The Evolution of Behavior Change


Health is simple. Humans are complicated.

Health and exercise professionals know this well. Helping a client change their daily habits is the most important part of sustainable health and fitness—and the most challenging.

For decades, health and exercise professionals, scientists and researchers have been digging into human psychology and unearthing philosophies, theories and methods for how to change human behavior to improve both physical and mental health.

“Anyone who is confronted with people in need in their daily practice, or anyone who wants to clarify certain data through empirical research, knows all too well that we know far too little about what is the object of our study: human behavior,” renowned Belgian researcher Paul Eelen once said.  

Every theory or model has its pros and cons, but thanks to years of study and practice, health and exercise professionals have a multitude of resources to pull from to figure out what works best for their clients and their community.

“When behavior therapy originated…its identity was formed by opposing the conventional psychotherapeutic practices, which were dominated by the psychoanalytic model. The breakthrough of behavior therapy was undoubtedly fostered by the discomfort with the psycho-analytical paradigm: both in terms of its theoretic underpinnings and its clinical efficiency,” Eelen wrote.

Over the last several decades, successful coaches, trainers and medical professionals have moved away from viewing clients as “broken” and in need of “fixing” and instead have recognized that clients are whole, resourceful, and capable of change, putting the client in charge and creating opportunities for collaboration. What follows is a brief timeline of the evolution of behavior change over the last century.

A Timeline of Behavioral Change

1911: American educational psychologist Edward Thorndike “initially proposed that humans and animals acquire behaviors through the association of stimuli and responses.” His work was followed up by Johns Hopkins University psychologist John Watson, who brought forth modern behaviorism. “Watson made the notorious claim that, given a dozen healthy infants, he could determine the adult personalities of each one, ‘regardless of his talents, penchants, tendencies, abilities, vocations and the race of his ancestors.’”

1950s: The Health Belief Model (HBM) was created by social scientists at the U.S. Public Health Service “in order to understand the failure of people to adopt disease prevention strategies or screening tests for the early detection of disease.” While people are often initially motivated by health concerns, recent research has found that this “motivational bubble” of trying to avoid disease or health problems, doesn’t last or work for the long-term.

1970s: Health psychology developed in the 1970s “as a field of psychology that examines the causes of illness and studies ways to promote and maintain health, prevent and treat illness and improve the healthcare system,” wrote Safarino and Smith in Health Psychology Biopsychosocial Interactions. This form of psychology focuses on a bio-psycho-social view for understanding health and illness and recognizes that social, psychological, and biological factors all contribute to chronic illness and wellness. .

1980s: The Transtheoretical Model of Behavior Change, also referred to as the stages of change was developed by Prochaska and DiClemente with an emphasis on viewing intentional behavior change as a process.   This theory is one of the most popular in the health arena and includes the stages of change, the process of change, Decisional Balance, and self-efficacy according to ACE’s Professional’s Guide to Health and Wellness Coaching.   This model helps determine a client’s readiness to change and also their decision making abilities

1998:  The Centers for Disease Control and Prevention and the American Psychological Association cosponsored a national conference on integrating behavioral and social science with public health and subsequently published a book on the topic.

2020: The American Council on Exercise released its ACE Mover Method as a behavior-change guide for health and exercise professionals. The ACE Mover Method uses principles of behavior change science and includes elements of positive psychology, motivational interviewing, TTM and self-determination theory. The method includes a simple ABC Approach that can be used with clients at any time: Ask open-ended questions, Break down barriers and Collaborate. The philosophy of the Method centers on three main principles:

  1. Understanding that the client is the best expert on themselves
  2. Effective communication through open-ended questions and active listening is key to helping your client take strides forward
  3. Focusing on your client’s strengths and understanding they are resourceful and capable of change

The ACE Mover Method reflects the belief that coaching is about collaborating with clients, rather than fixing and directing their lifestyle changes.

“You’re not there to tell anyone what to do. You’re there to ask good questions and listen intently, to offer compassion, to explore a person’s individual vision, and to build a caring relationship. Your job is to assist someone else with making a change, and how you go about it matters. You’re there to help him or her spot the learning opportunity, set the groundwork, and see things through,” an article in Harvard Business review states.

“Your role as a coach is not to fix what is broken or tell people what you think they should do, but instead you are there to cultivate a meaningful client interaction with curiosity, confidence, unconditional positive regard, respect, empathy,  and trusting that the client is truly capable of change.  You are there, centered in each interaction, to be a non-judgmental guide, that asks the right questions at the right time to engage, focus, and evoke, listen to understand values, meaning, and beliefs, and to collaborate on the next steps. “



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