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Bridging Behaviorism
A New Approach to Engagement
© 2013 Health Fitness Corporation
2
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
© 2013 Health Fitness Corporation
3
Two Models, One Goal:
Sustained Engagement
Dennis Richling, MD, Chief Medical and
Wellness Officer, HealthFitness (moderator)
© 2013 Health Fitness Corporation
4
Engagement
• A Pledge, or a Promise
…is a marriage
-an alignment of purpose and values
Participation
© 2013 Health Fitness Corporation
5
How Do We Engage People?
Educate
them…
Incent them…
Reframe
the message…
Open
a
door
© 2013 Health Fitness Corporation
6
Motivation is Important to Change
Behavior
© 2013 Health Fitness Corporation
7
Goal:
Adopt Healthy Behaviors
for the rest of their life
© 2013 Health Fitness Corporation
8
How much motivation do we need?
• A new behavior model…
Dr. BJ Fogg
Stanford Persuasion Technology Laboratory
© 2013 Health Fitness Corporation
9
© 2013 Health Fitness Corporation
9
© 2013 Health Fitness Corporation
9
B =MATMotivation
High
Motivation
Low
Motivation
Hard to do Easy to do
Ability
Fogg Behavior Model
Behavior Shaping
Desired
Behavior
© 2013 Health Fitness Corporation
10
Exciting New Research?
Yes, but...
© 2013 Health Fitness Corporation
11
When Do Behaviors Change?
• Epiphanies
• Change of context
• Psychological processes
• Make it easier
© 2013 Health Fitness Corporation
12
© 2013 Health Fitness Corporation
12
© 2013 Health Fitness Corporation
12
Bridging Science to Increase Engagement
15%
65%
10%
10% Motivated with Risks
Little Motivation and
Risks
No Motivation and
Risks
No Risks
© 2013 Health Fitness Corporation
13
© 2013 Health Fitness Corporation
13
© 2013 Health Fitness Corporation
13
Bridging Behaviorism
Radical
Behaviorism
Fogg Behavior
Model
Precursors Model
Transtheoretical Model
© 2013 Health Fitness Corporation
14
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
© 2013 Health Fitness Corporation
15
Behavioral Approach?
• Emphasis on measurement
• Emphasis on observable results
• Criteria = behavior change
• Justification
© 2013 Health Fitness Corporation
16
© 2013 Health Fitness Corporation
16
© 2013 Health Fitness Corporation
16
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?
© 2013 Health Fitness Corporation
17
© 2013 Health Fitness Corporation
17
© 2013 Health Fitness Corporation
17
Bridging Behaviorism
Radical
Behaviorism
Fogg Behavior
Model
Precursors Model
Transtheoretical Model
© 2013 Health Fitness Corporation
18
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
© 2013 Health Fitness Corporation
19
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
© 2013 Health Fitness Corporation
20
Incentives, Rewards, Reinforcers
• Incentive
– “…the expectation of reward that induces action
or motivates effort.”
(www.thefreedictionary.com)
© 2013 Health Fitness Corporation
21
Incentives, Rewards, Reinforcers
• Reward
– “Something given or received in recompense for
worthy behavior….” (www.thefreedictionary.com)
© 2013 Health Fitness Corporation
22
© 2013 Health Fitness Corporation
22
© 2013 Health Fitness Corporation
22
Incentives, Rewards, Reinforcers
• Positive Reinforcer
Don't Shoot the Dog! The
New Art of Teaching and
Training.
By Karen Pryor
Strengthens behavior it follows
© 2013 Health Fitness Corporation
23
Example: Timeframes for Incentives,
Rewards & Reinforcers
Incentive Reward Reinforcer
Long-term Intermediate Brief
$650/Yr $10/Wk $0.05/Min
500 pts/Yr Movie ticket 1 pt/20 steps
© 2013 Health Fitness Corporation
24
Two Types of Learning/Conditioning
• Pavlovian or
Classical Conditioning
• Operant Conditioning
http://psychology.about.com/od/behavioralpsychology/a/classical-vs-
operant-conditioning.htm
© 2013 Health Fitness Corporation
25
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
© 2013 Health Fitness Corporation
26
Subtle reminders to make healthy
choices easier
Jim Rogers
Chairman & CEO
Eastman Chemical Company
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.
“Hopefully, over time, we’re going to
find ourselves reaching for the green
spoon a lot more than the red
spoon.”
© 2013 Health Fitness Corporation
27
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.
© 2013 Health Fitness Corporation
28
© 2013 Health Fitness Corporation
28
© 2013 Health Fitness Corporation
28
Incentives, Rewards, Reinforcers
• Positive Reinforcer
Don't Shoot the Dog! The
New Art of Teaching and
Training.
By Karen Pryor
Strengthens behavior it follows
© 2013 Health Fitness Corporation
29
Negative Reinforcer; Punisher
• Negative Reinforcer or Reinforcement
(strengthens behavior)
• Punisher or Punishment
(weakens behavior)
© 2013 Health Fitness Corporation
30
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”
© 2013 Health Fitness Corporation
31
Escape and Avoidance Shuttle Box
www.themezoom-neuroeconomics.com
© 2013 Health Fitness Corporation
32
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.
© 2013 Health Fitness Corporation
33
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
© 2013 Health Fitness Corporation
34
© 2013 Health Fitness Corporation
34
© 2013 Health Fitness Corporation
34
Three Levers for Engagement
Motivation
Perseverance
Involvement
Engagement
© 2013 Health Fitness Corporation
35
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.
Defining the Levers
© 2013 Health Fitness Corporation
36
© 2013 Health Fitness Corporation
36
© 2013 Health Fitness Corporation
36
Maintenance
Action
Preparation
Contemplation
Precontemplation
Stages of Change and Engagement
© 2013 Health Fitness Corporation
37
Bridging Behavior, Cognition and Affect
The dynamic Interplay of
Self, Mind, Body and
Therapeutic Change
Source: Fred J. Hanna, PhD
I
© 2013 Health Fitness Corporation
38
Precursors and Change
© 2013 Health Fitness Corporation
39
© 2013 Health Fitness Corporation
39
© 2013 Health Fitness Corporation
39
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
40
Radical
Behaviorism
Fogg Behavior
Model
Precursors Model
Bridging Behaviorism
Transtheoretical Model
© 2013 Health Fitness Corporation
41
© Used with permission
© 2013 Health Fitness Corporation
42
© 2013 Health Fitness Corporation
42
© 2013 Health Fitness Corporation
42
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
© 2013 Health Fitness Corporation
43
Appendix
© 2013 Health Fitness Corporation
44
Antecedent(s), Behavior & Consequence
Antecedent(s)
• Stop light
turns from
green to yellow
• Stop light
turns from
yellow to red
• Stop light
turns from red
to green
Behavior
• Foot moves
from gas pedal
to brake pedal
• Foot presses
harder on the
brake pedal
• Foot moves
from brake to
gas pedal and
presses down
Consequence
• Car begins to
slow down
• Car slows to
a stop
• Car begins to
speed-up
© 2013 Health Fitness Corporation
45
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”
• Each time I try to
think: “When
someone smiles
at you, smile
back”
• I smile back at
her and
introduce myself
Consequence
• Next time the
girl and I look
at each other,
neither of
us smiles
• When I think this
10 times, my
Mom gives me
$1.00 extra
• She says “I’m
Sue and I just
transferred here

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Northwestern energy corporate wellness program managed by HealthFitness
 

Bridging behaviorism: A new approach to employee engagement

  • 1. Bridging Behaviorism A New Approach to Engagement
  • 2. © 2013 Health Fitness Corporation 2 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
  • 3. © 2013 Health Fitness Corporation 3 Two Models, One Goal: Sustained Engagement Dennis Richling, MD, Chief Medical and Wellness Officer, HealthFitness (moderator)
  • 4. © 2013 Health Fitness Corporation 4 Engagement • A Pledge, or a Promise …is a marriage -an alignment of purpose and values Participation
  • 5. © 2013 Health Fitness Corporation 5 How Do We Engage People? Educate them… Incent them… Reframe the message… Open a door
  • 6. © 2013 Health Fitness Corporation 6 Motivation is Important to Change Behavior
  • 7. © 2013 Health Fitness Corporation 7 Goal: Adopt Healthy Behaviors for the rest of their life
  • 8. © 2013 Health Fitness Corporation 8 How much motivation do we need? • A new behavior model… Dr. BJ Fogg Stanford Persuasion Technology Laboratory
  • 9. © 2013 Health Fitness Corporation 9 © 2013 Health Fitness Corporation 9 © 2013 Health Fitness Corporation 9 B =MATMotivation High Motivation Low Motivation Hard to do Easy to do Ability Fogg Behavior Model Behavior Shaping Desired Behavior
  • 10. © 2013 Health Fitness Corporation 10 Exciting New Research? Yes, but...
  • 11. © 2013 Health Fitness Corporation 11 When Do Behaviors Change? • Epiphanies • Change of context • Psychological processes • Make it easier
  • 12. © 2013 Health Fitness Corporation 12 © 2013 Health Fitness Corporation 12 © 2013 Health Fitness Corporation 12 Bridging Science to Increase Engagement 15% 65% 10% 10% Motivated with Risks Little Motivation and Risks No Motivation and Risks No Risks
  • 13. © 2013 Health Fitness Corporation 13 © 2013 Health Fitness Corporation 13 © 2013 Health Fitness Corporation 13 Bridging Behaviorism Radical Behaviorism Fogg Behavior Model Precursors Model Transtheoretical Model
  • 14. © 2013 Health Fitness Corporation 14 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
  • 15. © 2013 Health Fitness Corporation 15 Behavioral Approach? • Emphasis on measurement • Emphasis on observable results • Criteria = behavior change • Justification
  • 16. © 2013 Health Fitness Corporation 16 © 2013 Health Fitness Corporation 16 © 2013 Health Fitness Corporation 16 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?
  • 17. © 2013 Health Fitness Corporation 17 © 2013 Health Fitness Corporation 17 © 2013 Health Fitness Corporation 17 Bridging Behaviorism Radical Behaviorism Fogg Behavior Model Precursors Model Transtheoretical Model
  • 18. © 2013 Health Fitness Corporation 18 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
  • 19. © 2013 Health Fitness Corporation 19 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
  • 20. © 2013 Health Fitness Corporation 20 Incentives, Rewards, Reinforcers • Incentive – “…the expectation of reward that induces action or motivates effort.” (www.thefreedictionary.com)
  • 21. © 2013 Health Fitness Corporation 21 Incentives, Rewards, Reinforcers • Reward – “Something given or received in recompense for worthy behavior….” (www.thefreedictionary.com)
  • 22. © 2013 Health Fitness Corporation 22 © 2013 Health Fitness Corporation 22 © 2013 Health Fitness Corporation 22 Incentives, Rewards, Reinforcers • Positive Reinforcer Don't Shoot the Dog! The New Art of Teaching and Training. By Karen Pryor Strengthens behavior it follows
  • 23. © 2013 Health Fitness Corporation 23 Example: Timeframes for Incentives, Rewards & Reinforcers Incentive Reward Reinforcer Long-term Intermediate Brief $650/Yr $10/Wk $0.05/Min 500 pts/Yr Movie ticket 1 pt/20 steps
  • 24. © 2013 Health Fitness Corporation 24 Two Types of Learning/Conditioning • Pavlovian or Classical Conditioning • Operant Conditioning http://psychology.about.com/od/behavioralpsychology/a/classical-vs- operant-conditioning.htm
  • 25. © 2013 Health Fitness Corporation 25 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
  • 26. © 2013 Health Fitness Corporation 26 Subtle reminders to make healthy choices easier Jim Rogers Chairman & CEO Eastman Chemical Company 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. “Hopefully, over time, we’re going to find ourselves reaching for the green spoon a lot more than the red spoon.”
  • 27. © 2013 Health Fitness Corporation 27 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.
  • 28. © 2013 Health Fitness Corporation 28 © 2013 Health Fitness Corporation 28 © 2013 Health Fitness Corporation 28 Incentives, Rewards, Reinforcers • Positive Reinforcer Don't Shoot the Dog! The New Art of Teaching and Training. By Karen Pryor Strengthens behavior it follows
  • 29. © 2013 Health Fitness Corporation 29 Negative Reinforcer; Punisher • Negative Reinforcer or Reinforcement (strengthens behavior) • Punisher or Punishment (weakens behavior)
  • 30. © 2013 Health Fitness Corporation 30 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”
  • 31. © 2013 Health Fitness Corporation 31 Escape and Avoidance Shuttle Box www.themezoom-neuroeconomics.com
  • 32. © 2013 Health Fitness Corporation 32 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.
  • 33. © 2013 Health Fitness Corporation 33 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
  • 34. © 2013 Health Fitness Corporation 34 © 2013 Health Fitness Corporation 34 © 2013 Health Fitness Corporation 34 Three Levers for Engagement Motivation Perseverance Involvement Engagement
  • 35. © 2013 Health Fitness Corporation 35 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. Defining the Levers
  • 36. © 2013 Health Fitness Corporation 36 © 2013 Health Fitness Corporation 36 © 2013 Health Fitness Corporation 36 Maintenance Action Preparation Contemplation Precontemplation Stages of Change and Engagement
  • 37. © 2013 Health Fitness Corporation 37 Bridging Behavior, Cognition and Affect The dynamic Interplay of Self, Mind, Body and Therapeutic Change Source: Fred J. Hanna, PhD I
  • 38. © 2013 Health Fitness Corporation 38 Precursors and Change
  • 39. © 2013 Health Fitness Corporation 39 © 2013 Health Fitness Corporation 39 © 2013 Health Fitness Corporation 39 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
  • 40. © 2013 Health Fitness Corporation 40 Radical Behaviorism Fogg Behavior Model Precursors Model Bridging Behaviorism Transtheoretical Model
  • 41. © 2013 Health Fitness Corporation 41 © Used with permission
  • 42. © 2013 Health Fitness Corporation 42 © 2013 Health Fitness Corporation 42 © 2013 Health Fitness Corporation 42 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
  • 43. © 2013 Health Fitness Corporation 43 Appendix
  • 44. © 2013 Health Fitness Corporation 44 Antecedent(s), Behavior & Consequence Antecedent(s) • Stop light turns from green to yellow • Stop light turns from yellow to red • Stop light turns from red to green Behavior • Foot moves from gas pedal to brake pedal • Foot presses harder on the brake pedal • Foot moves from brake to gas pedal and presses down Consequence • Car begins to slow down • Car slows to a stop • Car begins to speed-up
  • 45. © 2013 Health Fitness Corporation 45 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” • Each time I try to think: “When someone smiles at you, smile back” • I smile back at her and introduce myself Consequence • Next time the girl and I look at each other, neither of us smiles • When I think this 10 times, my Mom gives me $1.00 extra • She says “I’m Sue and I just transferred here