Nutrition and Exercise for Wellness and Recovery: A Randomized Controlled Trial of a Community-Based Health Intervention.

OBJECTIVE: The purpose of this study was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) intervention for improving competency and behaviors related to diet, physical activity, and weight management. METHODS: Participants with psychiatric disabilities were recruited from four community mental health agencies and a hospital-based psychiatric outpatient clinic and randomly assigned to the NEW-R intervention (N=55) or control condition (N=58). Outcome measures included the Perceived Competence Scale, Health-Promoting Lifestyle Profile (HPLP), and weight change; random-effects regression models were used. A follow-up analysis examined the interactions of group, time, and site. RESULTS: Fifty of the 55 intervention participants and 57 of the 58 control participants completed the study. The two groups did not differ significantly on any measured baseline characteristic. The intervention group had statistically significant improvements, compared with the control group, in perceived competence for exercise and healthy eating, total HPLP score, and scores on two HPLP subscales (nutrition and spiritual growth). No significant difference between groups was found for weight loss. A study condition × time × site effect was observed: at the three sites where mean weight loss occurred, NEW-R participants lost significantly more weight than did control participants. CONCLUSIONS: NEW-R offers promise as an intervention that can initiate the change to healthy lifestyle behaviors and boost perceived competence in a healthy lifestyle. It may also be effective for weight loss when administered in supportive settings.

Development of a Participation Focused Measure of Interoception for Adults.

Interoception is awareness of one's own internal bodily states. Currently, no participation-based measure of interoception exists. The purpose of this study was to identify items with adequate psychometric properties for a participation-based interoceptive measure grounded in Dunn's Sensory Processing Framework named the Sensory Profile: Interoception (SPI). Using a cross-sectional psychometric design, internal consistency was examined by calculating Cronbach's alpha for each of the four subscales of the SPI. Concurrent validity was studied using Pearson Product Moment Correlations to identify relationships between the SPI and the Adolescent Adult Sensory Profile (A/ASP) subscales. Interoception items correlating most strongly with their intended subscale were identified, maintaining 70 of the original 101 items (N = 55). The resulting subscales (sensitivity, avoiding, registration, and seeking) had good internal consistency (α = .63-.88) and correlated moderately with the corresponding A/ASP subscale. The findings provide preliminary support for the SPI's internal consistency and concurrent validity.

Corrigendum: Construct Validity of the Sensory Profile Interoception Scale: Measuring Sensory Processing in Everyday Life.

[This corrects the article DOI: 10.3389/fpsyg.2022.872619.].

Construct Validity of the Sensory Profile Interoception Scale: Measuring Sensory Processing in Everyday Life.

Scholars and providers are coming to realize that one's ability to notice and respond to internal body sensations (i.e., interoception) contributes to an overall sense of wellbeing. Research has demonstrated a relationship between interoceptive awareness and anxiety, for example. Currently, however, tools for evaluating one's interoception lack the conceptual foundation and clarity necessary to identify everyday behaviors that specifically reflect interoceptive awareness. Unlike existing interoceptive measures, the Sensory Profile Interoception (SPI) scale is participation-based and grounded in Dunn's Sensory Processing framework. In this study we investigated concurrent validity by correlating the SPI with the Adolescent/Adult Sensory Profile (A/ASP); we investigated construct validity by correlating the SPI with the Perth Alexithymia Scale (PAS), the Body Awareness Scale (BAS), and the State-Trait Anxiety Inventory (STAI). Using the REDCAP online platform, 74 college-aged participants completed the measures. Using Spearman rank order correlations there were statistically significant relationships between the corresponding sensory pattern subscales on SPI and A/ASP (r = 0.277 to r = 0.582). The PAS was only weakly related to the registration subscale of the SPI (r = 0.260). The BAS had significant relationships with seeking and avoiding on the SPI (r = 0.496 and r = 0.385). The STAI had significant relationships with sensitivity and registrations of the SPI (r = 0.266 and r = 0.361 for state; r = 0.403 and r = 0.321 for trait). Taken together, these findings provide evidence of construct validity of the SPI to identify participation patterns associated with both high and low interoception. With the more precise information the SPI provides, professionals can design tailored interventions to support everyday life goals and researchers can study interoception within authentic activities.

Retrospective Analysis of Studies Examining Sensory Processing Preferences in People With a Psychiatric Condition.

IMPORTANCE: When occupational therapists understand sensory processing preferences, they can create environments that promote participation. OBJECTIVE: To determine the sensory processing preferences of people with a psychiatric condition as measured by the Adolescent/Adult Sensory Profile (A/ASP). DATA SOURCES: PubMed, PsycINFO, ERIC, CINAHL, and OTseeker were searched from 2002 through January 2018. STUDY SELECTION AND DATA COLLECTION: Studies that included people with psychiatric conditions and measured sensory processing preferences using the A/ASP were included. Studies had to report means and standard deviations for all four A/ASP subscales. The retrospective analysis involved extracting sensory processing quadrant scores from each study and comparing these scores with the A/ASP norms by means of independent-samples t tests. FINDINGS: Five studies revealed a general pattern of greater sensory sensitivity, sensation avoiding, and low registration and less sensation seeking among people with a psychiatric condition. For each condition (schizophrenia, high risk for psychosis, bipolar disorder, major depressive disorder, posttraumatic stress, and obsessive-compulsive disorder), scores in at least two of the four sensory processing quadrants were significantly different from the normative scores, with some variability in sensory processing preferences across the psychiatric conditions. CONCLUSIONS AND RELEVANCE: The sensory processing preferences of people with a psychiatric condition differ from those of the normative sample. This research can lead to condition-specific sensory-based interventions targeting a person's specific sensory needs in the context of occupational performance. WHAT THIS ARTICLE ADDS: This article provides new information that compares and contrasts the sensory processing preferences of people with different types of psychiatric conditions. This information can be useful in treatment planning.

Effectiveness of Interventions for Weight Loss for People With Serious Mental Illness: A Systematic Review and Meta-Analysis.

OBJECTIVE: We examined the effectiveness of weight loss interventions in community-based settings for people with serious mental illness (SMI). METHOD: Four databases were searched for randomized controlled trials published in 2008 or later that met the criteria for the research question and used weight loss as an outcome measure. Data were extracted, and weight loss was analyzed using a meta-analysis. Similarities and differences in interventions were analyzed qualitatively. RESULTS: Seventeen studies and a total of 1,874 participants with various diagnoses of SMI were included in the meta-analysis. The various lifestyle-focused interventions had a significant effect on weight loss with an overall effect size of -0.308 (p < .001). CONCLUSION: Community-based interventions for people with SMI are effective for weight loss. Occupational therapists can be involved in the provision of weight loss interventions and in the development and study of intervention components that are most effective.

Measuring learning potential in people with schizophrenia: A comparison of two tasks.

Learning potential measures utilize dynamic assessment methods to capture performance changes following training on a cognitive task. Learning potential has been explored in schizophrenia research as a predictor of functional outcome and there have been calls for psychometric development in this area. Because the majority of learning potential studies have utilized the Wisconsin Card Sorting Test (WCST), we extended this work using a novel measure, the Rey Osterrieth Complex Figure Test (ROCFT). This study had the following aims: 1) to examine relationships among different learning potential indices for two dynamic assessment tasks, 2) to examine the association between WCST and ROCFT learning potential measures, and 3) to address concurrent validity with a performance-based measure of functioning (Test of Grocery Shopping Skills; TOGSS). Eighty-one adults with schizophrenia or schizoaffective disorder completed WCST and ROCFT learning measures and the TOGSS. Results indicated the various learning potential computational indices are intercorrelated and, similar to other studies, we found support for regression residuals and post-test scores as optimal indices. Further, we found modest relationships between the two learning potential measures and the TOGSS. These findings suggest learning potential includes both general and task-specific constructs but future research is needed to further explore this question.

A pilot study of the Nutrition and Exercise for Wellness and Recovery (NEW-R): A weight loss program for individuals with serious mental illnesses.

OBJECTIVE: This purpose of this study was to evaluate the Nutrition and Exercise for Wellness and Recovery (NEW-R) weight loss intervention. METHOD: Using a pretest/posttest design, 18 participants recruited from a community-based mental health program were assessed at baseline, immediately following the intervention (8 weeks), and at 6-month follow-up. The intervention was delivered by an occupational therapist and occupational therapy graduate students and consisted of 8 weekly sessions lasting 2 hr. Outcomes included changes in weight, and levels of knowledge about nutrition and exercise. RESULTS: Participants lost an average of 3 pounds at immediate postintervention, and lost an average of 10 pounds at the 6-month follow-up. Participants also demonstrated significant increases in their knowledge about nutrition and physical activity. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The results of this study provide preliminary support for the impact of the NEW-R intervention on weight loss and knowledge about diet and exercise.

Treatment response to the RENEW weight loss intervention in schizophrenia: impact of intervention setting.

BACKGROUND: Individuals with serious mental illness have high rates of obesity and a need for specialized weight loss intervention programs. This study examines the efficacy of the RENEW weight loss intervention and examines the impact of the intervention setting on outcomes. METHOD: 136 individuals with serious mental illness from 4 different settings were randomly assigned to receive the RENEW weight loss intervention or a control condition of treatment as usual. The RENEW intervention is a one year program that includes an intensive, maintenance and intermittent supports phase. RESULTS: The intervention group experienced a modest weight loss of 4.8 lbs at 3 months, 4.1 lbs at 6 months and a slight weight gain of 1.5 lbs at 12 months. The control group gained a total of 6.2 lbs at 12 months. However when settings were examined separately the responder sites had a weight loss of 9.4 lbs at 3 months, 10.9 lbs at 6 months and 7 lbs at 12 months. DISCUSSION: These results suggest that the settings in which individuals receive services may act as a support or hindrance toward response to weight loss interventions. The concept of the obesogenic environment deserves further examination as a factor in the success of weight loss programs.

Cross cultural adaptation of the Adolescent/Adult Sensory Profile: establishing linguistic equivalency and psychometric properties of the Arabic version.

BACKGROUND: Cross-cultural adaptation of standardized outcome measures between different languages is a common procedure that allows healthcare professionals around the world to utilize such measures in their own languages. The purpose of this study was to investigate the accuracy of translating and cross-culturally adapting the Adolescent/Adult Sensory Profile from English to Arabic and to assess the psychometric properties of the Arabic version. METHODS: A backward-forward translation process was used to translate the measure. Eighty-seven bilingual participants completed an English and an Arabic translated version of the measure. RESULTS: The percent agreement for each of the Arabic and English items ranges from 0.77 to 0.98. The kappa values range from 0.79 to 0.84. Test-re-test reliability of the Arabic version was tested on 35 participants. The percent agreement between the first and the second assessment using the Arabic version of the Adolescent/Adult Sensory Profile ranges from 0.80 to 0.96. The kappa values range from 0.82 to 0.88. Internal consistency for the Arabic version was 0.84 and 0.82 for the English version. Construct validity of the Arabic version (n = 560) was tested using factor analysis. Four factors were rotated using a Varimax rotation procedure. The factors' classification and the items' distribution related to these factors were very similar to the English version of the Adolescent/Adult Sensory Profile. Only 9 items of the 60 items (15%) had different distribution than the original version. CONCLUSION: The Arabic version of the Adolescent/Adult Sensory profile has very good psychometric properties and can be utilized with confidence with Arabic-speaking individuals. Implications for Rehabilitation Arabic-speaking countries lack standardized rehabilitation assessments written in Arabic. The Adolescent/Adult Sensory Profile is a widely used measure with good psychometric properties and one of rare instruments that measures sensory processing in adult and adolescent. The translation and cross-cultural adaptation of the Adolescent/Adult Sensory Profile yielded an Arabic version of the profile with very good psychometric properties. The Adolescent/Adult Sensory Profile - Arabic is now one of a few, and much needed, assessments with established psychometric properties that are available to occupational therapists in Arabic-speaking communities. The instrument can be administered with confidence among Arabic speakers.

Objective and subjective sleep disturbances in individuals with psychiatric disabilities.

Sleep disturbances are common complaints in individuals with psychiatric disabilities, frequently occurring at onset and with exacerbation of illness. A small descriptive study of community-based overweight individuals (N = 9) completed the Pittsburgh Sleep Quality Index, wore an ActiGraph and kept a sleep diary for 7 to 14 days. All but two participants had poor sleep efficiency based on actigraphy scores, an objective measure of sleep. These scores were in agreement with the Pittsburgh Sleep Quality Index, a self-report measure, in all but one participant. The findings indicate the Pittsburgh Sleep Quality Index is a comprehensive measure to use in assessing sleep in individuals who have psychiatric disabilities.

Weight loss intervention for people with serious mental illness: a randomized controlled trial of the RENEW program.

OBJECTIVE: This study assessed phases one and two of a three-phase weight-loss program called RENEW--Recovering Energy Through Nutrition and Exercise for Weight Loss--among individuals with serious mental illness at four mental health centers. RENEW provides meal replacements twice daily and intensive instruction in nutrition and meal preparation, exercise, and goal setting for three months followed by three months of maintenance. METHODS: Individuals grouped by the psychiatric medication they took were assigned randomly to RENEW or to a control group. RESULTS: Participants who completed RENEW (N=47) had lost more weight on average than had the control group (N=42) at three and six months (weight loss of 5.3 and 4.4 pounds, respectively, versus weight gain of .1 pounds and weight loss of .9 pounds, respectively; F=5.74, df=2 and 82, p=.005). Results did not vary on the basis of type of medication. CONCLUSIONS: Weight loss programs that address cognitive impairments that may accompany serious mental illness can be effective.

Learning potential as a predictor of skill acquisition in people with serious mental illness.

Twenty-five individuals with serious mental illness completed a grocery shopping skills intervention and a test-train-test version of the Wisconsin Card Sorting Test (WCST), which yielded indices of static performance and learning potential. WCST learning potential predicted skill acquisition beyond the static index of traditional WCST performance.

Patterns of association between performance in a natural environment and measures of executive function in people with schizophrenia.

This study examined the relationships between a set of real-world performance measures and a set of executive function measures with a sample of community based individuals with schizophrenia (N=80). Participants were given a battery of cognitive tests and were evaluated with a real-world performance measure, the Test of Grocery Shopping Skills (TOGSS). Using canonical correlation analysis, executive functions of planning, problem solving, working memory, and task persistence were significantly related to grocery shopping efficiency and accuracy. Two canonical variates with moderate correlations (0.547 and 0.519) explain that 30% of the variance in the executive function and grocery shopping measures was shared. These results identify patterns of association between executive function performance and the independent living skill of grocery shopping indicating the Test of Grocery Shopping Skills may be considered a sensitive measure of executive function performance in a real-world setting.

Safety considerations when promoting exercise in individuals with serious mental illness.

Histories and physical exams, completed prior to starting a weight loss program, showed that 52% (N=106) had high risk for coronary artery disease (CAD), 40% had difficulty performing a tandem gait (indicator of balance), and 30% had an existing musculoskeletal disorder. These risks are realistic concerns when recommending exercise and/or walking.

The prevalence of night eating syndrome and binge eating disorder among overweight and obese individuals with serious mental illness.

The prevalence of night eating syndrome (NES) and binge eating disorder (BED) was assessed among overweight and obese, weight-loss-seeking individuals with serious mental illness (SMI). Sixty-eight consecutive overweight (BMI > or = 25 kg/m(2)) and obese (BMI > or = 30 kg/m(2)) individuals with SMI (mean age = 43.9 years; mean BMI = 37.2 kg/(2); 67.6% Caucasian, 60.3% female) who were enrolled in a group behavioral weight loss treatment program were assessed at baseline for NES and BED with clinician-administered diagnostic interviews. Using conservative criteria, 25.0% met criteria for NES, 5.9% met criteria for BED, and only one participant met criteria for both NES and BED. This is the first study to find that obese individuals with SMI, compared with previously studied populations, are at significantly greater risk for NES, but are not at greater risk for BED. Stress, sleep, and medication use might account for the high prevalence of NES found in this population.

Doing daily life: how occupational therapy can inform psychiatric rehabilitation practice.

TOPIC: This paper provides an overview of occupational therapy in the context of psychiatric rehabilitation and mental health recovery. PURPOSE: The paper delineates practical aspects of occupational therapy's involvement in the mental health field with a discussion of occupation and the elements of conceptual models that guide the practice of occupational therapy. SOURCES USED: CINAHL, Psych Info, Medline. CONCLUSION: Occupational therapy is a key discipline in the field of psychiatric rehabilitation and brings to the field a strong theoretical and knowledge base along with unique procedures and practices. It is important for the psychiatric rehabilitation field to learn from all disciplines, including occupational therapy.

Functional assessment and intervention in occupational therapy.

TOPIC: Occupational therapists consider the person, the environment and the occupation (personally meaningful activities) in the assessment and intervention process with the ultimate goal being occupational performance. PURPOSE: This paper describes functional assessment and intervention from the perspective of the occupational therapist with specific examples of assessment instruments and intervention approaches. A scenario of a person in recovery with a particular occupational performance goal is woven throughout the paper to apply the concepts of functional assessment and intervention to a specific situation. SOURCES USED: CINAHL and PubMed databases; Existing assessment manuals and research on these instruments. CONCLUSIONS: Occupational therapists are just one discipline of many within psychiatric rehabilitation. Multidisciplinary teams can be most effective when they work collaboratively and maximize the expertise of all contributors. By describing the occupational therapy process, providing a scenario, and offering suggestions for collaboration, it is hoped that this paper fosters dialogue among occupational therapists and others involved in psychiatric rehabilitation.