5 Changing Behavior Using the

Common-Sense Model of Self-Regulation

Linda D. Cameron, Sara Fleszar-Pavlović, and Tenie Khachikian

Practical Summary

People often grapple with the challenge of motivating themselves or others to

engage in adaptive behaviors in response to anxiety-arousing threats to their well-
being. Such challenges can emerge in contexts such as illness diagnoses, health risks,
environmental threats, sports competitions, public performances, or job interviews.
Conversely, practitioners often face the challenge of persuading individuals to engage
in behaviors that are in their best interests or the interests of the public good when the
individuals either are unmotivated to do so or have stronger preferences for
alternative actions such as those providing immediate gratication or avoidance of
a threat. The common-sense model of self-regulation describes how beliefs, emotions,
action plans, and appraisals of progress toward behavioral goals can inuence
behaviors in threatening or risky situations. This chapter describes the model and
reviews its strategies for changing behavior to improve health-related outcomes as
well as changing behaviors in other life domains.

5.1 Introduction The common-sense model integrates and builds

The common-sense model of self-regulation
(Leventhal, Brissette, & Leventhal, 2003;
Leventhal, Meyer, & Nerenz, 1980) delineates
cognitive and emotional processes inuencing
the self-regulation of behavior. In the context of
the model, self-regulation refers to the processes
used to control or direct thoughts, emotions, and
actions toward the attainment of goals. These
processes involve dynamic iterations of setting
goals, planning and enacting behaviors, evaluat-
ing progress toward goal attainment, and revising
goals and actions accordingly. The model was
initially developed to focus on managing health
threats such as somatic symptoms, health-risk
communications, and illness experiences.
on theory and research from multiple scientic
elds. First, it draws on control theory principles
that behavior is construed as constantly changing in
order to move one’s status toward one’s goals,
standards, and ideals (Miller, Galanter, & Pribram,
1960; see Chapter 9, this volume). Second, it incor-
porates emotion regulation processes delineated by
theories of emotion and research on how fear arou-
sal motivates protective actions (Leventhal, 1970;
Leventhal, Singer, & Jones, 1965). The key under-
standing arising from this emotions research, that
communications must elicit both fear arousal and
action planning, is central to the model (see also
Chapter 34, this volume). Third, the model
https://doi.org/10.1017/9781108677318.005
 Changing Behavior Using the Common-Sense Model of Self-Regulation
integrates anthropological research on explanatory
models of illness, revealing how these mental
models have common structures across cultures
(Kleinman, 1980, 1988). Specically, these mental
models encompass attributes reecting beliefs
about symptoms, causes, timeline, consequences,
and control through treatments. That these attri-
butes hold consistently across cultures suggests
a universal need to understand these features of an
illness experience. Finally, the model draws on
cognitive science, delineating abstract, conceptual
processes and concrete-experiential processes that
are triggered in response to stimuli and operate in
parallel (Epstein, 1994). Abstract, conceptual cog-
nition involves reasoned, linguistic processing of
information, whereas concrete-experiential pro-
cesses involve perceptual, image-based contents.
The integration of these multiple processes
involving control dynamics, emotion regulation,
mental models, and cognitive processes is a key
strength of the common-sense model and under-
scores its potential for guiding behavior change
techniques. The model is also used to understand
and predict outcomes such as quality of life and
distress (e.g., Richardson et al., 2016); however,
this literature is beyond the scope of this chapter.
This chapter reviews the common-sense
model of self-regulation and its application to
Risk-Action Link
Threat
T P Representation
H E Identity
R R Consequences
E C Abstract Control
A E Conceptual Cause
T P Timeline
Coherence
T
I Concrete
C O Experiential
U N Representation of
E S
Emotional Reaction
(e.g., fear or worry)
Figure 5.1 The common-sense model of self-regulation
61
interventions for behavior change. Given that the
primary focus of the model is health-related beha-
viors, the chapter focuses largely on its application
to changing behaviors in response to health threats.
Importantly, however, the model incorporates self-
regulation processes involved in response to threats
and challenges more generally, such as environ-
mental risks, education-related challenges, and
political threats to social justice. The chapter thus
considers applications of the model to changing
behaviors in other arenas and highlights the need
for theory development and research to broaden the
model’s relevance and use to behavior more
generally.
5.2 Brief Overview of the
Common-Sense Model and
Evidence
The common-sense model of self-regulation (see
Figure 5.1) emphasizes the roles of individuals’
common-sense beliefs about threats and rules for
coping decisions. Perceptions of threat cues simul-
taneously activate problem-focused self-regulation
via efforts to control the threat itself and emotion-
focused self-regulation via efforts to manage dis-
tress-related arousal. In the problem-focused arm of
the model, the activation of a mental schema or
Coherence
Coping for Threat Appraisal of Coping
Control Outcomes
Coping for Appraisal of Coping
Emotional Control Outcomes
Attentional Deployment
Cognitive Reappraisal
Proactive Behaviour
Response Modulation
62 L I N D A D . C A M E R O N , S A R A F L E S Z A R - P A V L O V I Ć, A N D T E N I E K H A C H I K I A N
representation of the threat elicits emotional
responses and guides action plans for threat-
reducing behavior. For example, an unusual lump
can activate a representation of cancer, which can
trigger worry and motivate scheduling a medical
appointment. The emotion regulation arm involves
efforts that can often fuel protective behavior; for
example, worry about a rapid resting pulse can
stimulate physical activity efforts. When fear is
high, however, it can have the counterproductive
effects of inhibiting behaviors that themselves pose
threats of yielding negative consequences, such as
when someone has a detection test – for example,
a mammogram (Lerman et al., 1991) or chest x-ray
(Leventhal & Watts, 1966). Appraisals of problem-
focused and emotion-focused coping outcomes
feedback to revise the representations and emo-
tional arousal. Problem-focused and emotion-
focused regulation involve both abstract conceptual
processes and concrete-experiential processes.
Whereas abstract processes can lead to relatively
“cool” deliberative appraisals and decision-making,
concrete-experiential processes can evoke rela-
tively “hot” responses and impulsive reactions
(Epstein, 1994).
The model provides further elaboration on
three features of the self-regulation process:
representations, coherence, and emotion regula-
tion behaviors. These features are discussed in
turn, followed by considerations regarding varia-
tions of the model and general principles for
applying it to behavior change.
5.2.1 Representations
Representations activated by illness cues (e.g.,
sore throat) incorporate the ve attributes of
explanatory models (Cameron, Durazo, & Rus,
2016; Kleinman, 1988): (1) identity, including
its label (e.g., strep throat) and symptoms (e.g.,
fever, fatigue); (2) causes (e.g., exposure to bac-
teria); (3) timeline or duration, which may be
acute, cyclical (it comes and goes), or chronic;
(4) consequences (e.g., need to miss work); and
(5) actions for its control or cure (e.g., antibiotics,
rest). This representation guides action planning
(e.g., seeking medical care, taking the prescribed
antibiotics) and provides reference points for
appraising outcomes of actions (e.g., whether
the sore throat has subsided).
A representation’s conceptual content (e.g.,
abstract knowledge about strep throat as caused
by bacterial infection) and concrete-experiential
content (e.g., memories of languishing in bed with
strep throat) can differentially inuence emotional
and behavioral reactions. Concrete-experiential
content can be more powerful than conceptual con-
tent in stimulating distress and motivating protec-
tive efforts (Cameron & Chan, 2008).
Similar to representations of illness, representa-
tions of illness risk are activated by threat cues
from media messages (e.g., about sun exposure
and skin cancer), tests of susceptibility (e.g.,
genetic testing for skin cancer risk), personal char-
acteristics (e.g., pale skin), and other sources. Risk
representations include attributes comparable to
those of illness representations: identity risk
(label and characteristics conferring risk), causal
risk (factors causing the condition), timeline
(likely times in one’s life for its onset, likely dura-
tion), consequences (intrapersonal and interperso-
nal outcomes), and control/cure (whether and how
the condition can be treated or controlled).
5.2.2 Coherence
The common-sense model identies coherence, or
how representational attributes and their links with
protective actions are understandable and “make
sense,” as critical for motivating adaptive beha-
viors. Representational coherence, or having
a clear understanding of the threat, can reduce dis-
tress caused by confusion and increase protection
motivations (Durazo & Cameron, 2019). For exam-
ple, someone diagnosed with gingivitis could feel
calmer on learning that it is a controllable bacterial
infection and the reason for one’s bleeding gums,
and this understanding could motivate regular
 Changing Behavior Using the Common-Sense Model of Self-Regulation
toothbrushing and ossing. Risk-action link coher-
ence, or a clear understanding of how protective
actions work to control the threat, can further moti-
vate protective action (e.g., Cameron et al., 2012;
Lee et al., 2011; see Appendix 5.1, supplemental
materials). For example, women smokers might be
motivated to quit if they understand how smoking
increases cervical cancer risk by introducing
chemicals into the bloodstream that reach and
alter cervical cells.
5.2.3 Emotion Regulation
The common-sense model also delineates four types
of emotion regulation behaviors (Cameron & Jago,
2008; Gross, 1998): attentional deployment, cogni-
tive reappraisal, proactive behavior, and response
modulation. Attentional deployment involves
efforts to focus on a threat (e.g., by either attending
to or perseverating about an upcoming job inter-
view) or avoid it (e.g., by distracting one’s thoughts
away from it). Cognitive reappraisal involves rein-
terpreting the threat to be more benign (e.g., reinter-
preting the interview as an opportunity or exciting
challenge). Proactive behavior includes efforts to
prepare for or manage the threat (e.g., searching
the Internet for information about the organization)
and includes seeking social support (e.g., asking
others for interviewing tips). Response modulation
includes modifying communications about emo-
tional experiences (e.g., expressing or suppressing
emotions to others) and acting to reduce emotional
arousal (e.g., via relaxation exercises or alcohol or
substance use). Through these processes, reactions
such as fear or worry can motivate adaptive beha-
vior or they can foster efforts that impede adaptive
behavior (e.g., avoidance and substance misuse).
5.2.4 Variations of the Common-Sense
Model
Variations of the common-sense model take into
account specic contextual factors (e.g., cancer
survivorship; Durazo & Cameron, 2019),
63
behavior-related factors such as medication
beliefs (e.g., Hagger et al., 2017; Horne et al.,
2019), and factors that alter or moderate proposed
common-sense model relationships (Hagger
et al., 2017). For example, the revised common-
sense model developed by Hagger and colleagues
(2017) incorporates treatment beliefs, behavioral
beliefs such as self-efcacy, and the moderating
inuences of illness characteristics (e.g., type of
illness), dispositional and personality factors
(e.g., dispositional optimism), and emotional
representations (e.g., fear levels). A later version
(Hagger & Orbell, 2019) elaborates further on
model features such as mediational processes,
behavior and treatment beliefs as determinants
of coping and outcomes that are independent of
threat representations, and additional moderators
(e.g., trait negative affectivity, perfectionism).
5.2.5 Applications of the
Common-Sense Model to
Behavior Change
The common-sense model can guide efforts to
change a range of behaviors for managing health
and other threats. Types of behaviors (with exam-
ples from the health eld) include prevention
efforts (e.g., Lee et al., 2011), informed decisions
(e.g., Cameron et al., 2012), detection and man-
agement efforts (e.g., Levine et al., 2016), and
emotion regulation behaviors inuencing well-
being (e.g., Cameron et al., 2007). It can be used
to promote single behaviors (e.g., genetic testing
for disease risk; Marteau & Weinman, 2006),
cyclical behaviors (e.g., u vaccinations; Parker
et al., 2016), and lifestyle habits (e.g., sunscreen
use; Hubbard et al., 2018).
Which features of the model to target in inter-
ventions will vary according to characteristics of
the behavior. Specically, determining which com-
mon-sense model components to target requires
considerations of whether the desired behavior
involves (1) the prevention, detection, or manage-
ment of a threat; (2) singular, cyclical, or ongoing
64 L I N D A D . C A M E R O N , S A R A F L E S Z A R - P A V L O V I Ć, A N D T E N I E K H A C H I K I A N
enactment; (3) the need to manage distress inter-
fering with behavior enactment; and (4) the need
for feedback or training in appraising behavioral
outcomes. Threat representations, coherence, and
imagery processes can be useful targets for most
behaviors. Emotion regulation can be particularly
important in contexts evoking high fear, such as
diagnoses of serious conditions or stressful public
performances. Appraisal processes are critical tar-
gets for cyclical and ongoing behaviors, for which
enabling individuals to receive and interpret feed-
back can motivate continued behavior and helpful
revisions to behavior. Examples include insulin
monitoring for diabetes control (Levine et al.,
2016), performance appraisal in occupational set-
tings (Fletcher, 2001), and provision of feedback to
teachers in schools (Stormont & Reinke, 2013).
Table 5.1 illustrates how common-sense model
constructs can be operationalized as techniques
and intervention components.
5.3 Strategies Targeting
Representations to Elicit
Behavior Change
Strategies for changing representational attributes
(identity, cause, timeline, consequences, controll-
ability, and coherence) to promote behaviors
include psychoeducational approaches, communi-
cation skills training for clinicians and practi-
tioners, and motivational interviewing. These
approaches and their use within health settings
are discussed in the following sections.
5.3.1 Psychoeducational Approaches
One approach for instilling adaptive illness repre-
sentations is through personal sessions during
which an educator reviews the individual’s illness
beliefs and corrects inaccurate perceptions. These
approaches range in intensity and requisite train-
ing from cognitive behavior therapy (e.g.,
Christensen et al., 2015) to short messages in
communications such as pamphlets (e.g., Scott
et al., 2012). In one intervention (Petrie et al.,
2002), patients hospitalized for myocardial infarc-
tion participated in three sessions with a trained
educator prior to discharge. They received infor-
mation about the pathophysiology of myocardial
infarction, along with illustrations to instill con-
crete images of the condition; and engaged in
discussions about their representational beliefs
and the recovery process. Compared to usual-
care participants, intervention participants exhib-
ited positive changes in illness beliefs and returned
to work more quickly. Subsequent research repli-
cated and extended these ndings by demonstrat-
ing that the intervention increased exercise and
reduced telephone consultations with doctors
(Broadbent et al., 2009).
Similar psychoeducational approaches apply the
common-sense model to develop letters and pamph-
lets promoting representational beliefs that motivate
healthy behaviors. For instance, an intervention let-
ter providing information about controllability and
consequences increased cardiac rehabilitation atten-
dance among myocardial infarction patients
(Mosleh et al., 2014). Similarly, dental services
utilization was increased for children whose parents
received letters with information addressing dental
caries identity, consequences, causes, control, time-
line, coherence, and emotional representations
(Nelson et al., 2017). As another example,
a pamphlet with information about symptoms, time-
line, and consequences of oral cancer decreased
anticipated delay in seeking care for oral cancer
symptoms and increased self-examination inten-
tions (Scott et al., 2012). Importantly, the pamphlet
was as effective as a comparable in-person session
in motivating these behaviors relative to a control,
no-information group.
New social media and computer graphics tech-
nologies extend the scope of these psychoeduca-
tional approaches. For example, text messaging
programs targeting illness representations can
promote adherence with medications for control-
ling asthma (Petrie et al., 2012) and HIV/AIDS
(Perera et al., 2014). Computer animations
 Changing Behavior Using the Common-Sense Model of Self-Regulation
Table 5.1 Translation of common-sense model constructs into techniques and intervention components for
promoting physical activity and a healthy diet to lose weight
Construct Technique example
Representations Communication to change
representations
Risk-Action Link Communication to instill
Coherence understanding of the
relationship between specic
actions and health risk
Coping for Threat Action planning
Control
Emotion Regulation Recognize internal emotional Identify typical situations that elicit obesity-related
states
Coping for Attentional deployment:
Emotional efforts to focus on reducing
Control the threat
Proactive behavior:
management of the threat
Cognitive reappraisal:
reinterpretation of the threat
as more benign
Response modulation:
reduction of emotional
arousal
Appraisal of Coping Self-monitoring
Outcomes
demonstrating physiological changes induced by
behaviors can instill mental images that enhance
representational and risk-action link coherence
and, in turn, motivate protective action. For
example, three-dimensional animation showing
cardiac changes in response to healthy versus
unhealthy habits can improve representational
65
Example message or task
Identity: Description of the levels of excess body fat
identied as obesity.
Cause: Inactivity and overeating foods high in sugar
or fat contribute to weight gain.
Consequences: Obesity increases the risk of diabetes,
heart disease, and cancer.
Control: A combination of physical activity and
a low-calorie diet can reduce weight.
Timeline: It will take about 5 months to lose about
20 pounds.
Coherence: Images illustrating visceral and subcu-
taneous fat and how they affect bodily organs.
Explanation of how physical activity promotes fat loss
by burning calories and increasing metabolism.
Develop a detailed dietary intake plan and physical
activity schedule.
distress and stress-induced eating.
Place motivational cues, such as pictures of oneself
at an ideal weight, healthy foods, and exercise
gear, around the home.
Use emotional distress as a prompt to engage in
physical activity to feel positive about oneself.
Reinterpret weight loss as a challenge that can be
achieved.
Seek social support; use relaxation exercises to
reduce obesity-related distress.
Use an app to record daily weight status, diet, and
physical activity.
beliefs, coherence, and behaviors among seden-
tary adults (Lee et al., 2011; see Appendix 5.1,
supplemental materials). A trial of an animated
intervention for patients with acute coronary syn-
drome yielded similar, benecial effects on ill-
ness beliefs and adaptive behaviors (Jones et al.,
2015).
66 L I N D A D . C A M E R O N , S A R A F L E S Z A R - P A V L O V I Ć, A N D T E N I E K H A C H I K I A N
5.3.2 Communication Skills Training
for Clinicians
Clinicians often do not know or acknowledge
that their patients’ illness representations may
not align with their own knowledge (Salmon,
Peters, & Stanley, 1999). Consequently, clini-
cians often direct consultations in ways that
fail to elicit their patients’ inaccurate beliefs,
thereby missing opportunities to address and
modify them (Davison & Pennebaker, 1997).
In an intervention designed to improve com-
munication behaviors during consultations
about hypertension management (de Ridder,
Theunissen, & van Dulmen, 2007), clinicians
were trained to discuss illness representations
with their patients. Compared to care-as-usual
consultations, consultations by trained clinicians
were of a higher quality in terms of communi-
cation behaviors, information exchanges about
representational beliefs, and affective utterances.
Elliott et al. (2008) also found that a common-
sense model–guided intervention for training
pharmacists to discuss illness representations
in telephone consultations with patients receiv-
ing new medications improved medication
adherence.
5.3.3 Common-Sense Model–Guided
Motivational Interviewing
Motivational interviewing, dened as a “colla-
borative, person-centered form of guiding to elicit
and strengthen motivation for change” (Miller &
Rollnick, 2009, p. 137), has been particularly
effective with individuals hesitant to change their
behavior (see Chapter 45, this volume). The goal
is to increase their intrinsic motivation to modify
behavior using persuasive and supportive strate-
gies. Structuring motivational interviews to
address illness representations can be particularly
effective in galvanizing behavior for individuals
who are ambivalent to behavior change, such
as individuals with poorly controlled diabetes
(Keogh et al., 2011) or periodontitis due to
poor oral hygiene (Godard, Dufour, & Jeanne,
2011).
5.4 Strategies Targeting Emotion
Regulation Processes to Change
Behaviors
The common-sense model identies three
categories of strategies for targeting emotion
regulation processes to change behaviors: (1)
increasing worry and related emotions that
motivate adaptive behavior; (2) reducing
worry or distress that inhibits adaptive beha-
vior; and (3) changing emotion regulation
behaviors that inuence well-being. The fol-
lowing subsections discuss each category,
along with examples of strategies and relevant
evidence.
5.4.1 Arousing Worry and Related
Emotions
Communications and interventions can focus on
enhancing worry to motivate adaptive behaviors
in conditions where worry is low. Indeed, the
original version of the common-sense model
was specically developed to account for the
motivational effects of fear appeals and condi-
tions under which they elicit behavior change
(Leventhal, Meyer, & Nerenz, 1980; Leventhal,
Singer, & Jones, 1965; Leventhal, Watts, &
Pagano, 1967). Worry positively predicts adap-
tive actions (e.g., Cameron, 2008; Magnan &
Cameron, 2015; McCaul, Schroeder, & Reid,
1996), and intervention strategies that increase
worry enhance protection motivations (e.g., Lee
et al., 2011; Magnan & Cameron, 2015). Fear
appeals, such as graphic warnings on tobacco
products, are frequently used to change behavior
(Magnan & Cameron, 2015; Noar et al., 2016;
see Chapter 34, this volume). Importantly, fear
appeals motivate behavior change primarily
when individuals maintain sufcient beliefs
 Changing Behavior Using the Common-Sense Model of Self-Regulation
about self-efcacy, that is, that one can change
the behavior, and response-efcacy, that is, that
the behavior change will reduce risk (Witte &
Allen, 2000). Otherwise, fear appeals can induce
defensive avoidance and reactance, including
rejection of message credibility.
Other strategies for increasing worry to moti-
vational levels include communications that
enhance risk-action link coherence by providing
individuals with a clear understanding of how
a behavior reduces risk (Lee et al., 2011). In
addition, framing risk messages with metaphors
that arouse worry can serve to transfer worry
associated with well-known threats to underap-
preciated risks. For example, one study demon-
strated that a message describing sun exposure
with an enemy combat metaphor of the sun as an
enemy whose rays attack skin and metaphorically
framing sun protection products as superheroes
increased worry and sunscreen intentions, with
worry mediating the metaphoric message effects
on intentions (Landau, Arndt, & Cameron, 2018).
These effects did not hold for individuals with
low fear about enemy combat and for whom the
metaphor did not activate worry.
5.4.2 Reducing Worry That
Impedes Behavior
For situations in which fear or worry impedes
adaptive behaviors, interventions can focus on
enhancing emotion regulation behaviors to promote
behavior change. The common-sense model points
to three such strategies: mindfulness practices,
emotional expression, and cognitive reappraisal.
Mindfulness exercises can reduce distress by
reshaping attentional focus and promoting non-
threatening, nonjudgmental appraisals of stressful
experiences (Goldin et al., 2017). Mindfulness
practices can facilitate changes of numerous beha-
viors including binge eating (Kristeller, Wolever,
& Sheets, 2014), excessive internet gaming (Li
et al., 2017), athletic performance (Perry et al.,
2017), and weight loss (Tapper et al., 2009).
67
Expressive writing tasks, through which indi-
viduals disclose feelings about stressful experi-
ences, can also reduce threat-related distress
(Frattaroli, 2006; Pennebaker, 1997). Expressive
writing can improve desired behaviors and per-
formance, although current evidence remains
limited to selected behaviors such as academic
performance (e.g., Cameron & Nicholls, 1998),
aggressive behavior (Kliewer et al., 2011), and
sleep behavior (Arigo & Smyth, 2012). Other
behaviors likely to benet from expressive writ-
ing include treatment adherence and athletic per-
formance, although these effects remain untested.
Cognitive reappraisal strategies, which are
central to cognitive behavioral therapies, can
reduce anxieties blocking adaptive behavior. For
example, a message encouraging students to
reappraise test anxiety as facilitating their cogni-
tive abilities improves exam performance; more-
over, its benets generalize to performance in
other academic pursuits (e.g., Brady, Hard, &
Gross, 2018). Similar benets of anxiety reap-
praisal hold for public speaking (Beltzer et al.,
2014), singing (Brooks, 2014), reducing discri-
minatory behavior toward minority groups
(Schultz et al., 2015), and reducing disordered
eating (McLean, Paxton, & Wertheim, 2011).
5.4.3 Changing Emotion Regulation
Behaviors
A third set of efforts targeting emotion regulation
aims to change emotion regulation habits to facil-
itate general well-being. Some emotion regulation
interventions target a specic strategy (e.g., pro-
moting mindfulness tendencies in daily life;
Quaglia et al., 2016). Others target multiple emo-
tional regulation habits. For example, interventions
targeting mindfulness, cognitive reappraisal, and
emotional expression tendencies have demon-
strated improvements in these habits and, in turn,
adjustment and quality of life (Cameron et al.,
2007; Cameron, Carroll, & Hamilton, 2018; Giese-
Davis et al., 2002).
68 L I N D A D . C A M E R O N , S A R A F L E S Z A R - P A V L O V I Ć, A N D T E N I E K H A C H I K I A N
5.5 Strategies Targeting Problem-
Focused Coping with Action
Plans to Elicit Behavior Change
Early studies guided by theoretical precursors of
the common-sense model revealed the impor-
tance of developing action plans for achieving
behavior change (Leventhal, Singer, & Jones,
1965; Leventhal & Watts, 1966, Leventhal,
Watts, & Pagano, 1967). They demonstrated that
a combination of threat arousal, via messages
about the dangers of tetanus or cigarette smoking,
and a specic plan for taking action, such as for
obtaining a tetanus vaccination or reducing smok-
ing, was needed to induce behaviors (vaccina-
tions or reductions in smoking). Subsequent
research substantiated the efcacy of action plan-
ning for behavior change (Gollwitzer, 1999;
Norman & Conner, 2005; see Chapters 6, 7, and
39, this volume). Efcacious action planning
requires (1) setting realistic expectations for
goal attainment; (2) clearly detailing actions; (3)
specifying schedules and conditions for action;
(4) instilling prompts or reminders; and (5), if
needed, obtaining behavior skills training (e.g.,
training in how to study for an examination or
maintain a compost pile).
Mental imagery techniques offer potent means
for creating and implementing action plans. Mental
imagery engages concrete-experiential processing
of visual and perceptual mental contents that link
strongly with emotional processes (Cameron &
Chan, 2008). Once formed and rehearsed, mental
imagery schema or scripts engage automatic infor-
mation processes that can prompt behavior inde-
pendently of deliberative, volitional processes
(Epstein, 1994). Mental simulation exercises guid-
ing one to vividly imagine the situation, the process
through which a behavior is enacted, and the attain-
ment of the behavioral goal can be particularly
effective in improving performance (Pham &
Taylor, 1999). Mental simulations of action plans
have been shown to improve numerous behaviors,
including physical activity, academic performance,
and sleep behavior (Conroy & Hagger, 2018; Pham
& Taylor, 1999; Loft & Cameron, 2013; see
Chapter 33, this volume).
5.6 Strategies Targeting Appraisals
to Elicit Behavior Change
Self-monitoring and feedback provision are com-
monly used to improve appraisal processes and
change numerous behaviors, including gambling
and dietary habits (e.g., Hsu, Rouf, & Allman-
Farinelli, 2018; Rodda et al., 2018; see Chapter
37, this volume). Self-monitoring and feedback
components are prevalent in computer (e.g.,
Chambliss et al., 2011), smartphone (e.g., Burke
et al., 2017), and social media–based programs
(e.g., Cavallo et al., 2012), with wearable activity
trackers (e.g., Fitbit; Cadmus-Bertram et al.,
2015) as notable examples.
A common-sense model–guided intervention
for improving self-monitoring and feedback
appraisals to enhance Type 2 diabetes self-
management provides an example of the benets
of harnessing appraisal processes (Levine et al.,
2016). Intervention participants utilized an auto-
mated, self-management monitor that provided
reminders to self-test blood glucose, feedback on
test results, interpretations of the results, and
“action tips” based on results (e.g., “take one glu-
cose tablet” or “increase physical activity”).
Intervention compared to control participants
exhibited higher self-testing rates and better gly-
cated hemoglobin levels over the subsequent year.
The research team recently supplemented the
intervention with procedures for monitoring asso-
ciations between blood glucose levels and beha-
vior (McAndrew et al., 2008).
Most interventions implementing self-
monitoring or feedback provision do so as part of
multicomponent programs without testing their
independent inuences on behavior change.
However, studies testing self-monitoring or feed-
back provision as sole interventions demonstrate
their unique efcacy (e.g., Hutchesson et al., 2016;
 Changing Behavior Using the Common-Sense Model of Self-Regulation 69

Sidebar 5.1 Need help with asthma control? There’s a common-sense model app for that!

The utilization of mHealth platforms provides new opportunities for delivering

common-sense–guided interventions. The Adolescent Adherence Patient Tool
(ADAPT; Kosse et al., 2019) for helping adolescents with asthma improve their
adherence to their medications is a notable example of this approach. The
intervention addresses the low rates of adherence to asthma medications during the
adolescent years (Orrell-Valente et al., 2008). Causes of poor adherence include
inaccurate understanding of asthma’s chronicity, symptoms of poor control, and the
necessity of the medications; lack of worry or concern; poor regulation of asthma-
related distress; and forgetting to take medications (Holley et al., 2016).
ADAPT targets these multiple factors through coordinated mechanisms. Short
videos and chats with pharmacists promote accurate illness representations as well as
action plans for adherence. Weekly measures to monitor symptoms and adherence
are included to improve appraisal processes and adjust worry to motivational levels
(e.g., when symptoms are elevated or minimized). Individually tailored reminders
prompt medication use at appropriate times and prevent forgetting. The program
also provides a peer chat function for sharing experiences and emotional support.
ADAPT was tested in a cluster randomized controlled trial involving 66 Dutch
pharmacies, with 234 adolescents aged 12–18 years assigned to 6 months of either
app use or usual care. ADAPT improved medication adherence for adolescents with
poor adherence rates at baseline, who tended to be older and have poorer initial
control of their asthma. ADAPT thus appears to be helpful for those adolescents who
are particularly vulnerable to problems with medication use and asthma control.
ADAPT holds considerable promise as an mHealth intervention that can be easily
implemented and widely disseminated within health care systems. It also provides
a useful model for apps aimed at changing habitual, ongoing behaviors in other
domains such as education, the workplace, and environmental conservation.

Zabatiero et al., 2013). For example, parents who
received in-the-moment feedback from clinicians
about their parenting behavior during parent-child
interactions reduced their intrusive behavior and
improved their sensitivity to their child’s experi-
ences (Caron, Bernard, & Dozier, 2018).
5.7 Evidence Base for the Use of the
Common-Sense Model in
Changing Behavior
As highlighted in prior sections, specic common-
sense model–based behavior change strategies (e.g.,
mindfulness, fear arousal, action planning, self-
monitoring) have received extensive testing through
trials that examine the mechanism by which each
strategy affects behavior. However, trials testing
behavior change interventions specically guided
by the model and targeting or testing multiple com-
ponents of the model remain limited. An mHealth
intervention for asthma control, described in
Sidebar 5.1, provides a compelling example of the
utility of common-sense model–guided interven-
tions targeting multiple mechanisms.
Most interventions guided by the common-sense
model have focused on changing illness representa-
tions to promote behavior change; of these, most
also target medication beliefs (Broadbent et al.,
70 L I N D A D . C A M E R O N , S A R A F L E S Z A R - P A V L O V I Ć, A N D T E N I E K H A C H I K I A N
2009; Mosleh et al., 2014; Petrie et al., 2012; Scott
et al., 2012) or problem-focused coping through
action-planning strategies (Broadbent et al., 2009;
Petrie et al., 2002; Scott et al., 2012). Such inter-
ventions adhere to common-sense model principles
that optimal change arises from interventions tar-
geting multiple facets of the self-regulation system;
however, they do not provide evidence of the inde-
pendent effects of representational changes on
behavior. Further, studies yielding evidence that
interventions altered representational attributes did
not test whether these changes mediated the inter-
vention effects on behavior. Disentangling the
unique contribution of each representational attri-
bute to behavior change represents another area
demanding empirical attention. Such tests for med-
iation require appropriate assessments of changes in
measures of mechanisms and behaviors over time
(MacKinnon, Fairchild, & Fritz, 2010).
Evidence on the efcacy of common-sense
model–guided interventions to improve clinician
communication skills or motivational interview-
ing to promote behavior change also remains
limited. While the ndings from the few trials
are promising, more research is needed to deter-
mine their efcacy, effectiveness, and capacity
for reach.
Similarly, research on common-sense model–
guided interventions enhancing emotion regula-
tion skills or appraisal processes to improve
behaviors remains scant. To date, emotion regu-
lation interventions are limited in their reliance
on intensive, group-based programs (Cameron
et al., 2007, 2018). Future research efforts should
focus on developing less-intensive programs
delivered individually or through internet formats
to enhance their feasibility and capacity for reach.
This research area is further limited by
a preponderance of studies employing small sam-
ples (e.g., Jones et al., 2015; Perera et al., 2014;
Petrie et al., 2002). Studies testing moderators of
intervention effects are also lacking, constraining
our understanding of the boundary conditions of
intervention effects and which social groups
might benet most. The sole study testing for
moderation of common-sense model–based inter-
ventions (Cameron et al., 2005) revealed that the
Petrie et al. (2002) intervention targeting myocar-
dial infarction illness perceptions induced detri-
mental behavioral responses for patients high in
negative affectivity, that is, the patient’s tendency
to experience anxiety and related emotions. That
the intervention lowered cardiac rehabilitation
attendance and exercise while increasing dietary
fat intake for anxiety-prone individuals under-
scores the need to screen for this characteristic
to determine intervention t.
Finally, more research is needed in which the
common-sense model is used to take cultural dif-
ferences in illness representations and coping
beliefs into account when designing behavior
change interventions. A core strength of the com-
mon-sense model is its reliance on common-sense
beliefs about illnesses and treatments, both of
which are shaped by cultural belief systems
(Cameron et al., 2016). The power of the model
for guiding culturally tailored interventions is
demonstrated by an intervention to increase shoe
wearing among Ethiopians at risk for podoconiosis
(“mossy foot”) by promoting coherent understand-
ings of the links between genetic susceptibility,
walking barefoot, and exposure to affected soil
(McBride et al., 2019). Much research is needed
to develop behavior change interventions that
incorporate culturally relevant beliefs.
Despite these limitations of the evidence base,
research offers promise for using the common-
sense model to design behavior change interven-
tions with benets demonstrated in diverse illness
settings (e.g., chronic, acute, and risk for illnesses)
and populations (e.g., adolescents, racial/ethnic
minorities, and older populations). Considerable
scope exists for extending the model to change
behaviors in other domains involving threats to
psychosocial well-being, goal attainment, and the
public good. For example, it has been applied to
understand and predict behavior in response to
environmental risks (Severtson, Baumann, &
 Changing Behavior Using the Common-Sense Model of Self-Regulation
Brown, 2006), with implications for specic com-
mon-sense beliefs that could be targeted to
increase protective actions.
5.8 Summary and Conclusions
The common-sense model of self-regulation pro-
vides a rich framework for understanding behavior
in threatening or risky situations and identies
cognitive, emotional, and behavioral mechanisms
that can be targeted to change behavior. Growing
evidence supports the use of multiple strategies for
changing threat representations, emotional arou-
sal, problem-focused coping, and appraisal pro-
cesses to promote initiation and maintenance of
behaviors that lead to adaptive outcomes such as
reduced risk, better functioning, and better psy-
chological well-being. Most research testing com-
mon-sense model–based strategies for behavior
change has focused on behaviors for managing
illness and other health threats. Similar approaches
can be taken to inform interventions to improve
academic performance by anxious or struggling
students, public performance affected by social
anxiety, job performance, pro-environmental
behaviors, and political behaviors such as increas-
ing votes for policies to improve the public good.
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