--- module: 099-03 language: en chapter: 99 title: "Learning, Development, Cognition, Stress, and Behaviour Change" module_title: "Stress, motivation, habits, and behaviour change" source_sha256: 80c4307338ce128d1c6c04f96d96b541d3005dd41fb66a520d56bfd36a699c1a --- # Stress, motivation, and behaviour change ## Stress and its physiology ### Stressor is the event, stress the response ### Threat, challenge, loss, or irrelevance ### Acute stress prioritises attention and energy ### Harm: extreme, prolonged, poor recovery ### Rapid sympathetic and adrenal-medullary response #### Noradrenaline: alertness, vascular tone #### Adrenaline: cardiac output, ventilation, glucose ### Slower hypothalamic-pituitary-adrenal axis #### Cortisol mobilises substrates, alters immunity #### Feeds back to brain and pituitary ### One cortisol value needs timing and context ## Allostasis and appraisal ### Allostasis: stability through change ### Allostatic load: cumulative physiological cost #### A framework, not a standard clinical test ### Poverty, discrimination, caregiving sustain demand #### Not reducible to individual attitude ### Primary appraisal: what is at stake ### Secondary appraisal: options and coping resources ## Coping, control, and support ### Problem-, emotion-, meaning-focused coping ### Direct action if controllable, acceptance if not ### Avoidance relieves briefly, maintains fear ### Perceived control helps unless illusory or blaming ### Predictability permits preparation ### Support quality matters more than contact ### Advice ignoring autonomy becomes a demand ## Motivation and expectancy ### Drives, incentives, and goals ### Dopamine: learning reward predictors, not pleasure ### Wanting, liking, effort, learning dissociate #### Cue pull without pleasure in addiction ### Expectancy-value: success, value, cost ### Risk information changes one component ### Ask which immediate costs dominate ## Self-efficacy and autonomy ### Self-efficacy: confidence for a specific behaviour #### Practice, modelling, encouragement, physiology ### Not generic self-esteem ### Specific attainable goals with feedback ### Break broad goals into observable steps ### Autonomous versus controlled motivation ### Competence, autonomy, relatedness ### Controlling rewards undermine interest ### Informed choice is not abandonment ## Habits and planning ### Cue-linked responses from stable repetition ### Persist after the outcome loses value ### Knowledge change alone has limited effect ### Redesign cues, friction, sequence, reinforcement ### Implementation intention links cue to action ### Action planning: where, when, how ### Coping planning: response to barriers ### Plans must stay flexible ## Behaviour models and conversation ### Capability, opportunity, motivation ### Keeps structural barriers in view ### Training, reminders, redesign match gaps ### Stage models match support to readiness #### Progress is not always in order ### Motivational interviewing explores ambivalence #### Elicits own reasons, avoids argument ## Risk and behavioural economics ### Immediacy, vividness, dread, trust shape risk ### Relative risk without baseline misleads ### Absolute frequencies with the same denominator ### Check understanding in the person's own words ### Defaults, present bias, loss aversion, norms ### Ethical defaults: transparent, easy refusal ### Incentives can coerce when resources are scarce ## Relapse, evaluation, and synthesis ### Relapse is information, not moral failure ### Lapse: review, self-compassion, restart ### Stress narrows attention, strengthens habits ### Lifestyle cannot remove structural adversity ### Specify mechanism and outcome ### Engagement is not benefit ### Monitor stigma and widening disparities ### Smallest mechanism-matched intervention, then revise