Habit reversal therapy employs behavioural replacement rather than any attempt
to suppress unwanted behavioural responses. This is important because evidence
suggests that thought suppression can have rebound effects, increasing the thoughts
we wish to suppress (Wegner, 1994; Wenzlaff and Wegner, 2000). Consequently,
techniques that involve acknowledgement or acceptance of unwanted thoughts or
urges and planned responses may be more effective (Najmi, Riemann and Wegner,
2009; Sheeran, Aubrey and Kellett, 2007). For example, Erskine, Georgiou and
Kvavilashvili (2010) evaluated the effects of smokers trying not to think about smoking
and found that, compared to controls, smokers trying to suppress thoughts about
smoking increased cigarette smoking.
There are interesting parallels between ‘habit reversal therapy’ and what Kessler
(2009) calls ‘food rehabilitation’. The latter also begins with building awareness, both
of cues in our everyday environment that prompt overeating and of our own
‘premonitionary urges’ or feelings that we are about to revert to a habitual response.
By training the reflective system to identify urges generated by the impulsive system
just before we respond to cues, we can create space for reflective initiation of
competing behaviours, just as a friend’s reminder can change how we lock our front
door. The next stage of food rehabilitation is the specification and learning of relevant
competing behaviours, such as deliberately walking by the cake shop or taking another
route to work. Kessler (2009) emphasizes cognitive and emotional reconstruction, that
is, learning to reflectively nurture new thoughts and emotions in relation to con -
ditioned cues. Over time this results in attitude change that further bolsters motivation
to change. For example, one person having undergone food rehabilitation noted that,
‘Once I thought a big plate of food was what I wanted and needed to feel better...
now I see it for what it is... fat on fat on sugar on fat that will never provide lasting
satisfaction and only keeps me coming back for more.’ This is a radical cognitive and
emotional reconstruction of food cues that might previously have prompted excitement
and positive thoughts. Such reconstruction serves to sustain motivation to avoid
unhealthy foods and reduce impulsive prompting of unhealthy eating. Reconditioning
the impulsive system requires multiple learning opportunities because the associations
that regulate the system have themselves developed through repeated pairings. Thus
‘food rehabilitation’ and other habit-breaking interventions require practice and more
practice. Moreover, since such interventions can be very challenging to complete
requiring considerable time and effort, people are likely to do better if they have good
social support (see Chapter 5) to maintain training until the impulsive system has been
successfully reconditioned.
FROM SPECIFICATION OF CHANGE PROCESSES TO
COMPLEX INTERVENTIONS
We have seen how progress towards behaviour change intervention design proceeds
from initial testing of predictive models (such as operant conditioning or protection
motivation theory – see Chapter 7), through to experimental tests of techniques
designed to change specified regularity mechanisms (e.g. the use of inhabitation
training to reduce automatic responses to specified cues) through to more complex
interventions such as Kessler’s ‘food rehabilitation’. Campbell et al.(2000) provide a
CHANGING BEHAVIOUR 209