Increasing attendance for psychotherapy: Implementation intentions and the self-regulation of attendance-related negative affect.
Abstract
The present study evaluated an implementation intention intervention that aimed to increase attendance at scheduled, initial appointments for psychotherapy by helping clients to manage negative feelings about attendance. Participants received a postal questionnaire that measured their views about attending psychotherapy. One half of the sample was randomly assigned to an implementation intention induction that was embedded in the questionnaire. Intention-to-treat analysis (N=390) indicated that participants who formed implementation intentions were more likely to attend compared to controls (75% vs. 63%), and this effect was even stronger among participants who returned the questionnaire (83% vs. 57%). Whereas anticipated affective costs (e.g., shame) had a negative impact on attendance for most participants, this effect was attenuated when participants formed implementation intentions and perceived that attendance would be beneficial. Thus, implementation intention formation can help clients to deal effectively with negative feelings that might otherwise prevent them attending their first psychotherapy appointment.
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Sheeran et al. (2007) showed that an intention formation intervention ('if-then plan' based on normalising anticipated negative affect) helped participants in a non-perinatal sample self-regulate and attend their initial psychotherapy appointments.
“Sheeran et al. (Citation2007) showed that by implementing an intention formation (‘if-then plan’ based on normalising anticipated negative affect) participants in a non-perinatal sample were able to self-regulate, which subsequently helped them to attend their initial psychotherapy appointments.”
From The feasibility and acceptability of a single-session Acceptance and Commitment Therapy (ACT) intervention to support women self-reporting fear of childbirth in a first pregnancy. (2023) · cites this paper as Sheeran et al., 2007
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Webb, T. L., Sheeran, P., Totterdell, P., Miles, E., Mansell, W., & Baker, S. (2010) · British Journal of Social Psychology · doi:10.1348/014466610x533623 · Cited by 31 · see citing works
“In addition, previous studies have either assumed that affect influences behaviour (Achtziger et al., 2008) or merely measured the impact of affect on behaviour (Sheeran et al., 2007), thereby limiting the causal conclusions that can be drawn.”
BackgroundSelf-citationLo, S. H., Good, A., Sheeran, P., Baio, G., Rainbow, S. J., Vart, G., von Wagner, C., & Wardle, J. (2013) · Health Psychology · doi:10.1037/a0033507 · Cited by 31 · see citing works
Self-citationChanging Behavior Using the Health Belief Model and Protection Motivation Theory
Orbell, S., Zahid, H., & Henderson, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.004 · Cited by 32 · see citing works
van Dongen, A., Abraham, C., Ruiter, R. A. C., & Veldhuizen, I. J. T. (2012) · Annals of Behavioral Medicine · doi:10.1007/s12160-012-9449-3 · Cited by 30 · see citing works
“, [49, 52–55]).”
Burkard, C., Rochat, L., Blum, A., Emmenegger, J., der Linden, A. J. V., & der Linden, M. V. (2014) · Neuropsychological Rehabilitation · doi:10.1080/09602011.2014.887023 · Cited by 29 · see citing works
Changing Behavior by Changing Environments
Marteau, T. M., Fletcher, P. C., Hollands, G. J., & Munafo, M. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.014 · Cited by 27 · see citing works
Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review
Jardine, J., Bowman, R., & Doherty, G. J. (2022) · Journal of Medical Internet Research · doi:10.2196/37851 · Cited by 28 · see citing works
“…digital-only inclusion criteria excluded some interesting interventions that could easily be reproduced digitally (eg, a postal survey on implementation intentions [102] and an educational handout about the dose-effect relationship of therapy and expectation setting around treatment length [103]).”
Videogame assisted emotional regulation training: an act with RAGE-Control case illustration
Ducharme, P., Wharff, E., Hutchinson, E., Kahn, J., Logan, G., & Gonzalez-Heydrich, J. (2012) · Clinical Social Work Journal · doi:10.1007/s10615-011-0363-0 · Cited by 27 · see citing works
Design, Implementation, and Evaluation of Behavior Change Interventions: A Ten-Task Guide
Abraham, C., & Denford, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.019 · Cited by 26 · see citing works
Changing Behavior Using the Reflective-Impulsive Model
Deutsch, R., & Strack, F. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.012 · Cited by 28 · see citing works
Dyadic Behavior Change Interventions
Scholz, U., Berli, C., Lüscher, J., & Knoll, N. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.043 · Cited by 23 · see citing works
Developing Behavior Change Interventions
Hankonen, N. E., & Hardeman, W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.021 · Cited by 26 · see citing works
Rothman, A. J., Klein, W. M. P., & Sheeran, P. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.020 · Cited by 25 · see citing works
Self-citationCharting variability to ensure conceptual and design precision: a comment on Ogden (2016)
Abraham, C. (2016) · Health Psychology Review · doi:10.1080/17437199.2016.1190293 · Cited by 23 · see citing works
“In another IIF intervention, Sheeran, Aubrey, and Kellett (2007) aimed to increase attendance at psychotherapy appointments among those who had already made appointments.”
BackgroundImagery, Visualization, and Mental Simulation Interventions
Hagger, M. S., & Conroy, D. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.033 · Cited by 22 · see citing works
Changing Behavior Using the Common-Sense Model of Self-Regulation
Cameron, L. D., Fleszar‐Pavlović, S. E., & Khachikian, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.005 · Cited by 23 · see citing works
Gollwitzer, P. M., & Sheeran, P. (2025) · Annual Review of Psychology · doi:10.1146/annurev-psych-021524-110536 · Cited by 26 · see citing works
Self-citationSchauman, O., Aschan, L., Arias, N., Beards, S., & Clement, S. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200540 · Cited by 21 · see citing works
Engagement of Stakeholders in the Design, Evaluation, and Implementation of Complex Interventions
Hudson, J. L., Moon, Z., Hughes, L. D., & Moss-Morris, R. E. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.024 · Cited by 20 · see citing works
Young, R. A., Domene, J. F., & Valach, L. (2014) · Springer eBooks · doi:10.1007/978-1-4939-0773-1 · Cited by 20 · see citing works
“appointments for psychotherapy, increases attendance (Sheeran et al. 2007).”
Clough, B. A., Eigeland, J. A., Madden, I., Rowland, D., & Casey, L. M. (2019) · Internet Interventions · doi:10.1016/j.invent.2019.100256 · Cited by 22 · see citing works
“to suggest that continually engaging with psychotherapy offers substantial benefits (Sheeran et al., 2007).”
BackgroundUri Gneezy, B., Kajackaite, A., & Meier, S. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.036 · Cited by 20 · see citing works
Targeting automatic processes to reduce unhealthy behaviours: a process framework
Larsen, J. K., & Hollands, G. J. (2021) · Health Psychology Review · doi:10.1080/17437199.2021.1876572 · Cited by 19 · see citing works
“Formation of implementation intentions has also shown to increase attendance for psychotherapy (Sheeran et al., 2007) and can help patients achieve their goals (Duhne et al., 2020).”
BackgroundResultSniehotta, F. F., Dombrowski, S. U., Avenell, A., Johnston, M., McDonald, S., Murchie, P., Ramsay, C. R., Robertson, K., & Araújo‐Soares, V. (2011) · PLoS ONE · doi:10.1371/journal.pone.0023040 · Cited by 19 · see citing works
“Recently, several studies have shown that inexpensive theory based intervention based on simple planning interventions, letters or leaflets may be effective in improving attendance [53,54] and for the present line of research it might be sensible to explicitly add an intervention focussing on attendance to the first m…”
BackgroundA neuroscience-based approach to changing organizational behaviour
Rock, D. (2018) · Healthcare Management Forum · doi:10.1177/0840470417753968 · Cited by 19 · see citing works
Processes underlying ambivalence in help‐seeking: The loss of valued control model.
Schauman, O., & Mansell, W. (2012) · Clinical Psychology Science and Practice · doi:10.1111/j.1468-2850.2012.01277.x · Cited by 19 · see citing works
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“For example, some authors have proposed that treatment non-attendance may be influenced by common anxieties and fears about therapy (Sheeran et al., 2007; Vogel et al., 2007).”
BackgroundRuiter, R. A. C., Crutzen, R., de Leeuw, E., & Kok, G. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.018 · Cited by 17 · see citing works
Murphy, E., Mansell, W., Craven, S., Menary, J., & McEvoy, P. (2012) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000811 · Cited by 16 · see citing works
Changing Behavior Using Social Identity Processes
Reynolds, K. J., Branscombe, N. R., Subašić, E., & Willis, L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.016 · Cited by 17 · see citing works
Matcham, F., McNally, L. M., & Vogt, F. (2013) · British Journal of Health Psychology · doi:10.1111/bjhp.12078 · Cited by 16 · see citing works
Brinkhof, L. P., Ridderinkhof, K. R., Murre, J. M. J., Krugers, H. J., & de Wit, S. (2023) · BMC Psychology · doi:10.1186/s40359-023-01259-3 · Cited by 18 · see citing works
Delgadillo, J., Moreea, O., Murphy, E., Ali, S., & Swift, J. (2015) · Journal of Clinical Psychology · doi:10.1002/jclp.22228 · Cited by 14 · see citing works
Assessing and promoting the use of implementation intentions in clinical practice.
Duhne, P. G. S., Horan, A., Ross, C., Webb, T. L., & Hardy, G. (2020) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2020.113490 · Cited by 15 · see citing works
The Role of Habits in Maladaptive Behaviour and Therapeutic Interventions
Verhoeven, A. A. C., & de Wit, S. (2018) · Springer eBooks · doi:10.1007/978-3-319-97529-0_16 · Cited by 17 · see citing works
Webb, T. L., & de Bruin, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.037 · Cited by 14 · see citing works
Murphy, E., Mansell, W., Craven, S., & McEvoy, P. (2016) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246581400023x · Cited by 12 · see citing works
“make clear plans or implementation intentions regarding attendance (Sheeran et al., 2007) or exploring pessimism about pursuing therapy goals may be of benefit.”
BackgroundPalayiwa, A., Sheeran, P., & Thompson, A. R. (2010) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2010.29.5.575 · Cited by 13 · see citing works
Self-citationHoward, S., Houghton, C. M. G., White, R., Fallon, V., & Slade, P. (2023) · Psychology & Health · doi:10.1080/08870446.2021.2024190 · Cited by 12 · see citing works
“Sheeran et al. (2007) showed that by implementing an intention formation (‘if-then plan’ based on normalising anticipated negative affect) participants in a non-perinatal sample were able to self-regulate, which subsequently helped them to attend their initial psycho-therapy appointments.”
BackgroundMaking Mindfulness Meditation a Healthy Habit
Miles, E., Matcham, F., Strauss, C., & Cavanagh, K. (2023) · Mindfulness · doi:10.1007/s12671-023-02258-6 · Cited by 16 · see citing works
“…lapses (Herman & Polivy, 1984), a self-compassionate response recognizing that one lapse does not undo all one’s progress can be helpful (Homan & Sirois, 2017), as can using implementation intentions to plan for continuing action after a lapse despite negative emotions (e.g., Sheeran et al., 2007).”
Public Health Communication Reduces COVID-19 Misinformation Sharing and Boosts Self-Efficacy
Rasmussen, J., Lindekilde, L. E., & Petersen, M. B. (2024) · Journal of Experimental Political Science · doi:10.1017/xps.2024.2 · Cited by 12 · see citing works
“Other interventions move beyond nudging accuracy motivations by seeking to equip people with better capabilities for identifying and avoiding sharing misinformation (Lee 2018; Guess et al. 2020; Hertwig and Grüne-Yanoff 2017; Sheeran and Orbell 2000; Sheeran et al. 2007; Van Der Linden 2022).”
BackgroundCritical and Qualitative Approaches to Behavior Change
Chamberlain, K., & Lyons, A. C. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.030 · Cited by 12 · see citing works
A delay discounting model of psychotherapy termination.
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“Moreover, strategies aiming to lessen the discrepancy between client expectations and what actually occurs in therapy have consistently proven useful in decreasing treatment drop-out (Ogrodniczuk et al., 2005; Reis & Brown, 2006; Sheeran et al., 2007).”
BackgroundMaximizing User Engagement with Behavior Change Interventions
Yardley, L., Morrison, L. G., Müller, I., & Bradbury, K. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.025 · Cited by 11 · see citing works
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The Science of Behavior Change: The Road Ahead
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Autonomy-Supportive Interventions
Reeve, J., & Cheon, S. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.035 · Cited by 9 · see citing works
Implementation Science and Translation in Behavior Change
Łuszczyńska, A., Łobczowska, K., & Horodyska, K. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.023 · Cited by 9 · see citing works
Keeler, A. R., Nydegger, L. A., & Crano, W. D. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1145969 · Cited by 8 · see citing works
Planning Interventions to Change Behavior
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de Ridder, D. T. D., Gillebaart, M., & Friese, M. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.040 · Cited by 9 · see citing works
Epton, T., & Armitage, C. J. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.038 · Cited by 8 · see citing works
- Authors
- Sheeran, P., Aubrey, R., & Kellett, S.
- Affiliations
- University of Sheffield (GB)
- Bradford Royal Infirmary (GB)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2007
- Volume
- 75
- Issue
- 6
- Pages
- 853-863
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2075056632
- Cited by
- 151
- References
- 67
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 9 · 2022: 7 · 2021: 3 · 2020: 54 · 2019: 1 · 2018: 3 · 2017: 1 · 2016: 9 · 2015: 8 · 2014: 7 · 2013: 9 · 2012: 6
- FWCI
- 7.61
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- implementation intentions, self-regulation, negative affect, help-seeking, anticipated benefits
- MeSH terms
- Adolescent, Adult, Female, Humans, Male, Middle Aged, Patient Compliance, Patient Dropouts, Psychotherapy, Social Control, Informal, Mood Disorders, Self Efficacy, Intention
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