Why behavior change is difficult to sustain

Abstract

Unhealthy behavior is responsible for much human disease, and a common goal of contemporary preventive medicine is therefore to encourage behavior change. However, while behavior change often seems easy in the short run, it can be difficult to sustain. This article provides a selective review of research from the basic learning and behavior laboratory that provides some insight into why. The research suggests that methods used to create behavior change (including extinction, counterconditioning, punishment, reinforcement of alternative behavior, and abstinence reinforcement) tend to inhibit, rather than erase, the original behavior. Importantly, the inhibition, and thus behavior change more generally, is often specific to the "context" in which it is learned. In support of this view, the article discusses a number of lapse and relapse phenomena that occur after behavior has been changed (renewal, spontaneous recovery, reinstatement, rapid reacquisition, and resurgence). The findings suggest that changing a behavior can be an inherently unstable and unsteady process; frequent lapses should be expected. In the long run, behavior-change therapies might benefit from paying attention to the context in which behavior change occurs.

Keywords: Behavior change; Behavioral inhibition; Context; Contingency management; Relapse.

Figure 1

Resurgence of extinguished operant behavior. Left to right, the top panels illustrate the rate at which subjects performed the target first behavior (L1 for Lever 1) during the acquisition phase, response elimination (extinction) phase, and the resurgence test phase (respectively). The bottom panels illustrate the rate of the replacement behavior (L2 for Lever 2) during the response elimination and resurgence testing phases. Groups that received 4 (Ext 4), 12 (Ext 12), or 36 (Ext 36) sessions of response elimination training showed reliable resurgence of L1 responding that did not differ significantly (upper right). From Winterbauer et al. (2013).

Figure 2

Resurgence of operant behavior that was suppressed by an abstinence contingency. Left to right, the top panels show the rate at which subjects performed the target first behavior (R1 for Response 1) during acquisition, response elimination (Extinction), and resurgence testing. The bottom panels illustrate the acquisition of the replacement behavior (R2) during response elimination and testing. The groups differed in their treatment during response elimination: Group Extinction received R1 extinction while R2 was reinforced; Group 45 s Negative Contingency was required to abstain from R1 for at least 45 s if an R2 response was to be reinforced; subjects in Group Yoked received reinforcement at the same points in time as a subject in the Negative Contingency group but without being required to abstain from R1. Note that the latter groups showed the same reduced, but not eliminated, resurgence (upper right). From Bouton and Schepers (2014).