The Challenge of Embedding New Behaviours

This blog is by Philip Booth, Wigwam Coordinator, and is adapted from a blog he wrote last year on his personal blog site (i).

It’s all very well talking about stuff like increasing exercise, juicing, best times to eat, self massage, cold showers and more, but the biggest challenge is often how to make those behaviours part of everyday life. There are libraries of books written about ‘behaviour change’ but I’ve not found many of them accessible. In this blog I want to unpick some of what I have found useful.

A while back for work (not Yes to Life) I went on an online half day ‘Healthy Lifestyles’ course. It looked at drivers and enablers to making change – so for example if someone says ‘I want to feel less stressed and know how it is to be relaxed’ this might be a useful ‘driver’ to helping them to improve wellbeing. It is great to understand these ‘drivers’ as they are key in creating change – and a cancer diagnosis can certainly be a driver! Indeed there is evidence to show that a diagnosis of cancer is a’ teachable moment’ when many people are very motivated to make changes.

On the course there were also lots about how to help someone make changes. Interestingly if you take responsibility for helping the change for someone else then the person you are trying to help will often take the other view – this even has a name; ‘the righting reflex’. So staying away from telling someone what to do is key and instead it is useful to try to reflect back what the person is saying. If you hear ‘change talk’ then explore and clarify to enable the person to come up with the answers.

Wider societal factors

The course was great at helping folk explore where they are and changes they may wish to make. However these approaches often focus on the individual and this plays into wider societal views that blame individuals for problems (ii). So for example overweight people are fat because of their personal choices about eating and exercise. This ignores the role of economic status, upbringing, genetics, neighbourhoods being less walkable, the explosion in cheap fast-food and processed foods, and the way parents talk to their children about weight – all of these have an impact on obesity. It is also over forty years since Susie Orbach wrote, ‘Fat is a Feminist Issue’. We don’t seem to have learnt much over those years (see Suzie comment in The Guardian in note iii)!

Indeed we often see problems, like obesity, smoking, heavy drinking, and poverty, cast as personal failures. Sometimes cancer is also seen like that. The recent Cancer Research UK’s campaign about obesity led to some criticism; some argued it was framed as if obesity was a lifestyle choice. If so, this can only encourage weight stigma. We know ‘fat shaming’ has a counter-productive effect and leads to further weight gains. Long-lasting change is most likely to happen when it’s self-motivated and rooted in positive thinking.

We need a more holistic approach that seeks to change lifestyle habits by looking at the psychological and physical factors that underpin them but also recognise those wider factors. Of course to affect change now we need to take personal responsibility and there are numerous approaches. However I guess I’m calling for some self-compassion and understanding that lifestyle, upbringing, environment, community and much more also play a role; it is not just our behaviour yet that is what we can focus on to create personal changes.

A Model of Change

One of the interesting ways of accounting for success and failure in making healthy changes, is the transtheoretical model (TTM). TTM is one of the most widely used and sees change as a process not an event – although it is not without criticism. In brief you can go from precontemplation to contemplation to preparation to action to maintenance, where the changes are adopted and are practiced for the rest of your life.

Understanding where you are in that process can help look at what intervention is best at that point – and therefore move to the next step. Although it’s acknowledged that these stages are not as discreet as the model suggests; folks come in and out of the process, relapse and restart. This is not for this blog as you can read lots about this in many places.

Making self care habitual

The short ‘Healthy Lifestyles’ introduction course didn’t really get into more specific tools to embed new behaviours. Yet it seems to me this is possibly one of the more valuable ways we can support ourselves and others? B.J. Fogg writing in the acclaimed book, “Tiny Habits: The Small Changes That Change Everything” (iv) says 3 things will change your behavior in the long term:

Option A: Have an epiphany

Option B: Change your environment

Option C: Take baby steps

He writes on the website: “Creating an epiphany is difficult. So rule out Option A unless you have magical powers—I don’t. On the other hand, Option B and Option C are practical. And they can lead to lasting change if you follow the right program”. I think for me cancer was one of those epiphany moments.

The book is full of much good info. Ayurvedic practitioner Dr Sam Watts of Mind, Body, Medical in a FaceTime video last year suggested four key tools that are covered in the book – I found them all great:

1. Tagging. This is where you ’tag’ your new behaviour onto an existing behaviour. So for example tagging meditation onto doing the school run; using time sitting in the car after dropping the children off. Or as in my case, a cold shower and a self massage after a warm shower. To me this is such a brilliant way of embedding new behaviours. One suggestion from a Wigwammers was to create a ‘morning to night list’; here’s part of their example: (i) Set alarm clock five mins earlier to write in gratitude journal (ii) After brushing teeth look straight into your eyes in search of one thing that you love about yourself, write a sticky note and apply to mirror as a reminder (iii) When you open your fridge to make breakfast/plan the day’s meals check that your fruit and veg stock variety to include all the colours of the rainbow

2. Small goals. The more we are successful, the more successful we are; success breeds success. So small goals will lead to dopamine hits which will help us perceive we are successful and encourage us more. This TEDx talk says just do the new behaviour for a minute and take the struggle out- see here.

3. Deadtime. Where can we fit stuff in? While the kettle is boiling is there time for squats, stretches or breathing? Or using 10 mins in lunch break or while waiting to pick up kids for a mindfulness activity?

4. Positive mindset. We can change reality by changing perceptions – one example that I remember is Victor Frankl, who maintained his body weight in the concentration camp by creating his own reality. So are there ways to turn negative thoughts into positive ones before going to sleep?

Yoga; starting a new group with others

For me knowledge is one of the key factors that help – knowing that something can have an impact is a significant motivators for me. I liked this blog which covers that aspect, ’10 Science-backed Tips to Making a Health Behaviour Change that Sticks’ – see here. When I find so many useful behaviours which ones should I prioritise? Finding our ‘protocol’ or self-care practices is an on-going challenge – and sometimes delight! I also see some of those practices changing and adapting as life goes on…..that’s another blog!

I can’t finish this blog without saying again that having support or doing things with others is often one of the most important aspects towards achieving success in behaviour change – I’ve written before about that here.

Lastly it is said that it takes 21 days to structurally alter the brain so that a new behaviour becomes a habit. Gloucestershire’s Katie Elliott of ‘Little Challenges’ says “I’ve learned that a new behaviour should feel so easy that we’ll be able to do it successfully at least 80% of the time. If not, the aim is to keep making the behaviour simpler until it feels like something that would be manageable on pretty much any day – even a really dreadful one. Only once we’re in the habit of doing that one small thing successfully – and having experienced an increased sense of self-efficacy as a result – is it time to scale up to something a little more ambitious. And then again. And again. It sounds slow, but it’s actually a lot quicker than setting huge goals and never reaching them”.

Good Luck! I’d love to hear your ideas for behaviour change; do add to the comments.

Notes: (i) ​https://myunexpectedguide.blogspot.com/2020/09/how-to-embed-new-behaviours.html (ii) https://www.psychologytoday.com/us/blog/real-healing/201308/i-see-fat-people                        (iii) https://www.theguardian.com/society/2018/jun/24/forty-years-since-fat-is-a-feminist-issue And see research into the links between inequality and obesity have been highlighted in research by for example Kate Pickett and Richard Wilkinson: https://www.equalitytrust.org.uk/spirit-level And more on personal responsibility: https://www.healthaffairs.org/doi/10.1377/hlthaff.2009.0739 (iv) See more at: https://www.tinyhabits.com and https://youtu.be/A0veC0L7pM0