By Brianna Z. Kauer, M.S., BCBA
Guest Author; Owner, Create Behavior Solutions
According to the World Health Organization, 1.6 million people died from diabetes in 2016. It is currently the 7th leading cause of death in the United States. This is a disease that can be significantly managed by diet and exercise, yet people are dying from it at high numbers (along with heart disease and many other diseases). Eating and exercise are basic human behaviors and there is an urgent need to use effective behavior change strategies when it comes to health related behaviors. We have a science for that!
The majority of people know what they should or should not be doing when it comes to health behaviors, however, attaining long-term behavior change is not always easy. Research is showing us approaches which can make it more likely that people will be able to change their health-related behaviors.
A recent article by Zhang, Leeming, Smith, Chung, Hagger and Hayes (2018) explains the impact of using Acceptance and Commitment Therapy (ACT) in the context of health behavior change. There is huge potential to create positive and long lasting change in the health of many people’s lives through the use of behavior change strategies based in ACT. The authors recommend that practitioners working in the field of health behavior change design their intervention programs based on ACT.
ACT is a branch of Behavior Analysis which aims to improve psychological flexibility through 6 core processes, which are: acceptance, mindfulness, values, committed action, defusion, and self-as context. ACT emphasizes committed actions (i.e., specific goals) that are connected to a person’s chosen values – what really matters to you. With acceptance and mindfulness, a person learns to contact the present moment and acknowledge the private events (e.g., thoughts, feelings, urges, body sensations) they experience without fusing with them or allowing them to determine their behavior.
When attempting to change your behavior around health, there are many strategies to shape your behavior by shaping your environment (traditional contingency management/behavior interventions). However, when it comes to humans with complex language systems, often our behavior is shaped by variables we can’t see (i.e., private events). When an individual wants to make changes related to health behaviors, it is often necessary to address the impact of private events and the context in which they occur. What ACT brings to the table is the understanding that self-regulating your behavior often needs to begin by examining the impact and context of your thoughts.
The initial step to building psychological flexibility is to notice your private events, followed by the practice of changing the context of those private events rather than the events themselves. For example, mindfulness practices may be used to build an awareness of urges and temptations with particular foods rather than attempting to get rid of those urges. Try telling yourself “don’t think about chocolate cake” and see how often those words, images and urges pop up – it doesn’t work because the verbal stimulus related to that food is present. Attempting to avoid the thought or urge may actually make it stronger. Struggling to avoid thinking about something usually results in the very thought coming up again and again. We use language to relate one thing with another and it is difficult to unlearn those relationships. This is where it is really useful to understand Relational Frame Theory, which describes language processes and cognition and is the underlying theory behind ACT.
Instead of trying to control private events, ACT encourages individuals to change their relationship to these events (Hayes, 2004). It is possible to observe your private events (e.g., I notice I’m having the urge to eat another piece of chocolate cake – it just happens to be a thought in my mind) and accept your experience in the moment while also committing to behaviors that lead you towards your valued direction. It is possible to take actions towards your values even in the face of difficult private events and this is where change takes place (e.g., I recognize and accept the urge to eat cake while I take the action of eating organic carrots instead). Behavior patterns that emerge from this process will have a much greater chance of sustainability over time. When you commit to taking actions towards your health, it is important to relate those actions to something that is deeply meaningful to you (i.e., values/reinforcers).
With the growing concern over health ailments (especially ones that can be prevented through behavior-change), now more than ever we need this scientific approach to health behavior-change. Behavior science and specifically ACT have leading roles in the application of health behavior-change.
Do you have experience with health behavior change and ACT? Let us know in the comments below, and be sure to subscribe to bSci21 to receive the latest articles directly to your inbox!
If you are interested in learning more about ACT, be sure to check out our ACT Resource Guide for BCBAs.