The transtheoretical model of change: An application to bulimia nervosa.

Assessed the applicability of the transtheoretical model of change to bulimia nervosa. 139 females (mean age 29.8 yrs) with a current or past diagnosis of bulimia nervosa were administered stages of change, processes of change, and treatment preference questionnaires. Ss differentially utilized selected change processes depending on their stage of change; that is, there was both an increase and a decrease in the use of particular change processes depending on Ss' readiness for change. Ss' preferred treatment provided corroborating data in support of the stage construct. These data generally support the application of the transtheoretical model of change to bulimia. It is concluded that assessment of patients' stage of change and tailoring interventions accordingly may result in more favorable treatment outcomes than traditional treatment protocols. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evaluation of a "target problem" approach to outcome measurement.

Examined the agreement among 3 sources (patients, therapists, and independent judges) in their evaluation of psychotherapeutic improvement for 25 outpatients in group psychotherapy. Sources used a "target problem" approach that involved constructing an ideographic problem list for each patient before entering therapy. After 8 and 12 mo of therapy, they rated improvement on each of the individualized problems. Sources did not generally agree either on the content of Ss' problems or on Ss' improvement, even when assessment of agreement was limited to specific problem areas. Furthermore, mean target problem improvement ratings were highly correlated with simple global ratings made by each source, suggesting that the elaborate problem identification procedure was unnecessary. These findings, typical for psychotherapy outcome research, suggest psychometric weaknesses in ideographic assessment approaches that have been gaining popularity. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sequential analyses of therapist-client interaction during change events: A task-focused approach.

In this article, we describe a task-focused approach that uses sequential analyses as deductive techniques for studying therapist–client interactions in the context of clinical microtheories of change events. The methodology is demonstrated in a study of a class of change events in client-centered therapy referred to as the resolution of problematic reactions. Logit-loglinear analysis and binomial z scores were used to test the effects of therapist behavior, assessed by therapist vocal quality and by the therapist task-relevant system, on client process assessed by client vocal quality and by the Experiencing Scale. The results indicated (a) that therapist productive voice facilitated a shift from poor to productive client voice and a shift from low to intermediate experiencing and (b) that therapist task-specific interventions directed toward resolution facilitated shifts to high experiencing. This task-focused approach to sequential analyses has the potential to yield clinically and theoretically relevant findings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alliance predicts patients' outcome beyond in-treatment change in symptoms.

The authors examined the relations among therapeutic alliance, outcome, and early-in-treatment symptomatic improvement in a group of 86 patients with generalized anxiety disorders, chronic depression, or avoidant or obsessive–compulsive personality disorder who received supportive–expressive dynamic psychotherapy. Although alliance at Sessions 5 and 10, but not at Session 2, was associated with prior change in depression, alliance at all sessions significantly predicted subsequent change in depression when prior change in depression was partialed out. The results are discussed in terms of the causal role of the alliance in therapeutic outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Perceived self-efficacy, outcome expectancies, and negative mood states in end-stage renal disease.

Tested A. Bandura's (1977) social learning theory, which hypothesizes that the joint experience of weak efficacy and strong outcome expectancies induces negative mood states. 70 end-stage renal disease patients served as Ss. Perceived self-efficacy was measured via Ss' self-rated control over health and over life in general. Outcome expectancies were assessed on Rotter's Internal–External Locus of Control Scale and the Health Locus of Control Scale. The 3 dependent variables were Ss' scores on the Beck Depression Inventory, Self-Esteem Inventory, and self-ratings of helplessness. Data were analyzed using a hierarchical multiple-regression strategy. The efficacy and outcome measures each correlated significantly and uniquely with the 3 dependent variables. Weaker efficacy and weaker outcome expectancies were associated with increased depression, lower self-esteem, and subjective feelings of helplessness. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient and therapy process variables relating to dropout and change in psychotherapy.

Investigated the relationship between pretherapy patients and process variables and change in 91 19–54 yr old adults who received psychotherapy from 26 trainees at a university teaching hospital. Pretherapy measures included Rotter's Internal–External Locus of Control Scale, the Eysenck Personality Inventory, and the SCL-90 (Revised). Upon termination of therapy, Ss completed the SCL-90, the Barrett-Lennard Relationship Inventory—Form OS64, and a personal evaluation form; therapists completed a psychotherapy process inventory and a discharge summary. Results indicate that process variables rather than preexisting S traits were the best predictors of outcome. Therapist ratings of Ss' involvement in therapy were the best single predictor of symptomatic change. Variables differentiating dropouts from remainers were also investigated. Few outcome differences were observed between Ss who remained in and Ss who dropped out of therapy. (27 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Metatheoretical assumptions and psychotherapy orientation: Clinician attributions of patients' problem causality and responsibility for treatment outcome.

Investigated (1) the role of metatheoretical assumptions regarding clinicians' attributions of patient responsibility for problem cause and therapeutic change in contributing to similarities and dissimilarities in theoretical orientation and (2) the implications of these assumptions for clinical practice. 43 experienced clinicians with either psychodynamic, cognitive-behavioral, family-systems, or eclectic orientations participated. Two case vignettes served as stimuli in assessing Ss' conceptualization focus in clinical material, intervention strategies, treatment recommendations, and attributions of patient responsibility for problem cause and therapeutic change. Psychodynamic Ss diverged most from the other groups by attributing lower levels of patient responsibility for both problem cause and role in change. The other 3 orientations clustered together. In terms of clinical implications of the attribution of responsibility to patients, significant relations were observed with estimated costs of treatments recommended, areas of conceptual focus on case material, and types of interventions proposed. The assessment of attributions of responsibility for problem cause and treatment outcome is discussed as a meaningful area of research in the psychotherapeutic process. (8 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teacher judgments concerning the acceptability of school-based interventions.

Investigated the influence of behavior problem severity, interventionist, and modality of case presentation on teacher's judgments of school-based interventions. 54 regular and special education teachers attending a university summer course used an intervention scale and the Semantic Differential to rate all possible combinations of 2 interventions (principal or teacher implemented) applied to 2 behavior problems (daydreaming and destruction of others' property). Ss read about or viewed a videotape of a 5th-grade boy engaging in 1 of the 2 problem behaviors. An ANOVA of Ss' ratings of intervention acceptability showed that behavior problem severity and interventionist significantly affected Ss' judgments of intervention acceptability. Findings show that interventions that could be implemented by the teacher were more acceptable. In addition, Ss rated interventions as more acceptable when applied to behavior problems of greater severity. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Cognitive bias and depression in psychiatrically disturbed children and adolescents.

Developed a cognitive bias questionnaire for children (CBQC) to examine the relation between cognitive distortion and depression in 39 psychiatrically disturbed 8–16 yr olds. Results indicate that the Depressed–Distorted scale from the CBQC was significantly correlated with Ss' psychiatric and self-reported ratings of depression and could significantly discriminate affective from nonaffective disorders. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient defense/therapist interventions.

Studied patient defensive behavior and therapist addressing defense (TAD) in short-term dynamic psychotherapy and brief adaptive psychotherapy in 28 adult patients with personality disorders. Three levels of patient defense (immature, intermediate, and mature) were coded. Only intermediate defensive behavior such as intellectualization and rationalization decreased. The greater the frequency of Ss' intermediate and immature defenses early in treatment, the better the outcome. Ss' defensive behavior was significantly correlated with the therapist addressing this behavior and with a decrease in immature and intermediate defenses. The frequency of TAD was significantly correlated with patient outcome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Subjective certainty and resistance to change.

"Ss were led to believe that they were exchanging numbered counters with one another, through a messenger, to the end that all six members could achieve simultaneous solutions to a problem… . The crucial determination was whether or not S would break his own solution to yield to a simulated request from another group member for one of the numbers he was using… . evidence is used to support an interpretation of yielding to group pressure which takes account of Ss' perceptual modes of organizing complex, ambiguous situations." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computerized versus motivational interviewing alcohol interventions: Impact on discrepancy, motivation, and drinking.

The authors conducted two randomized clinical trials with ethnically diverse samples of college student drinkers in order to determine (a) the relative efficacy of two popular computerized interventions versus a more comprehensive motivational interview approach (BASICS) and (b) the mechanisms of change associated with these interventions. In Study 1, heavy drinking participants recruited from a student health center (N = 74, 59% women, 23% African American) were randomly assigned to receive BASICS or the Alcohol 101 CD-ROM program. BASICS was associated with greater post-session motivation to change and self-ideal and normative discrepancy relative to Alcohol 101, but there were no group differences in the primary drinking outcomes at 1-month follow-up. Pre to post session increases in motivation predicted lower follow-up drinking across both conditions. In Study 2, heavy drinking freshman recruited from a core university course (N = 133, 50% women, 30% African American) were randomly assigned to BASICS, a web-based feedback program (e-CHUG), or assessment-only. BASICS was associated with greater post-session self-ideal discrepancy than e-CHUG, but there were no differences in motivation or normative discrepancy. There was a significant treatment effect on typical weekly and heavy drinking, with participants in BASICS reporting significantly lower follow-up drinking relative to assessment only participants. In Study 2, change in the motivation or discrepancy did not predict drinking outcomes. Across both studies, African American students assigned to BASICS reported medium effect size reductions in drinking whereas African American students assigned to Alcohol 101, e-CHUG, or assessment did not reduce their drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of change in emotion-focused and problem-focused worksite stress management interventions.

Ninety volunteers in a media organization were randomly allocated to an Acceptance and Commitment Therapy (ACT, n?=?30) group that sought to enhance people's ability to cope with work-related strain, an Innovation Promotion Program (IPP, n?=?30) that helped individuals to identify and then innovatively change causes of occupational strain, or a waitlist control group (n?=?30). Both interventions lasted 9 hr, spread over 3 months. Improvements in mental health and work-related variables were found following both interventions. As hypothesized, changes in outcome variables in the ACT condition were mediated only by the acceptance of undesirable thoughts and feelings. In the IPP condition, outcome change was mediated only by attempts to modify stressors. Discussion focused on the importance of understanding the mechanisms underpinning change in occupational stress management interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attitude change through reward of verbal behavior.

"72 Ss were induced to engage in debates on 3 different issues, taking sides opposite to those which they had indicated as their own in an opinion pretest. Half of the Ss were rewarded, in a predetermined order, by a purported vote which proclaimed them the better debators, while the other half were punished by presumably losing the debate. Posttests of Ss' opinions showed a tendency of the 'winners' to change their opinions in the direction of their debates, while the 'losers' did not change significantly. A control group of nondebators likewise showed no significant change in opinions." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of behavioral problem analysis versus instructional environment information on teachers' perceptions.

Compared 2 types of problem analysis information for their effects on 48 regular education teachers' problem attributions, ratings of acceptability, and preferences for intervention alternatives. Ss were given problem analysis vignettes containing either behavioral or instructional environment information after watching a videotape of a 2nd-grade girl exhibiting classroom behavior problems. Instructional environment information led to more problem attributions involving conditions in the classroom. Behavioral information led to more problem attributions concerning student characteristics and behavior and remote contextual variables. Ss in both informational conditions preferred instructional modification as a means of responding to the student's problems. Ratings of the intervention categories correlated significantly with Ss' problem attributions, perceptions of problem severity, and perceived likelihood for resolution in the classroom. (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)     

College students as companions to long-term mental hospital patients: Some considerations.

51 student volunteers for a companionship program each visited a mental hospital patient 1 hr/wk, for an average of 18 wk. Ss' ratings of certain aspects of patients' appearance and behavior correlated with psychiatric aides' ratings of patients' contact. But only the behavior ratings (rather than appearance ratings) correlated significantly with Ss' liking for the relationship. Patients' sex, education, years of hospitalization, and age were the best predictors of Ss' interest in future companionship. Some implications are that the Ss' apparent discouragement in relating to chronic patients might be lessened if experienced students were assigned to long-term patients and if the period of companionship were shortened. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Self-concept change in behavior modification.

Studied changes in self-concept as a function of behavioral treatment for test anxiety. 72 test-anxious (Alpert-Haber Achievement Anxiety Test) undergraduates were randomly assigned to systematic desensitization (SD) relaxation-training only, or no-treatment control conditions. Levels of test anxiety, self-esteem, and self-ideal-self discrepancy are assessed prior to and following treatment. The SD and relaxation treatments were both effective in reducing test anxiety. Ss' ratings of satisfaction with treatment were equivalent in the 2 treatment conditions. SD Ss showed improvement in self-esteem and significant reductions in self-ideal-self discrepancies; however, Ss who received relaxation training only, or no treatment, did not change significantly. This differential effectiveness of the SD and relaxation procedures is discussed in terms of the beneficial effects of imagined successful coping. Comparisons of Ss' changes in test anxiety and in self-concept suggest that an explanation of change based on simple generalization of treatment effects would be sufficient. (30 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The role of readiness to change in response to treatment of adolescent depression.

The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of fluoxetine (an antidepressant medication), cognitive–behavioral therapy, their combination, and a pill placebo. An abbreviated Stages of Change Questionnaire was used to obtain 4 readiness to change scores: precontemplation, contemplation, action, and maintenance. The association between each readiness score and depression severity across 12 weeks of acute treatment for depression, as measured by the Children’s Depression Rating Scale—Revised, was examined. Although treatment response was not moderated by any of the readiness scores, baseline action scores predicted outcome: Higher action scores were associated with better outcome regardless of treatment modality. Furthermore, treatment effects were mediated by change in action scores during the first 6 weeks of treatment, with increases in action scores related to greater improvement in depression. Assessing readiness to change may have implications for tailoring treatments for depressed adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attributional styles and life events in the classroom: Vulnerability and invulnerability to depressive mood reactions.

A core prediction of the reformulated model of learned helplessness and depression states that when confronted with the same negative life event, people who display a tendency to attribute negative outcomes to internal, stable, or global factors should be more likely to experience a depressive reaction than people who typically attribute negative outcomes to external, unstable, or specific factors. The present study tested that prediction with 227 undergraduates by determining whether the content of Ss' attributional styles at 1 point in time predicted the severity of their depressive response (Multiple Affect Adjective Check List) to receiving a low grade on an exam at a subsequent time. Consistent with the prediction, Ss with an internal or global attributional style for negative outcomes at Time 1 experienced a depressive response when confronted with a low grade; Ss with an external or specific attributional style were invulnerable to this response. In contrast to results for the internality and globality dimensions, Ss' scores along the stability attribution dimension were not correlated with the severity of their depressive response to the low grade. In the absence of a negative life event, Ss' generalized tendencies to make internal or global attributions for negative outcomes at Time 1 were not significantly correlated with their subsequent changes in depressive mood, although there was a nonsignificant positive correlation between severity of depressive response and the tendency to make global attributions for negative outcomes at Time l. (14 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)