The application of motivational theory
to generating assisted quit attempts
Robert West
University College
London
September 2008
1
Aims of the talk
1. Briefly review main concepts of relevant
motivational theories
2. Introduce a new integrative theory: PRIME
Theory
3. Review practical ways in which this can be
applied to promoting quit attempts that use
evidence-based assistance
2
The nature and extent of the problem
In England in 2008 so far ...
2%
19%
Did not try to stop
Tried to stop unaided
19%
60%
Smoking Toolkit Study: www.smokinginengland.info
Tried to stop with NRT
OTC
Behav support
3
Current theoretical approaches
• Broad theoretical approaches
– Learning theory
– Decision theory
– Personality theory
• Integrative theory
– Social cognitive theory
4
Learning theory
• behaviour is controlled by
– anticipated reward and punishment learned
by association, often operating outside
conscious awareness
• interacting with
– environmental cues and internal drive states
Emphasis on: non-rational processes, the effect of
experience, biological drives, habit learning
5
Decision theory
• behaviour is controlled by
– choices based on comparison of advantages
and disadvantages
• interacting with
– opportunities and ways in which choices are
presented (framing)
Emphasis on: analysis and inference, conscious
decision making, evaluation
6
Personality theory
• Behaviour is controlled by
– dispositions towards impulsiveness, reward
sensitivity, punishment sensitivity, sensation
seeking, anxiety, conscientiousness etc. that
vary across individuals
• interacting with
– the immediate environment
Emphasis on: individual differences in motivational
dispositions that go beyond habit and preferences
7
Social Cognitive Theory
• behaviour is controlled by
– comparison of expected costs and benefits, shaped in
part by goals, self-efficacy, and observing other
people’s behaviour
• interacting with
– self-regulatory capabilities and environmental factors
Emphasis on: goals, self-efficacy, social learning, selfregulation and the interaction with the environment
8
The need for an integrated theory ...
that
• brings together learning theory, decision theory,
social cognitive and other approaches
• accounts for individual differences in dispositions
such as impulsiveness
• uses concepts that are readily measurable
• provides guidance on what motivational
intervention techniques to apply in different
situations
9
PRIME Theory
1.
2.
3.
4.
The structure of the motivational system
Dispositions and how they change
The role of identity and self-control
The unstable mind
10
1: the structure of the motivational system
• Behaviour is controlled by
– the balance between potentially competing impulses and inhibitions
active at the time
• which are generated for intentional behaviours by
– the strongest of potentially competing motives (‘wants’, ‘needs’ and
‘oughts’) present at the time
• which are generated by
– imagined futures and associated feelings of pleasure or satisfaction (for
wants) and/or relief from or avoidance of discomfort (for needs)
– evaluations which are beliefs about what is good or bad, right or wrong,
useful or not useful (for oughts)
– remembered plans which are more or less specific imagined actions
and starting conditions together with a strength of commitment
• which are generated by
– stimuli in the internal and external environment
• interacting with
– more or less fluid or stable dispositions
11
The structure of motivation
p
Plans
r
Responses
i
Impulses
m
Motives
e
Evaluations
12
2: dispositions and how they change
• Dispositions refer to the propensity of the elements in the
motivational system to respond in particular ways to
stimuli and other elements
• They change over varying timescales through:
–
–
–
–
–
–
–
habituation and sensitisation
associative learning
storing mental representations
analysis (calculation, deduction, generalisation)
maturation
homeostatic physiological mechanisms
pharmacological and physical ‘insults’
• The change process is variable often involves periods of
unstable switching between semi-stable states
13
3: identity and self-control
• Identity refers to the disposition to form mental
representations about ourselves and feelings associated
with these
• It is an important source of motives and evaluations
• It includes (but is not limited to):
– labels: categories in which we place ourselves
– attributes: descriptions of ourselves
– rules: plans that apply repeatedly
• Self-control:
– refers to the application of ‘oughts’ arising from identity
– requires and depletes mental energy proportionate to the effort
applied
– greater effort is required to overcome stronger competing wants
and needs
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4: the unstable mind
• the brain has evolved to be inherently unstable,
like a ‘fly-by-wire’ aircraft
• this confers great adaptability but:
– requires constant ‘balancing input’ to prevent the
formation of maladaptive dispositions
– has resulted in evolution of a ‘need for order’
15
Key points
• Understanding behaviour
– Focus on competing motives at the moment in
question
– Judge these in terms of ‘wants’, ‘needs’ and ‘oughts’
and how these are triggered in the immediate
environment
• Changing behaviour
– Focus on establishing:
• strong ‘wants’ as often as possible
• clear-cut rules about actions that provide order and tie in
closely with core aspects of identity
– Move away from a focus on beliefs and gradual
movement towards action
16
PRIME Theory applications
• Coincide with some existing theories
– use personal, moral and financial incentives
– foster norms
– maximise self-efficacy
– focus on feelings
– make rules specific
– develop identity change
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Novel implications 1
• GPs should promote assisted cessation without
asking first whether smokers are ready to make
a quit attempt
• PRIME concepts:
–
–
–
–
dispositional instability
situational responsiveness
need for order
generating positive feelings about the target
behaviour
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Novel implications 2
• Use more communications bursts focusing on
generating immediate physical action
• PRIME concepts:
– providing stability to unstable dispositions
– summation of impulses that have brief existence
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Novel implications 3
• When promoting the services, greater emphasis
should be placed on creating a concrete
attractive visual image of what it is like to speak
to an advisor who will be ‘friendly’, ‘expert’,
‘professional’, and give ‘practical advice’ rather
than talking about success rates
• PRIME concepts
– focus on generating an attractive mental
representation rather than changing beliefs
– using existing schemata to provide stability to those
representations
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Novel implications 4
• Communications should promote a ‘personal
rule’ of ‘at least one quit a year’ and towards the
end of the year ask ‘Have you tried this year?’
• PRIME concepts
– the importance of rules as sources of motives
– increasing sense of order
– the importance of raising priority for immediate action
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Conclusions
• Theories of behaviour potentially have much to offer:
– but are incomplete, overlapping and do not map well on to the
physical world
• PRIME Theory:
– focuses on:
• immediate wants, needs and oughts, and translating these into
impulses
• generating attractive mental representations, identity and rules as a
means of doing this
– provides
• ideas for practical interventions
• hypotheses for future research
22