An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments: Introduction to the Special Section

This article introduces the special section, “An Experimental Therapeutics Focus on Novel Mechanistic Targets in Cognitive Behavioral Treatments.” The purpose of this special section is to highlight research that follows the recommended Science of Behavior Change (SOBC) developmental progression for an experimental medicine approach to identifying and testing mechanisms of behavior change. Emphasis was placed on the earlier stage “pipeline” of investigations of novel mechanisms for behavior change: mechanisms that are undergoing the initial stages of validation. In this series, seven empirical articles are presented and are followed by an article detailing a checklist for reporting mechanistic research studies in order to improve communication of findings in the field. The final article in this series discusses the history, current status, and future directions for the SOBC approach to mechanistic science as viewed by National Institute of Health program officials.     

Predictors of Long-Term Exercise Engagement in Patients With Obsessive-Compulsive Disorder: The Role of Physical Activity Enjoyment

Most U.S. adults, even more so those with psychiatric conditions like obsessive-compulsive disorder (OCD), do not engage in the recommended amount of physical activity (PA), despite the wide array of physical and mental health benefits associated with exercise. Therefore, it is essential to identify mechanistic factors that drive long-term exercise engagement so they can be targeted. Using the science of behavior change (SOBC) framework, this study examined potential predictors of long-term exercise engagement as a first step towards identifying modifiable mechanisms, in individuals with OCD, such as PA enjoyment, positive or negative affect, and behavioral activation. Fifty-six low-active patients (mean age = 38.8 ± 13.0, 64% female) with a primary diagnosis of OCD were randomized to either aerobic exercise (AE; n = 28) or health education (HE; n = 28), and completed measures of exercise engagement, PA enjoyment, behavioral activation, and positive and negative affect at baseline, postintervention, and 3-, 6-, and 12-month follow-up. Significant predictors of long-term exercise engagement up to 6-months postintervention were baseline PA (Estimate = 0.29, 95%CI [0.09, 0.49], p = .005) and higher baseline PA enjoyment (Estimate = 1.09, 95%CI [0.30, 1.89], p = .008). Change in PA enjoyment from baseline to postintervention was greater in AE vs. HE, t(44) = −2.06, p = .046, d = −0.61, but endpoint PA enjoyment did not predict follow-up exercise engagement above and beyond baseline PA enjoyment. Other hypothesized potential mechanisms (baseline affect or behavioral activation) did not significantly predict exercise engagement. Results suggest that PA enjoyment may be an important modifiable target mechanism for intervention, even prior to a formal exercise intervention. Next steps aligned with the SOBC framework are discussed, including examining intervention strategies to target PA enjoyment, particularly among individuals with OCD or other psychiatric conditions, who may benefit most from long-term exercise engagement’s effects on physical and mental health.     

The Role of Religious Leaders in Promoting Healthy Habits in Religious Institutions

The growing obesity epidemic in the West, in general, and the USA, in particular, is resulting in deteriorating health, premature and avoidable onset of disease, and excessive health care costs. The religious community is not immune to these societal conditions. Changing health behavior in the community requires both input from individuals who possess knowledge and credibility and a receptive audience. One group of individuals who may be uniquely positioned to promote community change but have been virtually ignored in the applied health and consulting psychology literature is religious leaders. These individuals possess extraordinary credibility and influence in promoting healthy behaviors by virtue of their association with time-honored religious traditions and the status which this affords them—as well as their communication skills, powers of persuasion, a weekly (captive) audience, mastery over religious texts that espouse the virtues of healthy living, and the ability to anchor health-related actions and rituals in a person’s values and spirituality. This article focuses on ways in which religious leaders might promote healthy habits among their congregants. By addressing matters of health, nutrition, and fitness from the pulpit and in congregational programs, as well as by visibly adopting the tenets of a healthier lifestyle, clergy can deliver an important message regarding the need for healthy living. Through such actions, religious leaders can be effective agents in promoting critical change in these areas.     

Predicting Mothers' Intentions to Limit Frequency of Infants' Sugar Intake: Testing the Theory of Planned Behavior1

This study examines the ability of the Theory of Planned Behavior to account for mothers' intentions to limit the frequency of their infants' sugar consumption. One group of mothers (experimental) was exposed to a dental health education program designed to promote this behavior, the other (control) group was not. Each group of mothers was interviewed twice; the intervention was delivered to mothers in the experimental group immediately after their first interview. The interviews incorporated measures of the key constructs in the Theory of Planned Behavior (attitudes to behavior, subjective norms, perceived behavioral control, and behavioral intentions). Results indicated that the addition of perceived behavioral control resulted in small but significant increments in the amount of explained variance in intentions, thereby supporting the theory. Although the change in intentions to perform the advocated behavior was not significantly greater in the experimental group than in the control group, there was a significant change in attitudes to the behavior in the experimental group but no such change in the control group. Moreover, amount of change in behavioral intentions was significantly correlated with amount of change in attitudes, but not with amount of change in subjective norms or perceived behavioral control. Analysis of behavioral beliefs indicated that the attitude change reflected a change in a specific behavioral belief that was targeted in the intervention. Further analyses focused on the role played by direct experience of the behavior and show that such experience tended to enhance the role of perceived behavioral control in intention formation, apparently because mothers who have older children have discovered that they have relatively little control over frequency of child's sugar consumption. The implication of these results for the Theory of Planned Behavior are discussed.     

Capitalizing on the potential of mobile health applications as behavioral interventions: A research agenda for calorie-tracking and activity-tracking applications

Mobile health applications (mHealth apps) are widely used tools that provide support for people seeking help managing their health in a particular behavioral domain (e.g., physical activity). Despite their popularity, evidence for the effectiveness of mHealth apps as stand-alone behavioral interventions is limited. Psychological and behavioral scientists can play a critical role in addressing this gap by pursuing programs of research that leverage basic behavioral science principles to test links between key features of mHealth apps (e.g., goal setting, feedback) and behavior change. To demonstrate this approach to evaluating mHealth apps, we systematically examine five key features of popular calorie-tracking and activity-tracking apps, explain how these features align with established behavior change techniques, discuss the evidence base for the effectiveness of these techniques within each behavioral domain, and situate predictions about how individual app features may promote behavior change in a conceptual model. Through this work, researchers can guide the design of mHealth apps and optimize them for facilitating sustained health behavior change.     

THE INTERPLAY BETWEEN RELIGIOUS LEADERS AND ORGAN DONATION AMONG MUSLIMS

Bioethics and health researchers often turn to Islamic jurisconsults (fuqahā’) and their verdicts (fatāwā) to understand how Islam and health intersect. Yet when using fatwā to promote health behavior change, researchers have often found less than ideal results. In this article we examine several health behavior change interventions that partnered with Muslim religious leaders aiming at promoting organ donation. As these efforts have generally met with limited success, we reanalyze these efforts through the lens of the theory of planned behavior, and in light of two distinct scholarly imperatives of Muslim religious leaders, the ?ilmī and the islāhī. We argue for a new approach to health behavior change interventions within the Muslim community that are grounded in theoretical frameworks from the science of behavior change, as well the religious leadership paradigms innate to the Islamic tradition. We conclude by exploring the implications of our proposed model for applied Islamic bioethics and health research.     

The Need for a More Effective Science of Cultural Practices

Behavior analysis has produced a robust theoretical analysis of the contingencies involved in cultural evolution. Yet, thus far, the empirical yield of this work remains quite limited. With this paper, I attempt to provide specific examples of the ways to advance an experimental analysis of the contingencies involved in cultural evolution. I begin with a review of the theoretical analyses developed by behavior analysts and other contextually oriented scientists. Next, I submit that, if the goal of our science is both predicting and influencing cultural phenomena, we must produce experimental analyses of the impact of meta-contingencies on organizations’ practices. There is no more pressing reason for doing this than the threat of climate change posed by the continuing growth in human use of fossil fuels. Therefore, the paper provides an analysis of the contingencies influencing organizational practices now affecting continued use of fossil fuels and the contingencies for organizations seeking to prevent their use. One concrete step to advance a science of cultural change relevant to climate change would be to create a database of organizations that are promoting vs. working to prevent fossil fuel consumption and the consequences that seem to maintain their practices. I call for experimental analysis of the impact of altering consequences for these practices and for experimental analyses of interventions intended to change the norms, values, and behavior of organizational leaders who can influence fossil fuel consumption. I then discuss the role of prosocial behavior and values in affecting behavior relevant to reducing fossil fuel consumption because the empirical evidence shows that prosociality favors more “green” behavior. Recent advances in prevention research have identified interventions to promote prosociality, but we need experimental analyses of how advocacy organizations can be more effective in getting these interventions widely adopted.     

Theory-Based Health Behavior Change: Developing, Testing, and Applying Theories for Evidence-Based Interventions

Theories are needed to explain and predict health behavior, as well as for the design and evaluation of interventions. Although there has been a history of developing, testing, applying, and refining health behavior theories, debates and limitations in evidence exist: The component of theories which, for example, predicts change should be better elaborated so that we can more easily understand what actually drives behavior change. Theories need to be empirically testable in two ways. Theories need to specify a set of changeable predictors to describe, explain, and predict behavior change, and they should enable us to design an effective intervention that produces exactly those changes in behavior that are predicted by the relevant theory. To make this possible, theories need to be specified in such a way that they can be rigorously tested and falsified. Moreover, for the design of theory-based interventions it must be possible to derive change techniques from the theory and to use them to generate changes in behavior. Based on eight state-of-the-science articles that make conceptual and empirical contributions to the current debate on health behavior theories, various approaches are discussed to gain further insights into explaining and changing health behaviors and the iterative process of theory development.     

Feasibility of a pilot intervention targeting self-care behaviors in adults with diabetes mellitus

Diabetes has reached epidemic proportions and is widely encountered by clinicians in medical settings. National Standards for diabetes education recommend utilization of an interdisciplinary team, setting individual lifestyle goals and managing barriers. However, typical diabetes education programs lack integration of strategies for translating recommendations into behavioral actions. The present intervention was developed to assess the feasibility and efficacy of a short-term cognitive-behavioral intervention aimed at optimizing self-care behaviors in adults with diabetes in a “real world” medical setting. Participants were 20 adults who had completed medical model outpatient diabetes education. The intervention consisted of 6 weekly sessions that addressed the role of behavior in diabetes including self-care barriers, cognitions and self-regulation. Pre-post intervention data indicated greater specificity in goal-setting. Participants who kept activity records had the greatest lifestyle activity behavior change. Findings suggest that a brief intervention addressing realistic goal-setting is feasible and can promote meaningful health behavior changes. Clinical psychology can provide a bridge between current diabetes care recommendations and available medical resources by providing training in and delivery of empirically supported behavior change strategies and evaluation of diabetes care treatment approaches.     

Interventions to Promote Sun Protection Behaviors: What Do We Know About the Efficacy of Health‐ and Appearance‐based Messages and the Role of Cognitions and Emotions?

Human behavior has been implicated as a critical component in the development of a number of diseases, including skin cancer. More than 85% of all skin cancers are attributed to over‐exposure to the sun, and two primary types of interventions have been utilized to motivate sun protection practices – those that focus on the health consequences (i.e., skin cancer) and those that highlight the negative appearance consequences (i.e., wrinkles and age spots) of sun exposure. Both health‐based and appearance‐based interventions have been demonstrated to increase awareness of sun exposure dangers and of recommended risk reduction behaviors. Much of the literature examining the efficacy of appearance‐based interventions also contains evidence of behavior change in response to such interventions. The role of consciously accessible attitudes and perceptions as mechanisms of behavior change has been extensively examined, and there is evidence that sun protection interventions may promote behavior change in part by altering various health‐related cognitions (e.g., perceived susceptibility to skin damage). However, the role of nonconscious mechanisms in the efficacy of sun protection interventions has received little empirical attention. A growing body of literature, primarily in other health contexts, has demonstrated that behavior is sometimes more strongly predicted by emotions than cognitions, and that processes outside of conscious awareness may affect behavior change. It is suggested that both future sun protection interventions, and health promotion theories in general, could benefit from a thorough examination of the role that emotions and autonomic reactions may play in intervention efficacy.     

A Community Psychology of Men and Masculinity: Historical and Conceptual Review

This paper introduces the special section by presenting a historical and conceptual review of theory and research on the psychology of men and masculinity and then introducing the section’s papers. Men have power because of their gender, but differ in access to power based on other individual characteristics such as social class, income, education, ethnicity, sexual orientation, or physical strength. Men typically have been studied as generic rather than gendered beings in psychology. In contrast, a gendered analysis of men highlights the ways in which men’s experience, masculinity, and behavior contribute to health and social problems and to resources commonly addressed by community psychologists. Our gendered analysis suggests ways of working with men in group, organizational, and community settings to create positive individual and social change. Crucial to this analysis is the paradox that enacting masculinity both privileges and damages men. A second paradox stems from men having power as a group over women while individual men feel powerless or victimized by women as a group. The papers in this volume illustrate key themes of our historical and conceptual review through studies of adolescent and adult men as fathers, patients, partner abusers, support group participants and community members, and through examination of the impact of their gendered identities and behavior on health, well being, and justice.     

亲社会名声与亲社会行为

亲社会名声是行动者获得的亲社会特质声誉, 它有益于行动者的社会适应。行动者首先通过亲社会行为建立亲社会名声, 亲社会名声又通过间接互惠和同伴选择过程对行动者产生外在激励作用, 通过自我概念对行动者产生内在激励作用, 进而促进其亲社会行为。行动者的贫富水平、亲社会行为的公开性、自我获益和宣传方式影响其亲社会名声的获得。未来研究应关注亲社会行为与亲社会名声之间的相互促进过程, 探索行动者亲社会行为的代价与获益如何交互影响其亲社会名声; 行动者的社会阶层如何通过对人们预期的影响而调节行动者的亲社会名声; 亲社会名声促进亲社会行为的内在机制与边界条件。     

Establishing and maintaining healthy environments. Toward a social ecology of health promotion.

Earlier research on health promotion has emphasized behavior change strategies rather than environmentally focused interventions. The advantages of integrating lifestyle modification, injury control, and environmental enhancement strategies of health promotion are substantial. The author offers a social ecological analysis of health promotive environments, emphasizing the transactions between individual or collective behavior and the health resources and constraints that exist in specific environmental settings. Directions for future research on the creation and maintenance of health promotive environments also are examined.     

Health Promotion,Health Locus of Control,and Health Behavior: Two Field Experiments1

In spite of a sizable body of research on the effects of information promotions on health knowledge and health behavior, relatively little is known about how such efforts affect change (or why they do not). This paper addresses that problem by exploring the particular role that health locus of control (HLC) beliefs play in individual responses to health promotion efforts aimed at encouraging preventive health behaviors. Two field experiments are presented. The first experiment examined the extent to which HLC beliefs are related to differences in individual levels of health knowledge following the distribution of an informational booklet on health. Internals high on health value who received the information booklet demonstrated greater health knowledge three months later than did other subjects, although this difference was greater among men than among women. The second experiment explored how HLC beliefs interact with differently framed “control” messages to promote behavior change in breast self-examination (BSE). HLC beliefs interacted with the control language of the BSE promotional message and a neutral reminder to affect subsequent BSE practice. Together, these studies suggest a more influential role for health locus of control beliefs in shaping responses to health messages than has previously been documented in field settings.     

Communicating to Farmers About Skin Cancer The Behavior Adaptation Model

Although health campaigns promote avoidance of behaviors that put an individual's health at risk, often these behaviors cannot be avoided, and campaign messages designed to encourage behavior adaptation afford greater likelihood of success. With that in mind, a model of health risk behavior adaptation was proposed and tested using four different behaviors in a communication campaign aimed at reducing farmers' risk for skin cancer, farmers and farm wives answered a series of questions about their skin cancer prevention and detection behaviors and attitudes. Interpersonal expectancies, social resources, and actual procedural knowledge predicted perceived procedural knowledge and public commitment, which, in turn, predicted behavior adaptation.     

Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence

Numerous theories in social and health psychology assume that intentions cause behaviors. However, most tests of the intention- behavior relation involve correlational studies that preclude causal inferences. In order to determine whether changes in behavioral intention engender behavior change, participants should be assigned randomly to a treatment that significantly increases the strength of respective intentions relative to a control condition, and differences in subsequent behavior should be compared. The present research obtained 47 experimental tests of intention-behavior relations that satisfied these criteria. Meta-analysis showed that a medium-to-large change in intention (d = 0.66) leads to a small-to-medium change in behavior (d = 0.36). The review also identified several conceptual factors, methodological features, and intervention characteristics that moderate intention-behavior consistency.     

Community‐Based Participatory Research With Black Churches

Black Americans are more likely than other racial/ethnic groups to rely on spiritual and religious resources for mental health support. As such, counselors must seek unique ways to reach and understand Black communities. This article provides an overview of Black Americans' help‐seeking behaviors, the significance and culture of the Black Church, and a framework for counselors and counseling researchers to form effective partnerships to conduct community‐based participatory research initiatives that will produce empirical outcomes and promote culturally responsive mental health and wellness programming in Black communities.     

Emotional states and physical health

Positive emotional states may promote healthy perceptions, beliefs, and physical well-being itself. To explore potential mechanisms linking pleasant feelings and good health, the authors consider several lines of research, including (a) direct effects of positive affect on physiology, especially the immune system, (b) the information value of emotional experiences, (c) the psychological resources engendered by positive feeling states, (d) the ways in which mood can motivate health-relevant behaviors, and (e) the elicitation of social support. As anticipated by the Greek physician Hippocrates, positive emotions and healthy outcomes may be linked through multiple pathways.     

虚拟健康社区医生贡献行为的形成机制

虚拟健康社区医生贡献行为(Doctor Contribution Behavior in Virtual Health Communities, V-DCB)在社会福祉创造中发挥着重要作用。从价值共创理论视角, 结合群体卷入模型和积极心理学研究, 提出在线服务交往中医生贡献行为前因后果的理论模型。首先从资源投入视角对V-DCB的概念和内涵进行分析, 并探讨测量工具的维度。接着分析社会交换和社会认同双重动机下的V-DCB行为卷入过程, 以及服务生态系统资源补充的激励作用。最后探讨V-DCB对医患双方幸福感共创的影响, 以及资源匹配因素对行为者幸福感产生的调节效应。