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Goal setting in psychotherapy: The relevance of approach and avoidance goals for treatment outcome
Psychotherapy Research
Abstract
The present study is the first aimed at investigating the influence of goal definition on treatment outcome in a sample of depressed patients. Data from 657 inpatients admitted to a psychosomatic clinic in Germany being treated in a cognitive-behavioral therapy program were analyzed. Treatment goals were identified as either approach or avoidance, and the sample was classified accordingly. Patients who identified approach goals only were placed in the approach group, and those who identified at least one avoidance goal were placed in the avoidance group. Results showed that framing goals using avoidance terms was associated with less symptomatic improvement but did not affect goal attainment. Findings from this research should be utilized in practice not only for process management such as individual treatment planning but also to control outcome quality. Furthermore, goal definition should be considered as a control variable in research on depression.
... Although a few studies have highlighted the importance of clients' goal orientation in individual psychotherapy (Wollburg & Braukhaus, 2010), no study has examined the working alliance and clients' goal orientation in tandem as important and interrelated constructs in psychotherapy. This is important for several reasons. ...
... First, we argue that a client and therapist must not only agree on the goals and tasks of therapy, but these goals and tasks should be conducive for client growth. Wollburg and Braukhaus (2010) demonstrated that clients' goal orientation was associated with treatment outcome, such that clients reported greater symptom reduction when they identified approach goals, as opposed to avoidance goals. This finding supports the notion that both the agreement on the goals and tasks of therapy as well as the valence of these goals and tasks (e.g., avoidance vs. approach motivation) are important for positive treatment outcomes. ...
... To the best of our knowledge, only two studies have applied achievement goal orientation theory to the study of psychotherapy processes and outcomes (Elliot & Church, 2002;Wollburg & Braukhaus, 2010). Elliot and Church (2002) tested the relationship between avoidance therapy goals and changes in clients' subjective well-being and found that clients' who articulated more avoidance goals for therapy (e.g., avoid eating unhealthy foods) reported smaller increases in pre-post well-being. ...
Research suggests that a client’s achievement goal orientation and alliance are important for positive treatment outcomes. However, it is currently unknown how a member’s goal orientation and alliance in tandem relate to members’ improvement in group therapy, despite conceptual wisdom regarding the additive effect of a high alliance and a mastery or approach goal orientation. Therefore, this study sought to examine the congruence between members’ goal orientation and the member–group alliance on members’ perceived improvement in group therapy. Data for this study came from 99 clients across 10 interpersonal process groups. Polynomial regression and response surface analysis were used to test the congruent and discrepant effects of members’ goal orientation (i.e., approach-performance, avoidance-performance, and mastery orientation) and group alliance on their perceived improvement in group therapy. As hypothesized, members who reported congruent high group alliance and high mastery orientation or approach orientation compared to congruent low alliance and low mastery or approach orientation reported high levels of improvement in group therapy. Regarding discrepant effects, discrepant high alliance and low avoidance orientation compared to low alliance and high avoidance was positively related to improvement in group therapy, and discrepant high alliance and low approach orientation compared to low alliance and high approach was positively related to improvement in group therapy. Last, discrepant high alliance and low mastery and low alliance and high mastery were positively related to improvement in group therapy, suggesting a compensatory effect between mastery orientation and alliance on improvement.
... Studies explored factors such as whether the goals used avoidance or approach to formulation (59-62), how effortful goals were (63), whether goals were pleasurebased (63), as well as participant factors such as an individual's dialogical self-experience (1), severity of symptoms (64,65), and the quality of a participant's working alliance with the practitioner (66,67). Participants diagnosed with depression (1, 59-62), schizophrenia (63), or a range of mental illnesses (1,64,65,67) were included and recruited from community-based services (59)(60)(61)(63)(64)(65)(66)(67) and/or hospitals (62,67). ...
... Five studies explored the goal planning of people diagnosed with depression (59)(60)(61)(62)64). These studies reported that generally, participants identified more approach (moving to a desirable state) than avoidance (moving away from undesirable end state) goals, with no differences in types of goals found between those diagnosed with depression and control groups (59)(60)(61). ...
... These studies reported that generally, participants identified more approach (moving to a desirable state) than avoidance (moving away from undesirable end state) goals, with no differences in types of goals found between those diagnosed with depression and control groups (59)(60)(61). A large study identified that framing goals as approach or avoidance did not influence goal attainment, although less symptomatic improvement was seen in service users identifying avoidance goals (62). Whilst a smaller study reported that participants diagnosed with depression rated approach goals as less likely to be achieved, undesirable goal outcomes more likely to occur, and perceived less control over their goal outcomes Develop a list of frequently reported treatment goals and understand relative importance ...
Introduction
Goal planning is routinely employed in mental health service delivery to identify priorities for treatment and support the achievement and evaluation of outcomes. Previous systematic reviews of the literature have focused on the use of goal planning in a range of physical and cognitive disability settings, but there is a lack of information regarding how goal planning is used in mental healthcare.
Aims
This systematic integrative review aimed to understand the types of goals, effectiveness of goal planning, the experience of goal planning and barriers and facilitators to effective goal planning in mental healthcare settings.
Methods
Five databases were systematically searched using key terms related to mental health AND goal planning. The search was supplemented through citation chaining. Due to the heterogeneity of the studies, a narrative synthesis approach to data analysis was undertaken.
Results
Fifty-four studies were identified through the search of the literature following the PRISMA guidelines. Data was systematically extracted and thematically organized. There was a high level of heterogeneity among the studies, originating from a range of countries and with diverse characteristics and focus. Four themes emerged from the data analysis and included: (i) goal planning as a central aspect of interventions; (ii) types of goals planned; (iii) factors that influenced goal planning and/or attainment; and (iv) collaboration and concordance in goal planning.
Conclusion
This review found some support for the use of goal planning to improve outcomes in mental healthcare although there was no identified standardized approach to the use of goal planning. Individualized, recovery-oriented and collaborative goal planning was recommended but not always used in practice. Further research to understanding the most appropriate skills and training needed to support collaborative and effective goal planning is needed.
Systematic review registration
[https://www.crd.york.ac.uk/prospero/], identifier [CRD42020220595].
... Dennoch sind Therapieziele und ihr Einfluss auf den Behandlungserfolg bisher wenig erforscht (vgl. Wollburg & Braukhaus, 2010). Ziel dieser Arbeit ist es, den Erkenntnisstand zu erweitern und zu untersuchen, welche Arten von Therapiezielen in Zusammenhang mit dem anfänglichen Behandlungsfortschritt in Verbindung stehen. ...
... B. das Gewinnen von mehr Selbstvertrauen oder auf die Vermeidung eines unangenehmen Zustands, wie z. B. das Ablegen von Selbstzweifeln, fokussiert sein (Elliot & Church, 2002;Wollburg & Braukhaus, 2010). Bei einer Kategori-sierung anhand dieses Kriteriums zeigte sich bei Wollburg und Braukhaus (2010) eine sehr gute Interrater-Reliabilität (κ = .89) ...
... Bezüglich des Zielfokus ergab sich, dass das Formulieren von Vermeidungszielen im Vergleich zu Annäherungszielen mit einer geringeren Symptomreduktion verknüpft war, auch wenn sich keine Unterschiede in der Zielerreichung zeigten (Wollburg & Braukhaus, 2010). Auch wiesen Patient_innen mit mehr Vermeidungszielen einen geringeren Zuwachs im selbstberichteten Wohlbefinden auf (Elliot & Church, 2002). ...
Zusammenfassung. Hintergrund. Der Zusammenhang zwischen Inhalt und Ausrichtungsfokus von Therapiezielen und erfolgreichem Therapieverlauf ist wenig erforscht, wobei insbesondere eine mögliche Assoziation von Inhalt und Fokus vernachlässigt wurde. Fragestellung. Untersucht wurde die Assoziation von Therapiezielinhalt und -fokus und deren Zusammenhang mit frühem Therapiefortschritt. Methode. 716 Therapieziele von 163 Patientinnen und Patienten in ambulanter KVT wurden nach Inhalt und Fokus (Annäherung vs. Vermeidung) kategorisiert und der Zusammenhang von Zielart und Zielerreichung sowie Symptomreduktion nach 12 Sitzungen analysiert. Ergebnisse. Zielinhalt und –fokus waren assoziiert. Die fremdbeurteilte Zielerreichung war bei problembezogenen Annäherungszielen am höchsten. Die Symptomreduktion war dagegen am höchsten, wenn problembezogene Vermeidungsziele vorlagen. Schlussfolgerung. Therapiefortschritt steht im Zusammenhang mit den gesetzten Therapiezielen. Welche Therapiezielart, insbesondere welcher Fokus Therapiefortschritt und -erfolg begünstigt, bleibt weiterer zu erforschen. Dabei sollten zukünftig Zielinhalt und –fokus gemeinsam untersucht werden.
... a FBSSI Psychological Institute of the Russian Academy of Education, 9, Bld 4, Mokhovaya Str., Moscow, 125009, Russian Federation b Russian Presidential Academy of National Economy and Public Administration (The Presidential Academy, RANEPA), 82-84, Prospect Vernadskogo, Moscow, 119571, Russian Federation help clarify the relationship between the client and the therapist (Jansson, 2015). There are several empirical studies showing the relationship between some characteristics of goal setting and the effectiveness of counseling (Brace, 1992;Berking, Holtforth, Jacobi, & Kröner-Herwig, 2005;Wollburg & Braukhaus, 2010). ...
... E. Wollburg, C. Braukhaus (2010) studied how the type of goal formulation affects the psychotherapy outcomes in depressed patients. The study involved 6,570 people as participants, who had undergone a course of cognitive-behavioral, or multimodal psychotherapy and drug therapy for seven weeks. ...
... Features of a goal GS1-1 Positive GS1-2 Negative GS1-3 There are no third parties GS1-4 Specific (includes criteria for achieving) GS1-5 Global GS1-6 Achieved by means of psychotherapy: GS1-6-1 Change in thoughts GS1-6-2 Change in emotions GS1-6-3 Behavioral change GS1-6-4 Change in attitudes GS1-7 Not achievable by means of psychotherapy GS1-8 Clear GS1-9 Formulated with the use of professional language GS1-10 Duplicating the client's words from the case GS1-11 Using anti-and pseudo-scientific concepts GS1-12 A goal is not related to the content of the client's case Characteristics of the goals were identified on the basis of data from the studies of E. Wollburg, C. Braukhaus (2010), D. Dörner (1997, and the works of Doran (1981), A. Newell, G. Simon (Newell & Simon, 1972), J.J. Platt, G. Spivack (1975). Each of the characteristics is associated with a more or less effective problem solving, and its manifestation can act as a criterion differentiating professionals with different levels of expertise. ...
Abstract
The purpose of the study was to develop a method to assess the different characteristics of goal setting among psychotherapists with varying professional experience, and also to trace the relationship between the parameters of goal setting and the effectiveness of psychotherapy. To do this, a productive methodological basis can be a procedure for the study of professional thinking used in the psychology of expertise. The authors identified the characteristics and conditions of goal setting that contribute to the better achievement of goals. The basis for the development of the method was an assumption that the analysis of someone else’s psychotherapeutic session from an expert position should stimulate the specialist’s ideas about the standard goal setting process. The authors developed a grid of categories for the analysis of structured interview records. Studies using the developed procedure can be carried out in the following areas: 1) identifying the characteristics of goals that are more or less effective in the context of therapy outcomes; 2) studying the transformation of a goal setting process in connection with building up the professional experience of a psychotherapist; 3) revealing the peculiarity of the representation of a client’s problem by psychotherapists with varying degrees of expertise; 4) studying the features of goal-setting and the representation of a client’s problem by psychotherapists of different approaches. The approbation of this methodology for studying goal setting among therapists with more than 10 years of experience allowed us to identify the main characteristics of the problem and target state descriptions that correlate with the effective achievement of psychotherapeutic results, according to other research.
... Although a large body of research exists examining the impacts of self-regulation foci in general, few have investigated the role of regulatory focus in psychotherapy. Wollburg and Braukhaus (2010) found that depressed inpatients who reported only promotion-focused treatment goals (approach group) reported slightly more gains in depressive symptoms compared to those who reported one or more prevention-focused treatment goal (avoid group). Thus, greater promotion focus and lower prevention focus may be associated with greater depression treatment outcomes, respectively. ...
... Taken together, these studies highlight the potential role of regulatory focus in some aspects of psychotherapy (Eddington et al. 2015;Katz et al. 2016;Strauman et al. 2016;Wollburg and Braukhaus 2010), although these studies are limited to examining this association in the context of psychotherapy outcomes and psychotherapy engagement. However, regulatory focus may contribute to other important aspects associated with treatment-seeking and psychotherapy outcomes-including attitudes toward psychotherapy, credibility beliefs, outcome expectations-that have not been examined. ...
... In summary, regulatory focus theory suggests that people differ in their motivations to achieve their personal goals (Higgins 1997), and preliminary findings suggest regulatory focus may play an important role in optimizing psychotherapy outcomes (Wollburg and Braukhaus 2010), matching clients to treatments (Eddington et al. 2015), and facilitating treatment engagement (Katz et al. 2016). However, the relationship between regulatory focus and other important aspects of psychotherapy process associated with outcomes remain unexplored, including client attitudes toward psychotherapy, credibility beliefs, and psychotherapy outcome expectations (Constantino et al. 2011;Swift and Greenberg 2015). ...
Client variables in psychotherapy have been shown to play an important role in psychotherapy, explaining a significant amount of variance in treatment engagement, the therapeutic alliance, and psychotherapy outcomes; however, little is known about how the client variables develop. Specifically, there may be internal characteristics of the client that underlie several client attitudinal variables that play a role in psychotherapy. The purpose of this study was to test one particular client internal characteristic (regulatory focus) as a predictor of the psychotherapy use intentions, attitudes, credibility beliefs, and outcome expectations that clients hold. Participants from a nation-wide sample of adult clients (N = 663) and a sample of college students (N = 192) completed measures of regulatory focus, treatment use intentions, attitudes toward psychotherapy, credibility beliefs, and outcome expectations. Taken together, participants’ promotion-focus and prevention-focus scores significantly predicted treatment use intentions, attitudes, credibility beliefs, and outcome expectations. Specifically, across both samples a greater promotion-focus was significantly associated with more positive attitudes, credibility beliefs, and expectations. In contrast, a greater prevention-focus was significantly associated with more negative attitudes and not significantly related to credibility beliefs for psychotherapy. These results suggest that researchers and clinicians may want to focus on increasing promotion-focused goals and attitudes in clients in order to increase psychotherapy treatment-seeking and engagement.
... (Thal et al., 2022b). However, whereas active fostering of approach-motivated therapy goals is among the most studied interventions in psychotherapy research (DeFife and Hilsenroth, 2011;Wollburg and Braukhaus, 2010), the effects of intentions in psychedelic therapy have not yet been systematically investigated. ...
... In the present study, as hypothesized based on the contextual-experiential model (Figure 1), therapeutic intentions were positively associated with all five GCMs. This result is consistent with the established finding from psychotherapy research that patients' treatment goals have a decisive influence on the therapeutic process (DeFife and Hilsenroth, 2011;Michalak and Holtforth, 2006;Wollburg and Braukhaus, 2010). Hedonic intentions were also positively associated with resource activation but negatively associated with the problem-related GCMs, that is, problem actuation, clarification, and mastery. ...
Abstract
Background: Therapeutic and salutogenic effects of psychedelic drugs have been attributed to psychotherapeutic or psychotherapy-like processes that
can unfold during the acute psychedelic experience and beyond. Currently, there are no psychometric instruments available to comprehensively assess
psychotherapeutic processes (as conceptualized by empirical psychotherapy research) in the context of psychedelic experiences.
Aims: We report the initial validation of the General Change Mechanisms Questionnaire (GCMQ), a self-report instrument designed to measure five
empirically established general change mechanisms (GCMs) of psychotherapy—(1) resource activation, (2) therapeutic relationship, (3) problem
actuation, (4) clarification, and (5) mastery—in the context of psychedelic experiences.
Methods: An online survey in a sample of 1153 English-speaking and 714 German-speaking psychedelic users was conducted to evaluate simultaneously
developed English- and German-language versions of the GCMQ.
Results: The theory-based factor structure was confirmed. The five GCMQ scales showed good internal consistency. Evidence for convergent validity
with external measures was obtained. Significant associations with different settings and with therapeutic, hedonic, and escapist use motives
confirmed the hypothesized context dependence of GCM-related psychedelic experiences. Indicating potential therapeutic effects, the association
between cumulative stressful life events and well-being was significantly moderated by resource activation, clarification, and mastery. Factor mixture
modeling revealed five distinct profiles of GCM-related psychedelic experiences.
Conclusion: Initial testing indicates that the GCMQ is a valid and reliable instrument that can be used in future clinical and nonclinical psychedelic
research. The five identified profiles of GCM-related experiences may be relevant to clinical uses of psychedelics and psychedelic harm reduction.
... Moreover, activity or participation related goals were associated with better outcomes on GPE and non-classifiable goals were associated with poorer outcomes for pain intensity. Previous studies on other patient groups have found comparable results, with improved outcomes for patients having goals comparable to activity or participation [32][33][34]. They studied patients with stroke [32], depression [33] and vulvodynia [34], and suggested that associations with motivation, behaviour change and self-efficacy could be possible explanations. ...
... Previous studies on other patient groups have found comparable results, with improved outcomes for patients having goals comparable to activity or participation [32][33][34]. They studied patients with stroke [32], depression [33] and vulvodynia [34], and suggested that associations with motivation, behaviour change and self-efficacy could be possible explanations. One study has found strong links between goal preferences and activity CI Confidence intervals, HSCL10 Hopkins Symptom Check List 10 item version. ...
Abstract Background Goal setting is linked to person-centred care and is a core component in physiotherapy, but the associations between goal classes, patient characteristics and outcome measures for musculoskeletal disorders has not been investigated. The study’s purpose was to examine 1) how goals used in clinical practice for patients with musculoskeletal disorders (MSD) are distributed in classes based on ICF, 2) if goal classes were associated with patient characteristics and 3) whether goal classes were associated with treatment outcome. Methods Data analysis from a longitudinal observational study (N = 2591). Goals were classified in symptom, function/structure, activity/participation and non-classifiable. Associations between patient characteristics and goal classes were examined using x2 and one-way ANOVA. Association between goal classes and outcomes were examined using multiple logistic and linear regression models. Outcomes are reported at 3 months or end of treatment if prior to 3 months. Results There was a high variability in goals used for patients with MSD. 17% had symptom goals, 32.3% function/structure, 43.4% activity/participation and 7.4% non-classifiable goals. We found significant associations between goal classes and age, gender, severity, region of pain/diagnosis and emotional distress (all p
... At the initial session, the therapist usually, implicitly or explicitly, asks the client to report their goals with regards to treatment (e.g., symptom reduction) and/or wider personal goals (e.g., to have a better relationship with their children; Michalak and Holtforth, 2006). Goal setting has been associated with goal attainment (Webb and Sheeran, 2006) and goal attainment has, in turn, been associated with positive emotions and wellbeing (Wiese, 2007), better therapeutic outcomes (Tryon, 2018;Wollburg and Braukhaus, 2010), and higher personal recovery (Sommer et al., 2019). However, setting a goal is a necessary but often insufficient step to achieving the desired outcome and research typically finds a considerable gap between intentions (or self-instructions to perform particular behaviors or to obtain certain outcomes, Triandis, 1980) and behavior (Sheeran and Webb, 2016). ...
... There may also be differences in the types of goals that mental health service users set and strive for. For example, clients have been found to set more avoidance goals (e.g., 'to not be anxious'; Elliot and Friedman, 2007) than approach goals (e.g., 'to be more relaxed'), as well as less specific goals (e.g., 'gain skills'; Dickson and Moberly, 2013); both of which have been in turn associated with worse symptomatology (Dickson and MacLeod, 2004;Wollburg and Braukhaus, 2010) and less goal progress (Elliot and Church, 2002). Furthermore, the nature of some mental health difficulties includes avoidance behaviors (Barlow et al., 2011), which can negatively influence goal attainment (Forster et al., 1998). ...
Rationale
Striving for goals is a key part of psychological therapy, but people often struggle to translate their goals into action. Prior evidence has found that forming if then plans (or ‘implementation intentions’) is an effective way to bridge the gap between goals and action. However, it is unclear if therapists naturally prompt their clients to form implementation intentions and, if not, whether training would be feasible.
Method and results Study 1
Researchers coded the behavior change techniques used in 40 sessions of therapy for depression using a Cognitive Behavioral Therapy approach and a Person-Centered Experiential Therapy approach and found that therapists do not typically prompt their clients to form implementation intentions in either therapeutic approach.
Method and results Studies 2 and 3
The aim was to develop and evaluate a training program for therapists on implementation intentions. Training was delivered face-to-face to 69 cognitive-behavioral therapists (Study 2), and online to 87 therapists working across models (Study 3) and therapists completed self-report measures of their use and knowledge of implementation intentions before training, post-training, and follow-up. The training significantly increased therapists' use and knowledge of implementation intentions.
Conclusions
Taken together, these findings suggest therapists can be trained in the use of implementation intentions and that appropriate content might be integrated into training programs.
... In addition, motivational incongruence has been found to relate to high levels of psychological symptoms such as anxiety and depression as well as low levels of well-being (Brockmeyer et al., 2014;Kelly, Mansell, & Wood, 2015). Particularly the attainment of approach goals, as opposed to avoidance goals, has been found to relate to symptomatic improvement (Wollburg & Braukhaus, 2010). In medical settings, incongruence has been linked to physical health. ...
... On the basis of consistency theory's empirically supported assumption that incongruence is a major contributor Fig. 2 Mediation model of change in approach incongruence mediating the association between change in pain interference and general distress at post-treatment with z-standardized β-coefficients to the development and maintenance of psychopathological symptoms and distress (Berking et al., 2003;Brockmeyer et al., 2014), we tested for the first time in chronic pain patients whether changes in motivational incongruence over the course of therapy were associated with reductions in psychological distress at post-treatment. Results demonstrated that the reduction in approach-motive incongruence, i.e., better motive satisfaction, was correlated with less general distress at post-treatment above and beyond improvements in pain-related factors, whereas reductions in avoidancemotive incongruence did not add further explained variance in the model, these results being in line with previous research (Wollburg & Braukhaus, 2010). However, these effects based on pre-post assessments cannot be interpreted as causal due to the non-experimental design of the study and due to the significant findings of the cross-lagged analysis for the reversed direction of prediction, i.e., change of general distress being significantly correlated with reduced motivational incongruence at post-treatment. ...
According to consistency theory, insufficient motive satisfaction (motivational incongruence) is associated with psychological distress and mental disorders. High levels of distress and comorbid psychological disorders are common in patients with chronic pain. The aim of the present study was to investigate the role of motivational incongruence in chronic pain patients and the association of incongruence change with symptom improvement. Inpatients with chronic pain in multimodal interdisciplinary treatment (n = 177) completed questionnaires measuring motivational incongruence, psychological distress, pain intensity and pain interference at the beginning and end of a multimodal interdisciplinary inpatient treatment program at a tertiary psychosomatic university clinic. Results demonstrated that pain and motivational incongruence were significantly reduced at post-treatment, and reductions in incongruence were associated with reductions in psychological distress. In particular, better satisfaction of approach motives mediated the association between reduction of pain interference and psychological distress at post-treatment. Findings suggest that a reduction of motivational incongruence may be part of successful treatment of chronic pain.
... In psychological approaches that emphasize cognitions and self-talk, therapists often encourage clients to change their thoughts and language to be more positive and action-oriented (e.g., what clients want instead of what they do not want to happen; Wright, Basco, & Thase, 2006). In an outcome study evaluating the effects of a cognitive-behavioral therapy program on mood outcomes, clients who framed their goals in terms of avoidance had less symptomatic improvement compared with clients who framed their goals positively, although they were still able to achieve their goals (Wollburg & Braukhaus, 2010). This suggests that goal attainment might be unaffected by the type of motivation, while mood symptoms may improve when goals are framed positively. ...
... While it was not surprising that a review of negative consequences resulted in significantly better outcomes than RC given substantial empirical support in favor of negative phenomena, findings in support of PCR were noteworthy. In trying to understand these positive results, it is important to consider the existing literature suggesting that positive reinforcement is more effective in behavior modification than punishment (Azrin & Holz, 1966;Skinner, 1948), that humans are biased to think optimistically about the future (Boucher & Osgood, 1969) and favor positive information in regard to the self (Alicke & Sedikides, 2011), and that framing one's goals positively leads to a more positive mood (Wollburg & Braukhaus, 2010). From a theoretical perspective, PCR includes all of these elements; it is rooted in positive reinforcement, it employs a future-oriented approach that highlights positive outcomes, it focuses on personal information, and it prompts the person to consider what he or she can achieve, thereby improving positive mood. ...
There is limited information available to assist evidence-supported detection and referral of mental, social, and physical health issues affecting performance in circus artists. Therefore, this study examines mental, social, and physical health of artists in 2 circus settings (circus school, professional circus). The specific aims were to assess overall health and develop data-informed wellness screening methods in these populations, assisting referral guidelines for performance and health optimization. A comprehensive psychometrically validated battery of standardized measures was administered to 109 professional circus artists employed by Cirque du Soleil and students enrolled in the National Circus School. Compared with students, professionals reported significantly fewer problems with social isolation, fatigue, and factors that interfere with circus performance specific to shows/evaluations; they also reported greater satisfaction in their social roles and overall circus performance. Professionals also reported significantly less severe depression, and greater receipt of emotional and informational support compared with normative samples. Scores of students were similar to those of normative samples, although their scores measuring anxiety and fatigue were higher. There were no significant differences between professionals and students in perceived interferences during training, or circus-related problems with coaches and classmates/coworkers. For all participants, scores on measures of mental, social, and physical health were negatively associated with factors reported to interfere with circus performance. Participant responses to the measures were used to develop guidelines to facilitate detection of factors interfering with performance and to assist informed referrals.
... In psychological approaches that emphasize cognitions and self-talk, therapists often encourage clients to change their thoughts and language to be more positive and action-oriented (e.g., what clients want instead of what they do not want to happen; Wright, Basco, & Thase, 2006). In an outcome study evaluating the effects of a cognitive-behavioral therapy program on mood outcomes, clients who framed their goals in terms of avoidance had less symptomatic improvement compared with clients who framed their goals positively, although they were still able to achieve their goals (Wollburg & Braukhaus, 2010). This suggests that goal attainment might be unaffected by the type of motivation, while mood symptoms may improve when goals are framed positively. ...
... While it was not surprising that a review of negative consequences resulted in significantly better outcomes than RC given substantial empirical support in favor of negative phenomena, findings in support of PCR were noteworthy. In trying to understand these positive results, it is important to consider the existing literature suggesting that positive reinforcement is more effective in behavior modification than punishment (Azrin & Holz, 1966;Skinner, 1948), that humans are biased to think optimistically about the future (Boucher & Osgood, 1969) and favor positive information in regard to the self (Alicke & Sedikides, 2011), and that framing one's goals positively leads to a more positive mood (Wollburg & Braukhaus, 2010). From a theoretical perspective, PCR includes all of these elements; it is rooted in positive reinforcement, it employs a future-oriented approach that highlights positive outcomes, it focuses on personal information, and it prompts the person to consider what he or she can achieve, thereby improving positive mood. ...
Motivation is an integral part of human life and one of the most fundamental aspects of behavior change. Although interventions have been developed to motivate goal-oriented behavior, controlled outcome studies have yet to compare the relative merits of reviewing perceived positive consequences for goal achievement (positive consequences review [PCR]) with reviewing negative consequences of not accomplishing goals (negative consequences review [NCR]). In this study, 93 undergraduate students who were interested in improving motivation for lifestyle behaviors completed baseline measures (i.e., motivation to perform healthy lifestyle behaviors, University of Rhode Island Change Assessment Scale, goal achievement, Positive and Negative Affect Schedule, likelihood of seeking professional assistance). Participants were subsequently randomly assigned to PCR, NCR, or relaxation control conditions. They were reassessed immediately after the respective experimental conditions were implemented and 7 days after baseline. Repeated measures analyses indicated that both PCR and NCR were more efficacious than relaxation in enhancing motivation, goal achievement, and positive affect, with PCR yielding larger effect sizes ( p s < .05). No significant interaction effects were found in reducing negative affect and increasing desire to seek professional assistance ( p s > .05). Future directions are discussed in light of the results.
... Cognitive behaviorist therapists study focused on symptoms, attempting to exchange the negative schemes in the emotions and thoughts of the client with positive schemes (Boterhoven De Haan & Lee, 2014;Butler, Chapman, Forman, & Beck, 2006;Foreman & Pollard, 2011;Wollburg & Braukhaus, 2010). On the other hand, psychotherapists oriented towards multi-cultural therapy suggest that most psychotherapy theories were based on the basic values of European-Americal culture, thus it would be dangerous to conceive these as universal values (Corey, 2013). ...
... An evaluation based on theory would suggest that cognitive behavioral theory was preferred the most due to its symptom oriented structure, its ability to produce solutions to psychological problems within a short period of time (Boterhoven De Haan & Lee, 2014;Butler, Chapman, Forman, & Beck, 2006;Wollburg & Braukhaus, 2010), its structured and eclectic nature, its applicability in different cultures (Corey, 2013), its ability to examine the private experiences of the client/patient using a scientific approach (Weishaar, 1993), the fact that it was researched the most, its functional nature, its ability to provide a practical and efficient treatment, and its clear and intelligible characteristics (Leahy, 2002). In fact, Moyer, Sohl, Knapp-Oliver, and Schneider (2009) determined that in one third of all psychosocial responses conducted during the last 25 years utilized primarily cognitive, behavioral or cognitive-behavioral methods. ...
The aim of the study is to evaluate the primary theoretical orientation of mental health workers (psychiatrist, psychologist, psychological counselor and social worker) in Turkey. The study was conducted with 133 psychiatrists, 312 psychologists, 430 psychological counselors and 198 social workers, a total 1073 (572 female, 501 male) mental health workers. Mental health workers between the ages of 22 and 73, from every city in Turkey participated in the study. Personal Information Form designed by the researchers was used as data collection tool in the study. Personal Information Form was emailed to the professionals and the data was collected online. Collected data were analyzed by frequency and percentage calculations. The findings of the study demonstrated that the primary theoretical orientation of psychiatrists and psychologists were cognitive behaviorist therapy, of psychological counselors were constructivist therapy and of social workers were system/family systems therapies. Furthermore, it was observed that the least preferred psychotherapy approach by the professionals was the multi-cultural therapy. The results of the study were discussed within the realm of the literature, and recommendations were presented for mental health workers and researchers.
Keywords: theoretical orientation, mental health workers, therapy. [JCBPR 2018; 7(2.000): 72-79]
... In psychological approaches that emphasize cognitions and self-talk, therapists often encourage clients to change their thoughts and language to be more positive and action-oriented (e.g., what clients want instead of what they do not want to happen; Wright, Basco, & Thase, 2006). In an outcome study evaluating the effects of a cognitive-behavioral therapy program on mood outcomes, clients who framed their goals in terms of avoidance had less symptomatic improvement compared with clients who framed their goals positively, although they were still able to achieve their goals (Wollburg & Braukhaus, 2010). This suggests that goal attainment might be unaffected by the type of motivation, while mood symptoms may improve when goals are framed positively. ...
... While it was not surprising that a review of negative consequences resulted in significantly better outcomes than RC given substantial empirical support in favor of negative phenomena, findings in support of PCR were noteworthy. In trying to understand these positive results, it is important to consider the existing literature suggesting that positive reinforcement is more effective in behavior modification than punishment (Azrin & Holz, 1966;Skinner, 1948), that humans are biased to think optimistically about the future (Boucher & Osgood, 1969) and favor positive information in regard to the self (Alicke & Sedikides, 2011), and that framing one's goals positively leads to a more positive mood (Wollburg & Braukhaus, 2010). From a theoretical perspective, PCR includes all of these elements; it is rooted in positive reinforcement, it employs a future-oriented approach that highlights positive outcomes, it focuses on personal information, and it prompts the person to consider what he or she can achieve, thereby improving positive mood. ...
... 58 For example, a patient may want complete pain resolution (goal) but may not expect to achieve this through physical therapist-led rehabilitation (expectation). 54 Activity-or participation-related goals are associated with improved perceived effect of physical therapy treatment for patients with chronic pain, stroke, and depression. 1, 46,59 However, goals that are focused on symptoms rather than function might be less achievable using physical therapies. 1,7 This is seen in patients with chronic low back pain, where those with negative expectations of physical therapist-led treatment had worse pain and function after treatment. ...
... Prior research provided evidence that the pursuit of a high proportion of avoidance goals relative to approach goals was harmful to one's psychological functioning and well-being [56]. Wollburg and Braukhaus [57] examined the relevance of approach and avoidance goals for treatment outcome using a sample with depressed inpatient individuals. Having just one goal phrased in avoidance terms was linked to less improvement of symptoms, though they did not hinder goal achievement. ...
Background
As the return to alcohol use in individuals with alcohol use disorder (AUD) is common during treatment and recovery, it is important that abstinence motivation is maintained after such critical incidences. Our study aims to explore how individuals with AUD participating in an app-based intervention with telephone coaching after inpatient treatment perceived their abstinence motivation after the return to alcohol use, whether their app use behavior was affected and to identify helpful factors to maintain abstinence motivation.
Methods
Using a mixed-methods approach, ten participants from the intervention group of the randomized controlled trial SmartAssistEntz who returned to alcohol use and recorded this in the app Appstinence, a smartphone application with telephone coaching designed for individuals with AUD, were interviewed about their experiences. The interviews were recorded, transcribed and coded using qualitative content analysis. App use behavior was additionally examined by using log data.
Results
Of the ten interviewees, seven reported their abstinence motivation increased after the return to alcohol use. Reasons included the reminder of negative consequences of drinking, the desire to regain control of their situation as well as the perceived support provided by the app. App data showed that app use remained stable after the return to alcohol use with an average of 58.70 days of active app use (SD = 25.96, Mdn = 58.50, range = 24–96, IQR = 44.25) after the return to alcohol use which was also indicated by the participants’ reported use behavior.
Conclusions
The findings of the study tentatively suggest that the app can provide support to individuals after the return to alcohol use to maintain and increase motivation after the incidence. Future research should (1) focus on specifically enhancing identification of high risk situations and reach during such critical incidences, (2) actively integrate the experience of the return to alcohol use into app-based interventions to better support individuals in achieving their personal AUD behavior change goals, and (3) investigate what type of support individuals might need who drop out of the study and intervention and discontinue app use altogether.
Trial registration
The primary evaluation study is registered in the German Clinical Trials Register (DRKS, registration number DRKS00017700) and received approval of the ethical committee of the Friedrich-Alexander University Erlangen-Nuremberg (193_19 B).
Supplementary Information
The online version contains supplementary material available at 10.1186/s13722-024-00457-7.
... Approach-based Recovery goals typically involve movement towards a desired outcome (Sherratt & MacLeod, 2013). They enact change and generate more positive emotions than avoidance-based goals, which typically centre on reducing undesirable thoughts or behaviours (Bailey, 2019;Wollburg & Braukhaus, 2010). ...
Goal-setting is a tool that empowers consumer recovery. Though the pandemic has affected consumer goal-setting, the nature and extent of this impact have not been examined in a recovery setting. The aim of this study is to assess whether the recovery goals of individuals with serious mental illness changed in association with the COVID-19 pandemic. In this mixed-methods design, data were collected from a purposeful sample of consumers (nTOTAL = 355) aged 19-67 years (MAGE = 44.56, SD = 13.05) attending Recovery Camp, a 5-day therapeutic-recreation programme for individuals living with severe mental illness (e.g., PTSD, schizophrenia). Consumer-set goals were examined across 5 programmes prior to March 2020 (nPRE = 126) and 11 following (nPOST = 229). Goals were set on day one, with attainment self-scored on day five. Chi-squared goodness-of-fit tests compared goal proportions per domain; tests of independence assessed changes in goals pre- and post-pandemic. Six goal domains were identified: Approach-Based Recovery, Avoidance-based Recovery, Novel Physical Activities, Relationships, Health, and Recreation/Relaxation. Irrespective of the pandemic, goal attainment was consistently high across all programmes (86.56%). Approach-based Recovery goals were predominant pre-pandemic, but were significantly reduced post-pandemic (p = 0.040). Goals related to Relationships and Novel Physical Activities took precedence throughout the pandemic. Post-COVID-19, consumer recovery goals reveal increased desire for connection, novelty-seeking, and positive behavioural change.
... They found that clients' who articulated more avoidance goals for therapy, such as avoiding performing worse than others, reported smaller increases in pre/post well-being. In a similar study, Wollburg and Braukhaus (2010) found that avoidance goal orientation was associated with less symptomatic improvement in therapy. These studies provide preliminary data of the importance of clients' goal orientation within a therapeutic context, supporting efforts to construct and validate a measure of clients' achievement goal orientation in psychotherapy that can accurately measure and facilitate better understanding of the role of achievement goal orientation in psychotherapy process and outcome. ...
Previous research has examined the role of clients’ goal orientation, or the motives one uses to achieve specific tasks or goals in individual therapy highlighting the importance of clients’ goal orientation within a therapeutic context. Constructing and validating a measure of clients’ achievement goal orientation in group psychotherapy is needed to allow for additional methodologically sound research to examine the role of achievement goal orientation in the process and outcome of group psychotherapy. Data from 99 adult group members across 23 interpersonal process groups were used to investigate the psychometric properties of the Patterns of Adapted Learning Scales—Group Psychotherapy Version (PALS-GP), including internal reliability, structural validity, and concurrent and criterion-related validity. The PALS-GP scores revealed an overall good internal consistency (α = .76–.86) and yielded a robust three-factor structure. Evidence of concurrent and predictive validity was also demonstrated with a measure of group alliance and client improvement, respectively. The PALS-GP appears to be a promising instrument for measuring goal orientation with a clinical population participating in group therapy.
... Furthermore, psychological distress and mental disorders can be sources of incongruence themselves (Westermann et al., 2019). A reduced incongruence after treatment has generally been linked to better therapeutic outcomes, especially when approach goals are met rather than avoidance goals (Berking et al., 2003;grosse Holtforth et al., 2005;grosse Holtforth, 2008;Wollburg & Braukhaus, 2010). Since goal adjustment seems to increase the quality of life and well-being among patients with chronic pain (Esteve et al., 2018;Ramírez-Maestre et al., 2019), redefining and engaging in new realistic goals might reduce perceived motivational incongruence. ...
We set out to replicate findings of significant (a) reductions in pain, psychological distress, and motivational incongruence (i.e., insufficient motive satisfaction) after interdisciplinary multimodal pain treatment and (b) associations between reductions in motivational incongruence (i.e., improved motive satisfaction) and decreases in psychological distress (Vincent et al., Journal of Clinical Psychology in Medical Settings 28:331–343, 2021). 475 Patients with chronic primary pain completed standardized self-reported questionnaires assessing motivational incongruence, psychological distress, pain intensity, and pain interference at intake and discharge from a tertiary psychosomatic university clinic. We used hierarchical linear models to analyze motivational incongruence’s effects on psychological distress. We partially replicated Vincent et al.’s findings. Significant reductions in pain, psychological distress, and motivational incongruence after treatment were found. Reductions in motivational incongruence were associated with reductions in psychological distress. Similarly, a better motive satisfaction mediated the relationship between pain interference and psychological distress. Our findings show that reducing motivational incongruence may be a key component of treating chronic primary pain; we recommend to assess and target motivational incongruence to improve interdisciplinary multimodal pain treatment.
... Except for two goals, namely not to transfer one's old patterns to one's children (n = 2) and to become better without pills (n = 1), which may be classified as avoidance goals, all reported goals were approach goals. Framing goals using avoidance terms was shown to be associated with less symptomatic improvement but did not affect goal attainment [59]. ...
Access to psychotherapy is still limited by various barriers, and little is known about the facilitating circumstances. This study aims to assess self-reported barriers and facilitators to psychotherapy utilisation in private practice and how these access factors relate to psychotherapy goals as formulated by patients. The dataset consists of 21 face-to-face semi-structured interviews with patients treated by psychotherapists in private practice in Austria. Data were analysed using qualitative content analysis, including a frequency count of the number of codings to analyse relations between categories. A critical external barrier theme was unaffordable psychotherapy and confusion about how the Austrian funding system works. A negative experience with psychotherapy prior to the current one, such as not being understood and answered well enough by one's therapist, was a frequently reported internal barrier. Individuals who faced more internal barriers and more external facilitators in seeking therapy, such as moral support from significant others and professionals , formulated less elaborate treatment goals. Although the study was carried out amid the COVID-19 pandemic, the pandemic played a minor role in patients' self-reported barrier and facilitator themes.
... Health care and consumer well-being research offer empirical support for a Psychological and behavioral engagement direct association between in-role BCE and goal attainment. For example, patient participation in goal setting leads to better psychotherapy outcomes (Wollburg and Braukhaus, 2010), and weight loss patients' in-role BCE, along with compliance with program instructions, facilitates their achievement of health-related goals (Dellande et al., 2004). Extra-role BCE also helps customers achieve their goals due to reciprocity norms (Gouldner, 1960), as stipulated by social exchange theory (Blau, 1964). ...
Purpose
Customer engagement (CE) literature features divergent definitions and conceptualizations. To clarify its meaning, antecedents and outcomes, this paper aims to propose that psychological customer engagement (PCE) is the mechanism by which customers’ readiness to engage influences behavioral customer engagement (BCE) in the form of in-role and extra-role behaviors, which then affect customers’ goal attainment, satisfaction and retention.
Design/methodology/approach
Set in the fitness center industry, this study combines perceptual data (from customers) and behavioral data (from the fitness center) to reveal a hierarchy of effects: customer readiness to PCE to BCE to customer goal attainment, satisfaction and retention.
Findings
Customer readiness variables (role clarity, ability, motivation) influence in-role and extra-role BCE directly and indirectly through PCE. Extra-role BCE is associated with goal attainment and satisfaction, and the latter is linked to customer retention. In-role BCE is associated with goal attainment only.
Research limitations/implications
The proposed integrative model bridges the psychological–behavioral divide in CE literature and encourages the adoption of a broader nomological network that accounts for the effects of customers’ characteristics and actions on their goal attainment, satisfaction and retention.
Practical implications
Managers can enhance CE by improving customer role clarity, ability and motivation. Relative to in-role BCE, extra-role BCE appears more critical because it affects both goal attainment and satisfaction directly and retention indirectly.
Originality/value
The novel integrative approach, combining BCE and PCE in a single model, also provides a consumer-oriented view on CE, which establishes a more comprehensive perspective, as summarized in the proposed model of consumer engagement.
... Although we are unable to identify how the separate intervention phases impacted behaviour differently, we do know that both online and offline behaviours were influenced for most participants. The importance of focusing on online and offline behaviours has been emphasised in the internet addiction literature [40], and it also fits with the concept of 'approach goals' (moving towards something positive) being influential [41]. Making changes in both areas was important for the participants in the present study. ...
Smartphones have become the primary devices for accessing the online world. The potential for smartphone use to become problematic has come into increasing focus. Students and young adults have been shown to use their smartphones at high rates and may be at risk for problematic use. There is limited research evaluating interventions for problematic smartphone use. The present research aimed to develop and evaluate a digital intervention for problematic smartphone use in a student population. A mixed-method case series design was used. The participants were 10 students with mild–moderate dependency on the online world (measured via a self-report questionnaire). An intervention comprising goal setting, personalised feedback, mindfulness, and behavioural suggestions was delivered via a smartphone application. Time spent on smartphones was measured objectively through the same application. Changes in problematic technology use, wellbeing, mindfulness, and sleep were also evaluated. The findings indicate that the intervention resulted in a reduction in self-reported problematic smartphone use, but not screen time. The findings also indicate that over the course of participation, there was a positive influence on wellbeing, online dependency, mindfulness, and sleep. However, the mechanisms of change could not be determined. The study provides preliminary evidence that a light-touch, smartphone-delivered package is an acceptable and effective intervention for students wishing to better manage their problematic smartphone use.
... Often there is resistance or stigma toward mental health and wellbeing activities (Clement et al., 2015;Thornicroft et al., 2016), indicating the need to focus on changing beliefs about the effectiveness of wellbeing behaviours and beliefs about the consequences of implementing those behaviours (Sheeran et al., 2016). Finally, goal-setting aids in strategy formation and achievement of physical health improvements as well as behavioural regulation via self-monitoring (Wollburg and Braukhaus, 2010;Michie et al., 2011a). A further justification for why the project team chose these determinants over others can be found in Supplementary Appendix 1. ...
Replicating or distilling information from psychological interventions reported in the scientific literature is hindered by inadequate reporting, despite the existence of various methodologies to guide study reporting and intervention development. This article provides an in-depth explanation of the scientific development process for a mental health intervention, and by doing so illustrates how intervention development methodologies can be used to improve development reporting standards of interventions. Intervention development was guided by the Intervention Mapping approach and the Theoretical Domains Framework. It relied on an extensive literature review, input from a multi-disciplinary group of stakeholders and the learnings from projects on similar psychological interventions. The developed programme, called the “Be Well Plan”, focuses on self-exploration to determine key motivators, resources and challenges to improve mental health outcomes. The programme contains an online assessment to build awareness about one’s mental health status. In combination with the exploration of different evidence-based mental health activities from various therapeutic backgrounds, the programme teaches individuals to create a personalised mental health and wellbeing plan. The use of best-practice intervention development frameworks and evidence-based behavioural change techniques aims to ensure optimal intervention impact, while reporting on the development process provides researchers and other stakeholders with an ability to scientifically interrogate and replicate similar psychological interventions.
... Within psychotherapy research, the concepts of goal and goal consensus have generated a considerable body of research that has had a substantial influence on training, supervision, and practice. The goal aspect of psychotherapy, both as studied within the framework of the working alliance concept and independently as a therapeutic change principle expressed in goal-informed therapy is demonstrably a potent factor of change (Bordin, 1979(Bordin, , 1994Michalak & Grosse Holtforth, 2006;Michalak et al., 2004;Tryon et al., 2018;Wampold & Imel, 2015;Wollburg & Braukhaus, 2010). Wampold and Imel's (2015) summary of studies of the relationship of goal consensus/collaboration to outcome demonstrated an effect size of 0.72, which is among the highest effect sizes for any single factor in psychotherapy. ...
Objective
To better understand how therapists facilitate client goal attainment in therapy, we analyzed therapists’ future‐oriented actions in good outcome cases in which clients recorded high ratings on goal items in the Working Alliance Inventory‐Short Revised.
Method
We selected clients who were within the clinical range (OQ‐45.2) at pretreatment, demonstrated reliable change at the end of treatment, and recorded high WAI client goals scores early in treatment. Qualitative analyses of transcripts of the initial three sessions and client posttreatment interviews were integrated into a combined analysis to identify themes across the two separate sets of findings.
Results
Therapist future‐oriented activity included: (1) Picking up explicit and implicit intentions; (2) using linguistic devices, such as meta‐communication, action language, and hedging; (3) using evocative interventions; and (4) nudging the client into practicing change. Core finding: Therapists aligned with clients’ directionality in a forward‐driven, gradually evolving process.
Conclusion
Conceptual and clinical implications are discussed.
... Die BIT-T stellt ein empirisch entwickeltes Klassifikationssystem dar. Die So waren in anderen Studien Annäherungsziele im Vergleich zu Vermeidungszielen mit einer höheren Symptomreduktion assoziiert (Wollburg & Braukhaus, 2010). Auch standen Annäherungsziele mit einem größeren Zuwachs im subjektiv erlebten Wohlbefinden der Patientinnen und Patienten in Zusammenhang (Elliot & Church, 2002). ...
... Goal setting has required a person-centered approach (Doig, Prescott, Fleming, Cornwell, & Kuipers, 2015). Goals laid the groundwork for therapeutic interventions (Wollburg & Braukhaus, 2010) and were essential to recovery (McGuire, Lysaker, & Wasmuth, 2015). Collaborative goal setting allowed an avenue for clients and psychiatric nurses to work together therapeutically (McGuire et al., 2015), where both parties were resourceful and active in the pursuit of personcentered goals (Borg & Kristiansen, 2004). ...
The knowledge base and understanding regarding psychiatric nursing interventions in acute care settings has been limited. The purpose of this hermeneutic phenomenological study was to explore psychiatric nurses’ experiences in providing nursing interventions to adult clients in acute care settings. Six expert psychiatric nurses were recruited through purposive, snowball sampling and participated in key informant interviews. Analysis of the data revealed the central theme of person-centered care (PCC), which involved developing and delivering PCC plans; determining goals; fostering empathy, support, and hope; listening in one-to-one interactions; providing person-centered teaching; and enhancing coping strategies.
... Finally, in contrast to problem-focused measures, goal-focused measures allow for the setting of "approach," as well as "avoidance," objectives; and there is evidence that the former may be more effective regulatory devices (Elliot & Church, 2002). For instance, clients who are oriented toward approach goals show better psychotherapeutic outcomes than those oriented to avoidance goals (Elliot & Church, 2002;Wollburg & Braukhaus, 2010). ...
Routine outcome monitoring can support client progress in psychotherapy and provide evidence on population‐level outcomes. However, measures have been almost exclusively nomothetic. Idiographic tools provide a complementary approach, combining individually set outcomes with standardized progress ratings. Evidence suggests that goal‐focused idiographic measures may particularly facilitate client progress, and this systematic review aimed to identify and critically evaluate such measures, as used in psychotherapy. In total, 104 texts were eligible for inclusion in the review, with nine measures identified. These took the form of multidimensional tools, brief rating forms, and goal attainment scaling. Psychometric and clinical evidence suggests that these measures may be appropriate tools for supporting client progress, but there is insufficient evidence to validate their use for population‐level evaluation.
... applications reach from sports and exercise (e.g., Locke & Latham, 1985) to psychotherapy (e.g., Wollburg, & Braukhaus, 2010) to education and learning (e.g., Schunk, 1990). The main reason for the widespread application of goal setting is its reliably found strong effect on outcomes. ...
Goal setting has been shown to be a strong predictor of attaining a negotiation outcome. However, neither the type of negotiation nor the outcome level, dyadic versus individual outcomes, has been systematically analyzed. Further, there is a lack of theoretical and empirical integration concerning the framing of a goal. We integrate the framing literature, both loss and gain frames and combine it with regulatory focus as another goal setting theory. Using a multilevel meta-analysis, we investigated the effects of goal difficulty and goal specificity on negotiation outcomes. We found that for individual outcomes, regardless of the negotiation setting, there is support for the effect of goal difficulty, but we did not find an effect of goal specificity in any setting. Additional moderators such as goal symmetry are examined, and recommendations for more research on negotiation scenarios and their impact are made.
... 3 These different motivational systems produced different behavioral outcomes and lead to novel treatments for physical and psychological health. 4 Despite these results, no studies have examined how these motivational systems work for patients whose treatment typically involves the prevention goal of reducing pain -patients with osteoarthritis. The closest approximations have examined how depression (which has been argued as an underdeveloped promotion orientation) 5 is associated with poorer osteoarthritis treatment outcomes, 6 how selfdiscrepancies between current and idealized selves predict more pain in osteoarthritis, 7 and how positive and negative beliefs about treatment differentially influence those processes in osteoarthritis patients. ...
Objective
The present study examined the proposition that patients need to focus on something beyond simply “getting better”. In a sample of arthritis sufferers, we distinguished individuals by the goals that motivated them – moving toward aspirational goals and maximizing gains (promotion focus) rather than obligations and minimizing losses (prevention focus) – and how these motivational styles influenced treatment.
Methods
Patients (N=254) participated in a randomized controlled trial of resistance training and self-management, providing 6 time points of data over 2 years. Promotion and prevention focus at baseline were used to predict the course (compliance and changes in coping self-efficacy) and outcome (changes in physical functioning) of treatment.
Results
Arthritis sufferers with strong promotion orientations showed significant improvements in physical functioning (a direct positive impact on physical health); there were no significant associations with treatment compliance and coping self-efficacy. Arthritis sufferers with strong prevention orientations complied less with the treatment and showed little change in coping self-efficacy during treatment, which, in turn, predicted worse physical functioning over time (a pernicious, indirect influence on treatment outcome).
Conclusion
A focus on positive approach-oriented goals may improve overall treatment response, whereas a focus on negative avoidance-oriented goals may degrade treatment response through reduced compliance and self-efficacy.
... More specifically, within the therapeutic context, Elliot and Church (2002) showed that clients who adopted more avoidance goals evidenced smaller increases in wellbeing from the start to end of therapy, experienced less goal progress, and were less satisfied with the work. Similarly, Wollburg and Braukhaus (2010) found that clients with more avoidance goals showed less reductions in depression symptomatology. ...
This chapter, ‘The psychology of goals: A practice-friendly review’, examines psychological evidence and theory on goals and goal processes, and draws out implications for clinical practice. Research indicates that psychological wellbeing is associated with the actualisation of goals: having important goals in one’s life, believing that they are attainable, progressing towards them (at an appropriate pace), and achieving them. These processes, however, are mediated by several significant goal dimensions, such as how important the goals are, whether the goals are ‘approach’ or ‘avoidance’, and the extent to which the goals are conscious. Goals can be conceptualised as existing in a hierarchical framework, with ‘higher order’ goals achieved through ‘lower order’ goals. Here, wellbeing is also associated with lower levels of goal conflict, and more effective means of goal-actualisation. This conceptual framework can be used to facilitate the process of formulation in therapy, and to inform therapeutic practice.
... Thus, clients with fewer interpersonal concerns were more likely to achieve therapy approach goals even though they had some avoidance goals than were clients with more interpersonal concerns. Another study (Wollburg & Braukhaus, 2010) found that, although having avoidance goals did not affect goal attainment, clients who had avoidance goals achieved less symptom improvement than did clients who had only approach goals. ...
This chapter, ‘Goals and psychotherapy research’, examines goals in psychotherapy as they relate to clinical outcomes by surveying the extant research. Following a brief discussion of the importance of goals for personal development, the chapter focuses on research concerning the collaborative relationship between client and psychotherapist in goal-setting and effecting psychotherapy tasks to meet therapy goals, with particular emphasis on the client-therapist collaborative-outcome relationship. Next, the chapter reviews goal-psychotherapy outcome research for both adult and child/adolescent clients. The research presented is interpreted using clinical examples. The chapter closes with conclusions gleaned from the research reviewed followed by suggestions for practitioners.
... Furthermore, we can see clear strands of the same ideas in clinical research on client motivation and readiness for change (Faris, Cavell, Fishburne, & Britton, 2009;Grosse Holtforth, 2008;Grosse Holtforth, Grawe, & Castonguay, 2006;Miller & Rose, 2009;), goals (Michalak & Grosse Holtforth, 2006;Tryon & Winograd, 2011;Wollburg & Braukhaus, 2010), hope ( Irving et al., 2004), and expectancy ( Barber et al., 2014;Constantino et al., 2011), as well as the extensive alliance research that deals with how to engage clients in a mutual collaboration about change work (e.g., Fl?ckiger, Del Re, Wampold, Symonds, & Horvath, 2012;Horvath et al., 2011). These are all examples of per- spectives that we might say deal with client agency, or that presupposes recognition of client agency, as they all concern the mobilization of the client's internal resources and control over one's life, that is, the client's own capacity for change. ...
Objective: Within a mixed methods program of research the present study aimed at expanding knowledge about interactions in the initial therapeutic collaboration by combining focus on client interpersonal style and therapist contribution. Method: The study involves in-depth analyses of therapist–client interactions in the initial two sessions of good and poor outcome therapies. Based on interpersonal theory and previous research, the Inventory of Interpersonal Problems (IIP-64-C) was used to define poor outcome cases, that is, low proactive agency cases. To compare good and poor outcome cases matched on this interpersonal pattern, cases were drawn from two different samples; nine poor outcome cases from a large multi-site outpatient clinic study and nine good outcome cases from a process-outcome study of highly experienced therapists. Results: Qualitative analysis of therapist behaviors resulted in 2 main categories, fostering client’s proactive
agentic involvement in change work and discouraging client’s proactive agentic involvement in change work, 8 categories and 22 sub-categories. Conclusion: The findings revealed distinct and cohesive differences in therapist behaviors between the two outcome groups, and point to the particular therapist role of fostering client agency through engagement in a shared work on change when clients display strong unassertiveness and low readiness for change.
... Working toward goals is important in many forms of counselling and psychotherapy (e.g. Cox & Klinger, 2011;Wollburg & Braukhaus, 2010). Such goals should not be limited to eradicating symptoms. ...
A theory of goal-directed action is proposed as a conceptual link between vocational and mental health counselling. Originally emerging from the vocational counselling field, contextual action theory is presented as a critical conceptual link not only between mental health and occupational life but also between counselling practices in these domains. This specific application of goal-directed action to vocational and mental health counselling is addressed by describing counselling as goal-directed action, the five tasks of counselling it invites, and tools for supporting client goals, such as the self-confrontation interview.
... These goals might be functionally identical from the therapist's point of view, all indicating that coping skills, communication strategies, and conflict resolution might be treatment components; but the client's willingness to try learning them will vary markedly depending on the frame. It matters whether the goals are "approach" oriented, increasing positive behaviors or positive functioning, versus "avoidance" oriented, focusing on symptom reduction (Wollburg & Braukhaus, 2010): Approach goals may actually produce larger symptom reductions. Good goals also connect with the client's strengths. ...
Evidence-based assessment (EBA) streamlines literature reviewing and organizing clinical assessment by targeting the vital few topics, “satisficing,” and focusing on three major phases of clinical activity: prediction of diagnoses or other criteria, prescription of treatment or moderating factors, and process measurement. EBA is an organizing framework for applying a dozen steps to guide treatment. Technology is changing clinical assessment by increasing the efficiency and accuracy of scoring and feedback, as well as innovations that make more intensive assessment feasible. Fully implementing EBA suggests changes in training and requires a practice overhaul in exchange for greater efficiency, more accurate decisions, incrementally better outcomes, and increased service accessibility that could enable psychological science to help more people.
... To conclude, Socratic dialogue in a meaning-centered psychotherapy is a valuable tool to promote spiritual resources in the client, to generate meaning dissonance and motivate change, and to guide the discovery of a meaningful life in individuals. This approach is not only of benefit to logotherapists clinicians but it is also useful across a range of orientations and settings that emphasize the need of facilitating value clarification, goal setting, motivation to change, and the discovery of a life worth living in clients (Ryan et al. 2011;Steffen 2013;Wollburg & Braukhaus 2010). Thus, the described approach warrants further exploration and validation as a technique used within several therapeutic models and mental health settings. ...
Research findings have systematically pointed out the importance of addressing meaning in life in several mental health disorders and, therefore, in clinical practice. The growing interest in Meaning-centered interventions has allowed for the consolidation of a strong theoretical model of clinical practice suitable to the needs of today’s clinicians. This document elaborates on a logotherapeutic model of psychotherapy. Meaning-centered therapy and logotherapy (meaning therapy or therapy through meaning) are used interchangeably throughout the paper. The article reviews the basic tenets underlying Meaning-centered psychotherapy, summarizes the working model for clinical practice, and expands on the application of the Socratic dialogue technique in individual therapy as well as in group logotherapy. Final comments emphasize the importance of research for the advancement of logotherapy.
... Goal-setting has a long tradition in psychotherapy practice (Wollburg and Braukhaus, 2010). Conscious goal-setting helps facilitate goal achievement (Kolb and Boyatzis, 1970). ...
Social anxiety disorder (SAD) is a common debilitating mental illness with large negative effects on quality of life and economic productivity. Modern psychotherapy treatments utilizing cognitive–behavioral theory are increasingly delivered over the Internet and more recently using smartphone applications. The Challenger App written natively for the Apple iPhone was developed at the Stockholm University Department of Psychology for the treatment of SAD and uses a number of advanced features not previously seen in past mental health applications; these include real-time location awareness, notifications, anonymous social interaction between users, a high-degree of personalization and use of gamification techniques. This paper explores design considerations for the various components of the app, their theoretical and evidence base, and research opportunities that exist for apps making use of these novel features.
... Goal-setting has a long tradition in psychotherapy practice (Wollburg and Braukhaus, 2010). Conscious goal-setting helps facilitate goal achievement (Kolb and Boyatzis, 1970). ...
Background: Randomized controlled trials have yielded promising results for internet-delivered cognitive behavior therapy (iCBT) for patients with social anxiety disorder (SAD). Smartphone assisted treatment is potentially cost effective and could also bring the treatment closer to the patient’s real life environment than desktop application delivered iCBT.
The newly developed smartphone application “Challenger” is generating exercises that are customized to the user’s environment, involving places and people in their vicinity. Based on what skills the user wants to improve, appropriate challenges are randomly selected and created by the app. The user can follow their progress and history on a board game, where they move forward for each challenge they complete. They can also fill their own board with rewards that they find appealing and motivating. After a challenge completion, the user is prompted to write a note reflecting on the experience and to report their anxiety level during the challenge. If the user so chooses, the note can then be sent anonymously, much like a message in a bottle, to another randomly selected user to provide supportive feedback. That feedback is sent back to the challangee which can then choose to “like”, be indifferent to, or dislike (report abuse) the feedback.In summary, “Challenger” generates customized behavioral experiments, as well as exposure exercises that are performed in the patients vicinity and provides the means to reflect on the experience and to receive anonymous social community support.
Objective: The present study aims to evaluate the feasibility and acceptance of the newly developed smartphone application “Challenger” for treating social anxiety disorder (SAD) and to report on the preliminary data regarding how the anonymous social community support function is being used. It also aims to assess significant changes in the self-reported social anxiety symptoms and ecological momentary assessments over time.
Methods: A set of valid and commonly used questionnaires were used in the study. Level of social anxiety symptoms was assessed using MINI-SPIN every other day. In addition, once a week PHQ9 and GAD7 were administered in the smartphone application in order to get a general level of depression and anxiety respectively.
Result: At the present date 92 participants have enrolled in the treatment program. The MINI-SPIN scores (M=6.75, SD=3.62) indicate that this is a sample of participants with primarily social anxiety problems. The PHQ9 (n=85, M=3.38, SD=2.43) and GAD-7 (n=84, M=4.07, SD=2.60) scores suggests that the group is well-functioning with low levels of depression and general anxiety. Concerning the social feedback system we can report that 62% (n=161) of the notes being sent have been liked. About 10% has received the opinion “indifferent”, while 13% were given feedback but not yet rated. 15% was not given feedback yet and 0 comments has been reported as abusive.
Conclusions: Preliminary results indicate that using Challenger could decrease social anxiety and depressive symptoms, but data collection is still at an early stage and we will know much more at the time of the conference.
... For example, in a reanalysis of the TDCRP data Blatt, Zuroff, Hawley, and Auerbach (2010) found differing levels of perfectionism in the ostensibly homogeneous depressed patient samples, and these differences significantly effected both the therapeutic alliance and the treatment outcome. Similarly, in a study of 657 depressed inpatients Wollburg and Braukhaus (2010) identified a clinically important source of patient heterogeneity: patients who framed their goals in AVOIDANCE terms showed significantly less symptomatic improvement than did patients who framed their goals in APPROACH terms. ...
Objective:
Although the effectiveness of psychotherapy is well documented, little progress has been made in elucidating mechanisms of change. Major impediments to progress are the homogeneity assumptions evident in many psychotherapy studies. Case-specific research strategies avoid treating patients, therapists, and treatments as homogeneous variables and such studies are more successful at elucidating the link between psychotherapy processes and treatment outcome.
Method:
A case-specific, process-outcome study comprised of 39 patients treated by experienced therapists is presented. We did not focus on a supposedly homogeneous diagnostic group of patients (e.g., depressed patients) or particular manualized brands of therapy. Instead, we identified each patient's particular problems and conflicts (plan formulation) and then determined the degree to which therapists effectively addressed the patient's problems-that is, the degree to which therapists' interventions were compatible with (i.e., responsive to) the patient's plan.
Results:
Correlations between ratings of therapist responsiveness (plan compatibility of interventions) and a variety of outcome assessments were significant and substantial (accounting on average for 25% of outcome variance).
Conclusion:
The findings presented here suggest that the extent to which therapists are responsive to their patients' plans is a strong predictor of treatment outcome and of patients feeling positively about their therapy experience.
... Eine sehr aktuelle deutsche Studie beschäftigt sich ebenfalls mit der Bedeutung von Annäherungs-und Vermeidungszielen für das Therapieergebnis bei 657 stationären depressiven Patienten (Wollburg & Braukhaus, 2010). Die Autoren konnten zeigen, dass Patienten, die ausschließlich Annäherungsziele formulierten, deutlich besser von der Behandlung profitierten, als Patienten, die auch Vermeidungsziele nannten, obwohl beide Patientengruppen etwa 50% der genannten Ziele erreichen konnten. ...
Das Erreichen motivationaler Annäherungs- und Vermeidungsziele dient der Befriedigung psychologischer Grundbedürfnisse. Die Bedeutsamkeit motivationaler Ziele ist kulturabhängig. Die vorgenommene Betrachtung von Annäherungs- und Vermeidungszielen in Deutschland und Chile soll Erkenntnisse über deren kulturspezifische Beschaffenheit erbringen. Inkongruenz, das gefühlte Nicht-Erreichen motivationaler Ziele, kann Depressionen auslösen und aufrechterhalten (Grawe, 1998). Es besteht ein Zusammenhang von bindungsbezogener Angst, Schamerleben und Depression. In dieser Arbeit soll der Zusammenhang von bindungsbezogener Angst und Depressionen über Inkongruenzerleben und Schamgefühle erklärt werden. Simpson und Rholes (2004) führen ein Modell ein, das den Zusammenhang zwischen Bindungsangst und Depression über die Konzepte der Beziehungsdeprivation und der dysfunktionalen Beziehungseinstellungen erklärt. Diese Konzepte könnten zu Inkongruenzerleben und Schamgefühlen führen. In dieser Studie wurde daher an einer klinischen und an einer Kontrollstichprobe der Zusammenhang zwischen bindungsbezogener Angst und Depression untersucht, indem der Einfluss von Inkongruenzerleben und Scham als Mediatorvariablen betrachtet wurde. Bindungsstil wurde mithilfe des ECR-RD (Ehrenthal, Dinger, Lamla, Funken & Schauenburg, 2008) erfasst, Schamgefühle mit dem HFS (Kämmerer, Rosenkranz, Parzer & Resch, 2003). Zur Erfassung der subjektiven Bedeutsamkeit spezifischer Ziele wurde der FAMOS (Grosse Holtforth & Grawe, 2002) eingesetzt. Der Grad der Umsetzung motivationaler Ziele wurde mithilfe des INK (Grosse Holtforth, Grawe & Tamcan, 2004) erhoben. In beiden Ländern wurden Kontrollpersonen und depressiv Erkrankte in die Erhebung einbezogen. Weitere eingesetzte Instrumente waren das Beck-Depressions-Inventar-II (Hautzinger, Keller & Kühner, 2006; Sanz, Perdigón & Vázquez, 2003) sowie die Heidelberger Kulturfragebogenbatterie (Freund et al., im Druck; Olhaberry et al., im Druck). Überwiegend befriedigende bis sehr gute Reliabilitäten können als Beleg für die Güte der Neuübersetzungen des INK (Grosse Holtforth et al., 2004) und des FAMOS (Grosse Holtforth & Grawe, 2002) ins Chilenische gelten. Der Zusammenhang zwischen bindungsbezogener Angst und Depressivität wird über Inkongruenzerleben und Schamgefühle vermittelt. Es ergab sich ein Interaktionseffekt von Nationalität und Depression bezüglich des Inkongruenzerlebens: Die deutschen Kontrollpersonen zeichnen sich durch höheres Inkongruenzerleben aus als die chilenischen Kontrollpersonen, während sich die klinischen Stichproben nicht voneinander unterscheiden. Weiterhin konnten kulturspezifische Unterschiede in der Bedeutsamkeit von Annäherungs- und Vermeidungszielen festgestellt und über kulturvermittelnde Variablen erklärt werden. Inkongruenz und Scham konnten als Mediatorvariablen eingesetzt und Inkongruenzerleben konnte als Diskrepanz zwischen Selbstbildern operationalisiert werden. Das Modell von Simpson und Rholes (2004) kann damit um Inkongruenzerleben und Scham erweitert werden. Durch diese Erweiterung kann genauer erklärt werden, wie es durch einen ängstlichen Bindungsstil als Vulnerabilitätsfaktor zum Entstehen von Depressionen kommt. Die kulturspezifische Ausprägung motivationaler Ziele konnte bestätigt und über kulturvermittelnde Variablen erklärt werden. Aufgrund der geringen Stichprobengröße war die Validierung der Fragebögen nur eingeschränkt möglich und ist für die Zukunft wünschenswert. Nichtsdestotrotz ist mit deren sorgfältiger Übersetzung und erstem Einsetzen ein wichtiger Schritt bereits getan.
... (4) Goal-setting: setting explicit goals regarding activity level of the worker and the final RTW date (or maximum duration of the sickness benefit period) is part of the Brainwork Intervention. Defining the expected recovery period will give the Brainwork participant a better perspective on his recovery, increase his sense of control, encourage a faster recovery and reduce the number of psychological complaints [26][27][28]. (5) Providing advice for daily structure: Brainwork participants are advised to maintain a good day structure by getting up at a specific predetermined time and planning an activity for the morning. The activity can be, for example, a visit to the gym but is not limited to exercise. ...
Background: Among the working population, unemployed, temporary agency and expired fixed-term contract workers having psychological problems are a particularly vulnerable group, at risk for sickness absence and prolonged work disability. Studies investigating the effectiveness of return-to-work (RTW) interventions on these workers, who are without an employment contract, are scarce. Therefore, a RTW intervention called 'Brainwork' was developed. The objective of this paper is to describe the 'Brainwork Intervention' and the trial design evaluating its effectiveness in reducing the duration of sick leave compared to usual care. Methods/Design: The 'Brainwork Intervention' is designed to assist unemployed, temporary agency and expired fixed-term contract workers who are sick-listed due to psychological problems, with their return to work. The 'Brainwork Intervention' uses an activating approach: in the early stage of sick leave, workers are encouraged to exercise and undertake activities aimed at regaining control and functional recovery while job coaches actively support their search for (temporary) jobs. The content of the intervention is tailored to the severity of the psychological problems and functional impairments, as well as the specific psychosocial problems encountered by the sick-listed worker. Discussion: The methodological considerations of the study design are discussed. In this trial we evaluate the effectiveness of an intervention in real occupational health practice, rather than under highly controlled circumstances. The results will be published in 2015. Trial registration: Trial registration number: NTR4190.
... Outro fator relacionado à mudança é a maneira como o paciente decide enfrentar suas dificuldades. A esse respeito destaca-se sua participação ativa no processo, ou seja, o fazer face aos seus problemas ou tentar evitá-los (Frank, 1971;Wollburg & Braukhaus, 2010). Isso pode ser observado no estudo de Honda e Yoshida (2012) que visou compreender os fatores que influenciaram a chance de progresso e retrocesso em atendimentos prestados em uma clínica-escola. ...
Este trabalho apresenta proposta de se combinar o critério da eficácia adaptativa com os da Lista Hierárquica de Indicadores Genéricos de Mudança (LHIGM), para se compreender melhor como as pessoas mudam em psicoterapia. Procede-se inicialmente a uma breve revisão dos fatores de mudança que sustentam a teoria genérica de mudança em que se baseia a LHIGM. A Lista apresenta uma sequência ideal do que ocorre se a psicoterapia obtiver êxito e permite observar empiricamente os indicadores ao longo das sessões. A eficácia adaptativa compreende as respostas do indivíduo frente às dificuldades e vicissitudes da vida. Propõe-se que exista associação entre a qualidade da eficácia adaptativa e a possibilidade do paciente avançar para os níveis mais elevados da hierarquia dos Indicadores Genéricos, assim como, que o avanço na hierarquia dos indicadores corresponda a mudanças na eficácia adaptativa. Sugerem-se pesquisas para melhor avaliar essas hipóteses.
... To conclude, Socratic dialogue in a meaning-centered psychotherapy is a valuable tool to promote spiritual resources in the client, to generate meaning dissonance and motivate change, and to guide the discovery of a meaningful life in individuals. This approach is not only of benefit to logotherapists clinicians but it is also useful across a range of orientations and settings that emphasize the need of facilitating value clarification, goal setting, motivation to change, and the discovery of a life worth living in clients (Ryan et al. 2011;Steffen 2013;Wollburg & Braukhaus 2010). Thus, the described approach warrants further exploration and validation as a technique used within several therapeutic models and mental health settings. ...
Research findings have systematically pointed out the importance of addressing meaning in life in several mental health disorders and, therefore, in clinical practice. The growing interest in Meaning-centered interventions has allowed for the consolidation of a strong theoretical model of clinical practice suitable to the needs of today’s clinicians. This document elaborates on a logotherapeutic model of psychotherapy. Meaning-centered therapy and logotherapy (meaning therapy or therapy through meaning) are used interchangeably throughout the paper. The article reviews the basic tenets underlying Meaning-centered psychotherapy, summarizes the working model for clinical practice, and expands on the application of the Socratic dialogue technique in individual therapy as well as in group logotherapy. Final comments emphasize the importance of research for the advancement of logotherapy.
Improving emotion regulation abilities, a process that requires learning, can enhance psychological well-being and mental health. Empirical evidence suggests that emotion regulation can be learned—during development and the lifespan, and most explicitly in psychotherapeutic interventions and experimental training paradigms. There is little work however that directly addresses such learning mechanisms. The present article proposes that learning in specific components of emotion regulation—emotion goals, emotional awareness, and strategy selection—may drive skill learning and long-term changes in regulatory behavior. Associative learning (classical and instrumental conditioning) and social learning (including observational, instructed, or interpersonal emotion regulation processes) are proposed to function as underlying mechanisms, while reinforcement-learning models may be useful for quantifying how these learning systems operate. A framework for how people learn emotion regulation will guide basic science investigations and impact clinical interventions.
OBJECTIVE: To (i) investigate the goals and expectations of participants enrolled in a clinical trial of physiotherapist-led treatment for femoroacetabular impingement (FAI) syndrome and (ii) explore associations between their expectations and self-reported hip burden and kinesiophobia.
METHODS: Data from 150 participants with FAI syndrome who participated in a clinical trial were analysed. Participants described their most important treatment goal and the expectation of achieving this goal throughout physiotherapy treatment. The International Hip Outcome Tool (iHOT-33) subscales were used to assess self-reported hip burden. The Tampa Scale for Kinesiophobia was used to assess kinesiophobia. Participants goals were qualitatively analysed using content analysis. Linear regression was used to explore associations between patient expectations and iHOT and Tampa Scale for Kinesiophobia scores.
RESULTS: Participants with FAI syndrome reported goals relating to exercise (52%), improving activities of daily living quality (23%), improving physical function (15%), and reducing pain (10%). Negative expectations regarding physiotherapist-led treatment were reported by 68% of participants. Those with negative expectations reported worse scores for the iHOT-Total score (mean difference = 12 points, 95%CI = [4 to 19]), and iHOT-Symptoms (14 points, [7 to 21]) and iHOT-Social (11 points, [2 to 21]) subscales compared to those with positive expectations. Treatment expectations were not associated with iHOT-Sport, iHOT-Job, and Tampa Scale for Kinesiophobia scores (p > 0.05).
CONCLUSION: Patients with FAI syndrome had a generally negative expectation of physiotherapist-led treatment. There was a mismatch between patients’ goals and current treatment approaches. Participants with FAI syndrome and negative expectations reported worse quality of life, symptoms, and social concerns than those with positive expectations.
Objective:
Narrative review of the processes of goal setting and goal attainment scaling, as practical approaches to operationalizing and implementing the principles of shared decision making (SDM) in the routine care of people living with major depressive disorder (MDD).
Methods:
We searched electronic databases for clinical studies published in English using key terms related to MDD and goal setting or goal attainment scaling. Two clinical studies of goal setting in MDD are considered in detail to exemplify the practicalities of the goal setting approach.
Results:
While SDM is widely recommended for people living with mental health problems, there is general agreement that it has thus far been implemented variably. In other areas of medicine, the process of goal setting is an established way to engage the patient, facilitate motivation, and assist the recovery process. For people living with MDD, the concept of goal setting is in its infancy, and only few studies have evaluated its clinical utility. Two clinical studies of vortioxetine for MDD demonstrate the utility of goal attainment scaling as an appropriate outcome for assessing functional improvement in ways that matter to the patient.
Conclusions:
Goal setting is a pragmatic approach to turning the principles of SDM into realities of clinical practice and aligns with the principles of recovery that encompasses the notions of self-determination, self-management, personal growth, empowerment, and choice. Accumulating evidence supports the use of goal attainment scaling as an appropriate personalized outcome measure for use in clinical trials.
Objective:
Goal setting is an important factor that contributes to positive outcomes in psychotherapy, yet research has not focused on this particular aspect of process and outcome of psychotherapy for transgender and nonbinary (TNB) patients.
Methods:
The present study used secondary data analysis from a pilot randomized controlled trial focused on trans-affirmative therapy for TNB patients (N = 19). The aims of the present study were twofold: 1) gain an in-depth understanding of goals prior to the course of psychotherapy for TNB patients and 2) determine the outcome of goal setting after a 12-session course of psychotherapy with TNB patients. Content analysis and descriptive statistics were used to analyze the data.
Results:
Results indicated that the majority (70%) of goals were met at termination. The results also indicated that the majority of goals (73%) were not related to gender. The content analysis revealed that there were five overarching themes regarding the types of goals described by TNB patients: 1) managing mental health symptoms, stress, and distress; 2) developing skills to improve well-being; 3) working on relationships; 4) exploring and understanding of trans identity (gender identity); and 5) orienting towards positive growth and development. Patients' mean scores indicated that goals focused on developing skills to improve well-being were rated the highest regarding change over the course of 12 sessions of psychotherapy.
Conclusions:
This study illuminates the importance of assessing TNB patients' goals and understanding which goals resulted in the highest amount of self-reported change over 12 sessions of psychotherapy.
Introduction: Health maintenance in workers implies assessment of occupational risks and development of techniques of their elimination in order to increase labor efficiency and working life expectancy. Objective: To develop the system for maintaining health of social workers based on occupational risk assessment and management. Materials and methods: In 2019–2022, studies of working conditions, socio-demographic status, and psychological wellbeing of social workers were conducted in the clinic of F.F. Erisman Federal Research Center for Hygiene. Results: We established groups of social workers at risk of health disorders, such as common diseases and various manifestations of occupational burnout, including groups with null, early, and severe signs of job burnout, and elaborated programs for disease prevention incorporating targeted techiques of health maintenance. Conclusion: We provide a rationale for the system of preserving physical and mental health of social workers that contains various modules aimed at optimizing working conditions, mitigating risk factors, preventing health disorders, including occupational burnout, and promoting a healthy lifestyle.
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
Most contemporary achievement goal conceptualizations consist of a performance goal versus mastery goal dichotomy. The present research offers an alternative framework by partitioning the performance goal orientation into independent approach and avoidance motivational orientations. Two experiments investigated the predictive utility of the proposed approach-avoidance achievement goal conceptualization in the intrinsic motivation domain. Results from both experiments supported the proposed framework; only performance goals grounded in the avoidance of failure undermined intrinsic motivation. Task involvement was validated as a mediator of the observed effects on intrinsic motivation. Ramifications for the achievement goal approach to achievement motivation and future research avenues are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Proceeding from a model of feature-positive goal monitoring, two studies tested hypothesized associations between approach goals and positive self-evaluations and between avoidance goals and negative self-evaluations. The existence of feature-positive searches in goal monitoring was expected to bias self-evaluations toward perceiving success for approach goals and failure for avoidance goals. Study 1 established the existence of a relationship between goal framing and global self-evaluations, or psychological well being, subjects with more avoidance goals evaluated themselves more negatively on measures of self-steem, optimism, and depression. Study 2 confirmed the causal role of goal framing in this relationship, for self perceptions of success and satisfaction differed as a function of manipulated approach versus avoidance goals.
A hierarchical model of approach and avoidance achievement motivation was proposed and tested in a college classroom with 178 undergraduates. Mastery, performance-approach, and performance-avoidance goals were assessed and their antecedents and consequences examined. Results indicated that mastery goals were grounded in achievement motivation and high competence expectancies; performance-avoidance goals, in fear of failure and low competence expectancies; and performance-approach goals, in achievement motivation, fear of failure, and high competence expectancies. Mastery goals facilitated intrinsic motivation, performance-approach goals enhanced graded performance, and performance-avoidance goals proved inimical to both intrinsic motivation and graded performance. The proposed model represents an integration of classic and contemporary approaches to the study of achievement motivation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This research investigated the relationship between clients' pursuit of avoidance (relative to approach) therapy goals and change in subjective well-being (SWB) from the beginning to the end of therapy. Results indicated that clients with more avoidance therapy goals evidenced a smaller increase in SWB over the course of therapy than those with fewer avoidance goals. Mediational analyses indicated that avoidance therapy goals predicted lower therapist satisfaction, lower therapist satisfaction predicted lower perceptions of therapy effectiveness (perceived problem improvement and perceived goal progress), and these lower perceptions of therapy effectiveness proximally predicted the observed change in SWB. Ancillary analyses linked the adoption of avoidance therapy goals to early parental loss through separation/divorce or death. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The question of how affect arises and what affect indicates is examined from a feedback-based viewpoint on self-regulation. Using the analogy of action control as the attempt to diminish distance to a goal, a second feedback system is postulated that senses and regulates the rate at which the action-guiding system is functioning. This second system is seen as responsible for affect. Implications of these assertions and issues that arise from them are addressed in the remainder of the article. Several issues relate to the emotion model itself; others concern the relation between negative emotion and disengagement from goals. Relations to 3 other emotion theories are also addressed. The authors conclude that this view on affect is a useful supplement to other theories and that the concept of emotion is easily assimilated to feedback models of self-regulation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
D. Watson and A. Tellegen (1985) proposed a "consensual" structure of affect based on J. A. Russell's (1980) circumplex. The authors' review of the literature indicates that this 2-factor model captures robust structural properties of self-rated mood. Nevertheless, the evidence also indicates that the circumplex does not fit the data closely and needs to be refined. Most notably, the model's dimensions are not entirely independent; moreover, with the exception of Pleasantness–Unpleasantness, they are not completely bipolar. More generally, the data suggest a model that falls somewhere between classic simple structure and a true circumplex. The authors then examine two of the dimensions imbedded in this structure, which they label
Negative Activation (NA) and
Positive Activation (PA). The authors argue that PA and NA represent the subjective components of broader biobehavioral systems of approach and withdrawal, respectively. The authors conclude by demonstrating how this framework helps to clarify various affect-related phenomena, including circadian rhythms, sleep, and the mood disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Examined relations between characteristics of personal goal strivings (e.g., importance, past attainment, effort) and components of subjective well-being (positive and negative affect and life satisfaction). 40 undergraduates generated lists of their personal strivings and rated each striving on a series of dimensions. Ss also recorded their moods and thoughts by use of an experience-sampling method on 84 occasions over a 3-wk period. Positive affect was found to be most strongly related to striving value and past fulfillment, whereas negative affect was associated with low probability of future success, striving ambivalence, and between-striving conflict. Striving importance and instrumentality (low conflict) were the strongest predictors of life satisfaction. Possible explanations for the connections between striving fulfillment and positive affect and between striving conflict and negative affect are discussed. It is concluded that the concept of personal striving is a useful heuristic device for understanding individual differences in subjective well-being. The concept is proposed as an alternative to the traditional trait approach to personality. (71 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Nach der Konsistenztheorie [1] spielen von Grosse Holtforth u. Grawe [2] [3] explizierte Ziele von Patienten eine herausragende Rolle bei Entstehung, Aufrechterhaltung und Behandlung psychischer Störungen. Somit sollten effektive Therapieformen die subjektive Wichtigkeit dieser klinisch relevanten Ziele „normalisieren”. Das Ausmaß dieser Veränderungen sollte dabei in einem positiven Zusammenhang mit dem Therapieerfolg stehen. Um diese Hypothesen zu prüfen, wurden bei 64 Patienten, die eine stationäre kognitive Verhaltenstherapie absolvierten, klinisch relevante Ziele über den Fragebogen zur Analyse motivationaler Schemata (FAMOS) [2] vor und nach der Therapie erfasst. Die Ergebnisse zeigen erwartungskonform, dass Normalisierungseffekte vor allem in den Skalen auftreten, die in vorherigen Studien mit Psychopathologie assoziiert waren.
Two studies used a target detection task to examine temperament-related attentional biases toward and away from significant stimuli. Pretarget cues were used to orient attention to locations carrying a positive incentive value (where points could be gained) or a negative value (where points could be lost). Under both involuntary and voluntary conditions, extraverts were slow to shift attention away from positive locations, whereas introverts were slow to shift from negative locations. These biases were enhanced on trials following negative feedback and tended to be strongest in Ss high in Neuroticism. The findings support models proposing that Extraversion reflects the combined activity of positive (strongest in extraverts) and negative (strongest in introverts) incentive motivational processes. They further suggest that incentive processes regulate the ability to shift attention away from, rather than toward, significant stimuli.
Self-knowledge is conceptualized as a self digest that summarizes one's relations to the world and the personal consequences of these relations. It is a handy sourcebook that serves self-regulatory functions. It is distinguished from the classic notion that self-knowledge contains one descriptive actual self. The self digest contains information about three kinds of actual selves that differ in self-regulatory function: (a) an instrumental self, (b) an expectant self, and (c) a monitored self. It represents not only the actual self but desired (and undesired) selves that reflect different kinds of self-regulatory focus (i.e., promotion or prevention). It represents not only one's own standpoint but also the standpoint of others whose beliefs one is motivated to take into account. This self-regulatory perspective is used to reconsider self-esteem, self-enhancement, self-consistency, self-presentation, and cross-cultural differences in the self.
The present research investigated one antecedent and various consequences of pursuing avoidance personal achievement goals over the course of a semester. The authors assessed participants' achievement-relevant goals using the newly devised Achievement Goals Questionnaire. The motive to avoid failure, assessed with self-report and projective measures, was established as an antecedent of avoidance goal pursuit. Avoidance regulation was shown to have deleterious consequences for a host of achievement-relevant and general well-being outcomes at the end of the semester, including longitudinal change in subjective well-being. Perceived competence was validated as a mediator of the direct relationships observed. The results highlight the need to attend to avoidance, as well as approach, forms of self-regulation and the need to consider both motive disposition and goal constructs in accounting for competence-relevant behavior.
Three studies demonstrated that avoidance personal goals are positively related to physical symptom reports. These results were obtained (a) using both longitudinal and retrospective methodologies and (b) controlling for neuroticism and other alternative predictor variables. In 2 of the studies, a process model was validated in which perceived competence and perceived controlledness were shown to mediate the observed relationship between avoidance goals and symptomatology. Specifically, avoidance goals predicted perceived competence and perceived controlledness, and these variables in turn predicted longitudinal and retrospective symptom reports. Ancillary results help clarify the unique roles of neuroticism and avoidance goals as predictors of physical symptomatology.
Quality management of inpatient psychotherapy must integrate the different aspects of process-quality management as well as the evaluation of treatment outcome. The aim of our study was to investigate the association of the achievement of individually arranged and continuously re-evaluated therapy goals with symptomatic measures of treatment outcome (SCL-90-R, Giessener Beschwerde Bogen). 51 inpatient subjects were assessed directly before and after treatment and again at approximately 1 year after treatment (mean range 14.7 months). Therapy goal achievement was assessed on a weekly basis and, in addition, globally at the end of treatment. Pre/post-treatment results remained stabile at the follow-up assessment (SCL-90-R GSI effect size: 1.2). No significant association was found between therapy goal achievement and the degree of improvement of symptoms. This result leads us to the conclusion that the continuous evaluation of therapy goals during treatment seems to be a good instrument for quality management, but it is not suitable for the evaluation of treatment outcome.
Relatively little research has studied emotional disturbance from a motivational perspective. The current study aimed to investigate personal goal systems at different levels of analysis, namely, personal goals, associated causal explanations and goal expectancies, as a function of dysphoria. Dysphoric (n=28) and non‐dysphoric (n=28) adolescents (16–18‐yr‐olds) selected from a larger school sample completed tasks that measured number of approach goals and avoidance goals, causal explanations for goals, and perceived likelihood and control estimates for idiographic goals. As predicted dysphoric adolescents, relative to controls, generated a combination of more avoidance goals and fewer approach goals, and thought of more reasons that explain why goals would not be achieved and fewer reasons that explain why goals would be achieved (irrespective of goal type), and considered avoidance goal outcomes as more likely to occur and approach goal outcomes as less likely to occur. In addition, dysphoric adolescents anticipated less personal control in implementing their goals than controls. Overall, the data identified distinct personal goal systems that function differently in dysphoric and non‐dysphoric adolescents.
Two studies examined the influence of approach and avoidance social goals on memory for and evaluation of ambiguous social information. Study 1 found that individual differences in avoidance social goals were associated with greater memory of negative information, negatively biased interpretation of ambiguous social cues, and a more pessimistic evaluation of social actors. Study 2 experimentally manipulated social goals and found that individuals high in avoidance social motivation remembered more negative information and expressed more dislike for a stranger in the avoidance condition than in the approach condition. Results suggest that avoidance social goals are associated with emphasizing potential threats when making sense of the social environment.
The difficulties inherent in obtaining consistent and adequate diagnoses for the purposes of research and therapy have been pointed out by a number of authors. Pasamanick12 in a recent article viewed the low interclinician agreement on diagnosis as an indictment of the present state of psychiatry and called for "the development of objective, measurable and verifiable criteria of classification based not on personal or parochial considerations, but on behavioral and other objectively measurable manifestations."Attempts by other investigators to subject clinical observations and judgments to objective measurement have resulted in a wide variety of psychiatric rating scales.4,15 These have been well summarized in a review article by Lorr11 on "Rating Scales and Check Lists for the Evaluation of Psychopathology." In the area of psychological testing, a variety of paper-and-pencil tests have been devised for the purpose of measuring specific
Recent findings indicate that frontal brain asymmetry may be a marker of for depression. However, the psychological predispositions that account linkage between frontal brain asymmetry and depression are unclear. approach-withdrawal hypothesis is the primary framework that has been to account for the linkages between frontal brain asymmetry and or emotional disorders. We review evidence consistent with this and suggest several directions for its extension. One such direction is to constrain the approach-withdrawal hypothesis by linking frontal asymmetry to the known functions of the prefrontal cortex. On this we propose that frontal brain asymmetry may be preferentially linked processes that promote the temporal continuity and shifting of or emotional priorities and the suppression of interference by sources of motivation or emotion. We review evidence from and neurobiological studies of depression that is broadly consistent with these predictions. We emphasise the need for future studies testing our hypotheses.
The present research comprises two studies designed to investigate both antecedents and consequences of pursuing avoidance (relative to approach) personal goals over the course of a semester-long period. Results revealed that neuroticism was positively related to the adoption of avoidance personal strivings (Study 1), and participants with low perceptions of their life skills were more likely to adopt avoidance personal projects (Study 2). Avoidance regulation proved deleterious to both retrospective and longitudinal subjective well-being (SWB), as participants with a greater proportion of avoidance goals reported lower SWB over the course of the semester and evidenced a decrease in SWB from the beginning to the end of the semester. Ancillary analyses attested to the robustness of these results across a variety of alternative predictor variables. Path analyses validated perceived progress as a mediator of the direct relationships observed.
Two studies examined the impact on emotion and motivation of framing the same goal in terms of either a positive outcome focus or a negative outcome focus. In Study 1, contingencies associated with either reaching the goal (positive outcome focus) or failing to reach the goal (negative outcome focus) were emphasized. In Study 2, performance feedback was given as subjects worked on a task such that the goal was framed in terms of either a positive or a negative outcome focus. Framing with a positive outcome focus changed dejection-related emotions (e.g., dissatisfaction) more than agitation-related emotions (e.g., nervousness), whereas the reverse was true for framing with a negative outcome focus. In addition, persistence was greater in the positive-outcome-focus condition (both studies), as was performance (Study 2). Implications for self-discrepancy theory and for goal theories of motivation are discussed.
This study examined whether persons who possess different types of self-discrepancies are sensitive to different types of psychological situations as evident in their memory for another person's experiences. All subjects read the same essay in which a target person experienced events reflecting different types of psychological situations (e.g., the presence of a positive outcome; the absence of a negative outcome). The target person's experiences were circumstantial and not personality related (e.g., finding money on the street; escaping an unpleasant school day because of an election). Half the subjects were predominant actual: ideal discrepancy persons, who, according to self-discrepancy theory, are oriented toward hopes and wishes and are sensitive to the presence and absence of positive outcomes. The remaining subjects were predominant actual: ought discrepancy persons, who are oriented toward sanction-dictated duties and obligations and are sensitive to the absence and presence of negative outcomes. Events that reflected the presence and absence of positive outcomes should be remembered better by predominant actual: ideal than by predominant actual: ought discrepancy persons, whereas the reverse should be true for events that reflect the absence and presence of negative outcomes. This prediction was confirmed, and the predicted interaction remained significant even when subjects' pre-essay mood, postessay mood, and change in mood were statistically controlled. These results suggest that a chronic pattern of self-beliefs representing a distinct psychological situation produces sensitivity to events reflecting that psychological situation, despite there being no overlap in content or topic between the pattern and the events.
Individual differences in emotional reactivity or affective style can be decomposed into more elementary constituents. Several separable of affective style are identified such as the threshold for reactivity, peak amplitude of response, the rise time to peak and the recovery time. latter two characteristics constitute components of affective chronometry The circuitry that underlies two fundamental forms of motivation and and withdrawal-related processes-is described. Data on differences in functional activity in certain components of these are next reviewed, with an emphasis on the nomological network of surrounding individual differences in asymmetric prefrontal The relevance of such differences for understanding the nature affective dysfunction in affective disorders is then considered. The ends by considering what the prefrontal cortex “does” in certain of affective style and highlights some of the important questions for future research.
First-year students (N = 2,678) demonstrated differences on help-seeking attitudes and coping strategies by gender and race. African Americans had more positive attitudes toward seeking help for impersonal issues, whereas Asian Americans were more likely to use avoidant coping strategies. Women were more receptive to professional help than were men. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The current zeitgeist strongly emphasizes genetic and biochemical approaches to psychopathology over psychological and psychobiological approaches. It is argued that a psychobiological model, involving a theory of motivation derived from the animal learning literature, offers an attractive theoretical bridge between neurochemical influences and the phenotypic features of psychiatric disorders. This model involves separate but interactive appetitive and aversive motivational systems that control behavioral activation (appetitive) and inhibition (aversive). Ways in which these motivational constructs can be relevant to psychopathology are discussed for anxiety, psychopathy, childhood disorders, depression, mania, drug abuse, and schizophrenia. Because of this general application, motivational constructs offer an attractive theoretical framework for understanding psychopathology.
Application of the motivational theory to psychophysiology suggested that heart rate may be significantly influenced by appetitive motivation. A series of studies have shown that heart rate during performance of a continuous motor task does respond to appetitive motivation in the form of performance-contingent monetary incentives, but does not respond to aversive stimulation in the form of failure feedback. Nonspecific skin conductance fluctuations have not responded to appetitive motivation in this paradigm, but this failure could possibly be due to ceiling effects. Nonspecific skin conductance fluctuations do respond to aversive stimulation in other contexts. These findings suggest that under the right circumstances appetitive motivation can be assessed via heart rate and aversive motivation via skin conductance.
This study examined the relationships of the traits associated with Gray's behavioural approach system (BAS) and behavioural inhibition system (BIS) with cognitive processing of emotional information. Initially, participants completed questionnaires covering trait impulsivity and anxiety, and BAS and BIS sensitivities. They were then tested individually. After completing a questionnaire of current positive and negative moods, they completed three tasks measuring processing of pleasant, unpleasant and neutral information. Consistent with Gray’s theory, the results showed that impulsivity and BAS sensitivity were associated with the processing of pleasant information, while anxiety and BIS sensitivity were associated with the processing of unpleasant information. These findings imply that Gray’s BAS–BIS theory can be extended to cognitive processing of emotional information.
This paper presents a general statistical methodology for the analysis of multivariate categorical data arising from observer reliability studies. The procedure essentially involves the construction of functions of the observed proportions which are directed at the extent to which the observers agree among themselves and the construction of test statistics for hypotheses involving these functions. Tests for interobserver bias are presented in terms of first-order marginal homogeneity and measures of interobserver agreement are developed as generalized kappa-type statistics. These procedures are illustrated with a clinical diagnosis example from the epidemiological literature.
According to the consistency theory clinically relevant goals, as explicated by Grosse Holtforth and Grawe, play a prominent role in the development, maintenance and therapy of psychological disorders. Thus effective psychotherapies should "normalize" the subjective importance of these goals. These changes should be positively associated with the success of psychotherapy. To test these assumptions, clinically relevant goals of 64 inpatients undergoing cognitive behavioral therapy were assessed by the Inventory of Approach and Avoidance Goals (German: Fragebogen zur Analyse motivationaler Schemata, FAMOS) before and after therapy. Results show effects of normalization, as expected, especially on scales associated with psychopathology in former studies.