Motives and health-related behaviour: incremental prediction by implicit motives

The study assessed whether implicit motives, which operate largely outside of conscious awareness, can provide any incremental prediction of health-related behaviour over that provided by explicit motives. In a cross-sectional survey study, 251 young adults completed measures of sun exposure behaviour, sun protection behaviour and risk-related sexual behaviour, participatory motives for these behaviours, life goals (representing explicit dispositional motives), and the Single Category Implicit Association Test adapted to measure implicit motives. Analysis was by structural equation modelling. Power life goal (the goal of asserting oneself and seeking social status) predicted sun exposure behaviour and risk-related sexual behaviour. Altruism life goal (acting for the welfare of others) predicted sun protection behaviour and inversely predicted risk-related sexual behaviour. These effects of life goals were mediated by participatory motives. Implicit dispositional achievement motive (the largely unconscious need to succeed at challenging tasks) inversely predicted sun exposure behaviour, this effect being mediated by a reduction in appearance-related participatory motive for sun exposure. Implicit dispositional achievement motive also inversely predicted risk-related sexual behaviour, this effect being direct. It is concluded that implicit dispositional motives can provide some incremental prediction of health-related behaviour. Possibilities for further research, including the experimental manipulation of motive engagement, are discussed.     

A pragmatic approach to measuring adherence in treatment delivery in psychotherapy

ABSTRACT

Measuring therapists’ adherence to treatment manuals is recommended for evaluating treatment integrity, yet ways to do this are poorly defined, time consuming, and costly. The aims of the study were to develop a Therapy Component Checklist (TCC) to measure adherence to manualised CBT; to test its application in research and clinical practice; to determine its validity; and consider its cost benefits. We conducted a randomised trial in 230 people with cancer evaluating effectiveness of CBT for depression. In this, therapists delivered manualised treatment. Experts agreed on key components of therapy and therapists were asked to record these after therapy sessions by ticking a TCC. Inter-rater reliability was tested using an independent rater. Therapists delivered 543 CBT sessions. TCCs were completed in 293, of which 39 were assessed by the independent rater. Self-reported TCC data suggested close adherence to the manual. Prevalence-adjusted and bias-adjusted kappa scores suggested substantial agreement, (>0.60) in 38 out of 46 items. Self-rating of adherence saved around £96 per rating. In conclusion the TCC provides a quick and cost effective way of evaluating the components of therapy delivered. This approach could be applied to other psychological treatments and may help with linking therapeutic interventions with outcome.