Changing Health Behaviors With Experimental Medicine
How can some people simply walk away from cigarettes, while others struggle? A one-size-fits-all approach does not provide the optimal way for people to successfully quit smoking, start to exercise, or begin a diet. University of Minnesota psychology professor Alexander Rothman is moving beyond one-size-fits-all methods by developing fresh and individualized strategies to impact people’s health-related behaviors.
Rothman uses an approach called experimental medicine (EM), which is designed to identify strategies that will provide patients with the right set of tools necessary to influence their behaviors. Rothman and his colleagues recently published a paper in the Annual Review of Psychology that lays out the EM approach. “The approach rests on identifying the targets or mechanisms that guide behavior and then conducting a programmatic series of studies that develop techniques that are able to elicit change in those targets,” Rothman says.
Thus, this approach involves identifying two things: first, the desired target of the intervention; and second, an intervention strategy that is able to modify the target. The target, in this case, could be a new set of thoughts and feelings for the subject; the intervention is the method to alter those thoughts and feelings.
The next step consists of evaluating the conditions necessary for the intervention to reach its target as well as the conditions necessary for the intervention to produce the desired behavior. Rothman’s lab uses this approach to develop and test intervention strategies that help people initiate and maintain changes in their health behavior.
Rothman has used this approach to develop and test strategies across a range of health behaviors, typically collaborating with colleagues who have expertise in a specific health domain such as obesity, smoking, or some other health related problem. “I’m a little bit unusual in that I work across a wide range of problems,” Rothman says.
Despite its complexity, the approach Rothman and his collaborators are using isn’t all that different from the typical development of medications. “We’re asking the same questions but applying them to a different set of tools. Instead of asking about how a medication is administered or what its dosage should be, we’re asking how we should communicate information or provide guidance regarding your behavior. What needs to be done to make you feel capable or confident? Or make you feel optimistic about a new pattern of behavior?” Rothman asks.
Smoking Cessation Studies
Last year Rothman worked with Rachel Burns, a former graduate student who is now on the faculty at Carleton University, and other collaborators to identify which types of smokers benefit most from an extended smoking cessation program. Smokers who wanted to quit were assigned to either a traditional 8-week treatment program or a longitudinal treatment program in which care was available for up to a year.
Although smokers benefited from the longitudinal treatment program, this was particularly true for those who struggled to quit. For these smokers, the longitudinal treatment program worked to sustain or increase their satisfaction with their effort and confidence in their ability to quit. Both of these mental states increased their likelihood of successfully quitting smoking.
The next step, then, is to identify how best to structure the delivery of longitudinal care and to determine whether there are specific groups of smokers who would benefit from a particular structure of the program. Rothman’s current project seeks to provide data to help answer this question. Working in collaboration with colleagues in the University of Minnesota’s Academic Health Center and Minneapolis VA Medical Center and funded by a grant from the National Cancer Institute, Rothman and collaborators plan to systematically test different ways of structuring smoking cessation treatments for a group of smokers who choose to participate in a lung cancer screening program.
All of the participants in this study will start with the current state-of-the-art program, involving phone counseling and over-the-counter nicotine replacement products. After a period of time, the researchers will systematically adjust the treatment strategies in response to how well people are responding to the initial treatment. This method allows the research team to test different levels of intervention for different people based on which interventions already work or do not work for them.
“What we really want to figure out is what is the right dose and structure of the treatment program for a given person. Who needs only a few calls and some supporting materials and who needs access to a full year of support? We need to figure out the optimal dose of the necessary treatment in order to enable people to succeed,” Rothman says.
By developing a more systematic understanding of who needs what, Rothman and his team can provide information that practitioners need to offer the best interventions, in just the right doses.