The cognitive theory, unlike some of the approaches can also be used to predict behaviour. Ley, 1981, 1984, developed the ‘Cognitive Hypotheses Model of Compliance’, which explains compliance with health advice as a combination of patient satisfaction with the consultation, understanding of the information received, and the ability to recall the information. Using this model, positive future behaviour can be influenced by increasing the patient’s satisfaction with the consultation, their understanding of the information given (this can be achieved by the professional using less technical language), and their recall of the information (achieved when the professional repeats the more important information).
Using this model, a diabetic teenager’s lack of adherence to a diet could be explained due to the fact that their consultation with the professional recommending the course of treatment was rushed, and the information given to them was difficult to understand.
Whereas the cognitive approach uses both thought and behaviour to make predictions, the behaviourist approach is concerned with the behaviour only.
The Behaviourist approach has other similarities to the cognitive view, in that it is based on the present, not past experience (unlike the psychoanalytic approach). However, the main focus for behaviourist psychologists is the influence of the environment, and is not concerned with internal mechanisms within the brain. The behaviourist view believes that humans are more or less shaped through constant interactions with the environment and that learning and experience are key factors in determining personality. They believe that the observation of behaviour within a person should be the key focal point of the study of psychology. Two methods commonly used are lab experiments (as environmental factors can be controlled, and therefore precise results can be achieved) and the use of animals (they believe that learning mechanisms in animals are similar to those in humans and it is not always ethically correct to carry out certain forms of experiment on humans).
Within this theory, Skinner proposed a version of the law of effect, ‘behaviour is shaped and maintained by its consequences’. (Gross, R et al, 2000, page 414). The consequences are classified as positive reinforcement (when a positive behaviour is followed by a positive outcome, to encourage the repetition of positive behaviour/strengthening behaviour), negative reinforcement (when positive actions are rewarded by removal of an adverse/painful effect, strengthening behaviour) and punishment (where negative behaviour is followed by an undesirable response to weaken/discourage the repletion of such behaviour). (Gross, R et al, 2000, page 415). This theory is known as ‘Operant Conditioning’.
Another theory within the behaviourist approach is that of Albert Bandura, who developed the ‘Social Learning Theory’. This theory believes that behaviour can be learnt from watching, and the imitating (modelling). The behaviour is more likely to be copied if the individual the person is imitating is the same sex, or is perceived as powerful or nurturing. It was seen that individuals are capable of judging the likely consequences of their own actions, by observing the consequence for others of their actions. This was found using the ‘Bobo Doll experiment’.
A behaviourist explanation of adherence to a diet could be to look at the role that reward and punishment plays. Reward could be in terms of encouragement or positive reinforcement, or in the form of materialistic reward. For example a child who adopted a new form of diet than that of his parents, who was not encouraged or rewarded for their positive behaviour, but instead punished and made to feel different (in a negative way), would be more likely to revert back to previous eating habits that are accepted and encouraged by their family (operant conditioning); whereas a child who’s family actively encouraged, and possibly even adopted the new diet themselves would be more likely to adhere as they would see what they are doing as something positive (social learning theory).
The behaviourists do not believe in looking in detail to the cause of behaviour, but instead looking for ways to overcome it. Both the behaviourist and the cognitive approach are very different to the psychoanalytic approach.
The Psychoanalytical approach (psychodynamic approach) in contrast to the behaviourist approach, looks at the inner causes of behaviour, in particular the role of the unconscious mind and the importance of early experience. It uses psychoanalysis and in-depth case studies to uncover and bring to the conscious mind, deep, hidden, repressed memories, drives and instincts to help explain behaviour. The psychoanalytic approach believes that events in childhood are strongly related; if not the key to adult problems (this can be broadened to suggest that past experience in adult-hood can be the cause of problems later in life also).
Freud (1856-1939) put forward a number of different theories about behaviour. His first was that there are three parts to the mind: the conscious, the pre-conscious and the unconscious. He compared it to an iceberg in that we are only aware of what is on the surface, and therefore a large amount of the contents of our mind we are unaware of. (Putwain D, et al, 2004, page 35).
Another of his theories was the ‘Model of Personality’, which sees the structure of personality in three parts, the id (the personality trait we are born with that operates on the ‘pleasure principle’ which seeks instant gratification), the ego (which represents the ‘rational self’, and is prepared to wait for gratification), and the superego (which represents the ‘better self’, and operates on a set of values and a conscience which derives from a wish to be like parent-‘ego ideal’). Once the three parts of your personality are developed, the id and the superego can come into conflict that the ego cannot cope with. When this occurs, the unexpressed energies from the id, and the super ego must find expression elsewhere. This can be in the form of dreams, but most commonly in the form of defence mechanisms. Defence mechanisms are the forces that suppress painful memories, or unacceptable thoughts out of the conscious mind, and allow the ego to maintain control. There is successful defence which is sublimation (an alternative way of expressing an impulse from the id, e.g. painting and sculpting). The other type of defence is unsuccessful defence, the most common of which is repression (an unconscious action where unpleasant thoughts or actions are locked away). Other unsuccessful defences include displacement, denial, regression and isolation.
The psychoanalytic approach would look to events in childhood to understand compliance or lack of to a diet. Therefore, adherence to a diet could be explained due to past experience of witnessing a relative or close friend with diabetes, die from the condition, which would give a patient an understanding of the severity of the illness and therefore the subconscious motivation to be compliant with a diet. It would explain lack of compliance with a diet possibly being a result of denial, i.e. the patient does not want to believe that they are ill and need to comply, and the mind has suppressed the knowledge of needing to comply into the sub-conscious. Bringing these issues to the conscious mind requires psychoanalysis that can only be carried out by a trained professional, and is therefore not a very useful approach in relation to this study. The humanist approach also uses a form of counselling, but it is non-directive unlike psychoanalysis.
The humanistic approach views the human being as a free and generous individual, who strives to achieve their potential (self-actualise). Unlike the psychoanalytic approach, behaviour is not monitored by past experience but focuses on conscious experience from their present state. Within the humanist approach, scientific methods are disregarded and considered inappropriate for the study of human beings, and they instead use clinical practice (non directive counselling) and case study observation to explain causes of behaviour. In using the humanistic approach, perception plays a very large role, including how two individuals can view a situation with great variation, and also that current and conscious circumstances may alter perception. Initial counselling focuses on advancing the patient through the realisation that to reach their full potential; deficit needs (e.g. hunger) must first be met. This theory was introduced by Maslow, and is known as the ‘Hierarchy of Motivation’. In reference to health care, it explains that the patient’s physiological needs must first be met before compliance is achieved i.e. it would explain in this study, that if the patient is hungry, they cannot be expected to adhere to a diet.
The biological approach is completely unique in that it views man as a biological organism and believes all behaviour is biologically driven by our physical structure, in particular by our brain, central nervous system (CNS), and hormones, not our mental processes, environment or past experience. It believes that evolution is a key factor in explaining why our behaviour has evolved as it is. As a result of this, the biological approach also studies genetics to discover which of and to what extent our behaviours are inherited. Explanation of behaviour relies on a measurement of biological factors, e.g. temperature, heart rate and brain waves. Biological psychologists tend to treat abnormal or unwanted behaviour with medication or control of physical features.
The biological approach would explain adherence, not as a conscious thought or action (as with cognitive and behaviourist approaches), but as a biological reaction from the body.
Eysenck proposed the theory that the population is divided into two halves, introverts and extroverts, and that introverts have a higher level of arousal than extroverts. Combining other aspects of personality, such as neuroticism with being an introvert, and those individuals may have a higher level of fear, resulting in a treatment that other people may accept, inducing high levels of fear. Using this theory, it could be expected that introverts are less likely to comply with medical treatment than extroverts.
Biological psychologists would also look at homeostasis as the body’s regulation of hunger that is controlled by the CNS and overlooked by the autonomic nervous system (ANS). They would explain that if the diet is a big change to the body and the person is left feeling hungry, then the patient would override the diet in order to leave the body feeling satisfied, and in the same way, if there is a fault in the homeostasis mechanism resulting in the body craving certain foods, the body will fulfil these cravings. Therefore lack of adherence could be due to a faulty homeostasis mechanism.
Each theory uses different reasons to explain a teenager’s adherence/lack of, to a diet. All are valid; however some are more useful in relation to this study than others. The cognitive approach is the most practical for this study, as it gives both possible explanations of the behaviour, and can be used to predict (and influence) future behaviour. It is therefore utilised more in the health service as it highlights ways in which health care professionals, and the media influence behaviour, and therefore enables them to increase the future compliance with medical treatment. This theory is even more useful when combined with the behaviourist approach and their ‘conditioning theories’. The cognitive approach is of more use than the behaviourist approach when used alone, as the behaviourist approach is generally of more use in reference to young children.
Although the psychoanalytic approach also has explanations for behaviour, it is of least use in this case study, as only trained psychoanalysists are able to use analysis, not the professionals who will be involved in the teenagers care. It is also only able to explain things after they have happened, and not predict future behaviour. It is therefore of very little use in this study. The humanistic approach is also of little use in general health care, as it uses non-directive counselling, which is very time consuming. (However it has a larger application in mental health settings).
The biological approach can be used to explain behaviour in reference to an individuals genetics and internal biological functions, possibly that a teenager eats a lot of sugar because the body craves it, but offers little prediction for future behaviour. It therefore has limited use in this study.
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Payne, S et al. (2002) Psychology for Nurses and the Caring Professions.
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Putwan, D et al. (2003) AS in a Week Psychology. Birmingham: Letts.
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