Human behavior and health

‫الرحيم‬ ‫الرحمن‬ ‫هللا‬ ‫بسم‬
Saudi Arabia
Ministry of higher education
Al-Baha University
******
Faculty of Applied Medical Sciences
Public Health Department
Health and Human behavior
Prepared and presented by :
Dr. Abdalla Hassaballa Elmanna
Assistant professor of health education
Email:dr.abdalla.sd@gmail.com

Lecture No 1
• Introduction to human behavior
Objectives:
By the end of this lecture the students
should be able to:
1. Define behavior and related terms
2. Define and understand healthy
behavior.

Human Behavior and Health
• Introduction
promoting healthy behaviors. Think of those
people who as a result of receiving health
education messages are now using an
insecticide treated net (ITN), or the number of
households that have constructed latrines so
that they are able to protect themselves from
disease.

continuous
• A person’s behavior may be the main cause of
their health problems, but it can also be the
main solution. Human behavior is among the
major determinants of the health of
individuals, families or communities. Healthy
behaviors contribute to the overall health of
individuals and communities and unhealthy
behaviors adversely affect the quality of life
people at different levels. Most health issues
cannot be dealt with by treatment alone.

Definition of health behavior and other related terms
1. Behavior is an action that has a specific
frequency, duration and purpose
whether conscious or unconscious. It
are what we “do” and how we “act”.
People stay healthy or become ill, often
as a result of their own action or
behavior.

continuous
1. Any activity undertaken by an individual,
regardless of actual or perceived health
status, for the purpose of promoting,
protecting or maintaining health, whether or
not such behavior is objectively effective
towards that end.
Reference: Health Promotion Glossary, 1986.

The following are examples of how people’s
actions can affect their health:
1. Using mosquito nets and insect sprays helps
to keep mosquito away.
2. Feeding children with bottle put them at risk
of diarrhea.
3. Defecating in an open field will lead to
parasitic infection.
4. Unsafe sex predisposes people to unwanted
pregnancy, HIV/AIDS and other STDs.

• In health education it is very important to be
able to identify the practices that cause, cure,
or prevent a problem. The words actions,
practices and behaviors are different words of
the same

1. Life style
• Refers to the collection of behaviors that make up a
person’s way of life-including diet, clothing, family life,
housing and Work.
2. Customs
• It represents the group behavior. It is the pattern of
action shared by some or all members of the society.
3. Traditions
• Are behaviors that have been carried out for a long
time and handed down from parents to children.

1. Culture
• Is the whole complex of knowledge, attitude,
norms, beliefs, values, habits, customs,
traditions and any other capabilities and skills
acquired by man as a member of society.

Examples of behaviors promoting health and preventing
diseases
Healthy behavior:
1. Actions that healthy people undertake to
keep themselves or others healthy and
prevent disease. Good nutrition, breast
feeding, reduction of health damaging
behaviors like smoking are examples of
healthy behaviors.

Examples of behaviors promoting health and
preventing diseases-Preventive health behaviors
2. These are actions that healthy people
undertake to keep themselves or others healthy
and prevent disease or detect illness when there
are no symptoms. Examples include Eating a
balanced diet, hand washing with soap, using
insecticide treated mosquito nets and exclusive
breastfeeding to age six months.

preventing diseases- Illness behaviors
• These include any activities undertaken by
individuals who perceive themselves to be ill.
This would include recognition of early
symptoms and prompt self referral for
treatment. For example a person who feels
that they are ill might visit the nearby health
centre or consulting with the doctor or other
health worker, taking a pain killer if you have a
headache.

diseases- Sick-role behaviors
• These include any activities undertaken by
individuals who consider themselves to be ill, for the
purpose of getting well. It includes receiving
treatment from medical providers and generally
involves a whole range of potentially dependent
behaviors. It may lead to some degree of exemption
from one’s usual responsibilities. For example a
person who feels that he is ill might visit the nearby
health centre and receive tablets to be taken home,
and might then not do as much work as normal.

diseases-Compliance behaviors
• This means the person will be following a
course of prescribed treatment according to
the instructions that the health worker has
given them e.g. Washing your hands after
going to the latrine as suggested by the health
worker; taking your medicine regularly in the
case of heart pressures ,TB, AIDS …etc.

preventing diseases-Utilization behaviors
• This is the sort of behavior that is described
when people use their health services such as
immunization services, antenatal care, family
planning, immunization, taking a sick person
for treatment

Examples of behaviors promoting Rehabilitation behaviors
health and preventing diseases-
• Rehabilitation behaviors
• What people need to do after a serious illness
to prevent further disability
• Community action
• Actions by individuals and groups to change
and improve their surroundings to meet
special needs.

Types of behavior
• Modeling behavior

Cultural behavior
17 Year old Tagenarine Chanderpaul, son of
Shivnarine Chanderpaul taking guard like his
father, its a Caribbean old school pratice.

Attitudinal behavior
• Psychologists define
attitudes as a learned
tendency to evaluate
and behavior things in a
certain way

Ethical behavior (Institutional)

Hypnosis behavior
• The induction of a state of consciousness in
which a person apparently loses the power of
voluntary action and is highly responsive to...
• Example: mesmerism - trance - hypnotism

Persuasion behavior
• Persuasion is underneath the umbrella term
of Influence. In other words, persuasion is
influence, but it requires communication,
whereas influence doesn't necessarily

Coercion behavior
• The act of compelling by force of authority.

Innate behaviour (God element?)
• Instinct or innate behavior is the inherent
inclination of a living organism toward a
particular complex behavior

Factors affecting human behavior
• Psychologists identify four reasons for human
behavior which include
1. Thoughts and feelings.
2. People who are important to us.
3. resources:
4. Culture

1- Thought and feeling which include
1. knowledge
2. believes
3. attitudes
4. and values

Thought and feeling which include Knowledge
Knows things, objects, events, persons, situations and
everything in the universe. It is the collection and
storage of information or experience. It often comes
from experience. We also gain knowledge through
information provided by teachers, parents, friends,
books, newspapers, Etc…E.g. knowledge about
methods of prevention of Malaria

Believes
• Believes are usually derived from our
parents, grand parents and other
respected people in addition to religious,
customs and traditions .

Attitudes
• Attitude is relatively constant feelings,
predispositions or set of beliefs directed
towards an object, person or situation. They
are evaluative feelings and reflect our likes
and dislikes. They often come from our
experiences or from those of people close to
us. They either attract us to things, or make
wary of them.

Attitudinal behavior
• Psychologists define
attitudes as a learned
tendency to evaluate
and behaviour things in
a certain way

Values
• Are broad ideas and widely held assumptions
regarding what are desirable, correct and good
that most members of a society share
• Values are so general and abstract that they do
not explicitly specify which behaviors are
acceptable and which are not.
• Instead, values provide us with criteria and
conceptions by which we evaluate people,
objects and events as their relative worth, merit,
beauty or morality.

2- People who are important to us
• The second reason for our behavior related to
the influence of people whom are important
to us.
• Family
• Peers, teachers
• Employers, health providers
• Community leaders
• Decision makers

3-Resources
• A third reason for people behavior is the
availability of resources like (money, facilities,
labor, services and skills).

4- Culture
• The normal behaviors ,believes ,values and use of resources
in a community form pattern or way for life .these is known
as culture .
• Cultures has been developed from many thousands of
years by people living together and sharing experiences in
certain environment .cultures are continue to change some
times slowly and some times quickly, due to natural events
or contact with other people with different cultures ,while
normal behavior is one of the aspects of culture ,culture in
its turn has deep influence in behavior .
• In the practical you can see, hear, and understand culture
whenever you are in the community by observing dress,
common foods and organization of work or by listing to
songs.

The role of human behavior in prevention of disease and
promotion of health-Health education toward disease
prevention
• What is prevention:
• Prevention is defined as the planning for and
the measures taken to forestall the onset of a
disease or other health problem before the
occurrence of undesirable health events.

There are three distinct levels of prevention: primary,
secondary, tertiary prevention.
Healthy person early signs Disease Death
Primary prevention Secondary prevention Tertiary prevention

Primary prevention:
• Primary prevention is comprised of those activities carried
out to keep people healthy and prevent them from getting
disease. Health education, as part of primary prevention,
helps people to understand their bodies and value their
health, to know about diseases, and how to make the best
use of organized health services. It can motivate them to
look after themselves by practicing hygienic personal
habits, such as using safe water, mosquito nets, and child-
spacing methods. It can encourage them to be responsible
for their own environment in terms of water supplies and
excreta disposal. Health education can also bring health
workers in closer touch with the needs of the people they
serve so that, by working together, they can develop a
healthier life for the community as a whole .

Secondary prevention
• Secondary prevention includes preventive measures that lead to an
early diagnosis and prompt treatment of a problem before it
becomes serious. It is important to ensure that the community can
recognize early signs of disease and go for treatment before the
disease become serious. Health problems like tuberculosis can be
cured if the diseases are detected at an early stage. In secondary
prevention, health education can help people understand and value
different screening procedures, such as those involved in exercise
services. It teaches about the early symptoms and signs of
important diseases (e.g. leprosy and tuberculosis) so that people
can recognize them and go for check up at an early stage. It can
help them cooperate in reporting diseases in surveillance programs
for such diseases as measles, rabies and malaria.

Tertiary prevention
• Tertiary prevention seeks to limit disability or complication
arising from an irreversible condition. Even at this stage
actions and behaviors of the patient are essential. Health
education in tertiary prevention can help people to
understand diseases better and to cooperate with the
medical services in carrying out treatment properly- for
example, continuing with treatment for tuberculosis until
cured. While people are attending for treatment, health
educators can give them new and up-to-date information
about how to prevent diseases such as malaria and
gastroenteritis. Health education posters in clinic waiting
areas can also be used to spread information.
•

Five Modes of Intervention
1. Health promotion
2. Specific Protection
3. Early Diagnosis and treatment
4. Disability Limitation
5. Rehabilitation

Interventions to Promote Health
1. Health Education
2. Environmental Modification
3. Nutritional Interventions
4. Lifestyle and behavioral changes

Major Variables
in Behavior Change
• Thoughts and ideas inside a person’s mind have
significant influence on an individual’s health
behaviors. These variables interact with social and
environmental factors and it is the synergy among all
these influences that operate on behavior.
• Knowledge: An intellectual acquaintance with facts,
truth, or principles gained by sight, experience, or
report.

Changing Your Health Behaviors
• Change depends on the individual:
– Identify what is most important to you or what poses
the most immediate threat to health; for example:
• Diet
• Relationships
• Stress management
• Safe sex
• Drug/alcohol use
• Exercise
• Use of tobacco

Theory and Why It is Important
• A theory is a set of interrelated
concepts, definitions, and propositions
that explains or predicts events or
situations by specifying relations among
variables.

Theory and Why It is Important
Theories can guide the search to:
• Understand why people do or do not practice
health promoting behaviors;
• Help identify what information is needed to
design an effective intervention strategy; and
• Provide insight into how to design a program
so it is successful.

Theory and model
• Theories and models help explain
behavior, as well as suggest how to
develop more effective ways to
influence and change behavior.

Factors That Influence Behavior
Change• Predisposing factors:
– Knowledge, beliefs, and attitudes based on life
experiences as well as gender, age, race,
socioeconomic background
• Enabling factors:
– Skills and abilities, resources available; can be
positive or negative
• Reinforcing factors:
– Presence or absence of support, encouragement or
discouragement from those around you

Types of theories
•explanatory theory •Intervention theory

The most widely-used theoretical
models of health behavior:
1. The Health Belief Model (HBM)
2. The Transtheoretical Model/Stages of Change
(TTM)
3. Social Cognitive Theory (SCT)
4. The Social Ecological Model.

Health Belief Model
The Health Belief Model (HBM) was developed to help
understand why people did or did not use preventive
services offered by public health departments in the
1950’s, and has evolved to address newer concerns in
prevention and detection (e.g., mammography screening,
influenza vaccines) as well as lifestyle behaviors such as
sexual risk behaviors and injury prevention. The HBM
theorizes that people’s beliefs about whether or not they
are at risk for a disease or health problem, and their
perceptions of the benefits of taking action to avoid it,
influence their readiness to take action.

Core constructs of the HBM
• Perceived susceptibility and perceived severity
• Perceived benefits
• perceived barriers
• Cues to action
• Self-efficacy (added more recently)

Important Theories and Their Key
Constructs

Constructs of the HBM
• Perceived susceptibility: Belief of a person
regarding the possibility of acquiring a
disease or harmful state as a result of a
particular behavior
• Define population at risk (apply descriptive
epidemiology)
• Personalize risk (discussion, role play,
simulation, case study)
• Consistent with actual risk (apply analytical
epidemiology)

Constructs of the HBM (cont’d)
• Perceived severity: Belief of a person
regarding the extent of harm that can result
from the acquired disease or harmful state as
a result of a particular behavior
– Specify consequences of the risk and the
condition (lecture, discussion, self-
reflection, case study, case narration, video
presentation)

• Perceived benefits: Belief of a person
regarding the usefulness of the methods
suggested for reducing risk or seriousness of
the disease or harmful state resulting from a
particular behavior
– Define action to take (clear steps, specific
demonstration, re-demonstration)
– Clarify the positive effects to be expected
(discussion, lecture, self-reading, video
presentation, computer-aided presentation)

• Perceived barriers: Belief of a person
regarding actual and imagined costs of
performing the new behavior
• Reassurance (one-on-one counseling, case
study, discussion, active listening)
• Correction of misinformation (lecture, video
presentation, role play)
• Incentives (tangible and intangible aids,
verbal encouragement, case accounts)
• Assistance (providing services,
transportation)

• Cues to action: Precipitating force that
makes the person feel the need to take
action
– Provide how-to information (lecture,
demonstration, re-demonstration, role play)
– Employ reminder system (buddy system, log,
diary, Post-it notes)
©microvector/Shutterstock

• Self-efficacy: Belief or confidence in
performing a behavior
– Provide training in small steps
(demonstration, re-demonstration)
– Progressive goal setting (self-reflection, diary)
– Verbal reinforcement (one-on-one
counseling)
– Reduce anxiety (stress management
techniques)
©Eskemar/Shutterstock

Applications of HBM
• Screening behaviors (TB, breast cancer, colorectal
cancer, influenza vaccinations, Tay-Sachs
disease, high blood pressure, etc.)
• Preventive behaviors (seat belt use, smoking
cessation, physician visiting, etc.)
• Health promotion behaviors (exercise, healthy
nutrition, etc.)
• Treatment compliance behaviors (diabetes, end-
stage renal disease, bronchial asthma, weight
loss, etc.)

Theory of Reasoned Action (TRA) Theory of
Planned Behavior (TPB)
• The Theories
• TRA, TPB & IBM are essentially one theory
that has evolved over time
• TRA developed first; after the addition of
perceived behavioral control to the model,
TPB was developed
• TPB was expanded to include components of
other theories of behavior

Theory of Reasoned Action
Developed by Ajzen & Fishbein in 1980
Basic Assumptions:
1. ▫People are rational and will make
predictable decisions in specific
circumstances
2. ▫An “intention to act” is the most important
determinant of behavior
3. ▫We do not always act the way we intend to

Transtheoretical Model/Stages of
Change/ Key Constructs
• Long-term changes in health behavior involve multiple
actions and adaptations over time. Some people may not
be ready to attempt changes, while others may have
already begun implementing changes in their smoking,
diet, activity levels, and so on. The construct of “stage of
change” is a key element of The Transtheoretical Model
(TTM) of behavior change, and proposes that people are at
different stages of readiness to adopt healthful behaviors.
The notion of readiness to change, or stage of change, has
been examined in health behavior research and found
useful in explaining and predicting changes for a variety of
behaviors including smoking, physical activity, and eating
habits. The TTM has also been applied in many settings.

Two Variables :
Theory of Reasoned Action:
Attitudes about
the behavior
Subjective norms
Behavioral Intention Behavioral
Theory of Reasoned Action:
Attitudes + Subjective Norms = Intention (leads to behavior)

Two Variables
1. Attitudes
Beliefs about the consequences of the behavior
Appraisal of positive and negative aspects of
adopting or changing a behavior
2. Subjective Norms
•What “significant others” do and expect
•The degree to which someone wants to
conform to others’ behaviors or expectations

Theory of Reasoned Action
• Predicts a person will adopt, maintain or change
a behavior if they believe:
1. the behavior will benefit them
2. the behavior is socially desirable
3. there is social pressure to conform to the
behavior
4. the opinion of others matters to them
• In practice, two methods of impacting behavior
are to influence attitudes and exert social
pressure

Theory of Planned Behavior
•A third factor influencing behavioral intention was
added to the Theory of Reasoned Action =
Behavioral Control
• Behavioral control = control beliefs + perceived
power
Theory of Planned Behavior
A third factor influencing behavioral intention was added
to the Theory of Reasoned Action = Behavioral Control
Behavioral control = control beliefs + perceived power

Transtheoretical Model/Stages of Change

Important Theories and Their Key Constructs
Stages of change is a heuristic model that describes
a sequence of steps in successful behavior change
1. Precontemplation;
2. Contemplation;
3. Preparation;
4. Action; and
5. Maintenance.

• The stages of change model can be used both to
help understand why people at high-risk for
diabetes might not be ready to attempt
behavioral change, and to improve the success of
health counseling.
• Another application of the stages of change
model in organizations and communities
involves conceptualizing organizations along the
stages-of-change continuum according to their
leaders’ and members’ (i.e., employees’)
readiness for change.

Behavior Change Stages and Their Characteristics
Precontemplation No recognition of need for or interest in change (in the
next six months)
Contemplation Thinking about changing (in the next six months)
Preparation Planning for change (generally within the next month)
Action Adopting new habits (for at least six months)
Maintenance Ongoing practice of new, healthier behavior (over six
months and chances to return to old behavior are few)

People do not always move through the stages
of change in a linear manner – they often
recycle and repeat certain stages, for example
individuals may relapse and go back to an earlier
stage depending on their level of motivation and
self-efficacy.

Social Cognitive Theory
Social cognitive theory (SCT), the cognitive formulation of
social learning theory that has been best articulated by
Bandura, explains human behavior in terms of a three-
way, dynamic, reciprocal model in which personal factors,
environmental influences, and behavior continually
interact (See Figure 3). SCT synthesizes concepts and
processes from cognitive, behavioristic, and emotional
models of behavior change, so it can be readily applied to
counseling interventions for disease prevention and
management. A basic premise of SCT is that people learn
not only through their own experiences, but also by
observing the actions of others and the results of those
actions.

Key constructs of social cognitive theory that are
relevant to health behavior change interventions
include:
• Observational learning
• Reinforcement
• Self-control
• Self-efficacy

Learning through Observation
• Process of Observational Learning
• Once we “know” how a behavior should look and
remember the elements or steps, we still may not
perform it smoothly.
• In the production phase, practice makes the
behavior smoother and more expert.
• Motor Production Process
• We may acquire a new skill or behavior through
observation, but we may not perform that
behavior until there is some motivation or
incentive to do so.

Learning through Observation
Reinforcement in Observational Learning
• is learning by observing others.
• if people can learn by watching, they must be
focusing their attention, constructing images,
remembering, analyzing, and making decisions that
affect learning.
Vicarious Reinforcement
Example:
A child who sees a sibling being spanked for a
misdemeanor quickly learns not to do the same
thing.

Social Cognitive Theory Social
Cognitive Theory ,key constructs
• Self-efficacy, or a person’s confidence in his or
her ability to take action and to persist in that
action despite obstacles or challenges,
• Is especially important for influencing health
behavior change efforts.

Reciprocal Determinism
The key Social Cognitive Theory construct of
reciprocal determinism means that a person can
be both an agent for change and a responder to
change. Thus, changes in the environment, the
examples of role models, and reinforcements
can be used to promote healthier behavior.

Social Ecological Model
The social ecological model helps to understand factors
affecting behavior and also provides guidance for
developing successful programs through social
environments. Social ecological models emphasize
multiple levels of influence (such as individual,
interpersonal, organizational, community and public
policy) and the idea that behaviors both shape and are
shaped by the social environment. The principles of
social ecological models are consistent with social
cognitive theory concepts which suggest that creating
an environment conducive to change is important to
making it easier to adopt healthy behaviors.

Change• Motivation
– Wanting to change is important to begin the change
process
• Must be combined with common sense, commitment and
realistic understanding of the process
• Rewards or incentives can be good tools for motivation to
change

Change
• Beliefs and attitudes
– Belief : appraisal of the relationship between some
object, action, or idea and some attribute of that
object, action or idea
• May develop from direct experience (you experience
health changes from behavior), or indirect experience
(someone you know experienced changes)
– Attitude: relatively stable set of beliefs, feelings, and
behavioral tendencies in relation to someone or
something

Figure 1.3 Factors That Influence Behavior-
Change Decisions
Figure 1.3

• Skills : The ability to do
something well, arising from
talent, training, or practice.
• Belief : Acceptance of or
confidence in an alleged fact or
body of facts as true or right
without positive knowledge or
proof; a perceived truth.

Attitude: Manner, disposition, feeling,
or position toward a person or thing.
Values: Ideas, ideals, customs that
arouse an emotional response for or
against them.

Planning
is the process of making
thoughtful and systematic
decisions about
what needs to be done,
how it has to be done,
by whom, and
 with what resources.
Planning is central to health education
and health promotion activities

• If you do not have a plan, it will not be
clear to you how and when you are going
to carry out necessary tasks.

Health Belief Model
INDIVIDUAL PERCEPTIONS MODIFYING FACTORS
LIKELIHOOD OF ACTION
Demographic
Variables
Socio-psychological
Variables
Perceived
susceptibility
Perceived severity
Perceived benefits
of
preventive
action
Perceived barriers
to prevent action
Perceived
threat
Likelihood of taking
recommended
preventive health
action
Cues to Action
Information
Reminders
Persuasive
communications
Experience

• This process
involves
exposing people
to fear-invoking
objects or
situations
intensely and
rapidly.

Categories of Belief
• Perceived Seriousness
• Perceived Susceptibility
• Perceived Benefits
• Perceived Barriers

Seriousness
• Relative severity
of the health
problem.
– e.g.
Seriousness of
hepatitis
encourages
individuals to
get the
hepatitis
vaccine.
Susceptibility
• Nature and
intensity of
perceptions
affect willingness
to take
preventive
action.

Benefits
• Anticipated value of
the recommended
course of action.
• Must believe
recommended
health action will
do good if they are
to comply.
Barriers
• Perception of
negative
consequences
• Greatest predictive
value of whether
behavior will be
practiced.

Stages of Change
• Pre-contemplation
• Contemplation(inspection, observation, survey etc.)
• Preparation
• Action
• Maintenance

Pre-contemplation
• Definition
– Not considering changing their
behavior
– Lack of awareness
• Intervention Approach
– Novel information
– Persuasive communications
– Experiences

Contemplation
• Definition
– Person is beginning to consider
behavior change
– Important stage of information
acquisition
– Motivated by role modeling and
persuasive communications
– Receptive to planned or incidental
learning experiences.

Preparation
• Definition
– Deciding to change by preparing and
experimenting.
– Psychological preparation of trying on or
visualizing new behaviors and sharing the
idea with others. Deciding to change.
– How-to get information, skill development,
attitude change

Action
• Definition
– Actually trying the new behavior
– Skill
– Reinforcement
– Support
– Self-management
– Attitude and attribution change

Self-Directed Behavior
Modification Project
Modified from:09-19-06
Reference: Watson, D. L. & Tharp, R. G. (1997) Self-directed behavior:
Self-modification for personal adjustment (7th ed.). Pacific Grove, CA:
Brooks/Cole.

• Specific behavior to be changed (concrete and
observable)
• Specific situations in which the behavior
occurs
• Choose a behavior that you are motivated to
change.
• Short-term vs. long-term goals
Identifying the Target Behavior

1. Make a list of concrete examples.
2. List the details of your problem.
3. Become an observer of yourself.
4. Your strategy should always be to increase
some desirable behavior.
Specifying Behaviors in Situations

My goal is _________________
(what you want to do)
when_____________________.
(the situation)
When you’re not doing what you want to
be doing…

• I want to quit goofing off and study more;
or
• I want to increase studying in those
situations in which I should study.
When the problem is getting rid of
some undesirable behavior…

5. Specify the chain of events that will lead to
your goal.
6. Observe other people who are successful at
what you are trying to do, and then try their
tactics yourself.
7. Think of alternative solutions.
Specifying Behaviors in Situations

• Expect mistakes.
• Don’t blame mistakes on your personality.
• Prepare for temptations.
Anticipating Obstacles

• Antecedents
• Behavior
• Consequences
Observing your Behavior: Structured
Diaries

Antecedents Behaviors –
actions, thoughts,
or emotions
Consequences
When did it happen?
Whom were you with?
What were you doing?
Where were you?
What were you saying
to yourself?
What thoughts were
you having?
What feelings were
you having?
What were you
saying to yourself?
What thoughts did
you have?
What feelings were
you having?
What actions were
you performing?
What happened as a
result?
Was it pleasant or
unpleasant?

Antecedents Behaviors Consequences
Waiting for the bus
Sitting in class
Lying in bed thinking
Reading
Stressed
Nail biting
Nail biting
Nail biting
Nail biting
Nail biting
Embarrassed that others
might see
Same
Just wish I would quit
Same
Gives me something to do

Antecedents Behaviors – Consequences
April 3. Saturday
morning at breakfast.
Kids argued a lot.
April 6. Came home
from work feeling
tired. My boy talked
back to me.
April 10. Had an
argument with my
wife. Then in the car
the kids started
quarreling.
I spanked both of
them.
Started to spank
him but stopped.
Grounded him for
an hour instead.
Spanked them –
actually slapped
them.
Made them even more
cross.
Felt pretty good about
that. Was glad I didn’t
hit him. He calmed
down while he was
grounded.
It spoiled our whole
outing. I felt guilty.
They felt rotten.

Antecedents Behaviors Consequences
feeling stressed
spankingfeeling bad
kids’ misbehavior
substitute
kids’ misbehaviorpunishmentfeeling good
(no spanking)
But if instead:

• Number of cookies per day
• Number of text messages per day
• Minutes studying per day
• Number of days jogging per week
• Number of times biting nails per day
• Hours slept per night
• Money spent on junk food per day
Simple counting: Frequency or
duration

1. Do the counting when the behavior
occurs, not later.
2. Be accurate and strict in your counting.
Try to include all instances of the
behavior.
3. Keep written records.
4. Keep the recording system as simple as
possible. Try to fit it into your usual
habits.
Four rules for self-observation

• Throughout life, regulation by others and
the self (particularly through verbal
instructions) acts as a powerful guide to
behavior.
• Operant behavior is a function of its
consequences.
• A positive reinforcer is a consequence that
maintains and strengthens behavior by its
added presence.
Principles of Self-Regulation

• A negative reinforcer is a consequence
that strengthens behavior by being
subtracted from the situation.
• Behavior that is punished will occur less
often.
• An act that was reinforced but no longer is
will begin to weaken.
• Intermittent reinforcement increases
resistance to extinction.

• Most operant behavior is eventually
guided by antecedent stimuli, or cues, the
most important of which are often self-
directed statements.
• An antecedent can be a cue or signal that
an unpleasant event may be imminent.
This is likely to produce avoidance
behavior.

• Through conditioning, antecedents come
to elicit automatic reactions that are often
emotional.
• Many behaviors are learned by observing
someone else (a model) perform the
actions, which are then imitated.

• What stimuli seem to control the behavior? In
what situations does the behavior occur?
• Do you react automatically to some cue with
undesirable behavior?
• Do you react to some cue with an unwanted
emotion? What is the conditioned stimulus for
it?
• What are you saying to yourself before the
behavior?
Antecedents

•Is it strong and quite frequent, or is it weak and
not very frequent?
•Is any element of your problem due to something
you are avoiding, perhaps unnecessarily?
•Are you aware of models in your past whose
behavior you may have copied?
•Is the behavior resistant to extinction either
because it is intermittently reinforced or because
it is an avoidance behavior?
Behavior

• Are your desired behaviors positively reinforced?
• What actions make the desired behavior difficult?
Are they reinforced?
• Is it possible that the desired behavior is being
punished?
• Is your own self-speech rewarding or punishing
your behavior?
• Are the consequences for some behaviors difficult
to identify, perhaps because of intermittent
reinforcement?
Consequences

• Rules that state the techniques to use in
specific situations
• Goals and subgoals
• Feedback about your behavior based on
your self-observations
• A comparison of the feedback to your goals
to see if you are progressing
• Adjustments in the plan as conditions
change
Features of a good plan

Human behavior and health

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