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  • 1. Ahtinen, Aino
    et al.
    Mattila, Elina
    Välkkynen, Pasi
    Kaipainen, Kirsikka
    Vanhala, Toni
    Ermes, Miikka
    Sairanen, Essi
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Myllymäki, Tero
    Lappalainen, Raimo
    Mobile mental wellness training for stress management: feasibility and design implications based on a one-month field study.2013In: JMIR mHealth and uHealth, ISSN 2291-5222, Vol. 1, no 2, article id e11Article in journal (Refereed)
    Abstract [en]

    Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens.

    OBJECTIVE: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management.

    METHODS: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week's and one month's use. In-depth user experience interviews were conducted after one month's use to study the acceptance and user experiences of Oiva.

    RESULTS: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems.

    CONCLUSIONS: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection.

  • 2.
    Ahtinen, Aino
    et al.
    VTT, Tampere, Finland.
    Välkkynen, Pasi
    VTT, Tampere, Finland.
    Mattila, Elina
    VTT, Tampere, Finland.
    Kaipainen, Kirsikka
    VTT, Tampere, Finland.
    Ermes, Miikka
    VTT, Tampere, Finland.
    Sairanen, Essi
    University of Jyväskylä, Finland.
    Myllymäki, Tero
    University of Jyväskylä, Finland.
    Lappalainen, Raimo
    University of Jyväskylä, Finland.
    Oiva – A mobile phone intervention for psychological flexibility and wellbeing2012In: Designing for Wellness and Behavior Change workshop, 2012Conference paper (Other academic)
    Abstract [en]

    To provide a scalable solution to mental health problems caused by stress, we developed Oiva, a mobile phone intervention for improving mental and physical wellbeing. Oiva is based on Acceptance and Commitment Therapy (ACT) and its aim is to teach the users skills to increase their psychological flexibility. The application contains 45 text, audio, and video exercises. Two user studies demonstrated the usability and acceptability of the application and concept. The evaluations also revealed that the users expected guidance on the application for performing the intervention program. They also wanted to have possibilities to individualize the application by saving their own reflections about the exercises as notes. The preliminary evaluation results indicate that Oiva is a good starting point for the further design and research of mobile applications for reducing stress and improving wellness.

  • 3.
    Järvelä-Reijonen, E.
    et al.
    nstitute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland.
    Karhunen, L.
    nstitute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland.
    Sairanen, Essi
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of Psychology, University of Jyväskylä.
    Muotka, J.
    Department of Psychology, University of Jyväskylä.
    Lindroos, S.
    Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki.
    Laitinen, J.
    Finnish Institute of Occupational Health.
    Puttonen, S.
    Finnish Institute of Occupational Health .
    Peuhkuri, K.
    Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki.
    Hallikainen, M.
    nstitute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland.
    Pihlajamäki, J.
    nstitute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland.
    Korpela, R.
    Medical Faculty, Pharmacology, Medical Nutrition Physiology, University of Helsinki.
    Ermes, M.
    VTT Technical Research Centre of Finland, .
    Lappalainen, R.
    Department of Psychology, University of Jyväskylä.
    Kolehmainen, M.
    nstitute of Public Health and Clinical Nutrition, Clinical Nutrition, University of Eastern Finland.
    The effects of acceptance and commitment therapy on eating behavior and diet delivered through face-to-face contact and a mobile app: A randomized controlled trial2018In: International Journal of Behavioral Nutrition and Physical Activity, ISSN 1479-5868, E-ISSN 1479-5868, Vol. 15, no 22, p. -14Article in journal (Refereed)
    Abstract [en]

    Background: Internal motivation and good psychological capabilities are important factors in successful eating-related behavior change. Thus, we investigated whether general acceptance and commitment therapy (ACT) affects reported eating behavior and diet quality and whether baseline perceived stress moderates the intervention effects. Methods: Secondary analysis of unblinded randomized controlled trial in three Finnish cities. Working-aged adults with psychological distress and overweight or obesity in three parallel groups: (1) ACT-based Face-to-face (n = 70; six group sessions led by a psychologist), (2) ACT-based Mobile (n = 78; one group session and mobile app), and (3) Control (n = 71; only the measurements). At baseline, the participants' (n = 219, 85% females) mean body mass index was 31.3 kg/m2 (SD = 2.9), and mean age was 49.5 years (SD = 7.4). The measurements conducted before the 8-week intervention period (baseline), 10 weeks after the baseline (post-intervention), and 36 weeks after the baseline (follow-up) included clinical measurements, questionnaires of eating behavior (IES-1, TFEQ-R18, HTAS, ecSI 2.0, REBS), diet quality (IDQ), alcohol consumption (AUDIT-C), perceived stress (PSS), and 48-h dietary recall. Hierarchical linear modeling (Wald test) was used to analyze the differences in changes between groups. Results: Group x time interactions showed that the subcomponent of intuitive eating (IES-1), i.e., Eating for physical rather than emotional reasons, increased in both ACT-based groups (p = .019); the subcomponent of TFEQ-R18, i.e., Uncontrolled eating, decreased in the Face-to-face group (p = .020); the subcomponent of health and taste attitudes (HTAS), i.e., Using food as a reward, decreased in the Mobile group (p = .048); and both subcomponent of eating competence (ecSI 2.0), i.e., Food acceptance (p = .048), and two subcomponents of regulation of eating behavior (REBS), i.e., Integrated and Identified regulation (p = .003, p = .023, respectively), increased in the Face-to-face group. Baseline perceived stress did not moderate effects on these particular features of eating behavior from baseline to follow-up. No statistically significant effects were found for dietary measures. Conclusions: ACT-based interventions, delivered in group sessions or by mobile app, showed beneficial effects on reported eating behavior. Beneficial effects on eating behavior were, however, not accompanied by parallel changes in diet, which suggests that ACT-based interventions should include nutritional counseling if changes in diet are targeted.

  • 4.
    Järvelä-Reijonen, Elina
    et al.
    University of Eastern Finland, Finland.
    Karhunen, Leila
    University of Eastern Finland, Finland; University Jyvaskyla, Finland.
    Sairanen, Essi
    University Jyvaskyla, Finland.
    Rantala, Sanni
    University Helsinki, Finland.
    Laitinen, Jaana
    Finnish Institute Occupational Health, Finland.
    Puttonen, Sampsa
    Finnish Institute Occupational Health, Finland.
    Peuhkuri, Katri
    University Helsinki, Finland.
    Hallikainen, Maarit
    University of Eastern Finland, Finland.
    Juvonen, Kristiina
    University of Eastern Finland, Finland.
    Myllymäki, Tero
    University Jyvaskyla, Finland.
    Föhr, Tiina
    University Jyvaskyla, Finland.
    Pihlajamäki, Jussi
    University of Eastern Finland, Finland; University Jyvaskyla, Finland.
    Korpela, Riitta
    University Helsinki, Finland.
    Ermes, Miikka
    VTT Tech Res Ctr, Finland.
    Lappalainen, Raimo
    University Helsinki, Finland.
    Kolehmainen, Marjukka
    University of Eastern Finland, Finland; University Jyvaskyla, Finland.
    High perceived stress is associated with unfavorable eating behavior in overweight and obese Finns of working age.2016In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 103, p. 249-258, article id S0195-6663(16)30144-1Article in journal (Refereed)
    Abstract [en]

    Stress-related eating may be a potential factor in the obesity epidemic. Rather little is known about how stress associates with eating behavior and food intake in overweight individuals in a free-living situation. Thus, the present study aims to investigate this question in psychologically distressed overweight and obese working-aged Finns. The study is a cross-sectional baseline analysis of a randomized controlled trial. Of the 339 study participants, those with all the needed data available (n = 297, 84% females) were included. The mean age was 48.9 y (SD = 7.6) and mean body mass index 31.3 kg/m(2) (SD = 3.0). Perceived stress and eating behavior were assessed by self-reported questionnaires Perceived Stress Scale (PSS), Intuitive Eating Scale, the Three-Factor Eating Questionnaire, Health and Taste Attitude Scales and ecSatter Inventory. Diet and alcohol consumption were assessed by 48-h dietary recall, Index of Diet Quality, and AUDIT-C. Individuals reporting most perceived stress (i.e. in the highest PSS tertile) had less intuitive eating, more uncontrolled eating, and more emotional eating compared to those reporting less perceived stress (p < 0.05). Moreover, individuals in the highest PSS tertile reported less cognitive restraint and less eating competence than those in the lowest tertile (p < 0.05). Intake of whole grain products was the lowest among those in the highest PSS tertile (p < 0.05). Otherwise the quality of diet and alcohol consumption did not differ among the PSS tertiles. In conclusion, high perceived stress was associated with the features of eating behavior that could in turn contribute to difficulties in weight management. Stress-related way of eating could thus form a potential risk factor for obesity. More research is needed to develop efficient methods for clinicians to assist in handling stress-related eating in the treatment of obese people.

  • 5. Lappalainen, Raimo
    et al.
    Sairanen, Essi
    Univ Jyvaskyla, Dept Psychol, Jyväskylä, Finland.
    Järvelä, Elina
    Rantala, Sanni
    Korpela, Riitta
    Puttonen, Sampsa
    Kujala, Urho M
    Myllymäki, Tero
    Peuhkuri, Katri
    Mattila, Elina
    Kaipainen, Kirsikka
    Ahtinen, Aino
    Karhunen, Leila
    Pihlajamäki, Jussi
    Järnefelt, Heli
    Laitinen, Jaana
    Kutinlahti, Eija
    Saarelma, Osmo
    Ermes, Miikka
    Kolehmainen, Marjukka
    The effectiveness and applicability of different lifestyle interventions for enhancing wellbeing: the study design for a randomized controlled trial for persons with metabolic syndrome risk factors and psychological distress.2014In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, article id 310Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Obesity and stress are among the most common lifestyle-related health problems. Most of the current disease prevention and management models are not satisfactorily cost-effective and hardly reach those who need them the most. Therefore, novel evidence-based controlled interventions are necessary to evaluate models for prevention and treatment based on self-management. This randomized controlled trial examines the effectiveness, applicability, and acceptability of different lifestyle interventions with individuals having symptoms of metabolic syndrome and psychological distress. The offered interventions are based on cognitive behavioral approaches, and are designed for enhancing general well-being and supporting personalized lifestyle changes.

    METHODS/DESIGN: 339 obese individuals reporting stress symptoms were recruited and randomized to either (1) a minimal contact web-guided Cognitive Behavioral Therapy-based (CBT) intervention including an approach of health assessment and coaching methods, (2) a mobile-guided intervention comprising of mindfulness, acceptance and value-based exercises, (3) a face-to-face group intervention using mindfulness, acceptance and value-based approach, or (4) a control group. The participants were measured three times during the study (pre = week 0, post = week 10, and follow-up = week 36). Psychological well-being, lifestyles and habits, eating behaviors, and user experiences were measured using online surveys. Laboratory measurements for physical well-being and general health were performed including e.g. liver function, thyroid glands, kidney function, blood lipids and glucose levels and body composition analysis. In addition, a 3-day ambulatory heart rate and 7-day movement data were collected for analyzing stress, recovery, physical activity, and sleep patterns. Food intake data were collected with a 48 -hour diet recall interview via telephone. Differences in the effects of the interventions would be examined using multiple-group modeling techniques, and effect-size calculations.

    DISCUSSION: This study will provide additional knowledge about the effects of three low intensity interventions for improving general well-being among individuals with obesity and stress symptoms. The study will show effects of two technology guided self-help interventions as well as effect of an acceptance and value-based brief group intervention. Those who might benefit from the aforesaid interventions will increase knowledge base to better understand what mechanisms facilitate effects of the interventions.

    TRIAL REGISTRATION: Current Clinical Trials NCT01738256, Registered 17 August, 2012.

  • 6.
    Mattila, Elina
    et al.
    VTT Technical Research Centre of Finland Ltd, Tampere, Finland.
    Lappalainen, Raimo
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Välkkynen, Pasi
    VTT Technical Research Centre of Finland Ltd, Tampere, Finland & Vincit Oy, Tampere, Finland.
    Sairanen, Essi
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Lappalainen, Päivi
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Karhunen, Leila
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland & Institute of Clinical Medicine, Clinical Nutrition, Kuopio University Hospital, Kuopio, Finland.
    Peuhkuri, Katri
    Faculty of Medicine, Pharmacology, Medical Nutrition Physiology, University of Helsinki, Helsinki, Finland.
    Korpela, Riitta
    Faculty of Medicine, Pharmacology, Medical Nutrition Physiology, University of Helsinki, Helsinki, Finland.
    Kolehmainen, Marjukka
    University of Eastern Finland, Kuopio, Finland, Kuopio University Hospital, Kuopio, Finland & VTT Technical Research Centre of Finland Ltd, Kuopio, Finland .
    Ermes, Miikka
    VTT Technical Research Centre of Finland Ltd, Tampere, Finland.
    Usage and Dose-Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis from the Intervention Arm of a Randomized Controlled Trial2016In: JMIR mhealth and uhealth, E-ISSN 2291-5222, Vol. 4, no 3Article in journal (Refereed)
  • 7.
    Sairanen, Essi
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Lappalainen, Päivi
    University Jyvaskyla, Finland.
    Hiltunen, Arto
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Psychological inflexibility explains distress in parents whose children have chronic conditions2018In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 7, article id e0201155Article in journal (Refereed)
    Abstract [en]

    Experiential avoidance, cognitive defusion, and mindfulness have all been associated with psychological disorders and well-being. This study investigates whether they predict psychological distress, i.e., symptoms of burnout, depression, stress and anxiety, in parents of children with chronic conditions. We hypothesized that these factors would exhibit a large degree of common variance, and that when compared to mindfulness and defusion, experiential avoidance on its own would predict a larger proportion of unique variance. 75 parents of children with chronic conditions having burnout symptoms who participated in an intervention study completed measures of burnout, stress, anxiety, depression, experiential avoidance, cognitive defusion, and mindfulness at the beginning of the intervention study (baseline). We ran several regression analyses to assess the predictive ability of these different constructs. Experiential avoidance on its own accounted for 28-48% of the variance in different psychological symptoms. Cognitive defusion and mindfulness did not make a significant contribution to explaining burnout, stress and anxiety, but cognitive defusion contributed to explaining depression. The results confirmed our hypothesis, supporting research on the importance of psychological flexibility as a central factor in understanding the occurrence of psychological distress.

  • 8.
    Sairanen, Essi
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). University of Jyväskylä, Finland.
    Lappalainen, Raimo Ilmari
    University of Jyväskylä, Finland.
    Lapveteläinen, Anja Terttu
    University of Eastern Finland, Kuopio, Finland.
    Karhunen, Leila Johanna
    University of Eastern Finland, Kuopio, Finland.
    Perceptions, Motives, and Psychological Flexibility Associated with Weight Management2012In: Journal of Obesity & Weight Loss Therapy, E-ISSN 2165-7904, Vol. 2, no 5, p. 1-6Article in journal (Refereed)
  • 9.
    Sairanen, Essi
    et al.
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Lappalainen, Raimo
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Lapveteläinen, Anja
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio.
    Tolvanen, Asko
    Department of Psychology, University of Jyväskylä, Jyväskylä, Finland.
    Karhunen, Leila
    Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio.
    Flexibility in weight management.2014In: Eating Behaviors, ISSN 1471-0153, E-ISSN 1873-7358, ISSN 1471-0153, Vol. 15, no 2, p. 218-24, article id S1471-0153(14)00022-1Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to investigate the relationships between changes in flexible vs. rigid restraints of eating during weight management, as well as how changes in the cognitive restraint of eating were related to psychological well-being and flexibility. The data includes information on 49 overweight persons who participated in a weight loss and maintenance (WLM) intervention and a follow-up assessment after 8-9 months. An increase in flexible cognitive restraint during the weight loss intervention was related to better weight loss maintenance and well-being. The more flexible restraint increased during the WLM intervention, the more psychological distress decreased. Moreover, larger reduction of rigid restraint during the follow-up period (between the WLM intervention and the follow-up assessment) was related to a better maintenance of improved psychological well-being at the follow-up endpoint. These results suggest that increasing flexible control while reducing rigid control of eating after an active weight loss phase improves success in weight management and the psychological well-being of weight losers.

  • 10.
    Sairanen, Essi
    et al.
    University of Jyväskylä, Finland .
    Tolvanen, Asko
    Karhunen, Leila
    Kolehmainen, Marjukka
    Järvelä, Elina
    Rantala, Sanni
    Peuhkuri, Katri
    Korpela, Riitta
    Lappalainen, Raimo
    Psychological flexibility and mindfulness explain intuitive eating in overweight adults2015In: Behavior modification, ISSN 0145-4455, E-ISSN 1552-4167, Vol. 39, no 4, p. 557-79Article in journal (Refereed)
    Abstract [en]

    The current study investigated whether mindfulness and psychological flexibility, independently and together, explain intuitive eating. The participants were overweight or obese persons (N = 306) reporting symptoms of perceived stress and enrolled in a psychological lifestyle intervention study. Participants completed self-report measures of psychological flexibility; mindfulness including the subscales observe, describe, act with awareness, non-react, and non-judgment; and intuitive eating including the subscales unconditional permission to eat, eating for physical reasons, and reliance on hunger/satiety cues. Psychological flexibility and mindfulness were positively associated with intuitive eating factors. The results suggest that mindfulness and psychological flexibility are related constructs that not only account for some of the same variance in intuitive eating, but they also account for significant unique variances in intuitive eating. The present results indicate that non-judgment can explain the relationship between general psychological flexibility and unconditional permission to eat as well as eating for physical reasons. However, mindfulness skills-acting with awareness, observing, and non-reacting-explained reliance on hunger/satiety cues independently from general psychological flexibility. These findings suggest that mindfulness and psychological flexibility are interrelated but not redundant constructs and that both may be important for understanding regulation processes underlying eating behavior.

  • 11.
    Sairanen, Essi
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). University of Jyväskylä, Finland.
    Tolvanen, Asko
    University of Jyväskylä, Finland.
    Karhunen, Leila
    University of Eastern Finland, Finland.
    Kolehmainen, Marjukka
    University of Eastern Finland, Finland.
    Järvelä-Reijonen, Elina
    University of Eastern Finland, Finland.
    Lindroos, Sanni
    University of Helsinki, Finland.
    Peuhkuri, Katri
    University of Helsinki, Finland.
    Korpela, Riitta
    University of Helsinki, Finland.
    Ermes, Miikka
    VTT Technical Research Centre of Finland, Finland.
    Mattila, Elina
    University of Helsinki, Finland.
    Lappalainen, Raimo
    University of Jyväskylä, Finland.
    Psychological flexibility mediates change in intuitive eating regulation in acceptance and commitment therapy interventions2017In: Public Health Nutrition, ISSN 1368-9800, E-ISSN 1475-2727, Vol. 20, no 9, p. 1681-1691Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Despite the promising results related to intuitive eating, few studies have attempted to explain the processes encouraging this adaptive eating behaviour. The focus of the present study was on exploring mechanisms of change in intuitive eating and weight in acceptance and commitment therapy (ACT) interventions. Mediation provides important information regarding the treatment processes and theoretical models related to specific treatment approaches. The study investigates whether psychological flexibility, mindfulness skills and sense of coherence mediated the interventions' effect on intuitive eating and weight.

    DESIGN: Secondary analysis of a randomized control trial. Mediation analysis compared two ACT interventions - face-to-face (in a group) and mobile (individually) - with a control group using a latent difference score model. Settings Data were collected in three Finnish towns.

    SUBJECTS: The participants were overweight or obese (n 219), reporting symptoms of perceived stress.

    RESULTS: The effect of the interventions on participants' (i) BMI, (ii) intuitive eating and its subscales, (iii) eating for physical rather than emotional reasons and (iv) reliance on internal hunger and satiety cues was mediated by changes in weight-related psychological flexibility in both ACT groups.

    CONCLUSIONS: These findings suggest that ACT interventions aiming for lifestyle changes mediate the intervention effects through the enhanced ability to continue with valued activities even when confronted with negative emotions and thoughts related to weight.

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