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A New Approach for Multiple Health Behavior Change
Megan Oser, PhD, Member of the Multiple Health Behavior Change SIG
Interventions promoting change in more than one health behavior at a time present unique challenges. The question of when a sequential versus simultaneous treatment approach is warranted to target multiple health behaviors illustrates one such challenge (Prochaska et al., 2008). The presentation by Bonnie Spring, PhD, at the 2009 Annual SBM Conference about weight loss and smoking cessation was a prime example of research targeting interrelated health behaviors. Dr. Spring's work and a recent review article by Prochaska and colleagues (2008) highlight mixed findings whereby simultaneous health behavior change sometimes results in iatrogenic effects and sometimes synergistic helpful effects. Prochaska et al., (2008) claim that, to date, no theory of behavior change directly addresses how to intervene on more than one behavior simultaneously. Solutions to the question of sequential vs. simultaneous treatment might be more informative if the question is reframed to identify common principles of health behavior change shared across separate treatments (Moses & Barlow, 2006).
Clinical behavior analysis provides one theoretically coherent approach to determine when it may be effective and how to intervene on multiple health behaviors. Given that multiple poor health behaviors often co-occur, with the majority of US adults engaging in two or more health risk behaviors (Fine et al., 2004; Pronk et al., 2004), evaluating the function of health behaviors rather than viewing such behaviors as separate problems suggests useful points of intervention. When topographically different health behaviors are serving the same function it may be beneficial to target these behaviors simultaneously. In other words, change in one behavior may support change in another co-occurring behavior if they share the same underlying mechanism.
For example, if an individual is consuming high fat foods when feeling emotionally distressed as well as living a sedentary lifestyle maintained by depression, then both health behaviors (poor diet and lack of exercise) are hypothesized as functioning to obtain immediate short-term reinforcement and avoidance of negative emotions. Using this framework, the intervention would target emotion regulation processes hypothesized to result in multiple health behavior change. Similarly, an individual may be forgetting to take his/her prescription medications and also complains of being too busy and forgetting to eat breakfast. In this case, both health-related behaviors may be conceptualized as a function of poor stimulus control. Simple behavioral interventions aiming to integrate cues into the daily routine may facilitate these new health behaviors becoming more habitual. However, if poor medication adherence is a function of poor rule generation (e.g., "medications hurt me" or "feeling good means that I do not have to take my medications") it is unlikely that establishing cues in the patient's environment will lead to better adherence. Couching each health behavior in the context in which it commonly occurs is crucial to successfully changing multiple health behaviors with a single intervention. Identifying which behavioral processes to modify by examining shared contingencies maintaining different albeit co-occurring health behaviors (e.g., deficits in self-control) would open a potentially promising door to the emerging field of MHBC.
Fine, L., Philogene, G., Gramling, R., Coups, E., Sinha, S. (2004). Prevalence of multiple chronic disease risk factors. 2001 National Health Interview Survey. American Journal of Preventive Medicine, 27, 18-24.
Moses, E. & Barlow, D. (2006). A new unified treatment approach for emotional disorders based on emotion science. Current Directions in Psychological Science, 15(3), 146-150.
Prochaska, J., Spring, B., Nigg, C. (2008). Multiple health behavior change research: An introduction and overview. Preventive Medicine, 46, 181-188.
Pronk, N., Anderson, L., Crain, A. et al. (2004). Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. American Journal of Preventive Medicine, 27, 25-33.