Drive, reward sensitivity and the flattening of both.
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151 to 175 of 1,483Shame and the motivation to change the self.
A central question of human psychology is whether and when people change for the better. Although it has long been assumed that emotion plays a central role in self-regulation, the role of specific emotions in motivating a desire for self-change has been largely ignored. We report 2 studies examining people's lived experiences of self-conscious emotions, particularly shame, in motivating a desire for self-change. Study 1 revealed that when participants recalled experiences of shame, guilt, or embarrassment, shame-and, to some degree, guilt-predicted a motivation for self-change. Study 2 compared shame, guilt, and regret for events and found that although shame experiences often involved high levels of both regret and guilt, it was feelings of shame that uniquely predicted a desire for self-change, whereas regret predicted an interest in mentally undoing the past and repairing harm done. …
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Role of pill-taking, expectation and therapeutic alliance in the placebo response in clinical trials for major depression.
Background: Pill-taking, expectations and therapeutic alliance may account for much of the benefit of medication and placebo treatment for major depressive disorder (MDD). Aims To examine the effects of medication, placebo and supportive care on treatment outcome, and the relationships of expectations and therapeutic alliance to improvement.
Method: A total of 88 participants were randomised to 8 weeks of treatment with supportive care alone or combined with double-blind treatment with placebo or antidepressant medication. Expectations of medication effectiveness, general treatment effectiveness and therapeutic alliance were measured (trial registration at ClinicalTrials.gov: NCT00200902).
Results: Medication or placebo plus supportive care were not significantly different but had significantly better outcome than supportive care alone. Therapeutic alliance predicted response to medicati…
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Treating severe and enduring anorexia nervosa: a randomized controlled trial.
Background: There are no evidence-based treatments for severe and enduring anorexia nervosa (SE-AN). This study evaluated the relative efficacy of cognitive behavioral therapy (CBT-AN) and specialist supportive clinical management (SSCM) for adults with SE-AN.
Method: Sixty-three participants with a diagnosis of AN, who had at least a 7-year illness history, were treated in a multi-site randomized controlled trial (RCT). During 30 out-patient visits spread over 8 months, they received either CBT-AN or SSCM, both modified for SE-AN. Participants were assessed at baseline, end of treatment (EOT), and at 6- and 12-month post-treatment follow-ups. The main outcome measures were quality of life, mood disorder symptoms and social adjustment. Weight, eating disorder (ED) psychopathology, motivation for change and health-care burden were secondary outcomes.
Results: Thirty-one participants were …
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Stuart GL, Shorey RC, Moore TM, Ramsey SE, Kahler CW, O'Farrell TJ, Strong DR, Temple JR, Monti PM (2013)randomised controlled trialMEDLINE-indexed journal, not yet read by usAddiction (Abingdon, England)49 citations Randomized clinical trial examining the incremental efficacy of a 90-minute motivational alcohol intervention as an adjunct to standard batterer intervention for men.
Aims: The efficacy of batterer intervention programs to reduce intimate partner violence (IPV) is questionable, with individuals with alcohol problems particularly unlikely to benefit. We examined whether adding adjunctive alcohol intervention to batterer intervention reduced the likelihood of substance use and violence relative to batterer intervention alone.
Design: Randomized clinical trial.
Setting: Batterer intervention programs in Rhode Island, USA.
Participants: A total of 252 hazardous drinking men in batterer intervention programs. Participants were randomized to receive 40 hours of standard batterer program (SBP) or the SBP plus a 90-minute alcohol intervention (SBP + BAI). None withdrew due to adverse effects. Data were collected at baseline, 3-, 6- and 12-month follow-up, with follow-up rates of 95, 89 and 82%, respectively.
Measurements: Substance use was measured with a wel…
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Motivational enhancement to improve adherence to positive airway pressure in patients with obstructive sleep apnea: a randomized controlled trial.
Background: Obstructive sleep apnea (OSA) is associated with a variety of medical conditions. Positive airway pressure (PAP) is an effective treatment for improving sleep, yet adherence rates are low. The aim of the current study is to test two treatments versus standard care in improving adherence to PAP.
Method: Two hundred twenty-seven patients with OSA were randomized to standard care (SC), education (ED) and motivational enhancement therapy (MET). Adherence was measured objectively and the first week of adherence (prior to the intervention) was used as an a priori moderator of the effect of the various interventions. Mediators of treatment response were also examined using theory-based measures of decisional balance and self-efficacy.
Results: Adherence declined over time for all three groups. There was a significant interaction between level of adherence during the first week of tr…
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Randomized controlled trial of contingency management for stimulant use in community mental health patients with serious mental illness.
Objective: The primary objective of this study was to determine whether contingency management was associated with increased abstinence from stimulant drug use in stimulant-dependent patients with serious mental illness treated in a community mental health center. Secondary objectives were to determine whether contingency management was associated with reductions in use of other substances, psychiatric symptoms, HIV risk behavior, and inpatient service utilization.
Method: A randomized controlled design was used to compare outcomes of 176 outpatients with serious mental illness and stimulant dependence. Participants were randomly assigned to receive 3 months of contingency management for stimulant abstinence plus treatment as usual or treatment as usual with reinforcement for study participation only. Urine drug tests and self report, clinician-report, and service utilization outcomes we…
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Predicting adoption of exposure therapy in a randomized controlled dissemination trial.
The present study examined organizational, client, and therapist characteristics as predictors of use of and proficiency in exposure therapy (ET) after training. Therapists naïve to ET (N=181) were randomized to: (1) online training (OLT), (2) OLT plus motivational enhancement (ME), or (3) OLT+ME plus a learning community. Twelve weeks after training, self-reported use of ET in clinical practice was high (87.5%) and therapists demonstrated moderate clinical proficiency. Use of ET was predicted by therapist degree, self-efficacy, and knowledge. Clinical proficiency was predicted by therapist anxiety sensitivity, attitudes, and knowledge, as well as organizational and client barriers. Several of these effects were moderated by training condition, indicating that therapists who received more comprehensive training were less impacted by barriers and showed enhanced adoption in the presence o…
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Chronic care management for dependence on alcohol and other drugs: the AHEAD randomized trial.
Importance: People with substance dependence have health consequences, high health care utilization, and frequent comorbidity but often receive poor-quality care. Chronic care management (CCM) has been proposed as an approach to improve care and outcomes.
Objective: To determine whether CCM for alcohol and other drug dependence improves substance use outcomes compared with usual primary care.
Design, setting, and participants: The AHEAD study, a randomized trial conducted among 563 people with alcohol and other drug dependence at a Boston, Massachusetts, hospital-based primary care practice. Participants were recruited from September 2006 to September 2008 from a freestanding residential detoxification unit and referrals from an urban teaching hospital and advertisements; 95% completed 12-month follow-up.
Interventions: Participants were randomized to receive CCM (n=282) or no CCM (n=281…
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Compassion training alters altruism and neural responses to suffering.
Compassion is a key motivator of altruistic behavior, but little is known about individuals' capacity to cultivate compassion through training. We examined whether compassion may be systematically trained by testing whether (a) short-term compassion training increases altruistic behavior and (b) individual differences in altruism are associated with training-induced changes in neural responses to suffering. In healthy adults, we found that compassion training increased altruistic redistribution of funds to a victim encountered outside of the training context. Furthermore, increased altruistic behavior after compassion training was associated with altered activation in brain regions implicated in social cognition and emotion regulation, including the inferior parietal cortex and dorsolateral prefrontal cortex (DLPFC), and in DLPFC connectivity with the nucleus accumbens. These results sug…
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Motivational interviewing and exercise programme for community-dwelling older persons with chronic pain: a randomised controlled study.
Aims and objectives: To examine the effectiveness of an integrated motivational interviewing and physical exercise programme on pain, physical and psychological function, quality of life, self-efficacy, and compliance with exercise for community-dwelling older persons with chronic pain.
Background: Chronic pain is common among older persons. Indeed, motivation for managing pain is poor, and may cause negative consequences. Motivational interviewing maybe effective in treating chronic pain.
Design: Single-blinded randomised control study.
Methods: Older persons with chronic pain (n = 56) were recruited from two elderly community centres. They were blinded from the group allocation. The programme was conducted by an motivational interviewing-trained physiotherapist and registered nurses. Participants in the experimental group received an 8-week integrated motivational interviewing and phys…
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Foy CG, Vitolins MZ, Case LD, Harris SJ, Massa-Fanale C, Hopley RJ, Gardner L, Rudiger N, Yamamoto K, Swain B, Goff DC, Danhauer SC, Booth D, Gaspari J (2013)randomised controlled trialMEDLINE-indexed journal, not yet read by usContemporary clinical trials14 citations Incorporating prosocial behavior to promote physical activity in older adults: rationale and design of the Program for Active Aging and Community Engagement (PACE).
Despite the benefits of regular physical activity among older adults, physical activity rates are low in this population. The Program for Active Aging and Community Engagement (PACE) is an ongoing randomized controlled trial designed to compare the effects of two interventions on physical activity at 12 months among older adults. A total of 300 men and women aged 55 years or older will be randomized into either a healthy aging (HA) control intervention (n = 150), which is largely based upon educational sessions, or a prosocial behavior physical activity (PBPA) intervention (n = 150), which incorporates structured physical activity sessions, cognitive-behavioral counseling, and opportunities to earn food for donation to a regional food bank based on weekly physical activity and volunteering. The PBPA intervention is delivered at a local YMCA, and a regional grocery store chain donates the…
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A randomized trial of contingency management delivered by community therapists.
Objective: Contingency management (CM) is an evidence-based treatment, but few clinicians deliver this intervention in community-based settings.
Method: Twenty-three clinicians from 3 methadone maintenance clinics received training in CM. Following a didactics seminar and a training and supervision period in which clinicians delivered CM to pilot patients, a randomized trial evaluated the efficacy of CM when delivered entirely by clinicians. Sixteen clinicians treated 130 patients randomized to CM or standard care. In both conditions, urine and breath samples were collected twice weekly for 12 weeks. In the CM condition, patients earned the opportunity to win prizes ranging in value from $1 to $100 for submitting samples negative for cocaine and alcohol. Primary treatment outcomes were retention, longest continuous period of abstinence, and proportion of negative samples submitted.
Resul…
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Preoperative home-based physical therapy versus usual care to improve functional health of frail older adults scheduled for elective total hip arthroplasty: a pilot randomized controlled trial.
Objective: To investigate the feasibility and preliminary effectiveness of a home-based intensive exercise program to improve physical health of frail elderly patients scheduled for elective total hip arthroplasty (THA).
Design: Single-blind pilot randomized controlled trial.
Setting: Patients' homes and a general hospital in The Netherlands.
Participants: Frail patients (N=30) older than 65 years.
Intervention: A preoperative, home-based program supervised by an experienced physical therapist to train functional activities and walking capacity. The control group received usual care consisting of 1 session of instructions.
Main outcome measures: Feasibility was determined on the basis of adherence to treatment, patient satisfaction, adverse events, walking distance (measured with a pedometer), and intensity of exercise (evaluated with the Borg scale). Preliminary pre- and postoperative e…
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Taylor LD (2012)randomised controlled trialMEDLINE-indexed journal, not yet read by usDeath studies1 citations Death and television: terror management theory and themes of law and justice on television.
Based on terror management theory, it was hypothesized that media choices may be affected by the salience of death-related thoughts. Three experiments with samples of undergraduate students were conducted to investigate whether such a process would affect preferences for law and justice television programming. In the first experiment (n = 132), individuals for whom mortality had been made salient through experimental induction preferred more programs with law and justice themes than individuals for whom mortality had not been made salient. In the second experiment (n = 761), this effect was observed regardless of trust in law enforcement and only for participants induced to think about death, not those induced to think about pain. In the third experiment (n = 163), participants for whom mortality was salient who watched a crime drama that showed justice being carried out showed a diminis…
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Oxytocin increases heart rate variability in humans at rest: implications for social approach-related motivation and capacity for social engagement.
Context: Oxytocin (OT) plays a key regulatory role in human social behaviour. While prior studies have examined the effects of OT on observable social behaviours, studies have seldom examined the effects of OT on psychophysiological markers such as heart rate variability (HRV), which provides an index of individual's motivation for social behaviour. Furthermore, no studies have examined the impact of OT on HRV under resting conditions, which provides an index of maximal capacity for social engagement.
Objective: To examine the effects of OT on HRV measures in healthy male participants while at rest. OT was hypothesised to increase HRV, compared to placebo, and that the effects would be greatest for a non-linear measure of HRV (the detrended fluctuation scaling exponent).
Methods: Twenty-one male participants were recruited for this study. Participants were non-smokers, not on any medicat…
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Smoking cessation and quality of life: changes in life satisfaction over 3 years following a quit attempt.
Background: There has been limited research addressing changes in subjective well-being as a result of quitting smoking.
Purpose: The purpose of this study was to use longitudinal data to determine the relation between smoking cessation and subjective measures of well-being, including global quality of life (QOL), health-related QOL (HR-QOL), affect, relationship satisfaction, and stressor occurrence.
Methods: As part of a randomized, placebo-controlled smoking cessation trial, 1,504 participants (58.2% women, 83.9% white) completed assessments and had their smoking status biochemically confirmed at baseline and years 1 and 3 post-quit.
Results: Compared with continuing smokers, quitters showed improved global QOL, HR-QOL, and affect at years 1 and 3 and fewer stressors by year 3. Smoking status did not influence marital relationship satisfaction.
Conclusions: Successful quitters, in con…
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Effect of a cash transfer programme for schooling on prevalence of HIV and herpes simplex type 2 in Malawi: a cluster randomised trial.
Background: Lack of education and an economic dependence on men are often suggested as important risk factors for HIV infection in women. We assessed the efficacy of a cash transfer programme to reduce the risk of sexually transmitted infections in young women.
Methods: In this cluster randomised trial, never-married women aged 13-22 years were recruited from 176 enumeration areas in the Zomba district of Malawi and randomly assigned with computer-generated random numbers by enumeration area (1:1) to receive cash payments (intervention group) or nothing (control group). Intervention enumeration areas were further randomly assigned with computer-generated random numbers to conditional (school attendance required to receive payment) and unconditional (no requirements to receive payment) groups. Participants in both intervention groups were randomly assigned by a lottery to receive monthly …
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Does computerized working memory training with game elements enhance motivation and training efficacy in children with ADHD?
This study examined the benefits of adding game elements to standard computerized working memory (WM) training. Specifically, it examined whether game elements would enhance motivation and training performance of children with ADHD, and whether it would improve training efficacy. A total of 51 children with ADHD aged between 7 and 12 years were randomly assigned to WM training in a gaming format or to regular WM training that was not in a gaming format. Both groups completed three weekly sessions of WM training. Children using the game version of the WM training showed greater motivation (i.e., more time training), better training performance (i.e., more sequences reproduced and fewer errors), and better WM (i.e., higher scores on a WM task) at post-training than children using the regular WM training. Results are discussed in terms of executive functions and reinforcement models of ADHD…
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Maintenance of exercise after phase II cardiac rehabilitation: a randomized controlled trial.
Background: Patients who have completed Phase II cardiac rehabilitation have low rates of maintenance of exercise after program completion, despite the importance of sustaining regular exercise to prevent future cardiac events.
Purpose: The efficacy of a home-based intervention to support exercise maintenance among patients who had completed Phase II cardiac rehabilitation versus contact control was evaluated.
Design: An RCT was used to evaluate the intervention. Data were collected in 2005-2010 and analyzed in 2010.
Setting/participants: One hundred thirty patients (mean age=63.6 years [SD=9.7], 20.8% female) were randomized to exercise counseling (Maintenance Counseling group, n=64) or contact control (Contact Control group, n=66).
Intervention: Maintenance Counseling group participants received a 6-month program of exercise counseling (based on the transtheoretical model and social co…
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Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial.
Background: Rates of smoking cessation have not changed in a decade, accentuating the need for novel approaches to prompt quit attempts.
Methods: Within a nationwide randomized clinical trial (N = 849) to induce further quit attempts and cessation, smokers currently unmotivated to quit were randomized to a practice quit attempt (PQA) alone or to nicotine replacement therapy (hereafter referred to as nicotine therapy), sampling within the context of a PQA. Following a 6-week intervention period, participants were followed up for 6 months to assess outcomes. The PQA intervention was designed to increase motivation, confidence, and coping skills. The combination of a PQA plus nicotine therapy sampling added samples of nicotine lozenges to enhance attitudes toward pharmacotherapy and to promote the use of additional cessation resources. Primary outcomes included the incidence of any ever occ…
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Becoming happier takes both a will and a proper way: an experimental longitudinal intervention to boost well-being.
An 8-month-long experimental study examined the immediate and longer term effects of regularly practicing two assigned positive activities (expressing optimism and gratitude) on well-being. More important, this intervention allowed us to explore the impact of two metafactors that are likely to influence the success of any positive activity: whether one self-selects into the study knowing that it is about increasing happiness and whether one invests effort into the activity over time. Our results indicate that initial self-selection makes a difference, but only in the two positive activity conditions, not the control, and that continued effort also makes a difference, but, again, only in the treatment conditions. We conclude that happiness interventions are more than just placebos, but that they are most successful when participants know about, endorse, and commit to the intervention.
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Why envy outperforms admiration.
Four studies tested the hypothesis that the emotion of benign envy, but not the emotions of admiration or malicious envy, motivates people to improve themselves. Studies 1 to 3 found that only benign envy was related to the motivation to study more (Study 1) and to actual performance on the Remote Associates Task (which measures intelligence and creativity; Studies 2 and 3). Study 4 found that an upward social comparison triggered benign envy and subsequent better performance only when people thought self-improvement was attainable. When participants thought self-improvement was hard, an upward social comparison led to more admiration and no motivation to do better. Implications of these findings for theories of social emotions such as envy, social comparisons, and for understanding the influence of role models are discussed.
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A randomized trial of computer-based communications using imagery and text information to alter representations of heart disease risk and motivate protective behaviour.
Objective: Advances in web-based animation technologies provide new opportunities to develop graphic health communications for dissemination throughout communities. We developed imagery and text contents of brief, computer-based programmes about heart disease risk, with both imagery and text contents guided by the common-sense model (CSM) of self-regulation. The imagery depicts a three-dimensional, beating heart tailored to user-specific information.
Design: A 2 × 2 × 4 factorial design was used to manipulate concrete imagery (imagery vs. no imagery) and conceptual information (text vs. no text) about heart disease risk in prevention-oriented programmes and assess changes in representations and behavioural motivations from baseline to 2 days, 2 weeks, and 4 weeks post-intervention.
Methods: Sedentary young adults (N= 80) were randomized to view one of four programmes: imagery plus text, …
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Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I (2011)randomised controlled trialMEDLINE-indexed journal, not yet read by usLancet (London, England)520 citations Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial.
Background: Smoking cessation programmes delivered via mobile phone text messaging show increases in self-reported quitting in the short term. We assessed the effect of an automated smoking cessation programme delivered via mobile phone text messaging on continuous abstinence, which was biochemically verified at 6 months.
Methods: In this single-blind, randomised trial, undertaken in the UK, smokers willing to make a quit attempt were randomly allocated, using an independent telephone randomisation system, to a mobile phone text messaging smoking cessation programme (txt2stop), comprising motivational messages and behavioural-change support, or to a control group that received text messages unrelated to quitting. The system automatically generated intervention or control group texts according to the allocation. Outcome assessors were masked to treatment allocation. The primary outcome wa…
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Factors associated with outcome of cognitive-behavioural therapy for complicated grief: a preliminary study.
Complicated grief (CG), also called prolonged grief disorder, is a debilitating condition that can develop following a loss. There is growing evidence that cognitive-behavioural interventions are efficacious in the treatment of CG. The present preliminary study used data from 43 patients with CG who were randomly assigned to cognitive-behavioural therapy in an earlier treatment trial to explore (a) predictors of outcome of cognitive-behavioural therapy for CG and (b) the relationship between symptom improvement and changes in loss-related negative cognitions and avoidance behaviours. Analyses showed that worse treatment outcome was associated with lower education attainment, loss of a partner/child (instead of some other relative), early treatment discontinuation, less patient motivation and more severe CG symptoms at pre-treatment. As predicted, stronger reduction in CG severity was sig…
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