Edward P. Sarafino, PhD
Department of Psychology, College of New Jersey
Self-management refers to the application of behavioral and cognitive principles to change one’s own behavior by gaining control over conditions that encourage undesirable behaviors or discourage desirable ones. As such, self-management brings together many of the processes covered in this volume into a specifically targeted program of behavior change. This chapter provides a brief overview of these principles and processes, as well as ways that they can be used to create self-directed change. More detailed and extensive descriptions of self-management are available in books by Sarafino (2011) and Watson and Tharp (2014).
A self-management program focuses on changing a target behavior, which is the behavior that the person wants to change, and achieving a behavioral goal, which is the level of the target behavior the individual wants to reach. For example, for the target behavior of studying, a student might have the weekly behavioral goal of spending two hours in focused study for every hour of scheduled class time. By reaching the behavioral goal, the student is likely to achieve an important outcome goal, an intended abstracted or general result, such as improving the student’s grades. Often, people think of an outcome goal to achieve and then determine what the target behavior and behavioral goal should be to accomplish the desired outcome.
Some target behaviors involve a behavioral deficit. For example, the person may not perform the activity often enough, long enough, well enough, or strongly enough. Other target behaviors involve a behavioral excess, in which the activity is performed too frequently, too strongly, or for too long. For many people, physical exercise is a behavioral deficit and smoking cigarettes is a behavioral excess. A person is likely to achieve her behavioral goal if she has a high degree of self-efficacy, the belief that she can succeed at a specific activity she wants to do, such as changing a behavior in a self-management program.
Experience leads to learning and plays a critical role in the development of almost all traits and behaviors. Learning is a relatively permanent change in behavioral tendency that results from experience. There are two main types of learning (see chapter 6):
These types of learning can occur through direct experience or vicariously, such as by observing the learning experiences of other people—a process called modeling. When we see someone act afraid of snakes in a scary movie or see a plumber disassemble a faucet in our home, we may learn these behaviors through modeling. The learning process also establishes a behavior’s antecedents: cues that precede and set the occasion for the behavior. For instance, if we notice that we are hungry and see appealing food (the antecedents), we reach for it and eat it, which is an operant behavior. For respondent behaviors, the antecedent is the conditioned stimulus. As I will discuss in more detail below, the conditioned response often functions to produce a consequence in everyday life.
Behaviors that are firmly established tend to become habitual—that is, they are performed automatically and without awareness, as when we reach absentmindedly for a candy and put it in our mouth. Habitual behaviors become less dependent on the consequences—for example, the reinforcement they receive—and more dependent on the antecedent cues, such as noticing the candy out of the corner of our eyes. The behavior has been linked to this cue in the past. Antecedents can be overt—that is, open to or directly observable through our senses—or covert: internal and not open to observation. Negative emotions, such as anger or depression, can serve as covert antecedents, leading some people to buy things compulsively (Miltenberger et al., 2003). People often have more difficulty changing habitual behaviors, such as overeating or smoking cigarettes, than nonhabitual ones.
To modify a target behavior effectively, the behavior needs to be clearly defined in order to be measured accurately. Only by measuring the target behavior is it possible to determine whether it has changed. Casual observation of the behavior usually does not provide an accurate picture of the behavior’s occurrence.
To evaluate a self-management program, data must be collected on the behavior’s occurrence before and after the program. The data collected before trying to modify the target behavior is called baseline data; the term “baseline” also refers to the period of time during which those data are collected. The data collected when trying to modify the behavior is called intervention data; the term “intervention” also refers to the period of time during which those data are collected. Self-management programs generally include a baseline phase and an intervention phase, with data on the target behavior collected in each phase.
Because behavior can change in many ways, it is necessary to select the types of data that best reflect both the way you want the behavior to change and progress made toward the behavioral goal. Is the goal to modify how often the behavior occurs, how long it occurs, or how strongly it occurs? These measures form three types of data:
A less frequently used type of data in self-management is quality, or how well the target behavior is performed, such as playing a musical instrument or performing athletic skills. Sometimes it is useful and important to collect more than one type of data for a particular target behavior—for instance, you might design a self-management program to increase the frequency, duration, and magnitude of the physical exercise a client performs.
To assess changes in the target behavior, it is helpful to construct a graph—a drawing that depicts variations in the data—showing how one variable changes with another variable. A variable is a characteristic of people, objects, or events that can vary. The frequency, duration, and magnitude of a behavior are variables, and so is time. For self-management programs, the therapist creates a line graph with two axes: the horizontal (abscissa) line scales time, such as days, and the vertical (ordinate) line scales the target behavior’s occurrence. Baseline data are plotted on the left side across time, and intervention data are plotted across time to the right of baseline. If the intervention data show a substantial improvement in the target behavior over its level in baseline, this is a clear sign that the self-management program was successful. For example, in a self-management program to reduce cigarette smoking, the level of the graph in baseline for smoking frequency would be sharply higher than in intervention.
A functional assessment is a procedure that helps define the target behavior exactly and identifies connections between the behavior and its antecedents and consequences. The target behavior can be an operant behavior or a respondent behavior. In general, to carry out a functional assessment of a behavior, the client must observe and record each instance of the behavior and the antecedents and consequences she identifies. Several days of observation and record keeping will be needed before or overlapping with the baseline period. Using the information that is collected, the therapist can then determine how to alter the antecedents and consequences that have produced and maintained the behavior in the past. This plan will form the basis for the self-management program.
Behavior learned through operant conditioning follows a standard sequence: one or more antecedents lead to the behavior that produces one or more consequences. To change an operant behavior, the therapist must manage its antecedents and consequences.
One strategy for managing operant antecedents is to develop or apply new ones. When applying a new antecedent, the appropriate behavior needs to be reinforced when it occurs. Three methods for developing new antecedents are prompting, fading, and modeling. A prompt is a stimulus that is added to the desired or normal antecedent for an appropriate behavior, and prompting is a procedure that adds the prompt. The function of prompting is to remind a client to perform a behavior he already knows how to do or to help him perform one that he doesn’t do often or well enough. Some prompts involve physically guiding a behavior, such as grasping a client’s hand to help her apply the frosting design on a fancy cake. Other prompts are verbal, telling a client what to do or not do, such as a sign in the kitchen that says “no snacking.” And other prompts are pictorial or auditory, such as a photo of a client when he was slimmer or an alarm that reminds him to stop talking on the phone. Once the normal antecedents lead reliably to the desired behavior, the therapist can use fading, a procedure by which prompts are gradually removed. In modeling, people learn behaviors by watching someone else perform them.
Other methods to develop or apply new antecedents involve making environmental changes and using cognitive strategies. Because antecedents generally occur in the environment, desirable behavior can be encouraged by making environmental changes in three ways: first, by replacing the old environment with a new one (e.g., moving to a quieter location to study); second, by altering the availability of items that encourage undesirable behavior or discourage desirable behavior (e.g., removing cigarettes for someone trying to quit smoking); third, by narrowing, which is limiting the range of situations for an undesirable behavior, such as by limiting the places where or time of day when the behavior is allowed (e.g., reducing the amount of time spent watching TV by limiting the behavior to a specific place and time).
A cognitive strategy to apply as a new antecedent is self-instruction, which involves using a statement that helps a client perform a behavior or tells her how to perform it. A self-instruction is similar to a verbal prompt, only it is usually applied covertly. The instructions must be reasonable; a client telling herself that she can perform an impossible feat or that changing her behavior will have far-reaching effects on her life is not believable and will lead to failure.
To change operant behavior in self-management programs, two types of consequences—reinforcement and punishment—can be considered. Reinforcement can be classified as positive, which involves introducing or adding a stimulus after the behavior is performed, or negative, which involves reducing or removing an existing unpleasant circumstance if an appropriate behavior occurs. Reinforcement is most effective when it occurs immediately after the behavior rather than after a delay. To reduce a behavioral excess, extinction should be used when possible to decrease the likelihood and vigor of the target behavior. The technique of punishment can be used for reducing a behavioral excess, but it can have problematic side effects. Generally, positive reinforcement is the most commonly used and effective consequence in self-management programs and is the type on which I will focus.
When choosing positive reinforcers to apply for changing an operant behavior, it is important to use the ones that have a high level of reward value, the degree to which the reward is desirable. The greater the reward value, the more likely it will be to reinforce behavior (Trosclair-Lasserre, Lerman, Call, Addison, & Kodak, 2008). Two dimensions of a reinforcer that affect their reward value are quantity and quality. For example, when using candy as a reinforcer, a large amount and favorite flavor will be more effective than a small amount and merely acceptable flavor. A few types of positive reinforcers that therapists frequently apply in self-management programs include
Tokens have no reward value of their own; they become reinforcers by being associated with the backup reinforcers they can buy. They are useful in making reinforcement immediate, bridging the gap between behaving appropriately and getting the backup reinforcer. One way to select the reinforcers used in a self-management program is to have the client fill out a survey called the “preferred items and experiences questionnaire” (Sarafino & Graham, 2006). It is not advisable to use reinforcers that could work against the behavioral goal, such as using candy as a reward in a program to reduce caloric intake.
Once the reinforcers have been selected, the therapist has to plan how and when to apply them. In self-management programs, reinforcers are usually self-administered. This is convenient, but the reinforcer should not be too easily earned. If the person cannot objectively determine whether the behavior deserves a reward, other people may need to judge whether the reward has been earned. Whenever possible, the reinforcement should be administered immediately after the desired behavior occurs—the longer the delay, the less effective it is likely to be.
People learn emotional behaviors, such as avoidance behavior in response to fear, through direct or indirect respondent conditioning. The conditioning is direct when the conditioned stimulus (such as a dog) is paired with an unconditioned stimulus (such as growling and an attack by the dog); the conditioning is indirect when the learning is acquired through modeling, imagining it, or learning from others.
To start a self-management program, the therapist needs to construct a rating scale to assess the intensity of the emotional response. In addition, a functional assessment is needed to identify and describe the antecedents, behavior, and consequences (Emmelkamp, Bouman, & Scholing, 1992). The reason to identify the consequences of the emotional behavior is that respondent and operant conditioning usually occur together in real life—for instance, behaving in a fearful manner may lead to reinforcement, such as getting out of doing chores. The respondent behaviors can be managed by applying behavioral, affective, and cognitive methods.
Behavioral methods can be useful in a self-management program to reduce an emotional behavior. One method is extinction: presenting the conditioned stimulus (for example, a flying insect) without the unconditioned stimulus (stinging) and associated response (pain), thereby weakening the emotion (fear). Fearful people anticipate the possibility of a conditioned stimulus, such as insects that can sting, and avoid situations where these insects might be. As a result, extinction does not occur, and fear persists (Lovibond, Mitchell, Minard, Brady, & Menzies, 2009). A self-management program to reduce fear can discourage avoidance and encourage extinction of the behavior.
Another behavioral method that can reduce emotional behavior is systematic desensitization, in which conditioned stimuli are presented while the therapist encourages the person to relax (Wolpe, 1973). To carry out this procedure, the therapist needs to create a list of conditioned stimuli that can elicit various levels of fear (e.g., of stinging insects), and then arrange the list as a stimulus hierarchy—that is, the conditioned stimuli are rank ordered, from very mild to very strong, for the intensity of the fear they would elicit. An example of a mild stimulus might be seeing a bee perched on a railing five feet away outside a closed window. A strong stimulus might be standing in a small room with a bee flying around (in this example, the client has enough room to stay away from it). Systematic desensitization combines these exposures with relaxation exercises. For example, the therapist might first present the client with the mildest stimulus in the hierarchy and ask her to rate the intensity of her fear on a rating scale. This series of steps constitutes a “trial” in the procedure. The trial would then be conducted repeatedly until the rating is zero for two successive trials. Then, repeated trials would be performed with the next-strongest stimulus in the hierarchy until the rating is zero for two successive trials. This procedure would continue until all of the stimuli in the hierarchy have been addressed. Reducing a moderately strong fear is likely to take at least several sessions lasting between fifteen and thirty minutes each.
Relaxation techniques, including progressive muscle relaxation and meditation, can be useful for reducing emotional distress. In progressive muscle relaxation, the client may pay attention to bodily sensations while alternately tensing and relaxing specific muscle groups. For instance, the client might repeatedly tense and relax muscles in the arms, followed by muscles in the face, then shoulders, then stomach, and then legs; holding and releasing the breath can be included as well. In meditation sessions (see chapter 26), the client would contemplate or focus attention on an object, event, or idea. For example, he might focus attention on a meditation stimulus, such as a static visual object, spoken sound (a mantra), or his own breathing. After practicing the relaxation technique for many sessions and mastering it, the client can probably shorten the sessions; in meditation, he could simply quit earlier, and in progressive muscle relaxation, he might eliminate or combine certain muscle groups.
Cognitive methods, which modify one’s thoughts that serve as antecedents to emotional behavior (see chapter 21), can also be used to reduce emotions and beliefs in self-management programs. For instance, the client might think I can’t protect myself against a bee, which makes the fear stronger and more likely to occur. To combat this type of thinking, the therapist could instruct the client to make self-statements of two types. First, coping statements are declarations the client says to herself that emphasize her ability to tolerate unpleasant situations, such as “Relax, I’m in control because I can move away from the bee.” Second, reinterpretative statements are things the client says to herself that redefine the circumstance, such as by giving herself a reason to view it differently. For example, she might say, “The bee’s not interested in me and won’t be as long as I leave it alone.” Another cognitive method for reducing fear is distraction, such as shifting attention from a conditioned stimulus that elicits an emotional behavior to other overt or covert stimuli. For instance, if the client sees a bee while outside, she could shift her attention to a beautiful flower or tree.
To maximize the effectiveness of a self-management program, it should include methods to address the target behavior itself, its antecedents, and its consequences. The choice of methods to include in the plan will depend on the answers to two questions:
For example, positive reinforcement is an essential method to correct an operant behavioral deficit, and extinction and punishment would be useful in decreasing a behavioral excess. The results of the functional assessment should inform the final plan.
After selecting the techniques to apply, they should be designed to be most effective—for instance, choose reinforcers with high reward value, and make sure the client will not receive reinforcers he hasn’t earned. Also, make sure the criteria for reinforcement are neither too stringent, making it unlikely the client will earn enough of them, nor too easy, making it unlikely that his behavior will improve enough to reach the behavioral goal. Suggest that the client involve friends and family, if they want to help.
Prepare the materials needed to carry out the self-management program. You don’t want the client to run out of them in the middle of the process; this is especially important if the materials are reinforcers. In addition, it’s a good idea to formalize the plan in a behavioral contract, which spells out clearly the target behavior, the conditions in which it should or should not be performed, and the consequences for performing the behavior (Philips, 2005). Have the client write out the contract and sign it; if the client has chosen to enlist the aid of other people to carry out the plan, have the client describe their role in the contract, and then have them sign it, too.
Collecting data is an essential part of implementing a self-management program. Before trying to change the target behavior, baseline data must be collected so the client can see the starting level of the behavior and compare it with these levels after the intervention begins. Be sure to have clients record each instance of the behavior as soon as it happens; stress that if they wait until later, their memory of it won’t be as accurate. This means that clients must have recording materials on hand whenever the behavior could occur. If a client is trying to change a target behavior that occurs absentmindedly, such as cursing or nail-biting, have him devise a procedure that helps him remember to watch for the behavior and record the data. The client should plot the data in a graph during the baseline phase and continue doing so throughout the intervention. Check the graph during the intervention to see whether or not the client’s behavior has improved from baseline and continues to improve across the weeks of intervention. If the improvements are not as strong as you or client would like, examine the methods being used and try to make them stronger.
People who change their behavior sometimes revert back to their old way of behaving over time. This process starts with a lapse, an instance of backsliding, such as when a client who has succeeded at exercising regularly skips a day. The client can probably bounce back from a lapse if she knows that backsliding is common and should be expected. If the client doesn’t bounce back, a relapse may occur—the undesired behavior returns at its old level, such as not exercising at all. Many methods are available to maintain behavior changes. For example, the therapist can reintroduce parts of the intervention methods, such as prompts or reinforcers, or develop a buddy system in which the client and a friend or relative who has changed a similar behavior keep in touch and provide each other with encouragement and ideas for how to maintain the behavior.
Self-management describes methods that individuals can use themselves to increase desirable and decrease undesirable behaviors. These methods are rooted in behavioral and cognitive principles. The most common behavioral principles include classical conditioning, operant conditioning, shaping, and modeling; the most common cognitive principles include self-statements (such as coping and reinterpretative statements) and distraction. Carrying out a self-management plan requires the accurate and frequent assessment of the target behavior, a clear behavioral goal, and a functional assessment of the antecedent and consequences of the target behavior. Self-management programs should be an integral part of many, if not all, treatments of psychological problems.
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