Requirements for Relaxation Coaching

A Formalization of the Fogg Behavior Model

Rogier M. van Eijk

Department of Information and Computing Sciences, Utrecht University, Utrecht, the Netherlands

Keywords:

Relaxation Training, Persuasive Design, Coaching Systems.

Abstract:

Relaxation training consists of doing regular (e.g., daily) relaxation exercises over a longer period of time

(e.g., months). Adherence to relaxation training is for many people difﬁcult because of time constraints, social

obligations, forgetting to practice and so on. This is a pity because relaxation training can act as a natural

antidote to health-related effects of excessive stress like poor sleep. In this paper, we present a formal model

of relaxation coaching that is rooted in the theory of persuasive design. This model supports the development

of coaching systems that can improve people’s adherence to relaxation training with its associated health

beneﬁts.

1 THE NEED FOR RELAXATION

Ben is a ﬁfty year old teacher of mathematics at a

secondary school. He suffers from a lot of stress in

his life. Each day he has deadlines that he cannot

ﬁnish and so he spends most of his evenings marking

assignments and exams. When lying in bed he feels

wide awake, worrying about tomorrow and unable to

fall asleep. When he gets up in the mornings he feels

exhausted.

In today’s society, many people have problems

related to excessive stress, like poor sleep (American

Psychological Association, 2014). Excessive stress

and poor sleep have negative effects on people’s

health and well-being (Everly Jr. and Lating, 2013).

Excessive stress is known to accelerate the aging pro-

cess (Liu and Mori, 1999). Poor sleep is a prevalent

problem for the elderly (Kamel and Gammack, 2006).

Ben visits his general practitioner who prescribes

him relaxation training. In eight weekly sessions

with a therapist, Ben practices relaxation and starts

to feel better. He ﬁnds himself spending less time

lying awake in bed and he feels more refreshed in the

mornings.

Relaxation training is a mind-body intervention

that counteracts the harmful effects of stress (Dusek

and Benson, 2009). It has been shown helpful for

aging people (Galvin et al., 2006; Glei et al., 2012).

Relaxation training is an integral part of insomnia

therapy (Morin and Espie, 2004) and has been shown

helpful for elder people with poor sleep (Friedman

et al., 1989; Sun et al., 2013).

After the eighth and last training session, Ben

receives from his therapist a transcript of the relax-

ation exercise to practice at home on a regular basis.

Although Ben is motivated the ﬁrst couple of days,

he starts to skip doing the exercise more and more

and eventually stops practicing altogether. A few

weeks later he sleeps as badly and feels as stressed

as before.

Traditional relaxation training is provided through

individual or group sessions supervised by a therapist

(Everly Jr. and Lating, 2013). Usually, these sessions

are supplemented with home-practice assignments

(Bernstein et al., 2000). Adherence to relaxation

training is difﬁcult (Taylor et al., 1983; Jacob et al.,

1984) due to for instance time constraints, social

obligations and simply forgetting to practice (Mur-

doch, 2000).

Ben installs a mobile coaching application. The

system assists Ben in understanding the workings

and effects of the relaxation exercises, modifying

exercises to his speciﬁc needs and circumstances and

in actually performing the exercises. With the use of

the coaching system Ben starts to practice relaxation

on a regular basis at home. He regains the beneﬁts

from his improved relaxation skills, like less stress

and better sleep.

van Eijk R..

Requirements for Relaxation Coaching - A Formalization of the Fogg Behavior Model.

DOI: 10.5220/0005427600310036

In Proceedings of the 1st International Conference on Information and Communication Technologies for Ageing Well and e-Health (ICT4AgeingWell-

2015), pages 31-36

ISBN: 978-989-758-102-1

 2015 SCITEPRESS (Science and Technology Publications, Lda.)

Mobile coaching systems have the potential to im-

prove therapy adherence by providing additional sup-

port (Klein et al., 2013). This holds also for insomnia

therapy (Espie et al., 2013). The elderly form a di-

verse group with a variety of characteristics (Gregor

et al., 2002), which requires the tailoring of support

to speciﬁc needs and circumstances .

In this paper, we address the problem of develop-

ing coaching systems to improve adherence to relax-

ation training by providing tailored support. The main

contribution of the paper is the development of the ba-

sic requirements for relaxation coaching in the form

of a formal model that is rooted in the theory of per-

suasive design (Section 3). In Section 2 we provide

background on relaxation training and persuasive de-

sign. In section 4 we provide conclusions and outlines

for further research.

2 RELAXATION & PERSUASION

The stress response is an activation of the sympathetic

nervous system which due to the mediation of stress-

related hormones like cortisol and epinephrine leads

to physiological phenomena like an increase of oxy-

gen consumption, blood pressure and heart rate. In

this way, the body is prepared for taking action. Ex-

cessive invocation of the stress response can lead to

many kinds of health issues and diseases (Everly Jr.

and Lating, 2013).

The relaxation response is the exact opposite of

the stress response (Benson, 1993): the sympathetic

nervous system is de-activiated leading to among oth-

ers a decrease in oxygen consumption, blood pres-

sure and heart rate. In this manner, the body works

towards rest and recovery. The relaxation response

can act as a natural antidote to the stress response,

undoing (parts of) its harmful effects. Whereas the

stress response occurs involuntary and automatically,

the relaxation response needs to be consciously in-

voked and requires repeated practice in the form of

relaxation exercises. Many types of relaxation exer-

cises exist. Prominent types are (mindfulness) medi-

tation, progressive muscle relaxation and yoga.

Building new behavior like doing relaxation ex-

ercises on a regular basis at home can be supported

by technology (Oinas-Kukkonen, 2012). Such sup-

porting technology is usually referred to as persuasive

technology (Fogg, 2003). Persuasive technology aims

at changing people’s behavior and / or attitudes in

a non-forceful way without using non-ethical means

such as deception. The design of persuasive technol-

ogy is not an easy task and attempts are easy to fail.

Different models of human behavior are used

in the development of persuasive technology (Mohr

et al., 2014). Relaxation exercises are a relatively sim-

ple and well-deﬁned type of behavior. To understand

the persuasive aspects of such behavior, the Fogg be-

havior model can be used (Mohr et al., 2014). Ac-

cording to the Fogg behavior model (Fogg, 2009), for

particular behavior to occur three factors have to come

together: A person should (i) be motivated to do the

behavior, (ii) have the ability to perform the behavior

and (iii) the behavior should be triggered. If one of (i),

(ii) and (iii) is not met, the behavior will not occur.

3 COACHING ALGORITHM

In his paper, Fogg provides a qualitative description

of his behavior model (Fogg, 2009). However, for a

coaching system to support behavior change and be

able to reason about the different components of be-

havior we need a (simple) formal model. This model

is presented in Table 1.

Motivation. Fogg deﬁnes three dimensions of mo-

tivation: ‘pleasure and pain’, ‘hope and fear’ and ‘so-

cial acceptance and rejection’. We will consider each

of these in the light of relaxation training.

First, a person’s motivation depends on the emo-

tions and sensations of pleasure and pain that he or

she experiences in the here and now. In the context of

relaxation training this dimension can be operational-

ized as the state of relaxation and/or stress a person

experiences and the immediate effects exercises have

on this state.

The relaxation effects of exercises depend on the

type of exercise and the type of person. Some breath-

ing exercises have almost immediate calming effects

like for instance ‘ocean breathing’. This is a tech-

nique from yoga in which the practitioner slows down

his or her breath by a muscle contraction in the throat.

A few minutes of ocean breathing in bed can induce

a profound state of relaxation. Additionally, different

people prefer different types of relaxation exercises.

A way to measure relaxation is in terms of so-

called subjective units of relaxation (SURS) (Everly Jr.

and Lating, 2013). On this scale, a score of 10 corre-

sponds to a dreamlike state of profound relaxation,

while a score of 5 corresponds to the state of an av-

erage person on an average day. A score of 1 corre-

sponds to a panic attack (Everly Jr. and Lating, 2013).

For instance, if a person feels very stressed (e.g., has a

SURS of 3) and wants to feel better than average (e.g.,

SURS of 6) and ocean breathing results in an increase

of 1 unit per 5 minutes practicing, then the person is

motivated to do up to 15 minutes of ocean breathing.

ICT4AgeingWell2015-InternationalConferenceonInformationandCommunicationTechnologiesforAgeingWelland

e-Health

Table 1: Components of Relaxation Coaching

Fogg behavior model Relaxation training Units

Motivation Pleasure Relaxation state SURS

Hope Sleep quality sleep hours / bed hours

Social acceptance Social status social levels

Ability Time Duration minutes

Money Price euro’s

Non-routine Skill progression skill levels

Physical effort Energy kJ / hour · kg

Brain-cycles Information words / minute

Social deviation Privacy deviation privacy levels

Triggering Spark Education motivation

Facilitator Modiﬁcation ability

Signal Instruction performance levels

Secondly, ‘hope and fear’ constitutes the dimen-

sion of thoughts and feelings about future states of

being. In the context of relaxation training this can

be operationalized as the anticipated longer-term ef-

fects of relaxation training, like better sleep. In in-

somnia therapy, relaxation exercises are performed on

a regular basis (e.g., once or twice daily) for weeks or

months (Morin and Espie, 2004). Different measure-

ments of quality of sleep exist (Buysse et al., 1989), a

prominent one being ‘sleep efﬁciency’. This measure

amounts to the time a person has slept divided by the

total time the person has spent in bed. For instance,

if a person has practiced a daily progressive muscle

relaxation for three weeks, which led to an improve-

ment in sleep efﬁciency from 0.5 to 0.6, and he wants

to improve his sleep efﬁciency to 0.7 then he will be

motivated to practice the daily relaxation exercise for

another three weeks (assuming a linear relation be-

tween duration of practice and sleep efﬁciency).

Finally, ‘social acceptance and rejection’ concerns

the social dimension of motivation. We can opera-

tionalize it as social status, which is a combination of

education, profession, marital status and sex (Holling-

shead, 1975). In the context of relaxation training,

we can take this to be the combination of received

relaxation training (e.g., education in the form of a

completed 8-week mindfulness training, a 500 hour

yoga teacher training and so on) and provided relax-

ation training (e.g., 3 years experience as a profes-

sional yoga teacher). We can quantify this as a social

level between 1 and 10 (e.g., 1 denotes the level of a

beginner student and 10 denotes the level of an expert

teacher). For instance, a person who has practiced

mindfulness meditation for four years (e.g., level 4)

and wants to progress one level is motivated to do a

mindfulness teacher training program (e.g., yielding a

social status of level 5).

Ability. The ability to do a relaxation exercise de-

pends on the resources one has available to practice.

According to the Fogg behavior model, ability can

be decomposed into the availability of six different

resources: time, money, non-routine, physical effort,

brain cycles and social deviance.

We start with the time it takes to perform a behav-

ior. In the context of relaxation training, the ability

to do a relaxation exercise depends on the duration of

the exercise and the time one has available to practice.

For instance, if a person is able to spend 5 minutes of

practice and the practice consists of an exercise with

a duration of 3 minutes then the person has the ability

to do it. On the other hand, if for the same person un-

der the same circumstances the practice would consist

of a 7 minute exercise, the person would be unable to

do it.

Secondly, we consider ‘money’: the monetary

costs that are associated with the behavior. Different

exercises have different costs associated with them.

There are many relaxation exercises freely available

on the Internet. Other exercises are described in books

or on DVD’s that the practitioner must buy to get ac-

cess. Yet other exercises are learned under supervi-

sion of a relaxation therapist, which are even more

expensive. So for instance, if a person is not able to

spend any money on a relaxation practice, then he will

be able to do freely available exercises, but not ones

that are supervised by a therapist.

Let us consider ‘non-routine’. A routine behav-

ior is a behavior that people are used to do, possi-

RequirementsforRelaxationCoaching-AFormalizationoftheFoggBehaviorModel

bly over and over again. A non-routine behavior on

the other hand, is a behavior that people are not used

to do and maybe have never done before. We can

operationalize the resource ‘non-routine’ in terms of

skill levels, quantiﬁed by natural numbers between 0

and max skill. Relaxation training programs involve a

progression through skill levels. For instance, differ-

ent yoga techniques are assigned different skill lev-

els leading practitioners to progress from one level

to a next (Iyengar, 1966). So for instance, an abso-

lute beginner (level 1) who has no ability to progress

yet has the ability to do a yoga posture like mountain

pose (level 1) but is unable to do a headstand (level 4)

(Iyengar, 1966).

Next, we consider the resource ‘physical ef-

fort’. Different relaxation exercises require dif-

ferent amounts of physical effort. For instance,

mindfulness-based stress reduction contains both

seated and walking meditation exercises (Kabat-Zinn,

1990). A walking exercise requires more physi-

cal effort than a sitting exercise (Montoye, 2008).

The resource ‘physical effort’ can be operationalized

in terms of energy expenditure, quantiﬁed by natu-

ral numbers between 0 and max

energy. Usually,

this is expressed in kilojoules per hour per kilogram

bodyweight, although other alternative measures ex-

ist (Montoye, 2008). Walking takes 3, 5 times more

energy than sitting (i.e., 3, 5 and 1, 0 kJ · h

−1

· kg

−1

respectively). So for instance, a person who is able

to spend 2, 0 kJ · h

−1

· kg

−1

has with respect to the re-

source ‘physical effort’ the ability to practice a sitting

meditation, but is not able to do a walking practice.

Next comes the resource ‘brain cycles’. Accord-

ing to Fogg, this concerns the thinking process that

is involved in performing the behavior. Some relax-

ation exercises require only a few instructions to per-

form. An example is a breath awareness exercise in

which a practitioner is simply asked to concentrate on

his or her breath and when attention waivers to notice

the source of distraction and then bring the attention

back to the breath (Kabat-Zinn, 1990). Other relax-

ation exercises involve many more instructions, like

for instance progressive muscle relaxation in which

the practitioner is required to tense and release spe-

ciﬁc muscles in speciﬁc ways in speciﬁc orderings

(Bernstein et al., 2000). We operationalize the re-

source ‘brain cycles’ as the information to be pro-

cessed in order to perform the behavior. This can op-

erationalized as information processing speed (Kail

and Salthouse, 1994). In the context of relaxation

training, we can quantify this as the number of words

of the instruction per minute. For instance, a person

who is not able to process more than 30 words per

minute is able to do a breath awareness exercise with

an instruction of 20 words per minute, while being

unable to do a progressive muscle relaxation exercise

involving an instruction of 60 words per minute.

Finally, we consider the resource ‘social de-

viance’. According to Fogg this amounts to going

against the norms of a social context. Some relaxation

exercises require more privacy than others. For in-

stance, progressive muscle relaxation should be done

in a quiet environment with no distractions. It re-

quires the practitioner to sit down and close his or

her eyes. Some informal mindfulness exercises on the

other hand, require the practitioner just to be aware

of sensations and thoughts and should be done in the

midst of hectic everyday life. We operationalize ‘so-

cial deviance’ as the difference between achieved pri-

vacy and desired privacy (Altman, 1976). It can be

quantiﬁed in terms of levels of privacy, ranging from 0

to max privacy. Achieved privacy corresponds to the

level of privacy of the actual context, while desired

privacy corresponds to the level of privacy that is the-

oretically required for the exercise. So for instance, if

a person is in a business environment (e.g., achieved

privacy level 1) and he is able to deviate one level of

privacy, he is able to do an informal mindfulness ex-

ercise (e.g., desired privacy level 2), but not able to do

a progressive muscle relaxation (e.g., desired privacy

level 5).

Triggering. According to Fogg, a trigger is some-

thing that tells people to do a behavior. There are three

types of triggers: sparks, facilitators and signals.

A spark is used to increase a person’s motivation

for the behavior. We operationalize this as the ed-

ucation that comes with relaxation training, explain-

ing among others the rationale, workings and effects

of the exercises. Manuals for relaxation training like

the manuals of mindfulness based stress reduction

(Kabat-Zinn, 1990) and progressive muscle relaxation

(Bernstein et al., 2000) contain a lot of educational

material. For instance, education on the nature of

stress (e.g., the harmful effects of the stress response)

and relaxation (e.g., the need to repeatedly invoke the

relaxation response as an antidote to excessive stress)

and their effects on sleep (e.g., it is easier to sleep

with a calm mind than an overactive one) can increase

a person’s motivation for doing relaxation exercises.

Education can be measured in terms of the effects it

has on a person’s motivation. For instance, by in-

forming a person about the effects of having done a

daily progressive muscle relaxation exercise for three

weeks (i.e., an improvement in sleep efﬁciency from

0.5 to 0.6), the person becomes motivated to do the

practice for another three weeks.

A facilitator is used to increase a person’s ability

ICT4AgeingWell2015-InternationalConferenceonInformationandCommunicationTechnologiesforAgeingWelland

e-Health

to do the behavior. We operationalize this as the mod-

iﬁcation of exercises to a person’s needs and circum-

stances. For instance, the tailoring of exercises to the

individual is an important aspect of yoga (Desikachar,

2010). Modiﬁcation can be measured in terms of its

effects on the ability of a person to do the exercise.

For instance, if for a meditation exercise the instruc-

tion to walk (which requires 3, 5 kJ · h

−1

· kg

−1

) is

modiﬁed to an instruction to stay seated (requiring

1, 0 kJ · h

−1

· kg

−1

), then a person who can spend 1, 0

kJ · h

−1

· kg

−1

gains the ability to do the exercise.

Finally, a signal is used to let a person actually

perform the behavior. We operationalize it as the in-

struction that is needed to perform the exercise. Ex-

ercise can have different instructions. For instance,

the instruction of an exercise can vary from just men-

tioning the name of the exercise (‘do 15 minutes of

body scan now’) to a detailed, step-by-step guidance

through the exercise (‘. . . now bring your attention

to your feet . . .’). Performance can be measured as

a number between 0 and max performance. For in-

stance, for a person who does not know the body scan

exercise, the instruction ‘do 15 minutes of body scan

now’ does not lead to the performance of the exer-

cise (e.g., performance level 0), while a step-by-step

guidance through the exercise results in an actual per-

formance of the exercise (e.g., level 1).

Algorithm. Finally, we take the described com-

ponents together in a basic algorithm of relaxation

coaching. Figure 1 depicts the pseudo code of the

algorithm.

The algorithm takes as input a relaxation train-

ing program trp, which is modeled as a list of exer-

cises. In each round of the algorithm, the next exer-

cise of the list (i.e., head(trp)) is selected. The coach

assesses the person’s motivation with respect to this

exercise and while the person is not motivated to do

the exercise, the coach intervenes through education.

After that an assessment of the person’s abilities is

made and the coach modiﬁes the exercise to ﬁt it to

the person’s circumstances. Finally, an assessment

of the performance is made: While the exercise has

not been performed, the coach provides instruction

to do the exercise. In the last step of the algorithm,

the performed exercise is removed from the training

program, yielding tail(trp) and the new exercise to

be performed is selected. The algorithm terminates

when there are no more exercises to be done (that is,

e equals NIL).

Related Work. Stress@work is a system for stress

coaching that monitors people’s stress at work and

gives recommendations how to handle it (Bakker

COACH(rtp:relaxation training program)

e:exercise;

m:motivation;

a:ability;

p:performance;

e=head(rtp);

WHILE e!=NIL do;

WHILE NOT motivated(m,e) do

m=educate(m,e);

END-WHILE

WHILE NOT able(a,e) do

a=modify(a,e);

END-WHILE

WHILE NOT performed(p,e) do

p=instruct(p,e);

END-WHILE

trp=tail(trp);

e=head(trp);

END-WHILE

Figure 1: The coaching algorithm.

et al., 2012). The system encompasses an algorithm

for stress intervention that involves the recommenda-

tion of relaxation exercises. This model is not clearly

rooted in the theory of persuasive design.

A model of exercise support in the context of in-

somnia therapy is provided by Beun and colleagues

(Beun et al., 2014). This model identiﬁes exercises

support as a cyclic process consisting of four stages

of exercise support: introduction, plan and commit,

task execution and evaluation. No further details on

the application to relaxation exercises are provided.

4 CONCLUSIONS

We have developed basic requirements for relaxation

coaching in the form of a formal model that is rooted

in the theory of persuasive design.

The model is to be considered as a ﬁrst step to be

further reﬁned and extended with other operational-

izations and measures. To mention one example, the

resource ‘physical effort’ can be extended with a mea-

sure for physical impairments (e.g., incapability to

stand or walk, a shoulder injury and so on).

Next steps of the requirement engineering process

are the design, prototyping and evaluation of mobile

relaxation coaching systems, which should provide

further feedback to improve the formal model.

RequirementsforRelaxationCoaching-AFormalizationoftheFoggBehaviorModel

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