Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment

This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.     

Exploring Decision Making Around Therapist Self‐Disclosure in Cognitive Behavioural Therapy

Background

Therapist self‐disclosure (TSD) usage varies greatly among different psychotherapy orientations. Anecdotal evidence seems to suggest that there are reasons for its judicious use, and a small number of researchers have proposed guidelines for how TSD should be used to help therapists across psychotherapy models make decisions around disclosure. However, there is almost no literature specifically exploring how cognitive behaviour therapy (CBT) practitioners make decisions around employing TSD within the CBT framework.

Objective

This study aimed to explore how experienced CBT practitioners make decisions around TSD.

Method

In‐depth qualitative interviews were conducted with six clinical psychologists who were trained and experienced in CBT, and the interviews were analysed thematically.

Results

There were two overarching themes in terms of how they made decisions to self‐disclose: (A) the rules for TSD use, which included sub‐themes (a) it must have a clear purpose, (b) it must fit, (c) the therapist must maintain boundaries, and (d) the therapist must always reflect on his/her use of TSD; and (B) how they use TSD, which included subthemes of (a) using it as a tool for change and (b) using it to manage the therapeutic relationship.

Conclusion

Participants’ decisions on whether or not to self‐disclose were strongly influenced by the CBT model, and this process went beyond what is suggested in the transtheoretical literature. Understanding this process may lead to the development of CBT‐specific guidelines for making TSD‐related decisions.     

Do we feel the same level of guilt about the wrongdoings of close ones and distant ones? The mediating role of behavioural control

Understanding whether and why individuals' emotional responses are different to the same behaviour performed by different others is important for understanding phenomena in social interaction. Given that there is no relevant research in Eastern culture testing such issues, the present research including two studies was conducted with Chinese samples and investigated whether Easterners experience more vicarious guilt about close ones' immoral behaviours than distant ones' immoral behaviours and the underlying mechanism of the effect. Study 1 showed that people felt more guilty when recalling close ones' misdeeds than distant ones' misdeeds. Study 2 replicated the findings of Study 1 using the scenario method and demonstrated that behavioural control partially mediated the effect of relationship closeness on vicarious guilt, that is, people reported more behavioural control over close ones' immoral behaviours, which in turn resulted in more vicarious guilt. Implications for social interaction and directions for future research are discussed.     

Capturing the Structure of Distinct Types of Individual Differences in the Situation‐specific Experience of Emotions: The Case of Anger

The aim of this paper was to understand why some people experience certain emotions in a specific situation, whereas others do not. We postulate that these individual differences arise from individual differences in two underlying processes of emotion elicitation: (i) individual differences in the emotion components (appraisals and action tendencies) that situations activate in a person and (ii) individual differences in how these emotion components are related to subjective emotional experience. In this paper, we re‐analysed data from two studies on anger to capture the structure of these two types of individual differences by using clustering modelling techniques. Consistent results across the two studies demonstrated that individuals differ in anger because they (i) differ in how easy they experience anger‐relevant appraisals (Studies 1 and 2) and action tendencies (Study 2) in increasingly negative situations and (ii) differ in which of these components are necessary to experience anger. Copyright © 2011 John Wiley & Sons, Ltd.     

Testing the theory underlying the success of point-of-choice prompts: A multi-component stair climbing intervention

Objectives

Point-of-choice prompts consistently increase stair climbing in public access settings. This study investigated the single and combined effects of a volitional and motivational component of a stair climbing intervention to test the theory underlying the success of point-of-choice prompts.

Design

Quasi-experimental, interrupted time series cross-over design.

Methods

Ascending stair/escalator choices were observed in a UK tram station (n = 38,187). Baseline observations (2 weeks; stage 1) preceded a 2-week point-of-choice prompt positioned alone (stage 2) followed by an additional message positioned at the top of each climb (6 weeks; stage 3). Four weeks after message removal, another baseline (2 weeks; stage 4) preceded installation of the intervention components in reverse order. Thus, the message positioned alone at the top of each climb (4 weeks, stage 5) was supplemented with the point-of-choice prompt (2 weeks, stage 6). Logistic regression analyses of stair/escalator choice included the independent variables of intervention components, gender, time of morning and pedestrian traffic volume.

Results

There was no change in stair climbing percentages when only one intervention component was used, i.e. only the point-of-choice or the message at the top of each climb. In contrast, stair climbing increased when both components of the intervention were installed. Additionally, men took the stairs more than women and stair climbing was more common earlier in the morning and at higher pedestrian traffic volumes.

Conclusions

A motivational component targeting intentions increased the effectiveness of a volitional point-of-choice prompt for stair climbing in a setting where choice of the stairs incurred a time penalty for pedestrians due to the site layout.     

Servicescapes: The role that place plays in stay‐at‐home mothers’ lives

Over the past decade, increasing attention has been paid to gender‐related consumption behaviour. However, a relative gap in our knowledge still exists when it comes to understanding the changes that occur as a result of motherhood and how this may influence their interactions in the retail environment. The purpose of this article is to explore stay‐at‐home mothers’ experiences in the servicescape to gain a better understanding of how they associate with servicescapes during this transitional period, how they use retail space to suit their needs, and how they use retail space to negotiate their role as a stay‐at‐home mother. Five stay‐at‐home mothers with children younger than 5 years were provided with disposable cameras and asked to photograph servicescapes that they visited regularly. Over a 1‐year period, they were interviewed several times, and photo‐elicitation techniques were used throughout the interviewing process. The results of this study suggest that when consumers undergo role or identity changes, certain places can be used to smooth this process. Not only can the retail environment be used as a coping mechanism for stay‐at‐home mothers, it can also be viewed as a “second place” as opposed to a “third place”, thus enabling isolated consumers to feel connected with the outside world. Last, this study highlights the temporal dimensions of place. Throughout one's lifetime, one will form attachments to and patronise different places, which will evolve and change as individuals, accordingly, take on different roles and identities. Copyright © 2012 John Wiley & Sons, Ltd.     

Keeping the Peace—Police Behaviour at a Mass Event

This study examined the collective behaviour of the police during a football match at the 2006 Football World Cup. What peacekeeping and aggravating processes could be identified and what were their consequences? Data were collected using observation and field interviews. Some critical situations could have escalated into riots; however, the police showed trust in the majority of the supporters' intentions to be peaceful. Distrust was reserved for selected individuals who were under surveillance. This, together with tactics involving using different forces for different tasks and an overall organisational strategy focusing on the festivity of the event, was the main reason for the peaceful outcome. A friendly but firm approach was successful in keeping the peace. Copyright © 2012 John Wiley & Sons, Ltd.     

Differential effects of seating arrangements on disruptive behavior of fifth grade students during independent seatwork

We investigated teacher versus student seat selection in the context of group and individual seating arrangements. Disruptive behavior during group seating occurred at twice the rate when students chose their seats than when the teacher chose. During individual seating, disruptive behavior occurred more than three times as often when the students chose their seats. The results are discussed in relation to choice and the matching law.     

Intentions to participate in counselling among front-line,at-risk Irish government employees: an application of the theory of planned behaviour

ABSTRACT

The study set out to examine intentions to engage in counselling among at-risk Irish government employees and the differential utility of two alternative theory of planned behaviour (TPB) models of behaviour to explain intentions to participate in counselling. Individuals (N=259) employed in a front-line, at-risk occupation for the Irish government completed a TPB-based questionnaire. Quantitative analyses revealed that participants held positive to neutral intentions to participate in counselling, irrespective of gender. The original TPB model explained 49.9% of variance in intentions whereas an alternative TPB model, splitting the perceived behavioural control (PBC) construct between its internal and external control components, explained a further 8.9% of variance. Furthermore, self-efficacy was found to be the strongest predictor of intentions. This study therefore supports the use of the TPB in understanding counselling-seeking behaviour.