Transtheoretical Approach Research Articles

Bridging the Gap Between Existential/Experiential Psychotherapies and ACT (Acceptance and Commitment Therapy)

Effective and efficacy-based psychotherapy treatments are those that hold descriptive conceptualizations, remove ambiguity from clinical decision-making, and match treatments to the needs of the client. The contemporary zeitgeist of psychotherapy best practice supports an integrated view structuring information from a transtheoretical approach, matching therapist and client related variables, and accounting for the strength of the therapeutic alliance. This article seeks to examine the bridge between two psychotherapy orientations: existential/experiential therapy and ACT (acceptance and commitment therapy). Clinical utility and research-based credibility is found within the two theories. The bridges between them are flexible, congruent, and can be unified within basic constructs and values. These models offer strong, effective alternatives for form and practice of psychotherapy.

Online Interventions for Social Marketing Health Behavior Change Campaigns: A Meta-Analysis of Psychological Architectures and Adherence Factors

BackgroundResearchers and practitioners have developed numerous online interventions that encourage people to reduce their drinking, increase their exercise, and better manage their weight. Motivations to develop eHealth interventions may be driven by the Internet’s reach, interactivity, cost-effectiveness, and studies that show online interventions work. However, when designing online interventions suitable for public campaigns, there are few evidence-based guidelines, taxonomies are difficult to apply, many studies lack impact data, and prior meta-analyses are not applicable to large-scale public campaigns targeting voluntary behavioral change.ObjectivesThis meta-analysis assessed online intervention design features in order to inform the development of online campaigns, such as those employed by social marketers, that seek to encourage voluntary health behavior change. A further objective was to increase understanding of the relationships between intervention adherence, study adherence, and behavioral outcomes.MethodsDrawing on systematic review methods, a combination of 84 query terms were used in 5 bibliographic databases with additional gray literature searches. This resulted in 1271 abstracts and papers; 31 met the inclusion criteria. In total, 29 papers describing 30 interventions were included in the primary meta-analysis, with the 2 additional studies qualifying for the adherence analysis. Using a random effects model, the first analysis estimated the overall effect size, including groupings by control conditions and time factors. The second analysis assessed the impacts of psychological design features that were coded with taxonomies from evidence-based behavioral medicine, persuasive technology, and other behavioral influence fields. These separate systems were integrated into a coding framework model called the communication-based influence components model. Finally, the third analysis assessed the relationships between intervention adherence and behavioral outcomes.ResultsThe overall impact of online interventions across all studies was small but statistically significant (standardized mean difference effect size d = 0.19, 95% confidence interval [CI] = 0.11 - 0.28, P < .001, number of interventions k = 30). The largest impact with a moderate level of efficacy was exerted from online interventions when compared with waitlists and placebos (d = 0.28, 95% CI = 0.17 - 0.39, P < .001, k = 18), followed by comparison with lower-tech online interventions (d = 0.16, 95% CI = 0.00 - 0.32, P = .04, k = 8); no significant difference was found when compared with sophisticated print interventions (d = –0.11, 95% CI = –0.34 to 0.12, P = .35, k = 4), though online interventions offer a small effect with the advantage of lower costs and larger reach. Time proved to be a critical factor, with shorter interventions generally achieving larger impacts and greater adherence. For psychological design, most interventions drew from the transtheoretical approach and were goal orientated, deploying numerous influence components aimed at showing users the consequences of their behavior, assisting them in reaching goals, and providing normative pressure. Inconclusive results suggest a relationship between the number of influence components and intervention efficacy. Despite one contradictory correlation, the evidence suggests that study adherence, intervention adherence, and behavioral outcomes are correlated.ConclusionsThese findings demonstrate that online interventions have the capacity to influence voluntary behaviors, such as those routinely targeted by social marketing campaigns. Given the high reach and low cost of online technologies, the stage may be set for increased public health campaigns that blend interpersonal online systems with mass-media outreach. Such a combination of approaches could help individuals achieve personal goals that, at an individual level, help citizens improve the quality of their lives and at a state level, contribute to healthier societies.

Increasing Access to Health Care Among Immigrant Populations: A Transtheoretical Approach

Increasing Access to Health Care Among Immigrant Populations: A Transtheoretical Approach

A transtheoretical approach to case conceptualization and treatment planning as a method of identifying the appropriate stage for creating change in therapy

This article will examine a therapeutic methodology that may have some promise for use with an Asian clinical population. The model presented is a transtheoretical model that uses a particular atheoretical method of case conceptualizing. Client change is the ultimate goal of therapeutic intervention, so clients' readiness to change is incorporated into the treatment planning. Finally, interventions are examined by way of examples.

Cervical Cancer Screening Among Taiwanese Women: A Transtheoretical Approach

To assess Papanicolaou (Pap) test screening behaviors of Taiwanese women, to explore factors affecting stages of change, and to determine whether constructs from the transtheoretical model are applicable to Taiwanese women with regard to Pap screening. Descriptive, cross-sectional. A hospital in Taiwan. 222 female hospital workers. Data were collected with a questionnaire. Cervical screening behavior, perceived barriers and benefits, self-efficacy, and stages of change. Fifty-six percent of participants reported engaging in regular screening practice. The stage of respondents' cervical cancer screening was significantly associated with age, marital status, and history of human papilloma virus-positive and abnormal tests. Self-efficacy scores were significantly higher for women who were in action or maintenance than those in precontemplation or relapse (p < 0.0001). Women in relapse reported significantly more perceived barriers than those in action-maintenance (p = 0.005). No significant differences were found in the level of perceived benefits (p = 0.702) to regular Pap screening among women in the various stages. Pap screening was low among the entire sample and nonexistent among women younger than age 30. The transtheoretical model only was partially applicable to the Taiwanese women in this study. Reinforcement of self-efficacy was more important for women in the sample than emphasizing the benefits of or decreasing the barriers to regular Pap screening. Strategies for younger unmarried women might include education programs emphasizing the importance of routine annual screening and enhancing women's understanding of the relationship between Pap tests and cervical cancer.

Combining Motivational Interviewing And Physical Activity Program To Improve Self-efficacy In Obese Adolescents

There have been a relatively large number of studies examining the influence of physical activity (PA) in obesity treatment for youths. The literature on PA interventions, however, has demonstrated inconsistent effects in youths on behavioral changes outside of PA program. Combining PA program with Motivational interviewing (MI) seems to be a significant strategy to maintain changes in youths' behavior. MI is a therapeutic technique designed to enhance an individual's motivation to change behaviors and move him or her into action. PURPOSE: This study examined the effectiveness of an eight-week intervention program that was developed to increase obese adolescent's self-efficacy in physical activity. Social learning theory (self-efficacy), body-image and the transtheoretical approach of behavioral change were used as the guiding theoretical frameworks in this study. METHODS: Twenty-four adolescents were selected from a centre for adolescent with diet problem and divided into three groups (PA vs PA+MI vs Control). A series of questionnaires were completed including the Self-Efficacy questionnaire, the Body Shape Questionnaire, and the stages of change questionnaire. RESULTS: Repeated measures analysis of variance was performed to compare adolescent's self-perceptions (self-efficacy, body image and stages of change), and three conditions (PA vs PA+MI vs C), obtained across the three times of measurement (just before the program vs at the end of the program vs one month later). Interaction effects were obtained with higher self-efficacy, body image and stages of change for the PA+MI group than for PA group in tests two and three except for stages of change in test three. The control group did not change at any of the tests. CONCLUSIONS: These preliminary results indicate that the addition of MI to a PA program participation with obese adolescents enhanced both self-efficacy and body-image, with strong suggestions of relapse among individuals receiving PA only. Indeed, one month later, these two groups shown similar pattern of behavioral change whereas self-efficacy and body-image are significantly higher for PA+MI group at the same period. Given that self-efficacy is an important predictor of engagement in new behaviors, one can suggest that the participants of the PA program will relapse more easily.

Good Women, Martyrs, and Survivors

This article analyzes select psychological and social models to provide a new theoretical framework for South Asian women subjected to partner violence. It focuses on women's help-seeking behaviors and efforts to end violence. Analysis of the stress-coping paradigm, the ecological model, and the transtheoretical approach indicates the possibility of integrating their core constructs of cognitive, contextual, and process elements to provide a culturally relevant model for South Asia. Each model is reviewed from a Sri Lankan clinical perspective to discuss its relevance to South Asian women's experience with, and responses to, violence. This initial theoretical framework will need to undergo further comprehensive theorizing and rigorous empirical testing in different South Asian countries to assess its validity.

René J. Muller, Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession

Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession by Rene J. Muller powerfully challenges the current paradigm of mental illness. Muller’s arguments are the culmination of 10 years of clinical observation and frustration in three urban psychiatric hospitals. Muller successfully compels professionals of all levels of expertise to examine psychiatric diagnosis and treatment from what has become an unconventional angle. Muller reemphasizes the significance of the human being and free will into a practice that has become so heavily reliant on brain dysfunction. Initially, Muller describes the evolution of the Diagnostic and Statistical Manual of Mental Disorders. To support his arguments, Muller integrates various case examples. In addition, misconceptions about schizophrenia, bipolar disorder, paranoia, and depression are explained. Muller proposes a novel and refined method of conceptualizing mental disorders that emphasizes a dimensional approach. A major strength of Muller’s Doing Psychiatry Wrong: A Critical and Prescriptive Look at a Faltering Profession is the relevance of his perspective to a wide-range of individuals. In his writing, Muller is not afraid to go against the grain of current societal beliefs. The radical approach that Muller adopts gives his stories universal appeal. Although the arguments are most specifically directed towards psychiatrists and psychologists, all mental health and medical professionals may be influenced by Muller’s arguments. Furthermore, Muller’s perspective has the ability to challenge how mental health patients and lay members of society view personal struggles with mental illness. Muller effectively confronts the role of marketing and sales in the current conceptualization and treatment of mental illness. Consequently, Muller’s extreme arguments also have relevance to business and legal professionals. Muller’s perspective is supported by theory and knowledge gathered from various realms of scholarly work. He criticizes the current approach to mental diagnosis and treatment on the grounds that biology is overemphasized and psychology is underemphasized. In contrast, Muller successfully integrates theories of the mind, philosophical ideas, and biological science into a comprehensive theory. Muller manages to raise questions about the biological evidence being used to support current theories. Furthermore, Muller emphasizes that true understanding of mental disorders cannot be accomplished without accepting a multidisciplinary approach. In Doing Psychiatry Wrong, Muller effectively reintroduces the importance of understanding the distinctiveness of each patient. Muller argues that in psychiatric practice, human beings have been reduced to neurons and brain structures. Although Muller believes that symptoms are relevant to diagnosis, he argues that the meaning underlying symptoms is of greater importance. Muller suggests that symptoms should be understood before a diagnosis is given. In addition, he argues that patient motivation and free will should be assessed. Muller successfully emphasizes the importance that patients’ unique life stories have to a profession dedicated to helping individuals. In the final chapter of the book, Muller provides an alternative approach to diagnosis that can be implemented by psychologists or psychiatrists. Muller emphasizes a dimensional approach in his model. The guidelines provided are simple, straightforward, and encompass transtheoretical approaches. Despite the practicality of these A. L. Marquart (&) Psychology Department, Case Western Reserve University, Mather Memorial Building #103, 11220 Bellflower Road, Cleveland, OH 44106-7123, USA e-mail: Abby.marquart@gmail.com; abby.marquart@case.edu

Building the Supervisory Alliance with Beginning Therapists

ABSTRACT Outcome studies in psychotherapy research have indicated the importance of the therapeutic alliance independent of the therapeutic orientation. However, because of the multiple demands placed on beginning therapists and their supervisors, the therapeutic relationship is often neglected during supervision, often with problematic results. This article proposes that for beginning therapists, clinical supervisors must take into account the supervisory alliance as a means of helping therapists learn to develop their therapeutic alliances. Using ego-analytic theory as a guide to supervision, the authors underscore how to develop this alliance in an effective manner. Specific suggestions and case examples are given to highlight this trans-theoretical approach.

A Transtheoretical Approach to Case Formulation

In answer to the need for a comprehensive, systematic, yet flexible case formulation method, the present article describes the Causal Analysis and Synthesis of Events (CASE) system, a transtheoretical case formulation method. This method of functional case formulation is useful in terms of explicating the problem and identifying potential areas for intervention when dealing with clinical problems of both an intrapersonal and interpersonal nature. Further, this formulation method may improve communication between the therapist and the client during case conceptualization and facilitate dialogue between therapists of different theoretical orientations. This paper describes the case formulation method and includes an example incorporating this case formulation technique for a young man with social phobia.

Stages of change and stuttering: A preliminary view

As a way to better understand the process of change that occurs in stuttering, Craig [Craig, A. (1998). Relapse following treatment for stuttering: a critical review and correlative data. Journal of Fluency Disorders, 23, 1–30] compared the behavioral changes that people who stutter often experience with and without treatment to those that have been observed for certain (non)addictive behavior disorders such as smoking, overeating, phobia and anxiety disorder. The process underlying these behavioral changes has been described by the transtheoretical or “stages of change” model, which is a model of behavior change that can illuminate “where” a person is in the process of change, and how this may relate to the outcome of either treatment or self-change attempts [Prochaska, J. O., & DiClemente, C. C. (1986). The transtheoretical approach. In J. C. Norcross (Ed.), Handbook of eclectic psychotherapy. New York: Brunner/Mazel]. The purpose of the present study was to analyze the extent to which the responses of adults who stutter on a modified Stages of Change Questionnaire yield interrelations among questionnaire items that are consistent with a stage-based interpretation. Results of both confirmatory and exploratory factor analyses indicated that while the modified questionnaire was a relatively good fit for participant responses, the structure derived from the exploratory analysis provided a significantly better fit to the observed data. Results suggest that a questionnaire incorporating items that better reflect the unique behavioral, cognitive and affective variables that characterize stuttering may better discriminate stages of change in people who stutter as they move through therapy, or are engaged in self-directed change. Educational objectives : After reading this paper, the learner will be able to: (1) describe the transtheoretical or “stages of change” model; (2) describe the various processes that are associated with different stages of change; (3) summarize research findings in stages of change as they apply to a variety of clinical populations; (4) discuss the applicability of the findings from the present study to stuttering treatment, and (5) relate conventional strategies and techniques used in stuttering therapy to different stages in the process of change.

Contemplating cycling to work: Attitudes and perceptions in different stages of change

In 1996 the UK government introduced the National Cycle Strategy which aimed to double the number of cycling trips by the end of 2002 and double them again by 2012. So far, however, these targets have not been met. The House of Commons ascribes this to ‘a fundamental lack of commitment to cycling on an individual, regional and national level’. This paper addresses the individual level by examining the views of commuters in different stages of change as distinguished by Prochaska’s model [Prochaska, J.O., DiClemente, C.C., 1984. The Transtheoretical Approach: Crossing Traditional Boundaries of Change. Dow Jones/Irwin, Homewood IL]. This model views behaviour change as a process rather than an event. Two studies were conducted amongst university staff and students: a survey study and an action study. The studies showed that as people progress from precontemplation to action their attitudes towards cycling become more positive and their perceptions of various personal and external barriers change. This suggests that different strategies are necessary to move people in different stages of change to action and maintenance. At the moment, it seems that regular cyclists form a very small minority of people who will cycle under most circumstances simply because they like cycling. The majority of people have never contemplated cycling. There is, however, also a group of people who would like to cycle and could be persuaded to cycle under the right circumstances.

Using a motivational paradigm to improve handwashing compliance

The education and training of staff is frequently cited as essential to the development and maintenance of hand hygiene compliance, which is often quoted as the single most effective measure to prevent Hospital Acquired Infection. Despite much time, effort and cost, there is a growing frustration within infection control that training programmes do not appear to have a lasting effect on behaviour or produce consistently good hand hygiene compliers. This paper intends to encourage debate by suggesting that handwashing needs to be considered within a wider educational context and the motivational factors that impact upon performance acknowledged and addressed. A critique of learning theories in relation to hand hygiene will discuss why the use of traditional programmes in isolation may be unsuccessful, and how models and theories based in other disciplines could be adapted to help produce sustainable changes in practice. This paper recognises the contribution of contemporary training methods but argues that models such as [Prochaska, J., DiClemente, C., 1984. The Transtheoretical Approach; Crossing Traditional Boundaries of Therapy. Dow Jones Irwin, Homewood] stages of change transtheoretical model (TTM) and the interventionist paradigm of motivational interviewing could be borrowed and adapted from health promotion and applied to hand hygiene as their function, to increase understanding and enhance motivation in order to achieve sustainable behavioural change, are attributes which have resonance for a challenging problem like hand hygiene compliance.

Relapse Prevention: Maintenance Strategies in the Treatment of Addictive Behaviours (2nd edition), * G. Alan Marlatt and Dennis M. Donovan (eds), * New York, The Guilford Press, 2005, pp. 416, ISBN 1593851766, 32.50

The overall theme of the book is relapse prevention for behaviours that are considered to be addictive. These include alcohol and substance misuse, eating disorders, smoking, gambling and sexual behaviours. The relapse prevention approach is located clearly within a cognitive behavioural therapy (CBT) model, so although the chapters are ‘disorder’ specific, the approaches described and advocated in each are transferable and readers may experience some degree of repetition. Throughout the book, motivational interviewing (Miller and Rollnick, 2002) and the transtheoretical approach to behaviour change (Prochaska and Di Climente, 1984) are continually referenced and reinforced. Social workers in the addiction field and more generally may be well acquainted with these models which will act as a useful starting point for the focus of relapse prevention more specifically. From the start of the book, the authors assume a fairly significant knowledge of the cognitive behavioural framework including basic tenets such as coping skills enhancement, development of self-efficacy, harm reduction techniques, motivational approaches and contingency management. References are made throughout to Donovan and Marlatt (2005), The Assessment of Addictive Behaviours. Whilst useful concepts relating to cognitive behavioural assessments are available in other texts such as Hawton et al. (1989), Cigno and Bourn (1998) and Straussner (2004), I would suggest that because of an assumed familiarity with the related work by the editors, the two books might best be used together in terms of the overall approach.

How Do Master's Level Marriage and Family Therapy Students View Their Basic Therapy Skills? An Examination of Generic and Theory Specific Clinical Approaches to Family Therapy

This study examined the similarities and differences between marital and family therapy (MFT) students' beliefs about the importance of specific MFT skills, and the perceptions of experienced therapists in practice about the same skills. The data suggest overlap but not complete agreement between the perceptions of novice and experienced therapists regarding both generic and theory specific skills. Similarities and differences between these findings and earlier research about common factors in family therapy are addressed. Recommendations about clinical training that is not organized around traditional family therapy theories, but rather based on two trans-theoretical approaches to therapy labeled expert and collaborative are explored.

Trauma and disconnection: A trans-theoretical approach

The paper indicates how the notion of disconnection may be used to synthesise knowledge concerning the pathogenic effects of exposure to trauma. This notion is offered as a complement to that of overwhelment, which is currently a dominant explanatory concept regarding the effects of trauma [Van der Kolk (1996) Trauma and memory, in Van der Kolk et al . (Eds) Traumatic stress , New York: Guilford Press]. Conceptualising trauma as disconnection, at various levels of functioning, has implications for effective treatment. These implications are explored with reference to case material.

Using the transtheoretical approach to facilitate change in the heart failure population.

Heart failure is a significant health problem that requires a multidisciplinary approach for successful intervention. Five million Americans currently suffer from heart failure, resulting in an annual expenditure estimated at $20-$40 billion. However, with early identification and intervention, the progression of heart failure can be stopped. Change in lifestyle and adherence to a prescribed plan of care recommended for heart failure treatment can lead to improved quality of life. The Transtheoretical Model provides a framework for facilitating the behavioral changes necessary for the optimal treatment of heart failure. Future research is suggested to evaluate outcomes of behavioral changes in heart failure populations upon implementation of this model. (c)2001 by CHF, Inc.

A transtheoretical approach to changing organizations.

Several authors have reflected on the underdeveloped state of organizational change theory, research, and practice. This field needs an integrative framework that can synthesize major approaches to change. The Transtheoretical Model has the potential to do for organizational change what it has done for individual behavior change. Conceptually the stages-of-change dimension can be used to integrate principles and processes of change from divergent models of change. Practically, the stages-of-change dimension can be applied by leaders to reduce resistance, increase participation, reduce dropout, and increase change progress among employees.

Fifty Strategies for Counseling Defiant, Aggressive Adolescents: Reaching, Accepting, and Relating

Fifty strategies for establishing and maintaining a therapeutic relationship with defiant, aggressive adolescents are offered. Many of these are taken from the literature, whereas others are unique to this article. A variety of strategies, ranging from reframes to the use of paradox are provided, and take a transtheoretical approach using ideas from cognitive behavioral as well as existential, Gestalt, psychodynamic, and multicultural therapies. Strategies are arranged under 3 categories: reaching, accepting, and relating. The strong desire of defiant adolescents for freedom and autonomy is also discussed, with suggestions for using this in motivating defiant adolescents to work in counseling.

Cessation Related Perceptions and Behavior of Former and Current Smokeless Tobacco Users

Four hundred fourteen former and 73 current users of smokeless tobacco were questioned about their experiences in giving up smokeless tobacco. Their responses were compared with those of 463 ex-smokers to determine whether former smokeless tobacco users differed from former smokers in using specific cessation techniques. Of the smokeless tobacco users, 77% were interested in quitting, but only 7% wanted to quit “now.” Seven percent of the daily users reported that a college-based health or fitness professional had advised them to quit. Former smokeless tobacco users were significantly more likely than former smokers to report that smoking cigarettes was related to their efforts to give up smokeless tobacco than former smokers were to report using smokeless tobacco as a strategy to stop smoking. Former smokeless tobacco users were also significantly more likely than former smokers to report current tobacco use. Smokeless tobacco cessation programs based on the transtheoretical approach to behavior change are recommended.