Choosing to engage and choosing to persist: The role of non-specific factors in health-promoting activities.

OBJECTIVE: Non-specific factors play an important role in determining benefits from health-promoting activities. Previous studies have focussed on beneficial outcomes of motivation during engagement. There are two aims of this project. First, we investigated whether expectancy and intrinsic motivation influence people's decisions to engage with health-promoting activities in the first instance and then subsequently adhere to them. Second, we examined the effects of providing information on health-promoting activities as a method of influencing expectancy and intrinsic motivation. METHOD: In two studies, participants were informed about a health-promoting activity (Study 1: A breathing exercise for well-being; Study 2: A gratitude exercise for smoking cessation) and told that it has either a 'known' or 'unknown' effectiveness. Participants were then given the opportunity to engage with the activity over the following days. Expectancy and intrinsic motivation were measured after reading the information and prior to engagement with the activity. Adherence to the activity was measured at follow-up. RESULTS: In both studies, intrinsic motivation positively predicted willingness to engage with the activities as well as subsequent adherence. Expectancy predicted adherence in Study 1 and choices to engage in Study 2, but not after controlling for intrinsic motivation. Describing the gratitude exercise as having a known effectiveness in Study 2 enhanced motivation and adherence to the activity. CONCLUSIONS: The non-specific benefit brought by intrinsic motivation plays an important role in choosing to engage with health-promoting activities as well as subsequent adherence. Our results also show that simple statements about the potential benefits of a health-promoting activity can motivate engagement and adherence. Statement of contribution What is already known on this subject? Previous studies have established that non-specific factors, namely expectancies and intrinsic motivation, play an important role in determining benefit when engaging in health-promoting activities. These studies have neglected how non-specific factors relate to initial choices to engage in health-promoting activities in the first instance. Intrinsic motivation has been found to be more strongly related to benefit than expectancies in real-world health-promoting activities. What does this study add? Intrinsic motivation predicts choices to engage with a health-promoting activity. Simple statements about benefits of a health-promoting activity motivate engagement.

Common Factor Mechanisms in Clinical Practice and Their Relationship with Outcome.

UNLABELLED: This study investigates three common factor mechanisms that could affect outcome in clinical practice: response expectancy, the affective expectation model and motivational concordance. Clients attending a gestalt therapy clinic (30 clients), a sophrology (therapeutic technique) clinic (33 clients) and a homeopathy clinic (31 clients) completed measures of expectancy and the Positive Affect and Negative Affect Schedule (PANAS) before their first session. After 1 month, they completed PANAS and measures of intrinsic motivation, perceived effort and empowerment. Expectancy was not associated with better outcome and was no different between treatments. Although some of the 54 clients who endorsed highest expectations showed substantial improvement, others did not: 19 had no change or deteriorated in positive affect, and 18 had the same result for negative affect. Intrinsic motivation independently predicted changes in negative affect (ß = -0.23). Intrinsic motivation (ß = 0.24), effort (ß = 0.23) and empowerment (ß = 0.20) independently predicted positive affect change. Expectancy (ß = -0.17) negatively affected changes in positive affect. Clients found gestalt and sophrology to be more intrinsically motivating, empowering and effortful compared with homeopathy. Greater improvement in mood was found for sophrology and gestalt than for homeopathy clients. These findings are inconsistent with response expectancy as a common factor mechanism in clinical practice. The results support motivational concordance (outcome influenced by the intrinsic enjoyment of the therapy) and the affective expectation model (high expectations can lead for some clients to worse outcome). When expectancy correlates with outcome in some other studies, this may be due to confound between expectancy and intrinsic enjoyment. KEY PRACTITIONER MESSAGE: Common factors play an important role in outcome. Intrinsic enjoyment of a therapeutic treatment is associated with better outcome. Active engagement with a therapeutic treatment improves outcome. Unrealistic expectations about a therapeutic treatment can have a negative impact on outcome.

Mood enhancement in health-promoting non-aerobic exercise: the role of non-specific mechanisms.

Eighty participants took part in a 5-day intervention Qi Gong study to enhance well-being and were randomised to either positive or body focus and either high or low hand position. The high hand position improved negative affect and was reported more intrinsically motivating but was unrelated to perceived effort. Positive focus produced better positive affect. For all groups combined, intrinsic motivation and effort predicted all three outcomes. The association between expectancy and perceived benefit was mediated via intrinsic motivation and perceived effort. Results support motivational concordance and positive focus as mechanisms of benefit but not response expectancy.

Nonspecific mechanisms that enhance well-being in health-promoting behaviors.

OBJECTIVE: We tested whether the nonspecific or placebo enhancement of well-being brought about by a health-promoting behavior was due to expectancy having an unmediated effect on outcome (response expectancy theory) or because expectancy was mediated through the behavioral and affective consequences of positively valued goal satisfaction (motivational concordance theory). METHOD: Fifty-seven participants completed a breathing exercise (a simplified Buteyko technique) purporting to enhance well-being over a period of 4 days. Participants were randomized to receive either easy or difficult task instructions. Expectancy was measured at baseline and perceived effort (as an indicator of motivation) and adherence were measured at follow-up. Well-being was measured by perceived change in well-being at follow-up and by change in the Positive and Negative Affect Scale between baseline and follow-up. RESULTS: Expectancy (r = .42), adherence (r = .57), and effort (r = .90) correlated with perceived benefit. Multiple regression and mediation analysis showed that effort predicted (p < .01) well-being independently of expectancy for all 3 measures of well-being, and that where expectancy predicted outcome, its effect was mediated by effort. Adherence failed to predict additional variance to outcome compared with effort and expectancy. CONCLUSION: These results are consistent with the hypothesis that placebo effects in therapeutic contexts are mediated via the affective consequences of performing a motivated ritual.