April 24, 2011 by Frederick Muench, Ph.D. (http://www.behavioral.net/blogs/fmuench/technology-supports-self-modeling)
Perhaps the most critical moment in the behavior change process is when someone makes a decision to change their behavior. It is that moment where they decide that the consequences—or potential consequences—of their current behavioral patterns are greater than the short-term benefits and that changing may improve their lives. This moment is a pivotal turning point in which they come to believe that they can and will change. Typically, these moments are triggered by a critical event (e.g., a drinking and driving arrest) or the buildup of repeated events (e.g., stepping on the scale every night). Furthermore, these motivational bursts tend to occur while an individual is in their natural environment, such as lying in bed reviewing the day’s events.
Regardless of the path to this cognitive shift, it is during this moment that an individual is highly motivated to meet their behavioral goals. In fact, at this moment the individual becomes their own best advocate. Their self-efficacy is high; they believe they can and will achieve their goals. This is the moment that every motivational interviewing therapist wants to achieve in session. However, this “ah-ha” experience is typically fleeting for most individuals, as rates of initial behavior change have not translated into similar rates of behavioral maintenance – even for those who seek professional assistance.
Of those who do achieve some success early on, most individuals revert back to their old unhealthy behaviors within weeks or months of their initial decision to change. This pattern is remarkably similar across behaviors: exercise, smoking cessation or nearly any other goal-directed behavior that requires persistence and long-term motivation. At its core, motivation is fleeting if not reinforced appropriately.
Several years ago, we published an article suggesting that capturing a person’s cognitions in their own words during a motivational interviewing therapy session when commitment is high and then sending it to the individual when motivation is lower could be an effective means to help maintain motivation over time (Muench, 2006). This article was based on the concept of self-modeling, which posits that an individual can learn by reviewing their own behavior from a previous time or in a different context in the present (Dowrick, 1999). As Bandura (1986) highlights, “model-observer” attribute similarity increases success, and this is heightened when an individual is their own model (Dowrick, 1999). Self modeling interventions have been used to improve sports performance as well as treat a variety of disorders such as selective mutism and social phobia.
Self-modeling was born out of audio and video recording and replay technology. The earliest published reference to a recording tool used for therapeutic means indicated that a tape recorder could function as a self-therapeutic technique to enhance self-awareness (Shor, 1955). Today, self-modeling can be enhanced dramatically through web-based, IVR or mobile capture of text or audio and video recordings at critical behavior change moments which can then be relayed to the individual on their mobile phone when motivation may be lower. The 24 hour accessibility of technology provides an opportunity to capitalize on the fleeting nature of the “ah-ha” experience.
This crucial moment, where the individual is the person they want to be, should be captured. However, among the options currently available, capturing the core of the “ah-ha” experience for the individual has largely been ignored. Typical patient centered tailored interventions usually capture constructs such as how motivated an individual is at the moment (e.g. quantitative) which is very different from capturing why someone wants to change. This may be especially important because individuals typically remember their decisions (that one wants to change) but the reasons why and the emotional tone associated with reasons typically decay with time. Self-modeling provides the opportunity to capture the qualitative aspects of these important moments.
The findings from self-modeling interventions reveal that there are specific questions that can guide the data capture process to hopefully maximize replay effectiveness. These findings across self-modeling studies suggest that:
1- self-modeling interventions that highlight the desired behavior or target goal are most effective, and,
2- highlighting the negative aspects of a behavior results in negative outcomes.
This is particularly important because it reveals self-modeling needs to be more than reviewing ones diary or filming oneself and reviewing it later. It is an intervention strategy in which one must be careful to choose to capture and review positive behaviors and cognitions that promote self-efficacy. As Bray and Kehle (1996) highlight – at its core, self-modeling is ‘‘catching me when I’m good … and reminding me of it.’’ Based on the research effective self-modeling should be driven by specific questions to improve motivation when reviewed – as the review process is the intervention – not the acquisition process. For example, we are working on interventions that use self-modeling via SMS and IVR in which individuals write down or record what they would say to themselves if they were considering not changing or losing motivation. Regardless of how the data is captured (audio, video, sms, mms) the goal is to ensure that the data capture phase is designed to maintain motivation at a later date when an individual may be less motivated.
These messages/audio recordings can get sent to the individual if they respond to an assessment question indicating they are losing motivation, during previously identified critical trigger periods, through random prompting or through user initiated help prompts. At these moments, the individual can remind themselves of who they want to be and why it is so important to maintain ones goals. Even if one did not have the capabilities to use interactive technologies, simply asking our patients to record statements on their mobile phones like why they want to change, what they will do in the face of barriers and what might they say to themselves if they were considering not changing -then then reminding them to listen to it at a later date could be a simple means to implement self-modeling interventions.
Self-modeling is a true patient-centric intervention that can be generalized to a number of behavior change goals. There is very little that is more tailored than an individual receiving a message or audio/video file that they created to help motivate them to change. Patient centered interventions using technology have typically focused on capturing a quantitative snapshot of the individual at a moment in time and using that to offer feedback and guide the intervention. Technology has also made it significantly easier to capture a qualitative snapshot of the individual during critical moments in the change process. The combination of these techniques may help us realize greater benefits to our populations while keeping the locus of control within the patient’s own hands.