Self-control and grit: associations with weight management and healthy habits.

Weight management requires resisting immediate temptations in one's environment (self-control) as well as the ability to persevere towards one's long-term goals despite minor setbacks (grit). This study sought to establish relationships between self-control, grit, and behavioral and health outcomes in the context of a couples-based weight management intervention. Couples (n = 64 dyads) in a behaviorally based intervention completed measures of self-control and grit at study entry and the end of treatment (6 months). Habit automaticity for self-weighing and exercise as well as objective weights were measured at baseline, 6 months, and 12 months (maintenance). Self-control and grit increased during treatment; these increases were significantly associated with greater self-weighing habit automaticity at 6 months. Baseline self-control, changes in self-control, and baseline grit were also associated with 6-month exercise automaticity. Only baseline grit was associated with weight loss maintenance. No partner effects were observed. Findings suggest that self-control and grit are malleable constructs that may play an important role in health behavior habits associated with weight management.ClinicalTrials.gov: NCT02570009, October, 7, 2015.

Challenging terrains: socio-spatial analysis of Primary Health Care Access Disparities in West Virginia.

Existing measures of health care access were inadequate for guiding policy decisions in West Virginia, as they identified the entire state as having limited access. To address this, we compiled a comprehensive database of primary health care providers and facilities in the state, developed a modified E2SFCA tool to measure spatial access in the context of West Virginia's rural and mountainous nature, and integrated this with an index of socio-economic barriers to access. The integrated index revealed that the rural areas, especially in the southern part of the state, have especially limited access to primary health care. 1. Introduction. An emerging public health issue which has been exacerbated by the COVID-19 pandemic, is that of healthcare deserts, which are places where basic affordable health care is not accessible for residents. This problem has become worse in rural areas as rural hospitals close. In these areas, including West Virginia, scattered populations suffer from limited access to primary healthcare services. Uneven geographic and socio-economic barriers to accessing primary health care are major contributing factors to these health disparities. West Virginia's unique rural and mountainous settlement patterns, aging population, and economic crisis over the past two decades have resulted in unequal access to the primary healthcare services for its residents. The rural nature of the state makes it difficult to maintain medical facilities accessible to much of the population, especially as rural hospitals have been closing, such as the one in Williamson, WV (Jarvie, 2020). The mountainous terrain slows down travel across winding roads, lengthening travel times to the nearest hospital, while an aging population has increased health care needs. Lastly, an economic crisis and higher poverty rate makes West Virginians less able to pay for health care. As a result, West Virginians are confronting a health crisis. According to a recent report by the West Virginia Health Statistics Center (2019), West Virginians rank first in the country for heart attacks, have the second-highest obesity rate and prevalence of mental health problems in the country, along with the fourth-highest rate of diabetes and fifth-highest rate of cancer. An issue faced by West Virginia's policymakers is the limitations of tools for identifying and assessing healthcare deserts, as they are poorly suited for the unique challenges in West Virginia. Academic research has not analyzed comprehensive primary healthcare accessibility in WV, although previous studies have focused on Appalachia (e.g., Behringer & Friedell 2006; Smith & Holloman, 2011; Elnicki et al., 1995; Donohoe et al., 2015, 2016a, 2016b), and others focus on access to more specialized services (Valvi et al., 2019; Donohoe, 2016a). Existing approaches to identify the healthcare deprived areas, such as Health Professional Shortage Areas (HPSA), are not suitable for guiding West Virginia policies, because every one of the 55 counties within the state has several HPSAs, which makes prioritizing resources difficult. The lack of easily accessible, comprehensive, and up-to-date physician and healthcare facility database creates additional difficulties. Physician license datasets were found to often include inconsistent, misleading, and out-of-date information. The last limitation of the HPSA designation is that it is based on zip code areas and census tracts, which are not ideal as zip code areas lack spatial context and much covariate data, while rural census tracts are too large to capture spatial variation of access. In this context, the WV HealthLink project was begun with joint effort with WV Rural Health Initiative (RHI) to fill gaps in research and support decision making for primary healthcare access in West Virginia. The goals of the projects are: (1) to help West Virginia's three medical schools provide specialized professional training in rural healthcare; (2) to address health disparities by investing in clinical projects in underserved areas; and (3) to retain health professionals in WV. In 2018, to support these goals, HealthLink was invited by the RHI's leadership to analyze disparities in primary health care access in West Virginia and develop tools for rural healthcare decision-making. These goals also create a comprehensive and up-to-date physician and facility database, new analysis tools, and new visualization tools for decision support. The goals of this paper are to assess the spatial and social accessibility of primary health care in West Virginia, and to understand spatial and social determinants that shape this access. To achieve these goals, this paper completes the following objectives: (1) define primary healthcare and access; (2) build an extensive and up-to-date primary healthcare database; (3) develop an assessment framework for WV; and (4) visualize the results for policy makers and practitioners. The structure of this paper is as follows. First, we describe three methodological problems encountered as we define primary health care access. Second, we present the methods used to resolve these problems, and conclude by presenting our modified enhanced two-step floating catchment area (E2FCA hereafter) approach and its results for WV. Our foci in this modification were improving the accuracy of the analysis regarding measuring distance, considering distance decay effect, and more precisely representing the location of supply and demand.

Agreeableness and Conscientiousness promote successful adaptation to the Covid-19 pandemic through effective internalization of public health guidelines.

Social distancing (SD) was an effective way of reducing virus transmission during the deadly and highly infectious COVID-19 pandemic. Using a prospective longitudinal design, the present study explored how the Big 5 traits relate to variations in SD in a sample of university students (n = 285), and replicated these findings using informant reports. Self-determination theory's concepts of autonomous motivation and intrinsic community values were explored as potential mechanisms linking traits to SD. Individuals who were higher on trait agreeableness and conscientiousness engaged in more SD because they more effectively internalized the importance and value of the guidelines as a function of their concerns about the welfare of their communities. Informant reports confirmed trait agreeableness and conscientiousness to be associated with more SD. These results enhance our understanding of individual differences associated with better internalization and adherence to public health guidelines and can inform future interventions in similar crises.

Autonomy support in a couples weight loss trial: Helping yourself while helping others.

INTRODUCTION: Self-determination theory proposes that autonomy-supportive environments produce better health outcomes, and evidence demonstrating the importance of autonomy support for health behavior change has become increasingly clear. The bulk of the previous research has focused on the effects of receiving autonomy support, whereas the present study focuses on the potential impact of providing autonomy support for improving the weight loss and relationship satisfaction of the support provider. METHOD: Sixty-four couples were randomized to a standard weight loss intervention or to an intervention that included training to enhance autonomy support behavior (e.g., empathic responding, accepting personal choices, etc.). Groups met weekly for 6 months, with assessments at baseline, 3, 6, and 12 months. The assessment of provided autonomy support was based on ratings of videotaped interactions of the couple discussing weight loss issues and on partner report of the autonomy support they received. RESULTS: The results did not show any condition effects; however, the results for both conditions indicated that beyond receiving autonomy support, providing autonomy support was associated with greater sustained weight loss for the support provider, and for men greater relationship satisfaction over time. DISCUSSION: The results confirm the importance of couples-based interventions and autonomy support for behavior change. In addition, it appears that providing autonomy support is useful for both the recipient and the provider. These results point to the need for developing targeted interventions to facilitate the provision of autonomy support. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Evidence of the Associations between Individual and Partner Autonomy Support and Physiological Stress in the Context of Conversations about Weight among Couples Who are Overweight or Obese during a 6-Month Intervention.

The aim of the study was to examine the impact of supportive communication on acute physiological stress responses during weight-related conversations taking place throughout a couples' weight loss program. Participants were 47 married or cohabitating couples where each partner had a BMI of 25-40 kg/m2. Couples were randomized as a dyad into a traditional weight loss program or a program that also included training in providing support to one's partner throughout the weight loss process. Structured conversations between partners about weight management were videotaped at baseline and 6 months. Participants provided saliva samples before and after the conversations, which were assayed for cortisol and salivary alpha-amylase (sAA) to determine physiological stress and anxiety responses to conversations about weight. The results indicated that receiving support from one's partner when discussing weight-related issues was associated with greater physiological stress, as indicated by higher cortisol and sAA levels, whereas providing support to one's partner was associated with lower cortisol levels and higher sAA levels. The findings suggest that receiving support is not a universally positive experience, especially for populations facing health issues. The mixed findings for support provision align with previous studies identifying a negative association between affectionate communication and cortisol levels, as well as a positive association between sAA and anxiety and emotional arousal. The findings and their implications for understanding the physiological correlates of couples' conversations about weight are discussed.

The role of goal-related autonomy: A self-determination theory analysis of perfectionism, poor goal progress, and depressive symptoms.

Adopting a self-determination theory perspective, this 3-wave longitudinal study explores the role of perfectionism in goal pursuit and the experience of depressive symptoms. The findings highlight the role of goal-related autonomy in mediating the opposite effects of self-critical and personal standards perfectionism on goal progress and depressive symptoms over the course of an academic year. The results suggest a way of understanding the pathway to depressive symptoms and poor goal progress in perfectionists. They point to a number of implications for clinical practice when working with self-critical perfectionists. Specifically, they indicate that interventions aimed at promoting autonomous motivation, may not only bolster goal progress but also act as a protective factor against depressive symptoms. Together, the results indicate that autonomous motivation is central to goal progress and suggest that low goal-related autonomy can be linked to negative outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A randomized controlled trial of a theory-based weight-loss program for couples.

OBJECTIVE: Weight gain occurs during marriage, yet obesity treatment is focused on individuals. Outcomes may be improved by targeting joint weight loss and the interpersonal milieu that fosters spousal interdependence. Self-determination theory (SDT) posits that autonomy-supportive environments (e.g., promote meaningful choice, minimize control) produce better health outcomes. This trial tested an SDT-informed weight-loss intervention intended to facilitate autonomy support in couples. METHOD: Sixty-four couples were randomized to standard behavioral weight loss (BWL) that couples attended together or to a SDT-informed weight-loss intervention (SDT-WL) that aimed to bolster autonomy support (AS). Groups met weekly for 6 months with assessments at 0, 3, 6, and 12 months. RESULTS: Percent weight loss at 6 and 12 months was 10.4% ± 6.5% and 9.2% ± 8.2%. No differences were observed between the BWL and SDT-WL conditions in percent weight loss or changes in AS. Across conditions, higher baseline AS predicted greater weight loss at 6 and 12 months (ps <.001). Increases in AS over time predicted greater weight loss at 6 and 12 months (ps ≤ .02). Post hoc moderation analysis indicated that only participants with low (but not high) baseline AS achieved greater gains in AS at 12 months in SDT-WL than in the BWL conditions (p < .02). CONCLUSIONS: Although no differences were found between conditions on weight loss or changes in autonomy support behavior, autonomy support from one's spouse predicted weight loss in both couples-based weight-loss approaches. For couples with low levels of AS, an SDT-informed approach was effective at increasing this desirable interpersonal behavior. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

The role of partner autonomy support in motivation, well-being, and weight loss among women with higher baseline BMI.

INTRODUCTION: The association of partner autonomy support with women's motivation for healthy eating, weight-related health behavior change, and psychological well-being has been largely overlooked. Results of 2 studies showed that the positive association between autonomy support and a variety of motivational and psychological outcomes was especially pronounced for women with high body mass index (BMI) (+1 SD) compared to low BMI (-1 SD). METHOD: In Study 1, autonomy support was measured as male partners' report of their behavior in a cross-sectional design. In Study 2, autonomy support was measured as female participants' perceptions of their partners' behavior in a longitudinal home environment-based behavioral weight loss intervention. RESULTS: Study 1 showed that autonomy support from partners was associated with greater self-determined motivation for healthy eating and self-reported well-being among women with higher BMI. Study 2 showed that changes in partner autonomy support over 18 months of a home-based weight loss intervention were associated with increases in motivation for treatment and greater weight loss, especially for women who had higher baseline BMI. DISCUSSION: Both studies demonstrated that autonomy support was associated with adaptive functioning across weight status but that it was especially potent for women with higher BMI. This pattern of findings is explained in terms of the pressures women with higher BMI may feel about their weight-related behaviors. (PsycINFO Database Record

Project TEAMS (Talking about Eating, Activity, and Mutual Support): a randomized controlled trial of a theory-based weight loss program for couples.

BACKGROUND: Obesity risk is shared between spouses, yet existing weight loss programs focus on individuals and not the marital dyad. Given the interdependence of weight in couples, weight management outcomes might be improved by targeting joint weight loss and the creation of an interpersonal milieu that supports long-term behavior change. According to Self-Determination Theory (SDT), greater autonomous self-regulation of behaviors, and subsequently better treatment outcomes, are observed in needs supportive environments in which personally meaningful choice is supported and criticism and control are minimized. Correlational analyses confirm these pathways in weight management, with needs support from one's spouse or partner emerging as a distinct predictor of weight loss success. Research is now needed to establish causal links and to develop and test weight loss interventions designed to facilitate the needs supportive behavior of spouses. METHODS: Project TEAMS (Talking about Eating, Activity, and Mutual Support) is a randomized controlled trial testing a couples-based intervention, grounded in SDT, designed to change the social context of weight loss by training spouses to provide needs support for each other's eating and physical activity behavior. Sixty-four couples will be randomized to either 6 months of behavioral weight loss treatment informed by SDT (SDT-WL) or to 6 months of standard behavioral weight loss treatment (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 3, 6, and 12 months. By bolstering needs support, SDT-WL is predicted to increase autonomous self-regulation and perceived competence and produce greater weight loss and maintenance than standard behavioral treatment. Exploratory analyses will examine the SDT process model prediction that the influence of needs support on treatment outcomes will be mediated by autonomous self-regulation and perceived competence. DISCUSSION: This study addresses the fundamental importance of interpersonal support in weight management by focusing on couples rather than individuals and using a rich theoretical framework to train spouses in supportive behaviors. TRIAL REGISTRATION: Clinicaltrials.gov ; NCT02570009 .

Consequences of interpersonal spin on couple-relevant goal progress and relationship satisfaction in romantic relationships.

Large fluctuations in a person's interpersonal behavior across situations and over time are thought to be associated with poor personal and interpersonal outcomes. This study examined 2 outcomes, relationship satisfaction and goal progress, that could be associated with individual differences in dispersion of interpersonal behavior (interpersonal spin) in romantic relationships. Need satisfaction and perceived autonomy support for goal pursuit from the partner were examined as mediator variables. Spin was measured using an event-contingent recording (ECR) methodology with a sample of 93 cohabiting couples who reported their interpersonal behavior in interactions with each other during a 20-day period. Relationship satisfaction and goal completion were measured at the end of the ECR procedure (T2) and approximately 7 months after the ECR (T3). Need satisfaction and perceived autonomy support were measured at T2. In both genders, higher spin was associated with lower T2 relationship satisfaction. There was also a decline in relationship satisfaction from T2 to T3 among men with high spin partners. In both genders, higher spin was associated with lower need satisfaction, and lower need satisfaction was associated with a decline in relationship satisfaction from T2 to T3. In both genders, higher spin was associated with lower perceived autonomy support, and lower support was associated with decreased progress in goal completion from T2 to T3. The effects of spin were independent of the effects of mean levels of behavior. These findings extend the understanding of the detrimental consequences of dispersion in interpersonal behavior to the disruption of the person's romantic relationships.

Goal internalization and persistence as a function of autonomous and directive forms of goal support.

Two prospective studies examined the relations of autonomy support and directive support to goal internalization and goal persistence over a year. Study 1 examined the role of support and internalization in semester-long goals set by college students and whether the goals were reset in the following semester. Study 2 examined semester-long goals and long-term developmental goals. Study 1 showed that autonomy support was not only significantly associated with greater internalization and goal success in the fall semester, but it was also significantly associated with actually resetting and subsequently succeeding at goals that one had failed to reach. Study 2 showed that autonomy support was significantly associated with progress for short-term goals over the semester, whereas directive support was unrelated to progress. For long-term goals, autonomy support was significantly related to greater internalization of goals and to greater goal satisfaction, whereas directive support was significantly negatively related to these outcomes. These studies point to the beneficial effects of autonomy support on goal internalization and resilient persistence. The effects of directive support (null vs. negative) were moderated by the timeline of the goals.

Autonomy support, self-regulation, and weight loss.

OBJECTIVE: Social support is believed to contribute to weight loss success, yet the type of support received is rarely assessed. To develop more effective weight loss interventions, examinations of the types of support that are associated with positive outcomes are needed. Self-Determination Theory suggests that support for an individual's autonomy is beneficial and facilitates internalization of autonomous self-regulation. We examined whether autonomy support and directive forms of support were associated with weight loss outcomes in a larger randomized controlled trial. METHOD: Adults (N = 201; 48.9 ± 10.5 years; 78.1% women) participating in a weight loss trial were assessed at 0, 6, and 18 months. Autonomy support (AS), directive support, and autonomous self-regulation (ASR) were measured at 0 and 6 months and examined in relation to 18-month weight loss outcomes. RESULTS: Baseline AS and ASR did not predict outcomes; however, AS and ASR at 6 months positively predicted 18-month weight losses (ps < .05), encouragement of healthy eating at 6 months was negatively related to 18-month weight losses (p < .01), and other forms of directive support were not associated with outcomes. CONCLUSIONS: Autonomy support predicted better weight loss outcomes while some forms of directive support hindered progress. Weight loss trials are needed to determine whether family members and friends can be trained to provide autonomy support and whether this is more effective than programs targeting more general or directive forms of support.

Distinguishing autonomous and directive forms of goal support: their effects on goal progress, relationship quality, and subjective well-being.

Three studies examined the relations of autonomy support and directive support to goal progress over 3 months. Autonomy support was defined in terms of empathic perspective-taking, whereas directive support was defined in terms of the provision of positive guidance. Results from Study 1 revealed that autonomy support between romantic partners was significantly positively related to goal progress over 3 months, and that the beneficial effect of autonomy support was mediated by enhanced autonomous goal motivation. Study 2 involved female friend dyads and extended the goal progress results to include both self-reports and reports by peers. Study 3 showed that autonomy support similarly promoted progress at vicarious goals. Across three studies, autonomy support was also significantly associated with improved relationship quality and subjective well-being. Directive support was marginally associated with better goal progress across the three studies and unrelated to relationship quality or well-being.

The effects of self-criticism and self-oriented perfectionism on goal pursuit.

Five separate studies examined the associations of self-criticism and self-oriented perfectionism with goal pursuit across a variety of domains. Although self-criticism has previously been shown to be related to diminished goal progress, a controversy remains regarding the potential association between aspects of "positive perfectionism," such as self-oriented perfectionism, and enhanced goal progress. The results of the five studies demonstrated a consistent pattern of negative association between self-criticism and goal progress. The results also showed a positive association between self-oriented perfectionism and goal progress when self-criticism was controlled. The important role of self-criticism for understanding the impact of perfectionistic concerns is highlighted by these results. Implications for the debate concerning the possible positive effects of perfectionistic strivings are also discussed.

Autonomous motivation, controlled motivation, and goal progress.

Although the self-concordance of goals has been repeatedly shown to predict better goal progress, recent research suggests potential problems with aggregating autonomous and controlled motivations to form a summary index of self-concordance (Judge, Bono, Erez, & Locke, 2005). The purpose of the present investigation was to further examine the relations among autonomous motivation, controlled motivation, and goal progress to determine the relative importance of autonomous motivation and controlled motivation in the pursuit of personal goals. The results of three studies and a meta-analysis indicated that autonomous motivation was substantially related to goal progress whereas controlled motivation was not. Additionally, the relation of autonomous motivation to goal progress was shown to involve implementation planning. Together, the three studies highlight the importance for goal setters of having autonomous motivation and developing implementation plans, especially ones formulated in terms of approach strategies rather than avoidance strategies. The present research suggests that individuals pursuing goals should focus relatively greater attention on enhancing their autonomous motivation rather than reducing their controlled motivation.

Bolstering implementation plans for the long haul: the benefits of simultaneously boosting self-concordance or self-efficacy.

Recent studies suggest that implementation planning exercises may not be as helpful for long-term, self-initiated goals as for short-term, assigned goals. Two studies used the personal goal paradigm to explore the impact of implementation plans on goal progress over time. Study 1 examined whether administering implementation plans in an autonomy supportive manner would facilitate goal progress relative to a neutral, control condition and a condition in which implementation plans were administered in a controlling manner. Study 2 examined whether combining implementation plans with a self-efficacy boosting exercise would facilitate goal progress relative to a neutral, control condition and a typical implementation condition. The results showed that implementation plans alone did not result in greater goal progress than a neutral condition but that the combination of implementation plans with either autonomy support or self-efficacy boosting resulted in significantly greater goal progress.

Implementation intentions, perfectionism, and goal progress: perhaps the road to hell is paved with good intentions.

Two studies explored whether perfectionism moderates the impact of implementation intentions on goal progress. Study 1 used an implementation intention manipulation to examine the effects of these plans in interaction with perfectionism on the progress of New Year's resolutions. Study 2 added a repeated implementation intention condition and monitored affect and monthly goal progress. The results of both studies revealed a significant backfire effect of the implementation intentions on goal progress for participants high on a particular dimension of perfectionism (socially prescribed perfectionism). These perfectionists reported doing significantly worse at reaching their personal goals when they were asked to formulate implementation intentions than when they completed a control exercise. There also was evidence that implementation planning aroused negative affect for socially prescribed perfectionists. These results are the first to suggest that implementation planning may be contra-indicated for individuals with self-critical tendencies.

Attaining personal goals: self-concordance plus implementation intentions equals success.

The present article includes separate meta-analyses showing that self-concordance and implementation intentions are significantly positively associated with goal progress. Study 1 confirmed the positive relations of both self-concordance and implementation intentions to weekend goal progress. Study 2 confirmed the positive relation of self-concordance with monthly progress on New Year's resolutions but failed to find a direct benefit for implementation intentions. Both studies, however, obtained a significant interaction effect indicating that goal self-concordance and implementation intentions combined synergistically to facilitate goal progress. The article also reports a meta-analysis and results from the 2 studies that demonstrated that goal progress was associated with improved affect over time.

Children and affect: strategies for self-regulation and sex differences in sadness.

Thirty-two children, aged 6 to 11, were interviewed concerning their responses to distressing situations. Results indicate that the children possessed expectancies for coping with both sadness and anger. Coping strategies were predominantly behavioral, verbalized, and self-oriented; the most common was to engage in a distracting activity. Strategies employed with parents differed from those used with peers, and girls reported higher proportions of sadness-inducing events than did boys.