Negative thoughts about making changes: Testing a cognitive-behavioral theory of noncompliance

Abstract

Despite the demonstrated efficacy of psychotherapy in the treatment of a variety of psychological difficulties, a persistent problem is resistance to and noncompliance with that treatment. Cognitive-Behavioral therapists theorize that clients' negative beliefs and attitudes about the effectiveness of treatment, their ability to complete therapeutic assignments, and so on, are primary underlying causes of noncompliance. This dissertation tested this model. Twenty-eight individuals experiencing high levels of perceived stress completed a six week stress management training course. Measures of stress, beliefs about making changes, and compliance with treatment directives were made at regular intervals. The statistical technique called mediational analysis was used to test a causal linkage from negative attitudes and beliefs to treatment compliance, and from compliance to outcome. Although participants' mean levels of stress and distress showed significant reductions, there was little support for the proposed beliefs-compliance-outcome model. Alternative explanations for these results were considered. Support was expressed for continued development of the Negative Beliefs about Changing measure.