Boosting behavioral adaptability to enhance older adults' mental health/well-being and quality of life using a habit-based metacognitive self-help intervention.

backgroundBehavioral adaptability (i.e., the adaptive changes in behavior in accordance with internal or external demands) comprises an integral element of resilience. In later life, behavioral adaptability may be achieved through harnessing relatively intact habitual processes. Hence, we developed a habit-based meta-cognitive self-help intervention (MCSI) that aims to promote behavioral adaptability by supporting effective and independent striving for personal goals through the gradual automatization of regular, efficient routines.

methodsThis MCSI contains two goal-oriented components - goal-setting and goal enactment - and four metacognitive habit-based components, including psycho-education on habits and planning, monitoring of behavior change opportunities, if-then (implementation intention) planning, and if-then plan evaluation. In the present study, we compared a strategy group (following the entire MCSI, n = 49) to a control group (following a version of the intervention that omitted the metacognitive habit-based components, n = 52) of individuals aged 65 or above. A training phase, where participants practiced applying intervention components to a shared goal (daily walking), was followed by a test phase, in which participants independently applied goal-oriented and/or metacognitive habit strategies to a personal daily habit (e.g., balance exercises, eating fruit, reading, chores).

resultsWe found that both groups achieved high frequencies of their target behaviors and showed favorable improvements in mental well-being, quality of life and various other outcome variables. Moreover, the metacognitive habit-based components of the MCSI offered meaningful additional benefits, including greater regularity in the timing of the behaviors, stronger routine formation (during training), stronger improvements in quality of life, self-management abilities and lifestyle satisfaction, and reductions in apathy. Interestingly, benefits were particularly evident for individuals with poorer mental health (i.e., higher levels of depression, apathy, and/or loneliness).

conclusionsAltogether, while both groups experienced benefits, the habit-based MCSI seemed to offer a particularly promising means to empower individuals to adapt their behavior to pursue their goals and remain resilient in later life. Limitations and suggestions for future research to determine (long-term) benefits (for specific subgroups) are discussed.

trial registrationPre-registered, partly retrospectively. This study was pre-registered before the major part of the data was collected, created, and realized. Only a small part of the data of some participants (comprising the baseline and other pre-intervention measures), and the full dataset of the first few participants, was collected prior to registration, but it was not accessed yet. See: https://osf.io/5b9xz , but also Brinkhof et al. (2023).