How long do people stick to a diet resolution? A digital epidemiological estimation of weight loss diet persistence.

OBJECTIVE: To use Internet search data to compare duration of compliance for various diets. DESIGN: Using a passive surveillance digital epidemiological approach, we estimated the average duration of diet compliance by examining monthly Internet searches for recipes related to popular diets. We fit a mathematical model to these data to estimate the time spent on a diet by new January dieters (NJD) and to estimate the percentage of dieters dropping out during the American winter holiday season between Thanksgiving and the end of December. SETTING: Internet searches in the USA for recipes related to popular diets over a 15-year period from 2004 to 2019. PARTICIPANTS: Individuals in the USA performing Internet searches for recipes related to popular diets. RESULTS: All diets exhibited significant seasonality in recipe-related Internet searches, with sharp spikes every January followed by a decline in the number of searches and a further decline in the winter holiday season. The Paleo diet had the longest average compliance times among NJD (5.32 ± 0.68 weeks) and the lowest dropout during the winter holiday season (only 14 ± 3 % dropping out in December). The South Beach diet had the shortest compliance time among NJD (3.12 ± 0.64 weeks) and the highest dropout during the holiday season (33 ± 7 % dropping out in December). CONCLUSIONS: The current study is the first of its kind to use passive surveillance data to compare the duration of adherence with different diets and underscores the potential usefulness of digital epidemiological approaches to understanding health behaviours.

Practitioner perfectionism: relationship to ambiguity tolerance and work satisfaction.

Perfectionism among psychological practitioners is a common phenomenon, but a neglected topic in the research literature. This article presents data indicating that perfectionism is negatively related to both tolerance of ambiguity and satisfaction of conducting psychotherapy in a sample of 197 doctoral-level, private-practice psychologists. Results demonstrated that high, socially prescribed perfectionism and low tolerance of ambiguity are associated with reduced enjoyment of conducting psychotherapy. Several methods to self-evaluate and moderate perfectionism in clinicians are offered.

Conducting psychotherapy with psychotherapists II: clinical practices and collegial advice.

This study examined psychotherapists' experiences in conducting treatment with fellow mental health professionals. 349 psychologists (35% response) rated the extent to which their therapeutic approach with psychotherapists differed from their approach with laypersons of comparable intelligence, socioeconomic status, and diagnosis. Respondents also provided recommendations for conducting effective treatment with this elite clientele. Psychologists indicated that their practices with fellow psychotherapists were in most respects similar to those used with laypersons; 55 of the 78 items were rated of equivalent frequency. Practitioners' self-characterization as "a therapists' therapist" was related to the manner in which they treated mental health professionals. Broadly speaking, two types of advice were offered: to cultivate a warm and collaborative therapeutic relationship and to maintain proper boundaries. Recommendations for clinical work and future research on psychotherapists' psychotherapy are advanced.

Treating anger in psychotherapy: introduction and cases.

Although client anger is a ubiquitous presenting problem for psychotherapy and a challenging in-session phenomenon for the psychotherapist, it has been oddly neglected by the clinical community. This article introduces an issue of In Session devoted to the conceptualization and treatment of anger in psychotherapy from multiple theoretical perspectives. The authors generate consensual definitions of anger, aggression, and hostility and then provide two case vignettes that the contributors address in their subsequent articles. Both technical diversity and strategic convergence, it is suggested, are required to enhance the effective treatment of anger disorders.

A bibliography of mental patients' autobiographies: an update and classification system.

OBJECTIVE: This article brings to the present earlier bibliographies of books written by former mental patients. These books provide an inside view of mental disorder that can be useful in teaching, public education, theory, and research, and they have played a catalyzing role in mental health reform and in theory development. METHOD: The authors list seven anthologies and 48 autobiographies of former patients published since 1980 and introduce a classification system intended to increase the research value of this important archive. RESULTS: Recent books of this genre show more individuals with a mood disorder and more therapists and more women as authors. CONCLUSIONS: The research potential of these books suggests the value of an electronic database for classifying and retrieving the information they contain.

Admission requirements, acceptance rates, and financial assistance in clinical psychology programs. Diversity across the practice-research continuum.

129 directors (80% response) of APA-accredited clinical psychology programs provided information pertaining to admission requirements, acceptance rates, financial assistance, and theoretical orientations. Summary data are presented and comparisons are made among 4 types of clinical programs: PsyD programs, practice-oriented PhD programs, equal-emphasis PhD programs, and research-oriented PhD programs. Clinical doctoral programs held similar expectations for undergraduate preparation in psychology, but robust differences emerged on preferred Graduate Record Examination scores, acceptance rates, and financial assistance. In the most extreme comparison (PsyD vs. research-oriented PhD programs), students were 4 times more likely to gain acceptance but 6 times less likely to receive full financial assistance in PsyD programs. Implications of these results for potential graduate students and for the future of applied psychology programs are briefly discussed.

Looking weakly in all the wrong places? Comment on Shapiro et al. (1994).

This invited comment applauds the impressive outcome study conducted by Shapiro and his colleagues (1994) in which psychodynamic-interpersonal therapy was compared with cognitive-behavioral therapy in the treatment of depression. Our limited argument with their article is the uncritical support accorded to the equivalent outcomes conclusion and the implicit rejection of differential efficacy among the psychotherapies as a function of patient variables. Two principal objections are that Shapiro et al. overestimated the statistical power of their analyses to detect genuine interactions and selected variables that are not particularly relevant or amenable to psychological treatment.

In search of how people change. Applications to addictive behaviors.

How people intentionally change addictive behaviors with and without treatment is not well understood by behavioral scientists. This article summarizes research on self-initiated and professionally facilitated change of addictive behaviors using the key trans-theoretical constructs of stages and processes of change. Modification of addictive behaviors involves progression through five stages--pre-contemplation, contemplation, preparation, action, and maintenance--and individuals typically recycle through these stages several times before termination of the addiction. Multiple studies provide strong support for these stages as well as for a finite and common set of change processes used to progress through the stages. Research to date supports a trans-theoretical model of change that systematically integrates the stages with processes of change from diverse theories of psychotherapy.

Attendance and outcome in a work site weight control program: processes and stages of change as process and predictor variables.

This naturalistic study assessed client changes during treatment and identified salient predictors of therapy attendance and outcome. Subjects were assessed on processes and stages of change, self-efficacy, social support, weight history (including expectations, goals, and reasons for losing weight), and demographics at the beginning, middle, and end of a 10-week, behaviorally oriented work site program for weight control. Significant shifts from contemplation to action occurred for clients remaining in treatment. There were also significant modifications in the use of change processes as a result of treatment: counterconditioning, contingency management, stimulus control, interpersonal control, and social liberation increased while medication use, wishful thinking, and minimizing threats decreased. Change processes employed during the early portion of the group treatment were the best predictors of treatment attendance and outcome, superior to self-efficacy, social support, weight history, and demographic variables. The results supported a transtheoretical model that emphasizes dynamic processes and stages as core dimensions for understanding how people change.

Treating ourselves vs. treating our clients: a replication with alcohol abuse.

In an attempt to replicate previous findings, this study compared the change processes that psychologists report using when treating clients (n = 132) and when treating themselves (n = 140) for alcohol abuse. The results essentially replicated earlier research in that employment of particular change processes varied as a function of theoretical orientation for psychologists' client change but not for psychologists' self-change. Several processes, such as stimulus control and self-liberation, were employed more often with self-change, but medication more often with clients. Five possible explanations for this pattern and a general "facilitation effect" are discussed.

Concurrent validation of the Levels of Attribution and Change (LAC) Scale.

This study examined the temporal reliability and concurrent validity of the LAC Scale, a multidimensional measure of the loci of causal attributions, in a sample of 95 college students. Test-retest coefficients for the 10 subscales averaged .78 for a 2-week interval and .70 for 4 weeks. Six of seven hypotheses related to concurrent validity were supported empirically, including predicted interrelations between the LAC and social desirability, distress severity, psychological-mindedness scores, and the expanded Attributional Style Questionnaire. It is concluded that the LAC Scale is an internally and temporally reliable instrument that possesses concurrent validity and that measures attributional dimensions largely independent of the ASQ.

The movement toward integrating the psychotherapies: an overview.

There is a growing tendency among psychotherapists to ignore the ideological barriers dividing schools of psychotherapy and to define what is common among them and what is useful in each of them. After a brief introduction the authors provide a short glossary of terms often associated with psychotherapy integration. They then characterize integrative-eclectic therapists, describe the forces fostering their emergence, and outline recurrent themes of the movement and points of contention within it. The authors hope to encourage clinical thinking about the less ideological approaches to psychotherapy and to advance the integrative movement, which is likely to influence psychotherapeutic practice for decades to come.

Ringing in the new year: the change processes and reported outcomes of resolutions.

This study tracked the coping processes and self-reported outcomes of 213 adults making New Year's resolutions in order to identify prospective variables which predict successful self-change and to examine the relative effectiveness of various coping strategies. Prior to January 1st, participants provided information on their resolutions, demographic characteristics, and five variables previously associated with positive outcome. Subsequent telephone interviews ascertained short-term retrospective accounts of the utilization of 14 coping strategies and self-reported outcomes over six months. Readiness to change and self-efficacy, but not social support or behavioral skills, prospectively predicted successful outcome at both one week and one month. Successful resolvers were also found to report employing significantly more behavioral strategies and less self-blame and wishful thinking than unsuccessful resolvers. These findings are discussed within the context of previous research on self-initiated change, and several implications for clinical practice are offered.

Correlates of the Egocentricity Index in child and adolescent outpatients.

This study examined the Rorschach and MMPI covariates of Exner's Egocentricity Index, 3r + (2): R, in a sample of child and adolescent outpatients (n = 46). Consistent with previous findings on adult psychiatric inpatients (Barley, Dorr, & Reid, 1985), significant positive correlations were obtained between the Index and M, FM, X + %, and D when controlled for the number of protocol responses. The Egocentricity Index was negatively associated with lambda and, in a subsample of adolescents (n = 19), depression scores. The index bore no significant relationship to either Minnesota Multiphasic Personality Inventory (MMPI) validity or clinical scales, also congruent with earlier investigations. Implications for the interpretation of childrens' Egocentricity Indices are discussed.

The resolution solution: longitudinal examination of New Year's change attempts.

This study prospectively tracked the self-change attempts of 200 New Year's resolvers over a 2-year period in order to more fully understand the coping determinants of maintenance and the natural history of lapses and relapses. Seventy-seven percent maintained their pledges for 1 week but only 19% for 2 years. Successful resolvers reported employing significantly more stimulus control, reinforcement, and willpower than the unsuccessful over the 2 years; social support and interpersonal strategies failed to predict success before 6 months but did so thereafter. Counterconditioning and fading were retrospectively nominated as the most efficacious coping strategies; paucity of willpower and failure of stimulus control were reported as the most hindering to maintenance. Fifty-three percent of the successful group experienced at least one slip, and the mean number of slips over the 2-year interval was 14. Slips were typically precipitated by a lack of personal control, excessive stress, and negative emotion.

The therapist's therapist.

The authors present questionnaire data from 509 psychologists, psychiatrists, and social workers on their personal treatment experiences. The findings address the relative importance of various therapist selection criteria, the professional and personal attributes of the chosen therapist, and the nascent trend of seeking more female and nonmedical psychotherapists.

Self-change of psychological distress: laypersons' vs. psychologists' coping strategies.

This study investigated the change processes that laypersons (N = 270) and psychologists (N = 158) reported using to overcome psychological distress. Eighty-nine percent of the community sample and 82% of the professional sample experienced at least one episode of distress. Interpersonal relationships and willpower strategies were employed commonly in both samples; medication was used infrequently. Gender, education, and previous treatment were related to coping processes among laypersons. A comparative analysis indicated that, relative to laypersons, psychologists exhibited a larger and more varied repertoire of coping strategies.

Predicting change in smoking status for self-changers.

Fourteen different measures were investigated as predictors of change in smoking status for self-change efforts at smoking cessation. Adult subjects (N = 866) were classified into five stages of change: precontemplation, contemplation, action, maintenance, and relapse. Subjects were assessed on 10 change processes, self-efficacy, temptations to smoke, and their decisions weighing the advantages and disadvantages of smoking; and these 14 variables were used as predictors of change in smoking status 6 months later. Six significant functions were found which predicted movement for each of the stages. These predictors are of both theoretical interest and practical significance because they may be modified in self-change efforts to overcome addictive behaviors. Overall, the change processes of self-reevaluation and the helping relationship and the self-efficacy and decisional balance variables were the most efficacious predictor variables. A general pattern emerged in which processes oriented more toward environmental events, such as dramatic relief and social liberation, tended to predict failure or no progress whereas more experientially oriented processes predicted progress.