Positive reinforcement can motivate preventive behaviors

Eating right, exercising, avoiding the sun or using sunscreen, moderating alcohol consumption, abstaining from tobacco use, getting mammograms, Pap smears, colonoscopies—almost every measure we’re asked to take to safeguard our future health is difficult.  It’s a strange paradox that we have to work in some way, to expend energy, and experience discomfort of some kind in order to gain benefit in life.

Wouldn’t it be nice if the most pleasurable things also produced long-term benefit?

But it seems they rarely, if ever, do.  Short-term pain appears to be an almost universal requirement for long-term gain.  Which, though unfortunate, at least helps explain why people have so much trouble following through on plans to make themselves healthier in the long run.  An ounce of prevention may be worth a pound of cure, but even that ounce seems beyond many of us.

The reason for this likely has to do with the kind of reinforcement available to motivate preventive behaviors.  Positive reinforcement is generally accepted to be superior to negative reinforcement in changing behavior as it leads to more lasting behavioral modification.  In a positive reinforcement schedule, a reward is given after a desired behavior occurs (e.g., a dog gets praise after pooping outside).

The most powerful positive reinforcement schedule is called the variable ratio schedule where rewards are given after a random number of responses (meaning a rat will get food after pressing a bar once, then five times, then seven times, then three times, then eight times, etc.).  The weakest positive reinforcement schedule is called the fixed interval schedule where rewards are given only at certain time intervals after the desired response (e.g., a rat will get food after pressing a bar only if 10 seconds have passed since the last reward was given).

The problem with reinforcing preventive behaviors is that the reward comes not only too long after the desired behavior (years or even decades) but also in the form of something that fails to happen (e.g., you don’t have a heart attack or get colon cancer or breast cancer).  This is called avoidance conditioning (when a behavior prevents an aversive stimulus from starting) and is one of the weakest forms of the already weak negative reinforcement schedule.  It explains many failures, including our government’s to invest enough money and resources in anti-terrorist activities until after the Twin Towers fell, despite decades of warnings from experts that a terrorist attack on U.S. soil was an eventual certainty.

Imagine then the psychological factors working against you when you’re confronted with a delicious piece of pie that part of you wants to eat for the reward of immediately feeling good and that part of you doesn’t for the reward of not gaining weight or not having your cholesterol rise and therefore increasing the likelihood of your not having a heart attack in twenty years.  If all behavior arises from some motivation, it’s not hard to see why carrying out behaviors that prevent future illness is so difficult.

Certainly, some of us find even the weak reinforcement schedule of avoidance conditioning motivating.  Perhaps we’ve already had a heart attack or have a close relative who developed or even died from, say, cervical cancer.  But for many of us, the reward of preventing something bad from happening in the future is too remote to motivate desirable behaviors in the present, or to avoid non-desirable behaviors when non-desirable behaviors produce short-term pleasure (e.g., eating fattening foods) or enable us to escape short-term pain (e.g., not exercising).

How then can we become better motivated?

1. Educate yourself
. People are far more motivated to act when they not only know why they should but own it themselves.  Don’t just trust your doctor.  Find out for yourself the benefits of what’s being recommended.  Make them your concern, not just your doctor’s concern for you.  Learn about them firsthand, on the Internet or in the library (remember what that is?).  Leverage the fact that we’re all more motivated by ideas that feel like our own than ideas that feel like someone else’s.

2. Tackle one painful change at a time
.  Don’t quit smoking, start exercising, and radically change your diet all in one week.  Pick one intervention at a time and stick with it until it becomes an ingrained habit.  Then move on to the next.

3. Find and focus on the positive benefits preventive behaviors provide you now
.  The decreased coughing that smoking cessation brings.  The extra energy sleeping a full 8 hours a night releases.  The peace of mind a negative colonoscopy provides.  The benefits each of us finds motivating in this regard will naturally vary from person to person.  Think creatively about what can motivate you to take better care of yourself.  Find something concrete, something separate from the distant health benefit itself.

4. Enlist a partner to encourage you and whom you can encourage
.  Make it a contest between you to see who can make the most long-lasting changes in behaviors that lead to healthier lives.  Or make it a competition.  Or a series of shared goals.  Or whatever works.  Attach yourself to a person (or even better yet, to a group of people) who already thinks and behaves the way you want to yourself.  Their influence on you will prove to be greater than you expect.  Even if this means distancing yourself from some old friends (perhaps who drink too much, or use drugs, or simply downplay the importance of healthy behaviors) and finding new ones—do it.

5. Remember the glass is always half full
.  Don’t allow yourself to become discouraged and give up (or fail to start) healthy preventive measures just because you fail at starting or continuing one (e.g., smoking cessation).Despite the many barriers to adopting preventive care behaviors in our lives, many of us do manage to do it.  If you’re struggling to implement new healthy behaviors, a final suggestion would be to talk to people you know who’ve been more successful than you.  Listen to them talk about how they do it, what works for them.  You never know what you’re going to hear that will work for you.

Alex Lickerman is an internal medicine physician at the University of Chicago who blogs at Happiness in this World.  He is the author of The Undefeated Mind: On the Science of Constructing an Indestructible Self.

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  • http://www.probodywork.com Alex

    Yes reinforcement of healthy behaviors is slightly more complex than training Skinner rats. Fortunately we have our hopes and aspirations for being around to enjoy the next generation and yes all the points you mentioned do help. Thanks.

  • HJ

    Mammograms don’t prevent breast cancer.

    The issue with screening is not having to wait for benefit, it’s not knowing whether there is any benefit. I don’t have cervical cancer and if I had chosen not to get pap smears all these years, I would still not have cervical cancer. I could look at the time, money and discomfort of pap smears as wasted opportunities.

    Exercise has immediate rewards. Perhaps you have never had a “runners high.”

    Eating a piece of grandma’s apple pie, made with whole natural ingredients probably isn’t going to cause a heart attack 20 years from now. Grandpa lived to be 91. With all the current research, why is fat still the bad guy?

    • Nepenthe

      In response to HJ:
      I was actually astonished by your comment. Do you have current research that found that fat intake doesn’t contribute to heart disease? You may not have the genetic makeup of your Grandpa that warded off death, nor the lifestyle, level of job stress, blood pressure, exercise, nor the emotional makeup.
      (Love that “natural” argument. Are you aware that cocaine, oleander, foxglove, mold, Salmonella, just to name a few natural ingredients, can be toxic?)
      We as a society, generally, no longer have the lifestyles that promoted long lives, in spite of high fat in our diets – walking, farming, hard physical work, etc.
      I really am interested in those studies.

  • http://www.peopleskillsdecoded.com Eduard @ People Skills Decoded

    Influence and motivation are my favorite topic, so I just had to share my thoughts on it :)

    I think that bottom line people feel motivated and want to do certain things if those things subjectively bring value into their lives. And this applies both at the professional and personal level. That is the only real way you can motivate or influence someone.

    Now, the challenge is to understand the specific values of each person and to find a way of motivating her using her values, not yours. This does require good communication, and relationships management skills.

    Best,

    Eduard

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