On Wellbeing

14th September 2023

Nudge theory: What does the hot topic of behavioural science mean for mental health?

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Understanding what we do and why is an underrated superpower. Acquiring knowledge around behaviour and behaviour change can be transformative for both individuals and organisations.


Behaviour change is a complex process. Our behaviour dictates our choices – yet so many of us are making choices that are not helpful to us. Our behaviour and our thought patterns dictate most of our waking hours. Finding greater strength to shape our behaviour is a critical life skill.


Culturally, behaviour change has become a hot topic. In marketing and business, for example, the ambition is to figure out how to get people to choose to buy products and to change learned habits. In short, how can people be influenced into a certain purchase decision?


More importantly, the last few years has seen the rise in the role of behavioural science in health. Initially, of course, physical health – how can we eat less and move more? How can we alter our behaviour so that we don’t drink the whole bottle of wine? So that we don’t light up another cigarette? Unfortunately, information alone does not lead to behaviour change. Willpower and motivation are finite rather than limitless. So why do we tend to focus on giving people information and emphasising willpower and motivation? Instead, we need to create habits and learn techniques to alter our behaviour.


Changing behaviours


More recently, we are beginning to consider how behaviour change theory can enhance our mental health. Changing lifestyle behaviours are closely related to our mental health. Behaviour does not exist in a vacuum. So, if our mood is low or we are struggling mentally then behaviour change techniques will not be as effective. Simply put, trying to follow a plan to lose weight or run a 10k and trying to alter habitual behaviour will be much harder if our psychological wellbeing is not in good shape.


So we need to have a strong foundation of mental health to effectively change behaviour. Also, behaviour change theory in itself can actually enhance our mental health. Techniques and tools to change behaviour can help us to alter the way we see the world, how we frame things, how to perceive situations and how to become more resilient and cope with life.




Behaviour change theory is intrinsically linked in several ways to mental health.


The common issues so many of us share – low mood, anxiety, stress, trauma – have physiological and deep-rooted psychological bases. But there are also elements which are habitual and patterns of behaviour.


Take happiness as an example. So many of us declare: “I just want to be happy”. Yet happiness is not a personality trait. It is a learned skill. Techniques such as gratitude and reframing can help. Building up tiny daily habits to incorporate more of the things that make you feel valued and alive in your daily life. We can implement behaviour change techniques to make ourselves happier. We can also use these to reduce stress, counter anxiety and re-frame situations.


In relation to other people, we tend to make assumptions around why people behave in the way they do but these assumptions are often incorrect and lead to ineffective communication. This can lead to poor decisions and misunderstanding, because we don’t understand the root of either our own behaviour – or someone else’s. In other words, understanding behaviour is critical to navigating life.


Next, let’s take a look at three key behaviour theories to increase our understanding of current thinking. At On Wellbeing we like to combine aspects of learning from different evidence-based sources in order to tailor our tools to help users.


Three key behaviour models


Three well known behaviour change principles or theories are the COM B model, the Theory of Motivational Interviewing and the Transtheoretical Model of Behaviour Change. Let’s consider these concepts from a real-world application perspective.


A widely known model of behaviour change is the Transtheoretical Model of Behaviour Change (or TTM). It recognises that when we change behaviour we don’t go from 0 to 100 overnight. Instead, for successful behaviour change, most of us need to go through a series of steps. So trying to make the leap from not doing something to doing something – or from feeling one way to feeling another way is in fact a series of transitional behaviours. Of course, we all hear stories of how someone who quit smoking overnight, but this is not the reality for most of us. We tend to go forward, back, stop, forward again and so on.


The TTM defines the stages of change as:


Precontemplation

Before you have even thought about making a change.


Contemplation

You are thinking about it but haven’t done anything about it. Many of us are chronic contemplators.


Preparation

Maybe you have found some resources to help you such as self-help books, or checked out the times of the local swimming pool, or looked at some recipes you could cook instead of ordering a take away.


Action

You are doing what you told yourself you’d do – drinking less, moving more, actively reducing your stress with tools and techniques, altering your routine to bring about more happiness into your day.


Maintenance

When you have been doing this thing for six months or more.


Relapse is identified as the sixth stage but this does not always happen and when it does, it doesn’t necessarily mean you go right back to the beginning.


Why is it helpful to see our behaviour in stages? Because research has identified that different mechanisms and support systems along the way can help to nudge us into the next stage. If you want to help someone then identify where they are on the ladder of change. If you want to help yourself, like so many of us who are stuck in contemplation, we can find ways to shift into action.


More simply though, it’s helpful for people to understand that real change requires some respect for the process.




To sustain change you should:


Think

Instead of rushing into it we need to contemplate what it will mean to give up a behaviour or start a new one. We need to really analyse why we do or don’t do the ‘thing’. When we take up a new behaviour or cease an old behaviour there will be a downside. If you give up eating take aways, the downside is time taken for shopping and cooking. If you drink less, this may impact relationships with friends or loved ones. If you start exercising this will take up time and may impact your relationship with a partner who doesn’t appreciate that you now have less time to spend together. If you give up your anxiety or your stress then you may lose a part of your identity which then leaves you feeling exposed or vulnerable. This ‘contemplation’ stage is essential for behaviour change.


Prepare

People launch into altering a behaviour or trying to do things differently without doing the groundwork first. What foundation stones need to be in place? How can you change the environment you are in, so that you can do things differently? This might be an actual room change. It might be altering the way you travel to work. It might be shopping differently. In terms of your mental health, it might be taking notifications off your phone or carving out 30 minutes every day for meditation. But rather than just launching into it one day and then wondering why you can’t keep the new behaviour up, instead we need to prepare ourselves, our environment and those people who may be impacted by the change. We need to anticipate barriers, holidays, work commitments, events, family.


Act

What tricks and techniques can you use to keep the new behaviour going? It’s important here not to assume that everything will suddenly fall into place when you start the new behaviour. There will be pitfalls and barriers. Hopefully many of these will have been anticipated when you prepared. But what will you do when times get tough and you need to keep going? How can you sustain interest if you easily get bored? How will you build on what you are already doing?


These are three points of reflection that are critical to sustained change. You are far more likely to be successful if you work through these issues and accept that there are most definitely downsides to change, even if on the face of it all seems positive. You are also far more likely to be successful if you see change as a slow process, however agonising that may be. Prepare the landscape and think carefully first.


Capability, opportunity and motivation are essential


The COM B model recognises that to change a behaviour we need to have the C – the capability, the O – the opportunity and the M – the motivation. The COM B model is widely used in many current behaviour interventions. What can we take from this theory for a real world application?




When we talk about having the capability, we mean both physical and psychological. So psychologically do you need more knowledge or understanding to change the behaviour? Physically do you need more skill development or training or physical resources such as recipes? In terms of opportunity, we mean physical and social. Are you able to gather support from those around you? This is critical for change. Are the physical opportunities available? For example, do you actually have access to a swimming pool? Are you able to make choices in your work to manage your resources better? When we talk about motivation, we mean reflective and automatic. Automatic motivation is about creating habits and that ‘point of decision’. Perhaps creating rewards and positive consequences for yourself. Reflective motivation is preparing to motivate yourself ahead of time – setting goals and tracking progress.


The power of compassion


Clinical psychologist Paul Gilbert’s famous book ‘The Compassionate Mind’ was critical in our understanding of how compassion can transform lives. His work showed that when we look at the root of negative thoughts about ourselves and really ask ourselves to validate those thoughts, we start to understand where they come from. For example, from a fear of abandonment, or feeling shameful, or feeling inferior. Many of us believe that in order to ‘force’ ourselves to change we need to adopt a bootcamp military style approach. We need to tell ourselves how terrible we are, how ridiculous we are, how needy we are. But in fact, the opposite occurs. Researchers have shown that self-compassion towards ourselves, increases our motivation for self-improvement. he paradox is that accepting our failures and giving ourselves plenty of compassion around them is more likely to drive change than beating ourselves up and forcing ourselves into strict regimes.


You might think that showing ourselves self-compassion could lead to a lack of motivation or complacency around change or goals. But allowing yourself to confront your failures and mistakes and weaknesses actually allows you to be curious about them rather than defensive. From this place of compassionate curiosity, we can begin to ask ourselves more relevant questions about the failures and negative habits. When we really explore the root of these from a non-judgmental place, we are far more likely to be successful in making changes in the future.


So rather than getting angry about your mental or physical health struggles, understand that these are just your way of coping with the world or current situation. That these behaviours have served you for so long but now it is time to change Don’t give yourself a hard time about what has been because this is counterproductive to change.


Motivational interviewing


One well known approach in counselling is called ‘Motivational Interviewing’ and this very much builds on self compassion. We can learn tips from this technique to use with ourselves. Motivational interviewing (MI) is full of self-compassion and focuses on ‘change talk’ – asking careful questions around what you want to change and why. What benefits will you get? What will happen in the future if you do change? It asks you to really assess where you are on the change spectrum. How ready are you really? Most importantly, in relation to compassion, it asks you to give yourself affirmations. To express how well you are doing now. MI asks you to gently develop discrepancy. That is, to see the difference between where you are right now and where you want to be. To see how your current behaviours and values may not be serving your higher goals. Most importantly, MI really supports the development of self-efficacy. Self-efficacy is the absolute belief that you are going to be successful in what it is you are trying to do. This sounds so simple but can be so difficult to truly embody.


Talk to yourself and explain that any negative habits or behaviours or mood states you might experience on a regular basis are in fact a very effective way of coping with the world. Tell yourself how well you have done. Then, and only then, can you begin to think about how things could begin to be different and see you have the power to make that a reality.