Journal of Behavioral Medicine最新文献

The selection of appropriate statistical models is essential for accurately interpreting the analysis of count data, especially in behavioral medicine. Traditionally, Poisson and Negative Binomial models have been commonly employed, but they may not always be the most optimal choices, particularly when dealing with data with an abundance of zeroes, which can be effectively modeled using zero-inflated and zero-altered (hurdle) models. Additionally, U-shaped distributions where the data are clustered around both ends-low and high counts-with fewer occurrences in the middle, cannot be adequately captured by traditional approaches and further complicate the analysis. This paper critically examines the widespread use of zero-inflated Poisson (ZIP) and zero-inflated negative binomial (ZINB) models in the context of adolescent substance use data, identifying their potential limitations. Using a dataset from a smoking study of 1263 adolescents who reported smoking behavior across eight waves, we analyzed the sparse count outcome "Days Smoked in the Past Month," with covariates such as sex, age, and GPA recorded at each wave. Through a comprehensive evaluation of smoking behavior count outcomes-employing model identification via the Kolmogorov-Smirnov (KS) test, validation through confirmation studies, and regression analysis guided by Akaike Information Criterion (AIC). The range of models covered includes: ZIP, Poisson hurdle (PH), ZINB, negative binomial hurdle (NBH), zero-inflated negative binomial with fixed r (ZINB-r), negative binomial hurdle with fixed r (NBH-r), zero-inflated beta-binomial (ZIBB), beta-binomial hurdle (BBH), zero-inflated beta-binomial with fixed n (ZIBB-n), beta-binomial hurdle with fixed n (BBH-n), zero-inflated beta-binomial with fixed alpha and beta (ZIBB-ab), beta-binomial hurdle with fixed alpha and beta (BBH-ab), zero-inflated beta negative binomial (ZIBNB), and beta negative binomial hurdle (BNBH). Our study demonstrates the superior model fitting and regression analysis capabilities of the ZIBB and BBH models. Notably, our findings reveal the effectiveness of the ZIBB model in capturing the U-shaped distribution observed in real-world data. This underscores the importance of exploring a wider range of models beyond ZIP and ZINB for count data analysis. This study advocates for the broader application of these more sophisticated models in behavioral medicine, with the goal to enhance the accuracy and reliability of research outcomes.

Obesity in the United States is highly prevalent and often comorbid with other burdensome and debilitating conditions, such as chronic pain. To better address pain in the context of obesity, it is important to consider vulnerability factors associated with pain experiences. Anxiety sensitivity (i.e., fears of the potentially harmful consequences of anxiety-related symptoms) is an actionable transdiagnostic vulnerability factor robustly linked to pain. However, the unique role of specific sub-facets of anxiety sensitivity on pain-related outcomes such as pain intensity and disability have not been examined among individuals with weight-related concerns (e.g., obesity). The current study sought to explore the unique role of anxiety sensitivity sub-facets (i.e., physical, cognitive, and social concerns) with pain intensity and disability. Participants included 158 adults (61.8% female, M_age = 31.6, SD = 10.68) who completed a baseline assessment for a larger randomized controlled trial for stress and weight-related behaviors (e.g., emotional eating). Results indicated that higher anxiety sensitivity physical concerns was associated with increased pain intensity and disability, whereas higher anxiety sensitivity social concerns was associated with lower pain intensity and disability. The present findings suggest the potential clinical utility of targeting anxiety sensitivity physical concerns in pain management among individuals with weight-related concerns.

Both emotion regulation and physical activity are associated with improved emotional well-being, including high self-esteem. However, most prior work comparing this relationship is limited by either subjective bias or ecological validity. Using objective (i.e., accelerometer-derived) measures of physical activity, this study investigated the relationship between moderate-to-vigorous physical activity (MVPA) and two trait emotion regulation strategies. We predicted that trait reappraisal (i.e., the habitual use of cognitive reappraisal to regulate emotions in daily life), but not trait suppression (i.e., the habitual use of expressive suppression to regulate emotions in daily life), would be associated with higher engagement in MVPA. We also predicted that physical activity would buffer reliance on trait reappraisal, such that individuals who engaged in more MVPA would be less likely to report emotion regulation difficulties or low self-esteem. Participants (N = 251 adults, ages 17-88 years) filled out questionnaires assessing trait emotion regulation, emotion regulation difficulties, and self-esteem, and wore an ActiGraph® on their non-dominant wrist for one week (M(SD) = 7.46(2.32) days). Regression and moderation analyses were conducted on variables of interest. Neither trait reappraisal nor suppression were associated with MVPA. MVPA significantly moderated the negative relationship between trait reappraisal and emotion regulation difficulties, such that the relationship was stronger at lower levels of MVPA. Effects were not found with self-esteem or trait suppression. These results indicate that MVPA may be beneficial in maintaining emotional well-being, particularly in the face of emotion regulation difficulties.

Physical activity (PA) levels among breast cancer survivors following surgery are often low, with unclear roles played by pain-related factors. This study investigates the changes in PA and its contributing factors, including pain-related factors, in 184 breast cancer survivors throughout the acute post-operative stage of 1 week (T1), the sub-acute stage of 4 months (T4), and the long-term stage of 12 months (T12). A linear mixed model was utilized to evaluate PA changes in the first year post-surgery. Multivariate regression analyses explored associations between moderate-to-vigorous physical activity (MVPA) and patient characteristics, pain-related factors, emotional and physical functioning, and quality of life (QoL) at each timepoint separately and also explored factors in the acute and sub-acute stage contributing to MVPA at T12. Weekly minutes of MVPA and steps had a significant increase between T4 and T12. All models, adjusted for age and BMI, were significant (p < 0.01) but explained only small proportions of variance of MVPA at T1 (AdjR² :15%), at T4 (AdjR² :25%) and at T12 (AdjR² :26%). Pain-related factors, together with emotional and physical symptom burden, negatively impacted PA at various points in time. Despite these challenges, higher QoL and existential well-being were positive influences. Breast cancer survivors demonstrate increasing PA over the first year post-surgery. Contributing factors differ for each timepoint, highlighting the complex interplay of emotional and physical factors in promoting active lifestyles. Rehabilitation interventions need to hold the time-dependency of contributing factors into account and aim to address both immediate and long-term needs.

Being diagnosed with a chronic illness is a life-altering experience that can be shaped, for better or worse, by psychological factors. How patients think about their illness-their core beliefs about what it means and what it might bring such as whether it is catastrophic, manageable, or even an opportunity-can influence how they respond and adapt. This research introduces the concept of illness mindsets and presents the initial validation of the Illness Mindset Inventory (IMI), a new tool designed to assess these beliefs and their implications for health and well-being. Study 1 examines the factor structure, internal reliability, and discriminant validity of the 9-item IMI in N = 201 healthy participants and N = 200 participants with cancer, diabetes, cardiovascular disease, and/or chronic pain. Study 2 investigates cancer patients (N = 463) with different degrees of illness severity and tests the pre-registered hypothesis that the IMI will account for variability in functioning over and above measures of illness severity. In Study 1, illness mindsets were associated with between 5.7 and 12.1% additional variance in physical, social, and emotional functioning, above and beyond disease status. In Study 2, illness mindsets accounted for between 6.9 and 12.0% additional variance in physical functioning, social functioning, and emotional distress in people diagnosed with cancer above and beyond cancer stage, cancer status, trait optimism, and self-efficacy. Illness mindsets may help account for variance in individual functioning beyond disease status and disease severity. Future research can probe the IMI's utility in supporting patient care; in predicting functioning before, during, and after a diagnosis; and as a potential target for intervention.

Chronic pain is a significant public health problem linked to notable functional impairment and economic burden. Despite considerable research attention, chronic pain treatments only yield small to medium sized effects for pain complaints. Better understanding the pain experience may help improve treatment outcomes for pain. Specifically, intraindividual variation in pain intensity represents a potentially important avenue that captures the dynamic nature of pain and may improve overall understanding of pain. Limited work has examined metrics of intraindividual pain variation across chronic pain populations, but no work has examined how these metrics are associated with pain functional outcomes (pain-related disability, negative affect, and activity avoidance). Therefore, the current study utilized ecological momentary assessment to assess pain intensity, pain-related disability, negative affect, and activity avoidance, 5 times a day for 7 days, among 48 adults with chronic pain. Results suggested that pain instability metrics (e.g., intraindividual standard deviation) were associated with pain-related activity avoidance, while dynamic metrics of variability (e.g. % of time in high pain) were directly associated with pain-related disability and negative affect. Results from the current study have important clinical implications that can be applied to the assessment of pain to guide further treatment planning. Contextualizing pain as a dynamic experience that can be captured via intensive self-report assessment may improve overall intervention outcomes.

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.

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.