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In Search of How People Change: Applications to Addictive Behaviors
Abstract
How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.
... All of this should be undertaken in the light of the patient's specific health needs and expectations, as well as their state of readiness to change (Prochaska et al, 1992;Buxton et al, 1996). Young and Dinan (1999) discuss how to identify the issues to be addressed when devising an individualised activity plan for older people, compatible with an individual's pathologies and medication. ...
... q Basis to match the intervention to the patient's social and economic need. q Means to identify motivational processes (current and past) and select appropriate counselling styles and motivational strategies that may be linked to an individual's stage of readiness to change (Prochaska, et al 1992). ...
This National Quality Assurance Framework provides guidelines for exercise referral systems, with the aim of improving standards among existing exercise referral schemes, and helping the development of new ones.
The Framework focuses primarily on the most common model of exercise referral system, where the GP or practice nurse refers patients to facilities such as leisure centres or gyms for supervised exercise programmes. Guidance covers issues including patient selection, evaluation and long-term follow up.
This National Quality Assurance Framework for Exercise Referral Systems was jointly commissioned by the Department of Health from two expert bodies: the British Association of Sports and Exercise Sciences (BASES) and Exercise England (see Appendix 1). Exercise England was the National Governing Body (NGB) for exercise and fitness from 1994 until the end of January 2000 but is no longer in existence.
... Adherence to home exercise programs is a common challenge for people with LBP [43]. It is an important component of behaviour change and according to the Transtheoretical Model of behaviour change, it may take at least six months to change behaviour [44]. The six included studies all had intervention lengths of less than six months [29][30][31][32][33][34]. ...
... This is an interesting finding and should be interpreted with caution as the results are of two studies reporting on the Kaia app with relatively short intervention duration (12-weeks). Further research with intervention durations of at least six months [44] should be undertaken to add clarity to these results. ...
Purpose
To explore the effectiveness of smartphone apps for the self-management of low back pain in adults.
Methods
Prospectively registered systematic review of randomised controlled trials (2008–) published in English. Studies investigating smartphone apps for the self-management of low back pain (adults ≥18 years), including ≥1 NICE low back pain and sciatica clinical guideline-recommended component and functioning without health professional input were included. Outcomes were pain, function, quality of life and adherence.
Results
Six studies were included (n = 2100 participants). All comparator groups incorporated some form of management (n = 3 physiotherapy, n = 2 GPs, n = 1 not specified). Three studies reported a significant decrease in pain intensity in the intervention group compared with the control. One study reported no significant difference between groups in pain self-efficacy. One study reported a significant reduction in disability (function) in the intervention group compared with the control. Two studies reported no between-group differences in quality of life. One study reported no correlation between adherence (app use) and change in pain intensity and one study reported that app use mediated the effect of teleconsultations on pain improvements.
Conclusions
Inconclusive evidence exists for the use of smartphone applications for the self-management of low back pain. Further research is needed.
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Implications for Rehabilitation
• Smartphone apps have the potential to improve outcomes for people with LBP aligned with current self-management guidelines.
• There is a paucity of literature exploring smartphone apps for LBP self-management and current evidence is inconclusive for smartphone app use without supported care.
• Commercially available smartphone apps are not well regulated for content or alignment with evidence-based guidelines and recommendations.
• Further evaluation of commercially available apps is required to guide and instil confidence in consumers and health professionals that consumer-accessible apps may lead to improved outcomes.
... Prior research and theory indicate that motivation and agency are mechanisms underlying smoking cessation treatment enrollment, and motivation, agency, and stress/negative affect are key mechanisms of quitting Table 1 SPIRIT Flow Diagram of enrollment, interventions, and assessments * Denotes brief version (brief 1-item versions as adapted from the full scales) smoking [58][59][60][61][62][63][64][65][66]. ST and AT were designed to address these mechanisms. ...
... Motivation refers to one's willingness or desire to change a behavior [67], and it plays a critical role in decisions related to behavior change and in the likelihood of achieving and maintaining change (see [58,59]). Motivation is characterized by frequent fluctuations. In the context of smoking, over one-third (41%) of US smokers report daily changes in their motivation to quit smoking [68], and most quit attempts are unplanned [69,70]. ...
Background
Smoking is the leading cause of preventable morbidity and mortality in the United States. Individuals with low socioeconomic status have disproportionately high smoking rates and greater difficulty quitting smoking. Efficiently connecting underserved smokers to effective tobacco cessation programs is crucial for disease prevention and the elimination of health disparities. Smartphone-based interventions have the potential to enhance the reach and efficacy of smoking cessation treatments targeting underserved smokers, but there is little efficacy data for these interventions. In this study, we will partner with a large, local hunger-relief organization to evaluate the efficacy and economic impact of a theoretically-based, fully-automated, and interactive smartphone-based smoking cessation intervention.
Methods
This study will consist of a 2-group randomized controlled trial. Participants (N = 500) will be recruited from a network of food distribution centers in West Central Florida and randomized to receive either Standard Treatment (ST, n = 250) or Automated Treatment (AT, n = 250). ST participants will be connected to the Florida Quitline for telephone-based treatment and will receive a 10-week supply of nicotine replacement therapy (NRT; transdermal patches and lozenges). AT participants will receive 10 weeks of NRT and a fully-automated smartphone-based intervention consisting of interactive messaging, images, and audiovisual clips. The AT intervention period will span 26 weeks, with 12 weeks of proactive content and 26 weeks of on-demand access. ST and AT participants will complete weekly 4-item assessments for 26 weeks and 3-, 6-, and 12-month follow-up assessments. Our primary aim is to evaluate the efficacy of AT in facilitating smoking abstinence. As secondary aims, we will explore potential mediators and conduct economic evaluations to assess the cost and/or cost-effectiveness of ST vs. AT.
Discussion
The overall goal of this project is to determine if AT is better at facilitating long-term smoking abstinence than ST, the more resource-intensive approach. If efficacy is established, the AT approach will be relatively easy to disseminate and for community-based organizations to scale and implement, thus helping to reduce tobacco-related health disparities.
Trial registration
Clinical Trials Registry NCT05004662. Registered August 13, 2021.
... This finding also tallies with recent coaching literature which stressed on positive psychology coaching (e.g., strength and courage) facilitating employees' psychological capital development, including self-efficacy, hope, resilience and optimism (Giraldez-Hayes, 2021). Aligning with the readiness to change model (Prochaska et al., 1993), our study results outline specific or implied indicators, including astonishment, fear or voice and tone, for coaches to distinguish coachees' emotional switch as the cognitive precursor of the behaviours of resistance to or support for organisational change. ...
... Following from readiness for change model (Prochaska et al., 1993), our study suggested flexible change management practices should be considered due to fluctuating scenarios in the coachee's social environment. Therefore, this research took an initial step to re-evaluate organisational change management via individual cognitive prospect (George and Jones, 2001) and acknowledged psychological resources being predictors of the resistance intention at both social and individual level (Sonenshein and Dholakia, 2012). ...
Purpose
This study aims to investigate resistance to change and change management through a micro-level interpersonal perspective. Specifically, this paper addresses in what way external change experts, such as coaches, identify distinctive emotional and behavioural indicators of resistance and facilitate individuals to develop positive strengths and motivation to change.
Design/methodology/approach
The authors drew upon critical realism and abductive research methodology to understand connections between coaching intervention and individual change resistance through 21 in-depth interviews with independent coaches listed in coaching associations in Germany.
Findings
This study first re-evaluates the implications of resistance and extends its meaning from negative obstacles into natural emotional responses of individuals and constructive resources for change. In addition, the study results indicate resistance can be distinguished through both explicit behaviours, body language along with implicit emotional reactions, like being tired or making small jokes. Moreover, several micro-level interpersonal approaches for coaches to apply in dealing with resistance, including understanding coachees' cognitive status and working environment, adapting varied communication styles as well as drawing upon coachees' strengths.
Practical implications
The research results offer organisations (e.g. managers and human resource professionals) essential guidelines in micro-level change management strategy by considering external coaching as a valuable option to deal with varied individual, social and contextual factors (e.g. organisational power and politics). From the organisational investment perspective, indicators of resistance and approaches to facilitate coachees' emotional reactions can be served as a preliminary protocol for stakeholders to evaluate the effectiveness of their change management schemes. Moreover, the framework outlined in this research can be considered in the future coaching education and professional development programmes.
Originality/value
Overall, this study demonstrates that external coaching is one of the valuable approaches in responding to individual resistance in organisational change management. The research findings widen existing bipolar paradigms of resistance (either change obstacles or positive resource) into a neutral spectrum that holds an impartial view on emotional reactions to change. Furthermore, individual differences and contextual factors play essential roles in the change process, e.g. coachees' personality, personal experiences, knowledge, interpretations to change process and topics as well as organisational context (e.g. power, hierarchy and culture) need to be considered into change management strategy.
... It uses a collaborative method of communication and information exchange that aims to enhance motivation and commitment to change by facilitating constructive patient sense-making about health (Salvo and Cannon-Breland, 2015). In MI, the readiness of a patient to engage in treatment is considered and individuals typically move through different stages several times before change occurs (Prochaska et al., 1992). Ideally, interventions should be developed according to the patient's state of readiness to change. ...
Although high rates of poor adherence/persistence have been documented in ADHD, there is limited research targeting the problem. This systematic review evaluated interventions to address poor adherence/persistence to ADHD pharmacotherapy, with the aim of guiding the development of future interventions. An extensive search was conducted from January 1980 until January 2021. Thirteen studies were identified involving interventions based on psychoeducation, behavioural therapy, combined psychoeducation/behavioural therapy, technology-based interventions, written informed consent and a nursing support line. All 13 studies (including five RCTs) reported improvement in adherence/persistence and five studies (including four RCTs) also reported improvement in ADHD symptomatology. Almost all studies involved interventions utilising some form of education. Three RCTs of psychoeducation alone were included, with two of the three studies reporting adherence benefits at three and 12 months respectively. The third RCT was terminated early due to poor recruitment. A behavioural intervention RCT reported improved adherence six months post intervention (but not at 12 months), although a substantial drop-out rate was observed. A final RCT included used a Smartphone Application and reported a short term increase in adherence. The authors of the studies in this review make salient attempts at improving adherence and provide insight for future intervention development. We believe future interventions should involve combinations of strategies, have a theoretical framework and target the most common reasons for non-adherence. Interventions should also be integratable into routine care and include patient input to maximise sustainability.
... This process of behaviour change can be viewed through the model of Prochaska and Di Clemente [25,33], which portrays six phases: Precontemplation, no intention to change behaviour; Contemplation, awareness of the problem but no commitment to change; ...
Respiratory rehabilitation is the penultimate step in the medical management of patients with severe COPD-19. It is an essential step before patients’ returning home, and is usually carried out in specialised Follow-up and Rehabilitation Clinics. When discharged from hospital, patients with post-severe COVID-19 usually progress in their medical condition. However, they may remain frail and have a constant fear of possible deterioration leading to (re)hospitalisation and a return to baseline. Psychological support in this phase can reduce patients’ anxiety and increase their motivation to carry out daily rehabilitation activities. This support provides a stable and consistent basis for patients to focus on their progress, leaving the difficulties behind. Being aware of the improvements in their physical condition allows them to maintain their motivation to continue to be physically active. Psychological support during respiratory rehabilitation aims at preparing patients to return to the normal life they had before the disease. It is usually based on brief psychotherapies that focus on strengthening the patient's abilities through behavioural changes and through reducing risk behaviours. Only after this phase is it sometimes possible to deal with complex issues and to cope with personality mechanisms and maladaptive behaviour patterns.
... Stimulus control involves modifying the environment to trigger healthy behavior. All TTM constructs were initially validated and associated in a smoking cessation context (Prochaska et al., 1992). As well, their respective association with PA related behaviors have been extensively studied (Marshall & Biddle, 2001). ...
Objective: The objectives were a) to test whether a Processes of Change (POC)-personalized Transtheoretical model (TTM)-based intervention could increase physical activity (PA) among inactive adults, and b) to examine whether the intervention increased the level of TTM theoretical constructs. The following hypotheses were formulated: 1) PA levels will be significantly higher during and after the intervention in comparison to baseline measures; 2)the level of targeted POCs will significantly increase during the intervention; 3) non targeted POCs will stay stable, and 4) SE and DB levels will significantly increase during the intervention. Method: A series of N-of-1 with A (1 to 2-week)-B (10-week)-A’(2-week) design were conducted with 12 inactive adults. Behavioral counselors used behavior change techniques to target TTM constructs and supervise PA. Interventions were individualized based on the 5 POCs with the lowest pre-intervention level. PA was evaluated using an accelerometer and via an agenda. TTM measures were weekly collected online. PA data were analyzed with piecewise linear models. A visual analysis was run to examine the TTM constructs. Results: Device, self-reported and TTM data were available for five, seven and five participants, respectively. A significant self-reported PA increase for six participants was found during the phase B and A2. A significant device-measured PA increase was observed in two participants during the study. A substantial increase of targeted POC from baseline for all participants with available data was observed. Conclusion: This study provides the first evidence of behavioral and psychological effects of a POC-personalized TTM-based intervention in inactive adults
... Furthermore, many people with eating disorder symptoms are low on motivation/readiness to change (Vandereycken, 2006), hence a key priority for interventions should be around helping to motivate individuals to initiate and maintain changes to their eating behaviour (Price-Evans & Treasure, 2011). This is important due to the key role that motivation plays in making and maintaining behavioural changes to recover from an eating disorder (Prochaska et al., 1993). Low motivation to change has been found to negatively predict engagement, adherence and outcomes with eating disorder treatments and interventions (Clausen et al., 2013). ...
Objective:
The primary aim was to assess the feasibility of undertaking a study evaluating the novel Motivational and Psycho-Educational Self-Help Programme for Athletes with Mild Eating Disorder Symptoms (MOPED-A). A mixed-methods approach was adopted to explore the feasibility of recruiting and retaining participants, and to evaluate the acceptability of measures, procedures and the intervention. A secondary aim was to explore the potential efficacy of MOPED-A in reducing athletes' eating disorder symptoms.
Method:
Thirty-five athletes were recruited. Participation involved completing MOPED-A over a 6-week period and completing self-report measures at baseline (T1), post-intervention (T2) and 4-week follow-up (T3). A subsample (n = 15) completed an interview at T2.
Results:
Retention was good throughout the study (n = 28; 80%). Quantitative and qualitative feedback suggested the format, delivery, content and dosage of MOPED-A were acceptable. Athletes valued that the intervention was tailored to them, and this facilitated both participation and completion. Over a third of participants reported disclosing their eating difficulties and deciding to seek further support. Large reductions in eating disorder symptoms were detected at T2 and sustained at T3.
Conclusions:
The MOPED-A intervention can be feasibly implemented, is acceptable to participants, and demonstrates potential for reducing symptoms in athletes. A larger, controlled trial is warranted.
... However, participants in the current study highlighted the possibility that only athletes who are intrinsically motivated to change their behaviors will benefit from, and complete, self-help programs. Indeed, being intrinsically motivated to start making and maintaining behavioral changes is fundamentally important in recovering from an eating problem (Prochaska et al., 1993;Sjogren, 2017). Self-help interventions may therefore not be suitable for athletes who are in denial of their eating problem or lack motivation to change. ...
Eating psychopathology is prevalent among athletes yet little is known about how to effectively support athletes with eating difficulties. This study aimed to understand athletes’ and sport professionals’ experiences of, and perspectives towards, supporting athletes with eating psychopathology. Forty-five participants took part in the study and data were collected using two methods: (a) individual interviews were held with athletes with current or previous eating psychopathology symptoms (n = 13); and (b) six focus groups were conducted: two with athletes with no history of eating psychopathology (n = 13), two with coaches (n = 7), and two with sport practitioners (n = 12). The data were analyzed using thematic analysis and two overarching themes were identified. Theme 1 (Tensions around addressing eating psychopathology in athletes) highlighted challenges with communication, conflicting perceptions around the responsibility of addressing and intervening with athlete eating concerns, and difficulties with obtaining relevant and timely support for athletes. Theme 2 (Considerations for developing practical tools to support athletes with eating psychopathology) highlighted a desire for future resources to consider confidentiality, to preserve athletes’ identities and facilitate independence where the athlete is in control of the degree and pace of engagement. In conclusion, tensions exist between athletes and sport professionals which make addressing eating psychopathology in athletes difficult. There is a need to develop accessible, confidential and tailored practical support resources which athletes can engage with independently to support them in the early stages of an eating problem.
... Semi-structured interviews were conducted to encourage participants to share their experience of IPV. The Transtheoretical Model of Behavior change (TTM) was used as a framework to develop the interview guide (Prochaska et al., 1993). The semi-structured interview consisted of five main questions designed to explore participants' understanding of IPV, how they responded and managed IPV, and the factors that influenced their response to IPV. ...
Intimate partner violence (IPV) silently pervades Bhutanese women's lives and is closely linked to the country's unique collectivist societal structure. There is a dearth of empirical research identifying and addressing barriers to help-seeking for women who experience IPV in Bhutan. This study sought to gain an in-depth understanding of the factors that influence and prevent Bhutanese women in IPV relationships from seeking help. Semi-structured interviews were conducted with 15 Bhutanese women experiencing IPV and accessing counseling at Respect, Educate, Nurture, and Empower Women (RENEW). RENEW is a nonprofit organization that provides support services to women affected by IPV. Qualitative data analysis revealed five themes that represent barriers to seeking help for IPV experienced by Bhutanese women. These themes are (1) Perceived stigma: I don't want to bring a bad name. .. what will they think of me?', (2) Children's well-being: I need to think of my child's school, food, clothes, (3) Limited understanding of IPV: He did not cause any physical harm. .. . there was no beating, (4) Limited knowledge of support sources: 'I was not sure whether they would entertain my issue or not, and (5) Lack of support: They didn't do anything to stop him. This study reveals novel insights about the importance of IPV knowledge among Bhutanese women and supportive responses from different sources such as informal and formal networks to facilitate women's help-seeking behaviors. It provides evidence for relevant stakeholders and service sectors to develop programs and policies appropriate and responsive to the needs of Bhutanese women experiencing IPV. 475 Barriers to Help-Seeking From IPV Among Bhutanese Women
... of relapses to lower stages there would always be a need for external support 21 . This external support is also often required to initiate the desired change process that is to realize a need for change, getting prepared for change, and setting way forward for taking required action. ...
Determinants of employee health and happiness: a wellness perceptive from Islamic and general point of view at public sector organizations in Islamic Republic of Pakistan
... No equilíbrio de decisões, o sujeito avalia os prós e os contras da mudança de comportamento. A autoeficácia, por sua vez, envolve a confiança que o indivíduo tem em si mesmo para superar situações de desafio em sua mudança comportamental e a habilidade de enfrentar as tentações contrárias a uma modificação saudável (Mostafavi et al., 2015;Prochaska et al., 1992). ...
The objective of the study was to identify, in adolescents with excess weight, the stage of behavior change related to the consumption of sugars-rich and high-fat foods, based on the transtheoretical model. This is a cross-sectional study with adolescents with overweight or obesity from Santa Cruz do Sul/RS/Brazil, registered at schools in an urban area. Nutritional status (by body mass index) and cardiovascular risk (by waist circumference) were assessed. An instrument was applied in order to quantify the number of daily portions of sugar-rich and high-fat food sources consumed, the stage of change by the transtheoretical model, as well as the barriers, benefits, and self-efficacy regarding changes in habits of eating those foods. A total of 246 adolescents, with a mean age of 12.9 ± 1.8 years, was evaluated. Sixty-one percent were female; 77.3%, pubertal; 53.3%, obese; 57.3% had cardiovascular risk. Eighty-seven percent of the sample consumed more than 3 servings/day; and 53.7% were in the preparation stage. The barrier score (16.9 ± 4.5) was lower than the scores of benefits (27.7 ± 5.2) and self-efficacy (31.1 ± 6.4). The mean benefit score was significantly higher in the group with cardiovascular risk (28.8 ± 4.5 vs 26.4 ± 5.7; p < 0.001). It was concluded that a majority of the adolescents consumed more than 3 servings of sugar-rich and high-fat foods per day; the predominant stage of change was preparation. The barrier score was lower, as compared to the scores of benefits and self-efficacy, and there were no significant differences between the groups overweight or obesity.
... However, the purpose of the research and suggested standards [8][9][10][11][12][13][14][15][16][17] were followed as guided by Maslow's "hierarchy of needs." e hierarchy of needs theory is a theory of the structure of human needs initiated by the American psychologist Maslow [20]. e content mainly involves four aspects (C1 to C4). ...
Due to the rapid development of social economy, general hospital buildings of China are undergoing changes in their models, technology, and medical systems. Changes in the model of hospitals may affect the functional structure, streamline layout, and spatial form of the hospital building. The biological-psychological-social (biopsychosocial) model covers the overall significant factors in healthcare. The model focuses on the hospital public environment. For the advocacy of patient-centered medical concepts, researchers have put forward newer and higher requirements as well. However, there is scarcity of research that targets the psychological impact of general hospital public space environment construction on the patients’ health. Moreover, there is no unanimously recognized standard questionnaire for the public space environment. The purpose of this article is to investigate the needs of inpatients for the space environment, to understand the influencing factors of various space environments, and to explore the law of patient needs. The research intends to provide a theoretical background for the construction of a patient-centered space environment. A dedicated questionnaire was designed to systematically collect the significant features and factors. Using cluster sampling, a total of four medical and surgical wards were investigated. The data obtained from 430 questionnaires were statistically analyzed by SPSS-10.0. Various statistical operations such as descriptive analysis, independent sample t test, one-way analysis of variance, and linear and logistic regressions were performed over the data. The psychological impact was studied from four aspects. The highest score (3-4 points) obtained for the larger number of patients (84.4%) testifies that the public space environment has a significant impact on patients’ mental health. Besides healthcare, outcomes of the paper may be used in various related domains such as psychological well beings, spatial analysis, social interaction, and public space designing.
1. Introduction
Evaluation of the impact of the hospital indoor public space is important for the well-being of inpatients. However, until recently, the designing of hospitals lacks such healthy considerations. From the 1950s to the present, the development of hospitals in China is roughly divided into three stages. The first stage was from the 1950s to the 1970s, when the country’s productivity was relatively backward and the people’s living standards were low. Even in this day and age of technology, proper healthcare facilities and the availability of hospital buildings are the challenges [1] to be overcome. Recently, a universal hospital building model is suggested to address this important need [2]. Due to the economic and technological requirements, public space is only to satisfy the people flow, whereas no consideration has been paid to take into account the psychological needs of users. The second stage is from the 1970s to the 1990s. In the said period, considerable advancement and reforms were made and productivity was improved. With the economic boost, the people’s living standards were improved. The scale and complexity of hospitals were greatly increased. Hospitals have been equipped with advanced and expensive tools. Emphasis was paid on the teaching function of hospitals, and the importance of logistics was also been recognized. As a result, the three-level functional structure of hospitals was replaced by the five-level functional structure leading to the design of a large-scale building complex [3]. The third stage of hospital development is ongoing since the 1990s. With the rapid development of urbanization in the country, the demand for the construction of modern hospitals also increased. There have been many new constructions and expansion projects going on. This brought new development opportunities to the hospital’s architectural design [4]. According to the healthcare study reports, medical activities need to be patient centered rather than disease centered. A patient needs to be treated as a person rather than a damaged machine. Self-esteem and care of patients play important roles in the entire diagnosis and treatment process. A whole medical process revolves around the conscious satisfaction of the patients. The goal of a hospital designer is to ensure whether the hospital space truly creates a healthy medical environment. A designer should consider proper spacing for the patient’s family members, visitors, and medical staff while designing models of a conducive hospital. Public space refers to the space for patients, family members, medical staff, and other users in the hospital while seeking medical treatment. It is also an important space for taking rest and stress relief. The quality of the space has an important impact on the overall image of the hospital, the psychological thoughts of patients, and emotions of medical staff. People are also becoming aware of the fact that good public space in hospitals plays an important role in promoting the recovery of patients and reducing their suffering. For hospitals, the first group of people to be concerned should be patients, followed by visiting attendants and medical staff. Among them, patients are divided into outpatients and inpatients. From the perspective of the age structure, children and the elderly are more physically and mentally capable. Weak and aged patients require special care, while women and disabled are the vulnerable groups and require special attention. In the era of the global market economy, hospitals have been transformed from the former social welfare and nonprofit unit into a profitable and welfare department. The well-functioned [5], comfortable, convenient, friendly, and coordinated public space environment will undoubtedly create a good impression by users. This will also improve the image of the entire hospital and greatly increase the hospital’s affinity and cohesion. The hospital has become the center of the community, appearing as a brand-new management agency for physical and mental health. Therefore, meeting the behavioral and psychological needs of users, paying attention to the communication between people, and the communication between people and the environment have become the inevitable requirements for the further development of general hospitals. This forces architects to reflect and explore how to create a modern and humanized public activity space that meets the fundamental needs of people. This is the purpose and significance of the author’s choice of this topic for research and discussion.
2. Related Work
In recent years, the promotion of “golden health card” and the establishment of a tertiary medical network have gradually replaced the single outpatient registration method by means of online appointment registration [6], electronic registration, and electronic accounting. With the “one card” registration, price adjustment and payment have become easier. By dint of the technology, the patient’s frequent visits and traveling has been reduced to a greater extent. The pressure during the peak period of medical visits in various public spaces has been relieved. Personnel has been rationally diverted, and the behavior patterns of patients in public spaces have gradually been optimized. The emergence of the remote medical network has shortened the time and space distance between the family and the hospital. For example, Harbin No. 1 Hospital delivers treatment plans through international computer networks to save patients’ lives. The ‘ECG phone monitor” developed by the 54th Hospital of Chengdu Military Region can enable patients from thousands of miles away to receive hospital diagnoses [7]. All these factors affect the form, content, and use area of public spaces such as registration, waiting for doctors, and waiting for medicine. At the same time, the above-mentioned technologies increase the proportion of nonfunctional spaces in public spaces.
The development of science and technology has greatly expanded the functions of hospitals. Like the content of medical services, medical buildings have become more complex. But at the same time, the overall structure of the hospital has become more hazy and difficult to understand. The elderly public spaces have become less adaptable to such changes. Under the pressure of huge institutions, it is difficult to effectively link public spaces with different functional departments like hospitals. With frequent rebuilt and expansion of hospitals to accommodate the development of medical technology, public spaces in most of the hospitals have been shrunk. Thus, hospitals have become more chaotic and irregular. Dizzy has become synonymous to public spaces in hospitals. In order to enable patients to have a concise medical process, walking distance for patients is reduced. At the same time, to make a possible relationship between outpatients, hospitalization, medical technology, and other important departments more compact and convenient, some standard hospitals have been erected. Spacious hospitals consist of streets, a shared atrium, and integrated halls for divisions. This improves the sense of spatial direction and the integrity of the entire hospital building space [8].
When, where, and how people's activities and behaviors change are the most basic information in architectural creation. Through the research on environmental psychology in the hospital building, we can truly understand the needs of patients and medical staff to summarize the basic characteristics of the user’s behavior. This will provide a base for scientific and rational architectural design. Environmental psychology research must be an important factor in architectural design, paving the way for more humane architectural design [9]. When one is familiar with the environmental psychology of space, people’s living space and the relationship between psychological distance and actual distance can be well considered. Similarly, the intersection of personal space and other people’s space, and the sense of openness and closure of space be better reflected. During architectural or environmental designing, one can organize space appropriately, arrange buildings or building groups carefully, adjust their area, height, and distance reasonably. A design processed in this way not only has the academic basis of environmental psychology but also broadens the design horizon. Thus, the designing process meets the perspective of environmental psychology and the people’s psychological requirements. While designating the layout of a hospital building, space should be as spacious and extended as possible. There ought to be smooth lines, a reasonable structure, distinct levels, and an elegant appearance. There should be a variety of design and construction methods such as glass grids, greening of the central hall, flower placement, and decorative embellishments to create a three-dimensional and beautiful environment. Space has to be considered in the designing so as to provide patients and medical staff with a pleasing and easy-to-see work environment for medical treatment. The buildings and facilities of the hospital should be patient centered in every aspect covering the pathological, physical, and psychological requirements of the patients. Moreover, the privacy and convenience of the patients should be considered. The research results of aesthetics and behavioral psychology are to be considered in the designing of the indoor environment to avoid a boring and/or cold indoor space environment. The color, decoration, materials, lighting, sound, audiovisual, and other aspects are to be carefully arranged to create a warm and pleasant atmosphere to relieve the nervousness of the patients [10]. If possible, the outdoor landscape and the indoor environment should be infiltrated and merged with each other as much as possible. In addition, the layout of furnishings, furniture, daily necessities, lamps, and potted plants need to be ensured. It should also be considered that how better the effects of light and shadow are obtained. The indoor atmosphere should be designed in accordance with the psychological laws of the visual environment. All in all, the design of hospital building space should be based on the research studies and opinions of patients and medical staff. Research works have been carried out in the literature to ensure comfortable spatial solutions in hospitals and healthcare buildings. For instance, Lacanna et al. [11] proposed the indoor public space measurement (IPSM) method to facilitate designers and researchers in evaluating patient-centered spatial solutions. The work of Singha [12] mentioned the risks of hospital buildings being constructed without keeping in view the demands and facilitation of users. Similarly, Berdejo‐Espinola et al. [13] necessitate the need for public spaces and green spaces for health and healing.
It is convenient for the needs of different people to form a humanized design concept and to create a comfortable, cordial, and detailed working space for medical treatment [14–18]. Therefore, it is the demand of the day to meet the behavioral and psychological needs of users to pay attention to the communication between people and the environment. Keeping in view the facts, architects should strive to create a modern and humanized public activity space while designing general hospitals[19]. The focus should be to meet the fundamental needs of people.
3. Method
This research work intends to analyze and assess the psychological impact of public space in healthcare buildings. The data mining techniques are utilized after systematic data elicitation. Through orderly investigation, data were gathered about the current situation and development trend of public space, the function, space, behavior patterns, and psychological needs of users. Details of the research work are presented in the following sections.
3.1. Sampling Method
Cluster sampling was used to sample four internal medicine and surgical wards in a tertiary A hospital. The patients chosen for questioning were suffering from common and frequently-occurring diseases. Because patients in obstetrics, gynecology, pediatrics, emergency, burns, and other departments have their particularities, only relevant questions were asked. Inappropriate facts and findings are not included in this study. The designed questionnaire consists of 3 parts, namely, the basic information of the patient, and the content of the patient’s needs and satisfaction. Basic information includes department, age, gender, marital status, ethnicity, occupation, degree of socialization, degree of self-care, agree to participate in medical insurance, family income per capita, number of days in the hospital, days after surgery, number of hospitalizations, whether or not they have lived in other hospitals, and questions about the availability of 14 items in the hospitals. There are a total of 32 requirements. To systematically analyze the impact of the hospital’s public space environment on the patient’s psychology, the Likert 4-level scoring method is used. For a question, “No” is treated as a 1-point score. In the available literature, there is no standard questionnaire. Therefore, a dedicated questionnaire was devised for this purpose. However, the purpose of the research and suggested standards [8–17] were followed as guided by Maslow’s “hierarchy of needs.” The hierarchy of needs theory is a theory of the structure of human needs initiated by the American psychologist Maslow [20]. The content mainly involves four aspects (C1 to C4). C1: adequate rest facilities (such as pavilions, balconies, vending machines, and seats) are set up in places where all patients may stay (such as waiting rooms, atriums, corridors, and telephone booths). Thus, the C1 aspect improves patients a sense of belonging. C2: the ward is quiet and clean with fresh air, which is more conducive to treatment. C3: a good environment in the public space of the hospital, which can avoid people around when waiting for treatment, medicine, or rest, and entertainment in the public space (including patients and medical staff) causing interference to patients. C4: an artistic atmosphere is introduced (such as placing sculptures, paintings, rich spatial colors, and medical treatment accompanied by light music). This aspect can make patients feel happier.
3.2. Survey Object and Method
The eligibility criteria of the survey consisted of patients sober minded, patients over 18 years old, and patients willing to cooperate in the study. Other criteria considered were the willingness of the participants to fill in the questionnaire on their own allow participants to fill the questionnaire in case of illiterate individuals. Considering that the patient was not yet familiar with the environment and staff when they were first admitted to the hospital, patients who were hospitalized for more than 3 days were selected for the investigation. The exclusion criteria of the survey ignore patients who were unconscious, mentally abnormal, or who refused to investigate. Using the on-site surveys, investigators intensively distributed the questionnaires in two weeks. The patients, who were unable to answer the question on the spot, were allowed to fill in at their own ease. The questionnaires were then collected after proper filling. Each questionnaire took 10 to 30 minutes. The illiterate individuals’ questionnaire can be filled out by the nurse one by one and/or according to their consent. The entire practice was about the subjective feelings of the respondents, and the investigators were not involved in any guiding efforts other than in the case of illiterates. A total of 460 questionnaires were issued, and 452 were retrieved. 8 cases did not complete the survey. The recovery rate was 98.3%. Out of the 452 cases, 22 cases did not meet the requirements, accounting for 4.8%. The excluded cases were being under 18 years of age (4 cases). Moreover, there were missing items in 6 cases. Finally, 430 white-effect questionnaires were identified and considered for onward processing.
3.3. Evaluation Scale Performance and Data Processing
The performance of the scale was evaluated from the 430 questionnaires collected. The reliability coefficient was Cronbach’sα coefficient, and the correlation analysis (Pearson coefficient) was used to evaluate the validity of the content on the basis of the analysis and evaluation validity standards [21]. The total Cronbach’sα coefficient of the four items is 0.9602, which is larger than 0.9036 in the preliminary survey. The figure indicates that the scale has high internal consistency. The Cronbach’sα coefficient in each factor is greater than 0.7 (see Table 1).
Factor
C1
C2
C3
C4
Cronbach’sαcoefficient
0.9050
0.8947
0.9256
0.8974
... These factors are not explained accurately in TTM. [3][4] Rather, the people who deliver the intervention have to have the competencies and the background to understand and synthesize unique interventions for each person. 35 The same rationale and critique concern Lawrence et al., 14 study. ...
Introduction: Smoking has been a deadly and disease-linked hazardous habit worldwide, resulting in overall decrease in quality of life.
Global numbers are growing and aims on reduction are not met. The application of ‘Trans-Theoretical’ (TTM) and ‘Theory of Planned
Behavior’ (TPB) models on smoking may provide assistance on reduction and maintenance.
Aim: Therefore, a systematic review of the current literature took place in order to evaluate and compare the efficacy of TTM and TPB
against smoking. The outcome may assist field practitioners in their designs and practice.
Methods: An electronic research was conducted in 5 electronic databases. 3,871 initial titles were located and retrieved. The titles retrieved were then accessed using inclusion/exclusion criteria and then were evaluated using 10 main criteria to answer and meet the
research aims.
Results: Research for titles resulted in the inclusion of 10 studies, of which 5 used TTM and 5 TPB as a behavior change model on
smoking cessation. The quality and efficacy of papers was almost identical, while only one out of the overall 10 studies was efficient on
smoking cessation.
Conclusion: The review may provide some strong implications on low efficacy for both TTM and TPB, while there might be a need for
new change-of-behavior models against smoking.Practitioners who design individual interventions against smoking may have to seek
for alternative to TTM and TPB models of behavior change
... Heightened motivation to change attitudes and behaviours is a factor in predicting programme completion [65], which in turn reduces likelihood of reoffending [65,100]. This can allow for higher levels of supervision and compliance [65], lifestyle and outlook changes [118], programme and treatment adherence [135,212,[218][219][220], and establishing a positive therapeutic alliance between the participant and diversion team [221,222]. Motivational and behaviour change elements such as motivational interviewing and cognitive behavioural or social learning strategies can be embedded [102, 155, 210-212, 218, 219]. ...
Purpose
Women in prisons are known to suffer with more mental health difficulties and many experience challenges prior to incarceration. Diversion programmes are initiatives designed to divert people with pre-existing mental illness from the criminal justice system into mental health services. The variability of effectiveness of interventions makes realist approaches particularly appropriate for diversion programmes, and this paper presents the first realist review to be undertaken across the breadth of this topic. This realist review aimed to explain the successes, failures and partial successes of these programmes as an intervention to improve the outcomes of women offenders with mental health issues.
Methods
We conducted a realist review of published literature explaining the impact of diversion programmes on participants with mental health issues. Consultations with six specialists in the field were conducted to validate the principles and hypotheses about key dynamics for effective programmes.
Results
The review included 69 articles. We identified four essential principles, developed through thematic groupings of context-mechanism-outcome configurations, to articulate key drivers of the effectiveness of diversion programmes: coordination between services; development and maintenance of relationships; addressing major risk factors; and stabilisation through diversion programmes.
Conclusions
The behaviour of women offenders is driven by need, and the complex needs of this group require individualised plans that incorporate relationships as vehicles for support and change. Although there is a role for gender-specific interventions, it is not fully understood and further research is required. Implications for future interventions are discussed.
... The LRP consisted of three main components. Firstly, it was based on the Stages of Change Model that conceptualizes the process of how people change (Prochaska et al., 1993). Along their journey in the LRP, participants received stage-specific interventions and gradually progressed through four distinct stages, namely (pre-)contemplation, preparation, action, and maintenance. ...
Background
Effective lifestyle intervention is essential to promote transition from an addictive life to a drug-free lifestyle. This study retrospectively evaluated the Lifestyle Redesign Program (LRP), a lifestyle intervention featured with motivational enhancement, in promoting drug-free and engaging lifestyle in young drug users in Hong Kong.
Methods
Retrospective observational design with single-group pre-and-post intervention comparison was adopted. Participants were recruited from two residential detoxification centers. Demographics, abstinence information, engagement status, and outcome measures including self-efficacy on drug avoidance, perceived general health and quality of life were collected. Data were analyzed with descriptive statistics, paired t-test and Spearman’s rank-order correlation.
Results
A total of 86 participants were recruited. Seventy-two of them (83.7%) maintained abstinence for at least 2 months and 64 of them (74.4%) had meaningful engagement in terms of competitive employment or study after completing the LRP. Statistically significant improvements were found in self-efficacy on drug avoidance (t = 8.3, p < .01, d = 0.90), perceived general health (t = 7.4, p < .01, d = 0.79), and overall quality of life (t = 5.4 to 8.3, p < .01, d = 0.59 to 0.89).
Conclusions
The findings provide preliminary evidence that LRP is associated with promoting abstinence and achieving healthy lifestyle for young drug users. More controlled studies are recommended to rigorously examine its effectiveness.
... They emphasize that adapting a person's diet or changing to more physical activity is more than a matter of being ''just willing''; it involves ''stages of change,'' including a shift from ''not recognizing there is a problem'' to ''active problem solving by looking for the 'best fit' solution.'' 8 These stages of change are connected with personal characteristics of the individual. At the personal level, it might be that dealing with obesity is more difficult for some than for others. ...
... This is a conceptual framework that lays out factors which affect health behaviors such as self-monitoring of blood glucose. The framework draws elements from the Reasoned Action Approach [76,77], the Health Belief Model [78,79] Goal-setting theory [80] and the Transtheoretical Model (Stages of Change) [81,82]. An individual's intention to initiate a behavior is influenced by his attitudes, social norms, and self-efficacy. ...
Background
Insulin-dependent diabetes is a challenging disease to manage and involves complex behaviors, such as self-monitoring of blood glucose. This can be especially challenging in the face of socioeconomic barriers and in the wake of the COVID-19 pandemic. Digital health self-monitoring interventions and community health worker support are promising and complementary best practices for improving diabetes-related health behaviors and outcomes. Yet, these strategies have not been tested in combination. This protocol paper describes the rationale and design of a trial that measures the combined effect of digital health and community health worker support on glucose self-monitoring and glycosylated hemoglobin.
Methods
The study population was uninsured or publicly insured; lived in high-poverty, urban neighborhoods; and had poorly controlled diabetes mellitus with insulin dependence. The study consisted of three arms: usual diabetes care; digital health self-monitoring; or combined digital health and community health worker support. The primary outcome was adherence to blood glucose self-monitoring. The exploratory outcome was change in glycosylated hemoglobin.
Conclusion
The design of this trial was grounded in social justice and community engagement. The study protocols were designed in collaboration with frontline community health workers, the study aim was explicit about furthering knowledge useful for advancing health equity, and the population was focused on low-income people. This trial will advance knowledge of whether combining digital health and community health worker interventions can improve glucose self-monitoring and diabetes-related outcomes in a high-risk population.
... 3 Prochaska and DiClemente reported that patients in an advanced stage of change are mostly rejecting by hearing about cannabis legalization and will certainly not differentiate between THC and cannabidiol. 4 These cannabis-dependent patients would revise their motivation to stop the use of the substance and definitely regress in their cycle of change stages. ...
... In the past, behaviour change has been explained by the goal-setting theory (Edwin 1968), which argues that setting a clear goal rather than an ambiguous one and a difficult goal rather than an easy one, will bring higher motivation and better results. The transtheoretical model of behaviour change (see Prochaska et al. 1992) also discusses that it is necessary to make an appropriate approach for each of the five stages (that is, precontemplation, contemplation, preparation for action, action, and maintenance) to promote behaviour change. ...
This paper analyzes the attributes that would cause behaviour change based on responses to questions about behaviour change, examines how satisfaction with their life is associated with the respondents’ behaviour change, and determines whether there would be any difference in their levels of satisfaction between those who can change their behaviour and those who cannot. Behaviour change has been studied in diverse fields and has gradually been attracting attention. However, we have yet to see much research that discusses the dependent attributes of people’s behaviour change or to what extent behaviour change influences people’s sense of satisfaction in life. In this research, we conducted a factor analysis of responses to surveys to identify behaviour change and examined the dependency of the obtained factors on age, sex, positive thinking, and the degree of self-determination. We also analyzed how behaviour change is associated with life and workplace satisfaction. Our findings revealed that sex, positive thinking, and the degree of self-determination affected all three behaviour change factors. Positive thinking had a positive effect on all three factors, while male dummy had a negative impact on all three factors. The self-determination index positively affected persistence in learning and malleability, but it had a negative impact on receptivity. Age affected only malleability, while male dummy had a positive impact. We have also examined how a person’s ability to change their behaviour affected their satisfaction level in their life and workplace. Our findings showed that malleability, among the behaviour change abilities, played an important role in enhancing the satisfaction level in a person’s life, and demonstrated a statistically significant positive effect on health, stress, income, and relationship with their partner. With regard to the satisfaction level in the workplace, the behaviour change abilities (persistence in learning, malleability, receptivity) had common effects on satisfaction with work environment, job discretion, peers at work, perception of doing a good job, their immediate supervisor, and job security; persistence in learning and malleability had a positive effect, whereas receptivity had a negative impact. On all these items, the strongest impact was made by persistence in learning, and a relatively weak effect was made by receptivity.
... In addition, even at the end of training, there continued to be variability in trainees' readiness for change. Prochaska et al. (1992) described five Stages of Change that are useful in this regard: (a) precontemplation, (b) contemplation, (c) preparation, (d) action, and (e) maintenance. At the time of the post-training interviews, all of the trainees appeared to be in the latter four of these stages. ...
This study evaluated the fidelity and effectiveness of a parent coach training program for toddlers at risk for autism spectrum disorder and identified factors required for successful training implementation under real-world conditions. Training addressed four tiers of clinical competence and was delivered to early intervention providers across 23 partner agencies in a large Canadian province. Results indicated that mean trainee fidelity scores were within the range reported in previous community-based training studies but there was considerable variability across trainees. Implementation facilitators included agency learning climate, leadership support, and trainee readiness for change. Implementation barriers included time/caseload demands and challenges related to technology learning and infrastructure. Results have implications for parent coach training in community settings.
... The TTM also suggests covert and overt activities people can use to progress through stages (Prochaska et al., 2015), named as the ten Processes of Change. Empirical evidence has shown a systematic relationship between the five stages and the ten processes of change, suggesting that individuals in the early stages rely on more cognitive, affective and evaluative processes to move through stages, while individuals in later stages rely on commitments, conditioning, contingencies, environmental controls, and social support (Prochaska et al., 1992). For instance, for a person in the precontemplation stage, the process of consciousness-raising will increase awareness of the causes, consequences, and cures for problematic behavior. ...
Despite a wealth of behavior change theories and techniques available, designers often struggle to apply theory in the design of behavior change technologies. We present the Behavior Change Design (BCD) cards, a design support tool that makes behavioral science theory accessible to interaction designers during design meetings. Grounded on two theoretical frameworks of behavior change, the BCD cards attempt to map 34 behavior change techniques to five stages of behavior change, thus assisting designers in selecting appropriate techniques for given behavioral objectives. We present the design of the BCD cards along with the results of two formative and one summative study that aimed at informing the design of the cards and assessing their impact on the design process.
... Smokers in the pre-contemplation stage are often described as resistant or unmotivated and tend to avoid information, discussion, or idea about the targeted health behavior. 18 Smokers in the contemplation stage are also often seen as ambivalent about changing or as procrastinators. 19 Therefore, the greater the awareness of the health risks of smoking, the more active the attitude is towards quitting smoking. ...
Background
Smoking cessation reduces the risk of severe illnesses in the long run and contributes to improving health. This study evaluated the short-term and long-term effectiveness of workplace smoking cessation intervention implemented using the transtheoretical model.
Methods
Participants were assessed at baseline before the intervention and after 6 months and 4 years of follow-ups. Data on changes in participants’ perception of smoking prohibition in the workplace, knowledge of the hazards of smoking, attitude towards quitting smoking, and behavior related to tobacco harm prevention were collected.
Results
Results showed the prevalence of smoking cessation was 31.5% (95% CI: 25.4-38.1%) after 6 months and 10.7% (95% CI: 6.9-15.6%) after 4 years. At the abovementioned time points, the prevalence of second-hand smoke exposure, and the proportion of people who demonstrated correct knowledge of smoke hazards initially decreased and then increased. The proportion of participants who had seen or received information about tobacco harm prevention provided in the workplace increased from 75.6% at baseline to 95.6% (increased by 20.0%) after 6 months and finally to 97.2% (increased by 21.6%) after 4 years ( P < .001). However, the percentage of participants who hoped their workplace continued to provide smoking cessation services rose from 80.0% at baseline to 93.6% (increased by 13.6%) after 6 months and then fell to 78.0% (decreased by 2.0%) after 4 years ( P < .001).
Conclusion
The short-term effectiveness of the transtheoretical model in promoting workplace smoking cessation is substantial, but in the long-term, effectiveness weakens.
... Model of change. The Transtheoretical Model (TTM) construes behavior change as an intentional process that unfolds over time and involves progress through a series of six stages of change (Prochaska, DiClemente, & Norcross, 1992a). This model was used mostly in subjects that were related to health, including exercise adoption (Lee, 1993), condom use (Bowen and Trotter, 1995), blood donation (Chandler and Ferguson, 1996) and HIV prevention . ...
The effectiveness of interpersonal communication between Doctors and Patients relating to Obesity issues in Malaysia
... This suggests that this avenue could be particularly useful for individuals who are more reticent in general or experience heightened guilt and/or shame in relation to their thoughts or behaviour. It could further be useful for individuals who are at contemplative stages of change (according to the Transtheoretical Model of Change; Prochaska et al., 1993), who acknowledge their problem behaviour and the possibility of change, but might not yet be committed to acting. The live chat service might therefore be critical in the early stages of service user engagement and development of motivation to achieve change. ...
The report can be downloaded from:
https://www.lucyfaithfull.org.uk/faithfull-papers-research.htm
... In contrast to the models focusing on community or organizational level, the Theory of Planned Behavior Model [1], Trans-theoretical Model of Behavior Change (Prochaska 1992), Health Belief Model (Strecher 1997), and IMB (Information Motivation and Behavior Skill) Model (Chandra 2010) are built upon theories of behavioral change on an individual level. These models have been applied to a specific intervention of chronic diseases, and have shown clinical efficacy. ...
The objective of this research is to investigate the feasibility of applying behavioral predictive analytics to optimize patient engagement in diabetes self-management, and to gain insights on the potential of infusing a chatbot with NLP technology for discovering health-related social needs. In the U.S., less than 25% of patients actively engage in self-health management, even though self-health management has been reported to associate with improved health outcomes and reduced healthcare costs. The proposed behavioral predictive analytics relies on manifold clustering to identify subpopulations segmented by behavior readiness characteristics that exhibit non-linear properties. For each subpopulation, an individualized auto-regression model and a population-based model were developed to support self-management personalization in three areas: glucose self-monitoring, diet management, and exercise. The goal is to predict personalized activities that are most likely to achieve optimal engagement. In addition to actionable self-health management, this research also investigates the feasibility of detecting health-related social needs through unstructured conversational dialog. This paper reports the result of manifold clusters based on 148 subjects with type 2 diabetes and shows the preliminary result of personalization for 22 subjects under different scenarios, and the preliminary results on applying Latent Dirichlet Allocation to the conversational dialog of ten subjects for discovering social needs in five areas: food security, health (insurance coverage), transportation, employment, and housing.
... Prior Institutional Review Board approval was obtained. The 5-min survey [17] was administered by trained interviewers and included 21 items assessing sociodemographic characteristics, oral cancer knowledge, past (history) and current risk behaviors, and readiness to quit smoking [18] . Alcohol abuse history was assessed with the CAGE (Cutting down, Annoyance by criticism, Guilty feeling, and Eye-openers) questionnaire [19] . ...
Background: Screening people who are at high risk of developing oral cancers is a promising tool for decreasing morbidity and mortality attributable to this cancer. Methods: A consortium led by the New York University College of Dentistry conducted a three-day oral cancer screening during June 1999. As part of the screening intake, the authors conducted a survey to assess the sociodemographic characteristics, level of knowledge of risk factors and predictors of oral cancer awareness among the subjects. The authors performed bivariate and multivariate analyses using two indicators of oral cancer awareness as dependent variables. Results: The 803 subjects were racially and ethnically diverse, 66 percent were 40 years of age or older, 43 percent had a history of smoking, and 9 percent were likely to have had a history of alcohol abuse. Race/ethnicity, education level and knowledge of risk factors for oral cancer were predictors of awareness of an oral cancer examination, whereas only knowledge and possible history of alcohol abuse were predictors of having a history of examinations. Conclusions: This screening program attracted a diverse sample of people at high risk of developing oral cancer due to smoking and likely history of alcohol abuse. Consistent with other national and international studies, the authors found a lack of knowledge of the risk factors associated with oral cancer and a low rate of histories of oral cancer examinations among the subjects.
... The Trans-Theoretical Model (Prochaska and DiClemente, 1983;Prochaska, DiClemente, and Norcross, 1992;Prochaska and Velicer, 1997) Preparation: When action is likely to be taken within a month. By this stage, individuals have a 'plan of action' and may have some form of selfmotivation. ...
Taking the first steps towards learning to cope with both the threat and the actuality of disasters is a great challenge. Resilience and adaptation to climate change indicate processes of flexibility and adjustment. The range of adaptations open to individuals and by extension collectives will be limited in many ways. One important limiting dynamic is associated with capacity to learn, and the depth or superficiality of any learning. This includes the relative capacity individuals hold to deal with the challenges to normality that disasters bring.
Central to the argument of experience of learning as influencing learning outcomes is the degree to which learning opens space for reflection. Having the time, space and opportunity for reflection is more likely to allow the learner to undergo deeper shifts in values and associated behaviour - so called transformational learning and that this opens important space for learning to live with disaster risk and loss. This provides a framework with which to identify and assess TL and its drivers, rather than explain how it might be carried out. Study populations were identified to represent a specific social context for learning:
1. The Community Emergency Response Team (CERT). This group provides formal training courses for local actors at risk to become community emergency response teams.
2. Listos. A less formal learning programme aimed at Spanish speakers in Santa Barbara, centred on personal and family preparedness.
3. UK based humanitarian NGO practitioners whose responsibility lies with enacting policy change within their organisations through monitoring and evaluation and learning roles.
This thesis explores these different learning contexts, testing the hypothesis that learning outcomes expressed through value and behavioural change are linked to the experience of learning - who learning is shared with, what is being learned and how this is reinforced.
... Instead, motivation can be facilitated by an empathic listening style, talks about change and resolution of ambivalence about change (Rollnick and Allison 2004). Three key concepts in motivational interviewing are readiness for change, which can be linked to the transtheoretical or stages of change model (Prochaska et al. 1992); ambivalence regarding the losses associated with change, even when change is desired; and resistance, which is the reluctance to change in response to the worker's pressure or cajoling. ...
... To meet each purpose in respective stage indicates successive progress of counselling. Therefore stages of change concept under TM have been widely implemented in clinical studies for health-related behaviours (Prochaska and DiClemente, 1992;Lechner and De Vries, 1995;Laforge et al., 1999). For instance, Calfas et al. (1996) reported stage-matched Physician-based Assessment and Counselling for Exercise (PACE) as significant for the United States population. ...
Internet addiction (IA) is recognised as a cause of public health concern worldwide (Aboujaoude et all; 2006). In addition Transtheoretical model (TM) for Readiness to change in behaviour proposed by Prochaska and Di. Clemente (1992), has been extensively used in the field of counselling to modify addictive behaviour. In this context, the present study was carried out to design the awareness and sensitisation programme (ASP) based on TM and extended by analysing the significance of this programme on IA and its allied competence and health risk (Youth-Self Report), for internet addict adolescents (N=180).ASP was designed under four successive stages namely Orientation, Pre-contemplation, Contemplation and Preparation. Each stage comprised of stage-matched-activities to meet its specific purpose. The measurement outcomes were; Young"s Internet Addiction Test developed by Young (1998) and Youth Self-Report TM(Narrow Band Syndrome Scale) developed by Achenbach T.M. and Rescorla L.A. in 2001. Pretest-Post test with control group design was adopted for this study. The obtained data was statistically analysed under descriptive and analysis of covariance (ANCOVA) analysis with the help of Statistical Package for Social Sciences (SPSS-version 22), and a p value of less than 0.05 and 0.01 was determined to be statistically significant. In result, descriptive analysis for pre-test measure of both experimental and control groups revealed the prevalence of IA and its P a g e | 2146 competence and health risk are in clinical borderline range (CBR). In result the efficacy of ASP is found to be significant over IA and its consequential competence and health risk in terms of emotional and behavioural problems distinguished under internalizing (Anxiety & Depression sub-scale) and externalizing (Rule breaking behaviour and aggressiveness sub-scale) scales, however except Thought problems sub-scale, this program is found to be less competent for problems those are comprised under NINE (Social and Attention Problems sub-scale) scale of health risk.
... Evaluation of underpinning theories: social cognitive theory, transtheoretical model and theory of reasoned action The rapid review identified three theories that have been used most frequently in the reviewed interventions, namely, SCT (Bandura, 1986), transtheoretical model (TTM) of change (Prochaska et al., 1992) and theory of reasoned action (TRA) (Fishbein, 1967). For all theories reported in the reviewed interventions, see Table 4. Therefore, these three theories were selected for further analysis against the factors that have been shown to be significantly associated with well-being behaviors. ...
Purpose
In social marketing practice, there is no all-encompassing approach that guides researchers and practitioners to build theory-driven social marketing interventions. While the Co-create–Build–Engage (CBE) process offers a roadmap for marketing application, including outlining when and where social marketing’s eight benchmark principles have been applied, limited practical guidance on how and when theory should be applied is offered. This paper reports one case study demonstrating how theory was applied to deliver a theory-informed well-being behavior change intervention.
Design/methodology/approach
This paper proposes and applies a new five-step theory-driven social marketing intervention build process (BUILD) drawn from an extensive base of social marketing research and application. Using a case study method, we showcase how the five-step process was applied to inform the design, build and implementation of a well-being behavior change intervention.
Findings
This study proposes a five-step process to build theory-driven social marketing interventions called BUILD: Begin with the objective, Use theory, Initiate program design, Let’s produce and Develop the engagement plan. This study provides a step-by-step and easy-to-follow BUILD process which outlines how social marketers can apply a selected theory to inform program design and implementation.
Practical implications
The BUILD process offers a roadmap to build theory-driven social marketing interventions that include all elements of intervention development, namely, objective-setting, theory evaluation, selection and application, producing the program and planning for program engagement.
Originality/value
This study provides a novel five-step process to help social marketing researchers and practitioners build theory-driven social marketing interventions.
... • Estágio de prontidão para mudança: resultados da escala que mede os diferentes estágios motivacionais para a mudança de comportamentos e hábitos, envolvendo a Pré-contemplação; a Contemplação; o Planejamento ou preparação; a Ação; e a Manutenção. 52 • Estado de humor: humor autorreferido da pessoa participante, que pode ser identificado por meio do preenchimento de escalas, questionários ou entrevistas. ...
... The primary conceptualization of motivation in the context of treatment for AUD has been the stages of change, a component of the Transtheoretical Model (Prochaska, 1984). According to this model, reducing or quitting drinking is a process that occurs as a progression through qualitatively distinct stages representing increasing readiness to change behavior (Prochaska et al., 1992). Evidence for the proposal that the effects of AUD treatment are due, in part, to progression through the stages of change or increased readiness has received limited support (Field et al., 2020;Reid & Carey, 2015;Stein et al., 2009). ...
Background:
Progression through the stages of change is proposed to be a mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure is invariant across patient subgroups, treatment conditions, and time. In the present study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach.
Methods:
We conducted a secondary data analysis of Project MATCH (N=1726; Mage =40.2, SD=10.9; 75.7% male; 80.0% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and posttreatment (3 months after baseline).
Results:
A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit.
Conclusions:
The measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to appropriately test the proposal that progression through the stages explains treatment effects.
... Each item is scored on a four-point (0, 1, 2, 3) ordinal scale; dynamic items receiving a 2 or 3-point rating represent criminogenic needs to be addressed through risk management interventions, while items with 0 and 1 ratings represent low risk areas. Change is evaluated through a modified application of the stages of change model (Prochaska et al., 1992), which outlines a series of cognitive, behavioral, and experiential processes as individuals attempt to remediate areas of concern that influence their violent offending. ...
The present study features the development of new risk categories and recidivism estimates for the Violence Risk Scale (VRS), a violence risk assessment and treatment planning tool. We employed a combined North American multisite sample (k = 6, N = 1,338) of adult mostly male offenders, many with violent criminal histories, from correctional or forensic mental health settings that had complete VRS scores from archival or field ratings and outcome data from police records (N = 1,100). There were two key objectives: (a) to identify the rates of violent recidivism associated with VRS scores and (b) to generate updated evidence-based VRS violence risk categories with external validation. To achieve the first objective, logistic regression was applied using VRS pretreatment and change scores on treated samples with a minimum 5-year follow-up (k = 5, N = 472) to model 2-, 3-, and 5-year violent and general recidivism estimates, with the resulting logistic regression algorithms retained to generate a VRS recidivism rates calculator. To achieve the second objective, the Council of State Governments' guidelines were applied to generate five risk levels using the common language framework using percentiles, risk ratios (from Cox regression), and absolute violent and general recidivism estimates (from logistic regression). Construct validity of the five risk levels was examined through group comparisons on measures of risk, need, protection, and psychopathy obtained from the constituent samples. VRS applications to enhance risk communication, treatment planning, and violence prevention in light of the updated recidivism estimates and risk categories are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... To truly rely on intrinsic motivation, the individual needs to be ready to embrace behavior change from the inside out. Readiness for change can be contextualized in the Transtheoretical Model of the process of intentional behavior change (Prochaska et al., 1992). The model assumes that people move through a series of five nonlinear stages of change when modifying behavior: (1) precontemplation -do not see the need to modify behavior; ...
Objectives
This paper describes and integrates self-determination and mindfulness research in intellectual and developmental disability, with a focus on how both approaches shift the focus to intervening from the “inside out” rather than from the “outside in.”
Methods
A targeted overview of self-determination and mindfulness research in intellectual and developmental disabilities is provided. Parallels and areas of divergence are described, with implications derived for the integration of the two approaches to promote positive outcomes for people with intellectual and developmental disabilities.
Results
There is a synergistic relationship between self-determination and mindfulness-based interventions. Promoting internal resources, self-awareness, and emotion regulation through mindfulness may provide the foundation on which to build specific self-determination skills.
Conclusions
There is a need for ongoing work to develop and test, in partnership with disabled people, the impacts and outcomes of integrated approaches to promoting mindfulness and self-determination. This will require changes across multiple levels, and issues related to diversity and equity must be at the forefront.
This paper presents a literature review on models applied to Design for Sustainable Behaviour, aiming to identify similarities and gaps in this area of knowledge. Each model has its own structure to promote behavioural change. Models used in the scope of Product Design and Service Design will be presented. Some models have stages, as in the case of the Mindful Design model (Niedderer, 2014), Behavioural Intervention model (Bhamra et al., 2011), Design for Healthy Behaviour (Ludden and Hekkert, 2014), the NADI model (Bijl-Brouwer, 2017), Service Design model for Self-Care (Aly et al., 2017), the Cleaner Cooking Intervention model (Jürisoo et al., 2018) and the Channel Design model (Wünderlich et al., 2019). There are also models that do not have specific stages, but they point out elements to generate insights for behavioural change, as in the case of Fogg's Behaviour model (Fogg, 2009), the Design with Intent (Lockton et al., 2010), Design for Socially Responsible Behaviour (Trompt et al., 2011) and Design the Built Environment for Mental Health Services (Liddicoat et al., 2020). Despite this difference in structure, there are also similarities. For example, in the Behavioural Intervention model, the stage of behavioural elements analysis, there is a connection with the NADI model, which proposes the analysis of needs and aspirations; with the Channel Design model, that analysis internal and external aspects of the user; with the Design the Built Environment of Mental Health Services that presents principles and questions to generate insights at the individual, contextual and relational level; with the Mindful Design model that analysis the interactions and the individual's intention; with Fogg's Behaviour model and Cleaner Cooking Intervention model, where both emphasize the individual's motivations and skills. At the intervention level stage, elements of the Design for Healthy Behaviour to guide, maintain and ensure change are evident. And, in the intervention stage, it can be associated with the Design for Socially Responsible Behaviour that mentions restriction, coercion, seduction and persuasion, as well as Design with Intent with the strategies to activate, motivate or restrict a behaviour. However, each model has its own structure and details about the elements that are possibly not considered in another model. These details can connect and contribute to improve the behavioural change process for sustainability. There are studies that connect specific parts of models and build a unique structure (Cash et al., 2017; De Medeiros et al., 2018; Irizar-Arrieta et al., 2019), however, with predominance in models focused on the development of physical artefacts. Thus, there is a gap to connect models focused on physical artefacts with models focused on services. Another gap is there are few empirical researches on the application of these models. In this sense, bringing this mapping and 894 27nd International Sustainable Development Research Society Conference, Mid Sweden University, 13-15 July 2021 the specific characteristics of each model to improve the application, can effectively contribute to sustainable development in order to accelerate progress towards the SDGs in times of crisis. The study contributes to SDG 12, target 12.9.
El trabajo de la Red promep sobre conducta humana compleja ha reconocido
las posibilidades de estudio del comportamiento sustitutivo relacionado con
criterios extradisciplinares. El presente capítulo presenta un esfuerzo para hacer
explícito cómo el comportamiento sustitutivo se identifica, en forma de
competencias, en la evaluación e intervención del consumo adictivo de alcohol
en adolescentes. Aunque se acota a esta problemática, puede sugerir vías
análogas de interpretación en otras.
Health psychology as a discipline has existed for more than four decades and is primarily concerned with research, theory, and practice at the nexus of psychology and health. The discipline is well established across Europe, the United States, and Australia with health psychology societies, postgraduate programmes, conferences, and academic journals dedicated to the discipline in the majority of these countries. However, in South Africa, health psychology remains a broad umbrella term under which psychologists and other health care professionals conduct research. Health psychology is concerned with the biological, social, psychological, contextual, and structural drivers of health and illness, and relies on theory and empirically-driven research to identify and understand important links between health and behaviour. In South Africa, where a large proportion of the population faces multiple co-occurring disease epidemics, such as HIV/AIDS, TB, COVID-19, diabetes, and heart disease, there is a need for a uniting sub-discipline like health psychology to focus intervention efforts and to meet the sustainable development goals. The recent re-establishment of a special interest group in health psychology in the Psychological Society of South Africa (PsySSA) is an important first step. In this article, and as members of the newly re-established special interest group in health psychology, we call attention to the need to promote health psychology in South Africa. In this article, we describe the paradigmatic traditions and theoretical models that inform the discipline. We then argue why health psychology should be prioritised again and recommend future directions for health psychology in South Africa.
In the U.S., black men are at highest risk for requiring kidney transplants but are among those least likely to register for organ donation. Prior outreach used videos culturally targeted for Black communities, yet registration rates remain insufficient to meet demand. Therefore, we assessed whether generic versus videos culturally targeted or personally tailored based on prior organ donation beliefs differentially increase organ donor registration. In a randomized controlled trial, 1,353 participants in Black-owned barbershops viewed generic, targeted, or tailored videos about organ donation. Logistic regression models assessed the relative impact of videos on: 1) immediate organ donor registration, 2) taking brochures, and 3) change in organ donation willingness stage of change from baseline. Randomization yielded approximately equal groups related to demographics and baseline willingness and beliefs. Neither targeted nor tailored videos differentially affected registration compared with the generic video, but participants in targeted and tailored groups were more likely to take brochures. Targeted (OR = 1.74) and tailored (OR = 1.57) videos were associated with incremental increases in organ donation willingness stage of change compared to the generic video. Distributing culturally targeted and individually tailored videos increased organ donor willingness stage of change among Black men in Black-owned barbershops but was insufficient for encouraging registration.Abbreviations: CI - confidence interval; DMV - Department of Motor Vehicles; BOBs - Black-owned barbershops; ODBI - organ donation belief index; ODWS - organ donation willingness stage of change; OR - odds ratio.
This study examined the Council of State Governments’ five-level system for risk communication, as applied to the Static-99R and Violence Risk Scale–Sexual Offense Version (VRS-SO). Aims of the system include increasing consistency in risk communication and linking risk categories to psychologically meaningful constructs. We investigated concordance between risk levels assigned by the instruments, and distributions of VRS-SO dynamic needs associated with Static-99R risk levels, among a multisite sample ( n = 1,404) of persons who have sexually offended. Concordant categorical risk ratings were assigned in just over a third of cases, suggesting that consistency remains a concern with the system, particularly when conceptually disparate tools are applied. Densities of criminogenic needs varied widely among persons assigned the same risk level by the Static-99R and diverged from the descriptions ascribed by the system. These findings can inform clinical assessments and further refinement of the system.
Pharmacists are often involved in creating, implementing, and evaluating initiatives that aim to improve medication use. Pharmacy initiatives can occur in various settings, can involve interactions with patients or prescribers to optimize medication use, and incorporate information from multiple sources. Similar to pharmacy initiatives, public health initiatives are heterogeneous, complex, and work with the public to improve health behaviors in a variety of settings. Various program planning and health behavior change techniques are utilized in the planning of public health programs. Community‐based public health programs designed using social and behavioral theories have shown improved outcomes when compared with programs not based on theory. Given the overlapping objectives for planning community‐based public health programs and pharmacy initiatives, the use of social and behavioral theories may provide pharmacists with an additional tool to assist in creation of multi‐layered, effective pharmacy initiatives. Data supporting two health behavior theories focused on individuals (Transtheoretical Model and Health Belief Model), and one ecological model (Social Ecological Model) are reviewed and applied to three different pharmacy initiative scenarios. Greater incorporation of behavioral change theories and models may be helpful in creating effective, comprehensive pharmacy initiatives.
Os capítulos 1 a 5 apresentam o contexto de inserção das PICS na sociedade ocidental, sua potência como práticas terapêuticas num ambiente dominado pela visão biomédica, suas limitações e as possibilidades de avaliação de seus benefícios usando os métodos consagrados para produção e síntese de evidências na área da saúde.
Os capítulos 6 a 11 apresentam o método e os resultados de mapas de evidências sobre a efetividade de várias PICS como recurso terapêutico: acupuntura e auriculoterapia, meditação e mindfulness, plantas medicinais e fitoterápicos, práticas corporais da medicina tradicional chinesa e yoga.
Por fim, os capítulos 12 a 14 apresentam experiências e estudos sobre a implementação de políticas e programas de PICS.
Bu kitapta sağlık kavramı açıklanarak, fiziksel aktivitenin birey ve toplum
sağlığın korunması ve iyileştirilmesi üzerindeki etkileri kapsamlı olarak ele alınmaktadır.
Bireyin günlük yaşamını sürdürmesi için gerekli olan enerji harcaması
olarak tanımlanan fiziksel aktivite ile sağlıkla ilgili fiziksel uygunluğun bir
veya birkaç bileşenini iyileştirmeyi amaçlayan egzersiz eğitimiyle ilgili konular
farklı yönleriyle ve zengin bir içerikte fizyoterapist bakış açısıyla yer bulmaktadır.
Beslenme ile ilgili temel prensipler, yaşamın farklı dönemlerinde, kronik
hastalıklarda, engelli bireylerde, çalışan kişilerde ve sporcularda sağlığın korunmasında
beslenmenin önemi diyetisyen bakış açısıyla kapsamlı olarak irdelenmektedir.
Omurga, diş, işitme sağlığı, bilişsel sağlık, üreme sistemi ve cinsel
sağlık, uyku ve tütün kontrolü gibi sağlığın korunması açısından özel konular
hakkındaki bilgiler alanlarında değerli deneyime sahip akademisyenler tarafından
kitapta yer bulmaktadır.
La broncho-pneumopathie chronique obstructive (BPCO) représente la troisième cause de décès dans le monde. Elle touche 15 millions Français mais seul 1/3 reçoivent un diagnostic médical. Le dépistage et l’évaluation initiale des patients représentent un enjeu essentiel dans la prise en charge à long terme de la BPCO dans l’objectif d’améliorer la qualité de vie et de diminuer le handicap.La réhabilitation respiratoire (RR) est un traitement efficace de la BPCO, qui consiste en une prise en charge globale du malade comportant un réentrainement à l’effort, de la kinésithérapie respiratoire et une éducation thérapeutique du patient.Le test de marche de 6 minutes (TM6) est le test universel utilisé pour évaluer la performance physique du patient et constitue l’outil principal d’évaluation de l’effet de la réhabilitation. Toutefois, il persiste des patients non-répondeurs selon ce critère mais qui expriment une amélioration de leur état général selon d’autres critères. En effet, ce test est facile à réaliser mais n’évalue que la capacité globale à la marche au cours d’un test court, alors que le succès du programme de réhabilitation dépend d’autres acquisitions physiques (force, équilibre, endurance), psychologiques (anxiété, dépression, estime de soi, motivation) et éducative (connaissance de la maladie, de ses traitements, acquisition de la capacité de l’auto-soin).Nous proposons d’analyser la réponse des patients BPCO à la RR afin de déterminer des phénotypes de patients avec des clusters selon leurs réponses à la RR, et d’identifier les prédicateurs de la réponse à la RR, pour à terme pouvoir proposer une optimisation de la RR selon ces phénotypes.
Introduction : Le maintien de la pratique d’une activité physique est primordial pour conserver les bénéfices de la prise en charge pluridisciplinaire. Or, les patients lombalgiques chroniques sont peu préparés à une approche autonome. Il est nécessaire de les accompagner dans cette démarche de changement de comportement pour les amener vers une pratique physique régulière.
Objectif: L’objectif général était de déterminer des stratégies d’amélioration de l’observance en activité physique chez des patients lombalgiques chroniques.
Méthode : 3 études ont été menées. La première a cherché à déterminer l’efficacité d’un programme d’activité physique, court, hors structure de soins pour des patients lombalgiques en activité professionnelle. La seconde consistait en l’évaluation d’un programme d’éducation ajouté à la prise en charge pluridisciplinaire sur l’observance en activité physique des patients lombalgiques chroniques. La troisième consistait à établir des normes musculaires isométriques sur sujets sains.
Résultats/conclusion : Ces études ont montré les bénéfices de l’activité physique dans la prise en charge de la lombalgie chronique, tant sur la douleur que sur les paramètres fonctionnels et psychologiques. Or, la pratique d’une activité physique seule ne permet pas de modifier les comportements des patients. La mise en place d’un programme d’éducation permet une amélioration significative de l’observance au programme de soins et à l’activité physique, restant toutefois modérée. Pour autant, ces études ont permis d’appréhender le caractère complexe du changement de comportement pouvant amener les patients lombalgiques à adopter un style de vie actif.
Introduction : Le maintien de la pratique d’une activité physique est primordial pour conserver les bénéfices de la prise en charge pluridisciplinaire. Or, les patients lombalgiques chroniques sont peu préparés à une approche autonome. Il est nécessaire de les accompagner dans cette démarche de changement de comportement pour les amener vers une pratique physique régulière.Objectif : L’objectif général était de déterminer des stratégies d’amélioration de l’observance en activité physique chez des patients lombalgiques chroniques.Méthode : 3 études ont été menées. La première a cherché à déterminer l’efficacité d’un programme d’activité physique, court, hors structure de soins pour des patients lombalgiques en activité professionnelle. La seconde consistait en l’évaluation d’un programme d’éducation ajouté à la prise en charge pluridisciplinaire sur l’observance en activité physique des patients lombalgiques chroniques. La troisième consistait à établir des normes musculaires isométriques sur sujets sains.Résultats/conclusion : Ces études ont montré les bénéfices de l’activité physique dans la prise en charge de la lombalgie chronique, tant sur la douleur que sur les paramètres fonctionnels et psychologiques. Or, la pratique d’une activité physique seule ne permet pas de modifier les comportements des patients. La mise en place d’un programme d’éducation permet une amélioration significative de l’observance au programme de soins et à l’activité physique, restant toutefois modérée. Pour autant, ces études ont permis d’appréhender le caractère complexe du changement de comportement pouvant amener les patients lombalgiques à adopter un style de vie actif.
We investigated the boundary between child physical abuse and reasonable child
discipline. To determine that boundary, we asked participants to write the criteria
they used to administer corporal punishment, as well as their perceptions of the
criteria used by other parents. To analyze the data, we used text mining techniques.
The results revealed that the two sets of criteria differed according to multiple
factors, including the parent, the child, the cause, the type, and the expected results
of the punishment. The participants believed that corporal punishment was an
acceptable method of discipline only if it was administered according to a clear and
mutually understood rule. Without such a rule, however, and if the child was made
to be fearful, the punishment was considered to be abuse. If the punishment
stemmed from thoughtful parental reasoning processes, it was considered acceptable
discipline, but if it sprang from volatile parental emotions, such as anger, it was
considered abuse. It was also considered acceptable discipline if the severity of the
punishment was mild; otherwise, it was thought to be abuse. Furthermore, we
explored whether positive beliefs about the efficacy of corporal punishment related
with agreement/disagreement between the punishment criteria of individual parents
and the criteria of other parents. The majority of participants(70%) agreed to the
use of corporal punishment as a method of discipline. Their positive belief about
corporal punishment was higher when their punishment criteria matched that of
other participants. Finally, there was a positive correlation between positive beliefs
about corporal punishment and parental stress. These findings showed that success
in ending the use of corporal punishment to discipline children depends not only
on changing the perceptions of parents on an individual basis, but also on changing
the attitudes held by our society as a whole.
Studies of how eating behaviours change in later life have been dominated by the studies of physiological and biological influences on malnutrition. Insights from these studies were consequently used to develop interventions, which are predominantly aimed at rectifying nutritional deficiencies, as opposed to interventions that may enable older adults to eat well and enjoy their food-related life well into older age. The objective of the present review is to summarise the existing knowledge base on psychosocial influences on eating behaviours in later life. Following comprehensive searches, review and appraisal, 53 articles were included, both qualitative (22) and quantitative (31) papers to provide a more complete understanding of the mechanisms underpinning the psychosocial factors influencing eating behaviours. An integrated analysis identified eight underpinning psychosocial factors that influences eating behaviours in later life; (1) health awareness & attitudes, (2) food decision making, (3) perceived dietary control, (4) mental health & mood, (5) food emotions & enjoyment, (6) eating arrangements, (7) social facilitation, and (8) social support. The importance and lasting influence of early food experiences were also identified as contributing to eating behaviours in later life. The review concludes with the call for further investigation into specific psychosocial factors that influence eating behaviour, improvements in methodologies, and a summary of psychosocial barriers and enablers to eating well in later life.
Hailed by one reviewer as "the bible of the integration movement," the inaugural edition of Handbook of Psychotherapy Integration was the first compilation of the early integrative approaches to therapy. Since its publication psychotherapy integration has grown into a mature, empirically supported, and international movement, and the current edition provides a comprehensive review of what has been done.
Reflecting the considerable advances in the field since the previous edition's release in 2005, this third edition of Handbook of Psychotherapy Integration continues to be the state-of-the-art description of psychotherapy integration and its clinical practices by some of its most distinguished proponents. Six chapters new to this edition describe growing areas of psychotherapy research and practice: common factors therapy, principle-based integration, integrative psychotherapy with children, mixing psychotherapy and self-help, integrating research and practice, and international themes. The latter two of these constitute contemporary thrusts in the integration movement: blending research and practice, and recognizing its international nature. Also closely examined are the concepts, history, training, research, global themes, and future of psychotherapy integration. Each chapter includes a new section on cultural considerations, and an emphasis is placed throughout the volume on outcome research. Charting the remarkable evolution of psychotherapy integration itself, the third edition of this Handbook will continue to prove invaluable to practitioners, researchers, and students alike.
327 adult outpatients (aged 18–62 yrs) completed the Stages of Change (SOC) Scales (E. A. McConnaughy et al; see record
1984-11195-001), the Millon Clinical Multiaxial Inventory, and a symptom checklist battery during intake. Results confirm the McConnaughy et al findings that the SOC Scales provide a reliable method of measuring SOC in psychotherapy. Four distinct stages (precontemplation, contemplation, action, and maintenance) and 8 stage profiles emerged. Despite differences between degree of psychopathology in the 2 studies' populations, the SOC emerged as a reliable phenomenon for clients entering therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Developed a test designed to measure 4 stages of change hypothesized to account for a temporal dimension in the change process occurring in psychotherapy: (1) precontemplation, (2) contemplation, (3) action, and (4) maintenance. An initial pool of items was reduced to a final test of 32 items on the basis of principal components analysis, Chronbach's coefficient alpha, and item analysis results. 155 Ss commencing psychotherapy were administered the questionnaire; they returned it before their 3rd therapy session. A cluster analysis was performed on the standardized scores for each S on each of the 4 scales. The resulting 18-cluster solution produced 7 major and 2 minor client profiles that were highly distinct and that represented 90% of the Ss. (13 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Ss in precontemplation (
n = 166), contemplation (
n = 794), and preparation (
n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-mo and 6-mo cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-mo follow-up. Implications for recruitment, intervention, and research are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated the processes of change that psychotherapists report using to help clients overcome psychic distress and the processes therapists report using to overcome their own distress. 299 psychotherapists (mean age 45.4 yrs) responded to either the therapist-treat-client or therapist-treat-self form of the Processes of Change Questionnaire. Results indicate that change processes used for treating clients varied in frequency as a function of the S's orientation. In contrast, there were no discernable differences on any of the change processes for self-change among Ss of diverse persuasions. Findings suggest that psychotherapists recommend medication and facilitative relationships more frequently for clients than for themselves, but they favor counterconditioning, self-liberation, and stimulus control more for themselves than for their clients. It is suggested that (a) therapists may assume that they are healthier than their clients, (b) therapists may believe change processes good for the patient are not necessarily good for the practitioner, and/or (c) salient differences exist between change processes under therapist control and those under self-control. (43 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Offers transtheoretical therapy as one alternative when seeking a synthesis for the increasing proliferation of therapeutic systems. From a comparative analysis of 18 leading systems, 5 basic processes of change were identified by the present 1st author (1979). They are consciousness raising (feedback, education), conditional stimuli (counterconditioning, stimulus control), catharsis (corrective emotional experiences, dramatic relief), choosing (self-liberation, social liberation), and contingency control (reevaluation, contingency management). Each process can be applied at the level of either the individual's experience or environment. The present authors (see record
1982-31158-001) have identified the following stages of change: contemplation, termination, action, and maintenance. The verbal processes of change—consciousness raising, catharsis, and choosing—are most important during the 1st 2 stages, while behavior therapies (conditional stimuli and contingency control) are needed once a commitment is made. It is suggested that in the transtheoretical model, cognitive restructuring is seen as the result of the individual effectively applying the appropriate processes of change during each of the appropriate stages of change. (27 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cigarette smokers who quit on their own (n = 29) were compared with subjects from two commercial therapy programs: A version Group (n = 18) and Behavior Management Group (n = 16). Subjects were administered a Change-Process Questionnaire and a demographic and smoking-history questionnaire within seven weeks of successful cessation, then interviewed again in five months. Using a transtheoretical model of change developed by Prochaska (1979) six verbal and four behavioral processes of change and three stages of change (Decision to Change; Active Change; Maintenance) were analyzed. Subjects in each treatment group were middle class, heavy-smoking adults. The change-process analysis of cessation discriminated between the self-quitters and therapy quitters and between the two groups of therapy subjects on five variables. Stages of change interacted with the processes of change in the cessation of smoking behavior. Verbal processes were seen as important in making the decision to change while action processes were critical for breaking the actual smoking habit. Maintenance of cessation was related to, but not dependent on, how subjects actively changed smoking behavior.
This article examines data from 10 longterm prospective studies (N greater than 5,000) in relation to key issues about the self-quitting of smoking, especially those discussed by Schachter. When a single attempt to quit was evaluated, self-quitters' success rates were no better than those reported for formal treatment programs. Light smokers (20 or less cigarettes per day) were 2.2 times more likely to quit than heavy smokers. The cyclical nature of quitting was also examined. There was a moderate rate (mdn = 2.7%) of long-term quitting initiated after the early months (expected quitting window) of these studies, but also a high rate (mdn = 24%) of relapsing for persons abstinent for six months. The number of previous unsuccessful quit attempts was unrelated to success in quitting. Finally, there were few occasional smokers (slips) among successful long-term quitters. We argue that quitting smoking is a dynamic process, not a discrete event.
Subjects (N = 970) representing five stages of smoking cessation (precontemplation, contemplation, action, maintenance, and relapse) were given a 65-item test measuring 10 basic processes of change. Subjects recorded the last time they quit smoking, their current use, the frequency of occurrence, and the degree of item helpfulness. A 40-item questionnaire provided highly reliable measures of 10 processes of change, labeled (a) consciousness raising, (b) dramatic relief, (c) self-liberation, (d) social liberation, (e) counterconditioning, (f) stimulus control, (g) self-reevaluation, (h) environmental reevaluation, (i) reinforcement management, and (j) helping relationship. In a confirmatory analysis, 770 subjects were assessed 6 months later. The analysis both confirmed the 10-process model and revealed two secondary factors, Experiential and Behavioral, which were composed of 5 processes each and reflected how individuals in particular stages use more than 1 process at a time. The transtheoretical model of change and available external validity evidence are reviewed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Among a group of 45 severely head-injured clients in a post-acute rehabilitation programme, the clients' awareness of deficits and readiness to change are examined in relation to performance in treatment. Results lend qualified support to the hypothesis that head-injured clients who are aware of their deficits tend to have better treatment performance as rated by their therapists. Implications for measuring these constructs, matching treatment strategies to specific stages of change, and future investigation of the full application of these findings, are discussed.
In 1979 we set out together on a journey. We decided to try to read every study that had ever been published (in languages we could understand) on the effectiveness of different approaches to treating alcohol problems. We had no idea what lay in store for us.
Investigated the processes of change that psychotherapists report using to help clients overcome psychic distress and the processes therapists report using to overcome their own distress. 299 psychotherapists (mean age 45.4 yrs) responded to either the therapist-treat-client or therapist-treat-self form of the Processes of Change Questionnaire. Results indicate that change processes used for treating clients varied in frequency as a function of the S's orientation. In contrast, there were no discernable differences on any of the change processes for self-change among Ss of diverse persuasions. Findings suggest that psychotherapists recommend medication and facilitative relationships more frequently for clients than for themselves, but they favor counterconditioning, self-liberation, and stimulus control more for themselves than for their clients. It is suggested that (a) therapists may assume that they are healthier than their clients, (b) therapists may believe change processes good for the patient are not necessarily good for the practitioner, and/or (c) salient differences exist between change processes under therapist control and those under self-control. (43 ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
In 1986, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) invited the Institute of Medicine, an arm of the National Academy of Sciences, to assess the current state of knowledge about alcoholism and to delineate salient research issues. Two volumes resulted; the first, in 1987, was called Causes and Consequences of Alcohol Problems: An Agenda for Research. This second and final volume deals with prevention and treatment research.
Since NIAAA paid for this study, and because it was written by a committee, the reader should not be surprised by its bureaucratic literary style or its tendency to elephantine generalities. Little effort is made here to shape the data and opinions into elegant, concise research strategies. Readers must be artful enough to do this on their own. To be fair, the authors do state that they wanted to avoid assigning priority to research goals. Instead, they identified as many goals
• Utilization of health and mental health services by noninstitutionalized persons aged 18 years and older is examined based on interviews with probability samples of 3,000 to 3,500 persons In each of three sites of the National Institute of Mental Health Epidemiologic Catchment Area (ECA) program: New Haven, Conn, Baltimore, and St Louis. In all three ECAs, 6% to 7% of the adults made a visit during the prior six months for mental health reasons; proportions were considerably higher among persons with recent DSM-III disorders covered by the Diagnostic Interview Schedule (DIS) or severe cognitive impairment. Between 24% and 38% of all ambulatory visits by persons with DIS disorders were to mental health specialists. In seeking mental health services, men were more likely to turn to the specialty sector than to the generalist; women used both sectors about equally. The aged infrequently received care from mental health specialists. Visits for mental health reasons varied considerably depending on specific types of DIS disorder.
Surveyed a representative sample of American psychologists engaged in psychotherapy concerning their characteristics, activities, affiliations, theories, and selected attitudes. 410 members (aged 24–79 yrs) of Division 29 (Psychotherapy) of the American Psychological Association responded to an 82-item questionnaire. Survey results are described and compared to the findings of a similar survey by J. C. Norcross and J. O. Prochaska (e.g., see record
1982-21987-001) of American clinical psychologists (Division 12 members). Among the most salient findings were that (1) over 80% of Ss have had personal therapy and highly value these experiences as preparation for providing therapy; (2) individual therapy is the most popular therapeutic modality, but over one-half of the Ss engage in marital and family therapy; (3) while therapists spend relatively small percentages of their time doing research, they do as a group publish and present papers; (4) private practice is the modal affiliation of the Ss and may be the most equitable employment setting; and (5) psychodynamic orientations have experienced renewed preference with eclecticism declining, suggesting a need for more integrative models of therapy. (35 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Discusses the process of determining prescriptive psychotherapies through a single clinical exemplar. Authors from varied therapeutic traditions (multimodal, experiential, rational-emotive, eclectic, integrative) address the issues involved in the treatments of choice for simple phobias and the values and limitations of a prescriptive approach. Divergent therapeutic goals and multiple decision points are interacting reasons for the paucity of consensus on prescriptive therapies of choice. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Social systems have developed out of the need for the regulation of individual behaviors in order to facilitate communal living. A major goal of the control developed by social systems is the subordination of individual needs to the larger goals of the survival of the group. What is beneficial for an individual is often a satisfaction attained at the expense of pain or harm to others or to oneself at a future time. It is for such reasons that a Skinnerian analysis has viewed society as a giant mechanism for the enforcement of self-regulation. Social and cultural evolution has developed elaborate agencies of religion, education, government, family, and law. But they leave many loopholes in the control of individuals.
With the publication of "Action and Insight," Paul Wachtel carries forward the important innovations in theory and technique that made his earlier book, "Psychoanalysis and Behavior Therapy," a classic.
The first part of the book presents a searching reexamination of some of the key concepts of psychoanalysis. Metapsychology and energy concepts, transference, the role of internal structure and external environment, and the nature of psychological conflict are among the subjects that are redefined and modified under Wachtel's critical scrutiny.
Addressing psychotherapeutic technique, Part II demonstrates that an integrative approach can enhance clinical effectiveness.
Wachtel then interweaves his development of the cyclical psychodynamic perspective—a point of view for which he is particularly known—with an examination of the nature of evidence and progress in clinical research.
The last few chapters of the book explicitly address the social implications of the psychological enterprise, examining how the theoretical perspectives that guide the practice of psychotherapy can help clinicians deal with the pressing social problems that form the larger context of patients' difficulties.
This is a book that will enable students as well as seasoned clinicians to draw new connections among the subfields of psychology and between psychology and society, enriching readers' understanding and enhancing their ability to help people in trouble. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Contends that more adequate and integrative solutions to phobias (as opposed to improvement only) are needed to facilitate recovery. Approximately 25–50% of phobic clients drop out of psychological treatment, and less than 30% recover with the help of psychotherapy. Dropouts and recovery rates are related to clients' stages of change at the beginning of therapy. Greater therapeutic effectiveness with phobic and other clients can be achieved by matching interventions to each client's stage and level of change. Clients with phobias should be referred to psychoanalysis therapy only when a client is in the early contemplation stage and the phobia is occurring in the context of intrapersonal or intrapsychic conflicts. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Tested the effectiveness of an individually delivered behavioral multicomponent smoking intervention (SI) against offering advice only (AO) to 267 patients (aged 30–75 yrs) after coronary arteriography. After 6 mo, 51% of AO Ss and 62% of SI Ss reported abstinence. Validated rates were 34% and 45% for AO and SI Ss, respectively. At 6 mo, the SI had the most effect for Ss with more severe coronary artery disease (CAD) who had been admitted with a myocardial infarction even after controlling for baseline characteristics such as stage of readiness for change, sex, and self-efficacy. At 12 mo follow-up, only severity of disease mediated SI effects. Similar results were seen for cotinine-validated cessation. Data confirm the effectiveness of individually administered SI for more seriously ill patients with CAD. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Investigated coping methods among mental health professionals and nonprofessionals to identify personal characteristics related to coping and to compare psychotherapists' self-change with laypersons' self-change. The all female Ss (83 33–91 yr old psychologists, 108 23–63 yr old counselors, and 94 18–77 yr old laypersons) were administered questionnaires to measure psychic distress, strategies used to change problem behavior, and ways of coping. Results indicate that approximately 80% of the psychotherapists and 90% of the laypersons experienced at least 1 episode of high distress in the past 3 yrs. Relationship and occupational problems were the most frequent precipitants. Psychotherapists' orientations were not related to personal coping; by contrast, laypersons' characteristics did influence their coping. Implications for clinical practice and research involve the assessment of self-change in naturalistic settings, the need to explore individual differences in the stability and variability of coping, and coping differences due to personal characteristics. (52 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
In 1984, a group of researchers, theorists, and therapists gathered at an international conference in Scotland to contribute to the development of a more comprehensive model of change for the treatment of addictive behaviors. The conference and this book that grew out of the conference are signs of the Zeitgeist; they are part of a new attempt to integrate diverse systems of psychotherapy (Prochaska, 1984). In his classic call for a rapproachment across competing systems of therapy, Goldfried (1980) signaled that it is time to move beyond parochial approaches to treatment. It is time to move toward more comprehensive models of change.
There is little convergence or empirical research on factors shared by diverse psychotherapies. We reviewed 50 publications to discern commonalities among proposed therapeutic common factors. The number of factors per publication ranged from 1 to 20, with 89 different commonalities proposed in all. Analyses revealed that 41% of proposed commonalities were change processes; by contrast, only 6% of articulated commonalities were client characteristics. The most consensual commonalities across categories were development of a therapeutic alliance, opportunity for catharsis, acquisition and practice of new behaviors, and clients' positive expectancies. The frequency of selected commonalities is presented and directions for future research are outlined. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Studied predictions of trends in psychotherapy over the next decade by 75 psychologists, using Delphi methodology. Directive, present-centered, problem-focused, and brief therapies were expected to increase, whereas historically oriented, comparatively passive, and long-term approaches were predicted to decrease. Self-help groups and social workers were expected to proliferate, while the proportion of psychotherapy provided by psychiatrists was expected to diminish. Integrative, systemic, and cognitive orientations will be in the ascendancy, as opposed to classical psychoanalysis. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Provides an account of core knowledge in the field of addictions for students, academics, professionals and trainees in psychology, psychiatry, social work and related health disciplines. Topics include the origins and processes of addiction to the ways in which people overcome addictions, the implications for interventions, accounts of the different forms of addiction, including alcohol, tobacco and other drugs, gambling, eating and sex, and a psychological model of addictions which challenges former models. A comprehensive review of the research literature with a large reference base is also included. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Efficacy expectations are postulated to mediate all behavior change. This study examined the construct of self-efficacy in the self-change of smoking behavior. A 31-item measure of self-efficacy was used that included ratings of both temptation (cue strength) and confidence (efficacy). The subjects were 957 volunteers representing five stages of self change: (1) immotives, (2) contemplators, (3) recent quitters, (4) long-term quitters, and (5) relapsers. Subjects were assessed initially and at a 3- to 5-month follow-up. The self-efficacy scale proved to be an extremely reliable and coherent instrument with identifiable but not clearly interpretable subcomponents. Groups of subjects demonstrated significant differences in total self-efficacy scores. Efficacy expectations demonstrated small but significant relationships with smoking history variables and the pros and cons of smoking, but not with demographic, life stress, or persistence measures. Subject's efficacy evaluations at the initial assessment were related to changes in status for recent quitters and contemplators at the follow-up. The relationship between temptation and efficacy ratings is complex and varies for subjects in the various stages of change. Correlations between total self-efficacy and temptation scores were largest for contemplators (r = –.65) and relapsers (r = –.67) and smallest for the recent quitters (r = –.18). Finally, the magnitude of the difference between temptation and efficacy increased with length of abstinence for subjects in maintenance.
The stages-of-change model for smoking cessation was specified using interview and biochemical data from a sample of Mexican—American smokers in south Texas. Factor analysis of items measuring the processes of change for smoking indicated the stability of the structure of these constructs for this population. The scales discriminated among groups of smokers with different intentions toward smoking cessation. Intention to change was predictive of cessation category 1 to 2 years later and mediated the influences of three process-ofchange cognitions on behavior. Number of years of smoking was independently negatively related and age was positively related to cessation category. Our findings for Mexican—Americans showed that the stages and processes of change are generalizable to this population and that they predict cessation behavior prospectively.
This study prospectively tracked the self-change attempts of 200 New Year's resolvers over a 2-year period in order to more fully understand the coping determinants of maintenance and the natural history of lapses and relapses. Seventy-seven percent maintained their pledges for 1 week but only 19% for 2 years. Successful resolvers reported employing significantly more stimulus control, reinforcement, and willpower than the unsuccessful over the 2 years; social support and interpersonal strategies failed to predict success before 6 months but did so thereafter. Counterconditioning and fading were retrospectively nominated as the most efficacious coping strategies; paucity of willpower and failure of stimulus control were reported as the most hindering to maintenance. Fifty-three percent of the successful group experienced at least one slip, and the mean number of slips over the 2-year interval was 14. Slips were typically precipitated by a lack of personal control, excessive stress, and negative emotion.
Fourteen different measures were investigated as predictors of change in smoking status for self-change efforts at smoking cessation. Adult subjects (N = 866) were classified into five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Subjects were assessed on 10 change processes, self-efficacy, temptations to smoke, and their decisions weighing the advantages and disadvantages of smoking; and these 14 variables were used as predictors of change in smoking status 6 months later. Six significant functions were found which predicted movement for each of the stages. These predictors are both theoretical interest and practical significance because they may be modified in self-change efforts to overcome addictive behaviors. Overall, the change processes of self-reevaluation and the helping relationship and the self-efficacy and decisional balance variables were the most efficacious predictor variables. A general pattern emerged in which processes oriented more toward environmental events, such as dramatic relief and social liberation, tended to predict failure or no progress whereas more experientially oriented processes predicted progress.