OTJR: Occupational Therapy Journal of Research

Habits form the basis of many human behaviors. They can support daily routines, but they also can become cumbersome and interfere with a satisfying life. This article introduces the construct of habits on a continuum, from habit impoverishment, a condition in which habits are not available to support daily life, to habit domination, a condition in which habits consume so much energy that they interfere with a satisfying life. Habits have been studied from the points of view of many disciplines. This article invites readers to study habits from a neuroscience point of view. A number of neuroscience principles explain how habits can be formed and how they might be supported within the nervous system. The article introduces the concepts of thresholds for action, modulation, and motivation to reestablish homeostasis. These constructs are used to propose a model for interpreting behavior that incorporates neuroscience principles and related behavioral responses. The article explains these patterns of responding in relation to adaptive and maladaptive behavior.

This article examines the role of positive events in older women's adaptation to rheumatoid arthritis. In one study, women with rheumatoid arthritis were compared with healthy older women. The women with rheumatoid arthritis showed a less-active pattern of social engagement than the healthy women, and less-stable patterns over time. In a second study, women with rheumatoid arthritis participated in an intervention designed to enhance active patterns of social engagement. The intervention succeeded in increasing positive social-engagement patterns. Improvements in quality of life and reduction in disease activity coincided with these changes. Most improvements in well-being did not last, but the women's beliefs in their capacity to cope with their illness were enhanced, and those beliefs remained significantly higher than levels before the intervention.

Previous research has found a two-factor model of habit and routine in daily living to be related to mental health and the occurrence of daily events in the lives of middle-aged and older adults. The study reported in this article extended research on the variable, routinization, to a sample of women with fibromyalgia syndrome, a chronic, debilitating disorder characterized by widespread pain and fatigue. The two factors found previously, Having Order and Routine in Life, and Disliking Disruption, were investigated further. The Having Order variable was significantly related to mental health when level of physical functioning was included in prediction equations, and active coping efforts were effective for the high-order group in improving mental health. The Disliking Disruption factor was not significantly influential. Results are discussed in terms of the therapeutic implications for improving the mental health and coping efforts of people with adjustment-threatening illnesses.

Over the duration of our lives, we each develop a rhythm and a routine in our use of space and in our relationships with the places of our lives that provide a sense of being in place. We gradually come to wear our environment like a glove, as, with increasing familiarity, it almost literally becomes a part of our persona. As we grow older or become increasingly frail, we adapt to reduced physical capabilities and changes in our environment in a manner that allows us to continue functioning effectively. This article explores the implications for occupational therapy of habitual use of the environment by older people and the sense of being in place that characteristically results. It is argued that sensitivity to the development and the maintenance of being in place provides a template for effective intervention when physical capabilities are compromised. Using the framework provided by complexity theory, and empirical observations from an ethnographic study of growing old in an Appalachian community, the article considers homeostatic adjustments that older people make in the use and the meaning of the spaces and the places of their lives as they accommodate to changing circumstances. By exploring the role and the uses of habituation (learning through repetition) in this process of gradual, often almost imperceptible, environmental adjustment, occupational therapists will be able to enrich their potential for developing strategies for intervention that effectively use a knowledge of habit in treatment.

This study used a prospective, within-group comparison design to examine differences in the severity of disability in a community-based sample of 59 older women being treated for depression. The independent variables were three constructs: perceived skills, perceived habits, and demonstrated skills. The dependent variables were functional mobility, personal care, and instrumental activities of daily living. Results indicated that the expression of overall disability differed significantly among the three constructs. Participants' perceptions of their skill independence were greater than their ability to demonstrate independence in those skills, and their demonstrated skills of task independence were greater than their perceived ability habitually to use those skills independently. Objective, performance-based skill measures indicated greater disability than subjective, self-report skill measures, and supported the view that in older adults, depression-related disability reflects a combination of skill and habit deficits. Item analyses revealed five distinct patterns of relationships among perceived skills, perceived habits, and demonstrated skills. Practitioners need to be aware of the constructs being used to measure disability because the severity of disability may depend on the construct being used. Furthermore, the types of interventions appropriate for disability related to each construct or pattern of constructs may vary.

Infants and toddlers acquire information about the world from their senses. When this process occurs as expected, children learn; when young children have disabilities, the process can be disrupted. This preliminary report outlines the initial phase of measurement development for the Infant-Toddler Sensory Profile, a caregiver questionnaire in which parents report the frequency with which their children engage in particular behaviors indicative of sensory responsiveness. In future phases, researchers will conduct a national standardization of the profile, and validation studies.

Vulnerability to visual backward masking is thought to predate the onset of symptoms of schizophrenia. That makes this attention and information-processing phenomenon a promising candidate as a gene-determined trait that helps portend schizophrenia. Two proposed mechanisms of masking include integration and interruption. Prior studies of backward masking in schizophrenia have been hampered by the use of stimuli that are meaningless except under specific conditions. Because of this, it has been difficult to differentiate integration from interruption. The study reported in this article sought to apply criteria of meaningfulness and independence to the backward-masking task. The computerized masking program created for this study, DMASK 1.0, used visual stimuli that enabled the measurement of four discrete response options, thus differentiating between integration and interruption. Selected for the study and administered DMASK 1.0 were 14 people with nonparanoid schizophrenia, 15 people with nonpsychotic major depression, and 20 people with no mental illness (controls). As expected, the people with schizophrenia were more vulnerable to masking than either the control group or the people with depression. Also, as predicted, integration responses were present but did not differ among groups. Finally, as predicted, the people with nonpsychotic depression did not differ from the controls on most key masking variables.

The study reported in this article examined the role of a sense of purpose in life in recovery from total knee-replacement surgery in 59 older people. Participants completed questionnaires two weeks before, four weeks after, and six months after surgery. Regression analyses predicted health at six months from purpose in life, controlling for initial health and age, education, and gender. The results revealed that purpose in life was directly related to better mental health and indirectly related, through active coping, to better physical health. The findings support the efforts of occupational therapists to increase purposeful habits of living.

Habit was measured as a trait of routinization in a sample of 72 older people selected as participants in a study of major life stressors and mental health. The relationship between routinization and psychological distress was assessed by tests of main effects and interactions of one component of routinization (disliking disruption in daily activity), activity limitation and perceived health, and recent stressful life events. Both sets of multiple regression tests of these variables showed significant triple interactions qualifying the significant main effects. The interactions complemented one another, revealing that less routinized participants reported greater distress when experiencing ill health and higher levels of negative events. These effects did not appear for the more highly routinized participants, however. The latter group showed high levels of distress regardless of their activity limitation or perceived health. The results suggest that routinization (in the form of disliking disruption in daily living) is associated with distress beyond the effects of major life stressors.

Retention of physicians continues to be a problem across much of rural North America, and research has neglected the sociogeographical process that leads to it. John Dewey's philosophy, including his insight into habits, suggests that retention is a process of “place integration” or “habitat” formation. A qualitative study of retention in Kentucky illustrates the process. For rural physicians this process revolves around the enhancement of security, freedom, identity, and meaning in place.

The purpose of this pilot study was to describe daily-living habits of Native American women with chronic diseases. The participants were 14 females who were either healthy (the control group) or had rheumatoid arthritis (RA), diabetes mellitus (DM), or both (RA+DM). Participants underwent an evaluation of joint motion and were interviewed regarding daily-living routines and habits, and social and family role integration. The results showed that participants with RA and RA+DM had more joint limitations, more disability, and less role integration than participants in the control and DM groups. Using the toilet was the first task of the day for the majority of participants. Most participants took showers in the morning, and the face was usually one of the first body parts washed. The order in which daily tasks were performed is reported for each participant.

Of the myriad ideas presented at and stimulated by the January 1999 research conference on habit, a select few seemed to have the most salience for practice: understanding the nature of habits; following skill training with habit training; attending to habits in a context; anticipating that a breakdown of daily-living habits may lead to a breakdown of skill; and recognizing that the repetitiveness of habits can lead to boredom. This article briefly elaborates on each of these ideas.

Although a number of diverse research areas underscore the importance of habit and routine, there has been little theoretical coherence to this work considered as a whole. Varying definitions of habit and routine, as well as the extremely broad range of phenomena to which they apply, have hampered the ability to develop any overarching synthesis. In connection with a recent conference sponsored by the American Occupational Therapy Foundation, this article offers a preliminary theoretical synthesis of habit and routine with respect to definitional issues, relation to quality of life, and potential benefits to consumers with disabilities.

This article represents a compilation and a synthesis of the research questions that the presenters and the participants, both representing many disciplines, discussed during the research conference on the concept of habit in January 1999. The research questions are organized into three general categories: specification and measurement questions, descriptive and relational questions, and intervention questions. Research and theory development in the area of habits will move forward with a concerted, multidisci-plinary initiative to address and refine the questions that are listed here.