy during medication discontinuation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of endogenous angiotensin II on renal nerve activity and its cardiac baroreflex regulation

The effects of physiologic alterations in endogenous angiotensin II activity on basal renal sympathetic nerve activity and its cardiac baroreflex regulation were studied. The effect of angiotensin II type 1 receptor blockade with intracerebroventricular losartan was examined in conscious rats consuming a low, normal, or high sodium diet that were instrumented for the simultaneous measurement of right atrial pressure and renal sympathetic nerve activity. The gain of cardiac baroreflex regulation of renal sympathetic nerve activity (% delta renal sympathetic nerve activity/mmHg mean right atrial pressure) was measured during isotonic saline volume loading. Intracerebroventricular losartan did not decrease arterial pressure but significantly decreased renal sympathetic nerve activity in low (-36+/-6%) and normal (-24+/-5%), but not in high (-2+/-3%) sodium diet rats. Compared with vehicle treatment, losartan treatment significantly increased cardiac baroreflex gain in low (-3.45+/-0.20 versus -2.89+/-0.17) and normal (-2.89+/-0.18 versus -2.54+/-0.14), but not in high (-2.27+/-0.15 versus -2.22+/-0.14) sodium diet rats. These results indicate that physiologic alterations in endogenous angiotensin II activity tonically influence basal levels of renal sympathetic nerve activity and its cardiac baroreflex regulation.     

Behavioral self-management controlled-drinking strategies in a context of secondary prevention.

This research was conducted as part of a long-term project designed to establish innovative early intervention programs in a public health setting. Problem drinkers were recruited from the general population and were randomly assigned to either a waiting-list control condition or a treatment condition based on behavioral self-management strategies or on a modified developmental counseling approach. The drinkers participated in 12 weekly individual counseling sessions and in 1-year and 2-year follow-up evaluations. Significant others were involved to provide data corroboration. Problem drinkers in both treatment programs reported significantly greater improvements from pre- to postassessment in alcohol consumption, mood, and participation in social activities than did waiting-list subjects, who tended to remain the same or to worsen. No differences emerged between the two types of treatment. The improvements made at postassessment remained constant over the 2-year follow-up period. The results were corroborated by significant others' reports. (PsycINFO Database Record (c) 2010 APA, all rights reserved)