Tailored Interventions for Motivating Smoking Cessation: Using Placebo Tailoring to Examine the Influence of Expectancies and Personalization.

The present study examined mechanisms underlying the effectiveness of tailored interventions for motivating smoking cessation. The study used a placebo-tailoring design to test whether the efficacy of tailoring was due, in part, to personalized features in addition to the theoretically based content. Two hundred forty adult smokers were randomized to 1 of 3 conditions: standard booklet, minimally personalized booklet, or extensively personalized booklet. The interventions varied in their degree of ostensible tailoring, yet the actual smoking-related content of the booklets was identical. A dose-response relationship was hypothesized, with the greatest apparent tailoring producing the most positive outcomes. This pattern was found for evaluation of the booklets, with trends for readiness to change and self-efficacy increases. Moreover, as hypothesized, the effect of the interventions on readiness was moderated by participants' expectancies about tailoring. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Mediators of a brief hypnosis intervention to control side effects in breast surgery patients: Response expectancies and emotional distress.

Objective: The present study was designed to test the hypotheses that response expectancies and emotional distress mediate the effects of an empirically validated presurgical hypnosis intervention on postsurgical side effects (i.e., pain, nausea, and fatigue). Method: Women (n = 200) undergoing breast-conserving surgery (mean age = 48.50 years; 63% White, 15% Hispanic, 13% African American, and 9% other) were randomized to a hypnosis or to an attention control group. Prior to surgery, patients completed assessments of hypothesized mediators (response expectancies and emotional distress), and following surgery, patients completed assessments of outcome variables (pain, nausea, and fatigue). Results: Structural equation modeling revealed the following: (a) Hypnotic effects on postsurgical pain were partially mediated by pain expectancy (p p = .12); (b) hypnotic effects on postsurgical nausea were partially mediated by presurgical distress (p = .02) but not by nausea expectancy (p = .10); and (c) hypnotic effects on postsurgical fatigue were partially mediated by both fatigue expectancy (p = .0001) and presurgical distress (p = .02). Conclusions: The results demonstrate the mediational roles of response expectancies and emotional distress in clinical benefits associated with a hypnotic intervention for breast cancer surgical patients. More broadly, the results improve understanding of the underlying mechanisms responsible for hypnotic phenomena and suggest that future hypnotic interventions target patient expectancies and distress to improve postsurgical recovery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of alcohol expectancy priming and mood manipulation on subsequent alcohol consumption.

Studies showing that verbal priming can implicitly affect alcohol consumption have been used to support cognitive models of expectancies. However, because expectancy words reflect affective states as well as drinking outcomes, mediation through an affective pathway remains theoretically plausible (i.e., such words inadvertently may affect mood, which in turn influences drinking). The primary pathway was identified (and expectancy theory was tested) by comparing memory priming (using alcohol expectancy or neutral words) with mood induction (using positive or neutral music); an unrelated experiment paradigm allowed the priming manipulation to implicitly affect drinking. Men in the alcohol priming group drank significantly more than men in each of the other conditions, and, consistent with theory, men with histories of heavier drinking drank the most when primed with alcohol expectancies, indicating that expectancies can function as automatic memory processes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy challenge and drinking reduction: Experimental evidence for a mediational process.

Substantial correlational evidence supports a causal (mediational) interpretation of alcohol expectancy operation, but definitive support requires a true experimental test. Thus, moderately to heavily drinking male college students were randomly assigned to 1 of 3 conditions in a pre–post design: expectancy challenge (designed to manipulate expectancy levels), "traditional" information, and assessment-only control. Expectancy challenge produced significant drinking decreases, compared with the other 2 groups. Decreases in measured expectancies paralleled drinking decreases in the challenge condition. Significant increases in alcohol knowledge in the traditional program were not associated with decreased drinking. These experimental findings support a causal (mediational) interpretation of expectancy operation. The implications for a cognitive (memory) model of expectancies and for prevention and intervention programs for problem drinking and alcoholism are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Manipulation of thinness and restricting expectancies: Further evidence for a causal role of thinness and restricting expectancies in the etiology of eating disorders.

To test the eating disorder expectancy theory contention that expectancies for reinforcement from thinness play a causal role in body dissatisfaction and eating disorder symptoms, the authors manipulated expectancies in 2 studies. Participants were exposed to either a psychoeducational intervention or an experimental manipulation of thinness and restricting expectancies. Study 1 participants were symptomatic college women who attended 3 experimental sessions and 1 follow-up session, each 1 week apart. Study 2 participants were high school girls who received the 3 experimental sessions clustered into 2 meetings; they completed symptom measures at baseline and at follow-up. In both samples, the thinness expectancy manipulation produced greater declines in thinness expectancies and body dissatisfaction than did the psychoeducational intervention. For high school girls, the thinness expectancy manipulation also produced a greater decline in overall eating-disordered attitudes. These results provide further support for the role of expectancies in the etiology of eating-disordered behaviors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lowering risk for early alcohol use by challenging alcohol expectancies in elementary school children.

Altering alcohol expectancies has reduced alcohol use among young adults and may lead to successful prevention of early alcohol use. The authors randomly assigned 216 4th-grade children to an expectancy challenge or control condition and used individual-differences scaling to map expectancies into memory network format, with preference mapping to model likely paths of association. After expectancy intervention, children exhibited a greater likelihood to associate alcohol use with negative and sedating consequences and a decreased likelihood to associate alcohol with positive and arousing consequences. Children and adults who emphasize negative and sedating effects have been found to be less likely to use alcohol. Therefore, expectancy challenge interventions that have been successful at modifying expectancies and subsequently decreasing alcohol consumption of adults may be useful in reducing the likelihood of early alcohol use among children. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Chronic and temporary distinct expectancies as comparison standards: Automatic contrast in dispositional judgments.

In 4 studies, the authors examined whether making outcome expectancies distinct resulted in their use as comparison standards and, consequently, in contrastive dispositional inferences for a target's behaviors. The expectancies examined were based on either chronic future-event expectancies (Study 1) or temporary, manipulated expectancy standards (Studies 2–4). Analyses revealed that when contextual expectancies were distinct or separable from target information, participants' dispositional judgments were contrasted from them under cognitive load and overcorrected (assimilated to them) under no load. These effects were mediated by participants' behavior categorizations. Evidence suggestive of a proceduralized form of correction for task difficulty and an effortful awareness-based correction for the effects of expectancies also were found. Results are examined in light of recent models of the dispositional inference process. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in activation of alcohol expectancies in memory in relation to changes in alcohol use after participation in an expectancy challenge program.

Memory model-based expectancy studies have shed light on the process by which expectancies may influence drinking but have not related changes in expectancy activation to drinking changes. In the present study, 38 undergraduates completed a drinking measure and factor-based and memory model-based expectancy measures, before and after an expectancy challenge intervention designed to alter expectancies. Expectancies were mapped into memory network format with individual differences scaling and likely paths of activation were modeled with preference mapping. Results indicated that exposure to the expectancy challenge led to a change in likely activation of expectancies for men, but not for women. In the 30 days after the intervention, alcohol use among men decreased significantly but did not change among women. Therefore, changes in likely activation corresponded to changes in drinking. These findings support a memory model conceptualization of expectancy influence on drinking. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Does one size fit all African American smokers? The moderating role of acculturation in culturally specific interventions.

There is a consensus that interventions for ethnic minority populations should be culturally specific (CS). A previous study found that although African American smokers indicated a preference for CS self-help materials over standard materials, several outcomes were superior for the standard information (Webb, 2008). The current study reports on a priori analyses that tested level of acculturation as a moderating variable for the efficacy of CS interventions in a sample of low-income African Americans. Participants (N = 182) completed the African American Acculturation Scale--Revised before receiving a CS smoking cessation guide or a standard guide. As hypothesized, level of acculturation predicted evaluations of the intervention content, readiness to quit smoking, and 24-hr point prevalence abstinence at the 3-month follow-up. Lower levels of acculturation (i.e., more engagement in traditional African American culture) predicted a preference for CS materials and greater readiness to quit smoking after receiving the CS guide. Yet, among participants who were less acculturated, 24-hr abstinence was greater after receiving the standard guide. Overall, these findings emphasize that individual differences in levels of acculturation to the dominant culture affect receptivity to CS written interventions. Intragroup differences should be considered prior to the provision of CS interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy and Cost-Effectiveness of a Minimal Intervention to Prevent Smoking Relapse: Dismantling the Effects of Amount of Content Versus Contact.

Relapse prevention remains a major challenge to smoking cessation efforts. T. H. Brandon, B. N. Collins, L. M. Juliano, and A. B. Lazev (2000) found that a series of 8 empirically based relapse-prevention booklets mailed to ex-smokers over 1 year significantly reduced relapse. This study dismantled 2 components of that intervention: the amount of content (number of booklets) and the frequency of contact. Content and contact were crossed in a 2 X 2 factorial design. The criteria of at least 1 week of abstinence at baseline was met by 431 participants, 75%-85% of whom returned 12-, 18-, and 24-month follow-up questionnaires. Eight booklets produced consistently higher point-prevalence abstinence rates than did a single booklet, but frequency of contact did not affect outcome. Moreover, the high-content interventions were highly cost-effective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Manipulation of expectancies about counseling and psychotherapy: Review and analysis of expectancy manipulation strategies and results.

A comprehensive review was undertaken of investigations in which an attempt was made to manipulate clients' expectations for counseling or psychotherapy. Six strategies that have been used in attempting expectancy manipulation were described, and their effectiveness evaluated. Three sets of conclusions seem to be supported by the present data. First, the use of a complicated experimental intervention to manipulate expectancies seems to be both unnecessary and unfruitful. Audiotaped and videotaped interventions are most likely to be effective. Verbal interventions have typically been ineffective and effectiveness of printed documents is in doubt. Second, experience in actual counseling sessions may have an effect on clients' expectancies, but it is unclear whether the changes observed are a function of counseling or are due to some interaction involving the confounding factors that previous investigators have failed to eliminate. Third, identification of the specific conditions under which these expectancy manipulation strategies will produce expectancy changes requires further research. Finally, recurring methodological shortcomings are examined and suggestions for future research are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancy-value constructs and expectancy violation as predictors of exercise adherence in previously sedentary women.

This prospective study examined effects of expectancy of exercise benefits, value of benefits, expectancy violation, and self-efficacy (SE) on exercise behavior and study dropout in sedentary women (n?=?86). SE predicted exercise for study completers but did not predict study dropout. After 6 and 12 weeks, participants evidenced expectancy violations, particularly for fitness and weight. Initial value, expectancy, and Expectancy?×? Value did not predict exercise for study completers, but dropouts had higher initial positive expectancies than did completers. Expectancy violations produced in Weeks 1–6 did not predict exercise in Weeks 7–12 in study completers, but dropouts in Weeks 7–12 had higher expectancy violations for weight in Weeks 1–6 than did completers. Follow-up revealed that study dropouts stopped exercising. Identifying individuals with high initial expectancies and expectancy violations may improve health behavior intervention and research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effects of nicotine dose, instructional set, and outcome expectancies on the subjective effects of smoking in the presence of a stressor.

The balanced placebo design (BPD) was used to evaluate the independent effects of nicotine dose and smoking-related expectancies on self-reported anxiety, urge to smoke, and withdrawal symptoms. After anxious mood was induced, participants smoked either a de-nicotinized cigarette or one with standard nicotine content. Nicotine dose was crossed with instructions that the cigarette was either de-nicotinized or standard. Nicotine cigarettes produced greater anxiety reduction than de-nicotinized cigarettes. Nicotine instructions attenuated anxiety only among those who held relevant expectancies. Nicotine dose and instructional set interacted such that either nicotine cigarettes or instructions that the cigarettes contained nicotine were sufficient to reduce urge to smoke. Implications of these findings and methodological issues regarding use of the BPD with cigarettes are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of alcohol-related expectancies in adolescents: Separating pharmacological from social-learning influences.

Constructed an adolescent expectancy questionnaire for use with 1,580 Ss aged 12–19 yrs. Expectancy factor structure was determined separately in 12–24 yr olds, 15–26 yr olds, and 17–29 yr olds, and in low- vs high-experience drinkers. Six expectancy factors repeated across all age groups: Physical Tension Reduction, Diversion from Worry, Increased Interpersonal Power, Magical Transformation of Experiences, Enhanced Pleasure, and Modification of Social–Emotional Behavior. Five of these were present in Ss with little or no drinking experience. Expectancy factor content became more homogeneous with increasing drinking experience and age. Results indicate that relatively well-developed expectancies exist prior to alcohol usage, but that pharmacological experience with alcohol crystallizes existing expectancies. The factors extracted were remarkably consistent with those from factor analytic investigations of alcohol expectancies in adults. Findings suggest that intervention to decrease the risk of adult problem drinking must begin with children. (19 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Same wording, distinct concepts? Testing differences between expectancies and motives in a mediation model of alcohol outcomes.

Per definition, alcohol expectancies (after alcohol I expect X), and drinking motives (I drink to achieve X) are conceptually distinct constructs. Theorists have argued that motives mediate the association between expectancies and drinking outcomes. Yet, given the use of different instruments, do these constructs remain distinct when assessment items are matched? The present study tested to what extent motives mediated the link between expectancies and alcohol outcomes when identical items were used, first as expectancies and then as motives. A linear structural equation model was estimated based on a national representative sample of 5,779 alcohol-using students in Switzerland (mean age = 15.2 years). The results showed that expectancies explained up to 38% of the variance in motives. Together with motives, they explained up to 48% of the variance in alcohol outcomes (volume, 5+ drinking, and problems). In 10 of 12 outcomes, there was a significant mediated effect that was often higher than the direct expectancy effect. For coping, the expectancy effect was close to zero, indicating the strongest form of mediation. In only one case (conformity and 5+ drinking), there was a direct expectancy effect but no mediation. To conclude, the study demonstrates that motives are distinct from expectancies even when identical items are used. Motives are more proximally related to different alcohol outcomes, often mediating the effects of expectancies. Consequently, the effectiveness of interventions, particularly those aimed at coping drinkers, should be improved through a shift in focus from expectancies to drinking motives. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Expectancies versus background in the prediction of college drinking patterns.

Examined the alcohol expectancies of 321 17–40 yr old undergraduates as a function of Ss' drinking patterns and Ss' expectancies to demographic/background variables for their ability to predict problematic and nonproblematic drinking patterns. Ss completed a demographic data sheet, alcohol expectancy questionnaire, and customary drinking record. Factor analysis of Ss' self-reported drinking yielded 3 drinking styles: nonproblematic social drinking, frequent drinking with alcohol-related problems, and contextually determined alcohol consumption. Optimal alcohol expectancy and demographic/background predictors of each drinking style were selected and compared via multiple regression procedures. Predictor equation efficiency was then examined in a new cross-validation sample of 176 Ss. Results indicate that alcohol expectancies increased the predictability of college drinking patterns and that alcohol expectancies were differentially related to problematic and nonproblematic features of college drinking. (12 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The P300 as an electrophysiological probe of alcohol expectancy.

Language-based measures indicate that alcohol expectancies influence alcohol consumption. To relate these measures to brain actions that precede verbal output, the P300 component of the Event-related potentials (ERPs) was used to detect violations of individually held alcohol expectancies. As predicted, P300 amplitude elicited by negative alcohol expectancy stimuli was positively correlated with endorsement of positive/arousing alcohol expectancies on the language-based measures, such that the higher an individual's positive/arousing expectancies, the larger was the P300 elicited by negative alcohol expectancy stimuli. These results demonstrated concordance between language-based measures of alcohol expectancies and electrophysiological probes of expectancy. While it remains unknown whether these expectancy processes are integral to decision pathways that influence consumption, these findings suggest that such processing can occur very quickly outside of conscious deliberation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The education of depressed primary care patients: what do patients think of interactive booklets and a video?

BACKGROUND: Clinicians, policy makers, and health care administrators are attempting to improve depression outcomes in the primary care setting. Despite positive evidence about the efficacy of self-help materials and psychoeducational interventions, use of educational materials designed for the primary care patient are receiving little attention in present depression initiatives. The present study describes the use and evaluation of three educational materials by depressed primary care patients. METHODS: As a part of a randomized control trial, depressed primary care patients were identified by primary care physicians and randomized to a clinical trial exploring a new method of treating depression. Patients assigned to the new method of treatment received a package of educational materials at the time of the baseline interview. These materials included two brief interactive booklets (medication booklet, behavioral health booklet) and a short video. The present analysis concerns data obtained from 108 intervention patients in a telephone survey conducted 1 week after they received the package of educational materials. RESULTS: Approximately three quarters of the subjects reported that they read or viewed all of the educational products. The majority rated the products as somewhat to significantly helpful: medication booklet 81%; behavioral health booklet 82%; and video 69%. Previously reported results include findings of significantly better medication adherence and improved clinical outcomes by patients with major depression who received a primary care intervention that included the educational products discussed in this paper. CONCLUSIONS: Educational materials may play a significant role in improving depression treatment outcomes in the primary care setting.     

Effect of multicomponent interventions on caregiver burden and depression: The REACH multisite initiative at 6-month follow-up.

Meta-analysis was used to examine pooled parameter estimates of 9 active compared with 6 control conditions of the Resources for Enhancing Alzheimer's Caregiver Health (REACH) project at 6 months on caregiver burden and depressive symptoms. Associations of caregiver characteristics and outcomes were examined. For burden, active interventions were superior to control conditions (p=.022). Also, active interventions were superior to control conditions for women versus men and for caregivers with lower education versus those with higher education. For depressive symptoms, a statistically significant association of group assignment was found for Miami's family therapy and computer technology intervention (p=.034). Also, active interventions were superior to control conditions for Hispanics, nonspouses, and caregivers with lower education. Results suggest interventions should be multicomponent and tailored. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation of a single-session expectancy challenge intervention to reduce alcohol use among college students.

In this study, the authors developed and evaluated a single-session experiential expectancy challenge (EC) intervention, seeking to reduce alcohol use by changing key positive expectancies among moderate to heavy drinking male and female college students. Participants (N=217) were randomly assigned to attend a 90- to 120-min EC session, CD-ROM alcohol education, or assessment only. Participants were assessed at pretest, posttest, and 1-month follow-up. Exposure to the EC intervention led to significant decreases in alcohol expectancies and subsequent alcohol consumption in both genders at follow-up. No significant changes were evident in either control condition. This study is the first to effectively decrease expectancies and drinking in college students with a single-session EC intervention. Further, although several studies have demonstrated the utility of the intervention with men, it is the first to do so with women. This study represents a critical step in the process of translating an innovative, theory-based intervention into a more practical format that makes it more accessible to those who seek effective drinking-reduction strategies for college campuses. (PsycINFO Database Record (c) 2010 APA, all rights reserved)