Using motivational interviewing as a supplement to obesity treatment: a stepped-care approach.

OBJECTIVE: This investigation was designed to improve behavioral weight loss program (BWLP) treatment outcomes by providing stepped care (SC) to individuals experiencing difficulties with weight loss during treatment. SC entails transition to more intensive treatments when less intensive treatments fail to meet treatment goals. In a BWLP, motivational interviewing (MI) may increase participants' motivation toward behavioral change and thus complement the acquisition of behavioral change skills. It was hypothesized that BWLP+SC (MI) participants (i.e., participants who failed to meet weight loss goals and received MI) would demonstrate superior treatment outcomes when compared with BWLP (SC matched) participants (i.e., participants who failed to meet weight loss goals but did not receive MI). DESIGN: Fifty-five obese, sedentary adults were randomly assigned to a BWLP+SC or a BWLP. MAIN OUTCOME MEASURES: Changes in weight, cardiorespiratory fitness, self-reported physical activity, and diet (i.e., calories, percentage daily intake of fat, protein, and carbohydrates) in response to treatment were assessed. RESULTS: Participants significantly decreased their weight, increased physical activity/fitness, and improved dietary intake (ps<.05). BWLP+SC (MI) participants lost more weight and engaged in greater weekly exercise than BWLP (SC matched) participants who did not receive MI (ps<.05). CONCLUSION: For individuals experiencing weight loss difficulties during a BWLP, MI may have considerable promise.     

Using the theory of planned behaviour to predict screening uptake in two contexts

Given current policy that decisions about screening should be based on informed choice, such decisions should reflect people's values and attitudes. This prospective study compares the attitudes and other cognitive predictors of screening uptake in two contexts: when conducted as part of a routine visit and when it is conducted at a separate, test-specific visit. It was conducted in two hospitals in England, differing in method of screening organisation. 1499 pregnant women offered serum screening for Down Syndrome completed a questionnaire assessing theory of planned behaviour constructs: attitude towards undergoing the test, subjective norms of others, perceived behavioural control and intention to undergo the test.

Intention predicted screening uptake in both screening settings, but more strongly when screening was part of a routine visit. Perceived behavioural control was not predictive of uptake, and only weakly predictive of intention in both settings. Subjective norm predicted intention more strongly when it referred to partner and friends than when it referred to health professionals, in both settings.

Attitude was more strongly predictive of intention to attend screening when screening was organised as a part of routine screening, rather than requiring a separate visit. These results suggest that offering a screening test at a routine visit compared with a separate visit is more likely to facilitated uninformed choices, given the stronger association between attitudes and intention and the absence of an association with the perceived influence of health professionals.     

Introspective physicalism as an approach to the science of consciousness

Most 'theories of consciousness' are based on vague speculations about the properties of conscious experience. We aim to provide a more solid basis for a science of consciousness. We argue that a theory of consciousness should provide an account of the very processes that allow us to acquire and use information about our own mental states - the processes underlying introspection. This can be achieved through the construction of information-processing models that can account for 'Type-C' processes. Type-C processes can be specified experimentally by identifying paradigms in which awareness of the stimulus is necessary for an intentional action. The Shallice (1988b) framework is put forward as providing an initial account of Type-C processes, which can relate perceptual consciousness to consciously performed actions. Further, we suggest that this framework may be refined through the investigation of the functions of prefrontal cortex. The formulation of our approach requires us to consider fundamental conceptual and methodological issues associated with consciousness. The most significant of these issues concerns the scientific use of introspective evidence. We outline and justify a conservative methodological approach to the use of introspective evidence, with attention to the difficulties historically associated with its use in psychology.     

Analysing cycling as a social practice: An empirical grounding for behaviour change

Despite significant national and local efforts over the last decade to stimulate uptake of cycling in the UK, levels of cycling (particularly utility cycling) remain at around 2% of journeys. Understanding of cycling behaviour and subsequent development of interventions has typically been undertaken using an individualist approach, often relying on psychologically based models of behaviour. This paper argues that Social Practice Theory (SPT) may be a valuable addition to practitioner’s toolboxes by providing an alternative means of understanding the complex dynamics between the elements that constitute the practice of utility cycling, allowing it to be considered as a social issue, rather than focusing solely on individual behaviour. This is demonstrated within the paper by the use of SPT to reanalyse quantitative and qualitative datasets that explore views and experiences of both cyclists and non-cyclists. Therein, the practice of utility cycling is described according to its three elements; materials, meaning and competences and the potential benefits of this approach are discussed; particularly its ideological shift away from ‘victim blaming’ and its natural support of interdisciplinary intervention design.     

Using a psychoeducational approach to increase the self-esteem of adolescents at high risk for dropping out

The effectiveness of an ecologically oriented approach in changing the self-concepts of 80 high-risk adolescents was investigated. Participants were administered a self-esteem scale before and after an eight-week psychoeducational program designed for dropout prevention. Results indicated significant reductions in dropout rates and increased self-esteem among participants.     

Towards a new image of science: Science teaching and non-analytical philosophy of science

This paper describes an attempt to develop a pedagogy for teaching philosophy in science rather than a philosophy of science to be taught in the Bulgarian educational system.     

Psychoanalysis as a science: a response to the new challenges

Few theoretical issues in psychoanalysis have been more constantly argued than the status of our discipline as a science. For long the attack has been from the logical positivists and the extensions of their argument by Karl Popper. Over recent decades the debate about the place of our metapsychology has intensified the concerns about our scientific status. In this paper I respond briefly to the logical positivist, the Popperian, and the information-processing systems theory arguments and then develop at greater length a response to the two current, most widespread philosophy-of-science assaults upon our credibility as science, that of the hermeneuticists (Ricoeur, Habermas, Gadamer, and others), and the newest, that of the philosopher, Adolf Grünbaum.     

N-of-1 methods: A practical guide to exploring trajectories of behaviour change and designing precision behaviour change interventions

Objectives(1) To introduce N-of-1 methods and how they can help the researchers identify predictors of behavioural outcomes, (2) to provide examples of studies that test individual theory-based predictions of physical activity and/or exercise; (3) to provide a practical example dataset to illustrate how to design and undertake a basic analysis for an N-of-1 study; and (4) to suggest a future agenda for N-of-1 physical activity and exercise research.DesignFactors for consideration when designing an N-of-1 study include variability of predictors and outcomes, assessment frequency and appropriate analysis methods. Existing literature and piloting can help inform these aspects.MethodsWe use a dataset of 24 individuals who collected data over 28 days to illustrate example analysis procedures. Data, guidance and associated SPSS and R syntax are made available to provide researchers with tools to learn about and practice N-of-1 analysis.ResultsGuidance on dealing with missing data, looking at graphical representations of N-of-1 data, managing autocorrelation using the prewhitening method and analysing N-of-1 datasets is provided. Using the example dataset, we demonstrate how to identify antecedents of physical activity (steps) to assess directionality of associations. We also include an overview of aggregating N-of-1 datasets using multilevel modelling.ConclusionsN-of-1 methodology provides a means of tracking individual patterns of behaviour and identifying potential antecedents of physical activity and exercise to help determine causality. Assisted by mobile technologies, there is great potential to enrich our understanding of movement behaviour using this approach to inform interventions.     

Using system differences to orchestrate change: a systems-guides intervention model

Successful community-based interventions require that change agents give attention to the complexities of interwoven systems, described in the literature as complicated or complex, purposeful or purposive. The author further notes the separate standards, norms, principles and/or goals (here-named systems-guides) of systems. This paper describes the author's experience as a consultant to a multi-system collaboration where observed tensions among participants resulted in the author's implementation of a three-step systems-guides model, which can increase change agents' effectiveness with systems. The steps comprise: detection (of systems, systems-guides, and discrepancies between them; here through observation); documentation (of discrepancies; here through small group discussions); dissemination (to systems participants; here to the collaboration). Two small but fundamental systems changes emerged from systems participants, not from the change agent/author who facilitated systems members' recognition of discrepancies. A major limitation in the implementation of this systems-guides model centers on the critical necessity of the close relationship change agents must have with the involved systems.     

Using public feedback to increase contributions to a multipurpose senior center

Multipurpose senior centers are expanding their services to meet the demands of a growing population. Unfortunately, federal agencies have not matched this expansion with monetary support. Many senior centers hold fund-raisers to supplement their budgets, but the impact of these projects is rarely evaluated. This study assessed the effectiveness of a public posting strategy designed to increase donations to an ongoing fund-raiser for a multipurpose senior center. The fund-raiser, "Coupons for Caring," consisted of senior volunteers clipping grocery coupons from newspapers, sorting them, and attaching them to their respective products in local grocery stores. Grocery store customers were given the option of donating the coupons to the senior center or redeeming them when they purchased the products to which the coupons were attached. In the experimental condition, signs were posted that included visual and written instructions, feedback on the value of coupons donated by customers the previous week, and feedback on the overall amount of money donated to the senior center. The signs were posted near each cashier stand and at the front entrances of the grocery stores in a multiple baseline across grocery stores. The percentage of coupons donated to the senior center increased at each store after the signs were posted.     

Working alliance as a predictor of change in depression during blended cognitive behaviour therapy

Blended Cognitive Behaviour Therapy (bCBT) is a new form of treatment, mixing internet-based modules and face-to-face therapist sessions. How participants rate the therapeutic alliance in bCBT has not yet been thoroughly explored, and neither is it clear whether therapist- and patient-rated alliances are predictors of change in depression during treatment. Depression and alliance ratings from 73 participants in a treatment study on bCBT (part of the E-COMPARED project) were analysed using growth curve models. Alliance, as rated by both patients and therapists, was high. The therapist-rated working alliance was predictive of subsequent changes in depression scores during treatment, whereas the patient-rated alliance was not. A therapeutic alliance can be established in bCBT. The role of the therapist-rated alliance seems to be of particular importance and should be carefully considered when collecting data in future studies on bCBT.     

Using consumer preference information to increase the reach and impact of media-based parenting interventions in a public health approach to parenting support

Within a public health approach to improving parenting, the mass media offer a potentially more efficient and affordable format for directly reaching a large number of parents with evidence-based parenting information than do traditional approaches to parenting interventions that require delivery by a practitioner. Little is known, however, about factors associated with parents' interest in and willingness to watch video messages about parenting. Knowledge of consumer preferences could inform the effective design of media interventions to maximize parental engagement in the parenting messages. This study examined parents' preferred formats for receiving parenting information, as well as family sociodemographic and child behavior factors that predict parents' ratings of acceptability of a media-based parenting intervention. An ethnically diverse sample of 162 parents of children ages 3-6 years reported their preferences for various delivery formats for parenting information and provided feedback on a prototype episode of a video-format parenting program based on the Triple P Positive Parenting Program. Parents reported the strongest preference for self-administered delivery formats such as television, online programs, and written materials; the least preferred formats were home visits, therapists, and multiweek parenting groups. Parents' ratings of engagement, watchability, and realism of the prototype parenting episode were quite strong. Parents whose children exhibited clinical levels of problem behaviors rated the episode as more watchable, engaging, and realistic. Mothers also rated the episodes as more engaging and realistic than did fathers. Lower income marginally predicted higher watchability ratings. Minority status and expectations of future problems did not predict acceptability ratings. The results suggest that the episode had broad appeal across groups.     

A diagnostic approach to increase reusable dinnerware selection in a cafeteria

The current project tested a diagnostic approach to selecting interventions to increase patron selection of reusable dinnerware in a cafeteria. An assessment survey, completed by a sample of 43 patrons, suggested that the primary causes of wasteful behavior were (a) environmental arrangement of dinnerware options and (b) competing motivational variables. A functional relation between environmental arrangement and reusable product selection was demonstrated in a reversal design. However, the largest effect occurred as function of a multicomponent intervention involving environmental arrangement, employee involvement, and personal spoken prompts with motivational signs. The results support the use of informant assessments when designing community interventions.     

Creating a strategy for progress: a contextual behavioral science approach

Behavior analysis is a field dedicated to the development and application of behavioral principles to the understanding and modification of the psychological actions of organisms. As such, behavior analysis was committed from the beginning to a comprehensive account of behavior, stretching from animal learning to complex human behavior. Despite that lofty goal, basic behavior analysis is having a generally harder time finding academic support, and applied behavior analysis has narrowed its focus. In the present paper we argue that both of these trends relate to the challenge of human language and cognition, and that developments within clinical behavior analysis and the analysis of derived relational responding are providing a way forward. To take full advantage of these developments, however, we argue that behavior analysts need to articulate their unique approach to theory, to develop more flexible language systems for applied workers, and to expand their methodological flexibility. This approach, which we term contextual behavioral science, is meant as an evolutionary step that will allow behavior analysis to better capture the center of modern psychological concerns in both the basic and applied areas. Clinical behavior analysis is showing a way forward for behavior analysis to regain its vision as a comprehensive approach to behavior.     

Evolutionary social science: A new approach to violent crime

Evolutionary Social Science unites evolutionary psychology and social science. Its core assumptions are that: (1) modern societies owe their character to an interaction of hunter–gatherer adaptations with the modern environment; (2) some changes in societies reflect change in individuals; (3) historical changes and cross-societal differences can be due to similar adaptational mechanisms, and (4) different social contexts modify development through adaptive mechanisms. Preliminary research is reviewed concerning historical and cross-national variation in violent crime to illustrate the new research strategy. Societal differences in violence can be partly explained in terms of reduced parental investment and increased mating aggression.     

Enhancing interest in science: exemplars as cues to communal affordances of science

A deterrent to recruiting students into STEM pathways is the stereotype that STEM fields do not afford communal goals to work with or help others. We investigate the challenges to cueing communal opportunities in science via brief exposure to scientist exemplars. Both male and female scientists depicted as engaged in communal work increased beliefs that science afforded communal goals and positivity toward science careers (Study 1). Without the direct performance of communal activities, communal affordances were cued only when a female scientist was prototypic of her gender category and respondents were highly communally oriented (Study 2). To change stereotypes that science does not involve communal goals, both female and male scientists can highlight communal aspects of their work.