Intervention Strategies for Changing Health Behavior

Applying the Disconnected Values Model

Mark H. Anshel

• Publisher: Routledge
• Year: 2015
• eBook ISBN: 9781317310594
• Topic: Psychology
• Subtopic: Applied Psychology
• Index: Psychology

Changing habits, particularly habits that are self-destructive and unhealthy, is among the most challenging goals of therapists and coaches who work with clients in promoting a healthier lifestyle. The purpose of this book is to "help the helper," that is, to assist the person whose professional mission it is to provide a service that enables clients or patients to acknowledge their unhealthy habits and to replace them with more desirable, healthier routines. It focuses on the power of helping clients identify: (1) the inconsistency between their core values – what they consider most important in life – with one or more unhealthy habits, (2) the costs and long-term consequences of this inconsistency, called a "disconnect" in the model, and (3) their willingness to conclude that the consequences of this inconsistency is unacceptable. At that stage, (4) clients should be prepared to work with a coach in developing and carrying out an action plan that aims to remove the disconnect between the client's values and at least one of their unhealthy habits.

Part I
The Need to Change Health Behavior

1
Explaining the Causes of Unhealthy Habits

Our Self-Destructive Nature

Our unhealthy habits are catching up with us, both individually and culturally. It is more important than ever to acknowledge our self-destructive and unhealthy lifestyles and attempt to change them. The financial and personal costs of these so-called “bad habits” are extreme. We cannot make these changes alone, however. We need specialists, such as exercise and diet coaches and mental health professionals, who can show us the way, help us understand reasons for our self-destructive behavior, and help us support our new lifestyle.

Changing the thoughts, emotions, and behaviors of others is a very difficult, sometimes impossible, task. Fitness coaches, registered dieticians, even personal physicians try to influence their client’s/patient’s habits, often to no avail. Most of us need what is called “social support” to replace our unhealthy habits with more desirable, healthier rituals. We need to change our self-destructive behaviors and make more prudent lifestyle choices. Easier said than done, as supported by empirical research (e.g., see a review by Hall & Fong, 2007) and the extensive experience of this writer in applied settings.

Our Self-Destructive Nature

Why do we—around the world but especially in Western nations—consciously engage in behaviors that we know are unhealthy and simply bad for us? We make the decision to consume food, often in the absence of hunger; to eat in response to certain emotions rather than strictly for reasons of hunger; and to consciously refrain from engaging in regular physical activity. This is why so many of us need “experts” to tell us what to eat and how and when to exercise, to obtain the motivation to live a healthy lifestyle from our medical practitioners and (to lesser extent) from our religious leaders, and to develop routines that provide the daily structure to maintain good health. One source of our motivation to engage in healthy habits is friends and professionals, collectively referred to as social support (Wills & Shinar, 2000).

Most of us function better and are more likely to carry out healthy habits in the company or due to the support of others. Examples include an exercise partner, a personal trainer, a dietician, or a mental health professional; we need someone to whom we feel accountable, whose company motivates us to carry out the rituals of a healthy lifestyle, or individuals we trust to remind us to do the right thing. Coaches help others to develop and carry out various routines so that, over time, the client performs these functions independently, a process called self-regulation.

Based on their published model about the causes of health behavior, Professors Peter Hall and Jeffrey Fong (2007) from the University of Waterloo in Ontario, Canada, have concluded that our self-destructive nature is primarily based on two factors. First, people compare the “costs” and “benefits” of a given action, and if the benefits outweigh the costs and consequences of an action, they are more likely to take the “preferred” action. Thus, in response to hunger, boredom, or some emotion, eating a bag of French fries or ice cream minutes before bedtime satisfies hunger, tastes good, and is reasonably inexpensive—all benefits but all unhealthy. Second, the benefits of an unhealthy habit are experienced very quickly—sometimes immediately (e.g., satisfying hunger, inexpensive)—while the short-term costs (e.g., indigestion, poor sleep, weight gain) and long-term consequences (e.g., heart disease, obesity, type 2 diabetes) are much longer-term outcomes than filling up before bedtime. Because we are a culture that condones and demands immediate gratification, culturally we take the route that leads to rapid satisfaction. “Besides,” many overweight people have told me, “my whole family is overweight.”

As Hall and Fong (2007, p. 6) explain:

Behaviors judged to be maladaptive in the long-run are usually driven by a strongly favorable balance of immediate costs and benefits. That is, many “maladaptive” behaviors are associated with substantial long-term costs and few (if any) long-term benefits; however, these same behaviors are frequently associated with many benefits and few costs for the individual at the time of action. In contrast, many avoided behaviors that seem “adaptive” to the outside observer (e.g., consuming raw vegetables) are, in fact, associated with substantial costs (and few benefits) at the time of actions, leading to the perplexing but common state of affairs where individuals know “what is good for them,” but do not do it.

Thus, perhaps the most compelling reason why we tend to avoid health protective behaviors would be in response to these longer-term considerations (Hall & Fong, 2003). This book addresses the ways that future and current health care providers, fitness and diet coaches, and mental health professionals can combat the challenges of overcoming resistance to following proper behavior patterns and combat their addiction of immediate gratification. Most health protective behaviors, such as proper eating habits, applying sunscreen, driving within the speed limit (or slower in inclement weather), exercising regularly, and not smoking, involve inconvenience and sometimes discomfort, embarrassment, and additional expense. Some of these habits have addictive properties.

Challenges of Changing Health Behavior

As researchers have repeatedly shown, habits are very difficult to break, even unhealthy ones. Simply informing a person about the ill effects of their undesirable behavioral tendencies (e.g., late-night eating, smoking, reducing high-fat foods, the inability to cope with chronic stress, ingesting mind-altering drugs) will not necessarily result in behavior change. Study after study on the effects of educational programs on replacing unhealthy (e.g., smoking, alcohol, anabolic steroids) or illegal behaviors (e.g., manufacturing or ingesting mind-altering drugs, committing a crime) have shown that providing educational materials, lectures, and even the words of a person’s medical practitioner or religious leader will not necessarily result in long-term changes in attitudes or behaviors about the negative habit. A person’s self-destructive actions are better explained by the “culture” of a person’s peer group, the person’s self-esteem, or evidence of psychopathology (e.g., chronic depression, anxiety, emotional eating, irrational thinking). Thus, merely increasing a person’s knowledge about the negative consequences of a certain habit will not necessarily result in the long-term change of that habit. What is more likely to influence behavior change and to reduce the likelihood of continued self-destructive actions? One approach is to stay positive.

Instead of associating maladaptive behaviors with poor health, Loehr and Schwartz (2003) take a more positive approach. In their intervention work with corporate clients, the author-practitioners associate healthy habits with improved energy and superior performance. These are outcomes with which most people can identify. The authors assert that unhealthy habits reduce a person’s physical and mental energy. Proper eating, for instance, promotes positive emotions and heightened mental focus, which are linked to the person’s sense of purpose about what he or she considers truly important (e.g., family relationships, success and effectiveness in the workplace, a strong spiritual life).

The challenge of mental and physical health care professionals, then, is to help patients/clients create four possible situations that will promote health behavior change: (1) the person experiences continued short-term benefits and/or positive feedback on certain behaviors (e.g., favorable scores on a medical or fitness test; encouraging words from a fitness coach, dietician, or medical practitioner), which will eventually lead—perhaps over a period of weeks—to a new habit of the desirable behaviors (e.g., eating an easily digestible snack while avoiding full meals if hungry before bedtime); (2) providing conditions that will facilitate the person’s continuation of this favorable behavior pattern (e.g., social support, referring the person to a specialist or expert for “coaching”; (3) providing extensive and meaningful evidence of the eventual consequences of the negative, unhealthy habit (e.g., testimony of a cancer-stricken person who smoked for many years, an athlete whose health suffered from prolonged ingestion of steroids, a chronic smoker suffering from emphysema, photos and stories of drivers killed due to alcohol intake or speeding); and (4) promoting evidence of favorable outcomes from replacing the negative (unhealthy) behavior with a positive (healthy) one.

How does a mental health professional or coach successfully prevent, stop, initiate, or maintain specific behavior patterns to improve one’s health and quality of life? How do we overcome the propensity of careless and toxic behaviors by individuals who do not comprehend the long-term consequences of their actions and, therefore, do not tend to take responsibility for them? What about the person who suffers from mental illness, such as clinical depression, chronic anxiety, and irrational thinking, and who “explains away” the self-destructive behavior patterns, in which the long-term consequences of these actions are irrelevant, rationalized, or not recognized? Answering these questions represents the focus of this book. Let’s begin the process of obtaining these answers by defining some important concepts.

Health is a positive state of physical, mental, and social well-being, not simply the absence of injury or disease that varies over time along a continuum from wellness to illness or injury (Sarafino & Smith, 2011). Health psychology is a field of study and practice concerned with understanding the psychological, behavioral, and social factors that predict, describe, and determine an individual’s health status, ranging from good health to illness, physically and mentally. Researchers have known for many years, for example, that smoking and other forms of tobacco use results in heart disease, compromises the immune system, and promotes different types of cancers. Clinical depression reduces energy and promotes thoughts of suicide and other forms of irrational thinking. Diet is now thought to influence attention deficit hyperactivity disorder (ADHD) and age of starting menarche among children and preadolescents.

Applied health psychology is first defined by understanding the concept of health, then by reviewing the concept of psychology, and finally by determining how the psychological factors that affect health have implications in real-world settings. These implications include examining how environmental and situational factors influence a person’s mental and physical well-being and how practitioners (e.g., mental health professionals, medical practitioners, fitness/nutrition/life coaches) can influence the individual’s health, well-being, and quality of life. At the core of applied health psychology is the attempt to understand, prevent, manage, and, if possible, eradicate the onset of mental and physical disease (Anshel, 2014).

Health psychologists attempt to promote a person’s mental and physical health by: (1) understanding the personal and situational factors that explain a person’s health or illness; (2) favorably influencing the individual’s mental state by understanding the causes of dysfunctional or maladaptive behavioral patterns (i.e., “bad” habits that negatively influence health and well-being); (3) preventing or treating illness through the use of various forms of therapy and interventions; (4) identifying the psychological, behavioral, and situational factors that explain a person’s illness or dysfunction; and (5) determining the effects of cognitive and behavioral strategies on improving mental and physical health and quality of life.

Use of the title (and credential) “health psychologist” infers that the individual is a licensed clinical or counseling psychologist with a specialization in understanding the personal (i.e., a person’s thoughts, emotions, personality traits) and environmental factors (i.e., psycho-social stress, relationships) that may explain a person’s physical and mental condition. In addition, health psychologists are interactive with medical practitioners, rehabilitation and physical therapists, dieticians, personal trainers/exercise coaches, and other specialists whose expertise will accompany the array of services and expertise needed to provide proper counsel and intervention strategies.

While the content of this book addresses changes in health behavior, among the most common and important behavior patterns is exercise. Readers will notice this emphasis but should be able to transfer this material to other unhealthy behaviors, such as poor diet and improper eating habits, smoking, tobacco use, in general, poor sleep, excessive stress, poor coping skills, and others. Table 1.1 outlines the various definitions related to health and exercise.

“Wellness,” a more global concept, is usually defined as a generalized state of good health, the optimal soundness of body and mind. More specifically, wellness is “the achievement of the highest level of health possible in physical, social, intellectual, emotional, environmental, and spiritual dimensions” (Hopson, Donatelle, & Littrell, 2009, p. 2). “Wellness” and “health” are often used interchangeably. Wellness has several dimensions, and the dimension that is most closely allied with this book is physical wellness. To Hopson et al., physical wellness consists of “all aspects of a sound body, including body size and shape, sensory sharpness and responsiveness, body functioning, physical strength, flexibility and endurance, resistance to diseases and disorders, and recuperative abilities” (p. 4). One subdimension of physical wellness is physical fitness.

Physical fitness is the ability of the human organism to function efficiently and effectively (Corbin & Lindsey, 1994). Because physical fitness is a very important outcome of engaging in exercise and other forms of physical activity, mental health professionals, as well as others who counsel in the health field, should help clients/patients achieve better fitness through an array of strategies that will be discussed in this book. The benefits of engaging in regular physical activity, particularly exercise, is enormous, and getting clients/patients to increase their level of physical activity should be a primary outcome of the counseling process.

Researchers have designated five subdimensions, or measures, of physical fitness. These are cardiorespiratory endurance (also called “aerobic fitness”), which focuses on improved function of the heart and lungs; muscular strength; muscular endurance; flexibility; and body composition (also referred to as “percent body fat”). Hopson et al. (2009) further define health-related components of physical fitness as “components of physical fitness that have a relationship with good health” (p. 31).

Table 1.1 Definitions of dimensions and subdimensions of health and wellness

Health: a positive state of physical, mental, and social well-being	Wellness: a generalized state of good health and the optimal soundness of body and mind
Health Psychology: a field of study and practice concerned with understanding the psychological, behavioral, and social factors that predict, describe, and determine an individual’s health status	Physical Wellness: all aspects of a sound body, including body size and shape, sensory sharpness and responsiveness, body functioning, physical strength, flexibility and endurance, resistance to diseases and disorders, and recuperative abilities
Applied Health Psychology: a field of study and practice concerned with examining how environmental and situational factors influence a person’s mental and physical well-being and how practitioners (e.g., mental health professionals/health psychologists, fitness and nutrition coaches) influence the individual’s health, well-being, and quality of life	Physical Fitness: ability of the human organism to function efficiently and effectively. Includes cardiorespiratory endurance (aerobic fitness), muscular strength, muscular endurance, flexibility, and body composition
Health Psychologist: a licensed clinical psychologist with a specialization in understanding the personal and environmental factors that may explain a person’s physical and mental condition	Exercise Psychology*: the study of psychological factors underlying participation in and adherence to physical activity programs

* There is no formal or legal recognition, at this time, of the professional titles “exercise psychologist” or “fitness psychologist.” However, a licensed psychologist who is credentialed in the state (or Canadian province) in which he or she practices may use either of these terms to describe an area of specialization or expertise.

One form of achieving better physical fitness is a type of physical activity called “exercise.” Different forms of exercise achieve each of the five types of physical fitness. Why some individuals choose to exercise, while others do not, and how practitioners can improve exercise participation and maintenance are just a small segment of a field that deals with the...

Table of contents

• Cover
• Title
• Copyright
• Contents
• Preface
• Part I The Need to Change Health Behavior
• Part II Theoretical Foundations and Support
• Part III Describing the Disconnected Values Model
• Part IV Adherence and Compliance to New Healthy Habits
• Part V Cognitive and Behavioral Strategies That Promote Healthy Habits
• Part VI Personal Factors That Influence Health Behavior Change
• Additional Readings
• Appendix A: Sample Client Workbook for Applying the Disconnected Values Model
• Appendix B: Exerciser Checklist: Guidelines for High Quality Exercise Experiences
• Index