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Bridging behaviorism: A new approach to employee engagement

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HealthFitness’ Dennis Richling, M.D., chief medical and wellness officer, and Ed Framer, Ph.D., director of health and behavioral sciences, joined Fred Hanna, Ph.D., professor of counselor education, …

HealthFitness’ Dennis Richling, M.D., chief medical and wellness officer, and Ed Framer, Ph.D., director of health and behavioral sciences, joined Fred Hanna, Ph.D., professor of counselor education, University of Northern Colorado, to discuss a new approach to employee engagement at the 23rd Annual Art & Science of Health Promotion Conference March 20-22, 2013.
Listen to an audio recording of the presentation here: http://healthfitness.com/insights/events/

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  • 1. Bridging BehaviorismA New Approach to Engagement
  • 2. © 2013 Health Fitness Corporation2Speakers:• Dennis Richling, MD, Chief Medical and WellnessOfficer, HealthFitness (moderator)• Edward Framer, Ph.D., Director, Health &Behavioral Sciences, Science and Analytics, HealthFitness Corporation• Fred Hanna, Ph.D., Professor of CounselorEducation, University of Northern Colorado; author,Therapy with difficult clients: Using the precursorsmodel to awaken change
  • 3. © 2013 Health Fitness Corporation3Two Models, One Goal:Sustained EngagementDennis Richling, MD, Chief Medical andWellness Officer, HealthFitness (moderator)
  • 4. © 2013 Health Fitness Corporation4Engagement• A Pledge, or a Promise…is a marriage-an alignment of purpose and valuesParticipation
  • 5. © 2013 Health Fitness Corporation5How Do We Engage People?Educatethem…Incent them…Reframethe message…Openadoor
  • 6. © 2013 Health Fitness Corporation6Motivation is Important to ChangeBehavior
  • 7. © 2013 Health Fitness Corporation7Goal:Adopt Healthy Behaviorsfor the rest of their life
  • 8. © 2013 Health Fitness Corporation8How much motivation do we need?• A new behavior model…Dr. BJ FoggStanford Persuasion Technology Laboratory
  • 9. © 2013 Health Fitness Corporation9© 2013 Health Fitness Corporation9© 2013 Health Fitness Corporation9B =MATMotivationHighMotivationLowMotivationHard to do Easy to doAbilityFogg Behavior ModelBehavior ShapingDesiredBehavior
  • 10. © 2013 Health Fitness Corporation10Exciting New Research?Yes, but...
  • 11. © 2013 Health Fitness Corporation11When Do Behaviors Change?• Epiphanies• Change of context• Psychological processes• Make it easier
  • 12. © 2013 Health Fitness Corporation12© 2013 Health Fitness Corporation12© 2013 Health Fitness Corporation12Bridging Science to Increase Engagement15%65%10%10% Motivated with RisksLittle Motivation andRisksNo Motivation andRisksNo Risks
  • 13. © 2013 Health Fitness Corporation13© 2013 Health Fitness Corporation13© 2013 Health Fitness Corporation13Bridging BehaviorismRadicalBehaviorismFogg BehaviorModelPrecursors ModelTranstheoretical Model
  • 14. © 2013 Health Fitness Corporation14A New Look at What RadicalBehaviorism (Behavior Analysis)has to Offer Health Promotion andEngagementEdward Framer, Ph.D., Director, Health &Behavioral Sciences, Science and Analytics,Health Fitness Corporation
  • 15. © 2013 Health Fitness Corporation15Behavioral Approach?• Emphasis on measurement• Emphasis on observable results• Criteria = behavior change• Justification
  • 16. © 2013 Health Fitness Corporation16© 2013 Health Fitness Corporation16© 2013 Health Fitness Corporation16How the conversation got started1. Can we work together to improve how HealthFitnessbuilds it intervention models?2. Engagement is critical to the success of healthpromotion and in fact all therapeutic change3. Schools of psychotherapy, coaching and healthbehavior change, including even the Eastern thinkingof yoga psychology4. Why behaviorism is often the odd man out5. Assertion: Radical behaviorism also deals withconsciousness, thoughts and feelings6. How can we use these various approaches, together,to improve engagement?7. How can we use the various approaches, together, toimprove health behavior change?
  • 17. © 2013 Health Fitness Corporation17© 2013 Health Fitness Corporation17© 2013 Health Fitness Corporation17Bridging BehaviorismRadicalBehaviorismFogg BehaviorModelPrecursors ModelTranstheoretical Model
  • 18. © 2013 Health Fitness Corporation18Radical Behaviorism• Skinnerian behaviorism or operant psychology• Why radical?– Methodological behaviorism only what isobservable from the outside?– Radical behaviorism accepts consciousness– Thoughts are behaviors, too– The same rules that apply to learning to stop acar when the light turns red apply to learning tohave or change thoughts or statements
  • 19. © 2013 Health Fitness Corporation19Radical Behaviorism and Health Promotion• What does behaviorism, and especiallyradical behaviorism, have to offer thehealth promotion/wellness field thatmost of us have come to love?– An analytic framework– Behavior change technologies– A way to clarify the intrinsic/extrinsic incentivesfight– Both individual-clinical and population-cultureapproaches
  • 20. © 2013 Health Fitness Corporation20Incentives, Rewards, Reinforcers• Incentive– “…the expectation of reward that induces actionor motivates effort.”(www.thefreedictionary.com)
  • 21. © 2013 Health Fitness Corporation21Incentives, Rewards, Reinforcers• Reward– “Something given or received in recompense forworthy behavior….” (www.thefreedictionary.com)
  • 22. © 2013 Health Fitness Corporation22© 2013 Health Fitness Corporation22© 2013 Health Fitness Corporation22Incentives, Rewards, Reinforcers• Positive ReinforcerDont Shoot the Dog! TheNew Art of Teaching andTraining.By Karen PryorStrengthens behavior it follows
  • 23. © 2013 Health Fitness Corporation23Example: Timeframes for Incentives,Rewards & ReinforcersIncentive Reward ReinforcerLong-term Intermediate Brief$650/Yr $10/Wk $0.05/Min500 pts/Yr Movie ticket 1 pt/20 steps
  • 24. © 2013 Health Fitness Corporation24Two Types of Learning/Conditioning• Pavlovian orClassical Conditioning• Operant Conditioninghttp://psychology.about.com/od/behavioralpsychology/a/classical-vs-operant-conditioning.htm
  • 25. © 2013 Health Fitness Corporation25Discriminative Stimulus• “When a stimulus signals the availability ofreinforcement it is called the SD, or discriminativestimulus. …it reliably signals the availability ofreinforcement.”• “Stimulus control is said to occur when anorganism behaves in one way in the presence of agiven stimulus and another way in its absence.”• In plain English: A reliable cue or triggerhttp://en.wikipedia.org/wiki/Stimulus_control
  • 26. © 2013 Health Fitness Corporation26Subtle reminders to make healthychoices easierJim RogersChairman & CEOEastman Chemical CompanyCase Example:Eastman Chemical CompanyAs part of the company’s healthmanagement efforts, Eastmanleadership told employees thecompany was placing green spoonsin the cafeteria’s healthy foodchoices and red spoons in the lesshealthy foods.“Hopefully, over time, we’re going tofind ourselves reaching for the greenspoon a lot more than the redspoon.”
  • 27. © 2013 Health Fitness Corporation27Antecedent(s), Behavior & ConsequenceAntecedent(s)•Doctor says Ineed to exercisemore•Worksite HealthCoach asks aboutmy doctor’sexercise rec.•Plan results in 10daily 1 minutecalls from mycoach in 3 weeksBehavior•I wonder how I,someone whohates exercise,will do that.•I get upset, butadmit that I needhelp•With each cue Iget up and walkat least 100steps. I also try toget 100 steps onnon call days.(Use Outlook)Consequence•I feel bad, but donothing. I don’t thinkabout PA.•Coach praises myhonesty and offers tohelp me setup aplan.•I earn regular praisefrom my coach andeven begin to praisemyself. I also start tofeel more relaxed.
  • 28. © 2013 Health Fitness Corporation28© 2013 Health Fitness Corporation28© 2013 Health Fitness Corporation28Incentives, Rewards, Reinforcers• Positive ReinforcerDont Shoot the Dog! TheNew Art of Teaching andTraining.By Karen PryorStrengthens behavior it follows
  • 29. © 2013 Health Fitness Corporation29Negative Reinforcer; Punisher• Negative Reinforcer or Reinforcement(strengthens behavior)• Punisher or Punishment(weakens behavior)
  • 30. © 2013 Health Fitness Corporation30Escape and Avoidance BehaviorESCAPE: perform an operant response thatgets you away from an ongoing punishingstimulus. “Get me out of here”AVOIDANCE: perform an operant responsethat prevents the occurrence of a punishingstimulus. “Prevent pain/discomfort”
  • 31. © 2013 Health Fitness Corporation31Escape and Avoidance Shuttle Boxwww.themezoom-neuroeconomics.com
  • 32. © 2013 Health Fitness Corporation32Summary• Many more principles that have application tohealth promotion• Attaches to so much else in the field, including thework Dr. Hanna will speak about next and theintroductory material that Dr. Richling used to setup our discussion.
  • 33. © 2013 Health Fitness Corporation33Precursors Model:Foundations for SuccessfulEngagement and ChangeFred Hanna, Ph.D., Professor of CounselorEducation, University of Northern Colorado;author, Therapy with difficult clients: Using theprecursors model to awaken change
  • 34. © 2013 Health Fitness Corporation34© 2013 Health Fitness Corporation34© 2013 Health Fitness Corporation34Three Levers for EngagementMotivationPerseveranceInvolvementEngagement
  • 35. © 2013 Health Fitness Corporation35Involvement• Dedication to a task or undertaking that oftenincludes strong interest, devotion, fascinationand/or commitment.Motivation• The desire to attain a goal; includes the exertionof effort and willpower toward achieving thatgoal.Perseverance• Sustained drive and energy toward a desiredgoal; includes the determination to break throughany barriers.Defining the Levers
  • 36. © 2013 Health Fitness Corporation36© 2013 Health Fitness Corporation36© 2013 Health Fitness Corporation36MaintenanceActionPreparationContemplationPrecontemplationStages of Change and Engagement
  • 37. © 2013 Health Fitness Corporation37Bridging Behavior, Cognition and AffectThe dynamic Interplay ofSelf, Mind, Body andTherapeutic ChangeSource: Fred J. Hanna, PhDI
  • 38. © 2013 Health Fitness Corporation38Precursors and Change
  • 39. © 2013 Health Fitness Corporation39© 2013 Health Fitness Corporation39© 2013 Health Fitness Corporation39Precursors AssessmentProblem or Issue:Precursor and its Markers None (0) Trace (1) Small (2) Adequate (3) Abundant (4)1. Sense of Necessity• Expresses desire for change• Feels a sense or urgency2. Willing for Anxiety or Difficulty• Open to experiencing emotion• Likely to take risks3. Awareness• Able to identify problems• Identifies thoughts, feelings4. Confronting the Problem• Courageously faces the problem• Sustained attention toward issue5. Effort toward Change• Eagerly does homework• High energy; active cooperation6. Hope for Change• Positive outlook; open to future;• High coping; therapeutic humor7. Social Support for Change• Wide network of friends, family• Many confiding relationships
  • 40. © 2013 Health Fitness Corporation40RadicalBehaviorismFogg BehaviorModelPrecursors ModelBridging BehaviorismTranstheoretical Model
  • 41. © 2013 Health Fitness Corporation41© Used with permission
  • 42. © 2013 Health Fitness Corporation42© 2013 Health Fitness Corporation42© 2013 Health Fitness Corporation42Q & A• Dennis Richling, MD, Chief Medical and WellnessOfficer, HealthFitness (moderator)• Edward Framer, Ph.D., Director, Health & BehavioralSciences, Science and Analytics, Health FitnessCorporation• Fred Hanna, Ph.D., Professor of Counselor Education,University of Northern Colorado; author, Therapy withdifficult clients: Using the precursors model to awakenchange
  • 43. © 2013 Health Fitness Corporation43Appendix
  • 44. © 2013 Health Fitness Corporation44Antecedent(s), Behavior & ConsequenceAntecedent(s)• Stop lightturns fromgreen to yellow• Stop lightturns fromyellow to red• Stop lightturns from redto greenBehavior• Foot movesfrom gas pedalto brake pedal• Foot pressesharder on thebrake pedal• Foot movesfrom brake togas pedal andpresses downConsequence• Car begins toslow down• Car slows toa stop• Car begins tospeed-up
  • 45. © 2013 Health Fitness Corporation45Antecedent(s), Behavior & ConsequenceAntecedent(s)• Girl in classsmiles at me• My watch alarmrings 3 timesper hour• A new girl inclass smilesat meBehavior• I look awaythinking: “Sheprobably doesn’treally like me”• Each time I try tothink: “Whensomeone smilesat you, smileback”• I smile back ather andintroduce myselfConsequence• Next time thegirl and I lookat each other,neither ofus smiles• When I think this10 times, myMom gives me$1.00 extra• She says “I’mSue and I justtransferred here

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