Using Behavior Change Apps
Connect with your clients through technology.
Everyone has been a small child (or had one or two!). Does the phrase “You’re not the boss of me” ring a bell? Or how about, “I can do it myself”?
Self-determination theory and self-efficacy theory state the key characteristics to achieving behavior change are autonomy, self-efficacy and competence (Bandura 1977; Ryan & Deci 2017). From our earliest experiences onward, we’re inherently disposed to autonomy and self-efficacy as a pathway to decision-making. Nearly 400 years ago Blaise Pascal, renowned philosopher and polymath, observed that people are generally better persuaded by self-discovered reasons than by those from others’ minds (Pascal & Stewart 1950). It still holds true today.
One way fitness professionals can support behavior change efforts with clients is by using various behavior change apps. To understand how apps support behavior change and how well-qualified fitness and wellness professionals may use them to further their clients’ goals, it’s important to embrace the fundamental truth that Pascal observed. He found that a key—if not the key—part of the decision-making process is driven by the individual’s belief that they are in control and are not being directed, persuaded or compelled by others. This article reviews research into the efficacy of behavior change apps and explores ways to apply the findings to effective program design.
Change is a uniquely difficult decision. A person is not simply deciding to do something new, but to also give up something. Loss aversion is a cognitive bias that illustrates how the pain of losing something is twice as powerful as the pleasure (benefit) of gaining something (Kahneman & Tversky 1979).
The change decision is further complicated by time. The benefit of the new behavior invariably takes time and sustained effort. Therefore, it’s not uncommon for people to feel ambivalent about behavior change; in fact, they often express reasons both for and against change (Miller & Rollnick 2013). Research indicates that the decision scale is not tipped through more knowledge of beneficial health behaviors or therapeutic lifestyle prescriptions for medical conditions, even when it comes from a physician (Phillips, Frates & Park 2020).
If more knowledge and expertly prescribed and designed actions are ineffective in freeing clients to enjoy the change they seek, then is more effort the answer? In the short term, maybe, but for meaningful, sustainable change, it doesn’t appear so. Effortful self-control, or willpower, is often framed as a forceful inner struggle between higher-level cognitive control processes and lower-level automatic or habitual tendencies. Attempting to overcome unwanted habit loops by effortful self-control can feel aversive and often fails. This type of willpower corresponds to extrinsically motivated behaviors—that is, norms, rules or ideas that originally came from outside of the person. This expectation to engage in a specific behavior because it’s directed or expected by others often results in a guilt, anxiety or stress response if one fails to follow through (Ludwig, Brown & Brewer 2020).
Neuroscience shines a light on why primarily focusing on effortful self-control doesn’t yield sustainable results. The prefrontal cortex (PFC) is the region of the brain that sorts through decisions and consequences; determines the best path forward; orchestrates thoughts aligned with goals; and manages, redirects and suppresses urges that may not be socially acceptable or desirable. The PFC is sometimes referred to as “the brain’s CEO” or “the adult in the room,” and it is imperative the PFC is fully engaged if people are trying to change their behavior—especially those habits that have been wired into place over many years.
However, during times of stress, regions of the PFC “go offline,” impacting self-regulatory brain regions (Arnsten 2015; Milyavskaya & Inzlicht 2017). Conversely, autonomously motivated behavior is accompanied by more pleasant, affective experience than nonautonomous behavior and includes feelings of interest, curiosity and enjoyment (Ryan & Deci 2017; Stanko-Kaczmarek 2012). Interestingly, autonomously motivated behavior change has proven to be more successful than willpower-based efforts when it comes to weight loss, exercise and smoking cessation, among other types of changes, which lends support to its sustainability (Ludwig, Brown & Brewer 2020).
Behavior Change Apps Research
Significant peer-reviewed evidence supports using apps with clients who are seeking to change a behavior. Below are a few highlights:
- There is strong evidence for the efficacy of mobile phone apps for lifestyle modification with type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes (Wu, Guo & Zhang 2019).
- The Calm app effectively offers mindfulness meditation that reduces stress and improves mindfulness and self-compassion in stressed college students (Huberty et al. 2019).
- Digital behavior change interventions may increase physical activity and physical functioning and reduce sedentary time and systolic blood pressure in older adults (Stockwell et al. 2019).
- Mobile app–based interventions could be useful for improving various health promotion behaviors, including diet and physical activity for the general healthy population. Most of the app interventions reviewed focused on monitoring health status and behavior change, as well as providing feedback or health-related information (Lee et al. 2018).
Some apps are specifically designed to be used with a coach to increase client autonomy and self-awareness, such as the Ate app, which has a coach dashboard. Either way, making the most of these behavior-change apps will be up to you. Choosing to intentionally cultivate an environment where your client can find their own way—with you being present and nonjudgmental rather than pressuring or pushing—will likely lead to their growth.
As you use the app with your clients, ask open-ended questions that invite them to be clear, active and in a state of discovery. Below are some sample questions.
- What is the opportunity?
- What is exciting to you about this?
- What do you want to explore?
- What is the challenge?
- What is your next step?
Behavior Change Apps
Below is a selection of top-rated apps that support behavior change.
This mindful food journal helps people uncover habits and realign goals. It uses a visual, mindful and nonjudgmental approach to building a more meaningful relationship with food and makes tracking each meal as simple as taking a photo. Rather than relying on calorie counting, it nonjudgmentally elicits self-awareness as a path to an empowering relationship with food. This app syncs to Apple Health and Apple Watch, and coaches can watch a client’s progress in real time, as well as engage in private and group chats (and more) from a dashboard. Ate includes options such as open-ended questions, reflections and experiments, all of which help increase coach/client engagement.
As the name implies, this app is focused on relaxation, meditation and sleep, with a “mission to make the world happier and healthier.” Calm offers guided sessions, breathing exercises, visualizations, sleep stories and music designed to assist with focus and relaxation.
This app is a “virtual home for health and wellness coaching,” built for coaches by a health coach. A “practice management platform” for cultivating coaching and client relationships, YourCoach uses algorithms to match dedicated, verified and practicing health and wellness coaches with employers. Marina Borukhovich, founder and CEO, describes the app as “an operating system for behavior change, powered by a technology-augmented force of health coaches.”
As the name implies, this app focuses on increasing a person’s feelings of well-being through a science-supported approach. The app is highly engaging and offers several effective tools grounded in positive psychology, mindfulness and cognitive behavior therapy. Happify offers a way to measure emotional well-being to help people see and experience improvement and satisfaction.
Transformation Is the Best Behavior Change App
This sentence says it best: People don’t resist change; they resist being changed. (Senge 1997). When we fully embrace this concept, we can then leverage behavior change apps not to change people but to empower them to change themselves. Using behavior change apps in this manner is another step to move any fitness professional’s practice beyond transactional into transformational, in service of the whole person.
Choosing the Right App
To determine which app and tech is best
for your professional practice, ask yourself
the following guiding questions:
- Which app will keep my client highly engaged?
- How many times a week or a day will my client
use or interact with the app?
- Which apps will provide a deeper, more relevant
connection opportunity with my client without
increasing my time or schedule commitment?
- How does the app cultivate autonomous motivation?
Arnsten, A.F.T. 2015. Stress weakens prefrontal networks: Molecular insults to higher cognition. sNature Neuroscience, 18 (10), 1376–85.
Bandura, A. 1977. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 84 (2), 191–215.
Huberty, J., et al. 2019. Efficacy of the mindfulness meditation mobile app “Calm” to reduce stress among college students: Randomized controlled trial. JMIR mHealth and uHealth, 7 (6), e14273.
Kahneman, D., & Tversky, A. 1979. Prospect theory: An analysis of decision under risk. Econometrica, 47 (2), 263–91.
Lee, M., et al. 2018. Mobile app-based health promotion programs: A systematic review of the literature. International Journal of Environmental Research and Public Health, 15 (12), 2838.
Ludwig, V.U., Brown, K.W., & Brewer, J.A. 2020. Self-regulation without force: Can awareness leverage reward to drive behavior change? Perspectives on Psychological Science, 15 (6), 1382–99.
Milyavskaya, M., & Inzlicht, M. 2017. What’s so great about self-control? Examining the importance of effortful self-control and temptation in predicting real-life depletion and goal attainment. Social Psychological and Personality Science, 8 (6), 603–11.
Miller, W.R., & Rollnick, S. 2013. Motivational Interviewing: Helping People Change (3rd ed.). New York: Guilford Press.
Pascal, B., & Stewart, H.F. 1950. Pascal’s Pensées. New York: Pantheon.
Phillips, E.M., Frates, E.P., & Park, D.J. 2020. Lifestyle medicine. Physical Medicine and Rehabilitation Clinics of North America, 31 (4), 515–26.
Ryan, R.M., & Deci, E.L. 2017. Self-Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness. New York: Guilford Press.
Senge, P.M. 1997. The fifth discipline. Measuring Business Excellence, 1 (3), 46–51.
Stanko-Kaczmarek, M. 2012. The effect of intrinsic motivation on the affect and evaluation of the creative process among fine arts students. Creativity Research Journal, 24 (4), 304–9.
Stockwell, S., et al. 2019. Digital behavior change interventions to promote physical activity and/or reduce sedentary behavior in older adults: A systematic review and meta-analysis. Experimental Gerontology, 120, 68–87.
Wu, X., Guo, X., & Zhang, Z. 2019. The efficacy of mobile phone apps for lifestyle modification in diabetes: Systematic review and meta-analysis. JMIR mHealth and uHealth, 7 (1), e12297.