The implementation of guided Internet-based cognitive behaviour therapy for panic disorder in a routine-care setting: effectiveness and implementation efforts

Panic disorder is a common mental disorder. Guided Internet-based cognitive behavioural therapy (Guided Internet-based cognitive behaviour therapy (ICBT)) is a promising approach to reach more people in need of help. In the present effectiveness study, we investigated the outcome of guided ICBT for panic disorder after implementation in routine care. A total of 124 patients were included in the study, of which 114 started the treatment. Large within-group effect sizes were observed on the primary panic disorder symptoms (post-treatment: d = 1.24; 6-month follow-up: d = 1.39) and moderate and large effects on secondary panic disorder symptoms and depressive symptoms at post-treatment and follow-up (d = .55–1.13). More than half (56.1%) of the patients who started treatment recovered or improved at post-treatment. Among treatment takers (completed at least five of the nine modules), 69.9% recovered or improved. The effectiveness reported in the present trial is in line with previous effectiveness and efficacy trials of guided ICBT for panic disorder. This provides additional support for guided ICBT as a treatment alternative in routine care.     

IMPLEMENTATION OF AN EVIDENCED‐BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well‐described in the literature. The authors worked as a community‐partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low‐income community. We used qualitative ethnographic methods to document the adaption of an evidence‐based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0‐ to 84‐month‐old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.     

Antecedents and outcomes of unit cohesion and affective commitment to the Army

Group cohesion and affective commitment have shown to have critical relevance to military organizations in particular. The relationship between cohesion and affective commitment is established, and the two constructs share a number of common organizational antecedents and employee outcomes. The authors explored the relationship between cohesion and affective commitment in a model that incorporates antecedents (effectiveness of immediate leadership and procedural justice) and consequences (organizational citizenship behaviors [OCBs] and turnover intentions) common to both. Respondents (N = 714, 102 women, 612 men) were Canadian Army personnel. The models suggest that cohesion partially mediates the relationships between (a) perceptions of immediate leadership and affective commitment to the Army and (b) perceptions of unit procedural justice and affective commitment to the Army. Furthermore, affective commitment to the Army partially mediates the relationship between unit cohesion and turnover intentions but fully mediates the relationship between unit cohesion and OCBs. This model helps explain some common variance between unit cohesion and organizational affective commitment.     

Comparing implementation intention interventions in relation to young adults’ intake of fruit and vegetables

This study tests whether the effectiveness of implementation intention-based interventions to increase fruit and vegetable intake in a young adult population can be enhanced using additional pre-intervention instructions and alternative formats; namely, an ‘if-then’ implementation intention versus a more general, ‘global’ plan that does not explicitly link a situational cue with a goal-directed response. Participants (N?=?557) completed pre-test measures of planning, motivation and behaviour with respect to increasing their fruit and vegetable intake before being randomised to a 3 (intervention format: control vs. ‘if-then’ vs. ‘global’ implementation intentions)?×?2 (pre-intervention instruction vs. no pre-intervention instruction) between-participants design. Results revealed a significant intervention format by time interaction, such that intake significantly increased by 0.50 portions in the if-then format condition compared with 0.31 in the global format and 0.01 in the control condition. These results suggest that ‘if-then’ manipulations are superior in promoting behaviour change in an applied setting. The use of pre-intervention instructions had no additional effect on behaviour, providing evidence for the efficacy of implementation intentions even when experimenter demand is reduced. Evidence is also presented to suggest that reported increases in intake are not related to demand characteristics.     

Predicting physical activity in adolescents: The role of compensatory health beliefs within the Health Action Process Approach

Objective: Compensatory health beliefs (CHBs), defined as beliefs that healthy behaviours can compensate for unhealthy behaviours, may be one possible factor hindering people in adopting a healthier lifestyle. This study examined the contribution of CHBs to the prediction of adolescents’ physical activity within the theoretical framework of the Health Action Process Approach (HAPA).

Design: The study followed a prospective survey design with assessments at baseline (T1) and two weeks later (T2).

Method: Questionnaire data on physical activity, HAPA variables and CHBs were obtained twice from 430 adolescents of four different Swiss schools. Multilevel modelling was applied.

Results: CHBs added significantly to the prediction of intentions and change in intentions, in that higher CHBs were associated with lower intentions to be physically active at T2 and a reduction in intentions from T1 to T2. No effect of CHBs emerged for the prediction of self-reported levels of physical activity at T2 and change in physical activity from T1 to T2.

Conclusion: Findings emphasise the relevance of examining CHBs in the context of an established health behaviour change model and suggest that CHBs are of particular importance in the process of intention formation.     

Predicting intention to use condoms in homosexual men: An application and extension of the theory of reasoned action

Abstract

A questionnaire based on the Theory of Reasoned Action was developed and tested to identify predictors of intention to use condoms. The questionnaire consisted of three original components: Behavioral Intentions, Attitudes and Subjective Normative Beliefs, and a new component, Behavioral Norms. Age of HIV antibody status were also collected. Internal consistency of the four components of the questionnaire was high: Cronbach's alpha coefficients ranged from 0.76 to 0.87. Logistic modelling identified the significant predictors of intentions to use a condom as Attitudes (Odds Ratio = 2.7, 95% CI 1.80?4.06, P < 0.001) and Behavioral Norms (Odds Ratio = 1.49,95% CI 1.06?2.11, P = 0.03). Contrary to the theory that demographic variables are not important predictive variables of intention, HIV antibody positive status and age were found to directly influence Behavioral Intentions to use a condom. About 50% of men older than 25 years of age intended to use a condom, irrespective of HIV status. Overall, 59% of men 25 years of age and younger intended to use a condom, but the percentage was affected by HIV status; 22% in men who were HIV positive and 63% in men who were HIV negative. These findings indicate that after modification, to include HIV antibody status, Age and Behavioral Norms, the Theory of Reasoned Action can identify significant predictors of intention to use a condom.     

Exploring teenagers' adaptive and maladaptive thinking in relation to the threat of hiv infection

Abstract

Teenagers' HIV-preventive cognitions were explored within a protection motivation theory framework. Five hundred and seven adolescent men and women from two cohorts (sixteen and eighteen) completed a confidential postal questionnaire. The effect of demographic variables, previous sexual experience and appraisal of threat and coping resources upon HIV-relevant cognitions was investigated using path analysis. Cognitions promoting (adaptive) and inhibiting (maladaptive) preventive behaviour were considered. Anticipated condom use, intention to limit number of sexual partners and willingness to consider an HIV antibody test were included as adaptive HIV-preventive cognitions. Coping appraisal measures were strongly associated with anticipated condom use but threat appraisal measures were not. Gender, previous sexual experience, coping appraisal measures and denial accounted for 33% of the variance in anticipated condom use. Overall the results provided qualified support for Protection Motivation Theory. Implications for health education are highlighted.     

Identifying the ‘if’ for ‘if-then’ plans: Combining implementation intentions with cue-monitoring targeting unhealthy snacking behaviour

Implementation intentions aimed at changing unwanted habits require the identification of personally relevant cues triggering the habitual response in order to be effective. To facilitate successful implementation intention formation, in the present study, planning was combined with cue-monitoring, a novel way to gain insight into triggers for unhealthy snacking. It was tested whether keeping a cue-monitoring diary and tailoring implementation intentions accordingly improves plan effectiveness. A 2 Monitoring (cue-monitoring, control)?×?2 Planning (implementation intention, goal intention) between subjects design was adopted. Participants (N = 161) monitored their unhealthy snacking behaviour for a week using either a cue-monitoring or a control diary. Participants then formulated a goal intention or an implementation intention tailored to their personal cue. Snacking frequency and caloric intake from unhealthy snacks were examined using a seven-day snack diary. The results did not indicate an interaction but yielded a main effect of Monitoring. Cue-monitoring either or not combined with implementation intentions reduced unhealthy snacking behaviour compared with control. Findings emphasise the effectiveness of cue-monitoring, suggesting that on the short term, cue-monitoring suffices to decrease unhealthy snacking, without additional benefit from planning. Future research should examine whether supplementing cue-monitoring with implementation intentions is required to establish long-term behaviour change maintenance.     

The impact of self-efficacy and implementation intentions-based interventions on fruit and vegetable intake among adults

This study tested the effect of interventions designed for people who do not eat yet the recommended daily fruit and vegetable intake (FVI) but have a positive intention to do so. Adults (N?=?163) aged 20–65 were randomised into four groups: implementation intentions (II group), self-efficacy (SE group), combination of II?+?SE group) and a control group receiving written information on nutrition. Study variables were measured at baseline, post-intervention and at 3-month follow-up. At follow-up, compared to the control group, FVI increased significantly in the II and II?+?SE groups (1.5 and 1.9 servings per day, respectively). Most psychosocial variables significantly increased compared to the control group, with the exception of SE for vegetable intake (VI). Moreover, at 3-month follow-up, change in FVI was mediated by changes in fruit intake (FI) intention and VI action planning. In conclusion, II interventions were efficient to increase FVI, with or without consideration for the development of SE. Thus, future studies should favour the adoption of this approach to bridge the intention–behaviour gap for FVI.     

Parents As Teachers:

A follow-up mail survey of the continuing use of behavior modification procedures was conducted with 30 families who had participated in a training program for parents of preschool children with autism four to seven years previously. According to their reports 86% of the parents had used behavioral procedures during the past week to manage their child's behavior and 54% said they used the techniques to teach their child a new skill. More than half of the parties said they no longer used “formal” behavior modification procedures including data collection. Mothers were more likely to use formal behavior modification than father and systematic paternal use of behavioral techniques was linked to maternal use- only one father used the techniques including data collection when his wife did not. Retrospective parental evaluations of the parent training workshop were all positive, although the parents who viewed their children as doing better gave stronger endorsements than the parents who say their children as more limited.