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Medical Adherence And Aging Social And Cognitive
Perspectives 1st Edition Denise C. Park Digital Instant
Download
Author(s): Denise C. Park, Linda L. Liu
ISBN(s): 9781591477310, 159147731X
Edition: 1
File Details: PDF, 16.63 MB
Year: 2007
Language: english
Medical Adherence
and Aging
SOCIAL AND
COGNITIVE PERSPECTIVES

E D I T E D BY

Denise C. Park
Linda L. Liu

AMERICAN PSYCHOLOGICAL ASSOCIATION

WASHINGTON, DC
Copyright © 2007 by the American Psychological Association. All rights reserved.
Except as permitted under the United States Copyright Act of 1976, no part of this
publication may be reproduced or distributed in any form or by any means, including, but
not limited to, the process of scanning and digitization, or stored in a database or
retrieval system, without the prior written permission of the publisher.

Published by
American Psychological Association
750 First Street, NE
Washington, DC 20002
www.apa.org

To order In the U.K., Europe, Africa, and the Middle

APA Order Department East, copies may be ordered from
P.O. Box 92984 American Psychological Association
Washington, DC 20090-2984 3 Henrietta Street
Tel: (800) 374-2721 Covent Garden, London
Direct: (202) 336-5510 WC2E 8LU England
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Online: www.apa.org/books/
E-mail: [email protected]

Typeset in Goudy by World Composition Services, Inc., Sterling, VA

Printer: Maple—Vail Press, Binghamton, NY

Cover Designer: Berg Design, Albany, NY
Technical/Production Editor: Devon Bourexis
The opinions and statements published are the responsibility of the authors, and such
opinions and statements do not necessarily represent the policies of the American
Psychological Association.
Library of Congress Cataloging-in-Publication Data
Medical adherence and aging : social and cognitive perspectives / edited by Denise C.
Park and Linda L. Liu.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-59147-731-0
ISBN-10: 1-59147-731-X
1. Older people—Health and hygiene. 2. Patient compliance. 3. Medicine and
psychology. I. Park, Denise C. II. Liu, Linda L. III. American Psychological
Association.
[DNLM: 1. Patient Compliance. 2. Aged. 3. Cognition. 4. Patient
Compliance—psychology. W 85 M489 2007]
R727.43.M4322 2007
616—dc22 2006024262

British Library Cataloguing-in-Publication Data

A CIP record is available from the British Library.

Printed in the United States of America

First Edition
 CONTENTS

Contributors vii
Preface ix.

I. Theoretical Frameworks 1
Chapter 1. A Broad View of Medical Adherence: Integrating
Cognitive, Social, and Contextual Factors 3
Denise C. Park and Michelle L. Meade
Chapter 2. The Role of Goal Setting and Goal Striving
in Medical Adherence 23
Peter M. Gollivitzer and Gabriele Oettingen
Chapter 3. Prospective Memory Components Most at Risk
for Older Adults and Implications for
Medication Adherence 49
Mark A. McDaniel and Gilles O. Einstein
Chapter 4. Patient-Doctor Interactions in an Aging Society:
The Opportunities for Behavioral Research 77
Elaine A. Leventhal and Howard Leventhal

II. Understanding Doctors' Instructions 91

Chapter 5. How Older Patients Learn Medical Information 93
Scott C. Brown
Chapter 6. Representations of Self and Illness in the
Patient-Physician Relationship 123
Manfred Diehl, Angelenia Semegon, and
Lise M. Youngblade
Chapter 7. Trusting Medical Authorities: Effects of
Cognitive Aging and Social Vigilance 147
Emily Chan, Oscar Ybarra, Denise C. Park,
Joel Rodriguez, and Julie A, Garcia

III. Adherence to Treatment 167

Chapter 8. Motivational Models and Volitional Processes
in the Promotion of Health Behaviors 169
Sheina Orbell
Chapter 9. Judgment and Decision Processes in Older Adults'
Compliance With Medical Regimens 201
Linda L. Liu and Richard Gonzalez

IV. Technology and Treatment 233

Chapter 10. Customized Communication in Patient
Education 235
Matthew W. Kreuter, Ricardo Wray, and
Charlene Caburnay
Chapter 11. Helping Patients Follow Their Doctor's
Instructions: Matching Instructional Media
to Task Demands 251
Anne Collins McLaughlin, Wendy A. Rogers, and
Arthur D. Fisk
Chapter 12. Using Telecommunication Technologies to
Deliver Home-Based Care to Seniors 269
Pamela Whitten
Author Index 291
Subject Index 303
About the Editors 311

vi CONTENTS
 CONTRIBUTORS

Scott C. Brown, University of Miami Miller School of Medicine,

Miami, FL
Charlene Caburnay, St. Louis University, St. Louis, MO
Emily Chan, The Colorado College, Colorado Springs
Manfred Diehl, Colorado State University, Fort Collins
Gilles O. Einstein, Furman University, Greenville, SC
Arthur D. Fisk, Georgia Institute of Technology, Atlanta
Julie A. Garcia, University of Michigan, Ann Arbor
Peter M. Gollwitzer, New York University, New York, NY
Richard Gonzalez, University of Michigan, Ann Arbor
Matthew W. Kreuter, St. Louis University, St. Louis, MO
Elaine A. Leventhal, Robert Wood Johnson Medical School, New
Brunswick, NJ
Howard Leventhal, Rutgers, The State University of New Jersey, New
Brunswick
Linda L. Liu, University of Michigan, Ann Arbor
Mark A. McDaniel, Washington University, St Louis, MO
Anne Collins McLaughlin, Georgia Institute of Technology, Atlanta
Michelle L. Meade, University of Illinois at Urbana-Champaign
Gabriele Oettingen, New York University, New York, NY
Sheina Orbell, University of Essex, Colchester, England
Denise C. Park, University of Illinois at Urbana-Champaign
Joel Rodriguez, University of Michigan, Ann Arbor
Wendy A. Rogers, Georgia Institute of Technology, Atlanta
Angelenia Semegon, University of Florida, Gainesville
Pamela Whitten, Michigan State University, East Lansing
Ricardo Wray, St. Louis University, St. Louis, MO
Oscar Ybarra, University of Michigan, Ann Arbor
Lise M. Youngblade, Colorado State University, Fort Collins

VII
 PREFACE

As the projected life span of individuals increases, issues surrounding

the health care of older adults have shifted from focusing on recuperation
and rehabilitation toward goals of disease prevention and self-management
of health concerns. In particular, older adults are expected to play a more
active role in managing their own care and treatment, including setting
and striving to achieve health improvement goals, coordinating their medical
regimens, researching and making decisions about their treatment options,
and integrating new technologies into their daily lives. All of these medical
behaviors must be performed against a backdrop of age-related cognitive
changes that may affect older patients' ability to comprehend and remember
medical instructions.
This volume adopts a multidisciplinary approach toward issues that
influence medical adherence and how patients follow medical instructions,
with a focus on older adults. The goal is to provide a means for theoretical
issues in cognitive and social psychology to inform and improve how medical
instructions and treatment plans are presented to and understood by elderly
patients. To this end, this book brings together behavioral scientists, some
of whom are specialists in aging and others who are not, to discuss important
issues at the intersection of social psychology, cognition, and medicine. It
focuses on the theoretical frameworks proposed by leading cognitive and
social psychologists as the basis for understanding how patients process
medical and health information, adhere to their doctors' medical instruc-
tions, and use medical information technology.
The book is unique because it provides an opportunity for cognitive
and social psychological perspectives to inform key issues in health care
such as patient comprehension of and compliance with medical instruction.
The chapters are presented by experts in the field of cognitive or social

IX
psychology, by researchers in aging, and by specialists in medicine and health
care (many of the authors are experts in more than one of these areas).
The unifying theme of the book is the relevance and potential contribu-
tions of theories of cognitive and social psychology to facilitating older adults'
ability to translate their doctors' instructions into appropriate behaviors
in their daily lives. Part I, Theoretical Framework, lays the theoretical
groundwork and provides an overview of basic cognitive psychological pro-
cesses that are relevant to how patients understand and comply with their
medical care instructions. These four chapters survey the work on cognitive
processing, motivation, and prospective memory and serve as a backdrop
for the remaining chapters. Part II, Understanding Doctors' Instructions,
focuses on factors that influence the comprehension of medical information,
such as patients' existing beliefs about their illnesses, the familiarity of the
information presented, and the changes in susceptibility to deception that
occur with age. Part III, Adherence to Treatment, addresses the issue of
medical compliance and illustrates how cognitive and social psychological
theories on motivation and decision making can inform the development
of simple and practical strategies to improve patient compliance with medical
directives. Part IV, Technology and Treatment, explores the role of technol-
ogy in health care and discusses ways in which access to this technology
can be improved for senior adults.
This book is the result of a conference sponsored by the Roybal Center
for Aging and Cognition: Health, Education, and Training (sponsored by
the National Institute on Aging [NIA]). We are grateful for the support of
the NIA.

PREFACE
 I
THEORETICAL
FRAMEWORKS
 A BROAD VIEW OF MEDICAL
1
ADHERENCE: INTEGRATING
COGNITIVE, SOCIAL, AND
CONTEXTUAL FACTORS
DENISE C. PARK AND MICHELLE L. MEADE

Put very simply, medical adherence refers to the probability that a patient
will follow a doctor's health instructions. Most conceptual models as well
as research on the topic of medical adherence have focused primarily on
medication adherence, that is, the probability that a patient will take pills
or other medications prescribed by a physician in the appropriate amounts
and at the appropriate times. The topic of medical adherence is much
broader and encompasses a range of medical behaviors, for example, (a)
adhering to lifestyle recommendations made by a physician or other health
care provider, such as dietary or activity changes; (b) using medical equip-
ment, such as an oxygen tank, properly; (c) implementing recommended
medical procedures, such as regularly changing a dressing or monitoring
blood glucose; and (d) taking prescribed medications accurately. Virtually
all successful health care outcomes require that the recipient of the services
follow a set of instructions to ensure recovery from a surgery or management
of a chronic illness. In many cases, services are provided to the patient by
family members or friends, so there are many cases in which it is appropriate
to think of adherence from a systems perspective and consider the psychoso-
cial, cognitive, and contextual variables associated with caregiving to deter-
mine whether instructions will be followed. Despite the centrality of the
medical adherence issue to successful outcomes, the focus of most health
care research dollars is directed toward improving medical procedures, tech-
nologies, and drugs, with relatively little concern directed toward the vari-
ables that influence whether patients can or will successively complete
treatment requirements. In this chapter (and indeed in the entire volume),
variables that affect patients' adherence to medical instructions are examined
in an effort to better understand how to positively impact adherence to
treatment regimens.
It is useful to think of three important components that contribute to
medical adherence behaviors, some of which have received relatively little
attention. The first component involves psychosocial influences on adher-
ence. Variables such as belief systems, motivational states, social networks,
and relationship to physician or health care provider are explored under
this rubric. Although much work remains to be done, this area has received
more rather than less attention, particularly in the area of belief systems
and cognitive models of adherence, exemplified by the large body of literature
related to the self-regulatory model proposed by Leventhal and Cameron
(1987; Cameron & Leventhal, 2003; see also chap. 4, this volume) as well
as the health beliefs model (Becker, 1989; Rosenstock, 1990).
A second domain that has recently received more attention is the role
of cognitive function in medication adherence, particularly as it relates to
an aging population. Our lab has taken an active role in understanding this
topic (e.g., Brown & Park, 2002; Morrell, Park, Kidder, & Martin, 1997;
Park et al., 1999; Park, Willis, Morrow, Diehl, & Gaines, 1994; Shifren,
Park, Bennett, & Morrell, 1999; Skurnik, Yoon, Park, & Schwarz, 2005),
with some significant findings from our work being counterintuitive. For
example, we have frequently reported that older adults are more adherent
to pill regimens than are young adults, despite diminished cognitive capacity
(Brown & Park, 2003; Morrell et al., 1997; Park et al., 1999). In this chapter,
we discriminate between situations in which decreased cognition does affect
adherence negatively and those in which declining cognition is relatively
unimportant or is compensated for by more powerful variables.
This leads to the third domain—which remains relatively unexplored
in the study of medical adherence—and that is the role that contextual
variables play in whether patients adhere to treatment regimens. The envi-
ronment in which an individual functions, the magnitude of the routines
that govern individual behaviors, and the level of busyness or engagement
that characterizes a person are all important predictors of adherence (Martin
& Park, 2003; Park, 1996; Park et al., 1999). Moreover, as we describe in

PARK AND MEADE

this chapter, one can capitalize on the predictability of an environment to
enhance the prospect of medical adherence (Liu & Park, 2004).
In this chapter, we focus primarily on the role of cognitive and contex-
tual factors in medical adherence, while integrating psychosocial variables
and belief systems into our discussion whenever appropriate. We discuss
initially the role that limited cognitive capacity may play in affecting medical
adherence, and we distinguish between effortful and automatic processes as
they relate to cognitive capacity and adherence. Then we make an important
distinction between the early stages of adherence (comprehending and re-
membering medical instructions, protocols, or regimens) and later stages
(actual implementation of medical instructions), as well as what variables
influence these different stages of adherence. We conclude with promising
future directions for research development to facilitate adherence to medi-
cal instructions.

DIMINISHED COGNITION AND MEDICAL ADHERENCE

It is important to recognize that the population of individuals who must

follow medical instructions comprises many individuals with diminished
cognition. Older adults consume a disproportionate amount of health care,
and there is clear evidence that with age many cognitive functions, including
speed of information processing, working memory capacity, and long-term
memory, decline (Park et al., 2002). Additionally, many patients with psy-
chiatric or neurologic disorders, as well as some HIV patients, show evidence
of cognitive compromise, and patients in these diagnostic categories have
high adherence requirements. Finally, patients who are ill (e.g., feverish)
or in pain may also temporarily have less cognitive capacity available to
them. Thus, the group of individuals who are cognitively compromised in
some way and must follow medical instructions is a large one. For this
reason, it makes sense to consider the implications of declining cognition for
medical adherence. Although the implications would appear to be obvious—
that with less cognitive capacity, individuals will have more trouble
adhering—there is considerable research that suggests this is not always the
case. It is important to recognize that both effortful and automatic processes
are important in medication adherence and that decreases in cognition that
occur with age or in other compromising conditions occur primarily in
effortful but not automatic processes (Brown & Park, 2003). To the extent
that adherence involves automatic processes, diminished cognition will not
play an important role.
The term effortful process refers to cognition that involves activation
of executive processes and deliberate efforts to encode, retrieve, inhibit, or
manipulate information. Effortful processes have often been described as

A BROAD VIEW OF MEDICAL ADHERENCE

conceptually driven or top-down processes (e.g., Jacoby, 1983). Examples
of effortful cognitive processes include learning a list of words and then later
trying to recall it, or studying a set of medical instructions and consciously
attempting to translate the instructions into a personal plan of action. There
are marked, easily documented changes in cognitive function that occur in
effortful processes with age (Park et al., 2002).
In contrast, automatic processes operate often without the individual's
conscious awareness and require little engagement of executive function
and deliberate processing of information. Automatic cognition is often de-
scribed as data driven or bottom-up, reflecting the important role that
external environmental cues play in determining information that automati-
cally comes to consciousness without active encoding or retrieval effort.
Examples of automatic processes include completing a three-letter word
stem with a word that you just heard earlier, or after brushing your teeth
in the morning, reaching for the bottle of pills on the bathroom counter
that you take every morning as soon as you put down your toothbrush.
There is some debate as to whether automatic processes may operate slightly
less efficiently with age (La Voie & Light, 1994; Park & Shaw, 1992), but
there is strong agreement that the deficits (if any) in automatic processes
with age are much less pronounced than in effortful processes. Thus, when
thinking about medical adherence processes, it is important to recognize
that cognitively compromised populations will likely only show deficits in
the facets of medical adherence that involve effortful processes, unless they
are severely compromised, as might be the case in some very advanced
stages of HIV and would always be the case for advanced cases of Alzhei-
mer's disease.

THE EARLY STAGES OF MEDICAL ADHERENCE:

COMPREHENDING AND REMEMBERING
MEDICAL INSTRUCTIONS

Medical adherence is not a global behavior and has a number of

component processes (Park, 1992). To take medication successfully or follow
medical instructions appropriately, an individual must first be able to compre-
hend the instructions, then later remember the instructions or, at least,
have the written instructions directly available at the time of implementa-
tion. Given that an individual successfully comprehends and remembers the
instructions, he or she must then prospectively remember to perform or
implement the instructed action. Much of the adherence literature focuses
on remembering to take medications and relatively little addresses the issue
of accurate comprehension and memory for what is to be done. We argue
that it is this early phase—particularly comprehension of a regimen or

PARK AND MEADE

instruction—that is most compromised by cognitive frailty and a domain
to which much more attention needs to be directed, particularly in the area
of medical equipment (see chap. 11, this volume).
We initially investigated the problem of comprehension by orally
presenting young and old adults with a series of fictitious prescriptions, as
if they were receiving instructions from a physician (Morrell, Park, & Poon,
1989). We found consistent evidence that older adults showed not only
poorer memory for the instructions but also poorer comprehension than
young adults of the materials. When young and older adults had the medica-
tion available to them in writing and could consult the information when
developing a plan for when to take the medications, older adults consistently
made more errors. Morrell et al. (1989) also reported that when given as
much time as desired to study the medical information prior to a memory
test, older adults still made more mistakes on a memory test compared with
young adults. Of particular concern was that when participants had unlimited
study time, younger adults chose to study the medication information sig-
nificantly longer than did older adults before indicating they were ready to
take the memory test. This finding illustrates that older adults may have
metacognitive failures (not knowing that they do not know the medical
regimen or procedure) that contribute to nonadherence.
In basic laboratory research, we have consistently reported that older
adults have intact picture recognition memory (Park, Puglisi, & Smith, 1986;
Park, Royal, Dudley, & Morrell, 1988), so in a later study, we redesigned
medication labels to have a pictorial format (Morrell, Park, & Poon, 1990)
and compared younger and older adults' memory for pictorial labels with
their memory for well-organized verbal labels. An example of the pictorial
labels appears in Figure 1.1. Morrell et al. (1990) found somewhat surprisingly
that the pictorial labels did not facilitate memory in the older adults relative
to the verbal labels, but they did facilitate memory in the young adults. It
seemed that the novel format for the pictorial labels required more cognitive
effort to use for the older adults than the more familiar verbal labels. Similar
findings were reported by Morrow, Leirer, and Andrassy (1996), who showed
older adults were better able to paraphrase medication schedules when the
information was presented in text format than when presented with icons
of clocks pictorially depicting the schedule. These findings highlight the
importance of relying on familiar formats and procedures in interventions
to improve adherence. Although it would be an oversimplification to suggest
that new formats will not be successful, it is important to recognize that
novelty likely introduces cognitive load for older adults, at least until a high
degree of familiarity is achieved with the intervention.
One commonly available and frequently used intervention to assist
in medication adherence is various medication organizers or medication
containers that are sold over the counter. These devices typically have bins

A BROAD VIEW OF MEDICAL ADHERENCE

 Verbal Label Mixed Label
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figure 17. Examples of labels used in experiment. From "Effects of Labeling

Techniques on Memory and Comprehension of Prescription Information in Young
and Old Adults," by R. W. Morrell, D. C. Park, and L. W. Poon, 1990, Journals of
Gerontology: Psychological Sciences, 45, p. P168. Copyright © The Gerontological
Society of America. Reproduced by permission of the publisher.

or wells marked with days or times, or both. Consumers are to load the
organizers with their medications, typically for a week, and then carry the
organizer around with them. The organizers solve the problem of remember-
ing whether a medication has been taken, because if it has not been, it will
be obvious by looking at the date-time slot. At the same time, once the
consumer takes medications out of the original prescriptions vials, all infor-
mation about the medication, including name, quantity, and time to be
taken, is lost. Hence, if the consumer loads the medication organizers incor-
rectly, this has the potential to be quite dangerous. To investigate the safety
of these devices, we tested the ability of a group of patients with arthritis
taking multiple medications to correctly load different types of organizers
with their own medications (Park, Morrell, Frieske, Blackburn, & Birchmore,
1991). There are many different types of devices, but two of the most
common are shown in Figure 1.2. The top organizer, referred to as a 7'day
with times organizer had a much lower rate of loading errors than the bottom
one, referred to as a 7-day without times organizer. The failure to load correctly
the 7-day without times organizer is particularly disturbing because consum-
ers lose all identity information about the medication—even what time of
day it is to be taken, which likely further compounds the errors that occur
after it is initially incorrectly loaded. In contrast, the 7-day with times

PARK AND MEADE

 7-Day With Times Organizer
SUN • WON • TUE * WED * THU • FRI • SAT ^
. .
/ V/ v/ v. ^^^
X S

MORN MORN MORN MORN MORN MORN MORN

7-Day Without Times Organizer

S M T W T F S
Figure 1.2. Schematic representation of the three types of organizers used in the
study. From "Cognitive Factors and the Use of Over-the-Counter Medication Or-
ganizers by Arthritis Patients," by D. C. Park, R. W. Morrell, D. Frieske, B. Blackburn,
and D. Birchmore, 1991, Human Factors, 33, p. 60. Copyright 1991 by the Human
Factors and Ergonomics Society. Reprinted with permission.

organizer had quite a low error rate (about 5%); we believe that the organizer
actually serves to structure consumers' cognition, and the act of loading it
may actually enhance comprehension of a medication regimen. Neverthe-
less, these findings illustrate the potential risks associated with over-the-
counter medication organizers, as well as the fact that generally they are
designed to facilitate the act of implementation of a prescription regimen
and that good comprehension of the regimen is essential if these organizers
are to be loaded correctly.
In a subsequent effort to understand the role of enhancing comprehen-
sion of medical information on adherence, Park, Morrell, Frieske, and
Kincaid (1992) studied adults ages 60 and over taking four or more medica-
tions and provided them with materials designed to enhance comprehension.

A BROAD VIEW OF MEDICAL ADHERENCE

One group received a poster for their refrigerator developed by the experi-
menters that provided detailed information, day by day, hour by hour, on
exactly which medications were to be taken at a given time. There was a
check-off area on the poster, so that participants could mark when they
took the medication. The poster relieved participants of any need to compre-
hend their regimen—they merely picked up the appropriately marked vial
at the stated time. In short, participants continued to have a prospective
memory task to adhere—remembering to take the medication—but the
comprehension burden was considerably diminished. Another group re-
ceived a 7-day with times organizer that the experimenter loaded with each
participant's medications. This also relieved the comprehension burden of
a regimen but still required prospective memory to take the medications.
A third group received both types of cognitive supports, and the fourth
group was a no-treatment control group that took their medications without
any of the cognitive aids. Medication adherence was monitored for 1 month
with sensitive barcode scanners, providing relatively accurate measures of
adherence.
The results were initially surprising. A median split of participants
into a young-old (ages 70 and younger) and old-old (ages 71 and greater)
showed that adults in the young-old control group had a 94% adherence
rate, and because adherence was already so high, the interventions did not
improve adherence rates in this group. In contrast, the adults in the old-
old group had a lower adherence rate (82%) and showed significantly greater
levels of adherence when they received the two comprehension aids—a
medication organizer and a medication refrigerator poster. This is an impor-
tant set of findings, first, because it indicates that adherence rates in young-
old adults are actually quite high and that this group is not at particularly
high risk of nonadherence. Second, the findings suggest that very old adults
are at risk of nonadherence and that the nonadherence is primarily due to
comprehension difficulties in them, because providing older adults with the
dual cognitive aids increased their adherence to 98%. It is important to
recognize that this magnitude of adherence was obtained without any pro-
spective reminders, suggesting that comprehension, not prospective remem-
bering, is the biggest barrier to adherence in this population.
The work just described, because it focused on the role of medication
organizers and specific medication instructions, provides relatively little
insight into issues associated with following instructions about medical
conditions and medical procedures. Individuals who are experiencing mem-
ory decline as a result of either age or medical condition will, of course, be at
risk of having some difficulty remembering medical information or following
medical instructions. Brown and Park (2002) reported that older adults had
more difficulty than young adults in acquiring information presented to
them about a disease. It is surprising that they were particularly resistant

10 PARK AND MEADE

to acquiring new information about a familiar disease (e.g., breast cancer)
compared with an unfamiliar one (e.g., acromegaly). It appears that patients
may resist changing existing schemas about familiar diseases and are more
open to learning novel information about a disorder for which they have
no preconceived notions.
Individuals who are cognitively frail may also be prone to distortions
of presented instructions. For example, Skurnik et al. (2005) demonstrated
how the illusion of truth associated with familiar information can make
false information seem true to older adults. There is a well-documented
finding (called the illusion of truth effect) that demonstrates that familiar
information, even if the individual understood it to be false at the time of
acquisition, feels true later on because of its familiarity and the loss of
context about a statement's truth value (Hasher, Goldstein, & Toppino,
1977). Because older adults rely more on familiarity to remember things
than do young adults (Jacoby, 1999), they should be unusually susceptible
to the illusion of truth. Skurnik et al. (2005) presented young and old adults
with medical statements during acquisition, along with the truth value of
each statement (e.g., true or false). Some statements were presented once
and others three times. After 3 days, participants were presented with the
old statements as well as some new statements, and they had to indicate
whether the medical statements were new or were statements they had been
told were true or false. Older adults were more certain that statements they
had studied as false three times were true than statements they had studied
as false only once! In contrast to older adults, younger adults did remember
statements they were told were false three times were false but had a bias
to remember items presented only once as true, as shown in Figure 1.3. In
short, the more frequent statements felt familiar to the older adults, and
familiar information feels true, so they were more likely to misremember
medical information repeatedly presented to them as false. The younger
adults, however, did remember the context and so had explicit memory for
the false items as false when they were presented three times.
The basic message from Skurnik et al.'s (2005) study is that older
adults will often remember medical instructions that they hear but forget
the context in which they learned it. Thus, telling older adults, for
example, "Some people think this medication is safe to take with food.
That's not true." might be less effective than instructing them, "Never
eat at the time you take this medication." They might forget the truth
value of the former statement and remember only "medication is safe to
take with food" and make a serious mistake. Presenting medical instructions
and then negating them (as in "It's safe to smoke around your oxygen
tank, right? Don't do it!") is a dangerous practice with older adults, as
they may remember the initial false statement and not the discontinuing
sentence that follows it.

A BROAD VIEW OF MEDICAL ADHERENCE I1

 • "true to false
n "false" to true

1 Presentation 3 Presentations 1 Presentation 3 Presentations

Younger Adults Older Adults

Figure 1.3. Memory for truth and falsity when truth value is disclosed on each
presentation, by age and repetition. From "How Warnings About False Claims Become
Recommendations," by I. Skurnik, C. Yoon, D. C. Park, and N. Schwarz, 2005, Journal
of Consumer Research, 31, p. 717. Copyright 2005 by the University of Chicago
Press. Reprinted with permission.

Once older adults come to believe an inaccurate health statement as

true, it may be difficult for them to remember contradictory (yet accurate)
information. Rice and Okun (1994) tested participants' memory for accurate
statements about osteoarthritis. Participants were less likely to remember
the accurate statements that contradicted their previous misconceptions
than they were to remember accurate statements that were consistent with
their previous beliefs. Follow-up research indicated that older adults were
even less likely to remember disconfirming, accurate statements when the
information was personally relevant to them because they had the disease
(Okun & Rice, 2001). These findings suggest that once participants believe
inaccurate information, they are resistant to changing it.
Another aspect that may play into tendencies to adhere is the wealth
of information about medical conditions and treatments available through
the media, particularly the ability to find detailed information about a
particular illness or treatment on the Internet within a matter of seconds
by initiating a simple search. Increasingly, the Internet is finding its way

12 PARK AND MEADE

into the everyday lives of older adults, and the magnitude of this will only
increase as the baby boomers age. There is even direct marketing of medical
information to consumers, as well as tailoring of individual messages that
are designed to be particularly motivating to individuals with a particular
configuration of characteristics (see chap. 10, this volume). The potential
for environmental influences via the Internet and media outlets affecting
or biasing memory and comprehension of medical instructions is something
that will play an ever greater role in following medical instructions and will
be difficult to comprehend or control in understanding medical adherence,
as environmental factors will vary considerably across individuals.
Another domain that will be important in affecting the
comprehension—memory component of medication adherence is that of
collaborative cognition. It is often the case that patients operate as dyads
with another family member (e.g., spouses, elder parent with child, or
caregiver with patient) when developing treatment adherence plans. In
understanding the dynamics associated with comprehending a medical regi-
men or instructions, it may be important to treat patients as a dyadic unit
and assess whether members of the dyad have sufficient information to
adhere to a plan. Alternatively, it may be more important that a caregiver
understand adherence plans than the patient, although sometimes the in-
structions may be delivered by the patient. It is important to recognize that
the caregiver may be the same age, or even older, than the patient and that
the existence of a caregiver does not necessarily mitigate problems with
instructions. Understanding how to use dyads effectively to improve compre-
hension and memory of a medical regimen is an important direction for
future research of medical adherence.
Another important issue with respect to comprehension of medical
instructions is the clarity of the material actually presented to patients. In
1991, the Patient Self-Determination Act (1990; Omnibus Budget Reconcil-
iation Act, 1990) became effective and required that hospital and nursing
home patients be given information about legal rights regarding living wills
and durable powers of attorney for health care. Park, Eaton, Larson, and
Palmer (1994) surveyed hospital administrators regarding problems with
implementing the law. The second most common problem cited was the
inability of patients to comprehend the information that was presented,
confirming the difficulty medical institutions have in presenting complex
information in a format readily comprehended by patients. In a later study
comparing nursing homes with hospitals, 74% of both nursing homes and
hospitals cited "difficulty in conveying information to residents/patients"
as a significant problem encountered in implementing the Patient Self-
Determination Act, again suggesting that patients often receive information
and materials that even those delivering the information suspect cannot
be understood.

A BROAD VIEW OF MEDICAL ADHERENCE J3

 There is a substantial body of research on how to make both written
text and spoken language more comprehensible to older adults. If fact, some
researchers have focused specifically on the topic of increasing comprehensi-
bility of medical instructions for older adults. Rice, Meyer, and Miller (1989)
demonstrated that organization plays an important role in older adults'
memory for medical information. Older adults remembered significantly
more information from medical passages organized so that the most important
information was presented at the highest level of content structure. Presenta-
tion format can also influence older adults' processing of medical information.
Morrow, Leirer, and Altieri (1995) found that older adults' comprehension
and subsequent memory for medical information are improved when the
information is presented in a list format (rather than a paragraph format).
Further, presenting medical information in a list format reduced age differ-
ences in comprehension, memory, and making inferences (Morrow, Leirer,
Andrassy, Hier, & Menard, 1998). Repeating medical information also helps
older adults better remember it (Morrow, Leirer, Carver, Tanke, & McNally,
1999b), and it is interesting to note that when given the option to repeat
a medical message, both young and older adults often choose repetition,
thereby improving their memory (Morrow, Leirer, Carver, Tanke, &
McNally, 1999a). In her testimony to the U.S. Senate Special Committee
on Aging given on June 2005, Denise Park reviewed an array of brochures
designed to present information to older adults that were of limited clarity
and proposed that congressional standards requiring design and review of
government-produced materials for comprehensibility be implemented
(Consumer Fraud and the Aging Mind, 2005).

LATER STAGES OF MEDICAL ADHERENCE:

IMPLEMENTING MEDICAL INSTRUCTIONS

We now turn to a discussion of the act of implementing medical

instructions, once comprehended. The act of remembering to perform a
medical instruction is often called a prospective memory task (see chap. 3,
this volume), that is, remembering to perform a planned action. The data
presented earlier in this chapter suggested that when electronic monitors
were used, older adults had a relatively high rate of adherence (Morrell et
al, 1997; Park et al., 1992). However, in these studies, participants were
required to carry a wallet with a small bar-code scanner in it and to scan
the appropriate code each time they took a medication, thus recording the
date and time. Carrying around the bar-code scanner and wallet made the
act of remembering to take medications relatively salient, and the wallet
could have served as a memory cue.

14 PARK AND MEADE

 In a later study, Park et al. (1999) attempted to get a more naturalistic
measure of medication adherence by using the Medication Event Monitoring
System (MEMS). With this system, participants received new lids for their
medication bottles that had a microchip embedded in them. Each time they
opened the bottle to take a medication, the date and time were recorded.
The use of the MEMS system provided a relatively unobtrusive way to
monitor medication adherence. Park et al. recruited 122 patients with rheu-
matoid arthritis ranging in age from 34 to 84 and collected detailed psycho-
social, cognitive, and health status information from the patients, and even
collected measures of disease severity from patients' physicians. Patients
were all taking a large number of medications, and all of their medications
were outfitted with the MEMS system. Patients left the laboratory and
medication events were monitored for 4 weeks, providing detailed informa-
tion about medication behaviors. The extensive battery collected provided
a plethora of individual differences measures. Structural equation modeling
was used on these individual differences measures to determine the causal
factors associated with nonadherence.
The results were somewhat surprising. As in the earlier studies (Morrell
et al., 1997; Park et al., 1992), younger adults were less adherent than older
adults (see Hinkin et al., 2004, for similar conclusions regarding young and
older adults' adherence to AIDS medications). Given this finding, it is not
surprising that higher cognitive function was not the best predictor of
adherence. Nor did beliefs about illness, depression, anxiety, or disease
severity prove to be strong predictors of adherence. Rather, the best predictor
of adherence was how busy and routine patients reported their lives to be
using the Martin and Park (2003) Busyness Questionnaire. The busier and
less routine patients' lives were, the more likely they were to be nonadherent.
Because middle-aged adults reported leading the busiest lives, they also
tended to be the most nonadherent. Thus, not only did the finding from
earlier studies replicate, but the mechanism underlying the apparent superi-
ority of older adults for this phase of adherence was isolated.
Both the constructs of busyness and routinization are important in
understanding why older adults have such high adherence rates. A low level
of busyness provides older adults with sufficient unstructured time to monitor
the activities they need to perform for the day. Busy middle-aged individuals
who are multitasking are less likely to have the time available to monitor
future obligations, and thus are more likely to miss the appropriate time
window when they must perform a prospective task. Additionally, however,
we believe that a high level of routinization in one's life (which also was
more characteristic of older adults) operates to automatize prospective behav-
iors that must be performed on a regular basis (Brown & Park, 2003). If an
individual is required to take their medication every morning with food and

A BROAD VIEW OF MEDICAL ADHERENCE ]5

he or she leads a routine life, it is likely that the individual will eat breakfast
at a regular time (and often even eat the same thing for breakfast). As an
example, perhaps one might place one's medication on the kitchen table
and take it each morning after drinking orange juice. After a few days of
remembering to take one's medications after the orange juice, there will be a
tendency to spontaneously or automatically reach for the medication after
taking the orange juice without conscious thought that it is time for medica-
tion, much as one might spontaneously reach for a toothbrush upon entering
the bathroom in the morning. After a few days of remembering, the orange
juice automatically cues reaching for the medication bottle. This seems like
a particularly plausible basis for the good adherence behavior of older adults
given the high scores they achieve on levels of routinization (Martin &
Park, 2003) combined with the high levels of adherence they evidence.
Brown and Park (2003) argued that adherence to medications and
medical procedures might be improved by exploiting the component of
memory and cognition that remains relatively unchanged with age—
automatic processes. Thus, Liu and Park (2004) attempted to engage auto-
matic processes to enhance medical adherence in a sample of older adults,
relying on a technique used by Brandstatter, Lengfelder, and Gollwitzer
(2001; see also chap. 2, this volume). Brandstatter et al. reported that
young adults who were required to imagine the specific steps involved in
implementing a desired behavior were more likely to complete the imagined
behavior in the future than a control group. They suggested that forming
detailed implementation plans enhanced goal achievement through the
engagement of automatic processes and a tendency to act when they later
encountered some of the cues they imagined. Chasteen, Park, and Schwarz
(2001) demonstrated that the development of such implementation inten-
tions was effective for improving older adults' performance of a simple
prospective memory task in the laboratory. On the basis of these findings,
Liu and Park (2004) hypothesized that implementation intentions would
facilitate the performance of a more complex health adherence behavior
by older adults outside of the laboratory. They trained older adults who had
never used a glucose monitor and had no history of diabetes to use a glucose
monitor to record the date and time the glucose was measured. Then, the
adults were divided into one of three groups. The implementation group
imagined exactly what they would be doing the next day at four different
times when they were to draw blood from their finger with a lance and test
it with the glucose monitor. A rehearsal group repeated the instructions
multiple times across a rehearsal interval, and a third group wrote the pros
and cons of testing their blood glucose. Then, participants left the laboratory
and were instructed to use the blood glucose monitor at the same appointed
times everyday for 3 weeks.

16 PARK AND MEADE

 Rehearsal Deliberation Implementation
Instruction Type
Figure 1.4. Average proportion of blood glucose tests performed correctly as a
function of instruction type received. Error bars represent +1 SEof the mean. Prop. =
proportion. From "Aging and Medical Adherence: The Use of Automatic Processes
to Achieve Effortful Things," by L. L. Liu and D. C. Park, 2004, Psychology and Aging,
19, p. 321. Copyright 2004 by the American Psychological Association.

Results are shown in Figure 1.4 and indicate that the implementation
instructions were superior in maintaining adherence to the glucose monitor-
ing regimen over the other two rehearsal conditions. Of particular interest
is the rinding that the behavior continued to increase over the 3-week
period—a truly remarkable finding given that participants engaged in only
one 5-minute session before the 1st day. The improvement in the latter
part of the time period speaks to the automatization of the behavior through
routine. Once participants began performing the behavior (as a result of
the implementation instructions), they began to integrate it into their daily
routine such that the performance of the behavior each day served to increase
the probability that it would be performed on subsequent days as a result
of the increased likelihood that more environmental cues would be encoun-
tered that were associated with the behavior and enhance adherence. The
finding that a simple 5-minute practice session enhanced and maintained
adherence over a 3-week period speaks to the importance of automatic
processes in controlling adherence behavior as well as the ability to harness
such processes in older adults to maintain adherence behaviors.

A BROAD VIEW OF MEDICAL ADHERENCE 17

 DIRECTIONS FOR THE FUTURE

There is much innovative research that remains to be done on the

topic of medical adherence, particularly in the interaction of cognitive
processes with environmental cues and demands. The data we have presented
suggest that the most problematic aspect of following medical directions in
cognitively frail populations has to do with comprehension and memory of
instructions rather than in actually remembering to perform the adherence
task. Moreover, the data suggest that it is likely easier to improve the
implementation component of medical adherence even further in older
adults by exploiting the component of memory that remains intact with
advanced age or decreasing cognitive function—automatic processes. The
challenge to researchers is to understand how to structure information and
instructions so that they will be effective. Although much is known about
typeface, luminance, and other variables affecting visual perception and
aging, considerably less is known about the most effective medium for
presenting medical instructions, how effective video training tapes might
be for the use of complex equipment, and what role the Internet and
other media might play in affecting interpretation and retention of medical
information and instructions. It is likely that the move to decreased hospital-
ization will continue over time, with increased caregiving by relatives or
unskilled adults. It is critically important that a better understanding be
achieved of how to present medical information so that it can be compre-
hended and remembered, and also what social contexts and motivational
states maximally facilitate adherence in cognitively frail adults. It is not
always the case that cognition is the limiting factor in adherence, even in
cognitively compromised adults. As this chapter illustrates, sometimes con-
text plays a more important role than cognition. Understanding the role
of these variables individually is important, but a full understanding of
adherence will be achieved only when naturalistic studies are done that
examine the behavior and variables that affect it in complex settings and
integrate social, contextual, and cognitive perspectives.

REFERENCES

Becker, L. A. (1989). Family systems and compliance with medical regiments. In

C. N. Ramsey Jr. (Ed.), Family systems in medicine (pp. 416-431). New York:
Guilford Press.
Brandstatter, V., Lengfelder, A., & Gollwitzer, P. M. (2001). Implementation
intentions and efficient action initiation. Journal of Personality and Social Psy-
chology, 81, 946-960.

18 PARK AND MEADE

Brown, S. C., & Park, D. C. (2002). Roles of age and familiarity in learning of
health information. Educational Gerontology, 28, 695-710.
Brown, S. C., & Park, D. C. (2003). Theoretical models of cognitive aging and
implications for translational research in medicine. The Gerontologist, 43,
57-67.
Cameron, L. D., & Leventhal, H. (2003). Self-regulation, health, and illness: An
overview. In L. D. Cameron & H. Leventhal (Eds.), The self-regulation of health
and illness behavior (pp. 1-13). New York: Routledge.
Chasteen, A. L., Park, D. C., & Schwarz, N. (2001). Implementation intentions
and facilitation of prospective memory. Psychological Sciences, 6, 457-461.
Consumer Fraud and the Aging Mind, 109th Cong., 59 (2005) (testimony of Denise
C. Park).
Hasher, L., Goldstein, D., & Toppino, T. (1977). Frequency and the conference of
referential validity. Journal of Verbal Learning and Verbal Behavior, 16, 107-112.
Hinkin, C. H., Hardy, D. J., Mason, K. L, Castellon, S. A., Durvasula, R. S., Lam,
M. N., &. Stefaniak, M. (2004). Medication adherence in HIV-infected adults:
Effect of patient age, cognitive status, and substance abuse. AIDS, 18, 19-25.
Jacoby, L. L. (1983). Remembering the data: Analyzing interactive processes in
reading. Journal of Verbal Learning and Verbal Behavior, 22, 485-508.
Jacoby, L. L. (1999). Ironic effects of repetition: Measuring age-related differences
in memory. Journal of Experimental Psychology: Learning, Memory, and. Cognition,
25, 3-22.
La Voie, D., & Light, L. L. (1994). Adult age differences in repetition priming: A
meta-analysis. Psychology and Aging, 9, 539-553.
Leventhal, H., & Cameron, L. (1987). Behavioral theories and the problem of
compliance. Patient Education and Counseling, 10, 117-138.
Liu, L. L., & Park, D. C. (2004). Aging and medical adherence: The use of automatic
processes to achieve effortful things. Psychology and Aging, 19, 318-325.
Martin, M., & Park, D. C. (2003). The Martin and Park Environmental Demands
(MPED) Questionnaire: Psychometric properties of a brief instrument. Aging:
Clinical and Experimental Research, 15, 77-82.
Morrell, R. W., Park, D. C., Kidder, D. P., & Martin, M. (1997). Adherence to anti-
hypertensive medications across the life span. The Gerontologist, 37, 609-619.
Morrell, R. W., Park, D. C., & Poon, L. W. (1989). Quality of instructions on
prescription drug labels: Effects on memory and comprehension in young and
old adults. The Gerontologist, 29, 345-353.
Morrell, R. W., Park, D. C., &. Poon, L. W. (1990). Effects of labeling techniques
on memory and comprehension of prescription information in young and old
adults. Journal of Gerontology, 45, P166-P172.
Morrow, D. G., Leirer, V. O., & Altieri, P. (1995). List formats improve medication
instructions for older adults. Educational Gerontology, 21, 151-166.
Morrow, D. G., Leirer, V. O., & Andrassy, ]. M. (1996). Using icons to convey
medication schedule information. Applied Ergonomics, 27, 267-275.

A BROAD VIEW OF MEDICAL ADHERENCE 19

Morrow, D. G., Leirer, V. O., Andrassy, J. M., Hier, C. M., 6k Menard, W. E.
(1998). The influence of list format and category headers on age differences
in understanding medication instructions. Experimental Aging Research, 24,
231-256.
Morrow, D. G., Leirer, V. O., Carver, L. M., Tanke, E. D., & McNally, A. D.
(1999a). Effects of aging, message repetition, and note-taking on memory for
health information. Journals of Gerontology Series B: Psychological Sciences and
Social Sciences, 54B, P369-P379.
Morrow, D. G., Leirer, V. O., Carver, L. M., Tanke, E. D., 6k McNally, A. D.
(1999b). Repetition improves older and younger adult memory for automated
appointment messages. Human Factors, 41, 194-206.
Okun, M. A., & Rice, G. E. (2001). The effects of personal relevance of topic and
information type on older adults' accurate recall of written medical passages
about osteoarthritis. journal of Aging and Health, 13, 410-429.
Ominibus Budget Reconciliation Act of 1990, Pub. L. No. 101-508, 4206 and 4751,
codified at 42 U.S.C. 1395cc(a) (1) (Q), 1395 mm (c) (8), 1395cc (f), 1396(a
(57), (58), 1396a(w) (1990).
Park, D. C. (1992). Applied cognitive aging research. In F. I. M. Craik & T. A.
Salthouse (Eds.), Handbook of cognition and aging (pp. 449-493). Mahwah,
NJ: Erlbaum.
Park, D. C. (1996). Aging, health, and behavior: The interplay between basic and
applied science. In R. J. Resnick & R. H. Rozensky (Eds.), Health psychology
through the lifespan: Practice and research opportunities (pp. 59-75). Washington,
DC: American Psychological Association.
Park, D. C., Eaton, T. A., Larson, E. ]., & Palmer, H. T. (1994). Implementation
and impact of the Patient Self-Determination Act. Southern Medical journal,
87, 971-977.
Park, D. C., Hertzog, C., Leventhal, H., Morrell, R. W., Leventhal, E., Birch-
more, D., et al. (1999). Medication adherence in rheumatoid arthritis patients:
Older is wiser, journal of American Geriatrics Society, 47, 172-183.
Park, D. C., Lautenschlager, G., Hedden, T., Davidson, N., Smith, A. D., 6k
Smith, P. (2002). Models of visuospatial and verbal memory across the adult
life span. Psychology and Aging, 17, 299-320.
Park, D. C., Morrell, R. W., Frieske, D., Blackburn, B., & Birchmore, D. (1991).
Cognitive factors and the use of over-the-counter medication organizers by
arthritis patients. Human Factors, 33, 57—67.
Park, D. C., Morrell, R. W., Frieske, D., & Kincaid, D. (1992). Medication adherence
behaviors in older adults: Effects of external cognitive supports. Psychology and
Aging, 7, 252-256.
Park, D. C., Puglisi, J. T., & Smith, A. D. (1986). Memory for pictures: Does an
age-related decline exist? Psychology and Aging, I, 11-17.
Park, D. C., Royal, D., Dudley, W., & Morrell, R. (1988). Forgetting of pictures
over a long retention interval in old and young adults. Psychology and
Aging, 3, 94-95.

20 PARK AND MEADE

Park, D. C., & Shaw, R. (1992). Effect of environmental support on implicit and
explicit memory in young and old adults. Psychology and Aging, 7, 632-642.
Park, D. C., Willis, S. L, Morrow, D., Diehl, M., & Gaines, C. L. (1994). Cognitive
function and medication usage in older adults. Journal of Applied Gerontology,
13, 39-57.
Patient Self-Determination Act, Pub. L. No. 101-508, 104 Stat. 1388 (1990) (codi-
fied as amended at 42 U.S.C. §§ 1395cc(a) (1) (Q), 1395cc(f) (2000)).
Rice, G. E., Meyer, B. ]., & Miller, D. C. (1989). Using text structure to improve
older adults' recall of important medical information. Educational Gerontology,
15, 527-542.
Rice, G. E., & Okun, M. A. (1994). Older readers' processing of information that
contradicts their beliefs, journal of Gerontology, 49, 119-128.
Rosenstock, I. M. (1990). The health belief model: Explaining health behavior
through expectancies. In K. Glanz, F. M. Lewis, & B. K. Reiner (Eds.), Health
behavior and health education (pp. 39-62). San Francisco: Jossey-Bass.
Shifren, K., Park, D. C., Bennett, ]. M., & Morrell, R. W. (1999). Do cognitive
processes predict mental health in individuals with rheumatoid arthritis? Journal
of Behavioral Medicine, 22, 529-547.
Skurnik, I., Yoon, C., Park, D. C., & Schwarz, N. (2005). How warnings about false
claims become recommendations, journal of Consumer Research, 31, 713-724.

A BROAD VIEW OF MEDICAL ADHERENCE 21

 THE ROLE OF GOAL SETTING
2
AND GOAL STRIVING IN
MEDICAL ADHERENCE
PETER M. GOLLWITZER AND GABRIELE OETTINGEN

From a motivational—volitional perspective, a first prerequisite for med-

ical adherence is that people walk away from a health care provider (or
from medical instructions obtained elsewhere) with a strong intention (goal)
to act on the advice or instructions given. Second, and equally important,
people need to effectively translate their goals into action, not only right
after the advice has been given but also weeks and months thereafter. What
facilitates the setting of adherence goals, and what guarantees acting on
them? In this chapter we try to answer both of these questions, starting
with the issue of goal setting and continuing with the problem of goal
implementation. More specifically, we outline self-regulatory strategies that
help people set adherence goals and attain them.

23
 SETTING MEDICAL ADHERENCE GOALS

Determinants of Goal Setting

Goal pursuit starts with setting goals for oneself or adopting goals
assigned by others. Most theories of motivation (Ajzen, 1991; Atkinson,
1957; Bandura, 1997; Brehm & Self, 1989; Carver & Scheier, 1998; Goll-
witzer, 1990; Locke & Latham, 1990; Vroom, 1964) suggest that people
prefer to choose and adopt goals that are desirable and feasible. Desirability
is determined by the estimated attractiveness of likely short-term and long-
term consequences of goal attainment. Such consequences may pertain to
anticipated self-evaluations, evaluations of significant others, progress toward
some higher order goal, external rewards of having attained the goal, and
the joy-pain associated with moving toward the goal (Heckhausen, 1977).
In the medical setting, perceived desirability of following doctors' or
other health care providers' instructions has been discussed as pertaining
to the personal value of health, the perceived personal vulnerability, the
perceived severity of the experienced illness, the perceived benefits of the
regimen, the costs of following the regimen, and so forth (Hochbaum, 1958;
Rosenstock, 1974). Perceived desirability may also relate to people's beliefs
about whether they should adhere to the suggested medical instructions
(Ajzen & Fishbein, 1980). Finally, as Brownlee, Leventhal, and Leventhal
(2000) pointed out, the weight of the various health-related beliefs in
determining the desirability of following a given medical instruction is
influenced by how a person mentally represents the illness, how the suggested
regimen fits a person's self-concept, and how the physician or health care
provider manages to communicate the information relevant to the various
desirability-related beliefs. The effectiveness of communication in turn de-
pends not only on how patients and providers relate to each other (e.g.,
trust) but also on features of the provided message (e.g., verbal instructions
only vs. verbal instructions mixed with pictorial representations; Morrell,
Park, 6k Poon, 1990).
Feasibility of a goal depends on people's judgments of their capabilities
to perform relevant goal-directed behaviors (i.e., self-efficacy expectations;
Bandura, 1997), their beliefs that these goal-directed behaviors will lead to
the desired outcome (i.e., outcome expectations, Bandura, 1997; instrumen-
tality beliefs, Vroom, 1964), the judged likelihood of attaining the desired
outcome (i.e., general expectations; Oettingen, 1996), or desired outcomes
in general (i.e., optimism; Scheier & Carver, 1987). These various feasibility-
related beliefs are informed by a person's experiences in the past (e.g., by
one's own performance, by observing performances of similar others, or by
persuasion of respected others; Bandura, 1997).

24 GOLLWITZER AND OETTINGEN

 Thus, in the medical setting perceived feasibility of a medical instruc-
tion should be codetermined by the perceived usefulness of the behavior
and the experienced confidence in one's ability to perform the required
behavior (Rogers, 1983), which in turn are based on one's past experiences.
Again, the strength of these beliefs should be moderated by the person's
illness representations, his or her self-concept, and the quality of
patient—provider communication.
Goal theories (summaries by Gollwitzer & Moskowitz, 1996; Oettingen
& Gollwitzer, 2001) implicitly assume that high perceived feasibility and
desirability will assure that people set strong goals (i.e., form strong goal
commitments). However, research exploring the psychological processes on
which goal setting is based indicated that the way people approach the task
of setting a goal makes a difference. For example, whether the goal-setting
determinant of feasibility will take effect depends on the mode of self-
regulatory thought with which the task of setting a goal is approached
(Oettingen, 1996, 1999).

Self-Regulation of Goal Setting

Oettingen (1999) suggested that feasibility beliefs are considered in

goal setting only when people experience a necessity to act. In other words,
high expectations lead to setting binding goals when people face the question
of whether they should try to reach a desired outcome. In a series of experi-
ments (Oettingen, Pak, & Schnetter, 2001), it has been demonstrated that
a necessity to act readily emerges when people first mentally elaborate the
desired future but then switch to mentally elaborating the negative reality
that stands in the way of realizing the desired future. Such mental contrasting
of the desired future with impeding reality makes people think of whether
they have a chance to close the gap between future and reality by overcoming
present obstacles. If feasibility-related beliefs are high, such mental contrast-
ing leads to strong goal commitments; if they are low, no respective goals
are formed.
In a typical study (Oettingen et al., 2001, Study 4), male freshmen
enrolled in vocational schools first judged the probability of improving in
mathematics, the most important subject in their 1st year of study. Partici-
pants then generated positive aspects of improving in mathematics (e.g.,
pride, career prospects) and negative aspects of impeding reality (e.g., being
distracted, being disinterested). They then were divided into three groups
to form mental elaborations of these aspects. In the positive fantasy/negative
reality contrast group, participants mentally elaborated positive aspects of
improving in math and negative aspects of reality standing in its way, in
alternating order, beginning with a positive aspect. In the positive fantasy

THE ROLE OF GOAL SETTING 25

or indulging group, participants mentally elaborated only the positive aspects
of improving in math; in the negative reality or dwelling group, participants
mentally elaborated only the negative aspects of impeding reality. When
participants' commitment toward the goal of improving in mathematics was
assessed (in terms of effort in class and course grades as rated by the teacher),
strength of goal commitment was in line with perceived feasibility in the
mental contrast group but not in the indulging and dwelling groups. No
matter whether perceived feasibility was low or high, goal commitment was
at a medium level in the latter two groups. Apparently, mental contrasting
makes people set binding goals for themselves if expectations of success are
high but refrain from setting binding goals if expectations of success are
low. Indulging and dwelling, however, cause people to be weakly pulled by
the positive future or pushed by the negative reality, respectively, indepen-
dent of expectations.
A series of further experiments using fantasy themes of different life
domains replicated this pattern of results (Oettingen, 2000, Study 2; Oettin-
gen, Honig, & Gollwitzer, 2000; Oettingen et al., 2001, Studies 1-4). For
instance, in young adults, mental contrasting has been found to create
expectancy-dependent goals to solve interpersonal conflicts, to get to know
an attractive person, to combine work and family life, and to study abroad,
whereas indulging and dwelling failed to do so. In school settings, mental
contrasting facilitated the expectancy-dependent setting of goals to excel
in learning a foreign language. In all of these studies, cognitive, affective,
and behavioral aspects of goal commitment were measured by means of self-
report or observations by independent raters. Mental contrasting created
expectancy-dependent goal commitments, irrespective of whether the de-
sired future was self-set or assigned, and related to short-term or long-term
projects (up to 6 months). Moreover, mental contrasting turned out to be
an easy-to-apply self-regulatory strategy, as described effects were obtained
even when participants elaborated the desired future and current impeding
reality only very briefly (i.e., were asked to imagine only one positive aspect
of the desired future and just one respective obstacle; Oettingen et al., 2000,
Study 1). In all of these studies, indulging in a positive future or dwelling
on the negative reality created goal commitments of only medium strength
that were independent of perceived feasibility.

Mental Contrasting Changes Health Behavior

Mental contrasting has also succeeded in creating strong health-
promoting goals, for example, the goal of reducing cigarette consumption
in college students who smoke (Oettingen, Mayer, & Thorpe, 2006). To
measure expectations, research participants were first asked to indicate how
likely it is that they will reduce their cigarette consumption. Thereafter,

26 GOLLWITZER AND OETTINGEN

they listed positive aspects of a future of reduced smoking (e.g., pretty skin,
increased physical fitness, heightened self-respect) and aspects of present
reality that stand in the way of attaining such a positive future (e.g., peer
pressure, parties, stress). Like in the study on improving in mathematics,
participants in the mental contrast group had to alternate in their mental
elaborations between two positive aspects of a future with less smoking and
two negative aspects of impeding reality. In the positive future-only control
group, participants had to only mentally elaborate four positive aspects of
the future, and in the negative reality control group, participants had to
only mentally elaborate four negative aspects of impeding reality.
After participants had completed these different types of mental elabo-
ration, they were handed a diary containing an hourly calendar for the next
14 days in which they were requested to record each cigarette smoked.
Contrasting participants with high expectations smoked less than 7 cigarettes
per day, whereas comparable high expectations control participants (those
who elaborated only the future or elaborated only the negative reality)
smoked more than 10 cigarettes per day. This finding implies that in light
of high expectations of success, mental contrasting is a very useful self-
regulatory tool to set strong goals. Physicians or health care providers who
opt to maximize medical adherence (e.g., to eat low-fat foods) in their
patients should therefore try to follow a two-step strategy. First, they should
attempt to enhance feasibility-related beliefs by strengthening their relevant
determinants (e.g., pointing to successful past performances or to successful
performances of similar others, providing easy-to-process and useful informa-
tion on how to successfully select low-fat food). Second, to make such
feasibility-focused interventions behaviorally relevant, physicians should ask
their patients to mentally contrast positive aspects of a desired future (e.g.,
slim and healthy body, looking nice and feeling well) with present impeding
reality (e.g., old habits of eating foods high in fat, loving tasty foods, higher
costs of low-fat foods), so that present reality is experienced as an obstacle
to the desired future, thus creating a necessity to act. It is not enough to
put participants' minds on positive consequences of adherence only or solely
on obstacles of present reality. The latter two strategies instill goal commit-
ment of just moderate strength by a pull or push mechanism, respectively.
They do not capitalize on the induction of high expectations of success.

Mental Contrasting Changes Patient-Provider Communication

The importance of mental contrasting in medical contexts has also
been demonstrated in a study geared at setting goals to improve the quality
of patient-provider communication (Oettingen, Hagenah, et al., 2006,
Study 1). More specifically, pediatric nurses had to indicate their expecta-
tions that they would be able to improve the way they interacted with their

THE ROLE OF GOAL SETT/NG 27

patients' relatives. In the contrast group, the nurses alternated in their
mental elaborations between positive aspects of a future in which they
improved the relationships with the relatives (e.g., contentment, affection,
evenness of temper) and negative aspects of reality that impeded such a
future (e.g., lack of time, too many patients, lack of patience). In the
positive fantasy group, the nurses mentally elaborated only positive aspects
of improved communication, and in the negative reality group, they elabo-
rated only negative aspects of impeding reality. Two weeks later, all partici-
pating nurses were asked how hard they had tried to improve their relations
with patients' relatives and to indicate their interest in participating in a
workshop on improving communication with patients' relatives. Again,
high-expectancy participants in the mental contrast group showed the
strongest commitment to improve communication with patients' relatives.
They reported having tried harder, and they were more interested in partici-
pating in the workshop than were participants in the control groups (the
elaboration of the future-only and the reality-only groups).

Mental Contrasting and Efficiency in Health Service Managers

In an intervention study, personnel managers of four different large
hospitals (Oettingen, Hagenah, et al., 2006, Study 5) were trained in using
the self-regulatory strategy of mental contrasting and were asked to apply
it to their pressing everyday problems. A control group was trained in using
and applying the strategy of thinking only about positive aspects of having
solved such problems. Two weeks later, all of the participants were asked
how successful they were over the last 2 weeks in organizing their time,
making decisions, completing overdue projects, and relinquishing futile
projects. Participants in the mental contrast group reported having organized
their time better, having made decisions with greater ease, having completed
more overdue projects, and having relinquished more futile projects as
compared with participants in the positive future-only control group. These
findings suggest that mental contrasting of everyday problems forces manag-
ers in the health care domain to take a more decisive stand with respect
to approaching and solving their daily tasks. The present study also indicates
that the self-regulatory strategy of mental contrasting can be easily learned
and successfully applied to all kinds of everyday problems, not just the ones
that were used to acquire the technique.

Summary

The determinants of goal setting (high perceived feasibility and desir-

ability) do not necessarily guarantee that people will commit themselves
strongly to attaining a positive future (e.g., reducing cigarette consumption,

28 GOLLWITZER AND OETTINGEN

obtaining physical fitness). It takes the application of the self-regulatory
tool of mental contrasting (i.e., juxtaposing the positive future with relevant
hindrances and obstacles posed by present reality) to make people act on
their high expectations of success (feasibility). But the presented research
suggests that mental contrasting not only benefits patients in setting strong
health-promoting and disease-preventing goals but also can be used by health
care providers to help them set binding goals to improve their communica-
tion with patients. Finally, the self-regulatory strategy of mental contrasting
can be easily taught and learned. As it is a general cognitive procedure,
once acquired, it may be applied to any health-related problem or concern
patients, providers, or managers in the medical setting might have.

IMPLEMENTING MEDICAL ADHERENCE GOALS

In traditional theories on goal striving, the intention to achieve a

certain goal is seen as an immediate determinant (or at least predictor) of
goal-directed action, and a strong intention is expected to facilitate goal
attainment more than a weak intention (Ajzen, 1991; Ajzen & Fishbein,
1980; Sheeran, 2002). Over time, evidence has accumulated showing that
forming strong intentions was only a prerequisite for successful goal attain-
ment as there are a host of subsequent implemental problems that need to
be solved successfully (Gollwitzer, 1996). For instance, after having set a
goal (e.g., to reduce smoking), people may procrastinate in acting on their
intentions and thus fail to initiate goal-directed behavior. Moreover, in
everyday life people normally strive for multiple, often even competing
goals, many of which are not simple short-term but long-term projects that
require repeated efforts (e.g., to lose weight). Goal pursuit may come to an
early halt because competing projects have temporarily gained priority and
the individual fails to successfully resume the original project. Also, to meet
their goals, people have to seize viable opportunities to act, a task that
becomes particularly difficult when attention is directed elsewhere (e.g.,
one is absorbed by competing goal pursuits, wrapped up in ruminations,
gripped by intense emotional experiences, or simply tired) and when these
opportunities are not obvious at first sight or only present themselves briefly.
In an attempt to find a self-regulatory tool for effective goal implemen-
tation, Gollwitzer (1993, 1996, 1999) distinguished between goal intentions
and implementation intentions. Goal intentions (goals) have the structure
of "I intend to reach Z," whereby Z may relate to a certain outcome or
behavior to which the individual feels committed. Implementation inten-
tions (plans) have the structure of "If situation X is encountered, then I
will perform the goal-directed response Y." Holding an implementation
intention commits an individual to perform the specified goal-directed

THE ROLE OF GOAL SETTING 29

response once the critical situation is encountered. Both goal intentions
and implementation intentions are set in an act of will, whereby the first
specifies the intention to meet a goal or standard, and the second refers to
the intention to perform a plan. Commonly, implementation intentions are
formed in the service of goal intentions as they specify the where, when,
and how of goal-directed responses. For instance, a possible implementation
intention in the service of the goal intention to eat healthful food would
link a suitable situational context (e.g., one's order taken at a restaurant)
to an appropriate behavior (e.g., asking for a low-fat meal). As a consequence,
a strong mental link is formed between the situation of the waiter taking
an order and the goal-directed response of asking for a low-fat meal.

Why Implementation Intentions Are Expected to

Facilitate Goal Implementation

The mental links created by implementation intentions are expected

to facilitate goal attainment on the basis of psychological processes that
relate to both the anticipated situation and the specified response. Because
forming implementation intentions implies the selection of a critical future
situation, it is assumed that the mental representation of the situation
becomes highly activated, hence is more accessible. This heightened accessi-
bility should make it easier for one to detect the critical situation and readily
attend to it even when one is busy with other things. Moreover, this
heightened accessibility should facilitate the recall of the critical situation.
As forming implementation intentions involves first a selection of an effec-
tive goal-directed behavior that is then linked to the selected critical situa-
tion, initiation of the intended response should become automated. Initia-
tion should be swift and efficient and should not require conscious intent
once the critical situation is encountered.

The Specified Situation

The accessibility hypothesis with respect to the specified situation was
tested in studies measuring how well participants holding implementation
intentions attended to, detected, and recalled the critical situation as com-
pared with participants who had formed only goal intentions (Gollwitzer,
Bayer, Steller, & Bargh, 2002). In a study using a dichotic listening paradigm
(i.e., different information is presented simultaneously to research partici-
pants' left and right ears and participants have to repeat, or shadow, the
information presented to the ear to which the experimenter asks them to
attend), it was observed that words describing the anticipated critical situa-
tion were highly disruptive to focused attention in participants in the imple-
mentation intention group as compared with participants in the goal inten-

30 GOLLWITZER AND OETTINGEN

tion group (i.e., the shadowing performance of the attended materials
decreased). In a study using the embedded figures test (Gottschaldt, 1926),
in which smaller a-figures are hidden within larger b-figures, enhanced
detection of the hidden a-figures was observed when participants had speci-
fied the a-figure in the i/-part of an implementation intention (i.e., had
made plans on how to create a traffic sign from the a-figure). In a cued-recall
experiment, participants in the implementation intention group recalled the
situational options to attain a given goal more effectively than participants
in the goal intention group. Finally, Aarts, Dijksterhuis, and Midden (1999)
using a lexical decision task observed faster lexical decision times (i.e.,
recognizing presented stimuli as words vs. nonwords) for those words that
described critical cues specified in implementation intentions. It is important
to note that the faster lexical responses to these critical words (i.e., their
heightened accessibility) mediated the beneficial effects of implementation
intentions on goal attainment. The latter result implies that the goal-
promoting effects of implementation intentions are based on the heightened
accessibility of selected critical situational cues.

The Specified Goal-Directed Behavior

The postulated automation of action initiation (also described as
strategic delegation of control to situational cues; Gollwitzer, 1993, p. 173)
has been supported by the results of various experiments that tested
immediacy, efficiency, and the presence or absence of conscious intent.
Gollwitzer and Brandstatter (1997, Study 3) demonstrated the immediacy
of action initiation in a study wherein participants had been induced to
form implementation intentions that specified viable opportunities for
presenting counterarguments to a series of racist remarks made by a
confederate. Participants with implementation intentions initiated the
counterarguments more quickly than the participants who had formed the
mere goal intention to counterargue.
In further experiments (Brandstatter, Lengfelder, & Gollwitzer, 2001,
Studies 3 and 4), the efficiency of action initiation was explored. Participants
formed the goal intention to press a button as fast as possible if numbers
appeared on the computer screen, but not if letters were presented (go/
no-go task). Participants in the implementation intention condition also
made the plan to press the response button particularly fast if the number
3 was presented. This go/no-go task was then embedded as a secondary task
in a dual-task paradigm. Participants in the implementation intention group
showed a substantial increase in speed of responding to the number 3
compared with the control group, regardless of whether the simultaneously
demanded primary task (a memorization task in Study 3 and a tracking task
in Study 4) was either easy or difficult to perform. Apparently, the immediacy

THE ROLE OF GOAL SETTING 31

of responding induced by implementation intentions is also efficient in the
sense that it does not require much in the way of cognitive resources
(i.e., can be performed even when dual tasks have to be performed at the
same time).
In a final set of two priming experiments, Bayer, Achtziger, Gollwitzer,
Malzacher, and Moskowitz (2006) tested whether implementation inten-
tions led to action initiation without conscious intent once the critical
situation was encountered. In these experiments, the critical situation was
presented subliminally, and its facilitating influence on initiating the goal-
directed behavior was assessed. Results indicated that subliminal presenta-
tion of the critical primes led to a speed-up in responding in participants
with implementation intentions but not in participants with mere goal
intentions. These subliminal priming effects suggest that when planned
through implementation intentions, the initiation of goal-directed behavior
becomes triggered by the anticipated situational cue, without the need for
further conscious intent.
There might be additional or even alternative process mechanisms to
the stimulus perception and response initiation processes described earlier.
For example, furnishing goals with implementation intentions might produce
an increase in goal commitment, which in turn causes heightened goal
attainment. However, this hypothesis has not received any empirical support.
For instance, when Brandstatter et al. (2001, Study 1) analyzed whether
heroin addicts under withdrawal benefit from forming implementation inten-
tions in handing in a newly composed curriculum vitae before the end of
the day, they also measured participants' commitment to do so. Although
the majority of the participants in the implementation intention group
succeeded in handing in the curriculum vitae on time, none of the partici-
pants in the goal intention group succeeded in this task. These two groups,
however, did not differ in terms of their goal commitment ("I feel committed
to compose a curriculum vitae" and "I have to complete this task") measured
after the goal intention and implementation intention instructions had been
administered. This finding was replicated with young adults who participated
in a professional development workshop (Oettingen et al., 2000, Study 2),
and analogous results are reported in research on the effects of implementa-
tion intentions on meeting health promotion and disease prevention goals
(e.g., Orbell, Hodgkins, & Sheeran, 1997).

Implementation Intentions and Their Effects on

Performing Wanted Behaviors

Given that implementation intentions facilitate attending to, detect-

ing, and recalling viable opportunities to act toward goal attainment and,
in addition, automate action initiation in the presence of such opportunities,

32 GOLLWITZER AND OETTINGEN

people who form implementation intentions should show higher goal attain-
ment rates as compared with people who do not furnish their goal intentions
with implementation intentions. This hypothesis is supported by the results
of a host of studies examining the attainment of various types of goal
intentions (a recent meta-analysis by Gollwitzer & Sheeran, 2006, listed
more than 90 studies demonstrating implementation intention effects).
Many of the goals analyzed in these studies related to health protection and
disease prevention (e.g., resisting taking up smoking, taking up regular
exercise, performing breast self-examination, preventing binge drinking,
eating a low-fat diet, using vitamin supplements regularly, flossing, and
reducing snack food consumption).

Types of Goals
Gollwitzer and Brandstatter (1997) analyzed the attainment of a goal
intention that had to be acted on at an inconvenient time (e.g., writing a
report about Christmas Eve during the subsequent Christmas holiday). Other
studies have examined the effects of implementation intentions on goal
attainment rates with goal intentions that are somewhat unpleasant to
perform. For instance, the goal intentions to perform health-protecting and
health-enhancing behaviors such as regular breast examination (Orbell et
al., 1997), cervical cancer screening (Sheeran & Orbell, 2000), resumption
of functional activity after joint replacement surgery (Orbell & Sheeran,
2000), and engaging in physical exercise (Milne, Orbell, & Sheeran, 2002)
were all more frequently acted on when people had furnished these goals
with implementation intentions. Finally, implementation intentions were
found to facilitate the attainment of goal intentions when it was easy to
forget to act on them (e.g., regular intake of vitamin pills, Sheeran &
Orbell, 1999; the signing of worksheets with the elderly, Chasteen, Park,
&Schwarz, 2001).

Potential Moderators
The strength of the beneficial effects of implementation intentions
depends on the presence or absence of several moderators. First, implementa-
tion intention effects are more apparent the more difficult it is to initiate
the goal-directed behavior. For instance, implementation intentions were
more effective in completing goals that research participants perceived to
be difficult as compared with easy to implement (Gollwitzer & Brandstatter,
1997, Study 1). Moreover, forming implementation intentions was more
beneficial to patients with frontal lobe impairment, who typically have
problems with executive control, than to college students (Lengfelder &
Gollwitzer, 2001, Study 2).

THE ROLE OF GOAL SETTING 33

 Second, the strength of commitment to the respective goal intention
also matters. Orbell et al. (1997) reported that the beneficial effects of
implementation intentions on compliance in performing a breast examina-
tion were observed only in those women who strongly intended to perform
a breast self-examination. This finding suggests that implementation inten-
tions do not work when the respective goal intention is weak. In line with
this conclusion, the beneficial effects of implementation intentions on a
person's recall of the specified situations (Gollwitzer, Bayer, et al., 2002,
Study 3) can no longer be observed when the respective goal intention has
been abandoned (i.e., the research participants were told that the assigned
goal intention need no longer be reached as it had been performed by
some other person). Third, the strength of the commitment to the formed
implementation intention makes a difference, too. In Gollwitzer, Bayer, et
al.'s (2002) Study 3, the strength of the commitment to the implementation
intention was varied by telling the participants (after an extensive personal-
ity testing session) that they were the kind of people who would benefit
from either rigidly adhering to their plans (i.e., high commitment) or staying
flexible (i.e., low commitment). The latter group showed lower implementa-
tion intention effects (i.e., cued-recall performance for selected opportuni-
ties) than the former. Finally, the strength of the mental link between the
i/-part and the then-part of an implementation intention should also affect
how beneficial forming implementation intentions turns out to be. For
example, if a person takes much time and concentration encoding the
if—then plan or keeps repeating a formed if-then plan by using inner speech,
stronger mental links should emerge, which in turn should produce stronger
implementation intention effects (Steller, 1992).
Applying these findings to the health domain, a health care provider
who is concerned about maximizing the implementation of health goals in
his or her patients should ask them to form respective implementation
intentions. This is particularly true when the patients regard the implementa-
tion of the goal to be difficult (e.g., has to be acted on at inconvenient
times, is unpleasant to perform, or is easy to forget). However, health care
providers first need to be sure that the patients are highly committed to
the health goal at hand. If this is not the case, measures to raise the perceived
feasibility and desirability should be taken, and the mental contrasting
procedure should be applied to achieve strong goal commitments. Moreover,
implementation intentions should be suggested in a way so that patients
find it easy to strongly commit to the plans made (e.g., patients are allowed
to fill the i/-parts and then-parts of implementation intentions with what
they feel fit best to their daily lives and behavioral capabilities; Murgraff,
White, & Phillips, 1996). Finally, physicians or other health care providers
may want to motivate patients to mentally repeat the formed implementation

34 GOLLWITZER AND OETTINGEN

plans to strengthen the links between the situations specified in the i/-part
and the goal-directed responses selected for the then-part.

Implementation Intentions and the Control of Unwanted Intrusions

Research on implementation intentions has focused mostly on the

self-regulatory issue of getting started with goals that one wants to achieve,
that is, doing more good (e.g., engaging in regular physical exercise) and
less bad (e.g., avoiding unhealthful foods). However, once a person has
initiated goal pursuit, he or she still needs to bring it to a successful ending.
People need to protect an ongoing goal from being thwarted by attending
to attractive distractions or by falling prey to conflicting bad habits (e.g.,
the goal of eating less fatty foods may conflict with the habit of snacking).
There are two major strategies in which implementation intentions can be
used to control unwanted intrusions that potentially hamper the successful
pursuit of wanted goals: (a) directing one's implementation intentions toward
the suppression of anticipated unwanted responses to disruptive stimuli and
(b) blocking all (even nonanticipated) kinds of unwanted influences from
inside or outside the person by directing one's implementation intentions
toward spelling out the wanted goal pursuit (Gollwitzer, Bayer, & McCul-
loch, 2005).

Responding to Unwanted Intrusions With Suppression

If, for instance, a person wants to eat healthfully and not fall prey to
tempting foods (such as chocolate bars), the person can protect him- or
herself from snacking on tempting chocolate bars by furnishing the goal of
not falling prey to temptations with suppression-oriented implementation
intentions. Suppression-oriented implementation intentions can take differ-
ent forms. They may focus on reducing the intensity of the unwanted
response (i.e., falling for the temptation) by intending not to show the
unwanted response: "And if my friend offers me chocolate, then I will not
long for it and take it!" But they may also try to reduce the intensity
of the unwanted response by specifying the initiation of the respective
antagonistic response: "And if my friend offers me chocolate, then I will think
of fruits and ask for them!" Finally, suppression-oriented implementation
intentions may focus a person away from the critical situation: "And if my
friend offers me chocolate, then I'll simply ignore his offer and my cravings!"
Two lines of experiments analyzed the effects of suppression-oriented
implementation intentions. The first line analyzed the control of unwanted
spontaneous attentional responses to tempting distractions (Gollwitzer &
Schaal, 1998). Participants had to perform a boring task (i.e., perform a

THE ROLE OF GOAL SETTING 35

series of simple arithmetic tasks) while being bombarded with attractive
distractive stimuli (e.g., clips of award-winning commercials). Whereas con-
trol participants were asked to form a mere goal intention ("I will not let
myself get distracted!"), experimental participants in addition formed one
of the following two implementation intentions: "And if a distraction arises,
then I'll ignore it!" or "And if a distraction arises, then I will increase my
effort at the task at hand!" The "ignore" implementation intention always
helped participants to ward off the distractions (as assessed by their task
performance), no matter whether the motivation to perform the tedious
task (assessed at the beginning of the task) was low or high. The "effort
increase" implementation intention, however, could only achieve this when
motivation to perform the tedious task was low. Possibly, when motivation
is high to begin with, effort increase implementation intentions may create
overmotivation that hampers task performance. It seems appropriate there-
fore to advise highly motivated individuals who experience temptations
(e.g., a person who is extremely motivated to reduce fat intake) to resort
to implementation intentions that ignore the temptation rather than to
implementation intentions that focus on the strengthening of efforts.
The second line of experiments analyzing suppression-oriented imple-
mentation intentions studied the control of the activation of stereotypical
beliefs and prejudicial evaluations (Gollwitzer & Schaal, 1998). In various
priming studies using short stimulus onset asynchronies (less than 300 ms),
research participants with implementation intentions indeed managed to
inhibit the automatic activation of stereotypical beliefs and prejudicial evalu-
ations about women, the elderly, the homeless, and soccer fans. The imple-
mentation intentions used specified being confronted with a member of the
critical group in the if-part, and a "then I won't stereotype" (alternatively:
"then I won't evaluate negatively") or a "then I will ignore the group
membership" response in the then-part. No matter which of the two formats
was used, both types of suppression-oriented implementation intentions
were effective.

Blocking Detrimental Self-States

In the research presented in the last paragraph, implementation inten-
tions specified a critical situation or problem in the i/-part that was linked
to a then-part describing an attempt to suppress the unwanted response to
an intrusive or tempting stimulus. This type of self-regulation by implementa-
tion intentions requires that the person correctly anticipate potential hin-
drances to achieving the goal and what kind of unwanted responses these
hindrances elicit. However, implementation intentions can also be used to
protect oneself from responding to unwanted intrusions by taking a different
approach. Instead of gearing one's implementation intentions toward antici-

36 GOLLWITZER AND OETTINGEN

pated potential hindrances (or temptations) and the unwanted responses
triggered thereof, the person may form implementation intentions geared
to stabilizing the goal pursuit at hand. For instance, if a person who has
the goal of eating low-fat foods stipulates in advance how he or she will go
about having dinner (i.e., "When the waiter asks my order for the dessert,
then I will request the berries"), internal distractions or interferences from
inside (e.g., being hungry, tired, nervous) should not show any effect. The
critical interaction with the waiter should simply run off as planned, and
the intrusive self-states of being hungry or tired should not succeed in
affecting the critical goal-directed behavior of ordering a low-fat dessert.
As is evident from this example, the present self-regulatory strategy
should be of special value whenever the influence of detrimental self-states
(e.g., being upset) on derailing one's goal-directed behavior has to be con-
trolled. This should be true no matter whether such self-states and their
influence on behavior reside in the person's consciousness or not. Gollwitzer
and Bayer (2000) tested this hypothesis in a series of experiments in which
participants were asked to make or not make plans (i.e., form implementation
intentions) regarding their performance on an assigned task. Prior to begin-
ning the task, participants' self-states were manipulated in such a way that
performing the task at hand became more difficult (e.g., a state of self-
definitional incompleteness prior to a task that required perspective taking,
Gollwitzer & Wicklund, 1985; a good mood prior to a task that required
evaluating others nonstereotypically, Bless & Fiedler, 1995; a state of ego
depletion prior to a task that required persistence, Baumeister, 2000; Mura-
ven, Tice, & Baumeister, 1998). It was observed that the induced critical
self-states negatively affected task performance only for those participants
who had not planned out working on the task at hand through implementa-
tion intentions (i.e., had only set themselves the goal of coming up with a
great performance). In other words, successful task performance depended
on additional implementation intentions that spelled out how to perform
the task at hand to block the effects of these detrimental self-states.
This research provides a new perspective on the psychology of self-
regulation. Effective self-regulation is commonly understood in terms of
strengthening the self, so that the self can meet the challenge of being a
powerful executive agent (Baumeister, Heatherton, & Tice, 1994). There-
fore, most research on goal-directed self-regulation focuses on strengthening
the self in such a way that threats and irritations become less likely, or on
restoring an already threatened or irritated self. Instead, Gollwitzer and
Bayer's (2000) research introduced a perspective on goal-directed self-
regulation that focuses on facilitating action control without changing the
self. It is assumed that action control becomes easy if a person's behavior
is directly controlled by situational cues and that forming implementation
intentions achieves such direct action control. As this mode of action

THE ROLE OF GOAL SETTING 37

control circumvents the self, it does not matter whether the self is threatened
or secure, agitated or calm, because the self is effectively disconnected from
its influence on behavior.
The research by Gollwitzer and Bayer (2000) supports this line of
reasoning by demonstrating that task performance (e.g., taking the perspec-
tive of another person, judging people in a nonstereotypical manner, and
solving difficult anagrams) is not impaired by the respective detrimental
self-states (e.g., self-definitional incompleteness, mood, and ego depletion) if
performing these tasks has been planned in advance through implementation
intentions. Support for this line of reasoning also comes from studies that
analyze special groups of individuals who are known to have problems with
action control because of various attention, memory, and executive function
deficits. For instance, Brandstatter et al. (2001, Studies 1 and 2) demon-
strated that patients with schizophrenia and individuals addicted to heroine
under withdrawal benefited greatly from forming implementation intentions
when it came to performing an experimental go/no-go task or the real-life
task of composing a curriculum vitae, respectively. Moreover, Lengfelder
and Gollwitzer (2001) observed improved task performance on a go/no-go
task in patients with frontal lobe impairment who had formed respective
implementation intentions, even under conditions of high cognitive load
created by a difficult dual task. Finally, Park and collaborators (Chasteen
et al., 2001; Liu & Park, 2004) reported research with older adults indicating
that implementation intentions facilitated the performance of experimental
tasks (i.e., signing one's name on each worksheet) and real-life tasks (i.e.,
performing regular blood glucose tests) that engage prospective memory
processes known to decline in older adults.
The studies with special samples suggest that implementation inten-
tions block not only the negative effects of variable detrimental self-states
(e.g., irritation) on goal attainment (task performance) but also the negative
effects of more stable deficits in the cognitive functioning underlying effec-
tive action control. As implementation intentions are known to automate
the implementation of the goal or task, the cognitive deficits overcome by
implementation intentions should be of the more effortful type. The self-
regulatory strategy of planning out goal striving through implementation
intentions therefore is an easy-to-use and cheap alternative to training
individuals who show deficits in effortful cognitive functioning.

Blocking Adverse Situational Influences

People's goal pursuits are threatened not only by detrimental self-states
(e.g., being tired) or stable aspects of the self (e.g., lacking certain executive
functions) but also by adverse situational contexts (e.g., peer pressure).

38 GOLLWITZER AND OETTINGEN

There are many situations that have negative effects on goal attainment
unbeknownst to the person who is striving for a goal. A prime example is
the social loafing phenomenon in which people show reduced effort in the face
of work settings that produce a reduction of accountability (i.e., performance
outcomes can no longer be checked at an individual level). As people are
commonly not aware of this phenomenon, they cannot form implementation
intentions that specify a social loafing situation as a critical situation, thereby
rendering an implementation intention that focuses on suppressing the social
loafing response as an unviable self-regulatory strategy. As an alternative,
however, people may resort to forming implementation intentions that
stipulate how the intended task is to be performed and thus effectively block
any negative situational influences.
Indeed, when Endress (2001) ran a social loafing experiment that used
a brainstorming task (i.e., participants had to find as many different uses
for a common knife as possible), she observed that participants with an
implementation intention ("And if I have found one solution, then I will
immediately try to find a different solution!") but not participants with a
mere goal intention ("I will try to find as many different solutions as possi-
ble!") were protected from social loafing effects. Further studies that support
the idea that implementation intentions make a goal pursuit invulnerable
to adverse situational influences are reported by Trotschel and Gollwitzer
(in press). In their experiments on the self-regulation of negotiation behav-
ior, loss-framed negotiation settings (i.e., the negotiation goal is framed in
terms of avoiding losses) failed to unfold their negative effects on fair and
cooperative negotiation outcomes when the negotiators had planned out
their goal intentions to be fair and cooperative in terms of if—then plans.
In a similar vein, Gollwitzer (1998) reported experiments in which ongoing
goal pursuits (e.g., to drive safely, to concentrate on a given math task)
that had been planned out in advance by implementation intentions were
protected from intrusive influences of competing goals (e.g., to be fast and
to attend to a person asking for help, respectively) activated outside of
awareness by using classic goal-priming procedures (Bargh, 1990; Bargh,
Gollwitzer, Lee-Chai, Barndollar, & Trotschel, 2001).
These findings suggest that the self-regulatory strategy of planning out
goal pursuit in advance places a person in the position of reaping positive
outcomes without having to change the environment from an adverse to
a facilitative one. This is very convenient, as such environmental change
is often cumbersome or not under the person's control (e.g., a person with
the goal of reducing fat intake cannot easily change the menu at a favorite
restaurant). Also, often people are not aware of the adverse influences of
the current environment (e.g., the automatic activation of bad eating habits
in situations in which the person has sinned repeatedly and consistently in

THE ROLE OF GOAL SETTING 39

Discovering Diverse Content Through
Random Scribd Documents
cammina indipendente e segna i principi della musica istrumentale
assoluta. Da ultimo rammentiamo di lui il grandioso Salmo 54º a
sette voci, in cui non si sa se più si debba ammirare la sapiente
disposizione delle voci o la grandiosità e ricchezza armonica, e la
sonata Pian e forte per più strumenti (tromboni, fagotti, cornetti,
viole e violini) splendida di fasto e colore.
Enrico Schütz, il grande precursore di Bach, quando venne per la
seconda volta a Venezia per studiarvi il nuovo genere di musica
(l'opera) scrisse: «Quando io venni a Venezia, approdai dove aveva
passato i miei primi anni di studio alla scuola del Grande Gabrieli.
Gabrieli, o dei immortali, quale uomo egli era! Se l'antichità lo avesse
conosciuto, l'avrebbe preferito ad Amfione, e se le Muse si fossero
sposate, Melpomene (!) l'avrebbe preso per marito».
Alla sua epoca appartiene pure Giovanni Croce di Chioggia (1560-
1609) pregievolissimo e severo autore di musica sacra, come pure di
musica profana (Mascarate — Triaca musicale — capricci, ecc.).
Quantunque la scuola veneziana basi come la romana sui
fiamminghi, pure la differenza che passa fra l'una e l'altra è
rimarcabilissima. La musica dei maestri veneziani rispecchia la
pompa, lo sfarzo delle feste della regina della lagune, dei palagi, dei
dipinti di Paolo Veronese e Tiziano. Ai fiamminghi bastavano alcune
voci che si contrapponevano ed univano nè essi si servono di
istrumenti. I veneziani sostituiscono alle singole voci cori intieri e li
rinforzano con istrumenti per colorire e far maggiormente spiccare il
disegno. Nella scuola romana il principio conservativo è maggiore e
più tenace, mentre la veneziana è decisamente più progressista.
Perciò la posteriore riforma musicale trovò a Venezia terreno più
ferace che a Roma, tanto che l'opera musicale drammatica si può
dire ad eccezione delle origini veneziana.
Passando alla scuola romana incontriamo pure una certa affinità fra
le due arti della musica e pittura. Come Tiziano e Gabrieli sono i
prototipi delle scuole veneziane, così in Roma Raffaello e Palestrina
presentano alcuni punti di contatto, che indicano l'intima
connessione che passa fra le due scuole, la comunità degli ideali e
dei propositi. Alla ricchezza e varietà del colorito veneziano
corrispondeva l'effetto grandioso, la pompa dell'armonia e delle voci,
forse la sensualità dell'esteriore, diremmo quasi il verismo. In
Raffaello e Palestrina l'effetto sta soltanto in seconda linea e cede il
primo posto all'intensità del pensiero, all'idea, alla forma perfetta e
classica che aborre da ogni lenocinio ed apparenza e da tutto quello,
che non sia assolutamente necessario. A Roma dove le antiche
tradizioni e le memorie erano troppo vive, perchè venissero
dimenticate e messe in disuso, il culto del severo canto gregoriano
non poteva fare a meno di influenzare potentemente colle sue
melodie la musica. Per questo le opere della scuola classica romana
basano sul canto gregoriano, dal quale esse traggono la loro
caratteristica, che le distingue da tutte le altre.
Fra i molti compositori che fiorirono in Roma prima di Palestrina
nominiamo Costanzo Festa fiorentino ( † 1545), grande e dotto
contrappuntista, Cristoforo Morales di Siviglia, fecondo ed inspirato
precursore di Palestrina nella idealità dello stile. Di lui si cantavano
ed erano celebri le Lamentazioni ed alcuni Magnificat.
I veri fondatori della scuola romana sono però a reputarsi i
fiamminghi e fra questi Giacomo Arcadelt, cantore a Roma nel 1540,
morto a Parigi, compositore semplice e severo, del quale ancor oggi
si eseguisce un'Ave Maria, ammirabile per purezza e semplicità di
stile, ma non come si credeva prima Claudio Goudimel, che pare non
fosse mai in Italia e si confonde con Gaudio Mell, che forse fu
maestro di Palestrina.
Giovanni Pierluigi, detto Palestrina dalla sua patria, nacque nel 1514,
secondo Haberl nel 1536, da modesti genitori. Venne presto a Roma
dove fu assunto per la sua bella voce fra i ragazzi cantori di S. Maria
Maggiore ed istruito nella musica. In seguito divenne scolaro di
Arcadelt. Dopo alcun tempo passato come direttore della cappella di
Palestrina fu nominato nel 1551 successore di Arcadelt nel posto di
Magister puerorum nella cappella Giulia. Depose questo ufficio per
divenir cantore della papale nel 1555, donde fu scacciato ancor nello
stesso anno da Paolo IV con altri due cantori perchè ammogliato. Dal
1555 al 1561 fu direttore in S. Giovanni Laterano, quindi fino al 1571
in S. Maria Maggiore. In questo tempo furono composte le tre
famose Messe, fra le quali quella di Papa Marcello, a cui la leggenda
suol attribuire di aver salvata la musica figurata dal bando della
Chiesa. L'occasione fu la seguente. Nella 22ª e 24ª sessione del
Concilio di Trento fu stabilito di bandire dalla Chiesa la musica
mondana e di rimettere ai vescovi e concilii provinciali le ulteriori
riforme necessarie. Pio IV nominò ai 2 Agosto 1564 una
commissione di 8 cardinali, che doveva stabilire le riforme da
introdursi. Queste si occuparono specialmente del testo ed in
seconda linea dei temi delle melodie, che non dovevano esser tolte
da canzoni profane. Principalmente poi trattavasi della possibilità di
udire chiaramente il testo nelle complicazioni polifoniche, nelle quali
s'erano introdotti tali abusi, che il cardinale Capranica ebbe a dire
che a sentire i cantori gli sembrava udire un branco di porcellini
chiusi in un sacco. Palestrina fu allora incaricato dalla commissione di
comporre una Messa che corrispondesse alle esigenze della
chiarezza del testo. Egli invece ne compose tre, che furono eseguite
ai 28 Aprile 1565 nel Palazzo del cardinale Vitellozzo. L'impressione
che la terza, dedicata al protettore di Palestrina, Papa Marcello, fece
sugli uditori, fu tale che si decise di desistere da ogni ulteriore
riforma e di raccomandarla come modello. Haberl crede che essa fu
scritta più anni prima del 1565 e la sua importanza più che
nell'intima bellezza che viene superata da altre messe di Palestrina
sta nell'uso conseguente dello stile declamato, nel raggruppamento
magistrale delle voci e nella varietà di colorito.
All'esecuzione di questa Messa seguita due mesi dopo si dice che
Papa Giulio IV abbia esclamato: «Un altro Giovanni ci fa presentire
nella terrestre Gerusalemme quel canto che l'apostolo Giovanni
rapito in estasi sentì nella celeste». In seguito a questo successo
Palestrina fu nominato maestro compositore della cappella papale,
nella quale carica durò fino alla sua morte, avvenuta ai 2 Febbraio
1594, l'anno di morte di Orlando Lasso.
L'importanza di Palestrina per la musica sacra è somma. Sarebbe
però erroneo il credere, che egli fosse un riformatore nel senso solito
della parola, ma è forse appunto in ciò che sta la sua grandezza,
nell'aver cioè saputo coi mezzi conosciuti raggiungere tanta altezza.
Anzi considerando le opere dei madrigalisti contemporanei o di poco
a lui posteriori, egli è ben meno moderno di questi, che sono col loro
stile cromatico i veri romantici del secolo XVI. Egli è piuttosto il
genio, che chiude una grande epoca che in lui, come la susseguente
con Sebastiano Bach, raggiunse la perfezione, quasi concentrando
tutte le sue forze e virtù in un uomo solo che le desse l'impronta
storica. Nella sua musica è raggiunta la perfezione della forma, la
misura del bello non è mai oltrepassata come qualche volta in
Orlando; egli non abusa dei melismi, non fa uso di armonie strane e
ricercate nè di ritmi originali e insoliti. Le sue doti tecniche principali
sono la bellezza e perfezione della linea melodica, la trasparenza
delle voci e la chiarezza del testo, difficilissima a raggiungere nella
polifonia. Il contrappunto e le più ardue soluzioni non sono mai
scopo ma soltanto mezzo, ed egli, adoperandole sovranamente, non
ci pensa neppure ma tende più in alto. Da ciò dipende quell'infinita
dolcezza, religiosità e mite melanconia che ci destano le sue opere,
quel sentimento indefinito di speranza e di aspirazione alle cose alte.
Nè perciò Palestrina è mai effeminato, come non lo è Raffaello, mai
sentimentale come i posteriori, perchè la sua tristezza è quella d'un
uomo, che sa che con lui non è tutto finito ma che la vita eterna,
guiderdone dei giusti, lo aspetta. Spitta osserva che se Orlando
Lasso fosse nato un secolo più tardi, egli sarebbe divenuto un
grande compositore drammatico, ciò che non è pensabile per
Palestrina, perchè egli come Bach ha bisogno della solitudine per
concentrarsi e trae tutto dal suo intimo.
L'intelligenza delle opere di Palestrina non è cosa d'ognuno. Chi le
giudica semplicemente coi nostri pensieri e criteri artistici non saprà
mai trovarvi quella virtù, che ne è la principale. La musica di
Palestrina non vuol essere eseguita in concerto ma in chiesa, per la
quale fu scritta. Allora soltanto si capirà quale tesoro d'ispirazione,
religiosità e d'arte sia contenuto in essa, in quelle brevi e semplici
melodie, che non sono le nostre ma che ci sottraggono alle cure
terrene, in quei maestosi accordi, in quell'avvicendarsi di voci ora
dolcissime ora potenti e maschie, che sembrano innalzarsi al cielo
per chiedere grazia e perdono. Allora soltanto si capirà che questa è
arte vera e grande, e che essa non potrà mai perire, giacchè essa è
superiore ai capricci del gusto ed immutabile nelle sue eterne leggi.
Palestrina fu autore assai fecondo. Fra le sue moltissime
composizioni, che Baini, il suo ammiratore e biografo, divide in 10
stili (!), nominiamo la serafica messa Assumpta est Maria, forse la
più sublime composizione del genere, la Messa di Papa Marcello, il
Motetto Tenebrae factae sunt, il grandioso Stabat Mater a due cori
una delle opere più grandiose della musica da chiesa di ogni tempo,
in cui il dolore ha accenti celestiali di rassegnazione e speranza; gli
Improperi, le Lamentazioni ed i Motetti del Cantico dei Cantici a
cinque voci, opera d'una ineffabile dolcezza e soavità, una Salve
Regina a cinque voci.
Wagner nel suo studio su Beethoven ne giudica così: «L'unica
progressione nel tempo si palesa quasi soltanto nel più delicato
cambiamento del colore fondamentale, che ci fa apparire i più
svariati passaggi mantenendo ferma l'affinità più ampia, senza che
noi ci possiamo accorgere di un'alterazione di linee in questo
cambiamento. Così risulta un quadro quasi senza tempo e spazio,
una visione affatto sopranaturale, che ci commuove sì
profondamente».
Palestrina esercitò colle sue opere un grande influsso sull'arte
musicale religiosa dei suoi tempi. Egli fu l'antesignano di quella
stupenda e numerosa scuola d'autori italiani, che seguirono le sue
aspirazioni ed ideali e le cui numerosissime composizioni sono colle
sue il modello della vera musica da chiesa. Lo stile di tutte queste è
quello che da Palestrina ebbe il nome e che ha per impronta la
semplicità unita alla maestà e grandiosità, un'eterea altezza priva
d'ogni sensualità e reminiscenza mondana, una serenità serafica, che
trasporta in regioni più alte, la perfezione della forma e della misura,
escluso ogni elemento drammatico, o, per dirla con espressione più
adattata all'epoca nostra, ogni sentimento di soggettivismo, come
s'addice alla Chiesa cattolica che domanda che l'individuo non pensi
alle cure terrene ma si unisca in un rapimento di fervore e speranza
alla comunità dei fedeli. Eppure se eccettuiamo Lodovico da Vittoria
(1540-1613?), spagnolo di Avila, direttore della Cappella Sistina, che
gli è quasi pari, nessuno dei contemporanei e posteriori seppe
raggiungere Palestrina, perchè la sua arte è troppo personale e quasi
troppo soprannaturale per venir imitata od essere suscettibile di
progresso nello stesso ambito e già Pietro della Valle la chiama
monumento da museo (1640).
Contemporanei di Palestrina furono Giovanni Maria Nanini (1540?
-1607) che fondò con Palestrina una celebre scuola, dalla quale
uscirono insigni maestri quali Felice e Giovanni Anerio, Giovanni
Animuccia, Giovanni Guidetti (1532-1592) che ebbe l'incarico di
rivedere con Palestrina i libri del Canto gregoriano, alla qual difficile
impresa egli dovette poi attendere solo, Francesco Soriano romano
(1549-1631) originale ed ardito innovatore, il celebre Luca Marenzio
e Marcantonio Ingegneri (1550), l'autore dei celebri Responsori che
fino pochi anni fa si credevano di Palestrina.
Fra gli autori dell'epoca dell'incipiente decadenza nominiamo
Gregorio Allegri (1586-1652) della famiglia di Correggio, l'autore del
celebre Miserere a due cori, che si canta il Venerdì Santo nella
cappella Sistina, composizione stupenda nella sua semplicità di
accordi di seguito, i due Mazzocchi, Ercole Bernabei (1670-1690),
Orazio Benevoli (1602-1672), direttore a Roma ed a Vienna, da
ultimo a S. Pietro, autore di composizioni nelle quali la polifonia
raggiunge il numero di 12, 14, 24 e 48 voci, insuperabile nell'arte di
aggruppare voci e cori, senza che la chiarezza ne soffra. La sua arte
è talmente grande, che ad una voce egli sostituisce un intiero coro e
scrive pezzi in stile fugato con entrate per coro invece di singole
voci, interrompendo saggiamente la troppa polifonia con brani in cui
canta un solo coro e tutte le voci si acquietano in un maestoso
corale.
Giunti a questo punto non sarà forse senza utilità l'esaminare
brevemente i diversi generi di composizione sviluppatisi dopo i primi
tentativi polifonici. La musica medioevale dotta appartiene ad
eccezione dell'Ars nova quasi esclusivamente alla Chiesa. Come la
pittura e scultura sceglievano senza eccezione soggetti sacri, così i
musicisti fiamminghi e le scuole posteriori fino al seicento dedicarono
il meglio delle loro opere alla chiesa. Fra le composizioni sacre spetta
il primo posto alla Messa, la parte più importante della liturgia. Ma si
avrebbe un'opinione ben falsa se si credesse, che i maestri antichi
abbiano scelto con predilezione il testo della Messa per la varietà dei
sentimenti ed affetti, per la diversità di espressione e carattere delle
singole parti, giacchè siamo ancora ben lontani
dall'individualizzazione dei sentimenti nella musica. Il testo della
messa non è che una semplice preghiera, affatto priva di carattere
drammatico e passionale. Il musicista non cerca punto di tradurre
nella sua opera il significato dei singoli pensieri ma si contenta di
scrivere della musica, che nell'intonazione generale corrisponda allo
scopo liturgico e sia nel medesimo tempo opera d'arte musicale.
Premesso ciò, si comprende come la maggior parte delle messe
antiche sieno ben di rado scritte su di un tema originale, giacchè
l'invenzione melodica aveva poca importanza.
Affine alla Messa nella maniera di composizione è il motetto (da
motto o motus) ora su testo della chiesa, ora su altre parole. Esso
basa nella forma originaria sulla congiunzione di due o tre melodie
profane o sacre di testo diverso, mentre il basso (o tenore) è di
solito tolto dal canto gregoriano. Coltivato dapprincipio con
predilezione venne poi decadendo quando fu scelto per spiegarvi
tutte le arti più complicate del contrappunto. Allo stile del motetto
appartenevano le narrazioni evangeliche ed i Salmi.
Il bisogno di dar più libera espressione ai sentimenti ed affetti
dell'animo senza le pastoje del canto fermo, la coltura crescente, la
vita socievole dell'epoca del Rinascimento influirono sullo sviluppo di
un'altra forma di composizione, che in certo riguardo preludia alla
Monodia, cioè al Madrigale che rappresenta quasi la musica da
camera del secolo XVI. La parola deriva da mandra (Pietro Aaron lo
chiama ancora Mandriale) ed indicava una specie di poesia pastorale.
Esso è uno dei vanti della poesia e musica italiana e vi lavorarono
per perfezionarlo intiere generazioni. Il Madrigale è a 3 fino ad 8 voci
— di solito a cinque — varia nella melodia non però legata al canto
fermo, cerca di esprimere colla musica il carattere del testo e sfugge
dalle complicazioni scolastiche, cercando invece d'essere espressivo.
Ciò doveva aver per necessaria conseguenza maggior libertà nell'uso
della tonalità, che s'avvicina talvolta alla cromatica e rompe l'austera
diatonica antica. Il Madrigale appartiene intieramente alla musica
profana ma altresì alla polifonica, sicchè passa di solito poca
differenza fra la maniera del Motetto e del Madrigale, quantunque vi
predomini la linea melodica, anche perchè la poesia dei madrigali a
versi di diverso numero di sillabe dava occasione a maggior
caratteristica, a ritmi più svariati, libertà di forma ed imitazioni
musicali.
I primi madrigali si distinguono ancor poco dai motetti ma la
differenza diventa col progredire del tempo sempre più grande,
quando cioè si sviluppò il sentimento dell'accordo ed il basso diventa
una parte importante. Allorchè poi si cominciò a ridurre i madrigali
per una voce sola e liuto od altri strumenti, che eseguivano tutte le
voci ad eccezione della superiore, che si cantava, era già preparata
la strada alla monodia e difatti per stile madrigalesco s'intende poi lo
stile recitativo e drammatico.
I cultori del Madrigale formano una legione ed infinite sono le loro
opere, tanto che p. e. dal 1535 al 1600 si stamparono cinquecento
raccolte di madrigali ed ogni raccolta ne conteneva dai venti ai
cinquanta. I più celebri furono gli italiani fra i quali nominiamo oltre
Willaert, che fu tra i primi a coltivarlo, Festa, Palestrina, Anerio e
sopra tutti Luca Marenzio (1550-1599) detto il più dolce cigno
d'Italia, bresciano, ispirato e melodioso, ed il principe di Venosa
Carlo Gesualdo (1560?-1614) ardito innovatore, che precorse i suoi
tempi.
Celebri madrigalisti conta pure l'Inghilterra (Bird, Gibbons, Bull,
ecc.).
Altro genere di composizioni erano le canzoni profane dei musicisti
(chansons, Lieder) pure di stile polifonico di solito a tre voci sul tema
di qualche canzone popolare, ma che con questa nulla avevano a
fare e che somigliavano piuttosto al motetto.
Contemporanee al madrigale e pure di origine italiana sono le
Villanelle, villotte, canzoni alla Napolitana, frottole, ecc. Le più
antiche sono le frottole, canzoni polifoniche a più voci scritte senza
grande arte ma non senza una certa freschezza ed ispirazione.
Marco Cara, Bartolomeo Tromboncino, Giorgio della Porta sono i più
noti cultori di questo genere. Le Villanelle e le altre specie di canzoni
posteriori le fecero andare in disuso. Queste son scritte in stile più
libero del madrigale, e quantunque non appartengano alla musica
popolare hanno più volte lo stile omofono, la melodia nel soprano, la
varietà di ritmo. Celebri autori di Villanelle furono Giovanni Gastoldi
(1556-1622) e Baldassare Donati († 1603).
L'epoca di Palestrina è quella del canto a cappella. Esso era affatto
diverso dalle opere dell'Ars nova e ripigliava piuttosto le tradizioni del
tempo dell'organum e del discanto. Perchè poi l'Ars nova, senza
dubbio più moderna e popolare, sia sì presto decaduta, tanto che se
ne perdette quasi la traccia, è ben difficile spiegare. Forse vi influì la
venuta dei maestri fiamminghi in Italia, ai quali era ignota la nuova
pratica di musica e che erano sempre anche eccellenti cantori. La
posizione dominante che essi presero alle corti italiane e nelle
cappelle delle chiese, si ripercosse sulla produzione che divenne
interamente vocale.

LETTERATURA

Friedrich Ludwig — Die mehrstimmige Musik des XIV Iahrhundertes.

Sammelbände der intern. Musikgesellschaft — Jahrgang IV, Heft
1, 1902.
J. Wolf — Florenz in der Musikgeschichte des XIV. Jahrhundertes,
Do. Heft 3, 1902.
Gandolfi Riccardo — Illustrazioni di alcuni cimeli concernenti l'arte
musicale in Firenze, Firenze, 1882.
Riemann H. — Alte Hausmusik, Lipsia, Breitkopf und Härtel
(trascrizioni).
R. Eitner — Adrian Willaert, Musikhefte für Musikg. XIX.
— Iacob Arcadelt, Musikhefte für Musikg. XIX.
— Cyprian Rore, Musikhefte für Musikg. XIX.
G. Baini — Memorie storico critiche della vita e delle opere di Giov.
Pier Luigi Palestrina, 1828.
W. Baümker — Palestrina, Freiburg, 1877.
Spitta Phil — Palestrina. Deutsche Rundschau, 1894, fasc. 7º.
Brenet M. — Palestrina, Paris, Alcan, 1906.
Cametti A. — Cenni biografici di G. Palestrina, Milano, Ricordi, 1894.
E. Schmitz E. — Palestrina, Lipsia, Breitkopf und Härtel 1914.
Collet H. — Victoria, Paris, Alcan, 1914.
Cesari G. — Le origini del Madrigale cinquecentesco, Riv. music. ital.,
XIX, fac. 2º.
Le opere di Palestrina e Vittoria furono pubblicate dalla casa
Breitkopf und Härtel di Lipsia.
Raccolte di opere scelte degli altri autori sono:
Proske — Musica divina.
Dommer — Musica sacra.
Stephan Lück — Sammlung ausgezeichneter Compositionen für die
Kirche, Leipzig, Braun, 3 volumi, ecc.
Torchi — L'Arte musicale in Italia, vol. 1º-2º (Ricordi).
Cfr. E. Vogel — Bibliothek der gedruckten weltlichen Vocalmusik
Italiens aus den Iahren 1500-1700.
 CAPITOLO IX.
Misteri e Passioni. — Origine dell'opera.

L'uso di rappresentare azioni sacre si rintraccia ormai nel Medio Evo.

Il testo della Messa e della Passione racchiude in sè elementi
eminentemente drammatici, che eccitavano alla rappresentazione. I
Misteri e Miracles più antichi cominciarono col far recitare da diversi
chierici le parole dette dalle singole persone. La lingua era la latina
nè usavasi apparato scenico. In seguito venne sostituita la lingua
volgare e si passò dalla chiesa alle piazze davanti le chiese, ai
mercati. A Pasqua del 1244 si eseguì in simil modo la Passione e
Risurrezione di Cristo sul Prato della Valle a Padova e ci restano
notizie di altre rappresentazioni a Cividale e negli Abruzzi (Pianto
delle Marie). Speciali corporazioni si dedicano a queste azioni sacre,
così, per es. la Compagnia del Gonfalone a Roma, la Confraternita
dei Battuti a Treviso, la Confrérie de la Bazoche a Parigi, ecc.
Trasportati questi misteri della Chiesa sulla piazza ed introdottavi la
lingua volgare vi subentra l'elemento popolare comico e con questo
la scurrilità. La chiesa scaglia bandi ma indarno. Il diavolo diventa
una specie di Arlecchino, che porta le spese del divertimento. Egli sta
di solito legato in una botte e finisce col prendere delle bastonate.
Ciarlatani, merciaioli, lo scemo sono frammisti alle persone sacre e
parlano una lingua da trivio. La più sconcia caricatura di queste
azioni sacre erano la fête de l'âne, le Diableries e Messe degli asini in
uso in Francia dal secolo XII al XVI. La così detta prosa de asino
(Orientis partibus, ecc.) era il canto di prammatica di queste feste.
La biblioteca di Parigi conserva in un manoscritto questa prosa de
asino ed un'intiera Messa degli asini in notazione. Le biblioteche di
Padova, Cividale, Parigi, S. Gallo, ecc., posseggono molti manoscritti
con Misteri ed azioni sacre antiche.
I Misteri venivano quasi sempre cantati. Le melodie erano simili alle
gregoriane ed alle sequenze; in seguito vi si introdussero canzoni
popolari. Quando poi il realismo vi prese piede, il canto cessò e le
azioni sacre vennero decadendo e trasformandosi in drammi sacri o
mondani recitati. Una specie di azione sacra, se tale si può dire si
conservò però anche posteriormente nella Passione e da questa
trasse forse la origine l'Oratorio. S. Filippo Neri (1515-1595), per
trattenere il popolo dal prendere parte alle licenziose feste del
Carnevale, istituì funzioni sacre, che si facevano dapprincipio nel
convento di San Gerolamo a Roma e poi nell'Oratorio di Santa Maria
in Vallicella. Esse consistevano in sermoni e racconti della bibbia con
intercalate laudi spirituali, specie di inni sillabici a quattro voci con
piccoli a soli senza rappresentazione scenica. Animuccia (1514?
-1570), Asola ed altri composero più di queste laudi in stile
popolaresco, molte delle quali furono pubblicate senza nome
dell'autore a Venezia nel 1563 e posteriormente. La prima funzione
ebbe luogo nel 1564. In seguito esse divennero vere azioni sacre,
misteri, moralità, esempi e si chiamarono oratori, prendendo forse il
nome dal locale dove si eseguivano. Alcuni autori vogliono invece far
derivare il nome dalle arti oratorie, che si insegnavano nelle scuole e
conventi, dove si eseguivano funzioni unite a produzioni musicali.
L'oratorio originario si distingue in due categorie, il latino ed il
volgare. Il primo ha somiglianza col medioevale liturgico e rinacque
nel 1600 in forma di dialogo in lingua latina senza rappresentazione
scenica ma collo storico che racconta. Il secondo deriva dalle antiche
laudi, originariamente canzoni a strofe poi simili al motetto. La
Congregazione dell'Oratorio fondata a Roma nel 1575 diffuse in Italia
e Francia questo genere di musica semisacra. Nel 1600 si eseguì in
S. Maria in Vallicella la Rappresentazione di anima e di corpo con
musica di Emilio del Cavaliere, membro della Camerata fiorentina dei
Bardi, gentiluomo romano, nato circa il 1550, prima a Roma poi a
Firenze. Essa consta di piccoli inni scritti nello stile madrigalesco e di
a soli con accompagnamento di cembalo, lira doppia, due flauti ed
un violino all'unisono col soprano. In questi sono ormai messe in
pratica le teorie della Camerata fiorentina, nè mancano intieramente
e l'ispirazione e l'arte come lo mostrò l'esecuzione del 1912 a Roma.
Il testo di questa rappresentazione che non è di Laura Guidiccioni
come di solito si scrive ma del padre Agostino Manni, è un'allegoria
strana in cui i personaggi incarnano soggetti astratti, come il tempo,
la vita, il corpo, ecc. La rappresentazione non è però da mettersi fra
gli oratorî ma per la forma e la musica appartiene piuttosto al
melodramma.
Ma già ancor prima dell'Oratorio troviamo in Italia rappresentazioni
di soggetto mondano con musica. Un embrione di queste è ormai il
Jeu de Robin et Marion di Adam de la Halle già menzionato, eseguito
a Napoli verso la fine del Secolo XIII, un grazioso idillio, che può
interessare ancor oggi. Le canzoni (senza accompagnamento) che ci
rimangono, palesano un deciso sentimento per la melodia e la
tonalità moderna.
Arteaga ci racconta d'una specie di mascherata allegorica con cori,
salmodie, danze, accompagnate da istrumenti, che si fece con
grande sfarzo nel 1388 in Milano in occasione delle nozze di
Galeazzo Sforza con Isabella d'Aragona. Di simili rappresentazioni,
che ebbero luogo in Roma, Firenze e Venezia, ci è pure conservata la
memoria, così d'una cantata, La Conversione di S. Paolo, con
musiche di Francesco Beverini eseguita a Roma all'epoca di Sisto IV,
circa il 1480, di un dramma del Poliziano, Orfeo, con musica di
Zarlino, eseguito alle feste per Enrico III di Francia in Venezia nel
1574, di un altro dramma, Orbecche (1541), musicato da Alfonso
della Viola in Ferrara, del Pastor fido del Guarini con musica di
Luzzasco e di altri (Striggio, Malvezzi, Luca Marenzio, Banchieri,
ecc.). La musica di tutte queste azioni si limitava ad alcuni cori con
pezzi istrumentali e qualche a solo e si eseguiva soltanto negli
intermezzi degli atti con poca o nessuna attinenza coll'azione, che
veniva semplicemente declamata e rare volte interrotta da un coro
nello stile madrigalesco.
Un discorso di Vincenzo Giustiniani pubblicato dal Solerti contiene
questo passo caratteristico: «L'anno santo del 1575 o poco dopo
cominciò un modo di cantare diverso da quello di prima... massime
nel modo di cantare con una voce sola sopra un istrumento con
l'esempio di un Gio. Andrea Napolitano e del sig. Giulio Cesare
Brancaccio e d'Alessandro Merlo romano, che cantavano un basso
nella larghezza dello spazio di 22 voci (3 ottave) con varietà di
passaggi nuovi e grati all'orecchio di tutti».
A noi sembra cosa incredibile, che in quella epoca in cui le canzoni
popolari avevano ormai ritmo e melodia decisa e spiccata, non si
abbia saputo applicare questi nuovi elementi al dramma stesso, ai
monologhi ed ai dialoghi. Eppure una cosa sì naturale, ed
apparentemente sì facile a farsi, non successe che più tardi dopo
mille tentativi infruttuosi, tanto era ancor potente la polifonia che si
considerava come l'unica maniera di musica dotta. Le prove però
non mancarono. O si faceva cantare da una sola voce di solito la
parte del contralto e si eseguivano cogl'istrumenti le altre parti reali,
o si faceva cantare un monologo o dialogo da più voci nello stile
polifonico. La più interessante opera di questo genere è
l'Amfiparnaso di Orazio Vecchi, distinto contrappuntista (1550?
-1605), una specie di commedia buffa, in cui le parti dei singoli
personaggi (Pantalone, Francatrippa, dottor Graziano, Ebrei, ecc.),
vengono cantate dal coro in madrigali a 5 voci.
I musicisti anteriori al secolo XVII che intuirono ed in certo modo
divinarono la grande rivoluzione musicale posteriore furono quel
Cipriano de Rore, scolaro di Willaert, che fece uso ed abuso della
cromatica senza saperne comprendere l'importanza, Luca Marenzio
ed ancor più Carlo Gesualdo, ricco di «espressioni veementi a forza
di straordinarie modulazioni» (Martini).
Altro e maggiore spirito innovatore fu Lodovico Grossi di Viadana,
chiamato Lodovico Viadana (1564-1627), uno di quegli uomini, cui,
come a Guido d'Arezzo, la fama si compiacque di attribuire scoperte
musicali ed innovazioni, per quanto ne manchi la prova. Quantunque
i suoi celebri Concerti ecclesiastici, a una, due, tre e quattro voci con
il basso continuo per suonar nell'organo sieno stati pubblicati la
prima volta nel 1602, essi furono certo scritti in una epoca anteriore,
sicchè spetta senza dubbio anche a lui parte della gloria data alla
Camerata fiorentina. In questi concerti le voci sono trattate come
veri a solo differentemente dalla polifonia ed il carattere è
melodioso, diviso in periodi e ritmico nel senso moderno della parola.
Una vera novità fu l'aggiunta del basso continuo, non il numerato
come di solito si asserisce, nel quale viene ridotta l'armonia,
staccandola dalle voci e facendola servire da vero accompagnamento
e base al canto. La prefazione ai concerti ci spiega come Viadana sia
giunto all'introduzione od almeno all'applicazione conseguente del
basso continuo. Essendo ai suoi tempi sempre più frequente l'uso di
far eseguire composizioni a più voci da una sola con
accompagnamento di altre od istrumenti in causa dello stile fugato e
ricco di contrappunti ne risultavano riduzioni incomplete con molte
interruzioni, alla quale suppliva appunto il basso continuo, che
empiva le lacune e rendeva più scorrevole e completa l'armonia. Il
Basso generale o numerato non fu introdotto da lui, giacchè la parte
dell'organo non porta che qualche indicazione del diesis e bemolle
della terza ma non cifre di accordi, come, p. es. la Euridice di Peri e
Caccini, pubblicate ormai prima dei Concerti.
Chi ne abbia avuto l'idea, non si seppe ancora accertare, nè si sa se
esso abbia avuto origine dal bisogno pratico di scrivere una partitura
o schizzo della composizione con indicazione degli intervalli delle voci
mancando allora le nostre partiture, oppure dall'intuizione degli
accordi. La supposizione più probabile è la prima giacchè il basso
numerato non fu per lungo tempo che una cosa meccanica, una
specie di tabulatura senza alcun influsso sulla maniera di comporre e
perchè altrimenti non sarebbe spiegabile l'immensa sorpresa che
recò la posteriore teoria di Rameau sull'armonia. Non è improbabile
che il basso numerato fosse introdotto già prima di Viadana per
comodità degli organisti, onde risparmiare spazio, giacchè, come
scrive Agazzari, altrimenti «per la quantità e varietà d'opere
bisognerebbe l'organista maggior biblioteca d'un legale». Ma altresì
si può ammettere che il basso numerato influì ad avvezzare
l'orecchio o meglio l'occhio a comprendere l'essenza e la natura
dell'accordo ed a leggere la musica non più orizzontalmente ma
verticalmente. A Viadana spetta il merito od il biasimo di avere
introdotta la monodia nella musica da Chiesa, la cosidetta seconda
pratica di musica, o stile concertante a differenza dello stile a
cappella, che fu certo la prima e maggior cagione del suo
decadimento. Egli pure poi come gli altri menzionati tentò
d'esprimere colla musica il sentimento delle parole e di darle motivi
caratteristici.
Lo stile dei concerti non è del resto ancora il recitativo, perchè le
melodie chiuse non vi sono evitate ed è trascurata l'accentazione
delle parole. Il lagno generale era la mancanza d'espressione, di
gentilezza e soavità che si rimproverava alla polifonia, la quale nel
suo complicato tessuto di voci impediva di intendere le parole del
testo ed escludeva la possibilità di esprimere i sentimenti individuali,
«essendo nato il contrappunto in tempi rozzissimi e fra uomini d'ogni
sorta di letteratura e gentilezza nudi, e che con li nomi stessi
dimostrano la loro barbarie» (G. B. Doni).
La soluzione di questo problema doveva trovarsi in Firenze, che fu la
vera culla della musica drammatica e per conseguenza moderna,
dove la vita in seguito alle lotte intestine era più agitata, e dove
ebbe principio il Rinascimento delle arti. Gli studi umanistici e
specialmente greci furono una delle cause della nuova rivoluzione
musicale. Gli spiriti cessarono di rivolgersi esclusivamente al cielo e
piegando gli sguardi alla terra «a questa bella d'erbe famiglia e di
animali», si sprigionò dai petti un alito di vita calda e sensuale. La
corte dei Medici accoglieva in quel tempo dotti, poeti, artisti e
musici, che si ritrovavano in convegni a trattare questioni di scienza
ed arti. Specialmente nella casa di Giovanni Bardi, Conte di Vernio,
uomo assai colto, poeta e musico si radunavano molti artisti e dotti
per trattare sopratutto di questioni musicali. Assidui frequentatori di
questa Camerata erano Giulio Caccini romano (1550?-1618), Jacopo
Peri (1561-1633) di origine fiorentina, Emilio del Cavaliere, Vincenzo
Galilei, padre di Galileo (1540-1610), il poeta Ottavio Rinuccini,
Girolamo Mei, Pietro Strozzi ed Jacopo Corsi, nella casa del quale
avevano luogo le riunioni, dopochè Giovanni Bardi fu chiamato come
camerlengo alla Corte di Clemente VII.
Dalla lettura degli autori greci, che decantavano la musica delle
tragedie e dalle dottrine platoniche si era venuta formando la
persuasione della sublimità di questa musica e si cercava di scoprirne
la natura e la qualità. Il dialogo di Vincenzo Galilei sulla musica
antica e moderna (1581) contiene la vera sfida di guerra alla musica
antica. Egli pubblicò alcuni frammenti musicali di inni greci scoperti
ma non seppe trovare la chiave per decifrarli. E così successe, che
credendo di imitare la musica greca, della quale allora assolutamente
nulla si sapeva ed oggi poco si sa, nacque lo stile drammatico, così
detto rappresentativo. L'onore di aver fatto i primi tentativi spetta
pure a Vincenzo Galilei, che compose la scena di Ugolino di Dante
per voce sola ed accompagnamento di viola ed alcuni brani delle
Lamentazioni di Geremia, quantunque da un passo di Baldassar
Castiglione (I, 13) «ma sopratutto parmi gratissimo il cantare alla
viola per recitare, il che tanto di venustà ed efficacia aggiunge alle
parole che è gran meraviglia» si possa arguire, che simili tentativi
furono fatti ancor prima. Il plauso che ne ottenne fu grande e ben
presto si trovarono imitatori, fra i quali Giulio Caccini, che, nel 1601
pubblicò col titolo di Nuove musiche una raccolta di pezzi scritti
alcuni anni prima con accompagnamento di chitarrone o tiorba
romana, specie di liuto a 10 corde. Essa contiene dodici madrigali a
una voce, dieci arie ed alcuni frammenti tolti dal Rapimento di
Cefalo. I madrigali sono semplici declamazioni, le arie si avvicinano
alla canzone a strofe. Il basso numerato è senza interesse ma
abbastanza corretto. Nella prefazione «ai lettori» vien data l'idea del
nuovo stile, del quale Caccini si proclama inventore e sviluppata la
teoria del canto. Lo stile di queste composizioni è diverso dal
polifonico e si avvicina all'arioso senza melodia periodizzata,
limitandosi ad una declamazione accentuata con piccole frasi
melodiche e ritmo non deciso. In complesso però le Nuove musiche
sono ben poca cosa ed appartengono più che al nuovo stile alla
pratica del bel canto, che era fra i supremi fini della Camerata.
Riemann sempre in cerca di novità ha tentato ultimamente una
riabilitazione delle Nuove musiche, cambiandone in parte il ritmo
segnato che è il solito C, mentre in realtà vi si mescolano altri ritmi
di 3⁄4 e 3⁄2, nè si può negare, che la nuova divisione ritmica rende
quelle composizioni più agili e meno angolose.
Questa innovazione non rispondeva però ancora all'idea della
Camerata, che si pensava essere stata la musica delle tragedie
greche qualche cosa di medio fra la parola ed il canto, più di una
declamazione passionata e meno che una melodia ritmica, in una
parola il recitativo secco della nostra musica. Chi lo scoprì ed
introdusse fu Jacopo Peri († 1633), il Zazzerino, celebre cantante e
musicista, che musicò la Dafne di Rinuccini, eseguita in casa Corsi
nel 1594, la prima vera opera scritta nello stile rappresentativo che
corrispondeva a quanto si crede, agli ideali ellenici della Camerata,
perchè ne andò perduta la musica ad eccezione di due brani
insignificanti, che sono composti da Bardi e non da Peri.
Sembra strano che un tale genere di musica, che destò tanta
ammirazione e plauso, non abbia tosto trovato imitatori, giacchè non
ci è conservata alcuna memoria di dramma in musica fra la Dafne e
l'Euridice, questa pure scritta da Rinuccini, con musica di Jacopo
Peri, rappresentata a Firenze ai 6 ottobre del 1600 in occasione delle
nozze di Maria dei Medici con Enrico IV di Francia nel palazzo Pitti in
presenza della corte e dei nobili fiorentini con grande sfarzo di
scene, vestiari e macchine. Peri cantò egli stesso la parte di Orfeo,
mentre Caccini, che avea pure composto alcuni pezzi, dirigeva i cori.
L'orchestra nascosta dietro la scena, si componeva di un
clavicembalo, un chitarrone, un liuto grosso ed una lira grande, oltre
molti istrumenti a fiato e corda, che accompagnavano i cori o
suonavano i ritornelli.
Giulio Caccini compose esso pure l'Euridice e la pubblicò nel 1600
presso Giorgio Marescotti. Questi due drammi per musica, o
tragedie, come si chiamavano allora, sono scritti nello stile
rappresentativo ed in essi erano messe in pratica le teorie nuove,
frutto delle conferenze della Camerata fiorentina. Noi usi alla melodia
moderna possiamo a stento capacitarci dell'ammirazione che
destarono ai loro tempi, giacchè essi non contengono che lunghi
recitativi con piccoli brani nello stile arioso e cantabile, avendo Peri e
Caccini voluto escludere i pezzi chiusi, la melodia organica e
periodizzata, perchè credevano che i Greci non l'avessero conosciuta
od usata nei loro drammi. Anzi si può dire che questa nuova musica
che evitava di progetto la melodia e specialmente il periodo melodico
era un regresso in confronto dell'Ars nuova fiorentina del Trecento e
Quattrocento, come è pure ormai da rigettarsi l'opinione comune che
l'introduzione della monodìa sia un merito della Camerata, giacchè
questa la troviamo e migliore ancora prima e perchè le aspirazioni
dei riformatori erano precipuamente rivolte alla verità drammatica da
raggiungersi colla chiara ed accentata declamazione e
l'accompagnamento istrumentale armonico. Del pari poco elaborati
sono i cori, di gran lunga inferiori a quelli dell'epoca anteriore e
contemporanea, nè gran fatto interessante è l'accompagnamento
scritto per semplice basso, che procede alle volte a tentoni e
soltanto nei momenti più caratteristici e passionali un poco si avviva
e muove. E neppure si può pensare ad un orchestra con parti
differenti per gli istrumenti, giacchè era lasciato al suonatore di
scegliere a suo piacimento e secondo il suo buon gusto e tatto
musicale le note degli accordi del tono indicato dal basso.
I meriti della Camerata fiorentina risultano perciò specialmente dopo
i nuovi studi molto più modesti di quanto si credeva prima. Lo stil
nuovo è ormai abbastanza chiaramente accennato nei madrigali
drammatici e negli intermezzi madrigaleschi di Striggio, Marenzio,
Vecchi ed altri. Nè nelle due Euridici troviamo ancora il vero
recitativo drammatico ma piuttosto degli ariosi rozzi. La loro
importanza sta invece nel predominio del canto a solo e
nell'introduzione del canto espressivo, che segue il testo. Ciò
nullostante essa fu immensa per la musica, poichè ambedue
segnarono il principio della vera rivoluzione musicale,
dell'emancipazione dalla musica semplicemente polifonica e dalla
diatonica dell'epoca anteriore. La mancanza della melodia
periodizzata era meno importante che il tentativo di dar alle parole
espressione adeguata e giusta, che è visibile ad ogni pagina di
queste due opere, nelle quali ormai si fa uso della dissonanza per
caratterizzare e si va trasformando la salmodia antica in vera
recitazione e declamazione drammatica.
Tanto Peri che Caccini ci hanno lasciato nella Prefazione delle loro
opere un Credo artistico, che merita venir citato almeno in parte,
anche perchè esso ha una certa rassomiglianza colle teorie
wagneriane.
(Peri) «.... Veduto che si trattava di poesia drammatica, e che però si
doveva imitar col canto chi parla (e senza dubbio non si parlò mai
cantando), stimai che gli antichi Greci e Romani usassero
un'armonia, che avanzando quella del parlare ordinario, scendesse
tanto dalla melodia del cantare che pigliasse forma di cosa
mezzana.... Conobbi, parimenti nel nostro parlare, alcune voci
intonarsi in guisa che vi si può fondare armonia; e nel corso della
favella, passarsi per altre molte che non si intuonano finchè si torni
ad altra capace di movimento di nuova consonanza.... E però, sì
come io non ardirei affermare questo essere il canto nelle greche e
nelle romane favole usato, così ho creduto esser quello che solo
possa donarcisi dalla nostra musica, per accomodarsi alla nostra
favella.... E spero che l'uso delle false, sonate e cantate senza paura
non vi saranno di noia, massime nelle arie più meste e più gravi....».
(Caccini) «E questa è quella maniera, altresì, la quale discorrendo
Ella (Bardi) diceva essere stata usata dagli antichi Greci.... Nella qual
maniera di canto, ho io usato una certa sprezzatura, che io ho
stimato che abbia del nobile, parendomi con essa di essermi
appressato quel più alla natural favella.... non havendo mai nelle mie
musiche usato altr'arte, che l'immitazione de' sentimenti delle parole,
toccando quelle corde più affettuose, le quali ho giudicato più
convenirsi per quella grazia che si ricerca per ben cantare....».
E così era nato un nuovo genere di musica, che per un capriccio o
caso dovevasi alla fisima d'aver rinnovellato la tragedia greca colla
quale non aveva certo neppur lontana somiglianza nè di questa
l'importanza etica, ma che era destinato a dominare il campo
musicale fino al nostro tempo ed in futuro. Ma se la speranza o la
credenza d'aver ripristinata la musica greca che colla sua teoria era
stata soltanto un ostacolo al progresso dell'arte musicale, non fu che
una vana illusione, la nuova e grande innovazione era la espressione
di quell'istinto essenzialmente umano, che solamente nell'unione del
sentimento spirituale del Cristianesimo col sensuale del Paganesimo
vedeva o divinava la perfezione artistica. E come il sentimento
ellenico, il piacere estetico della perfezione della forma fu quello che
produsse la rivoluzione nella pittura e cagionò il Rinascimento delle
arti e della letteratura, così l'unione dell'idea del mondo greco, il
sentimento umano e terreno collo spiritualismo del Cristianesimo
ispirò nuova vita alla musica e la fece arte umana vera e capace di
esprimere la gioia ed il dolore del singolo individuo, che agognava ad
indipendenza di azione e di pensiero. La poesia, che nello stile
polifonico aveva perduta ogni importanza, viene rimessa nei suoi
diritti, la musica diventa la compagna di lei e ne nasce l'elemento
lirico musicale.
Il dramma, come l'avevano ideato Peri e Caccini non poteva ancora
corrispondere agl'ideali, che essi forse intravedevano ma non
sapevano realizzare, giacchè la polifonia non era nelle loro opere
eliminata ma soltanto trasformata e la tecnica e l'arte erano ancora
insufficienti ad esprimere l'elemento soggettivo, che in quei tempi di
risorgimento delle arti e del pensiero si faceva sempre più potente.
L'opera di Peri e Caccini era nata alla corte dei Medici fra lo sfarzo
delle feste e la pompa delle vesti e scenarî ed era monopolio dei
principi. Il popolo vi restava estraneo, perchè le sue canzoni, le sue
melodie parlavano altrimente al suo cuore ed altrimente lo
commovevano. Alla nuova opera mancava ancora la vita interna,
l'alito vivificatore che la facesse non una semplice parodia della
tragedia greca ma l'espressione vera delle passioni umane. E forse
per questo Peri e Caccini dopo l'Euridice non ritentarono la prova.
Questa è la storia esterna dell'origine dell'opera musicale. Ma ne
esiste un'altra non meno importante e non meno vera, colla quale la
Camerata fiorentina nulla ha da fare. Questa ha dato senza dubbio
l'impulso immediato ma non è da credere che l'idea fecondatrice
avrebbe creato l'opera, quando i tempi non fossero stati maturi e
non fosse stata preparata nella pratica e nella teoria la
trasformazione della polifonia alla monodia.
La teoria greca conosce le consonanze ma più in teoria che in
pratica. L'organum colle quarte e quinte parallele, il bordone colle
seste e terze non ebbero alcuna importanza per la intelligenza
dell'armonia, ma rimasero rozzi tentativi meccanici. Da questi principî
poteva però nascere l'armonia se non fosse stato introdotto col
discanto il principio del moto contrario delle voci, che non si curava
punto dell'accordo o consonanza delle voci, affidata al caso od
all'istinto. La terza si riconobbe col tempo per consonanza ma
imperfetta, tanto che il principio e la fine delle composizioni non
hanno che la quinta e l'ottava ma non la terza. Chi divinò il nostro
sistema d'armonia ma non seppe trarne conseguenze pratiche fu
Giuseppe Zarlino nelle sue Istituzioni armoniche e forse ancor prima
di lui un altro italiano Lodovico Fogliarti nella sua Musica theorica
(1529). Ed a sconquassare l'edificio delle tonalità antiche servirono
certo i tentativi di introdurre la cromatica e l'enarmonica, fatti da
Nicola Vicentino, Cipriano de Rore, Gesualdo e Marenzio. A dar
l'ultimo crollo alla teoria antica e far comprendere l'accordo servì poi
il basso generale per quanto probabilmente per caso e non per frutto
di speculazioni teoriche.
Le canzoni popolari ebbero pure grande parte alla nuova rivoluzione
musicale. L'uso di mettere la melodia o canto fermo nel tenore va
adagio cessando ed il soprano cambia di spesso il nome di discanto
in quello significativo di cantus. Le composizioni scritte per voci ed
istrumenti e la maniera di cantare una o due voci ed eseguire con
istrumenti le altre servì pure a far comprendere l'accordo. Petrucci
stampò ormai nei primi anni del secolo XVI, dunque molti decenni
prima dell'opera composizioni per soprano e liuto (tenore e basso).
La parte di questo per l'impossibilità di tenere le note doveva
diventare una specie di accompagnamento della voce che dominava
anche per la poca sonorità dell'istrumento. Lo stesso si può dire delle
composizioni scritte per più liuti, dove la melodia è sempre nella
prima parte. E neppure bisogna tener fermo all'asserzione che Peri e
Caccini sieno i primi monodisti perchè il basso dei Concerti
ecclesiastici di Viadana, stampati nel 1602 ma scritti prima non è una
semplice parte vocale ma un vero basso istrumentale e perchè la
melodia è più scorrevole che nelle melopee dei primi, che
propugnavano la «nobile sprezzatura del canto».
La nuova forma fu dunque piuttosto la conseguenza dello svegliarsi
della coscienza musicale e dei progressi dell'arte che del caso o delle
sedute della Camera fiorentina. Ma se ammettendo ciò, si attenua la
gloria di questa, non spetterà meno all'Italia il vanto di aver creato
l'opera drammatica musicale. «Soltanto la nazione che deriva dai
Romani e nella quale s'era ridotto quello che restava dei Greci, trovò
forme che innalzavano la musica sopra lo strimpellare di suonatori e
pifferai pagati e le speculazioni di scolastici all'indipendenza di arte
bella. Gli Italiani seppero con grazia e successo far cose, che in ogni
altro paese sarebbero state impossibili e riuscite ridicole, tanto essi
avevano assorbito l'arte antica e le sue forme. Persino imprese che
basavano palesemente su premesse false riuscirono a bene. Come
sarebbe stato possibile in Germania, in Inghilterra od in Francia, di
trovare coi mezzi che disponevano gli Italiani le due forme
fondamentali della musica, l'opera e l'oratorio? Noi sappiamo che le
loro premesse erano affatto infondate, giacchè nella musica greca
non si troverà nulla che potesse servire di modello alla musica
italiana che se ne faceva derivare; tali contradizioni, riconosciute o
meno, avrebbero reso lo spirito germanico inetto a compiere
qualsiasi cosa, mentre l'Accademia fiorentina, camminando sulle
nuvole della fantasia come su di una strada aperta, raggiunse il suo
scopo. Gli Italiani consideravano l'antichità non come freddi
indagatori ma come artisti e ciò, a cui uno storico non avrebbe
prestato alcuna attenzione, era l'unica cosa che per essi aveva
valore. Il sentimento della forma artistica era in loro talmente
potente, che bisogna ammettere che fosse piuttosto un istinto
congenito della bellezza che il frutto di una coltura di più secoli.
Chi potrebbe credere che la stessa nazione che aveva raggiunto la
perfezione nei cori di chiesa, nel canto polifonico profano, nel
madrigale potesse subito dopo creare la cosa più semplice, il
recitativo, la monodia e l'arte del canto? Quasi tutto ciò che esiste di
nuovo in questo riguardo lo dobbiamo a loro, e quando le altre
nazioni avevano incominciato ad appropriarsi le nuove forme, gli
Italiani le sorprendevano con delle nuove. (Chrysander, Händel, vol.
I, 153).

LETTERATURA

A. D'Ancona — Origine del Teatro in Italia, Firenze, 1877.

C. Coussemaker — Drames liturgiques du moyen-âge, Rennes, 1860.
F. I. Mone — Schauspiele des Mittelalters, 1846.
Commemorazione della Riforma melodrammatica, Firenze, 1895,
Galletti e Cocci.
E. Rolland — Histoire de l'Opéra en Europe avant Lully et Scarlatti,
1895.
Alaleona D. — Studi su la storia dell'oratorio musicale in Italia.
Torino-Roma, 1908.
— Le laudi spirituali italiane nei secoli XVI e XVII. Rivista musicale
italiana. 1909, fasc. 1º.
Goldschmidt Hugo — Zur Geschichte der italienischen Oper im XIII.
Jahrhundert. Leipzig, Breitkopf und Härtel, 1901.
Pasquetti Guido — L'oratorio musicale in Italia. Storia critica
letteraria. Firenze, Le Monnier, 1906.
Schering Arnold — Die Anfänge des Oratoriums. Lipsia, 1907,
Breitkopf und Härtel.
Parazzi — Vita ed opere musicali di Lodovico Grossi Viadana, Milano.
Ehrichs Alfred — Giulio Caccini, Leipzig, Hesse, 1909.
A. Solerti — Le origini del Melodramma. Torino, Bona, 1901.
— Gli albori del Melodramma. Palermo, Sandron, 3 v., 1903.
— Musica, ballo e drammatica arte alla Corte medicea, ed altre feste
fiorentine dal 1600 al 1640. Firenze, Bemporad, 1903.
R. Eitner — Die Quellen zur Entstehung der Oper-Monatshefte für
Musikgeschichte.
R. Kiesewetter — Schicksale und Beschaffenheit des weltlichen
Gesanges, Lipsia, 1841.
L'Euridice di Peri e Caccini è pubblicata in edizione tascabile di
Ricordi e Comp., Milano, senza trascrizione del basso.
L'Euridice di Peri col basso decifrato, vol. X della Pubblikationen für
Musikforschung, 1881.
La rappresentazione di anima e corpo in edizione facsimile per cura
di F. Mantica, Roma.
Composizioni di Caccini, Orazio Vecchi, Malvezzi, Viadana,
contengono le opere di Kiesewetter, Gevaert (les gloires de
l'Italie), Ambros, Proske (Musica divina).
Torchi — (L'arte musicale in Italia) volume 2º e seg. Cfr. anche L.
Torchi, Canzoni ed arie italiane, ad una voce del secolo XVII.
Rivista musicale italiana, anno I, fascicolo 4º e la pubblicazione
musicale corrispondente: Canzoni ed arie del XVII secolo (Ricordi
e Comp.).
 CAPITOLO X.
Claudio Monteverdi e l'opera veneziana e
napolitana.

La Camerata fiorentina aveva dato l'impulso alla nuova evoluzione

musicale e l'idea aveva trovato terreno fecondo negli animi
desiderosi di nuove cose e destantisi alla vita moderna di pensiero.
L'esempio di Firenze trovò presto imitatori e già nel 1601 si eseguì a
Bologna l'Euridice e nel 1604 a Parma la Dafne. In Roma, la sede
della polifonia, il dramma per musica si contenta ancora di fornire
divertimento al popolo e nel 1606 troviamo rappresentazioni popolari
sulle piazze con musica di Paolo Quagliati, che ricordano l'antico
carro greco di Tespi. Ma l'idea fiorentina minacciava spegnersi e
restare una semplice utopia di letterati e dilettanti, tanto più che i
membri della Camerata erano o gentiluomini o letterati, che della
musica non avevano cognizioni profonde, mentre Caccini e Peri
erano buoni musicisti e discreti contrappuntisti, ma non potevano
paragonarsi ad altri musicisti dell'epoca, dottissimi teorici.
La riforma doveva perciò trovare degli inimici nella classe dei
musicisti stessi, che s'erano formati ad altri studî e che non
risparmiavano le più aspre critiche alla nuova musica: «Se tornassero
in vita Iusquino, Mutone e gli altri, che di questo sapevano assai pur,
trasecolerebbero in vedere sì poca cognizione e quanto malamente
hoggidì i compositori se ne sappiano servire, cose che mi fanno
arrossire e vergognare per loro» (Lodovico Zacconi, Pratica di musica
1622).
Il nuovo stile rappresentativo non era ancora il passo decisivo per
romperla colla polifonia e s'era fermato a mezza strada, non osando
abbandonare intieramente le antiche tradizioni e viceversa
rinunziando alla melodia ed alle forme musicali. L'arte aveva bisogno
di un vero musicista, che sapesse liberare l'idea della Camerata da
tutto quello di artificioso e pedantesco che traeva con sè e la
fecondasse. Essa lo ebbe in Claudio Monteverdi.
Nato in Cremona nel 1567, frequentò la scuola di Marcantonio
Ingegneri, eccellente contrappuntista dell'epoca. Dopo molti anni
passati alla Corte dei Duchi Gonzaga a Mantova, diventò direttore di
cappella a S. Marco in Venezia dove rimase fino alla morte (1643).
Quantunque egli abbia scritto più musica polifonica da chiesa e
profana, egli deve la sua fama al dramma musicale. La sua prima
opera Orfeo, favola per musica su testo di Rinuccini, fu
rappresentata nel 1607 a Mantova alla corte di Vincenzo Gonzaga.
Ormai in questa prima opera egli si mostra di gran lunga superiore a
Peri ed a Caccini, giacchè in essa non v'è più lo stile semplicemente
declamatorio dell'Euridice, ma un nuovo stile che palesa chiaramente
il sentimento lirico ossia essenzialmente musicale.
L'Orfeo come lo dimostrarono le recenti esecuzioni è veramente
l'opera d'un genio che precorse i tempi, giacchè in esso troviamo
ormai più o meno sviluppati i germi delle maggiori innovazioni
posteriori comprese quelle di Gluck, e Wagner e le moderne.
Quest'arte divinatoria è tanto più meravigliosa in un'epoca in cui non
c'era nulla da imitare ma pressochè tutto da creare, perchè la
superiorità di Monteverdi su Peri e Caccini è immensa. La musica
dell'Orfeo non è oggi punto invecchiata ed ha interesse più che
storico, perchè in essa v'è ben poco di formale ma tutto è vero,
ispirato e convincente.
All'Orfeo segue già nel 1608 per le nozze di Francesco Gonzaga con
Margherita di Savoia, Arianna, quel dramma pur troppo perduto ad
eccezione del celebre brano del lamento, che fu come una
rivelazione e che destò il più grande entusiasmo, tanto che il
contemporaneo Bonini scrive «che non è stata casa, la quale avendo
cembali o tiorbi in casa non avesse il lamento». E l'ammirazione non
è esagerata, se si pensa alla potenza espressiva di quel piccolo
brano, derivante specialmente dal sapiente e nuovo uso della
dissonanza.
Monteverdi scrisse alcune altre opere, che furono rappresentate con
grande plauso a Venezia ed altrove (Adone, Le nozze di Enea con
Lavinia, Il ritorno di Ulisse, L'incoronazione di Poppea). La musica
delle ultime due ci è restata e quella dell'Incoronazione di Poppea
supera anche quella dell'Orfeo per maturità e specialmente per la
caratteristica ed il sentimento drammatico del dialogo.
Monteverdi è veramente il primo musicista moderno. Egli merita
questo nome, perchè egli fu il primo che liberò intieramente la
musica dai ceppi della polifonia e dalla retorica dei fiorentini
facendola esprimere le passioni umane coi più veri ed appassionati
accenti. I personaggi dei suoi drammi non sono più semplicemente
una piccola parte di un tutto, ma esseri umani, che pensano,
agiscono, sentono, soffrono per sè individualmente e che esprimono
con accenti proprî le loro passioni. A confermar ciò basti la
menzionata scena dell'Arianna, in cui mai il dolore ebbe accenti più
veri e toccanti. Ma egli di ciò non si contenta. Abbandona
intieramente il sistema diatonico antico e vi sostituisce il cromatico,
intuendo colla perspicacia del genio l'importanza della dissonanza
per far spiccare i diversi caratteri ed i momenti più drammatici. Egli
fa uso dell'accordo di dominante nella cadenza, adopera
ripetutamente senza preparazione l'intervallo di nona, la settima
diminuita, il tritono, il diabolus antico, dove si tratti concentrare
l'espressione ed individualizzare, punto badando alle tradizioni e
sorridendo alle invettive che gli scagliava il pedante Artusi in scritti
mordaci — ma stimando come egli scrisse, che «potessero essere
considerate altre feconde cose intorno all'armonia e che vi fosse una
moderna pratica differente dalla determinata, la quale, con
quietanza del senso e della ragione difende il moderno comporre». E
così si diffondeva nella musica quel grido di dolore della umanità
nata per soffrire e combattere, la dissonanza, che è la vera
espressione individuale dell'uomo pensante in mezzo alla natura
impassibilmente serena.
Monteverdi si può pure chiamare il padre dell'istrumentazione,
giacchè, se Peri e Caccini si contentarono di far accompagnare i loro
canti da più istrumenti per rinforzo delle voci senza studiarne le
particolarità ed il colorito speciale e senza dar loro importanza,
Monteverdi studia ormai la natura di ogni istrumento, colorisce
l'istrumentazione, aggiunge nuovi effetti, come il tremolo e il
pizzicato degli istrumenti a corda, e da loro esistenza propria
servendosene ad esprimere quello che le parole non ponno dire. In
quanto egli sia in ciò superiore ai suoi antecessori si vede
confrontando i suoi intermezzi e ritornelli, p. es. il graziosissimo a più
viole dell'Orfeo con quello di flauti dell'Euridice di Peri. In genere i
brani istrumentali dell'Orfeo (Sinfonie e Ritornelli) sono ammirabili e
piccole poesie musicali, che stanno in stretta relazione coll'azione
drammatica e la caratterizzano alle volte felicemente con poche
battute, permettendolo anche la varietà degli strumenti impiegati,
che nell'Orfeo sono: 2 cembali, 2 controbassi (specie di viole grandi)
10 viole da braccio, arpa doppia, 2 violini piccoli alla francese, 2
cetre, 2 piccoli organi, 3 viole di gamba, 4 tromboni, 1 regale (specie
di organo), 2 cornette, 1 flautino alla vigesima seconda, 1 clarino
(tromba) 3 trombe sordine. Le parti istrumentali delle opere di
Monteverdi non sono scritte in esteso ma sono solamente indicati gli
strumenti, per cui si deve arguire che gli accompagnatori dovevano
essere provetti musicisti, a meno non si voglia supporre che siano
andate perdute le parti.
I Madrigali di Monteverdi, quantunque di forma tradizionale
contengono una quantità di elementi popolareschi e drammatici
raggiunti col largo uso della cromatica e della dissonanza. Fra i
Madrigali guerrieri trovasi il celebre Combattimento di Tancredi e
Clorinda per voci e quattro viole, dove s'incontra per la prima volta il
tremolo ed il pizzicato.
Monteverdi fu non soltanto un eminente musicista sempre in cerca di
novità nel campo della teoria e tecnica ma altresì un fine esteta, che
si rendeva ragione di quello che faceva d'uopo al dramma musicale.
Egli non sceglie a caso i libretti ma li vaglia e giudica, come secoli
dopo faceva Verdi, mettendo a dura prova i poeti. Così p. e.
essendogli stato dato l'incarico dal Duca di Mantova Ferdinando di
musicare la favola di Teti e Peleo di Scipione Agnelli, egli risponde al
suo signore: «Et come potrò io con il mezzo loro movere li affetti!
Mosse l'Arianna per esser donna, mosse parimenti Orfeo per essere
uomo e non vento. Le armonie imitano loro medesime et non con
l'orazione et li strepiti dè venti, et il belar delle pecore, il nitrir dei
cavalli et va dicendo, ma non imitano il parlar dè venti che non si
trova. La favola tutta poi, quanto alla mia non poca ignoranza, non
sento che punto mi mova e con difficoltà anco la intendo, nè tanto
che lei mi porti con udire naturale ad un fine che mi mova. L'Arianna
mi porta ad un giusto lamento et lo Orfeo ad una giusta preghiera,
ma questa non so a qual fine, sicchè, che vuole la S. V. Ill.ma che la
musica possa in questa!»
Contemporaneo di Monteverdi ed a lui in molti riguardi affine è
Marco da Gagliano, fiorentino (circa 1575-1642), autore di Madrigali
e drammi musicali, dei quali ci restano la Dafne e la Flora. Anche in
queste due opere troviamo lo stile fiorentino ma più scorrevole ed
espressivo. Degno di menzione è il Proemio della Dafne, nel quale
l'autore dà utilissimi ammaestramenti ed indicazioni ai cantanti ed
attori circa la maniera d'esecuzione.
Il processo di sviluppo dell'opera in musica continua con Pier
Francesco Caletti Bruni detto Cavalli (1600-1676) di Crema, scolaro
ed erede del genio di Monteverdi, direttore di cappella in S. Marco a
Venezia. Fra le sue (34-39) opere drammatiche, la prima delle quali
fu Le nozze di Teti e di Peleo (1639), ebbe grande successo il
Giasone (1649), ed a ragione, perchè vi abbondano scene di grande
bellezza e verità come p. e. il lamento di Isifile e Maria «dell'antro
magico». Cavalli perfezionò lo stile e diede più libera movenza al
recitativo ed all'aria, che quantunque non sia ancora sviluppata, pure
ha carattere decisamente arioso e melodia organicamente
periodizzata. Ammirabile è poi nelle sue composizioni il magistrale
aggruppamento delle parti, (duetti, terzetti e quartetti), la