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Why Behavior Change is a Bunch of #Bullshit and What You Can Do about It

I have generally been an advocate of behavior change science. Designing healthy habits and routines can be an effective way to elicit change in the appropriate environment. However, similar to some of the legitimacy issues executive consulting faced when “life” coaches hit the scene, a wave of unqualified behavioral “designers” have been able to find an audience due to the increased ease at which garbage can be disseminated thanks to the power of the Internet. An important disclosure is I am one of those peddlers, so I am chucking big rocks at my big glass house. That said, it is long overdue to air some dirty laundry — so here we go…

Recidivism

Recidivism

Many popular behavior change interventions are designed for short intervention-behavior lags — i.e. the desired behavior of the user takes place almost at the same time as the intervention is administered. For instance, you see your Fitbit on your arm and get reminded to walk, so you get up from your desk and take a phone meeting outside while walking; or a more common example, a beep in your car nudges you to fasten your seatbelt, you hear the beep and you buckle up. But one of our many dirty little secrets is that these interventions are not particularly useful after the “treatment” has been administered (Rogers & Frey, 2014). For instance, taking the seatbelt example, one study showed that if drivers were reminded to fasten their seatbelt immediately before they drove off, their compliance was significantly better than if they were reminded 5 minutes earlier (Austin, Sigurdsson, & Rubin, 2006). Moreover, and more importantly, a delayed prompt (when there was a 5-minute lag between the prompt and the driver entering the car) the intervention was no more effective than receiving no prompt at all (i.e. the study’s control group). A few minutes seems to be enough for our attention to wander off and for another stimulus to take over — in other words, if an stimuli is not administered in real-time the effectiveness of the behavioral intervention diminishes — if (what people of my sort call) a “trigger” happens after the action that needs changing is taken, the intervention is usually a lot less effective.

Therefore, what behavioral designers and marketers often try to do is alter our thoughts in real time. Real-time stimulus is pretty effective and can acutely change our behavior in the short-term. These tactics are frequently used in conjunction with framing our choice as risk aversion. For example, if you are going to the beach and you get told that by not wearing sunscreen, you will have a higher chance of developing skin cancer, chances are you are more likely to buy sunscreen (for evidence of this see: Detweiler et al., 1999). But, it is questionable at best if you will actually change your habit of generally not buying sunscreen before going out in the sun; in the sunscreen study the perception of risk was only changed in that moment.  Changing thoughts in an enduring matter has proven to be much more difficult. Behavior interventions are supposed to be able to bridge time, but if the intervention is not administered just before the target behavior occurs, this is unlikely to happen. For instance, a study that looked at Biggest Loser contestants showed that during the show — when contestants were bombarded with different inputs, interventions and coaches — participants lost considerable weight. Six years later however they gained back, on average, 70% of the lost weight (Fothergill et al., 2016).

The hard reality about behavior change is it is not easy to create persistence — although there are different pathways that have been connected with the process for lasting behavior change. The problem is these complicated pathways are rarely designed well in novel behavior change models. Instead designers look for dramatic results so they can market themselves and their intervention. That is the bullshit part, so what can you do about it?

In their research paper, Todd Rogers and Kerin Frey (researchers from Harvard University) describe some of the features that are likely to bridge time. These include feeling socially accountable (e.g., not wanting to let down family and friends), linking performance with the intervention, pre-committing to a certain behavior and/or deliberately changing perceptions and consequential thoughts (Rogers & Frey, 2014). The importance of this last one (deliberately changing perceptions and consequential thoughts), has been shown to be extremely important for lasting behavioral change. This is why cognitive-behavioral therapy is touted as an evidence-based, efficient technique for changing habits — science continues to support the idea that deliberate practice creates new and lasting cognitive patterns and pathways (Pearson, Lipton, Cleland, & Yee, 2002).

Self-licensing

Self-licensing

The premise of self-licensing is that when you feel you have invested legitimate effort into something, an internal self-licensing cue can get produced that justifies a negative action, many times in the form of a hedonic action of consumption or self-gratification. Ever remember a time you rewarded your 30 minutes of cardio with a milkshake Jamba Juice. At least one study showed that a self-licensing cue leads to increased snack intake (Witt Huberts, Evers, & De Ridder, 2012). Self-licensing is a distinct behavioral mechanism that has been shown to be associated with unhealthy behaviors — distinct from other self-control failure mechanisms in the sense that the behavioral breakdown is actually masked as a reward.

The rub for you is the phenomenon of self-licensing (sometimes referred to as moral licensing) is widely recognized. Good behavioral designers know when people perform well they will feel liberated to engage in these behaviors (Merritt, Effron, & Monin, 2010). Why do you think most health clubs have a juice bar? Science suggests that even if you simply imagine doing something altruistic, you are more likely to indulge. If you, on the other hand, did not imagine doing a good deed, you are more likely to choose prudent behaviors (Khan & Dhar, 2006). It appears that when we feel virtuous this can often influence our future behavior in a negative way — because, come on, we all like a pat on the back once in a while.

False expectations regarding the future also seem to influence our choices. For instance, if we believe we will have to make a certain choice twice, this influences our decision and might make us more self-indulgent. Studies of consumers performed by Khan and Dhar (2007) showed that participants were more likely to choose an unhealthy snack (a chocolate chip cookie) over a healthy snack (low fat yogurt) if they believed they will have to make the same choice the week after. In other words — in our minds — just projecting we might do something healthy has us doing dumb shit in the present moment. The best advice I have got for you here is to be mindful and simply not do dumb shit. If you are reading this, chances are you are smart, so look at what you are trying to accomplish and gut check yourself to see if you are self-licensing. Since this phenomenon is common with those trying to lose weight I’ll use gym goers as an example. One, your treadmill is lying to you (see: Putting Very Little Weight in Calorie Counting Methods) — if you are looking to create a calorie deficit you are probably already overestimating the calories you have burnt exercising. Two, that fruit smoothie you think is a healthy reward for a job well done — it likely comes close to the caloric intake of a banana split. Not that I am suggesting you drink soda as an alternative, but keep in mind that if that was your guilty pleasure after a hard workout, you would likely be taking in 66% less calories than your average juice bar alternative.

Ego Depletion

Ego Depletion

The concept of self-licensing is similar to what some call ego depletion. Ego depletion and willpower have been blogged to death by folks like me so I won’t go too deep here. I am already stoked you have made it this far. The short version though is willpower is seen as a muscle that can get exhausted when we use it a lot (Baumeister et al., 2008). When our willpower’s capacity is temporarily used up, ego depletion causes us to make less restrained choices (like snacking on cookies or cake, instead of more healthy options like fruit or salad). Moreover, and what fascinates researchers is, when we use willpower resources in one area of our lives, this can backfire in seemingly unrelated areas of our lives. For instance, experiments have shown that when people tried to resist the temptation to eat sweets, they subsequently gave up faster on difficult mental exercises (Baumeister et al., 1998).

If you have read this far then by now you either agree or disagree with me that behavior change is incredibly complex and influenced by multiple factors and circumstances. However, to make these complex concepts comprehensible we have really smart thought leaders in this space dumbing down ideas at the cost of holistic comprehension. Take the very popular behavioral model proposed by BJ Fogg (BJ Fogg’s Behavoral Model) — this model has been accused by many that study behavior change as somewhat overly simplistic (although my guess is that for BJ simplicity was his intention). BJ’s model focuses on three elements of behavior: motivation, ability and trigger. In the model, motivation and ability need to be at certain thresholds for a target behavior to be ‘triggered’. BJ also defines subcomponents of each element — in his model, his three core motivators are: pleasure/pain, hope/fear, social acceptance/rejection. What I see as missing in BJ’s model is a road to long-term behavior change, as most of these levers are acute and episodic. The notable exception is social pressure; as I alluded before social pressure has been shown to be a useful method in some cases when we want to cement a certain behavior (we will not go too deep down the rabbit hole of social contagion here, but the science is interesting for those interested). One scientific example is a study that examined people who thought their neighbors could see a report of their energy usage. This group was more likely to reduce their energy usage, and more surprisingly the effect stayed measurable even years after the initial intervention was removed (Allcott & Rogers, 2014) — meaning these folks were still energy conscious even after the reports that their neighbors knew what they were up to stopped coming to their mailbox.

To be fair to BJ, he clearly knows the role environment contributes to our behavior, but the environment’s importance is downplayed in his popular model — and this model is constantly referenced by would-be behavioral designers. In the information regarding his Tiny Habits protocol BJ does mention three things that can change behavior in the long-run: an epiphany (very rare, like: holy shit, I just had a heart attack I should work out more), change of context (hey, what do you know? environment) and taking baby steps (aka BJ’s 2nd baby after his B=MAT model: Tiny Habits).

The truth is BJ just repackaged stuff from Kurt Lewin, that Lewin himself probably repackaged from someone else. We in the business all do this. As a gestalt psychologist, Lewin believed that a person’s environment determines their behavior, which he expressed with his formula: B= f (P, E). Behavior —in his view — is a function of a person (P) and their environment (E). In one of his original books, Lewin actually originally proposed that behavior is a function of a person’s entire situation: B=f(S) …later Lewin expanded situation (S) into person and environment (Lewin, 1936). Lewin’s contribution to behavior change was an emphasis on all the different elements that need to be considered to attempt to understand our behavior. Another gestalt psychologist, Kurt Koffka, summarized this in his famous (though often wrongly translated) saying: The whole is other than the sum of the parts. In other words, it is folly to approach behavior change using a purely reductionist approach. Lewin (1936) found we are often affected differently by the same physical environment, so even though I am admittedly bullish on them, even environmental changes fail us sometime.

However, in my opinion environmental interventions are where we are seeing the highest return on investment with regards to behavioral design. If you have not already, go down the rabbit hole of Brian Wansink’s work. Wansink is continuing to show us through his research how environmental design can influence our behavior. For instance, he popularized mindless eating ideas that suggest we often eat things without being aware of its nutritional value or volume (Wansink, 2004).

Halo Effect

Halo Effect

A study published this year in JAMA, described a randomized control trial that looked at the efficiency of weight-loss interventions. The hypothesis was that technology-enhanced weight-loss interventions will result in greater weight-loss compared to standard interventions. Surprisingly, the hypothesis was rejected. Participants who received a wearable device and an accompanying Web interface to monitor their diet and physical activity lost less weight compared to those who only received the standard intervention (Jakicic et al., 2016). Other researchers, too, concluded that when it comes to changing behavior, wearables might not be as beneficial as we once believed. I do believe wearables have potential, but it appears they cannot drive health behavior change alone (Patel, Asch & Volpp, 2015). There is a big gap between recording information and behavior change — to be honest after studying this now for over half-a-decade I believe the available data suggests that tracking devices probably cannot bridge this gap. Furthermore, it can take decades for a product to recover from a halo effect (Kerger et al., 2016). To be clear, some wearable devices can indeed deliver change (I am especially bullish on condition specific wearables). Also, some consumer products prove to be useful tools, because  (1) they are often bought by people who are already motivated to change and (2) successful behavioral interventions can be built around them (Patel, Asch & Volpp, 2015). Look: the key to sustainability of behavior change is to transform external motivation into internal — all of us know it — the problem is that it is a bit tricky.

Destination Addiction

Destination Addiction

Reality: we need to believe and be enrolled to some degree in our own behavior change, or we are generally just wasting our time. “Destination addiction” refers to those that are always chasing something, but find no fulfillment in the process of change. Take for instance someone who buys a wearable because they believe that tracking their progress will add enjoyment to something they really do not enjoy doing. A lot of my life is spent evaluating these wearables. Many of these devices actually do the opposite (i.e. they add dissatisfaction) by adding unneeded friction to a process that is difficult to begin with — in extreme cases these devices even risk changing our identity (Lupton, 2015). Furthermore, whether supported by a wearable of not, canned behavioral interventions run the risk of missing the real cause of a problem because many only focusing on symptoms (for instance, personally I am fat because I drink too much, and I drink too much because my baby cries; how is my Fitbit going to fix my crying baby? I am joking of course, but you get the point). Rigged protocols and behavior change technologies that run on static algorithms cannot always perform a deep and comprehensive assessment about your individual situation. It is rare that a single behavior change model applies to a large population. Also, behavioral interventions that use technology and online platforms often reduce the amount of human contact you are exposed to (to be fair to hardware and software designers, investors want to know a product is scalable and human invention is rarely scalable).  What does minimizing human interaction mean for the future behavior change through technology? I am not totally in the hater camp — some studies show that online therapy can be just as effective as face-to-face contact, plus it is more scalable and affordable (Mohr et al., 2012) — these are truths. However, the jury is out about the long-term effects these interventions can have, specifically their lasting effect on the human psychology and the process of socialization we have discussed throughout. Online interventions are very different to personal interventions. From what I can tell online modalities are not evaluated with the same amount of rigor as face-to-face practice. Also, individuals involved in the delivery of such models are not necessarily competent practitioners, especially since interactive computer-based communication has yet to provide an apples-to-apples comparison to face-to-face verbal exchange (Childress, 2000).

So what should you consider when it comes to evaluating behavioral interventions and their appropriateness? Perhaps some of the more obvious things include transparency regarding the intervention so you can determine fit, level of the interventions intrusiveness and the restrictions the intervention will have on your freedom. Our choices are often limited or eliminated altogether when certain goods or behaviors are banned or restricted — when our intrinsic drive is not truly altered and/or the intervention relies on artificial prohibitions, there is a good chance it can backfire (recidivism).

You see, if we can admit we are gaming ourselves, then at least we can enjoy the game. If we look at the world through the philosophical lenses of James P. Carse who wrote the book Finite and Infinite Games, poor behavior change protocols could be described as finite games. Their purpose is to reach a change, to end the process and win (losing weight, for example). When we rig the system in this fashion however, we get the results I previously highlighted in the Biggest Loser study. The game is over and we level set to the mean (i.e. back to our previous state). After all, most change comes with the potential for relapse. In my experience, behavior change protocols rarely have contingencies for this strong possibility. As an example, 80 to 95 percent of people who give up smoking or alcohol relapse within the first 12 months (Brandon, Vidrine, Litvin, 2007). I am not giving extra weight to the idea of Infinite Games by concluding with this concept, but do understanding that:

  • True change is not a destination; and,
  • we (and our users) might as well enjoy the ride.

These two ideas (that I hold as truths) will help us architect behavioral interventions for ourselves and others that have real lasting impact and will not fail us in the long-term.

Man, this post was a lot of words. I would love to stop talking now and learn from you in the comments below. What do you think?

 

Sources & further reading:

Allcott, H., & Rogers, T. (2014). The short-run and long-run effects of behavioral interventions: experimental evidence from energy conservation. American Economic Review, (10), 3003

Austin, J., Sigurdsson, S. O., & Rubin, Y. S. (2006). An examination of the effects of delayed versus immediate prompts on safety belt use. Environment and Behavior, (1), 140-149.

Baumeister, R. , Bratslavsky, E., Muraven, M., & Tice, D. (1998). Ego depletion: Is the active self a limited resource?. Journal of Personality And Social Psychology, 74(5), 1252-1265.

Baumeister, R. P., Sparks, E. P., Stillman, T. P., & Vohs, K. P. (2008). Free will in consumer behavior: self-control, ego depletion, and choice. Journal of Consumer Psychology: The Official Journal Of The Society For Consumer Psychology, 18(1), 4-13.

Botta, F., Moat, H., & Preis, T. (2015). Quantifying crowd size with mobile phone and Twitter data. Royal Society Open Science, 2(5), 6p.. doi:10.1098/rsos.150162

Brandon, T., Vidrine, J., & Litvin, E. (2007). Relapse and relapse prevention. Annual Review of Clinical Psychology, 3, 257-284.

Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re-appraisal. Journal of Management Studies, (6), 977-1002.

Carse, J. (2011). Finite and infinite games. Simon and Schuster.

Childress, C. A. (2000). Ethical Issues in Providing Online Psychotherapeutic Interventions. Journal of Medical Internet Research, 2(1), e5. http://doi.org/10.2196/jmir.2.1.e5

Detweiler, J. B., Bedell, B. T., Salovey, P., Rothman, A. J., & Pronin, E. (1999). Message framing and sunscreen use: gain-framed messages motivate beach-goers. Health Psychology, (2), 189-196.

Fothergill, E., Guo, J., Howard, L., Brychta, R., Chen, K., Skarulis, M. , & … Knuth, N. (2016). Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24(8), 1612-1619. doi:10.1002/oby.21538

Jakicic, J. M., Davis, K. K., Rogers, R. J., King, W. C., Marcus, M. D., Helsel, D., & … Belle, S. H. (2016). Effect of Wearable Technology Combined With a Lifestyle Intervention on Long-term Weight Loss. JAMA: Journal Of The American Medical Association, 316(11), 1161-1171. doi:10.1001/jama.2016.12858

Kerger, B. D., Bernal, A., Paustenbach, D. J., & Huntley-Fenner, G. (2016). Halo and spillover effect illustrations for selected beneficial medical devices and drugs. BMC Public Health, (1), doi:10.1186/s12889-016-3595-7

Khan, U., & Dhar, R. (2006). Licensing effect in consumer choice. Journal of Marketing Research, 43 (2), 259–266.

Khan, U., & Dhar, R. (2007). Where there is a way, is there a will? The effect of future choices on self-control. Journal of Experimental Psychology: General, 136(2), 277–288.

Lewin, K. (1936). Principles of Topological Psychology. New York: McGraw-Hill.

Lupton, D. (2015). Health promotion in the digital era: a critical commentary. Health Promotion International, 30(1), 174-183.

Merritt, A. C., Effron, D. A., & Monin, B. (2010). Moral Self-Licensing: When Being Good Frees Us to Be Bad. Social & Personality Psychology Compass, 4(5), 344-357. doi:10.1111/j.1751-9004.2010.00263.x

Mohr DC, Ho J, Duffecy J, Reifler D, Sokol L, Burns MN, Jin L, Siddique J. Effect of Telephone-Administered vs Face-to-face Cognitive Behavioral Therapy on Adherence to Therapy and Depression Outcomes Among Primary Care PatientsA Randomized Trial. JAMA. 2012;307(21):2278-2285. doi:10.1001/jama.2012.5588

Patel, M. S., Asch, D. A., & Volpp, K. G. (2015). Wearable devices as facilitators, not drivers, of health behavior change. JAMA: Journal Of The American Medical Association, 313(5), 459-460. doi:10.1001/jama.2014.14781

Pearson, F. S., Lipton, D. S., Cleland, C. M., & Yee, D. S. (2002). The effects of behavioral/cognitive-behavioral programs on recidivism. Crime and Delinquency, (3). 476-496.

Rogers, T., & Frey, E. (2014). Changing Behavior beyond the Here and Now. Working Paper Series. Retrieved from http://scholar.harvard.edu/files/todd_rogers/files/changing_behavior.pdf

Wansink, B. (2004). Environmental factors that increase the food intake and consumption volume of unknowing consumers. Annual Review of Nutrition, 24(1), 455-479. doi:10.1146/annurev.nutr.24.012003.132140

Witt Huberts, J. C., Evers, C., & De Ridder, D. D. (2012). License to sin: Self-licensing as a mechanism underlying hedonic consumption. European Journal of Social Psychology, 42(4), 490-496. doi:10.1002/ejsp.861

Microhealth Rewards

What are Microhealth Rewards?

The microhealth reward is a recycled innovation being reintroduced by way of the Affordable Care Act as a means of trying to motivate Americans to engage in healthy behaviors through extrinsic economic rewards. The way the law is currently written these monetary benefits can be marketed as either perceived rewards or penalties, but the basic premise of the expanded scope of these type of rewards equates to reductions in the cost of health insurance premiums if an individual is able to stay healthy (and in some cases prove it).

The way microhealth rewards will ultimately be adopted is still being played out. Monetary rewards for group challenges that fall under the realm of “participatory wellness programs” are nothing new, but there is empirical evidence to suggest that these types of rewards do not work (see Daniel Pink’s book Drive for a thorough investigation of this). Participatory wellness programs are usually available to any employee and can include incentives such as free or discounted fitness center memberships, free attendance to health education seminars or free health risk assessments.

Microhealth Rewards

“Health-contingent wellness programs” on the other hand offer microhealth rewards based on measures and outcomes. For example, you might receive a financial reward if you meet certain biometric requirements over time (ex. low cholesterol levels). Let’s say you move from an overweight BMI measure to a normal BMI measure within a given period of time, your employer will be able to offer you a financial incentive for your effort. You can also get rewards if you participate in certain activities and/or opt-in for services such as flu shots or regular visits with your doctor.

The expanded rewards that you can earn through a microhealth rewards program will now run the gamut, from  gift cards for meeting activity goals to reductions in the total cost of your health insurance premiums for sharing biometric data with your employer (it is important to note here that all Americans are protected by HIPAA and that these are opt-in programs. An employer cannot force you to have to share medical information with them).

Microhealth rewards are another measure to inspire healthcare providers to become accountable care organizations (ACOs). ACOs do not use the traditional fee for service model that is common among more traditional health care organizations. The Affordable Care Act is encouraging health care programs to move towards incentives that reward people (as well as insurance providers and healthcare organizations) for preventive health measures over treatment. The spirit behind this innovation is that there is a significant body of evidence to suggest healthy people spend less on healthcare (see: Health and Wellness Research Study: Corporate and Worksite Wellness Programs). However, as I have stated earlier there is also a significant body of evidence to suggest that wiring people to be extrinsically motivated to stay healthy also has considerable drawbacks. Therefore, it will be important to stay on top of how these rewards perform and adjust so that their potential for benefit is optimized.

Microhealth rewards was heralded at this year’s Health 2.0 Conference as a major upcoming trend in health and wellness. Personally, I believe it will be one of the most significant innovations in health and wellness in 2014.

Emphasizing Quality of Life over Longevity

Most individuals are aware of what steps they need to take in order to improve their health. Recent research conducted out of the University of Michigan (Rebranding Exercise: Closing the Gap Between Values and Behavior) finds that messages that encourage individuals to focus on immediate quality of life improvements tend to perform better promoting healthy behavior change than messages that encourage individuals to focus on making changes that contribute to their overall longevity. The thought is that this holds true because, in general, individuals tend to have difficulty making changes that have delayed or abstract rewards. It is easier for us to make changes that produce more timely rewards.

Physical exercise programs typically have both delayed and immediate benefits. Some of the long-term benefits include a decreased risk of serious disease and longer life. Some of the immediate benefits include increased feeling of well-being, decreased stress and improved sleep.

This study authored by Michelle Segar, Jacquelynne Eccles and Caroline Richardson suggests that marketers trying to get individuals to exercise more regularly might have better luck if they emphasize exercise’s ability to decrease stress and elevate mood. Immediate, concrete changes like reduced stress and increased mood are easy for most individuals to visualize, focus on and work towards.

The study’s utility transcends simply being applicable to exercise promotion. All positive lifestyle changes are more likely to occur if the focus is on noticeable short-term benefits rather than abstract, long-term benefits. An example would be a campaign promoting healthy eating habits. The campaign is more likely to be successful if the focus is on how healthy diet promotes increased energy than a focus on the long-term benefits healthy eating has on cardiovascular health. Human beings are not always logical, many of us suffer from the folly of instant gratification.

Organizations seeking to design more effective exercise programs should first spend some time evaluating the probable effectiveness of their messaging. Organizations that have been focusing on messaging that touts the long-term health benefits of exercise – instead of the immediate benefits – may want to consider reformulating the way the value of exercise is communicated to their employees. The University of Michigan study suggests that the more timely and relevant the exercise-related reward is perceived, the more likely it is that members of the target population will make positive changes.

Commenting on her study Michelle Segar suggests that while people claim to be motivated by the possibility of increased long-term health, the appeal of long-term health gains is rarely strong enough to cause lasting behavioral change. Wellness promoters should take note that some benefits of exercise many not be compelling enough to be an effective motivator for healthy behavior change amongst a wide audience.

These findings are not just for marketers and health promoters. Individuals looking to adopt new positive behaviors should spend some time asking themselves about what really motivates them, and perhaps break large health goals into smaller milestones that have appealing, short-term benefits. Effective behavior change is possible; it just has to stem from the right kind of tailored personal motivation. As more research is done on the effectiveness of different forms of motivation and motivational messages, individuals and groups will be better able to promote effective behavioral change.

Transtheoretical Model of Behavior Change

TTM
The Prochaska Spiral

At some time in their lives, most people have made various attempts to modify their behavior. It could be to lose weight, start saving money, stop smoking, etc. Sometimes these types of changes occur gradually, sometimes abruptly. Whether quickly, or over time, change usually occurs throughout a series of stages. These stages are outlined in the “Transtheoretical Model of Behavior Change,” or TTM.

TTM was founded in the early 1980s through the work of psychologist James O. Prochaska, PhD. This “readiness to change” model has enthused many to reevaluate theories about the most useful, apposite means of sustaining one’s self to achieve goals in relation to altering their behavior. The process in captured in the Prochaska Spiral.

Initiating one’s self into action is frequently more difficult than “just doing it,” and possibly less productive than anticipated. Without the proper emotional preparedness to tackle a particular goal, a person may actually sabotage their success. Prochaska devised a six-point model to clarify that lasting change seldom takes place due to a single ongoing resolve to act. More often than not, change develops from an understated, multifaceted, and at times, tortuous progression. A process that includes various phases of mental attentiveness such as thinking, pausing, going forward, going backwards, and sometimes starting all over again!

The Six-Stages of the Transtheoretical Model

Prochaska’s TTM hypothesis recognizes that enduring modification in a person’s behavior generally advances through six crucial stages: Precontemplation to Contemplation, and onto Preparation and Action. However, this is just the beginning, as individuals can indubitably slip back into the Preparation or Contemplation stages, if they lose their resolve.

For behavioral changes to be solidified, a person must enter into the Maintenance phase until the changed behavior “sticks,” so to speak. The final stage called Termination, means that the transformation is complete and permanently instilled in the person’s lifestyle.

-Precontemplation
Individuals in this phase desire to change; however, actual plans have not been conceived. This is because they may not be wholly cognizant of the potential advantages; they may be discouraged due to failure of past attempts, or lack energy.

-Contemplation
Those in the Contemplation phase are considering taking action, but are not altogether ready, or, do not understand how to go about getting started. They are open to feedback and information. This is somewhat a “dilly-dallying” stage.

-Preparation
At this stage, people are geared to take action. They are more strong-minded, certain, and dedicated. They are developing their plan of attack and may have already taken action in small steps.

-Action
Apart from just thinking about acting, a person at this stage is actually doing something. This stage is when all the prior small steps, seeming irrelevant choices, and small sacrifices come together to make a significant difference.

-Maintenance
Persons in the Maintenance phase have maintained the “Action” phase for a minimum of six months. This means that they have providentially shunned or conquered the obstructions that could have caused them to lapse into previous behaviors.

-Termination
When individuals in the Maintenance phase prolong their healthier behavior for at least two years, they go into Termination. In the Termination phase, the new behavior is wholly integrated and the temptation to relapse into old behavior has weakened. This constituent of behavior modification is no longer something an individual needs to do. It is part of their standard operating procedure.

Why the Transtheoretical Model of Behavior Change is so Important

The idea of comprehending the art of behavioral change is for a person to develop the life of their highest choosing. By integrating a particular lifestyle change that benefit’s them, they are reinforcing within themselves that they have the ability to do it. When people explore how they may utilize their vigor, awareness of self, and the acumen they’ve gained to embark on new areas of challenge or learning, growth occurs. This is why TTM is so important, it acknowledges that change takes time; thereby, setting individuals up to succeed.

Brief History of the Quantified Self Movement

People who use technology such as apps to keep track everything from air quality to their heart rate are often referred to as “Quantified Selfers” …or QSers for short. The information gathered by QSers is usually used to help them improve their health and/or well-being through the use of data. This makes the Quantified Self Movement not only beneficial in the behavior change community, but also for every individual who wants a better quality of life.

How Did the Movement Begin?

The Quantified Self Movement began in 2007 by Wired Magazine editors Gary Wolf and Kevin Kelly. It’s purpose was to promote an interest in self-tracking amongst users and developers. Mr. Wolf and Mr. Kelly now help maintain and moderate the Quantified Self website.

What is the Quantified Self Movement?

You may not have heard of the term ‘Quantified Self Movement’ as it goes by other aliases in the media such as ‘auto-analytics’, ‘self-tracking’, ‘life-logging’, and ‘life-hacking’. The movement uses many methodologies to achieve its goals.

The major methodologies are:

  • data collection
  • visualization
  • cross-referencing
  • discovery of correlations

(These are just the primary methods used based on the most widely utilized platforms of data-collection.)

Sharing Information

QSers are quick to share information about the tools they’ve used to life-log, as well as any tips they’ve gleaned and information about personal projects. Information is shared through various forums and blogs online as well as conferences where users can meet face-to-face.

The face-to-face meetings are called “Quantified Self Show and Tell Meetings”. These meetings are held all over the world, but the first ones began in the San Francisco Bay Area (of which I’ve attended many). The Quantified Self Conferences are working meetings for tool makers and users interested in the Quantified Self Movement.

Methods of Data Collection

Recent advancements in mobile technology has made it a lot easier to store, record, and track data. Most Quantified Selfers use handheld devices such as mobile phones or tablets to self-track. The data is normally stored in downloadable software or an app’s database (often in the cloud).

Currently some popular programs for self-tracking are:

  • Nike+ FuelBand
  • Fitbit
  • Body Media FIT
  • WakeMate
  • Zeo
  • Withings Body Scale

There are hundreds of devices and apps now used for a variety of different tracking purposes. Some of these innovations record activity data, some take biometric measurements… the innovation around what can be recorded is quickly expanding. The advances in recording and sharing health data on mobile devices has made mHealth extremely popular. As a zealot of this space I’m going to try and keep an updated list of wellness innovation related to tracking here.

MyPlate Controversy | Pie (chart) to Cure Obesity?

As you probably know by now the United States Department of Agriculture has retired the food pyramid and introduced MyPlate which has caused quite a stir in health and wellness circles. The outgoing food pyramid has been around for ages, but was deemed too complicated to understand (in the opinion of Agriculture Secretary Tom Vilsack). So we now have a pie plate to guide our nutritional choices:

MyPlate

In my opinion, a departure from the food pyramid is a good thing because the previous imagery used by the USDA gave the misconception that a diet with a foundation in carbohydrates (any carbohydrates: cereal, muffins, bagels, etc.) was a healthy approach…

Food Pyramid

MyPlate still suggests eating carbohydrates but now has more of an emphasis on whole grains. In addition, the total area representing grain-based food (on the plate) is significantly less than the pyramid. It should be noted however that carbohydrates are hardly eliminated in the new USDA model. In fact, there is still an arguably large amount of carbohydrates on the plate via fruits and vegetables. It is assumed the rest of MyPlate accounts for protein requirements (apparently there is no room for fats, oils, or sweets anymore | just kidding).

The USDA has built the sub-site ChooseMyPlate to help encourage and educate parents and individuals on quality food sources and MyPlate in general. One admirable aspect of ChooseMyPlate that I like is it gives families ideas of healthy, yet economical dietary choices for those struggling to make the right decisions on a budget.

So the basic paradigm shift is that the food pyramid was founded on the premise that one should consume more of what was at the bottom (of the triangle) and eating less of those things found at the top. In contrast to MyPlate, the pyramid appeared to have more choice. However, the idea behind the design of MyPlate is to provide a simplistic and direct connection to the food we eat. At a rudimentary level, this makes sense.

I commend Michelle Obama’s Let’s Move initiative to a healthier lifestyle and to the degree that people had difficulty understanding the former food symbol, I think we are moving in the right direction.

As with all good science it is important to continue the debate, there are those that believe mixing and matching food groups with nutrients will confuse consumers… and of course, different industry players and experts which might be affected by the promotion of MyPlate have their own opinions about the government’s efforts. There are also people that have conflicting ideologies about food intake, like Paleolithic diet proponents, or the PCRM with their vegetarian Power Plate.

Power Plate

So does all of this guarantee a healthier America? No. I am not a dietitian but portion control is a no-brainer when addressing weight management so it isn’t surprising that dietitians are perplexed by the lack of emphasis on portion control. However, in my opinion as a behavior change model MyPlate is moving us in the right direction… it is more usable, and will be much more helpful to children than its triangular predecessor.

Three Types of Certainty

Peak performers live their life with a high degree of certainty that they can achieve their goals. There are three different types of certainty: 1) opinion; 2) belief; and 3) conviction. Opinions are formed through transitory perceptions and it is easy to reformulate opinions based on new information and inputs. The fleeting nature of opinions make them a bit precarious as a useful tool for achieving goals. For instance, going out for a long run with just an opinion of successfully completing the run, you can easily be sabotaged to a new opinion of inadequacy when you begin to feel fatigued and/or feel like quitting.

Our beliefs are much stronger. Beliefs are often attached to emotional occurrences (ex. not wanting to be overweight) and/or reoccurring events (ex. habitual exercise) which create stronger neural pathways in the brain (than opinions). It is possible to change our beliefs as well but it requires more effort than merely changing an opinion about something. Using the same running analogy, a belief can help you push through fatigue because personal experience and prior accomplishments create resolve.

The highest form of certainty is our convictions. Throughout history many have achieved incredible successes through conviction, where others have created incredible chaos. Using the running analogy, a runner with a conviction to finish might push through an injury to complete a race (at considerable risk).

Convictions are extremely empowering (for better or worse) and can operate indiscriminately of ethical boundaries and common sense. There is much debate in psychology about the formation of convictions. Classic nurture versus nature arguments are applied throughout broad topics ranging from religious convictions to prejudicial ideologies. The truth is there’s still a lot we don’t know about how people develop their concepts of certainty.

What we do know is that certainty is needed to help drive decisions and initiate tasks. This should be intuitive… if someone can’t make up their mind this indecisiveness usually leads to inaction, and a lack of action is the quickest way to get nowhere. Peak performers create positive certainty by creating experiences and references that strengthen their beliefs and convictions. In the beginning this can be as simple as gathering information and talking to people that have previous knowledge. Eventually it requires taking continuous action. Action advantageously strengthens certainty and moves opinions to beliefs, and beliefs to convictions, which of course leads to more positive action. This loop creates powerful cycles that lead to continuous improvement.

There are risks and costs to action. But they are far less than the long range risks of comfortable inaction.
— John F. Kennedy

Weight as a Success Measure

In the health and fitness world we are bombarded with the word weight. Popular diet schemes have “weigh-ins” and mainstream media dramatizes the importance of weight as a success measure far too often. For instance, the network show The Biggest Loser spectacularly showcases people getting on a giant scale to announce to the world how much weight their participants have lost.

Weight as a Success Measure

The truth is that weight is only one of many measures you can use to gauge the success of a particular fitness regimen. Some people’s unhealthy obsession with weight loss influences them to worry about their scale weight so much that they will let themselves get dehydrated, lose valuable muscle, or in extreme cases fall victim to a life-threatening eating disorder. If your goal is weight loss, then weighing yourself all the time could actually deter you if you are swayed by days where internal fluid recalibration makes you believe you have had a setback.

Some fitness experts recommend only weighing yourself once a week. I’m actually a proponent of weighing yourself everyday because it is part of a daily routine that reminds me of my fitness goals, but that is because I have the self-disciple to not overreact if I see a five pound jump from one day to the next (and science backs up my methodology). These type of fluctuations are common, especially with dieters.

There are a number of other good data measures in addition to scale weight you can use to track your progress including body measurements (with a tape measure), body fat percentage, as well as fitness, flexibility and strength testing. In short, the scale is a valuable tool but there is no need to become a slave to daily weigh-ins.