Understanding Hard to Maintain Behaviour Change E-Book

Ron Borland

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Serie: Addiction Press
• Sprache: Englisch

Seitenzahl: 587

Veröffentlichungsjahr: 2013

Beschreibung

The book presents an integrative theory of hard-to-maintain behaviours, that includes hard-to-reduce or eliminate behaviours like smoking and other drug use, overconsumption of food or unsafe sex, and hard-to-sustain behaviours like exercise and sun-safe behaviours. Most of the examples come from the author's work on tobacco smoking, but it is relevant to anyone who is concerned to understand why some forms of desirable behaviour are so hard to achieve, and to those trying to help people change. It also has important implications for public health campaigns and for the development of policies to nudge behaviour in desirable ways.

The book provides readers with frameworks to:

• Determine whether a "hard to maintain" behaviour is a result of the skills needed to perform it, its reinforcement history, the way the person thinks about it, the context, or some combination of these.
• Better integrate cognitive and behavioural change strategies, including emergent strategies related to mindfulness and acceptance, plus novel ways of retraining operational processes.
• Understand the different nature of challenges for behaviours where multiple attempts are typically required before the desired behaviour pattern is sustained.
• Better understand the role of feelings and emotions as influences on behaviour.
• Understand the limits of environmental factors to determine change.
• Understand the limits of self-control and will-power.

Leseprobe

Table of Contents

Series Page

Title Page

Copyright

Preface

Acknowledgements

Chapter 1: An overview of the theory

Limitations of the existing theories

Core elements of CEOS

Biological constraints

Elaboration of CEOS theory

References

Chapter 2: Characteristics of hard-to-maintain behaviours

Types of behaviour to change

Hard-to-reduce/resist/eliminate behaviours

Hard-to-sustain behaviours

Combinations of both kinds of behaviour change

What is learnt in HTM behaviour change

References

Chapter 3: The roles of the operational and executive systems

The Operational System

The Executive System

What the ES can do

Relationship of CEOS to other dual-process theories

References

Chapter 4: Environmental influences: the context of change

The relatively stable environment

Changing the broader environment

The interactional environment

References

Chapter 5: Conceptual influences on change

Framing the problem

Organisation of concepts about change

The desirability of change

Goal achievability

Beliefs that can interfere with behaviour change

References

Chapter 6: The structure of the change process

Tasks involved in behaviour change

Getting behaviour change on the agenda

Making an attempt to change

Maintaining change: perseverance

Determinants of maintenance/relapse

Repeated attempts are the norm

References

Chapter 7: Interventions for behaviour change

Internal and external perspectives on change

Differences between HTR and HTS behaviours

Enhancing executive function: optimising understanding

Making relevant knowledge salient

Enhancing self-control

Enhancing self-reorientation

Creating more supportive environments

Integrative strategies

References

Chapter 8: Using CEOS to advance knowledge

Key features of CEOS theory

Key questions to answer for behaviour change

Measuring key constructs

Elements of a theory-driven research agenda

Implications for reducing inequities

Concluding comments

References

Index

Addiction Press aims to communicate current ideas and evidence in this expanding field, not only to researchers and practising health professionals, but also to policy makers, students and interested non-specialists. These publications are designed to address the significant challenges that addiction presents to modern society.

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Library of Congress Cataloging-in-Publication Data

Borland, Ron.

Understanding hard to maintain behaviour change : a dual process approach / Ron Borland.

pages cm

Includes bibliographical references and index.

ISBN 978-1-118-57293-1 (pbk.)

1. Behavior modification. 2. Change (Psychology) 3. Habit breaking. 4. Habit. I. Title.

BF637.B4B67 2014

153.8′5– dc23

2313034134

A catalogue record for this book is available from the British Library.

Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.

Cover image: iStock © Meinzahn

Cover design by www.hisandhersdesign.co.uk

The challenge of the rider controlling the elephant is one of the oldest metaphors for how our sometimes rational minds attempt to control our natural passions: the main theme of this book.

Preface

I have had the great fortune to work for a small organisation that has had a huge impact, not only in tobacco control, but also in skin cancer prevention and other areas of cancer control. Under the inspired leadership of Nigel Gray and David Hill, the Cancer Council Victoria has been a leading light in the development of evidence-driven approaches to health promotion, in particular, the use of mass media and other mass communication tools to drive both environmental and personal changes to reduce behavioural risk factors for cancer. For more than 25 years, I have been contributing to this effort, researching aspects of tobacco control and sun protection, including evaluating the impacts of mass campaigns. For the past 15 years, my work has focussed on smoking. This continues to be satisfying because all the successful efforts to reduce smoking (however small) add healthy years to people's lives. When I started to work in this area, there was implicit confidence that we would quickly get on top of the problem. As smokers came to realise how bad it was and the social desirability of smoking was reduced, most smokers would quit and the problem would largely go away. However, in countries such as Australia, and increasingly elsewhere, the agenda for change that was adopted in the early days of tobacco control efforts has been pretty much completely implemented, but we are still only about half way to our goal.

As I have researched the issue, including being involved in some of the early evaluations of concerted efforts to control tobacco use, I have become increasingly impressed (and concerned) by what a resilient habit smoking is. Not only has it proved difficult to get smokers to quit successfully, it has challenged much of what I had been taught as a psychology student about the nature of learning and unlearning and how they relate to persuasion and choice. I soon realised that this was not a unique challenge. The research I did on sun-protection behaviours highlighted the challenge of maintaining an under-cued set of behaviours, and of the need for constant campaigns, not just to remind people of the need to protect themselves, but also to maintain motivation to do so. Looking over the fence into other efforts to control problematic behaviours, I see similar challenges. Consistently doing enough of certain activities, such as exercising, is beset with similar problems. Many people find it extremely difficult to maintain weight loss, even though many can initially lose some. The difficulties of maintaining seemingly simple behaviour changes all point to this being a set of wicked problems, that is, ones for which the immediately obvious solution turns out to be dangerously over-simplistic.

Most failures to change complex behaviours are not for want of trying. Simple attempts to explain these failures as being due to lack of willpower are not particularly useful. Nor is it productive to disparage those who fail. Drug addicts are notorious for telling therapists that they really want to stop using, only to be found shooting up soon after. Contrary to the views of some, I see this not as lying, but as showing the difficulty of maintaining a consistent position when the environmental cues and the associated cravings for the drug vary so greatly from a doctor's clinic to the streets associated with use. Any useful new theory should be able to shed novel insights into the complexities and seeming inconsistencies of behaviour in these difficult areas.

The work of an applied scientist is of applying theory to solve problems and any theory testing is secondary. Throughout my career I have been frustrated by the limitations of existing theories and the lack of integration of theories used in one aspect of my work to inform other aspects. Working in the real world with complex problems that involve diverse aspects of human thought and behaviour, I have wanted a comprehensive theory that helped integrate understanding: a theory to understand a set of problems, rather than trying to view a problem through the distorting lens of a set of only partly applicable theories.

This book represents an attempt to build up a comprehensive theory of why some forms of behaviour change don't fit the mould of being easy and are difficult to institute and/or maintain, in the hope that it will lead to more effective interventions. It is informed by Alfred North Whitehead's aphorism ‘Seek simplicity and distrust it’. My aim is to keep things as simple as I can while taking into account the complex dynamics of human behaviour. Most of the elements of the theory are borrowed and/or adapted from other theories. What is unique here is the ways in which these components are put together and in the ways some of the elements of existing theories are rejected or modified.

My efforts to develop an alternative conceptualisation to the mass of overlapping and mutually inconsistent theorising around behaviour change have been a far from linear process. Some of my early ideas have been abandoned or modified in the face of evidence. However, the rate of need for change has gradually slowed (but not to zero) and I now have less discomfort in having to ‘fix’ my ideas. I believe the core ideas presented here can be defended and will remain pretty much as postulated, while some of the minor elements are less well grounded and thus may need to change as evidence accumulates. I encourage readers who find the basic ideas useful to let me know about failings and inconsistent evidence. This is not the last word.

Acknowledgements

This book has influences reaching many aspects of my life. The strong underpinnings of the theory in the ideas of Pavlov and Vygotsky owe much to my early mentor MB Macmillan, and the ideas from communication and systems thinking to Robyn Penman. David Hill, my long-term boss and mentor at the Cancer Council Victoria, has been a constant source of inspiration and advice and has shaped my thinking in innumerable ways. I am indebted to my research team from over the years for support, suggestions and helping me show how some of my early ideas were wrong. The emergence of the ideas in this book has benefitted from discussions over the years with many people, but particularly with Arie Dijkstra, Robert West, Geoff Fong and Mike Cummings.

Related directly to the present volume, particular thanks are due to James Balmford and David Young for incisive comments on drafts and to other members of my team for chasing references and other bits and pieces. I am also grateful for comments on a preliminary draft from Susan Michie, Steve Sutton and Jill Francis, in particular. I am indebted to those who pointed out the burgeoning thinking about dual-process theories within psychology of which I was unaware, which has allowed me to align my thinking with elements of that work. Finally thanks to my family, my wife Virginia Lewis, who not only put up with me but read and commented positively on key elements, and to Ross and Harry who at least humoured me.

Chapter 1

An overview of the theory

Most behaviour change is unproblematic. People's behaviour changes all the time, both in response to an ever-changing environment and their increasingly refined responses to it as they learn and adapt. This book is about trying to understand those aspects of human behaviour that aren't readily brought into concordance with environmental conditions and individual desires. It develops and elaborates a theoretical framework, called CEOS theory (I will explain the acronym later), which is designed to be a new and comprehensive way of thinking about how people change habitual behaviours. This involves understanding the constraints on and the potential of volitional attempts to change behaviour patterns that are under the moment-to-moment control of non-volitional processes.

The theory also focusses on the different processes involved in the initiation and maintenance of behaviour change. It is primarily designed to understand behaviours that are hard-to-maintain (HTM behaviours); that is, ones that while seen as desirable by the individual are not spontaneously adopted or are hard to sustain and/or are seen as undesirable and hard to reduce or eliminate in the long term. These behaviours include stopping smoking, eating healthy foods to maintain a desirable weight, exercising regularly and controlling alcohol consumption. CEOS theory also encompasses easy-to-change behaviour, where it is similar to many existing theories because there is less need to consider the conflict between volitional and non-volitional forces within the individual.

The focus of this book is on health-related behaviours. The big question it attempts to answer is: Is it possible to help people to enjoy and value healthy lifestyles, to the point where there is no longer any real effort involved in avoiding unhealthy and embracing healthy behavioural alternatives? Where this is not possible, can we develop strategies to help people maintain healthy options, at least most of the time, and to minimise unhealthy choices and to break unhealthy habits, even if it requires ongoing vigilance?

Key ideas and observations that have informed the need for a new theory include the following:

People sometimes don't act in ways that are objectively in their best interests even when they want to change; for example, they continue to smoke or continue a high-fat low-exercise lifestyle even though they want to be fit and healthy.

Even when people try to adopt healthy behaviours, these new forms of behaviour are difficult to maintain and are thus characterised by high rates of failure. The causes of these failures are not well understood, and attempts to reduce relapse rates have a bleak record.

Recent research has established that the determinants of deciding and trying to change are different from those of maintaining behaviour change, at least for smoking [1, 2]. (See Chapter 2 for more details.) Some of the things that motivate smokers to try to quit, and which quitting improves, are associated perversely with reduced chances of success. It is not yet known whether similar perverse relationships are present for other HTM behaviours.

CEOS is a biopsychosocial theory, in that it postulates that behaviour is co-determined by the interaction between biological factors, modifiable aspects within the individual (psychological factors) and aspects of the environment, especially social factors. Which of these influences is most important for any particular kind of behaviour, or as is the case here, which make it difficult to maintain desirable behaviours, is an empirical question.