Transtheoretical Framework Research Articles

The meaning and feeling of the time and space between psychotherapy sessions and everyday life: Client experiences of transitions

Objective To explore how clients in psychodynamic or psychoanalytic psychotherapy, conducted in the traditional in-person setting, experience the transitions in time and space between psychotherapy sessions and everyday life. Method Twelve semi-structured interviews were analyzed with inductive experiential thematic analysis, focusing on how the participants experience and make sense of the phenomenon in focus. Results The participants described therapy as a sheltered space where they could be open, vulnerable, receptive, and present. Approaching and leaving psychotherapy sessions, the participants established different behavioral patterns and routines dealing with their anxieties and resistances. In this in-between area, the participants could handle interconnections and differences between therapy and everyday life. Participants stressed the clinical impact of transitions: transitions affect both therapy and everyday life; disturbed transitions have an adverse impact; transitions are insufficiently addressed in therapy. Conclusion Transitions between therapy and life appear to be an essential but seldom recognized part of the therapy process beyond the borders of therapy sessions. Implications of these findings for psychotherapy training and practice are discussed, and a tentative transtheoretical framework for further research is proposed.

The Memory Wars Then and Now: The Contributions of Scott O. Lilienfeld

In this review, honoring Scott O. Lilienfeld, we reflect on key conflicts, controversies, and flash points in the so-called memory wars that have captured headlines, affected legislative action, and influenced civil suits and criminal trials. We trace the memory wars, beginning in the 1990s to the present. From the outset, the memory wars featured debates regarding repressed memories, recollections of trauma, and the hazards of memory recovery therapy, and these disagreements persist today in controversies concerning dissociative amnesia, beliefs about memory, suggestive psychotherapies, and the genesis of dissociative identity disorder (DID). We acknowledge Lilienfeld’s contributions, particularly to the sociocognitive model of DID, reviewed in the second half of the article, and to a recent transtheoretical framework that contrasts sharply with the posttraumatic view of DID. The memory wars greatly enhanced scientific understanding of memory, trauma, iatrogenic psychotherapies, and dissociative disorders. We conclude with suggestions for future research to deepen understanding of issues stimulated by the memory wars.

A Systematic Analysis of the Organizational Development Theory and Transtheoretical Framework in Weight Management

A Systematic Analysis of the Organizational Development Theory and Transtheoretical Framework in Weight Management

Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework.

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identifyempirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation.

The State of the Science on Cancer Diagnosis as a "Teachable Moment" for Smoking Cessation: A Scoping Review.

Theoretically, a cancer diagnosis has the potential to spur health behavior changes in physical activity, diet, substance use, medication adherence, and the like. The Teachable Moment heuristic is a parsimonious, transtheoretical framework for understanding the conditions under which behavior change might occur, with constructs that include affective, cognitive, and social factors. Application of the Teachable Moment to smoking cessation after cancer diagnosis might aid selection of predictors in observational studies and inform how to optimally design interventions to promote quit attempts and sustain abstinence, as many smoking cessation interventions for cancer survivors do not yield positive outcomes. This scoping review of 47 studies that span nearly 20 years of literature examines the measurement of the Teachable Moment constructs and what empirical support they have in explaining cancer survivors' smoking behavior. From this review, it appears the construct of affective response is more widely explored than risk perceptions, social role, and self-concept. Strong, negative affective responses (e.g., anxiety, general distress) may be a powerful contributor to continued smoking after a cancer diagnosis. Risk perceptions may also play a role in smoking behavior, such that never and former smokers espouse stronger perceptions of smoking-related risks than current smokers. Finally, due to a paucity of studies, the role of cancer survivors' self-concept (e.g., identity as a "cancer survivor") and changes in their social role (e.g., employee, athlete) are unclear contributors to their smoking behavior. In summary, the Teachable Moment holds promise in its application to smoking cessation after a cancer diagnosis, though more direct research is needed. This scoping review of the scientific literature is the first formal test of the extent to which cancer diagnosis has been explored as a "teachable moment" for smoking cessation, with results that provide insight into issues of measurement precision and breadth as well as empirical support of the "teachable moment" heuristic.

Smartphone and web-based independent consultation and feedback for joint replacement surgeries: a randomized control trial protocol

BackgroundCost control and usage regulation of medical materials (MMs) are the practical issues that the government pays close attention to. Although it is well established that there is great potential to mobilize doctors and patients in participating MMs-related clinical decisions, few interventions adopt effective measures against specific behavioral deficiencies. This study aims at developing and validating an independent consultation and feedback system (ICFS) for optimizing clinical decisions on the use of MMs for inpatients needing joint replacement surgeries.MethodsDevelopment of the research protocol is based on a problem or deficiency list derived on a trans-theoretical framework which incorporates including mainly soft systems-thinking, information asymmetry, crisis-coping, dual delegation and planned behavior. The intervention consists of two main components targeting at patients and doctors respectively. Each of the intervention ingredients is designed to tackle the doctor and patient-side problems with MMs using in joint replacement surgeries. The intervention arm receives 18 months' ICFS intervention program on the basis of the routine medical services; while the control arm, only the routine medical services. Implementation of the intervention is supported by an online platform established and maintained by the Quality Assurance Center for Medical Care in Anhui Province, a smartphone-based application program (APP) and a web-based clinical support system.DiscussionThe implementation of this study is expected to significantly reduce the deficiencies and moral hazards in decision-making of MMs using through the output of economic, efficient, sustainable and easy-to-promote cooperative intervention programs, thus greatly reducing medical costs and standardizing medical behaviors.Trial registration numberISRCTN10152297.

SCHOOL-BASED PHYSICAL ACTIVITY INTERVENTIONS IN SOUTHEAST ASIA: A SYSTEMATIC REVIEW

Background: This study attempts to review longitudinal school-based physical activity (PA) interventions in Southeast Asia countries Materials and Methods: ScienceDirect, PubMed and Scopus databases were used, which ranged from the years 2003 until April 2018. A total of twelve studies were included in the final review including seven from Malaysia, three from Singapore, one from Indonesia and one from Thailand. Results: The findings from Malaysian studies showed that EPaL provides students with cognitive and behavioural skills to cause changes in targeted behaviours by aiming to alter disordered eating behaviour, promoting PA, preventing sedentary lifestyle and enhancing eating behaviours. The integration of the transtheoretical framework improves participant adherence. Furthermore, circuit training was implemented during PE classes. The results showed significant improvements in the reduction of BMI, cardiovascular endurance and flexibility. In addition, MASCOT is ideal for promoting health and reducing obesity in Malaysian children as it has shown to improve BMI and total PA. In the Indonesian study, low-intensity endurance exercise of lower extremity has shown improvements in lower-extremity endurance as well as V02 max before for individuals with lower physical capacity. In Thailand, child health promotion programme has been shown to reduce the percentage of obesity of school children in the long--term. Finally, exergaming in the Singaporean studies showed improvements in attitude, self-efficacy, and perceived behavioural control. Conclusion: Limited studies were conducted on studying the cause of longitudinal PA implementation in school settings and its impact in Southeast Asia. Therefore, future studies are proposed to investigate this relationship and utilise comprehensive frameworks to identify domains for facilitating or inhibiting PA implementation. Keywords: Physical activity, school, children, intervention, exercise, Southeast Asian.

Dialectical behavior therapy skills training affects defense mechanisms in borderline personality disorder: An integrative approach of mechanisms in psychotherapy

Objective: Borderline personality disorder (BPD) is characterized by immature defense mechanisms. Dialectical behavior therapy (DBT) is an effective treatment for BPD. However, understanding the underlying mechanisms of change is still limited. Using a transtheoretical framework, we investigated the effect of DBT skills training on defense mechanisms. Method: In this randomized controlled trial, 16 of 31 BPD outpatients received DBT skills training adjunctive to individual treatment as usual (TAU), while the remaining 15 received only individual TAU. Pre–post changes of defense mechanisms, assessed with the Defense Mechanism Rating Scale, were compared between treatment conditions using ANCOVAs. Partial correlations and linear regressions were conducted to explore associations between defenses and symptom outcome. Results: Overall defense function improved significantly more in the skills training condition (F(1, 28) = 4.57, p = .041). Borderline defenses decreased throughout skills training, but not throughout TAU only (F(1, 28) = 5.09, p = .032). In the skills training condition, an increase in narcissistic defenses was associated with higher symptom scores at discharge (β = 0.58, p = .02). Conclusions: Although DBT does not explicitly target defense mechanisms, skills training may have favorable effects on defense function in BPD. Our findings contribute to an integrative understanding of mechanisms of change in BPD psychotherapy.

Distracted driving on the job: Application of a modified stages of change model

Stage-based interventions have been tested and found to be successful in helping people adopt healthy and safe lifestyles. The safety stages of change model, a modified version of Prochaska's transtheoretical framework, shows how workplace safety behavior can progress through five stages: pre-contemplation, contemplation, other-directed action, self-directed action, and maintenance. In this study, we explored the potential application of the safety stages of change model to study the use of cell phones and other electronic communication devices among employees prohibited from using them while driving on company business. About 18% of the study sample was made up of pre-contemplators and contemplators who should be considered a priority for interventions designed to reduce distracted driving in occupational settings. We used a series of discriminant function analyses to predict stage assignment based on a number of psychosocial factors related to employees' attitudes, decisional balance, self-efficacy, and normative beliefs. Even though interpretation of the results was complicated by partial misclassification of cases, the study succeeded in identifying what specific factors may facilitate progression to more advanced behavioral stages among employee drivers. Practical implications are discussed as a blueprint for future stage-based as well as non-staged safety improvement interventions in the workplace.

Developing Emotion-Based Case Formulations: A Research-Informed Method.

New research-informed methods for case conceptualization that cut across traditional therapy approaches are increasingly popular. This paper presents a trans-theoretical approach to case formulation based on the research observations of emotion. The sequential model of emotional processing (Pascual-Leone & Greenberg, 2007) is a process research model that provides concrete markers for therapists to observe the emerging emotional development of their clients. We illustrate how this model can be used by clinicians to track change and provides a 'clinical map,' by which therapist may orient themselves in-session and plan treatment interventions. Emotional processing offers as a trans-theoretical framework for therapists who wish to conduct emotion-based case formulations. First, we present criteria for why this research model translates well into practice. Second, two contrasting case studies are presented to demonstrate the method. The model bridges research with practice by using client emotion as an axis of integration. Key Practitioner Message Process research on emotion can offer a template for therapists to make case formulations while using a range of treatment approaches. The sequential model of emotional processing provides a 'process map' of concrete markers for therapists to (1) observe the emerging emotional development of their clients, and (2) help therapists develop a treatment plan. Copyright © 2016 John Wiley & Sons, Ltd.

Explaining how faculty members act upon residents' feedback to improve their teaching performance

Responsiveness to feedback is a complex phenomenon that requires and receives attention. However, knowledge on the responsiveness of faculty members to residents' feedback on their teaching performance is lacking. Excellent teaching performance is essential to ensure patient safety and residents' learning in residency training. This study aims to increase our understanding of how faculty staff react to and act upon residents' feedback on their teaching performance. This multi-specialty, multi-institution interview study was conducted to gain insight into: (i) how teaching faculty proceed after they have received residents' feedback on their teaching performance, and (ii) the factors that influence their progression. Between August and December 2011, 24 faculty members who had received formative feedback on their teaching performance through valid and reliable feedback systems participated in this study. They reflected upon their (re)action(s) during individual semi-structured interviews. The interview protocol and analysis were guided by a comprehensive transtheoretical framework describing and explaining stages and processes of behavioural change. Faculty staff involved in residency training used residents' feedback to different extents to adapt or improve their teaching performance. Important tipping points in the processes of change necessary for faculty staff to put feedback into practice were: experiencing negative emotions in themselves or recognising those in residents as a result of failure to act upon feedback; realising that something should be done with or without support from others, and making a strong commitment to change. In addition, having the confidence to act upon feedback and recognising the benefits of change were found to stimulate faculty members to change their teaching behaviour. The responsiveness of faculty members to residents' feedback on their teaching performance varies. The adapted transtheoretical framework explains how and why faculty members do or do not proceed to action after receiving residents' feedback. Given this, organising residents' feedback for faculty staff in a systematic way is a first step and is necessary to effect potential improvements in teaching performance.

“We Need to Talk About It!”: Doing CYC as Politicized Praxis

Like many others seeking to make room for alternative voices in the narrow canon of CYC theory and practice, our work is steeped in theoretical and activist perspectives on colonialism, neoliberalism, normativity, social power, and social change. This critical, multidisciplinary lens is too often cast outside the realm of authentic CYC. In this article, we share our simultaneous struggles with and passion for our work and the CYC field and consider what can be gained from a critical ethic of practice, research, and activism. Our transtheoretical framework, drawn from Indigenous, postcolonial, queer, feminist, and poststructural perspectives, helps us unpack how coming together critically, hopefully, productively enables us to trouble exclusionary notions of CYC. We present vignettes from our practice and research that explicitly challenge the assumption that critical practice is somehow less effective and less responsive to the realities of the diverse children, youth, families, and communities with whom we work.

The LGBTQ Responsive Model for Supervision of Group Work

Although supervision of group work has been linked to the development of multicultural and social justice competencies, there are no models for supervision of group work specifically designed to address the needs of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) persons. This manuscript presents the LGBTQ Responsive Model for Supervision of Group Work (RMSGW), offering a trans-theoretical framework through which group leaders and supervisors can plan and implement group interventions. Application of the LGBTQ RMSGW is described, with implications for practice and future research discussed.

Critical incidents and assistance-seeking behaviors of White mental health practitioners: A transtheoretical framework for understanding multicultural counseling competency.

An exploratory qualitative analysis of the critical incidents and assistance-seeking behaviors of White mental health psychologists and professional counselors was performed in an effort to examine a theoretical supposition presented within a Person(al)-as-Profession(al) transtheoretical framework (P-A-P). A concurrent nested strategy was used in which both quantitative and qualitative data were collected simultaneously (Creswell, 2003). In this nested strategy, qualitative data was embedded in a predominant (quantitative) method of analysis from an earlier study (see Middleton et al., 2005). Critical incidents categorized as informal (i.e., personal) experiences were cited more often than those characterized as formal (i.e., professional) experiences as influencing the professional perspectives of White mental health practitioners regarding multicultural diversity. Implications for the counseling and psychology professions are discussed.

Childhood Obesity: A Transtheoretical Case Management Approach

Childhood obesity is an increasing health problem because of its strong associations with chronic health problems in children and adults. Obesity during childhood commonly persists into adulthood and is resistant to interventions that involve only recommendations to decrease caloric intake and to increase caloric expenditure through increased physical activity. The challenge with this approach to childhood obesity is that it is not theoretically based, nor does it consider the child's or the parent's perceptions of the health problem or their transition along the stages of behavioral change. Case management has been proven to be successful in managing various chronic health problems in both adults and children. This article will introduce a new intervention model based on the transtheoretical framework by utilizing case management in a primary care setting to treat childhood obesity.

Case Study of a Transtheoretical Case Management Approach to Addressing Childhood Obesity

Childhood obesity is an increasing health concern that is strongly associated with chronic health problems persisting into adulthood. Obesity in childhood is resistant to interventions that involve only recommendations to decrease caloric intake and to increase caloric expenditure. The challenge with this approach to childhood obesity is twofold: It is neither theoretically based nor does it consider the children's or their parent's perceptions of their health problems. Of significance, this traditional approach also ignores the transition along the stages of behavioral change. Case management has proven to be successful in managing various chronic health problems in both adults and children. This case study will present a new intervention model to treat childhood obesity based on the transtheoretical framework utilizing case management in a primary care setting.

Patients' readiness for dietary change at the beginning of counselling: a transtheoretical model-based assessment.

The purpose of this study was to explore patients' readiness for dietary change within a theoretical framework of the transtheoretical model. The patients were recently diagnosed to have type 2 diabetes or impaired glucose tolerance. We discuss the theoretical aspects of appropriate dietary counselling strategies from a standpoint of patient-specific stages of change. The data included 32 audiotaped diabetes counselling sessions with 16 patients conducted by two nurses. The transcribed data was analysed by using deductive content analysis. The patients were at different stages of change of diabetes-affected dietary behaviour. Their stages of change varied in different dietary areas and within certain dietary habits. These stages of change could involve their overall dietary behaviour or some minor aspects of their diets. Understanding patient-specific stages of change orientates health counsellors to use the most appropriate counselling strategies. The transtheoretical framework helps counsellors to perceive the total range of patients' different stages of change and their effect on the implementation of counselling. However, determining patients' stages of change through examining counselling conversations is occasionally difficult. Further qualitative research is called for.

INTRINSIC AND EXTRINSIC MOTIVATION AND STAGE OF EXERCISE ADOPTION

Intrinsic and extrinsic motivation have been shown to be important predictors of exercise adoption and maintenance; very little is known about assessing specific aspects of exercise motivation within a transtheoretical framework. PURPOSE The current study evaluated intrinsic and extrinsic motivation for exercise by stage of motivational readiness in two healthy college samples. METHODS Sample 1 (S1: 101 women, 83 men, M=18.6±0.5 yrs) and Sample 2 (S2: 144 women, 76 men, M=21.5±4.27 years) completed McAuley's intrinsic motivation inventory (21 items), Lee's extrinsic motivation questionnaire (13 items), stage of motivational readiness for exercise, and measures of exercise. RESULTS Both samples had similar distributions by stage, and stage classifications matched self-report of physical activity. Precontemplation was underrepresented and combined with Contemplation. Intrinsic and extrinsic motivation increased across stages for both samples (p < .001), suggesting that both intrinsic and extrinsic motivation remain important throughout the adoption and maintenance process. Contemplators reported significantly lower intrinsic and extrinsic motivation than did those in Preparation and Action, and those in Preparation and Action reported significantly lower intrinsic and extrinsic motivation than did those in Maintenance. CONCLUSION Motivation did not differ between those in Preparation and Action, suggesting other potential mediators of early adoption of exercise. Supported in part by the School of Physical Activity and Educational Services, The Ohio State University

Inappropriate helping behavior and its impact on the identified patient.

An integrative approach to under- standing and treating inappropriate re- lationships is presented. It can be applied both to the professional field (known as helping syn- drome) and to the marital and family environ- ment (contributors). Examples illustrate typical colluding behaviors related to alcoholism, de- pression, and psychosomatic disorders. Psycho- dynamic perspectives are reviewed to describe the helper's personality and his/her underlying shortcomings. However, perspectives that focus solely on the individual are seen as limited and incomplete. Systems theory contributes commu- nicational and interpersonal knowledge. A re- sultant synthesis is proposed as an alternative. Situational, interactional, and intrapersonal in- fluences on behavior are integrated within a transtheoretical framework. A questionnaire is included to facilitate exploration on maladaptive behavior.