C. Diclemente | University of Maryland Baltimore County (original) (raw)

Papers by C. Diclemente

Research paper thumbnail of Consumer-Centered, Collaborative, and Comprehensive Care

Journal of Addictions Nursing, Apr 1, 2016

Research paper thumbnail of Reliability and Validity of an Observational Measure of Client Decision-Making: The Client Language Assessment – Proximal/Distal (CLA-PD)

Journal of Substance Abuse Treatment, 2016

Research paper thumbnail of Final results of the Maryland WIC food for life program

Preventive Medicine, 2003

The few randomized community trials in middle-income populations that tried to modify multiple di... more The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.

Research paper thumbnail of Motivational interviewing: A systematic erview and meta-analysis

Research paper thumbnail of Standardized, individualized, interactive, and personalized self-help programs for smoking cessation

Health Psychology, 1993

Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals... more Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.

Research paper thumbnail of Internal validity of project MATCH treatments: Discriminability and integrity

Journal of Consulting and Clinical Psychology, 1998

Research paper thumbnail of The process of smoking cessation

Italian Heart Journal, 2001

Research paper thumbnail of An empirical typology of subjects within stage of change

Addictive Behaviors, 1995

Research paper thumbnail of How Important Is the Therapeutic Alliance in Treating Alcoholism?

Research paper thumbnail of Smoking behaviour: An intriguing challenge for psychology

Research paper thumbnail of Predicting drinking change following screening and brief interventions (SBI) for alcohol-involved trauma patients

Alcoholism Clinical and Experimental Research

Research paper thumbnail of Understanding self-reported staging of dietary behavior in low-income women

Journal of health psychology, 2015

This study examined self-reported staging for the goal of eating a low-fat diet and several speci... more This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results indicated that staging of specific dietary consumption behaviors was significantly related to staging for the global goal of eating a low-fat diet. Women evaluate their motivation about eating low-fat diets based on perceived efforts and specific activities related to dietary consumption with important implications for dietary behavior change measurement and interventions.

Research paper thumbnail of On a roll: the process of initiation and cessation of problem gambling among adolescents

Journal of gambling studies / co-sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming, 2000

As gambling becomes more accessible and acceptable in society, problems associated with gambling ... more As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic beha...

Research paper thumbnail of Issues in the development of client-treatment matching hypotheses

Journal of studies on alcohol. Supplement, 1994

This article discusses observations and insights that were gained in the course of critiquing the... more This article discusses observations and insights that were gained in the course of critiquing the a priori client-treatment matching hypothesis that were developed for Project MATCH. A matching taxonomy is offered that differentiates eight types of ordinal and disordinal interactions and discusses their clinical and substantive implications. Previously reported alcohol treatment studies are used to illustrate many of these. Various issues in matching studies, such as power versus complexity, prediction versus explanation, matches versus mismatches and capitalization versus compensation, are discussed. Selective issues in choosing treatment and client-matching variables as they affect matching hypotheses are also addressed. The importance of developing a putative "causal chain" for testing the theory underlying matching processes is explicated and a procedure for testing this causal chain is outlined.

Research paper thumbnail of Process assessment in treatment matching research

Journal of studies on alcohol. Supplement, 1994

A complete understanding of the effects of treatment requires an examination of the process by wh... more A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.

Research paper thumbnail of Issues in the selection and development of therapies in alcoholism treatment matching research

Journal of studies on alcohol. Supplement, 1994

There are a large number of possible approaches to the treatment of alcohol abuse and dependence.... more There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Research paper thumbnail of Assessment issues and strategies in alcoholism treatment matching research

Journal of studies on alcohol. Supplement, 1994

Sensitive and comprehensive client assessment entails complex conceptual and methodological consi... more Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and functions of assessment to support matching. This is followed by a discussion of the strategies employed in Project MATCH to identify matching and outcome variables. The assessment battery used in Project MATCH is next described. Finally, an overview of issues surrounding administration of assessment measures is provided. Particular attention is given to the topics of sequencing and timing of measures.

Research paper thumbnail of Stages of change in the modification of problem behaviors

Progress in behavior modification, 1992

... Tags. Stages of change in the modification of problem behavior. ... To insert individual cita... more ... Tags. Stages of change in the modification of problem behavior. ... To insert individual citation into a bibliography in a word-processor, select your preferred citation style below and drag-and-drop it into the document. Progress in Behavior Modification, Vol. ...

Research paper thumbnail of Predicting the therapeutic alliance in alcoholism treatment

Journal of Studies on Alcohol, 2000

Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the... more Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.

Research paper thumbnail of Smoking

Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 1989

Research paper thumbnail of Consumer-Centered, Collaborative, and Comprehensive Care

Journal of Addictions Nursing, Apr 1, 2016

Research paper thumbnail of Reliability and Validity of an Observational Measure of Client Decision-Making: The Client Language Assessment – Proximal/Distal (CLA-PD)

Journal of Substance Abuse Treatment, 2016

Research paper thumbnail of Final results of the Maryland WIC food for life program

Preventive Medicine, 2003

The few randomized community trials in middle-income populations that tried to modify multiple di... more The few randomized community trials in middle-income populations that tried to modify multiple dietary risk factors for cancer only demonstrated small changes. This trial sought to decrease the percent of calories derived from fat and to increase fruit, vegetable, and fiber intake among low-income women served by the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) in Maryland. We conducted six-month intervention programs for 1055 women at ten WIC sites; 1011 women served as controls. Intervention participants were invited to five interactive nutrition sessions and were sent written materials. Controls received usual care. Women were surveyed at baseline, two months post intervention, and one year later. All analyses conducted used an intention-to-treat paradigm. Mean differences (intervention-control) in change from baseline were for percent calories from fat -1.62 +/- 0.33% (P < 0.0001), for consumption of fruits and vegetables 0.40 +/- 0.11 servings (P = 0.0003), and for fiber intake 1.01 +/- 0.31 grams (P = 0.001). These differences in change were related in a dose-response relationship to the number of sessions women attended and remained significant one year post-intervention for the first two outcomes. Multiple dietary improvements can be achieved in a low-income population with an effective, multi-faceted intervention program. The changes in this trial exceeded those in previous community trials conducted in higher SES populations.

Research paper thumbnail of Motivational interviewing: A systematic erview and meta-analysis

Research paper thumbnail of Standardized, individualized, interactive, and personalized self-help programs for smoking cessation

Health Psychology, 1993

Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals... more Smokers (N = 756) were randomly assigned by stage of change to (a) standardized self-help manuals (ALA+ condition), (b) individualized manuals matched to stage (TTT condition), (c) interactive expert-system computer reports plus individualized manuals (ITT condition), or (d) a personalized condition with 4 counselor calls, stage manuals, and computer reports (PITT condition). Over 18 months, the ITT group's results more than doubled those of the ALA+ group on abstinence measures. The ALA+ and TTT conditions were equivalent over 12 months, but at 18 months the TTT condition was more effective. The ITT condition was the best or comparable with the best treatment at all follow-ups for smokers at all stages of change. Results suggest that an effective expert system has been developed, and discussion focuses on delivering this system to entire populations of smokers.

Research paper thumbnail of Internal validity of project MATCH treatments: Discriminability and integrity

Journal of Consulting and Clinical Psychology, 1998

Research paper thumbnail of The process of smoking cessation

Italian Heart Journal, 2001

Research paper thumbnail of An empirical typology of subjects within stage of change

Addictive Behaviors, 1995

Research paper thumbnail of How Important Is the Therapeutic Alliance in Treating Alcoholism?

Research paper thumbnail of Smoking behaviour: An intriguing challenge for psychology

Research paper thumbnail of Predicting drinking change following screening and brief interventions (SBI) for alcohol-involved trauma patients

Alcoholism Clinical and Experimental Research

Research paper thumbnail of Understanding self-reported staging of dietary behavior in low-income women

Journal of health psychology, 2015

This study examined self-reported staging for the goal of eating a low-fat diet and several speci... more This study examined self-reported staging for the goal of eating a low-fat diet and several specific dietary consumption behaviors to understand better readiness for dieting. Self-assessed motivation, food frequency measures, and psychosocial variables were obtained from 2057 low-income women enrolled in the Maryland Food for Life Program. Results indicated that staging of specific dietary consumption behaviors was significantly related to staging for the global goal of eating a low-fat diet. Women evaluate their motivation about eating low-fat diets based on perceived efforts and specific activities related to dietary consumption with important implications for dietary behavior change measurement and interventions.

Research paper thumbnail of On a roll: the process of initiation and cessation of problem gambling among adolescents

Journal of gambling studies / co-sponsored by the National Council on Problem Gambling and Institute for the Study of Gambling and Commercial Gaming, 2000

As gambling becomes more accessible and acceptable in society, problems associated with gambling ... more As gambling becomes more accessible and acceptable in society, problems associated with gambling and gaming have begun to affect ever increasing numbers of adolescents. Although restricted from most forms of gambling by law, many adolescents are finding a path into problem gambling. Some are becoming compulsive gamblers early in their gambling career, facing a future filled with consequences and problems. Understanding the pathway or process by which these adolescents become engaged in gambling behavior and how they can extricate themselves from this addictive behavior can enhance the efficiency and effectiveness of our interventions. This article offers a perspective on the initiation and cessation of compulsive gambling using the basic elements of the process of intentional behavior change outlined in the Stages of Change from the Transtheoretical Model. The process of initiation of a problematic behavior is similar to the process of modification or cessation of a problematic beha...

Research paper thumbnail of Issues in the development of client-treatment matching hypotheses

Journal of studies on alcohol. Supplement, 1994

This article discusses observations and insights that were gained in the course of critiquing the... more This article discusses observations and insights that were gained in the course of critiquing the a priori client-treatment matching hypothesis that were developed for Project MATCH. A matching taxonomy is offered that differentiates eight types of ordinal and disordinal interactions and discusses their clinical and substantive implications. Previously reported alcohol treatment studies are used to illustrate many of these. Various issues in matching studies, such as power versus complexity, prediction versus explanation, matches versus mismatches and capitalization versus compensation, are discussed. Selective issues in choosing treatment and client-matching variables as they affect matching hypotheses are also addressed. The importance of developing a putative "causal chain" for testing the theory underlying matching processes is explicated and a procedure for testing this causal chain is outlined.

Research paper thumbnail of Process assessment in treatment matching research

Journal of studies on alcohol. Supplement, 1994

A complete understanding of the effects of treatment requires an examination of the process by wh... more A complete understanding of the effects of treatment requires an examination of the process by which the treatment produces the outcome as well as a thorough assessment of the outcomes. Process assessment assumes even greater importance in matching research than in other types of treatment research, since client-treatment interactions are hypothesized to be moderated or mediated by specific treatment components. The role of process assessment in treatment matching research is examined using Project MATCH as an illustrative example. Four process domains, including dose of treatment, within-session treatment activities, the therapeutic alliance and extra-session activities, are described in terms of their role as mediators or moderators of treatment outcome and the perspectives by which they are assessed in Project MATCH.

Research paper thumbnail of Issues in the selection and development of therapies in alcoholism treatment matching research

Journal of studies on alcohol. Supplement, 1994

There are a large number of possible approaches to the treatment of alcohol abuse and dependence.... more There are a large number of possible approaches to the treatment of alcohol abuse and dependence. From a practical and methodological standpoint, however, only a limited number of interventions can realistically be included in research studies of treatment matching. A key question in planning studies of matching is what treatments to include. The recent book by Beutler and Clarkin on systematic treatment selection in general psychotherapy provides a framework within which to discuss alcoholism treatment matching and the criteria applied to decisions concerning (1) modes of treatment, (2) treatment format, (3) specific therapeutic strategies and the (4) treatment setting. The methodological and practical issues raised and the decisions reached in Project MATCH are presented in each of these areas. The therapies chosen for Project MATCH, based on these criteria, are described.

Research paper thumbnail of Assessment issues and strategies in alcoholism treatment matching research

Journal of studies on alcohol. Supplement, 1994

Sensitive and comprehensive client assessment entails complex conceptual and methodological consi... more Sensitive and comprehensive client assessment entails complex conceptual and methodological considerations. Such activity is at the heart of matching clients to appropriate treatments. This article begins by specifying the goals and functions of assessment to support matching. This is followed by a discussion of the strategies employed in Project MATCH to identify matching and outcome variables. The assessment battery used in Project MATCH is next described. Finally, an overview of issues surrounding administration of assessment measures is provided. Particular attention is given to the topics of sequencing and timing of measures.

Research paper thumbnail of Stages of change in the modification of problem behaviors

Progress in behavior modification, 1992

... Tags. Stages of change in the modification of problem behavior. ... To insert individual cita... more ... Tags. Stages of change in the modification of problem behavior. ... To insert individual citation into a bibliography in a word-processor, select your preferred citation style below and drag-and-drop it into the document. Progress in Behavior Modification, Vol. ...

Research paper thumbnail of Predicting the therapeutic alliance in alcoholism treatment

Journal of Studies on Alcohol, 2000

Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the... more Prediction of the therapeutic alliance in alcoholism treatment (as rated by the client and by the therapist) was examined in light of a range of potentially relevant factors, including client demographics, drinking history, current drinking, current psychosocial functioning and therapist demographics. The data were gathered in Project MATCH. The present analyses were based on data from 707 outpatients and 480 aftercare clients assigned to one of the three Project MATCH treatments. Potential predictor variables were evaluated by first examining bivariate linear relationships between the variables and ratings of the alliance, and then entering blocks of these predictors into multiple linear regression equations with alliance ratings as the dependent variables. All analysis incorporated adjustments for the nonindependence of ratings pertaining to clients seen by the same therapist. In simple regressions evaluating bivariate relationships, outpatients' ratings of the alliance were positively predicted by client age, motivational readiness to change, socialization, level of perceived social support and therapist age, and were negatively predicted by client educational level, level of depression, and meaning seeking. Therapist ratings in the outpatient sample were positively predicted by the client being female and by level of overall alcohol involvement, severity of alcohol dependence, negative consequences of alcohol use, and readiness to change. Among aftercare clients, ratings of the alliance were positively predicted by readiness to change, socialization and social support, and were negatively predicted by level of depression. Therapist ratings of the alliance in the aftercare sample were positively predicted by the client being female and therapist educational level, and were negatively predicted by pretreatment drinks per drinking day. Of the variables having significant bivariate relationships with alliance scores, only a few were identified as significant predictors in multiple regression equations. Among outpatients, client age and motivational readiness to change remained positive predictors and client education a negative predictor of client ratings of the alliance, while client gender remained a significant predictor of therapist ratings. Among aftercare clients, readiness to change and level of depression remained significant predictors of client ratings, while none of the variables remained a significant predictor of therapist ratings. While the data indicate that several client variables predict the nature of both the client's and therapist's perception of the therapeutic alliance, the significant relationships are of modest magnitude, and few variables remain predictive after controlling for causally prior variables. The strongest relationship identified in both the outpatient and aftercare samples is that between clients' motivational readiness to change and their ratings of the alliance.

Research paper thumbnail of Smoking

Health psychology : official journal of the Division of Health Psychology, American Psychological Association, 1989