Read Dr. Berkman’s New Take on Healthy Choice

Healthy choices are neither good or bad; only thinking makes them so

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Healthy choices are more complicated than a devil-angel contest suggests.
Serggod/Shutterstock.com

Elliot Berkman, University of Oregon

Doing healthy things can feel like a battle between the angel on one shoulder and the devil on the other. The devil impels me to order the bacon burger for lunch, but the angel nudges my hand toward the salad.

This dichotomy goes way back in Western thought. Plato likened the process of making such choices to the charioteer of the soul commanding two horses, one “noble” and the other wicked. This allegory echoes throughout history in various forms. Other ready examples include reason versus passion as described by the Greeks, the Judeo-Christian battle between sin and redemption, and Freud’s account of the psyche’s superego and id. Our intuitions about healthy behaviors are deeply shaped by this history. Plus, hard choices simply feel like we are being pulled in two directions.

Getting to the root causes of healthy behaviors is important to science because they are a big part of individual and public health. The leading causes of death in the United States – cancer, heart disease and respiratory illness, among others – are all caused at least in part by our behavior. As a society, we could reduce the onset of these afflictions by learning new ways to change our behavior.

Despite the intuition, health behaviors are not the result of a battle between two opposing forces. So what are they? My colleagues and I recently suggested that they are the same as any other choice. Instead of a battle between two forces, self-control of unhealthy impulses is more like a many-sided negotiation. Various features of each option in a choice get combined, then the total values of the options are compared. This is kind of a fancy version of a “compare the pros and cons” model.

Problems with the battle analogy

These days, psychologists refer to the dichotomy in Western thought as “dual-process” models of health behavior. Such models come in many varieties, but they share two notable features. First, they describe behavior as a winner-take-all battle between two opposing forces. There is no compromise. Whichever force is stronger dictates behavior.

Second, beyond being in opposition to one another, the forces are also inflected with a moral tone, with one being good and the other wicked. The devil impels you to do bad things, the angel advises toward virtuous ones. Psychologists call the warring parties impulse and control, or hot and cold processes.

Casting behavior in the stark terms of pros versus cons is intuitive but might not be accurate. After all, our minds contain many more than just two systems for making decisions. As Walt Whitman said, “I contain multitudes.”

Plus, people have many ways to choose healthy options that don’t involve a battle. Avoiding a temptation in the first place is effective. If I know that I have trouble not ordering the bacon burger, then I can choose to go to a restaurant that doesn’t have one on the menu.

Also effective is fighting fire with fire by getting excited about a healthy option. And being healthy doesn’t need to be moralized. Indulgence can be a good thing, such as when it serves as a reward. Some people even plan indulgence in advance to give themselves a break. In studying healthy choices, scientists have learned that they are more complex than we previously thought.

Advantages of thinking of many choices

The cheeseburger is not bad. Only thinking makes it so.
Michaylovskiy/www.shutterstock.com, CC BY-SA

Let’s revisit the burger-vs.-salad example. Sure, the burger tastes good (a “hot” feature) and you know that the salad is healthy (a “cold” feature). But many other features could be relevant, too. Not all of them will fall clearly into the hot-cold dichotomy. The salad will seem more attractive if you want to impress the friends you’re with if you think they value health. Or maybe I think of myself as a “bacon person,” so I know ordering the burger with that topping will affirm that part of my self-concept.

The key point here is that people can have many reasons for making the healthy or unhealthy choice. A good psychological theory will be able to account for that diversity of motives.

Beyond being more realistic than hot-cold models, there are several ways that thinking of health as a choice can help us better understand it. Researchers working across a variety of disciplines have uncovered what they call “anomalies” in choice. These anomalies are quirks where choice differs – predictably – from what would be optimal. If health is a choice, then these anomalies apply to health, too.

One of my favorites is the decoy effect. There are cases where having a third option in a choice, even one that someone would never choose, can change behavior. Suppose I always prefer a burger to a moderately healthy salad. A restaurant owner could add a decoy choice to the menu, such as an Extremely Healthy SuperFood Salad, that would nudge me to choose the moderately healthy salad over the burger when I considered all three options. This behavior is anomalous – why would an option that I never choose influence my choice between two others? – but it is also useful in helping change health behaviors.

Another anomaly that can be useful for changing health behaviors is realizing that the value of something good is not constant. This is called the law of diminishing marginal utility. The value of something good depends on how much of that thing you’ve already consumed.

This is intuitive, but technically irrational. If I like M&M’s, eating the first one (going from 0 to 1 M&M’s) should feel just as good as eating my 104th one (going from 103 to 104 M&M’s). But we all know that is not the case. The deliciousness of things like M&M’s wears off as you keep eating them – their utility diminishes. In a clever series of studies, researchers found that merely imagining eating tasty treats before being served them reduced the amount people ate. Imagined eating, it seems, caused their utility to diminish.

Casting health behaviors as choice also helps clarify their neural underpinnings. The brain systems involved in simple choice are increasingly well-understood. The science has even progressed to the point that researchers can use computers to predict what people will choose and precisely how long it will take them in specific conditions. This improved understanding will eventually lead to more effective interventions for behavior change.

But wait – if healthy is just like any other choice, why does it feel like being pulled in two directions? We tend to moralize health behaviors in our society. Part of that feeling is probably related to the anticipated guilt of choosing the “bad” option.

An angel expels Adam and Eve from Paradise for making a bad choice in this Benjamin West painting.
Everett – Art/Shutterstock.com

And, morality aside, choice models show that people will feel torn when their preferences vacillate between options.

Just because there are two competing options doesn’t imply there are two competing systems. Feelings of conflict and indecision can arise even in a simple choice system such as the one described here.

The ConversationRemember that your health is not helpless amidst a battle between temptation and grace. It’s your choice, and science offers solutions to making a better one.

Elliot Berkman, Associate Professor, Psychology, University of Oregon

This article was originally published on The Conversation. Read the original article.

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We are hiring!

The SAN Lab is pleased to announce that we’re hiring a full-time project coordinator to work on a new longitudinal fMRI study of eating behavior change! Applications are due at the end of August, and the start date is in early September.

You can read more and apply HERE.

Project Description
The study is a four-arm RCT testing the efficacy of a behavioral response training, a cognitive intervention, and a dissonance-based intervention to change cancer-relevant eating behavior against a non-food control training.

Position Description
The Project Coordinator works closely with Dr. Berkman to direct the design and implementation of the intervention. The Project Coordinator supervises and trains staff, including NTTF employees, coordinates and tracks recruitment and retention of subjects, runs assessment sessions including neuroimaging, conducts telephone interviews, manages and analyzes neuroimaging and behavioral data, acts as the liaison of the project to on- and off-campus organizations, and works closely with Dr. Berkman to achieve project goals. Ongoing interaction with the internal review board for human subjects protection is also expected.

Compensation is commensurate with experience.

Minimum Requirements
• BA degree in psychology, neuroscience, or biology.
• Experience with human subjects research studies, particularly clinical trials.
• Expertise in SPSS and MATLAB, R, and/or Python.
• Experience with team management.

Professional Competencies
• Excellent oral and written communications skills, highly detail oriented, organized, and efficient, and able to work independently while seeking supervision as necessary.
• Outstanding interpersonal skills and creative problem solving are also critical.
• Proficiency in Microsoft Word, Excel, and text messaging.

Preferred Qualifications
• MA degree in psychology, neuroscience, or biology.
• Experience with clinical participant recruitment.
• Experience conducting standardized clinical assessments.
• Neuroimaging acquisition and/or analysis experience, preferably fMRI.
• Experience with obese/overweight, early adversity samples and/or community populations, ideally in the context of a randomized controlled trial.
• Experience developing marketing and public relations strategies.
• Expertise in SPSS and MATLAB, R, and/or Python.
• Experience with team management.

The University of Oregon is proud to offer a robust benefits package to eligible employees, including health insurance, retirement plans and paid time off. For more information about benefits, visit http://hr.uoregon.edu/careers/about-benefits.

The University of Oregon is an equal opportunity, affirmative action institution committed to cultural diversity and compliance with the ADA.  The University encourages all qualified individuals to apply, and does not discriminate on the basis of any protected status, including veteran and disability status.

UO prohibits discrimination on the basis of race, color, sex, national or ethnic origin, age, religion, marital status, disability, veteran status, sexual orientation, gender identity, and gender expression in all programs, activities and employment practices as required by Title IX, other applicable laws, and policies. Retaliation is prohibited by UO policy. Questions may be referred to the Title IX Coordinator, Office of Affirmative Action and Equal Opportunity, or to the Office for Civil Rights. Contact information, related policies, and complaint procedures are listed on the statement of non-discrimination.

In compliance with federal law, the University of Oregon prepares an annual report on campus security and fire safety programs and services. The Annual Campus Security and Fire Safety Report is available online at http://police.uoregon.edu/annual-report.

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Applied lessons from the neuroscience of goals and behavior change

Our latest paper, in Consulting Psychology Journal, summarizes some practical lessons about goals, behavior change, and self-regulation that we’ve learned from neuroscience research. Read more below!

Abstract

The ways that people set, pursue, and eventually succeed or fail in accomplishing their goals are central issues for consulting psychology. Goals and behavior change have long been the subject of empirical investigation in psychology, and have been adopted with enthusiasm by the cognitive and social neurosciences in the last few decades. Though relatively new, neuroscientific discoveries have substantially furthered the scientific understanding of goals and behavior change. This article reviews the emerging brain science on goals and behavior change, with particular emphasis on its relevance to consulting psychology. I begin by articulating a framework that parses behavior change into two dimensions, one motivational (the will) and the other cognitive (the way). A notable feature of complex behaviors is that they typically require both. Accordingly, I review neuroscience studies on cognitive factors, such as executive function, and motivational factors, such as reward learning and self-relevance, that contribute to goal attainment. Each section concludes with a summary of the practical lessons learned from neuroscience that are relevant to consulting psychology.

Citation info:

Berkman, E.T. (in press). The neuroscience of goals and behavior change: Lessons learned for consulting psychology. Consulting Psychology Journal. [pdf]

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How can behavioral economics inform behavior change?

Our latest paper asks how behavioral economics – and its catalogue of “anomalies” – can inform the study of health behavior and behavior change.

Objective: Traditional models of health behaviour focus on the roles of cognitive, personality and social-cognitive constructs (e.g. executive function, grit, self-efficacy), and give less attention to the process by which these constructs interact in the moment that a health-relevant choice is made. Health psychology needs a process-focused account of how various factors are integrated to produce the decisions that determine health behaviour.

Design: I present an integrative value-based choice model of health behaviour, which characterises the mechanism by which a variety of factors come together to determine behaviour. This model imports knowledge from research on behavioural economics and neuroscience about how choices are made to the study of health behaviour, and uses that knowledge to generate novel predictions about how to change health behaviour. I describe anomalies in value-based choice that can be exploited for health promotion, and review neuroimaging evidence about the involvement of midline dopamine structures in tracking and integrating value-related information during choice. I highlight how this knowledge can bring insights to health psychology using illustrative case of healthy eating.

Conclusion: Value-based choice is a viable model for health behaviour and opens new avenues for mechanism-focused intervention.

Citation Info: Berkman, E.T. (in press). Value-based choice: An integrative, neuroscience-informed model of health goals. Psychology & Health. [pdf]

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Is self-control just choice?

This is not self-control

This is not self-control

Our new paper at Current Directions in Psychological Science asks whether self-control is “special,” or whether it is just like any other choice. We present a model for understanding and modeling self-control as value-based choice, and discuss the advantages that emerge from this approach. The most significant implication: extensive knowledge about how value-based choice works, including its various quirks and biases, can be brought to bear on the questions of why self-control sometimes fluctuates over time and how it might be improved.

Citation info:
Berkman, E.T., Hutcherson, C.A., *Livingston, J.L., *Kahn, L.E., & Inzlicht, M. (in press). Self-control as value-based choice. Current Directions in Psychological Science. [pdf]

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DeStasio wins prestigious NSF award!

Congratulations to Krista DeStasio on earning a 2017 National Science Foundation Graduate Research Fellowship Award! The GRFP is awarded to highly promising doctoral candidates in many scientific fields, and fully funds three years of graduate school.

Congrats, Krista, on this well deserved award!

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Effects of stress on inhibitory control

Check out our new paper, led by grad student Leslie Roos, on the effects of acute stress on inhibitory control performance! The abstract is below:

Identifying environmental influences on inhibitory control (IC) may help promote positive behavioral and social adjustment. Although chronic stress is known to predict lower IC, the immediate effects of acute stress are unknown. The parasympathetic nervous system (PNS) may be a mechanism of the stress-IC link, given its psychophysiological regulatory role and connections to prefrontal brain regions critical to IC. We used a focused assessment of IC (the stop-signal task) to test whether an acute social stressor (the Trier Social Stress Test) affected participants’ pre- to post-IC performance (n = 58), compared to a control manipulation (n = 31). High frequency heart-rate variability was used as an index of PNS activity in response to the manipulation. Results indicated that stress impaired IC performance, blocking the practice effects observed in control participants. We also investigated the associations between PNS activity and IC; higher resting PNS activity predicted better pre-manipulation IC, and greater PNS stressor reactivity protected against the negative effects of stress on IC. Together, these results are the first to document the immediate effects of acute stress on IC and a phenotypic marker (PNS reactivity to stressors) of susceptibility to stress-induced IC impairment. This study suggests a new way to identify situations in which individuals are likely to exhibit IC vulnerability and related consequences such as impulsivity and risk taking behavior. Targeting PNS regulation may represent a novel target for IC-focused interventions.

Roos, L.E., Knight, E.L., Beauchamp, K.G., Berkman, E.T., Faraday, K., Hyslop, K., and Fisher, P.A. (in press). Acute stress impairs inhibitory control based on individual differences in parasympathetic nervous system activity. Biological Psychology. [pdf]

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Berkman Wins Early Career Award in Health Psychology

We have some great news!

Professor Elliot Berkman received the 2017 Early Career Award from the Social Personality & Health Network for his work integrating social and personality psychology and health behavior research. Congrats, Dr. Berkman!

The award was announced at the annual Social Personality Health preconference to the Society for Personality and Social Psychology Meeting in San Antonio, TX.

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Text messaging to help smokers quit: Does personalization matter?

This is a guest post by Krista DeStasio about her recent paper, published in the Journal of Smoking Cessation.

Changing habits and behaviors is hard. We can all think of a time that we set a goal – cutting down on sweets, for example – and didn’t stick with it despite our best intentions. Quitting smoking is such a goal for many people. Specialized quitting programs can increase success, but those programs are not accessible to everyone. However, it is now possible to help people via text message regardless of where they live and how much money they make because of the ubiquity of cell phones. Research shows that delivering cessation support via text messaging is effective for a variety of goals: quitting smoking, adherence to HIV treatment, and diabetes management, to name a few. Some studies tailor the messages to the participant, such as by providing gender-specific health information to pregnant women trying to quit smoking. Social psychology indicates that personally relevant information is given special attention and remembered better than information that the person doesn’t find self-relevant, suggesting that tailored cessation messages may be even more effective than standard treatment messages.

My colleagues, Anne Hill and Elliot Berkman, and I conducted a study to find out whether highly self-relevant messages would help people quit smoking more than generic or only moderately self-relevant ones. We reasoned that the self-authored messages may be more helpful than more generic, expert-authored messages, since they would be uniquely relevant to the person receiving them. In our study, all participants wrote text-length messages that they thought would be helpful to them during their quit attempt. A third of participants were additionally instructed to write those messages in the form of “if-then” statements, such as “If I feel like I need a cigarette, then I will chew gum instead.” This format, known as implementation intentions has been found to increase the likelihood of obtaining long-term goals. The other participants were not given instruction about message format. Participants then received either their own self-authored messages or standard treatment messages every day for a month. This gave us three groups in the study: people who received their own “if-then” messages and received those messages, people who received their own messages without detailed instruction, and people who wrote their own messages but received generic messages. Everyone received six text messages per day.

Interestingly, everyone in the study decreased their smoking. There was some indication that the if-then messages were better than the controls, but they weren’t significantly different than the other tailored messages. At least in this study, the level of self-relevance of the received messages didn’t make a huge difference in how effective the text messaging intervention was. However, all participants composed their own messages, so it is possible that the extra effort the participants put in to write the messages made a difference, even if they didn’t receive those messages during cessation. Our next studies will test this, as well as the possibility that receiving messages that are personalized but not self-authored would be just as effective for quitting as actual self-authorship.

Full citation info:

DeStasio, K.L., Hill, A.P., & Berkman, E.T. (in press) Efficacy of an SMS-based smoking intervention using message self-authorship: A pilot study. Journal of Smoking Cessation. [pdf]

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Calcott wins APA award!

Good news! Graduate student Rebecca Calcott has been awarded a Dissertation Research Award from the American Psychological Association to support her project, “Cognitive Control: A Bridge Between Neurotransmitters and Real-World Behavior.” Congratulations, Rebecca!

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