L. Alison Phillips

Habitual exercise instigation (vs. execution) predicts healthy adults' exercise frequency.

OBJECTIVE Habit is thought to be conducive to health behavior maintenance, because habits prompt behavior with minimal cognitive resources. The precise role of habit in determining complex behavioral sequences, such as exercise, has been underresearched. It is possible that the habit process may initiate a behavioral sequence (instigation habit) or that, after instigation, movement through the sequence is automated (execution habit). We hypothesized that exercise instigation habit can be empirically distinguished from exercise execution habit and that instigation habit strength is most predictive of future exercise and reflective of longitudinal exercise behavior change. Further, we evaluated whether patterned exercise action-that is, engaging in the same exercise actions from session to session-can be distinct from exercise execution habit. METHOD Healthy adults (N = 123) rated their exercise instigation and execution habit strengths, patterned exercise actions, and exercise frequency in baseline and 1-month follow-up surveys. Participants reported exercise engagement via electronic daily diaries for 1 month. Hypotheses were tested with regression analyses and repeated-measures analyses of variance. RESULTS Exercise instigation habit strength was the only unique predictor of exercise frequency. Frequency profiles (change from high to low or low to high, no change high, no change low) were associated with changes in instigation habit but not with execution habit or patterned exercise action. CONCLUSIONS Results suggest that the separable components of exercise sessions may be more or less automatic, and they point to the importance of developing instigation habit for establishing frequent exercise.

Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment

Many Veterans returning from service in Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) experience chronic pain. What is not known is whether for some OIF/OEF Veterans this pain is part of a larger condition of diffuse multisystem symptoms consistent with chronic multisymptom illness (CMI). We use data from a prospective longitudinal study of OIF/OEF Veterans to determine the frequency of CMI. We found that 1 yr after deployment, 49.5% of OIF/OEF Veterans met criteria for mild to moderate CMI and 10.8% met criteria for severe CMI. Over 90% of Veterans with chronic pain met criteria for CMI. CMI was not completely accounted for either by posttraumatic stress disorder or by predeployment levels of physical symptoms. Veterans with symptoms consistent with CMI reported significantly worse physical health function than Veterans who did not report symptoms consistent with CMI. This study suggests that the presence of CMI should be considered in the evaluation of OIF/OEF Veterans. Further, it suggests the pain management for these Veterans may need to be tailored to take CMI into consideration.

Stroke and TIA survivors’ cognitive beliefs and affective responses regarding treatment and future stroke risk differentially predict medication adherence and categorised stroke risk

Cognitive beliefs and affective responses to illness and treatment are known to independently predict health behaviours. The purpose of the current study is to assess the relative importance of four psychological domains – specifically, affective illness, cognitive illness, affective treatment and cognitive treatment – for predicting stroke and transient ischemic attack (TIA) survivors’ adherence to stroke prevention medications as well as their objective, categorised stroke risk. We assessed these domains among stroke/TIA survivors (n = 600), and conducted correlation and regression analyses with concurrent and prospective outcomes to determine the relative importance of each cognitive and affective domain for adherence and stroke risk. As hypothesised, patients’ affective treatment responses explained the greatest unique variance in baseline and six-month adherence reports (8 and 5%, respectively, of the variance in adherence, compared to 1–3% explained by other domains). Counter to hypotheses, patients’ cognitive illness beliefs explained the greatest unique variance in baseline and six-month objective categorised stroke risk (3 and 2%, respectively, compared to 0–1% explained by other domains). Results indicate that domain type (i.e. cognitive and affective) and domain referent (illness and treatment) may be differentially important for providers to assess when treating patients for stroke/TIA. More research is required to further distinguish between these domains and their relative importance for stroke prevention.

High healthcare utilization near the onset of medically unexplained symptoms

OBJECTIVE Patients with medically unexplained syndromes (MUS) often do not receive appropriate healthcare. A critical time for effective healthcare is the inception of MUS. The current study examined data from a prospective longitudinal study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers to understand the relationship of increasing physical symptom burden to healthcare utilization. METHODS Data was examined from a prospective study of OEF/OIF soldiers assessed before and one year after deployment (n=336). Physical symptom burden was measured with the Patient Health Questionnaire (PHQ-15). Analyses were conducted with polynomial regression and response surface analysis (RSA). RESULTS Increases in physical symptom burden predicted greater healthcare utilization one year after deployment: primary care practitioner (slope=-0.26, F=4.07, p=0.04), specialist (slope=-0.43, F=8.67, p=0.003), allied health therapy (e.g., physical therapy) (slope=-0.41, F=5.71, p=0.02) and mental health (slope=-0.32, F=4.04, p=0.05). There were no significant difference in utilization between those with consistently high levels and those with increases in physical symptom burden. CONCLUSION This is the first prospective study to examine, and show, a relationship between onset of clinically significant physical symptoms and greater healthcare utilization. Our data suggest that patients with increasing physical symptom burden have the same level of healthcare as patients with chronic physical symptom burden. Needed next steps are to better understand the quality of care at inception and determine how to intervene so that recommended approaches to care are provided from the onset.

Choose (and use) your tools wisely: “Validated” measures and advanced analyses can provide invalid evidence for/against a theory

Doyle and Mullan’s letter (2016) provides an opportunity to clarify some important issues in methods and theory not explicit in Leventhal, Phillips, and Burns (2016). Doyle and Mullan (2016) claim that (1) Leventhal et al. (2016) were biased in their overview of the Commonsense Model (CSM) by not citing the meta-analyses showing weak relationships between certain measures of CSM constructs and measures of treatment adherence (thereby harming the science by not including null results of the meta-analyses); and (2) the lack of meta-analytic support for the CSM means that the theory should be abandoned. Both claims are false for two main, related reasons: first, the meta-analyses were not relevant to the purpose of Leventhal et al. (2016) and so were not left out due to bias; second, and more importantly, even if the purpose of Leventhal et al. (2016) had been to provide a systematic review of research evidence for the CSM, the metaanalyses cited by Doyle and Mullan do not provide adequate or even valid evidence against the CSM. We will provide three specific arguments in support of these issues after restating the goals of the article targeted for criticism. Purpose of Leventhal et al. (2016)

The impact of E-diaries and accelerometers on young adults' perceived and objectively assessed physical activity

Objective: E‐diaries and accelerometers promise more objective, real‐time measurements of health behavior. However, social‐psychological theory suggests that using electronic behavioral monitoring may influence rather than just record physical activity (PA), especially when a device is novel. Design: Participants (n = 146) were randomly assigned to either an accelerometer‐only, e‐diary‐only, accelerometer + e‐diary, or a no‐technology control group for one week to assess how these technologies influenced PA, both perceived and actual, in young adults. Method: Participants reported their PA, overall and number of discrete exercise sessions (DES) at baseline and follow‐up; accelerometers provided daily step counts and e‐diaries captured daily reports of PA for the active week of the study. Results: Average daily steps in the accelerometer‐only and accelerometer + e‐diary groups did not differ nor did daily reports of PA via e‐diary compared to accelerometer + e‐diary group, showing that neither technology affected actual PA. ANCOVAS tested group differences in perceived PA; The accelerometer‐only group had increased perceived overall PA but not DES compared to no‐technology control. Conclusions: Accelerometers may increase perceived overall PA, but the tested technologies did not increase DES or actual PA, suggesting that they may be viable unbiased measures of PA. HighlightsWearing an accelerometer daily increased perceived but not actual PA.The accelerometer group reported more perceived mild & moderate but not vigorous PA.Completing an e‐diary daily did not change perceived or actual PA.Neither the e‐diary nor the accelerometer changed reported discrete exercise sessions.

Automatic processes and self-regulation of illness

ABSTRACT Research on the Commonsense Self-Regulation Model has emphasised reflective/conscious perceptual processes regarding illness threat (beliefs about symptoms, consequences, timeline, and curability) in predicting and changing coping behaviours. Understanding of illness self-regulation and avenues for intervention might be enriched by consideration of automatic processes that influence the recognition and identification of illness, response to illness, and ongoing management. This article adopts an integrative approach to (1) outline the theoretical importance of implicit processes in patients’ self-regulation of illness and methods to study them; (2) review research evidence for these processes, including interventions tested to modify them; and (3) outline avenues for future research. A substantial body of research on implicit processes (cognitive bias and interpretational bias) in illness maintenance in chronic illness has recently been extended to detection and interpretation of acute illness and new perspectives relating to the self-system. There is encouraging evidence that cognitive accessibility of coping and implicit attitudes may impact upon coping behaviours. Procedures that strategically automatise coping responses and create habits have considerable promise. We outline an agenda for future research in which health psychology accepts the challenge posed by the interplay of the reflective and associative systems in promoting effective self-regulation of illness.

Using the common-sense model to understand health outcomes for medically unexplained symptoms: a meta-analysis

ABSTRACT Consistent with the common-sense model of self-regulation, illness representations are considered the key to improving health outcomes for medically unexplained symptoms and illnesses (MUS). Which illness representations are related to outcomes and how they are related is not well understood. In response, we conducted a meta-analysis of the relationship between illness representations, self-management/coping, and health outcomes (perceived disease state, psychological distress, and quality of life) for patients with MUS. We reviewed 23 studies and found that threat-related illness representations and emotional representations were related to worse health outcomes and more negative coping (moderate to large effect). Generally, increases in negative coping mediated (with a moderate to large effect) the relationship of threat/emotional illness representations and health outcomes. Protective illness representations were related to better health outcomes, less use of negative coping and greater use of positive coping (small to moderate effect). The relationship of protective illness representations to better health outcomes was mediated by decreases in negative coping (moderate to large effect) and increases in positive coping (moderate effect). Perceiving a psychological cause to the MUS was related to more negative health outcomes (moderate to large effect) and more negative emotional coping (small effect). The relationship of perceiving a psychological cause and more negative health outcomes was mediated by increases in negative emotional coping. Improving our understanding of how illness representations impact health outcomes can inform efforts to improve treatments for MUS. Our results suggest behavioural treatments should focus on reducing threat-related illness representations and negative coping.