Synopsis
This text offers a comprehensive overview of new approaches to health-related behaviour from a self-regulation perspective. The authors outline the assumptions on which self-regulation theories are based, discuss recent research and draw out the implications for practice with a particular focus on changing health behaviour. The book is arranged in two sections – Goal Setting and Goal Activation in Health Behaviour and Goal Striving and Goal Persistence. The epilogue compares self-regulation theories with the prevailing social-cognitive models.
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About the Author
Denise T.D. de Ridder, Ph.D. is professor of Health Psychology at Utrecht University (The Netherlands) and scientific director of the Dutch Research Institute for Psychology and Health. Her research focuses on topics at the interface of coping and self-regulation with an emphasis on self-care behavior and adherence in chronic illness and eating and overweight in healthy individuals. She is co-editor of Psychology and Health and associate editor of Health Psychology Review.
John B.F. de Wit, Ph.D. is associate professor of Social Psychology of Health at Utrecht University (The Netherlands), and executive director of the master program in psychology at Utrecht University. His research interests encompass determinants of health behavior and strategies of change, and combine cognitive, motivational and volitional approaches to self-regulation. He has a longstanding involvement in the domains of sexuality and health, emphasizing the promotion as well as the maintenance of protective behaviors in vulnerable populations. Other work is concerned with motivational processes in risk perception and persuasion.
From the Back Cover
This important volume offers a comprehensive overview of new approaches to health-related behavior from a self-regulation perspective.
It outlines assumptions on which self-regulation theories are based, discusses recent research and draws out the implications for practice with a particular focus on changing health behavior. Reflecting the notion that health-promoting behavior is goal-directed, chapters consider key factors such as:
- social influences
- the nature of health goals
- health risk behavior
- unintentional behavior
- maintaining self-control
- frustrations in goal striving
- maintaining health behavior change.
Self-Regulation in Health Behavior offers a valuable new perspective on health behavior. It is essential reading for MSc students in health psychology, as well as researchers, practising health psychologists and clinical health psychologists.
From the Inside Flap
This important volume offers a comprehensive overview of new approaches to health-related behavior from a self-regulation perspective.
It outlines assumptions on which self-regulation theories are based, discusses recent research and draws out the implications for practice with a particular focus on changing health behavior. Reflecting the notion that health-promoting behavior is goal-directed, chapters consider key factors such as:
- social influences
- the nature of health goals
- health risk behavior
- unintentional behavior
- maintaining self-control
- frustrations in goal striving
- maintaining health behavior change.
Self-Regulation in Health Behavior offers a valuable new perspective on health behavior. It is essential reading for MSc students in health psychology, as well as researchers, practising health psychologists and clinical health psychologists.
Excerpt. © Reprinted by permission. All rights reserved.
Self-Regulation in Health Behavior
John Wiley & Sons
Copyright © 2006 John Wiley & Sons, Ltd.All right reserved.
ISBN: 978-0-470-02407-2
Chapter One
Self-regulation in Health Behavior: Concepts, Theories, and Central IssuesDenise T.D. de Ridder and John B.F. de Wit
Good health is of critical importance to many people while they are generally aware that their behavior plays an important role in achieving and maintaining physical well-being. In Western societies, it is difficult not knowing that one is, to some extent, responsible for one's own health as people are continuously reminded of the importance of their behavior for staying healthy by both public health campaigns and medical care professionals (Brownell, 1991). Yet, even though good health is generally considered important, and many people have good intentions for health behavior, the vast majority report difficulties in consistently performing those behaviors. They may find it hard, for instance, to maintain a healthy diet or a pattern of regular exercise in the face of temptations of modern life (e.g., Rothman, Baldwin & Hertel, 2004). Changing a bad health habit seems even more difficult than maintaining a good one (Polivy & Herman, 2002; cf. Norcross, Ratzin & Payne, 1989).
The proverbial road to hell does indeed seem to be paved with good intentions (cf. Powers, Koestner & Topciu, 2005). The question is: Why is it so difficult to act upon intentions or maintain attempts for changing health behavior, even for people who seem to be motivated? Only recently has the so-called "intention-behavior gap" started to attract substantial attention, and currently this is one of the most researched aspects of health behavior (e.g., Sheeran, 2002; Sheeran, Milne, Webb & Gollwitzer, 2005; also see Sheeran, Webb & Gollwitzer, this volume), and a crucial aspect of self-regulation. Self-regulation broadly refers to the processes of goal setting and goal striving, and includes dealing with a range of challenges that individuals may face when trying to achieve something that is important but, almost by definition, difficult to attain (Mischel, Cantor & Feldman, 1996). Important new questions arise from a self-regulation approach to health behavior, such as the following: How do people set health goals, and do they in fact have health goals? Are these goals authentic or merely a response to persuasive health messages or other social influences that are not well considered and therefore prone to failure? Which types of health goals motivate behavior, and what happens when health goals are in conflict with other goals? What are the conditions that promote or hinder the successful pursuit of health goals? And how do people deal with distractions and temptations when striving for health goals?
Self-regulation theories have not been designed uniquely to explain and understand health behavior and they are relevant in other important contexts as well, such as learning or organizational behavior (cf. Karoly, Boekaerts & Maes, 2005; for an overview, see Boekaerts, Pintrich & Zeidner, 2000). However, the health domain poses special challenges for self-regulation theories because of the substantial discrepancy that has been noted between the importance of individuals' health goals (or at least, what they report to be important health goals) and their frequent failure to act upon these goals. In fact, self-regulation failure in the health domain is a prototypical case to illustrate the relevance of a self-regulation approach to behavior (Baumeister, Heatherton & Tice, 1994). In turn, health behavior research can benefit from a self-regulation approach as this explicitly frames health behavior as a process of investing in long-term goals that require the control of immediate needs, which is one of the most important and difficult self-regulatory tasks (Brandtstdter & Renner, 1990; Mischel et al., 1996).
We feel that the self-regulation approach opens new perspectives for the study of complex health-related behaviors, and we are convinced that applying a self-regulation approach to critical issues in health behavior will result in a better understanding of why and when people effectively invest in their long term health than traditional approaches so far have done. In our overview of self-regulation approaches to health behavior we will not limit ourselves to one or two particular perspectives, as others have done (e.g., Cameron & Leventhal, 2003), but instead adopt a broad view that highlights important basic processes of self-regulation of health behavior, notably those involved in flexible goal setting and tenacious goal striving (Mischel et al., 1996). In the remainder of this chapter, we will first discuss what generally is meant by self-regulation, and briefly trace the historical roots of this approach. Next, we elaborate on different theoretical approaches to self-regulation, highlighting the cybernetic control approach (e.g., Carver & Scheier, 1998), a strength perspective of self-control (e.g., Muraven & Baumeister, 2000), and behavioral enaction strategy (e.g., Gollwitzer, 1999), respectively. We then proceed with highlighting critical issues related to the self-regulation of health behavior. In the last section we will give an overview of the book.
WHAT IS SELF-REGULATION?
Compared to other living creatures, human beings are noted for having an extensive ability to exert control over their inner states, processes, and responses (Baumeister et al., 1994). People are able to resist their own impulses, adapt their behavior to a range of standards, and change their current behaviors in the service of attaining distal goals (Baumeister, 1999). The term self-regulation is often used to refer broadly to efforts by humans to alter their thoughts, feelings, desires, and actions in the perspective of such higher goals (Carver & Scheier, 1998; Vohs & Baumeister, 2004). Hence, self-regulation refers to the person as an active agent and decision-maker, and is a vital aspect of human adaptation to life without which the individual would be a helpless spectator of events (Baumeister, 2005).
Psychologists' interest in self-regulation has burgeoned in recent years, and as an illustration Leventhal, Brisette and Leventhal (2003) found that two thirds of more than 2,700 publications containing the keyword "self-regulation" were published after 1990. This growing popularity promoted a range of views that differ in the various principles of self-regulation they emphasize and the specific mechanism they propose, but nevertheless share two basic properties (Cameron & Leventhal, 2003). A first common feature is to construe self-regulation as a dynamic motivational system of setting goals, developing and enacting strategies to achieve those goals, appraising progress, and revising goals and strategies accordingly. A second common characteristic is that self-regulation is also concerned with the management of emotional responses, which are seen as crucial elements of the motivational system, and that are conceived of as intricately linked with cognitive processes.
An issue of particular relevance in self-regulation concerns the processes involved in effective goal-pursuit that often extends over long periods of time and is frequently confronted with obstacles and temptations. How do individuals manage to successfully quit smoking, for instance, even though from time to time they may experience urges and cravings, and encounter numerous situations in which a cigarette is on offer? More generally, how do people manage the trade-offs and choices between distal goals and immediate urges? And how do they stay on track in cycles of waxing and waning commitment to their goals (cf. Klinger, 1977)? Some of these "preliminaries of willing" (cf. James, 1890), are related to the process of goal setting, and effective self-regulation is more likely when a goal is construed as personally meaningful, supported by favorable expectations about one's ability to execute the necessary actions, and the choice of appropriate standards for performance (Mischel et al., 1996). Several other processes contribute to the successful enaction of intentions, such as effective planning and adequate self-instruction to implement plans. Detailed overviews of "goal-guidance processes" (Maes & Karoly, 2005) are presented by other authors (e.g., Gollwitzer & Moskowitz, 1996; Kuhl, 2000; Maes & Karoly, 2005; Mischel et al., 1996).
Successful self-regulation requires the strategic mobilization of thought, feeling, and action (Cantor, 1990; Gollwitzer, 1996; Kuhl, 2000), in particular when facing obstacles and conflicts between goals, and self-regulation generally is construed as a systematic process that involves conscious effort to influence thoughts, feelings, and behaviors in order to achieve a goal in the context of a changing environment (cf. Zeidner, Boekaerts & Pintrich, 2000). Phrased differently, self-regulation entails individuals' involvement in the management of their own change processes (Abraham, Norman & Conner, 2000), including the conscious consideration of the relative importance of potentially competing goals, and goal prioritization in particular (Abraham & Sheeran, 2000). The unique contributions of the psychological self-regulation perspective to an explanation of (health) behavior can best be understood when considered in the historic context of other perspectives on behavior, especially insofar as they relate to the role of motivation (Bandura, 1986; Mischel et al., 1996).
The Emergence of a Self-regulation Perspective
Since the emergence of psychological science in the late 19th century, psychologists have proposed a range of substantially different views on the nature of motivational processes that underlie human behavior. However, be it the trait-disposition view, the biological perspective, psychoanalytic thinking or learning theory, to name but the most important perspectives, the approaches that have dominated thinking about motivation and behavior for most of the 20th century shared one critical assumption. All considered behavior to mostly result from non-reasoned processes. The precise processes that have been proposed differed between these perspectives, but none included reasoning. Indeed, for much of the history of psychological thought, motivational processes have been considered as substantially different from and independent of cognitive processes. Only more recently have scholars started to invoke human agency and systematically address the ways in which motivation and cognition are intricately linked (cf. Mischel et al., 1996). A major change in thinking about how motivation and cognition are related is evident in Bandura's view that cognitive processes play a central role in human learning as well as motivation (Bandura, 1977). An important cognitive process underlying motivation is that reinforcements create expectations of future outcomes, which guide behavior through the processes of goal setting and self-evaluation against these standards, a notion that has become central to the self-regulation perspective of behavior. Indeed, it has been noted that the concept of self-regulation originates with attempts to make learning theory more sophisticated and flexible to encompass a larger portion of behavior (Baumeister, 1998).
Bandura's writings (e.g., 1977, 1986) have proven particularly seminal for the emergence of a self-regulation perspective, highlighting central issues such as the symbolic representations of goals and self-reflective monitoring of behavior in the pursuit of goals. Bandura's Social Cognitive Theory posits that individuals engage in behavior because of the outcomes they hope to achieve, and these action expectations reflect the motivational function of reinforcement (Bandura, 1977, 1986). People strive to gain anticipated positive outcomes and to forestall potential negative outcomes, and this goal striving is further governed by individuals' self-efficacy beliefs. As a general rule, people undertake those tasks for which they judge themselves efficacious. Self-efficacy is particularly important to self-regulation because it influences a host of variables that come into play as people strive to regulate their behavior (Cervone, Mor, Orom, Shadel & Scott, 2004). Self-efficacy beliefs affect the level and type of goal individuals adopt, which in turn influences performance. Explicit, challenging goals raise motivation and goal attainment (Locke & Latham, 2002), and individuals with high self-efficacy are more likely to adopt and remain committed to highly challenging goals.
The major contribution of Social Cognitive Theory arguably lies in the proposition that self-efficacy beliefs affect standards of performance (i.e., goal setting), a suggestion that has rapidly been included in other motivational theories of behavior. Only recently increasing attention is being devoted to explicating the ways in which self-efficacy beliefs also affect strategies for achieving goals (Bandura, 1991; Cervone et al., 2004; Luszczynska & Schwarzer, 2005; Schwarzer, 1992), but the proposed mechanisms substantially overlap with processes that are central to other accounts of self-regulation. Also, according to Carver and Scheier (1998), Bandura has been somewhat reluctant to adopt the vocabulary of feedback control, which constitutes another important feature of self-regulation (Miller, Gallanter & Pribam, 1960; Carver & Scheier, 1982), and one that we will discuss in the next section.
MODELS OF SELF-REGULATION
Cameron and Leventhal (2003) note that the term self-regulation has been so widely used in recent years that one cannot but wonder whether all theories of (health) behavior are self-regulation models. Obviously, the answer should be no. Following other authors in the field of self-regulation (Carver & Scheier, 1998; Mischel et al., 1996), we apply three criteria for including models of behavior as self-regulatory models: (a) The explicit consideration of goals, (b) a view of the person as an active agent in shaping his or her own behavior, and (c) an emphasis on volitional processes in goal striving.
Central to all self-regulation models of behavior is the concept of goals. Different type of goal constructs have been proposed, including personal strivings (Emmons, 1986), life tasks (Cantor & Kihlstrom, 1987), personal projects (Little, 1983) or self-guides (Higgins, 1987), each emphasizing different aspects of goals but having in common the idea that goals energize and direct activities as they give meaning to people's lives (Baumeister, 1989). Indeed, understanding the person means understanding the person's goals (Carver & Scheier, 1999). By definition, goals are future-oriented as they relate to how people think of their unrealized potential and the kind of things they might want to achieve. Most theoretical accounts of self-regulation cast goals as guiding principles that people consciously and intentionally set to effectively steer their behavior (e.g., Austin & Vancouver, 1996; Elliott & Dweck, 1988; Pervin, 1989). We consider a theory to be a self-regulation model when it starts from the assumption that individuals are agents that somehow are involved in shaping their own destiny. This can be as active decision-makers, but also includes instances in which individuals act to achieve goals of which they are not consciously aware (e.g., Bargh & Chartrand, 1999; Fitzsimons & Bargh, 2004; Strack & Deutsch, 2004).
In addition to acknowledging the importance of goals and goal setting as motivational underpinnings of human action, a self-regulation theory of human behavior also should make explicit the processes that are involved in striving to attain the specified goal. That is, self-regulation theories are not only concerned with motivation but also with volition, and the processes of goal setting and goal striving are construed as intricately linked in a recursive process, which dynamically adapts to changes in the context in which the self-regulation occurs. We next introduce major theoretical approaches to self-regulation that differ in the extent in which they incorporate these different features. We distinguish among cybernetic control theory (e.g., Carver & Scheier, 1998), models of willpower and self-control resources (e.g., Baumeister et al., 1994; Mischel et al., 1996), and behavioral enaction theories (e.g., Gollwitzer, Fujita & Oettingen, 2004; Schwarzer, 2001).
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