Mental Contrasting With Implementation Intentions Reduces Drinking When Drinking Is Hazardous: An Online Self-Regulation Intervention

Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA

INTRODUCTION

Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control).

METHOD

Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework.

CONCLUSION

If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes.

CLINICAL TRIAL REGISTRATION

NCT05014984.

A Study Planning Exercise Associated with Decreased Distraction Levels among Introductory Biology Students

Students struggle to regulate their learning during independent study sessions. In this study, we ask whether an online behavioral intervention helped introductory students decrease distraction while studying. The intervention consisted of exam 1 reflection, exam 2 planning, and exam 2 reflection exercises. During planning, students formed a goal, mentally contrasted (MC) a positive outcome of their goal to their present reality, identified an obstacle, and formed an implementation intention (II) to overcome that obstacle. During reflection, students self-reported their distraction while studying. Distraction was the most frequently reported study obstacle, and decreasing distraction was the second most frequently reported study goal. While students who aimed to decrease distraction as a goal did not follow through, students who planned for distraction obstacles did follow through on decreasing distraction levels. Only about half of students generated an II that aligned with their study goal, which may provide one reason for the opposing follow-through of distraction framed as a goal versus as an obstacle. Lastly, we examined the specificity of students' II's and found no relationship with follow-through. Overall, MC with II holds promise as a self-regulatory technique to help introductory biology students change their behaviors while studying.

The effect of forming implementation intentions on alcohol consumption: A systematic review and meta-analysis

ISSUES

Meta-analysis was used to estimate the effect of forming implementation intentions (i.e., if-then plans) on weekly alcohol consumption and heavy episodic drinking (HED). Sample type, mode of delivery, intervention format and timeframe were tested as moderator variables.

APPROACH

Cochrane, EThOS, Google Scholar, PsychArticles, PubMed and Web of Science were searched for relevant publications to 31 March 2021. Random-effects meta-analysis was used to estimate the effect size difference (d) between individuals forming versus not forming implementation intentions on weekly consumption and HED.

KEY FINDINGS

Sixteen studies were included in meta-analyses. The effect size difference for forming implementation intentions on weekly alcohol consumption was d₊  = -0.14 confidence interval (CI) [-0.24; -0.03]. Moderator analyses highlighted stronger effects for: (i) community (d₊  = -0.38, CI [-0.58; -0.18]) versus university (d₊  = -0.04, CI [-0.13; 0.05]) samples; (ii) paper (d₊  = -0.26, CI [-0.43; -0.09]) versus online (d₊  = -0.04, CI [-0.14; 0.06]) mode of delivery; and (iii) volitional help sheet (d₊  = -0.34, CI [-0.60; -0.07]) versus implementation intention format (d₊  = -0.07, CI [-0.16; 0.02]). In addition, effects diminished over time (B = 0.02, SE = 0.01, CI [0.03; 0.01]). Forming implementation intentions had a null effect on HED, d₊  = -0.01 CI [-0.10; 0.08].

IMPLICATIONS

Forming implementation intentions reduces weekly consumption but has no effect on HED.

CONCLUSION

This review identifies boundary conditions on the effectiveness of implementation intentions to reduce alcohol consumption. Future research should focus on increasing the effectiveness of online-delivered interventions and integrating implementation intention and motivational interventions.

Mental contrasting with implementation intentions as a technique for media-mediated persuasive health communication

Mental Contrasting with Implementation Intentions (MCII) is a self-regulation strategy that combines the strategies mental contrasting (MC) in which individualscontrast a desired future with the current reality with the strategy of forming implementation intentions (II), which involves making concrete if-then plans (implementation intentions, II) to overcome the obstacles standing in the way of the desired future. Numerous studies across behavioral domains have demonstrated the effectiveness of this strategy in supporting people to adopt health-promoting behaviors or changing unhealthy behaviors. However, research on MCII has so far neglected the applicability of the concept in media-mediated persuasive health communication. This conceptual review aims to demonstrate and examine the potentials and effects of MCII as a technique to tailor media-mediated persuasive health messages and their dissemination through different media channels. In doing so, it draws on existing models of health behavior change, especially individuals' threat and coping appraisals. Potential effects of MCII on these cognitive factors are discussed, and practical implications for health message design are outlined.

Seeking care where they can: A systematic review of global trends in online alcohol treatment utilization among non-veteran and veteran women

Background

Findings from a person-level meta-analysis of online alcohol intervention trials suggest that women disproportionately seek out such interventions (Riper et al., 2018). Although women may be a "hidden population" that is particularly drawn to online alcohol interventions, trial design features may explain women's apparent over-representation in these trials.

Methods

This systematic review examined associations between gender-tailored recruitment/inclusion criteria and proportions of women enrolled in online alcohol intervention trials, evaluated whether community samples have greater proportions of women than clinical samples, and compared country-specific average proportions of women in trials to country-specific proportions of women with Alcohol Use Disorder (AUD).

Results

Forty-four trials met inclusion/exclusion criteria, 34 community samples and 10 drawn from clinical settings; 4 studies included U.S. veterans and were examined separately. The average proportion of community-recruited women across the studies was 51.20% and the average proportion of clinically-recruited women was 35.81%, a difference that was statistically significant. Across the countries with relevant trials, the expected proportion of those with AUD who are women is 27.1% (World Population Review, 2022). Only 2 studies used targeted recruitment for women so no between-group tests were conducted. There was not a statistically significant difference in the proportion of women across trials that did and did not use gender-tailored alcohol inclusion criteria.

Conclusions

Results from this systematic review suggest that study design factors do not account for the marked over-representation of women in online alcohol interventions, indicating that women are indeed a "hidden population" whose needs should be understood and accommodated.

Testing a first online intervention to reduce conformity to cyber aggression in messaging apps

Early adolescents frequently use mobile messaging apps to communicate with peers. The popularity of such messaging apps has a critical drawback because it increases conformity to cyber aggression. Cyber aggression includes aggressive peer behaviors such as nasty comments, nonconsensual image sharing, and social exclusion, to which adolescents subsequently conform. Recent empirical research points to peer group norms and reduced accountability as two essential determinants of conformity to cyber aggression. Therefore, the current study aimed to counteract these two determinants in a 2 (peer group norms counteracted: yes, no) x 2 (reduced accountability counteracted: yes, no) design. We created four intervention conditions that addressed adolescents’ deficits in information, motivation, and behavioral skills. Depending on the condition (peer group norms, reduced accountability, combination, or control), we first informed participants about the influence of the relevant determinant (e.g., peer group norms). Subsequently, participants performed a self-persuasion task and formulated implementation-intentions to increase their motivation and behavioral skills not to conform to cyber aggression. Effectiveness was tested with a messaging app paradigm and self-report among a sample of 377 adolescents (M_age = 12.99, SD_age = 0.84; 53.6% boys). Factorial ANCOVAs revealed that none of the intervention conditions reduced conformity to cyber aggression. Moreover, individual differences in susceptibility to peer pressure or inhibitory control among adolescents did not moderate the expected relations. Therefore, there is no evidence that our intervention effectively reduces conformity to cyber aggression. The findings from this first intervention effort point to the complex relationship between theory and practice. Our findings warrant future research to develop potential intervention tools that could effectively reduce conformity to cyber aggression.

Effectiveness of a Motivational Smoking Reduction Strategy Across Socioeconomic Status and Stress Levels

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions (MCII) as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control (n = 161) or MCII condition (n = 164). Data were collected via MTurk, during the U.S.’ initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low—but not high—in subjective-SES, MCII (vs. control) improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive (p = 0.11). Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant (p = 0.11). Per an exploratory analysis, we observed that stress significantly moderated the condition effect (p = 0.01), such that MCII (vs. control) facilitated reduction among those experiencing high (p = 0.03), but not low stress (p = 0.15). Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools.

The self-regulation of face touching - a preregistered experiment testing if-then plans as a means to promote COVID-19 prevention

Objective: Reducing face touching could help slow COVID-19's spread. We tested whether implementation intentions, a simple-to-use behaviour change intervention, reduce face-touching behaviour effectively.Design: In this pre-registered online study, we utilised a novel way to collect behavioural data during a pandemic. We obtained video recordings of 156 adults while performing three engaging tasks for four minutes each. After the baseline task, participants formed the goal to avoid touching their faces; some participants also formed implementation intentions, targeting either the frequency or duration of face touching.Main Outcome Measures: The 468 videos were rated by two independent raters for face touching frequency and duration.Results: Face touching was widespread. Compared to the baseline, there was a slight reduction in the frequency of face touching after the experimental manipulations. We observed a significant decrease in the length of face touching only for participants with duration-focused implementation intentions.Conclusion: While implementation intentions have effectively downregulated other unwanted behaviours, they did not reduce the frequency of face-touching behaviour. Still, duration-focused implementation intentions appear to be a promising strategy for face-touching behaviour change. This highlights the need for further optimisation and field research to test the effectiveness of implementation intentions in everyday life contexts.

Harnessing Wise Interventions to Advance the Potency and Reach of Youth Mental Health Services

Despite progress in research on evidence-based treatments (EBTs) for youth psychopathology, many youths with mental health needs do not receive services, and EBTs are not always effective for those who access them. Wise interventions (WIs) may help address needs for more disseminable, potent youth mental health interventions. WIs are single-component, social-psychological interventions designed to foster adaptive meaning-making. They have improved health-related and interpersonal youth outcomes, yet their potential to reduce youth psychopathology has not been systematically explored. Accordingly, we conducted a systematic, descriptive review characterizing WIs' potential to reduce youth mental health problems. Across 25 RCTs (N = 9219 youths, ages 11-19) testing 13 intervention types, 7 WIs qualified as "Well-Established," "Probably Efficacious," or "Possibly Efficacious" for reducing one or more types of youth psychopathology, relative to controls. Among these, 5 WIs significantly reduced youth depressive symptoms; 3, general psychological distress; and 1 each, eating problems, anxiety, and substance use. Three of these 7 WIs were self-administered by youths, and four by trained interventionists; collectively, they were 30-168 min in length and targeted clinic-referred and non-referred samples in clinical, school, and laboratory settings. Overall, certain WIs show promise in reducing mild-to-severe youth psychopathology. Given their brevity and low cost relative to traditional (i.e., therapist-delivered, 12- to 16-week, clinic-based) EBTs, WIs may represent beneficial additions to the youth mental healthcare ecosystem. Priorities for future research are proposed, including testing WIs for parents, younger children, and externalizing problems; as EBT adjuncts; and in schools and primary care clinics to increase access to brief, effective supports.

The Self-Regulation of Conformity: Mental Contrasting With Implementation Intentions (MCII)

The self-regulation of conformity has received little attention in previous research. This is surprising because group majorities can exert social strong pressure on people, leading them to overlook the pursuit of their own goals. We investigated if self-regulation by mental contrasting with implementation intentions (MCII) can reduce people's tendency to conform and facilitate their own goal-pursuit despite deviant majority influence. In a computer-based logical reasoning task, we exposed participants to a conformity manipulation, where we presented bogus diagrams showing the supposedly correct answers of a majority ingroup. Compared to participants who were not given a self-regulation strategy (Studies 1, 2, and 4) or who were in an active control group (Study 3), MCII helped participants to self-regulate conforming behavior in trying to solve the task and to independently solve the logical reasoning task, as indicated by increases in correct answers in the task. The findings suggest that MCII is an effective strategy to regulate people's tendency to conform and supports them to attain their goal despite deviant majority influence.

A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment

Mental contrasting with implementation intentions (MCII) is a self-regulation strategy that enhances goal attainment. This meta-analysis evaluated the efficacy of MCII for goal attainment and explored potential moderators. A total of 21 empirical studies with 24 independent effect sizes (15,907 participants) were included in the analysis. Results showed that MCII to be effective for goal attainment with a small to medium effect size (g = 0.336). The effect was mainly moderated by intervention style. Specifically, studies with interventions based on interactions between participants and experimenters (g = 0.465) had stronger effects than studies with interventions based on interactions between participants and documents (g = 0.277). The results revealed that MCII is a brief and effective strategy for goal attainment with a small to moderate effect; however, because of some publication bias, the actual effect sizes may be smaller. Due to small number of studies in this meta-analysis, additional studies are needed to determine the role of moderator variables.

Comparing mental contrasting with implementation intentions against solution-focused and autonomous planning

Research suggests that mental contrasting with implementation intentions (MCII) enhances commitment and goal attainment. However, most studies have used limited comparison conditions. The present study compared MCII against two other potentially effective approaches: autonomous planning (AP), and solution-focused planning (SFP). It was thought that condition would have an indirect effect on goal progress by affecting commitment. However, goal attainment expectancy was hypothesised to be a moderator such that MCII has positive effects when expectancy is high but negative effects when expectancy is low. Ninety-eight female students were randomly assigned to one of three conditions: 1) MCII, 2) AP, or 3) SFP. All students initially set themselves a goal for the coming week regarding personal projects. Mean commitment and goal progress were marginally higher in the MCII condition than in the AP and SFP conditions but the differences were not statistically significant and (as predicted) much smaller than in previous research. Expectancy did not appear to have a moderating effect. The apparent benefits of MCII were larger relative to AP than to SFP. Results suggest that MCII may sometimes be no more effective than other approaches to goal-setting and planning, particularly if they are evidence-based and carefully-designed. Implications for schools are addressed.

Evidence That Implementation Intentions Enhance Cognitive Training and Reduce Alcohol Consumption in Heavy Drinkers: A Randomized Trial

BACKGROUND

Current training tasks to improve the cognitive deficits thought to be involved in sustained heavy drinking need further investigation to optimize their effectiveness.

PURPOSE

The present study investigated whether combining implementation intention provision with a cognitive training task had a measurable effect on alcohol consumption in heavy drinkers and explored the neural mechanisms underpinning any reductions in subsequent alcohol consumption.

METHODS

Thirty-two heavy-drinking participants completed approach-avoidance and visual probe training tasks preintervention and postintervention during functional Magnetic Resonance Imaging. Participants in the intervention group were randomized to form implementation intentions and participants in the control condition read a goal intention. Alcohol consumption was recorded preintervention and at 1 month follow-up.

RESULTS

Compared to the control group, implementation intention provision significantly improved performance on alcohol-avoidance tasks postintervention, t(30) = -2.315, p = .028, d = .85, and reduced alcohol consumption by 6.9 units/week (1 unit = 10 mL or 8 g ethanol), F(1,30) = 4.263, p = .048 (d = .74), at follow-up. However, the analysis of functional Magnetic Resonance Imaging data revealed no significant differences between groups.

CONCLUSIONS

These findings show for the first time that implementation intentions targeting cognitive processes can significantly reduce alcohol consumption among heavy drinkers. However, there was no evidence that the effects were mediated by changes in neural activity. Further work is required to explore the neural mechanisms underpinning the operation of implementation intentions.

TRIAL REGISTRATION

This trial was registered (ISRCTN:35503634) and is available at https://www.isrctn.com/ISRCTN35503634.

An online randomised controlled trial of mental contrasting with implementation intentions as a smoking behaviour change intervention

Objective: We assessed the effectiveness of mental contrasting with implementation intentions (MCII), an established self-regulatory strategy, as a brief online smoking behaviour change intervention. We expected that MCII would enhance smoking reduction among the highly cigarette dependent because MCII is most effective for challenging pursuits. Design: Participants interested in reducing or quitting smoking were recruited online via Amazon Mechanical Turk. At Time 1, we assessed cigarette dependence using the Cigarette Dependence Scale (CDS-5), then administered one of two brief self-help interventions: MCII (n = 172) or a government-promoted control strategy (n = 174). Participants were invited to complete an online follow-up survey 4 weeks later (Time 2). Main Outcome Measure: At Time 1 and Time 2, we measured recent cigarette smoking with a retrospective, self-report questionnaire. We used these reports to compute smoking reduction scores, with an intent-to-treat approach. Results: MCII increased smoking reduction compared to the control strategy at high, but not low, levels of cigarette dependence. Conclusion: We found preliminary evidence consistent with MCII, delivered as a brief online intervention, as an effective smoking reduction strategy for highly dependent cigarette smokers. Further research is needed on MCII as a smoking behaviour change intervention.