C. Diclemente
University of Maryland Baltimore County, Psychology, Faculty Member
Research Interests:
Research Interests: Psychology, Clinical Psychology, Decision Making, Language, Medicine, and 11 moreMotivational Interviewing, Substance Abuse Treatment, Humans, Alcoholism, Cognitive Therapy, Psychological Intervention, Public health systems and services research, Reproducibility of Results, Discriminant Validity, Substance-Related Disorders, and professional patient relations
The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to... more
The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.
Research Interests:
Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus... more
Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.
Research Interests: Psychology, Health Psychology, Expert Systems, Education, Health Behavior, and 15 moreTreatment Outcome, Health, Medicine, Counseling, Self Help Groups, Humans, Smoking Cessation, Female, Male, expert System, Interpersonal Relations, American Psychological Association, Adult, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests: Psychology, Computer Science, Consulting, Motivational Enhancement Therapy, Medicine, and 15 moreMotivation, Humans, Alcoholism, Behavior Therapy, Female, Cognitive Therapy, Male, Cognitive Behavioral Treatment Method, Alcoholics Anonymous, Aged, Middle Aged, Alcohol dependence, Adult, Aftercare, and Ambulatory Care
Research Interests:
Research Interests:
Research Interests:
This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and... more
This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results indicated that staging of specific dietary consumption behaviors was significantly related to staging for the global goal of eating a low-fat diet. Women evaluate their motivation about eating low-fat diets based on perceived efforts and specific activities related to dietary consumption with important implications for dietary behavior change measurement and interventions.
Research Interests:
As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many... more
As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic beha...
Research Interests:
This article discusses observations and insights that were gained in the course of critiquing the a priori client-treatment matching hypothesis that were developed for Project MATCH. A matching taxonomy is offered that differentiates... more
This article discusses observations and insights that were gained in the course of critiquing the a priori client-treatment matching hypothesis that were developed for Project MATCH. A matching taxonomy is offered that differentiates eight types of ordinal and disordinal interactions and discusses their clinical and substantive implications. Previously reported alcohol treatment studies are used to illustrate many of these. Various issues in matching studies, such as power versus complexity, prediction versus explanation, matches versus mismatches and capitalization versus compensation, are discussed. Selective issues in choosing treatment and client-matching variables as they affect matching hypotheses are also addressed. The importance of developing a putative "causal chain" for testing the theory underlying matching processes is explicated and a procedure for testing this causal chain is outlined.
Research Interests:
A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance... more
A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.
Research Interests:
There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research... more
There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.
Research Interests:
Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and... more
Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and functions of assessment to support matching. This is followed by a discussion of the strategies employed in Project MATCH to identify matching and outcome variables. The assessment battery used in Project MATCH is next described. Finally, an overview of issues surrounding administration of assessment measures is provided. Particular attention is given to the topics of sequencing and timing of measures.
Research Interests:
... Tags. Stages of change in the modification of problem behavior. ... To insert individual citation into a bibliography in a word-processor, select your preferred citation style below and drag-and-drop it into the document. Progress in... more
... Tags. Stages of change in the modification of problem behavior. ... To insert individual citation into a bibliography in a word-processor, select your preferred citation style below and drag-and-drop it into the document. Progress in Behavior Modification, Vol. ...
Research Interests:
Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current... more
Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.
Research Interests:
While few believe in the uniformity myth about alcoholics, discovering relevant dimensions that usefully divide the treatment population and guide intervention has been a difficult task. This study evaluated a stages of change assessment... more
While few believe in the uniformity myth about alcoholics, discovering relevant dimensions that usefully divide the treatment population and guide intervention has been a difficult task. This study evaluated a stages of change assessment measure with a group of 224 adults entering outpatient alcoholism treatment. Subjects' scores on the precontemplation, contemplation, action, and maintenance stage subscales of the URICA were subjected to cluster analysis yielding five distinct and theoretically consistent profiles. Profiles were labeled as follows: 1. Precontemplation (n = 63) 2. Ambivalent (n = 30) 3. Participation (n = 51) 4. Uninvolved (n = 27), and 5. Contemplation (n = 53). These five groups of subjects demonstrated no differences on demographic characteristics but significantly differed on Alcohol Use Inventory subscales, a temptation to drink and abstinence self-efficacy measure as well as several outcome variables. Group differences support the validity of the cluster analytic profiles, confirm the interpretation of profile groups, and provide interesting contrasts consistent with the stages of change model. Classification of individuals on the stages of change offers a useful perspective for alcoholism treatment matching research.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This pilot study examined the feasibility and efficacy of a brief alcohol misuse preventive intervention for 178 7th-9th grade junior high school students attending sports physical examinations at three schools during the Summer of 1997.... more
This pilot study examined the feasibility and efficacy of a brief alcohol misuse preventive intervention for 178 7th-9th grade junior high school students attending sports physical examinations at three schools during the Summer of 1997. At 6-month posttest, fewer suburban intervention youth intended to use alcohol during the next 6 months (chi2 = 7.01, 1 df, p = .01), and fewer rural intervention youth used alcohol during the past 30 days (chi2 = 4.65, 1 df, p = .04), compared to control youth. When suburban and rural school samples were collapsed, intervention youth had significantly lower alcohol use on three of four measures than control subjects (p's < .05).
Research Interests:
This study examined the effects of a brief, pilot alcohol prevention intervention for 211 disadvantaged 6th grade school children at posttest and 1-year follow-up. Process data indicated that the intervention was successfully implemented... more
This study examined the effects of a brief, pilot alcohol prevention intervention for 211 disadvantaged 6th grade school children at posttest and 1-year follow-up. Process data indicated that the intervention was successfully implemented and well received by youth and parent/guardian participants. ANCOVA analyses indicated a significant difference on alcohol use frequency for drinking subjects at 1-month posttest, with less frequent use reported by intervention subjects than subjects receiving the minimal control materials, F(1,22) = 5.37, p = .03. No differences were found between intervention and control subjects on alcohol use measures at 1-year follow-up. Critical issues to be resolved related to the success of future prevention research and practice are discussed.
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
This study examined the effects of brief nurse consultations in preventing alcohol use among inner-city youth. Participants included 138 sixth-eighth grade students attending an inner-city public school in Jacksonville, Florida. Subjects... more
This study examined the effects of brief nurse consultations in preventing alcohol use among inner-city youth. Participants included 138 sixth-eighth grade students attending an inner-city public school in Jacksonville, Florida. Subjects were randomly assigned by computer to either the intervention (STARS program) or a control group. Baseline and three-month post-tests were conducted at the target school site. A significant difference was found on heavy alcohol use with intervention subjects showing a reduction and control subjects an increase in heavy drinking (t = -2.33, 120df, p = .02). No differences were found between groups on other alcohol use measures. This study's findings indicate that a series of brief nurse consultations appear to reduce heavy alcohol consumption among urban school youth.
Research Interests:
Research Interests: Health Promotion, Cancer, Public Health, Logistic Regression, Humans, and 15 moreFemale, Patient Compliance, Mammography, Group Intervention, Aged, Middle Aged, Adult, Analysis of Variance, Randomized Controlled Trial, Proportional Hazards Models, Logistic Models, Control Group, Breast Neoplasms, Patient selection, and mass Screening
Research Interests: Psychology, Cognitive Science, Health Psychology, Psychometrics, Test Validation, and 15 moreFactor analysis, Humans, Female, Construct Validity, Behavior change, Mammography, Middle Aged, Survey data, Questionnaires, Convergent Validity, Time Factors, Curriculum and Pedagogy, Reproducibility of Results, Factor structure, and The Transtheoretical Model
Research Interests: Psychology and Consulting
Research Interests:
Page 1. Psychometric Properties of the Decisional Balance Scale and the Temptations to Try Smoking Inventory in Adolescents Karen. Stschanek Hudmort Alexander V. Prokhorov Laura M. Koeliiy Carlo C. DiCiemente Ellen R. Gritz ABSTRACT. ...
Research Interests:
Research on the transtheoretical model has provided substantial support for both stages of change and processes of change (coping strategies influencing successful behavior change). This study examined whether timing of process use (using... more
Research on the transtheoretical model has provided substantial support for both stages of change and processes of change (coping strategies influencing successful behavior change). This study examined whether timing of process use (using particular change processes during one stage and not during others) influences quit success. Hypothesized patterns of optimal process use were those marked by more use of experiential processes and less use of behavioral processes during contemplation and preparation and by the reverse pattern during action. Participants (N = 388) began in contemplation or preparation and took action during a 4-6 week period. Multivariate analyses of covariance examined the relationship between patterns of process use and success in staying quit both at 1-month follow-up and 5-6 months later. For the most part, results supported the hypothesis that successful stage transitions involve doing the right thing at the right time: engaging in experiential process activities during contemplation and preparation stages and shifting to behavioral process activities during action.
Research Interests: Health Psychology, Education, Health Behavior, Coping Strategies, Multivariate Analysis, and 14 moreHumans, Smoking Cessation, Habits, Female, Male, Behavior change, Follow-up studies, Questionnaires, Adult, Time Factors, Psychological Models, The Transtheoretical Model, Psychology and Cognitive Sciences, and Medical and Health Sciences
Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm... more
Two hundred fifty-six pregnant women who had quit smoking were classified into the precontemplation (PC), contemplation (C), preparation (PA), or action (A) stages of change for postpartum smoking cessation based on a 3-item algorithm assessing personal goals, self-efficacy, and smoking behavior. Logistic regression and event history analyses indicated group differences in return to smoking at 6 weeks and 3, 6, and 12 months postpartum. The percentage of women who returned to postpartum smoking was highest in the precontemplation stage and decreased with each subsequent stage, that is, at 6 weeks 83% of PCs, 64% of Cs, 35% of PAs, and 24% of As had returned to smoking. Results lend support for the stages of change for postpartum smoking abstinence. Stage-based interventions may be developed to assist women in maintaining abstinence postpartum.
Research Interests: Health Psychology, Education, Health, Transtheoretical Model, Adolescent, and 14 moreLogistic Regression, Self Efficacy, Pregnancy, Humans, Smoking Cessation, Smoking, Female, Recurrence, Adult, Pregnant Women, Psychological Models, Psychology and Cognitive Sciences, postpartum period, and Medical and Health Sciences
Research Interests: Program Evaluation, Family, Health Education, Adolescent, Humans, and 15 moreChild, Female, Alcohol Drinking, Florida, Male, Follow-up studies, Questionnaires, School health services, Public health systems and services research, Randomized Controlled Trial, Curriculum and Pedagogy, Urban Population, Case Control Studies, Cohort Studies, and Protective Factor
The purpose of this paper was to describe the development of a comprehensive, stage-based model for the prevention of drug use titled the multi-component motivational stages (McMOS) model. The McMOS model is proposed as a multi-element,... more
The purpose of this paper was to describe the development of a comprehensive, stage-based model for the prevention of drug use titled the multi-component motivational stages (McMOS) model. The McMOS model is proposed as a multi-element, integrative theoretical framework for the development of prevention strategies and content which are matched to the developmental stages of drug use among youth, based on previous work by Prochaska and DiClemente. The major components of the McMOS drug prevention model include: (1) a stage-based framework which permits the matching of prevention strategies and messages to youths' stage of development in the change process; (2) the delineation of a continuum of stages ranging from the acquisition of drug use through the successful modification of drug use; (3) a two-level prevention schema for targeting a broader range of youth for intervention, including those regularly using drugs as well as those not yet regularly using drugs; (4) a drug specific emphasis for proposing prevention strategies targeting the most prevalently used drugs, based on epidemiologic research; (5) the delineation of major theoretical constructs influencing the movement of youth through the stages, based on three prominent behavioral theories; and (6) a framework for selecting a range of prevention delivery modes for youth at all stages and levels of behavioral change.
Research Interests:
Research Interests:
... Page 9. Acknowledgments I, Mary Velasquez, would like to thank my familyJerry, Keith, and Danielfor their support and encouragement of this work. ... I am especially appreciative to DonHennigan, whose love and encouragement... more
... Page 9. Acknowledgments I, Mary Velasquez, would like to thank my familyJerry, Keith, and Danielfor their support and encouragement of this work. ... I am especially appreciative to DonHennigan, whose love and encouragement sus-tained me while working on this project. ...