Previous studies have reported inconsistent relationships between body image, eating disorder symptoms, and acculturation-relevant variables. The current study examined these variables in a sample of White, Latina, and Black college women (N = 276). White and Latina participants selected slimmer personal body shape ideals than Black women. Among Black women, the discrepancy between perceived body shape and perceived ideal body shape for the United States was predictive of Eating Disorder Inventory Body Dissatisfaction (EDI-BD) and Drive for Thinness (EDI-DFT) scores. The discrepancy between perceived body shape and perceived ideal for their ethnic group also predicted EDI-BD scores. Among Latinas, the discrepancy between perceived body shape and perceived body shape ideal for their ethnic group was predictive of EDI-BD and EDI-DFT scores, whereas a discrepancy between perceived body shape and perceived ideal for the United States was not predictive of eating disorder symptoms. Finally, higher levels of acculturative stress, but not acculturation, were associated with EDI-BD scores among Black women and EDI-DFT scores among Latinas. Findings underscore the importance of considering cultural variables such as acculturative stress when conducting clinical work with ethnic minority women.

OBJECTIVEIn this secondary analysis, we examined whether older adults with diabetes (aged 60–75 years) could benefit from self-management interventions compared with younger adults. Seventy-one community-dwelling older adults and 151 younger adults were randomized to attend a structured behavioral group, an attention control group, or one-to-one education.RESEARCH DESIGN AND METHODSWe measured A1C, self-care (3-day pedometer readings, blood glucose checks, and frequency of self-care), and psychosocial factors (quality of life, diabetes distress, frustration with self-care, depression, self-efficacy, and coping styles) at baseline and 3, 6, and 12 months postintervention.RESULTSBoth older (age 67 ± 5 years, A1C 8.7 ± 0.8%, duration 20 ± 12 years, 30% type 1 diabetes, 83% white, 41% female) and younger (age 47 ± 9 years, A1C 9.2 ± 1.2%, 18 ± 12 years with diabetes, 59% type 1 diabetes, 82% white, 55% female) adults had improved A1C equally over time. Importantly, older and younger adults in the group conditions improved more and maintained improvements at 12 months (older structured behavioral group change in A1C −0.72 ± 1.4%, older control group −0.65 ± 0.9%, younger behavioral group −0.55 ± 1.2%, younger control group −0.43 ± 1.7%). Furthermore, frequency of self-care, glucose checks, depressive symptoms, quality of life, distress, frustration with self-care, self-efficacy, and emotional coping improved in older and younger participants at follow-up.CONCLUSIONSThe findings suggest that, compared with younger adults, older adults receive equal glycemic benefit from participating in self-management interventions. Moreover, older adults showed the greatest glycemic improvement in the two group conditions. Clinicians can safely recommend group diabetes interventions to community-dwelling older adults with poor glycemic control.

BackgroundSeasonal affective disorder (SAD) is a subtype of recurrent depression involving major depressive episodes during the fall and/or winter months that remit in the spring. The central public health challenge in the management of SAD is prevention of winter depression recurrence. Light therapy (LT) is the established and best available acute SAD treatment. However, long-term compliance with daily LT from first symptom through spontaneous springtime remission every fall/winter season is poor. Time-limited alternative treatments with effects that endure beyond the cessation of acute treatment are needed to prevent the annual recurrence of SAD.Methods/designThis is an NIMH-funded R01-level randomized clinical trial to test the efficacy of a novel, SAD-tailored cognitive-behavioral group therapy (CBT) against LT in a head-to-head comparison on next winter outcomes. This project is designed to test for a clinically meaningful difference between CBT and LT on depression recurrence in the next winter (the primary outcome). This is a concurrent two-arm study that will randomize 160 currently symptomatic community adults with major depression, recurrent with seasonal pattern, to CBT or LT. After 6 weeks of treatment in the initial winter, participants are followed in the subsequent summer, the next winter, and two winters later. Key methodological issues surround timing study procedures for a predictably recurrent and time-limited disorder with a focus on long-term outcomes.DiscussionThe chosen design answers the primary question of whether prior exposure to CBT is associated with a substantially lower likelihood of depression recurrence the next winter than LT. This design does not test the relative contributions of the cognitive-behavioral treatment components vs. nonspecific factors to CBT’s outcomes and is not adequately powered to test for differences or equivalence between cells at treatment endpoint. Alternative designs addressing these limitations would have required more patients, increased costs, and reduced power to detect a difference in the primary outcome.Trial registrationClinicaltrials.gov identifier NCT01714050

Efficacious treatments for seasonal affective disorder include light therapy and a seasonal affective disorder-tailored form of cognitive-behavioral therapy. Using data from a parent clinical trial, these secondary analyses examined the relationship between cognitive change over treatment with cognitive-behavioral therapy, light therapy, or combination treatment and mood outcomes the next winter. Sixty-nine participants were randomly assigned to 6-weeks of cognitive-behavioral therapy, light therapy, or combination treatment. Cognitive constructs (i.e., dysfunctional attitudes, negative automatic thoughts, and rumination) were assessed at pre- and post-treatment. Dysfunctional attitudes, negative automatic thoughts, and rumination improved over acute treatment, regardless of modality; however, in participants randomized to solo cognitive-behavioral therapy, a greater degree of improvement in dysfunctional attitudes and automatic thoughts was uniquely associated with less severe depressive symptoms the next winter. Change in maladaptive thoughts during acute treatment appears mechanistic of solo cognitive-behavioral therapy’s enduring effects the next winter, but is simply a consequence of diminished depression in light therapy and combination treatment.

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This study examined the association between cognitive vulnerability factors and seasonality. Students (N = 88), classified based on the Seasonal Pattern Assessment Questionnaire as experiencing moderate (n = 26) or mild (n = 32) seasonality, and nondepressed, low-seasonality controls (n = 30) completed explicit (i.e., dysfunctional attitudes, automatic negative thoughts, seasonal attitudes, and rumination) and implicit (i.e., implicit associations test) measures of cognitive vulnerability at one winter and one nonwinter assessment. Relative to low- and mild-seasonality participants, moderate-seasonality participants endorsed more automatic thoughts and rumination in winter and more dysfunctional attitudes across both seasons. Moderate- and mild-seasonality participants endorsed more maladaptive seasonal attitudes than did low-seasonality participants. All groups demonstrated increased dysfunctional attitudes, automatic thoughts, and rumination and stronger implicit associations about light and dark during the winter. The findings support a possible cognitive mechanism of winter depression onset and/or maintenance unique to individuals with moderate, as opposed to mild, seasonality.