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Background: Fear of fat is a relevant variable in initiating weight regulation behaviors in adolescents. However, little is known about the experiential and behavioral change processes that mediate the choice between healthy and unhealthy weight regulation behaviors in this population. Method: The general objective was to examine the predictive role of fear of fat on weight-related behaviors (healthy and unhealthy weight control behaviors) through the mediation of experiential and behavioral change processes (consciousness raising, counterconditioning, helping relationships, reinforcement management, self-liberation, self-reevaluation, stimulus control, substance use) in 838 adolescents aged 15–19 years from Mexico and Spain using parallel mediation analysis. Additionally, the study examined the correlations between the variables with regard to gender and country, as well as the differences in the use of processes of change across stages of change through the use of a multivariate analysis of variance. The Spanish version of the Fear of Fat, Stages of Change, Processes of Change, and Weight-Related Behaviors scales were used. Results: The mediation analysis showed that fear of fat predicted healthy weight control behaviors through consciousness raising, self-liberation, and stimulus control. On the other hand, fear of fat predicted unhealthy weight control behaviors through counterconditioning, stimulus control, and the use of weight loss substances. Intervening to reduce fear of fat may be a way to modify the processes of change used by adolescents to regulate their weight. Conclusions: The results of this study indicate that adolescents may initiate weight control behaviors as a result of fear of fat. This process is mediated by experiential and behavioral processes that influence weight regulation.

OBJECTIVES The current study aimed at identifying the theoretical relation of the transtheoretical model (TTM) to explain physical activity in Korean adults with physical disabilities. METHODS A total of 194 participants (Age Mean = 48.65 years) were voluntarily recruited for this study. Dissemination sources for participant recruitment included: (a) a press release issued through the authors’ university; (b) recruitment flyers posted on various websites (e.g., Independent Living Centers, Rehabilitation Research and Training Centers, Veteran’s Administration Hospitals); and (c) announcements made through and in conjunction with the Rehabilitation Research and Training Center on Health and Wellness consortium members. Through these procedures, 194 adults (80.83%) completed the survey form; there were 113 males (58.3%) and 81 females (41.7%). The remaining 46 (19.17%) were excluded because they did not complete the survey form or return. RESULTS Results indicated that the TTM constructs assessed were significantly (P < 0.001) associated with the stages of change for physical activity. The largest portion of variance was derived from the behavioral processes of change (ƞ2 = .40), followed by self-efficacy (ƞ2 = .30), the pros for exercise (ƞ2 = .19), the cognitive processes of change and the cons for exercise (ƞ2 = .16, respectively). Moreover, four discriminant functions (i.e., composite scores of the predictors) were produced in the first DDF analysis. These accounted for 71.0% (Wilks’ Λ = .31, χ2 [56] = 368.04, P < .001), 20.9% (Wilks’ Λ = .66, χ2 [39] = 129.91, P < 0.001), 6.3% (Wilks’ Λ = .88, χ2 [24] = 39.39, P < 0.05), and 1.8% (Wilks’ Λ = .97, χ2 [11] = 9.04, P = .62), respectively, of the between-group (stage of change) variability. CONCLUSIONS The results provide further cross-sectional support for the internal validity of the transtheoretical model, as the processes of change, self-efficacy, and decisional balance were important variables of a stage of change for physical activity, Additionally, the study is in general agreement with existing evidence among nondisabled populations and, therefore, it supports the external validation of TTM to a unique and understudied population segment.

Background: Obesity is associated with an increased prevalence of vascular risk factors and incidence of stroke. As such weight loss is recommended for patients living with obesity in the secondary prevention of stroke. Few studies, however, have examined the stages and processes of change for weight loss in stroke patients living with obesity. Objective: The aim of the study was to evaluate the stages and processes of change for weight loss in patients living with obesity who have had a recent stroke or TIA. Methods: Using a validated questionnaire, we assessed each patient’s stage of behavioral change according to the transtheoretical model (precontemplation, contemplation, preparation, action, and maintenance). We also examined 4 processes of behavioral change, which quantify activities and experiences that patients undergo on the way to behavioral change: emotional reevaluation (EMR), weight management action (WMA), weight consequence evaluation, and supporting relationships. Processes scores were compared between patients in the action and maintenance stages and those in the precontemplation, contemplation, and preparation stages. Results: Out of 49 patients who provided informed consent, 44 met the inclusion/exclusion criteria. Of these 44 patients, 6 (14%) were in the precontemplation stage of change, 7 (16%) were in contemplation, 2 (5%) were in preparation, 13 (30%) were in action, and 16 (36%) were in maintenance. Those in the action and maintenance stages accounted for the majority of participants (n = 29, 66%). Patients in the action and maintenance stages (N = 29) had higher EMR scores (mean 79, SD 13 vs. mean 68, SD 19, t = 2.0, p = 0.03) and WMA scores (mean 69, SD 13 vs. mean 59, SD 19, t = 2.0, p = 0.03) as compared to those in the precontemplation, contemplation, and preparation stages (N = 15). Conclusions: Our results suggest that without counseling or specific intervention, approximately two-thirds of stroke/TIA patients living with obesity are in the action or maintenance stage of behavior change with respect to weight loss and therefore more likely to succeed in intensive lifestyle-based interventions targeted towards weight loss. Patients who score higher in EMR and WMA are more likely to be in the action or maintenance stage of change.

The aim of this study is to examine the structural relationship in the transtheoretical model (TTM) of behavioural change constructs among undergraduate students. A cross-sectional study was carried out by randomly selecting students participating in campus co-curricular activities. Questionnaires, comprising queries on the stages of change (SOC) — an 18-item self-efficacy (SE) scale, a 10-item decisional balance (DB) scale, and 30-item processes of change (PoC) scale — were distributed to the students. Their answers were analysed using Mplus 8 software for structural equation modelling. There were 562 participants comprising 118 males (21.0 %) and 444 females (79.0 %) with average age of 19.81±1.22 SD. Most of them were involved in sports (46.3 %) and non-sports (46.6 %) programmes, and exercised at least three times per week for approximately 43 minutes per session. Minority of the undergraduate students (7.1%) are involved in uniform group. The initial hypothesized structural equation modelling showed that the data fitted well. The fit indices were within recommended values (CFI= 0.967; TLI= 0.939; SRMR= 0.034; RMSEA (CI: 90%) = 0.049 (0.028, 0.070); RMSEA p= 0.495). There were three hypothesized path relationships in this model. From the final structural model, the SOC had significant direct effects on SE (p = 0.001), DB (p < 0.001) and PoC (p < 0.001). In conclusion, the study showed a positive relationship between TTM constructs. It could act as an excellent baseline model for physical activity intervention or motivational intervention.

Despite the significant contribution of cognitive-behavioral therapy to effective treatment options for specific syndromes, treatment progress has been stagnating, with response rates plateauing over the past several years. This stagnation has led clinical researchers to call for an approach that instead focuses on processes of change and the individual in their particular context. Process-based therapy (PBT) is a general approach representing a model of models, grounded in evolution science, with an emphasis on idiographic methods, network models of case conceptualization, and enhancing wellbeing. In this paper, we describe the theory underlying PBT and present a case study for how to apply PBT tools and principles to deliver process-informed and person-centered evidence-based treatment. In addition, we discuss lessons learned from our case and provide suggestions for future considerations when implementing PBT in clinical settings.

Introduction: Acceptance and commitment therapy (ACT) is an effective treatment for chronic pain conditions. ACT seeks to produce clinical change by enhancing Psychological Flexibility (PF). This exploratory (feasibility and preliminary effectiveness) study presents a pilot application of an online ACT group intervention for fibromyalgia (FM) with an extensive Experiential Sampling (ES) assessment of outcome and process variables via smartphone. Method: 5-weekly ACT online group sessions were applied to 9 female FM patients. Questionnaire-based assessments of several clinical outcomes and PF processes were conducted pre- and post-intervention, and at 6-month follow-up. Extensive (6 weeks pre- and 6 weeks post-intervention) smartphone-delivered ES was implemented to gather process and outcome data in the patients' usual contexts. Clinically significant change was evaluated both at the group level and individually. Results: This treatment format appears to be feasible and acceptable to participants, with good adoption and completion rates (75 %) and excellent rates of treatment completion and clinical adherence (100 %). Participants showed significant reductions in affective pain, distress and biopsychosocial impact of FM both post-intervention and at 6-month follow-up (as measured with questionnaires), as well as significant improvements in satisfaction with actions and emotional discomfort (as measured through ES). Multilevel regression analyses indicated that PF-related processes assessed through ES had a significant impact on clinical outcomes and predicted the impact of FM at the 6-month follow-up. Conclusions: A brief online group ACT intervention for FM was both feasible and acceptable to participants. Also, there was preliminary evidence of effectiveness in enhancing pain-related PF and producing clinical benefits in FM.

Background: Young adults in Europe, North America, and Asia suffer from excessive depression and stress. The study examined the variations of ego resilience, stress, and depression according to motivational readiness in exercise. Methods: The study participants were recruited at four universities in South Korea in September 2016. The 464 subjects completed an online survey. The collected data were analyzed by descriptive statistics, ANOVA, and structural equation modeling. Results: Female subjects, participants in low income, and freshmen had higher levels of depression. Individuals who were in a later stage of motivational readiness for change in physical activity (PA) had higher levels of ego resilience and lower levels of stress and depression. Ego resilience had correlations with processes of change (r = 0.29, p < 0.001), depression (r = -0.78, p < 0.001), and stress (r = -0.82, p < 0.001). Processes of change had correlations with depression (r = -0.24, p < 0.001) and stress (r = -0.14, p < 0.01). Limitations: The present study did not define directional relationships among the variables. The direct comparison of the data analysis results to other studies was limited. The application of the current study's findings to youth or older adults can be limited. Conclusions: Individuals who are more motivated to be physically active have higher ego resilience and lower stress and depression. Higher ego-resilience and lower stress and anxiety can be found in people who are cognitively and behaviorally trying to increase or maintain PA, even before they truly become physically active.

Purpose: The aim of this study was to examine whether the efficacy of transtheoretical model (TTM)-based interventions on physical activity (PA) varied according to the following criteria: (1) interventions targeted the actual stages of change (SOCs) or did not; (2) participants were selected according to their SOC or were not; and (3) its theoretical constructs (decisional balance, temptation, self-efficacy, processes of change). Methods: Thirty-three randomized controlled trials assessing TTM-based interventions promoting PA in adults were systematically identified. Results: The between-group heterogeneity statistic (Qb) did not reveal any differential efficacy either in interventions targeting the actual SOC compared with those that did not (Qb = 1.48, p = 0.22) or in interventions selecting participants according to their SOC compared with those that did not (Qb = 0.01, p = 0.91). TTM-based interventions enhanced PA behavior whether they targeted the actual SOC (Cohen's d = 0.36; 95% confidence interval (CI): 0.22–0.49) or not (d = 0.23; 95%CI: 0.09–0.38) and whether they selected their participants according to their SOC (d = 0.33; 95%CI: 0.13–0.53) or not (d = 0.32; 95%CI: 0.19–0.44). The moderators of the efficacy of TTM-based interventions were the number of theoretical constructs used to tailor the intervention (Qb = 8.82, p = 0.003), the use of self-efficacy (Qb = 6.09, p = 0.01), and the processes of change (Qb = 3.51, p = 0.06). Conclusion: TTM-based interventions significantly improved PA behavior, and their efficacy was not moderated by SOC but by the TTM theoretical constructs.

This study’s purpose was to examine the structural relationship of the transtheoretical model (TTM) and the amount of physical activity (PA) among undergraduate students in health and medicine at Universiti Sains Malaysia. A cross-sectional study was carried out among students who took part in the co-curricular program. Co-curricular program includes activities that take place outside of the regular lectures or tutorials in the University. Students recruited through purposive sampling were informed that their participation was entirely voluntarily. Those interested completed the self-administered questionnaire, which consisted of the decisional balance, processes of change, self-efficacy, stages of change scales, and Godin leisure-time exercise questionnaire. Data were analyzed using Mplus version 8 for descriptive statistics and structural equation modeling analysis for inferential statistics. A total of 562 students participated in the study. The majority of the students was female (79.0%) and Malay (73.3%) and average of exercise sessions per week was 2.62, with a mean of 43.37 min per exercise session. The final structural model fit the data well based on several fit indices (SRMR = 0.046, RMSEA (CI: 90%) = 0.061 (0.045, 0.078), RMSEA p = 0.130). The model showed that stages of change significantly affected self-efficacy (p < 0.001), pros (benefits of exercise; p < 0.001), cons (barriers to exercise; p = 0.022), and processes of change (p < 0.001). The model also showed significant inter-relationships among the TTM constructs and supported seven hypotheses. Among all the variables examined, only processes of change significantly affected PA (p < 0.001). However, stages of change (p < 0.001) and pros (p =< 0.001) had significant indirect effects on PA via processes of change. The findings support that individuals’ stages of change affect their self-efficacy level, or the ability to make positive and negative decisions and perform behavior accordingly. The study confirms that making correct decisions and taking action accordingly can increase PA levels.

In the context of the popular uprisings in the Middle East and North Africa known as the Arab Spring, Jordan has remained at the second level both on the international scene and in the analyses made of this movement. The Hashemite Kingdom, characterised by its political stability and neutral position in the various confrontations that shape regional politics, has made changes in order to avoid the political processes being experienced by some of its neighbours. In this way, from a political science point of view and with an analysis that traces the processes, the developments that have taken place in Jordan are examined, putting particular emphasis on the central role of the tribal organisation within the monarchy.

Individual placement and support (IPS) has been found to be an effective intervention for rehabilitation to work in the field of mental health. Being as the principles used in IPS reflect core values in the concept of personal recovery, several other outcomes than just the percentage of clients gaining employment are of interest. The purpose of the study was to describe a number of unique processes and analyze these with a special concern for circumstances perceived as important for the individual IPS process. A collective instrumental case-study design was used and five cases were included. Data from three different sources were collected, both quantitative and qualitative. The findings illustrate how a relationship characterized by curiosity, interest and engagement in the individual client, positive risk-taking and time for reflected experiences resulted in processes of change. It was concluded that providing IPS is a type of specialized relationship-based work that includes advanced problem solving.

Payesh2010; 9: 155-164Accepted for publication: 31 October 2006[EPub a head of print-25 May 2010] Objective(s): To assess the effect of processes of change on resistance skills against substance abuse among petrochemical workers in Assaluyeh Plant in Iran.Methods: This was an experimental study (randomized intervention trial). In all 181 workers of petrochemical company in Assaluyeh were enterd into the study (90 participants in intervention group and 91 participants in control group). Data were collected by a questionnaire that was designed and validated by the researchers based on the Trans Theoretical Model (TTM). Both groups were interviewed before the intervention, based on which the educational needs were identified. One of the diagnostic surveys showed lack of resistance skills against substance abuse that required further education. To meet this requirement a TTM based education for intervention was applied.Results: The study showed significant improvement in most of the resistance skills among the intervention group, while both groups showed no significant differences in use of processes of change before the intervention (except for construct self revolution, that was higher in control group). The results after the intervention showed that intervention group had used all elements of processes of change (except dramatic relief).Conclusion: This study showed that processes of change in the TTM would lead to improved knowledge, attitude, self efficacy and self control. It also confirmed that the training materials based on the trans theoretical model can develop resistance skills against substance abuse that will ultimately result in a better health among the workers and could create a drug free workplace (safe workplace). Based on these findings the investigators recommend that all studies on health–related change behavior should continually use the behavioral theories and models.

Payesh2010; 9: 39-49Accepted for publication: 20 October 2008[EPub a head of print-7 March 2010] Objective(s): To assess the effect of processes of change on resistance skills against substance abuse among petrochemical workers in Assaluyeh Plant in Iran.Methods: This was an experimental study (randomized intervention trial). In all 181 workers of petrochemical company in Assaluyeh were enterd into the study (90 participants in intervention group and 91 participants in control group). Data were collected by a questionnaire that was designed and validated by the researchers based on the Trans Theoretical Model (TTM). Both groups were interviewed before the intervention, based on which the educational needs were identified. One of the diagnostic surveys showed lack of resistance skills against substance abuse that required further education. To meet this requirement a TTM based education for intervention was applied.Results: The study showed significant improvement in most of the resistance skills among the intervention group, while both groups showed no significant differences in use of processes of change before the intervention (except for construct self revolution, that was higher in control group). The results after the intervention showed that intervention group had used all elements of processes of change (except dramatic relief).Conclusion: This study showed that processes of change in the TTM would lead to improved knowledge, attitude, self efficacy and self control. It also confirmed that the training materials based on the trans theoretical model can develop resistance skills against substance abuse that will ultimately result in a better health among the workers and could create a drug free workplace (safe workplace). Based on these findings the investigators recommend that all studies on health–related change behavior should continually use the behavioral theories and models.

Background: Consuming fish plays a key role in human health and prevention of diseases. The aim of this study was using transtheoretical model to analyze the trend of fish consumption among women. Materials and Methods: In this descriptive-analytic research, 383 housewives who referred to health centers in Bandar Abbas were selected through a stratified sampling method. Data were collected by a questionnaire to determine fish consumption based on transtheoretical model and analyzed by using SPSS software version 19.0. with the significance level of P < 0.05. Results: Nearly 11.7% of the patients were found to be at the precontemplation stage; 3.9% were at the contemplation stage; 13.6% were at the preparation stage; 7.3% showed to be at the action stage, and 63.4% were at the maintenance stage. The results showed a significant relation of the constructs of the model with the stages of change of consuming one or two meals of fish a week. Moving through the stages of change from the precontemplation stage to maintenance stage was accompanied by an increase in decisional balance, self-efficacy, and processes of change (P < 0.05). Conclusion: It is suggested that in designing educational interventions in the light of this model, more emphasis is placed on perceived benefits and self-efficacy. The processes of change are advised to be used more often, and perceived barriers to fish consumption need to be reduced as far as possible.

This is a longitudinal in‐depth case study that was conducted within a Portuguese public sector organization, the National Postal Service of Portugal, where two management accounting innovations were implemented. The aim of one of the innovations – Income Statements – was to account for the financial results for the different areas within the organization, which could filter down to its basic elements. The aim of the other – Key Performance Indicators – was to provide indicators to monitor business performance. These innovations were not used in practice as planned, which afforded me the opportunity to explain the existing gap between their rules and routines. To do this, I based this study on the old institutional economics (OIE) inspired management accounting change literature. Following a strategy of collating together issues from more than one theory, this study contributes to the OIE inspired management accounting change literature by providing evidence that trust and power issues should be analyzed simultaneously and not separately, in order to extend our understanding of how management accounting innovations are (or are not) used in practice, and it also provides evidence that external and internal pressures or the lack of them should be considered through time and not only in explaining the initial stage(s) of the management accounting change processes. The study also provides practical insights for those who intend to carry out changes in management accounting practices in an organizational setting.

Over the past decades a great deal of attention has been dedicated to the broadening and diversification of the notion of narratives, which lead to a variety of models for narrative analysis and encouraged some to speak of a "narratological renaissance" (e.g., CURRIE, 1998; HERMAN, 1999). However, the application of these concepts to early development has faced a major challenge—the use of narratives (as both a theoretical framework and a methodological tool) to examine psychological processes prior to the acquisition of language. The present contribution offers a systematic approach to examine early emotional development grounded on narrative traditions. I begin by briefly presenting the relevant literature and linking it with the narrative-developmental approach proposed herein. This approach, I contend, implies that narratives and development are inextricably anchored to one another as narratives evolve over time through communication processes. I then describe within the narrative analysis the steps that I have developed to investigate emotions in the context of parent-toddler relationships. Thus, the narrative-developmental approach discussed aims to provide a conceptually grounded qualitative methodology to microscopically investigate the development of emotions and to demonstrate the inherently emergent nature of narratives. URN: urn:nbn:de:0114-fqs0103147

Durante as últimas cinco décadas, o termo "desenvolvimento" ocupou lugar de destaque nas ciências sociais e econômicas, na discussão política, na mídia e nas políticas públicas. Apesar disso, nunca houve unanimidade em torno desse conceito e, principalmente, sobre como o desenvolvimento pode ou deve ser fomentado. Este artigo busca explicitar, através de uma abordagem epistémico-sistemática, diferentes nuanças, elementos e aspectos relacionados ao conceito de desenvolvimento, tomando como referência as categorias e terminologias que a biologia explicita em relação aos processos de mudança. A observação de distinções, relações e mecanismos que ocorrem na dimensão biótico podem contribuir significativamente na definição e na dinâmica de processos de mudanças sociais e econômicas.