A clinical approach to nightmares and bad dreams in cognitive–behavioural therapy

SUMMARY Clinicians trained in cognitive–behavioural therapy (CBT) are frequently not trained to work with dreams. Given the high prevalence and impact of nightmares and bad dreams, empowering CBT therapists to effectively work with these sleep phenomena is crucial to improve therapeutic outcomes. This article briefly outlines a cognitive–behavioural model of dreams and reviews some clinical guidelines for directly and indirectly addressing nightmares and bad dreams in CBT practice.

Structural equation model of physical activity in Turkish schoolchildren: an application of the integrated behavioural model

ObjectivesChildhood obesity is increasingly prevalent in the developing world including Turkey. This study examined constructs of the integrated behavioural model associated with physical activity in a sample of schoolchildren in Ankara, Turkey using structural equation modelling.DesignCross-sectional survey by probability sampling.SettingFifteen schools of different socioeconomic strata in Ankara, Turkey with grade 4 students.Participants2066 (969 girls and 1097 boys) grade 4 schoolchildren and their parents selected using a probability-based sampling frame.Primary outcome measuresThree primary outcomes were used: moderate-to-vigorous physical activity, team sport participation, sedentary behaviour.ResultsData were collected from 2066 fourth-grade children from schools of three socioeconomic strata. Missing data were imputed using multiple imputation. To examine the integrated behavioural model, a structural equation model containing latent constructs for physical activity outcome expectancies, self-efficacy, home environment and social norms were fitted with the three outcomes above. Adequate model fit was achieved in the structural equation model (χ2=1821.97, df=872, p<0.001, Comparative Fit Index=0.91, Tucker Lewis Index=0.91, root mean square error of approximation=0.02, standardised root mean square residual=0.04). All scale items were significantly associated with their respective latent constructs (all p<0.001). Several significant pathways between latent constructs and outcomes of interest were observed (p<0.05). Self-efficacy was positively associated with moderate-to-vigorous physical activity (p<0.001) and team sport participation (p<0.001) and negatively associated with sedentary behaviour (p<0.001). Negative outcome expectancies were negatively associated with moderate-to-vigorous physical activity (p<0.01) and sedentary behaviour (p<0.01) while positive outcome expectancies were positively associated with team sport behaviour (p<0.001) and negatively associated with sedentary behaviour (p<0.05). Home support was positively associated with moderate-to-vigorous physical activity (p<0.01) and team sport participation (p<0.05). Finally, physical activity social norms were negatively associated with sedentary behaviour only (p<0.05).ConclusionsThis study supported the extension to Turkish children of the integrated behavioural model in relation to physical activity behaviours. Results illustrate multiple targets for interventions to increase physical activity.

Efficacy of cognitive-behavioural psychotherapy in the treatment of chronic fatigue in patients with multiple sclerosis – a literature review

Fatigue is one of the most common symptoms seen in patients with multiple sclerosis. Cognitive-behavioural psychotherapy can be a non-pharmacological approach for these patients. Van Kessel and Moss-Morris developed a cognitive-behavioural model to explain multiple sclerosis-related fatigue (2006). According to this model, inflammatory and demyelinating factors present in the central nervous system trigger fatigue, while cognitive interpretation, anxiety, or depressive symptoms and resting lifestyle are maintaining factors. Based on the cognitive-behavioural model of fatigue in multiple sclerosis, a protocol encompassing 8 treatment sessions was developed. For over 10 years, studies have been conducted to verify the effectiveness of cognitive-behavioural psychotherapy in the treatment of fatigue in patients with multiple sclerosis. The so far obtained results show that cognitive-behavioural psychotherapy has a moderate short-term effect on reducing fatigue, while the effect size in the long-term is small. The obtained results were undoubtedly influenced by several factors: the heterogeneity of the procedures used, the size of the research groups, and the large number of disease-related intermediary variables. Further research should be conducted to identify specific factors responsible for the effectiveness of cognitive-behavioural psychotherapy in the treatment of fatigue and to assess the long-term effects of therapy.

Stakeholder acceptability of the risk reduction behavioural model [RRBM] as an alternative model for adolescent HIV risk reduction and sexual behavior change in Northern Malawi

We sought to assess stakeholder acceptability of a risk reduction behavioural model [RRBM] designed for adolescent HIV risk reduction and whose efficacy we tested in selected schools in Northern Malawi. We used qualitative procedures in sampling, data collection and data analysis. Our data collection instrument was the semi-structured interview and we applied thematic content analysis to establish stakeholder evaluations of the RRBM model. The study population included10 experts working within key organizations and teachers from two schools. The organizations were sampled as providers, implementers and designers of interventions while schools were sampled as providers and consumers of interventions. Individual study participants were recruited purposively through snowball sampling. Results showed consensus among participants on the acceptability, potential for scale up and likelihood of model sustainability if implemented. In essence areas to consider improving and modifying included: focus on the rural girl child and inclusion of an economic empowerment component to target the underlying root causes of HIV risk taking behavior. Stakeholders also recommended intervention extension to out of school adolescent groups as well as involvement of traditional leaders. Involvement of parents and religious leaders in intervention scale up was also highlighted. The study serves as a benchmark for stakeholder involvement in model and intervention evaluation and as a link between researchers and project implementers, designers as well as policy makers to bridge the research to policy and practice gap.

Relationships, sustainability and agri-food purchasing behaviour in farmer markets in Italy

PurposeThe study aims to demonstrate that farmers' markets can represent a model of environmental, social and governance reference for modern agri-food systems facing the challenge of post COVID-19 pandemic reconstruction, responding to consumer expectations in terms of health, safety and wholesomeness of agri-food products.Design/methodology/approachA sample of consumers was surveyed in farmers' markets and social network analysis (SNA) was adopted as a methodological approach to reconstruct the links between the worlds of production and consumption and to derive the relative importance attributed to various factors that promote relational structures.FindingsThe work demonstrates the importance of sustainability – as a productive and behavioural model of firms – for the construction of efficient and durable relationship systems in two farmer markets in Sicily. In particular, four fundamental components emerge in the construction of networks represented by consumer sensitivity to sustainability processes, the individual behavioural model of purchasing and consumption, the expectation of political direction and the level and factors of knowledge of the firm. The clustering elements of the relationships were found to be the territory and local products, the environmentalist attitude and the protection of resources, as well as the adoption of a rational waste disposal policy, the fight against food waste, the encouragement of healthier and more sustainable consumption styles, clear and transparent communication and the activation of sustainable supply chain processes in line with the Sustainable Development Goals (SDGs).Originality/valueThe paper aims to demonstrate how alternative food systems can become a useful model for large enterprises, which are committed to rebuilding their business strategy to overcome the current crisis.