Transforming Chained Behaviors: Case Studies of Overcoming Smoking, Eczema, and Hair Pulling (Trichotillomania)a
The authors describe the format of a holistic health class provided to undergraduates at San Francisco State University in California. The class initially emphasizes self-monitoring and record keeping to enhance the students' self-awareness of negative emotions, symptomatic behaviors, and other “chained behaviors” leading to various problems, such as smoking or eczema. The students cultivate a variety of positive self-care behaviors and self-regulation skills, such as mindfulness, relaxation skills, visualization techniques, and seeking social support. Finally, they learn to substitute these self-care practices for the negative emotions and behaviors, in the moments of emerging awareness, thus interrupting the “chain of behaviors” leading to problems. The authors provide case narratives of three students implementing this program to address personal illnesses or problems (smoking, eczema, and trichotillomania).
Ratings of self-healing benefits through students' self-assessment and researchers rating of students' self-report papers.
Factors that students described as having significantly contributed to the success of their self-healing project.
Percentage distribution of various techniques utilized by the students in achieving their self-healing goals.
Student's record of cigarettes consumed and, intensity of cravings experienced. The intensity of cravings was recorded on a scale of 1–10, where 1 = very little and 10 = intense craving.
Self-measurement of change in eczema while performing the self-healing project.
Pictures depicting the prevalence of eczema before and after performing the self-healing project.
Self-recorded minutes of hair pulling per week.
Pre and post photos of same location on the scalp. Note that the hair has significantly grown back in.
Interrupting and transforming the chained behavior. The moment students become aware of the trigger or behavior that is chained to the development of a symptom, they interrupt and perform active new health-promoting behaviors, as illustrated by the dashed lines.
Erik Peper
I-Mei Lin
Rick Harvey
Marina Gilbert
Prathyusha Gubbala
Amy Ratkovich
Lauren Fletcher
Contributor Notes