Changing Your Health Behavior

Changing Your Health Behavior Ronald A. Kleinknecht, Ph.D. Professor of Psychology and Dean, College of Humanities and Social Sciences

Why Focus on Behavior Change ? Ø Genetic/biological processes set the template for many aspects of health and illness Ø Genes largely determine physical structures of our bodies (e.g. the CV system, cholesterol, certain cancer susceptibilities.) Ø So far, we can’t effectively change our genetic structures, but we can affect the environment in which genes develop and express their potential – Ø for better and for worse.

Contributions to Health Status Other 30%

Genetic 20%

Behavior 40%

Medical Care 10%

From: Kaplan, Sallis, & Patterson, 1991, Health and Human Behavior

The Leading Health Indicators are 10 major health issues for the nation. 1. Physical Activity

2. Overweight and Obesity 3. Tobacco Use 4. Substance Abuse 5. Responsible Sexual Behavior 6. Mental Health 7. Injury and Violence 8. Environmental Quality 9. Immunization 10. Access to Health Care http://www.healthypeople.gov/

Office of Disease Prevention and Health Promotion U.S. Department of Health and Human Services

Leading causes of death, 1900

Source: Centers for

Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

Leading causes of death, 1997 All ages, genders and ethnicity combined

Source:

Centers for Disease Control and Prevention, National Center for Health Statistics. National Vital Statistics System and unpublished data. 1997.

Bio–Psycho-Social* Model of Health and Illness *Political

Cognitive, attitudinal Emotional processes

Family, SES, ethnicity

Genes Healthy People 2010; CDPC

Today’s Focus:

Individual health-related Behavior

Ø primarily self-change Øbut the principles apply to many settings and circumstances.

Why Don’t people just change? Its for their own good!

Ø New Years’ resolutions:

Ø Dominated by health-related intentions,

Ø lose weight, exercise, stop smoking, drinking etc.

Ø It works for some:

Ø 19 % of resolutions are still in effect at 2 years Ø no matter what the area of resolution.

Ø Successful Changers Ø Ø Ø Ø

self -control strategies use self -monitoring contingency management, stimulus control

Ø Non-successful use only consciousness raising

Stages of Readiness for Health Behavior change “Transtheoretical Model” Prochaska,, DiClemente Prochaska DiClemente,, Norcross

Ø Precontemplation Ø

Sees no problem and no intention of change

Ø Contemplation Ø

Aware of problem, thinking of changing but no plans to change

Ø Preparation Ø

Intention, plans and maybe took initial steps but unstable

Ø Action: Ø

actively engaged in change but vulnerable to relapse in 1 st 6 months.

Ø Maintenance Ø

Learned the skills and using them regularly to maintain healthy behavior pattern

How do we get from Pre-contemplation and Contemplation to Action?

Ø Experiential procedures get our attention Ø Consciousness raising Ø

Ø

(photos, educational materials; developing anxiety of over health risks, self -liberation, self -help groups)

May give insight, anxiety, …. to move to contemplation and preparation

Ø can get us ready but does not initiate or sustain a behavior change as in Action stage

Health Beliefs Model: A model of cognitive variables necessary to initiate behavior change

Ø

Perception of health risk Øvulnerability to illness (e.g. If smoke, I might get cancer) Øseriousness of the illness (how bad is getting cancer?)

Ø

Cost - Benefit analysis Øwill behavior change reduce threat? ØCan I do what is needed (Self –Efficacy)* ØIs it worth the effort (barriers, side effects..)

Health Beliefs Model (Con’t.) Ø Decisional balance Ø perceived costs vs benefits of effort Ø

Ø

(Takes one from “contemplation” to “preparation stage”)

Cue to Action: (symptoms, insight, anxiety)

Ø Know what to do to effect change Ø Maintain it (> 6 months = “maintenance stage”) Ø deal with inevitable relapse Ø (stages rarely linear)

Effective Processes of change Cognitive and Behavioral procedures

Ø Effective for Action and Maintenance stages ØCognitive expectations: Self – Efficacy ØGoal Setting ØSelf-Monitoring ØStimulus Control ØSelf Reinforcement ØSocial Reinforcement

Self – Efficacy

Albert Bandura, (Cognitive Social Leaning theory, 1977)

Ø “Do you believe that you can effect a change in your targeted behavior? No way

Very Sure

1 ……………..…………………………….…….10 Ø “Do you believe that you can maintain a change in your targeted behavior? No way

Very Sure

1 ……………..………………………………….10 Ø

Rating of SE is predictive of effort and success.

Ø

S-E does not ensure that you’ll change, only that you’ll try.

How to Enhance SE: Ø Show yourself that you can do it. Ø

Set goals as small increments, each of which are readily attainable Ø (nothing

succeeds like success, even small ones)

Ø Observational learning Ø Observe others who are like you but are successful

Self-Monitoring Ø Become aware of your behavior pattern Ø Time, place, feelings, social situation…

Ø Define specific behaviors to be monitored Ø steps, miles, calories, carbs, anger episodes Ø determine how they will be recorded (pedometer, pda)

Ø Start with a clear baseline for later comparison Ø Self-monitoring is reactive, (increase then decrease if not reinforced)

Self – monitoring effects Ø Results:

10000 8000 6000

Steps

4000 2000

4/9 /20 04

4/8 /20 04

4/7 /20 04

4/6 /20 04

4/5 /20 04

4/4 /20 04

0 4/3 /20 04

(Baker & Kirchenhaum Kirchenhaum,, (1993);Boutelle & Kirchenbaum (1998)

12000

4/2 /20 04

Ø

Steps

4/1 /20 04

Ø Consistent monitors lose more wt than infrequent monitors, even in context of overall wt control program.

Stimulus control

over our mood, behavior and cognitive states.

Ø Discriminative Stimulus: Ø an external or internal cue that signals that a given response will be reinforced if performed.

Ø Example: Ø The Skinner box:

How to use Stimulus control Ø Identify and minimize stimuli that trigger target behaviors that you want to decrease: Ø Eliminate cues that compete with what you want to accomplish: (environmental manipulation) Ø

Avoid the Golden arches, smell of fries, magazine ads (“out of sight out of mind”)

Develop new stimuli to trigger new targeted behavior Ø Set new routines with strong associated cues Ø Wear a pedometer Ø Keep a public record

Self reinforcement

(strengthening new behaviors)

Ø Once a target behavior is performed, it needs to be strengthened by reinforcement Ø Contingency contracting Ø Self reinforcement or Ø external reinforcement

Ø Premack Principle: allow high probability event to occur, contingent on performing a low probability event.

Social Reinforcement and social processes Ø Make public your intentions as a formal commitment to put yourself on the spot Ø have others ask you how you are doing. Ø Predict your success (what are you going to do?) Ø

“Self -prophecy” becomes a “self -fulfilling prophacy”

Ø Join groups with common goals Ø Don’t allow it to be a “woe is me” session

Ø Arrange with others to support you if you adhere to your contract Ø and ignore you if you don’t

Effective Processes of change Cognitive and Behavioral procedures

Ø Effective for Action and Maintenance stages ØCognitive expectations: Self – Efficacy ØGoal Setting ØSelf-Monitoring ØStimulus Control ØSelf Reinforcement ØSocial Reinforcement

How does pedometer work to maintain exercise? Ø

Ø Ø Ø Ø Ø

Seen as an assessment device to monitor activity but in fact, it also has active treatment characteristics itself You ascribe meaning to it You monitor it It is a stimulus reminder (stimulus control) It is a source in self-reinforcement It is a focus of social support

Enhancing walking/running by use of a pedometer Ø Ø

Ø

Define target Self-observe and record (make graphs) Social commitment Ø predict

Ø

Ø Ø

Contingency contracting Self –reinforcement Social reinforcement