Could implementation intentions improve the efficacy of behavioral weight-loss treatment?

Although behavioral weight loss treatment can result in health benefits, the effects on weight loss are generally disappointing, with lost weight regained within a few years. Because these problems appear to be due to a failure to execute the strong weight control intentions formed during treatment, the use of implementation intentions is suggested to bridge that intention-behavior gap. In contrast to behavioral intentions, implementation intentions specify the situation in which the behavior should be enacted. Although implementation intentions have generally been very effective in increasing the likelihood of goal attainment for a wide range of behaviors, results with regard to eating have been mixed. Especially disappointing have been the findings of a large study that added implementation intentions to a clinical weight loss treatment and found no effects either on weight loss or on weight loss maintenance (Knäuper et al., 2018). I argue that this failure is due to the use of implementation intentions that target specific eating behaviors. According to the goal conflict model of eating, implementation intentions are most effective if they prime the weight control goal; implementation intentions targeting specific behaviors do not reliably do that. I review evidence that the implementation intention to think of dieting when confronted with palatable food items primes weight control thoughts. It also reduces eating of primed foods and even result in weight loss.

Assessment of factors influencing physicians' intention to prescribe transfusion using the theory of planned behavior.

BACKGROUND: Blood shortage is a persistent problem affecting Taiwan's health-care system. The theory of planned behavior (TPB) has been commonly used in studies of health advocacy. The purpose of this study was to develop a questionnaire measuring clinicians' intention to prescribe transfusion based on the TPB. METHOD: A questionnaire comprising 15 items for assessing clinicians' intention to prescribe blood transfusion was developed, and it collected demographic characteristics, tested patient blood management (PBM) and perceived knowledge of PBM. Furthermore, the questionnaire contained four subscales related to the TPB. A total of 129 clinicians participated in this pilot study between July and December2020. Item analysis and exploratory factor analysis were conducted to examine the validity and reliability of this measurement instrument. RESULTS: The results indicated no statistically significant correlations between the demographic characteristics and PBM test scores. Regarding perceived knowledge, the results of a one-way analysis of variance revealed that the effect of age, hierarchy of doctors, and education level were significant. In terms of subjective norms, a significant effect on education level was noted [t (129) = 2.28, p < 0.05], with graduate school graduates receiving higher scores than college graduates. An analysis of variance demonstrated the effects of hierarchy, education level, and medical specialty on perceived behavioral control. The results of the regression analyses revealed that perceived knowledge (ß = 0.32, p < 0.01) and subjective norms (ß = 0.22, p < 0.05) were significantly related to clinicians' behavioral intentions. CONCLUSIONS: This study revealed that factors affecting clinicians' blood transfusion management can be explained using the TPB-based questionnaire. This study demonstrated that physicians' perceptions of whether most people approve of PBM and their self-assessment of their PBM knowledge affect their intentions to proceed with PBM. According to this finding, a support system among physicians must be established and maintained to increase physicians' confidence in promoting PBM.

Improving Hand Hygiene Behavior Using a Novel Theory-Based Intervention During the COVID-19 Pandemic.

BACKGROUND: Promoting the adoption of personal hygiene behaviors known to reduce the transmission of COVID-19, such as avoiding touching one's face with unwashed hands, is important for limiting the spread of infections. PURPOSE: We aimed to test the efficacy of a theory-based intervention to promote the avoidance of touching one's face with unwashed hands to reduce the spread of COVID-19. METHODS: We tested effects of an intervention employing imagery, persuasive communication, and planning techniques in two pre-registered studies adopting randomized controlled designs in samples of Australian (N = 254; Study 1) and US (N = 245; Study 2) residents. Participants were randomly assigned to theory-based intervention or education-only conditions (Study 1), or to theory-based intervention, education-only, and no-intervention control conditions (Study 2). The intervention was delivered online and participants completed measures of behavior and theory-based social cognition constructs pre-intervention and one-week postintervention. RESULTS: Mixed-model ANOVAs revealed a significant increase in avoidance of touching the face with unwashed hands from pre-intervention to follow-up irrespective of intervention condition in both studies, but no significant condition effects. Exploratory analyses revealed significant effects of the theory-based intervention on behavior at follow-up in individuals with low pre-intervention risk perceptions in Study 2. CONCLUSIONS: Results indicate high adoption of avoiding touching one's face with unwashed hands, with behavior increasing over time independent of the intervention. Future research should confirm risk perceptions as a moderator of the effect theory-based interventions on infection-prevention behaviors.

The influence of 'deliberate' implementation intention on medical students' risk decision task outcomes.

Implementation intention is a kind of behaviour choice strategy in which individuals adopt specific and definite behaviour patterns to achieve behavioural goals. The standard form is 'if something happens, then I will do something'. Previous studies have shown that implementation intention strategy is a fast and effective mental skill with notable advantages. However, adding the requirement of 'deliberate' to the implementation plan will increase the probability of decision adjustment to a certain extent. In this study, the classic Balloon Analogue Risk Task (BART) was selected as the evaluation index of risk decision-making, and the 'deliberate' implementation intention was adopted to explore the impact of this behavioural strategy on risk selection. The recruited medical students were divided into two groups: the implementation intention group (n = 37) and the control group (n = 34). The baseline assessment for the BART was performed by all participants, and the intensive training of 'deliberate' implementation intention to 'make as much money as possible' was conducted before the post-test decision-making after one week. The adjusted BART (adj BART) value and AvgIncome were significantly higher than those at baseline in the implementation intention group(adj BART value: baseline 12.63 ± 2.90, post-test: 14.78 ± 2.66, F = 15.978, p < 0.001, η 2 = 0.307; AvgIncome: baseline 12.43 ± 2.56, post-test 15.00 ± 2.57, F = 20.953, p < 0.001, η 2 = 0.368). The mixed-model ANOVAs showed that there was a significant interaction between test time and group (adj BART value: F = 4.859, p = 0.031, η 2 = 0.066; AvgIncome: F = 4.261, p = 0.043, η 2 = 0.058). Conclusion: The implementation of 'deliberate' intention can help medical students make more rational judgements in risk decision-making tasks, avoid over conservative behaviour and obtain more benefits.

Proof of concept trial for a new theory-based intervention to promote child and adult behavior change.

Interventions to change children's behavior typically target adults or children, but rarely both. The aims were to: (a) evaluate acceptability and feasibility of an innovative theory-based intervention designed to change both child and adult behavior, and (b) generate effect sizes for a definitive randomized controlled trial. The oral health of sixty children aged 5-9 years with a repaired cleft lip and/or palate was assessed before randomization to one of three conditions: (a) control group, (b) intervention group in which children and adults were asked to form implementation intentions, or (c) intervention plus booster group in which adults were additionally sent a reminder about the implementation intentions they and their children formed. Oral health assessments were repeated at 6-month follow-up alongside exit interviews. The procedures proved popular and participants exposed to the intervention additionally reported believing that forming implementation intentions was effective. Descriptive statistics generally showed oral health improvements across all conditions, although the effects were more marked in the intervention plus booster condition, where plaque improved by 44.53%, gingivitis improved by 20.00% and free sugar consumption improved by 8.92% (vs. 6.43% improvement, 15.00% deterioration and 15.58% improvement in the control group, respectively). Data collection procedures were acceptable and the intervention feasible. The effect sizes suggest that the intervention plus booster condition has sufficient promise to proceed to a fully-powered randomized controlled trial. The intervention has the potential to be adapted to tackle other child health behaviors and to be deployed at scale.

In Lieu of Smoking: Are Smokers More Likely to Enact Certain Types of Implementation Intention Plans During a JIT Smoking Cessation?

BACKGROUND: To identify actionable and effective implementation intention (II) plans, we examined whether (a) IIs suggesting food or nicotine-based substitution strategies to help quit smoking cigarettes would be more likely to be enacted in real time, (b) IIs reminding participants to cognitively motivate themselves or engage in solitary activity would be more likely to be enacted than those suggesting seeking social support, and (c) II plan enactment based on the above strategies would be associated with reporting momentary lapse avoidance. METHOD: A sample of 57 Asian American young adult (18-25 years) smokers participated in a 4-week, mobile-based smoking cessation intervention, implemented in a Just-In-Time framework. User-specified IIs were categorized into nature of activity (cognitively motivate themselves, engage in solitary activity, seek social support) and type of substitution strategy (food, nicotine, no substitution). Outcome variable was momentary enactment of the given II. Generalized mixed linear models were used for analyses. RESULTS: IIs reminding participants to cognitively motivate themselves and/or engage in solitary activities were more likely to be enacted than IIs recommending seeking social support. IIs recommending nicotine-based substitution were more likely to be enacted than IIs that did not specify any substitution. IIs suggesting food-based substitution, however, were less likely to be enacted than those not suggesting a specific substitution. II plan enactment based on the above strategies was significantly associated with avoiding momentary lapses compared to when momentary lapses occurred. CONCLUSION: Specifying II recommendations found to be helpful with avoiding lapses in a smoking cessation context, can increase chances of II enactment, and improve overall health intervention outcomes.

Testing an Online, Theory-Based Intervention to Reduce Pre-drinking Alcohol Consumption and Alcohol-Related Harm in Undergraduates: a Randomized Controlled Trial.

PURPOSE: The present study tested the efficacy of a theory-based online intervention comprising motivational (autonomy support) and volitional (implementation intention) components to reduce pre-drinking alcohol consumption and alcohol-related harm. METHOD: Undergraduate students (N = 202) completed self-report measures of constructs from psychological theories, pre-drinking alcohol consumption, and alcohol-related harm at baseline and were randomly assigned to one of four intervention conditions in a 2 (autonomy support: present/absent) × 2 (implementation intention: present/absent) design. Participants completed follow-up measures of all variables at 4 weeks post-intervention. All participants received national guidelines on alcohol consumption and an e-mail summary of intervention content at its conclusion. Participants also received weekly SMS messages in the 4-week post-intervention period restating content relevant to their intervention condition. RESULTS: Neither statistically significant main effect for either the autonomy support or implementation intention intervention components nor an interaction effect was found on the outcome measures. However, statistically significant reductions in pre-drinking alcohol consumption and alcohol-related harm were observed across all groups at follow-up, when compared to baseline. CONCLUSION: Reductions in outcome measures were likely related to elements common to each condition (i.e., provision of national guidelines, assessment of outcome measures, e-mail summary, and SMS messages), rather than motivational and volitional components.

Intervention Mediators in a Randomized Controlled Trial to Increase Colonoscopy Uptake Among Individuals at Increased Risk of Familial Colorectal Cancer.

BACKGROUND: Understanding the pathways by which interventions achieve behavioral change is important for optimizing intervention strategies. PURPOSE: We examined mediators of behavior change in a tailored-risk communication intervention that increased guideline-based colorectal cancer screening among individuals at increased familial risk. METHODS: Participants at increased familial risk for colorectal cancer (N = 481) were randomized to one of two arms: (1) a remote, tailored-risk communication intervention (Tele-Cancer Risk Assessment and Evaluation (TeleCARE)) or (2) a mailed educational brochure intervention. RESULTS: Structural equation modeling showed that participants in TeleCARE were more likely to get a colonoscopy. The effect was partially mediated through perceived threat (ß = 0.12, p < 0.05), efficacy beliefs (ß = 0.12, p < 0.05), emotions (ß = 0.22, p < 0.001), and behavioral intentions (ß = 0.24, p < 0.001). Model fit was very good: comparative fit index = 0.95, root-mean-square error of approximation = 0.05, and standardized root-mean-square residual = 0.08. CONCLUSION: Evaluating mediating variables between an intervention (TeleCARE) and a primary outcome (colonoscopy) contributes to our understanding of underlying mechanisms that lead to health behavior change, thus leading to better informed and designed future interventions. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov , NCT01274143.

An implementation intention strategy can improve prospective memory in older adults with very mild Alzheimer's disease.

OBJECTIVES: This study tested whether (1) very mild Alzheimer's disease (AD) is associated with impaired prospective memory (PM) for tasks that are supported by either spontaneous retrieval (focal PM) or strategic monitoring (non-focal PM) and (2) implementation intention (II) encoding could improve PM performance in very mild AD. DESIGN: Thirty-eight healthy older adults and 34 with very mild AD were randomly assigned to perform two PM tasks in either the standard or the II encoding condition. METHOD: All participants performed blocks of category decision in which they were asked to respond to a focal PM target (e.g., the word 'orange') and a non-focal PM target (e.g., words that begin with the letter 'o'). Half of the participants encoded PM instructions in the standard manner, while the other half had a stronger encoding by forming IIs. PM accuracy and category decision accuracy and reaction times were measured. RESULTS: Participants with very mild AD showed deficits in both focal and non-focal PM performance compared to the healthy controls, reflecting deficits in both spontaneous retrieval and strategic monitoring. Participants with very mild AD in the II encoding condition showed better focal PM performance relative to those in the standard encoding condition. CONCLUSIONS: Deficits in both focal and non-focal PM are associated with very mild AD and IIs may be a helpful behavioural intervention for the focal PM deficits. PRACTITIONER POINTS: Multiple deficits in PM are observable in very mild AD. Implementation intentions may enhance focal PM in very mild AD. Future research using larger samples is needed to better understand the effect of II on non-focal PM tasks in healthy older adults and those with very mild AD. The use of simple laboratory PM tasks may limit the generality of our findings. Future research is needed to investigate whether IIs improve PM over a range of more realistic tasks.

Randomized test of a brief psychological intervention to reduce and prevent emotional eating in a community sample.

BACKGROUND: Emotional eating is associated with mental health problems and weight gain, but research has focussed on treatment rather than prevention. The present research tests a brief theory-based psychological intervention to reduce and prevent emotional eating in a community sample. METHODS: Two hundred and forty women were randomized to a control condition in which they were asked to identify emotional eating triggers and strategies for change (a 'volitional help sheet') or to an experimental condition in which they were asked explicitly to use the volitional help sheet to link emotional eating triggers with strategies for change and so form implementation intentions. RESULTS: Results showed that eating in response to boredom was more common than eating in response to anxiety or depression. There was a significant condition × time interaction showing that the formation of implementation intentions resulted in significantly lower levels of emotional eating in response to boredom at follow-up (d = 0.29). CONCLUSIONS: The intervention shows promise in reducing and preventing emotional eating, but further research is required to refine the tool and to examine whether eating in response to anxiety or depression is more common among clinical populations.

Targeting impulsive processes of eating behavior via the internet. Effects on body weight.

Because eating behavior can take on an impulsive nature many people experience difficulty with dieting to lose weight. Therefore, an experiment was conducted to test the effectiveness of two interventions targeting impulsive processes of eating behavior to facilitate weight loss: Implementation intentions to remind people about dieting versus a go/no-go task to change impulses toward palatable foods. Dieters performed an online training program (four times in 4 weeks) in which they were randomly assigned to a 2 (implementation intention condition: dieting versus control) × 2 (go/no-go task condition: food versus control) design. They formed either dieting implementation intentions (e.g., If I open the fridge I will think of dieting!) or control implementation intentions. Furthermore, they received either a go/no-go task in which behavioral stop signals were presented upon presentation of palatable foods (food go/no-go task), or upon control stimuli. Participants' weight was measured in the laboratory before and after the intervention. Strength of participants' dieting goal and their Body Mass Index (BMI; as a proxy for impulsiveness toward food) were examined as moderators. Results showed that both dieting implementation intentions and the food go/no-go task facilitated weight loss. Moreover, dieting implementation intentions facilitated weight loss particularly among people with a strong current dieting goal, whereas the food go/no-go task facilitated weight loss independent of this factor. Instead, the food go/no-go task, but not formation of dieting implementation intentions, was primarily effective among dieters with a relatively high BMI. These results provide the first preliminary evidence that interventions aimed at targeting impulsive eating-related processes via the internet can facilitate weight loss.

Effect of planning interventions on parent supervised oral health behaviors in primary school-age children: a randomized controlled trial.

OBJECTIVE: To compare the effect of planning interventions on self-reported changes in parents supervised oral health-related behaviors (OHRBs) and associated clinical oral health parameters for primary school-age children. METHOD AND MATERIALS: In total, 110 parent-child pairs (children aged 3 to 8 years) were randomly assigned to either of the two groups. In the "action planning" group, parent participants of the pair were asked to make an "action plan" using the "how, when, where" format for their child OHRBs. In the "implementation intention" group, parents were asked to form an "if-then plan" to improve OHRBs for their child. Self-reported changes on target OHRBs, change in plaque scores, change in plaque stagnation areas, and change in caries status of tooth surfaces were observed at 2, 8, and 12 weeks. RESULTS: Overall OHRBs scores changed significantly from baseline to 12 weeks for both interventions. The scores were significantly better with "if-then" planning than "action planning" (z = 4, P < .001) at 12 weeks. Plaque scores also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning (16.20 ± 5.24) than "action planning" (50.66 ± 11.24) at 12 weeks. The number of plaque stagnation areas also changed significantly from baseline to 12 weeks for both interventions, and improved significantly more with "if-then" planning at 12 weeks (12.80 ± 5.33) than "action planning" (42.76 ± 10.34) (t = -11.55, P < .001). There was significant change in the caries status of sound tooth surfaces with "action planning" at 12 weeks (z = 116.50, P = .023). There were no new caries lesions reported with "if-then" planning at 12 weeks. CONCLUSION: The study observed significant improvement in OHRBs and associated oral health parameters with planning interventions, preferring "if-then" planning over "action planning." It also elicited significant barriers to behaviors in action.

Evidence that implementation intentions reduce self-harm in the community.

OBJECTIVES: Implementation intentions are 'IF-THEN' plans that encourage goal-intended behaviour. This study was designed to test whether an intervention encouraging the formation of implementation intentions can reduce self-harm in the community. DESIGN: A randomized controlled design was used. METHODS: At pre-intervention, outcome variables (self-harm in both specified and unspecified critical situations and suicidality) and potential moderators of implementation intentions (goal intention, mental imagery, and exposure to self-harm) were measured using self-report questionnaires. The participants (N = 469, aged 18-66 years, 86.4% female, 6.8% male and 6.7% other) were then randomized to either an experimental (implementation intention) or control task. At three-months post-intervention, self-report questionnaires were used again to measure the outcome variables. RESULTS: There were no overall differences between the conditions at post-intervention. However, goal intention and mental imagery, but not exposure to self-harm, moderated the effects of condition on self-harm in specified critical situations. At high (mean + 1SD) levels of both goal intention and mental imagery, the experimental condition reported self-harming less frequently in the situations specified in their implementation intentions. CONCLUSIONS: Implementation intentions therefore represent a useful intervention for reducing self-harm in specified critical situations for people in the community who wish to avoid self-harm and those who frequently experience self-harm and suicide related mental imagery.

The Effect of Implementation Intentions on Prospective Memory Commission Errors under Different Cognitive Loads.

Prospective memory (PM) refers to the ability to remember to perform a planned event or activity at a specific time or situation in the future. Implementation intentions can promote a connection between PM cues and intended actions, thus improving an individual's PM performance. However, this simple and effective encoding strategy may also have negative effects. For example, an implementation intention may result in PM commission errors that occur when an individual makes a false PM response to repeated PM cues that are no longer relevant as the PM task has been completed. Existing studies have explored the effect of implementation intentions on PM commission errors under low cognitive load. However, the role of implementation intentions in promoting linkages between PM cues and actions tends to disintegrate under high cognitive loads. Therefore, this study aimed to explore the effect of implementation intentions on PM commission errors under different cognitive load conditions. In this study, 58 college students participated in a mixed experimental design of 2 (encoding methods: implementation intention, standard) × 2 (cognitive load conditions: low, high). The results showed that implementation intentions promoted PM commission errors under the low-cognitive-load condition only, and there was no difference in the performance of ongoing tasks between the implementation intention encoding and the standard encoding conditions. However, individuals in the implementation intention condition reacted more slowly when encountering previous PM cues. The results suggest that the effect of implementation intentions on PM commission errors relies upon automated processing as a whole. However, individuals in the implementation intention condition required more attentional resources to suppress the no-longer-relevant intended actions when previous PM cues appeared, supporting the dual-mechanism theory.

Instant habits versus flexible tenacity: Do implementation intentions accelerate habit formation?

Implementation intentions (strategic "if-then" plans) have been shown to support behaviour change. This may be achieved by mentally forming stimulus-response associations, thereby promoting habit formation. Does this deliberate attempt to instal "strategic automaticity" only offer advantages, or does it also come at the cost of reduced flexibility that characterises learnt habits? To investigate this, we tested healthy, young participants on a computerised instrumental learning task. Critically, we introduced implementation intentions ("if I see stimulus X, then I will respond") versus goal intentions ("for outcome Z, I will respond)" during instrumental acquisition, and subsequently assessed behavioural flexibility in an outcome-revaluation test. In Experiment 1, we conducted a between-subjects manipulation of strategic planning, and in Experiment 2, a within-subject manipulation. We hypothesised that implementation intentions would lead to strong stimulus-response associations and consequently impair performance when the signalled outcome value changed and therefore required a different response, while benefitting performance when the outcome value (and required response) remained the same. We found that implementation intentions supported instrumental learning, but impaired test performance overall (most robustly in Experiment 2), irrespective of whether the signalled outcome value had changed. We argue that this general detrimental effect of implementation intentions on test performance is likely a consequence of their negative effect on stimulus-outcome learning. Our findings warrant caution when applying if-then plans to situations where the agent does not already possess perfect knowledge of behavioural contingencies.While implementation intentions may support efficient and fast behavioural execution, this may come at the expense of behavioural flexibility.

Reducing binge eating through behavioral-focused versus emotion-focused implementation intentions in patients with binge eating disorder or bulimia nervosa: An experimental approach.

Binge eating disorder (BED) and bulimia nervosa (BN) are characterized by recurrent binge eating, episodes of consuming large amounts of food in a discrete period of time associated with a loss of control. Implementation intentions are explicit if-then plans that engender goal-directed action, and rely less on cognitive control than standard treatment options. In a sample with BED and BN, we compared two implementation intention conditions to a control condition. In the behavior-focused condition, implementation intentions targeted binge eating behaviors. In the emotion-focused condition, implementation intentions targeted negative affect preceding binge eating. In the control condition, only goal intentions were set. Each condition comprised three sessions. Participants kept food diaries for four weeks. Compared to the control condition both implementation intention conditions showed significant and large reductions of binge eating that persisted for six months. Effects did not differ between the behavior-focused and emotion-focused implementation intention conditions. These results demonstrate that three sessions on implementation intention formation can lead to long-term reductions in binge eating in patients with BED or BN. Learning how to form implementation intentions seems a recommendable addition to the current standard treatment. Future research could investigate the added value of fully personalized implementation intentions. CLINICAL TRIAL REGISTRATION NUMBER: NL52600.068.15.

A randomised controlled trial of volitional and motivational interventions to improve cervical cancer screening uptake.

OBJECTIVE: Cervical cancer is the fourth most common cancer to occur in women worldwide. In the UK, the NHS cervical screening programme invites eligible individuals to take part in screening every 3-5 years. At present, around 70% of individuals attend screening when invited. The present study aimed to test the effectiveness of a volitional and a motivational intervention alone and in combination on screening uptake at 16-week follow up. METHODS: 14,536 participants were recruited from the list of eligible participants invited for screening in Yorkshire, Humber and the North East regions of England in December 2021. They were randomised to a social norm-based motivational intervention (SNA); implementation intention-based Volitional Help Sheet (VHS); combined intervention (SNA + VHS); or treatment as usual control. The primary outcome was screening uptake measured via patient screening records at 16 weeks. RESULTS: Of the 14,466 participants with eligible data for analysis, 5793 (40.0%) attended for cervical cancer screening in the 16 weeks after the intervention mailing. Both age and deprivation influenced screening uptake, with lower uptake in the youngest individuals and those from more deprived areas. Compared to control, there was no evidence of any benefit from the VHS implementation intervention alone (Adj.OR = 0.99, 95% CI 0.90 to 1.10), the SNA motivational intervention alone (Adj.OR = 0.89; 95% CI: 0.80 to 0.99), or the combined intervention (Adj.OR = 0.96, 95% CI 0.86 to 1.06). CONCLUSION: The study did not support any benefit of either VHS or SNA interventions alone or in combination on cervical cancer screening uptake. It did demonstrate alarmingly low levels of screening uptake at 16 weeks which were well below the average rate. Future research needs to urgently investigate and understand the barriers to uptake following on from the COVID-19 pandemic.

Improving goal striving and resilience in older adults through a personalized metacognitive self-help intervention: a protocol paper.

BACKGROUND: Successful aging is often linked to individual's ability to demonstrate resilience: the maintenance or quick recovery of functional ability, well-being, and quality of life despite losses or adversity. A crucial element of resilience is behavioral adaptability, which refers to the adaptive changes in behavior in accordance with internal or external demands. Age-related degradation of executive functions can, however, lead to volition problems that compromise flexible adjustment of behavior. In contrast, the reliance on habitual control has been shown to remain relatively intact in later life and may therefore provide an expedient route to goal attainment among older adults. In the current study, we examine whether a metacognitive self-help intervention (MCSI), aimed at facilitating goal striving through the gradual automatization of efficient routines, could effectively support behavioral adaptability in favor of resilience among older adults with and without (sub-clinical) mental health problems. METHODS: This metacognitive strategy draws on principles from health and social psychology, as well as clinical psychology, and incorporates elements of established behavioral change and activation techniques from both fields. Additionally, the intervention will be tailored to personal needs and challenges, recognizing the significant diversity that exist among aging individuals. DISCUSSION: Despite some challenges that may limit the generalizability of the results, our MCSI program offers a promising means to empower older adults with tools and strategies to take control of their goals and challenges. This can promote autonomy and independent functioning, and thereby contribute to adaptability and resilience in later life. TRIAL REGISTRATION: Pre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz.

Coaching Strategies for Behavioral Voice Therapy and Training.

Coaching is one of the most common words in our modern vocabulary and has many meanings depending on the setting in which it is used. Coaching facilitates positive changes to achieve a goal, usually through indirect approaches, including improving an individual's outlook on their behaviors or attitudes. Its application has spread beyond the corporate world, and many medical specialties use coaching principles. The goals of this article are to introduce coaching as a profession, and to explore the function of a vocal coach to improve communicative and vocal performance. Moreover, differences between voice therapy and voice training are highlighted, including the principles subjacent to these interventions and the use of coaching strategies. Four strategies of professional coach practitioners adapted to the training and therapy of the voice with applications to both are described. These are: powerful questions, active listening, changing habits, and implementation intention. The use of these strategies may help individuals to achieve high voice performance. Most importantly, the speech-language pathologist voice specialist can apply these strategies particularly in cases of behavioral dysphonias, which can be resistant to traditional voice therapy.

Prospective memory performance and its improvement in individuals with high schizotypal traits: Evidence from eye-tracking studies.

OBJECTIVE: This study aimed to examine prospective memory (PM) performance and the potential effect of implementation intention on PM performance and the underlying mechanisms in individuals with high schizotypyal traits (HSTs) using eye-tracking paradigms. METHODS: In Experiment 1, 30 individuals with HSTs and 30 individuals with low schizotypal traits (LSTs) underwent a visual search task that involved PM cues, and participants' eye movements were recorded. In Experiment 2, 50 individuals with HSTs were randomly assigned to the implementation intention group and typical instruction group. RESULTS: In Experiment 1, individuals with HSTs had a lower PM accuracy and performed less PM cue monitoring (indicated by fewer total fixation counts on distractor words) than individuals with LSTs. In Experiment 2, implementation intention significantly improved PM accuracy and increased total fixation counts on distractor words in individuals with HSTs compared to the HST group with typical instruction. CONCLUSIONS: Individuals with HSTs were impaired in PM and showed reduced cue monitoring compared to individuals with LSTs. Implementation intention improved PM performance and facilitated cue monitoring in individuals with HSTs. SIGNIFICANCE: Our findings indicate that cue monitoring may be an important process of intervention target for PM for individuals in the schizophrenia spectrum.