Download Bridging Behaviorism

Bridging Behaviorism
A New Approach to Engagement
Speakers:
• Dennis Richling, MD, Chief Medical and Wellness
Officer, HealthFitness (moderator)
• Edward Framer, Ph.D., Director, Health &
Behavioral Sciences, Science and Analytics, Health
Fitness Corporation
• Fred Hanna, Ph.D., Professor of Counselor
Education, University of Northern Colorado; author,
Therapy with difficult clients: Using the precursors
model to awaken change
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© 2013 Health Fitness Corporation
Two Models, One Goal:
Sustained Engagement
Dennis Richling, MD, Chief Medical and
Wellness Officer, HealthFitness (moderator)
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Engagement
• A Pledge, or a Promise
Participation
…is a marriage
-an alignment of purpose and values
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How Do We Engage People?
Educate
them…
Incent them…
Reframe
the message…
Open
a
door
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Motivation is Important to Change
Behavior
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Goal:
Adopt Healthy Behaviors
for the rest of their life
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How much motivation do we need?
• A new behavior model…
Dr. BJ Fogg
Stanford Persuasion Technology Laboratory
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B =M A T
Fogg Behavior Model
Behavior Shaping
Motivation
High
Motivation
Low
Motivation
Desired
Behavior
Hard to do
Ability
Easy to do
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Exciting New Research?
Yes, but...
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When Do Behaviors Change?
• Epiphanies
• Change of context
• Psychological processes
• Make it easier
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Bridging Science to Increase Engagement
10%
10%
15%
Motivated with Risks
Little Motivation and
Risks
65%
No Motivation and
Risks
No Risks
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Bridging Behaviorism
Radical
Behaviorism
Transtheoretical Model
Precursors Model
Fogg Behavior
Model
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A New Look at What Radical
Behaviorism (Behavior Analysis)
has to Offer Health Promotion and
Engagement
Edward Framer, Ph.D., Director, Health &
Behavioral Sciences, Science and Analytics,
Health Fitness Corporation
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Behavioral Approach?
• Emphasis on measurement
• Emphasis on observable results
• Criteria = behavior change
• Justification
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How the conversation got started
1. Can we work together to improve how HealthFitness
builds it intervention models?
2. Engagement is critical to the success of health
promotion and in fact all therapeutic change
3. Schools of psychotherapy, coaching and health
behavior change, including even the Eastern thinking
of yoga psychology
4. Why behaviorism is often the odd man out
5. Assertion: Radical behaviorism also deals with
consciousness, thoughts and feelings
6. How can we use these various approaches, together,
to improve engagement?
7. How can we use the various approaches, together, to
improve health behavior change?
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Bridging Behaviorism
Radical
Behaviorism
Transtheoretical Model
Precursors Model
Fogg Behavior
Model
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© 2013 Health Fitness Corporation
Radical Behaviorism
• Skinnerian behaviorism or operant psychology
• Why radical?
– Methodological behaviorism only what is
observable from the outside?
– Radical behaviorism accepts consciousness
– Thoughts are behaviors, too
– The same rules that apply to learning to stop a
car when the light turns red apply to learning to
have or change thoughts or statements
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Radical Behaviorism and Health Promotion
• What does behaviorism, and especially
radical behaviorism, have to offer the
health promotion/wellness field that
most of us have come to love?
– An analytic framework
– Behavior change technologies
– A way to clarify the intrinsic/extrinsic incentives
fight
– Both individual-clinical and population-culture
approaches
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Incentives, Rewards, Reinforcers
• Incentive
– “…the expectation of reward that induces action
or motivates effort.”
(www.thefreedictionary.com)
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Incentives, Rewards, Reinforcers
• Reward
– “Something given or received in recompense for
worthy behavior….” (www.thefreedictionary.com)
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Incentives, Rewards, Reinforcers
•
Positive Reinforcer
Don't Shoot the Dog! The
New Art of Teaching and
Training.
By Karen Pryor
Strengthens behavior it follows
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Example: Timeframes for Incentives,
Rewards & Reinforcers
Incentive
Long-term
$650/Yr
500 pts/Yr
Reward
Intermediate
$10/Wk
Movie ticket
Reinforcer
Brief
$0.05/Min
1 pt/20 steps
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Two Types of Learning/Conditioning
• Pavlovian or
Classical Conditioning
• Operant Conditioning
http://psychology.about.com/od/behavioralpsychology/a/classical-vsoperant-conditioning.htm
© 2013 Health Fitness Corporation
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Discriminative Stimulus
• “When a stimulus signals the availability of
reinforcement it is called the SD, or discriminative
stimulus. …it reliably signals the availability of
reinforcement.”
• “Stimulus control is said to occur when an
organism behaves in one way in the presence of a
given stimulus and another way in its absence.”
• In plain English: A reliable cue or trigger
http://en.wikipedia.org/wiki/Stimulus_control
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Subtle reminders to make healthy
choices easier
Case Example:
Eastman Chemical Company
As part of the company’s health
management efforts, Eastman
leadership told employees the
company was placing green spoons
in the cafeteria’s healthy food
choices and red spoons in the less
healthy foods.
Jim Rogers
Chairman & CEO
“Hopefully, over time, we’re going to
find ourselves reaching for the green
spoon a lot more than the red
spoon.”
Eastman Chemical Company
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Antecedent(s), Behavior & Consequence
Antecedent(s)
•Doctor says I
need to exercise
more
•Worksite Health
Coach asks about
my doctor’s
exercise rec.
•Plan results in 10
daily 1 minute
calls from my
coach in 3 weeks
Behavior
•I wonder how I,
someone who
hates exercise,
will do that.
•I get upset, but
admit that I need
help
•With each cue I
get up and walk
at least 100
steps. I also try to
get 100 steps on
non call days.
(Use Outlook)
Consequence
•I feel bad, but do
nothing. I don’t think
about PA.
•Coach praises my
honesty and offers to
help me setup a
plan.
•I earn regular praise
from my coach and
even begin to praise
myself. I also start to
feel more relaxed.
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© 2013 Health Fitness Corporation
Incentives, Rewards, Reinforcers
•
Positive Reinforcer
Don't Shoot the Dog! The
New Art of Teaching and
Training.
By Karen Pryor
Strengthens behavior it follows
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Negative Reinforcer; Punisher
• Negative Reinforcer or Reinforcement
(strengthens behavior)
• Punisher or Punishment
(weakens behavior)
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Escape and Avoidance Behavior
ESCAPE: perform an operant response that
gets you away from an ongoing punishing
stimulus. “Get me out of here”
AVOIDANCE: perform an operant response
that prevents the occurrence of a punishing
stimulus. “Prevent pain/discomfort”
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Escape and Avoidance Shuttle Box
www.themezoom-neuroeconomics.com
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Summary
• Many more principles that have application to
health promotion
• Attaches to so much else in the field, including the
work Dr. Hanna will speak about next and the
introductory material that Dr. Richling used to set
up our discussion.
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Precursors Model:
Foundations for Successful
Engagement and Change
Fred Hanna, Ph.D., Professor of Counselor
Education, University of Northern Colorado;
author, Therapy with difficult clients: Using the
precursors model to awaken change
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Three Levers for Engagement
Motivation
Involvement
Perseverance
Engagement
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Defining the Levers
Involvement
• Dedication to a task or undertaking that often
includes strong interest, devotion, fascination
and/or commitment.
Motivation
• The desire to attain a goal; includes the exertion
of effort and willpower toward achieving that
goal.
Perseverance
• Sustained drive and energy toward a desired
goal; includes the determination to break through
any barriers.
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Stages of Change and Engagement
Precontemplation
Contemplation
Preparation
Action
Maintenance
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Bridging Behavior, Cognition and Affect
The dynamic Interplay of
Self, Mind, Body and
Therapeutic Change
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Source: Fred J. Hanna, PhD
© 2013 Health Fitness Corporation
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Precursors and Change
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Precursors Assessment
Problem or Issue:
Precursor and its Markers
None (0)
Trace (1)
Small (2)
Adequate (3)
Abundant (4)
1. Sense of Necessity
• Expresses desire for change
• Feels a sense or urgency
2. Willing for Anxiety or Difficulty
• Open to experiencing emotion
• Likely to take risks
3. Awareness
• Able to identify problems
• Identifies thoughts, feelings
4. Confronting the Problem
• Courageously faces the problem
• Sustained attention toward issue
5. Effort toward Change
• Eagerly does homework
• High energy; active cooperation
6. Hope for Change
• Positive outlook; open to future;
• High coping; therapeutic humor
7. Social Support for Change
• Wide network of friends, family
• Many confiding relationships
© 2013 Health Fitness Corporation
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Bridging Behaviorism
Radical
Behaviorism
Transtheoretical Model
Precursors Model
Fogg Behavior
Model
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© 2013 Health Fitness Corporation
© Used with permission
© 2013 Health Fitness Corporation
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Q&A
• Dennis Richling, MD, Chief Medical and Wellness
Officer, HealthFitness (moderator)
• Edward Framer, Ph.D., Director, Health & Behavioral
Sciences, Science and Analytics, Health Fitness
Corporation
• Fred Hanna, Ph.D., Professor of Counselor Education,
University of Northern Colorado; author, Therapy with
difficult clients: Using the precursors model to awaken
change
42
© 2013 Health Fitness Corporation
Appendix
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© 2013 Health Fitness Corporation
Antecedent(s), Behavior & Consequence
Antecedent(s)
Behavior
• Stop light
turns from
green to yellow
• Foot moves
from gas pedal
to brake pedal
• Car begins to
slow down
• Stop light
turns from
yellow to red
• Foot presses
harder on the
brake pedal
• Car slows to
a stop
• Stop light
turns from red
to green
• Foot moves
from brake to
gas pedal and
presses down
Consequence
• Car begins to
speed-up
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Antecedent(s), Behavior & Consequence
Antecedent(s)
• Girl in class
smiles at me
• My watch alarm
rings 3 times
per hour
• A new girl in
class smiles
at me
Behavior
• I look away
thinking: “She
probably doesn’t
really like me”
Consequence
• Next time the
girl and I look
at each other,
neither of
us smiles
• Each time I try to
think: “When
someone smiles
at you, smile
back”
• When I think this
10 times, my
Mom gives me
$1.00 extra
• I smile back at
her and
introduce myself
• She says “I’m
Sue and I just
transferred here
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© 2013 Health Fitness Corporation