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Books on the topic 'Transtheoretical Model of Behavior Change'

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Published: 4 June 2021

Last updated: 1 February 2022

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1

Clarke, Patricia. Exercise behaviour change in a GP referred sample and a 'Typical' sample: Application of the transtheoretical model and multidimensional scaling techniques. Birmingham: University of Birmingham, 1996.

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2

The A-B-C's of human experience: An integrative model. Belmont, CA: Brooks/Cole Wadsworth, 1999.

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3

Stopping the violence: A group model to change men's abusive attitudes and behaviors. New York: Haworth Maltreatment and Trauma Press, 1999.

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4

Stopping the violence: A group model to change men's abusive attitudes and behaviors : the client workbook. New York: Haworth Maltreatment and Trauma Press, 1999.

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5

Promoting Exercise and Behavior Change in Older Adults: Interventions with the Transtheoretical Model. Springer Publishing, 2001.

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6

Rossi, Susan Rose. APPLICATION OF THE TRANSTHEORETICAL MODEL OF BEHAVIOR CHANGE TO DIETARY FAT REDUCTION IN A NATURALISTIC ENVIRONMENT (CANCER). 1993.

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7

Chan, Emily Ying Yang. Health promotion planning approaches, human behavioural change models, and health promotion theories. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198807179.003.0003.

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Based on the conceptual building blocks introduced in the previous chapter, this chapter further sketches theoretical approaches and models that can be employed to guide rural health and disaster preparedness education programmes, namely the MAP-IT approach, precede–proceed model, P-Process, Health Belief Model, Transtheoretical (Stages of Change) Model, Theory of Planned Behaviour, Social Cognitive Theory, and complex interventions. These theories and models are intended to conceptualize human thought and behaviour and systematically explain the reasons behind actions such that they can be utilized to set the objectives and content of health intervention projects. Health literacy will also be discussed, with relevant examples for illustrative purposes.

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8

Gedies, Tracy. Using the transtheoretical model to guide adults with Type 2 diabetes as they change their behavior to adopt and adhere to a more active lifestyle. 2000.

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9

Feinstein, Marilyn S., and Robert E. Feinstein. Health Coaching in Integrated Care. Edited by Robert E. Feinstein, Joseph V. Connelly, and Marilyn S. Feinstein. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190276201.003.0025.

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Health care in the United States is in transition. Facilitating individual patient and population-based lifestyle change is critical for creating a healthier country. Fostering prevention, promoting lifestyle change, and dealing with the high incidence and prevalence of chronic disease is within the purview of health coaching, a new health discipline. This chapter describes the emergence, theories and methodologies, and efficacy of health coaching. We describe health coaching in practice, as primary care and integrated care environments begin to incorporate health coaching within multidisciplinary health care teams. Five major coaching approaches are discussed: the transtheoretical model (stages of change), motivational interviewing, solution-focused coaching, cognitive-behavioral coaching, and mindfulness-based stress reduction. An example of a brief coaching session is presented.

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10

Svrakic, Dragan M., and Mirjana Divac Jovanovic. The Fragmented Personality. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190884574.001.0001.

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This book pioneers a new model of personality disorder primarily intended to serve mental health professionals, those already in practice and equally those in training. In contrast to the static concepts of mental normalcy and pathology, the presented nosology is dynamic (accounts for the reversibility of mental functioning) and personalized, context- and time sensitive. In a 3D diagnostic cylinder, the coordinates cross match the person’s common level of mental functioning (vertical diagnosis) with his or her behavior style (horizontal diagnosis) at a point in space and a unit of time, giving the clinician precise milestones to monitor changes in diagnosis and progress in therapy. The central problem with persons suffering from personality disorder does not rest in their extreme behaviors but rather underneath the surface, in the fragmented substrate of personality (a core deficit sine qua non shared by all individual variants), while extreme behaviors merely represent variable compensatory strategies. Based on this model, mechanism-based treatments are outlined: reconstructive interpersonal psychotherapy (a novel, integrative, transtheoretical approach which relies on psychoanalytic and humanist traditions) and mechanism-based pharmacotherapy of neurobiological vulnerabilities associated with excessive temperament traits.

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11

Application of the transtheoretical model to exercise adherence. 1992.

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12

Application of the transtheoretical model to exercise adherence. 1993.

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13

Application of the transtheoretical model to exercise adherence. 1992.

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14

Heather, Nick, and Johannes Hönekopp. Readiness to Change and the Transtheoretical Model as Applied to Addictive Disorders. Oxford University Press, 2013. http://dx.doi.org/10.1093/oxfordhb/9780199795833.013.014.

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15

Moyer, Cheryl A. Learning and health behaviour change: An holistic model. 1991.

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16

Goldberg-Glen, Robin S. Adult day care paraprofessionals becoming behavior change agents: A training model. 1989.

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17

Kahn, Wallace J. The A-B-C's of Human Experience: An Integrative Model. Wadsworth Publishing, 1998.

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18

Conrad, Karen Maria. DEVELOPING AND TESTING A THEORETICAL CAUSAL MODEL OF SMOKING BEHAVIOR CHANGE AT THE WORKSITE (HEALTH BELIEF MODEL). 1989.

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19

Geller, E. Scott, and Timothy D. Ludwig. Intervening to Improve the Safety of Occupational Driving: A Behavior-Change Model and Review of Empirical Evidence. Haworth Press, 2001.

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20

Grima, Simon, and Rebecca Dalli Gonzi. Change and Continuity Management in the Public Sector: The DALI Model for Effective Decision Making. Emerald Publishing Limited, 2019.

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21

Grima, Simon, and Rebecca Dalli Gonzi. Change and Continuity Management in the Public Sector: The DALI Model for Effective Decision Making. Emerald Publishing Limited, 2019.

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22

Brownstein, Michael. Perception, Emotion, Behavior, and Change. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190633721.003.0002.

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This chapter describes the four components of unplanned spontaneous inclinations. These are (1) noticing a salient Feature in the ambient environment; (2) feeling an immediate, directed, and affective Tension; (3) reacting Behaviorally; and (4) moving toward Alleviation of that tension in such a way that one’s spontaneous reactions can improve over time. Noticing a salient feature (F), in other words, sets a relatively automatic process in motion, involving co-activating particular feelings (T) and behaviors (B) that either will or will not diminish over time (A), depending on the success of the action. The interaction of FTBA components is described in terms of recent debates about the contents of perception, affective representation, and model-free and model-based evaluative learning.

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23

Sr, Ralph E. Saucier. Success Through Behavioral Change: Change Your Behavior, Environment, and Life for the Better, with This Self-Help Model. iUniverse, Inc., 2006.

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24

Smitasiri, Suttilak, and Mahāwitthayālai Mahidon. Sathāban Wičhai Phōtčhanākān., eds. Social marketing Vitamin A-rich foods in Thailand: A model nutrition communication for behavior change process. 2nd ed. Nakhon Pathom, Thailand: Institute of Nutrition, Mahidol University, 1993.

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25

(Editor), Thomas C. Mawhinney, ed. Intervening to Improve the Safety of Occupational Driving: A Behavior-Change Model and Review of Empirical Evidence. Haworth Press, 2001.

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26

Decker, David J. Stopping the Violence: A Group Model to Change Men's Abusive Attitudes and Behaviors. Taylor & Francis Group, 2018.

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27

Decker, David J. Stopping the Violence: A Group Model to Change Men's Abusive Attitudes and Behaviors. Taylor & Francis Group, 2018.

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28

Decker, David J. Stopping the Violence: A Group Model to Change Men's Abusive Attitudes and Behaviors. Taylor & Francis Group, 2018.

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29

Decker, David J. Stopping the Violence: A Group Model to Change Men's Abusive Attitudes and Behaviors. Taylor & Francis Group, 2018.

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30

Martin, Jeffrey J. Theory of Planned Behavior and Stages of Change Models. Oxford University Press, 2017. http://dx.doi.org/10.1093/oso/9780190638054.003.0035.

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The theory of planned behavior (TPB) and stages of change (SOC) models have been used to predict physical activity (PA) in people with disabilities. The purpose of this chapter is to give an overview of the TPB and SOC models and the research findings stemming from testing them in people with impairments. The health action process approach (HAPA), designed with individuals with disabilities, is also introduced, along with suggested future research using the HAPA. The HAPA is in many ways a meta-theory, as it incorporates many constructs from theories discussed here and in other chapters. For instance, various forms of self-efficacy, outcome expectations, coping, planning, and social support are all included in the HAPA. In addition, the HAPA includes a three-stage model in which people are labeled as pre-intenders, intenders, or actors. Researchers intending to use the SOC theories and the TPB should know that they have come under criticism, and these criticisms are addressed in the chapter.

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31

The effectiveness of the stages of change model and experimental exercise prescriptions in increasing female adults' physical activity and exercise behavior. 1993.

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32

Karpyn, Allison. Behavioral Design as an Emerging Theory for Dietary Behavior Change. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190626686.003.0003.

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In the past two decades, public health interventions have moved from education strategies aimed at individuals to broad, multilevel interventions incorporating environmental and policy strategies to promote healthy food behaviors. These intervention programs continue to employ classic behavior change models that consider individuals as deliberate, intentional, and rational actors. Contrary to the ideas posited by rational choice theory, diet-related literature draws little correlation between an individual’s intentions and his/her resultant behavior. This chapter adds to the dual-system model of cognition—reflective or slow thinking, and automatic or fast thinking—and introduces an emerging theory for dietary behavior change called behavioral design. Behavioral design recognizes that human decisions and actions lie on a continuum between spheres and are continually shaped by the interactions between an agent (individual, group) and his/her/their exposure (environment). More specifically, behavioral design considers the importance of the “experience” left as time passes, such as conditioning, resilience, expectation, repeated behaviors, and normality, as the central and iterative influence on future decisions. Behavioral interventions must consider the individual’s “experience” resulting from his or her interaction with the environment, while acknowledging the fast and slow mechanisms by which choices are made. This chapter introduces aspects to consider when using behavioral design to increase healthier food behaviors and physical activity, and briefly discusses ethics questions related to intentional modification of environment for health behavior change.

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33

Chiaburu, Dan S., In-Sue Oh, and Sophia V. Marinova. Five-Factor Model of Personality Traits and Organizational Citizenship Behavior: Current Research and Future Directions. Edited by Philip M. Podsakoff, Scott B. Mackenzie, and Nathan P. Podsakoff. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780190219000.013.13.

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For over a quarter of a century, organizational scholars have sought to understand the ways in which employees contribute to organizational success through their organizational citizenship behavior (OCB). Concurrently, personality traits have provided an important lens for illuminating what motivates such discretionary efforts. Our first purpose is to provide a state-of-the art, theoretically grounded review of the literature linking five-factor model (FFM) of personality traits to OCB. Second, we strive to clarify both our criterion construct (OCB) and our predictor space in order to facilitate the integration of past research and pave the way for future research. For our criterion space, we focus on three prominent types of OCB: directed toward individuals (OCB-I), toward the organization (OCB-O), and toward change (OCB-CH). For our predictor space, we examine FFM personality traits and FFM-based dark-side personality traits. Third, we offer new fruitful directions for future research. We conclude with three key themes for future research.

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34

Kiviniemi, Marc T., and Lynne B. Klasko-Foster. The Behavioral Affective Associations Model. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190499037.003.0009.

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This chapter presents a conceptual overview of the role of affective associations in behavioral decision-making. It focuses first on the mechanisms through which affect influences behavior. It then describes the behavioral affective associations model and provides a summary of the research using the model with examples showing promotion of protective behavior and reduction of risky behavior. While observational studies are included, experimental studies in both laboratory and field settings are highlighted to model how interventions can manipulate affective associations to change behaviors. As affect is central to decision-making, new directions for research, such as the role of constructs related to affect, are explored as they relate to decision-making. Finally, implications for real-world interventions and techniques to use affect as a tool for behavior change are discussed.

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35

Weng, Helen Y., Brianna Schuyler, and Richard J. Davidson. The Impact of Compassion Meditation Training on the Brain and Prosocial Behavior. Edited by Emma M. Seppälä, Emiliana Simon-Thomas, Stephanie L. Brown, Monica C. Worline, C. Daryl Cameron, and James R. Doty. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780190464684.013.11.

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Compassion meditation is a form of mental training that cultivates compassion towards oneself and other people, and is thought to result in greater prosocial behavior in real-world settings. This framework views compassion as a quality that can be trained, rather than a stable trait, and scientists have started testing these hypotheses using neuroscientific and objective behavioral methods. How does this internal meditative practice translate to external behavioral changes? We propose an emotion-regulation model of compassion meditation, where responses to suffering may change through three processes: (1) increasing empathic responses, (2) decreasing avoidance responses, and (3) increasing compassionate responses to suffering. These altered responses to suffering may lead to behavioral transfer, where prosocial behavior is more likely to occur, even in a non-meditative state. We summarize the neuroscientific and behavioral literature that may provide early support for this model, and make recommendations for future research to further test the model.

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36

Maruska, Karen P., and Russell D. Fernald. Social Regulation of Gene Expression in the African Cichlid Fish. Edited by Turhan Canli. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199753888.013.012.

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How does an animal’s social environment shape its behavior and physiology, and what underlying molecular and genetic mechanisms lead to phenotypic changes? To address this question, the authors used a model system that exhibits socially regulated plastic phenotypes, behavioral complexity, molecular level access, and genomic resources. The African cichlid fishAstatotilapia burtoni, in which male status and reproductive physiology are under social control, has become an important model for studying the mechanisms that regulate complex social behaviors. This chapter reviews what is known about how information from the social environment produces changes in behavior, physiology, and gene expression profiles in the brain and reproductive axis ofA. burtoni. Understanding the mechanisms responsible for translating perception of social cues into molecular change in a model vertebrate is important for identifying selective pressures and evolutionary mechanisms that shape the brain and ultimately result in diverse and complex social behaviors.

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37

Janke, E. Amy, and David E. Goodrich. Adherence to Weight Loss and Physical Activity. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190600075.003.0005.

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Maintaining a healthy weight and engaging in regular physical activity are two health behaviors that can provide significant benefit to individuals with chronic pain. However, adhering to lifestyle programs that promote weight loss and/or physical activity can be challenging. A socioecological model of adherence to healthy lifestyle behaviors in individuals with pain can assist providers in understanding the physiological, intrapersonal/behavioral, and social/environmental factors that influence adherence. Providers can optimize adherence to weight loss by facilitating an effective patient–provider relationship, tailoring intervention approaches to meet a patient’s specific needs, and applying the Five A’s model of behavior change. Providers can support long-term engagement in physical activity by developing patient-centered exercise prescriptions based on an assessment of physical limitations, comorbidities, and age and to engage in shared decision-making to best account for patient preferences and barriers to exercise.

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38

Marchese, Dana D., Kimberly D. Becker, Jennifer P. Keperling, Celene E. Domitrovich, Wendy M. Reinke, Dennis D. Embry, and Nicholas S. Ialongo. A Step-By-Step Guide for Coaching Classroom Teachers in Evidence-Based Interventions. Oxford University Press, 2017. http://dx.doi.org/10.1093/med:psych/9780190609573.001.0001.

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A Step-By-Step Guide for Coaching Classroom Teachers in Evidence-Based Interventions highlights the consultation strategies used by the coaches on the PATHS to PAX Project with the Johns Hopkins Center for Prevention and Early Intervention working with classroom teachers in Baltimore City public schools. The PATHS to PAX Project is the integration of two of the most widely disseminated, evidence-based, universal school-based preventive interventions: the PATHS curriculum and the PAX Good Behavior Game, or PAX GBG. This book reviews the Universal Coaching Model and the Indicated Coaching Model for supporting teacher implementation, including establishing positive coach–teacher relationships as well as coaching strategies that reflect core principles of behavior change, such as modeling, reinforcement, and performance feedback. Also presented are lessons learned and real-life case examples from coaches working with classroom teachers, and strategies for addressing coaching challenges and barriers. The selection, training, and supervision of coaches are discussed, and more than 30 handouts are included in the Appendix for coaches to adapt and use in their work with classroom teachers.

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39

Apple, Robin F., and W. Stewart Agras. What Can You Expect from the Program? Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780195311686.003.0002.

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Chapter 2 covers what the patient can expect from the program, and includes an overview of the program, patient expectations, taking the patient's history, the CBT model of BN and BED, the rationale behind it, the use of the patient workbook, self-disclosure, and the structure of treatment (behavior change, identifying triggers, relapse prevention), session structure, self-monitoring, questions about starting treatment, homework, and self-assessment questions.

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40

Markwica, Robin. Emotional Choices. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198794349.001.0001.

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In coercive diplomacy, states threaten military action to persuade opponents to change their behavior. The goal is to achieve a target’s compliance without incurring the cost in blood and treasure of military intervention. Coercers typically employ this strategy toward weaker actors, but targets often refuse to submit and the parties enter into war. To explain these puzzling failures of coercive diplomacy, existing accounts generally refer to coercers’ perceived lack of resolve or targets’ social norms and identities. What these approaches either neglect or do not examine systematically is the role that emotions play in these encounters. The present book contends that target leaders’ affective experience can shape their decision-making in significant ways. Drawing on research in psychology and sociology, the study introduces an additional, emotion-based action model besides the traditional logics of consequences and appropriateness. This logic of affect, or emotional choice theory, posits that target leaders’ choice behavior is influenced by the dynamic interplay between their norms, identities, and five key emotions, namely fear, anger, hope, pride, and humiliation. The core of the action model consists of a series of propositions that specify the emotional conditions under which target leaders are likely to accept or reject a coercer’s demands. The book applies the logic of affect to Nikita Khrushchev’s decision-making during the Cuban missile crisis in 1962 and Saddam Hussein’s choice behavior in the Gulf conflict in 1990–91, offering a novel explanation for why coercive diplomacy succeeded in one case but not in the other.

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41

Ingram, Scott E. Climate. Edited by Barbara Mills and Severin Fowles. Oxford University Press, 2017. http://dx.doi.org/10.1093/oxfordhb/9780199978427.013.40.

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This chapter serves as an introduction to and reference for climate–human behavior studies in the Southwest. These studies investigate potential climatic impacts on social change and historical trajectories. To build foundational understanding, a representative climate–human behavior model is presented and evaluated, commonly used paleoclimatic data are detailed, and methods for identifying climate extremes (e.g., droughts, wet periods) in these data are described. Some extreme climate events and the challenge of identifying their influence (if any) on social change are noted. A familiarity with these aspects of climate–human behavior studies is essential for effectively evaluating interpretations of historical trajectories that invoke climatic influences.

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42

Hemmelgarn, Anthony L., and Charles Glisson. Introducing the ARC Organizational Strategies. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190455286.003.0004.

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This chapter describes the ARC model of three core strategies for developing effective human service organizations. These include (1) embedding guiding organizational principles, (2) providing organizational component tools for identifying and addressing service barriers, and (3) developing shared mental models. ARC’s strategies provide the tools and the reasoning to guide behaviors and processes among organizational members that ensure improved service quality and outcomes. These strategies are reviewed as part of ARC’s orchestrated and structured process to improve OSC (i.e., the cultures and climates that influence attitudes, decision making and behavior in organizations). The chapter identifies mechanisms of change that highlight the alignment of organizational priorities with the ARC principles, fostering relationships that provide availability, responsiveness, and continuity, as well as developing innovation capacity to adopt new technologies and approaches.

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43

Puttler, Leon I., Robert A. Zucker, and Hiram E. Fitzgerald. Developmental Science, Alcohol Use Disorders, and the Risk–Resilience Continuum. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780190676001.003.0001.

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The origins and expression of addiction are best understood within the context of developmental processes and dynamic systems organization and change. For some individuals, these dynamic processes lead to risk cumulative or cascade effects that embody adverse childhood experiences that exacerbate risk; predict early onset of drinking, smoking, or other substance use; and often lead to a substance use disorder (SUD) during the transitions to adolescence and emergent adulthood. In other cases, protective factors within or outside of the individual’s immediate family enable embodiment of normative stress regulatory systems and neural networks that support resilience and prevention of SUDs. A case study is provided to illustrate these processes and principles of the organization of addictive behavior. Finally, a model of risk to resilience captures the flow of development and the extent to which individual-experience relationships contribute to risk and resilience.

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44

Barzilay, Shira, and Abbie Cohen. Psychological Models of Suicide. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780190260859.003.0002.

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A comprehensive model of suicidal processes and behavior is essential for the assessment of imminent risk for suicide and for the design of informed interventions. This chapter provides descriptions of the three generations of the most influential theories of suicidal behavior as well as an assessment of their strengths and limitations. First-generation models were based on clinicians’ individual experiences and, more recently, on consensus opinion and clinical judgment. Second-generation prognostic models hypothesized that suicide risk was determined by measurable long-term biological, clinical, or demographic risk factors. Third-generation models of suicidal behavior focused on dynamic risk elements, which appear later in life, change over time, and are operational immediately proximal to suicide. This chapter provides a historical perspective on the evolution of the theoretical approaches to the understanding of psychological processes that make suicide possible.

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45

Kropf, Nancy P., and Sherry M. Cummings. Motivational Interviewing. Oxford University Press, 2017. http://dx.doi.org/10.1093/acprof:oso/9780190214623.003.0007.

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Chapter 7, “Motivational Interviewing: Theory and Practice,” provides the theoretical and practice foundation for motivational interviewing (MI). MI employs a client-centered counseling style for achieving behavior change by facilitating exploration and resolution of ambivalence. The trans-theoretical model of change is discussed, as is the “spirit of motivational interviewing,” which highlights the practitioner’s way of being with clients. The chapter presents skills and techniques to enhance older adults’ ability to work through ambivalence and develop a sustainable plan for action. In addition, later-life problems in functioning that benefit from the use of motivational interviewing are summarized, including substance abuse/misuse, chronic disease management, smoking cessation and diet, exercise and weight control. Contextual issues related to clinical practice, and special considerations for use of MI with older clients, are discussed. The chapter includes a case example of motivational interviewing with an older woman with alcohol misuse issues.

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46

Farb, Norman A. S., and Kyle Logie. Interoceptive appraisal and mental health. Oxford University Press, 2018. http://dx.doi.org/10.1093/oso/9780198811930.003.0012.

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Interoception is the process of sensing the body’s internal state. An emerging neurobiological model supports the idea that subjective well-being is influenced by how physiological changes are detected and appraised. Contemplative interventions such as mindfulness training, which appear efficacious in reducing emotional distress, may operate by promoting curiosity and flexibility in this appraisal process. This chapter reviews evidence about the relationship between interceptive appraisal and mental health, including an account of how contemplative training modulates interoceptive networks to alter interoceptive appraisal tendencies. New measures are needed to distinguish the effects of appraisal tendencies from more implicit effects of physiological change. To support this endeavour, pilot data is introduced from a novel, respiration-focused task that experimentally manipulates interoceptive awareness, and by extension the need for interoceptive appraisal, within a given level of physiological arousal. Potential applications of this task for exploring the influence of interoceptive appraisal on affect, cognition, and behavior are discussed.

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47

Omstedt, Anders. The Development of Climate Science of the Baltic Sea Region. Oxford University Press, 2017. http://dx.doi.org/10.1093/acrefore/9780190228620.013.654.

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Dramatic climate changes have occurred in the Baltic Sea region caused by changes in orbital movement in the earth–sun system and the melting of the Fennoscandian Ice Sheet. Added to these longer-term changes, changes have occurred at all timescales, caused mainly by variations in large-scale atmospheric pressure systems due to competition between the meandering midlatitude low-pressure systems and high-pressure systems. Here we follow the development of climate science of the Baltic Sea from when observations began in the 18th century to the early 21st century. The question of why the water level is sinking around the Baltic Sea coasts could not be answered until the ideas of postglacial uplift and the thermal history of the earth were better understood in the 19th century and periodic behavior in climate related time series attracted scientific interest. Herring and sardine fishing successes and failures have led to investigations of fishery and climate change and to the realization that fisheries themselves have strongly negative effects on the marine environment, calling for international assessment efforts. Scientists later introduced the concept of regime shifts when interpreting their data, attributing these to various causes. The increasing amount of anoxic deep water in the Baltic Sea and eutrophication have prompted debate about what is natural and what is anthropogenic, and the scientific outcome of these debates now forms the basis of international management efforts to reduce nutrient leakage from land. The observed increase in atmospheric CO2 and its effects on global warming have focused the climate debate on trends and generated a series of international and regional assessments and research programs that have greatly improved our understanding of climate and environmental changes, bolstering the efforts of earth system science, in which both climate and environmental factors are analyzed together.Major achievements of past centuries have included developing and organizing regular observation and monitoring programs. The free availability of data sets has supported the development of more accurate forcing functions for Baltic Sea models and made it possible to better understand and model the Baltic Sea–North Sea system, including the development of coupled land–sea–atmosphere models. Most indirect and direct observations of the climate find great variability and stochastic behavior, so conclusions based on short time series are problematic, leading to qualifications about periodicity, trends, and regime shifts. Starting in the 1980s, systematic research into climate change has considerably improved our understanding of regional warming and multiple threats to the Baltic Sea. Several aspects of regional climate and environmental changes and how they interact are, however, unknown and merit future research.

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