Jason S. Moser

About 1 in 3 individuals will sustain a secondary anterior cruciate ligament (ACL) injury within 24 months of returning to sport after ACL reconstruction (ACLR). While aberrant biomechanics and poor quadriceps strength have been associated with secondary ACL injury risk, unresolved injury-related fear has also been identified as a potential risk factor for additional ACL injuries in previously high-functioning, physically active populations. Virtual reality mindfulness meditation (VRMM) is a psychological intervention that may reduce injury-related fear and improve an individual's ability to stay in the present moment during stressful situations such as sport. There is a critical need to identify whether VRMM is a feasible intervention that could be implemented to address injury-related fear and reduce secondary ACL injury risk. This study aims to determine the feasibility, acceptability, and preliminary efficacy of a VRMM intervention with neuromuscular training rehabilitation (NTR) to reduce injury-related fear and improve jump-landing biomechanics in females with a history of ACLR, when compared to a sham virtual reality (VR) intervention+NTR. A double-blinded, 2-arm feasibility trial of 48 participants (24 per group) comparing VRMM+NTR and VR sham+NTR will be conducted. Recruitment, retention, adherence, and acceptability outcomes will be collected throughout the trial. Injury-related fear will be measured using the 11-Item Tampa Scale of Kinesiophobia. Jump-landing biomechanics will be assessed via peak knee abduction moment and peak knee flexion excursion. The change in outcomes will be compared between groups using 2×2 repeated measures ANOVA and partial η2 effect sizes. Significance will be set at P<.05. The study was funded in May 2021. The trial started in September 2023 and is anticipated to be completed in May 2027, with the first results expected to be submitted for publication in winter 2027. We expect to observe acceptable rates of retention, adherence, and acceptability to the VRMM intervention and more favorable outcomes in the VRMM+NTR group compared to the VR sham+NTR group. As of now, 55 participants have been screened for eligibility, of which 33 were ineligible. Twelve participants have been randomized, and 10 have completed the trial. Two participants withdrew from the trial before the completion of the full intervention protocol due to the study time commitment. The results of this trial will improve our understanding of the feasibility of VRMM and inform the next steps in behavioral intervention development to test the efficacy of VRMM in reducing injury-related fear in females after ACLR.

Emerging research indicates that people use multiple strategies to manage theiremotions in everyday life. Yet, we know little about what these strategy combinationslook like, how they function, or how individual differences influence these phenomena. We addressed these issues in two, 2-week daily diary studies performed during the height of the COVID-19 pandemic (N=422; Data collected April & September 2020). Each evening, participants rated their level of COVID-19 anxiety and indicated which of 18 emotion regulation strategies they used to manage it. There was tremendous diversity in the strategy combinations people used: 74% of the combinations were unique across participants and included strategies seldom studied together (e.g., exercise, journaling, social interaction, and cognitive reframing). On average, using a given strategy predicted same-day use of another strategy with only 1% accuracy. Despite this variability, a set of features consistently predicted effective regulation: using large and healthy repertoires of strategies in diverse ways predicted reductions in anxiety over time. Psychologically distressed individuals experienced more daily anxiety and drew on a wider, but more unhealthy set of strategies. However, when they used adaptive strategy combinations, they benefited just as much as less distressed individuals. These results illuminate the anatomy of people’s emotion regulatory lives, underscoring the need to develop frameworks that capture the diverse ways people manage their emotions. They also identify specific mechanisms that interventions can target to improve how people manage their emotions under ecologically valid conditions.

Purpose: There is minimal literature describing trait mindfulness in people who stutter and how aspects of trait mindfulness might relate to treatment outcomes and the experience of stuttering. The primary aim of this study was to determine whether there are differences in trait mindfulness in people who stutter compared to people who do not stutter to better inform the appropriateness of including mindfulness strategies in a comprehensive stuttering treatment plan. Method: Seventeen adults who stutter and 17 adults who do not stutter completed the Five Facet Mindfulness Questionnaire to measure trait mindfulness as well as either the Overall Assessment of the Speaker's Experience of Stuttering or the Overall Assessment of the Speaker's Experience of Speaking Ability to measure the impact of stuttering or speaking experiences on their lives. A subset of 16 adults who stutter completed a battery of assessments on personal characteristics associated with the experience of stuttering (experiential avoidance, repetitive negative thinking, and inattention characteristics). This allowed for comparisons of trait mindfulness between people who stutter and people who do not stutter as well as for analyses of the potential relationships between trait mindfulness and speaking experience within each population and of various personal characteristics in people who stutter. Results: No significant differences in trait mindfulness were found between people who stutter and people who do not stutter. A strong negative correlation was found between the trait mindfulness facet of nonjudging of inner experiences and experiential avoidance. Conclusion: Findings highlight the necessity of a comprehensive understanding of the specific characteristics of individual speakers when incorporating aspects of mindfulness into stuttering treatment.

Although the etiology of depression is incredibly complex, the narrative that it is caused by a simple “chemical imbalance” persists in lay settings. We sought to understand where people are exposed to this explanation (i.e., the “source”), and the relative influence of each source. A total of 1,219 college students were asked where they had heard of the chemical imbalance explanation and how much they believed this to be true. Independent raters coded open-ended responses and we used self-report measures to capture chemical imbalance belief endorsement. The most common sources of exposure to this explanation were the classroom, the Internet/media, other people (e.g., friends), and healthcare providers. In a regression analysis, only learning about the chemical imbalance explanation from healthcare providers uniquely predicted the adoption of the chemical imbalance belief. The correlation held even after controlling for depression symptoms, a family history of depression, and having had a diagnosis or treatment of mental health disorder (all of which also uniquely predicted chemical imbalance belief endorsement). These results suggest that healthcare providers play an important role in the dissemination of the chemical imbalance message, which is an oversimplified, scientifically controversial, and potentially treatment-interfering narrative. Interventions directed at healthcare providers may help them engage with more accurate messages.

Mindfulness meditation (MM) has decreased kinesiophobia in patients with knee pathologies. Mobile application-delivered MM (Mobile MM) may reduce kinesiophobia in individuals after anterior cruciate ligament reconstructions (ACLR). The purpose of this study was to examine the feasibility (i.e., retention, adherence, and acceptability) and preliminary efficacy of a 4-week Mobile MM intervention in individuals with a history of ACLR. Nine participants ≥1 year post unilateral ACLR completed 12 sessions of Mobile MM over 4 weeks via the Headspace mobile application that were facilitated remotely through a Health Insurance Portability and Accountability ACT of 1996 (HIPAA) compliant teleconference system. Participant retention of 100% and intervention adherence of 100% were observed. Participants reported moderate to high acceptability for the Mobile MM. A large between-group effect size of 1.6 [0.13, 2.98] in the Tampa Scale of Kinesiophobia-11 change score was observed. Mobile MM is a feasible intervention to address kinesiophobia in individuals with a history of ACLR.