Academic literature on the topic 'Mind body intervention'

Abstract Mind-body intervention has been well established as an alternative psychosocial intervention for managing depression. Mindfulness-based intervention (MBI) and health qigong (HQ) are two common forms of mind-body intervention which share the common focus on breathing. However, they may represent two distinct approaches with different mechanisms. MBI focuses more on mind-based practices whereas HQ may focus predominantly on body-based movement practices. Thus, a large research gap in comparing the unique therapeutic effects of mind-based and movement-based health practices on alleviating depression among older people is worthy of further investigation. A total of 45 community-dwelling Chinese older adults aged 60 or above with symptoms of clinical depression were recruited. They were randomly assigned to three different groups, including an MBI group, a HQ group, and a waitlist control (WLC) group. Comparisons were made before and after 8-week interventions. Regarding the primary outcome, the effect sizes between the MBI and WLC groups, as well as between the HQ and WLC groups, were reasonably large (Hedges’ g = 1.338 and 0.725, respectively), yet the effect size between the MBI and HQ groups was moderate (Hedges’ g = 0.325). Specifically, participants in the MBI group showed more improvements on perceived stress, self-efficacy, and mental health, whereas participants in the HQ group showed relatively better performance regarding interoception and physical mobility. Findings from this research demonstrate the unique therapeutic effects of mind-based and movement-based interventions on alleviating depression among older people. The application of two distinct forms of mind-body intervention in a Chinese context is discussed.

Purpose: To contribute to the treatment fidelity literature by providing real-world examples and suggestion for future research and potential clinical application, this article reports on implementation, assessment, and evaluation of treatment fidelity in mind–body self-care approaches in at-risk women. Method: Aligning with best practices, treatment fidelity was integrated into three randomized clinical trials. The first examined the effects of a tai chi intervention designed to decrease cardiometabolic risk factors in women; the second examined the effects of a tailored guided imagery intervention on pregnancy outcomes in African American women; and the third explored effects of a mindful physical activity intervention (yoga) on psychological outcomes in women with moderate to severe depressive symptoms. Findings: Each of the studies successfully designed, implemented, and evaluated strategies to address recommended treatment fidelity components. These strategies provided qualitative and quantitative data that informed intervention refinement, directions for future research, and application in clinical practice. Conclusions: The treatment fidelity framework used here is based on best practices and was a feasible and reliable approach for ensuring and reporting on treatment fidelity, which is contributing to future research to foster translation of potentially effective mind–body self-care approaches into practice.

Objective: This study aimed to evaluate the effectiveness of a structured mind-body intervention in reducing perceived stress and enhancing body awareness among adults. Methods and Materials: The study used a randomized controlled trial design with 30 adult participants from Pakistan, randomly assigned to either an intervention group (n = 15) or a control group (n = 15). The intervention group received nine weekly sessions of a structured mind-body program incorporating mindfulness practices, breathwork, progressive muscle relaxation, and mindful movement, while the control group received no psychological training during this period. Both groups completed assessments at three time points: pre-test, post-test, and three-month follow-up. Perceived stress was measured using the Perceived Stress Scale (PSS), and body awareness was assessed using the Body Awareness Questionnaire (BAQ). Data were analyzed using repeated measures ANOVA with Bonferroni post-hoc tests in SPSS-27. Findings: The intervention group showed a significant reduction in perceived stress from pre-test (M = 28.47, SD = 3.92) to post-test (M = 17.26, SD = 4.21), which was sustained at follow-up (M = 18.02, SD = 4.33), while the control group showed no meaningful change. Similarly, body awareness scores in the intervention group increased significantly from pre-test (M = 62.13, SD = 6.48) to post-test (M = 77.94, SD = 5.87) and remained elevated at follow-up (M = 76.80, SD = 6.03), with no substantial changes in the control group. Repeated measures ANOVA revealed significant time, group, and interaction effects (p < .001), with large effect sizes. Bonferroni post-hoc analysis confirmed the stability of changes from post-test to follow-up. Conclusion: The findings suggest that mind-body interventions are effective in reducing stress and increasing body awareness, with sustained effects over a three-month period, making them a promising approach for psychological and somatic well-being in general adult populations.

Background Despite current rehabilitation programs, long-term engagement in physical activity remains a significant challenge for patients with chronic obstructive pulmonary disease (COPD) and heart failure (HF). Novel strategies to promote physical activity in these populations are greatly needed. Emerging literature on the benefits of both mind–body interventions and web-based interventions provide the rationale for the development of the Mindful Steps intervention for increasing walking behavior. Objective This study aims to develop a novel multimodal mind–body exercise intervention through adaptation of an existing web-based physical activity intervention and incorporation of mind–body exercise, and to pilot test the delivery of the new intervention, Mindful Steps, in a randomized controlled feasibility trial in older adults with COPD and/or HF. Methods In phase 1, guided by a theoretical conceptual model and review of the literature on facilitators and barriers of physical activity in COPD and HF, we convened an expert panel of researchers, mind–body practitioners, and clinicians to inform development of the novel, multimodal intervention. In phase 2, we are conducting a pilot randomized controlled feasibility trial of the Mindful Steps intervention that includes in-person mind–body exercise classes, an educational website, online mind–body videos, and a pedometer with step-count feedback and goals to increase walking behavior in patients with COPD and/or HF. Outcomes include feasibility measures as well as patient-centered measures. Results The study is currently ongoing. Phase 1 intervention development was completed in March 2019, and phase 2 data collection began in April 2019. Conclusions Through the integration of components from a web-based physical activity intervention and mind–body exercise, we created a novel, multimodal program to impact long-term physical activity engagement for individuals with COPD and HF. This developmental work and pilot study will provide valuable information needed to design a future clinical trial assessing efficacy of this multimodal approach. Trial Registration ClinicalTrials.gov NCT03003780; https://clinicaltrials.gov/ct2/show/NCT03003780 International Registered Report Identifier (IRRID) DERR1-10.2196/27826

OBJECTIVE: As insomnia is highly prevalent, and side effects of medication are well-known, mind-body interventions are increasingly being sought. The objective of this study is to present a narrative review regarding the effects of mind-body interventions for the treatment of insomnia. METHOD: A PubMed search was conducted including only randomized, controlled trials in which the main objective was to treat insomnia. DISCUSSION: Twelve studies were selected. In three of the studies, objective parameters (polysomnography) were analyzed. Mind-body interventions were able to improve sleep efficiency and total sleep time. Most can ameliorate sleep quality; some can reduce the use of hypnotic drugs in those who are dependent on these drugs. CONCLUSION: According to the studies we selected, self-reported sleep was improved by all mind-body treatments, among them yoga, relaxation, Tai Chi Chih and music. Cognitive behavioral therapy seems to be the most effective mind-body intervention. Cognitive behavioral therapy was the only intervention that showed better results than medication. However, considering that only five of the twelve studies chosen reached a score of 3 in the Jadad scale, new studies with a higher methodological quality have to be conducted especially in mind-body interventions that belong to the complementary or alternative medicine field.

ABSTRACTBackground:Mind-body interventions have been associated with a range of positive outcomes in older adults with mild cognitive impairment (MCI). The aim of the present study was to review the impact of different non-pharmacological programs based on mind-body intervention for older adults with MCI.Methods:A comprehensive search method as required by the Cochrane Collaboration has been performed through the following databases: Google Scholar, Science Direct, PubMed, PsycINFO, MEDLINE, EMBASE, CINHAL, Cochrane, Ebsco. We included the studies that evaluated the impact of mind-body interventions such as mindfulness or meditation, yoga, Tai Chi and Qigong on cognitive function and everyday functionality of non-hospitalized adults aged 55 years or over with MCI.Results:Nine studies met the inclusion criteria. Results indicated that mind-body interventions improved cognitive function, everyday activities functioning, and mindfulness, as well as resulting in a moderate reduction in fall risk, depression and stress and lower risk of dementia at one year.Conclusion:Several mind-body interventions focused broadly on mindfulness, yoga and Tai Chi training have been studied. This review shows that mind-body interventions improved cognitive function and everyday activities functioning, memory, resilience and mindfulness in older adults with MCI. However, the conclusions faced limitations, such as small sample size, heterogeneity of outcome measures, lack of an active control group and absence of long-term follow up. Further high-quality evidence is needed in order to determine whether mind-body interventions are cost-effective for improving cognitive decline in older adults with MCI and for delaying the rapid progression from MCI to Alzheimer or other types of dementia.

The pandemic highlighted the need for alternative, more accessible access to mental health interventions that can be readily administered remotely. The purpose of this pre-post-interventional study was to evaluate the effectiveness of a virtual mind-body medicine training course on stress, anxiety, and depression levels. University employees and members of the Las Vegas community were recruited via self-selection and snowball sampling and subjected to online mind-body practice sessions in December of 2020. Stress, anxiety, depression, and quality of life were assessed pre- and post-intervention using standardized psychometric valid tools. The paired t-test and related samples marginal homogeneity tests were used for continuous and categorical outcomes, respectively. Depression and stress scores were significantly decreased (p < 0.001). Mean scores of professional quality of life improved post-intervention compared to pre-intervention (p = 0.03). A significantly larger proportion of participants reported no depression or stress post-intervention compared with pre-intervention (p < 0.001, p = 0.003, respectively.) This study suggests that virtual mind-body practices had a pronounced impact on stress and depression levels during the pandemic. These findings support virtual, online-guided mind-body medicine training as an effective intervention that can be administered virtually to reduce stress and depression symptoms.

Through the Celtic Knot Project, students learned that even the simple act of providing ice water to a patient addressed the mind, body, and spirit. It facilitated the students’ understanding of the holistic nature of nursing, the application of nursing interventions to achieve wellness, and the notion that each intervention can affect mind, body, and spirit collectively—that the whole is indeed more than the sum of its parts.

Comorbid chronic insomnia was found highly prevalent in breast cancer patients. It also persisted through survivorship. Negative emotions upon diagnosis and during the course of cancer treatment might complicate the underlying mediating factors between stress and insomnia found in non-cancer population. Cognitive Behavioural Therapy (CBT) has been evidenced in improving insomnia. With the appreciation of Mindfulness training in improving cognitive flexibility and rumination, a novel treatment approach integrating CBT and mindfulness—Mind-Body Intervention (MBI) was developed. 　　　There were three objectives in the research. Firstly, prevalence data on insomnia and clinical profile of Hong Kong Chinese breast cancer survivors were obtained. Secondly, the mediating roles of negative emotions, hyperarousal, pre-sleep arousals in the relationship between perceived stress and insomnia were examined. Thirdly, the effects of CBT and MBI for breast cancer survivors with insomnia were investigated. 　　　In the first study, 1049 women who survived from non-metastatic breast cancer were invited to complete a survey on stress, mental health, arousals and insomnia. Those who met psychophysiological insomnia were invited to participate in the second study, which was a multisite randomized controlled trial. The 73 participants were allocated to CBT (n=24), MBI (n=27) or waiting list control, WLC (n=22). Both treatments were five weekly-session group therapies. Outcomes on insomnia, mental health, arousals, dysfunctional beliefs, quality of life and mindfulness, were obtained on baseline, post-treatment, 3-month and 6-month follow-ups. 　　　Results of the first study revealed 34.6% of the participants suffered from clinical insomnia, while 15.1%, 27.4% and 12.8% endorsed moderate to extremely severe depression, anxiety and stress respectively. Duration of insomnia was correlated with insomnia severity. Hyperarousal was found moderating cognitive ore-sleep arousal and anxiety, these in turn, together with depression mediated the relationship between perceived stress and insomnia severity. Results of the second study supported the hypothesis both CBT and MBI improved insomnia and other psychological symptoms, while WLC did not. After treatment, significant decreases of 59 and 67 minutes of total wake time per night were found for CBT and MBI respectively. Sleep efficiency values significantly increased in CBT (12.2%) and MBI (12.7%). Moderate to large effect sizes and clinically significant differences were found in most sleep and psychological variables. Generally, CBT produced larger effect sizes than MBI on post-treatment. The therapeutic gains were found sustaining through 3-month to 6-month follow-ups in both treatments. However, the effect sizes of CBT were on the declining trend, while those of MBI were more stable. 　　　The results suggested that insomnia and anxiety were frequently experienced in breast cancer even after completing the medical treatments. The longer the survivors suffered from insomnia, the higher the severity was found. In additional to the cognitive pre-sleep arousal, the important mediating roles of depression and anxiety imply that insomnia treatments should incorporate strategies designed to help in decreasing rumination/worry before bedtime and improving mental health conditions. The findings also provided initial evidence for the efficacy of MBI as a viable treatment for insomnia. More vigorous randomized controlled trial and the long-term efficacy could be further studied.
published_or_final_version
Clinical Psychology
Doctoral
Doctor of Psychology

This dissertation focused on advancing the current research on the connection between physical and psychological health. This study focused on two psychotherapy groups that integrate mind-body practices in the form of yoga, meditation, and relaxation. These groups were ongoing and are held once a week for one hour in an urban outpatient mental health clinic. Participants in these groups attended consistently for approximately 1-4 years and experienced a wide-range of trauma and chronic pain symptoms. Because the groups were active and running for several years, this study followed a qualitative research approach to comprehensively capture the participants’ subjective experience. Understanding the experience of these particular clients could prove to be advantageous to the field of psychology as it will help to elucidate the individual’s experience of an integrated mind-body modality for trauma and pain treatment. Using phenomenological interviews, this study explored the subjective experience of individuals in these groups. In-depth interview questions focused on participants’ reactions to the mind-body interventions for combined physical and psychological symptom relief.

Infertility is a frequently occurring chronic health condition, which often persists throughout the reproductive years. Heightened anxiety symptoms often are comorbid with infertility diagnoses. Women experiencing infertility, and particularly those with anxiety symptoms, characterize an emerging population that deserves special attention. However, women experiencing infertility have identified barriers to seeking psychotherapy (e.g., fears of being dismissed from fertility treatment and/or stigmatized). Consequently, women diagnosed with infertility need a psychotherapy that not only can reduce these symptoms, but can also be private and convenient. The current study translated an empirically tested in-person mind/body protocol into an internet-based intervention to suit the needs of this population. Seventy-one women were randomly assigned to the intervention or a wait-list control. At the close of the study, only three participants had completed the intervention. At mid-assessment, relative to the wait-list group, the intervention group had a lower level of depressive symptoms and, for those with elevated anxiety symptoms at baseline, a lower level of anxiety symptoms. The findings suggest that even a partially completed internet-based intervention can reduce the anxiety and depressive symptoms of women with a diagnosis of infertility.

Background. Primary and secondary prevention trials have shown that implantable cardioverter-defibrillators (ICD) reduce the risk of cardiac death, but concerns have been raised regarding the psychological well-being of ICD patients. Anxiety can affect a significant proportion of these patients, but there is limited information about prevalence and determinants of anxiety after the implementation of the more recent guidelines for ICD implantation. Several behavioral interventions have been effective in improving anxiety in these patients, however the efficacy of mindfulness-based interventions (MBI) has not been investigated in ICD patients, and there is limited information regarding the characteristics of pre-intervention, “dispositional” mindfulness in patients with cardiovascular disease never exposed to mindfulness training. The aims of this dissertation project were: 1) To determine the feasibility of a randomized clinical trial of a phone-administered, mindfulness-based training program, as measured by recruitment and retention rates, treatment adherence and fidelity; 2) To evaluate the current baseline prevalence and determinants of anxiety in the study population and 3) To describe the correlates of dispositional mindfulness in the study population. Methods. The study was conducted at the Electrophysiology Service at the UMass Memorial Medical Center. All consecutive patients who recently underwent an ICD procedure or received ICD shocks were screened for eligibility to participate in a pilot randomized controlled trial in which an eight session, phone-delivered, weekly MBI was compared to a usual care condition. Assessments were performed at baseline and post-intervention. A cross-sectional design was used for aims 2 and 3. Anxiety was assessed using the Hospital Anxiety and Depression Scale; a shortened version of the Five Facets of Mindfulness questionnaire was used to evaluate mindfulness. Results. Thirty patients (21 M, 9 F; mean age 63.1 ±10.3 years) were enrolled in the study. The methods ultimately adopted to screen, recruit, and retain study participants were feasible to conduct and satisfactory to ICD outpatients, and the study intervention was safe. Phone delivery resulted in excellent retention rates and limited costs. Assessments of treatment fidelity showed that the content of the intervention was delivered as intended in almost 100% of cases. The study findings do not show a decrease in the overall prevalence of anxiety in ICD patients compared with earlier cohorts; anxiety was associated with young age, low socio-economic status and previous psychological morbidity, but not with ICD-related factors including prior shock delivery. Finally, baseline mindfulness was most strongly associated with previous psychological morbidity (in particular, depression), and current anxiety symptoms. Conclusion. Psychological morbidity appears to be the major determinant of anxiety in the patients currently enrolled in the study. Dispositional mindfulness is inversely associated with current anxiety and depression and with prior psychological morbidity, supporting the hypothesis of a modulating role of mindfulness on the processing of negative emotions. A phone-delivered, individual MBI is feasible, acceptable to patients and can be adequately delivered by trained instructors. The findings from this dissertation work support the need for larger clinical trials of MBI in ICD patients.

Background. Primary and secondary prevention trials have shown that implantable cardioverter-defibrillators (ICD) reduce the risk of cardiac death, but concerns have been raised regarding the psychological well-being of ICD patients. Anxiety can affect a significant proportion of these patients, but there is limited information about prevalence and determinants of anxiety after the implementation of the more recent guidelines for ICD implantation. Several behavioral interventions have been effective in improving anxiety in these patients, however the efficacy of mindfulness-based interventions (MBI) has not been investigated in ICD patients, and there is limited information regarding the characteristics of pre-intervention, “dispositional” mindfulness in patients with cardiovascular disease never exposed to mindfulness training. The aims of this dissertation project were: 1) To determine the feasibility of a randomized clinical trial of a phone-administered, mindfulness-based training program, as measured by recruitment and retention rates, treatment adherence and fidelity; 2) To evaluate the current baseline prevalence and determinants of anxiety in the study population and 3) To describe the correlates of dispositional mindfulness in the study population. Methods. The study was conducted at the Electrophysiology Service at the UMass Memorial Medical Center. All consecutive patients who recently underwent an ICD procedure or received ICD shocks were screened for eligibility to participate in a pilot randomized controlled trial in which an eight session, phone-delivered, weekly MBI was compared to a usual care condition. Assessments were performed at baseline and post-intervention. A cross-sectional design was used for aims 2 and 3. Anxiety was assessed using the Hospital Anxiety and Depression Scale; a shortened version of the Five Facets of Mindfulness questionnaire was used to evaluate mindfulness. Results. Thirty patients (21 M, 9 F; mean age 63.1 ±10.3 years) were enrolled in the study. The methods ultimately adopted to screen, recruit, and retain study participants were feasible to conduct and satisfactory to ICD outpatients, and the study intervention was safe. Phone delivery resulted in excellent retention rates and limited costs. Assessments of treatment fidelity showed that the content of the intervention was delivered as intended in almost 100% of cases. The study findings do not show a decrease in the overall prevalence of anxiety in ICD patients compared with earlier cohorts; anxiety was associated with young age, low socio-economic status and previous psychological morbidity, but not with ICD-related factors including prior shock delivery. Finally, baseline mindfulness was most strongly associated with previous psychological morbidity (in particular, depression), and current anxiety symptoms. Conclusion. Psychological morbidity appears to be the major determinant of anxiety in the patients currently enrolled in the study. Dispositional mindfulness is inversely associated with current anxiety and depression and with prior psychological morbidity, supporting the hypothesis of a modulating role of mindfulness on the processing of negative emotions. A phone-delivered, individual MBI is feasible, acceptable to patients and can be adequately delivered by trained instructors. The findings from this dissertation work support the need for larger clinical trials of MBI in ICD patients.

The researcher aimed to determine the effect of a dance and movement intervention on the perceived emotional well-being and self-esteem of a group of in-patient adolescents in Weskoppies Psychiatric Hospital. A quantitative study, using a quasi-experimental design, was carried out using the positive and negative affect scale for children (PANAS-C) and the Rosenberg self-esteem scale to measure the two independent variables, namely perceived emotional well-being and self-esteem. There were four participants in the experimental group and six in the control group. A between-group comparison was made between the pre-test and post-test scores of the two groups. Both groups completed the positive and negative affect scale for children (PANAS-C) and the Rosenberg self-esteem scale at which point the experimental group took part in a two week, twelve session, dance and movement intervention program. After two weeks both groups once again completed these two measures. Although the results were statistically non-significant, effect size and outcome patterns pointed to an improvement in these two variables due to the intervention program.
Dissertation (MA)--University of Pretoria, 2010.
Psychology
unrestricted

The purpose of this study is to examine the potential for yoga to contribute to sustainability objectives via pro-social and environmental attitudes and behaviours. It locates core principles and concepts embedded within the meaning of the term interconnectedness in both western and eastern histories of ideas, with particular emphasis on yoga, integralism, and ecological theory. It evaluates and investigates yoga's potential toward recognition or realisation of a non-dualist paradigm of interconnectedness that might invoke social and environmental change. It explores how a tripartite model of yoga understands interconnectedness at a deeper level than the mechanistic worldview, and could support proactive measures toward a more fair, just, and sustainable world. It locates cultural barriers to yoga's potential for a pro-environmental and pro-social worldview and lifestyle, suggesting options to advance yoga's ecological values by improved education and scholarship. To access suitable models, the study learnt and practiced traditional teachings, applied them to contemporary issues and sought perspectives from under-represented sources. To answer research questions on how yoga can benefit contemporary issues, it also critically reflected on how scholarship impacts upon the communities from which the knowledge is obtained. The project contributes new knowledge on interconnectedness, its meaning and historic cultural context. It contributes a novel epistemic and methodological framework consistent with traditional knowledge, particularly relevant for progress on culturally appropriate scholarship in yoga studies. The project is the first of its kind to deeply explore the meanings of the word interconnectedness. It is one of the most committed attempts to date to seek out a doctrinal model from the traditions that can embrace both transcendent and immanent aspects of yoga in both theory and practice toward a coherent eco-yoga model. In doing so it engages with a wide lacuna between rhetorical appeals to yoga as a sustainability praxis and mind body intervention by supplementing existing theory with some of the traditional knowledge to explain how yoga works, and how it can help to meet sustainability objectives like cultivating an interconnected worldview. The project calls to seriously examine the legacy of colonial classification systems and methodological issues in the representation of yoga cultures. It appeals for the review of academic conventions among yoga scholars and for the prioritisation of sincere regard for the impact of scholarship on yoga’s intangible cultural heritage value, particularly considering yoga’s protection under UNESCO.

This paper introduces the Bodymind model of Art Therapy and delineates the processes through which it has salutary effects on individuals coping with a variety of health related challenges. The goal of this model is to articulate how activation, reorganization, growth and reintegration of the self can emerge from bodymind processes activated by art therapy. It provides a framework for the conduct of research that will test the key theoretical mechanisms through which art therapy benefits clients. We expect this model to be a spring board for discussion, debate and development of the profession of art therapy. Furthermore, we hope readers can use this model to conduct sound mechanistic studies. This paper can inform social scientists and medical professionals on the manner in which art making can contribute to health.

Globally, it is estimated that 50 million people are currently living with dementia, which is expected to reach 75 million by the end of this decade. Recently, there has been increasing interest in the use of lifestyle interventions to delay both the onset and progression of dementia following a growing list of failed pharmaceutical trials. Habitual physical activity is one such target for lifestyle intervention due to promising longitudinal evidence linking higher levels of physical activity with greater cognition, slower cognitive decline and decreased risk of developing Alzheimer’s disease and all-cause dementia. Physical activity itself is associated with various clinical characteristics that are amenable to exercise intervention in older adults, including but not limited to, physical function, strength, muscle mass, cognition, psychological health, and functional independence. Robust anabolic exercise such as progressive resistance training (PRT) is a promising intervention which can augment cognition in healthy older as well many of the associated clinical characteristics that are significantly influenced by the catabolic processes observed within dementia, such as sarcopenia, frailty and malnutrition. However, the relationship between cognition and physical activity, and extent to which these clinical characteristics are modifiable following robust anabolic exercise, remain largely unanswered. Thus, the aims of this thesis are to (1) characterise levels of physical activity and sedentary time in populations with varying degrees of cognitive impairment, (2) evaluate the relationship between physical activity and sedentary behaviour with cognition across the cognitive spectrum, and subsequently (3) evaluate the effects of robust anabolic exercise on change in cognition and changes in physical activity and sedentary behaviour, and whether these changes are related to each other. To investigate these aims, we have evaluated two very different cohorts along the cognitive impairment spectrum: mild cognitive impairment (MCI) and Lewy body dementia (LBD). Specifically, MCI represents a stage of cognitive impairment where there is minimal functional impairment in daily activities, and where there is not necessarily an underlying pathological process causing impairment. Conversely, LBD represents a severe, rapidly progressing form of dementia with significant pathological underpinning that results in extensive cognitive, psychiatric, movement and autonomic symptoms. The relationship between physical activity and cognition, and subsequent response to intervention may differ with increasing disease severity, frailty, and functional limitations. Therefore, this thesis was able to rigorously evaluate these associations across the spectrum of cognitive impairment. There was a range of relevant of scientific methodologies and study designs included throughout this thesis in order to address these aims. The seven chapters of this thesis include a systematic review, cross-sectional observational studies, a randomised controlled trial, a protocol with rationale, a novel pilot study, and a thorough case report. Collectively, these chapters have provided a comprehensive picture of both the levels of physical activity and cognition in older adults with cognitive impairment, as well as their association with a diverse range of modifiable clinical characteristics. These findings provide robust rationale for the use of anabolic exercise in these cohorts to address modifiable aspects of their chronic diseases and geriatric syndromes, most notably frailty and disability. Lastly, the novelty of our findings provide a foundation for future investigations to further explore these associations within other types of cognitive impairment and refine effective interventions to attenuate cognitive decline and the risk of dementia.

Abstract The conceptualization of ‘techne’ (Foucault, 1984) offers an alternative perspective on technology, shifting the focus from technology’s functional rationale to human capacities for intervention. Spatially, a ‘threshold’ typically acts as a physical demarcation signifying transitions and interior-exterior passage. Etymologically, the conception of ‘threshold’ evolves and reveals that it encapsulates a shift between interiority and exteriority, necessitating the human mind and body to actively experience and engage in certain spatial conditions. This habitually produces and expresses temporal specificity in societal-cultural means. For instance, the western meaning of ‘threshold’ refers to ‘to treat and to thresh’ in ancient practice, while the Chinese perspective couples an object of ‘door’ [門] and the potential activity of ‘crossing’ [檻]. Drawing from an empirical study on the public Tsuen Wan Footbridge Network, this research problematizes its operation as negotiating techne – a multiplicity of potentialities for individuals to interact and experience tactical interventions beyond walking. This paper positions the footbridge network as the ‘morphogenesis of thresholds’, uncovering the living operation of volumetric hybridity as an assemblage of negotiating societal-cultural techne – a multiplicity of liminal habitual genres that constitute a totality of ‘identity-less’ lifestyles in a ‘scaleless’ volumetric city. Initial conclusions will highlight the importance of reinventing thresholds, viewing them as portals to human potentialities, rather than solely as markers of spatial usefulness to connect fragmented components or facilitate movements. Thereby, to consider the negotiation between individuals and the shared environment as a creative genesis of ‘tactical techne’ that generates sequence of liminal conditions.

ABSTRACT Backgrund: A growing body of evidence suggests that activity of the stress-responsive hypothalamic-pituitary-adrenal axis and its end-product cortisol also may be associated with perinatal emotional well-being. A number of preventive interventions, such as Yoga, targeting psychosocial and physiological risk factors for perinatal depression have utilized mind-body practices, which embody the idea that the mind interacts with the body to influence physical functioning, improve symptoms, and promote health. This study aimed to investigate effectiveness of prenatal yoga in reducing cortisol hormone in pregnancy Subjects and Method: This was a meta-analysis and systematic review. This study collected published articles during 2000 to 2020 from PubMed, Science Direct, Springer, Proquest, and Chocrane electronic databases. The inclusion criteria were full text, randomized controlled trial, and prenatal yoga intervention. The study subjects were pregnant women who received prenatal yoga for 8 to 20 weeks. Outcome was cortisol hormone reduction during pregnancy. The selected articles were analyzed by PRISMA flow chart and RevMan 5.3. Results: 5 articles from America and Asia were met the inclusion criteria. This study had high heterogeneity (I2=88%; p<0.001). Therefore, this study used random effect model (REM). Prenatal yoga reduced cortisol level 0.59 times in pregnancy (Mean Difference= -0.59; 95% CI= 1.18 to 0.01; p= 0.050). Conclusion: Prenatal yoga is effective to reduce cortisol level in pregnant women. Keywords: prenatal yoga, cortisol hormone, pregnant women Correspondence: Shiva Aflahiyah. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36 A, Surakarta 57126, Central Java. Email: shivaafla@gmail.com. DOI: https://doi.org/10.26911/the7thicph.05.47

This article introduces the use of design as a communication scenario in collaborative design to provide a holistic, intelligent education tool in the home setting. One out of every ten children has been subjected to sexual harm of varying extents. Implementing children's family sex education can endow children with the required correct knowledge and attitudes regarding sex. Co-design can help the children's family design forms, arrangement of sex, and other sensitive issues relaxed mind. The design prototype to develop a joint design workshop between children and parents was created during the co-design process. The interactive professional books for lessons from discussing body perception and alarms to discussing sex education knowledge comprehensively were expanded. It was concluded that the co-design method is effective in sex education intervention, and smart tools can link sex education institutions with families and empower children for equal dialogue.

Organ transplantation, as an extremely demanding, but impоrtant medical intervention, has always provided significant scope for opposing different legal and ethical principles. That scope is being expanded by considering the possibility that a sensitive category of persons, such as minors, may appear in the role of donor. While transplantation of organs from living minors is prohibited for the above reasons, cadaveric transplantation of organs from deceased children is legal in the law of the Republic of Serbia. This paper analyzes precisely such legally regulated organ donation, which implies the possibility of the appearance of a deceased minor as a donor. While, on the one hand, there is a growing need to take organs from children in order to transplant them and preserve the life of another child of appropriate age, such a decision has a significant emotional impact, above all, on the parents of the child. Keeping in mind that parents appear as the only authorized holders of the right to decide on the transplantation of an organ of a deceased minor, it is necessary to analyze the legal nature of the rights they have on the body and organs of the child. Also, it is necessary to point out the importance of more precise legal regulation of the conditions under which such transplantation can be performed, as well as the necessity of ensuring the autonomy of the will of the minor in terms of organ donation, which he could achieve for life.

Organ transplantation, as an extremely demanding, but impоrtant medical intervention, has always provided significant scope for opposing different legal and ethical principles. That scope is being expanded by considering the possibility that a sensitive category of persons, such as minors, may appear in the role of donor. While transplantation of organs from living minors is prohibited for the above reasons, cadaveric transplantation of organs from deceased children is legal in the law of the Republic of Serbia. This paper analyzes precisely such legally regulated organ donation, which implies the possibility of the appearance of a deceased minor as a donor. While, on the one hand, there is a growing need to take organs from children in order to transplant them and preserve the life of another child of appropriate age, such a decision has a significant emotional impact, above all, on the parents of the child. Keeping in mind that parents appear as the only authorized holders of the right to decide on the transplantation of an organ of a deceased minor, it is necessary to analyze the legal nature of the rights they have on the body and organs of the child. Also, it is necessary to point out the importance of more precise legal regulation of the conditions under which such transplantation can be performed, as well as the necessity of ensuring the autonomy of the will of the minor in terms of organ donation, which he could achieve for life.

A blacksmith is a person who forges, or shapes, metal by first heating it until it is red-hot, then uses tools like chisels and hammers to force the metal into the shape he desires. Blacksmiths usually work standing up and have to bend over to work on pieces of metal. The work can involve heavy lifting, use of power tools such as power hammers, drills, air chisels and hydraulic presses. However, use of such power tools and poor body posture lead to MSDs. Musculoskeletal disorders (MSDs) are common health problem throughout the world and a major cause of disability in the workplace. MSDs are found due to Inappropriate and poor working postures, lack of task variation, poor ergonomic design of work places, and poor design of plant layout, long working hours, low salaries and awkward schedules are all areas where relatively simple intervention can significantly reduce the rate of exposure to MSDs. They also deal with extremely hot objects and face a constant worry about fire and heat. The blacksmiths perform repetitive hammering jobs that give shape to the instruments. This type of job not only requires skill but is also time consuming. Hammering jobs are responsible for most of the incidents. In Iron & Steel and other manufacturing industries, foundries and forges produce a lots of pollutants in the environment – both working and ambient environment. In these processes, metals are extracted and produced from ores by various metallurgical processes and processes for moulding, melting and castings etc. are accompanied by evolution of heat, noise, dust fines, fly-ash, oxides of Nitrogen, Sulphur and metals. Particulate matters are generated in large quantities when preparing mould core sands and moulds melting metals, pouring metal, knocking out poured moulds and loading and unloading raw materials. Here metals are given a specific shape by metal castings for various engineering purposes. Gaseous matters like gases, vapours, fumes and smoke are produced during melting and pouring operations. The major pollutants are emitted from various work areas in Foundry i.e. Pattern shop, Sand preparation, moulding and core making, mould drying and ladle heating, cupola, electric arc furnace, pouring and mould cooling, knockout, fettling, heat treatment etc. In addition, various air pollutants and noise pollutants (Davis, 2002) are produced from forge shops and other manufacturing industrial units. So keeping all these factors in mind, a study was conducted to assess the risks involved among forging workers of Uttrakhand state of India. For this purpose 120 workers were taken through snowball technique. The data revealed that the most common problem faced by the workers was improper working posture and inappropriate working environment. Due to poorly designed work place, working environment, and working tools, workers physiological and psychological cost of work was high they reported to have health problems like back ache, shoulder ache and difficulty in movement of hands while in operation. Workers were also observed to be found irritated and restless.

Objectives. To conduct a systematic review of evidence regarding genitourinary syndrome of menopause (GSM) screening, treatment, and surveillance. Data sources. Ovid/Medline®, Embase®, and EBSCOhost/CINAHL® from database inception through December 11, 2023. Review methods. We employed methods consistent with the Agency for Healthcare Research and Quality Evidence-based Practice Center Program Methods Guidance to identify studies and synthesize findings for Key Questions related to screening for GSM, effectiveness and harms of U.S.-available interventions for GSM, appropriate followup intervals for patients using GSM treatments, and endometrial surveillance for patients using hormonal GSM treatments. For vaginal estrogen and vaginal or systemic non-estrogen hormonal interventions, energy-based interventions, and vaginal moisturizers, we first assessed study quality and then, for moderate or high-quality studies, reviewed outcomes related to GSM symptoms, treatment satisfaction, and adverse effects. For low-quality studies, we described limited study characteristics only. For studies of other non-hormonal interventions, we created an evidence map describing study characteristics without assessing study quality. Results. After assessing 107 publications for risk of bias (RoB), we extracted and synthesized effectiveness and/or harms outcomes from 68 publications describing trials or prospective, controlled observational studies that were rated low, some concerns, or moderate RoB (24 estrogen publications, 35 non-estrogen, 11 energy-based, and 4 moisturizers). Of 39 high, serious, or critical RoB publications, we extracted long-term harms from only 15 uncontrolled studies of energy-based interventions (all serious or critical RoB due to confounding). An additional 66 publications evaluating 46 non-hormonal interventions, including natural products, mind/body practices, and educational interventions, were described in an evidence map. Across all 172 publications, studies differed in GSM definitions, diagnosis, enrollment criteria, and outcomes assessed. Few studies enrolled women with a history of breast or gynecologic cancers. Overall, we found that vaginal estrogen, vaginal dehydroepiandrosterone (DHEA), vaginal moisturizers, and oral ospemifene may all improve at least some GSM symptoms, while evidence does not demonstrate the efficacy of energy-based therapies, vaginal or systemic testosterone, vaginal oxytocin, or oral raloxifene or bazedoxifene for any GSM symptoms. Harms reporting was limited, in part, by studies not being sufficiently powered to evaluate infrequent but serious harms, though most studies did not report frequent serious harms. Common non-serious adverse effects varied by treatment and dose. No studies evaluated GSM screening or directly addressed appropriate followup intervals or the effectiveness and harms of endometrial surveillance among women with a uterus receiving hormonal therapy for GSM. The longest followup period for active endometrial surveillance in an included trial was 12 weeks (vaginal estrogen) or 1 year (non-estrogen hormonal interventions). Conclusions. This systematic review provides comprehensive, up-to-date information to guide patients, clinicians, and policymakers regarding GSM. Despite the breadth of included studies, findings were limited by several factors, including heterogeneity in intervention-comparator-outcome combinations. Future studies would be strengthened by a standard definition and uniform diagnostic criteria for GSM, a common set of validated outcome measures and reporting standards, and attention to clinically relevant populations and intervention comparisons. Lack of long-term data assessing efficacy, tolerability, and safety of GSM treatments leaves postmenopausal women and clinicians without evidence to guide treatment longer than 1 year.

When humans engage with video, their brain and body interact in response to sensory input. To investigate these interactions, we recorded and are releasing a dataset from N=178 participants across five experiments featuring short online educational videos. This dataset comprises approximately 110 hours of multimodal data including electrocardiogram (ECG), heart rate, respiration, breathing rate, pupil size, electrooculogram (EOG), gaze position, saccades, blinks, fixations, head movement, and electroencephalogram (EEG). Participants viewed 3-6 videos (mean total duration: 28±5 min) to test attentional states (attentive vs. distracted), memory retention (multiple-choice questions), learning scenarios (incidental vs. intentional), and an intervention (monetary incentive). Demographic data, ADHD self-report (ASRS), and working memory assessments (digit span) were collected. Basic statistics and noteworthy effects: increased alpha power in a distracted condition, broadband EEG power increases from posterior to anterior scalp, increased blink-rate, and decreased saccade-rate in distracted and intervention conditions. All modalities are time-aligned with stimuli and standardized using BIDS, making the dataset valuable for researchers investigating attention, memory, and learning in naturalistic settings.

Objectives. Recently bereaved individuals face higher risks of adverse health outcomes, including increased risk of morbidity and mortality, increased risk of suicide, and lower functional status and quality of life. This systematic review assessed the available evidence on screening, diagnosing, and treating children and adults at risk for or diagnosed with grief disorders related to bereavement. Findings from this review informed a 2-day independent subject matter advisory panel convened on June 10, 2024, by the Substance Abuse and Mental Health Services Administration (SAMHSA) that assessed the feasibility of developing consensus-based quality standards for high quality bereavement and grief care. Data sources. We searched 14 databases from inception through June 2024, set up a submission for supplemental evidence portal, reference-mined pertinent reviews, and contacted experts. Review methods. We followed a registered and published protocol; Key Informants and a multidisciplinary expert panel provided input. We followed the Evidence-based Practice Center Methods Guide and assessed risk of bias, applicability, and strength of evidence (SoE). Results. In total, 219 studies met inclusion criteria (9 screening, 18 diagnosing, 189 grief interventions, and 3 grief disorder treatment). We did not identify studies that evaluated universal screening, and very few and diverse studies evaluated the effects of using a targeted screening approach for recently bereaved people (all outcomes insufficient SoE). The small body of evidence evaluating the diagnostic accuracy of tools to identify grief and risk of grief disorder did not apply the new Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) grief disorder diagnoses as the reference standard. There was low SoE for good diagnostic accuracy for the Inventory of Complicated Grief; SoE was insufficient for other tools. We identified numerous interventions for bereaved individuals, including psychotherapy, pharmacotherapy, expert-facilitated support groups, peer-support, self-help interventions, and other interventions. We found moderate SoE of positive effects of psychotherapy on grief disorder symptoms, grief outcomes, and depression symptoms. We also found moderate SoE for positive effects of expert-facilitated support groups on grief symptoms. Few studies reported on unintended consequences or harms of interventions. The body of evidence for individuals diagnosed with prolonged grief disorder per DSM or ICD is small; all identified studies evaluated psychotherapy, but reported on different outcomes and/or comparators (low or insufficient SoE). Conclusions. More research is needed on identifying effective screening approaches, and research on the diagnostic accuracy of tools was limited by a clinical diagnosis specific to grief that has only recently been introduced. A substantial body of evidence demonstrates positive effects of grief interventions on grief and depression symptoms, but more data are needed on the presence or absence of adverse events. Future research needs to assess the effects of treatment for people with a clinically diagnosed grief disorder.

Objectives. To evaluate the effectiveness and comparative effectiveness of pharmacologic and nonpharmacologic therapies for the acute treatment of episodic migraine in adults. Data sources. MEDLINE®, Embase®, Cochrane Central Registrar of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO®, Scopus, and various grey literature sources from database inception to July 24, 2020. Comparative effectiveness evidence about triptans and nonsteroidal anti-inflammatory drugs (NSAIDs) was extracted from existing systematic reviews. Review methods. We included randomized controlled trials (RCTs) and comparative observational studies that enrolled adults who received an intervention to acutely treat episodic migraine. Pairs of independent reviewers selected and appraised studies. Results. Data on triptans were derived from 186 RCTs summarized in nine systematic reviews (101,276 patients; most studied was sumatriptan, followed by zolmitriptan, eletriptan, naratriptan, almotriptan, rizatriptan, and frovatriptan). Compared with placebo, triptans resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (high strength of the body of evidence [SOE]). Data on NSAIDs were derived from five systematic reviews (13,214 patients; most studied was ibuprofen, followed by diclofenac and ketorolac). Compared with placebo, NSAIDs probably resolved pain at 2 hours and 1 day, and increased the risk of mild and transient adverse events (moderate SOE). For other interventions, we included 135 RCTs and 6 comparative observational studies (37,653 patients). Compared with placebo, antiemetics (low SOE), dihydroergotamine (moderate to high SOE), ergotamine plus caffeine (moderate SOE), and acetaminophen (moderate SOE) reduced acute pain. Opioids were evaluated in 15 studies (2,208 patients).Butorphanol, meperidine, morphine, hydromorphone, and tramadol in combination with acetaminophen may reduce pain at 2 hours and 1 day, compared with placebo (low SOE). Some opioids may be less effective than some antiemetics or dexamethasone (low SOE). No studies evaluated instruments for predicting risk of opioid misuse, opioid use disorder, or overdose, or evaluated risk mitigation strategies to be used when prescribing opioids for the acute treatment of episodic migraine. Calcitonin gene-related peptide (CGRP) receptor antagonists improved headache relief at 2 hours and increased the likelihood of being headache-free at 2 hours, at 1 day, and at 1 week (low to high SOE). Lasmiditan (the first approved 5-HT1F receptor agonist) restored function at 2 hours and resolved pain at 2 hours, 1 day, and 1 week (moderate to high SOE). Sparse and low SOE suggested possible effectiveness of dexamethasone, dipyrone, magnesium sulfate, and octreotide. Compared with placebo, several nonpharmacologic treatments may improve various measures of pain, including remote electrical neuromodulation (moderate SOE), magnetic stimulation (low SOE), acupuncture (low SOE), chamomile oil (low SOE), external trigeminal nerve stimulation (low SOE), and eye movement desensitization re-processing (low SOE). However, these interventions, including the noninvasive neuromodulation devices, have been evaluated only by single or very few trials. Conclusions. A number of acute treatments for episodic migraine exist with varying degrees of evidence for effectiveness and harms. Use of triptans, NSAIDs, antiemetics, dihydroergotamine, CGRP antagonists, and lasmiditan is associated with improved pain and function. The evidence base for many other interventions for acute treatment, including opioids, remains limited.

Objectives. To summarize the evidence regarding diagnosis, prophylactic treatment, symptomatic treatment, and repeat surgery of tethered spinal cord. Data sources. We searched PubMed®, Embase®, CINAHL, Web of Science, SCOPUS, clinicaltrials.gov, ICTRP, Cochrane Database of Systematic Reviews, PROSPERO, ECRI repository, G-I-N, MagicApp, and ClinicalKey from inception to March 2024; reference-mined reviews; and contacted research authors. Review methods. The review followed a detailed protocol and was supported by a Technical Expert Panel. Systematic review software (DistillerSR) was utilized for all screening and data extraction tasks. Citation screening was facilitated by machine learning; two independent reviewers each screened full text citations for eligibility; one literature reviewer extracted data and a methodologist checked for accuracy. Risk of bias assessments focused on key sources of bias for diagnostic and intervention studies. We conducted strength of evidence (SoE) and applicability assessments for key outcomes. The protocol for the review has been registered in PROSPERO (CRD42023461296). Results. Searches identified 6,285 citations; 2,005 were obtained as full text. In total, 103 studies met inclusion criteria, with an additional 355 case series providing additional information. We found the strongest evidence for accuracy of MRI in diagnosing tethered spinal cord. Specifically, studies indicated this modality has medium to high diagnostic sensitivity and specificity (moderate SoE). A small number of existing studies suggested benefits of prophylactic surgery, but it was also associated with complications such as surgical site infection (low SoE). A larger body of evidence evaluated various treatments for symptomatic patients, with the majority focused on surgical detethering. Studies reported improvement of neurological status after surgical detethering (low SoE), but it was also associated with post-operative complications such as cerebrospinal fluid leakage (moderate SoE). A very small body of evidence exists for revision detethering and spinal column shortening for repeat surgery (low or insufficient SoE for all outcomes). Across diagnosis, prophylactic treatment, symptomatic treatment, and repeat surgery there was insufficient evidence for multiple key outcomes (e.g., over- or undertreatment, clinical impact of diagnostic modalities, ambulation or quality of life outcomes) and thus no evidence statements could be derived. Conclusions. The evidence base for the diagnosis and treatment of tethered spinal cord is limited, with few exceptions (use of MRI or ultrasound for diagnosis, surgical detethering improving neurological status in symptomatic patients, complications associated with open detethering surgery) and would benefit from stronger study designs that include tool evaluations reporting diagnostic performance and treatment studies with concurrent comparator.

Executive Summary This report describes a series of experiments carried out by PRICE Lab, a research programme at the Economic and Social Research Institute (ESRI) jointly funded by the Central Bank of Ireland, the Commission for Energy Regulation, the Competition and Consumer Protection Commission and the Commission for Communications Regulation. The experiments were conducted with samples of Irish consumers aged 18-70 years and were designed to answer the following general research question: At what point do products become too complex for consumers to choose accurately between the good ones and the bad ones? BACKGROUND AND METHODS PRICE Lab represents a departure from traditional methods employed for economic research in Ireland. It belongs to the rapidly expanding area of ‘behavioural economics’, which is the application of psychological insights to economic analysis. In recent years, behavioural economics has developed novel methods and generated many new findings, especially in relation to the choices made by consumers. These scientific advances have implications both for economics and for policy. They suggest that consumers often do not make decisions in the way that economists have traditionally assumed. The findings show that consumers have limited capacity for attending to and processing information and that they are prone to systematic biases, all of which may lead to disadvantageous choices. In short, consumers may make costly mistakes. Research has indeed documented that in several key consumer markets, including financial services, utilities and telecommunications, many consumers struggle to choose the best products for themselves. It is often argued that these markets involve ‘complex’ products. The obvious question that arises is whether consumer policy can be used to help them to make better choices when faced with complex products. Policies are more likely to be successful where they are informed by an accurate understanding of how real consumers make decisions between products. To provide evidence for consumer policy, PRICE Lab has developed a method for measuring the accuracy with which consumers make choices, using techniques adapted from the scientific study of human perception. The method allows researchers to measure how reliably consumers can distinguish a good deal from a bad one. A good deal is defined here as one where the product is more valuable than the price paid. In other words, it offers good value for money or, in the jargon of economics, offers the consumer a ‘surplus’. Conversely, a bad deal offers poor value for money, providing no (or a negative) surplus. PRICE Lab’s main experimental method, which we call the ‘Surplus Identification’ (S-ID) task, allows researchers to measure how accurately consumers can spot a surplus and whether they are prone to systematic biases. Most importantly, the S-ID task can be used to study how the accuracy of consumers’ decisions changes as the type of product changes. For the experiments we report here, samples of consumers arrived at the ESRI one at a time and spent approximately one hour doing the S-ID task with different kinds of products, which were displayed on a computer screen. They had to learn to judge the value of one or more products against prices and were then tested for accuracy. As well as people’s intrinsic motivation to do well when their performance on a task like this is tested, we provided an incentive: one in every ten consumers who attended PRICE Lab won a prize, based on their performance. Across a series of these experiments, we were able to test how the accuracy of consumers’ decisions was affected by the number and nature of the product’s characteristics, or ‘attributes’, which they had to take into account in order to distinguish good deals from bad ones. In other words, we were able to study what exactly makes for a ‘complex’ product, in the sense that consumers find it difficult to choose good deals. FINDINGS Overall, across all ten experiments described in this report, we found that consumers’ judgements of the value of products against prices were surprisingly inaccurate. Even when the product was simple, meaning that it consisted of just one clearly perceptible attribute (e.g. the product was worth more when it was larger), consumers required a surplus of around 16-26 per cent of the total price range in order to be able to judge accurately that a deal was a good one rather than a bad one. Put another way, when most people have to map a characteristic of a product onto a range of prices, they are able to distinguish at best between five and seven levels of value (e.g. five levels might be thought of as equivalent to ‘very bad’, ‘bad’, ‘average’, ‘good’, ‘very good’). Furthermore, we found that judgements of products against prices were not only imprecise, but systematically biased. Consumers generally overestimated what products at the top end of the range were worth and underestimated what products at the bottom end of the range were worth, typically by as much as 10-15 per cent and sometimes more. We then systematically increased the complexity of the products, first by adding more attributes, so that the consumers had to take into account, two, three, then four different characteristics of the product simultaneously. One product might be good on attribute A, not so good on attribute B and available at just above the xii | PRICE Lab: An Investigation of Consumers’ Capabilities with Complex Products average price; another might be very good on A, middling on B, but relatively expensive. Each time the consumer’s task was to judge whether the deal was good or bad. We would then add complexity by introducing attribute C, then attribute D, and so on. Thus, consumers had to negotiate multiple trade-offs. Performance deteriorated quite rapidly once multiple attributes were in play. Even the best performers could not integrate all of the product information efficiently – they became substantially more likely to make mistakes. Once people had to consider four product characteristics simultaneously, all of which contributed equally to the monetary value of the product, a surplus of more than half the price range was required for them to identify a good deal reliably. This was a fundamental finding of the present experiments: once consumers had to take into account more than two or three different factors simultaneously their ability to distinguish good and bad deals became strikingly imprecise. This finding therefore offered a clear answer to our primary research question: a product might be considered ‘complex’ once consumers must take into account more than two or three factors simultaneously in order to judge whether a deal is good or bad. Most of the experiments conducted after we obtained these strong initial findings were designed to test whether consumers could improve on this level of performance, perhaps for certain types of products or with sufficient practice, or whether the performance limits uncovered were likely to apply across many different types of product. An examination of individual differences revealed that some people were significantly better than others at judging good deals from bad ones. However the differences were not large in comparison to the overall effects recorded; everyone tested struggled once there were more than two or three product attributes to contend with. People with high levels of numeracy and educational attainment performed slightly better than those without, but the improvement was small. We also found that both the high level of imprecision and systematic bias were not reduced substantially by giving people substantial practice and opportunities to learn – any improvements were slow and incremental. A series of experiments was also designed to test whether consumers’ capability was different depending on the type of product attribute. In our initial experiments the characteristics of the products were all visual (e.g., size, fineness of texture, etc.). We then performed similar experiments where the relevant product information was supplied as numbers (e.g., percentages, amounts) or in categories (e.g., Type A, Rating D, Brand X), to see whether performance might improve. This question is important, as most financial and contractual information is supplied to consumers in a numeric or categorical form. The results showed clearly that the type of product information did not matter for the level of imprecision and bias in consumers’ decisions – the results were essentially the same whether the product attributes were visual, numeric or categorical. What continued to drive performance was how many characteristics the consumer had to judge simultaneously. Thus, our findings were not the result of people failing to perceive or take in information accurately. Rather, the limiting factor in consumers’ capability was how many different factors they had to weigh against each other at the same time. In most of our experiments the characteristics of the product and its monetary value were related by a one-to-one mapping; each extra unit of an attribute added the same amount of monetary value. In other words, the relationships were all linear. Because other findings in behavioural economics suggest that consumers might struggle more with non-linear relationships, we designed experiments to test them. For example, the monetary value of a product might increase more when the amount of one attribute moves from very low to low, than when it moves from high to very high. We found that this made no difference to either the imprecision or bias in consumers’ decisions provided that the relationship was monotonic (i.e. the direction of the relationship was consistent, so that more or less of the attribute always meant more or less monetary value respectively). When the relationship involved a turning point (i.e. more of the attribute meant higher monetary value but only up to a certain point, after which more of the attribute meant less value) consumers’ judgements were more imprecise still. Finally, we tested whether familiarity with the type of product improved performance. In most of the experiments we intentionally used products that were new to the experimental participants. This was done to ensure experimental control and so that we could monitor learning. In the final experiment reported here, we used two familiar products (Dublin houses and residential broadband packages) and tested whether consumers could distinguish good deals from bad deals any better among these familiar products than they could among products that they had never seen before, but which had the same number and type of attributes and price range. We found that consumers’ performance was the same for these familiar products as for unfamiliar ones. Again, what primarily determined the amount of imprecision and bias in consumers’ judgments was the number of attributes that they had to balance against each other, regardless of whether these were familiar or novel. POLICY IMPLICATIONS There is a menu of consumer polices designed to assist consumers in negotiating complex products. A review, including international examples, is given in the main body of the report. The primary aim is often to simplify the consumer’s task. Potential policies, versions of which already exist in various forms and which cover a spectrum of interventionist strength, might include: the provision and endorsement of independent, transparent price comparison websites and other choice engines (e.g. mobile applications, decision software); the provision of high quality independent consumer advice; ‘mandated simplification’, whereby regulations stipulate that providers must present product information in a simplified and standardised format specifically determined by regulation; and more strident interventions such as devising and enforcing prescriptive rules and regulations in relation to permissible product descriptions, product features or price structures. The present findings have implications for such policies. However, while the experimental findings have implications for policy, it needs to be borne in mind that the evidence supplied here is only one factor in determining whether any given intervention in markets is likely to be beneficial. The findings imply that consumers are likely to struggle to choose well in markets with products consisting of multiple important attributes that must all be factored in when making a choice. Interventions that reduce this kind of complexity for consumers may therefore be beneficial, but nothing in the present research addresses the potential costs of such interventions, or how providers are likely to respond to them. The findings are also general in nature and are intended to give insights into consumer choices across markets. There are likely to be additional factors specific to certain markets that need to be considered in any analysis of the costs and benefits of a potential policy change. Most importantly, the policy implications discussed here are not specific to Ireland or to any particular product market. Furthermore, they should not be read as criticisms of existing regulatory regimes, which already go to some lengths in assisting consumers to deal with complex products. Ireland currently has extensive regulations designed to protect consumers, both in general and in specific markets, descriptions of which can be found in Section 9.1 of the main report. Nevertheless, the experiments described here do offer relevant guidance for future policy designs. For instance, they imply that while policies that make it easier for consumers to switch providers may be necessary to encourage active consumers, they may not be sufficient, especially in markets where products are complex. In order for consumers to benefit, policies that help them to identify better deals reliably may also be required, given the scale of inaccuracy in consumers’ decisions that we record in this report when products have multiple important attributes. Where policies are designed to assist consumer decisions, the present findings imply quite severe limits in relation to the volume of information consumers can simultaneously take into account. Good impartial Executive Summary | xv consumer advice may limit the volume of information and focus on ensuring that the most important product attributes are recognised by consumers. The findings also have implications for the role of competition. While consumers may obtain substantial potential benefits from competition, their capabilities when faced with more complex products are likely to reduce such benefits. Pressure from competition requires sufficient numbers of consumers to spot and exploit better value offerings. Given our results, providers with larger market shares may face incentives to increase the complexity of products in an effort to dampen competitive pressure and generate more market power. Where marketing or pricing practices result in prices or attributes with multiple components, our findings imply that consumer choices are likely to become less accurate. Policymakers must of course be careful in determining whether such practices amount to legitimate innovations with potential consumer benefit. Yet there is a genuine danger that spurious complexity can be generated that confuses consumers and protects market power. The results described here provide backing for the promotion and/or provision by policymakers of high-quality independent choice engines, including but not limited to price comparison sites, especially in circumstances where the number of relevant product attributes is high. A longer discussion of the potential benefits and caveats associated with such policies is contained in the main body of the report. Mandated simplification policies are gaining in popularity internationally. Examples include limiting the number of tariffs a single energy company can offer or standardising health insurance products, both of which are designed to simplify the comparisons between prices and/or product attributes. The present research has some implications for what might make a good mandate. Consumer decisions are likely to be improved where a mandate brings to the consumer’s attention the most important product attributes at the point of decision. The present results offer guidance with respect to how many key attributes consumers are able simultaneously to trade off, with implications for the design of standardised disclosures. While bearing in mind the potential for imposing costs, the results also suggest benefits to compulsory ‘meta-attributes’ (such as APRs, energy ratings, total costs, etc.), which may help consumers to integrate otherwise separate sources of information. FUTURE RESEARCH The experiments described here were designed to produce findings that generalise across multiple product markets. However, in addition to the results outlined in this report, the work has resulted in new experimental methods that can be applied to more specific consumer policy issues. This is possible because the methods generate experimental measures of the accuracy of consumers’ decision-making. As such, they can be adapted to assess the quality of consumers’ decisions in relation to specific products, pricing and marketing practices. Work is underway in PRICE Lab that applies these methods to issues in specific markets, including those for personal loans, energy and mobile phones.