How do people change?

1. How do people change? Robert West University College London

2. Outline • What is behaviour change? • What can change? • Pathways to change • Mechanisms of change • Dynamics of change • Transtheoretical model • A better model • Example of smoking

3. What is ‘behaviour change’? • Behaviour patterns are characteristic ways of responding to situations and events • Behaviour change is a change in those ways of responding • It can occur as a result of change to: • the situations and events to which the individual is exposed • the way that the individual responds

4. What can change? • ‘External’ change in the environment • cues and reminders • opportunity • models • ‘Internal’ change in the individual • plans • beliefs • desires • habits • emotions • capabilities

5. The structure of human motivation Response generation systems Primitive, inflexible Level 1: Instinctive and habit learning mechanisms Impulse/inhibition generation systems Level 2: Feelings attached to mental representations of possible futures Motive generation systems Level 3: Increasing flexibility and complexity Evaluation generation systems Generates beliefs Level 4: Plan generation and enactment systems Allows greatest flexibility and anticipation Level 5:

6. Pathways to internal change • Deliberate • a decision is made to make a change • this leads to changes to motivation • Unconsidered • change occurs without a conscious decision to do so

7. Deliberate change • Self-conscious intention to behave differently • Creates new desires that: • compete with existing desires and habits • can changes existing desires • can involve other behaviours that facilitate the change

8. Non-deliberate change • Habituation-sensitisation • emotional responses to events decrease or increase with continued or repeated exposure • Associative learning • emotional responses to events or situations are altered by their association with other events or situations • Cognitive adjustment • levels of attraction are changed through inference, communication etc.

9. The Transtheoretical Model • 5 stages of change • precontemplation • contemplation • preparation • action • maintenance • Processes of change • different processes for each stage transition

10. Problems with the model • Descriptively inaccurate • ‘stages’ do not exist in any meaningful sense • change process is fluid and variable • Predictively weak • ‘stage’ is a weaker predictor than • desire • intention • Barriers (e.g. dependence) • Heuristically unhelpful • interventions based on the TTM have not proved more effective than those based on other models or simple commonsense approaches • emphasis of ‘stage’ may lead to inappropriate intervention approach

11. A more accurate model • Deliberate change involves two phases: • initiation • attempted maintenance • Initiation arises from two drivers: • momentary tension • immediate degree of dissatisfaction with current situation and hope for an improved situation • triggers • events that precipitate the decision to change • Initiation takes two forms: • immediate change • intention to change

12. Attempted maintenance • Involves two channels • behaviour • the behaviour may conform more or less closely to the new identity • identity • the new identity may involve different degrees of: • coherence • commitment • specificity

13. Behaviour maintenance • Momentary balance of competing motivations given cues and opportunity • old instincts, old habits, old desires, old beliefs • versus • new identity-driven desire, new beliefs, new habits etc. • Higher-level motivations require more mental mental energy

14. The importance of identity change • Identity change is the basis for the desire to inhibit the old behaviour or engage in the new behaviour • Commitment to a coherent, specific new identity is essential to maintain behaviour change unless other changes take places to desires, habits etc. that will sustain the new behaviour

15. Lasting behaviour change • Lasting behaviour change requires minimal self-regulatory effort • reduction in old habits, old desires etc. • development of new habits, new desires etc. • changes to environment that minimise exposure to cues and opportunities that rekindle old habits, old desires etc. or maintain new ones

16. Initiation of smoking cessation • Drivers of initiation • Tension • concern about health, cost etc. • Triggers • momentary increases in concern caused by illness, price rise, inconvenience • Form of initiation • 50% of decision are put into effect immediately

17. Maintenance of smoking cessation • Attempts at maintenance • Behaviour • lapses caused by anticipated pleasure or relief of craving or discomfort in presence of cues or reminders overwhelming desire arising from new identity • Identity • observation that lapses are inconsistent with non-smoker identity results in reversion to smoker identity

18. Lasting maintenance • No longer finds smoking attractive • Extinction of cues driven urges • Competing behaviours have greater priority • Environment is no longer conducive to old behaviour or is conducive to new one • Fixed barrier around the behaviour

19. Conclusions • Model of behaviours change needs to: • diversity of pathways • responsiveness to immediate situation • the importance of identity change • importance of desire and habit