week 8 health psychology

Health Behavior Change Workbook

In PY 415, you have the opportunity to try to change one of your own health behaviors over 8 weeks.

This workbook consolidates many of the theories and practices used to understand and practice behavior change. Read through the workbook and fill out the worksheets marked with a to help you begin your health behavior change project for PY 415 Health Psychology.

Turn in this workbook when you submit your Health Behavior Change Project. You may type directly in the document, or you may print it, handwrite your responses, and scan it.

Section 1: Strategies for Behavior Change

Section 2: Predicting Success and Failure

Section 1: Strategies for Behavior Change

Forethoughts: Picking a Behavior to Change and Tracking It

1. Pick a behavior, not a “goal”. For example losing 25 pounds is a goal. Eating less junk food is a behavior. While most us think about the “goals” we want to achieve, it is the accumulation of behaviors that determine whether we reach a goal, and affect our ability to maintain our goal.

Examples of goals:	Examples of behaviors that correspond to goals:
Losing 25 pounds	Switching from fried chips to fruit or baked chips; Eating 2-3 cups of vegetables a day; Biking for 20 minutes, 4 times a week
Being healthier	Walking 2 miles, 4 times a week; Drinking between 9 and 13 cups of water/day (number of cups depends on your sex, physical activity level, and weight)
Quitting smoking	Not joining your co-workers’ smoking break; Cutting back from 20 cigs/day to 5
Feeling good in your relationship	Putting down your smart phone when your partner talks with you
Having “more time”	Cutting back websurfing time from unlimited to 30 minutes a day

If you came to this class with a goal, but you are not sure what behavior to work on to get there, we’ll talk about it.

2. Define your behavior concretely.

Losing weight is a common goal. It’s a great goal for someone whose weight might affect their health, but let’s make it a behavior – cutting back on eating fast food. Wonderful. But… now it gets messy. How do you want to define “fast food”? McDonald’s is fast food. Most people would agree there. What about the pre-made pizza at the Whole Foods cafeteria? Does that count? What about a baked potato at Wendy’s? Or that scrumptious Indian buffet? What about a Frappuccino? You got the idea. You’ll want to define what fast food means for you. We’ll go through this on a worksheet in a few pages.

After you define “fast food”, how do you define “cutting back”? Do you want to reduce your fast food consumption to one meal a day? One a week? One a month? Are snacks allowed but meals are not?

These definitions are really up to you. The important part is to be very clear to yourself about what counts and what doesn’t. Of course, you will not be able to account for every tiny potential circumstance in advance, but if you are very clear you will know what to do with those unforeseen circumstances when they arise.

3. Write down your Plan, in an easy to interpret manner. You’ll find that if you can’t write it down clearly, you might not have it clearly formed out in your head.

Here’s a real life example from one of our own professors.

“In February 2022, I decided to cut back on how much cheese I was eating. I ate too much cheese!”

Here’s her example:

· My Behavior

· Eat less cheese

· Cheese defined (for my purposes)

· sliced cheese, shredded cheese, feta cheese, cheesy bread, cream cheese, cottage cheese, paneer, wedge or block cheese

· The Plan to cut back on cheese

· don’t buy cheese, as defined above, at the grocery store

· if in a restaurant, select a meal that does not contain cheese, or ask if it can be removed

· if asked “would you like to add cheese to that?”, say “no thanks”

· Some exceptions:

· if at a friend’s house and they have cooked a meal that contains cheese, eat it

· if with a group of friends at a restaurant getting a shared dish with cheese, eat it

Important Note!

Lots of unhealthy behaviors are good to change, but the nature of doing this for a class assignment raises a few extra necessities to consider when picking your behavior. Please be sure you can answer “yes” to the following to help you pick a behavior that lends itself well to what you’ll need to do for class:

· Can I keep a count, tally, or otherwise track this behavior? (e.g., number of servings of fruits and veggies eaten per day can be easily tracked; eating “better” is not easily tracked)

· Do I have multiple opportunities to work on this behavior throughout the day? (e.g., don’t pick “going to the dentist regularly”)

· Is this behavior something I can do on my own? (e.g., walking or jogging is something I can do on my own, but playing tennis is not)

4. Tracking your behavior

Tracking behavior can play a big role in how successful we are at changing. Without tracking, it can be difficult to know if we are being successful. People tend to over- or underestimate their behaviors (e.g, we think we drink more water per day than we actually do, we think we smoke fewer cigarettes than we actually do), and tracking helps us be honest about our progress. It also helps us develop systems of rewarding ourselves for successes (more on that later).

Track your behavior with a smart phone app or calendar that you can keep with you.

My Plan

· My behavior

· Behavior defined (for my purposes)

· The Plan

· How will I track my behavior?

Strategy 1:

Self-Monitoring and Self Observation

One of the first strategies to use before changing is to really watch yourself in action (or, watching yourself avoiding action as the case may be).

Psychologists use two terms for this process: Self-Observation and Self-Monitoring

1 . Self-Observation = “watching” your thoughts and actions related to your behavior ex: Noticing when you are reaching for a cigarette, lighting a cigarette, smoking, becoming aware of a craving

2. Self-Monitoring = taking notes about what’s going on just before and during your behavior (see an example of self-monitoring from a smoker quitting in Figure 1)

Self-monitoring includes, for example:

What day is it?

What time is it?

Where am I?

How am I feeling?

Who is around?

What happened right before?

Figure 1.

Figure 1. An example of self-monitoring from a diary of someone interested in cutting back on smoking. After taking self-monitoring notes like this for a week or so, a person may begin to see patterns in when they are vulnerable to fail in their behavior change (which can help them anticipate and prepare to deal with a it before it happens). In what types of situations is the example person vulnerable to give in to smoking? Possibly when they are waiting, and when they seek (but do not get) social interaction. These patterns only become apparent when a person monitors their experiences. Strategy 2:

Implementation Intentions

Psychologist Peter Gollwizter of NYU researched what happened when people created short, succinct plans about when, where, and how they will respond to all the little situations encountered to get to their goals. (Gollwitzer’s research found that creating these plans is really helpful.) He called these succinct plans Implementation Intentions.

So here’s an example: if you goal was to lose 10 pounds, this does not happen overnight, but happens as a result of hundreds or thousands of little choices you make over the next few weeks and months. This is why the beginning of this workbook emphasized picking a behavior over picking a goal. Your implementation intentions eventually become automatic, but require you to make some simple plans before you encounter the situations that you need to consider.

The format that Gollwitzer developed for implementation intentions is really simple:

When… situation “x” arises… I will… do “y”.

Some examples:

When... it is Monday at 6:30…

I will… put on my sneakers and go for a jog.

When… I don’t feel like jogging…

I will… remind myself that it is for my health and that my family wants me to be healthier.

When… it is raining outside…

I will… I will go to the shopping mall and walk laps indoors there.

When… my alarm clock fails to go off or I accidentally sleep through it…

I will… I will jog when I get back from work at 4:00.

Implementation Intentions.

When…

I will…

When…

I will…

When…

I will…

When…

I will…

Strategy 3:

Rewarding yourself through Operant Conditioning

Operant Conditioning is the term psychologist use to describe what we are doing when we pair voluntary behaviors with consequences. Many parents use these techniques without realizing it (for example, taking away TV privileges for bad behavior or giving presents for good grades).

Basically, when people do something we want them to do again, we reward them (psychologists use the term “reinforce” instead of “reward”). When people do something we don’t want them to do again, we punish them. When little Mandy behaves at the dentist they give her a lollipop (and incidentally create for themselves wonderful job security!); when little Mandy puts a thumbtack on the teacher’s chair, she gets sent to the principal’s office.

Reinforcement increases likelihood of behavior

Punishment decreases likelihood of behavior

Positive something is presented

Negative something is removed

Reinforcement and Punishment
	Increases Likelihood of Behavior	Decreases Likelihood of Behavior
Stimulus Presented	Positive Reinforcement	Positive Punishment
Stimulus Removed	Negative Reinforcement	Negative Punishment

Examples of Reinforcement and Punishment in little Max’s life
	Increases Likelihood of Behavior	Decreases Likelihood of Behavior
Stimulus Presented	Parents give allowance to Max for washing the dog (one of his chores)	Parents spank Max after he lies to them about drawing with magic markers on the dog
Stimulus Removed	Max tickles his little brother until the brother admits that it was he that drew on the family dog.	Max’s parents take away his TV privileges for a week because he was found tickling and tormenting his brother.

You can use the ideas of reinforcement/punishment when you want to shape your own behavior by designing a plan to reward your successes and (if you want) punish your misses. Sometimes, simply not getting an anticipated reward is punishment enough. But depending on what you want to do, you may choose to develop a form of punishment. I’ll leave that up to you. The key though, is to have honesty with yourself. If you deserve your rewards – great! If you don’t, don’t give them to yourself.

An example: if I successfully drink 9 cups of water a day for at least 5 days in a week, I will teat myself to a girls’ night out at the movies on Saturday.

An important note: If you set up a rewards system, it’s important to be able to “reset” it often. If I decide to reward myself for drinking 9 cups of water on at least 28 days out of a month, I can easily become demotivated for a whole month if I miss 4 days at the beginning of the month. I have not incentive to get back on track until the next month! It’s much better to set up smaller chunks of time in the beginning (e.g., 1 day, 1 week, etc.). If you get good at that, you can then think about changing to longer time frames and bigger rewards.

Strategy 4:

Contingency Contracting

Contingency contracting is a form of operant conditioning. This method involves developing the plan that, if you fail to meet your goal, you will perform a behavior that goes against your beliefs. So for example, an aspiring vegetarian might write herself a contract that if she eats meat on more than 5 occasions in a month, she’ll donate money to a fur company.

Operant Conditioning, and Tracking Behavior

How might you use reinforcements to help shape your behavior? (Think both short term, e.g., daily, and long term, e.g., weekly or monthly).

How might you use punishments to help shape your behavior?

How could you use contingency contracting? Techniques to help you change:

Social Learning

We learn a lot by watching and observing others, even when we don’t intend to. Psychologists call this modeling, or social learning (see psychologist Albert Bandura for more on social learning and social observation). How the people you interact with behave has a really big impact on how you behave. What do they eat? What do they value? How do they treat other people? If those people you interact with on a regular basis do not behave the way you want to, look for those who do and seek to spend a little more time with them.

1) Surrounding yourself with people who model the behavior you want is one of the keys to long-term behavior change. When engaging in a new behavior, you look to others to learn from their experiences. If you are serious about running, you look toward experienced runners. If you are serious about quitting smoking, you look at the behavior of people who don’t smoke. We look toward these people to gain two main types of things: a. Tangible information Where to buy good shoes? What kind of shoes? How to avoid over-use injuries? b. Social support When the novelty of running wears off, and you feel discouraged about your waning enthusiasm, it helps to hear stories from others who have faced the same challenge.

Techniques to help you change:

Stimulus Control

The objects that surround you have a big influence on what you do. Habits are habits because they are automatic; done without much conscious thinking. Here’s the gem of this concept: you can easily use this to your advantage if you know what to do.

Consider a habit of turning on the TV when you walk in the door coming home from work. If your goal was to feel like you have “more time”, and the new behavior you are aiming for is not watching TV, then you can do things to make turning on the TV difficult. Put the remote in a different room or the garage (so you can’t just grab it without thinking), or tape a cover over the button on the TV itself. Or, unplug the TV if the plug is hidden in an awkward to reach location.

Psychologist call this “Stimulus Control” or “Environmental Control”, because you can intentionally control your environment to help you adjust your behavior. How you approach this will depend on whether you are interested in stopping a behavior or starting a behavior.

Here are some key points on how to use environmental control:

1) If you are trying to stop a behavior 1. Determine what cues trigger behavior you don’t want (e.g., TV remote) 2. Rid your environment of these cues (e.g., hide TV remote)

2) If you are trying to start a behavior 1. Determine what cues might help trigger your new behavior (e.g., pictures of famous runners) 2. Fill your environment with cues to trigger the behavior (e.g., put pictures up around your house)

Your Surroundings

Who You Surround Yourself With Who do you know who already behaves the way you want to behave?

How could you spend more time with this person or group of people? Be specific.

What You Surround Yourself With What cues in your environment might trigger the old behavior or help you remember to do your new behavior?

What changes can you make in your environment to either get rid of these cues, or surround yourself with more of them?

Section 2: Understanding Success and Failure

Q. How many psychologists does it take to change a light bulb? A. One. But the light bulb has to want to change.

-anon.

Theory of Planned Behavior

Whether we intend to engage in a new behavior depends on three main things: 1) whether we think the behavior is valuable, 2) how our friends and family view the behavior, and 3) whether we think we can actually pull it off. This culmination was described scientifically with the Theory of Planned Behavior, which was developed by researchers Icek Ajzen and Martin Fishbein in the mid-1970s and 80s to help psychologists understand what motivated people to change behaviors (see Figure). You can apply your own situation to this theory, to help you understand what elements of your life are bolstering your efforts to change, and what elements are keeping you hesitant or shaky.

Let’s take a look at the original theory by Ajzen and Fishbein. The theory itself appears in bubbles, along with typed questions on the left hand side that offer explanation as to what the phrases used by Aijzen and Fishbein mean (those phrases are “Behavioral Attitude”, “Subjective Norms”, and “Perceived Behavioral Control”).

Theory of Planned Behavior

“Behavioral Attitudes” What do I believe I have to gain from my new behavior?

Are those gains valuable to me? To what degree?

“Subjective Norms” What do my family and friends think of my old behavior? My new behavior?

Are the opinions of my family and friends important to me? To what degree?

“Perceived Behavioral Control” Describe what you need to be able to do this new behavior. a) skills

b) knowledge

c) financial resources

d) time

Do you have what you need based on what you wrote for a-d above?

Stages of Change

In the 1980s psychologists James Prochaska and Carlo Diclemente developed a model to outline a person’s readiness to change behavior. They called it the Transtheoretical Model, but it is also called the Stages of Change model. This model has been used heavily with smokers, assessing their readiness to quit smoking, but can be applied to pretty much any behavior. The idea behind Stages of Change is that people move through several “stages” when going through a behavior change (see Figure).

You have no intention of changing behavior; no recognition that you need to.

You are thinking about changing a behavior.

You are planning to change a behavior in the next month; Maybe you try out the new behavior but you are inconsistent.

You are performing the new behavior consistently.

You continue to perform the new behavior consistently for six months and longer.

Prochaska, DiClemente & Norcross, 1992

Health psychologists use this model to determine what type of intervention to give their clients. You can imagine that someone in PreContemplation would be a better audience for a public service announcement (PSA) about the harms of smoking, as compared with someone in Action, who would be better receptive to coupons for nicotine gum. The PSA would be wasted on the Action individual, and the coupons would be wasted on the PreContemplator. They are just in different stages of their path toward change.

The linear model in the illustration helps us see the different stages clearly. But there is something about it that is a little misleading. Can you guess what that might be?

When people move through these stages, they do not necessarily move in a “neat” and organized way from start to finish. In reality, we shift back and forth from different stages, often in response to events that happen in our lives (e.g., a diagnosis… a divorce… a move). We might shift from Action, back to PreContemplation, or from Maintenance to Preparation. So we look a little more like the next figure, the circle below.

You might be able to see examples in your past thoughts and actions that tell you when you were in one stage or another. Can you identify them, along with any life events that moved you between stages? If so, write them in below. It’s possible that you have not yet been through all of them! Here’s a hypothetical example from someone starting to exercise:

Example:

Didn’t think about exercise at all.

Started thinking I should do something.

Bought a pair of hiking boots that sat unused in my closet for 3 months.

Started hiking with my friend twice a week.

Still hiking with my friend twice a week. Joined a hiking club, too. Had a major set back after week-long business trip to Boston. But got back to hiking after 10 days.

October 2004: my doctor diagnosed me with diabetes and recommend exercise.

Moved from Pre-Contemplation to Contemplation

Friend I really admired invited me to go hiking with her.

Moved from Contemplation to Preparation.

June 2006: Grandmother died, of complications arising from diabetes.

Moved from Preparation to Action.

Your Turn:

PY 415 Health Psychology 15 | Page HB Workbook

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