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Vandyousefi S, Oettingen G, Wittleder S, Moin T, Sweat V, Aguilar AD, Ruan A, Angelotti G, Wong L, Orstad SL, Illengberger N, Nicholson A, Lim S, Cansler R, Portelli D, Sherman S, Jay MR. 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. Contemp Clin Trials 2024; 141:107523. [PMID: 38608752 DOI: 10.1016/j.cct.2024.107523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 03/31/2024] [Accepted: 04/08/2024] [Indexed: 04/14/2024]
Abstract
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.
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Affiliation(s)
- Sarvenaz Vandyousefi
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Gabriele Oettingen
- Department of Psychology, New York University, New York, NY, United States of America
| | - Sandra Wittleder
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Tannaz Moin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America; Department of Medicine, David Geffen School of Medicine, The University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Victoria Sweat
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Adrian D Aguilar
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrea Ruan
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Gina Angelotti
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Laura Wong
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Stephanie L Orstad
- Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Nicholas Illengberger
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Andrew Nicholson
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Sahnah Lim
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Rachel Cansler
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Dilara Portelli
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Scott Sherman
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America
| | - Melanie R Jay
- New York Harbor Veterans Health Affairs, New York, NY, United States of America; Department of Medicine, New York University Grossman School of Medicine, New York, NY, United States of America; Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States of America.
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Heimer M, Schmitz S, Teschler M, Schäfer H, Douma ER, Habibovic M, Kop WJ, Meyer T, Mooren FC, Schmitz B. eHealth for maintenance cardiovascular rehabilitation: a systematic review and meta-analysis. Eur J Prev Cardiol 2023; 30:1634-1651. [PMID: 37154363 DOI: 10.1093/eurjpc/zwad145] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/25/2023] [Accepted: 05/04/2023] [Indexed: 05/10/2023]
Abstract
AIMS To provide a quantitative analysis of eHealth-supported interventions on health outcomes in cardiovascular rehabilitation (CR) maintenance (phase III) in patients with coronary artery disease (CAD) and to identify effective behavioural change techniques (BCTs). METHODS AND RESULTS A systematic review was conducted (PubMed, CINAHL, MEDLINE, and Web of Science) to summarize and synthesize the effects of eHealth in phase III maintenance on health outcomes including physical activity (PA) and exercise capacity, quality of life (QoL), mental health, self-efficacy, clinical variables, and events/rehospitalization. A meta-analysis following the Cochrane Collaboration guidelines using Review Manager (RevMan5.4) was performed. Analyses were conducted differentiating between short-term (≤6 months) and medium/long-term effects (>6 months). Effective behavioural change techniques were defined based on the described intervention and coded according to the BCT handbook. Fourteen eligible studies (1497 patients) were included. eHealth significantly promoted PA (SMD = 0.35; 95%CI 0.02-0.70; P = 0.04) and exercise capacity after 6 months (SMD = 0.29; 95%CI 0.05-0.52; P = 0.02) compared with usual care. Quality of life was higher with eHealth compared with care as usual (SMD = 0.17; 95%CI 0.02-0.32; P = 0.02). Systolic blood pressure decreased after 6 months with eHealth compared with care as usual (SMD = -0.20; 95%CI -0.40-0.00; P = 0.046). There was substantial heterogeneity in the adapted BCTs and type of intervention. Mapping of BCTs revealed that self-monitoring of behaviour and/or goal setting as well as feedback on behaviour were most frequently included. CONCLUSION eHealth in phase III CR is effective in stimulating PA and improving exercise capacity in patients with CAD while increasing QoL and decreasing systolic blood pressure. Currently, data of eHealth effects on morbidity, mortality, and clinical outcomes are scarce and should be investigated in future studies. REGISTRATION PROSPERO: CRD42020203578.
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Affiliation(s)
- Melina Heimer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Sandra Schmitz
- School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Hendrik Schäfer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Emma R Douma
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Mirela Habibovic
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Willem J Kop
- Center of Research on Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Thorsten Meyer
- School of Public Health, Bielefeld University, Bielefeld, Germany
- Institute for Rehabilitation Medicine, Faculty of Medicine, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Frank C Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
- DRV Clinic Königsfeld, Center for Medical Rehabilitation, Ennepetal, Germany
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Abstract
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.
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Affiliation(s)
- Alexander Ort
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Andreas Fahr
- Department of Communication and Media Research, University of Fribourg, Fribourg, Switzerland
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Lee YS, Chia M, Komar J. A Systematic Review of Physical Activity Intervention Programs in ASEAN Countries: Efficacy and Future Directions. Int J Environ Res Public Health 2022; 19:ijerph19095357. [PMID: 35564751 PMCID: PMC9103551 DOI: 10.3390/ijerph19095357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/10/2022]
Abstract
A systematic review was conducted on the efficacy of interventions to improve physical activity. PubMed, Scopus and Web of Science were scanned for eligible studies published from 1978 to August 2021, resulting in a total of 52 relevant studies for review. The Downs and Black checklist was used as a quality assessment ool for a risk of bias assessment. The 52 studies were then broadly categorised into three major approach types: informational, behavioural and/or social, as well as direct. Within each major approach, studies were further sub-categorised into more specific intervention types before being assessed for their efficacy and applicability. Overall, the intervention types that seemed to be the most efficacious in increasing physical activity levels were those that involved home-based information provision, community-wide campaigns, incentivised change, individually adapted health behaviour programs, family-based social support interventions and the provision of self-monitoring tools. However, the results must be interpreted holistically, as many of the successful interventions included more than one approach type and success is likely contingent on effectively addressing several concurrent facets. The systematic review is registered on PROSPERO. Registration number: 282752.
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Voigt EC, Mutter ER, Oettingen G. Effectiveness of a Motivational Smoking Reduction Strategy Across Socioeconomic Status and Stress Levels. Front Psychol 2022; 13:801028. [PMID: 35369175 PMCID: PMC8973437 DOI: 10.3389/fpsyg.2022.801028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/15/2022] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Elizabeth C. Voigt
- Department of Global Public Health, New York University, New York, NY, United States
- Department of Psychology, New York University, New York, NY, United States
- *Correspondence: Elizabeth C. Voigt,
| | | | - Gabriele Oettingen
- Department of Psychology, New York University, New York, NY, United States
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Klusmann V, Gow AJ, Robert P, Oettingen G. Using Theories of Behavior Change to Develop Interventions for Healthy Aging. J Gerontol B Psychol Sci Soc Sci 2021; 76:S191-S205. [PMID: 34515775 DOI: 10.1093/geronb/gbab111] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Indexed: 12/28/2022] Open
Abstract
Healthy aging requires people to adopt and maintain beneficial behaviors in all stages of the life span. Supporting behavior change, including via the motivation to make and maintain those changes, is therefore important for the promotion of healthy aging. The aim of this overview is to introduce theoretical frameworks from the psychology of motivation that lend themselves to the development of effective interventions promoting behavior change conducive to healthy aging. We discuss theoretical frameworks referring to the determinants, properties, and functionality of goals aimed at behavior change, and consider the implications of the various theories for designing interventions to support healthy aging. We first consider theories that focus on beliefs and attitudes as determinants of goals, then we address theories that focus on the structure and content as important properties of goals, and, finally, we examine theories drawing on conscious and nonconscious processes underlying the functionality of these goals. We will present if-then planning and mental contrasting, as well as nudging and boosting, that is, novel strategies of behavior change that support the creation of scalable interventions for healthy aging across the life span. Against this background, new perspectives emerge for modern, state-of-the-art, and individually tailored interventions with the aim of enhancing older people's healthy living.
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Affiliation(s)
- Verena Klusmann
- Department of Psychology, University of Konstanz, Germany.,Department of Psychology and Human Movement Science, University of Hamburg, Germany
| | - Alan J Gow
- Centre for Applied Behavioural Sciences and Department of Psychology, School of Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - Philippe Robert
- CoBTEK Lab, IA Association, University Côté d'Azur, Nice, France
| | - Gabriele Oettingen
- Department of Psychology and Human Movement Science, University of Hamburg, Germany.,Department of Psychology, New York University, USA
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Monin JK, Oettingen G, Laws H, David D, DeMatteo L, Marottoli R. A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons with Early-Stage Dementia. J Gerontol B Psychol Sci Soc Sci 2021; 77:513-524. [PMID: 34171086 DOI: 10.1093/geronb/gbab115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Behavioral interventions can reduce distress for couples coping with early-stage dementia. However, most interventions are limited in accessibility and fail to address individualized goals. This pilot study examined the dyadic effects on multiple indicators of well-being of the Wish Outcome Obstacle Plan (WOOP) intervention which guides participants to use Mental Contrasting with Implementation Intentions (MCII) to achieve attainable goals in their daily lives. METHODS This randomized controlled trial included 45 older persons with early-stage dementia (PWD) and their spousal care partners (CPs: n = 90 individuals). CPs were assigned randomly to WOOP training immediately after baseline (WOOP) or after a three-month follow-up interview (Control; CON). Both groups received a dementia care education booklet. WOOP CPs were instructed to practice WOOP at least once a day for two weeks. All CPs and PWDs completed home surveys (baseline, two-weeks, and three months) measuring perceived stress, depressive symptoms, quality of life, and affect. RESULTS Mixed effects models showed significant intervention x time interaction effects with large effect sizes for CPs on three of the five outcomes over three months. Compared to CON, WOOP CPs had decreased perceived stress (δ = 1.71) and increased quality of life (δ = 1.55) and positive affect (δ = 2.30). WOOP PWD showed decreased perceived stress (δ = .87) and increased quality of life (δ = 1.26) but these effects were not statistically significant. DISCUSSION WOOP is a promising, brief intervention to improve dementia care partners' well-being that may also positively impact their partners with dementia.
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Affiliation(s)
- Joan K Monin
- Social and Behavioral Sciences, Yale School of Public Health
| | | | - Holly Laws
- Department of Psychology, University of Massachusetts Amherst
| | - Daniel David
- Rory Meyers College of Nursing, New York University
| | | | - Richard Marottoli
- Geriatrics, Yale School of Medicine, VA Connecticut Healthcare System
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Wang G, Wang Y, Gai X. A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment. Front Psychol 2021; 12:565202. [PMID: 34054628 PMCID: PMC8149892 DOI: 10.3389/fpsyg.2021.565202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Guoxia Wang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Yi Wang
- School of Psychology, Northeast Normal University, Changchun, China
| | - Xiaosong Gai
- School of Psychology, Northeast Normal University, Changchun, China
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Browne J, Battaglini C, Jarskog LF, Sheeran P, Abrantes AM, McDermott J, Elliott T, Gonzalez O, Penn DL. Targeting Physical Health in Schizophrenia: Results from the Physical Activity Can Enhance Life (PACE-Life) 24-Week Open Trial. Ment Health Phys Act 2021; 20:100393. [PMID: 34178113 PMCID: PMC8224902 DOI: 10.1016/j.mhpa.2021.100393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Poor health and low cardiorespiratory fitness (CRF) contribute substantially to the shortened lifespan of individuals with schizophrenia spectrum disorders (SSDs). Increasing physical activity has demonstrated value; however, there are limited interventions that are accessible and adequately address motivational challenges. This paper reports on an open trial of Physical Activity Can Enhance Life (PACE-Life), a motivational theory-based manualized multicomponent walking intervention. The primary aim was to examine the feasibility of implementing PACE-Life through meeting the recruitment target (n=14), attendance and adherence rates, and participant feedback. The secondary aim was to assess the impact of PACE-Life on intermediate targets (autonomous motivation and satisfaction of autonomy, relatedness, and competence needs), proximal outcomes (Fitbit steps/day and minutes spent walking), the primary outcome (CRF), and secondary outcomes (loneliness, symptoms, resting heart rate, blood pressure, weight, body mass index, and hip and waist circumference). Seventeen participants with SSDs enrolled in a 24-week open trial. Assessments occurred at baseline, midpoint, post-test, and one-month follow-up. The recruitment target was exceeded, the group attendance rate was 34%, Fitbit adherence rate was 54%, and participant feedback indicated satisfaction with the intervention as well as a positive group environment. There was a large improvement in the primary outcome of CRF with 77% of participants achieving clinically significant improvement at post-test. Small and medium effect size increases were observed in autonomous motivation and satisfaction of autonomy, relatedness, and competence needs. Fitbit data and secondary outcomes generally remained unchanged or worsened during the intervention. Results from this open trial indicate that PACE-Life leads to meaningful changes in CRF among people with SSDs.
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Affiliation(s)
- Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC, USA
| | - Claudio Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L. Fredrik Jarskog
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ana M. Abrantes
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - Jessica McDermott
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tonya Elliott
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Oscar Gonzalez
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L. Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
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Orleans-Pobee M, Browne J, Ludwig K, Merritt C, Battaglini CL, Jarskog LF, Sheeran P, Penn DL. Physical Activity Can Enhance Life (PACE-Life): results from a 10-week walking intervention for individuals with schizophrenia spectrum disorders. J Ment Health 2021; 31:357-365. [PMID: 33527859 DOI: 10.1080/09638237.2021.1875403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Premature mortality in individuals with schizophrenia spectrum disorders (SSDs) is largely due to high rates of chronic health conditions. Although exercise has been shown to improve health in this population, scalable and accessible interventions are limited. AIM To examine the impact of Physical Activity Can Enhance Life (PACE-Life), a novel walking intervention, on physical activity, and on secondary outcomes of cardiorespiratory fitness (CRF), physical health, autonomous motivation, social support, and quality of life. METHOD Sixteen individuals with SSDs were enrolled in a 10-week open trial. The intervention included walking groups, home-based walks, Fitbit use, and goal-setting and if-then plans. Within-group effect sizes were calculated to represent changes from baseline to post-test and 1-month follow-up. RESULTS Participants increased self-reported weekly walking minutes and decreased daily hours spent sitting; however, Fitbit-recorded exercise behavior changed only minimally. There were also improvements in secondary outcomes including autonomous motivation and hip circumference. CRF improved only minimally, and findings were relatively unchanged with outliers removed from the full sample. CONCLUSIONS This open trial demonstrates modest improvements in key parameters of exercise behavior and physical health from participating in PACE-Life. Future research should assess the efficacy of this intervention in a randomized controlled trial.
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Affiliation(s)
- Maku Orleans-Pobee
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Julia Browne
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kelsey Ludwig
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carrington Merritt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Claudio L Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L Fredrik Jarskog
- Department of Psychiatry, University of North Carolina School of Medicine, NC, USA
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
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Abstract
BACKGROUND Accelerating advances in health behavior change requires releasing the brake, as well as applying the throttle. This paper discusses six challenges or "brakes" that have slowed progress. PURPOSE/METHODS/RESULTS We engage with six issues that limit investigators' ability to delineate and test the strategy-target and target-behavior relations that underlie effective interventions according to the experimental medicine approach. We discuss the need for guidance on how to identify the relevant mechanism of action (target) in an intervention and whether a periodic table of health behavior constructs might aid investigators. Experimental and correlational analyses (prospective surveys and behavior change techniques) have been used to test the validity of targets, and we present evidence that there is little agreement among the findings from different research designs. Whereas target engagement is typically analyzed in terms of increasing scores on constructs that impel behavior change, we discuss the role of impeding targets and the benefits of adopting a broader construal of potential targets and approaches to engagement. There is presently a paucity of competitive tests regarding which strategies best engage targets and we discuss empirical criteria and conceptual developments that could enhance the evidence base. Finally, we highlight the need to take "context" or conditional intervention effects more seriously by leveraging the interplay between questions about why interventions work and questions about when and for whom they work. CONCLUSION Candid appraisal of the challenges facing research on health behavior change can generate new opportunities for theoretical development and offer direction and cumulative impetus for empirical work.
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Affiliation(s)
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, NC, USA
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Majmundar A, Cerrada C, Fang W, Huh J. In Lieu of Smoking: Are Smokers More Likely to Enact Certain Types of Implementation Intention Plans During a JIT Smoking Cessation? Int J Behav Med 2020; 27:556-564. [PMID: 32378047 PMCID: PMC8259899 DOI: 10.1007/s12529-020-09893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND To identify actionable and effective implementation intention (II) plans, we examined whether (a) IIs suggesting food or nicotine-based substitution strategies to help quit smoking cigarettes would be more likely to be enacted in real time, (b) IIs reminding participants to cognitively motivate themselves or engage in solitary activity would be more likely to be enacted than those suggesting seeking social support, and (c) II plan enactment based on the above strategies would be associated with reporting momentary lapse avoidance. METHOD A sample of 57 Asian American young adult (18-25 years) smokers participated in a 4-week, mobile-based smoking cessation intervention, implemented in a Just-In-Time framework. User-specified IIs were categorized into nature of activity (cognitively motivate themselves, engage in solitary activity, seek social support) and type of substitution strategy (food, nicotine, no substitution). Outcome variable was momentary enactment of the given II. Generalized mixed linear models were used for analyses. RESULTS IIs reminding participants to cognitively motivate themselves and/or engage in solitary activities were more likely to be enacted than IIs recommending seeking social support. IIs recommending nicotine-based substitution were more likely to be enacted than IIs that did not specify any substitution. IIs suggesting food-based substitution, however, were less likely to be enacted than those not suggesting a specific substitution. II plan enactment based on the above strategies was significantly associated with avoiding momentary lapses compared to when momentary lapses occurred. CONCLUSION Specifying II recommendations found to be helpful with avoiding lapses in a smoking cessation context, can increase chances of II enactment, and improve overall health intervention outcomes.
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Affiliation(s)
- Anuja Majmundar
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA.
| | - Christian Cerrada
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
| | - William Fang
- Department of Orthopaedic Surgery, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Jimi Huh
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor, Los Angeles, CA, 90032, USA
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Abstract
BACKGROUND People often fail to translate their intentions into health behaviors. PURPOSE The present research examined a new potential moderator of intention-behavior relations, namely, how realistic or unrealistic are respective goal intentions. Goal realism was defined as the degree to which intentions are aligned with expectations (i.e., predicted performance). METHODS A validation study (N = 81) examined our novel goal realism measure. Study 1 (N = 246) tested goal importance, fantasy proneness, and pathways thinking as predictors of realistic goal setting using a cross-sectional questionnaire design. Moderation of the intention-behavior relation was tested in prospective surveys of cervical cancer screening (Study 2, N = 854), physical activity (Study 3, N = 237), and performance of a suite of 15 health behaviors (Study 4, N = 378). RESULTS The validation study offered preliminary evidence concerning the convergent and predictive validity of the goal realism measure. Study 1 showed that goal importance, fantasy proneness, and pathways thinking interacted to predict how realistic were intentions to perform 11 health behaviors. In Study 2, realistic intentions better predicted women's attendance for cervical cancer screening compared with unrealistic intentions. Study 3 confirmed this finding for a frequently performed behavior (physical activity). In Study 4, multilevel modeling of longitudinal data for 15 health behaviors again revealed a significant goal realism × intention interaction. Greater realism was associated with improved prediction of behavior by intention. The interaction term remained significant even when past behavior, perceived behavioral control, and other predictors were taken into account. CONCLUSIONS The present findings offer new insights into the factors that lead to more realistic intentions and demonstrate that goal realism influences how effectively intentions are translated into action.
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Affiliation(s)
- Aya Avishai
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
| | - Mark Conner
- School of Psychology, University of Leeds, Leeds, UK
| | - Paschal Sheeran
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, NC, USA
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Mutter ER, Oettingen G, Gollwitzer PM. An online randomised controlled trial of mental contrasting with implementation intentions as a smoking behaviour change intervention. Psychol Health 2019; 35:318-345. [PMID: 31264451 DOI: 10.1080/08870446.2019.1634200] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
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.
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Buller MK, Bettinghaus EP, Fluharty L, Andersen PA, Slater MD, Henry KL, Liu X, Fullmer S, Buller DB. Improving health communication with photographic images that increase identification in three minority populations. Health Educ Res 2019; 34:145-158. [PMID: 30726902 PMCID: PMC6424148 DOI: 10.1093/her/cyy054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/26/2018] [Indexed: 05/22/2023]
Abstract
The homophily principle, that perceived similarities among people produce positive reactions, is a cross-cultural, global phenomenon. This study aimed to test the prediction that photographs that depict models similar to the target population improve health communication by increasing perceived identification in three racial/ethnic populations. Three separate nationally representative stratified samples (n = 1638) of African American, Hispanic and Native American adults were drawn from GfK's Knowledge Panel�. Participants read a message advocating increased physical activity and improved diets and completed measures on behavioral intentions, outcome and self-efficacy expectations and identification. The message contained photographs from a stock photograph service or photographs created for the research project to match the three minority populations, Real Health Photos (RHP). Structural equation modeling confirmed the theoretical hypothesis that RHP which matched the minority population increased behavioral intentions and was mediated by identification (P < 0.05) in all three racial/ethnic minority samples. Messages with only half of the matched RHP images had these same positive indirect effects among African Americans and Hispanics (P < 0.05). The impact of matching visual images in health messages to recipients derived from identification with the characters in images. Homophily and identification are hardwired, evolutionary, biological phenomena that should be capitalized on health educators with minority populations.
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Affiliation(s)
- M K Buller
- Research Department, Klein Buendel, Inc., Golden, CO, USA
| | | | | | - P A Andersen
- School of Communication, San Diego State University, San Diego, CA, USA
| | - M D Slater
- School of Communication, The Ohio State University, Columbus, OH, USA
| | - K L Henry
- Department of Psychology, Colorado State University, Ft. Collins, CO, USA
| | - X Liu
- Research Department, Klein Buendel, Inc., Golden, CO, USA
| | - S Fullmer
- Research Department, Klein Buendel, Inc., Golden, CO, USA
| | - D B Buller
- Research Department, Klein Buendel, Inc., Golden, CO, USA
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Hart T, Vaccaro M, Collier G, Chervoneva I, Fann JR. Promoting mental health in traumatic brain injury using single-session Behavioural Activation and SMS messaging: A randomized controlled trial. Neuropsychol Rehabil 2019; 30:1523-1542. [DOI: 10.1080/09602011.2019.1592761] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Tessa Hart
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | - Monica Vaccaro
- Moss Rehabilitation Research Institute, Elkins Park, PA, USA
| | | | - Inna Chervoneva
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jesse R. Fann
- University of Washington School of Medicine, Seattle, WA, USA
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Wittleder S, Kappes A, Oettingen G, Gollwitzer PM, Jay M, Morgenstern J. Mental Contrasting With Implementation Intentions Reduces Drinking When Drinking Is Hazardous: An Online Self-Regulation Intervention. Health Educ Behav 2019; 46:666-676. [PMID: 30836781 DOI: 10.1177/1090198119826284] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Introduction. Drinking alcohol has detrimental health consequences, and effective interventions to reduce hazardous drinking are needed. The self-regulation intervention of Mental Contrasting with Implementation Intentions (MCII) promotes behavior change across a variety of health behaviors. In this study, we tested if online delivery of MCII reduced hazardous drinking in people who were worried about their drinking. Method. Participants (N = 200, female = 107) were recruited online. They were randomized to learn MCII or solve simple math problems (control). Results. Immediately after the intervention, participants in the MCII condition (vs. control) reported an increased commitment to reduce drinking. After 1 month, they reported having taken action measured by the Readiness to Change drinking scale. When drinking was hazardous (Alcohol Use Disorders Identification Test ≥ 8, n = 85), participants in the MCII condition indicated a decreased number of drinking days, exp(β) = 0.47, CI (confidence interval) [-1.322, -.207], p = .02, and drinks per week, exp(β) = 0.57, CI [0.94, 5.514], p = .007, compared with the control condition. Discussion. These findings demonstrate that a brief, self-guided online intervention (Mdn = 28 minutes) can reduce drinking in people who worry about their drinking. Our findings show a higher impact in people at risk for hazardous drinking. Conclusion. MCII is scalable as an online intervention. Future studies should test the cost-effectiveness of the intervention in real-world settings.
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Affiliation(s)
- Sandra Wittleder
- 1 University of Hamburg, Hamburg, Germany.,2 New York University, New York, NY, USA
| | | | - Gabriele Oettingen
- 1 University of Hamburg, Hamburg, Germany.,2 New York University, New York, NY, USA
| | - Peter M Gollwitzer
- 2 New York University, New York, NY, USA.,4 University of Konstanz, Konstanz, Germany
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Aguiar LT, Nadeau S, Martins JC, Teixeira-Salmela LF, Britto RR, Faria CDCDM. Efficacy of interventions aimed at improving physical activity in individuals with stroke: a systematic review. Disabil Rehabil 2018; 42:902-917. [PMID: 30451539 DOI: 10.1080/09638288.2018.1511755] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: To identify interventions employed to increase post-stroke physical activity, evaluate their efficacy, and identify the gaps in literature.Materials and methods: Randomized controlled trials published until March 2018 were searched in MEDLINE, PEDro, EMBASE, LILACS, and SCIELO databases. The quality of each study and overall quality of evidence were assessed using the PEDro and the GRADE scales.Results: Eighteen studies were included (good PEDro and very low GRADE-scores). In seven, the experimental groups showed significant increases in physical activity (aerobics, resistance, and home-based training; counseling, aerobics, resistance, and home-based training; electrical stimulation during walking; functional-task training; robot-assisted arm therapy; accelerometer-based feedback, and physical activity encouragement). In seven, there were no significant between-group differences (physical activity plan; stretching, use of toe-spreaders, standard treatment; counseling; circuit video-game; functional-task; counseling and cognitive training). The combined experimental and control groups showed significant declines in physical activity in one study (aerobic training or stretching) and increases in three others (aerobic, resistance or sham resistance training; stroke-with advice or only stroke-counseling; aerobic training, educational sessions, standard treatment, and coaching, or mobilization and standard treatment). A meta-analysis could not be performed, due to heterogeneity.Conclusions: Some interventions improved physical activity after stroke. However, the interpretability is limited.Implications for rehabilitationIndividuals with stroke show low physical activity, which may compromise function and health.The use of interventions aimed at improving and maintaining physical activity of individuals with stroke are recommended.Some interventions, such as aerobic, resistance, and combined home-based training, electrical stimulation during walking, functional task training, and arm robot-assisted therapy, could improve the physical activity after stroke.
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Affiliation(s)
- Larissa Tavares Aguiar
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.,École de réadaptation, Université de Montréal (UdeM), Montréal, Canada
| | - Sylvie Nadeau
- École de réadaptation, Université de Montréal (UdeM), Montréal, Canada
| | - Júlia Caetano Martins
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
| | | | - Raquel Rodrigues Britto
- Department of Physical Therapy, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
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Liau AK, Neihart M, Teo CT, Goh LS, Chew P. A Quasi-Experimental Study of a Fitbit-Based Self-Regulation Intervention to Improve Physical Activity, Well-Being, and Mental Health. Cyberpsychology, Behavior, and Social Networking 2018; 21:727-734. [DOI: 10.1089/cyber.2016.0502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Albert K. Liau
- Educational Assessment Research Unit, College of Education, University of Otago, Dunedin, New Zealand
| | - Maureen Neihart
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Chua Tee Teo
- Psychological Studies Academic Group, National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Li Shan Goh
- National University Hospital, Singapore, Singapore
| | - Pony Chew
- Centre for Evidence and Implementation, Singapore, Singapore
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Gollwitzer PM, Mayer D, Frick C, Oettingen G. Promoting the Self-Regulation of Stress in Health Care Providers: An Internet-Based Intervention. Front Psychol 2018; 9:838. [PMID: 29962979 PMCID: PMC6013563 DOI: 10.3389/fpsyg.2018.00838] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 05/09/2018] [Indexed: 11/13/2022] Open
Abstract
The aim of our internet-based intervention study was to find out whether healthcare professionals can autonomously down-regulate the stress they experience at their workplace, using an established self-regulation tool called Mental Contrasting with Implementation Intentions (MCII). Applying MCII to reduce stress implied for our participants to repeatedly engage in a mental exercise that (1) required specifying a wish related to reducing stress, (2) identifying and imagining its most desired positive outcome, (3) detecting and imagining the obstacle that holds them back, and (4) coming up with an if-then plan on how to overcome it. We recruited on-line nurses employed at various health institutions all over Germany, and randomly assigned participants to one of three groups. In the MCII group (n = 33), participants were taught how to use this exercise via email and the participants were asked to engage in the exercise on a daily basis for a period of 3 weeks. As compared to two control groups, one being a no-treatment control group (n = 35) and the other a modified MCII group (n = 32), our experimental MCII group showed a reduced stress level and an enhanced work engagement. We discuss the strengths and weaknesses of the present study as well as ways to intensify MCII effects on stress reduction.
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Affiliation(s)
- Peter M Gollwitzer
- Department of Psychology, New York University, New York, NY, United States.,Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Doris Mayer
- Department of Psychology, University of Hamburg, Hamburg, Germany
| | - Christine Frick
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Gabriele Oettingen
- Department of Psychology, New York University, New York, NY, United States.,Department of Psychology, University of Hamburg, Hamburg, Germany
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Affiliation(s)
- Gabriele Oettingen
- Psychology Department; New York University; New York New York USA
- Institute of Psychology; University of Hamburg; Hamburg Germany
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