Behaviour change is a complex and multifaceted process that is often central to improving the health and well-being of individuals. However, it is riddled with challenges that can impede progress[1]. This article explores the difficulties of behaviour change and highlights the benefits of the “meaning response” as a valuable tool in facilitating change. Additionally, it offers key tips for healthcare professionals to effectively apply the meaning response to enhance behaviour change outcomes.
Behaviour change is at the core of many health and lifestyle interventions and strategies aimed at improving the well-being and quality of life for individuals. Whether it’s encouraging people to quit smoking, adopt a healthier diet, exercise more, or adhere to medication or food supplement regimens, the ability to modify behaviour is crucial. However, behaviour change is inherently challenging and multifaceted, as it involves altering ingrained habits, beliefs, and social dynamics.
In many ways, an ideal behaviour change intervention is one that provides the individual with all the necessary tools to make the decision that is best for them but ultimately allows them to make their own choice. Interestingly, this notion is in line with Socrates’ view, asserted in the Protagoras, that no person does evil except out of ignorance[2].
The meaning response, also known as the placebo response, represents the psychological and physiological changes that occur when an individual’s beliefs and expectations influence their health and behaviour. Understanding and harnessing the meaning response can be a valuable tool for healthcare professionals in promoting behaviour change[3].
Psychological Barriers
Behaviour change often faces significant psychological barriers. People may resist change due to fear of the unknown, perceived loss of control, or concerns about failure. Additionally, cognitive biases, such as confirmation bias and the status quo bias, can reinforce existing habits and deter individuals from adopting new, healthier behaviours.
Social and Environmental Factors
Social and environmental factors can be powerful determinants of behaviour. Peer pressure, societal norms, and the availability of unhealthy options in the environment can hinder efforts to change. Social support, or lack thereof, plays a significant role in shaping an individual’s ability to overcome these external barriers.
Motivation and Self-Efficacy
Motivation is a crucial factor in behaviour change. Often, individuals struggle to find the internal drive needed to initiate and sustain change. Self-efficacy, or the belief in one’s ability to successfully change, can be another major hurdle. A lack of confidence in one’s ability to manage a chronic illness resolution plan can hinder progress.
Information Overload
In the age of the internet and information abundance, people are often overwhelmed by conflicting advice and recommendations. This information overload can lead to confusion and a sense of helplessness, making it challenging to identify the best course of action. This paper demonstrates that patients do not uphold one consistent stance on a healthcare practitioner’s right to advise behaviour change. Rather, the extent to which patients treat health care professional’s behaviour change advice as acceptable is largely determined by the way in which the physician frames the advice[4].
Habit Formation and Maintenance
Behaviours are often deeply ingrained as habits. Breaking these habits and establishing new ones requires time and effort. The transition from conscious effort to automatic behaviour can be a protracted process, leading to relapses and setbacks.
The Power of the Meaning Response
Is There a Phenomenon?
Is there a response, which is not accounted for by regression to the mean (statistical artefact), natural history (people recovering over time), the Hawthorne effect (subjects behaving a certain way because they are being observed)?
Let us begin with what we know: for a wide range of medical conditions, the administering of a sham intervention—a biochemically inert dummy pill, or a sham surgical intervention—elicits medically significant recovery or relief from symptoms, recovery or relief that cannot be explained away as instances of regression to the mean, natural history, or the Hawthorne effect. We know it is not something smuggled in, so it is something else. Furthermore, for many medical interventions, where a pharmacologically active or surgical intervention is made, we know that success rates are often only explainable by reference to more than the pharmacology or the surgery; put slightly differently, medical treatment cannot simply be reduced to biochemistry and surgery.
The Role of Belief and Expectation
The well-known, but inaccurate term ‘placebo effect’ demonstrates the power of belief and expectation in shaping health outcomes. Placebos per se cannot cause the ‘placebo effect’ – by definition placebos are inert. It is the response of the subject to the placebo that determines the result, implying there is some interpretation of the placebo that propels the beneficial outcome. Moerman calls this effect of the conveyed meaning embodied in the placebo as the “meaning response”[5].
When individuals believe they are receiving an effective treatment, their bodies often respond with physiological changes, including the release of endorphins, activation of the body’s natural healing mechanisms, and reduced perception of pain or discomfort.
Harnessing the Meaning Response for Behaviour Change
The principles underlying the meaning response can be harnessed to facilitate behaviour change. Healthcare professionals can use the power of belief and expectation to motivate and support individuals in making positive health-related changes. This approach focuses on the psychological aspects of behaviour change, acknowledging that the mind has a profound impact on the body.
Key Tips for Healthcare Professionals
Provision of a plausible treatment rationale, including assumed and empirically supported unique and common mechanisms of action, rationale and related lifestyle change, meets the legal and moral demands of informed consent[6]. On the other hand, a plausible treatment rationale is all the more important because “clinical experience and an accumulating body of research suggests that clients who enthusiastically buy into a lifestyle treatment rationale show more favourable outcomes”.
Build Trust and Rapport
Trust is essential for the meaning response to work effectively. Healthcare professionals should prioritise building a strong therapeutic and participatory relationship with their patients. When individuals trust their healthcare providers, their belief in the recommended supplements, or medications and lifestyle behaviour changes become more potent.
Provide Clear Information and Expectations
Effective communication is crucial. Healthcare professionals should provide clear, understandable information about the proposed supplements, nutrition guidelines, investigations, lifestyle and behaviour changes, potential benefits, and what to expect during the process. Setting realistic expectations and emphasising the role of the meaning response can empower individuals to act.
Foster Positive Beliefs
Healthcare providers should encourage patients to adopt positive beliefs about their ability to change. This involves boosting self-efficacy and emphasising the potential for improvement. Affirmations and motivational interviewing techniques can help individuals develop a strong belief in their capacity to change. Presenting the premise, that health recovery is a journey, which the healthcare professional will share with them, is a powerful component of participatory and personalised health care.
Utilise Rituals and Symbolism
Rituals and symbolic or repetitive but validated actions can amplify the meaning response. Healthcare professionals can help patients create rituals around behaviour changes, such as starting an exercise routine, avoiding or including foods, recognising negative behaviour traits, encouraging family support, or managing stress. These rituals and supported practices enhance the psychological impact of the changes.
Monitor Progress and Provide Feedback
Regular monitoring and feedback are essential to maintaining motivation and fostering the meaning response. Healthcare professionals can track progress, celebrate successes, and offer constructive feedback to address setbacks and obstacles. As technology improves, patient outcomes as N-of-1 studies will become an important part of developing clinical insights and applications.
Encourage Social Support
Social support is a powerful catalyst for behaviour change. Healthcare professionals should encourage patients to engage with supportive friends, family members, or support groups. The collective belief in the potential for change can magnify the meaning response.
Continually Adapt and Reframe
Behaviour change is not a linear process. It requires adaptation and reframing of goals and strategies as patients encounter challenges. Healthcare professionals should be flexible and responsive to individual needs, adapting the approach as necessary.
Conclusion
Behaviour change is a complex process riddled with challenges, but understanding and harnessing the meaning response can be a valuable tool for healthcare professionals. By leveraging the power of belief and expectation, healthcare providers can motivate and support individuals in making positive health-related changes. Through building trust, providing clear information, fostering positive beliefs, utilising rituals, and encouraging social support, healthcare professionals can enhance the meaning response and improve behaviour change outcomes, ultimately leading to better health and well-being for their patients.
References
[1] Pinho S, Sampaio R. Behaviour Change Interventions in Healthcare. Int J Environ Res Public Health. 2022 Jun 9;19(12):7055
[2] Project Gutenberg; 2008. [(accessed on 8 June 2022)]. Plato. Protagoras. Available online: https://www.gutenberg.org/ebooks/1591 [Google Scholar]
[3] Hutchinson P, Moerman DE. The Meaning Response, “Placebo,” and Methods. Perspect Biol Med. 2018;61(3):361-378.
[4] Bergen C. The conditional legitimacy of behavior change advice in primary care. Soc Sci Med. 2020 Jun;255:112985.
[5] Moerman DE. The Meaning Response and the Ethics of Avoiding Placebos. Evaluation & the Health Professions. 2002;25(4):399-409.
[6] “the physician has an ethical obligation to help the patient make choices from among the therapeutic alternatives consistent with good medical practice”
