REVIEW OF METHODS FOR CONTROLLING BEHAVIORS

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 8. Observe and record Behavior: Every problem can be measured. Count the frequency or duration of a behavior; rate the intensity of an emotion. Record the number of calories, beers, cigarettes, minutes of exercise, or whatever concerns you. Also, rate 1-to-10 the intensity of your sadness or anger. Do this every day and make a big chart of your progress. Self-monitoring leads to self-evaluation which is necessary before self-praise or self-reinforcement.

 As mentioned in chapter 2, after making the changes you want (say lose 15 pounds) it is very important to monitor your weight every week. As soon as you gain just a pound or two, immediately go back to the weight loss program that worked for you. Losing one pound is fairly easy; losing 10 is hard.

 9. Record circumstances: Note and record the antecedents, especially how you feel before overeating, drinking, or having a cigarette. Also, note the time, prompting cues, and general situation you are in. This will help you identify your high-risk situations and the basic needs or emotions that need to be taken care of by some means other than eating, smoking, or drinking. This is very important (see # 11); remember, the environmental cues control much of our behavior.

 For instance, the circumstances that prompt smokers to puff on a lethal, nasty cigarette are: stress and to handle a social situation, other emotions (anger, depression, boredom), nicotine craving, a strong habit, and a desire to make a certain impression on others. You need to ask "why?" you smoke each cigarette.

 Also, observe the competing responses and their short-term payoffs (a relaxing beer or cigarette) that override the desired long-range objectives (health). Note other payoffs of the unwanted behavior, e.g. lots of comfortable talk about food, getting attention while consuming, being able to express yourself, etc..

 Recording the consequences of the lapses is also helpful, e.g. what did you eat and drink? What were the payoffs of the overeating, e.g. did you get to socialize? Did you get people to laugh and joke about bingeing and partying? Did you go into depression and withdraw? Did you have an upset stomach? Did anyone express concern, support, sympathy or offer help? All this information will increase your self-awareness and understanding.

 10. Disrupt old habits: Chew your food twice as many times as usual. Take out small helpings on a small plate or leave half of the food on your plate. Eat one food item at a time. Stop eating for 2-3 minutes during each meal, just to learn you can stop anytime. Carry your cigarettes in another pocket; smoke them with the other hand, etc.

 11. Substitute a new behavior: Exercise during the lunch hour instead of eating. Drink diet cola and have sugarless gum for dessert. Have sugarless candy instead of a smoke. Eat salads or a low-calorie soup instead of fattening food. If you eat because of loneliness, anxiety, or boredom, call up a friend or get involved in some activity instead of eating. Most urges are temporary surges, i.e. there is a strong compulsion to do some habit, but if you resist, the urgent need fades away. So, you sometimes you can wait it out... or replace the habit with a healthy, desirable reaction.

 Many families use food as a way of showing affection: "Mom made cookies for you, wasn't that nice?" or "Oh, take some more of my pasta, I made a lot for you." We are taught that you must have food or "you'll get sick." "You've got to have your protein...milk...vegetables..." There are powerful connections between food and emotions. We must break the unhealthy connections, replacing food with healthy, reasonable ways of handling the emotions: "You know I love your pies, Mother, but my health is more important right now. I know you love me and I love you, even without pie."

 12. Satiate behavior; paradoxical intention: Smoking has been treated by having the smoker smoke continuously inside a box (maybe a small closet) until he/she got sick; that's satiation (see # 18). Using paradoxical intention would involve changing the rules about how you respond to an urge to eat dessert. Instead of saying, "I'll just have a moderate sized piece of cake," one might say, "OK, you nagging appetite, so you want goodies! How about half this cake? You have to eat it all, right now!" (Obviously, not a good idea if you are prone to bingeing.)

 13. Challenge defeatist attitudes: If you say, "I've always been fat, I can't lose weight." Put that idea to a test: try eating less than usual for one meal, try exercising a little more than ordinary. If successful, challenge the idea that you are helpless and test your self-control again the next meal.

 Question your beliefs about eating, drinking or smoking being the only way to relax or be sociable. The old idea among "recovering" alcoholics that they are always just "one drink away from being a drunk" could help you avoid the first drink or smoke or dessert. But the same saying could become become a self-fulfilling prophesy after the first drink and, thus, cause a binge instead of a slight slip.

 Many of us rationalize our bad behaviors: "Oh, I'd gain weight and be a blimp, if I stopped smoking." Research has shown that men gain only 6 pounds and women 8 pounds after stopping smoking. Furthermore, smokers weigh less to start with, so they end up about the same as non-smokers after a year of not smoking. There is only a 10% chance of a person quitting smoking gaining 30 pounds, but obviously this 10% need both a stop smoking and a weight maintenance program.

 14. Expectations of success: If you think you can't quit smoking "cold turkey," set a reasonable, even an easy goal of 2 or 3 fewer cigarettes each day. Some initial success leads to more hopeful attitudes and to more success. Individuals who create positive mental pictures of the outcome of their self-help efforts actually change faster and the improvements last longer (Lazarus, 1984), if they have these fantasies of success several times a day. For example, a smoker might imagine being free of the fear of harming his/her health, free of feeling hooked by a drug, free of social criticism, free of smelly ash trays and bad breath, free of dead taste buds and stained teeth, and so on. When these things happen, self-praise can be a powerful reinforcer (# 16).

 15. Build intrinsic satisfaction: In self-help projects involving oral habits, one may become engrossed with self-control and the satisfaction of sticking to a diet, holding down on the beers or cigarettes, and so on. Focus your attention on these accomplishments, take pride in them, they should not go unnoticed. And the result--a healthy, attractive body--is a source of great and lasting satisfaction too. In some situations you can find activities to substitute for consuming something which can become very gratifying, e.g. if you work, exercise, socialize, do volunteer services, etc. more and consume less, the pleasure from these other activities can gradually replace for the pleasure you get from eating, drinking or smoking.

 16. Reward desirable behavior: It is vital that new habits be immediately reinforced almost every time. So, reward your self-control (if any) after every meal and "snack time." Alcoholics Anonymous has a reward system that also serves as a warning sign against buying booze. At your first AA meeting, you may pick up a red chip and carry it with your "booze" money, so it will be felt and seen before any alcohol is bought. In fact, in some AA groups, they have a rule that you must break and throw away the chip before taking your first drink. After one month of abstinence, the red chip is traded for a white one, three months later you get a blue one, and, finally, a silver dollar at your anniversary celebration. Every year is celebrated by drilling a hole in your silver dollar. What a great reward system! Design something like this for yourself.

 See the section on reinforcement earlier in this chapter and see Method #16 in chapter 11, which provides detailed information about how to use reinforcers to change behavior. This is a complex area, but science has explored this area thoroughly and knowledge is available for you to use every hour of every day.

 Many oral habits will need to be changed gradually; it may be too hard to go from 3000 calories to 1200 per day or from 2 packs of cigarettes to 6-8 per day or from 12 drinks to two per night. This changing in small steps is called "shaping." For instance, a smoker might move from 40 per day to 36 and hardly notice the difference. After staying at 36 for a week then reduce it to 32 or so for another week. When the smoker gets to 12-15 per day, the reduction each week may need to be less, perhaps changing from 12 per day for one week to 10 per day the next week. However, when one is down to 4 to 6 cigarettes per day, many people report it is easy to quit, presumably because most cigarettes are being smoked while stressed, i.e. paired only with unpleasantness. Smoking can be gradually reduced in two other ways: increase the time between smokes or smoke less of each cigarette (by marking with a felt pen where to stop). Each meal or each day you achieve your easy-to-reach goal you should be rewarded, but reward the behavior (eating < 400 calories for dinner) rather than the effects (losing 1/2 lb. today). You control your eating; the weight will take care of itself (especially if you exercise).

 Warning: Sometimes this gradual reduction is just an excuse to continue a bad habit (or worse--a way to cheat and keep the habit). Most experts in the areas of smoking and drinking say that going "cold turkey" is best. It is hard but the tension and cravings are over in a couple of weeks. If you use the gradual method, the tension of reducing your intake can go on for months.

 17. Negative reinforcement: If one were highly conscious of the unwanted consequences of overeating, smoking, or drinking, such as a fat body, early death, cancer, unattractiveness, self-centered greed, and so on, and thought of these stressful things every time one lost control, then avoiding these unpleasant thoughts (by not consuming unneeded stuff) would provide negative reinforcement. The warning signs in #1, if they turn you away from temptation, yield negative reinforcement, i.e. they stimulate behavior that reduces your worry about overeating, smoking, etc. Recognizing the bad consequences not only punishes the bad habit but reduction of these thoughts reinforces good self-control (however, excessive dwelling on food and how terribly delicious, sumptuous, and tantalizing food can be for you, may very well build the urge to eat).

 Remember most people deny how disgusting and dangerous smoking or drinking or over-eating is. If you are lying and telling yourself, "Oh, I carry my weight well," there is no payoff for eating less.

 18. Self-punishment: A dieter could decide to run an extra mile every time he/she ate more than the allotted calories; that's called correction. And he/she could agree to show a group of friends or a class an unattractive photo of him/herself in a skimpy outfit if he/she doesn't lose five pounds a month; that's punishment! Nailbiters can force themselves to show their nails to a class every week. Smokers could flip their wrists with a strong rubber band when they have a urge to smoke and twice during every cigarette.

 Or you can decondition yourself: sit before a mirror and indulge yourself (stuff in food, eat your favorite candy, bite your nails...), until you are very uncomfortable and disgusted, then do it 5 more minutes (Freidman, l975). Likewise, a fairly successful aversive conditioning method is "rapid smoking"--the smoker is required to take a drag every 5 or 6 seconds while doing something unpleasant, like cleaning dirty toilet bowls, or while thinking about an unpleasant experience, like being hurt or failing or looking foolish. The rapid smoking has to be done until you feel you can't take it anymore, maybe 8 to 10 minutes. After doing this, almost 40-45% stopped smoking for at least six months (Masters, et al, 1987).

 The effects of punishment are being researched (Matson & DiLorenzo, 1993). One person punishing another frequently causes hostility; self-punishment may work better, but little research has been done on this topic. My experience is that people quickly "forget" to administer the self-punishment (like flipping your wrist). Yet, support groups can effectively pressure the self-helper to report his/her progress and confront him/her about relapses.

 19. Mental processes: Unwanted behaviors and temptations, like a cold beer, can be made less attractive by imagining them paired with something unpleasant, like imagining vomiting into the beer. This is a mental process using classical conditioning or aversive conditioning, and usually called "covert sensitization." Homme (1970) suggested an operant approach using a series of thoughts: think of the unwanted behavior or the temptation--}think of the awful consequences--}think of resisting and being "good"--}think of good long-range consequences and something pleasant--}think of something to do right now, like play tennis, read, or go shopping.

 20. Extinction: This process involves the removal of all reinforcement for an unwanted behavior. But since the pleasures and unconscious payoffs of consuming things are naturally pleasurable or conditioned and automatically present, there is no way to instantly turn off these reinforcers. That is, food, drink, and cigarettes will still taste good to the user. The oral habits of eating and drinking have been paired with need-satisfying situations thousands of times. Even unconscious purposes may be served, such as getting fat to make you less sexy, drinking to help you feel more sociable or powerful, becoming out of control so someone will help you, not eating to run the risk of death, etc. These unconscious consequences can't all be eliminated but some can be counterbalanced with realistic self-awareness and self-criticism. Many other undesirable outcomes can be avoided. Examples: the drinker can ask friends, in advance, to refuse to clean up your clothes or vomit; if asked maybe they will avoid laughing at how much you drink or eat (if not, avoid them); you can ask your friends to tell you if they prefer that you not smoke (to counter your pleasure); you can avoid fishing for compliments and comments about not looking overweight, etc. You can take away some of the reinforcements from consuming but not all. The reinforcement of other unwanted behaviors may be easier to eliminate.


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