Personal Information Management (PIM) and Behavior Analysis

  

"Self-knowledge is conceptualized as a self digest that summarizes one's relations to the world and the personal consequences of these relations" (Higgins, 1996). Although self knowledge is as critical as world knowledge and knowledge about how other people think and behave I do not ever recall being taught, by my family or any teacher or professor, how to assess and inventory my own capabilities. I do, however, recall a lesson from a Little League coach.

During my first year as a player for the Gallagher Giants, a baseball team sponsored by the neighborhood oil company, I tried mightily to hit the ball whenever it was my turn to bat. I was physically strong as a boy and I could swing the bat with hypervelosity, but despite many, many opportunities, my bat never connected with the ball. The fact that I was inept at baseball hitting was obvious to the two cigar-smoking coaches that stood with wide stances along the chalk line running from third base to home plate. They did not know my name and they did not speak to me, but I did overhear one comment related to my struggle: "If that kid ever connects with the ball he'll hit a home run". I remember the coach's bromide as well as I recall the last game of the season. During the final game a new coach stood along the chalk line, his name was Mr. O'Halloran and he was slated to be the replacement head coach for the next season. He looked at me over the top of his glasses as I stepped up to the plate to take my turn at bat. After I swung and missed the first pitch, he said: "Hey Mike, come mere, you swing too soon kid, you gotta wait another second". "I do?". "Yeah, wait another second and you'll hit it outta the park" (that's how we talked in Pawtucket, Rhode Island). So, I went back to the plate repeating the rule, waited for the pitch, delayed my swing by a second, heard the crack of the ball against the bat, and watched the ball bounce off the outfield fence post and into center field. A triple, I hit a triple. I followed Mr. O'Halloran's advice and I delayed my swing. I had a new rule and I quickly learned that the rule resulted in favorable consequences. So, I went home on that autumn evening and wrote down Mr. O'Halloran's advice in a spiral notebook I kept between my mattress and box spring - and that was the first time I ever recorded information about how I should carry-on in the world. 
As a young boy, I was interested in cataloging the conditions under which I would successfully hit and catch baseballs. Today, as a behavior analyst concerned with human ingestive behavior, I am interested in studying the conditions under which adults successfully manage their health.
Henry David Thoreau

The frontiers are not east or west, north or south, but wherever a person fronts a fact. 

When Cameron Behavioral Medicine Network (CBMN) members first start the ten-stage Transformative Health program they do not typically possess any organized knowledge centered on: (1) the conditions under which they are able to successfully manage their nutrition, body weight, and exercise routines, and (2) the conditions under which they are most vulnerable and likely to lose personal control on a momentary (e.g., over the weekend) or extended basis (e.g., for a week or more). From my perspective, as a CBMN group facilitator, it is important to teach members how to assess cause and effect, and this requires the organization of a series of highly personal health experiments. Sustainable weight control and fitness involves a process of self-study, experimentation, and cataloging relevant information. I believe that if a person cannot verbally describe their own proactive and reactive strategies for managing their wellness and decreasing the likelihood of their own disease states, they are not optimally positioned to produce changes for lasting health.
A Series of Experiments
When CBMN members first begin the Transformative Health program, it is not uncommon for members to report physical discomfort taking the form of:

• Reflux
• Gastrointestinal problems (diarrhea, constipation, irritable bowel syndrome)
• Abdominal distension 
• Indigestion 
• Disruptions in their sleep/awake cycle 
• Tiredness 
• Migraines 

In response to these physical difficulties it is typical for members to take: antacids, H2 blockers, laxatives, fiber supplements, ranitidine, prescription and over-the-counter sleeping aids, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics. Members report that their health management decisions were influenced by television advertisements (e.g., a humorous advertisement for antacids) or their Primary Care Physician. Interestingly, not a simple CBMN member has ever been through the guided process of systematically evaluating the relationship between the foods they eat and their physical discomfort, rather, they have been guided toward pharmaceuticals and pharmacy products. 


Since all people consume a variety of foods, an elementary evaluation for physical discomfort requires: (1) an objective measure of the problem (e.g., esophageal pH monitoring), (2) the development of an intervention, such as the exclusion of high fat foods, spicy foods, fast foods, and food high in sugar content, (3) a re-evaluation (e.g., a repeat esophageal pH level), and (4) ongoing monitoring of symptoms (e.g., sore throat, hoarseness, difficulty swallowing). Evaluations can run along a continuum from the simplistic (such as the one described above) to the more sophisticated. A more advanced evaluation would involve a component analysis based on mathematical combinations and would be used for people with recurrent and treatment resistant problems. Behavior analysis provides the conceptual frame for conducting such evaluations, moreover, these forms of assessments should be done in collaboration with a Primary Care Physician or a naturopathic doctor such as our consultant, Dr. Janet Beaty


Cameron Behavioral Medicine Network members are not only required to identify foods that evoke physical distress, but also foods that produce a sense of fullness (e.g., high satiety foods) and optimize energy (e.g., oatmeal, citrus fruit, beans). Once a CBMN member understands the impact of a particular food, they will use their own Personal Information Management (PIM) system to catalog the critical information. It is essential that each group member conduct a series of mico-experiments and record the outcomes in their PIM system.  
Personal Information Management (PIM) and Behavior Analysis
According to Jones (2008), Personal Information Management refers to the "practice and the study of the activities a person performs in order to acquire or create, store, organize, maintain, retrieve, use, and distribute the information needed to complete tasks". Although PIM is not discussed in terms of health management, I think everyone would agree that personal health management is one of our most important tasks. In consequence, members of the CBMN are required to document the activities they perform in order to optimize their own health. Each member is given a customized Excel file with a PIM page to enter their personal information. By way of example, CBMN members are required to identify and document the following information as the result of a series of mico-experiments: 

1. Their exercise preferences, including "comfort" (high probability) workouts.
2. Trouble spots (e.g., weekends, restaurants, late nights).
3. Favorite high satiety foods (e.g., high protein foods producing a sense of fullness).
4. Foods that produce cravings and hunger (e.g., sugar, fast food).
5. Favorite high nutrient, low calorie foods (e..g, from the Aggregate Nutrient Density Index).  
6. Diverse meals falling within a caloric (as well as fat, sugar, and salt) target.
7. Conditions likely to produce adherence and non-adherence to a food plan.
8. Conditions likely to produce adherence and non-adherence to an exercise plan.
9. Educational articles (e.g., visualization of portion sizes).
10. Kedge goals (e.g., a 30-day Bikram challenge) that pull a person toward their health objectives. 

Our research shows that there is a correlation between active member responding (e.g., completing and submitting a PIM worksheet prior to the weekly behavioral community video conference call), weight loss, exercise adherence, and weekly progress. In short, adherence to weekly responsibilities produces optimal health benefits. In closing, it is our belief that a well organized Personal Information Management system functions as a self-generated guide for a person who drifts from their health objectives or experiences a relapse. Moreover, the field of behavior analysis provides the appropriate conceptual frame needed to optimize and sustain personal health. More to the point, behavior analysis provides the structures to systematically conduct the mico-experiments that are necessary to build self knowledge. 

CBMN Summary Points  

• It is critical that members acquire and create a digest of self knowledge regarding the conditions that will optimize their health.
• The field of behavior analysis provides the conceptual frame and requisite processes for acquiring self knowledge.
• A series of mico-experiments is required to understand the conditions that will optimize your health.
• A Personal Information Management (PIM) is needed to catalog critical information.
• Members need to acquire the ability to provide a comprehensive and fluent description of the proactive and reactive strategies they have acquired to optimize their health and reduce the likelihood of disease states.
• The entire process we follow must be data-driven and not subjective.

I am here for me, I am here for you.

Dr. Michael J. Cameron 
behavioralhealth.cameron@gmail.com