Behaviour Change

What motivates people to

change their behaviour?
� Normative beliefs

� Beliefs about whether most (or most important)

people approve or disapprove of our current or

proposed behaviour.

� Perceived control

� How much control we believe we have over a

particular behaviour

� E.g., addictive behaviour = low perceived control

� Fundamental attribution error – belief that outcomes are

more a function of personal action than they really are (ie

people tend to over-estimate the amount of individual control

they have). Can be functional or disfunctional.

What motivates people to

change their behaviour?
� Personal susceptibility –

� Belief that we are susceptible to a situation that

threatens something we value

� Perceived severity –

� Amount of the perceived threat (the higher the

perceived severity, the more likely the change)

� Perceived pros for change outweigh the cons

� Outcome expectancies

� Belief that change will be valuable (ie that

undertaking the recommended action will reduce the

perceived threat)

How to motivate people to change

� Identify important social support to

change normative beliefs

� Enhance the persons sense of control

� Use information to enhance severity and

susceptibility

� Help develop pros for change and

neutralize cons
� Emphasize benefits of change

What is this ad trying to do?

What is this ad trying to do?
What is the possible effect of this
warning label?
What helps people succeed in
making and maintaining change?
� Albert Bandura – social cognitive theory

� Basic conditions/pre-requisites for change:

� Positive expectancy

� Response expectations/response efficacy

� Self efficacy

� Behavioural capability

� Reinforcement/punishment

� Self control

Positive Expectancy
� A person must value the expected

outcome of change

� Create positive expectancies by asking a

person what they value. Link the

behavioural outcome to those values.

Response efficacy
� Belief that a recommended behavioural response

(such as a treatment) will be effective in

bringing about the desired change

� Create positive expectations through modeling

(show how similar people have succeeded)

� Provide realistic data from credible sources on

the programs success

Self efficacy
� The confidence a person has in their

ability to behave in a certain way in a

particular situation

� Increase efficacy by:

� Creating mastery experiences

� Positive modeling

� Replacing negative self-talk (e.g., discounting the

positive, magnification, etc.)

Behavioural capability
� Access to resources necessary for change (e.g.,

healthy food, sun screen or protective clothing)

� Assist the person to problem solve – ie acquire the

new resources in a sustainable way

� Skills to perform new behaviour(s)

� Skills to cope with temptations to relapse

� Learn through:

� Modeling (vicarious learning),

� Guidance and feedback (physical or verbal)

� Practice (imaginary or physical)

Reinforcement and punishment

� Principal of reinforcement (operant

conditioning):
� Behaviour can be altered by changing the

cues that precede behaviour or by altering the

consequences of a behaviour

� The more rewarding an experience, the more

likely it will be repeated

� The more punishing or unpleasant an

experience, the less likely it will be repeated

� Use a contract to “reward” healthy behaviour

Reinforcement and punishment

� Premack principal – use a more desirable behavior to reinforce a

less desirable behavior

� No TV until I’ve worked out; no sex without using a condom

� Counter conditioning – replace an unhealthy behaviour with a

healthy behaviour (ideally one that is incompatible with the negative

behaviour)
� Thought stopping and replace negative self talk with positive self talk

� Replace eating chips with eating fruit; shower instead of smoke

� Stimulus control – remove behavioural cues and alter behavioural

chains

� Change were you sit or avoid places you normally smoke or eat or

abuse alcohol.

� Change your normal pattern – e.g., how you light a cigarette

Self control
� Personal regulation of goal directed behaviour

� Provide opportunities for self observation,

decision making, goal setting, monitoring and

self reward

� Keep a diary; write down measurable, time related

behavioural goals; make a behavioural contract

specifying what will happen if goals are or are not

met; develop a self monitoring system

Change is a process
� It often takes time and practice to

learn a new behaviour.

� Prochaska and DiClemente found

that self changers tend to do

different things over time
� They identified five stages of change

Precontemplation
� Description:
� no intention of changing in next 6

months

� cons of change outweighs pros of

change (little or no threat; low

response efficacy)

� may be resistant or hostile toward

pressure to change

Contemplation
� Description:
� thinking about change in next 6

months

� no firm commitment to change

(ambivalence)

� cons of change about equal to pros

of change

� little confidence in ability to

change (low self efficacy)

Preparation
� Description:
� intends to change in next 30 days

� pros for change outweigh the cons

(positive response effiacy);

� self efficacy is moderately high

� may not have the, skills, resources,

or reinforcers to initiative or maintain

change

Action
� Description:
� first 6 months after making the change (risk

of relapse is high)

� may not have skills to cope with

temptations to relapse

� may not have adequate or appropriate

reinforcers in place (social, cognitive, or

environmental)

-may not have a means of monitoring

progress

-self efficacy may waiver

Maintenance
� Description: -
change has been maintained for at least six months but

still occasionally tempted to relapse

� self concept begins to change

Is the transtheoretical model valid?

Is the transtheoretical model valid?
McDonald, Jessup, Filsinger, Ahmed, Brown, in prep

281 eligible callers in contemplation

160 received book

for contemplators + prep/action

121 received book

for prep/action

130 provided data

at 6 month follow-up (81%)

108 provided data at

12 month follow-up (68%)

93 provided data at

12 month follow-up (77%)

104 provided data

at 6 month follow-up (86%)

randomized
91 provided data at

18 month follow-up (57%)

64 provided data at

18 month follow-up (53%)

Matched Mismatched

7 day Point Prevalence Abstinence

(Persons lost to follow-up recorded as smokers)

3.7

12

8.8

8.9 8.1

5.7

10

12

14

6 Month 12 Month 18 Month

% abstinent

Matched
Mismatched

Prob. grps are equal .46 .40 .82

McDonald et al, in prep.

What does this mean?

� Probably need to break change process into four

groups:

� Those who are not currently motivated to change

� Build susceptibility, severity, expectancies, etc.

� Those motivated to change

� Build response efficacy, self efficacy, self control, etc.

� Those struggling to maintain change

� Use operant learning, create social support, implement

control strategies, etc.

� Those who have successfully changed

� Completely confident they won’t relapse

� No intervention required

Methods to build motivation

� Asking questions about goals, values and beliefs

� Raising doubts by pointing out conflicting beliefs and

values

� Asking questions to elicit alternative behaviours (physical

and cognitive) for achieving stated goals and values

� Increase outcome expectancy

� provide objective risk data tailored to age, gender, family history and

co-morbid conditions

� provide info. on short & long term benefits of change

� Gently correct misconceptions

� Reduce demoralization by offering support and

ecouragement

Next lecture
� Two examples of how to change

behaviour:
� Quit smoking

� Reduce stress