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Given the prevalence of depression, it is worthwhile to consider a variety of treatment approaches to reach as many sufferers as possible, including highly accessible formats such as self-help books. Books based in acceptance and commitment therapy (ACT) and cognitive behavioral therapy (CBT) propose to treat depression through distinct processes of change, though the degree to which these treatments are distinguishable in this format is unclear. Furthermore, it is possible that some individuals may respond better to therapeutic processes from one approach over the other based on personal preferences. We tested the effects of ACT and CBT self-help books on processes of change in a sample of 139 depressed college students in which some participants were given a choice of treatment and others were randomized. Cognitive fusion, which improved better in the ACT group, was the only process of change that distinguished the two treatments. Additionally, early improvements in cognitive fusion were associated with less depression-related stigma at posttreatment. Lastly, randomization, instead of choosing a treatment, led to greater improvements in almost all processes of change. We discuss how these findings inform personalized care, tangible differences between ACT and CBT, and effective practices for treating depression at large scale. [ABSTRACT FROM AUTHOR]

Purpose: To develop effective and personalized interventions, it is essential to identify the most critical processes or psychological drivers that impact an individual's well-being. Some processes may be universally beneficial to well-being across many contexts and people, while others may only be beneficial to certain individuals in specific contexts. Method: We conducted three intensive daily diary studies, each with more than 50 within-person measurement occasions, across three data sets (n1 = 44; n2 = 37; n3 = 141). We aimed to investigate individual differences in the strength of within-person associations between three distinct process measures and a variety of outcomes. We utilized a unique idiographic algorithm, known as i-ARIMAX (Autoregressive Integrated Moving Average), to determine the strength of the relationship (Beta) between each process and outcome within individuals ("i"). All of the computed betas were then subjected to meta-analyses, with individuals treated as the "study". Results: The results revealed that the process-outcome links varied significantly between individuals, surpassing the homogeneity typically seen in meta-analyses of studies. Although several processes showed group-level effects, no process was found to be universally beneficial when considered individually. For instance, processes involving social behavior, like being assertive, did not demonstrate any group-level links to loneliness but still had significant individual-level effects that varied from positive to negative. Discussion: Using i-ARIMAX might help reduce the number of candidate variables for complex within-person analyses. Additionally, the size and pattern of i-ARIMAX betas could prove useful in guiding personalized interventions. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To synthesise qualitative research on individuals diagnosed with (or reportedly showing traits of) borderline pattern personality disorder who underwent dialectical behaviour therapy, aiming to comprehend their perceptions of change processes and the therapy's effects. Method: A comprehensive literature search was conducted across multiple online databases and grey literature sources. Papers were quality appraised using an adapted version of the Critical Appraisal Skills Programme tool. A metaethnographic approach was employed during the synthesis. Results: Eleven studies met criteria for inclusion in the review. The main themes identified through the synthesis process were the impact of DBT, the supportive structure and the 1:1 therapy component. Conclusions: The synthesis uncovered the importance of various processes within DBT that patients perceived as active ingredients for their change. Many of these processes aligned with proposed theoretical processes of change and quantitative research on DBT's effectiveness. [ABSTRACT FROM AUTHOR]

Within psychology and criminology research, violence between partners has often been approached from the perspective of victimization and the risk of recidivism. Many countries confirmed the societal nature of domestic violence while calling for a retributive justice model. However, the effectiveness of this type of policy has been challenged by research that has highlighted the limited effectiveness of punishment. Identifying the desistance process, which is still in development, is paramount, especially in intimate partner violence. This qualitative study analyse the process of ending the violence at work of 13 male perpetrators of partner violence. Through semi-structured interviews and a "life course" perspective, including a qualitative life history timeline, a thematic analysis of the discourses allowed the creation of an eight-step exit process model: (1) history of violence and development of relational scripts; (2) divergent expectations between partners; (3) understanding the violent event; (4) the attribution of responsibility; (5) the escalation of violence; (6) reassessment of oneself and the couple; (7) intrasubjective changes; (8) the development of strategies to end the violence. Moreover, the results showed two types of desistance processes anchored in life histories. We will discuss the modeling of exit processes from partner violence and, particularly, its implications for intervention with perpetrators. Thus, in order to promote the rehabilitation of perpetrators of violence between partners, stakeholders in the legal and therapeutic fields must be able to support the processes of desistance by adjusting intervention strategies based on the dynamics of violence and the exit trajectories from intimate partner violence. [ABSTRACT FROM AUTHOR]

Introduction: Access to treatment for trichotillomania has barriers and many people never receive evidence-based treatment. Understanding what treatments and modalities work, and how people get better through those treatments and modalities, is needed. Methods: We include analyses of moderators of treatment outcomes and preliminary processes of change from a randomized controlled trial assessing the efficacy of a fully automated website delivering acceptance-enhanced behavior therapy (AEBT) for adults (N = 81) with trichotillomania. All participants received an eight-module website of AEBT, and assessments were completed at baseline, mid-, post-treatment, and a one-month follow-up. Using multilevel modeling, the moderation effects of baseline trichotillomania specific psychological flexibility, age, baseline and time -varying anxiety, and baseline and time varying depression were explored. Preliminary process of change using psychological flexibility was explored. Results: Baseline trichotillomania-specific psychological flexibility is correlated with changes in symptom severity over time but not by condition. Lower trichotillomania specific psychological flexibility at baseline was associated with better outcomes. Age also moderated treatment outcomes, specifically, participants between 18 and 30 had better treatment outcomes than participants over 30 years old. Baseline anxiety correlated with symptom severity but did not moderate intervention effects. Changes in anxiety were correlated with symptom severity over time. Baseline depression was not a significant moderator. Preliminary process of change analyses suggests that changes in psychological flexibility is correlated with changes in trichotillomania symptom severity across time. This relationship did not change in strength over time and was not moderated by condition. Conclusion: This study highlights how baseline trichotillomania specific psychological flexibility and anxiety impact changes in symptom severity and the function in a website delivered AEBT for adults with trichotillomania. Additionally, it provides preliminary support of the role of trichotillomania-specific psychological flexibility as a process of change in treatment of trichotillomania. Implications are discussed. [ABSTRACT FROM AUTHOR]

• Vague truth criteria, post hoc rationalization, and moral relativism plague pragmatism. • If ultimate analytic goals are publicly and clearly stated these problems can be solved. • Functional contextualism, ACT, and RFT have shown how that can be done. • Some of the current criticisms recommend steps that have already failed us as a field. • More dramatic steps will be needed to create a better future for CBT. The present special section critical of Acceptance and Commitment Therapy or Training (ACT in either case) and its basis in psychological flexibility, relational frame theory, functional contextualism, and contextual behavioral science (CBS) contains both worthwhile criticisms and fundamental misunderstandings. Noting the important historical role that behavior analysis has played in the cognitive behavioral therapy (CBT) tradition, we argue that CBS as a modern face of behavior analytic thinking has a potentially important positive role to play in CBT going forward. We clarify functional contextualism and its link to ethical behavior, attempting to clear up misunderstandings that could seriously undermine genuine scientific conversations. We then examine the limits of using syndromes and protocols as a basis for further developing models and methods; the role of measurement and processes of change in driving progress toward more personalized interventions; how pragmatically useful concepts can help basic science inform practice; how both small- and large-scale studies can contribute to scientific progress; and how all these strands can be pulled together to benefit humanity. In each area, we argue that further progress will require major modifications in our traditional approaches to such areas as psychometrics, the conduct of randomized trials, the analysis of findings using traditional normative statistics, and the use of data from diverse cultures and marginalized populations. There have been multiple generational shifts in our field's history, and a similar shift appears to be taking place once again. [ABSTRACT FROM AUTHOR]

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.

Objective: The aim of this study to evaluation of processes of change related to trans theoretical model of enhancing behaviors of healthcare workers User electronic Hookah. Material: A simple random sample with probability of 56 males and 2 females health care workers(HCW) for the two group with different position . The sample was collected for the study group in Mosul General hospital that they was 58 Healthcare workers. Results: This study show the relationship for third axis (process of change) between pre, post1, post2 Mean, Standard deviation and P-value that has been measured by paired T test for study. For the study there is statistically significance at confidence interval 95% between pre and post-test1,pre and post-test 2 because P-value. Conclusions: This study concluded that the Sample chosen are in the younger age (25 years and more). Majority of them possess upper middle class of family income in study, however this increases the risk of smoking. [ABSTRACT FROM AUTHOR]

Background: Acceptance and Commitment Therapy interventions are increasing in use in neurological populations. There is a lack of information on the measures available. Purpose: To identify and classify the measures used in Acceptance and Commitment Therapy research studies with adults with acquired neurological conditions. Methods: PRISMA-ScR guided scoping review. MEDLINE, PsycInfo and CINAHL databases searched (up to date 29/06/2022) with forward and backward searching. All study types included. Extraction of Acceptance and Commitment Therapy process-of-change and health-related outcome measures. Outcomes coded using the Core Outcome Measures in Effectiveness Trials (COMET) taxonomy. Results: Three hundred and thirty three papers found on searching. Fifty four studies included and 136 measurement tools extracted. Conditions included multiple sclerosis, traumatic brain injury and stroke. Thirty-eight studies measured processes of change, with 32 measures extracted. The process measure most often used was the Acceptance and Action Questionnaire (n = 21 studies). One hundred and four health-related outcome measures extracted. Measures exploring quality of life, health status, anxiety and depression occurred most frequently, and were used in all included neurological conditions. COMET domains most frequently coded were emotional functioning/well-being (n = 50), physical functioning (n = 32), role functioning (n = 22) and psychiatric (n = 22). Conclusions: This study provides a resource to support future identification of candidate measures. This could aid development of a Core Outcome Set to support both research and clinical practice. Further research to identify the most appropriate and relevant targets and tools for use in these populations should include expert consensus, patient, carer and public involvement and psychometric examination of measures. [ABSTRACT FROM AUTHOR]

Objective: Further test mechanisms of the CHOICES intervention by replicating analyses of the experiential and behavioral processes of change (POC) for alcohol and for contraception as mediators of the intervention for reducing risk of alcohol-exposed pregnancy (AEP) using data from a more recent trial, CHOICES Plus (CP). Method: As in the prior study, replication models examined indirect paths from intervention to experiential POC for alcohol at 3 months, to behavioral POC at 9 months, to risky drinking and risk of AEP at 9 months and experiential POC for contraception at 3 months, to behavioral POC at 9 months, and to ineffective contraception and risk of AEP at 9 months. To test the temporal relationship, additional models examined the indirect path from behavioral POC for alcohol and POC for contraception at 3 months, to the experiential POC at 9 months, and to risk of AEP at 9 months. A final model tested the mediation of experiential and behavioral POC assessed at 3 months. Results: There was an indirect effect of the intervention on risky drinking (total indirect effect = −.13, 95% confidence interval [CI] [−.32, −.02]) but not AEP via the alcohol POC. There was an indirect effect of the intervention on ineffective contraception (total indirect effect = −.27, 95% CI [−.55, −.07]) and AEP (total indirect effect = −.22, 95% CI [−.46, −.06]) via the contraception POC. Conclusions: This study completely replicated the prior indirect effects of the CHOICES intervention on the targeted risk behaviors through the experiential and behavioral POC for each behavior. Findings support the utility of the POC for informing health behavior change interventions. What is the public health significance of this article?: This study replicates prior research supporting the utility of the processes of change (POC) as mediators of treatment for a brief preconception intervention to prevent alcohol-exposed pregnancy. Findings support the temporal relationship between experiential and behavioral POC, with the exception of contraception, for which both the experiential and behavioral processes remained important at 9 months. [ABSTRACT FROM AUTHOR]

Background: Breakfast is a very important meal. It can either make or break your day, and it can be a daunting task. Objectives:We used the transtheoretical model (TTM) to assess the trend of breakfast eating among elementary school students in Jiroft city, Iran. Methods: In this descriptive-analytic research, 290 elementary school students in Jiroft city were selected using stratified sampling. Data were collected using a questionnaire to assess breakfast eating trends according to TTM. The data were analyzed using SPSS version 16. Results: Approximately 9.3% of the participants were in the precontemplation stage, 21.7% in the contemplation stage, 7.2% in the action stage, 53.4% in the preparation stage, and 8.3% in the maintenance stage. There was a significant relationship between TTM constructs and stages of change in breakfast consumption 2 or more times a week. Moving from the precontemplation stage to the maintenance stage was associated with an increase in decisional balance, processes of change, and self-efficacy (P < 0.05). Conclusions: It is suggested to emphasize the importance of perceived benefitsandgreater self-efficacy in the design of educational interventions based on thismodel, increase the use of change processes, and decrease the perceived barriers as much as possible to establish correct behaviors. [ABSTRACT FROM AUTHOR]

Avatar Therapy has a significant impact on symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and to which aspects of their lives these improvements relate. Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as three months after Avatar Therapy. These encounters have been recorded and transcribed so that the discourse could be thoroughly analyzed, leading to the generation of an extensive theme grid. As the cases were analyzed, the grid was adapted in a back-and-forth manner until data saturation occurred. The content analysis allowed the identification of nine main themes representing different aspects of the patients' lives, each of which was subdivided into more specific codes. By analyzing the evolution of their frequency, it was observed that, following therapy, patients presented with fewer psychotic symptoms, better self-esteem, more hobbies and projects, and an overall improved lifestyle and mood. Finally, investigating the impact of Avatar Therapy on quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process. [ABSTRACT FROM AUTHOR]

A large portion of the U.S. population desires to lose weight, but only a small portion maintains a desirable body weight. We examined weight loss success and the psychological benefits of exercise among men and women who were obese and initially sedentary (N = 33). These participants completed anthropometric assessments and psychological inventories before and after graded exercise tests (GXTs) at the beginning and end of their enrollment in a 6-month behavioral weight loss program (BWLP). Participants significantly decreased their body weight, body mass index (BMI), and % body fat; they also increased their aerobic capacity and exercise time. They reported long-term increases in their stage of change, self-efficacy, exercise enjoyment and processes of change. They also reported immediate changes toward more positive affect, as measured with pre-to post-GXTs on both the Profile of Mood States (POMS) and State Anxiety Subscale (A-State) at the beginning and again at end of the BWLP. Mood benefits were reported on the POMS subscales of Tension, Depression, Anger, Vigor, and Confusion. At the end of the BWLP, Fatigue and Confusion continued to improve after a 20-min post-GXT recovery period. Finally, reductions in Depression and Fatigue after the first GXT were correlated with program success, as indicated by decreases in BMI, percent body fat, and body weight. Initial scores on trait enjoyment were associated with decreased BMI and body weight. Psychological benefits of exercise may help individuals who are obese and sedentary change their behavior and exercise perceptions from something they "should do" to something they "want to do." Feeling good during weight loss efforts is an important pathway to change and should be an explicit component goal of BWLPs. [ABSTRACT FROM AUTHOR]

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.

Historically, evidence-based treatment has followed the latent disease model, which emphasizes using specific protocols tied to diagnoses. Today, the field continues to move towards an individual approach with models of treatment based on change processes. Here, we describe Process-Based Therapy (PBT), a new way of thinking that is moving away from nomothetic studies of diagnosis-driven interventions toward an individual approach to treatment that recognizes the complexity of human suffering. In PBT, therapists select from a wide range of evidence-based interventions, tailoring treatment to meet a person's needs at a given point in time. PBT is used to analyze intra-individual changes at the level of complex networks of biopsychosocial events, then gathering these into subpopulation and overall population parameters using theory and experimental analysis. PBT emphasizes tracking patient progress over time and treating symptoms based on current experiences, as well as understanding a patient's past and predicting future experiences. Through specific analyses that aid in this process, therapists can use PBT to create a network with clients to visualize symptoms over time and areas of change. [ABSTRACT FROM AUTHOR]

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.

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. [ABSTRACT FROM AUTHOR]

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.

Leading theories regarding the mechanisms of exposure for OCD focus on Pavlovian fear reduction more than operant processes. Acceptance-based exposure directly targets operant behavior. Integrating these perspectives could lead to a more robust understanding of mechanisms of change in exposure and more effective and enduring treatments. The current study investigated acceptance and regulation of distress during exposure. Participants with intrusive thoughts were randomized into three groups, Acceptance (n = 23), Regulation (n = 20), and Control (n = 21), and completed two behavioral avoidance tests (BATs) 1 week apart. Active conditions completed a 30-min exposure plus 6 days of 10-min exposures at home; Control participants watched videos of the same durations. Self-report measures were collected at both sessions, and behavioral, subjective, and physiological repeated measures data were collected during both BATs. Compared to Control, active conditions decreased OCD symptom severity, rituals, and skin conductance levels, while Acceptance showed lower skin conductance levels than Regulation and Control. Acceptance showed greater willingness and psychological flexibility than Control, while Regulation did not. Results support theorized mechanisms of change in acceptance-based exposure and suggest willingness to experience distress may paradoxically lead to decreased physiological arousal, which has important implications for treatment and future research. • Acceptance and regulation procedures were more effective than a no treatment control condition. • Acceptance reduced skin conductance more than anxiety regulation and control conditions. • Acceptance increased willingness and psychological flexibility over other conditions. • Results suggest increase in willingness can result in lessened emotional reactivity. [ABSTRACT FROM AUTHOR]

Different chronological and archaeological indicators are synthesized to analyze the variability of the anthropic signal in three basins of the Puna of Salta, between ca. 11500 cal BP and 100 cal BP. This broad chronology is adequate to discuss different processes of change. Specifically, time series are considered based on the radiocarbon dates available in the Pastos Grandes, Pocitos and Ratones basins, and a macroregional comparison is made with similar series constructed for the whole of the Puna of Argentina. The complementarity between this information and the evidence gathered from different archaeological contexts contributes to the study of economic and technological changes and in the use of space and mobility, both in the Puna of Salta and in the highlands of the Northwestern Argentina in general. These processes are most notable from the late Middle Holocene and, mainly, during the Late Holocene. [ABSTRACT FROM AUTHOR]

In today's multi-religious context, faith has become for many an option alongside others, and churches increasingly find themselves in a minority position. The article aims to provide an insight into the particular situation of churches in Germany and asks how churches are feeling the challenge to rethink their way of being and carrying out their mission. [ABSTRACT FROM AUTHOR]

Objective: Researchers have suggested that psychotherapy may be enhanced by the addition of 3,4‐methylenedioxymethamphetamine (MDMA), particularly in the treatment of disorders wherein interpersonal dysfunction is central, such as social anxiety disorder. We review literature pertaining to three potential processes of change that may be instigated during sessions involving MDMA administration in the treatment of social anxiety disorder. Design: This is a narrative review that integrates research on the etiology and maintenance of social anxiety disorder and mechanisms of action of MDMA to examine how MDMA may enhance psychotherapy outcomes. Results: We first outline how MDMA may enhance memory reconsolidation in social anxiety disorder. We then discuss how MDMA may induce experiences of self‐transcendence and self‐transcendent emotions such as compassion, love, and awe; and how these experiences may be therapeutic in the context of social anxiety disorder. We subsequently discuss the possibility that MDMA may enhance the strength and effectiveness of the therapeutic relationship which is a robust predictor of outcomes across many disorders as well as a potential key ingredient in treating disorders where shame and social disconnection are central factors. Conclusion: We discuss how processes of change may extend beyond the MDMA dosing sessions themselves. [ABSTRACT FROM AUTHOR]

Objective. Some authors have suggested that verbal shaping is an active component in cognitive restructuring. The goal of the current study was to provide experimental evidence in support of the shaping hypothesis. Method. Three consecutively admitted adults with symptoms of anxiety and depression participated in the study. Participants underwent baseline, treatment comparison, crossover, and follow-up phases as part of an experimental single-case study. We selected two target irrational beliefs and praised either the client's approximations to a terminal (more adaptive) class of verbalizations (differential reinforcement of approximations) or just the terminal class of verbalizations (terminal reinforcement). Results. Irrational beliefs exposed to differential reinforcement of approximations was a more effective approach to reducing irrational beliefs. Conclusion. The study provides experimental evidence in support of the verbal shaping hypothesis. Our findings suggest that it may be possible to enhance clinical outcomes by actively engaging in verbal shaping during client-therapist verbal interaction. [ABSTRACT FROM AUTHOR]

Tobacco smoking is the leading cause of death in the world, accounting for more than eight million casualties. To reduce the prevalence of smoking, government and nongovernment players use interventions to reduce smoking and/or incite smoking cessation. These interventions are based on behavior change models. Foremost among those models is the Transtheoretical Model of Behavior Change developed by Dr Prochaska. The transtheoretical model theorizes that smoking cessation is a stage-wise change. This change is enabled by a set of processes of change. The current study identifies the relationship between two basic constructs of the model: processes of change and stages of change. The study also identifies the relative importance of different processes of change in different stages of change. Data analysis from this study shows that different processes of change have a differing influence on various stages of change. Experiential processes have a significant influence on the precessation stages and lack significant influence on the postcessation stages. On the contrary, behavioral processes have a significant influence on the postcessation stages and lack significant influence on the precessation stages. [ABSTRACT FROM AUTHOR]

Objectives: Mounting research has supported the beneficial effects of compassion-based interventions for improving psychosocial and physiological well-being and mental health. Teachers present a high risk of professional stress, which negatively impacts their mental health and professional performance. It is crucial to make compassion cultivation a focus in educational settings, supporting teachers in coping with the school context's challenges, and promoting their mental well-being. This study aims to test the feasibility of the Compassionate Mind Training programme for Teachers (CMT-T), as well as to preliminary explore possible mechanisms of change. Methods: Participants were 31 teachers from one public school in the centre region of Portugal, who underwent the CMT-T, a six-module Compassionate Mind Training group intervention for teachers. Feasibility was assessed in six domains (acceptability, implementation, practicality, adaptation, integration, and preliminary effectiveness), using self-reports, overall programme assessment, attrition, attendance, and home practice. Using a pre-post within-subject design, changes were assessed in self-reported psychological distress, burnout, well-being, compassion, and self-criticism. Mediation analysis for repeated measures designs was used to explore mechanisms of change. Results: The CMT-T was feasible in all the six domains. Participants revealed significant decreases in depression, stress, and fears of compassion to others, as well as significant increases in compassion to others, self-compassion, and compassion to others' motivations and actions after the CMT-T intervention. When self-criticism was controlled, decreases in burnout and increases in satisfaction with professional life, and self-compassion, were also found. Fears of compassion for others mediated the impact of CMT-T on teachers' burnout, and self-compassion mediated the intervention effect on psychological well-being. Conclusions: This pilot study provides evidence that CMT-T is feasible and may be effective in promoting teachers' compassionate motivations, attributes, and actions towards others and themselves and improving their mental health and well-being. These promising findings warrant further investigation within a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Research has demonstrated the efficacy of psychological skills training (PST), yet many athletes do not appear ready to do whatever it takes to improve the mental aspects of performance. Although the transtheoretical model of behavior change (TTM), generally, and readiness to change, specifically, have received considerable attention in a range of allied health fields, few studies have been conducted to examine this construct in applied sport psychology. The purpose of the current study was to examine National Collegiate Athletic Association (NCAA) Division I athletes' readiness for PST as it relates to their stage of change, decisional balance, self-efficacy, and use of processes of change. The data trends observed in the current study were consistent with the theoretical underpinnings of the TTM as well as previous research on NCAA Division I athletes. The results of the current study highlight the need to consider readiness to change when designing and implementing PST interventions. [ABSTRACT FROM AUTHOR]

The current study used the transtheoretical model (TTM) as a guiding theoretical framework to assess differences in processes of change, decisional balance, and self-efficacy among deaf individuals with different levels of physical activity. Overall, 146 participants (M age = 26.4 yr, SD = 4,28) completed anonymous questionnaires assessing the dimensions of the TTM. stages of change, processes of change, decisional balance, and self-efficacy. Analysis of variance showed that both experiential and behavioral processes of change were higher in the preparation, action, and maintenance stages than in the other stages. Accordingly, the benefits of physical activity participation were stronger in the preparation stage, whereas the costs were more evident in the precontemplation stage. Finally, self-efficacy at the preparation stage was higher than in the other stages. The findings revealed how different stages of physical activity participation can be explained through the TTM. and the implications for physical activity intervention are discussed. [ABSTRACT FROM AUTHOR]

The author offers an initial formulation of what an approach integrating common factors and the processes of change would look like. The dodo-verdict has been extant in the psychology literature for almost 100 years, and it is time to acknowledge the veracity of the dodo-bird verdict as we move toward therapeutic approaches focusing on factors the empirical approaches have in common. Although we now have hundreds of different theoretical models, no one model appears to be superior to any other. However, certain presenting conditions may be more suited to certain interventions. The MAGIC approach introduced here incorporates client motivation, the therapeutic alliance, goal-setting, implementation, and commitment. This gives us a basic structure of commonalities around which we will be able to build comprehensive psychotherapeutic strategies drawing on intervention techniques from many different models. After a brief consideration of historical factors, I will present one idea for an integrated approach followed by a discussion of some assumptive processes which are at work in the therapeutic cadre as well as a consideration of cultural diversities. [ABSTRACT FROM AUTHOR]

The current study investigates the physical activity distribution of Korea adults, examines the differences in the TTM constructs by the stage of physical activity, and identify the relationship between physical activity and the TTM constructs. A total of 799 adults (male: 326, female: 473, age = 46.8 years) recruited from S district in Seoul, Korea. Four Korean-version questionnaires were used to identify the stages of physical activity and its related psychological variables: stage of physical activity change scale, decision balance scale for physical activity, exercise self-efficacy scale, and processes of change scale for physical activity. Results indicated that a significant difference among male and female adults for physical activity stage distribution emerged (χ2 = 67.2, df = 4, p <.001). Data were analyzed by frequency analysis, χ2 test, MANOVA, and regression analysis. Self-efficacy, pros, cons, cognitive processes of change and behavioral processes of change differentiated across the stages of physical activity. Furthermore, the findings revealed that adults' physical activity was significantly correlated with the TTM constructs, and that the TTM constructs had a statistically significant impact on the physical activity. The current study provides starting points for interventions aimed at increasing physical activity levels based on the TTM. [ABSTRACT FROM AUTHOR]

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.

Throughout its history the strategy and tactics of contextual behavioral science (CBS) research have had distinctive features as compared to traditional behavioral science approaches. Continued progress in CBS research can be facilitated by greater clarity about how its strategy and tactics can be brought to bear on current challenges. The present white paper is the result of a 2 1/2-year long process designed to foster consensus among representative producers and consumers of CBS research about the best strategic pathway forward. The Task Force agreed that CBS research should be multilevel, process-based, multidimensional, prosocial, and pragmatic, and provided 33 recommendations to the CBS community arranged across these characteristics. In effect, this report provides a detailed research agenda designed to maximize the impact of CBS as a field. Scientists and practitioners are encouraged to mount this ambitious agenda. • The strategies and tactics of contextual behavioral science research are distinctive. • CBS research is multilevel, process-based, multidimensional, prosocial, and pragmatic. • Targeted research is needed in all five of these areas. • Thirty-three recommendations are offered to direct and improve CBS research. • These recommendations can be used as a quality improvement checklist. [ABSTRACT FROM AUTHOR]

In this article, the authors critically evaluate contemporary models of psychopathology and therapies, underscoring the limitations of traditional symptom-based classification approaches in mental health. The authors introduce a paradigm shift in the field, toward a process-oriented and dynamic systems approach to psychotherapy that offers deeper insights into the complex interplay of symptoms and individual experiences in psychopathology. These approaches offer a more personalized and effective understanding and treatment of mental health issues, moving beyond static and 1-dimensional views. The authors discuss the implications for clinical practice, emphasizing improved assessment, diagnosis, and tailored treatment strategies., Competing Interests: Disclosure The authors of this article have no conflict of interest to disclose. Dr S.G. Hofmann receives financial support from the Alexander von Humboldt Foundation (as part of the Alexander von Humboldt Professur) and the Hessische Ministerium für Wissenschaft und Kunst (as part of the LOEWE Spitzenprofessur). He also receives compensation for his work as an editor from Springer Nature and royalties and payments for his work from various publishers. Funding received from he Hessian Ministry of Education and Art., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Historically speaking, the behavioral tradition advanced functional analysis as a method of applying existing principles to novel situations. In the more than half a century since that idea was advanced, functional analysis has either fallen into disuse, as in most of applied psychology, or has been used but modified to a point that is virtually inapplicable elsewhere, as in applied behavior analysis work with severe developmental disabilities. In this paper we argue that the current challenges with COVID-19 present an ideal time to reinvigorate functional analysis by combining it with the growing body of evidence on processes of change, organized under an extended evolutionary meta-model. This new form of process-based functional analysis takes advantage of the strengths of contextual behavioral science, while opening avenues of fruitful interaction with other wings of intervention and evolutionary science more generally. Using the psychological flexibility model as an example, we show how this approach solves the key problems of classical functional analysis and helps professionals deal with novel challenges such as those posed by COVID-19. Humanity is now facing an extraordinary and unexpected situation. Behavioral science needs to rise to that challenge in a way that provides both immediate practical value and greater assurance of long-term benefits for our understanding of human complexity more generally. Process-based functional analysis can be a vehicle to do just that. • Functional analysis has nearly disappeared in mainstream intervention science. • Change processes and an extended evolutionary meta-model provides an alternative. • Process-based functional analysis is the result. • The psychological flexibility model provides a proof of concept. • This approach suggests how to research the COVID-19 crisis with lasting results. [ABSTRACT FROM AUTHOR]

L'éducation thérapeutique (ET) est un outil permettant au patient de trouver ses propres stratégies de changement en se confrontant au point de vue des autres, en abordant de nouvelles connaissances et en remobilisant certaines compétences. Le changement implique une multitude de processus psychologiques que l'on interroge peu. Quelle place accorde-t-on à ces processus psychologiques ? Quel est le rôle du psychologue de la santé dans l'ET ? Nous aborderons ces notions en parcourant un cas clinique d'un patient obèse ayant participé à une éducation thérapeutique « pour une perte de poids durable » (unité médicale de la nutrition, hôpital universitaire de Toulouse). The Therapeutic Education is a tool allowing the patient to find its own strategies of change by confronting with the point of view of others, by approaching new knowledge and recapturing some skills. The change involves a multitude of psychological processes, which we rarely question. What place do we grant to these psychological processes? What is the role of the psychologist of the health in the ET. We shall approach these notions by discussing a clinical case of a patient obese having participated in a therapeutic patient education "for a long-lasting loss of weight" (Medical Unit of the Nutrition, CHU de Toulouse). [ABSTRACT FROM AUTHOR]

To examine process of changes in two distinct psychotherapies—cognitive–behavioral therapy (CBT) and Panic-Focused Psychodynamic Psychotherapy (PFPP). Two hypothesized processes of change—misinterpretation of bodily sensations and Panic Specific Reflective Function (PSRF)—were tested in the CBT and PFPP arms of the Cornell-Penn Study of Psychotherapies for Panic Disorder. The Brief Bodily Sensations Interpretation Questionnaire (BBSIQ) measures misinterpretation of bodily sensations—a focus of CBT interventions. PSRF, a target of PFPP, assesses the capacity to reflect on the underlying meaning of panic symptoms. A sample of 138 patients (37.7% men, 72.56% Whites, and 16.7% Latinx) with primary Diagnostic and Statistical Manual for Mental Disorders–Fourth Edition (DSM–IV) panic disorder were included in the present analyses. Mixed effects models tested the effects of early change in BBSIQ and PSRF (intake through Week 5) on subsequent change in the Panic Disorder Severity Scale (PDSS; Week 5 through termination). Early change on both PSRF and BBSIQ predicted subsequent change in panic severity across the two treatments. As predicted, PSRF changed more in PFPP than in CBT, but, contrary to expectation, BBSIQ showed comparable changes in both groups. Counterintuitively, CBT patients benefited more in terms of panic symptom improvement when their PSRF improved than did PFPP patients. This is the first demonstration of general processes of change (PSRF and BBSIQ) across psychotherapies for panic disorder, suggesting that to the extent patients change their beliefs about the meaning of panic, their panic symptoms improve in time-limited, panic-focused psychotherapies. Public Significance Statement: Panic disorder is associated with disability and personal suffering, posing a significant public health problem not fully remediated by available treatments. Identifying processes of change associated with symptomatic improvement can guide development of targeted interventions and potentially improve response rates. We found that both the ability to reflect on panic symptoms and to accurately interpret one's bodily sensations predict subsequent symptomatic improvement in both cognitive–behavioral therapy (CBT) and brief psychodynamic therapy. This suggests that a sharper focus on these elements has the potential to improve outcomes in short-term treatments of panic disorder. [ABSTRACT FROM AUTHOR]

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.

Objectives: In this study, we investigated the differences in strategic constructs of the Transtheoretical Model (TTM) across accelerometer-determined sedentary time. Methods: A total of 201 college students participated in a TTM questionnaire for sedentary behavior and wore an accelerometer for 7 consecutive days to assess sedentary time. Multivariate analyses of variances (MANOVA) with post hoc pairwise comparisons were conducted to determine mean differences in the strategic constructs across quintiles of sedentary time. Tests for linear trends were conducted using orthogonal polynomial coefficients. Results: Compared with participants in higher quintiles of sitting time, 8 out of 10 processes of change (eg, mostly consciousness raising [η²p = .09]) were used significantly more frequently by those in the lowest quintile (p < .05) with negative linear trends (ptrend <.05). We found no statistically significant differences in the constructs of self-efficacy and decisional balance across the quintiles. Conclusions: Based on this preliminary analysis it appears that several intervention methods such as awareness raising, incentivization, self-motivation, and social norm building would be more beneficial to reduce sitting time or to protect their current sitting time from relapse. [ABSTRACT FROM AUTHOR]

After two decades of quiescence, clinical psychedelic research re-started in the 1990s and is rapidly accelerating. Early evidence for effectiveness is promising, but understanding of the psychological processes of change underlying observed benefits is limited. This paper outlines contextual behavioral science (CBS) as an ideal framework for understanding psychedelic experiences and the psychological processes of change involved in psychedelic assisted therapy. This paper argues that CBS-based therapies, such as Acceptance and Commitment Therapy (ACT), can contribute to deepening and maintaining the often profound acute effects of psychedelics. The paper begins by briefly outlining the current state of clinical psychedelic research. It then progresses to outlining why CBS may be uniquely positioned to potentially increase the efficacy of psychedelic-assisted therapy, how this scientific model fits with existing data on psychedelic-assisted therapy, as well as with leading neuroscientific theories such as the entropic brain theory. Finally, it concludes by suggesting avenues for future research on how CBS could contribute to psychedelic science, and vice versa. • Clinical psychedelic research re-started in the 1990s and is rapidly accelerating. • Understanding of the psychological processes of change limited. • Contextual behavioral science can be used to understand psychedelic assisted therapy. [ABSTRACT FROM AUTHOR]

Introduction/Purpose: The assessment of the patients' motivation as a predictor of behavioral change via five stages (pre-contemplation, contemplation, preparation, action, and maintenance) and four processes (emotional re-evaluation, weight management actions, environmental restructuring, and weight consequences evaluation) of change. Materials/Methods: A total of 542 participants (251 waiting for bariatric surgery (BS), 90 undergoing BS, and 201 controls) completed the Stages (S-Weight) and Processes (P-Weight) of Change in Overweight and Obese People questionnaires in a multicenter cross-sectional study. Results: A higher percentage of subjects seeking BS (31.7%) were in the action stage (16.7% of post-BS patients, p < 0.001; 14.9% of controls, p < 0.001). The referred body mass index (BMI) reduction was higher in subjects in active stages (3.6 ± 4.4 kg/m2 in maintenance versus 1.4 ± 1.4 kg/m2 in contemplation, p < 0.001). In the P-Weight questionnaire, patients looking for BS scored significant higher in the four processes of change than controls. In addition, a positive and significantly correlation between BMI and the four processes was observed. In the stepwise multivariate analysis, BMI and the S-Weight allocation were constantly associated with the four processes of change. Conclusion: Obesity is accompanied by a modifying behavioral stage, suggesting that subjects before BS are seriously thinking about overcoming excess weight. To identify subjects on the waiting list for BS who will be more receptive to weight lost interventions remains a challenge. [ABSTRACT FROM AUTHOR]