Why do we do things that we know aren't good for us? It's one of health care's thorniest questions. Up to 39 percent of premature deaths from leading causes in the United States — including heart disease, stroke and cancer — stem from risks including smoking, drinking, drug abuse, inactivity, poor food choices and other behaviors, according to the Centers for Disease Control and Prevention. Yet despite decades of efforts from health officials and providers, few behavioral interventions have been successful at helping adults significantly change their lifestyles.
"We are basically clear on things people should and shouldn't be doing, but with the exception of some progress on physical activity levels and weight loss, we haven't achieved anything as large in scope as progress on tobacco use, which took 50 years," says Jonathan King, PhD, program director at the Division of Behavioral and Social Research at the National Institute on Aging (NIA).
"Everybody should lose weight and get exercise and quit smoking and eat right, but nobody has a surefire way to help people do it," says Bill Riley, PhD, director of the Office of Behavioral and Social Sciences Research (OBSSR) at the National Institutes of Health (NIH). "We need to get to the root of this and see what really works."
Researchers funded by the NIH Science of Behavior Change initiative are working to do that. Co-chaired by the directors of the NIA and the National Institute of Nursing Research, the initiative is supported by the NIH Common Fund and has funded basic research since 2009 on the biological and behavioral components of behavior change, studies that are offering new insights into how people make choices and form habits.
"Many behavioral health strategies have been formulated to be one-size-fits-all, but we really don't know which parts work for most people," says King, who coordinates the initiative's collaborative efforts among NIH institutes, centers and offices. "Instead, we're thinking past specific problem behaviors and trying to find underlying patterns and mechanisms on which we can intervene."
The approach harkens back to the behavior change strategies that came out of psychologists' early laboratory work, Riley says. "Whether it was Skinner doing operant conditioning or Bandura doing modeling approaches, or even Pavlovian classical conditioning, that work on basic mechanisms eventually led to new techniques," he says. "In some ways, the Science of Behavior Change effort is a chance to go back to the lab."
Here are some of the studies that have been funded by the initiative:
Exploring influences on risk taking: A study by Peter Sokol-Hessner, PhD, and colleagues at New York University, found that people with greater interoceptive ability — the capacity to sense what's going on in their own bodies, such as their heartbeats — are more concerned about potential losses than potential gains when playing a risky gambling game (Cognition and Emotionopens in new window, 2015). That's important because people who have an aversion to loss may be more likely to avoid risks, including life changes or treatments that might ultimately benefit them. Teaching people to be aware of physiological responses — such as heartbeat — might help them recognize when a situation is triggering an emotion and help them to better control their reactions, Sokol-Hessner says. "Knowing the source of an emotion could change how you deal with it. You might instead take these risks if you think it's good for you," he says.
Understanding the link between poverty and decision-making: Johannes Haushofer, PhD, of Princeton University, has explored how stress caused by poverty can lead to poor economic decisions (Science, 2014). For instance, along with colleagues in the Netherlands, he found that stress increases impatienceopens in new window, which leads people to consume a reward, like a cash payout, rather than invest it for potentially larger returns later. "This does not bode well for investment in long-term outcomes such as health and education, which indeed is often lower in developing countries than elsewhere," he says. He believes that poverty alleviation programs should also focus on easing poverty's psychological toll.
Reappraising unpleasant scenes to change our reactions: Using brain imaging, Columbia University psychologist Kevin Ochsner, PhD, and colleagues are exploring the neural predictors of how adolescents control their emotional responses and how these change over time. Research has already found that people who have a hard time controlling their reactions to negative stimuli are more likely to engage in smoking, emotional eating, drug abuse and other unhealthy behaviors. Jennifer Silvers, PhD, and Ochsner studied how adolescents and young adults controlled their reactions to images of aversive events, such as a picture of people arguing. They asked participants to distance themselves by imagining they were seeing the aversive scenes through a camera lens and found that young adults were better able than adolescents to reduce responses in the amygdala — a brain region critical for signaling potential threats. Further, the smaller, albeit significant, reduction in amygdala response that adolescents were able to achieve was gone in less than 30 minutes, whereas in young adults amygdala reductions were longer lasting (Developmental Scienceopens in new window, 2014).
Controlling cravings: In a study that measured food cravings, Silvers found that children as young as age 6 could reappraise their wants and learn cognitive strategies to ward off obesity (Psychological Scienceopens in new window, 2014). "It is very encouraging that children who varied in terms of age, BMI and other factors were all capable of learning a new cognitive strategy and employing it with relatively little training," Silvers says. She hopes to study whether practicing cognitive strategies can influence eating behaviors in children and adolescents over time.
Helping patients remember what they've learned: After a 50-minute session of cognitive-behavioral therapy, clients may retain only up to one-third of what was covered, with higher retention leading to better treatment outcomes, according to a study by Allison Harvey, PhD, professor of psychology at the University of California, Berkeley, in press at the Journal of Consulting and Clinical Psychology. Harvey and her colleagues are testing a memory-support intervention that is combined with treatment as usual. The memory supports are based on basic science in cognitive psychology and include calling attention to, categorizing and reminding patients of key points, prompting repetition, practice remembering and praising recall. Preliminary data indicate the technique improves memory without extending a session's length. Harvey is also investigating whether follow-up text messages can help reinforce lessons learned.
Tapping into people's sense of purpose: Although hedonic pleasures such as eating a cupcake may satisfy people in the short term, eudemonic well-being — the deeper satisfaction associated with a sense of purpose and pursuing meaningful activities — may be better for our health in the long run. Barbara Frederickson, PhD, a professor of psychology at the University of North Carolina, Chapel Hill, and colleagues have found that adults who reported greater eudemonic well-being had lower levels of gene expression related to inflammation and higher levels of gene expression related to immunity (Proceedings of the National Academy of Sciencesopens in new window, 2013). People who reported greater levels of hedonic well-being had the reverse profile. Understanding how positive emotions change gene expression could lead to targeted and more effective ways to encourage sustained healthy behaviors, the researchers say.
Exploring incentives for changing habits: Smokers are more likely to quit when offered financial incentives than when given information guides and nicotine patches, according to a study led by Scott D. Halpern, MD, PhD, deputy director of the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania (New England Journal of Medicineopens in new window, 2015). The study enrolled more than 2,500 people and followed them for six months. One incentive involved a simple monetary reward for participants who were successful in quitting. Another incentive asked participants to deposit money in a fund that would later be refunded to them with an additional reward if they successfully quit. More people chose a simple reward over a deposit plan, but the deposit plans were the most effective, probably because they tapped into people's aversion to losing money, Halpern says. Based on these results, CVS Health, which partnered in the trial, says it will offer an incentive plan for its employees that requires a $50 deposit and pays out $750 to those who remain smoke-free for one year.
Exploring how social media may change behavior: Research by Megan Moreno, MD, of the University of Washington and colleagues is exploring the potential of social networking websites to identify substance abuse among college students and to provide targeted interventions. Some 83 percent of college students' Facebook profiles show references to alcohol, she says, which may be a significant new factor in other students' drinking habits, as it combines the influences of both peers and media. In a study tracking these references, Moreno found a dramatic increase of alcohol mentions on Facebook as students move from high school to college — a time when many young people start drinking (Computers in Human Behavior, 2014). In previous research, she found that students whose Facebook pages showed intoxicated or problem drinking were more likely to be problem drinkers. By following students' Facebook alcohol displays, including during events where there is a high risk for alcohol abuse, Moreno plans to develop and test interventions to see if they're acceptable and effective.
To see a list of studies funded by the Science of Behavior Change initiative, visit Funded Researchopens in new window. To find out about funding opportunities, go to Funding Opportunitiesopens in new window.
