Unlocking Human Potential: A Transformative Approach to Habit Formation Through Cue Utilization

Human behavior, a complex interplay of conscious and unconscious processes, is significantly shaped by habits – ingrained behavioral patterns triggered by specific internal or external cues. This analysis explores the scientific basis and practical application of habit modification, leveraging established behavioral models such as the habit loop and the Theory of Planned Behavior (TPB), to demonstrate how individuals can strategically manipulate cues to achieve personal transformation and desired outcomes. A core concept is the strategic manipulation of these cues, providing a powerful mechanism for behavior change and self-improvement. Key concepts discussed herein include the habit loop (comprising cue, routine, and reward), TPB (encompassing attitude, subjective norms, and perceived behavioral control), and operant conditioning principles (reinforcement and punishment). We will explore how these frameworks, grounded in neuroscience and behavioral psychology, can be applied to real-world situations.

Neurobiological Underpinnings of Habit Formation and the Habit Loop

Habit formation is deeply rooted in neuroplasticity, the brain’s capacity to reorganize neural pathways through repeated experiences. The consistent repetition of a behavior, triggered by a specific cue, strengthens associated neural connections, effectively automating the response. This process is significantly influenced by the brain’s reward system, particularly dopaminergic pathways, which reinforce behaviors associated with positive outcomes. The habit loop model provides a useful framework, positing that habits are comprised of three interconnected elements: a cue (the trigger), a routine (the behavior itself), and a reward (the reinforcing consequence). Understanding this neurobiological mechanism allows for targeted manipulation of environmental cues and reward systems, cultivating desired behaviors and weakening undesirable ones. The TPB further elucidates this process by highlighting that an individual’s intention to act is influenced by their attitude toward the behavior, social pressure (subjective norms), and perceived self-efficacy (perceived behavioral control). The interplay of these factors significantly impacts the likelihood of successful habit change.

Analyzing Real-World Habit Cues: A Case Study Approach

Consider these illustrative scenarios: A student consistently studies at the library (environmental cue) because the quiet atmosphere enhances concentration (reward), resulting in academic success. In contrast, an individual experiencing stress (internal cue) engages in emotional eating (routine) as a coping mechanism, providing temporary relief from negative feelings (reward). These examples highlight the critical role of both external and internal cues in triggering habitual behaviors, emphasizing the necessity of identifying and addressing both types of cues for effective habit modification. Successful interventions necessitate a personalized approach, recognizing the unique cue-behavior relationships within each individual. This individualized approach is crucial for maximizing the efficacy of behavior change programs.

Strategic Cue Utilization for Positive Behavior Change: A Multifaceted Approach

Several evidence-based strategies facilitate the proactive manipulation of habit cues to promote positive transformation:

1. Comprehensive Cue Identification and Analysis: Employing self-monitoring techniques, like detailed journaling or habit trackers, allows for the identification of cues linked to both positive and negative habits. This detailed analysis, potentially guided by a therapist or coach, facilitates the development of targeted interventions. The process involves self-reflection and careful observation of one’s own behavioral patterns.
2. Strategic Environmental Restructuring: Modifying the environment to minimize exposure to negative cues and maximize positive ones is essential. This might involve removing tempting foods from the home, creating a dedicated workspace, or using technology to block distracting websites. The goal is to optimize the environment to support desired behaviors.
3. Emotional Regulation and Cognitive Restructuring: Addressing the emotional drivers of habits is crucial. Mindfulness-based stress reduction, Cognitive Behavioral Therapy (CBT), and Dialectical Behavior Therapy (DBT) provide tools for managing emotional responses to cues, reducing the likelihood of engaging in maladaptive behaviors. Cognitive restructuring, a key CBT component, helps individuals challenge and replace negative or irrational thoughts that contribute to undesirable behaviors.
4. Habit Stacking and Chaining: Integrating new habits into existing routines (habit stacking) uses established behaviors as cues for new actions. For example, incorporating a brief exercise routine after a morning shower leverages the shower as a cue for exercise. Habit chaining involves linking multiple behaviors, creating a complex sequence. This approach draws on operant conditioning principles, enhancing adherence by associating new behaviors with established ones.
5. Reinforcement and Reward Systems: Consistent positive reinforcement strengthens desired behaviors. Self-reward systems, social support (accountability partners), and intrinsic satisfaction derived from goal achievement contribute to habit maintenance. The principles of operant conditioning, including positive reinforcement and shaping (gradually reinforcing closer approximations of the desired behavior), are vital for effective habit consolidation.

The Holistic Impact of Positive Habit Modification: A Synergistic Effect

The positive effects of successful habit modification extend beyond individual behaviors, impacting various aspects of well-being. Improved sleep hygiene, for instance, can enhance cognitive function, mood regulation, and productivity, creating a synergistic effect across multiple life domains. The cumulative impact of positive changes fosters holistic wellness, enhancing physical and mental health outcomes. This holistic perspective underscores the interconnectedness of lifestyle factors and their cumulative influence on overall health and well-being.

Conclusion and Recommendations: A Path Forward

Mastering habit formation through strategic cue utilization empowers individuals to achieve lasting positive change. This necessitates a multifaceted approach integrating self-awareness, environmental modifications, emotional regulation techniques, and strategic reinforcement methods. Future research should focus on developing personalized interventions, potentially leveraging technology advancements in behavioral tracking and AI-powered personalized feedback to optimize the effectiveness of habit-change strategies. The broader societal implication is a significant enhancement of individual well-being and productivity, contributing to a healthier and more productive society. Successful widespread adoption hinges on the development of user-friendly tools and accessible resources supporting individuals in their habit-change journeys. Crucially, culturally sensitive interventions that account for diverse beliefs, values, and societal norms are necessary to ensure equitable access to these strategies.

Reader Pool: Considering the ethical implications of influencing behavior through cue manipulation and the potential for misuse of these techniques, what safeguards and ethical guidelines should be implemented to ensure responsible application of habit-formation strategies?

Cultivating Gratitude: A Path to Enhanced Well-being

Contemporary society, characterized by pervasive stress and rapid societal change, often overshadows the subtle yet profound benefits inherent in daily life. This article examines the transformative impact of cultivating daily gratitude, defined as the conscious appreciation of one’s possessions and experiences. We will analyze its application through established psychological frameworks, including Positive Psychology’s emphasis on well-being and the principles of mindfulness. The exploration will encompass the multifaceted ways regular gratitude practices enhance well-being and provide practical strategies for integrating this practice into daily routines. Key concepts such as the broaden-and-build theory, hedonic and eudaimonic well-being models, attachment theory, and mindfulness-based stress reduction will be utilized throughout the discussion.

1. The Physiological and Psychological Correlates of Gratitude: A substantial body of research demonstrates a powerful bidirectional relationship between gratitude and both psychological and physiological well-being. The practice of gratitude significantly reduces levels of cortisol, a key stress hormone, leading to improved sleep quality and enhanced immune system function (as supported by the extensive research on psychoneuroimmunology). Furthermore, consistent with the hedonic and eudaimonic models of well-being, gratitude positively correlates with increased subjective well-being, life satisfaction, and overall happiness. This enhanced psychological state translates into improved resilience, coping mechanisms, and a greater capacity to navigate life’s challenges. The broaden-and-build theory further elucidates how positive emotions, such as gratitude, expand an individual’s cognitive resources and facilitate the building of personal resources, fostering a positive feedback loop of well-being.
2. Gratitude and Cognitive Reappraisal: The practice of gratitude acts as a cognitive restructuring technique, prompting a shift in perspective from perceived deficits to existing strengths. This process, consistent with Cognitive Behavioral Therapy (CBT) principles, reframes negative thought patterns by redirecting focus from what is lacking to what is present. For example, rather than dwelling on a missed opportunity, an individual might focus on existing skills, support systems, or future possibilities. This positive reframing mitigates the impact of negativity bias, promoting emotional regulation and psychological resilience.
3. The Enhancement of Interpersonal Relationships through Expressed Gratitude: Expressing gratitude fosters stronger interpersonal relationships by strengthening feelings of connection, appreciation, and mutual respect. This aligns with attachment theory, emphasizing the importance of secure attachments built on positive interactions and reciprocal emotional support. Explicit expressions of gratitude—such as verbal acknowledgements, written notes, or thoughtful gestures—strengthen bonds within families, work teams, and other social contexts. The demonstrable effect is increased collaboration, reduced interpersonal conflict, and a greater sense of belonging and social support.
4. The Synergistic Relationship Between Gratitude and Mindfulness: Gratitude acts as a potent facilitator of mindfulness. By consciously focusing on aspects of life worthy of appreciation, individuals cultivate present moment awareness, fostering deeper appreciation of their surroundings and experiences. This integrates with mindfulness-based stress reduction techniques, reducing rumination and promoting emotional regulation. The enhanced awareness facilitates a deeper understanding of one’s internal state and the external environment, ultimately contributing to emotional balance and overall well-being.

Effective strategies for cultivating daily gratitude include:

1. Structured Gratitude Practices: Implementing structured practices, such as maintaining a gratitude journal, conducting morning gratitude rituals, or engaging in gratitude meditations, creates consistent opportunities for conscious appreciation. These intentional practices reinforce positive emotions and promote mindful engagement with the present moment.
2. Expressing and Sharing Gratitude: Actively expressing gratitude to others, whether verbally, in writing, or through thoughtful actions, fosters stronger interpersonal connections and reciprocal positive emotions. This reinforces one’s own sense of gratitude and strengthens social bonds.
3. Incorporating Gratitude into Daily Routines: Integrating gratitude into everyday activities—such as appreciating a pleasant interaction, acknowledging personal achievements, or connecting with nature—provides continuous opportunities for reinforcing positive feelings and enhancing well-being. This effortless integration makes gratitude a sustainable and pervasive aspect of life.
4. Utilizing Gratitude as a Coping Mechanism: During challenging periods, cultivating gratitude provides a resilience-building strategy. Focusing on remaining positive aspects shifts focus from negativity, promoting hope and enhancing emotional regulation even amidst adversity. This cognitive reframing contributes to greater control and perspective during difficult times.
5. Community Engagement and Collective Gratitude: Participating in community-based gratitude initiatives cultivates a shared sense of appreciation and strengthens social bonds within a wider context. This shared experience fosters a sense of collective well-being and enhances overall community resilience.

Conclusions and Recommendations

The cultivation of daily gratitude offers a potent and accessible method for enhancing well-being across multiple domains. Utilizing the outlined strategies, individuals can experience significant improvements in emotional, relational, and physical health. Future research should explore long-term effects within diverse populations, including those experiencing chronic stress or mental health challenges. Investigating the integration of gratitude interventions within existing therapeutic modalities, such as CBT and mindfulness-based interventions, offers promising avenues for enhancing clinical outcomes. Furthermore, a more comprehensive understanding of the societal impacts of gratitude, particularly its potential to mitigate social inequalities and promote community resilience, is crucial. The development of standardized gratitude assessment measures and the creation of tailored interventions adapted to specific cultural and individual contexts are essential steps in harnessing the full potential of this impactful practice. A quantitative and qualitative research approach utilizing large-scale surveys coupled with in-depth case studies would allow for a more nuanced understanding of the impact and application of gratitude techniques.

Reader Pool: Considering the inherent biases in self-reported measures of gratitude, what alternative or complementary methods could be employed to more objectively assess the impact of gratitude practices on well-being?

Breaking Free from Addictive Behaviors: Leveraging Social Support for Enhanced Recovery

Addiction, a multifaceted condition stemming from a complex interplay of biological, psychological, and sociocultural factors, poses significant challenges to individuals and society. This article examines the pivotal role of social support in overcoming addictive behaviors, integrating established theoretical frameworks to elucidate its mechanisms and practical applications. We will define and apply key concepts such as Social Support Theory, the Transtheoretical Model of Change (Stages of Change), and Motivational Interviewing, illustrating their efficacy within diverse recovery contexts. Fifteen key aspects of accessing and utilizing support will be explored, demonstrating the multifaceted nature of a robust support network in fostering successful recovery.

Several prominent theoretical frameworks inform our understanding of addiction recovery. Social Support Theory emphasizes the profound influence of social relationships on an individual’s well-being and stress-coping abilities. The strength and quality of these relationships directly impact the individual’s resilience and capacity for navigating challenges inherent in the recovery process. The Transtheoretical Model (Stages of Change) provides a dynamic framework for understanding behavioral change, outlining distinct stages—precontemplation, contemplation, preparation, action, and maintenance—through which individuals progress. This model highlights the necessity of tailored support interventions at each stage, emphasizing the importance of individualized strategies. Motivational Interviewing, a client-centered, directive counseling method, facilitates intrinsic motivation by exploring and resolving ambivalence towards change. This collaborative approach empowers individuals to actively participate in their recovery journey.

1. **Establishing a Robust Support Network:** Central to successful recovery is the establishment of a strong support network, as highlighted by Social Support Theory. This network may comprise family, friends, peers in recovery, or healthcare professionals, providing emotional, informational, and practical support. This aligns with the preparation and action stages of the Transtheoretical Model, where tangible assistance is paramount. A strong support network acts as a buffer against the isolation often associated with addiction, mitigating the negative psychological impact, thus corroborating the stress-buffering hypothesis.

2. **Fostering Accountability and Enhancing Motivation:** Support networks provide essential mechanisms for accountability, a crucial element in achieving sustained behavior change. Regular check-ins, collaboratively established goals, and constructive feedback, consistent with Motivational Interviewing principles, bolster motivation and commitment to recovery. This collaborative approach actively addresses ambivalence, propelling individuals toward sustained positive change.

3. **Harnessing the Power of Shared Experience and Collective Learning:** Support groups, such as Alcoholics Anonymous or Narcotics Anonymous, offer valuable opportunities for individuals to share their experiences, learning from both successes and challenges of others. This shared experience diminishes feelings of isolation and provides practical strategies, illustrating the principles of Social Learning Theory and the efficacy of observational learning.

4. **Promoting Cognitive Restructuring and Shifting Perspectives:** Supportive environments offer alternative perspectives that challenge negative self-perceptions and maladaptive cognitive patterns frequently associated with addiction. This process, underpinned by Cognitive Behavioral Therapy (CBT) principles, aims to identify and modify dysfunctional thoughts and behaviors, leading to healthier coping mechanisms.

5. **Developing Effective Emotional Regulation and Coping Strategies:** Therapists and support groups provide tools and strategies for managing cravings, triggers, and emotional distress. Techniques like mindfulness, relaxation exercises, and stress management skills, aligned with Dialectical Behavior Therapy (DBT) principles, enhance emotional regulation and reduce vulnerability to relapse.

6. **Celebrating Milestones and Cultivating Self-Efficacy:** Acknowledging and celebrating achievements, regardless of size, reinforces self-efficacy—the belief in one’s capacity for success. This positive reinforcement strengthens motivation and commitment to long-term recovery. Bandura’s Social Cognitive Theory underscores the importance of this self-belief in achieving behavioral change.

7. **Exploring Complementary Therapies for Holistic Well-being:** Support networks often introduce individuals to complementary therapies such as art therapy, yoga, or meditation, promoting holistic well-being and stress reduction, complementing traditional therapeutic approaches.

8. **Reducing Stigma and Encouraging Open Communication:** Actively seeking support challenges the stigma surrounding addiction, normalizing the experience and encouraging others to seek help. Open communication within the support network fosters self-reflection and reduces feelings of shame and isolation.

9. **Proactive Trigger Identification and Management:** A supportive environment facilitates the identification of personal relapse triggers. Proactive strategies can then be implemented to manage or avoid these situations, minimizing the risk of relapse. This proactive approach emphasizes relapse prevention planning and preparation.

10. **Facilitating Relationship Repair and Strengthening Bonds:** Addiction often strains relationships. Support networks facilitate rebuilding trust and strengthening connections with family and friends, fostering a sense of belonging and social integration. This relational focus is crucial for sustained recovery.

11. **Promoting the Adoption of Healthy Habits and Routines:** Support networks encourage adopting healthier lifestyles and interests that replace addictive behaviors. Structured activities and peer support foster the establishment of healthy habits and routines, contributing to long-term behavioral change.

12. **Providing Access to Essential Resources and Information:** Support systems provide access to crucial resources such as treatment centers, financial assistance, and legal aid, contributing to a comprehensive approach to recovery. This ensures a holistic approach to addressing the needs of individuals navigating recovery.

13. **Fostering Self-Awareness and Personal Growth:** The introspective process inherent in seeking support promotes self-discovery and personal growth. This contributes to the development of healthier coping mechanisms and a stronger sense of self.

14. **Maintaining Sustained Motivation and Long-Term Recovery:** The consistent support and encouragement provided by a strong network maintain motivation and contribute significantly to the success of long-term recovery. This continuous support is critical for navigating challenges and maintaining abstinence.

15. **Promoting Community Reintegration and Social Inclusion:** Support groups and networks provide a sense of community and belonging, facilitating reintegration into society and reducing feelings of isolation. This social reintegration is vital for sustained recovery and overall well-being.

Conclusions and Recommendations

This analysis, integrating several theoretical frameworks, underscores the critical role of social support in addiction recovery. Social Support Theory, the Transtheoretical Model, and Motivational Interviewing provide a robust conceptual foundation for understanding the mechanisms by which support contributes to positive outcomes. A comprehensive approach, integrating individual therapy, group support, and complementary therapies, tailored to the individual’s stage of change (as per the Transtheoretical Model), appears most efficacious. Future research should focus on identifying specific components of social support most effective for different types of addiction, exploring the long-term influence of support networks on relapse prevention, and examining their impact on overall quality of life. This enhanced understanding will inform the development of more targeted, effective interventions, improving recovery rates and reducing the societal burden of addiction. A strong emphasis on accessibility and affordability of these support systems is crucial to ensure equitable access to effective treatment.

Reader Pool: Considering the multifaceted benefits of social support detailed in this article, what innovative strategies could be employed to enhance the integration of these principles within existing healthcare systems to improve both the efficacy and accessibility of addiction treatment?

Unlocking Human Potential: A Transformative Neuroscience-Based Approach to Habit Formation

Human behavior, a complex interplay of conscious choices and ingrained habits, profoundly impacts personal and professional success. This analysis explores the neuropsychological mechanisms underpinning habit formation, emphasizing the critical role of environmental and internal cues in driving behavioral change and achieving individual goals. We will examine relevant psychological principles and neuroscientific models, defining key concepts such as the habit loop (a three-stage process comprising cue, routine, and reward), cue-response mechanisms (the automatic association between a stimulus and response), and operant conditioning (learning through reinforcement and punishment). These will be framed within the theoretical lenses of Stimulus-Response theory, Hebbian learning, the ecological model of human development, cognitive behavioral therapy (CBT), and the biopsychosocial model of health to provide a comprehensive understanding and practical application in real-world contexts. The habit loop, a cornerstone of habit formation, highlights the cyclical nature of behavior initiation, execution, and reinforcement, providing a powerful framework for intervention.

Neuroplasticity and Habit Modification: Rewiring the Brain

Habit formation relies on the brain’s remarkable neuroplasticity—its capacity to adapt and reorganize neural pathways based on repeated experiences. According to Hebb’s Law (“neurons that fire together, wire together”), the repeated pairing of cues and responses strengthens associated synaptic connections, solidifying these behaviors. This neural efficiency, while beneficial for streamlining routine tasks, can also establish maladaptive habits. Crucially, this same neuroplasticity enables conscious modification. By repeatedly performing new actions in response to existing cues, individuals can effectively overwrite existing habit loops, reshaping behavioral patterns through deliberate practice and reinforcement learning. The strengthening of neural pathways associated with new habits gradually overrides previously dominant pathways, a process analogous to “rewiring” the brain. This process is supported by principles of synaptic pruning and long-term potentiation, which describe the strengthening and weakening of neuronal connections based on experience.

The Psychology of Habit Cues: Triggers and Behavioral Responses

Habit cues, or triggers, are stimuli initiating specific behaviors. These cues can be environmental (external)—locations, times, individuals, or objects—or internal, originating from psychological states (emotions, thoughts, physiological sensations). The Stimulus-Response theory aptly models this process: a cue (stimulus) automatically triggers a learned behavioral response (as in classical or Pavlovian conditioning) or a deliberate action driven by cognitive appraisal (as in operant conditioning). The efficacy of these cues stems from the brain’s ability to create efficient neural pathways through repeated cue-response pairings. Recognizing the nature of these cues—consciously perceived or subconscious—is crucial for effective habit modification. This understanding aligns with the principles of associative learning, where repeated pairings of stimuli and responses lead to automatic connections.

Strategic Implementation of Habit Cues for Positive Change: A Multifaceted Approach

Harnessing the power of cues requires strategic intervention. We can leverage this understanding to consciously design environments and mental strategies that promote desired behaviors. Effective strategies include:

1. Comprehensive Cue Identification and Analysis: Utilizing self-monitoring techniques (e.g., journaling, habit trackers) meticulously documents daily activities and identifies associated cues. This detailed approach allows for precise mapping of existing habit loops, informing subsequent interventions. This process aligns with principles of self-efficacy and behavioral self-management, empowering individuals to take control of their habits.
2. Environmental Restructuring: Optimizing the Physical and Social Context: Modifying the physical and social environment minimizes exposure to cues linked to undesirable habits and maximizes exposure to those associated with desired ones. This reflects environmental determinism, highlighting the profound influence of surroundings on actions. For instance, removing tempting snacks from the house reduces the likelihood of unhealthy snacking, a practical application of stimulus control.
3. Cognitive Restructuring and Emotional Regulation: Addressing Internal Cues: This involves challenging negative automatic thoughts associated with unwanted behaviors, replacing them with positive self-affirmations. Mindfulness and emotional regulation techniques mitigate the influence of emotional cues on behavior. This aligns with the core principles of Cognitive Behavioral Therapy (CBT), focusing on modifying maladaptive thought patterns and emotional responses, a cornerstone of many successful habit change programs.
4. Habit Stacking and Chaining: Leveraging Existing Routines: Integrating new habits into existing routines by “stacking” them onto established behaviors (e.g., after brushing teeth, meditate for five minutes). This leverages existing cue-response mechanisms to establish new habit loops, facilitating easier integration of desired behaviors. This strategy utilizes the power of existing routines to anchor new behaviors, enhancing adherence by reducing the cognitive load of remembering to perform the new habit.
5. Reinforcement and Self-Reward: Strengthening Positive Behaviors: Implementing a consistent system of reinforcement—rewarding desired behaviors—strengthens their association with positive outcomes. Positive reinforcement significantly enhances the probability of repeating the desired behavior. This principle reflects operant conditioning, where positive reinforcement strengthens desired behaviors, a key component in behavior modification techniques.

Illustrative Examples: Habit Cues in Real-World Scenarios

Consider a student who consistently studies in the library (external cue). The library environment becomes strongly associated with studying, automatically triggering this activity. Conversely, stress (internal cue) might trigger maladaptive behaviors such as excessive snacking or procrastination. Recognizing these cues—both internal and external—is crucial for effective habit modification. This emphasizes the significance of contextual factors in shaping behavior, as highlighted by the ecological model of human development, which considers the interplay of individual, interpersonal, organizational, community, and societal factors influencing behavior.

The Synergistic Effect: Holistic Well-being Through Positive Habit Formation

The benefits of positive habit formation extend beyond individual behaviors. For instance, improved sleep hygiene, facilitated by consistent bedtime routines, significantly enhances cognitive function, mood regulation, and overall health, positively influencing various life aspects. This interconnectedness demonstrates the holistic nature of habit change and its broader impact on well-being, aligning with the biopsychosocial model of health, which emphasizes the interplay of biological, psychological, and social factors in determining health outcomes. This holistic perspective is vital for understanding the multifaceted nature of habit change and its impact on overall wellness.

Conclusion and Recommendations: A Path Towards Sustainable Behavioral Change

Conscious manipulation of habit cues offers a powerful tool for sustainable behavioral change. A comprehensive approach integrating self-monitoring, environmental restructuring, cognitive reframing, and reinforcement strategies proves highly effective. However, achieving lasting change necessitates dedicated effort, patience, and consistent self-evaluation. Future research should investigate the efficacy of personalized interventions tailored to individual differences in cue responsiveness and habit formation. Longitudinal studies assessing long-term impacts on various aspects of well-being—including physical and mental health, and social relationships—will provide a more complete understanding of habit modification’s transformative potential. A rigorous evaluation methodology, incorporating both quantitative and qualitative data, will be crucial in assessing the effectiveness and impact of different interventions.

The applicability of these strategies is broad, ranging from enhancing workplace productivity through optimized routines to fostering healthier lifestyles. The key lies in understanding the underlying principles of habit formation and employing tailored interventions that address individual contexts and challenges. The integration of these principles into various settings, such as education, healthcare, and workplaces, holds significant promise for promoting positive behavioral change and improving quality of life.

Reader Pool: Considering the intricate interplay of neurological, psychological, and environmental factors in habit formation, how can we effectively design interventions that account for individual differences and promote long-term adherence to positive behavioral changes?