Module 6: a transdiagnostic perspective on compulsivity & habit-based interventions

Question 1

Habit-based interventions aim to promote lasting behavior change, by doing (2)

Answer 1

1. buiding desirable habits
2. breaking undesired ones

Question 2

self-report measures of habit (12) / the self-report habit index (SRHI) items, for now just aim to list the 3 broad categories that these items are divided into

Answer 2

Has been used most extensively to study real-life habits
1. I do frequently
2. I do automatically
3. I do without having to consciously remember
4. that makes me feel weird if I do not do it
5. I do without thinking
6. that would require effort not to do it
7. that belongs to my (daily, weekly, monthly) routine
8. I start doing before I realize that I’m doing it
9. I would find hard not to do
10. I have no need to think about doing
11. that is typically me
12. that I have been doing for a long time

categorized into:
1. Repetition
2. Automaticity
3. identity

Question 3

The Self-Report behavioral automaticity index

Answer 3

4-item subscale from the SRHI consisting of items 2,5,8,10

Question 4

Implementation intentions are

Answer 4

if-then plans that can help people achieve their goals by specifying critical situations and linking these to the desired behavior

e.g., If I watch television and feel hungry, then I eat fruit

Question 5

Concrete II’s work better than

Answer 5

goal intentions

e.g., I’m going to eat healthier/do sports/go jogging

Question 6

According to the ‘instant habit’ theory, II’s work so well because

Answer 6

II’s describe the desired S-R habit or a mental association that is made between the critical cues and the desired behavior

–> this ensures that behavior can be triggered automatically

Question 7

II’s are also effective because they focus on

Answer 7

critical cues so that every opportunity to carry out the desired behavior is recognized and used.

Question 8

Compulsivity broad definition

Answer 8

behavior that is continued despite the person being aware of the detrimental consequences

• these can be health-related, social or professional functioning

Question 9

what is the lecture about?

Answer 9

a transdiagnostic perspective on compulsivity & habit-based interventions

Question 10

Definition of a transdiagnostic perspective on compulsivity

Answer 10

common psychological/neurobiological processes are thought to underlie behavior that is continued despite explicit knowledge of devastating negative consequences in various disorders

Question 11

in part 2 of the course, you will look for those transdiagnostic processes including: (3)

Answer 11

• learning processes
  – Pos vs neg reinforcement vs punishment
  – Pavlovian versus instrumental conditioning
• cognitive control processes
• neurobiological processes

Question 12

Endophenotype

Answer 12

biological or psychological phenomena of a disorder believed to be in the causal chain between genetic contributions to a disorder and diagnosable symptoms of psychopathology

Question 13

Our course’s transdiagnostic perspective on compulsivity is in line with that of the Research domain criteria institute’s framework which…

Answer 13

considers mental health and psychopathology in the context of major domains of psychological neurobio processes rather than within established diagnostic categories

–> both emphasize interactions between different processes as constituting a disorder

Question 14

the possible utility of a transdiagnostic perspective

Answer 14

may open up new ways of exploring not only their development, co-morbidity, but most importantly this may provide new targets for prevention and treatment

Question 15

intention-behavior gap

Answer 15

the phenomenon that people have explicit decisions to change their behavior but fail to take action

• medium-large change in intention -> small-to-medium change in behavior

Question 16

how does the intention-behavior gap pose a challenge for motivational models

Answer 16

motivational models posit that intention is the main determinant of behavior but the intention-behavior gap goes against that

intention does not always lead to a behavior

examples of motivational models:
* health belief model
* theory of reasoned action
* theory of planned behavior

Question 17

the intention-behavior gap also points to limitations of what types of interventions

Answer 17

purely information-driven behavior change interventions
(and ofc the motivational model inspired interventions)

Question 18

Habits can explain the gap between intentions and behavior

Answer 18

As behavior repeatedly takes place, habit increases and becomes a better predictor of behavior than behavioral intentions
- Triandis, 1977

using habits we could study how to effectively change behavior through interventions

Question 19

Habits general information (3)

Answer 19

A) Almost half of our daily behaviors is performed in the same manner in the same situations
B) Habits allow for efficiency
C) Habits can also be disadvantageous because they make behavior inflexible

Question 20

Investigating habits in real life can be done in 2 ways

Answer 20

A) field experiments
- Neal’s popcorn experiment

B) Self-report measures
- SRHI: taps into the subjective experience of habit/automaticity

Question 21

The 4-item self-report behavioral automaticity index of SRHI items, suitable for when?

Answer 21

2) I do automatically
3) I do without having to consciously remember
5) I do without thinking
8) I start doing before I realize I’m doing it

suitable for everyday assessment of automaticity of behavior (its short)

Question 22

example of an experiment using the SRHI

The role of habits in a snacking experiment + results

Answer 22

Phase 1: habit strength measure (SRHI) and intention regarding snacking (+a power of food questionnaire)

Phase 2 (1 month later): 7-day snack diary

Results: Habit strength was the best predictor of unhealthy snacking

Question 23

Using questionnaires to track habits: repeated measurement of automaticity across behavioral repetitions shows that

Answer 23

with repetition, automaticity (habits) increases

Question 24

reinforcement in the role of habit formation + example

Answer 24

short-term reward (or absence of aversive consequences) are also an important determinant of habit formation

e.g., self-reported automaticity of a new habit of flossing was predicted by how pleasurable participants found this behavior to be (fits with the law of effect)

in contrast the perceived health benefits did NOT predict how fast the flossing became a habit

Question 25

disadvantages of self-report measures (3)

Answer 25

* Subjective * Self-report of automatic behaviour * Nonetheless, there is evidence that such measures can reliably predict behaviour

Question 26

the role of habits in other behaviors (6)

Answer 26

* consumer behavior * unhealthy snacking * smoking * drinking alcohol * fruit consumption * exercise

Question 27

Real world habit research in humans corresponds to animal research in identifying 3 determinants of habit formation

Answer 27

1. repetition - overtraining leads to insensitivity to outcome devaluation of 'behavioral autonomy' 2. context - insensitivity to outcome devaluation due to overtraining is context specific 3. reward - habits form faster with drug rewards than with natural rewards

Question 28

Therefore our daily behavior is not always determined by intentions, habits also play a role. When do habits override intentions and vice versa?

Answer 28

That depends on the availability of self-control resources --> behavior is determined by the interaction between intentions, habits and self-control resources

Question 29

when self-control is high (3)

Answer 29

– Intentions determine in the absence of habits – Habits can support intentions: when habit for the intended behaviour is strong, this renders strong motivation/intention at the choice point unnecessary, thereby freeing up cognitive resources. – Conflicting habits can compete with intentions --> the balance between these competing forces determine behavior

Question 30

when self-control is low (due to fatigue, stress, distraction)

Answer 30

habits are the main determinant of behavior so making healthy behavior a habit may shield against momentary motivation loss (when your goal is to be healthy)

Question 31

Interim summary (4)

Answer 31

* Behavior change is challenging -> ‘Intention-behavior gap’ * Much of our daily behavior is habitual. * Real-life habits can be investigated in field experiments and self-report measures (SRHI, SRBAI) * Intention X Habit X Self-control interaction

Question 32

You’re conducting an investigation of the formation of an exercise routine. During 6 weeks, you want to obtain a daily measure that reflects the subjective experience of habit formation. Which measure would be optimal to use? 1. Primed lexical-decision task 2. Self-reported habit index 3. Self-reported behavioral automaticity scale

Answer 32

Answer: 3) Self-reported behavioral automaticity scale - since 6 weeks is a long time, it's better to administer a short questionnaire like the SRBAI since it has fewer items

Question 33

How are current behavior change interventions lacking?

Answer 33

interventions and campaigns that try to motivate, change goals and provide information do not directly impact on S-R associations motivation is what gets you started but habit is what keeps you going

Question 34

Goal intentions vs implementions intentions

Answer 34

Goal intentions: I will lose 5 kilos Implementation intentions: If I'm in situation X, then I will take my medication * II's are if-then plans that link a critical cue to an instrumental action * specific if-then structure is important

Question 35

why are goal intentions usually ineffective?

Answer 35

they force you to be motivated ALL the time in order to do the intended behavior

Question 36

how do implementation intentions work?

Answer 36

In implementation an S-R formation forms over time just like in habits so it's almost like an instant habit but in II's the S-R association is formed differently - instead of repetition like in habits II's form S-R associations through conscious planning - it is strategic automaticity

Question 37

2 working mechanisms of II's

Answer 37

1) If: heightened cue accessibility -> detection of situation 2) If-then: strong stimulus-response link -> automatic activation of instrumental response + II's promote behavioral repetition in a stable context, so also gradual habit formation happens

Question 38

# 7 steps of behavior change Step 1

Answer 38

Choose a behavior that you are highly motivated to change - strong intention and intrinsic motivation are crucial for effectiveness of implementation intentions - combination of MI could be beneficial

Question 39

# 7 steps for behavior change Step 2

Answer 39

Determine the critical cue: in which situation do you carry out the "bad habit" - identifying the 'if' - preferably the cue or behavior reliably precedes the behavior and can be easily noticed - can be external vs. internal cue

Question 40

# 7 steps for behavior change Step 2: external vs. internal cues (Adriaanse et al., method + results)

Answer 40

Adriaanse, de Ridder & de Wit: II's with cue provided by researcher OR personal cue Method: * situational cues *If I come home and feel like snacking, then I will eat an apple* * motivational cue (comparable with internal cues) *If I am bored and I feel like snacking then I will eat an apple* dependent variable = *change in snacking* Results: Implementation intention: * more healthy snacks * less unhealthy snacks **but only when a personal, internal motivational cue was used**

Question 41

# 7 steps for behavior change Step 2: two strategies for determining critical cues

Answer 41

Strategy 1: Cue monitoring diary helps to identify critical cue Strategy 2: Mental contrasting = contrasting positive future with negative reality - raises awareness of the distance from the goal -> goal commitment - aids identification of obstacles/critical cues that hinder goal realization -> 'if!'

Question 42

# 7 steps for behavior change Step 3

Answer 42

Can the critical cue easily be avoided/changed? / Could we just avoid and change the cue to stop a behavior?? **Habit discontinuity hypothesis:** avoiding the old context disrupts old S-R habits, which may allow one to rethink new behaviors and choices

Question 43

# 7 steps for behavior change Step 3: experimental evidence for habit discontinuity hypothesis

Answer 43

* T1: intervention sustainability (info, motivating, goal setting) * after 8 weeks: T2: post measurement sustainable behavior Results: the intervention was most successful for people who had moved house recently (< 3 months)

Question 44

# 7 steps for behavior change Step 3 changing the context: nudging (3)

Answer 44

changing the context to promote the desired behavior - e.g., availability of popcorn vs. apples determines which is eaten more --> more apple available --> you eat more apple - also placing healthy fruits is accessible places can nudge healthy choices

Question 45

# 7 steps for behavior change Step 4

Answer 45

Link the right action to your critical cue - the 'then's - usually making the action a negation of something doesn't work (e.g., "then don't sleep) = **Ironic process theory** = attempts to suppress a thought actually renders it more salient and makes one more conscious of it instead habit substitution/replacement: replacing the old, unwanted response to a cue with a new, wanted, competing response

Question 46

# 7 steps for behavior change Step 5

Answer 46

Continue to monitor your behavior and adjust your plan if it is no longer optimal * II's as metacognitive strategy * e.g., if one behavior alternative isn't effective anymore, change it

Question 47

# 7 steps for behavior change Step 6

Answer 47

Once you have formed this habit, you can consider changing other habits multiple II's at the same time are not effective for behavior change esp when it pertains to the same behavior

Question 48

# 7 steps for behavior change Step 7

Answer 48

don't forget to celebrate your success by rewarding yourself

Question 49

Boundary conditions / could habit-based interventions work for all target populations and behaviors?

Answer 49

* when daily structure/regularity is low, it is challenging to build new routines (van de Vijver et al., 2023). * Vice versa, in highly conscientious people, the added benefit of a habit-based intervention may be low because they adopt the strategies mentioned above spontaneously (van de Vijver et al., 2023). * When motivation is low, motivational interviewing can – for instance - be a valuable addition to the intervention

Question 50

What does the review by Gardner et al. strive to do?

Answer 50

to narrow the gap between habit theory and the reality of human behavior 'in the wild'

Question 51

What kinds of critiques has the habit theory received? (3)

Answer 51

1. Persistence of habitual responses even when they no longer serve valued goals is not reliably replicated in humans in real-world contexts 2. There is a question of whether complex behaviors can ever be truly automated 3. Some research suggests tha habit gains dissipate over time, instead of becoming long lasting and behavior changing Gardner and colleagues strive to answer these critiques thereby closing the gap between habit theory and 'in the wild' behavior

Question 52

# 2.1 Habit is not habitual behavior According to the preferred definition in the source, how does habit generate behavior?

Answer 52

**habit is a cognitive process** whereby a (contextual) cue automatically triggers an impulse to act based on a cue-behavior association (learnt through consistent repetition in the presence of the cue) - Habits generate behavior by activating impulses, which then compete with other impulses to determine action --> so habit does not trigger behavior directly but activates impulses that energize behavior

Question 53

# 2.1 Habit is not habitual behavior PRIME theory

Answer 53

frustrating/activating an impulse arouses a conscious desire to act furthermore all psychological influences on action operate through impulses and these compete with one another. Behavior is the result of an impulse that wins. - habit is only one source of impulses and impulses from other psychological processes may win

Question 54

# 2.1 Habit is not habitual behavior What is the key difference between "habit" and "habitual behaviour"

Answer 54

"Habit" is the underlying cognitive construct that generates behavior, while "habitual behaviour" refers to the action that is produced by the habit process.

Question 55

# 2.2 Multiple habits can contribute to any given action What is the difference between an instigation habit and an execution habit

Answer 55

* Instigation habits trigger an episode of behavior (e.g., taking a shower after encountering the cue of waking up) * Execution habits automate the performance of the steps within that episode of behavior (e.g., executing the actual steps necessary for taking the shower, running water, using soap etc.) !!! the authors use 'habitual behavior' to refer to these two types of habits interchangeably

Question 56

# 2.2 Multiple habits can contribute to any given action Implications of instigation habits vs. execution habits for changing a given behavior

Answer 56

Associations that habitually instigate action affect *whether* a behavior is enacted Associations between subservient behaviors affect *how* the behavior is performed

Question 57

# 2.3 Complex behaviors can be habitually triggered why is the argument that effective habit formation interventions need to make complex behaviors fully habitual wrong?

Answer 57

a behavior can be both habitual and intentional * complex behaviors take longer to become a habit, yes * but the *start* of a complex behavior can become a habit because complexity of behavior is about execution, not instigation * **so forming instigation habits (the start of complex behaviors) should promote frequent repetition of simple and complex actions alike**

Question 58

# 2.3. Complex behaviors can be habitually triggered example that shows a behavior can be both habitual and intentional at the same time

Answer 58

A person who consciously decides to take a shower (intentional instigation) may enact the in-shower sequence automatically (habitual execution) Remember that instigation habits and execution habits still refer to the same underlying psychological mechanism

Question 59

# 3.0 The role of habit and intention in behavioral frequency What is the "habit-intention interaction hypothesis

Answer 59

The habit-intention interaction hypothesis proposes that as habit strengthens, the influence of intention on behavior in the presence of habit cues decreases, suggesting habit can override intention

Question 60

# 3.1 Habit and intention can complementarily determine action selection Explain how intention and habit can come together to promote action selection + why does this happen?

Answer 60

If habit and intention align, they interact to strengthen the translation of intention into action - e.g., people who intend to use sunscreen are more likely to act if they have strong sunscreen use habits - habit forms through consistent in-context repetition, which assuming free will, is likely driven by strong enduring intentions --> habits are a locked in response that while no longer triggered by intention is nontheless aligned with it

Question 61

# 3.2 Strong counterhabitual intention may override habit in long term When especially can stable and strong counterhabitual intentions override habits in the long term? (3)

Answer 61

especially when there is sufficient self-control, motivation and opportunity for inhibition

Question 62

# 3.2 Strong counterhabitual intention may overrise habit in long term What are some reasons for why the potential for habit to override counterhabitual intentions fail to replicate in real-life contexts

Answer 62

1. lab tasks restrict people's self regulatory capacities which when available, consistently allow for inhibition of habit tendencies 2. lab tasks focus on simple behaviors that don't correspond to real-life behaviors in which opportunity for inhibition is greater 3. even when 'action slips' happen (habit overrides counterhabitual intention), these are by definition, exceptional failures to act as intended --> instead, with sufficient motivation and self-regulatory capacity (+ inhibition), intention generally overpowers habit

Question 63

# 4.1 Habit formation may be neither necessary nor sufficient for change 3 reasons fow why habit formation may be neither necessary nor sufficient to sustain long-term behavior change

Answer 63

1. Habitual behaviors are cue-dependent so environmental changes that disrupt cue exposure will discontinue habitual action 2. any newly adopted behavior can be sustained by non-habit mechanisms like (enhanced liking or satisfaction with the decision to change) 3. strong counterhabitual intentions may override habits

Question 64

# 4.2 habit formation creates memory traces that may reactivate behavior Are unenacted habit associations fully extinguished according to the source? What is the implication of this?

Answer 64

No, unenacted habits are argued to be weakened but not fully extinguished. This means they retain the capacity to be reactivated, which explains why old habitual behaviors can reappear after periods of not being performed.

Question 65

# 5.1 Disrupting habitual behavior Describe the habit disruption strategy known as "habit inhibition."

Answer 65

Habit inhibition involves consciously and willfully stopping oneself from acting on a habit impulse. This can happen either before initiating the action sequence or during the sequence but before completion.

Question 66

# 5.1 Disrupting habitual behavior Reducing behavioral accessibility and habit cue discontinuity

Answer 66

limit availability of a habitual behavior after the impulse is triggered or diminish the likelihood that a habit impulse is activated they can be temporary, permanent, purposeful or incidental in nature

Question 67

# 5.1 Disrupting habitual behavior Reducing behavioral accessibility

Answer 67

adding friction so an action becomes unavailable or otherwise prohibitively effortful to enact - requires capability and opportunity to modify access in advance of the habit impulse being activated - purposeful: intentionally blocking gambling transactions - incidental: casino payment services failing, precluding gambling

Question 68

# 5.1 Disrupting habitual behavior habit cue discontinuity

Answer 68

purposeful: knowingly limiting exposure to cues - requires awareness of potential cues - also requires for it to be easy to avoid cues incidental: naturally occurring context changes

Question 69

# 5.2 What is the key mechanism of "habit substitution" for disrupting unwanted habits?

Answer 69

Habit substitution works by consistently performing an alternative, desired behavior in response to the cue that previously triggered the unwanted habit. The goal is to form a new, stronger association that displaces the old one.

Question 70

# 6.1 Implications for habit formation interventions habit formation interventions should do: (3)

Answer 70

1. automate wanted actions 2. protect against dips in motivation 3. augmented with strategies to sustain favorable motivation

Question 71

# 6.1 Implications for habit formation interventions when a habit formation approach is unfeasible? and what to do

Answer 71

with people with unpredictable or unstructured everyday lives --> non-habit mechanisms may better support lasting behavior change

Question 72

# 6.2 Implicatio for habit disruption interventions what to consider about habit disruption

Answer 72

1. use only when a behavior is truly habitual 2. there needs to be sufficient self-regulation across many occasions so it may be unsuitable for those with long-term impairments in self regulation 3. lapses should be framed as temporary, permissible setbacks (they easily happen when there is not enough self-control or cue discontinuation is temporary)

Question 73

# 6.2 Implications on habit disruption interventions Habit substitution, things to consider

Answer 73

1. whether 2. when 3. and how to employ inhibition or behavioral inaccessibility strategies to block established habitual behavior most effectively and how to best promote context-consistent repetition necessary to form a new alternative habit

Question 74

what are the three generally regarded essential criteria for defining a habit?

Answer 74

* repetition (learned behaviours), * context stability (presence of specific cues), * automaticity.

Question 75

How does Verhoeven et al describe automaticity in the context of habits, citing Bargh (1994)?

Answer 75

Automaticity, as proposed by Bargh (1994) and described in the text, includes four essential features: unintentionality, uncontrollability, lack of awareness, and efficiency.

Question 76

What is the key difference between goal-directed behaviour and habitual behaviour according to dual-process theories?

Answer 76

Goal-directed behaviour is flexibly guided by current motivation and sensitive to changes in outcome desirability, whereas habitual behaviour is controlled by stimuli and is less sensitive to the current goal status of the outcome.

Question 77

Based on the text, how is habit strength typically measured in health psychology research?

Answer 77

using self-report measures such as the Frequency x Context measure, the Self-Report Habit Index (SRHI), and the Self-Report Behavioural Automaticity Index (SRBAI).

Question 78

Provide one example from the text of how implementation intentions have been successfully applied in a clinical population to increase adaptive behaviour.

Answer 78

increasing psychotherapy attendance by planning to overcome attendance-related negative affect.

Question 79

what are two personality trait that has been found to negatively predict the effectiveness of implementation intentions?

Answer 79

* socially prescribed perfectionism (preoccupation to reach ideals and standards set by significant others) * impulsivity dimension urgency. (tendency to act impulsively under circumstances when negative affect is experienced)

Question 80

How can implementation intentions enhance cognitive-behavioural therapy (CBT), particularly for complex behaviors like addiction or rumination?

Answer 80

by forming clear "if-then" plans that link specific triggers to desirable responses, making behavior change more automatic and reducing reliance on effortful coping strategies. This supports habit formation and can reduce maladaptive responses like rumination or relapse.