Post-traumatic stress disorder (PTSD) is a severely debilitating psychological condition that can affect one’s capacity to work and well-being. Nature-based interventions (NBI) offer a unique avenue for treatment without the typical barriers current psychotherapeutic treatments create for veterans and emergency service personnel (ESP). Data from a pilot study involving military veterans suggests angling as one such NBI, but large-scale robust experimental work is required to assess the causal impact of NBIs. We will therefore conduct a full-scale randomised controlled trial powered to provide definitive evidence of the efficacy of a nature-based, group angling intervention for military veterans and emergency service personnel with PTSD. We will recruit 264 participants for a randomised waitlist-controlled trial of a 2-day, 1-night nature-based angling intervention. We will compare PTSD, anxiety, depression, and wellbeing outcomes between an active and control group. The primary outcome relates to the comparison of pre-intervention (2 weeks before the intervention), with post-intervention measures for the active and control groups taken at 2 and 4 weeks after the intervention. We will also assess if the changes in PTSD scores in the active group might be considered clinically significant and reliable by comparing baseline (2-week pre-intervention) and 2-week and 4-week post-intervention PTSD scores. Secondary outcomes include examining loneliness, expressed anger using baseline and 4-week post-intervention scores. Long-term efficacy will be assessed by 6- and 12-month follow-up surveys. Cost-effectiveness will also be assessed. Process analyses will include examining the contribution of mood change, nature restoration, peer support, and skill learning experiences to the outcomes during the intervention scores at the beginning and end of the intervention. This randomised controlled trial (RCT) will evaluate the efficacy of a nature-based intervention in reducing PTSD symptoms in military veterans and frontline workers such as emergency service personnel and contribute to the evidence base on the clinical impact of NBIs for mental health outcomes. ISRCTN13593648. Registered on 19 June 2024

This article presents qualitative findings from interviews with participants in an outdoor activity programme aimed at assisting them to alleviate symptoms of military-related post-traumatic stress disorder (PTSD). Aside from exploring if and how participants felt the programme helped them manage their PTSD symptoms, the study also sought to identify factors that may help to inform future programme development. Thematic analysis of transcripts drawn from semi-structured interviews focused on respondents’ reflections on programme participation, early life experiences, military and post-military experiences, and mental health issues. The results supported the conclusion that the outdoor activities in a natural environment provided participants with a setting redolent of previously positive military experience, in which these former soldiers felt they could safely reveal and discuss troubling mental health and military matters, without fear of stigma. They also reported the benefits of the calm, tranquil environment aiding not only openness with peers but providing immediate beneficial effects on feelings of safety, sleep, and subsequent wellbeing. Conclusions indicate that such nature-based interventions may be a useful adjunct in the toolbox of treatments striving to reduce military-related PTSD symptomology.

Background A nationwide targeted lung cancer screening program is underway in the United Kingdom, but uptake in recent trials remains modest, and little is known about the psychological processes that might influence uptake.Purpose This study aimed to understand how individuals respond to a lung cancer screening invitation by identifying the key psychological, cognitive, and affective variables shaping screening intention and the thought processes underlying them.Methods UK screening-eligible current and former smokers aged 55-74 years (N = 1106) read an online lung screening invitation before providing their unprompted thoughts and completing measures of cognitive and affective variables (attitude; descriptive, subjective, and moral norms; perceived behavioral control; fear; anticipated regret; and fatalism). Logistic regressions examined predictors of screening intention, with follow-up analyses linking thought content to significant cognitive and affective predictors.Results Moral and descriptive norms, perceived behavioral control, and inaction regret were positively associated with intention, while fear and anticipated regret associated with taking part and receiving abnormal results were negatively associated. Thoughts reflecting NHS program doubts, stigma, and cancer worry were consistently negatively associated with cognitive and affective predictors, whereas perceived screening benefits of early detection and peace of mind, and personal/family cancer history were positively associated.Conclusion Screening motivation was shaped by both cognitive and affective factors, underpinned by distinct thoughts. Findings suggest that health communication interventions may strengthen moral and descriptive norms, leverage inaction regret, and enhance self-efficacy by addressing feelings of stigma, embarrassment, and cancer worry to increase screening participation at this critical stage of national implementation. This study examined how people may respond when they are invited to a new United Kingdom lung cancer screening program that will invite people who are current or former smokers. Screening can detect lung cancer earlier, when treatment is more successful. Researchers surveyed 1106 current and former smokers aged 55-74 years. Participants read a lung cancer screening invitation, shared their immediate thoughts, and answered questions about their views and feelings about screening. People were more willing to attend screening when they felt confident they could cope emotionally with taking part, believed that others like them would also attend, felt that attending was the right thing to do, and thought they might regret missing the opportunity for early detection or peace of mind. People with a family history of cancer were also more positive about the program. People were less willing when they felt fearful about cancer, or worried about feeling stigmatized by health care professionals. These findings suggest that screening invitations should strengthen confidence, highlight that similar others attend screening, encourage reflection on the regret of missing the opportunity, reinforce the value and benefits of taking part, and help people cope with their fears about bad news or being stigmatized.

Given the importance of patients' ability to effectively self-manage their kidney disease, researchers have developed interventions focused on improving self-management for patients on dialysis. The review and meta-analysis aimed to evaluate the efficacy of these interventions and identify the characteristics of more effective interventions in this domain. A meta-analysis of randomised controlled trials to promote self-management in patients on dialysis (N = 4201, k = 45) evaluated: the effect of the interventions on psychological, behavioural, and physiological outcomes; the relationships between changes in outcomes; the moderation of outcomes by behaviour change techniques employed in the interventions; and intervention duration. The meta-analysis obtained moderate effect sizes, demonstrating improvement in behavioural (g = 0.50 to 0.65) and physiological health outcomes (g = -0.32 to -0.57). Fewer studies assessed psychological intervention targets, but large effects were obtained for knowledge change and quality of life (g = 0.65 and 1.17, respectively). Improved knowledge was positively associated with improved medication adherence, which in turn was associated with one physiological outcome. Interventions incorporating psychotherapeutic techniques such as CBT or rational emotive therapy achieved superior physiological outcomes, particularly when used in isolation. The findings support the interpretation that intervention strategies to enhance emotional self-management are effective in optimising outcomes for patients on dialysis.

BACKGROUND:Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population.METHODS:Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic.RESULTS:Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

[Background] Well-defined measures of therapeutic benefit are essential for evaluating therapies and services. However, there is no single gold standard for defining ‘successful’ outcomes. We therefore examined the potential impact of adopting different success criteria. [Method] We analysed data for 7,064 patients undergoing psychological therapy in a single UK IAPT (Increasing Access to Psychological Therapy) Service, each patient being assessed for depression (PHQ-9) and anxiety (GAD-7) both at the start and end of treatment. Predictors of successful outcomes based on these measures were analysed separately for three different success criteria: based either on assessing clinically significant change, or reliable change, in depression and anxiety. [Results] The choice of criteria had little bearing on which variables predicted successful outcomes. However, the direction of the relationship between initial PHQ-9 or GAD-7 score and outcome success reverses when the criteria used to judge success are changed: successful outcomes are less probable under clinically significant change criteria for patients entering the service with more severe depression and/or anxiety but are more probable for such patients under reliable change criteria. [Conclusion] Relevant for clinicians, researchers, and policymakers, the choice of success criteria adopted can substantially change the incentives for patient selection into a therapy service. Our analysis highlights how the methods used to evaluate treatment outcomes could impact the priorities and organisation of therapeutic services, which could then impact on who is offered treatment. We recommend further investigations of success criteria in other conditions or treatments to determine the reproducibility of the effects we found.

Objective Habitual behaviours are triggered automatically, with little conscious forethought. Theory suggests that making healthy behaviours habitual, and breaking the habits that underpin many ingrained unhealthy behaviours, promotes long-term behaviour change. This has prompted interest in incorporating habit formation and disruption strategies into behaviour change interventions. Yet, notable research gaps limit understanding of how to harness habit to change real-world behaviours. Methods Discussions among health psychology researchers and practitioners, at the 2019 European Health Psychology Society 'Synergy Expert Meeting', generated pertinent questions to guide further research into habit and health behaviour. Results In line with the four topics discussed at the meeting, 21 questions were identified, concerning: how habit manifests in health behaviour (3 questions); how to form healthy habits (5 questions); how to break unhealthy habits (4 questions); and how to develop and evaluate habit-based behaviour change interventions (9 questions). Conclusions While our questions transcend research contexts, accumulating knowledge across studies of specific health behaviours, settings, and populations will build a broader understanding of habit change principles and how they may be embedded into interventions. We encourage researchers and practitioners to prioritise these questions, to further theory and evidence around how to create long-lasting health behaviour change.

Objective: To achieve wellness in cancer survivorship, researchers and clinicians need a better understanding of what it means to live “well”, from the perspective of cancer survivors themselves. Methods: Australian and UK cancer survivors (N = 376) diagnosed in the previous five years, were asked “What does it mean to be well?” , with an open-ended text response. Responses were coded using content analysis. Demographics, time since diagnosis, coping style and symptom level were also assessed. Results: Descriptions of what it meant to be “well” were coded as absence-focused (living without negative impacts of illness, 32.7%) or presence-focused (living with health, function, or wellbeing, 37.8%). A further 29.5% of responses contained both elements. Lower symptom level and higher use of a fatalism coping style were associated with presence-focused definitions of being well. Conclusions: More meaningful conversations with cancer survivors about their goals for care would be facilitated by a better understanding of what it means to them to be “well”. As symptoms change over the course of survivorship, it may be necessary to re-examine each survivor’s goals of care.

The impact of environmental context on the psychological benefits derived from physical activity has attracted research attention in recent years. Previous reviews have compared effects of indoor versus outdoor exercise. This review compares the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological health outcomes in adult general populations. An electronic literature search identified 24 experimental studies meeting the inclusion criteria. Results were analysed via narrative synthesis (n = 24) and meta-analysis (n = 9) of effect on six outcomes. Narrative synthesis found in favour of the natural environment for anxiety, anger/hostility, energy, affect and positive engagement. Post-intervention effect sizes suggested duration and social context as potential moderators. The meta-analyses revealed large or moderate effects in favour of the natural environment for anxiety, fatigue, positive affect and vigour, and a small effect for depression. Results were subject to high risk of bias and heterogeneity. Physical activity undertaken outdoors in natural environments is more beneficial for a range of psychological outcomes compared with urban environments. The various effect sizes evident in the meta-analyses may be explained by differing mechanisms through which psychological gains are experienced during physical activity in nature.

Efforts to guide peoples' behavior toward environmental sustainability, good health, or new products have emphasized informational and attitude change strategies. There is evidence that changing attitudes leads to changes in behavior, yet this approach takes insufficient account of the nature and operation of habits, which form boundary conditions for attitude-directed interventions. Integration of research on attitudes and habits might enable investigators to identify when and how behavior change strategies will be most effective. How might attitudinally driven behavior change be consolidated into lasting habits? How do habits protect the individual against the vicissitudes of attitudes and temptations and promote goal achievement? How might attitudinal approaches aiming to change habits be improved by capitalizing on habit discontinuities and strategic planning? When and how might changing or creating habit architecture shape habits directly? A systematic approach to these questions might help move behavior change efforts from attitude change strategies to habit change strategies.

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians’ decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples ( n 1  = 402; n 2  = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.

Most men show genital sexual arousal to one preferred gender. Most women show genital arousal to both genders, regardless of their sexual preferences. There is limited knowledge of whether this difference is driven by biological sex or gender identity. Transgender individuals, whose birth sex and gender identity are incongruent, provide a unique opportunity to address this question. We tested whether the genital responses of 25 (female-to-male) transgender men followed their female birth sex or male gender identity. Depending on their surgical status, arousal was assessed with penile gauges or vaginal plethysmographs. Transgender men's sexual arousal showed both male-typical and female-typical patterns. Across measures, they responded more strongly to their preferred gender than to the other gender, similar to (but not entirely like) 145 cisgender (nontransgender) men. However, they still responded to both genders, similar to 178 cisgender women. In birth-assigned women, both gender identity and biological sex may influence sexual-arousal patterns.

Past research suggests that people process verbal quantifiers differently from numerical ones, but this suggestion has yet to be formally tested. Drawing from traditional correlates of dual-process theories, we investigated whether people process verbal quantifiers faster, less accurately, and with less subjective effort than numerical quantifiers. In two pre-registered experiments, participants decided whether a quantity (either verbal or numerical) of a nutrient, summed with a pictorial quantity, exceeded a recommended total. The verbal quantifiers were matched to average numerical translations (Experiment 1) as well as translations from participants themselves (Experiment 2). Across experiments, participants did not answer faster or find verbal quantifiers less effortful than numerical ones, but they made less accurate decisions on average with verbal quantifiers because they used more context-based decision shortcuts (e.g., 'minerals are healthy'). Our findings suggest that it is how much people rely on context that distinguishes their decisions with verbal and numerical quantifiers.

Despite evidence that survivorship support programmes enhance physical and psychosocial wellbeing, cancer patients and survivors often do not use these supportive care services. This study investigated the utility of the Common Sense Model of Self-Regulation for predicting supportive care use following cancer, and the mediating role of coping strategies. Cancer patients and survivors (n = 336 from Australia, n = 61 from the UK; 191 males, 206 females) aged 20–83 years (Mean (M) = 62.73, Standard Deviation (SD) = 13.28) completed an online questionnaire. Predictor variables were cognitive and emotional representations of cancer, as measured by the Illness Perception Questionnaire—Revised (IPQ-R), and problem- and emotion-focused coping strategies, as measured by the Brief-Coping Orientation to Problems Experienced inventory (Brief-COPE). The outcome variable was survivorship support programme use within the preceding month. Perceived personal control over cancer predicted supportive care use, but cancer-related emotional distress did not. Coping was an inconsistent mediator of the relationships. Problem-focused coping mediated the relationship between personal control and supportive care use; emotion-focused coping did not mediate between emotional responses to cancer and the uptake of survivorship support programmes. The Common Sense Model provides a useful framework for understanding survivorship support programme use. However, more clarity around the relationship between illness beliefs and coping is required.

People often expect antibiotics when they are clinically inappropriate (e.g., for viral infections). This contributes significantly to physicians' decisions to prescribe antibiotics when they are clinically inappropriate, causing harm to the individual and to society. In two pre-registered studies employing UK general population samples (n1  = 402; n2  = 190), we evaluated the relationship between knowledge and beliefs with antibiotic expectations, and the effects of information provision on such expectations. We conducted a correlational study (study 1), in which we examined the role of antibiotic knowledge and beliefs and an experiment (study 2) in which we assessed the causal effect of information provision on antibiotic expectations. In study 1, we found that both knowledge and beliefs about antibiotics predicted antibiotic expectations. In study 2, a 2 (viral information: present vs. absent) × 2 (antibiotic information: present vs. absent) experimental between-subjects design, information about antibiotic efficacy significantly reduced expectations for antibiotics, but viral aetiology information did not. Providing antibiotic information substantially diminishes inappropriate expectations of antibiotics. Health campaigns might also aim to change social attitudes and normative beliefs, since more complex sociocognitive processes underpin inappropriate expectations for antibiotics.

Prosociality is an ideal context to begin shifting traditional gender role stereotypes and promoting equality. Men and women both help others frequently, but assistance often follows traditional gender role expectations, which further reinforces restrictive gender stereotypes in other domains. We propose an integrative process model of gender roles inhibiting prosociality (GRIP) to explain why and how this occurs. We argue that prosociality provides a unique entry point for change because it is (a) immediately rewarding (which cultivates positive attitude formation), (b) less likely to threaten the gender status hierarchy, and therefore less susceptible to social backlash (which translates into less restrictive social norms), and (c) a skill that can be learned (which leads to stronger beliefs in one’s own ability to help). Using the GRIP model, we derive a series of hypothesized interventions to interrupt the self-reinforcing cycle of gender role stereotyping and facilitate progress toward broader gender equality.