Psychological health and meaningful action: what next for all of us?

Let’s unpack this with a whistle-stop tour of how different psychological schools of thought have approached intentions and actions. In the first half of the 20th century, behavioural scientists wanted psychology to sit firmly on scientific ground, so decided to limit themselves to studying what could be measured and observed. This led, among those who wished to view psychology as a science, a casting off of the internal world of memory, dreams, and imagination that had been the forefront of the psychoanalytic thinking that had come before.

Instead, there was a focus on observable stimuli and responses. What goes in and what comes out, with the black box of the mind being seen as the domain of philosophy, art, and literature.

Behavioural studies of conditioned learning with a focus on Antecedents Behaviours and Consequences still form the basis of many interventions today.

Can you think of aspects of this pandemic where such approaches were used?

But, with the invention of the first IBM processor came a new computer metaphor for the mind that allowed for some ‘opening up’ of the black box. Cognitive theories arising during this period posited at centre a logical and rational mind that makes reasoned actions in a step-by-step manner, like a computer.

The theory of planned behaviour posited that to understand behaviour we need to look at:

• Attitude: Do we view lockdown as something we agree with?
• Subjective norm: Is social isolation something acceptable socially?
• Perceived control: Do we have control over whether we self-isolate?

Another model commonly drawn upon in the field of habit change, such as alcohol and drug misuse, is the stages of change model, where we move from pre-contemplation to contemplation, through to serious determination, action, and maintenance, while trying to avoid relapse.

When it comes to behaviours such as addiction we may not feel like we have control, and we can swing between different stages of motivation for reasons that are difficult to predict and which get at our embodied experiences and drives. This highlights the important challenge of trying to reliably factor in those basic internal drives that had been the mainstay of psychoanalytic therapy. We are driven by core needs and motivations: hunger, thirst, panic, rage, desire for connection. We experience envy, we make social comparisons, we want to feel safe, secure, soothed, we want to achieve and to create things.

Researchers and clinicians began to ask how they could start to include these factors when thinking about intentions and actions. No matter how well-intentioned we are, if the intended change in behaviour does not account for the pulls of these more fundamental or evolved aspects of our human nature we may struggle to maintain it.

As we learned more about the human mind and brain, we were afforded the opportunity to revisit the world of experiences, memories, intentions, goals, and values under more measurable footing.

Recently when thinking about behaviour change implementation science, researchers have drawn on the COM-B model, according to which Capability, Opportunity, and Motivation inform Behaviour:

• Capability: having the necessary knowledge and skills
• Opportunity: all the factors that lie outside the individual in the environment
• Motivation: brain processes that energise and direct behaviour

Notice how this points to the importance of the environment as not just as something we want to act upon, but as something which can act upon us, as well as to the importance of how habitual processes and emotions can affect motivation. We’ll look at these factors in more detail when thinking about Carol’s hope to make a change in a healthcare setting.

Implicit in these models but sometimes understated is the centrality of relationships, for guiding motivation and affording opportunities. When we think about the idea of what might motivate someone, role models and sources of support are key. In therapy settings, this relationship is made explicit. We’ll draw on the centrality of relationships when formulating what next for Kevin.

Excitingly, with modern advances in affective and cognitive neuroscience, and large scale studies into psychoanalytic and cognitive behavioural therapy, the world of measurable, observable behaviours, and the internal world of symbols, memories, and emotions are beginning to be brought together.

In the coming step, we’ll think about what next for COVID-19 patients, Dr. Rogers will talk us through a recent review and we’ll use this to think about getting access to reliable knowledge as a starting place to informed action.