The extent to which sleep is causally related to mental health is unclear.One way to test the causal link is to evaluate the extent to which interventions that improve sleep quality also improve mental health.We conducted a meta-analysis of randomised controlled trials that reported the effects of an intervention that improved sleep on composite mental health, as well as on seven specific mental health difficulties.65 trials comprising 72 interventions and N ¼ 8608 participants were included.Improving sleep led to a significant medium-sized effect on composite mental health (gþ¼À 0.53), depression (gþ¼À 0.63), anxiety (gþ¼À0.51),and rumination (gþ¼À0.49),as well as significant small-to-medium sized effects on stress (gþ¼À0.42),and finally small significant effects on positive psychosis symptoms (gþ¼À0.26).We also found a dose response relationship, in that greater improvements in sleep quality led to greater improvements in mental health.Our findings suggest that sleep is causally related to the experience of mental health difficulties.Future research might consider how interventions that improve sleep could be incorporated into mental health services, as well as the mechanisms of action that explain how sleep exerts an effect on mental health.
ABSTRACT Aims This paper reviews a set of theories of behaviour change that are used outside the field of addiction and considers their relevance for this field. Methods Ten theories are reviewed in terms of (i) the main tenets of each theory, (ii) the implications of the theory for promoting change in addictive behaviours and (iii) studies in the field of addiction that have used the theory. An augmented feedback loop model based on Control Theory is used to organize the theories and to show how different interventions might achieve behaviour change. Results Briefly, each theory provided the following recommendations for intervention: Control Theory: prompt behavioural monitoring, Goal‐Setting Theory: set specific and challenging goals, Model of Action Phases: form ‘implementation intentions’, Strength Model of Self‐Control: bolster self‐control resources, Social Cognition Models (Protection Motivation Theory, Theory of Planned Behaviour, Health Belief Model): modify relevant cognitions, Elaboration Likelihood Model: consider targets' motivation and ability to process information, Prototype Willingness Model: change perceptions of the prototypical person who engages in behaviour and Social Cognitive Theory: modify self‐efficacy. Conclusions There are a range of theories in the field of behaviour change that can be applied usefully to addiction, each one pointing to a different set of modifiable determinants and/or behaviour change techniques. Studies reporting interventions should describe theoretical basis, behaviour change techniques and mode of delivery accurately so that effective interventions can be understood and replicated.
The present research examines whether forming implementation intentions can help people with social anxiety to control their attention and make more realistic appraisals of their performance. In Experiment 1, socially anxious participants (relative to less anxious participants) exhibited an attentional bias toward social threat words in a Visual Dot Probe task. However, socially anxious participants who formed implementation intentions designed to control attention did not exhibit this bias. Using a spatial cuing task, Experiment 2 showed that forming implementation intentions also promoted rapid disengagement from threatening stimuli. Experiment 3 ruled out the possibility that implementation intentions were effective merely because they provided additional goal-relevant information. In Experiment 4, participants gave a speech and subsequently rated their performance. Forming implementation intentions prevented the underestimation of performance that characterizes socially anxious individuals. Together, the findings suggest that forming implementation intentions may provide an effective means of handling self-regulatory problems in social anxiety.
Responding to our review of behaviour change theories 1, Latkin 2argues that current psychological theories of behaviour change are typically individualistic and emphasize decision-making and cognitive processes. Addictive behaviours, in contrast, require both physiological and social factors to be taken into account. We agree with this observation and note that there is increasing theoretical understanding of the role of associative, non-reflective processes that lead to habitual and emotionally driven behaviours. Examples of these are parallel process models 3, Bargh's concept of automaticity 4, in which the environment can prime particular responses outside conscious awareness, and West's PRIME theory which focuses upon how dispositions to experience powerful impulses develop and how these dispositions are expressed in particular situations 5. Because our paper did not focus upon unconscious influences on behaviour (see footnote 1), a complementary review of associative and emotion-orientated theories would be welcome. Our review used control theory (CT) as a framework for organizing theories of behaviour change. This theory has proved an influential 'meta'-framework for understanding self-regulation 6. CT's forebear, perceptual control theory, is also gaining support in other domains (e.g. clinical psychology 7). Several recent reviews of behavioural interventions also suggest that manipulating key components of CT has demonstrable effects on behaviour change 8, 9 Borland 10 argues for a distinction between motivational factors and self-regulatory capacity and skills. This distinction has been adopted widely in health psychology 11-13. For addictive behaviours, it has been used to classify behaviour change techniques (BCTs) in smoking cessation interventions, where 12 BCTs were categorized reliably as motivational and 14 as self-regulatory 14. Borland also highlights the need to clearly conceptualize and differentiate overlapping theoretical constructs. To address this issue, a consensus study simplified and integrated 131 identified constructs from 33 theories of behaviour and behaviour change into 12 theoretical domains 15. These have been mapped subsequently to BCTs identified from a wide literature as part of an ongoing programme of work 16. A similar question has been addressed using factor analysis; 12 factors underlying efforts at behaviour change were identified, five of which (motivation, task focus, implementation intentions, social support and subjective norms) discriminated between people who changed and those who did not 17. Willemsen & de Vries 18 draw attention usefully to a body of work relating intervention components to theoretical determinants of behaviour. This is highly relevant to the field of addiction, but we would argue for more rigorous linking of theoretical constructs and BCTs than has been undertaken hitherto in order to strengthen our interventions and theoretical understanding. This will require improved methods. Borland suggests that we focus upon intervention components rather than the theories from which they originate. Our view is that these are not either/or, and understanding the link between the two is key to advancing the science of behaviour change 19. None.
Despite extensive evidence that time perspective is associated with a range of important outcomes across a variety of life domains (e.g., health, education, wealth), the question of why time perspective has such wide-reaching effects remains unknown.The present review proposes that self-regulatory processes can offer insight into why time perspective is linked to outcomes.To test this idea we classified measures of time perspective according to the dimension of time perspective that they reflected (e.g., past, present-hedonistic, future) and measures of self-regulation according to the self-regulatory process (i.e., goal setting, goal monitoring, and goal operating), ability, or outcome that they reflected.A systematic search identified 378 studies, reporting 2,000 independent tests of the associations between measures of time perspective and self-regulation.Random-effects meta-analyses with robust variance estimation found that a future time perspective had small-to-medium-sized positive associations with goal setting (r+ = 0.25), goal monitoring (r+ = 0.19), goal operating (r+ = 0.32), self-regulatory ability (r+ = 0.35), and outcomes (r+ = 0.16).Present time perspective, including being present-hedonistic and present-fatalistic, was negatively associated with selfregulatory processes, ability, and outcomes (r+ ranged from -0.00 to -0.27).Meta-analytic structural equation models found that the relationship between future time perspective and outcomes was mediated by goal monitoring, goal operating, and self-regulatory ability, but not goal setting.As the first test of why time perspective is associated with key outcomes, the findings highlight the central role of self-regulation processes and abilities for understanding why people with certain time perspectives experience better outcomes.
Little progress has been made in economic evaluation of specialist cancer and palliative care nursing. A literature review of economic studies of clinical nurse specialists (CNSs) was undertaken to assess how the measurement of economic outcomes has been tackled in the literature to date. The initial search found 400 studies. Abstracts from all the studies were reviewed but only 17 studies met the basic criteria for inclusion, reporting primary cost and outcomes data, and clearly specifying the role of a CNS. All of the studies but one focused on direct patient care rather than other CNS roles and were undertaken alongside effectiveness studies. The economic evaluations considered only a narrow range of costs, but a wide range of outcomes. Specific nursing outcomes were only reported in a minority of studies. None of the studies reported cost-effectiveness ratios. However, CNS interventions were reported to be both less costly and more effective than alternative forms of care, negating the need for further cost-effectiveness analysis. Overall, the papers were not of good quality, reducing the validity of the findings. Robust economic evaluations of the CNS role need to be undertaken. These should involve nursing researchers and practitioners so that evaluations reflect the complex and multidimensional nature of CNS care and meet the required standard of evidence to influence practice.
Objectives Excessive alcohol consumption increases when students enter university. This study tests whether combining (1) messages that target key beliefs from the theory of planned behaviour ( TPB ) that underlie binge drinking, (2) a self‐affirmation manipulation to reduce defensive processing, and (3) implementation intentions (if‐then plans to avoid binge drinking) reduces alcohol consumption in the first 6 months at university. Design A 2 (self‐affirmation) × 2 ( TPB messages) × 2 (implementation intention) between‐participants randomized controlled trial with 6‐month follow‐up. Methods Before starting university, students ( N = 2,951) completed measures of alcohol consumption and were randomly assigned to condition in a full‐factorial design. TPB cognitions about binge drinking were assessed immediately post‐intervention ( n = 2,682). Alcohol consumption was assessed after 1 week ( n = 1,885), 1 month ( n = 1,389), and 6 months ( n = 892) at university. TPB cognitions were assessed again at 1 and 6 months. Results Participants who received the TPB messages had significantly less favourable cognitions about binge drinking (except perceived control), consumed fewer units of alcohol, engaged in binge drinking less frequently, and had less harmful patterns of alcohol consumption during their first 6 months at university. The other main effects were non‐significant. Conclusions The findings support the use of TPB ‐based interventions to reduce students’ alcohol consumption, but question the use of self‐affirmation and implementation intentions before starting university when the messages may not represent a threat to self‐identity and when students may have limited knowledge and experience of the pressures to drink alcohol at university. Statement of contribution What is already known on this subject? Alcohol consumption increases when young people enter university. Significant life transitions represent potential teachable moments to change behaviour. Interventions with a strong theoretical basis have been found to be more effective. What does this study add? A brief online intervention delivered to students before they start university can reduce alcohol consumption. The theory of planned behaviour can be used to inform the design of interventions to change health behaviour.
Situation selection involves choosing situations based on their likely emotional impact and may be less cognitively taxing or challenging to implement compared to other strategies for regulating emotion, which require people to regulate their emotions "in the moment"; we thus predicted that individuals who chronically experience intense emotions or who are not particularly competent at employing other emotion regulation strategies would be especially likely to benefit from situation selection. Consistent with this idea, we found that the use of situation selection interacted with individual differences in emotional reactivity and competence at emotion regulation to predict emotional outcomes in both a correlational (Study 1; N = 301) and an experimental field study (Study 2; N = 125). Taken together, the findings suggest that situation selection is an effective strategy for regulating emotions, especially for individuals who otherwise struggle to do so.
Background: Many interventions addressing weight-related problems
(e.g., obesity) promote self-weighing. However, while self-weighing has been associated with
weight loss, there is mixed evidence regarding the psychological impact of this behavior.
Methods: Twenty four studies (N = 11,490) were identified that included a measure of the
frequency of self-weighing and one or more psychological outcomes. Psychological outcomes were
divided into those pertaining to (i) affect (e.g., depression, anxiety), (ii) psychological
functioning (e.g., self-esteem), (iii) body-related attitudes, and (iv) disordered eating.
Findings: There was no association between self-weighing and affect (r+ = .00, 95% CI: -.08 to
.08), body attitudes (r+ = .05, 95% CI: -.04 to .15), or disordered eating (r+ = .01, 95% CI:
-.13 to .14). There was, however, small-sized negative association between self- weighing and
psychological functioning (r+ = .09, 95% CI: -.15 to -.03). Discussion: The present findings
suggest that, for the most part, self-weighing is not associated with adverse psychological
outcomes. Effect sizes were, however, heterogeneous and subsequent analyses will focus on
identifying moderators of the relationship between self-weighing and psychological
outcomes.
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