Kristin L. Schneider

Self-System Therapy as an Intervention for Self-Regulatory Dysfunction in Depression: A Randomized Comparison with Cognitive Therapy.

Self-system therapy (SST) is a new therapy based on regulatory focus theory (E. T. Higgins, 1997) for depressed individuals unable to pursue promotion goals effectively. The authors conducted a randomized trial comparing SST with cognitive therapy (CT) in a sample of 45 patients with a range of depressive symptoms to test 2 hypotheses: that SST would be more efficacious for depressed individuals characterized by inadequate socialization toward pursuing promotion goals and that SST would lead to greater reduction in dysphoric responses to priming of promotion goals. There was no overall difference in efficacy between treatments, but patients whose socialization history lacked an emphasis on promotion goals showed significantly greater improvement with SST. In addition, SST patients showed a greater reduction in dysphoric responses to promotion goal priming than did CT patients. The results illustrate the value of a theory-based translational approach to treatment design and selection.

Randomized Controlled Trial for Behavioral Smoking and Weight Control Treatment: Effect of Concurrent Versus Sequential Intervention.

The authors compared simultaneous versus sequential approaches to multiple health behavior change in diet, exercise, and cigarette smoking. Female regular smokers (N = 315) randomized to 3 conditions received 16 weeks of behavioral smoking treatment, quit smoking at Week 5, and were followed for 9 months after quit date. Weight management was omitted for control and was added to the 1st 8 weeks for early diet (ED) and the final 8 weeks for late diet (LD). ED lacked lasting effect on weight gain, whereas LD initially lacked but gradually acquired a weight-suppression effect that stabilized (p = .004). Behavioral weight control did not undermine smoking cessation and, when initiated after the smoking quit date, slowed the rate of weight gain, supporting a sequential approach.

The Effects of Treatments for Depression on Perceived Failure in Self-Regulation

Two studies examined the effect of treatments for depression on perceived failure in self-regulation, operationalized as within-self discrepancy. In Study 1, patients received group cognitive–behavioral therapy (CBT); in Study 2, patients received either individual CBT, interpersonal psychotherapy (IPT), or medication. Treatments showed equivalent efficacy, but only psychotherapy was associated with decreased self-discrepancy and priming reactivity. Highly self-discrepant patients showed less improvement than other patients in all treatments, even after controlling for initial severity. The findings suggest that treatments differ in their impact on self-regulatory cognition, and that highly self-discrepant patients may require longer or alternative treatment.

Make Better Choices (MBC): Study design of a randomized controlled trial testing optimal technology-supported change in multiple diet and physical activity risk behaviors

BackgroundSuboptimal diet and physical inactivity are prevalent, co-occurring chronic disease risk factors, yet little is known about how to maximize multiple risk behavior change. Make Better Choices, a randomized controlled trial, tests competing hypotheses about the optimal way to promote healthy change in four bundled risk behaviors: high saturated fat intake, low fruit and vegetable intake, low physical activity, and high sedentary leisure screen time. The study aim is to determine which combination of two behavior change goals - one dietary, one activity - yields greatest overall healthy lifestyle change.Methods/DesignAdults (n = 200) with poor quality diet and sedentary lifestyle will be recruited and screened for study eligibility. Participants will be trained to record their diet and activities onto a personal data assistant, and use it to complete two weeks of baseline. Those who continue to show all four risk behaviors after baseline recording will be randomized to one of four behavior change prescriptions: 1) increase fruits and vegetables and increase physical activity, 2) decrease saturated fat and increase physical activity, 3) increase fruits and vegetable and decrease saturated fat, or 4) decrease saturated fat and decrease sedentary activity. They will use decision support feedback on the personal digital assistant and receive counseling from a coach to alter their diet and activity during a 3-week prescription period when payment is contingent upon meeting behavior change goals. They will continue recording on an intermittent schedule during a 4.5-month maintenance period when payment is not contingent upon goal attainment. The primary outcome is overall healthy lifestyle change, aggregated across all four risk behaviors.DiscussionThe Make Better Choices trial tests a disseminable lifestyle intervention supported by handheld technology. Findings will fill a gap in knowledge about optimal goal prescription to facilitate simultaneous diet and activity change. Results will shed light on which goal prescription maximizes healthful lifestyle change.Trial RegistrationClinical Trials Gov. Identifier NCT00113672

Self-regulatory cognition and immune reactivity: idiographic success and failure feedback effects on the natural killer cell.

Inducing depressed and anxious individuals to write about their personal goals decreases natural killer (NK) cell activity, revealing a psychobiological pathway whereby experiences of failure can influence health (Strauman et al., 1993). However, it is unclear whether similar effects also occur in non-distressed individuals. This study used the same writing task to examine the acute physiological effects of presenting idiographic success and failure feedback by priming self-congruencies or self-discrepancies on three occasions (including a control condition). Blood samples were collected after each writing session to determine NK activity, and the number and type of lymphocytes in circulation were enumerated to help explain the cytolytic changes. The two self-relevant priming conditions were associated with significant alterations in immunity, and the high self-discrepant participants were more responsive. Both self-congruent (success) and self-discrepant (failure) priming induced significant shifts in mood, which partially mediated immune alterations but did not account for them completely. If repeated and sustained over time, incidental activation of self-discrepancies and self-congruencies could account for individual variation in immune responses.

Exercise and Energy intake in Overweight, Sedentary Individuals

Exercise expends energy, but without dietary intervention, exercise does not appear to produce substantial weight loss. The present study examined whether overweight, sedentary individuals increase their energy intake after moderate intensity exercise, particularly in the presence of negative mood. A repeated measures design was used where overweight, sedentary individuals (N=65) completed, in counterbalanced order, two conditions: 3 min of exercise (Active) and 3 min of sedentary activity (Sedentary) during one session. Snack foods were presented 10 min after each activity. Mixed-effects regression modeling revealed no significant effect of Active versus Sedentary condition on energy intake. However, moderational analyses revealed that change in negative mood interacted with condition to predict energy intake, such that participants who reported increased negative mood during exercise consumed more calories in the Active compared to the Sedentary condition. That a short bout of exercise resulted in mood deterioration and increased energy intake for some overweight, sedentary individuals is concerning. Further research examining behavioral and physiological mechanisms of mood deterioration and caloric overcompensation following exercise in overweight, sedentary individuals is warranted.

Affective benefits of exercise while quitting smoking : Influence of smoking-specific weight concern

The present study aimed to shed light on contradictory findings about the effects of exercise on negative affect during smoking cessation. The authors hypothesized that smoking-specific weight concern would moderate the relationship between exercise and negative affect. Baseline measures of smoking-specific weight concern, exercise, and negative affect were completed by 146 women participating in a randomized controlled trial of smoking cessation plus weight control. Exercise and negative affect were reassessed 1 week after the quit date. Among women with heightened smoking-specific weight concern, greater engagement in exercise was associated with less of an increase in negative affect. Results suggest that exercise may help temper negative affect states for women with heightened smoking-specific weight concern.

The Therapeutic Realizations Scale-Revised (TRS-R): psychometric characteristics and relationship to treatment process and outcome

Therapeutic realizations are one of five universal, session-level change processes explicated in the Generic Model of Psychotherapy. Realizations refer to session impacts, the moment-to-moment accomplishments that patients experience within sessions. This study establishes the psychometric characteristics and factor structure of a modified patient-rated measure of session-level effects, the Therapeutic Realization Scale-Revised (TRS-R). In addition, it shows the relationship of the TRS-R to treatment process and outcome from the perspective of both patients and therapists. The findings provide support for the TRS-R as a reliable and valid, multidimensional index of session-level treatment effects.

Universal session-level change processes in an early session of psychotherapy: path models

The authors used structural equation modeling to investigate universal change processes identified in the generic model of psychotherapy (GMP). Three path models of increasing complexity were examined in Study 1 in dynamic therapy. The best fitting model from Study 1 was replicated in Study 2 for participants receiving either cognitive or interpersonal therapy. Findings provided support for the universality of the GMP constructs in different types of therapy. Positive influences for therapeutic bond, openness, and realizations were observed, as was a surprising negative impact for one aspect of bond. Discussion highlights a complex conception of the therapy relationship that underscores the importance of investigating the multiple functions that the therapy relationship might serve in different psychotherapies.

Early psychotherapy process and cluster B and C personality pathology: similarities and differences in interactions with symptomatic and interpersonal distress

Abstract In a prior study (Kolden & Klein, 1996), the authors found that the relationships between global personality pathology and early psychotherapy change processes (as defined by the Generic Model of Psychotherapy) were moderated by the extent of the patients acute symptomatic and interpersonal distress. In the current study, the authors reanalyzed the same data to examine similarities and differences between personality disorder Clusters B (dramatic, emotional, or erratic) and C (anxious or fearful) in therapy process. In general, we found that more distressed patients reported greater defensiveness. There were no significant interactions between symptomatic distress and personality pathology in the prediction of any of the process variables. However, interpersonal distress moderated relationships between Clusters B and C and some therapy processes. Patients high in Cluster B felt more open and involved in the session when they were less distressed by their interpersonal problems at the start of therapy. In contrast, openness and insight were impeded among patients high in Cluster C when they were less distressed interpersonally. Therapists generally used more direct interventions and exploration of past experiences when working with patients higher in Cluster C pathology. However, therapists used direct interventions more specifically when patients with more severe Cluster B pathology were also higher in interpersonal distress. The discussion considers implications for the facilitation of productive early therapy process in patients suffering from Cluster B or C personality pathology.