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Behavior change has a pretty high failure rate when it comes from clinical work. Most people don’t have time for treatment research; they spend all their energies on trying things out anyway. This means that you should not be surprised if your child spends 10% or less learning new behaviors every single day before he actually starts therapy. But even worse than this problem is the fact with kids who come into the clinic.Let’s see about the neuroscience of behavior change. what I’d like to do is talk about some of the fundamental principles of behavior change from a neuroscience perspective. So I’d like to start with talking about the stages of change model and then introduce some brain theories of behavior change. We’re increasingly recognizing throughout medicine that most medical illnesses are preventable.

We’re increasingly recognizing throughout medicine that most medical illnesses are preventable. And that prevention involves behavior.

Repetition of behavior leads to encoding and brain systems that only change very slowly.

Almost all medical illnesses including cardiovascular disease, cancer and many more are related to stress and our ability to cope with tension.

Alcohol creates another disorder and initiates behavior problem.

If we think about all of the major health problems, that we face cardiovascular disease, diabetes, other diseases are all linked to diet, exercise.Even things like cancer that we may not think of as often being related to behavior. The disease is related to smoking behavior and what about the use of sunscreens that’s another behavior that can help to prevent life-threatening cancers. Almost all medical illnesses including cardiovascular disease, cancer and many more are related to stress and our ability to cope with stressors. So that is just about medical illnesses, then if we think additionally about what is traditionally called neuropsychiatric illnesses, depression is the most conspicuous example. Those neuropsychiatric illnesses alone account for more worldwide disability. actually 28% of all disability-adjusted life years with 10% of the World Challenge. Alcohol use disorders another hyperstimulation problem accounting for an additional 4%.

So across all illnesses both non psychiatry and psychiatric, we’ve got major issues that behavior change can help us to overcome.You may wonder why if we so clearly recognize the need for behavior change why is it hard to change? I think that the bottom line is that the repetition of behavior leads to encoding and brain systems that only change very slowly. There’s a brain system is called the habit system that involves a region of the brain known as the basal ganglia a discrete learning system in the brain. That helps to set up our habits and they’re slow to be established and they’re slow to be changed. After we’ve established habit it takes a lot of energy to overcome what we might call our prepotent or habitual responses and it’s difficult to switch to do something new once you’ve established. There’s another tendency, it’s called delay discounting in other words. We value fewer rewards and punishments that are farther away in the future. This is what I would call the bird in the hand phenomenon and that’s something that leads us to be captured by immediate rewards instead of long-term values. We’ll come back to that in a moment but first, let me talk about the stages of change model. This has really been found to be at the root of almost all models of behavior change. Basically what’s been found is that when it comes to medical decision making the kinds of decisions that are good for our health. These decisions are not a single event. For example, a smoker doesn’t suddenly quit and become a nonsmoker overnight. Behavior change is a process that unfolds through these series of stages of change and the stages are listed here they start with a level of pre-contemplation, then we move into a phase of contemplation then into action finally into maintenance and termination. I want to give a little bit more attention to each one of these phases this pre-con halation phase is that point a time in which we have really no intention to take action in the foreseeable future. So if we think about the smoking situation this would be an individual who really is smoking now. If you say gee don’t you know smoking is bad for you, they may say well yeah sure but I have no intention to change now. The next phase, once someone recognizes that they would like to change behavior they actually develop an intent to take action sometime within the next six months. At that point in time, there’s usually lots of ambivalence, sometimes a love-hate relationship with the addicted to a substance. I’ve heard people talking jokingly about smoking cigarettes and saying oh well their vegetables aren’t they because it’s derived from a plant product anyhow when in doubt people usually don’t act. So in this point of contemplation, there’s usually less action than there is thinking about it and just as an example, less than 50% of smokers who are in this contemplation phase quit for at least 24 hours within a 12-month period. It’s only when we get to the next stage the preparation phase where there’s actually an intention to act in the immediate future within the next month. It usually takes place only after there’s been some action in the prior year and at this point, the person actually has developed a plan of action. So person they already have consulted professional help about the kind of problem they may participate in the group. May have bought a book that talks about how to overcome the problem. These are the kinds of activities that reflect the preparation phase these people in the preparation phase are good targets for action-oriented treatment programs. They can be enlisted, engaged and actually succeed at changing behavior at this point but usually not before then there’s finally the action phase when individuals made a specific overt change just behavior within the prior six months. This is not the same as behavior change at this point. Behavior change is still in process but at least it marks a progression and the overall stages of change to a level that can be marked by action. So it’s one step in the overall process of change then following the implementation of the action. There’s a maintenance phase where the individuals working to prevent relapse which unfortunately for many of these behaviors is all too common. There’s less need to apply change processes at this point relative to the in the action stage so just support is needed. But this phase may last for quite awhile anywhere from six months to about five years before one has fully established new patterns of behavior.Then finally there’s the termination phase at this point there’s zero temptation for the prior bad habit, a hundred percent self-efficacy, and a healthy behavior becomes the automatic behavior and that’s the point that we usually want to get to is where the healthy behavior is our automatic behavior now. There’s been a lot of other theories a theorization about these stages of change and medical decision making one of the well-known theories is referred to as the Janis. Man theory and here the decision-making is referred to the self and to others and you can intersect that with how benefits occur and whether we receive approval from. There may be costs or disapproval that feed into that process both from ourselves and from others but according to port race the leader in this field of behavior change, it all boils down to just two factors. The pros of changing and the cons of changing and if we can alter that balance of the pros and cons of changing effectively, then we’re likely to succeed in achieving behavior change. So what are the implications for treatment development, first we have to set realistic goals considering the stage of change that a person is at that time. We have to recognize that people can usually move only from one stage of change to the next. But people can do so relatively rapidly we have to attend to the stages of change, but then we might be able to merge right through them another thing is that we need to explicitly focus on providing information that alters the balance of pros and for changing behavior. So you can imagine we can point out for example in smoking there are the advantages of not smoking and that it’s more pro-social your breath will be better and then there are the cons of not changing the disadvantages of continuing the behavior including the unbelievably bad health risks and other problems. So at early stages, as it turns out the study of the stages of change, hypothesis highlights that it really is better to focus on the pros of changing the advantages of changing rather than worrying about the disadvantages of change.

I think summarizes some of the current thinking about brain systems that are critically important in behavior change and the hope is that by thinking a little bit, about the brain, you can begin to think about. Well, what are the factors that go into my own process of behavior change? Referring to these different regions of the brain there’s the medial orbitofrontal cortex, ventromedial prefrontal cortex the lateral orbitofrontal cortex the anterior frontal polar cortex and the anterior cingulate cortex those are our main favorite regions. Some of the ideas that scientists have neuroscientists are thinking about how these different regions are involved in rewarded behavior. Well, the ventromedial prefrontal cortex or medial orbitofrontal cortex have been concerned with the activation that attributes value to reward. So here we need to bring in the idea of positive and negative prediction error and specifically the idea is that, at any point in time have an anticipation of what’s the likelihood that we’re going to be rewarded in a particular scenario and then when the actual reward comes it’s either going to be better. We thought or it’s going to be worse than we thought there’s a signal in the brain if it’s better than. Really wonderful examples particularly of monkeys who are trained with peanuts and raisins and monkeys like both peanuts and raisins but you can after feeding monkey peanuts then you can guess what they’re gonna like more. They’re gonna actually prefer raisins because they’d rather have something a little bit different. Great idea to consult professionals and you may ask professional psychologists or psychiatrists how behavioral activation theory and the approaches of behavioral activation therapy might work for you.

Behavioral changes are considered a mental disorder but can be cured with the proper guidance of a psychiatrist.

Courtesy: Robert Bilder, PhD

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