Time for a change: Putting the SOC Model to rest Robert West Fran Biel, MS

Stages of Change Shown just for review. I assume the other presenters will have thoroughly covered the SOC in earlier presentations.

…..but Model is so flawed that it has held back advances in HP Need to find a new theory! Reflect observations about behavior change Internally consistent Generates useful ideas, predictions Maps with sudden behavior changes

Dismantling Stage boundaries Assumption about plans Example – alcohol cessation Assumption about plans Disparate constructs in stages Distracting -Stage boundaries are arbitrary, and data about the percentage of subjects in a certain stage have little practical relevance. Example: alchohol cessation. An individual deemed to be in precontemplation by SOC would not be ready to cease alcohol abuse within next 6 months, but upon moving to contemplation, would be ready to stop abusing alcohol within the next six months. From a PH standpoint, what would having 20% of your target pop in precontamplation and 20% in contemplation mean for an intervention? -Assumed that individuals make coherent and stable plans. Stage definitions include disparate types of construct – such as time since quitting smoking, past quit attempts, and intention The focus on conscious decision-making is actually drawing attention away from important parts of human motivation. SOC neglects the roles of reward and punishment, and also associative learning (response-stimulus association) in developing bad habits.

Hold on! Some evidence the model holds Statement of the obvious Those in maintenance are more likely to change behavior at follow-up. Supported by weak correlation; not all studies find this association Statement of the obvious Thinking of doing something? You’re more likely to do it. Similarly, if you try something, you’re more likely to succeed than those who don’t. Still, setting up interventions in ways besides the SOC, such as looking at triggers and motives, are more effective than the SOC itself.

Walk away SOC as a security blanket Jargon is meaningless Promotes wrong intervention strategy Limits scope of interventions -SOC as a security blanket for behavioral health researchers – gives the appearance of rigor, when in fact putting somebody into a stage isnt always helpful to figuring out a treatment plan. SOC lets researchers go for soft outcomes (moving from one stage to the next) instead of a meaningful change. Jargon of SOC is meaningless – a precontemplator is somebody who is not planning on changing – no need for terminology to describe that state of being. Promotes wrong intervention strategy – don’t offer precontemplators a new drug therapy for their addiction, for instance, when it may really help them quit. Needlessly narrows the pool to which an intervention is offered. Ie quit smoking – don’t avoid precontemplators in cessation messaging, since they can become motivated to quit even if they’re unmotivated.

What we need New State of change model Motivational forces Motivational forces  new behavior pattern New model needs to have: -Account of balance of motivational forces that operate on habitual behaviors -How motivational forces need to change in order to have a new behavior pattern emerge

THE THEORY OF TRIADIC INFLUENCE Distal Influences Proximal Predictors Levels of Causation Ultimate Causes Social/ Personal Nexus Expectancies & Evaluations Affect and Cognitions Decisions Experiences Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural BIOLOGY/ PERSONALITY SOCIAL SITUATION CULTURAL ENVIRONMENT Values/ Evaluations Knowledge/ Expectancies Perceived Norms Information/ Opportunities Interpersonal Bonding Social Competence Interactions w/ Social Instit’s Others’ Beh & Atts Motivation to Comply Skills: Social+General Sense of Self/Control Will: Self- Determination 1 2 3 7 8 9 10 11 12 13 14 15 16 17 18 l 4 5 6 a b c d e f C F I B E H A D G g h i j k m n o p q r s t u v w x The TTI! SOC fits kind of into the expectancies and evaluations section. New SOC model fits into the social/personal nexus. SELF-EFFICACY BEHAVIORAL CONTROL SOCIAL NORMATIVE BELIEFS ATTITUDES TOWARD THE BEHAVIOR 19 20 21 22 23 DECISIONS/INTENTIONS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Related Behaviors J K 8

THE THEORY OF TRIADIC INFLUENCE Distal Influences Proximal Predictors Levels of Causation Ultimate Causes Social/ Personal Nexus Expectancies & Evaluations Affect and Cognitions Decisions Experiences Intrapersonal Stream Social/Normative Stream Cultural/Attitudinal Stream Biological/Nature Nurture/Cultural BIOLOGY/ PERSONALITY SOCIAL SITUATION CULTURAL ENVIRONMENT Values/ Evaluations Knowledge/ Expectancies Perceived Norms Information/ Opportunities Interpersonal Bonding Social Competence Interactions w/ Social Instit’s Others’ Beh & Atts Motivation to Comply Skills: Social+General Sense of Self/Control Will: Self- Determination 1 2 3 7 8 9 10 11 12 13 14 15 16 17 18 l 4 5 6 a b c d e f C F I B E H A D G g h i j k m n o p q r s t u v w x The TTI! SOC fits kind of into the expectancies and evaluations section. New SOC model fits into the social/personal nexus. Cause of behavior as sense of self/self control; create contextual change through interpersonal bonding and change of the normative environment; change behavior through interactions with social institutions (social attachments) SELF-EFFICACY BEHAVIORAL CONTROL SOCIAL NORMATIVE BELIEFS ATTITUDES TOWARD THE BEHAVIOR 19 20 21 22 23 DECISIONS/INTENTIONS Trial Behavior EXPERIENCES: Expectancies -- Social Reinforcements -- Psychological/Physiological Related Behaviors J K 9

Where did West go with this? PRIME Theory of Motivation (West, 2006)

Another View of PRIME

The best View of the PRIME Theory of Motivation

West’s foray into Chaos Theory: Bifurcation at a Cusp

Questions?