The Common Sense of Counseling Psychology: Introducing

The goal of therapy is typically to improve clients’ self-management of their problems, not only during the course of therapy but also after therapy ends. Although it seems obvious that therapists are interested in improving client’s self-management, the psychotherapy literature has little to say on the topic. This article introduces Leventhal’s Common-Sense Model of Self-Regulation, a theoretical model of the self-management of health, and applies the model to the therapeutic process. The Common-Sense Model proposes that people develop illness representations of health threats and these illness representations guide self-management. The model has primarily been used to understand how people self-manage physical health problems, we propose it may also be useful to understand self-management of mental health problems. The Common-Sense Model’s strengths-based perspective is a natural fit for the work of counseling psychologists. In particular, the model has important practical implicationsfor addressing how clients understand mental health problems over the course of treatment and self-manage these problems during and after treatment

Adoption and Appropriateness of mHealth for Weight Management in the Real World: A Qualitative Investigation of Patient Perspectives

BackgroundMobile health (mHealth) interventions for weight management can result in weight loss outcomes comparable to in-person treatments. However, there is little information on implementing these treatments in real-world settings. ObjectiveThis work aimed to answer two implementation research questions related to mHealth for weight management: (1) what are barriers and facilitators to mHealth adoption (initial use) and engagement (continued use)? and (2) what are patient beliefs about the appropriateness (ie, perceived fit, relevance, or compatibility) of mHealth for weight management? MethodsWe conducted semistructured interviews with patients with obesity at a single facility in an integrated health care system (the Veterans Health Administration). All participants had been referred to a new mHealth program, which included access to a live coach. We performed a rapid qualitative analysis of interviews to identify themes related to the adoption of, engagement with, and appropriateness of mHealth for weight management. ResultsWe interviewed 24 veterans, seven of whom used the mHealth program. Almost all participants were ≥45 years of age and two-thirds were White. Rapid analysis identified three themes: (1) coaching both facilitates and prevents mHealth adoption and engagement by promoting accountability but leading to guilt among those not meeting goals; (2) preferences regarding the mode of treatment delivery, usability, and treatment content were barriers to mHealth appropriateness and adoption, including preferences for in-person care and a dislike of self-monitoring; and (3) a single invitation was not sufficient to facilitate adoption of a new mHealth program. Themes were unrelated to participants’ age, race, or ethnicity. ConclusionsIn a study assessing real-world use of mHealth in a group of middle-aged and older adults, we found that—despite free access to mHealth with a live coach—most did not complete the registration process. Our findings suggest that implementing mHealth for weight management requires more than one information session. Findings also suggest that focusing on the coaching relationship and how users’ lives and goals change over time may be an important way to facilitate engagement and improved health. Most participants thought mHealth was appropriate for weight management, with some nevertheless preferring in-person care. Therefore, the best way to guarantee equitable care will be to ensure multiple routes to achieving the same behavioral health goals. Veterans Health Administration patients have the option of using mHealth for weight management, but can also attend group weight management programs or single-session nutrition classes or access fitness facilities. Health care policy does not allow such access for most people in the United States; however, expanded access to behavioral weight management is an important long-term goal to ensure health for all

Trauma exposure and disordered eating: A qualitative study

Quantitative studies have demonstrated a positive association between trauma exposure and disordered eating. However, reasons for this relationship are unclear. We used qualitative methods to understand why some individuals exposed to trauma report disordered eating. We conducted five focus groups and two dyadic interviews between spring 2013 and fall 2014 with women at a Veterans Health Administration medical center (N = 20). Most participants were recruited from outpatient mental health clinics. Participants completed demographic and psychological questionnaires. Using thematic analysis of transcripts, we identified trauma and disordered eating-related themes. Most participants were women of color (55%), and many reported psychological symptoms (65%). The mean age was 48 years (SD = 15). Thematic analysis resulted in three themes. First, trauma can be associated with disordered eating, often in relation to negative affect and maladaptive thoughts. Second, disordered eating can provide short-term, but not long-term, relief from trauma-related negative affect. Third, disordered eating can provide a mechanism to avoid unwanted attention from potential and past perpetrators of trauma. Trauma-related disordered eating, particularly in relation to sexual trauma, may have a distinct profile. Querying patients about causes of disordered eating when women report trauma histories may help clinicians ensure patients receive appropriate treatment