bad habits

theories of impulse

An overwhelming passion directly implies a practical conclusion to act on it. May overpower conclusions reached by reason

dual processing models

two models of information processing, one characterised by effortful, rule-based processing, the other by almost effortless, associative processing

Reflective-Impulse Model

accounts for the flaws of other dual-processing models, which only show how a decision is reached and also don't address why people sometimes behave differently from their reasoned decisions

RIM: the reflective system is limited in

1. working memory capacity

2. arousal

RIM: which system will win? depends on

1. relative strength of activation

2. situational and dispositional boundary conditions and moderators (may shift degree of activation

RIM: boundary conditions

• motivation to self-control

• self-control strength

• working memory capacity

• inhibition

the reflective system needs 2 things

1. motivation: function of the perceived costliness of a judgemental mistake to the self

2. opportunity: function of the available time and resourcees for processing

approaches for changing the contents of the impulse system

1. changing automatic associations

   1. evaluative conditioning procedures

2. changing attential biases

   1. modified visual probe task

3. changing approach tendencies

   1. pull or push a joystick for stimuli

approaches for improving ability to self-control

1. improving trait self-control

   1. deliberately conserve energy and plan it expenditures

   2. time to replenish

   3. implementation intentions

   4. train the muscle to have it spill over to other domains

2. training basic executive functions that underlie many self-control efforts

   1. e.g. inhibition or wokring memory updating

      1. go/no-go task

approaches for changing contents of the reflective system

key determinants:

• personal standards

• knowledge

• beliefs about one’s capabilities and the consequences of one’s behaviour

• intentions

• personal goals

• motivation

• skills

e.g.

• providing information about consequences of unhealthy behaviour

• prompting intention formatino, goal setting, and self-monitoring behaviour

theory of reasoned action / theory of planned behaviour

• Attitude: determined by individual’s belief about outcomes/attributes of performing the behaviour (behavioural beliefs), weighted by evaluations of those outcomes or attributes

  • Person who holds a strong belief that positively values outcomes will result from the behaviour will have a positive attitude towards the behaviour

• Subjective norm: determined why whether important referent individuals approve or disapprove of performing the behaviour (normative beliefs), weighted by their motivation to comply with those referents

  • Person who believes that certain referents think that they should perform a behaviour and who is motivated to meet their expectations will hold a positive subjective norm

• Perceived control: determined by beliefs about the presence or absence of facilitators and barriers to behavioural performance (control beliefs), weighted by their perceived impact of each control factors to facilitate or inhibit the behaviour (perceived power)

comments on theory of planned behaviour

• static

  • feedback loops

• limited predictive validity

  • norms, attitudes, pbc predict intentions, intententions on behaviour is harder becasue of situational factors

• cannot fully account for variance in intentions

  • accounting for the three has an impact on intentions

• rational thinking

  • reasoned thinking

• failture to provide interventions

  • guides where to intervene

integrated behavioural model

reasoned action approach

experiental attitude

emotional response; do you enjoy it

instrumental attitude

cogntive evaluation of the outcome, will it be useful

injunctive norm

what others think one should do

descriptive norm

what others are actually doing

capacity

perceive skill/ability to do the behaviour, can i do it

autonomy

perceived control/freedom fom external constraints, am i free to do it

findings: differences in the predictive power of RAA components in relation to intentions and actions for health protection vs. health behaviours

1. autonomy and injunctive norms are more important for intentions of protective behaviours

2. experiential attitudes and descriptive norms direct effect on health risk behaviour

Intention-behavioural gap

you can have intentions but doesn’t mean you actually do it

subjective social norm

my friends expect me to do it

3 principles of choice behaviour (drug use)

1. Preferences are dynamic

2. Given a series of choices, there is more than one way to frame the possible options

3. Individuals always choose the better option (in the moment; bounded reality)

Theory of excessive consumption

people do too much of anything they like. But this implies that the maladaptive consumption patterns are irrational or by accident, but this doesn’t fit with the analysis

• Local: overconsumption

• Global: identifies ideal consumption level and overall benefits are maximised

2 principles of behavioural economics

1. demand

2. discounting and related processes

demand

Measures how much person consumes at varying costs

• inelastic: Consumption remains high despite cost increases (e.g., smokers continue despite higher taxes)

• elastic: Consumption decreases as cost increases. (fruit less valuable than chocolate, would press less)

Unit price

Combines reinforcer magnitude + cost → how much effort/cost is takes to get reward + how much value reward has → cost per unit of reward

cost devided by reward value: corst is 1 euro, reward is 5 satisfaction = unit price is 0.2

• if you increase the price or make it less rewarding, the unit price goes up meaning its harder or less efficient to get the reward!!!

opportunity costs

situations where options are mutually exclusive; Access to alternative rewards (hobbies, social engagement, employment) reduces drug demand. (like raising price or lowering reward

delay discounting

rewards lose value the longer you have to wait

• Preference for immediate reward over larger delayed reward. Steep slopes = high impulsivity

prospect theory

people evaluate choices not on the utility of the outcomes of these choices, but rather based on possible gains and losses associated with the outcomes

Important components:

• The way people feel about a set of possible outcomes depends on their starting point (this is also known as reference dependence, meaning that decision makers evaluate outcomes as gains or losses depending on their starting, or reference, point)

• People’s sensitivity to both gains and losses may diminish depending on their starting point

  • 500 means for if you have nothing than if you have 1 million

• People exhibit loss aversion: that is, the disutility of a loss is much stronger than the utility of an equivalent gain (depends also on framing)

  • A: 200 people will be saved; B: 1/3 possibility all 600 live, 2/3 that everyone dies

    • People choose A

  • A: 400 people die; B 1/3 possibility no one dies, 2/3 that all 600 dies

    • People choose B

• People overweigh small probabilities (referred to as nonlinear probability weighting).

Endowment effect/status quo bias

overly oriented toward the present, not the future – more concerned about losing something they already have than about gaining something have not yet experienced

• Very sensitive to monetary incentives, especially those that are most tangible

What it is: Preference for current state or what you already have.

Example: Sticking with an old, poor insurance plan rather than switching to a better one.

Effect on health: Reduces uptake of better options or healthier behaviors

Relevant biases affecting (health) decisions

1. present bias/hyperbolic discounting

2. loss aversion

3. regret aversion

4. status quo/ endowment effect

5. excessive choice

6. decision fatigue

7. non-linear probability weighting

8. peanuts effect

9. narrow bracketing

10. rational-world bias

Present Bias / Hyperbolic Discounting

What it is: Overvaluing immediate rewards over long-term benefits.

Example: Eating junk food now instead of dieting for long-term health.

Effect on health: Leads to poor diet, smoking, skipping exercise, low medication adherence

Loss Aversion

What it is: Losses feel worse than equivalent gains feel good.

Example: People overpay for insurance to avoid a small possible loss.

Effect on health: Fear of side effects may prevent medication adherence or vaccination

Regret Aversion

What it is: Avoiding choices that might later cause regret.

Example: Not taking a risky but effective treatment to avoid “what if it goes wrong?”

Effect on health: Can reduce preventive actions like vaccinations or screenings

Decision Fatigue

What it is: Making too many decisions reduces decision quality.

Example: Judges granting fewer paroles later in the day.

Effect on health: Patients may skip appointments, fail to adhere to complex treatment plans

Excessive Choice

What it is: Too many options overwhelm decision-making.

Example: Complex Medicare drug plans → people pick poorly or don’t choose at all.

Effect on health: Can reduce engagement in preventive health behaviors or adherence

Non-linear Probability Weighting

What it is: Overweighting small probabilities, underweighting large ones.

Example: Playing lotteries despite tiny odds; fearing rare medication side effects.

Effect on health: Risky behavior choices or avoidance of beneficial but “uncertain” treatments

Peanuts Effect

What it is: Very small rewards or penalties are ignored.

Example: $1 discount for taking medicine is ignored.

Effect on health: Small incentives rarely change behavior; need frequent or salient rewards.

➔ Intervention need frequent + salient rewards

Narrow Bracketing

What it is: Focusing only on immediate costs/benefits instead of broader context.

Example: Skipping exercise today because “it’s raining,” ignoring long-term benefits.

Effect on health: Leads to short-sighted, unhealthy choices

Rational-World Bias

What it is: Assuming ppl make decisions fully rationally.

Example: Believing patients will follow instructions perfectly if “they know it’s good for them.”

Effect on health: Underestimates need for nudges, reminders, or incentive-based interventions

Contingency Management (CM)

Uses present bias – hyperbolic discounting + loss aversion + escalating shedule

treatment approach that provides rewards or incentives (e.g., vouchers, prizes, privileges) when individuals demonstrate desired behaviours, like abstinence from drugs or attending therapy.

• Start with a dollar on a day and then goes up → risk of loosing everything = the later the higher

CM shifts local choice: immediate reward for abstinence competes with immediate drug reward

By providing tangible, short-term incentives, CM turns the global, long-term goal (abstinence) into a local, immediately rewarding option

but… long term maintenance…?

Community reinforcement approach (CRA)

assisting individuals to develop alternative reinforcement that is mutually incompatible with substance use

Brief motivational interventions (BMIs)

increase motivation to change in part by fostering awareness of the costs and consequences.

• Pro’s and con’s + personalised feedback highlighting the tangible costs

• Think more about the long-term: outcomes are discussed over time, money over a week, health over time, etc. Increases global thinking

Fading procedures

increase a choice of larger, delayed rewards (decreasing discount rate)

• First 2 reinforcers of different size available after the same delay. Then delay of smaller reinforcer is decreased → over time, people learn to choose the delayed reinforcers, where they previously only chose the smaller-sooner option

Law of effect

response has rewarding consequences then it increases in frequency and strength. For punishment it is the opposite

Heyman

local vs. global

Bickel

reinforcer pathology = demand + delay discounting

improving impulse control

1. fading procedures (gradual reinforcement of delayed choices)

2. deposit contracts (precommitment, relaptse triggers negative consequences)

3. working memory training (improves self-control + reduces use)

4. phardmacological aids (enhance impulse control)

examples of nudges

• defaults/ opt-out systems

• financial incentives

• simplifying choices

choice architecture

Goal-directed behaviour

instrumental behaviours that are only performed when one has a certain goal and beliefs that this behaviour will increase the likelihood of reaching that goal

2 criteria of goal directed behaviour

• Belief criterion: goal-directed actions are mediated by knowledge of the causal action-outcome relationship

• Desire criterion: goal-directed actions are only executed when the outcome is currently desirable (outcome needs to be a goal)

habit

goal-directed action is repeatedly performed and triggered by contextual stimuli even when the consequences are no longer valuable

Habit discontinuity hypothesis

old S-R habits can be disrupted by a change in context, thereby providing a window of opportunity for adapting behaviour in light of one’s current goals

Slips-of-action test

to allow S-R associations to compete with R-O goal directed control.

• Instructed that most of the fruit outcomes are still valuable, but some have been devalued

  • Pressing devalued ones subtracts points from score

• Extinction phase: shown discriminative stimuli in rapid succession

  • If still valuable, they should respond with the corresponding key

  • If devalued, they should withhold

→ To perform well, they need knowledge of the outcomes of their action (belief criterion) + base their decision to respond or not on the current outcome value (desire criterion)

→ This time, S-R association may interfere with goal-directed performance

• Healthy participants are able to perform well on this test

  • Humans are able of goal-directed action (……)

Associative-Cybernetic (AC) model

the degree to which a behaviour is habitual is determined by the relative strengths of associations in S-R and R-O systems

PRIME theory

impulse generation is low-level cognitive process, outside of awareness, unless impulse is frustrated, then it becomes consciously experienced, as an urge to engage in behaviour

Determinants of habit strength

1. Those that aid intention formation

2. Those that facilitate the translation of intention into action

3. Those that aid continuation of a behaviour

4. Those that moderate the relationship between context-dependent repetition (CDR) and habit development

   1. e.g. choice

2 defining features of habit automaticity

1. activation by recurring context cues

2. insensitivity to short-term changes in goals (not goal dependent)

factors tipping the balance between goals/habit

1. time-pressure

2. distractions

3. limited task ability

4. limited willlpower

impaired executive functioning → increased habit performance

promoting formation of healthy new habits

1. behavioural repetition: the longer with frequent repetitions are most successful

2. context cues: more effective if behaviour is done in combination with the same cue

   1. Implementation plans: increase the likelihood people carry out their intentions

   2. Piggybacking: tying a new healthy behaviour to an existing habit

3. Rewards: intrinsic or extrinsic. Most effective when at the beginning: can increase motivation to do things they typically avoid

   1. Contingency contracts: avoiding negative consequences (having to pay money)

   2. Uncertain rewards are most effective: extra dopamine. Outcome is less responsible, then more reliant on the cue! More likely to become a habit!

breaking unhealthy habits

1. Cue disruption: use naturally life changes.

   1. Habit discontinuity interventions: capitalise on the window of opportunity: Give free public transit pass to car users, only worked for those who recently moved! (Effective for strong, but you cannot always do it…)

2. Environmental reengineering: changing performance environments, or the place where the unhealthy habits regularly occur (Can provide people with the knowledge and ability to reengineer their own personal environments)

   1. Adding friction: make it harder to perform unhealthy habits (e.g. Smoking bans)

   2. Reducing friction: promote accessibility to healthy behaviours over unhealthy ones (e.g. Opportunities to walk/cycle, accessibility of stores selling fresh foods)

3. Vigilant monitoring or inhibition: increases awareness of cues that trigger unhealthy habits + opportunities to inhibit them

   1. “Don’t do it”

   2. Most effective if paired with strategies that make healthy options cognitively accessible: If then

   3. Can be facilitated with GPS technology, nudges in specific locations

3 aspects of automaticity in habit

1. efficient

2. independent of intentions

3. not controlled by outcome

unconditioned stimulus (US)

food entering the digestive system

eating food

conditioned stimulus/ cue (CS)

netflix sound / smell of cookies

conditioned response (CR)

appetitive responses (psychological/ physiological/ neurocognitive)

salvating/ craving crisps

overgeneralisation

heightened responding to the CS- could result from overgeneralisation from CS+ to the CS- (neutral stimulus)

• Chocolate only in front of your own TV overgeneralised to other people’s TVs

extinction

repeated CS-noUS pairings can decline responding

• When watching your favourite TV show (CS) is deliberately no longer followed by food intake (noUS), food cue reactivity (eating desires) decreases over time

food cue reactivity

(strong motivation to eat, even in the absence of hunger; body prepares for food and increases motivation to eat) food-associated cues play a major role in overconsumption by evoking appetitive responses, motivating one to (over)eat

• central mechanism in overeating, obesity, + relapse—analogous to craving in addiction

• you smell it, and your body reacts to it by preparing for the food. Learned behaviour

measures

1. psychological: craving, urge, desire to eat

2. physiological: differences in your body

3. neuro-cognitive: brain activatino patterns, allocation of attentional resources

operant conditioning

learn to associate eating or food-seeking actions with the reinforcing effects of eating → can play a role in overeating

role of context in conditioning

Contexts are usually ‘background’ cues in which CSs are presented and operant behaviours are emitted

→ Contexts can engage behaviour, not by directly eliciting it, but by signaling whether or not the CS or the operant behaviour will be associated with food

→ Context plays an especially important role in extinction

Rapid reacquisition

if the cue is followed by the response. One time a CS-US can relapse

extinguished responding can quickly return when the food cue or action is paired with the reinforcer again

Reinstatement

(behaviour/stimulus specific) just eating the crisps (US) can lead to the next time again eating crisps when watching Netflix

simple exposure to the biologically-significant stimulus after extinction can cause responding to a food cue to recover

Renewal

(context specific) Netflix-chocolate association. Then goes on holiday. There is not an association. Bu then when she comes back, the association will come back. Same for treatment: only learned in the treatment setting, then you go home, it might still come back again. Treated in setting A, then go back to setting B (where it was originally learned) then it will come back

Spontaneous recovery

passing of time, forget about extinction

Resurgence

when an alternative behaviour is no longer reinforced. Crocheting instead of eating, then you stop crocheting means you will become likely to eat crisps again

an extinguished behaviour that has been replaced by a new behaviour returns when the new behaviour is itself extinguished

4 implications of extinction (renewal)

1. Extinction is not unlearning

2. Extinction depends on learning about the extinction context

3. Removal from the extinction context is sufficient to cause a return of the behaviour

4. Simple exposure to the context without emission of the operant behaviour is not sufficient to eliminate the renewal effect

To protect against rapid acquisition

1. Associate renewing cues (CS-reinforcer or action-reinforcer pairings) with extinction

   1. Occasional CS-reinforcer in extinction procedure → slows down the relapse when the actual regularly leads to the reinforcer again!

2. Associate the reinforced trials with ensuing extinction trials.

Occasionally reinforcement

Occasionally reinforced trials enable reinforced trials to be associated with extinction trials which could lead to more generalisation between extinction and reacquisition contexts, thereby slowing reacquisition – in other words, eating in response to a cue does not automatically mean that additional reinforcements follow

Techniques that improve exposure for overeaters in clinical practice:

• Do exposure in the overeating context

• Repeat exposure frequently

• Eat ‘favourite foods’ under conditions that do not cue overeating (e.g. at work, with therapist at café)

• Eat ‘favourite foods’ under conditions that do cue overeating (occasional reinforcement)

• Violate “if CS, then US” beliefs

• Add inhibition training

Pavlovian learning: extinction

when conditioned stimuli are presented repeatedly without the significant stimulus (that was previously associated with conditioned stimuli) (CS-noUS)

Operant learning: extinction

when action is allowed to occur without producing the rewarding significant stimulus

How to improve extinction learning

1. Strengthen the inhibition learning that occurs during extinction.

2. Increase generalization of learning from the extinction context to potential relapse contexts.

Strengthen the inhibition learning

• Correction of prediction error

• Spacing extinction trials

• Variability during exposure

• Extinction in multiple contexts

• Aversive stimuli

Increase generalization

• Conducting exposure in problem contexts

• Extinction in multiple contexts

• Retrieval cues & mental reinstatement

• Occasional reinforcement during extinction

behaviroual schemata

clusters of elements in the impulsive system

1. motor representations (R)

2. perceptual imput of context factors (S)

3. consequences (O)

changing contents of the reflective system, e.g.

• self-monitoring behaivour

• information/education

boundary conditions for RIM, 2 kinds with evidence

1. situational

   1. cognitive load

      1. high capacity = 1 number = explicit attitude

      2. low capacity = 8 numbers = implicit attitude

2. dispositional

   1. inhibitory control

      1. low inhibitory control (cortical measure) = implicit attitude

      2. high inhibitory control (corical measure) =/= predicted from IAT

IBM

• knowledge and skill

• habits

• salience of behaviour

• environmental constraints

importance of perceived behavioural control/self-efficacy

1. interventions for self-efficacy had medium effect on behaviour

2. compared high/low intention to use condoms (gay men) - didn’t differ in attitudes or norms, only differed in self-efficacy, and this predicted their intention

3. meta-analysis for health behaviour = 28% of variance in intentions with additional 13% from PBC

special properties of drugs

1. more immediate/salient than natural reinforcers

2. influence reward system so that other reinforcers are less rewarding

3. high rate of tolerance (habiuation)

2 problems of behavioural economics

1. lack of unifying theory

2. not fully distinct from economics

food cue reactivity measurement

1. attentional bias

2. neural changes to food: fMRI/EEG

3. self-report

reinstatement underlying mechanisms

1. primes reward circuts

2. reinfercer of the next response