Want to keep learning?

This content is taken from the Maudsley Learning & The Tavistock and Portman NHS Foundation Trust's online course, COVID-19: Psychological Impact, Wellbeing and Mental Health. Join the course to learn more.

Skip to 0 minutes and 1 secondHello, as Chris said, we're in the final week and we're starting to think about how to apply this learning beyond the course And that's by no means a straightforward task  and we need to be humble in the endeavour. We've all been there. We've all had a difficult weekend of cookies and crisps and cakes and got to Monday and thought "no more. I am a healthy person and I will fill my basket with healthy things" and it's all broccoli and spinach and fruit and that lasts till about Wednesday. Wednesday, we waiver. Thursday were eyeing up the cookies. Friday it's a different story.

Skip to 0 minutes and 33 secondsWe had an intention on Monday, driven by a motivation, and we had an intention on Friday driven by a motivation and we met them both. And, this is what makes bridging that gap between saying and doing difficult. And many of you will have reached the end of this course and may. have picked up some new learning or remembered some old learning and some of you may be thinking how to make space to mourn. Some of you may be thinking about how to see family more, or to make a change at work or, apply what you've heard here to some sort of other setting. That's a great place to be. What we're going to do this.

Skip to 1 minute and 15 secondsWeek is layout the ways in which implementation scientists, researchers, and therapists have explored that gap between saying and doing, intention and action, and we're going to look at how to make sure we're finding out useful information to guide our behaviours. The difference between, for example, hearing a story in the park and a newspaper article and a research study. Many of you have commented on how sensationalist and overwhelming news feeds can be. We're going to look at a range of different models that you may have heard of some, the Stages of Change model, the Combi Model, a Theory of Planned behaviour.

Skip to 2 minutes and 0 secondsSomething to listen out for as we go through these models is the difference between those that expect us to be logical and rational and reasonable. And those that also factor in ideas that go beyond this, we can use logic and reason, we certainly can, but we also have wishes and drives and messy emotions and they can conflict with one another. And all of this makes it very, very difficult.

Skip to 2 minutes and 34 secondsLook at the lock down period. Some very powerful people struggled to do what they were supposed to do so.

Skip to 2 minutes and 43 secondsApproaching this week, I think we require some humility and just some curiosity. We won't be endorsing or refuting any of the models will be laying them out for you to look at and think about and will be using the case stories as we hear the final Stages of Kevin and Carol's and Susan's journeys to illustrate some of the dilemmas  they face and what things they can keep in mind as they try to implement changes. We hope you get something from it and, as always, take care of yourselves as you go through the learning. Take care.

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.

Share this video:

This video is from the free online course:

COVID-19: Psychological Impact, Wellbeing and Mental Health

Maudsley Learning