Saturday, February 12, 2011

Health incentives - SDT, CPS , 12 steps

A attitude amongst politicians and some behavioral economists is to give money directly to people contingent on them getting good scores on health tests - for eg loosing weight or quitting smoking. This they say is more effective than spending on health services aimed at helping people lose weight or quit smoking. Companies are also giving incentives to employees to get good scores with their weight or smoking issues.

In an article –" Can incentives make us healthier "?, Alfie Kohn shares a SDT perspective why incentives not only don't work but may make things worse . He has a link in the article to a review of the research on incentives and health, and a link to a one hour talk on incentives in general and health issues in particular. I highly recommend the talk.

Can incentives make us healthier ? Alfie Kohn

A better approach is to use working with approaches rather than ' doing to ' people- trying to motivate them and ' incentivize ' them. CPS – collaborative problem solving addresses the underlying factors and the intrinsic concerns of people , gives them skills and fosters caring relationships. MI – motivational interviewing does the same. CPS and MI satisfy the SDT needs of autonomy , competence and relatedness.

Incentives undermine autonomy, competence and relatedness of peole trying to loose weight or quit smoking.


1 people feel ' being controlled and manipulated'

2 no commitment to the intrinsic value of ' wellness or healthy life styles'


1 people attribute their success to the reward, they begin to think of themselves as extrinsically motivated.

2 rewards impair creative and exploratory thinking by narrowing focus especially on tasks which require attention to quality and thinking.

3 rewards make people less cooperative , not sharing information or helping each other. This is even more problematic when rewards are made scarce – awards in a competitive environment. Their success is measured against others and dependent on the failure of others.

4 Focus is on ' behavior ' and money and not the intrinsic concerns and problems that are getting in the way of the person.

5 Rewards give the message that the valueor program  is not intrinsically worthwhile. We would not being involved if it was not for the money.


Relatedness refers to the people giving the rewards, others in the program and the program itself

1 people feel controlled by the people giving the rewards . Rewards turn people into objects - you do to them - incentivize them ' , rather than working with them

2 It shows lack of trust. People would not try or do their best if it was not for the reward.

3 Rewards set up competition and non-cooperation between members of the program.

4 Rewards negate the promotion of a ' caring community and support groups ' by focusing on rewards individuals are getting.

5 Rewards convert the value of ' wellness' from a social norm, a value into an economic norm. One relates to ' quitting smoking or losing weight ' in terms of money or economic benefit. So the decisions are made on whether the program is economically justified , how much money we will make. Instead the focus should be on converting money and other resources into '  experiences '  and processes ' , investing in wellness and a healthy lifestyle. To use a term from Eric Fromm  - To Be or to Have , rewards  foster a'  to have '  mindset , rather than a ' to Be ' mindset .

This reminds of the ' neighbour ' who approached a kid to take care of his dog , while he was overseas.
Neighbour asks the the kid -  How much - for looking after my dog while I am away
Kid - I am willing to pay  $10

6 The focus is on ' results ' - losing weight or quitting smoking and not on the process , a healthy lifestyle and a commitment to wellness..

The process – a healthy life style and a commitment to ' wellness' is a life time commitment.

The mistake people make is not to think of dieting as a life time activity.

In order to be successful in dieting people need to be competent in providing alternative meals that replace existing habits , have time for exercise , have the support of family , be involved in support groups ( for life ) and feel autonomous in their decisions. They have to deal with the underlying issues of the smoking or weight gain. Even if we stick to a diet and work out , if we are stressed out we will still gain weight. The hormone cortisol converts muscle into fat to help us deal with stress.

Cortisol and weight gain

There are many supports groups that use the ' 12 steps program' . It is not what you eat , but what's eating you that is making you put on weight.

Here is a link to an online support group. I am sharing ' working the steps ' of a leader called ' Lawrie' , the 3rd quarter of 2008 .

Working the 12 steps recovery group
The recovery group 2008 , 3rd qter- Lawrie



  1. Hi Allen,

    Under Autonomy, and my research investigates this, there is an assumption that promoting behavior change for reasons like "good health", etc are truly compelling and amenable to autonomy-building. I challenge the idea that promoting behavior change for any reason, that doesn't involve the individual personally determining it, will be optimal for promoting autonomy toward that behavior.
    Michelle Segar, PhD, MPH

  2. Hi Michelle,
    Thanks for your comment. I think that a person can feel autonomous and self determined even when he is not given a choice but can internalize the program and its value, finds the task or program extremely relevant to his life , identifies with the program in a way that they give expression to his inner being