Episodic Future Thinking in the Treatment of Risky Behaviors

There’s an extremely wide range of risky behaviors and circumstances. For example, smoking, drinking, practicing certain sports, or being in a pressurizing job. They can lead to heart attacks, cancer, COPD, and respiratory failure. In fact, risky behaviors refer to events that we tend to mentally try to escape because their presence creates danger for us: death.

Preventing these events, via healthier habits, behaviors, and lifestyles, is one of the objectives of health sciences and psychology in particular. In this context, recent research reported in Papeles del Psicólogo analyzed how future episodic thinking influences the avoidance of risky behaviors (Aonso-Diego et al., 2022).

“To keep the body in good health is a duty…otherwise, we shall not be able to keep our mind strong and clear.”

-Buddha-

Risky behaviors: an explanation from behavioral economics

People who engage in risky behavior are often aware of its effects. For example, Andrew, 21 is a young cannabis consumer. He’s aware that this substance is a real Russian roulette for the development of various clinical entities, such as depression or psychosis.

However, Andrew continues to consume cannabis. Why does he do so? In fact, there are various factors involved in maintaining unhealthy habits. For instance, impulsivity. This refers to a type of ‘unplanned and extraordinarily automatic behaviour’ (Matjasko et al., 2016).

We might assess Andrew’s decision as irrational. This is proposed by the theory of behavioral economics. It claims that our behavior is significantly influenced by both the environment (ie, context, laws, policies, and culture) and how reinforcing the stimulus (in this case, cannabis) is.

When the mentioned factors are combined (impulsivity and reinforcing value) it results in a dangerous cocktail. In this regard, treatments are developed whose objective is to reduce decisions that gravitate around impulsivity (González-Roz et al., 2020). Thus, intervention based on episodic future thinking has attracted the attention of researchers.

“Risky behaviors can be understood as a choice disorder characterized by two processes: an excessive assessment of the reinforcer, and impulsive decision making.”

-Alba González-Roz-

Those who assume risky behaviors know the effects or consequences that they represent.

Episodic future thinking

Episodic future thinking (hereinafter EFT) refers to the human’s ability to create, in their imagination, scenes of future events that may affect them. Deficits in this capacity are closely related to diseases such as obesity, depression, or anxious symptoms (Cha et al., 2022).

EFT is considered to be a treatment technique. From a cognitive perspective, the individual is trained to describe and visualize themselves in a future situation. One of the fruits of this training is that they improve their decision-making processes.

Furthermore, EFT contributes to the individual considering the reinforcing value of other stimuli. These are medium and long-term reinforcers (without pleasant effects in the present), such as exercising or including fruits and vegetables in the diet. However, these reinforcers could potentially be more pleasurable than risky behaviors like smoking, overeating, or drinking alcohol.

“Episodic future thinking has been investigated as a psychological intervention aimed at people suffering from obesity to reduce the consumption of caloric foods and favor decision making.”

-Tinuke Oluyomi Daniel-

How EFT helps prevent risky behaviors

In consultation, the therapist promotes EFT by guiding patients to project themselves into future situations. They achieve this by asking them questions that involve describing the time, place, how the event happens, and who are present. The more real and vivid the imagined situation, the better the individual will develop their EFT.

To this end, they use short sentences. For example, Andrew might verbalize that “In three days I’m going climbing with my girlfriend.” He writes it down and visualizes that situation for a few minutes.

After this exercise, he must assess the characteristics of his mental projection into the future. He has to ask if it was realistic and if the image he created in his mind was vivid. Then, the therapist asks him questions like “Did you enjoy yourself?”, “Did you feel comfortable?”, “How important was not using cannabis for you?”

“It is health that is real wealth and not pieces of gold and silver.”

-Mahatma Gandhi-

EFT is an isolated technique useful in protocols such as cognitive behavioral therapy.

Is EFT effective in preventing risky behaviors?

EFT is a good intervention strategy for reducing rash behavior. For example, clinical benefits have been reported in substance use (Voss et al., 2022) and in care behaviors related to diabetic disease (Epstein et al., 2022).

EFT is capable of potentially reducing the decisions that individuals sometimes make, as a consequence of impulsiveness. It’s configured as a useful tool in various contexts, such as obesity and promoting physical exercise. Moreover, it’s useful as an isolated technique. Alternatively, it can be introduced into broader treatment protocols (such as CBT), enhancing its benefits.

As you can see, EFT has extraordinary power when it comes to preventing risky behaviors. In fact, it’s expected that, over time, it’ll become an essential resource in the armory of every health professional.