Forming Implementation Intentions Research Articles

‘They’ve invited me into their world’: a focus group with clinicians delivering a behaviour change intervention in a UK contraceptive service

Although teenage conceptions rates in the United Kingdom (UK) have seen a downward trend recently, it remains imperative that contraceptive services for young people continue to improve. To ensure that evidence-based interventions are sustained in clinical practice, it is useful to assess the experiences of those delivering them. This study explores the experiences of sexual health clinicians who were trained to deliver a one-to-one behaviour change intervention aiming to improve contraceptive use in young women. The intervention was set in a UK NHS contraceptive and sexual health service and involved clinicians’ facilitating (within one-to-one consultations) the formation of implementation intentions (or ‘if-then’ plans) that specified when, where and how young women would use contraception. A focus group was conducted with seven clinicians who had delivered the intervention. A thematic analysis of the focus group revealed three overall themes: (1) How the intervention worked in practice; (2) barriers and benefits to delivering the intervention; and (3) positive changes to individual consultation style and wider ‘best practice’ within the clinic. Our findings show that, with support, clinical staff would be in favour of incorporating if-then planning as a strategy to help promote contraceptive adherence in young women.

Combining self-affirmation and implementation intentions to reduce heavy episodic drinking in university students.

Studies testing the effects of self-affirmation on alcohol-related cognitions and behavior in university students have produced equivocal results. Because self-affirmation is a motivational technique (i.e., designed to reduce defensive processing) it may need to be supplemented with volitional techniques, such as forming if-then plans, to translate positive intentions into behavior. Participants (N = 348) were randomly assigned to conditions in a 2 (self-affirmation) × 2 (implementation intention) between-participants factorial design. Participants completed a self-affirmation task (i.e., values essay) or not, read a summary about the health risks of binge drinking (8/6 units for men/women), and then completed an implementation intention task (i.e., forming if-then plans) or not. Participants then completed measures of message derogation, perceived risk, and intention as well as alcohol consumption 1 week later. All main and interaction effects for self-affirmation were nonsignificant. In contrast, participants who formed implementation intentions (vs. not) reported drinking fewer units of alcohol and engaged in binge drinking less frequently at 1-week follow-up. Additional analyses revealed that affirming a social value attenuated the effect of self-affirmation on intention, but augmented the effect of implementation intentions on behavior. Overall, the findings provide additional evidence for the positive effects of implementation intentions but question the use of self-affirmation to reduce alcohol consumption in university students. (PsycINFO Database Record

An exploratory randomised trial of a simple, brief psychological intervention to reduce subsequent suicidal ideation and behaviour in patients admitted to hospital for self-harm.

Implementation intentions link triggers for self-harm with coping skills and appear to create an automatic tendency to invoke coping responses when faced with a triggering situation. To test the effectiveness of implementation intentions in reducing suicidal ideation and behaviour in a high-risk group. Two hundred and twenty-six patients who had self-harmed were randomised to: (a) forming implementation intentions with a 'volitional help sheet'; (b) self-generating implementation intentions without help; or (c) thinking about triggers and coping, but not forming implementation intentions. We measured self-reported suicidal ideation and behaviour, threats of suicide and likelihood of future suicide attempt at baseline and then again at the 3-month follow-up. All suicide-related outcome measures were significantly lower at follow-up among patients forming implementation intentions compared with those in the control condition (ds>0.35). The volitional help sheet resulted in fewer suicide threats (d = 0.59) and lowered the likelihood of future suicide attempts (d = 0.29) compared with patients who self-generated implementation intentions. Implementation intention-based interventions, particularly when supported by a volitional help sheet, show promise in reducing future suicidal ideation and behaviour.

The Effects of Two Planning Interventions on the Oral Health Behavior of Iranian Adolescents: A Cluster Randomized Controlled Trial.

The aim of this study was to investigate the effectiveness of a planning intervention (specifying when, where, and how to act) and an implementation intention intervention (specifying the same in the format of an if-then plan) in increasing self-reported brushing in adolescents. The study adopted a cluster randomized controlled trial design, and 1158 students in 48 schools were randomized to planning, implementation intention, or active control conditions. After baseline assessment, all participants received a leaflet containing information and recommendations on oral health and instructions on correct brushing behavior. After reading the leaflets, they were provided with a toothbrush and toothpaste plus a calendar in which to record their brushing. Participants in the planning condition and in the implementation intention condition also received instructions to form specific plans regarding brushing behavior. Self-reported brushing, perceived behavioral control, self-monitoring, intention, frequency of planning, oral health-related quality of life, and dental plaque and periodontal status were measured 1 and 6months later. Both intervention conditions showed a significant improvement in the frequency of self-reported brushing, self-monitoring, frequency of planning, intention, perceived behavioral control, plaque index, periodontal health, and oral health-related quality of life compared to the control condition at both follow-ups. Comparing the two intervention conditions revealed that adolescents who received the implementation intention intervention had significantly greater improvement in the frequency of self-reported brushing, intention, frequency of planning, and periodontal health than those in planning condition. Taken together, the findings suggest that forming implementation intentions as well as planning has the potential to increase dental self-reported brushing rates in adolescents, but that forming implementation intentions has the strongest impact on dental hygiene behavior and is, therefore, recommended. The trial was registered with the ClinicalTrials.gov database (NCT02066987) https://www.clinicaltrials.gov/ct2/show/NCT02066987 .

Evidence that implementation intentions can overcome the effects of smoking habits.

In this study, the aim was to (a) test for the first time whether implementation intentions formed outside the laboratory can overcome the effects of habits, and (b) see whether the operation of implementation intentions could be improved by asking people to form certain "when-then" plans as opposed to uncertain "if-then" plans. The study employed a 2 × 2 fully factorial design with baseline and follow-up measures of smoking status and habits. Smokers (N = 168; circa 33 years of age; 79 women, 89 men) were randomly allocated to 1 of 2 intervention groups to form either if-then plans or when-then plans using supporting tools, or to 1 of 2 control conditions in which they were exposed to identical supporting tools but were not asked to form if-then plans or when-then plans. Certainty did not affect the operation of implementation intentions, but smokers who formed implementation intentions were significantly more likely to quit, χ2(1, N = 168) = 8.86, p < .01, and the effect was mediated by changes in smoking habits (95% CI [0.02, 0.14]). Similar effects were observed when cigarettes smoked per day, nicotine dependence, and craving served as the dependent variables. The findings demonstrate that people who have formed implementation intentions can overcome habits, such as smoking, outside the laboratory. The supporting tools described in the present research could be deployed at low cost with high public health reach to support behavior change. (PsycINFO Database Record

Turning Pain Into Cues for Goal-Directed Behavior: Implementation Intentions Reduce Escape-Avoidance Behavior ona Painful Task.

Pain automatically elicits escape-avoidance behavior to avert bodily harm. In patients with chronic pain, long-term escape-avoidance behavior may increase the risk of chronic disability. The aim of the presents study was to examine whether implementation intentions reduce escape-avoidance behavior during painful tasks in healthy individuals. Implementation intentions are "if-then" self-statements associating situational cues with goal-directed behaviors. Seventy healthy participants performed a painful finger pressing task, preceded by either implementation intention instructions with pain or a nonpain cue as a cue for goal-directed behavior, or control instructions. Escape-avoidance behavior was operationalized as task duration and response rate. Inhibitory control was measured using the Stop Signal Task. The pain implementation intentions resulted in the longest task duration (P=.02), and thus less escape-avoidance behavior. Low inhibitory control was associated with shorter task duration (P=.03), and thus more escape-avoidance behavior. The nonpain implementation intentions resulted in the highest response rate, but only when inhibitory control was low (P=.04). Implementation intentions referring to pain or nonpain reduce escape-avoidance behavior on a painful task. It is worthwhile to examine whether individuals in pain and with low inhibitory control benefit from interventions that incorporate implementation intentions. To our knowledge, this study is the first to show that forming implementation intentions reduces escape-avoidance behavior during pain and fosters nonpain goal pursuit. The use of implementation intentions is indicated to be an intervention that could be of use in patients with pain, particularly when inhibitory control is low.

Acceptance and Commitment Therapy and Implementation Intentions Increase Exercise Enjoyment and Long-Term Exercise Behavior Among Low-Active Women

The current study evaluated the long-term effectiveness of acceptance and commitment therapy (ACT) for promoting exercise behavior in comparison with planning in the form of implementation intentions (forming situational cues and action plans as to when, where, and how to incorporate exercise). We expected both interventions to increase exercise behavior (assessed using the Godin Leisure-Time Exercise Questionnaire; Godin and Shephard 1985) from baseline to 6-months post-intervention, but expected only ACT to also increase exercise enjoyment (assessed using the Physical Activity Enjoyment Scale; Kendzierski and DeCarlo 1991). A total of 32 women, randomized to receive a single session of either ACT training or instructions to form implementation intentions for exercise activities, took part in this study. The participants were contacted by email 6-months following the intervention to determine the amount of self-reported exercise. As expected, exercise amount increased in both groups. Contrary to our expectations, both groups also increased in exercise enjoyment. This study provides initial evidence that exercising can be increased through an ACT intervention. ACT and implementation intentions may both be effective and brief interventions for promoting exercise behavior and exercise-related enjoyment in low-active women. Future research needs to establish the psychosocial and personality factors that lead to the effectiveness of ACT and implementation intentions.

Promoting the translation of intentions into action by implementation intentions: behavioral effects and physiological correlates.

The present review addresses the physiological correlates of planning effects on behavior. Although intentions to act qualify as predictors of behavior, accumulated evidence indicates that there is a substantial gap between even strong intentions and subsequent action. One effective strategy to reduce this intention–behavior gap is the formation of implementation intentions that specify when, where, and how to act on a given goal in an if-then format (“If I encounter situation Y, then I will initiate action Z!”). It has been proposed that implementation intentions render the mental representation of the situation highly accessible and establish a strong associative link between the mental representations of the situation and the action. These process assumptions have been examined in behavioral research, and in physiological research, a field that has begun to investigate the temporal dynamics of and brain areas involved in implementation intention effects. In the present review, we first summarize studies on the cognitive processes that are central to the strategic automation of action control by implementation intentions. We then examine studies involving critical samples with impaired self-regulation. Lastly, we review studies that have applied physiological measures such as heart rate, cortisol level, and eye movement, as well as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) studies on the neural correlates of implementation intention effects. In support of the assumed processes, implementation intentions increased goal attainment in studies on cognitive processes and in critical samples, modulated brain waves related to perceptual and decision processes, and generated less activity in brain areas associated with effortful action control. In our discussion, we reflect on the status quo of physiological research on implementation intentions, methodological and conceptual issues, related research, and propose future directions.

Forming implementation intentions improves prospective memory in early psychosis

The study examined whether individuals with early psychosis are impaired in prospective memory (PM), that is, remembering to execute a planned intention in the future, and whether implementation intentions can improve their PM performance. Thirty participants with early psychosis and 33 healthy controls were randomly allocated to either an implementation intentions or control condition and completed a computerised event-based PM task. Participants were also administered two standardised tests of PM and an abbreviated IQ test. Results demonstrated that individuals with early psychosis showed PM deficits relative to healthy controls on the computerised PM task and on some standardised measures of PM. The PM performance of the early psychosis group benefited from forming implementation intentions. Implementation intentions was concluded to be an effective strategy for improving PM performance in individuals with early psychosis.

The effect of implementation intentions on transfer of training

AbstractTwo experiments investigated the effect of forming implementation intentions on transfer of training in two training programs. In the first experiment (N = 37), trainees who formed implementation intentions implemented active listening skills sooner, and to a greater degree, than those in the control group. In the second experiment (n = 28), conducted in the field, trainees who formed implementation intentions received a higher performance score for implementing the trained behavior compared with those in the control condition. Results from both experiments provide empirical evidence suggesting that forming implementation intentions at the end of a training program increases the likelihood of using the newly acquired skills.

Does forming implementation intentions help people with mental health problems to achieve goals? A meta-analysis of experimental studies with clinical and analogue samples.

People struggle to act on the goals that they set themselves, and this gap between intention and action is likely to be exacerbated by mental health problems. Evidence suggests that forming specific if-then plans (or 'implementation intentions') can promote goal attainment and a number of studies have applied such techniques in clinical contexts. However, to date, the extent to which planning can help people with mental health problems has not been systematically examined. The present review used meta-analysis to investigate the effect of if-then planning on goal attainment among people with a DSM-IV/ICD-10 diagnosis (i.e., clinical samples) or scores above a relevant cut-off on clinical measures (i.e., analogue samples). In total, 29 experimental studies, from 18 records, met the inclusion criteria. Excluding one outlying (very large) effect, forming implementation intentions had a large-sized effect on goal attainment (d+ = 0.99, k = 28, N = 1,636). Implementation intentions proved effective across different mental health problems and goals, and in studies with different methodological approaches. Taken together, the findings suggest that forming implementation intentions can be a useful strategy for helping people with mental health problems to achieve various goals and might be usefully integrated into existing treatment approaches. However, further studies are needed addressing a wider range of mental health problems.

Randomized test of a brief psychological intervention to reduce and prevent emotional eating in a community sample.

Emotional eating is associated with mental health problems and weight gain, but research has focussed on treatment rather than prevention. The present research tests a brief theory-based psychological intervention to reduce and prevent emotional eating in a community sample. Two hundred and forty women were randomized to a control condition in which they were asked to identify emotional eating triggers and strategies for change (a 'volitional help sheet') or to an experimental condition in which they were asked explicitly to use the volitional help sheet to link emotional eating triggers with strategies for change and so form implementation intentions. Results showed that eating in response to boredom was more common than eating in response to anxiety or depression. There was a significant condition × time interaction showing that the formation of implementation intentions resulted in significantly lower levels of emotional eating in response to boredom at follow-up (d = 0.29). The intervention shows promise in reducing and preventing emotional eating, but further research is required to refine the tool and to examine whether eating in response to anxiety or depression is more common among clinical populations.

Effects of Encouraging Rapid Implementation and/or Structured Planning of Quit Attempts on Smoking Cessation Outcomes: a Randomized Controlled Trial.

Recent research has led to debate over the benefit of planning quit attempts, suggesting that attempts implemented spontaneously may be more effective. The roles of planning and spontaneity require prospective examination. The purpose of this study is to test the benefit of encouraging smokers using an online program to quit as soon as possible (Rapid Implementation arm) and of structured planning advice incorporating implementation intentions (Structured Planning arm). Randomized controlled trial with 1601 cases in the Rapid Implementation arm and an additional 964 in the Structured Planning arm; 2565 in total. There was no effect of Rapid Implementation, but Structured Planning significantly increased 6-month sustained abstinence (14.6 vs 10.2%; p = 0.001). There was significantly less relapse after 1 week in the structured planning group (61.0 vs 71.2%, p = 0.001). A structured planning intervention delivered online can reduce relapse to smoking. Smokers should be encouraged to form implementation intentions and do most of their planning for relapse prevention after they have quit.

Field experiment of a very brief worksite intervention to improve nutrition among health care workers.

Despite the potential of worksite interventions to boost productivity and save insurance costs, they tend to be costly and tested in nonrandomized trials. The aim of the present study was to test the ability of a very brief worksite intervention based on implementation intentions to improve nutrition among health care workers. Seventy-nine health care workers were randomly allocated to a control condition or to form implementation intentions using standard instructions or with a supporting tool. Fruit intake and metacognitive processing (operationalized as awareness of standards, self-monitoring and self-regulatory effort) were measured at baseline and follow-up. Participants who formed implementation intentions ate significantly more fruit and engaged in significantly more metacognitive processing at follow-up than did participants in the control condition (ds > .70). The findings support the efficacy of implementation intentions for increasing fruit intake in health care workers and preliminary support for the utility of a tool to support implementation intention formation.

Attenuating the Escalation of Commitment to a Faltering Project in Decision-Making Groups

When groups receive negative feedback on their progress toward a set goal, they often escalate rather than temper their commitment. To attenuate such escalation, we suggest initiating a self-distancing response (i.e., taking the perspective of a neutral observer) by forming implementation intentions when, where, and how to act (i.e., making if-then plans). Implementation intentions should help groups to translate a self-distancing intention into action. In line with this reasoning, only groups that had added implementation intentions to their goal to make optimal investment decisions reduced their high levels of investment (Study 1) or maintained their moderate levels of investment (Study 2) after negative feedback. Groups that had merely formed goal intentions, however, escalated even when their decision goal was supplemented with self-distancing instructions (Study 1), and they escalated as much as control groups without such a goal (Study 2). Implications for improving group decision making by implementation intentions are discussed.

Evidence That a Volitional Help Sheet Reduces Alcohol Consumption Among Smokers: A Pilot Randomized Controlled Trial

Cigarette smokers have greater problems with alcohol than members of the general population, due partly to the influence of smoking on alcohol consumption. The present study was designed to test the ability of implementation intentions to reduce alcohol consumption among cigarette smokers. Sixty-five smokers (37 women, 28 men; age M=33.77, SD=9.69) were randomly allocated to an active control condition (n=31) or were asked to form implementation intentions using a volitional help sheet (n=34). The outcome measure was subsequent alcohol intake, measured 1-month postbaseline. There was a significant decrease in alcohol consumption in the intervention group but not in the control condition. At the end of the study, alcohol consumption had decreased significantly, by 2.00 standard units (i.e., 16 grams alcohol) per week in the intervention group, but had increased marginally (by 0.46 standard units per week) in the active control condition (d=0.63). The findings support the efficacy of the volitional help sheet to reduce alcohol consumption among smokers. Further research is needed to refine the volitional help sheet and explore its efficacy among other at-risk groups.

Identifying the ‘if’ for ‘if-then’ plans: Combining implementation intentions with cue-monitoring targeting unhealthy snacking behaviour

Implementation intentions aimed at changing unwanted habits require the identification of personally relevant cues triggering the habitual response in order to be effective. To facilitate successful implementation intention formation, in the present study, planning was combined with cue-monitoring, a novel way to gain insight into triggers for unhealthy snacking. It was tested whether keeping a cue-monitoring diary and tailoring implementation intentions accordingly improves plan effectiveness. A 2 Monitoring (cue-monitoring, control) × 2 Planning (implementation intention, goal intention) between subjects design was adopted. Participants (N = 161) monitored their unhealthy snacking behaviour for a week using either a cue-monitoring or a control diary. Participants then formulated a goal intention or an implementation intention tailored to their personal cue. Snacking frequency and caloric intake from unhealthy snacks were examined using a seven-day snack diary. The results did not indicate an interaction but yielded a main effect of Monitoring. Cue-monitoring either or not combined with implementation intentions reduced unhealthy snacking behaviour compared with control. Findings emphasise the effectiveness of cue-monitoring, suggesting that on the short term, cue-monitoring suffices to decrease unhealthy snacking, without additional benefit from planning. Future research should examine whether supplementing cue-monitoring with implementation intentions is required to establish long-term behaviour change maintenance.

Prospective memory in adults with high-functioning autism spectrum disorders: exploring effects of implementation intentions and retrospective memory load.

This study examined, for the first time, the impact of implementation intentions on prospective memory (PM) performance in adults with autism spectrum disorders (ASD) and further explored the role of retrospective memory for PM in ASD. PM was assessed with Virtual Week, a computerized game simulating upcoming everyday-life tasks. Twenty-seven adults with ASD and 27 age- and ability-matched controls were included. Half of the participants were instructed to form implementation intentions (i.e., encoding PM tasks in form of if-then statements), while the rest received simple PM instructions. Results provide first tentative evidence for beneficial effects of implementation intentions and PM tasks with low demands on retrospective memory for adults with ASD's PM. Overall, results point to the importance of planning and retrospective memory for successful prospective remembering in ASD.

Weakness of the will: Is a quick fix possible?

Weakness of the will may lead to ineffective goal striving in the sense that people lacking willpower fail to get started, to stay on track, to select instrumental means, and to act efficiently. However, using a simple self-regulation strategy (i.e., forming implementation intentions or making if-then plans) can get around this problem by drastically improving goal striving on the spot. After an overview of research investigating how implementation intentions work, I will discuss how people can use implementation intentions to overcome potential hindrances to successful goal attain- ment. Extensive empirical research shows that implemen- tation intentions help people to meet their goals no matter whether these hindrances originate from within (e.g., lack of cognitive capabilities) or outside the person (i.e., difficult social situations). Moreover, I will report recent research demonstrating that implementation intentions can even be used to control impulsive cognitive, affective, and behav- ioral responses that interfere with one's focal goal striving. In ending, I will present various new lines of implementation intention research, and raise a host of open questions that still deserve further empirical and theoretical analysis.

Strategic regulation of mimicry effects by implementation intentions

Although mimicry generally facilitates social interaction, sometimes mimicry effects can hamper pursuit of focal goals. Two studies tested whether the self-regulation strategy of forming implementation intentions (i.e., planning in advance the when, where, and how of one's goal striving) can be used to regulate mimicry effects. In Study 1, implementation intentions to be non-prejudiced ensured that mimicking increased attraction even for an unlikable person. In Study 2, implementation intentions to be thrifty reduced participants' susceptibility to the persuasive effects of being mimicked. Mere goal intentions to be non-prejudiced and to be thrifty did not suffice to regulate mimicry effects. We conclude that the strategic automaticity accomplished by implementation intentions allows people to intentionally strengthen (Study 1) and weaken (Study 2) mimicry effects in line with their goals. Implications for the effective self-regulation of mimicry effects are discussed.