Mental contrasting for health behaviour change: a systematic review and meta-analysis of effects and moderator variables
Abstract
Mental contrasting is a self-regulation imagery strategy that involves imagining a desired future and mentally contrasting it with the present reality, which is assumed to prompt the individual to realise that action is required to achieve the desired future. Research has combined mental contrasting with implementation intentions (MCII) ('if-then' plans), which is hypothesised to strengthen the effects. A systematic review was conducted to evaluate the effectiveness of mental contrasting for improving health-related behaviours. A meta-analysis (N = 1528) using random effects modelling found a main effect of mental contrasting on health outcomes, adjusted Hedges' g = 0.28 (SE = .07), 95% CI [0.13-0.43], p < .001 at up to four weeks, and an increased effect at up to three months (k = 5), g = 0.38 (SE = 0.6), CI [0.20-0.55], p < .001. The combination of mental contrasting with implementation intentions (MCII; k = 7) showed a similar effect, g = 0.28, CI [0.14-0.42], p < .001. Mental contrasting shows promise as a brief behaviour change strategy with a significant small to moderate-sized effect on changing health behaviour in the short-term. Analysis on a small subset of studies suggested that the addition of implementation intentions (MCII) did not further strengthen the effects of mental contrasting on health behaviours, although additional studies are needed.
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The effect of MCII on goal attainment is similar to Cross and Sheffield's (2019) meta-analysis finding of a small-to-medium effect on health behavior change.
“This is similar to Cross and Sheffield's (2019) meta-analysis, which found that MCII had a small-to-medium effect on health behavior change.”
From A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment (2021) · cites this paper as Cross and Sheffield's (2019)
Cross and Sheffield (2019) found a main effect of a mental contrasting intervention on adults' physical health outcomes, with adjusted Hedges' g = 0.28, 95% CI (0.13, 0.43) at up to 4 weeks, and an increased effect g = 0.38, 95% CI (0.20, 0.55) at up to 3 months.
“A meta-analysis by Cross and Sheffield (2019) found a main effect of a mental contrasting intervention on adults' physical health outcomes, with adjusted Hedges' g = 0.28, 95% CI (0.13, 0.43) at up to 4 weeks, and an increased effect [ g = 0.38, 95% CI (0.20, 0.55)] at up to 3 months.”
From A Meta-Analysis of the Effects of Mental Contrasting With Implementation Intentions on Goal Attainment (2021) · cites this paper as Cross and Sheffield (2019)
Cites
Implementation intentions: Strong effects of simple plans.
Gollwitzer, P. M. (1999) · American Psychologist · doi:10.1037/0003-066x.54.7.493 · Cited by 5,478 · see citing works
Implementation intentions and goal achievement: a meta-analysis of effects and processes
Gollwitzer, P. M., & Sheeran, P. (2006) · Advances in Experimental Social Psychology · doi:10.1016/s0065-2601(06)38002-1 · Cited by 3,236 · cited 2× · see citing works
“The majority of research to date has examined the effects of implementation intentions in which the researchers have guided participants’ ‘if-then’ plans (e.g., Armitage, 2004; Gollwitzer & Sheeran, 2006).”
BackgroundResultInfluentialGrey literature in meta-analyses of randomized trials of health care interventions
Hopewell, S., McDonald, S., Clarke, M. J., & Egger, M. (2007) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.mr000010.pub3 · Cited by 598 · see citing works
Stadler, G., Oettingen, G., & Gollwitzer, P. M. (2009) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.09.021 · Cited by 188 · see citing works
Kizilcec, R. F., & Cohen, G. L. (2017) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.1611898114 · Cited by 113 · cited 2× · see citing works
“In a sample of 17, 983 online learners, Kizilceca and Cohen (2017) found that MCII significantly increased online course completion rates for learners from individualist cultures where the obstacle concerned an everyday obligation.”
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Wang, G., Wang, Y., & Gai, X. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.565202 · Cited by 62 · see citing works
“, 2013), and mental contrasting alone or implementation intentions alone intervention studies found small-to-medium effect size (Belanger-Gravel et al., 2013; Carrero et al., 2019; Cross and Sheffield, 2019), MCII interventions had a small-to-medium effect size on behavior change.”
BackgroundMethodResultInfluentialGenerative artificial intelligence–mediated confirmation bias in health information seeking
Lopez‐Lopez, E., Abels, C. M., Holford, D., Herzog, S. M., & Lewandowsky, S. (2025) · Annals of the New York Academy of Sciences · doi:10.1111/nyas.15413 · Cited by 38 · see citing works
- Authors
- Cross, A., & Sheffield, D.
- Affiliations
- University of Derby (GB)
- Corresponding author
- Cross, Ainslea
- Venue
- Health Psychology Review
- Publisher
- Informa UK Limited
- Published
- 2019-03-29
- Volume
- 13
- Issue
- 2
- Pages
- 209-225
- ISSN
- 1743-7199 (ISSN-L)
- 1743-7202
- OpenAlex
- W2920841590
- Cited by
- 97
- References
- 5
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 7 · 2023: 13 · 2022: 5 · 2021: 8 · 2020: 50 · 2019: 1
- FWCI
- 2.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Psychology Review (publishedVersion)
- PubMed (publishedVersion)
- University of Derby Online Research Archive. (University of Derby) (submittedVersion)
- Topics
- Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
- Social Sciences › Arts and Humanities › Literature and Literary Theory › Media Influence and Health
- Social Sciences › Psychology › Developmental and Educational Psychology › Behavioral and Psychological Studies
- Keywords
- mental contrasting, implementation intentions, health behavior change, self-regulation, treatment moderators
- MeSH terms
- Self-Control, Humans, Outcome and Process Assessment, Health Care, Health Behavior, Effect Modifier, Epidemiologic, Imagery, Psychotherapy, Intention
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