You're changed if you do and changed if you don't: Mechanisms underlying paradoxical interventions.

We examined 2 mechanisms of change under paradoxical interventions: reactance and increased sense of self-efficacy. Procrastinating college students were randomly assigned to either paradoxical or self-control interventions. Effective study time and perceived self-efficacy were measured before and after treatment. In Study 1 nonverbal measure of initial reactance was employed. In Study 2 reactance was experimentally manipulated. Under paradoxical interventions, Ss higher on initial reactance benefited more from therapy than did Ss with low reactance; nonreactant Ss did not increase their effective study time, but they did improve in perceived efficacy to control their procrastination; increased study time was negatively correlated with increased self-efficacy. In self-control treatment, increased study time was accompanied by increased self-efficacy. Paradoxical interventions seem to reduce procrastination through the mechanism of reactance in some clients, whereas in others they lead to a cognitive change, possibly mediating a subsequent behavior change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What role do lay beliefs about hypertension etiology play in perceptions of medication effectiveness?

Background: Some people take the disease label "hypertension" literally; leading to the belief that increasing relaxation instead of medication is the best treatment for this condition. We experimentally tested the effect of such underlying beliefs on ratings of interventions for hypertension and compared alternative communication strategies to increase medication effectiveness ratings. Methods: Outpatients (N = 152) with a known diagnosis of hypertension read a vignette describing an asymptomatic condition and recommended treatment. Experimental factors were the disease label (Hypertension vs. Korotkoff's Syndrome) and type of argument designed to persuade the reader that medication is most effective (Causal vs. Correlational). Measures: Background measures included demographics, beliefs that stress causes health problems and trust in physicians. Outcomes were effectiveness ratings for interventions to treat the condition. Results: Participants who read a vignette describing "Hypertension" rated "relaxing more" as significantly more effective than participants exposed to the same condition but with the unfamiliar "Korotkoff's Syndrome" label, [F(1, 141) = 5.22, p = .024]. However, medication, reducing salty foods and losing weight were rated as more effective than relaxing more. Intervention ratings did not differ by type of argument presented. There was a significant interaction of disease label and trust in physicians [F(1, 125) = 7.01, p = .009]. Individuals with low trust rated medication as significantly less effective when exposed to an unfamiliar disease label. Conclusions: This study confirms the effect of the hypertension disease label on ratings of different interventions for the condition. However, participants rated biomedically recommended interventions as more effective than those not endorsed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of paradoxical and nonparadoxical interpretations and directives.

Explored the effects of consistent and inconsistent combinations of paradoxical and nonparadoxical interpretations and directives in brief counseling with 49 moderately depressed undergraduates. It was hypothesized that a consistent paradoxical intervention would be more effective than inconsistent interventions, which in turn would be more effective than a consistent nonparadoxical intervention. Ss who wanted to change were randomly assigned to 4 interview intervention conditions and a no-treatment control condition. In the intervention conditions, Ss received 2 interviews with counselors who gave 6 interpretations and 2 directives over the course of the interviews. Ss in the intervention conditions decreased their depression more than did Ss in the control condition. Paradoxical interpretations were associated with more symptom remission than were nonparadoxical interpretations, whereas the nature of the directives students received made little difference. Whether the interventions were consistent or inconsistent made little difference on changes in depression, but Ss had more favorable impressions of their counselors when interpretations and directives were consistent. The impact of the interventions on Ss' attributions of the cause of therapeutic change was also explored. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Career-intervention outcome: What contributes to client gain?

An earlier research integration of the career-counseling literature (Oliver & Spokane, 1981; Spokane & Oliver, 1983) found moderate effect sizes for various career interventions but did not explore the relations between specific study characteristics. The present study extended the data base of Spokane and Oliver and used more sophisticated coding and analysis procedures to examine the relations between study characteristics and outcomes. Two hundred forty treatment–control comparisons resulted from 58 studies containing 7,311 subjects. Class interventions were the most effective but required the greatest number of intervention hours. Four indexes of the relative efficacy of different career intervention modes revealed that individual counseling produced more client gain per hour (or session) than any other intervention mode. Intensity of treatment was the only significant contributor to outcome magnitude. Contrary to earlier reviews, there were clear differences in effectiveness among intervention modes, a finding that ought to be considered in treatment selection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing guidelines and innovations in general practice: which interventions are effective?

BACKGROUND: It is crucial that research findings are implemented in general practice if high-quality care is to be achieved. Multifaceted interventions are usually assumed to be more effective than single interventions, but this hypothesis has yet to be tested for general practice care. This review evaluates the effectiveness of interventions in influencing the implementation of guidelines and adoption of innovations in general practice. A systematic literature study was carried out using MEDLINE searches for the period from January 1980 until June 1994, and 21 medical journals were searched manually. Randomized controlled trials and controlled before and after studies (with pre- and post-intervention measurements in all groups) were selected for the analysis. Clinical area, interventions used, methodological characteristics and effects on clinical behaviour were noted independently by two researchers using a standardized scoring form. Of 143 studies found, 61 were selected for the analysis, covering 86 intervention groups that could be compared with a control group without the intervention. Information transfer alone was effective in two out of 18 groups, whereas combinations of information transfer and learning through social influence or management support were effective in four out of eight and three out of seven groups respectively. Information linked to performance was effective in 10 out of 15 groups, but the combination of information transfer and information linked to performance was effective in only three out of 20 groups. Some, but not all, multifaceted interventions are effective in inducing change in general practice. Social influence and management support can improve the effectiveness of information transfer, but information linked to performance does not necessarily do so. The variation in the effectiveness of interventions needs further analysis.     

Reframing and restraining directives in the treatment of clinical depression.

We tested the effects of reframing and restraining directives on depression of high- and low-reactant clients. Reframing was more effective than restraining or control, and level of reactance had no effect. Restraining did not differ from control. Subjects were 74 moderately to severely depressed outpatients. Results are discussed in light of the compliance–defiance model of paradoxical interventions and psychological reactance theory. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Efficacy of Play Therapy With Children: A Meta-Analytic Review of Treatment Outcomes.

The efficacy of psychological interventions for children has long been debated among mental health professionals; however, only recently has this issue received national attention, with the U.S. Public Health Service (2000) emphasizing the critical need for early intervention and empirically validated treatments tailored to children's maturational needs. Play therapy is a developmentally responsive intervention widely used by child therapists but often criticized for lacking an adequate research base to support its growing practice. A meta-analysis of 93 controlled outcome studies (published 1953-2000) was conducted to assess the overall efficacy of play therapy and to determine factors that might impact its effectiveness. The overall treatment effect for play therapy interventions was 0.80 standard deviations. Further analysis revealed that effects were more positive for humanistic than for nonhumanistic treatments and that using parents in play therapy produced the largest effects. Play therapy appeared equally effective across age, gender, and presenting issue. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution and the double bind in paradoxical interventions.

Tested the hypothesis that clear identification of an internal, nonvolitional agent of therapeutic change would enhance therapeutic change and the maintenance of change in response to paradoxical interventions (PIs) and explored the double-bind explanation of PIs. 29 depressed (as determined by the Beck Depression Inventory [BDI]) college students were assigned to 1 of 3 interview treatments containing PIs: A no-elaboration condition contained only PIs; a developmental-meaning condition contained an additional paragraph explicitly identifying a developmental agent of change; and a metacommunication condition contained an additional paragraph explicitly identifying the paradoxical nature and intent of the treatment. At follow-up, Ss completed a battery that included the BDI, a self-perception inventory, and the Barrett-Lennard Relationship Inventory. Results indicate that PIs that explicitly identified an internal, nonvolitional cause of change resulted in decreased external attribution of change but not greater therapeutic change. Explaining the double-bind aspects of PIs resulted in favorable client views of therapists but diminished the immediate therapeutic effects of the interventions. Results suggest that clients' perceptions of the qualities of their therapists and clients' attributions about the causes of their behaviors may not be causes of therapeutic change but simply additional dependent variables in the therapeutic process. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cost effectiveness and medical cost-offset considerations in psychological service provision.

Suggests that empirical evidence has demonstrated that psychological interventions can effectively treat a wide range of child and adult health problems. The focus of this review is on costing issues associated with psychological interventions, including cost-effectiveness and cost offset (i.e., a reduction in health care costs attributable to effective intervention). Recent evidence has demonstrated that psychological interventions can be more cost-effective than optimal drug treatment. For example, although having comparable effectiveness, cognitive-behavioral treatments for panic disorder and for depression have been estimated to cost approximately one-third less than pharmacological treatment. Further, a recent meta-analysis of 91 research studies published between 1967 and 1997 found that average health care cost savings due to psychological intervention were in the range of 20-30% across studies, and 90% of the studies reported evidence of a medical cost offset. In conclusion, the evidence indicates that psychological treatments (1) can be cost-effective forms of treatment and (2) have the potential to reduce health care costs, as successfully treated patients typically reduce their utilization of other health care services. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Oxidation in liposomes from egg phosphatidylcholine loaded with L-3,4-dihydroxyphenylalanine (DOPA) and dopamine: mutual effect of components

Effectiveness of continuous positive airway pressure (CPAP) as a treatment of obstructive sleep apnea can be limited by poor compliance, but little is known about how to improve compliance. We performed a randomized, controlled clinical trial among 33 subjects of two interventions to improve compliance. One group of subjects received weekly phone calls to uncover any problems and encourage use, another received written information about sleep apnea and the importance of regular CPAP use, and a third served as control subjects. We found that intervention improved CPAP compliance (p = 0.059) and that the effect was particularly strong when intervention occurred during the first month of CPAP treatment (p = 0.004). Although the sample size did not allow definitive investigation of other explanatory variables, subjects with lower levels of education or those with relatives who used CPAP may have benefited from intervention more than other subjects. We conclude that simple, inexpensive efforts to improve compliance with CPAP can be effective, especially when applied at the start of CPAP treatment, but optimal intervention may vary with certain patient characteristics.     

Career-intervention outcome: A replication and extension of Oliver and Spokane (1988).

Studies published between 1983 and 1995 that examined the effectiveness of career interventions were subjected to a meta-analytic review to replicate L. W. Oliver and A. R. Spokane's (see record 1989-06873-001) study. Using a sophisticated coding system and extensive data analyses, this study examined 268 treatment-control contrasts from 47 studies that involved 4,660 participants. The average overall effect sizes were smaller but similar to those found previously. Individual career counseling was found to be the most effective and efficient treatment, whereas computer interventions were the most cost-effective. The results of this study do not support the previous finding that treatment intensity predicted effect-size magnitude. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of positive reframing and paradoxical directives in counseling for negative emotions.

Examined the effects of 2 paradoxical directives on negative emotions of 46 undergraduates whose Beck Depression Inventory (BDI) scores ranged from 10 to 30 and who identified themselves as experiencing negative emotions that they wanted to change. According to the 2?×?2 design of the 4-wk study, Ss received either positive reframing statements or no reframing statements and either paradoxical or nonparadoxical directives in a 2-interview treatment. Three male and 3 female counselors delivered the treatment in all conditions. Change in negative emotions was measured by pre–post differences on the BDI and on a self-report mood scale. Results indicate that positive reframing produced greater reduction in negative emotions than no reframing, although negative emotions were reduced in all conditions. The 2 directives did not differ in their effects on either of the measures. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Paradoxical effects in the reaction time of schizophrenics.

"A reaction-time experiment was carried out, using lights of different intensities, to test Pavlov's suggestion that paradoxical effects are commonly found in schizophrenics. It was predicted that whereas normal persons tend to respond more quickly to more intense stimuli, schizophrenics respond more slowly to such 'ultramarginal' stimuli than to lights of weaker intensity. In 22 out of 24 chronic, nonparanoid schizophrenics, RTs to the brighter stimuli were longer than those to weaker stimuli in a first testing session but not in a second. Convalescent, shore-stay schizophrenics and normal controls showed no paradoxical effects. A tentative hypothesis to explain why the chronic patients did not show paradoxical effects on retest is proposed." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Change through paradox: Using self-verification to alter beliefs.

Past research has shown that conventional strategies of persuasion tend to be ineffective against people who are highly certain of their beliefs. To change the beliefs of such individuals, we devised a paradoxical strategy that consisted of posing superattitudinal leading questions (questions that encouraged respondents to make statements that were consistent with, but more extreme than, their own viewpoints). We expected that individuals who were high in belief certainty would resist such questions and, therefore, change their beliefs in the opposite direction. To test this reasoning, we used either a conventional or a paradoxical strategy to change people's beliefs about women's roles. As suggested by earlier research, the conventional strategy was effective in changing the beliefs of targets who were low in belief certainty only. In contrast, the paradoxical strategy was effective in changing the beliefs of targets who were high in belief certainty only. A follow-up investigation replicated this effect and indicated that paradoxical injunctions change people's positions on belief dimensions rather than their perception of the dimension itself. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Measurement of total and local bone morphogenetic protein concentration in bone tumours

OBJECTIVE: To evaluate the relative effectiveness of two self-help smoking interventions as adjuncts to a self-help manual and telephone support service (hotline) for older smokers. DESIGN: Subjects were stratified on baseline variables and randomised to one of two treatment conditions in a methods development study. SUBJECTS: 177 community-dwelling smokers aged 60 years and older. INTERVENTIONS: All subjects received a self-help manual and access to a smokers' telephone hotline. Subjects also received either mailings (Letters condition) or counselling telephone calls (Proactive condition) at four and eight weeks after enrollment. MAIN OUTCOME MEASURES: Use of the hotline and prevalence of abstinence lasting at least 48 hours (verified by a "significant other") were assessed at three and six months for the full sample. Seven-day abstinence was calculated for comparison with previous research. A subsample of 91 subjects was followed up at 12 months. RESULTS: Overall abstinence rates for the two conditions were in the range of typical self-help interventions. Men were more likely to be abstinent than women at follow up at three and six months. A significant gender x treatment interaction was found, with abstinence rates higher for men in the Letters condition, and women in the Proactive condition. Hotline use was high, with nearly half of subjects calling by 12 months. CONCLUSION: Both interventions appear promising for older smokers, but may be differentially effective for men and women. Older smokers will use a hotline; whether Letters and Proactive interventions can improve on manual and hotline effectiveness rates alone is being tested in a subsequent controlled trial.     

Interviewer disclosure modeling, information revealed, and interviewee verbal behavior.

Investigated the effectiveness of the interviewer as a model of and recipient for interviewee self-disclosure when modeled content revealed favorable or unfavorable personal information. Of 24 undergraduate males who served as Ss, 8 were in a control condition and received only minimal interview structuring. During a 30-min interview, Ss talked about their relationship with 4 target persons. Contrary to a "model status loss" hypothesis suggested by previous research, the disclosure of unfavorable information did not decrease the effectiveness of the interviewer's interventions. Although Ss' perceptions of their disclosing interviewer were in the expected direction on 9 of 10 interpersonal rating dimensions, between-group differences did not reach significance. Ss talked longer and achieved higher levels of self-exploration in both modeling conditions than in the no-model control situation. Frequency and patterning of Ss' positive and negative self-references also were related to treatment conditions. Implications for psychotherapy interventions and continued interview behavior research are discussed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review.

Objective: This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change. Method: Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include PsycINFO, PUBMED/MEDLINE, and Educational Resources Information Center. Twenty-one independent studies, representing 5,471 participants, were located and analyzed. Results: An omnibus weighted mean effect size for all identified MI interventions revealed a small, but significant, posttreatment effect size (mean d = .173, 95% CI [.094, .252], n = 21). Small, but significant, effect sizes were observed at follow-up suggesting that MI interventions for adolescent substance use retain their effect over time. MI interventions were effective across a variety of substance use behaviors, varying session lengths, and different settings, and for interventions that used clinicians with different levels of education. Conclusions: The effectiveness of MI interventions for adolescent substance use behavior change is supported by this meta-analytic review. In consideration of these results, as well as the larger literature, MI should be considered as a treatment for adolescent substance use. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Selective mutism: A review of the treatment literature by modality from 1980–1996.

Psychodynamic, family systems, behavioral, and psychopharmacological interventions of selective mutism are reviewed and discussed to examine effectiveness of treatment styles. Each modality has its own conceptualization of the disorder and specialized intervention techniques. While methodologies of the studies reviewed were often weak, there exist many treatment examples that illustrate effective interventions for selective mutism in childhood. The interventions that involved individualized or multimodal treatments produced the best overall results as evidenced through the symptom cessation. Many articles reported a close relationship between selective mutism and anxiety disorders. A clearer diagnostic understanding of selective mutism needs to be realized prior to generalizing a specific, effective treatment for this disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)