Changing Behaviour

The vast majority of people change their behaviour with no external help. They just do it. ‘Change experts’ include psychologists who advocate behaviour change techniques in their interventions. A behaviour change technique (BCT) is any systematic procedure (or a category of procedures) included as an active component of an intervention designed to change behaviour. The defining characteristics of a BCT are that it is:

• Observable
• Replicable
• Irreducible
• A component of an intervention designed to change behaviour
• A postulated active ingredient within the intervention (Michie et al., 2011).

The description, classification and investigation of BCTs has become a cottage industry. Places like UCL, Aberdeen and Cambridge Universities, together with IBM, have received several millions of pounds from the Medical Research Council and Wellcome Trust to construct an ‘ontology’ of behaviour change.

According to the project website, “Behavioural Scientists are developing an ‘ontology’: a defined set of entities and their relationships” which will be used to “organise information in a form that enables efficient accumulation of knowledge and enables links to other knowledge systems.”

bs-diagramdetailedThe top level of the ‘Behaviour Change Intervention Ontology’ (project website)

An ontology is a set of concepts and categories in a subject area that shows their properties and the relations between them. An ontology can only be helpful when nothing of importance to the system as a whole is left out.

A ‘BCT Taxonomy’ has been employed to code descriptions of intervention content into BCTs (Michie et al., 2011, 2013). The taxonomy aims to code protocols in order to transparently describe the techniques used to change behaviour so that protocols could be made clearer and studies could be replicated (Michie and Abraham, 2008; Michie et al, 2011). A taxonomy also can be used to identify which techniques are most effective so that intervention effectiveness could be raised and more people would change behaviour.

The production of a structured list of BCTs provides a ‘compendium’ of behaviour change methods which helps to map the domain of behaviour change and inform practitioner decision-making. However it also risks becoming a prescriptive ‘cook-book’ of what therapeutic techniques must be applied to patients presenting with a specific behavioural problem.

Another problem with the compendium approach is that BCTs are not all optimally effective when combined in ‘pick-and-mix’ fashion. There needs to be coherence to the package that is provided by a theory that offers power and meaning and connects the components into a working set.

I can illustrate this point by considering an intervention for smoking cessation, Stop Smoking Now (Marks, 2017). This therapy is an effective method for clearing the human body of nicotine. The desire to smoke and any satisfaction from smoking are abolished using different forms of CBT and mindfulness meditation. Stop Smoking Now includes 30 BCTs integrated within a coherent theory of change based on the concept of homeostasis. In Stop Smoking Now a structured sequence of BCTs is provided that takes into account the nesting of BCTs such that guided imagery works best in combination with relaxation and both of these work best following enhancement of self-efficacy, achieved using self-recording, positive affirmations and counter-conditioning.   In addition, our field evidence shows that the outcome is enhanced by having a personable delivery from a charismatic person who builds a positive therapeutic alliance.                  

bs-diagramdetailedWith so many missing elements, this an Incomplete Model of Behaviour Change

Where is the client person in the ‘Behaviour Change Intervention Ontology’, and what about their feelings and their own striving for new balance and equilibrium?  Where is the therapist and the therapeutic alliance?  The quality of the change agent, their clinical and interpersonal skills and the quality of the therapeutic alliance can be more important than the BCTs (Hilton & Johnston, 2017) .With so many missing elements, this is beginning to appear like a top-down model of behaviour change. One may be excused for wondering whether the people designing the ‘ontology’ have any real-world hands-on experience of delivering interventions.

Hagger and Hardcastle (2014) suggest that “Interpersonal style should be included in taxonomies of behavior change techniques”. The whole point is that the therapeutic alliance is something the therapist and the client need to strive for. The alliance creates a more equal power balance between therapist and the client. It is more important than another technique, another item on the list. It is more about the ‘chemistry’ of the client-therapist relationship than about a finely polished set of BCTs. The trouble is that the advocates of the BCT compendium/ontology appear unwilling to engage with the problem. Somewhat ironically, they are resistant to change. However, the problem will not just go away, but rears its head each and every time a therapist swings into action.

Behaviour change involves a collaboration between the client wanting to make the change, with their own desires and feelings, and the change agent/therapist. The therapeutic alliance between the two parties is crucial to the project’s ‘outcome’.  Therapist’s attributes such as being flexible, honest, respectful, trustworthy, confident, warm, interested, and open contribute to that alliance. From all of this it can readily be seen that the situation is far more complex than the proposed ‘Behaviour Change Intervention Ontology’. It is never as  simplistic as an ‘Intervention’,  ‘Mechanisms of Action’ and ‘Target Behaviour’.

To use an analogy, there is so much more to baking a cake than a set of ingredients. Of course one needs a set of ingredients (the BCTs) but one also needs a baker – the behaviour change agent (BCA). The BCA/therapist must be fully trained to prepare, mix and cook the ingredients, to be fully competent to deliver the BCTs in a stylish manner. The qualities of effective therapists have been studied for at least 50 years. The stock piling of a compendium of BCT ingredients without attending to the mixing and ‘baking’ of the ingredients by the BCA on the front line is a recipe for disaster.

smart chef character cooking behind kitchen table with various o

Including therapist attributes of flexibility, authenticity, respect, trustworthiness, confidence,  warmth, interest, and openness, along with the client’s goals, desires and striving provides a more accurate and comprehensive approach to behaviour change.

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“Milestone text of the 21st century”

In ‘A General Theory of Behaviour, David Marks has applied scientifically established theory to conceptualize disparate areas of Psychology in a manner that both unifies and brings greater insight, establishing this book as a milestone text of the 21st century.

Dr David A Holmes, Senior Lecturer in Psychology, Founder of the Forensic Research Group, Manchester Metropolitan University

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“Inspiring book…compelling read”

This inspiring book applies the seemingly simple biological concept of homeostasis to human behaviour.  There is beautiful historic detail about key researchers, whilst considering modern issues such as stress, lack of sleep and addiction. A compelling read, which feels like an engaging lecture, by a passionate and considered speaker.

Janine Crosbie, Psychology Lecturer, University of Salford,

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“Exceptional insights and a driving logic”

‘In A General Theory of Behaviour, David Marks embarks on the rare journey of creating a central theory of human behaviour, the things that underpin how we think, what we do, how we affiliate with others, and who we become.  Marks brings exceptional insights and a driving logic to bear to navigate through many fragmented theories of behaviour that are by their nature partial and limited.  It is not that these more fragmented theories are not often important, but that we need the grander theory to hold disparate ideas together.  Marks does so convincingly and in a way that is testable, refutable, and often even entertaining.  He demands that the reader think, question, and grasp a broad framework, and doing so will require the kind of thought that our internet-based, 140 character thinking has been reversing.  His ideas are truly worth the effort to sit back with a cup of coffee, and if necessary even a scotch, and think through, ponder, go back over, and incorporate into our appreciation of the eternal question of “what drives human behaviour.”  In A General Theory of Behaviour Marks has made a true contribution to psychology that comes from his careful listening, watching, and thinking over a decades-long career. It is his major contribution and one everyone interested in grasping the essence of human behaviour should tackle.’

Stevan Hobfoll, Rush University Medical Centre

Thank you most kindly Stevan E. Hobfoll!

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Dyshomeostasis in human feeding

In an environment that promotes widespread body dissatisfaction, angst and depression, homeostatic feedback loops are producing excessive consumption of unhealthy processed foods that over a protracted period causes obesity in large numbers of vulnerable people. Multiple clinical studies in different areas of medicine demonstrate the primary role of homeostasis in healthy functioning and the consequences of dyshomeostasis. Homeostasis can be overloaded or overridden with too strong a flow of inputs or outputs that disrupt its normal functioning: ‘The homeostatic behaviour of inflow controllers breaks down when there are large uncontrolled inflows, whereas outflow controllers lose their homeostatic behaviour in the presence of large uncontrolled outflows’ (Drengstig et al., 2012). Homeostasis can be disrupted anywhere, and perturbations will inevitably occur in normal functioning (Richards, 1960).

There are many examples of dyshomeostasis in clinical medicine. Well-known to psychologists, Hans Selye reported that a persistent environmental stressor (e.g. temperature extremes), together with an associated homeostatic hormonal response, leads to tissue injury that he termed a ‘disease of adaptation’ (Selye, 1946). Intestinal homeostasis breaks down in inflammatory bowel disease (Maloy and Powrie, 2011) and in the microbial ecology of dental plaque causing dental disease (Marsh, 1994). This form of dyshomeostasis can result from local infection and inflammation and give rise to complications that affect the nervous and endocrine systems (Maynard et al., 2012). An altered balance between the two major enteric bacterial phyla, the Bacteroidetes and the Firmicutes, has been associated with clinical conditions. Within the microbiota of the gut, obesity has been associated with a decreased presence of bacteroidetes and an increased presence of actinobacteria (Ley, 2010; Turnbaugh and Gordon, 2009). Kamalov et al. (2010) proposed a dyshomeostasis theory of congestive heart failure. Craddock et al. (2012) suggested a zinc dyshomeostasis hypothesis of Alzheimer’s disease.

Homeostasis regulation within the endocrinal and central nervous systems has been associated with feeding control. Cortical areas conveying sensory and behavioural influences on feeding provide inputs to the nucleus accumbens (NAc) and the lateral hypothalamic area (LHA) is the site of homeostatic and circadian influences (Saper et al., 2002). Hormones such as leptin circulate in proportion to body fat mass, enter the brain and act on neurocircuits that govern food intake (Morton et al., 2006). Through direct and indirect actions, it is hypothesized that leptin diminishes the perception of food reward while enhancing the response to satiety signals generated during food consumption that inhibit feeding and lead to meal termination.

Another important hormone is ghrelin which is the only mammalian peptide hormone able to increase food intake. Interestingly, ghrelin also responds to emotional arousal and stress (Labarthe et al., 2014; Müller et al., 2015). During chronic stress, increased ghrelin secretion induces emotional eating by acting at the level of the hedonic/reward system. As ghrelin has anxiolytic action in response to stress, this adaptive response may contribute to control excessive anxiety and prevent depression (Labarthe et al., 2014). In obesity, studies have shown a reduced ability to mobilize ghrelin in response to stress or central ghrelin resistance at the level of the hedonic/reward system which may explain the inability to cope with anxiety and increased susceptibility to depression (Figure 1). Reciprocally, studies have shown that people with depression have increased susceptibility to obesity and eating disorders (Marks, 2015).

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Figure 1. Model of hedonic/reward response to ghrelin after chronic stress in relation to anxiety and depression. Reproduced from Labarthe et al. (2014).

During chronic stress, increased ghrelin secretion induces emotional eating as hedonic reward. Ghrelin has anxiolytic actions in response to stress; this adaptive response helps to control excessive anxiety and prevent depression. In obesity, a lower ability to mobilize ghrelin in response to stress or central ghrelin resistance at the level of the hedonic/reward system may explain the inability to cope with anxiety and increased susceptibility to depression. Reciprocally, people suffering from depressed show increased susceptibility to obesity or eating disorders (due to an altered hedonic/reward response). Elevated ghrelin may also contribute to alcohol/drug craving as higher ghrelin levels correlate with greater alcohol craving.

In addition to leptin and ghrelin, other lipid messengers that modulate feeding by sending messages from the gut to the brain have been identified. For example, oleoylethanolamine has been associated with control of the reward value of food in the brain (Lo Verme et al., 2005; Tellez et al., 2013). Mice fed a high-fat diet had abnormally low levels of oleoylethanolamine in their intestines and did not release as much dopamine compared to mice on low-fat diets. Thus, alterations in gastrointestinal physiology induced by excess dietary fat may be one factor responsible for excessive eating in the obese (Tellez et al., 2013).

Extracted from Marks (2016)

Homeostasis Theory of Well-being

Homeostasis is a singular unifying principle for all living beings. Homeostasis operates at all levels of nature in every living system: in molecules, cells, tissues, organs, organisms, societies, ecosystems and the planet as a whole (Lovelock, 2009). Tissue homeostasis regulates the birth (mitosis) and death of cells (apoptosis); many diseases are directly attributable to defective homeostasis leading to over production or under production of new cells relative to cell deletion (Fadeel & Orrenius, 2005).

Biochemical and physiological feedback loops regulate billions of cells and thousands of compounds and reactions in the human body to maintain body temperature, metabolism, blood pH, fluid levels, blood glucose and insulin concentrations inside the body (Matthews et al., 1985). A body in good physical health is in biochemical and physiological homeostasis. Severe disruptions of homeostasis cause illnesses or can be fatal.

The General Theory of Behaviour (GTB) extends the principle to behaviour, experience and psychological well-being.

ABCD tetrad
A basic structure for homeostasis of behaviour
[Illustration credit: Graham McPhee]

The General Theory proposes that all behaviour and experience follow the principle of homeostasis (Marks, 2015, 2016, 2018). The GTB distinguishes between Physiological or ‘Type I’ Homeostasis and Psychological or ‘Type II’ Homeostasis. Other types of homeostasis operate at higher levels of organisation including the social level (Type III Homeostasis) and the ecological level (Type IV Homeostasis).

A person in good health is in a state of homeostatic balance that operates across systems of biochemical/physiological, psychological, social and ecological homeostasis. Outward and inward stability in a living being is only possible with constant accommodation and adaptation. All living beings strive to maintain equilibrium and stability with the surrounding environment through millions of micro-adjustments and adaptations to the continuously changing circumstances. Adjustments and adaptations can be both conscious and unconscious. The majority of fine adjustments are occurring at an unconscious level, hidden from both external observers and the individual actor.

The Homeostasis Theory of Well-being utilises the fact that human beings are natural agents of change. Humans adapt, accommodate and ameliorate under continuously changing conditions, both external and internal, to maximise the stability of physical and mental well-being. The Homeostasis Theory of Well-being (HTW) is illustrated below.

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The Homeostasis Theory of Well-being (Marks, 2015)

Well-being is the outcome of a multiplex of continuously changing feedback loops in a system of psychological homeostasis with four main component processes: well-being; cognitive appraisal; emotion; and action. Homeostasis maintain both physical and psychological equilibrium with the ever-changing external and internal environments, courtesy of an infinitude of micro-feedback-systems that fall within four macrosystems.

Psychological homeostasis regulates through feedback loops that control thought, emotion and action. Continuously flexible micro-adjustments of activity within feedback loops maintain equilibrium from moment to moment. Psychological homeostasis occurs in response to the infinite variety of circumstances that can affect well-being, including both internal adjustments (e.g. emotional regulation) and external adjustments using deliberate behavioural regulation (e.g. communicating, working, eating and drinking). In synchrony and synergy with all of the body’s other homeostatic mechanisms, psychological homeostasis operates throughout life during both waking and sleep.

In prevention and treatment of clinical conditions, individuals can help themselves and be helped by external techno aids to monitor and maintain physiological variables using behavioural forms of homeostasis, e.g. in diabetes, metabolic syndrome, hypertension, thyroid problems, skin disorders such as urticaria, or obesity. Biochemical, physiological and psychological homeostasis are of similar complexity. Behavioural forms of homeostasis occur in actions designed to support neural systems of regulation. Social homeostasis in supportive actions by other humans, requested or volunteered, provides another way to support and protect an individual’s well-being.

Inputs to homeostasis include technological systems such as: (1) scales for measuring body weight; (2) thermometers to measure body temperature; (3) pulse measurements; (4) electro-mechanical homeostasis, developed by engineers to enhance human control systems such as heating (thermostat), driving (cruise control), navigation (automatic pilot), and space exploration (computer navigation systems); (5) life support systems (e.g. artificial respirators, drip feeding, kidney dialysis, intensive care units); (6) medical and surgical interventions; (7) pharmaceutics; (8) alternative and complementary therapies; (9) yoga and meditation.

People are social and emotional beings and these features need to be restored into theories of behaviour. The Homeostasis Theory of Well-being needs to be tested in randomised controlled trials and prospective studies to determine its scientific validity and applicability to health care.

Stopping the Obesity Crisis

Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium at set-points using feedback loops for optimum functioning of the organism. Long-term disruptions of homeostasis or ‘dyshomeostasis’ arise through genetic, environmental and biopsychosocial mechanisms causing illness and loss of well-being including obesity, the addictions, and chronic conditions. These and many other phenomena of Psychological Homeostasis are explained in A General Theory of Behaviour.

Obesity dyshomeostasis is associated with a self-reinforcing activity of a vicious Circle of Discontent in which hedonic reward overrides weight homeostasis in an obesogenic and chronically stressful environment. Over-consumption of processed, high-caloric, low-nutrient foods, combined with stressful living and working conditions, have caused loss of equilibrium, overweight and obesity in more than two billion people.

The prevalence of obesity is higher in women and low-income groups who are more exposed to chronic stress and low purchasing power including some ethnic minority groups.

Research on different diets suggests that a plant-based diet containing low amounts of sugar, little or no red meat and the minimum of fats promotes weight-loss and prevents obesity, diabetes, metabolic syndrome, coronary heart disease, and cancer. A vegan diet with no meat, fish or dairy is especially anti-obesogenic.

The ‘thin ideal’ pervades popular culture with narratives and images of thinness which has an entirely negative effect on youth the world over. Legislation should be enacted to ban the use of artificially enhanced images of ultra-thin models in magazines and media.

Discrimination against people who are overweight or obese causes stress and socio-economic disadvantage. Approaches to the epidemic that invoke a narrative of ‘blame-and-shame’ exacerbate the problem. There are very few people who deliberately become obese through conscious effort or who would not like to avoid it if they possibly could.

Homeostatic imbalance in obesity includes a ‘Circle of Discontent’ (COD) a system of feedback loops linking weight gain, body dissatisfaction, negative affect and over-consumption. This homeostatic COD theory is consistent with a large evidence-base of cross-sectional and prospective studies.

A preliminary model suggests that obesity dyshomeostasis is mediated by the prefrontal cortex, amygdala and HPA axis with signalling by the peptide hormone ghrelin, which simultaneously controls feeding, affect and hedonic reward.

The totality of evidence within current knowledge suggests that obesity is a persistent, intractable condition. Prevention and treatment efforts targeting sources of dyshomeostasis provide ways of reducing adiposity, ameliorating addiction, and raising the quality of life in people suffering chronic stress.

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Vigorous and uncompromising Governmental actions are required, independent of corporate interests, at all levels of society to reduce the prevalence of obesity and related conditions. A four-armed strategy to halt the obesity epidemic is necessary.

There is an immediate need to enact anti-discrimination legislation to protect people with obesity and improve their quality of life. Anti-discrimination laws are necessary to eliminate one of the primary causes of obesity which fuels the Circle of Discontent. PLWO need legal protection from discrimination which has been shown to be detrimental to the mental health of the victims of obesity.

Legislation to enforce a mandatory code of practice is needed to resist and devalorize the thin-ideal. Precedents have been set in Israel and France to ban models with extremely low BMI, examples which should be followed in all countries. The retouching of pictures in fashion magazines to make the human subjects appear slimmer or more attractive should be controlled. Consumers should be informed when images of people have been manipulated.

Generic legislation is necessary to curb the widespread consumption of energy-dense, low nutrient foods and drinks. Mexico, France, Finland and Hungary and, most recently, the UK have set charges for a levy on sugary drinks, a step in the right direction. More generic taxation is necessary to incentivize producers and retailers to reformulate products. An ‘Unhealthy Commodities Tax’ which would yield revenue and improve the diet of a large segment of the at-risk population.

Improving the access to plant-based diets is an effective strategy for producing weight loss. The example of the WIC in the US indicates that increasing access to fruit and vegetables has a positive effect on food consumption towards a healthier diet. Following the WIC model, legislation should be considered in every state and country to improve F/V intake. Proceeds from a UCT could be used to subsidise the organic production of F/V with payments to growers and sellers to enable lower retail prices of organic F/V. Interventions to increase access and affordability of F/V would help to slow the obesity epidemic.

Huge resources have been invested on the monitoring of the epidemic and on the treatment of PLWO. The major part of future investment should be re-directed towards containment and control by legislating strategies for obesity prevention as was previously the case in tobacco control. No more kowtowing to industry. Let’s cease the “shock-horror” narrative of obesity at all levels of society and replace it by concrete actions.

We know what is required. Can our national governments show the necessary leadership and do what is necessary? The survival of the planet and the human race requires nothing less.

Stop Smoking Now

If you’re a smoker and want to give up the habit, then Stop Smoking Now is designed for you. The approach involves restoration of homeostasis without nicotine in the body or nicotine replacement, e-cigarettes or any other kind of crutch in the form of medication.

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The truth is Stop Smoking Now could not only save your life, it offers you a healthier and longer life as well. It also could save you a shed-load of money. A new car every year, fabulous holidays, and a much higher quality of life are all yours if you really want them. But it isn’t really about the money. It’s about your health and well-being.

To gain these benefits, all you need to do for the next 7-10 days is to follow the process. Yes, that’s right, it really is that simple. Hard to believe, right?

Well consider this. I have spent the last forty years fine-tuning the best possible ways for smokers to overcome the habit. My role as a Health Psychologist has brought me into contact with people from all backgrounds and cultures who have been at all the different stages of stopping smoking. In many cases, the smokers started out as desperate and hopeless cases, feeling that nothing could work for them. They had tried almost everything to stop smoking, but nothing had succeeded. Instead of blaming the faulty and futile systems they had been using to stop smoking, including most of all, their own willpower, they typically blamed themselves. They blamed themselves for being “weak”. Sounds familiar?

All a person needs to stop smoking is a system that actually works. A week or two weeks of serious application and, bingo, you will hit the jackpot, stop smoking, and remain a smoker for the rest of your life. Like many ex-smokers, you will experience feelings of joy and empowerment, hugely increased self-control and life satisfaction by achieving what previously seemed impossible – to stop smoking. Nothing can offer you a greater boost to your self-esteem than to stop smoking, absolutely nothing. It’s better than winning the lottery. Because it’s not just about the money you’ll save, it’s about a Whole New You.

Stop Smoking Now gives you the most effective method of stopping smoking. The processes described here will enable you to bring about the change.

I know – I have been there!

In my twenties virtually everybody was smoking. Smoking was the natural and normal thing to do. You could smoke almost anywhere. In shops, cafes, pubs, clubs, cinemas, theatres, absolutely everywhere. It seems crazy now, but that’s how it was. I was a pack-a-day smoker and guess what, I actually thought I was enjoying it. Sound familiar?

Cigarette advertising was everywhere. In newspapers, magazines, on TV, at the movies and on huge billboards all over the place. People would literally drive along motorways and freeways smoking cigarettes and crash their cars gawping at the billboards. It seems a different reality now, but that’s exactly how it was. All kinds of subtle and clever messages designed to get everybody to smoke a particular brand. Brands for ladies, brands for teens, brands for minorities, brands for everyone.

My brand was XXXXX. I don’t really know why. I can’t explain it. As far as I was aware, it had nothing to do with the evocative brand imagery. But at a pre-conscious level, it almost certainly had a lot to do with it. Of course, I tried other brands too, but I usually drifted back to XXXXX. I had probably been smoking for about 10-11 years when something happened that stopped me in my tracks and got me thinking. I switched to the low tar version of XXXXX, called XXXXX Ultra Lites.

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I was living in the US when I switched to this ‘sleek’ low-tar brand, a supposedly ‘safer’ method of smoking – ‘safer’ according to the the big tobacco companies, that is. My grey-and-white pack of XXXXX looked smooth and on-trend, the perfect thing for a ‘Man-about-Town’. Like millions of others all over the world, I was one ‘cool dude’ making the switch to ‘low tar’. Until I discovered the truth, that is…

Little did I realize at first what a complete sham these ‘lights’ really were. The tobacco companies had discovered the sneaky idea of making tiny holes in the sides of the filters so when you inhaled you got extra air mixed in with the smoke. This fooled the machines used for measuring cigarette tar levels into assigning lower tar levels inside the cigarettes. Millions of ‘cool dudes’ all over the world were being taken for a ride because the cigarettes contained the exact same chemical concoction of tobacco as the regular, high tar brands. And you paid extra for the privilege! When the government scientists finally figured out what was going on, the terms “light,” “low,” and “mild” in product labeling and advertisements were banned in the USA.

A week or two after I had made the switch I woke up one morning with an unexplained headache and began to notice I was having to inhale ever more deeply to get any real ‘satisfaction’ from my Ultra Lites. This was in 1976 when I was working at the University of Oregon with Professor Ray Hyman. Ray Hyman remains one of the tiny number of people to have one of Psychology’s few real ‘laws’ named after him: the ‘Hick-Hyman Law’.

One evening over dinner Ray gave me a penetrating stare and said: Given all you know about the ill-effects of smoking, why the heck are you still smoking? He stopped me dead, so to speak. I really couldn’t give a rational answer. It was at that very moment that I decided to give up smoking. Within a few days of preparation, I did it. I destroyed my remaining cigarettes and never smoked again.

As I sit at my laptop, forty years later, I can honestly say that I gave up smoking thanks to the headaches from my XXXXX Ultra Lites and the pep talk from my friend. My thanks go out to them both. This was the best health-related decision that I took in the whole of my life. Thanks Ray! Thanks XXXXX Ultra Lites! It’s now forty short years since I quit smoking.

Once I took the decision to quit smoking, however, it was far from plain sailing. I discovered how very difficult it can be. I was crotchety with the whole world. I couldn’t sleep properly. I was sharing my woes with the inside of a beer bottle. There was an inexplicable gap in my life. A vacuum of nothingness that was difficult to fill.

This was how it all started, the main reason I decided to write books and run programmes and campaigns to help other people to stop smoking. After I returned from my visit to the US, a very smart PhD student called Paul Sulzberger came to me with the idea. He and I started running Stop Smoking courses. We put together a course of five sessions that groups of people attended over a period of eight days. The sessions started on a Tuesday and finished the following Wednesday. It was highly successful. Eighty-five percent of smokers had given up by the end of the eight days. The remaining 15 percent had all reduced their consumption significantly.

News of our Stop Smoking programme spread like wildfire and we took the programme all over New Zealand and into Australia. We must have helped 20,000-plus smokers give up the habit. Our research and an independent research organisation told us that we were producing some very exciting results, the highest cessation rates ever recorded. We did ads on TV and in the major papers and franchised the system internationally and it is still running under various umbrellas to this day.

In the mid-80s I returned to London as Head and the first Professor of Psychology at the School of Psychology at Middlesex Polytechnic. The busy London lifestyle felt a bit different to more laid-back New Zealand. In my efforts to continue the march against smoking, I needed a more efficient approach so I converted the method into a self-help pack I called the QUIT FOR LIFE Programme, which was published by the British Psychological Society.

The BPS QFL Book Cover

In 2005, the first edition of the version you are now reading was published. In its current edition, Stop Smoking Now has proved to be the most successful stop smoking method ever invented. Yes, that’s right, ever invented.

I have the results of scientific trials prove this. One of my most memorable moments was when I returned on a visit to the beautiful South Island of New Zealand on holiday with my son, Michael. While in Dunedin we visited a friend who lived in the suburb of St Clair. It was a warm and sunny afternoon. A person who, at first I did not remember, had taken my smoking cessation programme many years before came over, looked me straight in the eye, and said: “You saved my life. You helped me stop smoking 25 years ago. Now I’m 75 and fit as a fiddle, thanks to you, I wouldn’t still be here if you hadn’t helped me stop smoking.” This is not the only time I have received the heart-warming announcement: “You saved my life”. Many others have said exactly the same thing.

I too probably wouldn’t still be alive today if I hadn’t stopped smoking. I know from bitter experience. I watched my one-and-only brother Jon die from throat cancer caused by smoking. Jon had only just reached his sixtieth birthday.

But that’s all history now. Let’s return to the present…You are on a different path, a path that can lead to health, increased quality of life, and happiness.

What You Need To Stop Smoking Now
You have taken the first precious step on the path to changing your smoking habit. You have within your hands a powerful and unique system designed to enable you to reach this important goal to stop smoking. You have the desire. You have the motivation. You have the ability. In this book, you have the strategies, the know-how you need to do it, to Stop Smoking Now. Follow the guidance in this book, and you will stop smoking in just a few days, and, think about it, you will never need to smoke again!

This will be the most important step to improve your health that you can take in the whole of your life. Experiencing the process from beginning to end is something you will never forget. You will be a changed person, a New You.

You already realize that smoking is the most stupid, addictive and harmful habit known to humankind. It is predicted that one billion people will die in the 21st Century as a consequence of smoking. One way of solving the world’s population explosion, I suppose… But a smoking-related death it’s not normally a quick death. Smoking-related illnesses are nasty, protracted and painful and require thousands of health care dollars. Having watched my brother slowly die in great pain, it’s something I wouldn’t wish on anybody.

Stop Smoking Now offers you the best chance to overcome your smoking habit without any help from Big Pharma. It offers you a way to extinguish the habit, once and for all. And that’s without taking a shed load of gut-busting drugs. The methods in this book have been evaluated with hundreds of smokers in randomized controlled trials. Tens of thousands of people like you have successfully overcome their smoking habit using these methods.

If you use all of the procedures with commitment and perseverance, you will overcome your smoking habit for ever. You twill be a Calm and Confident Non-Smoker.

Stop Smoking Now is in three stages.

Part One is all about Theory. I discuss the psychology of smoking and quitting. I introduce Cognitive Behaviour Therapy (CBT) and its cousin, ‘Mindfulness’, explain how they work, and how they can help you to give up smoking once and for all. It will help you to think about and become acutely aware of what you do when you smoke, why you do it, and what smoking really means to you.

If you’re not much interested in Theory and want to cut straight to the nitty-gritty, you can skip Part One and move directly to Part Two. Part Two is the Practical stuff, the guts of the whole system. It guides you, step by step, from the addicted smoker you are now to a new healthful life as a non-smoker. The process takes 7 to 10 days. This will be your new beginning, a brand new life, the most dramatic way to improve your quality of life, extend your lifespan and make you better off financially in one smart move.

Part Three is also Practical. It’s about Regaining your Life as a Non-smoker. It guides you over the pitfalls of being a recent quitter and helps you to prevent relapse and maintain your non-smoking permanently.

Why You Should Stop Smoking Now
Stopping smoking is, without any doubt, the most important thing you can do to improve your health. If you stop smoking:

• You will live longer and live a healthier life.
• You will significantly reduce your chance of having a heart attack, stroke, or cancer.
• Your skin, hair, body and clothes will no longer reek of tobacco.
• Your fingers will stop turning yellow.
• Your sex life will show a significant improvement.
• If you are pregnant, you will improve your chances of having a healthy baby.
• The people you live with, your loved ones and your children, will have a healthier, less polluted environment.
• You will save a lot of extra money to spend on luxuries and holidays.

How This Method Can Help You
There are thirty different procedures that have helped thousands of smokers give up the habit. Nobody can predict which particular procedures will work best for you – everybody is different. However, by trying this wide range of different procedures, you are giving yourself your best chance of success. Please try them all.

Believe it or not, you can possibly enjoy certain aspects of the process of stopping smoking. It is part of the design to make this method as an enjoyable and fun experience as possible. You will learn a lot about yourself and the potential you have to change yourself for the better. Yes, to actually make yourself a better and more aware and fully functioning person. But I would not be telling you the whole truth, if I didn’t tell you that it can be very, very difficult. You already know that.

An addicted smoker is always, to a degree, dysfunctional. The changes that make you will make will help you to be a fully functional human being again. Like you used to be before you took up the habit, or rather, before the habit took over you.

Drinking, eating, Internet surfing, shopping, chilling, watching TV, gaming, gambling – anything to excess can quickly turn into an addiction. Smoking is a habit which seems extremely difficult to change. As an ex-smoker I know. But smoking can be brought under control easily and permanently by applying this systematic programme.

The book can be used as a stand-alone, self-help, how-to method of quitting or it can be combined with the treatment offered by your local health service providers. Two or more smokers can also Stop Smoking Now together to generate an element of cooperation, or even competition. Who gets there first, is always an interesting challenge, as is Who stays there the longest?

I wish you absolute and complete success in becoming a happy and successful non-smoker.

A General Theory of Obesity

Inside every one us there exists a tension between comfort and discontent. When we assuage the discontent, we find comfort. When we resist comfort, the discontent builds stronger. This eternal struggle is an aspect of the human condition that creates a vicious and unforgiving circle. Within it lies a significant key to human nature, and to the nature of all sentient beings, the ‘Yin and Yang’ of life…it helps to explain the human struggle with overweight, obesity and the addictions.

Once the causes of obesity are fully understood, the obesity epidemic can be stopped. My book takes a step towards that goal. I propose an explanatory theory of an objective issue of undeniable importance to human beings – the obesity epidemic. The ideas are drawn from a range of disciplines including economics, endocrinology, epidemiology, neurobiology, nutrition, physiology, policy studies and psychology. The theory focuses on a universal feature of living beings, homeostasis, and the potential for its disruption, dyshomeostasis.

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The evidence points to ‘Obesity Dyshomeostasis’ as a problematic human response to contemporary conditions of living. Similar to racism, sexism and ageism, the current trend towards ‘blaming and shaming’ individual sufferers of obesity and overweight contributes to the problem. Only by reversing this form of prejudice, and the associated environmental conditions, will the obesity epidemic have any chance of being resolved (Marks, 2015a, 2016).

Summary of argument:

Health is regulated by homeostasis, a property of all living things. Homeostasis maintains equilibrium using feedback loops for optimum functioning of the organism. Dyshomeostasis, a disturbance of homeostasis, causes overweight and obesity, is estimated to be present today in more than two billion people world-wide.

Obesity Dyshomeostasis is associated with a ‘Circle of Discontent’, a system of feedback loops connecting weight gain, body dissatisfaction, negative affect and over-consumption. The Circle of Discontent is consistent with an extensive evidence-base.

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Obesity Dyshomeostasis occurs when homeostatic control of eating is overridden by hedonic reward. Appetitive hedonic reward is a natural response to an obesogenic environment containing endemic stress and easily accessible, high-energy foods and beverages. In a time of plentiful and cheap food, people eat more to comfort their discontents than purely for hunger. The comfort foods and beverages that are snacked on almost limitlessly are nutritionally deleterious to the health.

The objectives are: (i) To define, describe and discuss the concepts of psychological homeostasis and dyshomeostasis and their relevance to overweight, obesity, the addictions and chronic stress; (ii) To propose a General Theory of Well-Being founded on the construct of psychological homeostasis; (iii) Within the general theory, to specify the Obesity Dyshomeostasis Theory (ODT) of overweight and obesity; (iv) To summarize the body of evidence that is supportive of the general theory and the ODT; (v) To describe interventions for preventing overweight and obesity based on the ODT.

Obesity dyshomeostasis is mediated by the prefrontal cortex, amygdala and HPA axis with ghrelin providing the signalling for feeding dyshomeostasis, affect control and hedonic reward. Dyshomeostasis plays a causal role in obesity, the addictions and chronic conditions and is fueled by negative affect and chronic stress. Prevention and treatment efforts that target dyshomeostasis provide strategies for reducing adiposity, ameliorating the health impacts of addiction, and raising the quality of life in people suffering from chronic conditions and stress.

A four-armed strategy to halt the obesity epidemic consists of eliminating the causes of overweight and obesity: (1) Resisting and putting a stop to a culture of victim-blaming, stigma and discrimination; (2) Resisting and devalorizing the thin-ideal; (3) Resisting and reducing consumption of energy-dense, low nutrient foods and drinks; (4) Improving access to plant-based diets. If fully implemented, these interventions should be competent to restore the conditions for homeostasis in billions of people and the obesity epidemic could be halted.

Extracted from Obesity. Comfort vs Discontent