Efficacy of an experiential, dissonance-based smoking intervention for college students delivered via the internet

OBJECTIVE

College represents a window of opportunity to reach the sizeable number of cigarette smokers who are vulnerable to lifelong smoking. The underutilization of typical cessation programs suggests the need for novel and more engaging approaches for reaching college smokers. The aim of the present study was to test the efficacy of a dissonance-enhancing, Web-based experiential intervention for increasing smoking cessation motivation and behavior.

METHOD

We used a 4-arm, randomized design to examine the efficacy of a Web-based, experiential smoking intervention (Web-Smoke). The control conditions included a didactic smoking intervention (Didactic), a group-based experiential intervention (Group), and a Web-based nutrition experiential intervention (Web-Nutrition). We recruited 341 college smokers. Primary outcomes were motivation to quit, assessed immediately postintervention, and smoking abstinence at 1 and 6 months following the intervention.

RESULTS

As hypothesized, the Web-Smoke intervention was more effective than control groups in increasing motivation to quit. At 6-month follow-up, the Web-Smoke intervention produced higher rates of smoking cessation than the Web-Nutrition control intervention. Daily smoking moderated intervention outcomes. Among daily smokers, the Web-Smoke intervention produced greater abstinence rates than both the Web-Nutrition and Didactic control conditions.

CONCLUSION

Findings demonstrate the efficacy of a theory-based intervention delivered over the Internet for increasing motivation to quit and smoking abstinence among college smokers. The intervention has potential for translation and implementation as a secondary prevention strategy for college-aged smokers. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

"Not for all the tea in China!" political ideology and the avoidance of dissonance-arousing situations

People often avoid information and situations that have the potential to contradict previously held beliefs and attitudes (i.e., situations that arouse cognitive dissonance). According to the motivated social cognition model of political ideology, conservatives tend to have stronger epistemic needs to attain certainty and closure than liberals. This implies that there may be differences in how liberals and conservatives respond to dissonance-arousing situations. In two experiments, we investigated the possibility that conservatives would be more strongly motivated to avoid dissonance-arousing tasks than liberals. Indeed, U.S. residents who preferred more conservative presidents (George W. Bush and Ronald Reagan) complied less than Americans who preferred more liberal presidents (Barack Obama and Bill Clinton) with the request to write a counter-attitudinal essay about who made a “better president.” This difference was not observed under circumstances of low perceived choice or when the topic of the counter-attitudinal essay was non-political (i.e., when it pertained to computer or beverage preferences). The results of these experiments provide initial evidence of ideological differences in dissonance avoidance. Future work would do well to determine whether such differences are specific to political issues or topics that are personally important. Implications for political behavior are discussed.

Fostering students' reflection about bias in healthcare: cognitive dissonance and the role of personal and normative standards

BACKGROUND

To reduce cognitive dissonance about one's beliefs or behavior, individuals may compare their behavior to personal and/or normative standards. The details of this reflection process are unclear.

AIMS

We examined how medical students compare their behavior or beliefs to standards in discussions about implicit bias, and explored if and how different reflective pathways (preserving vs. reconciling) are associated with each standard.

METHODS

Third-year students engaged in a small-group discussion about bias. Some students and group facilitators also participated in a debriefing about the experience. Using qualitative methods, the transcripts from these 11 sessions were analyzed for evidence of student comparison to a standard and of reflection pathways.

RESULTS

Of 557 text units, 75.8% could be coded with a standard and/or a path of reflection. Students referenced personal and normative standards about equally, and preserved or reconciled existing beliefs about equally. Uses of normative standards were associated with preservation-type reflection, and uses of personal standards with reconciliation-type reflection.

CONCLUSIONS

Normative expectations of physicians are sometimes used to provoke students' consideration of implicit biases about patients. To encourage critical reflection and reconciliation of biased beliefs or behavior, educators should frame reflective activities as a personal exercise rather than as a requirement.

Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey

OBJECTIVE

The purpose of this paper is to assess whether smokers adjust their beliefs in a pattern that is consistent with Cognitive Dissonance Theory. This is accomplished by examining the longitudinal pattern of belief change among smokers as their smoking behaviours change.

METHODS

A telephone survey was conducted of nationally representative samples of adult smokers from Canada, the USA, the UK and Australia from the International Tobacco Control Four Country Survey. Smokers were followed across three waves (October 2002 to December 2004), during which they were asked to report on their smoking-related beliefs and their quitting behaviour.

FINDINGS

Smokers with no history of quitting across the three waves exhibited the highest levels of rationalisations for smoking. When smokers quit smoking, they reported having fewer rationalisations for smoking compared with when they had previously been smoking. However, among those who attempted to quit but then relapsed, there was once again a renewed tendency to rationalise their smoking. This rebound in the use of rationalisations was higher for functional beliefs than for risk-minimising beliefs, as predicted by social psychological theory.

CONCLUSIONS

Smokers are motivated to rationalise their behaviour through the endorsement of more positive beliefs about smoking, and these beliefs change systematically with changes in smoking status. More work is needed to determine if this cognitive dissonance-reducing function has an inhibiting effect on any subsequent intentions to quit.

How do deployed health care providers experience moral injury?

Combat deployments put health care providers in ethically compromising and morally challenging situations. A sample of recently deployed nurses and physicians provided narratives that were analyzed to better appreciate individual perceptions of moral dilemmas that arise in combat. Specific questions to be answered by this inquiry are: 1) How do combat deployed nurses and physicians make sense of morally injurious traumatic exposures? and 2) What are the possible psychosocial consequences of these and other deployment stressors? This narrative inquiry involves analysis of ten deployed military nurses' and physicians' aversive or traumatic experiences. Burke's dramatist pentad is used for structural narrative analysis of stories that confirm and illuminate the impact of war zone events such as betrayal, disproportionate violence, incidents involving civilians, and within-rank violence on military health care provider narrators. Results indicate cognitive dissonance and psychosocial sequelae related to moral and psychological stressors faced by military medical personnel. Discussion addresses where healing efforts should be focused.

Is choice-induced preference change long lasting?

The idea that decisions alter preferences has had a considerable influence on the field of psychology and underpins cognitive dissonance theory. Yet it is unknown whether choice-induced changes in preferences are long lasting or are transient manifestations seen in the immediate aftermath of decisions. In the research reported here, we investigated whether these changes in preferences are fleeting or stable. Participants rated vacation destinations before making hypothetical choices between destinations, immediately afterward, and 2.5 to 3 years later. We found that choices altered preferences both immediately after being made and after the delay. These changes could not be accounted for by participants' preexisting preferences, and they occurred only when participants made the choices themselves. Our findings provide evidence that making a decision can lead to enduring change in preferences.

[A comparative study of N400 in generalized anxiety disorder versus obsessive compulsive disorder patients]

OBJECTIVE

To explore the features of events-related potentials (ERP) component N400 in generalized anxiety disorder (GAD) versus obsessive compulsive disorder (OCD) patients and understand the cognitive pattern and processing characteristic for Chinese characters.

METHODS

ERP component N400 was recorded by Guangzhou Runjie WJ-1 ERP apparatus. And 41 GAD patients, 69 OCD patients and 58 normal controls (NC) were tested by the Chinese idioms ending with matching (congruent) or mismatching (incongruent) words.

RESULTS

(1) Latencies: Significant differences were found of N400 latencies in ending words with the same pronunciation but different forms and meanings (NC: (377 ± 40) ms, OCD: (395 ± 43) ms, GAD: (396 ± 43) ms, congruent; NC: (415 ± 32) ms, OCD: (429 ± 35) ms, GAD: (430 ± 36) ms, incongruent), ending words with the same meaning but different pronunciations and forms (NC: (411 ± 32) ms, OCD: (424 ± 40) ms, GAD: (433 ± 39) ms, incongruent), ending words with different pronunciations, forms and meanings (NC: (399 ± 47) ms, OCD: (427 ± 53) ms, GAD: (434 ± 42) ms, congruent; NC: (442 ± 36) ms, OCD: (465 ± 35) ms, GAD: (474 ± 35) ms, incongruent) (P < 0.05 - 0.01). Compared with NC, the N400 latencies were prolonged in GAD and OCD patients. Compared with OCD patients, the GAD patients also showed prolonged N400 latencies in ending words with different pronunciations, forms and meanings (incongruent situation). (2) Significant differences were found of N400 amplitudes in ending words with the same pronunciation but different forms and meanings (NC: (9 ± 5) µV, OCD: (6 ± 5) µV, GAD: (6 ± 5) µV, congruent; NC: (11 ± 6) µV, OCD: (5 ± 4) µV, GAD: (6 ± 4) µV, incongruent), ending words with similar forms but different pronunciations and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (7 ± 5) µV, congruent; NC: (14 ± 6) µV, OCD: (6 ± 5) µV, GAD: (9 ± 7) µV, incongruent), ending words with different pronunciations, forms and meanings (NC: (9 ± 5) µV, OCD: (5 ± 4) µV, GAD: (5 ± 3) µV, congruent; NC: (14 ± 6) µV, OCD: (9 ± 7) µV, GAD: (9 ± 7) µV, incongruent) (P < 0.05 - 0.01). Compared with NC, N400 amplitudes decreased in GAD and OCD patients respectively. Compared with OCD patients, the GAD patients also showed elevated N400 amplitudes in ending words with similar forms but different pronunciations and meanings (congruent).

CONCLUSION

The cognitive and emotional problems in GAD and OCD may be measured by N400 elicited by Chinese idioms. Notable N400 priming effects can be found in Chinese idioms.

Dissonance, resistance and commitment: a pilot analysis of moderated mediation relationships

BACKGROUND

Encouraging engagement is a challenge in forensic services. A model of behaviour change suggests that dissatisfaction with the self may express itself either as resistance to or commitment to engagement in treatment, and that this expression may be moderated by the individual's attributional style.

AIMS/HYPOTHESES

It was hypothesised that there would be relationships between measures of dissonance, resistance to treatment and commitment to treatment, and that these relationships would be moderated by locus of control.

METHOD

Thirty-two patients from within a high secure dangerous and severe personality disorder service completed assessments measuring dissonance, locus of control, resistance and commitment. These measures were analysed for a moderated mediation using techniques outlined by Preacher et al. (2007).

RESULTS

There were significant indirect relationships between dissonance and both resistance and commitment. These relationships were moderated by locus of control. However, the specifics of the relationships were not as expected - both internal and external locus of control interfered with therapy, but in different ways.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

A patient who experiences dissonance may translate this into either commitment to or resistance to treatment, depending on features of the patient such as attributional style.

When flexibility is stable: implicit long-term shaping of olfactory preferences

Preferences are traditionally assumed to be stable. However, empirical evidence such as preference modulation following choices calls this assumption into question. The evolution of such postchoice preference over long time spans, even when choices have been explicitly forgotten, has so far not been studied. In two experiments, we investigated this question by using a variant of the free choice paradigm: In a first session, participants evaluated the pleasantness of a number of odors. We then formed pairs of similarly rated odors, and asked participants to choose their favorite, for each pair. Participants were then presented with all odors again, and asked for another pleasantness rating. In a second session 1 week later, a third pleasantness rating was obtained, and participants were again asked to choose between the same options. Results suggested postchoice preference modulation immediately and 1 week after choice for both chosen and rejected options, even when choices were not explicitly remembered. A third experiment, using another paradigm, confirmed that choice can have a modulatory impact on preferences, and that this modulation can be long-lasting. Taken together, these findings suggest that although preferences appear to be flexible because they are modulated by choices, this modulation also appears to be stable over time and even without explicit recollection of the choice. These results bring a new argument to the idea that postchoice preference modulation could rely on implicit mechanisms, and are consistent with the recent proposal that cognitive dissonance reduction could to some extent be implicit.

A preliminary trial of a prototype Internet dissonance-based eating disorder prevention program for young women with body image concerns

OBJECTIVE

A group dissonance-based eating disorder prevention program, in which young women critique the thin ideal, reduces eating disorder risk factors and symptoms, but it can be difficult to identify school clinicians with the time and expertise to deliver the intervention. Thus, we developed a prototype Internet version of this program and evaluated it in a preliminary trial.

METHOD

Female college students with body dissatisfaction (N = 107; M age = 21.6 years, SD = 6.6) were randomized to the Internet intervention, group intervention, educational video condition, or educational brochure condition.

RESULTS

Internet and group participants showed greater pre-post reductions in eating disorder risk factors and symptoms than video controls (M ds = 0.47 and 0.54, respectively) and brochure controls (M ds = 0.75 and 0.72, respectively), with many effects reaching significance. Effects did not differ significantly for Internet versus group participants (M ds = -0.13) or for video versus brochure controls (M d = 0.25). Effect sizes for the Internet intervention were similar to those previously observed for group versions of this intervention.

CONCLUSIONS

Results suggest that this prototype Internet intervention is as efficacious as the group intervention, implying that there would be merit in completing this intervention and evaluating it in a fully powered trial.

Social smokers' management of conflicted identities

BACKGROUND

Although social smoking has increased among young adults, it remains a poorly understood behaviour. The authors explored how young adult social smokers viewed and defined smoking and the strategies they used to reconcile their conflicting smoker and non-smoker identities. The authors also examined alcohol's role in facilitating social smoking and investigated measures that would decouple drinking and smoking.

METHODS

The authors conducted 13 in-depth interviews with young adult social smokers aged between 19 and 25 years and used thematic analysis to interpret the transcripts.

RESULTS

The authors identified four key themes: the demarcation strategies social smokers used to avoid classifying themselves as smokers, social smoking as a tactic that ameliorates the risk of alienation, alcohol as a catalyst of social smoking and the difficulty participants experienced in reconciling their identity as non-smokers who smoke.

CONCLUSIONS

Although social smokers regret smoking, their retrospective remorse was insufficient to promote behaviour change, and environmental modifications appear more likely to promote smoke-free behaviours among social smokers. Participants strongly supported extending the smoke-free areas outside bars, a measure that would help decouple their alcohol-fuelled behaviours from the identity to which they aspire.

Testing mediators hypothesized to account for the effects of a dissonance-based eating disorder prevention program over longer term follow-up

OBJECTIVE

Test the hypothesis that reductions in thin-ideal internalization and body dissatisfaction mediate the effects of a dissonance-based eating disorder prevention program on reductions in eating disorder symptoms over 1-year follow-up.

METHOD

Data were drawn from a randomized effectiveness trial in which 306 female high school students (mean age = 15.7 years, SD = 1.1) with body image concerns were randomized to the 4-session dissonance-based prevention program or an educational brochure control condition, wherein school counselors and nurses were responsible for participant recruitment and intervention delivery.

RESULTS

Dissonance-intervention participants showed greater reductions in thin-ideal internalization, body dissatisfaction, and eating disorder symptoms; change in thin-ideal internalization predicted change in body dissatisfaction and symptoms; change in body dissatisfaction predicted change in symptoms; and all indirect effects were significant. Change in thin-ideal internalization fully mediated the effects of intervention condition on change in body dissatisfaction and partially mediated the effects on symptoms; change in body dissatisfaction partially mediated the effect of intervention condition on change in symptoms.

CONCLUSIONS

Findings provided support for the intervention theory of this eating disorder prevention program over longer term follow-up, extending the evidence base for this effective intervention.

Turning toward dissonance: lessons from art, music, and literature

Conflict and chaos are prevalent in health care, and perhaps especially in palliative care. Typically, our point of entry into our patients' lives is often at the moment of conflict, discord, or intense suffering. Despite this, little in our formal training as clinicians teaches us how to be present for this suffering. Much has been written about the process of communication with regard to giving bad news, handling family meeting conflicts, and negotiating shifting goals of care, but little has been addressed about how to train the clinician to be present with the dissonance and suffering. In this paper, we explore how music, art, and literature teach us how to stay in moments of tension. In turn, lessons on how to learn to lean into the dissonance of many palliative care encounters are extrapolated.

[The problem of the effectiveness of treatment of arterial hypertension in smokers]

In this review we give short characteristics of investigations devoted to assessment of effectiveness of cardiac drugs in patients who smoke. Basing on results of these investigations point of view is expressed that antihypertensive preparations of various classes differently affect smokers with arterial hypertension (AH). An opinion exists that drugs which improve endothelial function are preferable in smoking patients with AH. However special studies of comparative of efficacy of antihypertensive drugs from different classes in smokers are necessary.

An exploration of economic reasoning in hoarding disorder patients

Current models of hoarding disorder (HD) emphasize problems of decision-making. Evidence for neuropsychological impairment in HD, however, has been mixed. The present study examined whether HD patients show problems of economic reasoning that could be associated with decision-making problems. Forty-two HD patients, 29 obsessive-compulsive disorder (OCD) patients, and 36 healthy control participants completed the Iowa gambling task (IGT), a computerized card playing game that assesses participants' ability to learn and utilize a rule of sacrificing short-term gain for long-term gain, and a cognitive dissonance reduction task that measured changes in preference for items (art prints) after selecting or rejecting them. Results showed no deficits on the IGT for HD participants, and no difference in dissonance reduction results after selecting or rejecting items on the dissonance reduction task. Furthermore, performance on these two tasks was unrelated to hoarding symptom severity or self-reported indecisiveness. It is suggested that the problems of cognitive processing in HD patients may be largely related to as-yet understudied processes, including idiosyncratic categorization problems for personally-owned items as well as other aspects of economic reasoning.

Reducing obesity stigma: the effectiveness of cognitive dissonance and social consensus interventions

Obese individuals experience pervasive stigmatization. Interventions attempting to reduce obesity stigma by targeting its origins have yielded mixed results. This randomized, controlled study examined the effectiveness of two interventions to reduce obesity stigma: cognitive dissonance and social consensus. Participants were college undergraduate students (N = 64, 78% women, mean age = 21.2 years, mean BMI = 23.1 kg/m2) of diverse ethnicities. Obesity stigma (assessed with the Antifat Attitudes Test (AFAT)) was assessed at baseline (Visit 1) and 1 week later, immediately following the intervention (Visit 2). Participants were randomly assigned to one of three intervention groups where they received standardized written feedback on their obesity stigma levels. Cognitive dissonance participants (N = 21) were told that their AFAT scores were discrepant from their values (high core values of kindness and equality and high stigma), social consensus participants (N = 22) were told their scores were discrepant from their peers' scores (stigma much higher than their peers), and control participants (N = 21) were told their scores were consistent with both their peers' scores and their own values. Following the intervention, omnibus analyses revealed significant group differences on the AFAT Physical/Romantic Unattractiveness subscale (PRU; F (2, 59) = 4.43, P < 0.05). Planned contrasts revealed that cognitive dissonance group means were significantly lower than control means for AFAT total, AFAT PRU subscale, and AFAT social/character disparagement subscale (all P < 0.05). No significant differences were found between social consensus and controls. Results from this study suggest that cognitive dissonance interventions may be a successful way to reduce obesity stigma, particularly by changing attitudes about the appearance and attractiveness of obese individuals.

Predictors of self-mutilation in patients with borderline personality disorder: A 10-year follow-up study

BACKGROUND

Self-mutilation is a common and serious problem in patients with borderline personality disorder (BPD). The purpose of this study was to determine the most clinically relevant baseline and time-varying predictors of self-mutilation over 10 years of prospective follow-up among patients with BPD.

METHOD

Four semistructured interviews assessing axis I disorders, childhood adversity, adult experiences of abuse, and experiences of self-mutilation were administered at baseline to 290 patients meeting DIB-R and DSM-III-R criteria for BPD. Three of these interviews (all except for the childhood adversity interview) and two self-report measures pertaining to dysphoric affects and cognitions were administered at each of five contiguous two-year follow-up periods.

RESULTS

Eleven variables were found to be significant bivariate predictors of self-mutilation over the five follow-up periods. Six of these predictors remained significant in multivariate analyses: female gender, severity of dysphoric cognitions (mostly overvalued ideas), severity of dissociative symptoms, major depression, history of childhood sexual abuse, and sexual assaults as an adult.

CONCLUSIONS

Taken together, the results of this study suggest that factors pertaining to traumatic experiences throughout the lifespan are significant risk factors for self-mutilation over time. These results also suggest that major depressive episodes and cognitive symptoms, particularly overvalued ideas and dissociation, significantly heighten the risk of self-injurious behaviors tracked for a decade.

Can the absence of prejudice be more threatening than its presence? It depends on one's worldview

The present research used validated cardiovascular measures to examine threat reactions among members of stigmatized groups when interacting with members of nonstigmatized groups who were, or were not, prejudiced against their group. The authors hypothesized that people's beliefs about the fairness of the status system would moderate their experience of threat during intergroup interactions. The authors predicted that for members of stigmatized groups who believe the status system is fair, interacting with a prejudiced partner, compared with interacting with an unprejudiced partner, would disconfirm their worldview and result in greater threat. In contrast, the authors predicted that for members of stigmatized groups who believe the system is unfair, interacting with a prejudiced partner, compared with interacting with an unprejudiced partner, would confirm their worldview and result in less threat. The authors examined these predictions among Latinas interacting with a White female confederate (Study 1) and White females interacting with a White male confederate (Study 2). As predicted, people's beliefs about the fairness of the status system moderated their experiences of threat during intergroup interactions, indicated both by cardiovascular responses and nonverbal behavior. The specific pattern of the moderation differed across the 2 studies.

Determinants of self-perceived HIV risk in young south Africans engaged in concurrent sexual relationship

Concurrent sexual partnerships are increasingly believed to be a key factor explaining the size of the HIV pandemic in Southern and Eastern Africa. Little, however, is known about what determines if persons in concurrent relationships develop a perception of being at risk for HIV infection. Data from a representative sample of 2245 young sexually active inhabitants of Cape Town, South Africa, were analysed using multivariate logistic regression to examine what the correlates of HIV risk were in both those involved in concurrent relations (termed the high risk group) and in those not (the low risk group). A considerable difference was noted between males and females. In the high risk group, amongst the males, secondary level education (as compared with primary or post-secondary level), and believing in monogamy (as a means of HIV risk reduction) were correlated with a decreased-perception-of-HIV-risk. The usage of drugs was associated with an increased-perception-of-HIV-risk. Amongst the females, a longer time since sexual debut, having experienced sexual coercion, a greater number of sex partners in the past year and knowing someone who died of AIDS were correlated with an increased-HIV-risk-perception.