Exercise behaviour change in 40 to 65‐year‐old women: The SWEAT Study (Sedentary Women Exercise Adherence Trial)

Objective: The purpose of this study was to examine the relation between self‐reported psychological processes and changes in exercise behaviour in an 18‐month longitudinal stage‐based intervention trial in 115 initially sedentary women aged 40‐65 years. Design: A two‐way factorial design was used. Methods: Participants were assigned randomly to either moderate or vigorous and either home or centre‐based exercise. After six months, all participants exercised at home. Participants completed questionnaires at baseline, six, 12 and 18 months which assessed stage of exercise behaviour, self‐efficacy, decisional balance and processes of change. Results: 28 patterns of stage change were identified across the 18 months with 6.1% remaining sedentary and 45% demonstrating linear movement from contemplation to action to maintenance to continued maintenance. Two interpretable clusters were identified within both the contemplation (at baseline) and action (at six months) stages. Cluster membership, however, did not influence behaviour change. For participants demonstrating a linear pattern of change, self‐efficacy for overcoming barriers and behavioural processes increased from contemplation to action. Self‐efficacy for exercise competence increased from contemplation to action but was more pronounced for the vigorous exercise groups. Decisional balance showed a three‐way interaction and there was no change for experimental processes. There was no change in any variable from action to maintenance. Conclusions: The intervention was seen to be effective regardless of location or intensity of exercise. The relevance of substages is questionable in stage‐based interventions as women with a profile suggesting less readiness to change or sustain change were just as likely to adopt or maintain exercise.     

Self‐image and treatment drop‐out in eating disorders

Introduction . Drop‐out from treatment is a serious problem in eating disorders which remains poorly understood. The present study investigated whether self‐image and interpersonal theory could help to explain why eating disorder patients drop out of treatment. Method . Intake data on eating disorder patients who terminated treatment prematurely (N=54) were compared with patients who had completed treatment (N=54) and those who were still in treatment after 12 months (N=54). Self‐image was assessed using the structural analysis of social behaviour (SASB), and comparisons were made on demographic and clinical variables. Results . Patients who dropped out had initially presented with less negative self‐image and fewer psychological problems compared with remainers. Low levels of SASB self‐blame discriminated drop‐outs from completers and remainers and significantly predicted treatment drop‐out. Discussion . Drop‐out in eating disorders appears to be a complex phenomenon, not necessarily as pathological as often assumed. There may be important differences in the treatment goals of drop‐outs and therapists; patients who drop out may be choosing to disengage at a time when symptom improvement creates space for closer examination of interpersonal issues.     

Self‐management training for people with chronic disease: An exploratory study

Objective: To determine the effectiveness of a community‐based Chronic Disease Self‐management Course (CDC) for UK participants with a range of chronic diseases. Design: The study was a multiple baseline, pre‐test post test design with a sample of 185 participants who attended a CDC delivered in community settings by lay tutors, in the UK. Method: Data were collected by self‐completed questionnaires before attendance and at four‐month follow‐up. Results: The sample comprised 72% women (mean age = 53 years, mean disease duration = 16 years). The main chronic diseases included endometriosis, depression, diabetes, myalgic encephalomyelitis, osteoporosis and polio. Adjusting for baseline values and gender, small to moderate increases were found on cognitive symptom management, self‐efficacy (disease and symptoms) and communication with physician. A similar sized decrease was found on fatigue, and small decreases were evident on anxious and depressed moods, and health distress. There were no changes in the use of health care resources, or on self‐reported exercise behaviour. Conclusion: The results of this exploratory study suggest that self‐management training for people with chronic diseases can offer benefits in terms of enhanced self‐efficacy, greater use of cognitive behavioural techniques, and improvement in some aspects of physical and psychological well‐being.     

Self‐efficacy and future career expectations of at‐risk adolescents: The contribution of a tutoring program

Tutoring and mentoring programs may be a promisingintervention to help at‐risk children who may be in need of a positive influence in their lives. The purpose of the current study was to examine the contribution of tutoring to at‐risk adolescents’ self‐efficacy and future career expectations. Ninety‐eight tutees and 147 college student tutors completed the Self‐Efficacy Questionnaire for Children, the Work and Education subscale of the Future Expectations Scale for Adolescents, and a background questionnaire twice: first at the beginning and then toward the end of 8 months of tutoring. Both tutees and tutors reported higher levels of tutees’ social and emotional self‐efficacy as well as future expectations toward the end of the year. Tutors also reported higher levels of tutee academic self‐efficacy. Increased self‐efficacy was associated with increased levels of future expectations. Changes in academic and social self‐efficacy predicted changes in tutees’ future career expectations. Implications for theory and research are discussed.     

The impact of a self‐esteem group for people with eating disorders: an uncontrolled study

Low self‐esteem is widely recognized as a predisposing, precipitating and maintaining factor in the aetiology of eating disorders. This paper examines the effectiveness of a self‐esteem group for women with eating disorders, delivered repeatedly over a 20‐month period. Forty‐one patients began and 33 completed the programme and both pre‐ and post‐measures. Eight were excluded from the final analysis as they were in concurrent psychological treatment. Outcome was assessed using standardized measures and records of symptom levels and drop‐out rates. Significant improvements in self‐esteem, depression, and eating attitudes were observed. It is concluded that a treatment focusing solely on self‐esteem can be beneficial in reducing eating disordered attitudes. Copyright © 2003 John Wiley & Sons, Ltd.     

Predicting self‐efficacy using illness perception components: A patient survey

Objectives. To assess the measures of illness representation components in predicting measures of self‐efficacy in patients with coronary heart disease. Design. A longitudinal design was adopted with predictor variables and dependent variables (general self‐efficacy, diet self‐efficacy and exercise self‐efficacy) measured twice while participants were in hospital and 9 months following discharge. Change scores of the predictor variables can be calculated and dependent variables at baseline can be controlled. Method. A cohort sample of 300 patients admitted to hospital with coronary heart disease were given the questionnaire measuring their illness perception (illness representation components: identity, consequences, timeline and control/cure and outcome expectation for diet and exercise); self‐efficacy (general, diet and exercise self‐efficacy measures), demographic and illness characteristics and attendance on a cardiac rehabilitation programme. The patients were asked to complete the questionnaire in hospital before discharge following their cardiac diagnosis, and again, 9 months later, when participants were expected to be functioning independently of any rehabilitation programme. Results. Demographic and illness characteristics were found to have a more significant relationship with illness representation components than with specific self‐efficacy. The relationship between illness representation components and specific self‐efficacy changes overtime, consequence and timeline were significantly related to self‐efficacy measures initially; however, symptom and control/cure were the variables that were significantly related to self‐efficacy measures 9 months later. After statistically controlling individuals' baseline self‐efficacy measures, demographic and illness characteristic effects, symptom and control/cure were found to make significant contributions to exercise and diet self‐efficacy, respectively, 9 months later. Conclusion. A significant relationship exists between illness representation and self‐efficacy. There is potential to integrate both approaches to the assessment of psychosocial factors to provide effective individualized care in cardiac rehabilitation.     

The Relationship of Self‐Efficacy and Self‐Identity to Long‐Term Maintenance of Vigorous Physical Activity1

This study examines whether task and self‐regulatory self‐efficacy (scheduling and barriers), and self‐identity predict maintenance physical activity. Sixty‐seven maintenance runners completed self‐efficacy and self‐identity measures and, 4 weeks later, recalled their physical activity. Two multiple regression analyses indicated that when combined with self‐identity in independent models, both forms of self‐regulatory self‐efficacy predicted running frequency. A model consisting of task self‐efficacy and self‐identity significantly predicted running duration. In an extreme self‐identity group MANOVA, the high group showed more favorable social cognitions and behavior than the low group. These findings suggest that self‐efficacy theory is useful for studying maintenance physical activity. Self‐identity may be a useful predictor of maintenance physical activity and may relate to differences in social cognitions and behavior.     

Managing exercise with another highly valued and conflicting leisure time goal

Research has identified concurrent self‐regulatory efficacy as a consistent exercise predictor when adults pursue another non‐exercise leisure time goal. Although intergoal conflict is an inconsistent exercise predictor, prior research did not ensure that goals were sufficiently highly valued to truly conflict. Other possible exercise predictors have not been examined among concurrent goals. The purpose was to examine whether intergoal conflict and outcome expectations (likelihood; value) predicted moderate‐vigorous exercise over 1 month, beyond concurrent self‐regulatory efficacy, when adults held highly valued, conflicting exercise and non‐exercise goals concurrently. Eighty‐seven adult exercisers pursuing highly valued and conflicting exercise and non‐exercise goals completed online surveys assessing (1) concurrent self‐regulatory efficacy, intergoal conflict, and outcome expectations at Time 1 and (2) exercise over the prior month at Time 2. A hierarchical multiple regression (R² adjusted = 0.24, p < .001) revealed intergoal conflict and outcome expectations accounted for a significant additional 13% of exercise variance, beyond self‐regulatory efficacy. Future research should examine these social cognitions across adults who vary in their exercise levels (i.e., beginner, irregular, regular exercisers). Valuable information about which social cognitions should be targeted to improve exercise levels among each group to that of regular exercisers would result.     

Relationships between self‐consistency,trauma‐centred identity,and post‐traumatic adjustment

Background: Post‐traumatic stress disorder (PTSD) models suggest that trauma‐centred self‐change is motivated by self‐consistency. Aim: The objective of this study was to investigate the relationships between self‐consistency, trauma‐centred identity, and PTSD symptoms. Method: University students (n = 134) completed measures of trauma‐centred identity (Centrality of Events Scale), self‐consistency, and post‐traumatic stress symptoms (Impact of Events Scale—Revised, Centre for Epidemiological Studies—Depression Scale). Results: A significant positive correlation was found between trauma‐centred identity and post‐traumatic symptoms. However, self‐consistency was not related to post‐traumatic symptoms or trauma‐centred identity. Given the relationship between depressive symptoms and self‐consistency, the correlations were also conducted controlling for depression. When the effects of depressive symptoms were partialled out, both self‐consistency and trauma‐centred identity were positively correlated with intrusion symptoms. Discussion and Conclusion: The implications for PTSD models, which suggest self‐change is motivated by self‐consistency, are discussed and implications for clinical treatments are considered.     

Self‐stigma and coming out about one's mental illness

Self‐stigma can undermine self‐esteem and self‐efficacy of people with serious mental illness. Coming out may be one way of handling self‐stigma and it was expected that coming out would mediate the effects of self‐stigma on quality of life. This study compares coming out to other approaches of controlling self‐stigma. Eighty‐five people with serious mental illness completed measures of coming out (called the Coming Out with Mental Illness Scale, COMIS), self‐stigma, quality of life, and strategies for managing self‐stigma. An exploratory factor analysis of the COMIS uncovered two constructs: benefits of being out (BBO) and reasons for staying in. A mediational analysis showed BBO diminished self‐stigma effects on quality of life. A factor analysis of measures of managing self‐stigma yielded three factors. Benefits of being out was associated with two of these: affirming strategies and becoming aloof, not with strategies of shame. Implications for how coming out enhances the person's quality of life are discussed. © 2010 Wiley Periodicals, Inc.     

Sustaining self‐regulatory efficacy and psychological outcome expectations for postnatal exercise: Effects of a group‐mediated cognitive behavioural intervention

Objective . The objective of the current investigation was to examine if the effects of a group‐mediated cognitive behavioural counselling plus exercise intervention were superior to the effects of a standard exercise care condition on postnatal mothers' self‐regulatory efficacy (SRE), outcome expectations (OEs) and self‐directed physical activity (PA). Design . The design of the study consisted of two intervention conditions; group‐mediated cognitive behavioural counselling plus exercise (GMCB) and standard exercise (SE). Each condition consisted of two phases; a 4‐week supervised, centre‐based intensive exercise training phase followed by a 4‐week home‐based phase. Methods . Participants were 57 postnatal women randomly assigned to conditions (SE: N = 31; GMCB: N = 26). Measures of SRE and OEs were assessed prior to and following the centre‐based aspect of the intervention. Physical activity was measured following the intensive exercise training phase as well as the home‐based phase. Results . GMCB participants' SRE and OEs were sustained during the intervention whereas those of SE participants declined. GMCB participants also reported significantly greater time spent engaging in self‐directed PA at the conclusion of the intensive and home‐based phases. Mediation analysis revealed that SRE partially mediated the relationship between intervention condition and post home‐based PA as confirmed by a significant sobel test. Conclusions . These findings suggest that a theory‐based GMCB counselling plus exercise intervention is superior to the SE condition in sustaining SRE and OEs, and in promoting greater self‐directed PA. SRE partially mediated the relationship between intervention condition and post home‐based PA supporting the targeting of that variable for change as part of the intervention.     

Predicting and explaining transtheoretical model stage transitions in relation to condom‐carrying behaviour

Objectives The stages of change component of the transtheoretical model have been applied to safe sex behaviours in cross‐sectional analyses, but have not yet been subject to prospective analysis. It was predicted that: (a) cross‐sectional analyses would demonstrate good discrimination between the stages of change; (b) prospective analyses would allow for the identification of predictors of stage transitions; and (c) implementation intentions would explain progression from the preparation stage. Design This study employed an experimental longitudinal design. Participants were randomly assigned to the experimental (implementation intention) or control conditions and completed questionnaires at baseline and at 2‐month follow‐up. Methods Five hundred and twenty‐five adolescents who were broadly representative of the UK population completed questionnaires at baseline and follow‐up (N=393) measuring: demographic variables; stage of change; theory of planned behaviour constructs; anticipated regret; and moral norm in relation to condom‐carrying behaviour. The experimental condition completed a self‐generated implementation intention to carry condoms at the end of the baseline questionnaire. Results Discriminant function analyses indicated that the stages of change could be accurately discriminated from one another cross‐sectionally and that, longitudinally, the measured variables were able to predict transitions between most stages. Implementation intentions caused people to progress from the preparation stage. Conclusions Transitions between most stages were reliably predicted, thereby providing potential targets for intervention. The brief implementation intention intervention was effective and could easily be utilized and expanded to encompass a broader range of sexual health behaviours.     

Cognitive and behavioural correlates of non‐adherence to HIV anti‐retroviral therapy: Theoretical and practical insight for clinical psychology and health psychology

This cross‐sectional study identified variables associated with protease inhibitor (PI) non‐adherence in 179 patients taking anti‐retroviral therapy. Univariate analyses identified 11 variables associated with PI non‐adherence. Multiple logistic regression modelling identified three predictors of PI non‐adherence: low adherence self‐efficacy and seriousness of non‐adherence and HIV (p < .001), perceived absence of HIV associated illness (p < .01), and use of more than one type of recreational drug (p = .001). The model correctly classified 83.9% of the sample, offers psychologists insight into psychological barriers to treatment adherence to guide interventions for improving adherence, and supports a modified version of the reformulated health belief model.     

A validity and reliability study of the coping self‐efficacy scale

Objectives. Investigate the psychometric characteristics of the coping self‐efficacy (CSE) scale, a 26‐item measure of one's confidence in performing coping behaviors when faced with life challenges. Design. Data came from two randomized clinical trials (N1 = 149, N2 = 199) evaluating a theory‐based Coping Effectiveness Training (CET) intervention in reducing psychological distress and increasing positive mood in persons coping with chronic illness. Methods. The 348 participants were HIV‐seropositive men with depressed mood who have sex with men. Participants were randomly assigned to intervention and comparison conditions and assessed pre‐ and post‐intervention. Outcome variables included the CSE scale, ways of coping, and measures of social support and psychological distress and well‐being. Results. Exploratory (EFA) and confirmatory factor analyses (CFA) revealed a 13‐item reduced form of the CSE scale with three factors: Use problem‐focused coping (6 items, α = .91), stop unpleasant emotions and thoughts (4 items, α = .91), and get support from friends and family (3 items, α = .80). Internal consistency and test–retest reliability are strong for all three factors. Concurrent validity analyses showed these factors assess self‐efficacy for different types of coping. Predictive validity analyses showed that residualized change scores in using problem‐ and emotion‐focused coping skills were predictive of reduced psychological distress and increased psychological well‐being over time. Conclusions. The CSE scale provides a measure of a person's perceived ability to cope effectively with life challenges, as well as a way to assess changes in CSE over time in intervention research.     

A Path‐Analytic Model of Self‐Determination Theory in a Physical Activity Context

This study examines Self‐Determination Theory (SDT) in a physical activity context, using a prospective design to predict leisure time physical activity. We expected need satisfaction and self‐determined motivation to predict physical activity 1 month later. One hundred sixteen undergraduate students completed two questionnaires, 1 month after the other. As anticipated, a path analysis revealed the proposed model to fit the data. Specifically, each psychological need positively predicted self‐determined motivation, and competence negatively predicted nonself‐determined motivation. Self‐determined motivation was then found to predict physical activity 1 month later, while nonself‐determined motivation was not a significant predictor. These findings support the theoretical model proposed by SDT and the implications of these findings are discussed.     

An exploration of self‐complexity in individuals experiencing auditory hallucinations

Linville's self‐complexity (SC) theory suggests that reduced SC exacerbates the effects of stress, thereby creating a vulnerability to psychopathology. This exploratory study investigated SC in individuals experiencing auditory hallucinations. Twenty‐two clinical participants experiencing auditory hallucinations were recruited from inpatient and outpatient services. Twenty‐two control participants, matched on age and gender, were recruited from non‐clinical settings. All participants completed a card sort task relating to the self, and questionnaires of affect, self‐esteem and recent stress. Although groups did not differ in unitary SC, clinical participants displayed significantly reduced positive SC (pos‐SC) compared with controls. Pos‐SC was positively correlated with increased psychological well‐being, while negative SC was inversely related, across both groups. No stress‐buffering effects for SC were found. Findings are discussed with respect to previous literature, and clinical and research implications of the study are addressed, particularly in relation to the therapeutic potential for increasing pos‐SC in patients distressed by auditory hallucinations. Copyright © 2009 John Wiley & Sons, Ltd.     

Treatment appraisals and beliefs predict adherence to complementary therapies: A prospective study using a dynamic extended self‐regulation model

Objectives Complementary and alternative medicine (CAM) is used by large numbers of the general public and is increasingly becoming integrated into the mainstream. An understanding of why people use CAM in general has been developed in the literature, but relatively little is known specifically about adherence to CAM. We tested hypotheses (derived from a dynamic extended version of Leventhal's common‐sense model) that patients' beliefs about treatment, perceptions of illness, and treatment appraisals would predict adherence to CAM. Design A prospective self‐report questionnaire study was carried out with a 3‐month follow‐up period. Methods A total of 240 patients from five CAM clinics completed self‐report questionnaire measures of treatment beliefs, illness perceptions, and treatment appraisals at baseline. Three months later, they completed self‐report measures of adherence to therapists' recommendations concerning attendance, remedy use, and life‐style changes. Results Logistic regression analyses showed that positive perceptions of one's therapist and belief that mental factors do not cause illness independently predicted adherence to appointments. Positive beliefs in holistic health and finding it difficult to travel to appointments predicted adherence to remedy use. Using homeopathy was the only independent predictor of adherence to life‐style changes. Conclusions Treatment appraisals, treatment beliefs, and illness perceptions explain modest proportions of the variance in adherence to CAM. This study highlights the value of operationalizing the appraisal element of the common‐sense model when investigating adherence to treatment.     

Selective processing of threat‐related cues in day surgery patients and prediction of post‐operative pain

Objective: To investigate the use of a measure of selective processing bias associated with anxiety as a predictor of post‐operative pain independently of self‐report measures of anxiety. Methods: Forty‐seven women admitted for minor gynaecological surgical procedures completed a selective processing task (modified Stroop) and the State‐Trait Anxiety Inventory immediately prior to surgery. Following surgery they completed the McGill Short‐Form Pain Questionnaire. Intraoperative analgesia consumption was also recorded. Results: Participants demonstrated significantly slower colour‐naming times for physical threat cues than control cues. This was not due to an emotionality effect, as colour‐naming times for neutral and positive cues were not significantly different. This bias was congruent with the participants’ current concerns, as colour‐naming times were significantly slower for physical threat words than for social threat words. This index of selective processing bias significantly predicted post‐operative pain independently of self‐reported state and trait anxiety. Conclusions: The advantages of measures of psychological constructs that are not reliant on self‐reporting are discussed.     

Self-regulation following prostatectomy: phase-specific self-efficacy beliefs for pelvic-floor exercise

Objective. Beliefs in one's ability to perform a task or behaviour successfully are described as self‐efficacy beliefs ( Bandura, 1977 ). Since individuals have to deal with differing demands during a behaviour‐change process, they form phase‐specific self‐efficacy beliefs directed at these respective challenges. The present study, based on the Health Action Process Approach ( Schwarzer, 2001 ), examines the theoretical differentiation, relative importance, and differential effects of four phase‐specific self‐efficacy beliefs, including task self‐efficacy, preactional self‐efficacy, maintenance self‐efficacy, and recovery self‐efficacy. Design. In a prospective longitudinal study, 112 prostatectomy‐patients received questionnaires at 2 days, 2 weeks, 1 month, and 6 months post‐surgery. Methods. Participants provided data on phase‐specific self‐efficacies as well as phase indicators of health‐behaviour change, that is, intentions, planning, and pelvic‐floor exercise. Hierarchical regression analyses were conducted to test the study hypotheses. Results. Task self‐efficacy was not uniquely associated with intentions. Preactional self‐efficacy was related to action planning. Maintenance self‐efficacy did not predict behaviour. Recovery self‐efficacy was associated with re‐uptake of pelvic‐floor exercise after relapses only. Conclusion. Findings underline the importance of differentiating between task self‐efficacy and preactional self‐efficacy during early phases of behaviour change as well as of considering the occurrence of relapses as a moderator of potential effects of recovery self‐efficacy on the maintenance of behaviour change. Advanced knowledge on distinct, phase‐specific self‐efficacy beliefs may facilitate the design of effective tailored interventions for behaviour change.     

Genetic testing and the relationship between specific and general self‐efficacy

The study examined the extent to which variations in health‐specific self‐efficacy could affect general self‐efficacy. In a repeated measures design, 300 participants were administered an efficacy questionnaire, before and after an alleged news report, aimed at increasing or decreasing self‐efficacy over genetic‐testing decision making. The results found that self‐efficacy over testing was significantly reduced after reading the negative news report in those participants who felt personal efficacy over testing decisions was important. Levels of general self‐efficacy were also significantly decreased. The findings suggest that being denied control over a specific area of self‐efficacy can have a wider impact, with a lack of perceived efficacy over testing decision making adversely impacting on levels of general well‐being. The wider implications of this generalization effect and the processes involved in efficacy generalization are discussed.