Happiness in this World

Reflections of a Buddhist physician

5 Steps To Changing Any Behavior

Taking advantage of the way the mind works to yield change.

From quitting smoking to eating healthier to exercising regularly to getting more organized, most of us have a list of behaviors we'd like to begin (or end) that resist our attempts to do so. As a physician, I find myself giving advice about changing habits on a daily basis. Even though many of my patients are able to succeed in making desired changes in the short term, most of them revert to their original behaviors in the long term. What, then, are effective ways to alter behavior on a permanent basis?

The psychology that underlies the changing of behaviors is complex. Two researchers named Prochaska and DiClemente developed a way of describing it they called the Stages of Change Model. Though originally developed in the context of smoking cessation, it's five stages actually describe the process by which all behaviors change.

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THE STAGES

  1. Precontemplation. In this stage, we've either literally never thought about needing to change a particular behavior or we've never thought about it seriously. Often we receive ideas about things we might need to change from others—family, friends, doctors—but react negatively by reflex. After all, we're usually quite happy with our current stable of habits (if we weren't, we wouldn't have them in the first place). However, if we can find our way to react more openly to these messages, we might find some value in them. Remember, they aren't sent with the intent to harm.
  2. Contemplation. Here we've begun to actively think about the need to change a behavior, to fully wrap our minds around the idea. This stage can last anywhere from a moment—to an entire lifetime. What exactly causes us to move from this stage to the next is always, in my view, the change of an idea ("exercise is important") into a deeply held belief ("I need to exercise"), as I discussed in an earlier post, Cigarette Smoking Is Caused By A Delusion. What exactly causes this change, however, is different for everyone and largely unpredictable. What we think will produce this change isn't often what does. For example, it may not be the high cholesterol that gets the overweight man to begin exercising but rather his inability to keep up with his wife when they go shopping. This is the stage in which obstacles to change tend to rear their ugly heads. If you get stuck here, as many often do, seek another way to think about the value of the change you're contemplating. Remember, it's all about finding and activating a motivating belief.
  3. Determination. In this stage, we begin preparing ourselves mentally and often physically for action. The smoker may throw out all her cigarettes. The couch potato may join a gym. We pick quit days. We schedule start days. This mustering of a determination is the culmination of the decision to change and fuels the engine that drives you to your goal. I firmly believe that human beings possess the ability to manifest an unlimited amount of determination when properly motivated by a deeply held belief.
  4. Action. And then we start. We wake up and take a power walk. Or go to the gym. Or stop smoking. Wisdom—in the form of behavior—finally manifests.
  5. Maintenance. This is continuing abstinence from smoking. Continuing to get to the gym every day. Continuing to control your intake of calories. Because initiating a new behavior usually seems like the hardest part of the process of change, we often fail to adequately prepare for the final phase of Maintenance. Yet without a doubt, maintaining a new behavior is the most challenging part of any behavior change. One of the reasons we so often fail at Maintenance is because we mistakenly believe the strategies we used to initiate the change will be equally as effective in helping us continue the change. But they won't. Where changing a strongly entrenched habit requires changing our belief about that habit that penetrates deeply into our lives, continually manifesting that wisdom (and therefore that habit) requires that we maintain a high life-condition. If our mood is low, the wisdom to behave differently seems to disappear and we go back to eating more and exercising less (this isn't, of course, equally true for all behaviors, especially for addictive behaviors we've long ago abandoned). In a high life-condition, however, that changed belief will continue to manifest as action. When you're feeling good, getting yourself to exercise, for example, is easier because the belief that you should exercise remains powerfully stirred up and therefore motivating. The key, then, to maintaining new behaviors...is to be happy! Which is why it's so hard to maintain new behaviors.

ONE STAGE LEADS TO ANOTHER

The true power of this model really becomes apparent when we recognize these stages are sequential and conditional. In my medical practice, I first identify the stage in which a patient sits with respect to the behavior I want them to change. A smoker who's never seriously considered giving up tobacco would be in the stage of Precontemplation—and if I expected them to jump from that stage over Contemplation and Determination directly to Action, they'd almost certainly fail to change and frustrate us both. If, however, I focus on ways to move them from one stage to the next, I can "ripen" them at a pace with which they're comfortable: from Contemplation to Determination to Action to Maintenance. As an example, I often give patients in the stage of Precontemplation a simple assignment: I ask them to think about how the change I want them to make would improve their lives. That doesn't seem like such a difficult step, but if they do it, I've just moved them into Contemplation! That may seem like insignificant progress, but it's actually 1/5 of the work that needs to be done. Most people (though certainly not all) seem to be more comfortable embracing change in a step-wise fashion.

The utility of the Stages of Change Model isn't restricted to the medical arena but in fact extends to almost every area of life. As an example, my wife used it on me to get me to try sushi (which I now love!). It could be used in business perhaps on employees to yield changes like improved productivity or cooperation, or even on potential clients to get them to hire you! The potential applications are limited only by your imagination.

Finally, and most importantly, you can use this model on yourself. By recognizing which of the five stages of change you find yourself in at any one time with respect to any one behavior you're trying to change, you can maintain realistic expectations and minimize your frustration. Focus on reaching the next stage rather than on the end goal, which may seem too far away and therefore discourage you from even starting on the path towards it.

RELAPSE

The final stage of any process leading to behavior change is one extremely difficult to avoid: relapse. Though it may sometimes be inevitable, if you train yourself to view relapse as only one more stage in the process of change rather than as a failure, you're much more likely to be able to quickly return to your desired behavior. Alternatively, when you allow yourself to view relapse as a complete failure, that assessment typically becomes self-fulfilling. Just because you fell off the diet wagon during a holiday doesn't mean you're doomed to return permanently to poor eating habits—unless you think you are and allow yourself to become discouraged, in which case you will. Long term weight gain or loss, it turns out, isn't correlated to calorie intake on any one day but rather to calorie intake over a period of time, which essentially means if you overeat here or there on a few days only, it won't actually affect your long-term ability to lose weight.

The same is true, in fact, with any behavior you want to change. Never let a few days, or even weeks, of falling back into bad habits discourage you from fighting to reestablish the good habits you want. Always remember: none of us was born with any habits at all. They were all learned, and can all, therefore, be unlearned. The question is: how badly do you really want to change?

 

If you enjoyed this post, please feel free to explore Dr. Lickerman's home page, Happiness in this World.

Alex Lickerman, M.D., is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989.

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