Group of people out on morning walk

Understanding behaviour from a clinical perspective

Health care, especially from a Lifestyle Medicine perspective, is fundamentally about modifying behaviours to enhance health and wellbeing. Our understanding of what behaviour is informs our approach to behaviour modification, the strategies, and skills we employ. As a Developmental and Behavioural Paediatrician, I see children whose behaviours are construed as challenging and difficult relative to societal norms. In this context, neurodivergence (i.e., neurodevelopmental variance) is a framework that usually takes precedence. However, it is important to understand that behaviour is multidimensional and modulated by an interplay between intrinsic and extrinsic factors.

What is behaviour?

Behaviour may be simply defined as actions (observable manifestations) that occur in response to a stimulus. Why then can the same stimuli elicit different behaviours in different people, or elicit different behaviours in the same person in different environmental contexts? Behaviour is often intertwined with emotional regulation (or lack thereof) which is governed by neurohormonal and psychophysiological processes1. However, even at the level of brain structural, the neural pathways are interconnected and functionally interdependent i.e., functional specificity is relative2. Behaviour encompasses personal experiences and sociocultural context in which the behaviour occurs, the mental (inner) state of the proponent, and their neurobiological or genetic influences3.

Behaviour that is goal-directed is what is considered ‘appropriate’; appropriate behaviour is ‘situationally functional’4. In the past, appropriate patient behaviour in health care settings was limited to compliance and adherence to treatment. We now value the patient’s role and their power in managing and directing their own health and wellbeing. Our patients and clients can take personal responsibility for their health (lifestyle) choices because the volitional down-regulation of automatic neurohormonal pathways is possible4. However, we must realise there may be multiple intrinsic and extrinsic factors that enable or inhibit progress and need to be also addressed.

Behaviour in clinical practice

It is counter to our aims as health practitioners to hold singular constructs and work in silos, as is often the case. Much of the existing clinical and scientific research had been conducted with the aim of identifying and modifying single correlates of behaviour, often based on the presumption that there is linear causal relationship. Practitioners with limited exposure to multiple perspectives can become entrenched in a singular approach e.g., attributing behaviours to trauma (or Adverse Childhood Experiences), genetics or neurobiology alone, without giving due (and equal) consideration to all the other factors. This can limit the depth and breadth, and therefore the effectiveness, of the supports and therapies designed to assist people in modifying their behaviour. It behoves us to take a more multidisciplinary and transdiagnostic perspective of both what behaviour is and how we facilitate behaviour change3,4.

As behaviour change agents, we must not only endeavour to activate and enhance our patient or client’s volitional motivation (tap into their why) for behaviour change5, but also assist them in overcoming obstacles across multiple facets of their life (whole of person approach).

We can avoid becoming mired in the complexities by understanding that behaviour and its drivers are never as predictable or predetermined as some of the literature suggests. By modifying variables at any of the inflexion points of complexity, we can facilitate significant changes and make a lasting difference.

  1. Cicchetti, D., Ackerman, B., & Izard, C. (1995). Emotions and emotion regulation in developmental psychopathologyDevelopment and Psychopathology,7(1), 1-10. doi:10.1017/S0954579400006301
  2. Beauchaine TP, Constantino JN. Redefining the endophenotype concept to accommodate transdiagnostic vulnerabilities and etiological complexity. Biomark Med. 2017 Sep;11(9):769-780. doi: 10.2217/bmm-2017-0002. Epub 2017 Sep 11. PMID: 28891303; PMCID: PMC5771461.
  3. Popescu, Gabriela. (2014). Human Behavior, from Psychology to a Transdisciplinary Insight. Procedia – Social and Behavioral Sciences. 128. 10.1016/j.sbspro.2014.03.185.
  4. Beauchaine, T., & Cicchetti, D. (2019). Emotion dysregulation and emerging psychopathology: A transdiagnostic, transdisciplinary perspective. Development and Psychopathology,31(3), 799-804. doi:10.1017/S0954579419000671
  5. Achtziger, A., Gollwitzer, P.M. (2018). Motivation and Volition in the Course of Action. In: Heckhausen, J., Heckhausen, H. (eds) Motivation and Action. Springer, Cham.

This article has been written for the Australasian Society of Lifestyle Medicine (ASLM) by the documented original author. The views and opinions expressed in this article are solely those of the original author and do not necessarily represent the views and opinions of the ASLM or its Board.

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