"WOOP is my safe haven": A qualitative feasibility and acceptability study of the Wish Outcome Obstacle Plan (WOOP) intervention for spouses of people living with early-stage dementia.

OBJECTIVES: As symptoms emerge and worsen in people living with dementia, their spouses can benefit from behavioral interventions to support their adjustment as a care partner. The Wish Outcome Obstacle Plan (WOOP) intervention improves the well-being of spouses of people living with dementia early in the disease course, but intervention mechanisms and opportunities for improvement are unclear. The present study gave voice to spouses who participated in a trial of WOOP, describing how WOOP was incorporated into their lives and how it could be improved for future implementation. METHOD: For this qualitative study, we conducted longitudinal semi-structured interviews among 21 spouses of people living with dementia (three interviews over three months; 63 interviews total). Codebook thematic analysis was performed. RESULTS: Three meta-themes were derived: (1) assessing baseline strengths and limitations of WOOP, (2) learning from experience, and (3) fine-tuning and sustaining WOOP. Participants described how WOOP addressed their interpersonal and emotional stressors, their responses to behaviors of the person living with dementia, and their relationship quality. Considerations for future intervention delivery (e.g., solo vs. in group settings) and instructions (e.g., encouraging writing vs. thinking through the four steps of WOOP) were identified as areas of improvement. CONCLUSIONS: WOOP was described as a practical, feasible, and desirable intervention for spouses at the early stages of their partner's dementia. Participants made WOOP easier to incorporate in their everyday lives by adapting the design into a mental exercise that they used as needed. Suggestions from participants specified how to make the everyday use of WOOP more feasible, sustainable, and applicable in a variety of contexts. TRIAL REGISTRATION: ClinicalTrials.gov HIC 2000021852.

Low working memory reduces the use of mental contrasting.

Mentally contrasting a desired future with reality is a self-regulation strategy that helps people effectively pursue important personal wishes. People with higher self-regulation skills are more likely to spontaneously use mental contrasting. Because one central cognitive function underlying self-regulation is working memory capacity, we investigated whether people with low rather than high working memory capacity are less likely to spontaneously use mental contrasting. Study 1 provided correlational evidence that participants with lower working memory capacity, as measured by the Operation-Span Task, were less likely to use mental contrasting when elaborating an important interpersonal wish. Study 2 provided experimental evidence that manipulating low working memory capacity by inducing cognitive load (vs. no load) led fewer participants to use mental contrasting. The findings have theoretical implications by illuminating the processes that impede mental contrasting, and they have applied implications for understanding how to foster the use of mental contrasting in everyday life.

Evidence that Mental Contrasting Reduces Health Information Avoidance.

BACKGROUND: Although learning health information is beneficial for physical well-being, many people opt to avoid learning this information due to its potentially threatening nature. Such avoidance can lead to delays in seeking treatment. PURPOSE: This study tested the effectiveness of a self-regulation technique, mental contrasting (MC), specifically MC of a negative future with a positive current reality, in reducing health information avoidance regarding skin cancer (melanoma). We hypothesized that participants who engaged in MC would be more likely to choose to learn about their melanoma risk than those who completed a control, reflection activity. METHODS: We conducted a randomized controlled trial (N = 354). Participants were assigned to complete a MC or reflection (control) exercise prior to filling out a melanoma risk calculator. Participants were then asked whether they wanted to learn their melanoma risk, and how much information they would like to know. RESULTS: Chi-Square tests revealed that MC decreased melanoma risk information avoidance compared to the reflection activity (12% vs. 23.4%) but did not make participants more likely seek additional information. CONCLUSION: MC is a brief, engaging, and effective strategy for reducing health information avoidance that could prove useful in medical settings.

It is important to know about the status of one's health in order to take necessary precautions for positive health outcomes. However, people may often engage in "information avoidance," which is the tendency to neglect seeking available and potentially valuable health information. Avoiding health information, especially with regards to one's risk for various diseases, is harmful because it can delay timely treatment. In this study, we tested the effectiveness of mental contrasting­a self-regulation technique­in reducing information avoidance for melanoma skin cancer risk. We recruited 354 participants, and they were randomly assigned to engage in the mental contrasting exercise or reflection (control) exercise. The participants then filled out a melanoma risk calculator and were asked whether they would like to learn their risk for melanoma, and how much information they would like to know. The results showed that mental contrasting decreased melanoma risk information avoidance compared to the reflection activity (12% vs. 23.4%) but did not make participants more likely seek additional information. These findings suggest that mental contrasting can be a brief, engaging, and effective strategy for reducing health information avoidance.

Causality orientations and spontaneous mental contrasting.

Mental contrasting is a motivational behavior change strategy necessary for strong goal commitment. Meanwhile, general causality orientations are motivational patterns that represent individuals' motivation for behavior change and the reason for their goal commitment. The current study explored whether causality orientations predict spontaneous mental contrasting in Chinese university students. Study 1 investigated whether academic autonomy, control, and amotivated orientations correlate with spontaneous mental contrasting about an important academic goal. The findings of Study 1 reveal that autonomy orientation did not correlate with mental contrasting, whereas control and amotivated orientations were negatively correlated with mental contrasting. Study 2 investigated whether priming autonomy and control orientations, in addition to the neutral condition, would induce spontaneous mental contrasting about an academic goal related to the students' research topic. The results of Study 2 revealed that the autonomy condition orientation did not differ significantly from the controlled orientation condition. However, when compared to the neutral condition, the autonomy condition significantly predicted mental contrasting, whereas the controlled orientation condition did not show any significant difference. In Study 2, the autonomy-oriented participants generated more spontaneous mental contrast than the control orientation and neutral conditions. The findings show that controlled and amotivated orientations predicted negative mental contrasting. As a result, controlled and amotivated students must learn how to use mental contrasting to achieve high levels of goal commitment and achievement. Lastly, the study discussed its implications, limitations, and suggestions for future research.

Mental contrasting promotes effective self-regulation for the benefits of groups.

Self-regulation is essential for maintaining harmonious social connections and sustaining groups, yet little research has examined how individuals regulate their actions for the benefits of groups and which self-regulatory strategies promote effective self-regulation (active engagement and disengagement) in group contexts. In three experiments, focusing on identity groups (family and friends in Study 1) and two distinct functional groups (workplace teams in Study 2; sports teams in Study 3), we investigated whether mental contrasting of a desired future with the obstacle of reality, compared to indulging in the desired future, facilitates expectancy-dependent contributions for the benefits of groups. We assessed participants' expectancies of successfully contributing to their groups and varied the mode of thought (mental contrasting vs. indulging). Contributions to groups were measured 1 week (Studies 1 and 2) and 3 weeks later (Study 3). Results showed that mental contrasting guided people to align their actions with expectancy levels; the higher their expectancy, the more people contributed to their groups. In contrast, indulging resulted in insensitivity to expectancy levels. Our findings suggest the potential applicability of the mental contrasting strategy for promoting effective self-regulation in various group settings and provide insights into designing interventions to enhance individuals' engagement in groups.

Protocol for a prospective, randomized, controlled trial of Mental Contrasting with Implementation Intentions (MCII) to enhance the effectiveness of VA's MOVE! weight management program: WOOP (Wish, Outcome, Obstacle, Plan) VA.

INTRODUCTION: Intensive weight management programs are effective but often have low enrollment and high attrition. Lack of motivation is a key psychological barrier to enrollment, engagement, and weight loss. Mental Contrasting with Implementation Intentions (MCII) is a unique imagery technique that increases motivation for behavior change. We describe our study protocol to assess the efficacy and implementation of MCII to enhance the effectiveness of VA's MOVE! or TeleMOVE! weight management programs using a procedure called "WOOP" (Wish, Outcome, Obstacle, Plan) for Veterans. We hypothesize that WOOP+MOVE! or TeleMOVE! (intervention) will lead to greater MOVE!/TeleMOVE! program engagment and consequently weight loss than MOVE!/TeleMOVE! alone (control). METHOD: Veterans are randomized to either the intervention or control. Both arms receive the either MOVE! or TeleMOVE! weight management programs. The intervention group receives an hour long WOOP training while the control group receives patient education. Both groups receive telephone follow up calls at 3 days, 4 weeks, and 2 months post-baseline. Eligible participants are Veterans (ages 18-70 years) with either obesity (BMI ≥ 30 kg/m2) or overweight (BMI ≥ 25 kg/m2) and an obesity-associated co-morbidity. At baseline, 6 and 12 months, we assess weight, diet, physical activity in both groups. The primary outcome is mean percent weight change at 6 months. Secondary outcomes include changes in waist circumference, diet, physical activity, and dieting self-efficacy and engagement in regular physical activity. We assess implementation using the RE-AIM framework. CONCLUSION: If WOOP VA is found to be efficacious, it will be an important tool to facilitate weight management and improve weight outcomes. CLINICAL TRIAL REGISTRATION: NCT05014984.

Self-regulatory processes in goal striving during excellent distance-running performances: A qualitative study.

OBJECTIVE: Goal setting can improve endurance performance, yet how endurance performers maintain goal striving and bring it to a successful close has received limited attention. In this study, we investigated the self-regulatory processes employed by long-distance runners during goal striving in excellent competitive performances. METHOD: Through in-depth, event-focused interviews, we explored 21 long-distance runners' experiences of goal striving in excellent competitive performances (M = 77.43 h post-race). Furthermore, we recruited 10 additional participants with relevant experiences (runner n = 7, coach n = 2; sport psychologist n = 1) for external member-reflection interviews. FINDINGS: Through our matrix analysis, we interpreted that by contrasting their current and future goal status periodically throughout their excellent performances, using a process called mental contrasting with implementation intentions (MCII), this helped the runners to make decisions about whether to persist with a goal, or disengage from a goal and reengage with an alternative. Furthermore, our findings depict how these goal decisions unfolded when runners perceived they were behind, equalling, or exceeding their goal(s). We also illustrate how goal revision was used as an adaptive process to maximise performance, and to avert or manage action crises. CONCLUSIONS: Our findings extend theoretical understandings of goal striving and the self-regulatory processes endurance performers employ to attain and/or adapt their goals. Psychological support provided for athletes should go beyond simply setting goals, but also include training on mental frameworks such as MCII to manage goal-striving challenges and decisional conflict encountered during performances.

Combatting negative bias: a mental contrasting and implementation intentions online intervention to increase help-seeking among individuals with elevated depressive symptomatology.

Background: There are many reasons why individuals with depression may not seek help. Among those with elevated depressive symptomatology, some previous interventions aimed at increasing help-seeking have unintentionally decreased help-seeking intentions. Beck's cognitive theory of depression posits that individuals with elevated depressive symptomatology process information differently from those without depression (i.e., increased cognitive errors, negative bias); potentially explaining the iatrogenic results of previous interventions. Mental contrasting and implementation intentions (MCII; a self-regulatory strategy) interventions have successfully influenced physical and mental health behaviors. However, MCII has not been used specifically for initiating help-seeking for depression. The goal of this research was to ascertain whether an online MCII intervention could increase actual help-seeking or the intention to seek help for depression. Method: Two online randomized pre-post experiments were conducted to measure the primary outcome measures 2 weeks post-intervention (Study 1 collected Summer 2019: information-only control ["C"], help-seeking MCII intervention ["HS"], and comparison MCII intervention ["E"]; Study 2 collected Winter 2020: "C" and "HS"). At Time 1, adults recruited from MTurk had a minimum Beck Depression Inventory (BDI-II) score of 14 (mild depressive symptoms) and were not seeking professional help. Results: Study 1 (N = 74) indicated that the intervention was feasible, provided preliminary support, and clarified intervention components for Study 2. Study 2 (N = 224) indicated that the HS group reported greater intentions to seek help and actual help-seeking than the C group. Proportionally, actual help-seeking was more likely among individuals who received the HS intervention and either did not perceive themselves as depressed at Time 2 or had BDI-II scores indicating that their depressive symptomatology decreased from Time 1. Limitations: Participation was limited to US residents who self-reported data. Discussion: These studies indicate that a brief online MCII intervention to encourage help-seeking is feasible and preliminarily successful. Future studies should consider using ecological momentary assessment measurements to establish the temporal precedence of intervention effects and whether MCII is effective for encouraging help-seeking among individuals prone to experiencing cognitive errors who may not be experiencing negative bias (e.g., bipolar disorder or anxiety). Clinicians may find this method successful in encouraging ongoing treatment engagement.

A systematic review of the impact of future-oriented thinking on academic outcomes.

Future-oriented thought is a broad construct that characterize the ability to generate mental representations of the future and project oneself into a variety of hypothetical states. It is well established that the degree to which one is focused more on the past, present, or future has a variety of implications on psychological functioning. This study focuses on the relationship between future-oriented thought and academic performance of students. To bridge this gap, we conducted the first systematic review investigating the benefit of future-oriented thought on promoting positive outcomes in academic settings. Our systematic review comprised 21 studies (k = 21). Results identified a clear relationship between future-oriented thought and positive outcomes in academic settings. Furthermore, our systematic review reveals important relationships between future-oriented thought and academic engagement, as well as future-oriented thought and academic performance. Our findings suggest that those who are more future-oriented demonstrate higher levels of academic engagement compared to those who were less future-oriented. Our findings suggest that probing and guiding students toward a future goal may increase their academic engagement and performance.

Effects of mental contrasting on sleep and associations with stress: A randomized controlled trial.

Mental contrasting with implementation intentions (MCII) has been successfully applied to improve health-related behaviors (e.g. exercise). We explored its effectiveness to improve sleep outcomes beyond effects of sleep hygiene (SH) information, and investigated associations with stress. Eighty university employees (mean age: 29.6, SD = 4.5) were randomized to either a MCII + SH or a SH-only condition. During a baseline-week and a post-intervention week, sleep duration (Fitbit Alta and self-report), sleep quality, and stress were assessed daily and saliva was collected to assess the cortisol awakening response (CAR). In total, self-reported sleep quality and duration increased, but there was no meaningful condition*week interaction for sleep parameters or CAR. Higher average stress was associated with shorter sleep duration and lower sleep quality. Within-person, days with higher stress were followed by nights with lower sleep quality. Despite overall improvements, effects of MCII were not confirmed. MCII might be less effective to improve behaviors which are less controllable.

From habits to self-regulation: how do we change?

The Yale Cognitive Science department hosted the conference "From Habits to Self-Regulation: How Do We Change?" on November 4 and 5, 2011, to showcase current research on self-control in cognitive science, psychology, and neuroscience. The conference included a panel discussion by four philosophers who gave context for the scope and limitations of research on self-control. The common theme concerning the best method to attain lasting change included becoming aware of what one wants to change, increasing commitment to the goal of change, and imagining all of the potential problems and solutions to those problems.

A Controlled Pilot Study of the Wish Outcome Obstacle Plan Strategy for Spouses of Persons With Early-Stage Dementia.

OBJECTIVES: Behavioral interventions can reduce distress for couples coping with early-stage dementia. However, most interventions are limited in accessibility and fail to address individualized goals. This pilot study examined the dyadic effects on multiple indicators of well-being of the Wish Outcome Obstacle Plan (WOOP) intervention, which guides participants to use Mental Contrasting with Implementation Intentions to achieve attainable goals in their daily lives. METHODS: This randomized controlled trial included 45 older persons with early-stage dementia (PWD) and their spousal care partners (CPs: n = 90 individuals). CPs were assigned randomly to WOOP training immediately after baseline (WOOP) or after a 3-month follow-up interview (Control; CON). Both groups received a dementia care education booklet. WOOP CPs were instructed to practice WOOP at least once a day for 2 weeks. All CPs and PWDs completed home surveys (baseline, 2 weeks, and 3 months), measuring perceived stress, depressive symptoms, quality of life, and affect. RESULTS: Mixed-effects models showed significant intervention × time interaction effects with large effect sizes for CPs on three of the five outcomes over 3 months. Compared with CON, WOOP CPs had decreased perceived stress (δ = 1.71) and increased quality of life (δ = 1.55) and positive affect (δ = 2.30). WOOP PWD showed decreased perceived stress (δ = 0.87) and increased quality of life (δ = 1.26), but these effects were not statistically significant. DISCUSSION: WOOP is a promising, brief intervention to improve dementia CPs' well-being that may also positively affect their partners with dementia.

Effectiveness of a Motivational Smoking Reduction Strategy Across Socioeconomic Status and Stress Levels.

Smoking consequences are seen disproportionately among low-SES smokers. We examine the self-regulatory strategy of mental contrasting with implementation intentions (MCII) as a smoking reduction tool and whether its effectiveness depends on subjective-SES. This pre-registered online experiment comprised a pre-screening, baseline survey, and follow-up. Participants reported past-week smoking, subjective-SES, perceived stress, and were randomized to an active control (n = 161) or MCII condition (n = 164). Data were collected via MTurk, during the U.S.' initial wave of COVID-19. Participants were moderate-to-heavy smokers open to reducing or quitting. The primary outcome was self-reported smoking reduction, computed as the difference between recent smoking at baseline and follow-up. The secondary outcome was cessation, operationalized as self-reported 7-day point-prevalence abstinence at follow-up. Among those low-but not high-in subjective-SES, MCII (vs. control) improved smoking reduction by an average of 1.09 fewer cigarettes smoked per day, though this effect was not conclusive (p = 0.11). Similarly, quitting was descriptively more likely for those in the MCII than control condition, but the effect was non-significant (p = 0.11). Per an exploratory analysis, we observed that stress significantly moderated the condition effect (p = 0.01), such that MCII (vs. control) facilitated reduction among those experiencing high (p = 0.03), but not low stress (p = 0.15). Consistent with prior findings that MCII works best in vulnerable populations, MCII may be more effective for smoking reduction among high-stress than low-stress individuals. These findings contribute to growing research on income-related health disparities and smoking behavior change tools.

Mental contrasting of a negative future facilitates COVID-19 preventative behaviors: two randomized controlled trials.

Objective: The present research examined whether mentally contrasting a negative, feared future (i.e., infection with the Coronavirus) with a still positive reality can promote preventative actions in the context of the pandemic. Design: In two randomized controlled trials, we varied participants' mode of thought (mental contrasting of a negative future with a positive reality versus fantasizing of a negative future). Study 2 took into account the interpersonal nature of the pandemic and manipulated the mode of thought in a vicarious manner (vicarious mental contrasting versus vicarious negative fantasizing). Main Outcome Measures: After the manipulation, we assessed participants' intentions to learn about COVID-19 (Study 1) and attention to COVID-19 information (Study 1 and 2). Three days later, we measured the amount of physical distancing (Study 1 and 2). Results: Study 1 found that mental contrasting leads to more COVID-19 preventative behaviors than mere negative fantasizing. In Study 2, we observed that vicarious mental contrasting facilitates physical distancing among people who initially showed low compliance with COVID-19 preventative behaviors and thus were in most need of a boost in preventative behavior. Conclusion: The findings suggest that mental contrasting of negative fantasies may be an effective way to encourage COVID-19 preventative behaviors.

Mental contrasting with implementation intentions as a technique for media-mediated persuasive health communication.

Mental Contrasting with Implementation Intentions (MCII) is a self-regulation strategy that combines the strategies mental contrasting (MC) in which individualscontrast a desired future with the current reality with the strategy of forming implementation intentions (II), which involves making concrete if-then plans (implementation intentions, II) to overcome the obstacles standing in the way of the desired future. Numerous studies across behavioral domains have demonstrated the effectiveness of this strategy in supporting people to adopt health-promoting behaviors or changing unhealthy behaviors. However, research on MCII has so far neglected the applicability of the concept in media-mediated persuasive health communication. This conceptual review aims to demonstrate and examine the potentials and effects of MCII as a technique to tailor media-mediated persuasive health messages and their dissemination through different media channels. In doing so, it draws on existing models of health behavior change, especially individuals' threat and coping appraisals. Potential effects of MCII on these cognitive factors are discussed, and practical implications for health message design are outlined.

A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment.

Mental contrasting with implementation intentions (MCII) is a self-regulation strategy that enhances goal attainment. This meta-analysis evaluated the efficacy of MCII for goal attainment and explored potential moderators. A total of 21 empirical studies with 24 independent effect sizes (15,907 participants) were included in the analysis. Results showed that MCII to be effective for goal attainment with a small to medium effect size (g = 0.336). The effect was mainly moderated by intervention style. Specifically, studies with interventions based on interactions between participants and experimenters (g = 0.465) had stronger effects than studies with interventions based on interactions between participants and documents (g = 0.277). The results revealed that MCII is a brief and effective strategy for goal attainment with a small to moderate effect; however, because of some publication bias, the actual effect sizes may be smaller. Due to small number of studies in this meta-analysis, additional studies are needed to determine the role of moderator variables.

The Self-Regulation of Conformity: Mental Contrasting With Implementation Intentions (MCII).

The self-regulation of conformity has received little attention in previous research. This is surprising because group majorities can exert social strong pressure on people, leading them to overlook the pursuit of their own goals. We investigated if self-regulation by mental contrasting with implementation intentions (MCII) can reduce people's tendency to conform and facilitate their own goal-pursuit despite deviant majority influence. In a computer-based logical reasoning task, we exposed participants to a conformity manipulation, where we presented bogus diagrams showing the supposedly correct answers of a majority ingroup. Compared to participants who were not given a self-regulation strategy (Studies 1, 2, and 4) or who were in an active control group (Study 3), MCII helped participants to self-regulate conforming behavior in trying to solve the task and to independently solve the logical reasoning task, as indicated by increases in correct answers in the task. The findings suggest that MCII is an effective strategy to regulate people's tendency to conform and supports them to attain their goal despite deviant majority influence.

Using the theory of self-affirmation and self-regulation strategies of mental contrasting and forming implementation intentions to reduce social anxiety symptoms.

Background and Objectives: Based on the results of past research on emotion regulation and positive behavioral change via self-affirmation, it was hypothesized that self-affirmation should help socially anxious individuals to reduce social anxiety symptoms. The effectiveness of a brief self-affirmation intervention framed in terms of implementation intentions (if-then plans with self-affirming cognitions) was compared against forming non-affirming implementation intentions (with distraction as a way of coping) and inactive control condition. Additionally, it was tested whether mental contrasting can augment the impact of the self-affirmation intervention. Design/Methods: Participants (N = 198, aged 18-45) were randomly assigned to one of three intervention conditions (self-affirming implementation intention, mental contrasting with self-affirming implementation intention, or non-affirming implementation intention) or an inactive control-group. Social anxiety symptoms were assessed at baseline and at one-week post-intervention. Results: The difference between the interventions and the control group was substantial. However, there were no differences in the reduction of overall social anxiety levels between the interventions. Each of the interventions produced a statistically significant reduction in social anxiety (Cohen's ds from -.40 to -.50). Conclusions: The results indicate no advantage for self-affirming over non-affirming implementation intentions in reducing social anxiety symptoms. Moreover, no superiority of mental contrasting was found.

Taking Responsibility for Others and Use of Mental Contrasting.

Mentally contrasting a desired future with present reality fosters selective goal pursuit: People pursue feasible desired futures and let go from unfeasible ones. We investigated whether people are more inclined to spontaneously use mental contrasting when they feel responsibility. Studies 1 and 2 provided correlational evidence: Employees who felt responsible for completing an important team project (Study 1) and MTurk users who felt and actively took social responsibility (Study 2) were more inclined to use mental contrasting. Studies 3 and 4 added experimental evidence: Students who were instructed to imagine responsibility for giving an excellent class presentation in a group or alone (Study 3) and participants who elaborated on an idiosyncratic wish that involved responsibility for others or themselves tended to use mental contrasting (Study 4). Apparently, people who feel or take responsibility for others, the society, or themselves are more likely to use mental contrasting as a self-regulation tool.

Using mental contrasting with implementation intentions to reduce bedtime procrastination: two randomised trials.

Objective: The importance of getting a good night sleep is critical, yet for many this remains elusive. Bedtime procrastination-the notion that people delay going to bed for no legitimate reason-is one area that has received little attention, despite its associations with worse sleep outcomes. In the present research, we investigated how to effectively self-regulate bedtime procrastination.Design: In two studies (N1 = 383, N2 = 221), undergraduate students participated either in an online self-regulation exercise called mental contrasting with implementation intentions (MCII) or a motivationally-relevant control exercise (Study 1) or a sleep hygiene control group (Study 2). We then assessed outcomes three weeks (Study 1) or one week (Study 2) later.Main Outcome Measures: We assessed commitment to reduce bedtime procrastination and self-reported bedtime procrastination using two different measures.Results: We found that MCII (compared to control) increased commitment to reduce bedtime procrastination. In both studies this corresponded to a reduction in the average minutes of bedtime procrastination per night.Conclusion: MCII is a simple and cost-effective self-regulation tool for reducing bedtime procrastination. Future research should seek to reveal the mechanisms that undergird bedtime procrastination, as well as understand the present findings in other populations and contexts.