Rewarding Activities Research Articles

Web-Based Imagery Behavioral Activation (WIMBA): Study Protocol for a Randomized Controlled Trial Testing the Effects, Acceptability, and Feasibility of a Mental Imagery Activity Scheduling Training Delivered Online.

Behavioral activation (BA) is an effective and efficacious treatment for depression. Activity scheduling is the central treatment component of BA and involves planning of potentially enjoyable and rewarding activities. Evidence from non-clinical studies suggests that mental imagery simulations of planned activities can increase motivation and anticipated pleasure for these activities. We describe a randomized controlled trial testing a mental imagery activity scheduling training delivered online in four weekly sessions (total training duration approximately 90 minutes) in a sample meeting diagnostic criteria of a major depressive episode, as indicated by the Diagnostic Short-Interview for Mental Disorders (Mini-DIPS), and not currently receiving treatment. Participants (N = 140) will be randomized to either mental imagery activity scheduling or a wait-list control condition. Depressive symptoms (BDI-II) and behavioral activation (BADS) are the primary outcomes; BDI-II will be measured at Session 1, Session 4, and at two-week follow-up, BADS at Sessions 1-4 and at two-week follow-up. It is discussed how the expected results may reflect mechanisms and effects of a mental imagery activity scheduling training delivered online in a sample of individuals with depression. Concluding we outline next steps for future research and highlight the potential of this novel treatment for dissemination in the wider community and integration into routine care.

Synaptotagmin-4 induces anhedonic responses to chronic stress via BDNF signaling in the medial prefrontal cortex

Stressful circumstances are significant contributors to mental illnesses such as major depressive disorder. Anhedonia, defined as loss of the ability to enjoy pleasure in pleasurable situations, including rewarding activities or social contexts, is considered a key symptom of depression. Although stress-induced depression is associated with anhedonia in humans and animals, the underlying molecular mechanisms of anhedonic responses remain poorly understood. In this study, we demonstrated that synaptotagmin-4 (SYT4), which is involved in the release of neurotransmitters and neurotrophic factors, is implicated in chronic stress-induced anhedonia. Employing chronic unpredictable stress (CUS), we evaluated two subpopulations of mice, susceptible (SUS, anhedonic) and resilient (RES, nonanhedonic), based on sucrose preference, which was strongly correlated with social reward. The FosTRAP (targeted recombination in active populations) system and optogenetic approach revealed that neural activity in the medial prefrontal cortex (mPFC) was significantly associated with CUS-induced anhedonic behavioral phenotypes. By conducting weighted gene coexpression network analysis of RNA sequencing data from the mPFC of SUS and RES mice, we identified Syt4 as a hub gene in a gene network that was unique to anhedonia. We also confirmed that Syt4 overexpression in the mPFC was pro-susceptible, while Syt4 knockdown was pro-resilient; the pro-susceptible effects of SYT4 were mediated through a reduction in brain-derived neurotrophic factor (BDNF)-tropomyosin receptor kinase B (TrkB) signaling in the mPFC. These findings suggest that SYT4-BDNF interactions in the mPFC represent a crucial regulatory mechanism of anhedonic susceptibility to chronic stress.

The role of executive functions in mediating the relationship between adult ADHD symptoms and hyperfocus in university students

BackgroundHyperfocus, a state of intense, narrow and prolonged attentional focus, has been associated with symptoms of attention-deficit/hyperactivity disorder (ADHD) in both clinical and non-clinical populations. Hyperfocus may be explained by difficulties in executive control, typically observed in ADHD. AimsTo investigate (1) whether ADHD and executive functions (EF) are associated with hyperfocus and (2) whether EF mediate the relationship between ADHD symptoms and hyperfocus. Methods and proceduresA non-clinical sample of 380 university students (264 females) completed self-reports of ADHD, EF, hyperfocus and hyperfocus during rewarding activities. Outcomes and resultsIncreased difficulties in EF and severity of ADHD symptoms were significantly and positively correlated with a higher frequency of hyperfocus. Moreover, EF difficulties partially mediated the relationship between ADHD and hyperfocus (after controlling for sex and substance use), but not the relationship between ADHD and hyperfocus during rewarding activities. Conclusions and implicationsDifficulties in EF partially explained the higher frequency of hyperfocus, but not of hyperfocus during rewarding activities, among university students reporting more severe ADHD symptoms. Future research should investigate whether and how specific EF and other ADHD-related neurocognitive difficulties (e.g., reward sensitivity) contribute to various types of hyperfocus experiences in ADHD. What this paper adds?This paper is a first attempt to explain the relationship between adult ADHD symptoms and hyperfocus experiences. Our findings suggest that, although highly correlated, existing self-reports of hyperfocus measure different aspects of this experience: hyperfocus and reward-related hyperfocus. We replicate previous findings that indicated a greater frequency of both types of hyperfocus in ADHD. Additionally, we demonstrate a connection between EF difficulties and different aspects of hyperfocus. Finally, we extend previous findings by proposing that EF difficulties partially explain the relationship between ADHD and hyperfocus, but not the relationship between ADHD and reward-related hyperfocus. We hypothesize that other neurocognitive difficulties (e.g., reward sensitivity) may contribute to explain the relationship between ADHD and different aspects of hyperfocus.

Risk Assessment for Hepatobiliary Toxicity Liabilities in Drug Development.

Risk assessment of hepatobiliary toxicities represents one of the greatest challenges and, more often than not, one of the most rewarding activities in which toxicologic pathologists can partake, and often times lead. This is in part because each liver toxicity picture is a bit different, informed by a broad range and diversity of relevant data, and also in part because the heavily relied upon animal models are imperfect regarding predictivity of hepatic effects in humans. Following identification and characterization of a hepatotoxicity hazard, typically in nonclinical toxicology studies, a holistic and integrated assessment of liver-relevant endpoints is conducted that typically incorporates ADME (absorption, distribution, metabolism, and excretion) information (ideally, including extensive transporter data, exposure margins, and possibly concentration of parent/metabolite at region of injury), target expression/function, in silico prediction data, in vitro hepatocyte data, liver/circulating biomarkers, and importantly, species specificity of any of these data. Of course, a thorough understanding, developed in close partnership with clinical colleagues, of the anticipated liver disease status of intended patient populations is paramount to hepatic risk assessment. This is particularly important since the likelihood of translatable determinant hepatic events observed in nonclinical models to occur in humans has been reasonably well established.

Sensitivity to intrinsic rewards is domain general and related to mental health

Humans frequently engage in intrinsically rewarding activities (for example, consuming art, reading). Despite such activities seeming diverse, we show that sensitivity to intrinsic rewards is domain general and associated with mental health. In this cross-sectional study, participants online (N = 483) were presented with putative visual, cognitive and social intrinsic rewards as well as monetary rewards and neutral stimuli. All rewards elicited positive feelings (were ‘liked’), generated consummatory behaviour (were ‘wanted’) and increased the likelihood of the action leading to them (were ‘reinforcing’). Factor analysis revealed that ~40% of response variance across stimuli was explained by a general sensitivity to all rewards, but not to neutral stimuli. Affective aspects of mental health were associated with sensitivity to intrinsic, but not monetary, rewards. These results may help explain thriving and suffering: individuals with high reward sensitivity will engage in a variety of intrinsically rewarding activities, eventually finding those they excel at, whereas low sensitivity individuals will not.

"I Just Want to Feel Good Without Making You Feel Bad": Sexual Assertiveness Negotiation in Adolescent Romantic Relationships.

Sexual assertiveness is often conceptualized as an individual's ability to express one's own sexual needs, desires, and limits. Given that sexual assertiveness is embedded in interactions and can affect not only both partners' sexual well-being but also relationship satisfaction, dyadic approaches are needed to investigate sexual assertiveness negotiation within adolescent romantic relationships. This qualitative study aimed to document adolescents' ability to negotiate their sexual needs, desires, and limits with their partners during interactions where they discussed their sexual concerns. A directed content analysis, based on the life positions of the transactional analysis theory, was conducted on the interactions of 40 adolescent romantic dyads aged 14-19years (M = 16.65; SD = 1.49). The results revealed four categories of strategies: (1) mutual assertiveness: negotiation of one's own sexual needs, desires, and limits with those of the partner; (2) singular passiveness: repression of one's own sexual needs, desires, and limits to privilege those of the partner; (3) singular aggressiveness: prioritization of one's own sexual needs, desires, and limits over those of the partner; and (4) mutual lack of negotiation skills: neglecting both partners' sexual needs, desires, and limits. Among other things, adolescents' ability to be sexually assertive was hindered by anticipations, including assumptions leading to disregarding one's own sexual needs, desires, and limits or fearing to ignore the partner's. To promote mutually rewarding sexual activities and prevent sexual violence, sexual education initiatives should support adolescents' ability to assertively negotiate their sexuality with their partner and avoid passiveness, aggressiveness, and lack of negotiation.

Investigating the role of action-contingent expectancy biases in dysphoria-linked activity engagement behavioural choice

Reduced tendency to engage in potentially rewarding activities is a hallmark of depression. The present study investigated the role of future expectancy biases in depression-linked behavioural choice, in participants varying in self-reported depression symptoms (dysphoria). A novel laboratory paradigm was developed to test the hypotheses that the degree to which higher dysphoria is associated with reduced tendency to engage in a potentially rewarding activity is dependent on the presence of negative biases in the expected outcomes of activity engagement. Specifically, two types of expectancy biases were distinguished: a) the expected likelihood of a negative rather than positive outcome, and b) the expected emotional impact of either outcome. N = 176 undergraduate students with varied levels of dysphoria were given the opportunity to choose to engage in a coin-tossing game that could result in a win or loss monetary outcome in terms of charity donations, and then rated both types of expectancies. Results indicated that higher dysphoria was associated with more negative expectations concerning the likelihood of objective outcomes and the emotional impact of such outcomes, and as hypothesised, such negative expectancy biases mediated indirect associations between dysphoria and behavioural choice.

Intersections between environmental reward availability, loss aversion, and delay discounting as potential risk factors for cigarette smoking and other substance use

Behavioral theory suggests that density of environmental rewarding activities and biases in decision making influence risk for substance use disorder (SUD). To better understand intersections of these potential risk factors, this study examined whether environmental reward predicted smoking status or other drug use and whether such associations were independent of two decision-making biases known to predict SUD risk, namely loss aversion and delay discounting. Individuals that reported current daily cigarette smoking (n = 186; >10 cigarettes/day) and never-smoking (n = 241; <100 cigarettes lifetime) were recruited with standard crowdsourcing methods. Participants answered questions on alcohol and other drug use. Environmental reward was assessed using the Reward Probability Index (RPI), and loss aversion (LA) and delay discounting (DD) using a gamble-acceptance task and monetary choice questionnaire, respectively. Associations of RPI, LA, and DD with cigarette smoking, alcohol use, other drug use, and combinations of co-use were examined with logistic regression controlling for sociodemographic variables (educational attainment, gender, age). Low RPI (odds ratio[OR] = 0.97, p = .006), low LA (OR = 1.22, p < .001), and high DD (OR = 1.12, p = .03), were each independently associated with increased risk for cigarette smoking, as well as other substance use, and use combinations. We saw no evidence that RPI was significantly influencing associations between LA and DD with smoking status or other substance use. Finally, RPI, but not LA or DD, was significantly associated with depressed mood and sleep disturbance. These results provide new evidence on associations of RPI with smoking status and other substance use while further documenting independent associations between LA and DD and those outcomes.

Do what matters, no matter what! Factorizing positive activities during COVID-19 lockdown.

Behavioral activation (BA) interventions systematically encourage positive and value-based activities. Engaging in them is an effective way to counteract negative affect, but it is unknown whether there are subtypes of activities that may have differential effects on mood. This study investigated the factorial structure of 99 potentially rewarding activities used in an online BA intervention during the COVID-19 lockdown. About 3624 German-speaking participants evaluated a list of 99 activities that were easy to apply. We analyzed the initially 99 activities by means of confirmatory factor analysis. Since activities can either be seen as reflective or formative indicators, a reflective as well as a formative model was analyzed. Although the range of chosen activities differed clearly between respondents, a one-factor model provided the best fit. It seems that a general “activity” factor is more important for explaining whether people choose a certain activity or not, than specific characteristics of the activity itself.

The analysis of the problem of personality desocialization teenagers under the influence of social networks containing destructive content

Introduction. Adolescents and young people are one of the largest categories of social media users, they have great confidence in the information presented in the networks and are mostly destructive in nature. The reason for this is that destructive material is perceived by adolescents as credible and used as a guide for deviant or criminal behaviour. Existing conditions and methods of prevention of their desocialisation prove to be ineffective. The aim of the article is to identify social, personal and activity factors and causes of personality desocialization, taking into account the features of personality desocialization of adolescents and young people under the influence of social networks with destructive material, and to determine the basis for the development of a set of social and pedagogical measures to prevent adolescent desocialization. Materials and methods. Adolescents aged 13-17 from Magnitogorsk, Verkhneuralsk, District of Chelyabinsk Region, and Sibai, Republic of Bashkortostan, took part in the study. All in all 1415 people. The author's questionnaire, observations, analysis of statistical data were used. Based on the analysis of their answers to the questionnaire and the analysis of social networking material the grounds for the prevention of desocialization, directions and forms of organization of the process of training teenagers to work in social networks were determined. The results of the study. It has been proved that the problem must be seen as objectively existing and can only be solved by identifying and evaluating social media material (more than 92% receive information from social media only). It has been established that the basis of the problem of desocialization of adolescents and young people is the contradiction between holding their attention by available information, providing them with relative anonymity and the need for everyone to hide their "self". It was revealed that the majority of the adolescents have a low level of personal identification and self-esteem, have signs of inferiority complex and conflict with society (more than 52% of the adolescents communicate mainly with virtual friends; more than 47% of the respondents do not rely on others for help). We propose a method of preventing desocialization through the implementation of a set of socio-pedagogical conditions. Conclusion. Factors in preventing the desocialisation of adolescents and young people include targeted training for educators to educate and prepare adolescents for social media, building their digital competence; targeting a comfortable and authoritative social environment in which their communication, social behaviour and activities take place; and creating conditions for them to engage in interesting and rewarding activities

Factors Affecting Women Labor Utilization in Staple Crops Value Chains Activities in Southeast Nigeria

This paper identified socioeconomic, institutional and technological factors affecting women labor utilization in an on-farm and less rewarding staple crop value chain activities such as clearing, cultivation, planting and weeding compared to more rewarding off-farm post-harvest activities that facilitate input and output market such as threshing, shelling, processing, storage and marketing using data collected from 400 randomly selected women farmers in southeast Nigeria during 2019/20 crop year. Multinomial-logit results show that complementary input such as the use of credit, hired labor, fertilizers, agrochemicals, more land, adult men/women and extension services had a negative relationship with women’s engagement in less rewarding farm operations. The constraint militating against women’s labor utilization in staple crop value chain activities were lack of storage facilities, lack of credit, lack of improved input, poor road network and land tenure problems. The paper recommends institutional framework through extension education, technology-supply industries, financial institutions, improved road network to enhance women’s labor engagement in more beneficial value chains activities such as post-harvest operations since women farmer selling to the market are more rewarding than engagement in clearing, cultivation, planting and weeding so that more women will participate in the market.

Differential brain responses to alcohol-related and natural rewards are associated with alcohol use and problems: Evidence for reward dysregulation.

Multiple theoretical perspectives posit that drug use leads to biased valuation of drug-related reward, at the expense of naturally occurring rewarding activities (i.e., reward dysregulation). Recent research suggests that the comparative balance of drug-related and nondrug-related reward valuation is a powerful determinant of substance misuse and addiction. We examined differential neurophysiological responses-indexed with the P3 component of the event-related potential (ERP)-elicited by visual alcohol cues and cues depicting natural reward as a neurobiological indicator of problematic drinking. Nondependent, young adult drinkers (N = 143, aged 18-30 years) completed questionnaire measures assessing alcohol use and problems, and viewed alcohol cues (pictures of alcoholic beverages), high-arousing natural reward cues (erotica, adventure scenes), nonalcoholic beverage cues, and neutral scenes (e.g., household items) while ERPs were recorded. When examined separately, associations of P3-ERP reactivity to alcohol cues and natural reward cues with alcohol use and problems were weak. However, differential P3 response to the two types of cues (i.e., reward dysregulation P3) showed consistent and robust associations with all indices of alcohol use and problems and differentiated high-risk from lower-risk drinkers. The current results support the idea that the differential incentive-motivational value of alcohol, relative to naturally rewarding activities, is associated with increased risk for substance misuse and dependence, and highlight a novel neurophysiological indicator-the reward dysregulation P3-of this differential reward valuation.

Mental Health Aspects of Voluntary and Involuntary Sport Retirement.

Sports participation is an important factor in the mental health of athletes. A change in sports participation affects athlete mental health, in addition to other components of the athlete's life, including overall health and fitness, future career plans, current and future financial status, and available social network. Athletes should be encouraged to develop balanced lives that involve rewarding activities outside their sport. Clinicians should evaluate the mental health of athletes leaving sport for any reason, develop protocols to address any concerns, and assist with postsport career and life planning.

Learning it the hard way - how enjoying life and positive appraisal buffer the negative effects of stressors on mental health in the COVID-19 pandemic.

BackgroundHigher levels of stress and negative emotions such as anxiety and depression have been reported since the beginning of the COVID-19 pandemic, but it remains less clear how positive emotions, such as hedonic capacity, may be affected. Further, during lockdowns, the ability to learn new pleasurable activities (hedonic learning) may be particularly relevant. Here, we investigated if state hedonia and/or hedonic learning mediated the relationship between COVID-19 stress and mental health. Moreover, we explored whether positive appraisal style (PAS), a major resilience factor, influenced these relationships.MethodsUsing a cross-sectional design, 5000 German-speaking participants filled out online questionnaires targeting stressors, mental health, state hedonia, hedonic learning, and PAS between April 9 and May 15, 2020. After confirming the factor structure of our constructs, we applied latent structural equation modeling to test mediation as well as moderated mediation models.ResultsStress showed a positive association with mental health symptoms, which was buffered by both state hedonia and hedonic learning. While higher stress was related to lower state hedonia, participants reported more hedonic learning with greater stressor load. The latter effect was greater for individuals with high PAS.LimitationsThe present results should be replicated in longitudinal designs with representative samples to confirm the directionality and generalizability of effects.ConclusionsBoth state hedonia and hedonic learning buffered the effect of stress on mental health in an early phase of the COVID-19 pandemic. Learning new rewarding activities in combination with a PAS may be especially relevant for maintaining mental health during lockdowns.

What are the barriers and facilitators to participation in active recreation for people with learning disabilities? A scoping review

Accessible Summary Hobbies that are active can be a way of improving physical and mental well‐being for people with learning disabilities. Choice, tailoring an activity to a person's needs and companionship between people with learning disabilities and their caregivers can facilitate participation in hobbies that are active. Disregard for a person's physical and cognitive capabilities, and for their environmental or carer circumstances, can hinder participation in hobbies that are active. AbstractBackgroundActive recreation denotes engagement with meaningful and rewarding activities that can improve physical and mental well‐being for everyone; however, there are specific challenges to participation in active recreation for people with learning disabilities.AimTo understand what hinders and what enables participation in active recreation for people with learning disabilities.MethodUsing a scoping review framework, we retrieved relevant literature by searching MEDLINE 1946 (Ovid), PsycINFO, CINAHL Complete (EBSCO), Scorpus, PubMed and Web of Science. We extracted data, charted and synthesised them using the Model of Human Occupation (Kielhofner, 2008) and the social–ecological model (Boulton, Horne &amp; Todd, 2017).FindingsNineteen studies met our inclusion criteria. Key barriers identified in the studies included caregiver/coach knowledge and skill, caregiver resources, relational, environmental and individual capabilities. Key facilitators included choice, needs‐based tailored activities, positive relationships, consideration of cognitive and functional ability, motivational incentives and policy and organisational factors.ConclusionsParticipation in active recreation involves a complex interaction between individuals with learning disabilities, their caregivers and their wider organisational and community networks. This relationship warrants further exploration from the perspective of people with learning disabilities and their proxies, so that we can optimise how we design and deliver active recreational pursuits for this population.

Selecting and imagining rewarding activities during the COVID-19 lockdown: Effects on mood and what moderates them.

The COVID‐19 outbreak strongly restricted daily activities, creating a risk factor for negative affect and depression. This study assessed the immediate effects of a behavioural activation (BA) intervention on positive (PA) and negative (NA) state affect. We expected depression and anxiety to function as moderators reducing the intervention effects. In a quasi‐experimental online study, 3624 German‐speaking participants evaluated a list of rewarding activities between 9 April and 26 April 2020. A subsample of 2561 (71%) additionally engaged in an imagination task. Depression, anxiety, socioeconomic variables and COVID‐19 related burdens were assessed as moderators. There was an increase in PA (total sample d = .13; subsample: d = .27) and a decrease in NA (total sample d = −0.68; subsample: d = −0.71; all p < .001). The effects rose with higher levels of depression and anxiety (all p < .001). Furthermore, living with family enhanced the effects on NA, while additionally having to take care of children reduced them. An easy‐to‐use intervention prompting BA could improve state mood during lockdown. Participants with higher depression and anxiety benefit more. Implications for the prevention of mental health problems during a pandemic are discussed.

Pengembangan Kemandirian Kelompok Difabel Melalui Pemanfaatan Pemasaran Digital di Kota Magelang

Different physical or nonphysical conditions bring the disabled group into the depletion chain, both socially, politically, and economically. It started from the low access to education to low uptake in the industrial world. The effort to break the depletion chain is to develop the self-sufficiency of children with disabilities and independence from the Gerakan untuk Kesejahteraan Tunarungu Indonesia (Gerkatin) through the guidance of digital marketing utilization. The empowerment approach is used in this activity from the start of planning activities, implementation, to evaluation through participatory methods and learning by doing. From the results of community devotion activities, the target group becomes more economically independent with digital marketing skills and shifting the gadget addiction to more rewarding online activities. The formation of Magelang Disabled Digital Interprenenur Community is an effort to ensure the continuity of the program.

A qualitative study exploring adolescents' experience of brief behavioural activation for depression and its impact on the symptom of anhedonia.

Anhedonia, the loss of interest and pleasure, is a core symptom of depression and is associated with deficits in reward processing. Behavioural Activation for depression may address this symptom due to its focus on identifying and increasing intrinsically rewarding activities. This was a qualitative study employing reflexive thematic analysis (TA). Participants were eight treatment-seeking adolescents with a recent primary diagnosis of depression who had received eight sessions of Brief Behavioural Activation. Qualitative semi-structured interviews were conducted after treatment was completed. Three main themes emerged: (1) connecting, reviewing, and taking action: 'focus on getting better rather than what you're feeling'; (2) struggles, restrictors, and motivators: 'it seemed really unachievable'; and (3) feeling, acting, or seeing things differently: 'looking forwards in a more healthy way'. Both specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic strategies (e.g., self-monitoring) may be helpful in treating the symptom of anhedonia in adolescent depression. Motivational aspects of anhedonia, as well as anxiety, fatigue, and academic pressures act as potential barriers to recovery. This highlights the need for psychological treatments for adolescent depression to include explicit and targeted strategies to enhance motivation. Young people reported that specific Brief Behavioural Activation strategies (e.g., connecting with values) and more generic therapeutic techniques (e.g., self-monitoring) had a role in treating anhedonia. Barriers to engaging in Brief BA included: motivational anhedonia, fatigue, and academic demands.

Illness Stigma, Worry, Intrusiveness, and Depressive Symptoms in Youth With Inflammatory Bowel Disease.

Youth who experience IBD-associated stigma may manifest increased worry about aversive symptoms that can intrude on their participation in routine activities (eg, school, social events), potentially resulting in limited opportunities for reinforcement and increased depressive symptoms. The present study examined an IBD stigma → IBD worry → illness intrusiveness → depressive symptoms serial mediation model, in which stigma was hypothesized to confer an indirect effect on youth depressive symptoms through the serial effects of stigma on IBD worry and illness intrusiveness. Youth with IBD (N = 90) between the ages of 10 and 18 years were recruited from a pediatric gastroenterology clinic and completed measures of IBD stigma, IBD worry, illness intrusiveness, and depressive symptoms. In addition to several independent direct effects among the modeled variables, results revealed a significant IBD stigma → IBD worry → illness intrusiveness → depressive symptoms serial mediation path (effect = 0.63, 95% CI = 0.22 to 1.20), controlling for youth sex and IBD severity. The experience of IBD-related stigma may prompt increased worry about IBD symptoms, independent of the influence of disease activity. Further, heightened worry appears to amplify youths' experience of IBD-imposed limitations on routine and rewarding activities, increasing their risk for experiencing depressive symptoms. Our findings highlight the importance of regular screening for depressive symptoms, as well as the identification of potential risk factors associated with emotional adjustment difficulties. Stigma-specific treatment modules could be integrated within existing cognitive-behavioral approaches for reducing worry and depressive symptoms in youth with IBD.

포상담당관의 포상제활동 지도경험에 관한 현상학적 연구

포상담당관의 포상제활동 지도경험에 관한 현상학적 연구