A Protocol Study to Establish Psychological Outcomes From the Use of Wearables for Health and Fitness Monitoring.

Background: The last few decades people have increasingly started to use technological tools for health and activity monitoring, such as tracking apps and wearables. The main assumption is that these tools are effective in reinforcing self-empowerment because they support better-informed lifestyle decision-making. However, experimental research assessing the effectiveness of the technological tools on such psychological outcomes is limited. Methods and Design: Three studies will be conducted. First, we will perform a systematic review to examine the experimental evidence on the effects of self-tracking apps on psychological outcome measurements. Second, we will conduct a longitudinal field experiment with a between subject design. Participants (N = 150) begin a 50-day exercise program, either with or without the aid of the self-tracking app Strava. Among those who use Strava, we vary between those who use all features and those who use a limited set of features. Participants complete questionnaires at baseline, at 10, 25, and 50 days, and provide details on what information has been tracked via the platform. Third, a subset of participants is interviewed to acquire additional qualitative data. The study will provide a rich set of data, enabling triangulation, and contextualization of the findings. Discussion: People increasingly engage in self-tracking whereby they use technological tools for health and activity monitoring, although the effects are still unknown. Considering the mixed results of the existing evidence, it is difficult to draw firm conclusions, showing more research is needed to develop a comprehensive understanding. Trial registration: Netherlands Trial registration: NL9402, received on 20 April 2021; https://www.trialregister.nl/trial/9402.

Bio-psycho-social interaction: an enactive perspective.

What are the respective roles of physiological, psychological and social processes in the development of psychiatric disorders? The answer is relevant for deciding on interventions, prevention measures, and for our (self)understanding. Reductionist models assume that only physiological processes are in the end causally relevant. The biopsychosocial (BPS) model, by contrast, assumes that psychological and social processes have their own unique characteristics that cannot be captured by physiological processes and which have their own distinct contributions to the development of psychiatric disorders. Although this is an attractive position, the BPS model suffers from a major flaw: it does not tell us how these biopsychosocial processes can causally interact. If these are processes of such different natures, how then can they causally affect each other? An enactive approach can explain biopsychosocial interaction. Enactivism argues that cognition is an embodied and embedded activity and that living necessarily includes some basic form of cognition, or sense-making. Starting from an enactive view on the interrelations between body, mind, and world, and adopting an organizational rather than a linear notion of causality, we can understand the causality involved in the biopsychosocial processes that may contribute to the development of psychiatric disorders.

Defining Compulsive Behavior.

Compulsive tendencies are a central feature of problematic human behavior and thereby are of great interest to the scientific and clinical community. However, no consensus exists about the precise meaning of 'compulsivity,' creating confusion in the field and hampering comparison across psychiatric disorders. A vague conceptualization makes compulsivity a moving target encompassing a fluctuating variety of behaviors, which is unlikely to improve the new dimension-based psychiatric or psychopathology approach. This article aims to help progress the definition of what constitutes compulsive behavior, cross-diagnostically, by analyzing different definitions in the psychiatric literature. We searched PubMed for articles in human psychiatric research with 'compulsive behavior' or 'compulsivity' in the title that focused on the broader concept of compulsivity-returning 28 articles with nine original definitions. Within the definitions, we separated three types of descriptive elements: phenomenological, observational and explanatory. The elements most applicable, cross-diagnostically, resulted in this definition: Compulsive behavior consists of repetitive acts that are characterized by the feeling that one 'has to' perform them while one is aware that these acts are not in line with one's overall goal. Having a more unified definition for compulsive behavior will make its meaning precise and explicit, and therefore more transferable and testable across clinical and non-clinical populations.

Becoming more oneself? Changes in personality following DBS treatment for psychiatric disorders: Experiences of OCD patients and general considerations.

Does DBS change a patient's personality? This is one of the central questions in the debate on the ethics of treatment with Deep Brain Stimulation (DBS). At the moment, however, this important debate is hampered by the fact that there is relatively little data available concerning what patients actually experience following DBS treatment. There are a few qualitative studies with patients with Parkinson's disease and Primary Dystonia and some case reports, but there has been no qualitative study yet with patients suffering from psychiatric disorders. In this paper, we present the experiences of 18 patients with Obsessive-Compulsive Disorder (OCD) who are undergoing treatment with DBS. We will also discuss the inherent difficulties of how to define and assess changes in personality, in particular for patients with psychiatric disorders. We end with a discussion of the data and how these shed new light on the conceptual debate about how to define personality.

Effects of Deep Brain Stimulation on the Lived Experience of Obsessive-Compulsive Disorder Patients: In-Depth Interviews with 18 Patients.

Deep Brain Stimulation (DBS) is a relatively new, experimental treatment for patients suffering from treatment-refractory Obsessive Compulsive Disorder (OCD). The effects of treatment are typically assessed with psychopathological scales that measure the amount of symptoms. However, clinical experience indicates that the effects of DBS are not limited to symptoms only: patients for instance report changes in perception, feeling stronger and more confident, and doing things unreflectively. Our aim is to get a better overview of the whole variety of changes that OCD patients experience during DBS treatment. For that purpose we conducted in-depth, semi-structured interviews with 18 OCD patients. In this paper, we present the results from this qualitative study. We list the changes grouped in four domains: with regard to (a) person, (b) (social) world, (c) characteristics of person-world interactions, and (d) existential stance. We subsequently provide an interpretation of these results. In particular, we suggest that many of these changes can be seen as different expressions of the same process; namely that the experience of anxiety and tension gives way to an increased basic trust and increased reliance on one's abilities. We then discuss the clinical implications of our findings, especially with regard to properly informing patients of what they can expect from treatment, the usefulness of including CBT in treatment, and the limitations of current measures of treatment success. We end by making several concrete suggestions for further research.

The phenomenology of deep brain stimulation-induced changes in OCD: an enactive affordance-based model.

People suffering from Obsessive-Compulsive Disorder (OCD) do things they do not want to do, and/or they think things they do not want to think. In about 10% of OCD patients, none of the available treatment options is effective. A small group of these patients is currently being treated with deep brain stimulation (DBS). DBS involves the implantation of electrodes in the brain. These electrodes give a continuous electrical pulse to the brain area in which they are implanted. It turns out that patients may experience profound changes as a result of DBS treatment. It is not just the symptoms that change; patients rather seem to experience a different way of being in the world. These global effects are insufficiently captured by traditional psychiatric scales, which mainly consist of behavioral measures of the severity of the symptoms. In this article we aim to capture the changes in the patients' phenomenology and make sense of the broad range of changes they report. For that we introduce an enactive, affordance-based model that fleshes out the dynamic interactions between person and world in four aspects. The first aspect is the patients' experience of the world. We propose to specify the patients' world in terms of a field of affordances, with the three dimensions of broadness of scope ("width" of the field), temporal horizon ("depth"), and relevance of the perceived affordances ("height"). The second aspect is the person-side of the interaction, that is, the patients' self-experience, notably their moods and feelings. Thirdly, we point to the different characteristics of the way in which patients relate to the world. And lastly, the existential stance refers to the stance that patients take toward the changes they experience: the second-order evaluative relation to their interactions and themselves. With our model we intend to specify the notion of being in the world in order to do justice to the phenomenological effects of DBS treatment.

Social affordances in context: what is it that we are bodily responsive to?

We propose to understand social affordances in the broader context of responsiveness to a field of relevant affordances in general. This perspective clarifies our everyday ability to unreflectively switch between social and other affordances. Moreover, based on our experience with Deep Brain Stimulation for treating obsessive-compulsive disorder (OCD) patients, we suggest that psychiatric disorders may affect skilled intentionality, including responsiveness to social affordances.

On the nature of obsessions and compulsions.

In this chapter, we give an overview of current and historical conceptions of the nature of obsessions and compulsions. We discuss some open questions pertaining to the primacy of the affective, volitional or affective nature of obsessive-compulsive disorder. Furthermore, we add some phenomenological suggestions of our own. In particular, we point to the patients' need for absolute certainty and the lack of trust underlying this need. Building on insights from Wittgenstein, we argue that the kind of certainty the patients strive for is unattainable in principle via the acquisition of factual knowledge. Moreover, we suggest that the patients' attempts to attain certainty are counter-productive as their excessive conscious control in fact undermines the trust they need.

The ghost in the machine: disembodiment in schizophrenia--two case studies.

The notion of embodiment is central to the phenomenological approach to schizophrenia. This paper argues that fundamental concepts for the understanding of schizophrenia have a bodily dimension. We present 2 single cases of first-onset schizophrenic patients and analyze the reports of their experiences. Problems such as loss of self, loss of common sense, and intentionality disorders reveal a disconnectedness that can be traced back to a detachment from the lived body. Hyperreflectivity and hyperautomaticity are used as coping mechanisms, but reflect the same problem of the split between body and mind. It is argued that the sole focus on cognitive impairments leads to a distorted image of schizophrenia, and that the acknowledgment of its fundamental bodily roots enables one to see the coherence between the diverse symptoms. As for the practical implications of the phenomenological approach, further research is needed to investigate if and how body- and movement-oriented therapies might strengthen the embodiment of schizophrenic patients.