5 Steps To Changing Any Behavior

mountain

Photo: The U.S. Army

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.

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?

NEXT WEEK: The Truth About How To Lose Weight

12 comments to 5 Steps To Changing Any Behavior

  • Pete

    Alex, I look forward to applying these steps to next week’s topic as I try to lose 15 pounds!

  • In “Thinking in the Future Tense” Jennifer James outlines seven steps to change:

    1. Seeing the window
    2. Exploration
    3. Integration
    4. Plunge
    5. Landing
    6. Evaluation
    7. Sharing

    Bill: I’m not familiar with Jennifer James. I’ll be interested to look into her ideas.

    Alex

  • Mary Carlisle

    Well your view makes more sense to me then Jennifer James. LOL. Rhea got you to try Sushi huh? That lil’ determined woman. Thanks, Alex, this really helps me. I love your blog.

    Mary: She did! Can you believe it? And I’m so glad you’re finding the blog helpful.

    Alex

  • Tony LaPorta

    Some will call it Relapse. In my case…abstinence from drugs and alcohol…a total of 5.4 years. The coward calls it relapse. If I go back out there I knew what I was doing. I would have most likely planned it for days. I don’t relapse…I resume.

    Tony: I like your sense of responsibility.

    Alex

  • Vivian Eisenecher

    I read this article of yours in Ezine articles and decided to check out your website. I suppose these steps can be categorized in different ways as Jennifer James has done. Good work anyway!

    Vivian: Another person made a similar comment re: Jennifer James. I’d not been familiar with her work. The Stages of Change Model was developed in 1977, around the same time I think Jennifer James was working on her model. I wonder if there was a mutual influence?

    Alex

  • I have been studying the value of gradually changing new habits and this is one of the most valuable pieces I have read on the subject. I see that the gradualness is partly due to the fact that as you describe it, it is a multi-stage process.

    I have also found that changing one small habit at a time, leaving time for the new habit to become more and more automatic, makes it easier to make big changes than if I overreach with my first goal. That doesn’t work with smoking exactly, but it works with establishing a healthier diet or more ambitious work plans.

    Thanks again.

  • Susan Barschow

    I enjoyed your article very much. Over the years, I have found the best way to do things—quit smoking, stop drinking, etc. is to just stop. However, now I am beginning to think that my “just stop” is fueled by the various stages and that whether I know it or not, I have contemplated, determined, acted and maintained.

    Wonderful food for thought. I’m glad I found your website! Thank you.

    Susan: Glad you found the article interesting. Thanks for stopping by.

    Alex

  • chocophile

    Hi Alex,

    I will take your suggestion and leave the url to my site here: http://holisticdivorcecounseling.com. As I mentioned, it’s not just for divorce, but for all life’s challenges and transitions.

    Wishing you every goodness,
    Nicole

  • Drew

    Hi Alex,

    Through school I have been anticipating a medical career, but eventually got cold feet as I was putting my application together. One fear has been a general decline in support for the thinking, listening generalist. Your blog, among several in the online community, indicate to me that role models who enjoy their primary care work still exist, even if their numbers are waning.

    One of the big questions that I have wrestled with is the degree to which I could help patients achieve behavior change as a physician. I am more passionate about healthy living and wellness than science. Is it naive to think that taking my training to the highest level (MD) will allow me the most liberty with my patients? Currently I think the opportunities to develop relationships and foster behavior change would be greater with a lower level credential like an RD or even a personal trainer.

    I’m not trying to put you on the spot to make any decisions for me, but I think your experience could help answer a couple of my questions. As a physician, do you feel like you are in a good position to encourage behavior change? Or do you feel limited by the time-intensive nature of lifestyle coaching, that efficiency prompts you to spend time diagnosing and treating disease?

    Thanks for sharing your thoughts in this blog,

    Drew

    Drew: Excellent question. Not being either an RD or personal trainer, it’s hard for me to know to what degree they’re able to influence behavior change. As a physician, however, I’ve been astounded by my ability to influence the decision-making processes of my patients (note I didn’t say behavior change—that’s harder, and I’m not certain any one profession really has an advantage in it over any other). What influences people, I think, isn’t so much what you say but who you are to the person to whom you’re saying it. The real power I have as a physician to influence patients comes from the the trust I’ve been able to build with them over the years with regard to one of their most precious possessions: their health. Patients of mine have submitted themselves to dangerously invasive surgeries that required months to recover from at the hands of doctors they barely knew because I advised them to. The influence a doctor has (especially a primary care doctor) represents an awesome power that demands constant accountability. I’ve also found that after a number of years in the medicine game you get efficient enough to be able to attend to the psychospiritual aspects of health care as well as the diagnosis and treatment of disease if you care enough to do so.

    Hope that helps bring some clarity to your deliberations. The world needs more doctors who care about not just the health of their patients but their happiness as well!

    Alex

  • USCLawyer

    I appreciate your writing on this and other pages, and I agree with almost all of it. You make one point, however, with which I am not certain that I agree in every instance. You say that it is important to see relapse as part of the process, and not as an ultimate failure. Relapse can itself become an ingrained habit. I have seen people trying to lose weight, stop smoking or break other habits who have relapsed so often that relapse becomes easy. If relapse is not a failure and a catastrophic event, then those trying to break a habit have little incentive not to relapse. In effect, the effort to quit has become a short break from the habit, nothing more.

    While I agree that it is important to forgive yourself and get back up on the horse, it is far more important to resolve, once and for all, that there is no turning back. To quote Jesus the Christ, “Remember Lot’s wife.”

    USCLawyer: You do raise a good point. I didn’t mean to imply, in saying that relapse is a part of the process of change, that it is an inevitable part of the process of change and that it should, therefore, be so readily accepted that it becomes an expected part of the process of change. I wanted to make the point not just to encourage people to forgive themselves for its own value but because not recognizing that relapse is often a normal part of the process of change often decreases the likelihood that one will be able to make the change they desire permanent. How often I hear patients say that after binging just once they figured they’d blown their attempt at weight loss and abandoned any further efforts. It wasn’t the initial relapse that caused them to fail. It was the relapses that followed because they allowed themselves to be discouraged by the first one.

    Alex

  • Sara

    In re: to “relapse.” I’ve been doing a therapy group (that is more like a class in that we have a manual & homework) called Dialectical Behavioral Therapy. I have been participating in this group for about 2 years & also do individual therapy w/the instructor who is a PhD therapist.

    My reason for becoming involved in this type of “therapy” is for the treatment of bipolar disorder & other psychological issues that have been causing me much emotional pain & I have very unhelpful coping skills. All of the people in the group have serious mental health issues & have had suicide attempts, cutting behaviors, drug & alcohol problems, anorexia—just the whole gamut of dysfunctional behaviors.

    I also take medication but have been able to discontinue some & am decreasing the dosages of others in the hopes of getting off them completely as I am learning new thinking skills that lead to healthier behaviors. The “retraining” of the brain can change the pathways in your brain & you can reduce & eliminate paranoia & other symptoms associated w/serious mental illnesses. I’m proof of it. Regular therapy did not help me change my thoughts & behaviors; it helped me understand why I was depressed, had low self-esteem, was fearful & paranoid, etc., but it didn’t have any impact on my ability to change. But I probably am a stubborn case. (I say “complicated”; my husband says “interesting.”)

    In this group, “relapse” is a common occurrence, especially in the first few months when all the skills we are studying are new & the techniques are just being introduced. A major component of DBT is to be non-judgmental & compassionate towards yourself if you take the proverbial 2 steps back (relapse) from the 3 steps forward in progress you have been making.

    For me that was a very hard concept—to not think of myself as a failure & feed the failure self-concept w/thoughts like: I’ll never improve. I’ve been this way so long it is too late for me (I’m 56 & had my 1st suicide attempt at 15; my mother also had a serious mental illness & did commit suicide so I know “giving up” on getting well leads to hopelessness & to inevitably contemplating ending it all).

    I have so many problems & “issues” that I get overwhelmed sometimes. But in DBT part of the non-judgmental thinking is also looking at “Vulnerability Factors” (V.F.) that led to the relapse. If I can step back & analyze my relapse (for me it is rash harmful behaviors to try to get rid of my emotional pain as quickly as possible; others might be cutting or abusing alcohol or drugs, binge eating or anorexic restricting of food, etc.), I often see V.F.’s that preceded the relapse.

    For example, I may have been having a period of insomnia; a flare-up of a chronic pain issue I have; my eating may not have been balanced; an “anniversary reaction” to traumatic events in my past occurred; not exercising; not taking time out for pleasurable activities; hanging around w/people who are negative, mean or hurtful towards me, etc.

    Then it is easier for me to give myself some compassion for my relapse. I was in a vulnerable state (sort of like if you have a weakened immune system it is easier to catch a cold) & I can use this analyzing of my relapse to learn & plan how to avoid those V.F.’s in the future as much as possible.

    Every year I have a depression come on on the “anniversary” of my mother’s suicide when I was a teenager. Now I plan for it in advance by not adding any extra responsibilities to my life, taking extra time to rest & rejuvenate & alleviate stress, making sure my diet & exercise “programs” don’t get thrown to the wayside, & ask for help when I need someone to listen to me or just hug me & allow me to grieve. But I don’t go into full-blown depressions where I drop out of life like I used to.

    Also, another helpful thing DBT teaches is to look back & see how much progress you have made.

    So if you have had a relapse, look back & see the line of progress & not focus on this “blip.” Also, I use anger constructively. When I was trying to quit smoking (& have not smoked for over 10 years now), one day at work a customer was really rude to me & obnoxious. I became very upset & had to leave work, but on the way home I bought some cigarettes (had only quit for about 2 weeks at that time).

    After smoking a couple cigarettes (relapse), I thought to myself: “I’m not going to let that guy have this kind of power over me. He’d be happy that he caused me to start smoking again.” And I got angry at the cigarettes for having “control over me.” So I learned something w/that relapse—I don’t want to allow other people to “push my buttons” & have me do something to hurt myself because of it. I also strengthened my resolve to not let that flimsy paper full of tobacco have such power over me.

    If you are still trying to overcome your areas of difficulty, you are a success! If a relapse happens, learn from it, don’t attach too much power or emotion to it, be done w/it as quickly as possible & see it as an isolated incident—not as a sign of failure or a beginning of a trend.

    My long-winded 2 cents worth!!

    Sara: Wonderfully wise words. Thank you for sharing.

    Alex

  • Linda W.

    Hi, I realize this is sometime after the orginal post, but I just came across it. Very Interesting!

    It reminded me that I tried to quit smoking all through my 20s with only limited success. One day I saw a woman, in her 50s or so, with awful deep wrinkles all around her mouth and face, puffing on a cigarette and making them look so much worse. (It was obvious where the wrinkles came from.) My vanity caused me to quit on the spot!

    I think now I’ll try to apply this same method to my problems with procrastination.

    Thanks again,

    Linda: Glad you found it helpful.

    Alex

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