Journal of Behavioral Medicine最新文献

Cognitive Behavioral Therapy (CBT) is a commonly used intervention for smoking cessation. This PROSPERO-registered systematic review and meta-analysis (CRD42024581823) evaluated the long-term effectiveness of CBT in achieving abstinence for six months or longer. Sixteen randomized controlled trials (RCTs) involving 2,531 adults were included. Studies comparing CBT to minimal care and published in English or Korean were selected; those focusing on Acceptance and Commitment Therapy (ACT) or mindfulness were excluded. Results indicate that CBT significantly improves long-term cessation rates. Subgroup analyses showed that both CBT alone and CBT with pharmacotherapy were effective compared with minimal care. In particular, CBT demonstrated greater effectiveness among patients with smoking-related conditions such as COPD and cardiovascular disease. Risk of bias was generally rated as "some concerns," and the certainty of evidence was moderate. These findings support CBT's clinical utility, especially when integrated with pharmacological treatments or tailored to high-risk populations.

Cognitive-behavioral stress management (CBSM), which integrates active coping strategies, has been shown to enhance psychological adaptation in cancer survivors, resulting in reduced emotional distress and better quality of life. However, research on the impact of active coping in advanced cancer survivorship remains underexplored. This study examined whether active coping mediated the effects of CBSM on perceived stress among men with advanced prostate cancer (APC). APC survivors (N = 189) who had received androgen deprivation therapy (ADT) were randomized to a 10-week CBSM or a health promotion (HP) intervention and followed for one year. Structural equation modeling was used to test whether active coping mediated the effect of CBSM on perceived stress adjusting for relevant sociodemographic and clinical covariates, and to determine whether this mediating role was specific to the CBSM condition. CBSM predicted a decrease in perceived stress from baseline to 12 months post-baseline through active coping. As expected, this full mediating effect was observed only in patients who received CBSM. While active coping declined over time, CBSM appeared to have a buffer effect, helping to sustain coping compared to the control group. This may be particularly relevant for advanced cancer survivors, who often experience a general shift towards less coping over time, potentially due to psychological adaptation and increasing physical burdens. Findings suggest that sustaining active coping mechanisms through CBSM can contribute to reducing psychological stress and improving health-related quality of life in APC survivors. Future research should focus on optimizing interventions by tailoring coping strategies to the evolving needs of this population.

Rates of smoking in pregnancy have declined in most high-income countries. However, disparities between those of different socioeconomic statuses and ethnicities persist. We undertook this review to assess the effectiveness of interventions tailored to these equity-relevant characteristics on prenatal smoking cessation, postnatal abstinence and infant birth outcomes, and to assess whether outcomes are moderated by equity-relevant characteristics in universal interventions. We searched four databases and used supplementary search methods to identify randomized controlled trials of psychosocial smoking cessation interventions (including relapse prevention) delivered in pregnancy in high-income countries. We performed pairwise meta-analyses using robust variance estimation on tailored interventions and performed meta-regressions to test sensitivity to the proportion of minoritized ethnic participants in the trial sample. We analysed moderation of intervention effectiveness in universal interventions using harvest plots. We included 54 trials. Pairwise meta-analyses suggest intervention effectiveness for smoking cessation in pregnancy (OR 1.55, 95% CI 1.26, 1.91) and continued postnatal abstinence (OR 1.42 95% CI 1.19, 1.70). However, they did not suggest effectiveness for infant birth outcomes. In meta-regressions, effectiveness was moderated by the proportion of minoritized ethnic participants. Overall, prenatal smoking cessation and postnatal abstinence were not moderated by equity relevant characteristics in universal interventions. A reliance on universal interventions may be insufficient to positively affect existing disparities in smoking rates in pregnancy. Interventions that focus on addressing barriers to cessation related to material and financial deprivation may fail to account for broader sociocultural factors that are important to support minoritized ethnic groups.

Romantic partner undermining is a type of negative social influence that has the potential to make weight loss more challenging and consists of two components: (1) undermining behaviors, or overt romantic partner behaviors including criticism/complaint of weight control or interference behaviors (e.g., offering up high calorie foods), and (2) undermining attitudes, including negative beliefs that a romantic partner has about their significant other's weight loss attempts. The present study was the first to the authors' knowledge to investigate romantic partner undermining attitudes and behaviors reported by participants enrolled in in a behavioral weight loss (BWL) intervention, a first line treatment for weight loss. The study also examined whether partner undermining attitudes and behaviors differed by relationship quality and between those who did and did not choose their romantic partner to serve in a support role in the intervention. Participants (N = 128) enrolled in a group-based BWL intervention reported on perceived romantic partner undermining attitudes and behaviors at baseline and 3 months (end of the intensive period of BWL intervention). Results showed that participants perceived minimal romantic partner undermining at baseline (attitudes M = 2.2 ± 0.7, behaviors M = 2.3 ± 1.2) and 3 months (attitudes M = 2.0 ± 0.6, behaviors M = 1.9 ± 1.1). However, participants reported a significant reduction in total undermining attitudes (M change = - 0.2 points) and behaviors (M change = - 0.4 points) from baseline to 3 months (ps <.05), highlighting the potential of group-based BWL interventions to mitigate romantic partner undermining without explicit content focused on undermining. Future research should examine romantic partner undermining across time in varying weight control and relationship conditions and measure undermining at the daily or weekly level to reduce recall bias and improve ecological validity.

Youth living with chronic pain experience a complex symptom burden, with multiple symptoms that may fluctuate throughout their daily lives. We aimed to explore the daily variability of multiple symptoms including pain, fatigue, cognitive dysfunction, mood, stress, and sleep, in a sample of youth with mixed chronic pain diagnoses. Youth ages 10-17 living with heterogeneous diagnoses of chronic pain lasting 3 or more months with associated functional disability (N = 25) wore wristworn ecological momentary assessment (EMA) monitors for seven days. Three times daily, they provided ratings regarding intensity of pain, fatigue, cognitive dysfunction (perceived clarity and speed of thought), mood, and stress. They also rated sleep daily. Youth also completed a series of standard recall questionnaires corresponding to domains assessed in the EMA ratings. Descriptive statistics, intra-class correlation coefficients, and multilevel models were used to describe the EMA ratings, assess within- and between-person variability, and explore diurnal patterns of ratings. Both trait-like and state-like patterns were observed in the EMA ratings. Diurnal patterns were also observed, with less fatigue (B_EVENING = -0.85, p = .003) reported at day's end. At the within-person level, higher daily pain intensity was associated with worse same-day fatigue (B = 0.34, p < .001) and mood (B = 0.41, p < .001). Conclusions: Findings highlight the complex symptom burden and nuanced daily experiences of youth living with chronic pain, and may lead toward more precise, time-sensitive interventions.

We examined whether personal and vicarious experience with COVID-19 entails change in personal and comparative optimism (the belief that one is less at risk for hazards than others, also known as unrealistic optimism, optimistic bias, or illusion of unique invulnerability) in a large (N ≈ 5000) 5-Wave longitudinal study conducted in Belgium in December 2020-May 2021. Participants reported their experience with COVID-19 as well as their expectations concerning the likelihood that they and the average peer would get infected and, after an infection, would suffer severe disease or rather register a good outcome. Neither personal nor vicarious experience entailed change in comparative optimism, but both entailed reduced personal optimism about the likelihood of an infection and enhanced personal optimism concerning a good outcome. Personal and vicarious experience entailed reduced perceived control over the likelihood of infection and the likelihood of severe disease, and vicarious experience also reduced perceived control over a good outcome. However, changes in optimism were not mediated by effects on perceived control. We discuss methodological implications for research on determinants of risk perception as well as the implications of our findings for public health communication appealing to people's personal and vicarious experiences.

The present research examined the moderating effect of patient health engagement on the relationship between perceived stress and treatment adherence among patients with kidney failure undergoing hemodialysis. In this cross-sectional study, 184 patients from three hemodialysis outpatient clinics in Türkiye completed the Perceived Stress Scale, Patient Health Engagement Scale, and End-stage Renal Disease Adherence Questionnaire. Descriptive and inferential analyses preceded a moderation test using Hayes' PROCESS macro (Model 1) with age and weekly dialysis frequency as covariates. Results supported H1, showing that higher perceived stress was associated with lower adherence (b =- 25.90, SE = 6.38, p < 0.001), and in line with H2, the stress × engagement interaction was significant (b = 4.29, SE = 1.24, p = 0.001, ΔR² = 0.034), suggesting that engagement buffers the adverse impact of stress on adherence. Simple-slope analyses revealed that stress negatively predicted adherence at low (b = - 12.98, p = 0.001) and average engagement (b = - 7.09, p = 0.011), but not at high engagement (b = - 1.20, p = 0.697). These findings highlight patient health engagement as a protective resource that buffers stress-related non-adherence, suggesting that interventions to strengthen engagement may enhance adherence in hemodialysis care.

Patients awaiting kidney transplant carry a high symptom burden which has been associated with waitlist inactivation, mortality, and poorer post-transplant outcomes. However, few studies have tested the effects of symptom management interventions in this population. This Phase II study aimed to (1) test the feasibility and preliminary efficacy of an integrated stepped collaborative care intervention (CARES-Transplant) on patient-reported outcomes and unplanned healthcare utilization, and (2) explore treatment effects on family caregiver outcomes. The study was a randomized controlled trial designed to test the efficacy of CARES-Transplant versus standard of care (SC). Patients completed a battery of questionnaires at baseline and 3-months including the Center for Epidemiological Studies-Depression (CES-D) scale, Brief Pain Inventory, and Functional Assessment of Chronic Illness Therapy-Fatigue, and Rand Short Form-36. Caregivers were administered the CES-D, Perceived Stress Scale, and Pittsburgh Sleep Quality Index at baseline and 3-months. Patient unplanned health care utilization was assessed over the course of one-year post-randomization. Nineteen patients (mean age = 65 ± 6 years, 74% male, 90% White) and 8 caregivers (mean age = 61.3 ± 8.1 years, 100% female and white) were randomized. Reductions in pain intensity and interference were observed for CARES (- 0.2) while patients in the SC arm had increases in pain intensity and interference (+ 1.3, ES = 0.30). Similar trends were observed for fatigue (CARES = - 0.4 versus SC = - 7.7, ES = 0.41) and depressive symptoms (CARES = - 2.0 versus SC =  + 2.33, ES = 0.56). Lower rates of transplant-related complications (CARES mean = 1 versus SC = 3), fewer emergency room visits (CARES = 1.0 versus SC = 2.67) and 90-day readmissions (CARES = 0% versus SC = 28.6%) were also observed. A moderate to large effect size was observed for changes on caregiver reported depressive symptoms (CARES =  + 0.5 versus SC =  + 3.3, ES = 0.55) and sleep quality (CARES = - 1.5 versus SC =  + 0.07, ES = 0.34). The findings of this pilot study warrant a Phase III trial to test the efficacy of CARES-Transplant.Clinical trials registration number ClinicalTrials.gov NCT02938351.

The quality of social connections plays a vital role in chronic disease management, particularly for populations experiencing health disparities in Type 2 diabetes (T2D) outcomes. This study examined the influence of social network characteristics on diabetes management self-efficacy among Black/African American men with T2D, a population experiencing significant health disparities. Using a national sample of 1225 Black/African American men, we investigated how network composition, support patterns, and perceived health behaviors within networks relate to diabetes self-efficacy. Results revealed complex relationships between social network characteristics and self-efficacy. Having highly supportive network members emerged as the strongest positive predictor of diabetes self-efficacy (β = 0.27, p < 0.001), followed by network members' perceived engagement in healthy eating (β = 0.17, p < 0.001). Having a higher proportion of friends in one's network was positively associated with self-efficacy (β = 0.08, p =  0.005), while having a higher proportion of infrequent contacts showed a negative association (β = - 0.15, p =  0.001). Other network composition variables, including family relationships and healthcare provider presence, showed no significant associations with self-efficacy. Network structural characteristics, including size (β = - 0.01, p =  0.78) and relationship heterogeneity (β = 0.02, p =  0.49), also showed no significant associations. These findings suggest that the quality and nature of social relationships, particularly the presence of highly supportive friends and those modeling healthy behaviors, may be more important than network size or composition in promoting diabetes self-efficacy among Black/African American men. Results indicate a need for interventions that focus on fostering quality friendships and encouraging regular contact within networks, while also leveraging the positive influence of health behavior modeling among network members.