Multiple Behavior Change

Traditional  approaches  to  helping  individuals change  health  behaviors  focus  on  reflective  processes.  In  other  words,  in  these  approaches,  the first thing a practitioner might do is identify what a client thinks about a behavior. Thus, initial counseling may focus on increasing positive beliefs and perceived  benefits  associated  with  that  behavior and challenging less positive beliefs. Support may turn  to  building  confidence  to  initiate  and  then maintain the behavioral change.

Less   directive   approaches,   such   as   those involved  in  motivational  interviewing,  may  give the  individual  greater  freedom  to  identify  which behavior to work on, but again, the approach usually focuses on separate behaviors with an emphasis  on  working  through  cognitions  about  that behavior.  Given  that  people  often  have  a  cluster of  poor  lifestyle  behaviors,  the  challenge  emerges to identify how best to help clients with changing multiple health behaviors, as shown in Figure 1.

Debate  may  follow  in  epidemiology  about  the risk associated with each behavior, and thus which to  focus  on  first.  Also,  specialist  health  promotion  counselors  may  focus  on  physical  activity (PA)  while  others  focus  on  smoking  cessation  or diet.  Besides  being  inefficient,  trying  to  change multiple  behaviors  using  multiple  but  parallel  or distinct  counseling  approaches  can  lead  to  cognitive overload and perhaps multiple failure. Yet, so far, theory and practice remain primarily oriented toward understanding and changing single health behaviors.

multiple-behavior-change-sports-psychologyFigure 1  The Mediating Role of Health Behaviors in the Reciprocal Relationship Between Mental and Physical Well-Being

There  is,  however,  increasing  interest  in  developing new theories and guidance for practitioners to  help  clients  with  multiple  behavior  change,  as discussed  by  James  O.  Prochaska.  Not  only  does Figure 1 show how different lifestyles may mediate the  reciprocal  relationship  between  mental  and physical health but it also highlights that there are complex interrelationships between these different behaviors. For example, surveys suggest that more active  people  tend  to  also  drink  less  alcohol,  eat fewer  snacks,  and  smoke  less.  The  relationships are  not  always  so  straightforward:  Some  types of  sports  participation  are  associated  with  fewer healthy lifestyles than others.

The next question is whether engagement in PA prevents the reduction of healthy lifestyles, and, if it does, how? What changes as a result of playing sport or regularly exercising that discourages smoking, excessive alcohol use, or poor diet? Likewise, do  sedentary  lifestyles,  common  in  Westernized society, lead to other less healthy lifestyles and why? If  we  know  the  answers  to  these  questions,  this may help us develop PA interventions that impact on multiple health behaviors. These questions are relevant not only in the context of engaging young people  in  sport  and  PA  but  also  for  adults  who already have clusters of poor lifestyles.

There  is  evidence  that  more  physically  active children and adolescents are less likely to progress to  smoking,  taking  illicit  drugs,  drinking  alcohol excessively,  and  engaging  in  antisocial  behavior.

However,  it  is  difficult  to  produce  strong  causal evidence, as there may be a number of confounding variables. Nevertheless, there may be plausible psychological mechanisms, such as enhanced self efficacy,  self-perceptions,  and  self-esteem,  and enhanced  mood  from  PA.  Excessive  sedentary behavior  in  adolescence  may  lead  to  deactivation and  fatigue,  which  may  lead  to  turning  to  high-energy  food  and  other  substances  to  enhance mood.

Much  more  is  known  about  whether  PA  (of various  doses)  causally  influences  engagement in  other  behaviors  among  adults,  and  especially smoking  and  snacking.  Neuroscience  and  cognitive psychology have greatly advanced our understanding  of  addictive  processes  involved  in  both these  behaviors  in  particular.  Common  areas of  the  brain  are  activated  in  anticipation  of  a reward or reinforcement, when faced with cues or images  associated  with  the  behavior.  As  Figure  2 shows, with the circumplex model of affect at the center,  when  people  are  deprived  of  a  substance (regularly  used  to  regulate  mood),  or  feel  under pressure (with low mood) or view cues associated with the behavior (e.g., a cigarette pack, a picture of  someone  else  smoking),  this  generates  a  state  of  wanting.  By  smoking  or  snacking,  a  reward  is received and a sense of pleasure (on the horizontal axis of the model) or increased activation (on the vertical axis of the model) is experienced.

multiple-behavior-change-sports-psychology-f2Figure 2  The Potential Role of Physical Activity and Sedentary Behavior in Regulating Hedonic Behaviors Such as Snacking, Consuming Alcohol, and Smoking

A great deal of evidence has been accumulating over  the  past  30  years  on  the  acute  and  chronic effects  of  exercise  on  mood  and  affect.  Briefly, moderate-intensity exercise increases affective activation and pleasure. Recently, work has turned to also understanding the effects on urges, desire, and cravings  for  various  substances  such  as  nicotine and  high-energy  snack  food.  Researchers  have discovered that even a 15-minute brisk walk (that most people can achieve throughout a typical day) reduces  substance  cravings,  attentional  bias  to salient images, ad libitum smoking and snacking, during  temporary  abstinence,  under  stress  and  in the  presence  of  salient  cues.  Brain-imaging  studies have shown reduced activation in areas of the brain  associated  with  viewing  smoking-related images,  after  exercise  compared  with  rest.  With these  studies  in  mind,  new  counseling  interventions  have  been  developed  to  encourage  smokers to use PA as an aid to reducing and quitting smoking.  Given  that  self-regulation  of  snacking  and smoking and other health behaviors is a challenge, and these behaviors are often driven by automated rather than reflective mental processes, promoting PA  appears  to  have  a  role  in  enhancing  the  self regulation  of  multiple  behaviors,  irrespective  of whether there is an intention not to smoke or eat high-energy snack food.

 References:

  1. Oh, H., & Taylor, A. H. (2012). Brisk walking reduces ad libitum chocolate snacking in breaks between both low and high demanding cognitive tasks. Appetite, 58, 387–392.
  2. Prochaska, J. O. (2008). Multiple health behavior research represents the future of preventive medicine. Preventive Medicine, 46, 281–285.
  3. Taylor, A. H. (2010). Physical activity and depression in obesity. In C. Bouchard & P. T. Katzmarzyk (Eds.), Physical activity and obesity (pp. 295–298). Champaign, IL: Human Kinetics.
  4. Taylor, A. H., Everson-Hock, E. S., & Ussher, M. (2010). Integrating the promotion of physical activity within a smoking cessation programme: Findings from collaborative action research in UK Stop Smoking Services. BMC Health Services Research, 10,
  5. Taylor, A. H., & Ussher, M. (in press). Physical activity as an aid in smoking cessation. In P. Ekkekakis (Ed.), The Routledge handbook on physical activity and mental health. New York: Routledge.

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