How do you get a horse to drink?

1. How do you get a horse to drink? Robert West University College London November 2011

2. Ideas? • Tell it that water is good for it • Show it enticing pictures of drinking water • Offer it money • Warn it that if it doesn’t it will be punished • Set up a water-drinking skills training programme • Devise water-drinking regulations • Put up signs pointing the way to the pond • Show another horse doing it • Give it a straw

3. Givens? • Human behaviour arises from learned and innate reactions to external and internal stimuli occurring ‘in the moment’ • Reflective analysis, choice and intention play an important role but are only part of the picture • Much of our behaviour occurs • because anticipated pleasure or relief (even outside awareness) outweighs beliefs about what is good or bad • without evaluating more than one course of action • without any thought about the consequences at all • There are severe limits to the capability to influence behaviour if one ignores emotion, habit, instinct and drive • Current models of behaviour recognise this and attempt in different ways to provide an integrative account • This presentation draws on the comprehensive review by Doug Mook in the book ‘Motivation: the Organisation of Action’ and Robert West in ‘Theory of Addiction’

4. Common terms for methods for inducing behaviour change

5. COM-B system for analysing behaviour in context • Capability, motivation and opportunity all need to be present for a behaviour to occur • They all interact as part of a system • Motivation must be stronger for the target behaviour than competing behaviours Michie S, M van Stratten, West R(2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

6. Common terms for methods for inducing behaviour change

7. Behaviour Change Wheel Michie S, M van Stratten, West R(2011) The Behaviour Change Wheel: A new method for characterising and designing behaviour change interventions. Implementation Science, 6, 42.

8. Understanding motivation • Brain processes that energise and direct behaviour • Not limited to choice and goal pursuit • Needs to include • drive • habit • desire • instinct • self-regulation • etc.

9. Motivation: reflective and automatic Beliefs about what is good and bad, conscious intentions, decisions and plans Reflective Automatic Emotional responses, desires and habits resulting from associative learning and physiological states

10. PRIME Theory: the structure of human motivation www.primetheory.com

11. PRIME Theory: reflective and automatic processes www.primetheory.com

12. Automatic Perception: acquiring information from the senses Associative learning:operant and classical conditioning Maturation: changes associated with growing older Habituation: decrease in response with exposure Sensitisation: increase in response with exposure Imitation: direct copying Identification: forming one’s own identity from perceptions of others Consistency disposition: generation of motives, ideas from similar ones Dissonance avoidance: negating or blocking uncomfortable beliefs Objectification: generating evaluations from likes and dislikes Chemical ‘insult’: pharmacological responses Physical ‘insult’: brain lesions Reflective Assimilation: acquiring information via communication Inference: induction and deduction Analysis: formal and informal calculation There are multiple change processes www.primetheory.com

13. Self-control, identity and behaviour change • We are self-aware and form mental representations of ourselves to which are attached emotions (identity) • These include labels and rules • Deliberate behaviour change involves adopting a new personal rule • To the extent that this is based on evaluations it requires effortful self-control

14. PRIME Theory: 8 core propositions (1-4)

15. PRIME Theory: 8 core propositions (5-8)

16. Motivation to stop predicting quit attempts N=2088, p<0.001 for linear trend see www.smokinginengland.info

17. Attempts to stop according to GP advice to stop smoking N=7611, p<0.001 for difference between offer of support/prescription and others see www.smokinginengland.info

18. What happened after smoke-free? see www.smokinginengland.info

19. Predictors of quit success see www.smokinginengland.info

20. Key elements of PRIME relevant to designing behaviour change interventions • Focus on what influences desire at key moments • Focus on imagery (not just visual) as an important source of desire • Promote formulation of personal rules with clear boundaries linked to core aspects of identity • More generally, try to make identity work in favour of rather than against behaviour change • Pay attention to potentially conflicting behaviours at key moments • Pay attention to sources of individual differences in the plans, evaluations, desires and impulses and efficiency of influence down the hierarchy • Bring as many powerful sources of desire to bear at key moments as possible, however diverse their source

21. Getting a horse to drink • Make it thirsty (need) • Give it beer? (want) Make sure that it has the capability do it and has the opportunity, then try to motivate it by getting it to need or want it more than it needs or wants to do whatever else might be on offer

22. PRIME Theory: the structure of human motivation www.primetheory.com