The role of readiness to change in response to treatment of adolescent depression.

The effect of readiness to change on treatment outcome was examined among 332 adolescents (46% male, 74% Caucasian), ages 12 through 17 years (M = 14.6, SD = 1.5), with major depressive disorder who were participating in the Treatment for Adolescents With Depression Study (TADS). TADS is a randomized clinical trial comparing the effectiveness of fluoxetine (an antidepressant medication), cognitive–behavioral therapy, their combination, and a pill placebo. An abbreviated Stages of Change Questionnaire was used to obtain 4 readiness to change scores: precontemplation, contemplation, action, and maintenance. The association between each readiness score and depression severity across 12 weeks of acute treatment for depression, as measured by the Children’s Depression Rating Scale—Revised, was examined. Although treatment response was not moderated by any of the readiness scores, baseline action scores predicted outcome: Higher action scores were associated with better outcome regardless of treatment modality. Furthermore, treatment effects were mediated by change in action scores during the first 6 weeks of treatment, with increases in action scores related to greater improvement in depression. Assessing readiness to change may have implications for tailoring treatments for depressed adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers.

Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Motivational subtypes and continuous measures of readiness for change: Concurrent and predictive validity.

This study compared the concurrent and predictive validity of motivational subtypes versus a continuous measure of readiness for change as measured by the University of Rhode Island Change Assessment Scale (URICA; E. A. McConnaughy, J. O. Prochaska. & W. F. Velicer, 1983) in 252 individuals participating in a substance abuse treatment study (38% female; mean age = 36). Hierarchical cluster analysis identified a 2-cluster solution. Consistent with previous research, both the motivational subtypes and the continuous readiness measure exhibited good concurrent validity with both baseline characteristics and change process variables. Neither readiness-for-change measure predicted end treatment outcomes. Measures of readiness for change based on the URICA exhibit limited clinical utility, because they are not able to predict future behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive symptoms and readiness to quit smoking among cigarette smokers in outpatient alcohol treatment.

The authors examined whether length of alcohol abstinence and depressive symptoms were related to motivational readiness to consider smoking cessation among patients in alcohol treatment. Participants were adults (N = 253) enrolled in a smoking cessation trial. Controlling for gender, depressive symptoms, and nicotine dependence, hierarchical regression analysis of readiness scores revealed a significant interaction of days since last drink and depressive symptoms. It was found that a greater number of days since last drink was associated with greater readiness, but only among patients with low scores on the Center for Epidemiologic Studies Depression Scale (L. S. Radloff, 1977). The findings suggest that alcoholic smokers with low depressive symptoms are more receptive to quitting smoking after sustained alcohol abstinence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Longitudinal trends and gender differences in physical fitness and lifestyle factors in career U.S. Navy personnel (1983-1994)

This study examines long-term health and physical readiness trends in the U.S. Navy. We mailed lifestyle questionnaires to all participants in baseline studies between 1983 and 1989 who were still on active duty in 1994. Commands provided body composition and physical readiness test scores for the participants. Two longitudinal cohorts were created: an 8-year sample (N = 640) with matched data from 1986, 1989, and 1994; and an 11-year sample (N = 1,576), with data from 1983 and 1994. Analyses of both cohorts revealed significant improvements in cardiovascular fitness, muscle strength, exercise, lean body mass, dietary habits, and sleep, as well as significant decreases in tobacco and alcohol use and job stress. However, hypertension rates, percentage of body fat, and body mass index increased over time. Women's scores were significantly better than men's on a number of factors. Overall, these findings suggest that the Navy's health promotion efforts have had a significant positive effect on the fitness and health behaviors of career Navy men and women.     

Reducing sexual risk behaviors and alcohol use among HIV-positive men who have sex with men: A randomized clinical trial.

This randomized clinical trial (N = 253) evaluated the efficacy of a theory-based intervention designed to reduce both alcohol use and incidence of unprotected sexual behaviors among HIV-positive men who have sex with men with alcohol use disorders. An integrated, manualized intervention, using both individual counseling and peer group education/support, was compared with a control condition in which participants received resource referrals. The intervention was based on the transtheoretical model’s stages and processes of change, and motivational interviewing was used to enhance client readiness for change. Major findings include treatment effects for reduction in number of drinks per 30-day period, number of heavy drinking days per 30-day period, and number of days on which both heavy drinking and unprotected sex occurred. Practitioners employing this intervention may achieve enhanced client outcomes in reduction of both alcohol use and risky sexual behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stages of Change in Treatment-Seeking Pathological Gamblers.

The transtheoretical model has been applied to many addictive disorders. In this study, psychometrics properties of the University of Rhode Island Change Assessment (URICA) scale were evaluated in 234 pathological gamblers initiating treatment. Four components were identified--reflective of precontemplation, contemplation, action, and maintenance stages--with internal consistency from .74 to .88. Cluster analyses identified 4 patterns of responding, ranging from ambivalent to active change. The 4 clusters differed with respect to baseline gambling variables and treatment engagement and outcomes assessed 2 months later. A continuous measure of readiness to change was also correlated with gambling severity and predictive of reductions in gambling. This study provides initial support for reliability and validity of the URICA in treatment-seeking gamblers, and it suggests that stage of change may have an impact on outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol expectancies as a mediator of the relationship between injury and readiness to change drinking behavior.

There is a well-established relationship between alcohol expectancies and drinking behavior. The purpose of the present study was to extend the literature by examining the role of alcohol expectancies in determining readiness to change drinking behavior among injured emergency department patients who screened positive for hazardous drinking. Negative expectancies were found to partially mediate the relationships of alcohol-related injuries and injury aversiveness to readiness to change drinking behavior. Results suggest that negative alcohol expectancies are a potential means of increasing patients' readiness to change drinking behavior. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assessing readiness for change in the eating disorders: The psychometric properties of the readiness and motivation interview.

This study examined the psychometric properties of the Readiness and Motivation Interview (RMI), a symptom-specific measure of readiness and motivation for change in the eating disorders. For 4 symptom domains, the RMI assesses the extent to which individuals are in precontemplation, contemplation, and action/maintenance, and the extent to which change is made for internal versus external reasons. Ninety-nine individuals with eating disorders completed the RMI and measures to assess convergent, divergent, and criterion validity. RMI profiles revealed differences in readiness and motivation across symptom domains. The RMI demonstrated good reliability and construct validity, and RMI scores predicted anticipated difficulty of recovery activities, completion of recovery activities, decision to enroll in an intensive symptom-reduction program, and treatment dropout. The RMI may have important clinical applications by providing much-needed information on client readiness for action-oriented treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational stages and processes of change for continuous quality improvement in health care.

This article provides an overview of the transtheoretical model of change (TTM, or stage model) and how it can guide the development of stage-matched interventions to increase physicians' readiness for continuous quality improvement (CQI) in health care. In addition, this article describes the development and initial validation of two TTM measures—stages and processes of change—designed to assess the extent to which hospitals are engaging in activities that can facilitate individual providers' movement through the stages of change for CQI. 299 Ss participated in the study. A majority (57%) of informants reported that their organizations were in the maintenance stage for CQI. Organizational-level processes of change differed significantly across the stages: Hospitals in the precontemplation stage tended to use the processes least, and hospitals in the maintenance stage tended to use them most. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Use of the University of Rhode Island Change Assessment to measure motivational readiness to change in psychiatric and dually diagnosed individuals.

In this report, the original 4-factor structure of the University of Rhode Island Change Assessment (URICA; C. C. DiClemente & S. O. Hughes, 1990) was replicated, and the scale's internal consistency was found to be acceptable in a sample of 120 psychiatric and dually diagnosed inpatient participants, who had participated in a randomized clinical trial comparing standard treatment (ST) and ST plus motivational interviewing. Contrary to the authors' hypotheses, participants classified as having low motivational readiness to change, based on their URICA scores, demonstrated greater treatment adherence than high-readiness participants, in that they attended a greater proportion of therapy groups while hospitalized (54% vs. 39%; p     

The validity and reliability of the Violence Risk Scale-Sexual Offender version: Assessing sex offender risk and evaluating therapeutic change.

The Violence Risk Scale-Sexual Offender version (VRS-SO) is a rating scale designed to assess risk and predict sexual recidivism, to measure and link treatment changes to sexual recidivism, and to inform the delivery of sexual offender treatment. The VRS-SO comprises 7 static and 17 dynamic items empirically or conceptually linked to sexual recidivism. Dynamic items with higher ratings identify treatment targets linked to sexual offending. A modified stages of change model assesses the offender's treatment readiness and change. File-based VRS-SO ratings were completed on 321 sex offenders followed up an average of 10 years postrelease. VRS-SO scores predicted sexual and nonsexual violent recidivism postrelease and demonstrated acceptable interrater reliability and concurrent validity. A factor analysis of the dynamic items generated 3 factors labeled Sexual Deviance, Criminality, and Treatment Responsivity, all of which predicted sexual recidivism and were differentially associated with different sex offender types. The dynamic items together made incremental contributions to sexual recidivism prediction after static risk was controlled for. Positive changes in the dynamic items, measured at pre- and posttreatment, were significantly related to reductions in sexual recidivism after risk and follow-up time were controlled for, suggesting that dynamic items are indeed dynamic or changeable in nature. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sexual communication in the age of AIDS: the construction of risk and trust among young adults

Sexually transmitted diseases are extremely prevalent among youth, and it is only by understanding the processes involved in negotiating sexual relationships that effective prevention and intervention programs can be designed. This study explores sexual communication among young adults, how gender and sexual orientation influence negotiation for safer sex, the strategies employed for risk reduction, and the barrier to safer sex. It assumes sexual behavior as a communicative form, both reflective and reflexive, subject to interpretation, and created interactively within and between sexual partners. Data from in-depth interviews with 30 undergraduates at the University of California, Berkeley were triangulated with questionnaires (n = 159), secondary sources and informal interviews with university officials. Participants were representative of arts and science students, ethnically diverse and of varying sexual orientations. Interviews focused on the normative influences of family, school and friends regarding sexuality; and how relationships and sex were negotiated. They investigated how strategies for risk reduction, attitudes about HIV and testing, and contraceptive practices were managed differently by gender and sexual orientation and what the barriers to safer sex were in various situations. Interviews focused on the normative influences of family, school and friends regarding sexuality; how relationships were negotiated, and how trust and risk were constructed within relationships; how strategies for risk reduction, attitudes about HIV and testing, and contraceptive practices were managed differently be gender and sexual orientation; and what the barriers were to safer sex. Friends, the social culture at university, and the interaction of the two with the developmental tasks characteristic of the period between adolescence and adulthood were more important influences than parents or high school sex education classes in how sexual relationships were managed. How and whether friends talked about sex and practiced safe sex were strong normative influences in predicting safer sex among individuals. Negotiating for safer sex contains elements of impression management, requires assertiveness and takes constant effort, even among those who have made the most progress in incorporating it. Practicing safer sex involves a complicated process of sexual negotiation, requiring a degree of open communication about sexual desire and intent that is not widely available in this culture, and still less among young people. Risk and thus how sex is negotiated is assessed differently by gender, and varies further according to the degree of intimacy in the relationship or the sex act being contemplated. How sex is negotiated depends on the construction of risk and trust which differ by the type of relationship or sexual encounter being contemplated.(ABSTRACT TRUNCATED AT 400 WORDS)     

HIV risk correlates among non-injection cocaine dependent men in treatment

Guided by the AIDS Risk Reduction Model (ARRM), psychosocial correlates of HIV risk behavior were examined among noninjection cocaine dependent, heterosexual men (NI-CD-HM) in treatment. Subjects (N = 111) completed a structured interview to measure ARRM mediating variables and HIV risk behaviors. The results indicated that greater perceived susceptibility to contracting HIV, lower sexual self-efficacy, higher lifetime incidence of sexually transmitted diseases, and being under the influence of alcohol or other drugs during sex predicted having more sexual partners in the month prior to admission. Despite adequate knowledge of safer sex guidelines, subjects remained misinformed regarding certain aspects of HIV transmission. Men who perceived that their partners viewed condoms more positively and who exchanged drugs for sex were more likely to use condoms, yet condom use skills were typically inadequate to ensure effective prevention. These results suggest that HIV prevention interventions among NI-CD-HM should focus on improving knowledge, enhancing beliefs in the capacity to enact safer sex behaviors for preventing HIV and other STDs, building relevant skills (e.g., condom use, open sexual communication between partners), and emphasizing psychoactive substance abstinence. Couple interventions, in which partners actually rehearse safer sex negotiations, may be particularly effective in this regard.     

Social–cognitive beliefs, alcohol, and tobacco use: A prospective community study of change following a ban on smoking in public places.

Objective: To examine social–cognitive change associated with behavior change after the introduction of a smoke-free public places policy. Design: Adults (N = 583) who use public houses licensed to sell alcohol (pubs) completed questionnaires assessing alcohol and tobacco consumption and social–cognitive beliefs 2 months prior to the introduction of the smoking ban in England on July 1, 2007. Longitudinal follow-up (N = 272) was 3 months after the introduction of the ban. Main outcome measures: Social–cognitive beliefs, daily cigarette consumption, and weekly alcohol consumption. Results: Smokers consumed considerably more alcohol than did nonsmokers at both time points. However, a significant interaction of Smoking Status × Time showed that while smokers had consumed fewer units of alcohol after the ban, nonsmokers showed an increase over the same period. There was a significant reduction in number of cigarettes consumed after the ban. Subjective norms concerning not smoking, and perceived severity of smoking-related illness increased across time. Negative outcomes associated with not smoking were reduced among former smokers and increased across time among smokers. Regression analyses showed that changes in subjective norm and negative outcome expectancies accounted for significant variance in change in smoking across time. Conclusion: Results suggest that the smoking ban may have positive health benefits that are supported by social–cognitive change. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Posttraumatic stress disorder patients' readiness to change alcohol and anger problems.

Notes that recovery from combat-related posttraumatic stress disorder (PTSD) is often complicated by unacknowledged problems with alcohol and anger. 102 males combat veterans (aged 42–63 yrs) entering a residential PTSD rehabilitation program completed University of Rhode Island Change Assessment and process-of-change questionnaires based on J. O. Prochaska and C. C. DiClemente's transtheoretical model (TTM; J. O. Prochaska et al, 1992). Separate assessments were made for alcohol abuse and anger control. Four motivational subtypes were identified for both problems. Motivation to change alcohol problems was independent of that for anger. Relative to less-motivated peers highly motivated patients were more like to spontaneously identify alcohol or anger as problems in their life and made greater use of change strategies specified by the TTM. These results support extension of the TTM to anger management and to PTSD management. Treatment implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Which heavy drinking college students benefit from a brief motivational intervention?

Heavy drinking among college students is common and is often harmful. A previously reported randomized trial revealed that a brief motivational intervention (BMI) reduced the alcohol consumption of heavy drinking college students (K. B. Carey, M. P. Carey, S. A. Maisto, & J. M. Henson, 2006). For this study, the researchers conducted supplemental analyses of hypothesized predictors of change using the same sample (N = 495). Greater readiness to change, higher levels of self-regulation, and less engagement in social comparison all independently predicted reductions in drinking outcomes. Furthermore, self-regulation, social comparison, and future time perspective interacted with BMI and predicted drinks per week. As expected, greater self-regulation skills enhanced response to the BMI; the remaining interaction effects were unexpected. Overall, these findings suggest that BMIs produce relatively robust effects. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stage of change in self-management of chronic diseases: Psychometric properties of the Chinese version of the University of Rhode Island Change Assessment (C-URICA) Scale.

Objective: The University of Rhode Island Change Assessment (URICA) Scale has been widely used to assess the readiness to change with regard to various health-related behaviors. The present study aimed to develop a Chinese version of the URICA (C-URICA) for measuring the readiness to change of Chinese participants with chronic diseases. Participants: A group of participants (N=101; 87 women and 14 men) in a chronic disease self-management program were asked to complete the C-URICA. Method: The C-URICA was conducted at the baseline, middle, and end of the 6-week program. Changes in self-management behaviors were also measured. Results: Factor analyses revealed a moderate item-to-subscale fit, indicating that structural validity was retained. Item analyses suggested a moderate item quality. The C-URICA subscales can differentially and effectively predict participants' gains in self-management behaviors at the completion of the intervention program. Conclusion: The C-URICA is suitable for use among Chinese patients with chronic diseases. Further studies should explore the generalizability of the results to different diagnostic groups and subgroups among Chinese populations. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of a motivation enhancement intervention on veterans’ engagement in PTSD treatment.

This study is the first randomized controlled trial of the posttraumatic stress disorder (PTSD) motivation enhancement (PME) Group, a brief intervention based on Motivational Interviewing and designed to enhance combat veterans’ engagement in PTSD treatment by increasing awareness of the need to change PTSD-related problems. Outpatients in a year-long, group- and cognitive–behavioral therapy (CBT)–oriented Veterans Affairs PTSD treatment program were randomly assigned to 4 sessions of the PME Group (n = 60) or a Psychoeducation Group (n = 54) in the 2nd month of treatment. Hypotheses about the proposed impact of the PME Group on PTSD treatment engagement (i.e., readiness to change, perceived treatment relevance, and PTSD program attendance) were all supported, although predicted differences were not found on all measures. These results support the need to address readiness to change in combat-related PTSD treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality, Interpersonal, and Motivational Predictors of the Working Alliance in Group Cognitive-Behavioral Therapy for Partner Violent Men.

Recent studies have demonstrated that the working alliance predicts treatment outcome for partner violent men. This study examined the influence of personality and interpersonal characteristics, motivational readiness to change, and demographic factors on working alliance formation among a sample of men (N = 107) participating in a cognitive-behavioral group treatment program for partner violence. Motivational readiness to change was the strongest predictor of the working alliance. Psychopathic personality characteristics also emerged as a strong (negative) predictor of the working alliance. Lower levels of borderline personality characteristics and interpersonal problems, self-referred status, married status, and higher age and income predicted higher working alliance ratings. The results support recent clinical efforts to address motivational readiness in programs for partner violent men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)