Transportability of an empirically supported dissonance-based prevention program for eating disorders

This study sought to evaluate the degree to which positive effects remained when a well studied cognitive dissonance eating disorder prevention program was disseminated through a large national sorority under naturalistic conditions. All participants underwent a 2-session program run by peer facilitators. The sample included 182 undergraduate women from a local chapter of a national sorority at a large public university. Analyses revealed that the program significantly reduced body dissatisfaction, thin ideal internalization, dietary restraint, and the use of the media as a source of information about beauty, and restrained eating. Importantly, effect sizes were maintained at 5-months and 1-year follow-up. These findings demonstrate that empirically supported programs can remain effective when disseminated with careful training in large social systems.

Ideals, activities, dissonance, and processing: a conceptual model to guide educators' efforts to stimulate student reflection

PURPOSE

Medical schools are increasingly incorporating opportunities for reflection into their curricula. However, little is known about the cognitive and/or emotional processes that occur when learners participate in activities designed to promote reflection. The purpose of this study was to identify and elucidate those processes.

METHOD

In 2008, the authors analyzed qualitative data from focus groups that were originally conducted to evaluate an educational activity designed to promote reflection. These data afforded the opportunity to explore the processes of reflection in detail. Transcripts (94 pages, single-spaced) from four focus groups were analyzed using a narrative framework. The authors spent approximately 40 hours in group and 240 hours in individual coding activities.

RESULTS

The authors developed a conceptual model of five major elements in students' reflective processes: the educational activity, the presence or absence of cognitive or emotional dissonance, and two methods of processing dissonance (preservation or reconciliation). The model also incorporates the relationship between the student's internal ideal of what a doctor is or does and the student's perception of the teacher's ideal of what a doctor is or does. The model further identifies points at which educators may be able to influence the processes of reflection and the development of professional ideals.

CONCLUSIONS

Students' cognitive and emotional processes have important effects on the success of educational activities intended to stimulate reflection. Although additional research is needed, this model-which incorporates ideals, activities, dissonance, and processing-can guide educators as they plan and implement such activities.

Feeling validated versus being correct: a meta-analysis of selective exposure to information

A meta-analysis assessed whether exposure to information is guided by defense or accuracy motives. The studies examined information preferences in relation to attitudes, beliefs, and behaviors in situations that provided choices between congenial information, which supported participants' pre-existing attitudes, beliefs, or behaviors, and uncongenial information, which challenged these tendencies. Analyses indicated a moderate preference for congenial over uncongenial information (d=0.36). As predicted, this congeniality bias was moderated by variables that affect the strength of participants' defense motivation and accuracy motivation. In support of the importance of defense motivation, the congeniality bias was weaker when participants' attitudes, beliefs, or behaviors were supported prior to information selection; when participants' attitudes, beliefs, or behaviors were not relevant to their values or not held with conviction; when the available information was low in quality; when participants' closed-mindedness was low; and when their confidence in the attitude, belief, or behavior was high. In support of the importance of accuracy motivation, an uncongeniality bias emerged when uncongenial information was relevant to accomplishing a current goal.

The use of motivational enhancement strategies for the maintenance of weight loss among obese individuals: a preliminary investigation

AIM

To investigate the efficacy of motivational enhancement strategies integrated within a standard lifestyle modification program for the maintenance of weight loss and improved psychosocial functioning of obese adults.

METHODS

Twenty-two obese adults completed 20 sessions of a motivationally informed cognitive behavioural treatment for weight loss and maintenance. Treatment outcome measures included anthropometrics, obesity-specific quality of life, impulsive eating tendencies, body dissatisfaction, mood disturbance and maladaptive cognitions.

RESULTS

At post-treatment, there was a significant decrease in body weight (123.04 +/- 22.06 vs. 116.84 +/- 23.53, p < 0.001) with no significant change by the 12-month follow-up. Patients also reported significant improvements in obesity-related quality of life, impulsive eating tendencies, body dissatisfaction and maladaptive cognitions at post-treatment that were maintained at the 1-year follow-up.

CONCLUSIONS

The implementation of motivational enhancement strategies within a cognitive behavioural program results in sustained weight loss that compares favourably to previous lifestyle modification programs.

Investigating adaptive grieving styles: a Delphi study

There has been an evolution in the understanding of the nature of grief since S. Freud's initial work, Mourning and Melancholia (1917/1953). Mental health practitioners and researchers have established new models to aid in the conceptualization and treatment of grief issues. The purpose of this study was to examine the opinions of experts in the field of grief regarding elements of a new model of adult bereavement, Martin and Doka's (2000) adaptive grieving styles, using the Delphi Method to identify points of consensus. A survey of 20 experts in the field of thanatology reached consensus on 21 items in which the panelists addressed the uniqueness of the griever, recognized there are multiple factors that influence the grieving process (i.e., culture, personality, and gender), that most bereaved individuals use both cognitive and affective strategies in adapting to bereavement, and that bereaved individuals experience both internal and external pressures to grieve in particular ways.

A practitioner's guide to persuasion: an overview of 15 selected persuasion theories, models and frameworks

OBJECTIVE

To provide a brief overview of 15 selected persuasion theories and models, and to present examples of their use in health communication research.

RESULTS

The theories are categorized as message effects models, attitude-behavior approaches, cognitive processing theories and models, consistency theories, inoculation theory, and functional approaches.

CONCLUSIONS

As it is often the intent of a practitioner to shape, reinforce, or change a patient's behavior, familiarity with theories of persuasion may lead to the development of novel communication approaches with existing patients.

PRACTICE IMPLICATIONS

This article serves as an introductory primer to theories of persuasion with applications to health communication research. Understanding key constructs and general formulations of persuasive theories may allow practitioners to employ useful theoretical frameworks when interacting with patients.

Moral cognitive correlates of empathy in juvenile delinquents

INTRODUCTION

Numerous theories of anti-social behaviour have featured lack of empathy as an essential characteristic of the anti-social personality.

AIM

To investigate the relationships between empathy and three theoretically related moral cognitive constructs: moral judgement maturity, moral identity and self-serving cognitive distortion.

METHODS

Seventy-eight adjudicated juvenile delinquents aged 13 to 21 years who had been directed by the court to attend a 10-week empathy training programme completed self-report measures as part of routine evaluation. Their anonymized scores were retrieved from programme records.

RESULTS

Applying zero-order correlation, followed by regression analysis, we established that moral judgement maturity was associated with greater empathy, whereas extensive endorsement of self-serving cognitive distortions was associated with lower empathy. An observed association between moral identity and empathy was mediated or 'neutralised' by self-serving cognitive distortion.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Our results suggest that interventions designed to promote empathy and curtail anti-social behaviour should embrace strategies that facilitate moral judgement maturity and correct or counteract self-serving cognitive distortions.

Preventing eating disorders

This article reviews eating disorder (ED) prevention programs, highlighting features that define successful programs and particularly promising interventions, and how they might be further refined. The field of ED prevention has advanced considerably both theoretically and methodologically compared with the earlier ED prevention programs, which were largely psychoeducational and met with limited success. Recent meta-analytic findings show that more than half (51%) of ED prevention interventions reduced ED risk factors and more than a quarter (29%) reduced current or future eating pathology (EP). A couple of brief programs have been shown to reduce the risk for future onset of EP and obesity. Selected interactive, multisession programs offered to participants older than 15 years, delivered by professional interventionists and including body acceptance or dissonance-induction content, produced larger effects. Understanding and applying these results can help inform the design of more effective prevention programs in the future.

Reconceptualizing reflexivity and dissonance in professional and personal domains

Debates around 'reflexivity' and the construction of the gendered self within late modernity have occupied the attention of both 'reflexive modernization' theorists (Beck, Giddens and Lash 1994; Beck and Beck-Gernsheim 1996; Giddens 1991, 1992) as well as gender and feminist theorists. While theorists such as Beck and Giddens have been preoccupied with establishing the connection between reflexivity and the construction of the 'non-gendered' self, gender and feminist theorists have sought to amplify the debate by exploring the intersecting nexus of contemporary theorizing, more fully within this context. This paper explores the theoretical underpinnings of these debates and their application to specific professional and personal domains. I consider three case studies to assess these issues as outlined in my own work, Brooks 2006, and in the work of Wajcman and Martin 2002, and McDowell 1997, which draw on empirical research and explore changes to gender identity within professional and personal domains. I conclude that there is little evidence in the research presented here of any systematic reconfiguring of gender identities leading to a detraditionalization of gender as suggested by the 'reflexive modernization' theorists.

A phenomenological study to understand the experiences of nurses with regard to brainstem death

METHOD

In this study six nurses from general intensive care units were interviewed. The resulting transcripts were analysed using hermeneutic phenomenology.

FINDINGS

The findings fall into five categories, feelings, communication, protection, education, and technology. Nurses appear to suffer a degree of cognitive dissonance that both adds to their stress and leads to difficulties in explaining brainstem death to relatives.

CONCLUSION

Nurses need more education and support to enable them to overcome cognitive dissonance and so give relatives honest information. Verbal information should be supplemented with a written information leaflet given to all relatives.

Dissonance-based Interventions for the prevention of eating disorders: using persuasion principles to promote health

The limited efficacy of prior eating disorder (ED) prevention programs led to the development of dissonance-based interventions (DBIs) that utilize dissonance-based persuasion principles from social psychology. Although DBIs have been used to change other attitudes and behaviors, only recently have they been applied to ED prevention. This article reviews the theoretical rationale and empirical support for this type of prevention program. Relative to assessment-only controls, DBIs have produced greater reductions in ED risk factors, ED symptoms, future risk for onset of threshold or subthreshold EDs, future risk for obesity onset, and mental health utilization, with some effects persisting through 3-year follow-up. DBIs have also produced significantly stronger effects than alternative interventions for many of these outcomes, though these effects typically fade more quickly. A meta-analysis indicated that the average effects for DBIs were significantly stronger than those for non-DBI ED prevention programs that have been evaluated. DBIs have produced effects when delivered to high-risk samples and unselected samples, as well as in efficacy and effectiveness trials conducted by six independent labs, suggesting that the effects are robust and that DBIs should be considered for the prevention of other problems, such as smoking, substance abuse, HIV, and diabetes care.

[Cognitive disturbances in the progression of Parkinson's disease]

Cognitive impairment (CD) have been studied in 88 patients with progressive Parkinson's disease (PD). It has been shown that CD in PD have a progressive character mostly due the increase of intensity of dysregulation and neurodynamic disorders, disturbances of visual-spatial functions and, in some cases, insufficiency of nominative speech function. A 2-5 years follow-up revealed the high frequency of transformation of moderate cognitive dysfunction into dementia. The old age of patients at baseline, late-onset and severity of disease were identified as predictors of CD progression in PD. The highest rate of CD progression was observed in patients with more pronounced premorbid disturbances of regulative and visual-spatial functions.

Hooked on a feeling: emotional labor as an occupational hazard of the post-industrial age

Emotional labor is a subtle but serious occupational hazard that is likely to spread rapidly as the global service economy continues to grow. Emotional labor requires more than just acting friendly and being helpful to customers; the worker must manage his or her emotions to create a company-dictated experience for customers. The practice of emotional labor in an unsupportive work environment produces work-related stress, which has a wide range of potentially serious health effects. Though many employers do not acknowledge the existence of emotional labor, it is a real occupational hazard that may generate life-altering effects on physical and emotional health. While no official regulations or identification standards specify emotional labor as an occupational hazard, some guidelines exist regarding its outcome: occupational stress. Emotional labor should be recognized as an occupational hazard by the Occupational Safety and Health Administration (OSHA), but this hazard does not lend itself to regulation through standards. The business culture that demands its performance is questioned.

Design and pilot evaluation of an Internet spit tobacco cessation program

PURPOSE

To develop an interactive Web site to help smokeless tobacco (ST) users to reduce or stop their ST use and pilot test it for feasibility, acceptability, and short-term outcomes.

METHODS

An interactive, multiple-contact Internet ST cessation program was developed, refined based on feedback from 17 ST users, and pilot-tested for feasibility, acceptability, and short-term effects on the ST-related behavior and attitudes among baseball athletes attending 3 colleges in California. Consenting ST users completed a baseline questionnaire and enrolled on the Web site for help with stopping ST use. One month later, outcomes were assessed.

RESULTS

Although 18 ST-using baseball athletes enrolled on the Web site, follow-up data were obtained from 12 individuals. Loss to follow-up occurred when we were unable to contact participants by telephone or mailed surveys. At 1-month follow-up, over 80% (N=11) reported that the Web site was: "helpful in stopping or reducing my tobacco use"; easy to navigate; and "appealing." Moreover, 8% (n=1) self-reported abstinence from ST use. Among nonquitters, there was a 26% mean reduction in ST use per day compared to baseline values. In addition, among all enrollees, there was a 4-fold increase in motivation to quit (7% versus 31%) and a 21% increase in their confidence in being able to quit (67% versus. 85%) from baseline to follow-up.

CONCLUSION

The interactive ST cessation Web site was feasible to implement, acceptable to ST users, and appeared to reduce ST use, enhance motivation to quit, and increase confidence about one's ability to quit. Further study with a larger sample size and a control group is needed to determine efficacy to promote cessation of ST use.

Toward a theory of self-reconciliation following mistakes in nursing practice

PURPOSE

To explore nurses' responses to making mistakes in hospital-based practice in the US.

METHODS

A grounded theory approach was used to explore the process that occurs after nurses perceive that they have made mistakes in practice. Theoretical sampling was used and data were collected until saturation occurred. Ten participants, who were registered nurses, described 17 personal mistakes. The mistakes they described occurred in hospitals. All participants were practicing nursing either in hospitals or in other work settings.

FINDINGS

A process of "Self-Reconciliation After Making Mistakes in Hospital Practice" was identified, with four distinct categories: reality hitting, weighing in, acting, and reconciling. The core category was reconciliation of the self, personally and professionally.

CONCLUSIONS

This research was a first step toward the development of a theory of mistake making in nursing practice. This response to making mistakes is consistent with previous research and is related to cognitive dissonance theory. The responses to mistakes varied from less healthy responses of blaming and silence to healthier responses that included disclosure, apologizing, and making amends. Further research to develop the theory and to determine helpful interventions is suggested.

Perceptions of tenured nursing faculty related to decision-making for community service

Motivation for this study arose from the authors' commitment to community service and the perceived dissonance related to service in the tripartite faculty role. The purpose of this study was to understand perceptions related to the decision-making process of tenured nursing faculty in response to requests for community service. Qualitative methodology using in-depth interviews that were transcribed verbatim and analyzed for themes was used. Five major themes were identified: primacy of matching expertise with skills; search for impact; due diligence; institutional ambivalence regarding community service; and the variety of preparation. Participants reported a dissonance between stated institutional commitment to service and the actual weight it carried in tenure and promotion decisions. Junior faculty should be mentored to carefully determine service commitments, and outcome indicators to evaluate the quality of service activities need to be developed.

Intrapersonal conflict in goals and values of patients with unipolar depression

BACKGROUND

Although increased conflicts between attitudes and beliefs about certain goals or values are often discussed as important factors in depression, there are only few empirical studies investigating these relations among patients with depressive disorders.

METHODS

In the present study, we used the Intrapersonal Conflict Test to assess cognitive inconsistencies in goals or values. A total of 53 inpatients with unipolar depression and 24 nondepressed controls (inpatients of an internal and a surgery ward) participated in the study. In addition to the Intrapersonal Conflict Test, patients completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Inventory of Interpersonal Problems as well as the Problem Solving Inventory.

RESULTS

Compared with controls, patients with depressive disorders showed significantly higher scores for global inconsistencies, inconsistencies within different goals/values, as well as between goals/values and their perceived realization. Significant correlations were found between conflict measures and the Inventory of Interpersonal Problems, as well as the Problem Solving Inventory. Path analyses show that group differences in intrapersonal conflicts were partially mediated by interpersonal problems but not by depressive symptoms or cognitive vulnerability factors.

CONCLUSIONS

Given the cross-sectional design of the study, the findings of this exploratory study do not allow for conclusions regarding the role of intrapersonal conflicts in the development and course of depression. Nevertheless, the high levels of intrapersonal conflicts observed in the study suggest that inconsistencies in goals or values should be considered in the psychological treatment of depression.