Time for change: using implementation intentions to promote physical activity in a randomised pilot trial

Objective: A common barrier to exercise is a perceived lack of time. The current pilot study examined the effects of an implementation intention intervention to enhance exercise self-efficacy, increase confidence to exercise when facing time constraints, and increase physical activity in middle-aged adults (n?=?63, aged 35–69). Design: Participants received a pedometer (Fitbit) to objectively measure activity and were randomly assigned to either a control or intervention condition. After a 1-week baseline, the intervention condition received instructions to plan how, where, and when they would add steps to their daily routine to meet their step goal, using personalised schedules and maps. Both groups were contacted nightly via email. Main Outcome Measures: Physical activity (steps and time spent in moderate-to-vigorous activity), goal achievement, exercise self-efficacy, time-relevant exercise self-efficacy and affect. Results: Compared to the control, the intervention condition significantly increased in steps, time spent in moderate-to-vigorous activity, and time-relevant exercise self-efficacy. Goal achievement was related to greater time-relevant exercise self-efficacy and more positive affect at the daily level. Conclusion: Findings suggest that the personalised planning intervention increased physical activity and confidence in achieving physical activity goals under time constraints. Avenues for future directions, especially for producing more sustained effects, are discussed.     

Statewide Implementation of Cognitive Behavioral Therapy for Psychosis Through a Learning Collaborative Model

Cognitive Behavioral Therapy for Psychosis (CBTp) is an evidence-based psychotherapeutic intervention (EBPI) for adults with schizophrenia spectrum disorders that remains under-implemented in the United States (U.S.). There has been little empirical attention on implementation and dissemination strategies for this EBPI. The Learning Collaborative (LC) model is a method of implementing evidence-based practices across agencies and geographic regions that may facilitate CBTp implementation and dissemination in the US.We applied the LC model in an attempt to enhance the accessibility of CBTp in community mental health settings statewide. Providers (N = 56) from 12 agencies voluntarily participated in an in-person, CBTp workshop followed by 6 months of biweekly phone-based consultation sessions (Phase 1). Twenty-one providers opted to participate in an additional 6-month CBTp LC immediately following completion of the initial CBTp LC (Phase 2). Adoption, penetration, provider-perceived skill development, fidelity, as well as provider-perceived implementation barriers were re-assessed during and 6 months after completion of Phase 2.One year after the completion of the Phase 2 LC, 21% of the original trainee group across 3 of the 12 participating agencies continued to offer CBTp to clients. CBTp trainees were treating between one and two clients each. Self-assessed CBTp skills improved modestly over the Phase 2 consultation period. On average, both clinicians and supervisors reached an acceptable fidelity score on the sessions reviewed. Participating providers identified multiple barriers to CBTp implementation, including features of the training and consultation, the agency, the intervention itself, and psychosocial and clinical challenges associated with the client population.Few CBTp implementation studies have applied a framework to CBTp implementation. The authors adapted the LC model in an attempt to promote adoption of CBTp in community mental health clinics across a large, populous state with poor access to mental health services. Identified challenges and recommendations should be considered in future implementation efforts.     

Internal health locus of control predicts willingness to track health behaviors online and with smartphone applications

Given rising technology use across all demographic groups, digital interventions offer a potential strategy for increasing access to health information and care. Research is lacking on identifying individual differences that impact willingness to use digital interventions, which may affect patient engagement. Health locus of control, the amount of control an individual believes they have over their own health, may predict willingness to use mobile health (mHealth) applications (‘apps’) and online trackers. A cross-sectional study (n = 276) was conducted to assess college students’ health locus of control beliefs and willingness to use health apps and online trackers. Internal and powerful other health locus of control beliefs predicted willingness to use health apps and online trackers while chance health locus of control beliefs did not. Individuals with internal and powerful other health locus of control beliefs are more willing than those with chance health locus of control beliefs to utilize a form of technology to monitor or change health behaviors. Health locus of control is an easy-to-assess patient characteristic providers can measure to identify which patients are more likely to utilize mHealth apps and online trackers.     

Reduced adaptability,but no fundamental disruption,of norm‐based face coding following early visual deprivation from congenital cataracts

Faces are adaptively coded relative to visual norms that are updated by experience, and this adaptive coding is linked to face recognition ability. Here we investigated whether adaptive coding of faces is disrupted in individuals (adolescents and adults) who experience face recognition difficulties following visual deprivation from congenital cataracts in infancy. We measured adaptive coding using face identity aftereffects, where smaller aftereffects indicate less adaptive updating of face‐coding mechanisms by experience. We also examined whether the aftereffects increase with adaptor identity strength, consistent with norm‐based coding of identity, as in typical populations, or whether they show a different pattern indicating some more fundamental disruption of face‐coding mechanisms. Cataract‐reversal patients showed significantly smaller face identity aftereffects than did controls (Experiments 1 and 2). However, their aftereffects increased significantly with adaptor strength, consistent with norm‐based coding (Experiment 2). Thus we found reduced adaptability but no fundamental disruption of norm‐based face‐coding mechanisms in cataract‐reversal patients. Our results suggest that early visual experience is important for the normal development of adaptive face‐coding mechanisms.     

The clinician in the university: Reflections on a South African psychoanalytically oriented doctoral programme

There is increasing interest, both internationally and in South Africa, in strengthening the relationship between psychoanalytic practice and research. This paper reports on a psychoanalytically oriented doctoral programme offered at the University of the Witwatersrand in South Africa. The programme is described in relation to the broader context of the historical relationship of psychoanalysis to the university as well as to the specific context of the history of psychoanalysis in South Africa. Key challenges of the programme, specifically concerning research tensions and methodological and theoretical tolerance, are subsequently explored. The way in which these challenges manifested within a group context illustrates their potential for conflict as well as productive debate. The paper reflects on how this specific programme illuminates and extends some of the broader debates in the field of psychoanalysis.     

Escape from rich‐to‐lean transitions: Stimulus change and timeout

Extended pausing during discriminable transitions from rich‐to‐lean conditions can be viewed as escape (i.e., rich‐to‐lean transitions function aversively). In the current experiments, pigeons’ key pecking was maintained by a multiple fixed‐ratio fixed‐ratio schedule of rich or lean reinforcers. Pigeons then were provided with another, explicit, mechanism of escape by changing the stimulus from the transition‐specific stimulus used in the multiple schedule to a mixed‐schedule stimulus (Experiment 1) or by producing a period of timeout in which the stimulus was turned off and the schedule was suspended (Experiment 2). Overall, escape was under joint control of past and upcoming reinforcer magnitudes, such that responses on the escape key were most likely during rich‐to‐lean transitions, and second‐most likely during lean‐to‐lean transitions. Even though pigeons pecked the escape key, they paused before doing so, and the latency to begin the fixed ratio (i.e., the pause) remained extended during rich‐to‐lean transitions. These findings suggest that although the stimulus associated with rich‐to‐lean transitions functioned aversively, pausing is more than simply escape responding from the stimulus.     

The caregiving relationship under stress: foster carers’ experience of loss of the sense of self

This paper is an account of a piece of research which involved interviewing six foster carers who had ended a placement with a child under the age of five with an early experience of abuse and neglect. The paper describes one of the themes that emerged from the data analysis, the loss of the sense of self in the foster carers, and argues that the experience of attempting to provide care for these children led to internal shifts in the carers that reverberated throughout the network around the child. The paper suggests that knowing about the external reasons for placement breakdown is not enough without taking into account the impact on the internal world of the foster carers and the emotional impact of attempting to provide care for a child who has experienced abuse and neglect.     

“I Wanted to Feel the Way They Did”: Mimesis as a Situational Dynamic of Peer Mentoring by Ex-Offenders

Despite growing enthusiasm for peer mentoring as a criminal justice intervention, very little is known about what actually happens within these relationships. Drawing on an ethnographic study of peer mentoring in the North of England this article will foreground the concept of “inspiration” in these settings. It will argue that Rene Girard’s theory of mimesis offers a framework with which to analyze role modeling in mentoring relationships and that a Girardian reading also offers interesting insights into the unresolved problem of the origins of personal change.