Study guide with article summaries for Health and Medical Psychology at Leiden University - 2020/2021

An intake interview is an assessment interview. Before initiating counselling, psychotherapy, or psychiatric treatment, it is necessary and wise to conduct an intake interview.

In an intake interview, there are a number of questions that will be addressed.

What is an intake interview?

An intake interview is an assessment interview. Before initiating counselling, psychotherapy, or psychiatric treatment, it is necessary and wise to conduct an intake interview.

In an intake interview, there are a number of questions that will be addressed, which often include:

• Is the client suffering from a mental, emotional, or behavioural problem?
• If so, are his or her mental, emotional, or behavioural problems sufficient to require treatment?
• What form of treatment should be provided to the client?
• Who should provide the treatment and in what setting?

The intake interview procedures have been affected by managed care mental health programs. Today, practitioners need to be faster and more efficient in identifying client problems, establishing treatment goals, and outlining an expected treatment course. However, increasing speed does not always reflect efficiency. For example, when individuals need to work faster, it does not matter whether they are baking cakes, building cabinets, or something else: quality can always be compromised.

What about settings and professional groups?

An intake interview before treatment is necessary, no matter whether the setting is a social service agency, hospital, mental health center, college counselling center, or a private office. It also does not matter whether the interviewer is a social worker, psychiatrist, psychologist, or counsellor: all practitioners must have the ability to conduct an adequate intake interview. However, the nature and the focus of intake interviews varies depending on the type of practitioner, the setting, and the purpose of the interview, but even then there is more consistency than variation.

Often an intake interview is called ‘an intake’. For example, the intake interview is the entry point for clients who seek professional mental health assistance. Intakes however are not designed to help clients to resolve their problems, the only goal is assessment.

What are the objectives of intake interviewing?

There are three objectives of intake interviews:

1. Identifying, evaluating, and exploring the client’s chief complaint and associated therapy goals
2. Obtaining a sense of the client’s interpersonal style, interpersonal skills, and personal history.
3. Evaluating the client’s current life situation and functioning

To achieve these objectives (goals), one needs adequate skills and attentiveness to interpersonal processes and informational content. An additional goal of intake interviews is to communicate the results of the intake, often to other professionals or other interested parties. Often, in mental health settings, one also writes a report of the intake interview.

Identifying, evaluating, and exploring the client’s complaints and therapy goals

It is important to first understand what the client’s problem is. This can be achieved by asking: “Why are you here? How can I help you?”. After the opening statement, the interviewer should spend 5 to 15 minutes observing the client and try to understand their answers. Sometimes clients are clear, and sometimes it is unclear. It is also the task of the interviewer to help clients orient toward solutions early in the counselling process. Behind every client problem, there is a client goal. Common problems are anxiety, depression, and relationship conflicts. Problems can be very broad, and there is a wide range of symptoms, and therefore interviewers need to have general knowledge of psychopathology and DSM-IV-TR. Early in the intake, the interviewers can help clients to re-frame their problem statements into goal statements. For example, when a client is talking about anxiety, interviewers can translate language into something positive:

“I hear you talking about nervousness and anxiety. If I did understand you correctly, what you are saying is that you want to feel more relaxed and calm. I guess that therefore one of your general goals for therapy might be to feel calm and relaxed more often, is that right?”.

By re-framing, interviewers help clients to feel more hopeful and this also leads to a positive, therapeutic goal-setting process.

Prioritizing and selecting client problems and goals

Most clients come to an intake interview with a more than one problem. Then, after asking and observing the client for 5 to 15 minutes, the interviewer has to create a list of primary problems and goals. This is called a transitioning from client free expression to more structured interactions. This has two purposes: it allows the interviewer to check for any additional problems, and the transition begins the process of problem prioritization, selection, and goal setting.

Analyzing symptoms

After the interviewer has identified a primary problem together with the client, then there should be a thorough analysis of the problem, including emotional, cognitive, and behavioural aspects. This includes answering the following questions:

1. When did the problem or symptoms first occur? (In some cases, the symptom is one that the client has experienced before. If so, you should explore its origin and more recent development and maintenance).
2. Where were you and what exactly was happening when you first noticed the problem? (What was the setting, who was there, etc.?)
3. How have you tried to cope with or eliminate this problem?
4. Which efforts have been most effective?
5. Can you identify any situations, people, or events that usually precede your experience of this problem?
6. What exactly happens when the problem or symptoms begin?
7. What thoughts or images go through your mind when it is occurring?
8. Do you have any physical sensations before, during, or afterwards?
9. Where and what do you feel in your body? Describe it as precisely as possible
10. How frequently do you experience this problem?
11. How long does it usually last?
12. Does the problem affect or interfere with your usual ability to function at work, at home, or at play?
13. In what ways does it interfere with your work, relationships, school, or recreational pursuits?
14. Describe the worst experience you have had with this particular symptom. When the symptom is at its worst, what are your thoughts, images, and feelings then?
15. Have you ever expected the symptom to occur and it did not occur, or it occurred only for a few moments and then disappeared?
16.  If you were to rate the severity of your problem, with 1 indicating no distress and 100 indicating so much distress that it’s going to cause you to kill yourself or die, how would you rate it today?
17. What rating would you have given your symptom on its worst day ever?
18. What’s the lowest rating you would ever have given your symptom? In other words, has it ever been complete absent?
19. As we have discussed your symptom during this interview, have you noticed any changes? (Has it gotten any worse or better as we have focused on it?)
20. If you were to give this symptom and its effects on you a title, like the title of a book or play, what title would you give?

The order of these questions is good, but it is not standard. Before conducting an interview, one can review a list of questions similar to these and re-word them to fit your own style. You can also add new questions and delete others.

How can we use problem conceptualization systems?

To analyse client problems, some researchers suggest to use organized problem conceptualization systems. These systems are theory-based, but some are more eclectic. These systems guide interviewers by analysing and conceptualizing problems with strict attention to predetermined, specified domains of functioning.

Lazarus developed a ‘multimodal’ behavioural-eclectic approach. He developed the BASIC ID to represent a seven-modality system:

• Behavior. This means that specific, concrete behavioural responses are analysed. This is especially about behavior that clients engage in too often or too infrequently. For example, positive or negative habits or reactions. A question could be: “Are there some things you would like to stop doing?”
• Affect. Affect includes feelings, moods, and other emotions. A question could be: “What makes you happy?”
• Sensation. This is about sensory processing of information. Some clients report physical symptoms associated with high levels of anxiety. A question could be: “What happens to cause you those unpleasant situations?”
• Imagery. Imagery refers to internal, visual cognitive processes. Clients often experience pictures/images of themselves or of past/future events that affect them. A question could be: “When you are feeling anxious, what images come to your mind?”
• Cognition. According to Lazarus, it is important to closely evaluate client thinking patterns and beliefs. This usually includes an evaluation of distorted or irrational thinking patterns that occur almost automatically. A question could be: “When you meet someone new, what thoughts go through your mind?”
• Interpersonal Relationships. This is about communication skills, relationship patterns, and assertive capabilities. A question could be: “What words would you sue to describe the positive or health relationships that you have?”
• Drugs: This is about biochemical and neurological factors that can affect behavior, emotions, and thinking patterns. A question could be: “Are you participating in any regular physical exercise?”

This model emphasizes cognitive processes, and neglects spiritual, cultural, and recreational domains. There is another model, the ABC model: behavioural Antecedents, the Behavior or problem itself, and the behavioural Consequences. Interviewers can apply the following ABCs with their clients:

1. What events, thoughts and experiences precede the identified problem?
2. What is the precise operational definition of the problem?
3. What events, thoughts, and experiences follow the identified problem?

What are syndromes?

A syndrome is a set of responses that usually occur together. When you identify a symptom, it is important to explore it and to identify accompanying symptoms. One can use the DSM-IV-TR and the ICD-10 for this.

What about background and historical information?

In an intake interview, there are three sources of information used to assess the client’s personality and mental condition:

1. The client’s personal history
2. The client’s manner of interacting with others
3. Formal evaluation of client mental status.

How can we identify the client’s personal history?

After spending 15 to 25 minutes exploring the present problem, it is important to understand the reasons for why the client is seeking counselling. It is also important to explore the personal or psychosocial history, this can be done with ‘the question’:

“I think I understand why you are coming here for counselling. However, I wonder why you are coming now.”

This question aims to identify why the client is seeking help at this particular time in their life. It helps to determine whether a specific event lead to the referral. After the client answers the question, you can shift the interview’s focus from the problem to the person. For example, you can say:

“We discussed the concerns that caused you to come for counselling. Now I would like to try to get a more complete sense of how you have become the person you are today. One of the best ways for me to do that is to ask you some questions about your past.”

It is important to be nondirective: clients reveal significant information simply by what they choose to focus on and by what they choose to avoid to talk about. After a nondirective period of for example 2 to 5 minutes, there can be more structure provided and one can ask specific questions about their past. For example, many clients do not like to talk freely about their childhood: they like some structure and guidance. You can provide some structure by asking: “What is your earliest memory?”.

How to assess current functioning?

After exploring historical and interpersonal issues, interviewers should make one more shift and focus on current functioning. It is also important not to end an interview with a focus on the past. In the end of the interview, it is important to encourage clients to focus on personal strengths and environmental resources, and not on past problems.

Much of the stress that people experience is from worrying about the past or about the future. When one focuses on what one is doing now, there is no room to think about anything else. Mindfulness meditation is a form of meditation that can help to achieve deep relaxation and insight. It is a way to create a harmonious relationship with what is. Whatever you focus your attention one, you should always keep a gentle, non-judgmental and embracing attitude.

What is this chapter about?

Much of the stress that people experience is from worrying about the past or about the future. When one focuses on what one is doing now, there is no room to think about anything else. Mindfulness meditation is a form of meditation that can help to achieve deep relaxation and insight. It is a way to create a harmonious relationship with what is. Whatever you focus your attention one, you should always keep a gentle, non-judgmental and embracing attitude.

What is eating meditation?

The authors describe a conscious-eating meditation. They use a sandwich as an example, and state that you should: note the colour, shape, and texture of the sandwich and you should evaluate how you feel toward it. You should also be aware of your intention to begin eating: when you lift the sandwich, be aware of the lifting movement. Smell the food, and also feel how your teeth penetrate the bread. How does the food feel in your mouth? When you swallow, try to be aware of how the muscles contract and relax. Lastly, as you continue to each your sandwich, try to be aware of as many sensations as you can.

They also describe a walking meditation, and seeing meditation, which is pretty fun to read.

How can mindfulness be used for pain or discomfort?

People often try to resist pain. However, the more they resist it, the more it hurts. An alternative way is to soften around it: acknowledge the pain’s presence, and them allow yourself to experience whatever it is that hurts. When you do this, you relax your tense and you focus on the hurting itself. Softening also means that you notice but disregard your thoughts about how awful the discomfort is.

In 2014, 31% of working adults felt tension or stress, and 61% reported that they had enough resources to deal with this stress. A low salary and a lack of opportunities for growth were the most common sources of stress. Job insecurity is also in the top 5. Furthermore, uncertain job expectations and long working days were also in the top 5. With regard to interventions against work stress, the emphasis has probably been too much on 'red cape interventions' with the intention of stopping negative experiences, instead of on the 'green cape interventions', interventions with the aim of growing positive experiences. An example for the focus in this is increasing the employee resources. In this article, literature about stress management interventions is summarized, with an emphasis on green cape interventions.  

Theoretical framework

The authors use the job demands-resources (JD-R) model, a dual process model. This model reflects two mechanisms through which job demands and resources can lead to tension or motivation that subsequently influences organizational and individual outcomes. The first process is a health limiting process in which poorly designed jobs and chronic demands lead to poorer outcomes for employees and companies by exhausting the mental and physical resources of the employee. The second process, a motivational process, assumes that sources (for example, control, autonomy and feedback) can be motivators because they can help to achieve work goals or stimulate growth and development. This motivational process is especially important for health promotion and positive interventions. In particular, the mediating effect of burnout and work engagement between job demands and resources on the one hand, and well-being on the other, is supported by literature.      

Stress management interventions

Stress management interventions in 2008

The authors have categorized the different interventions into three categories: primary interventions are proactive and aimed at prevention and focuses on all employees, secondary interventions focus on employees at risk, and tertiary interventions focus on employees who need stress experienced guidance to to recover from this. Primary interventions are seen as the most effective, followed by secondary interventions and finally the tertiary interventions. Three meta-analyzes showed that stress management interventions are effective, but this seems to depend on the outcome being measured. Relaxation interventions are less effective than cognitive behavioral interventions. This is perhaps because relaxation is not aimed at changing cognitions but at letting go. CBT interventions are proactive. Moreover, a multimodal approach combining different types of interventions is no more effective than a unimodal approach, because it requires much more from the participant's resources. A system approach, in which both individual and organizational interventions are combined, is more effective because it does not necessarily exhaust the resources of the individual. The organization-oriented interventions are primary interventions and are the least researched. Whether these interventions are effective on their own is not yet clear.          

Recent developments

Mindfulness based interventions

In recent years there has been an increase in the number of interventions that use mindfulness techniques. The definition of mindfulness is "a state of giving attention to and awareness of what is taking place in the present." It could reduce employee stress by accepting an event and not judging it. The mindfulness-based interventions that are now being discussed are primary: aimed at all employees. According to a study by Wolver and colleagues, workers in the mindfulness and yoga condition experienced significantly a reduction of stress and improvement of sleep quality. There were also differences in heart rate variability and breathing, but no differences in blood pressure and work productivity. The intervention was just as effective when it was offered online as when it was done in real life. Research by Hülsheger and colleagues focused on the Mindfulness-Based Stress Reduction Program and Mindfulness-Based Cognitive Therapy. There was a significant decrease in emotional exhaustion and an increase in job satisfaction. Michel and colleagues (2014) found that participants who took a mindfulness intervention could psychologically detach themselves better from their work and experience less work-family conflict and were more satisfied with their work. Loving-kindness meditation also led to more positive affect, self-efficacy and job satisfaction and less psychological stress.           

Recovery interventions

Another intervention type focuses on facilitating experiences and improving processes that can reduce the negative effects of work stress. Hahn and colleagues (2011) studied the effectiveness of a recovery program consisting of four modules: psychological detachment from work, mastery, relaxation, and a check during leisure time. It consisted of two sessions of 4 to 5 hours. Improvement in all four areas was observed, as well as a decrease in stress and negative affect and a significant increase in self-efficacy. Siu and colleagues (2014) also showed positive results: higher scores on positive emotions and mastery and lower on emotional exhaustion and physical and psychological symptoms. However, the results were not statistically significant. Finally, there was an intervention that was tertiary and lasted 12 months. However, there was no standardization and no control group, so this means that no conclusions can be drawn.     

Multimodal interventions

Multimodal interventions consist of elements from different types of interventions, and are primary: available for all employees. Eisen and colleagues (2008) studied an intervention consisting of general stress education, stress reduction techniques, and progressive relaxation. They compared a group intervention with a computer-based intervention. In both groups there was a decrease in stress after each intervention module. However, there was no global decrease in stress after the intervention or a month later. The authors blame this on the fact that employees have not applied the skills learned in their daily lives. There were also a lot of dropouts in the computer group. Bourbonnais et al. (2011) investigated an intervention aimed at improvement in various psychosocial work factors. Three years after the intervention there was a significant improvement in almost all factors that were part of the study. Moreover, there was a decrease in work-related stress and burnout. The effectiveness of this intervention is probably due to the risk assessment that led to the development of the intervention. Cifre et al. (2011) did an intervention focused on the JD-R model. First they mapped out the psychosocial risk factors: few resources in the job (e.g. autonomy), innovation climate and perceived quality of training. Based on this analysis, they did a team redesign consisting of job redesign and training. This was a secondary intervention. The intervention led to increased self-efficacy and competence, perception of innovation climate and work involvement. Another intervention, Workplace Triple P (WPTP) is specially designed for parents with a job with the aim of building personal resources and coping behavior. It reduces dysfunctional parenting which in turn reduces general stress levels. This in turn led to a reduction in work-related stress.              

Summary and future research

There have been a number of new interventions since the meta-analysis by Richardson and Rtohstein (2008), namely mindfulness focused interventions, recovery interventions and multimodal interventions. Some studies had poor methodology, and most were primary and focused on individual outcomes. In addition, the measurements mainly consisted of self-reports. It must become more clear a) which outcomes are influenced by which types of interventions / activities, b) for whom an intervention type or specific intervention is most effective, c) the specific causal mechanisms.    

Health promotion and workplace welfare programs   

Stress management programs are generally red cape programs. Health promotion and well-being programs, on the other hand, are usually green cape programs because they focus on improving and promoting health. Madsen (2003) reported that welfare programs increase the emotional, intellectual, physical, social and spiritual well-being of employees, where well-being is defined as functioning at the highest possible level of yourself. Well-being programs in the workplace can focus on communication and awareness, or screening and assessment. A third category focuses on lifestyle and education programs. The latter category focuses on behavioral change and support. Previous research has shown that these programs have positive results for organizations, but there is not yet a lot of research into changes in employee behavior. Parks and Steelman (2008) found that it reduces absence and increases satisfaction.        

System approaches

Byrne et al. (2011) investigated annual assessments over a period of 7 years. It was a primary intervention focused on health risk assessment and educational video to raise employee awareness. It also included a lifestyle management tool to encourage employees to set specific goals to reduce their health risk and maintain their health. They found that most risk factors improved over time, but the biggest difference was between the first and second year of the intervention. There was clear evidence of lasting improvements in terms of increased physical activity, improved nutrition, less smoking, and an increase in the use of a seat belt. The implementation of health promotion programs in the workplace started in 1970, and about 70% of large and more than 50% of medium-sized organizations have such a program. Lincoln Industries is a small company that has implemented such a program. The primary purpose of this welfare program is to improve physical fitness and nutrition and increase employee satisfaction. It consists of health screenings and three activities in which employees can participate. Merrill et al. (2011) observed significant improvements in body fat, blood pressure and employee flexibility, with the greatest results among older employees and those with the highest risk factors. There was also an overall improvement in physical and mental health. One of the factors that contributed to this success is the culture of health created by Lincoln Industries' senior staff. Most health promotion programs take a medical perspective and focus on behaviors that are risky to health. Little work is done with positive psychology.    

Positive psychology interventions

Positive psychology interventions focus on increasing positive aspects of well-being and therefore not only on negative outcomes. An advantage is that individuals can often do this themselves. Only a few studies have looked at positive psychology in the workplace. Writing down things that you are grateful for at work leads to an increase in gratitude and work-related well-being. Writing down three positive things per working day also leads to less stress, fewer mental and physical health problems and being able to distance yourself better from work. It also reduces the negative effects of work-family conflict.   

Directions for future research

This article has shown that there is evidence that stress management interventions and workplace health promotion and that well-being programs can be effective. The authors indicate that prior to further research better theoretical models have to be developed to provide an integrative structure to interventions that indicate the specific effects of an intervention on organizational and individual level to explore causal mechanisms of intervention. There must also be a more integrated system perspective to understand the experiences of employees inside and outside the working environment, as well as the effects of these experiences on employees, families and organizations. Ideally, longitudinal studies should be carried out to serve as a barometer for the health of their employees and the working environment. Research has also shown that there may be important moderators of the effects, so more research needs to be done on this. This can be, for example, national or organizational culture. There must be more cross-cultural investigations to clarify similarities and differences . The quality of intervention studies is slowly improving. There should also be more studies with a control group. Literature suggests that interventions with a system approach and both an individual and organizational component are the most effective. Based on this article, the JD-R model is a useful framework. Recognizing multiple domains and resources is a useful extension, especially for the understanding of employee well-being.   

Als metafoor voor veel gezondheid gerelateerde zelfcontrole conflicten wordt er gebruik gemaakt van een paard en een berijder, waarbij het paard in een keer wild wordt en totaal de andere kant op gaat. Voor toekomstige ritten is het handig om drie dingen te hebben, namelijk een beter idee waar je naartoe wilt (missen van actieplannen en persoonlijke normen) , een betere kracht om het paard te controleren (inadequate zelfcontrole capaciteiten) en als laatste een getemd paard wat er niet zomaar vandoor gaat (impulsen en driften die gelijk bevredigd willen worden). In dit artikel wordt het belang van zelfcontrole besproken, vervolgens wordt er een model gegeven dat gebruikt kan worden bij interventie strategieën, die uitgelegd worden aan de hand van de bovenstaande metafoor.

Het belang van zelfcontrole

Zelfcontrole gaat over de vaardigheid van het zelf om dominante reacties of innerlijke staten te veranderen en ze te vervangen voor andere reactie in de dienst van hogere doelen, attituden of normen. Het falen van zelfcontrole is vaak gerelateerd aan problematische gezondheidsuitkomsten. Het is daarom erg belangrijk om goede, op theorie gebaseerde, interventies te hebben.

Het model

Voor een model is het belangrijk dat er drie dingen worden meegenomen: 1) reflectieve processen. 2) vaardigheden van zelfcontrole. 3) impulsieve processen. Duale systeem modellen kunnen hierbij goed gebruikt worden. In het huidige artikel wordt het reflective-impulsive model gebruikt. Dit model bestaat uit twee, interacterende, systemen die gedrag leiden, namelijk het impulsieve systeem en het reflectieve systeem. Het impulsieve systeem werkt snel en eist weinig van bronnen. Bij het zien van verleidingen worden automatische associaties geactiveerd en dit leidt vervolgens de aandacht en de informatie processen. Het reflectieve systeem bevat persoonlijke normen, attitudes en verwachtingen. Hierbij kunnen voor- en nadelen worden afgewogen om korte en lange termijn doelen te behalen. Zo wordt er een gedragsschema geactiveerd. Deze systemen werken vaak hand in hand en zorgen voor het uitvoeren van gedrag. Het bekorten van de invloed van het impulsieve systeem door het reflectieve systeem kost veel inspanning. Op het moment dat deze inspanning niet gegeven kan worden, zal het gedragsschema van het impulsieve systeem uitgevoerd worden. Interventies die op beide componenten richten zullen daarom ook effectiever zijn. Het is echter niet zo dat de reflectieve processen altijd voor goede/gezonde uitkomsten zorgen en andersom.

Het veranderen van de inhoud van het impulsieve systeem

Voor sommige mensen zorgt het impulsieve systeem voor gezondheid schadelijke gedragsschema’s. Voor deze personen zou het goed zijn om deze structuren te veranderen in gezondheid voordelige gedragsschema’s.

Het veranderen van automatische associaties

Deze automatische associaties ontstaan als een resultaat van herhaalde koppelingen van een object met positief en negatief affect. Het kan veranderd worden door evaluatieve conditioneringsprocessen, waarbij een geconditioneerde stimulus herhaaldelijk gekoppeld wordt aan een ongeconditioneerde stimulus met positieve of negatieve affectieve waarde. Het zou vooral goed werken bij mensen die een lage motivatie of laag vermogen hebben om te controleren.

Het veranderen van aandacht gerelateerde vooroordelen

Het controleren van de aandacht speelt een belangrijke rol voor zelfcontrole. Aandacht gerelateerde vooroordelen (wanneer sommige stimuli sterker de aandacht aantrekken/vangen dan anderen) zorgen voor obstakels bij het succesvol controleren van de aandacht. In een aantal onderzoeken is geprobeerd de aandacht te trainen om niet naar de schadelijke stimuli te gaan, maar naar neutrale stimuli. Dit werd gedaan door de visual-probe task. Hierbij worden er twee plaatjes getoond, waarbij na een korte tijd een sensor verschijnt die de participanten moeten aanwijzen. In de gemodificeerde versie verschijnt deze sensor bijna altijd achter de neutrale stimulus, zodat de aandacht wordt afgeleid van de substantie gerelateerde stimulus. Het effect van deze techniek is echter niet eenduidig. Tevens wordt er niet altijd een effect gevonden.

Het veranderen van benaderingstendensen

Het veranderingsmechanisme ligt hier in het veranderen van de benaderingstendensen in neutrale reacties of zelfs vermijdingstendensen. Het is een veelbelovend mechanisme. Het gebeurt vaak laat in de uitvoering van gedrag, net voordat de gedragsschema’s die geactiveerd worden door het impulsieve systeem beïnvloed kunnen worden door de activatie van de schema’s van het reflectieve systeem. Dit wordt vaak gedaan door middel van het trekken of duwen van een joystick, waarbij dan bijvoorbeeld ongezond gerelateerd wordt aan duwen en gezond aan trekken.

Het verbeteren van het vermogen van zelfcontrole

Om de impulsieve neigingen tegen te kunnen houden is zelfcontrole nodig. Er worden hier twee benaderingen besproken.

De karaktereigenschap zelfcontrole

Volgens het model van Baumeister et al., vertrouwd het vermogen van zelfcontrole op een beperkte bron, als het teveel wort gebruikt, wordt het minder en zullen pogingen van zelfcontrole eerder mislukken. Dit heeft een aantal implicaties om de uitkomsten voor zelfcontrole te verbeteren. Ten eerste het intentioneel behouden van de energie en het plannen van de besteding kan behulpzaam zijn. Als tweede is het belangrijk dat de bron weer aangevuld kan worden, nadat het intensief gebruikt is. Als derde zou het goed zijn om zeer inspannende taken uit te voeren, zonder te veel van de bron te gebruiken. Dit kan onder andere door gebruik te maken van implementatie intenties. Als vierde is er het idee dat als zelfcontrole op een spier lijkt, het getraind zou moeten kunnen worden om uithouding en brede veranderingen in zelfcontrole te kunnen bereiken. Uit onderzoek blijkt dat het trainen van zelfcontrole een zeer positief effect heeft op veel domeinen.

De leidende functies

Leidende functies worden omschreven als de basis cognitieve processen die alleen succesvolle zelfcontrole toestaan. Op het moment dat zelfcontrole beoefend wordt, wordt er heel erg sterk vertrouwd op deze leidende functies. Om zelfcontrole te verbeteren, kan dit dus verbeterd worden. De relatie hiertussen kan bidirectioneel zijn, waarbij door verbetering van zelfcontrole ook de leidende functies verbeteren. Uit onderzoek blijkt dat technieken die zich richten op reactie inhibitie veelbelovend zijn in het verbeteren van gezond gedrag.

Het veranderen van de inhoud van het reflectieve systeem

Er is ontzettend veel onderzoek gedaan naar interventies op dit gebied. In de laatste onderzoeken worden de belangrijkste determinanten bepaald. Dit zijn: persoonlijke normen en doelen, kennis, de gedachten over de eigen capaciteiten en consequenties van het gedrag en intenties. Uit onderzoek naar de effectiviteit van interventies blijkt dat interventies die vraag naar zelfmonitoring, en in ieder geval een verdere techniek die gebaseerd is op de controle theorie, bevatten effectiever zijn dan interventies die dit niet hebben.

Discussie

In dit artikel is er gekeken naar onderzoek dat probeert de automatische associaties, aandacht gerelateerde vooroordelen en benadering-vermijding tendensen te veranderen in het voordeel van gezond gedrag. Als tweede is er gekeken naar de pogingen om het vermogen van zelfcontrole te vergroten door het verbeteren van de karaktereigenschap zelfcontrole en leidende functies. Als laatste is er een recente taxonomie bekeken om interventies te organiseren en te systematiseren. Het theoretische raamwerk dat gebruikt is, is erg makkelijk gemaakt. De dingen zijn hierdoor makkelijk uit te leggen, maar de verschillen tussen de benaderingen worden hierdoor niet goed benadrukt. Er worden drie klassen van interventies gegeven, maar sommige strategieën kunnen op meer dan een component invloed hebben. Tevens kan er ook meer dan een component betrokken zijn bij de strategieën. Voor sommige interventies is echter nog meer onderzoek nodig om een goed beeld ervan te krijgen.

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Goede voornemens worden heel vaak gemaakt, maar niet zo vaak nageleefd. Uiteraard is dit wel afhankelijk van de persoon of van het soort goede voornemens, maar vaak is de intentie-gedragrelatie zwak. In dit artikel wordt een onderzoek beschreven naar een methode om goede voornemens effectiever te maken.

Ten eerste blijkt het belangrijk te zijn hoe het doel is geformuleerd, zoals bijvoorbeeld het goal-specificity effect. Je moet specifiek zijn, in plaats van vaag (‘ik ga mijn best doen’). Hiernaast is er het goal-proximity effect, wat betekent dat doelen dichtbij beter haalbaar zijn dan doelen ver weg. Ook is het belangrijk om een leerdoel op te stellen, in plaats van een prestatiedoel.

Ten tweede is zelf-discipline erg belangrijk om een doel te behalen. Een doel kan in de weg gestaan worden door verleidingen of conflicterende doelen.

Als je een doel gaat voorbereiden, heb je keuze uit veel verschillende manieren. Dit is soms lastig omdat je de situatie moet inschatten en dan moet bepalen welk gedrag het beste is. Dit lukt niet altijd, hoewel beslissingen op een bepaald moment juist voordeel kunnen hebben, omdat je niet alle situaties kan voorzien en dus ook niet van tevoren kan bedenken wat je in een bepaalde situatie gaat doen om je doel te blijven volgen. Vooruit beslissen kan ook meehelpen bij het tegengaan van verleidingen en slechte gewoonten.

Doelvoornemens vs. implementatievoornemens

Doelvoornemens zijn gericht op een bepaalde uitkomst (‘ik wil X bereiken’). Wensen worden dan vertaald naar doelen. Er wordt een verbintenis aangegaan die stimuleert tot een realisatie van het doel.

Implementatievoornemens specificeren het wanneer, waar en hoe van een doel (‘Als situatie X zich voordoet, zal ik Y doen’). Dit koppelt kansen met doelgerichte reacties. Omdat de situatie vooraf beschreven is, wordt het gedrag dat daarbij hoort makkelijker uit te voeren. Je hoeft je dan niet meer bewust bezig te houden met je doel, maar je wordt automatische gestuurd door geselecteerde situationele signalen.

Een probleem bij het behalen van het doel is beginnen. Soms is de aandacht op andere dingen gericht of ben je gewoon moe. Ook hier is het belangrijk om implementatievoornemens te gebruiken. Bij een onderzoek naar de plannen van studenten met de kerstvakantie werd gevraagd naar moeilijke en makkelijke voornemens. Bij moeilijke voornemens (paper schrijven) bleek tweederde van de studenten met implementatievoornemens geslaagd te zijn, tegen eenvierde van de studenten zonder deze voornemens. Bij makkelijke voornemens (sporten) haalde 80% van de studenten zijn doel, ongeacht het gebruik van implementatie-voornemens. Implementatievoornemens leveren dus hun voordeel bij moeilijke voornemens.

In de voorgaande onderzoeken wordt niet specifiek gekeken naar vervelende doelen. Uit onderzoek hiernaar bleken implementatievoornemens ook effectief. Hierbij gaat het om borstonderzoek, innemen van medicijnen en zware sportoefeningen.

Ook is er onderzoek gedaan bij mensen die moeite hebben met het reguleren van actie, zoals drugsverslaafden. De behoefte aan drugs verstoort de dagelijkse activiteiten. Er werden twee groepen gevormd die voor 17 uur hun CV geschreven moest hebben. De ene groep werd gevraagd om te bedenken wanneer en waar ze zouden schrijven. De andere groep werd gevraagd om te bedenken wanneer ze zouden gaan lunchen en waar ze dan zouden zitten (irrelevante implementatie-intentie). Tachtig procent van de eerste groep en niemand van de tweede groep had hun CV geschreven. Zelfs bij frontale kwabpatiënten die moeite hebben met bewuste besturing van gedrag, maar niet met automatisch gedrag, was implementatie-intentie effectief. Dit suggereert dat de effecten van implementatie-intentie vooral gebaseerd zijn op automatische processen.

Implementatie-intenties veroorzaken de mentale representatie van de bedoelde situatie. Daarom werken ze ook bij het herkennen van figuren en gesproken woorden.

Er worden verschillende onderzoeken besproken naar de invloed van implementatie-intenties op onbewuste processen. Hieruit komt naar voren dat deze intenties automatisch actie teweegbrengen. Als de kritieke situatie zich voordoet, wordt het doelgerichte gedrag onmiddellijk, efficient en onbewust gestart. Dit komt door de koppeling van gewenst doelgericht gedra met een bepaalde situatie.

De kracht van deze effecten wordt niet alleen bepaald door de sterkte van verbintenis met de voornemens, maar ook met het doel.

Bij verleidingen kun je een verschil maken tussen verleiding-verminderende implementatie (‘Als er een verleiding komt, zal ik deze negeren’) en taak-vergemakkelijkende implementatie (‘Als er een verleiding komt, zal ik meer moeite op de taak doen’). Het blijkt dat je bij een hoge motivatie niet aan de verleiding kan ontsnappen wanneer je van de laatste implementatie gebruik maakt. Dit kan namelijk zorgen voor overmotivatie en vermindert de prestaties.

Ook bij gewoonten kunnen implementatie-intenties blokkerend werken. Normaal bestel je een nagerecht met chocola als je naar het menu kijkt, maar nu bestel je met fruit. Het menu is de stimulus in dit geval, fruit is het nieuwe doel en chocola is de gewoonte.