Promoting Healthy Behavior Changeby Monica A. Frank, Ph.D.
The most difficult aspect of cognitive-behavioral therapy (CBT) is doing it. Just like other health practices such as exercise or nutrition, it has a wealth of research support but it requires consistent effort to be effective. The more you engage in the CBT methods, the more you will experience improvements in your life.
As a cognitive-behavioral therapist, I have found that most of my work involves motivating my clients. Although many clients start therapy with the motivation to reduce the negative symptoms and circumstances in their lives, that motivation is not enough. Think of it this way: you might know that regular exercise will improve your health, but is that knowledge alone enough to motivate you to exercise? For many people, it is not.
Therefore, in my opinion, the most critical element of CBT is motivation. The CBT tools and methods are effective if people use them. Which is why I developed the apps. Since more and more people have their phones or tablets with them all the time, I thought an app using CBT methods would create ease of access and use. In CBT we have always used a lot of paper and pencil assignments which can now be completed conveniently on your device.
However, even the app does not create motivation. So, other methods are needed. Some people are able to motivate themselves or receive help from a therapist. But this article is to introduce you to an exciting new program to help motivate you to use the tools in Excel At Life's apps. First, I want to discuss motivation so that you will have an understanding of why this program is so exciting. At the end of this article I will describe how you can earn cash while using Excel At Life's apps and learning the tools to change your life.
Primarily, the difference between intrinsic and extrinsic motivation is whether an individual is internally or externally motivated. For example, if a child practices the piano because she will receive a reward or because she won't be reprimanded, she is externally motivated to practice. However, a child who practices the piano because he loves the sound of the music and likes challenging himself to learn more difficult pieces is internally motivated to practice.
Why is intrinsic and extrinsic motivation important? Research has found that individuals who are intrinsically motivated are more likely to engage in the behavior or practice more frequently and longer. Someone who is extrinsically motivated is more likely to stop or quit especially if the external motivator is no longer present.
Therefore, we want to create the conditions for internal motivation. Generally, internal motivation first develops from external motivation. In the piano example, for instance, the child may have started practicing piano due to an external motivator such as anticipating a reward but then came to enjoy the music itself so that practice became internally motivated.
My article "Motivation: Intrinsic vs. Extrinsic" describes this aspect of motivation in more detail.
Many of my clients first attend therapy due to negative motivation. In other words, they are trying to avoid aversive consequences. Although negative motivation can initially be a powerful motivator due to the natural tendency to want to avoid unpleasantness, it is not a sufficient motivator especially if someone needs to do something unpleasant so as to be rewarded at some later point in time. For instance, people who do not find the process of exercise itself as enjoyable but who want the positive effects of exercise have to engage in something they findunpleasant for a later reward. It is more difficult to sustain behavior under this condition.
Therefore, it may be necessary to be creative in developing a positive motivational system in which a person can receive intermediate rewards when engaging in behaviors that may not be immediately rewarding. For example, if someone is dieting to lose weight, they need to engage in the unpleasant task of food restriction to achieve their goal. So, to help achieve the weight loss goal they can develop a daily reward system such as getting a massage or spending time reading (whatever may be motivating to that individual).
Several conditions must be met for motivation towards a goal to occur. Without these conditions, the motivation to engage in the behavior decreases.
1) Skill Set. If the individual does not have the necessary skills to achieve an outcome, they are less likely to be motivated towards that outcome. As I have mentioned in other articles I've written that if all that was necessary to change irrational thinking and behavior was having someone tell us to, then we all should be perfectly rational all the time because people are always telling us how to think and behave!
However, it is not that simple. And that is why CBT is so effective. CBT doesn't just tell you how not to think and behave, it provides you with the tools for change. The apps by Excel At Life helps you to create the skills needed to change your thinking and behavior.
2) Confidence of Outcome. Even with the necessary skills, an individual needs to believe that she or he has the ability to change the outcome. Certainly, developing the skills can help increase this confidence, but frequently the belief itself needs to be addressed. That is why many of my audios have motivational components to help change this belief. As I indicated earlier, this motivational aspect is a critical part of therapy. For many of my clients, most of my work is to convince them that that they are capable of change.
3) Reward. Finally, you are more likely to be motivated for change if you have intermediate rewards. The work in making lifestyle changes can be overwhelming so if you have frequent rewards as you are making changes you are more likely to achieve your goals.
How reward is provided can mean the difference between ongoing lifestyle changes and temporary change that reverts back to old behaviors. Again, weight loss is a good example of this. A person who approaches weight loss with a goal of losing a certain amount of weight in a short period of time may be able to lose the weight but is more likely to gain it back than a person who has a goal of making a lifestyle change that leads to weight loss. A lifestyle change is anything that you intend to make a consistent part of your life such as eating more fruits and vegetables or increasing exercise.
1) Continuous Reinforcement. When a person is rewarded every time they engage in a behavior, it is called continuous reinforcement. A good example of this is training an animal. If you give a dog a treat every time it raises its paw on command, it learns to raise its paw. However, the problem with continuous reinforcement is that it is likely to stop when the reward is stopped. So, if you stop giving the dog a treat, after a period of time it may stop raising its paw.
2) Intermittent Reinforcement. When a reward is given every few times a behavior occurs it is known as intermittent reinforcement. This type of reinforcement is very powerful in creating an ongoing behavior. Using the dog example, if the dog is given a treat only sometimes when it raises its paw on command, it is more likely to continue that behavior when the treat is no longer given. The reason this occurs is because it is unclear when the reinforcement ends.
However, in this example, it is often better to start with continuous reinforcement to create the behavior and them move to intermittent reinforcement to sustain the behavior.
How Do These Concepts Work Together? To create motivation for an ongoing behavior or lifestyle change, we want to create a behavior that is intrinsically motivated and that is associated with a positive outcome rather than avoiding a negative outcome. The best way to do this is to start with an intermittent reward that can help an individual during the time when there may not be immediate rewards from the behavior change itself. However, as the behavior changes and the individual begins to experience the natural rewards that occur, the intermittent reinforcement can be stopped.
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Dr. Monica Frank