You’re determined to lose weight. But as you drink your morning cappuccino, you start craving the croissant you usually have with it. Or at 5pm you find yourself thinking about the cold glass of beer you’d normally enjoy with colleagues after work. When it comes to the pull of short-term gratification versus the long-term goal of being 10kg lighter, short-term gratification often wins.
Jackie Andrade, professor in psychology at the University of Plymouth’s Institute of Health and Care Research, is working to find methods that will tip the scales in favour of long-term goals over short-term pleasures. Although her research focuses on losing weight, her pioneering techniques can apply to other behavioural changes, such as giving up alcohol or taking up exercise.
Andrade’s work in behavioural change has contributed to the university’s reputation for carrying out world-leading research that helps to shape policy, both nationally and regionally. The university’s focus is on interdisciplinary work and problem solving, so that it can improve the health and care of the populations it serves – both those who live in and around Plymouth and those in other rural, coastal and deprived communities all over the world.
It’s not surprising that its achievements have contributed to making the university a centre of excellence in psychological research, as well as the provider of the largest range of healthcare training in the south-west.
Making lifestyle changes, says Andrade, is “incredibly difficult”. The reason is that the behaviours we want to change are “usually interwoven with many aspects of our lives” – that morning croissant or after-work beer, for instance. Weight loss is particularly difficult to achieve because we all have to eat, and the act of eating reminds us of all the foods that we really enjoy – but when you’re dieting you’re having to deny yourself of these foods.
Andrade and two of her colleagues, Jon May, professor of psychology at the University of Plymouth, and David Kavanagh, professor at Queensland University of Technology, found that a craving was almost always accompanied by an act of imagination. “When I want a cup of coffee, I’m imagining which cup I’m going to have it in and what it will feel like in my hand, and what it will taste like, and how much more alert I’ll feel once I’ve had it,” says Andrade.
The team’s findings led to the development of the elaborated intrusion theory, whose central idea is that a particular desire for a substance only becomes powerful when you start to elaborate on it, by imagining how good it would feel to indulge.
Andrade and her colleagues put the theory to the test by stimulating cravings in research participants and asking how they felt. They found that their experiences involved a lot of mental imagery: they’d think about how a bar of chocolate looked, how it tasted, how it felt in the mouth.
It turned out it was possible to reduce the craving by asking the subjects to imagine something else. “Sometimes it’s as simple as asking them to imagine something different, like a rose garden or a train station,” Andrade says. “Doing that other imagery task leaves you unable to do the craving imagery, and as a result people’s reported levels of craving decreased.”
The next question was how to create cravings for healthy goals. The team’s answer was to develop a new coaching technique called functional imagery training (FIT). FIT is a way to strengthen people’s motivation by helping them create a “mental film” of how they will work towards their goal and how they will feel when they achieve it.
FIT begins with motivational interviewing, an existing technique that involves asking the person how they could achieve the change they want and helping them create a workable action plan. Andrade’s volunteers were encouraged to think about the pleasurable aspects of the change. “If you let people choose their own way of solving this problem, they choose things that hold some appeal for them,” says Andrade.
The second element amplifies that pleasure or appeal by helping the person imagine successfully taking steps towards their goal, using their chosen strategies. People are encouraged to practise this imagery until it becomes routine. The idea is to “scaffold your goals for the future to make those come to mind more vividly and more easily”.
A weight loss trial conducted by Andrade’s PhD student Linda Solbrig found that people using FIT lost five times more weight than those who received only the motivational interviewing intervention. Participants who received four hours of FIT – without any diet or exercise advice – lost 6kg over 12 months. The findings gained international publicity.
Andrade and her colleagues are now expanding the use of FIT, looking in particular at how it could be used to reduce anxiety and other mental health problems. In line with the university’s focus on using research for the benefit of the wider community, they are collaborating with a local charity, Devon Mind, to use FIT with its clients. They’re also working with the 29th Commando Regiment to use FIT to build resilience and motivation among recruits as a way of tackling the high dropout rate in training.
Once people have acquired the mental habit of using imagery, they can use it for any kind of behavioural change. Instead of telling people that their problem is that they are not informed well enough, Andrade would like to see policymakers “focus on building motivation and skills”. Separate clinics for weight loss or smoking cessation could be replaced by FIT as a single, universally applicable intervention. Once made, the changes tend to stick. As one of Andrade’s research volunteers said of his new gym habit: “I can look at myself and feel happy now. It was very surprising to me how quickly your mindset could change.”
Jackie Andrade is professor in psychology and recognised globally for her work in craving and behaviour change. She is the co-creator of Functional Imagery Training (FIT). Her contribution to the largest study of accidental waking during general anaesthetic transformed the understanding and practice in anaesthesia.
Read more about her research by visiting plymouth.ac.uk/plymouth-pioneers
