Motivation Change in Therapeutic Community Residential Treatment

Latent growth curve analysis was used to assess motivation change across 3 time points for 120 therapeutic community residents. Models included the time‐in‐variant predictor of readiness for treatment, which significantly predicted initial treatment motivation but not the rate of motivation change over time.     

Adolescents’ movement towards cessation of smoking: Role and relative value of the processes of change and nicotine dependence

The present study addresses the applicability of the Transtheoretical Model's processes of change in explaining adolescents’ readiness to quit smoking. Furthermore, the association between nicotine dependence and readiness to quit was assessed both directly, as well as indirectly through the processes of change. A cross-sectional survey was conducted, identifying 1547 weekly smokers aged 14–18 years. Structural equation modelling showed that the processes of change were only marginally associated with readiness to quit. Adding nicotine dependence to the model showed a direct association between nicotine dependence and readiness to quit. Only one process of change, self-liberation (i.e. choice/commitment to change and belief in the ability to change), was found to mediate this association. Nicotine dependence appeared to be highly important in adolescents’ readiness to quit.     

Assessing readiness for change in adolescents with eating disorders

The Readiness and Motivation Interview (RMI) is a semistructured interview measure of readiness and motivation to change that can be used for all eating disorder diagnoses. The RMI has demonstrated excellent psychometric properties and has both clinical and predictive utility in adult samples. This study examined the psychometric properties of the RMI in a younger population, namely, 12- to 18-year-old girls with eating disorders. Study participants (N = 65) completed the RMI and measures of convergent, discriminant, and criterion validity. Adolescents with eating disorders were able to conceptualize and articulate their readiness for change and to report the extent to which change efforts were for themselves versus for others. RMI readiness profiles across eating disorder symptom domains in adolescents were comparable to those in adults, with higher reported readiness to change binge eating than to change dietary restriction or compensatory strategies. Differences in internal consistency between adult and adolescent samples are discussed. Interviewing adolescents early in treatment about readiness may assist clinicians in forming an alliance with this difficult-to-engage population, while also providing valuable information for treatment planning.     

Differential effects of pretraining influences on readiness to change

Training and development are integral to organizational change but are difficult to accomplish effectively in dynamic and complex work environments. Such environments can lead to nonoptimal training conditions that reduce individuals' readiness to change and training effectiveness. On the basis of the transtheoretical model of change (J. O. Prochaska, C. C. DiClemente, & J. C. Norcross, 1992), the authors examined pretraining influences (choice, social support, and motivation to learn) on readiness to change under nonoptimal training conditions. They examined specific dimensions of readiness to change rather than a global readiness to change construct. Participants were 183 driving under the influence (DUI) offenders participating in a court-mandated, alcohol-related Weekend Intervention Program. Perceived choice to attend training, social support, and motivation to learn affected readiness to change when individuals were resisting, considering, acting on, or maintaining behavior or attitude change. These effects were also dependent on age. Results suggest how training effectiveness could be improved when trainees are least likely to learn.     

Measurement of readiness to reduce driving speed: a pilot study

Speeding is a preventable risky behavior that contributes to risk of accident. Readiness to change reflects an individual's recognition of and desire to change behavior. No measure to identify readiness to change has yet been validated for speeding. The Readiness to Change Questionnaire appraises readiness to change drinking behavior. The questionnaire was adapted to speeding and its psychometric properties examined. Participants (N = 112) completed the questionnaire and reported their usual driving speed. A clear component structure and acceptable internal consistency and test-retest reliability were found. Convergent validity was indicated by an association between higher readiness to change and lower driving speed. Results support the questionnaire's potential as a measure of readiness to change speeding, and advance research into the role of motivation in speeding behavior.     

Differences in Mothers' and Fathers' Readiness for Change in Parent Training

We investigated readiness for change (RFC), a construct that may contribute to the discrepancies between fathers' and mothers’ rates of participation in behavioral parent training. One hundred and twenty fathers and mothers of 2- to 7-year-old children with conduct problems completed standardized measures of RFC, child behavior problems, and parent stress as part of an intake to a parent-child interaction therapy clinic. Fathers reported less readiness for change, less confidence in their ability to make changes, were more defensive about the need to change, and saw treatment as less important than mothers. Results suggest that if clinicians match parent training interventions to mothers’ readiness, fathers may be left behind.     

组织变革准备研究回顾与整合

作为组织实施变革的前奏,组织变革准备包括：（1）组织本身处于变革就绪待发状态,和（2）组织成员在情感及认知上能够接受和容忍组织即将实施变革的程度。文章通过对组织变革准备相关概念、内容结构和测量、前因和后果的梳理,整合出一个新的分析框架。研究指出：未来在深化现有研究的同时,宜多采用跨层次的视角探讨相关构念在不同层面上的影响机制,结合具体变革情境开发有针对性的测量工具,弥补现有研究不足、指导企业实践。     

Ready,Set, Go: The Transtheoretical Model of Change and Motivational Interviewing for “Fringe” Clients

The author explores the applicability of the Transtheoretical Model of Change (TTM) and motivational interviewing (MI) as a collaborative approach in counseling “resistant” or ambivalent clients. The TTM and MI provide an empirically tested framework for employment counselors to assess and empower clients who are often labeled resistant or ambivalent (e.g., youth, mandated clients, street workers, single parents) about readiness for change. Together, the TTM and MI focus counselors to accept clients' current levels of readiness and intrinsic motivation, thereby supporting clients in the effort to reduce their ambivalence. Examples are given of how the TTM and MI may be practiced.     

Managing resistance in cognitive behavioural therapy: the application of motivational interviewing in mixed anxiety and depression

While cognitive behavioural therapy is highly effective in the treatment of anxiety and depression, a substantive number of individuals either refuse treatment, fail to respond to treatment or respond only partially. Arguably, ambivalence about change or about engaging in treatment tasks may in part be related to incomplete recovery rates in cognitive behavioural therapy. Motivational interviewing is a client-centred, directive treatment originally developed in the addictions domain whose goal is to enhance motivation for change by understanding and resolving ambivalence. This method has consistently received support for enhancing outcomes in the addictions domain, particularly when used as an adjunct to further treatment. As yet, motivational methods have not been generalized to the treatment of prevalent mental health problems, such as anxiety and depression. The present paper presents the application of a treatment targeting motivation (motivational interviewing adapted for anxiety and depression) to the management of resistance in cognitive behavioural therapy for 3 clients with mixed anxiety and depression. Motivational interviewing is conceived as an adjunct to highly effective traditional cognitive behavioural therapy methods, which is indicated for use with clients resistant to and significantly ambivalent about change-based techniques for managing anxiety or alleviating depression.     

Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy

Despite the major advances in the development of treatments for bulimia nervosa, drop-outs and a lack of engagement in treatment, continue to be problems. Recent studies suggest that the transtheoretical model of change may be applicable to bulimia nervosa. The aim of this study was to examine the roles of readiness to change and therapeutic alliance in determining engagement and outcome in the first phase of treatment. One hundred and twenty five consecutive female patients meeting DSM-IV criteria for bulimia nervosa took part in a randomised controlled treatment trial. The first phase of the sequential treatment compared four sessions of either cognitive behavioural therapy (CBT) or motivational enhancement therapy (MET) in engaging patients in treatment and reducing symptoms. Patients in the action stage showed greater improvement in symptoms of binge eating than did patients in the contemplation stage. Higher pretreatment scores on action were also related to the development of a better therapeutic alliance (as perceived by patients) after four weeks. However, pretreatment stage of change did not predict who dropped out of treatment. There were no differences between MET and CBT in terms of reducing bulimic symptoms or in terms of developing a therapeutic alliance or increasing readiness to change. The results suggest that the transtheoretical model of change may have some validity in the treatment of bulimia nervosa although current measures of readiness to change may require modification. Overall, readiness to change is more strongly related to improvement and the development of a therapeutic alliance than the specific type of treatment.     

Predictors of Response to Cognitive-Behavioral Therapy for Body Dysmorphic Disorder

Body dysmorphic disorder (BDD) is a common and distressing or impairing preoccupation with a perceived defect in physical appearance. Individuals with BDD engage in time-consuming rituals to check, hide, or “fix” their appearance or alleviate distress. BDD is associated with substantial psychosocial impairment and high rates of depression, hospitalization, and suicidality. Cognitive-behavioral therapy (CBT) is the treatment of choice for BDD, but not everyone benefits. We examined predictors of CBT-related improvement, an important topic that has received very limited investigation. Treatment was delivered in weekly individual sessions over 18–22 weeks. Results indicated that greater motivation/readiness to change (University of Rhode Island Change Assessment Questionnaire), greater treatment expectancy (Treatment Credibility/Expectancy Questionnaire), and better baseline BDD-related insight (Brown Assessment of Beliefs Scale) significantly predicted better CBT response at posttreatment. Baseline BDD symptom severity and depression did not predict outcome, suggesting that even patients with more severe BDD and depressive symptoms can benefit from CBT for BDD. Efforts should be aimed at enhancing readiness to change and confidence in the treatment at treatment onset as well as addressing the poor insight that often characterizes BDD.     

Predicting increases in readiness to quit smoking: A prospective analysis using the contemplation ladder

Abstract

Most smokers are not motivated to quit. The transtheoretical model posits mechanisms (processes of change and pros and cons) by which smokers might increase their stage of readiness to quit. While cross-sectional relationships among the stages of change, processes of change, and pros and cons are well established, there is little evidence that processes of change and pros and cons predict progressive stage movements. This study uses data from a large worksite-based cancer prevention study (the Working Well Trial) to test the hypothesis that processes of change and the pros and cons of smoking predict progressive movement up the contemplation ladder, which is an alternative measure of motivation to quit smoking based on social cognitive theory. The results indicate that experiential processes of change promote increases in readiness to quit smoking. This study provides further evidence for the predictive validity of the contemplation ladder and sheds light on how unmotivated, nonvolunteer smokers can be motivated to consider cessation.     

Matching therapeutic interventions to drug and alcohol abusers’ stage of motivation: The clients’ perspective

The present study aims to explore the issue of matching the appropriate therapeutic intervention according to the stage of readiness for change in addictive clients, following the model proposed by Prochaska and DiClemente in the 1980s. The study focuses solely on the perspectives of people with drug and alcohol problems, in contrast to previous ones which have been concerned with the researchers’ understandings and postulations of the issue under exploration. One of the most important findings of this study is that participants in the “early” stages of their readiness to change their addictive behaviour, irrespective of their gender or whether they had seen a therapist significantly prefer non-action-oriented therapeutic interventions than action-oriented interventions. Similarly, participants in the “later” stages, showed a significant preference to action-oriented than non-action interventions, irrespective of their gender or previous experience of counselling. It is suggested then that careful assessment of the stage of motivation and individual-tailored intervention should be an essential element of any treatment program for drug and alcohol addicted clients.     

Expanding the Mediational Model of the Effects of Health-Related Social Control

Tucker, Orlando, Elliott, and Klein (2006 ) proposed that the associations between social control attempts and health behaviors are mediated by affects. The evidence is mixed regarding whether affects fully mediate these associations. In a sample of 317 college students involved in heterosexual dating relationships, we tested Tucker's mediational model and an expanded mediational model that incorporated the action readiness component of emotions (motivation to change and reactance). Full mediation of the associations between (a) positive social control and health behavior change; and (b) negative social control and hiding unhealthy behavior were found only when motivation to change and reactance were included in the model. Unexpectedly, reactance and negative social control exerted direct effects on health behavior change.     

Building Schools’ Readiness to Implement a Comprehensive Approach to School Safety

Research consistently finds that a comprehensive approach to school safety, which integrates the best scientific evidence and solid implementation strategies, offers the greatest potential for preventing youth violence and promoting mental and behavioral health. However, schools and communities encounter enormous challenges in articulating, synthesizing, and implementing all the complex aspects of a comprehensive approach to school safety. This paper aims to bridge the gap between scientific evidence and the application of that evidence in schools and communities by defining the key components of a comprehensive approach to school safety and describing how schools can assess their readiness to implement a comprehensive approach. We use readiness and implementation data from the Safe Communities Safe Schools project to illustrate these challenges and solutions. Our findings suggest that (1) readiness assessment can be combined with feasibility meetings to inform school selection for implementation of a comprehensive approach to school safety and (2) intentionally addressing readiness barriers as part of a comprehensive approach may lead to improvements in readiness (motivation and capacity) to effectively implement a comprehensive approach to school safety.     

Determinants of Readiness for Out-group Social Contact: Dominance Relations and Minority Group Motivations

Findings that members of minorities are more ready for social contact with members of dominant groups than vice versa have been attributed to a motivation of minorities to integrate into the larger society. We theorize that minorities hold opposing motivations—to integrate vs. to maintain unique group identity—the balance of which determines readiness for out-group contact. Study 1 examined readiness for out-group contact among three groups of Israeli teachers—Jews (dominant group), Muslim Arabs, and Christian Arabs (minorities). According to sociohistorical analyses, Muslim Arabs are more activated to maintain uniqueness and less motivated to integrate than are Christian Arabs. Study 2 examined recent Russian immigrants to Israel (minority) and veteran Israelis (dominant). Individual differences in motivation to integrate vs. maintain minority group identity were measured among immigrants. In both studies, the balance of motivations predicted minority group readiness for contact with the dominant group.     

Correlates of Readiness to Change in Victims of Intimate Partner Violence

Intimate partner violence (IPV) is a social problem associated with significant morbidity; however, victims do not always utilize treatment and resources. One's readiness to change might be one variable impacting his or her pursuit of treatment and other resources. This study investigated correlates of readiness to change, and readiness to change's impact on treatment utilization. Data were collected from 223 women residing in battered women's shelters. Correlational analyses find that generally victims with more psychopathology and distress, as well as more social support, were more ready to change. Posttraumatic stress disorder symptoms, overall distress, and social support were the strongest predictors of readiness to change. Finally, victims higher in readiness to change were more likely to seek mental health treatment and other IPV-related services.     

Time to contemplate change? A framework for assessing readiness to change with offenders

An improved understanding of offenders' readiness to change would enhance our ability to assess and engage such readiness. This paper provides a critique of the Stages of Change Model (SCM) which is widely used to assess readiness to change with offenders. We argue that the SCM does not provide a sound theoretical basis for understanding offender readiness to change. We highlight problems measuring constructs with the SCM accurately and question the theoretical coherence and level of explanation of readiness to change offered by the model.The second section of the paper presents the Readiness to Change Framework (RCF) as an alternative theoretical framework for understanding readiness to change. The RCF has been designed as a generic framework for understanding readiness to change for multiple behaviors. The two models within the framework are described, and examples of how they may be useful to practitioners working in the area of readiness to change are presented. Finally, strengths, limitations, and potential further developments of the framework are discussed.     

Ready or not? Stages of change as predictors of brief group therapy outcome in bulimia nervosa

Although group therapy is often recommended for the treatment of bulimia nervosa, relatively little is known about predictors of short-term outcome. This pilot study examined whether a standardized measure of readiness for change might be related to changes in binge frequency. Sixteen bulimic patients participated in short-term cognitive behavioral group therapy for twelve weeks. Each patient completed the Change Assessment Scale prior to treatment, along with a battery of symptom measures which were readministered at the conclusion of therapy. Bulimic patients with positive outcome in binge frequency were at a higher stage of readiness for change at pretreatment than were patients with negative outcome. Results indicated that there may be methods of determining who would be most likely to benefit from cognitive behavioral group therapy, and tentatively suggest that interventions may be more successful when readiness for change is taken into consideration.