By António Labisa Palmeira, CIDEFES – Universidade Lusófona, Portugal; ISBNPA Executive Director
Long-term motivation for health-related behaviors can come from different sources. Behavioral scientists are still trying to work out how these sources fit together. For example, I go running nearly every day and have done so for 30+ years. How and why have I maintained this pattern? Daniel Kahnemann would suggest that dual motivational systems are at play: a system 1 that deals with instincts and emotions, and a system 2 that is deliberative and conscious. He might argue that system 2 prompts me to run because I am aware of the health benefits of exercise. On the other hand, Ed Deci might suggest that I am intrinsically motivated to run and do it because it aligns with my values and self and because I enjoy it.
Which of these is correct? I would argue that they both are, and that several other theories might also be critical in explaining behavioral maintenance. How do these theories work together and how can we use them in everyday practice? For example, how can systems 1 and 2 effectively share information with each other? By understanding these mechanisms, we may help patients in the pursuit of sustaining healthy behaviors.
I will argue that intrinsic motivation plays a role in this talk, and I will use Haidt’s Elephant and the Rider story to explore this idea. Haidt’s metaphor aligns with the dual processing model presented above, stating that the Elephant is our system 1, physiologically driven, instinctively affecting behavior and using implicit (subconscious) pieces of information. The Rider is our system 2, pros vs. cons driven, using explicit (conscious) pieces of information.
When the Rider is confused about which information is best, the Elephant storms in and does its thing instinctively. For example, because the Elephant evolved in an era of scarcity, it will push you to seize any opportunity to eat highly caloric foods or keep exertion to a minimum. Today, in an age of abundance, this is problematic because the Rider is overwhelmed with conflicting information about how to direct health-related behaviors. Just think about how many different diets are available… This overabundance of information contributes to the development of unhealthy habits like overeating and physical inactivity.
Habits are an automatic response to relevant cues and play a fundamental role in behavioral nutrition and physical activity. For example, with over 220 decisions per day over food alone, we better use habits to avoid decision paralysis (i.e., no decision at all because of the abundance of options available) and feed ourselves with something, even if it is not the healthiest choice.
So the big question is, how can we create healthier habits?
In my opinion, digital health devices can help us create healthier habits. For example, within the NoHoW project, our group developed an app that connected to smartwatches and other wearables, that constantly collected data about peoples’ “Elephantly” (i.e., bodily) states. The app then made this information explicitly and directly available for people to view. As a result, this gave the Rider a new resource: the self-monitoring data streaming from bodily states. This resource can be used to enrich self-regulatory processes and motivation to pursue healthier behaviors.
Offering the Rider first-hand access to what the Elephant is experiencing empowers people to create links between their own behaviors and their values, beliefs, and goals. For example, when I run, my Elephantly body tells me that I am feeling strong and energized. Then, when I check my smartwatch after a run, I see that I completed my 10,000 steps for the day. In this case, my Rider feels in control of the situation, as the Elephant and the Rider are aligned, and my mind makes a connection between feeling strong and energized and taking more steps. This reinforces the behavioral pattern.
Linking data from wearables with people’s’ internal somatic and emotional states can have the following effects:
- The Rider and the Elephant will become more aligned, and thereby facilitate behavior maintenance.
- When the Rider and Elephant are not aligned, it can cue people to re-evaluate (the effects of) their behavioral patterns.
- Healthy behaviors can become more internalized (i.e., these behaviors become part of your identity and integrated with what you are and do).
With this in mind, the answer to how and why I’ve maintained my running for 30+ years becomes clearer: I run because my Elephant and my Rider are aligned during my running. In Portuguese, there is a saying: “Quem corre por gosto, não cansa” – things you like to do, don’t make you tired. For me, this is a perfect example of how intrinsic motivation connects the Elephant and the Rider.
The evidence for this idea is relatively thin (here & here) and research is still in its early stages. Better sensors are needed, and app content needs to be evidence-based. The NoHoW project was designed with these concerns in mind, but much more research is required. We must also be aware of the problems resulting from APPtimism: you may find “an app for…” almost everything, but that does not mean that the app will be effective.
Keep these in mind when considering how an app or digital behavior change intervention can affect how the Elephant and the Rider interact to support health behaviors.
Learn about new technologies – keep track of new gadgets and the information that is becoming available. Then, focus on what the data they gather means and how they can help maintain healthy behaviors.
Look for structure – what’s heart rate variability? What’s cardiorespiratory fitness? The Rider loves feeling competent; these pieces of information provide the structure for competence to strive. Most apps explain these concepts, look for them, and learn a bit more about them.
Look for supportive environments, which are emotionally and relationally safe – Find out if the apps use the wearable information in a supportive environment, which is non-judgmental, enhances autonomous decision-making, and intrinsic motivation. While wearable data can be used as the currency for competitive duels (e.g. my Heart Rate Variability is lower than yours), the role of competition as a driver of behavior is unclear and there is much variability across individuals.
Information is a double-edged sword – be vigilant: information can lead to excessive behaviors. Use the information as a resource, not as the sole behavioral driver.