Exercise alone is an efficacious intervention for depression, but few studies have identified the benefits of using exercise to augment other psychosocial treatments. The purpose of the current series of studies was to examine the feasibility, acceptability, efficacy, and potential mechanism of the augmentation of behavioral activation (BA) with exercise. The starting point for this series was a meta-analysis of the strength and reliability of brain-derived neurotrophic factor (BDNF) as a putative mechanism of the mood and cognitive effects of exercise. Evaluating 29 studies, I found: (1) a moderate effect for BDNF increases following acute exercise, (2) a moderate effect for the intensification of this effect following a program of exercise, and (3) a small effect on resting BDNF following a program of exercise. Given these effects, I hypothesized that exercise added to BA would improve mood beyond that for BA combined with a control condition and that changes in BDNF would mediate these effects. In a clinical trial, 32 sedentary, depressed patients received 9 sessions of BA over 12 weeks and were randomized to receive an exercise or control (stretching) augmentation. Assessments of depression, quality of life, distress intolerance, perceived stress, cognition (memory, attention), and amount of exercise were conducted across the treatment period. Results demonstrated strong credibility ratings and completion rates comparable to other exercise interventions. The randomized treatment failed to lead to differential exercise between groups; all participants exercised more over time. Similarly, participants, regardless of condition, significantly improved on all outcome measures over time. BDNF significantly increased following acute exercise. However, the amount of exercise completed over time was not significantly related to changes in BDNF across acute episodes, nor did resting BDNF significantly improve over time. Nonetheless, effect sizes for these changes were in the moderate range, reflecting values for the literature as a whole. Finally, contrary to my hypothesis, BDNF changes were not associated with subsequent improvement in depression symptoms. Results from this trial raise questions whether BA may be a powerful enough intervention to increase exercise, thus explicit exercise prescriptions may not be necessary for patients receiving this intervention.

No description available.

The Behavioral Activation System (BAS) has been described as playing a central role in approach motivation and reward sensitivity (Gray, 1970). Self-report measures of BAS (e.g., Carver & White, 1994) have been used to index BAS activity, with higher scores interpreted as indicating greater BAS activity (e.g., Hundt et al., 2008). However, Beauchaine and colleagues (e.g., Brenner, Beauchaine, & Sylvers, 2005) have challenged this view, noting psychophysiological and neuroimaging evidence showing that externalizing behaviors are associated with reduced BAS functioning. Furthermore, global self-reported BAS scores are often used to index approach behavior, despite evidence that two main BAS traits, impulsivity and reward reactivity, are psychometrically distinct (Smillie et al., 2006). The present study tested a measurement model of these proposed components of BAS, as well as relationships between self-report and psychophysiological BAS indices. A large undergraduate student sample completed self-report indices (N=599) and a smaller subsample also completed psychophysiological (N=18) indices of BAS-related constructs. As hypothesized, a two-factor model with impulsivity and reward reactivity as separate, correlated constructs demonstrated better model fit than a one-factor alternative model. Associations between psychophysiological indices of BAS and indices of reward reactivity and impulsivity were mixed. Implications regarding future measurement of BAS and autonomic response to reward are discussed. / Master of Science

The purpose of this study was to examine behavioral inhibition system and behavioral activation system (BIS/BAS) motives and loneliness as predictors of eating disturbances (viz., drive for thinness, bulimic symptoms, & body dissatisfaction) in female college students. Three hundred and one female college students (ages ranging from 18–33 years) completed measures assessing for BIS/BAS motives, loneliness, and eating disturbances. Results of conducting regression analyses indicated that BIS/BAS motives, especially BIS motives, accounted for significant amounts of variance across all three eating disturbance outcomes examined (R2 range = .10 to .13). Moreover, the inclusion of loneliness as a predictor of eating disturbances was found to account for additional unique amounts of variance (ΔR2 range = .02 to .06), over what was accounted for by BIS/BAS motives. These findings indicate that in addition to the potential role of biologically linked variables like BIS/BAS motives, it is important to also consider the contributions of important psychosocial variables like loneliness for understanding eating disturbances among female college students.

No description available.

本論文の目的は，Acceptance & Commitment Therapy (ACT) に含まれる価値の明確化の手続きが，身体的な痛みを抱える者の行動を活性化させるかどうかを検討することであった。その結果，基礎研究（研究1, 2）からは，自らの過去の行動の機能を記述することにより，特定の課題の遂行量や時間が増加することが示された。また，臨床研究（研究3, 4）からは，価値の明確化を含むACTにより，慢性疼痛患者の価値に基づく活動や日中活動量が増加することが示された。 / 博士(心理学) / Doctor of Philosophy in Psychology / 同志社大学 / Doshisha University

Internet-delivered programs based on cognitive behavior therapy (CBT) have during the past decade shown to work in an effective way for the treatment of depression. Due to its accessibility and independence of time and location, smartphone-based CBT might represent the next generation of digital interventions. Depression is an affective disorder that affects as many as 350 million people worldwide. However, with CBT, depression can be treated, but access to this treatment is scarce due to limited health care resources and trained therapists. As a result of this, health care could highly benefit from the use of smartphones for delivering cost-effective treatment that can be made available to a large part of the population who suffer from depression. One treatment that should be especially suitable for the smartphone format is behavioral activation (BA), since it has strong empirical support as well as the benefits of being flexible and rather simple. The overall aim of the thesis was to test and further develop a BA smartphone application, as well as to build a method for how this smartphone application could be used in a comprehensive and effective way in depression treatment. To fulfill this aim, four studies were conducted. The results showed that smartphones have the ability to be used in an effective way in the treatment of depression, including as an add-on to traditional face-to-face sessions. The results also showed that the smartphone format was experienced as a portable and flexible way of accessing the treatment – and thus could be more present in everyday life. In conclusion, there is reason to believe that smartphones will be integrated even further in society and therefore may serve an important role in future mental health care. Since the first indications reveal that depression can be treated by means of a supported smartphone application, it is highly possible that applications for other mental health problems will follow. Furthermore, in this thesis, the same smartphone application has been tested in three different ways and there is potential to apply smartphones in a range of other formats, such as in relapse prevention and as a way to intensify treatment during periods when needed. From a psychiatric research point of view, as my research group has been doing trials on guided internet treatment for more than 15 years, it is now time to move to the next generation of information technology – smartphones. / Internetbaserad kognitiv beteendeterapi (KBT) har under det senaste decenniet visat sig fungera effektivt i behandling av depression. På grund av dess tillgänglighet och flexibilitet i tid och plats har smartphonebaserad KBT potential att bli nästa generation av digitala behandlingar. Depression är en affektiv sjukdom som drabbar så många som 350 miljoner människor världen över. Med hjälp av KBT kan depression behandlas. Dock är tillgången till denna behandling knapp på grund av begränsade resurser i form av utbildade terapeuter. Därmed skulle sjukvården kunna dra stor nytta av användningen av smartphones för att leverera kostnadseffektiv behandling, som kan göras tillgänglig för människor som lider av depression. En behandling som kan vara särskilt lämplig för smartphone-formatet är beteendeaktivering (BA), eftersom den har starkt empiriskt stöd samtidigt som den är flexibel och relativt enkel. Det övergripande syftet med avhandlingen var att testa och vidareutveckla en smartphone-applikation baserad på BA, samt att bygga en behandlingsmetod för denna smartphone-applikation som skulle kunna användas för att effektivt behandla depression. För att uppnå detta syfte genomfördes fyra studier. Resultaten visade att smartphones kan användas på ett effektivt sätt i behandling av depression, bland annat som komplement till traditionella live-sessioner. Resultaten visade också initiala indikationer på att smartphoneformatet upplevdes som ett portabelt och flexibelt sätt att komma åt behandlingen - och därmed blev mer närvarande i vardagen.

No description available.

Fysisk aktivitet som behandling mot depression har ett växande forskningsstöd. Denna uppsats utforskar vilka möjligheter och svårigheter som framkommer i psykologers beskrivning av att använda fysisk aktivitet som behandling. Vi gjorde semistrukturerade intervjuer med åtta psykologer och använde en reflexiv tematisk analytisk metod. Vi fann att fysisk aktivitet framstår både som en lösning och samtidigt ganska problematiskt vilket fångas i det övergripande temat: Fysisk aktivitet har löst problem, eller inte som vi utforskar i fyra teman. Analysen visar hur fysisk aktivitet förstås genom idéer om objektivitet, medicinska teorier och psykologiska teorier eller modeller såsom beteendeaktivering. Vi undersöker också de problem som uppstår i psykologens vardag med fysisk aktivitet som intervention. Analysen innefattar även hur psykologens roll i vården ser ut och hur psykologer navigerar den i relation till fysisk aktivitet som är något olika yrkeskategorier i vården kan använda. Detta för att kunna bidra till diskussionen om hur rekommendationer utformas genom att ställa frågan: Fysisk aktivitet för vem? / Physical activity is a widely acknowledged and used intervention for treating depression. This study explores possibilities and difficulties in psychologists’ accounts of using physical activity in everyday practice. We investigated how eight psychologists described physical activity in everyday practice using a semi-structured approach. We used reflexive thematic analysis methodology to interpret data and identify how physical activity appears to provide both a solution and new problems to the psychologists. We capture an idea where physical activity isa solution of problems, or not and explore this idea in four themes. We explore how physical activity is made sense of through ideas of objectivity, medical theories and psychological theories or models as behavioral activation, but also potential problems that arise in the everyday practice of psychologists. Our analysis could be viewed as exploring how psychologists navigate their role in the everyday health care promoting physical activity. The result could also be part of discussions in policy making, raising the question: physical activityon whose terms?

Social ångeststörning (SAD) är ett ångestsyndrom som orsakar stor funktionsnedsättning och försämrad livskvalitet. I föreliggande studie presenteras förklaringsmodeller till SAD med fokus på temperamentsforskning och reinforcement sensitivity theory (RST). Syftet var att genom explorativ faktoranalys identifiera latenta variabler i frågeformuläret ”Hur man var som barn” (HMVSB), som administrerats i en klinisk population (n= 100) och i en kontrollgrupp (n= 246). Faktoranalysen extraherade två faktorer som döptes till beteendeinhibering (BI) respektive beteendeaktivering (BA). Ett andra syfte var att jämföra den kliniska populationen med kontrollgruppen avseende de extraherade faktorerna. Resultaten visade att HMVSB uppvisade god intern konsistens och tillfredsställande instrumentell reliabilitet. Vissa signifikanta korrelationer mellan HMVSB och jämförda skattningsformulär vid SAD erhölls. Gruppjämförelserna visade att den kliniska gruppen var signifikant mer beteendeinhiberad och mer beteendeaktiverad som barn. En subgrupp med generaliserad SAD var både signifikant mer beteendeaktiverad och beteendeinhiberad som barn. Subgruppen med specifik SAD skilde sig ej signifikant från kontrollgruppen. Studien manar till att beakta temperamentala faktorer vid SAD där kombinationen hög BI och hög BA skulle kunna korrelera med allvarligare klinisk bild.