Many of us have tried unsuccessfully to change a habit. Have you ever set a new year's resolution that, a week later, was all but a memory? Is there something you do (or don't do) that you would like to change right now, but don't know how to make it happen?
Breaking unhelpful habits – or making good ones stick – is basically a form of what is known as behaviour change. This is a hot topic right now. It's a process that has the power to improve health, both at an individual and a community level.
With the rise of chronic illnesses such as heart disease and type 2 diabetes, and mental health issues such as depression and anxiety, many public health experts believe behaviour change is the key to turning the tide of ill health.
Many chronic illnesses can be managed, or even prevented by addressing the modifiable risk factors – ie, the factors a person can control – associated with the diseases. Physical inactivity, tobacco use, obesity and excess alcohol use are all modifiable risk factors. Addressing these can, in turn, reduce our likelihood of getting an illness, or improve the management of an existing illness.
So, how does something become a habit? University of Melbourne School of Population Health senior research fellow, Dr Adrienne O'Neil, says a behaviour may start for one reason and continue for another.
"We rarely continue performing a certain behaviour that does not provide us some sort of pay-off; this may be by way of an emotional, psychological and/or physiological response," says Dr O'Neil.
How do we know that a habit has become bad for us? When it has begun to interfere with our normal daily life, says Dr O'Neil.
"We should ask if the behaviour is interfering with our relationships, work performance or preventing us from achieving a goal," she says. "If the behaviour is detrimental, then it's time for a change."
Dr O'Neil says one of the most widely used models in behaviour change is Prochaska and DiClemente's 'Stages of Change'. Used mainly in clinical settings, it assesses a person's 'readiness'. There are a few versions of it, but here is one:
"The model supports the idea that an individual needs to be ready to change in order for change to occur," says Dr O'Neil. "There are also periods of our life in which we are more or less amenable to change – but I would never say 'you can't teach an old dog new tricks'!"
"Although the principles of behaviour change are fairly straightforward, implementing change requires dedication," Ms Needleman says. \
She says no matter the habit, the method to change it is the same. "I encourage my clients to set a global goal; for example, increase exercise," she says. "Then the next step is to break down the overarching goal into smaller, measurable targets."
Ms Needleman asks her clients to:
"Planning as comprehensively as you can ahead of time means that when the moment is needed for change to occur, there should be no surprises that may undermine the changes you are putting in place," says Ms Needleman. "Along with your thinking, it is important to plan for the emotions accompanying the behaviour, and how to address these within the new behaviour.
"It is also crucial not to start from a point of failure. So if your self-talk is negative, have a number of counter-thoughts ready to combat any initial pessimism. If we are our own 'inner coach', we are much more likely to accomplish behaviour change."
Ms Needleman says it is also important to look at how to begin the change in a practical manner. With exercise, for example, she says it is vital to know what motivates you, or stops you, from doing it.
"If you need to have your walking clothes out ready the night before to help you, then do it," she says. "If you find the weather is rainy and cold the next morning, have a plan B. It might be doing a 30-minute YouTube yoga sequence in the comfort of your own home.
"Be flexible and adaptive. If you find the approach is not working, tweak it slightly. And remember, the best way to implement change is to make it the pleasurable and easy option. Enlist a friend. Reward yourself, such as with a coffee after completing your walk, and be positive!"
Under the right conditions, people can change successfully, says Ms Needleman, but it can take time.
"I encourage my clients to respect the plan and respect the process of change," she says. "Habit formation takes time, so be patient."
Dr O'Neil says if clinicians and researchers know the context in which behaviour change can occur, great progress can be made at individual and population levels.
"We are not fixed by our genetics, personality or environment," says Dr O'Neil.
"At an individual level, we know that the physiological, psychological or emotional need must be recognised and interrupted for change to occur."
Using the example of obesity, Dr O'Neil says there are many challenges at a population level, especially given the sedentary lifestyle and fast-food trends in many countries.
"But the potential for behaviour change to drive healthier people and populations is also enormous. There is much work going on in the field of behavioural economics to effect this type of change," she says.
Ms Menzies says that by questioning the behaviour or habit, we can help to identify whether or not it is still beneficial. The habit might be meeting a need or desire she says (eg, too little time to cook, so order take-away). But if the habit isn't particularly healthy, then it might be time for a change. Ms Menzies says she then works with her client to re-set the routine and help establish new habits.
Echoing Dr O'Neil's sentiments, Ms Menzies says that most habits are originally formed due to a specific reason. "It may be that you are finishing your child's leftovers on the plate because you do not want to waste food," she says. "On the one hand, this habit is meeting a need in terms of not wasting food, but the trade-off is the increased food consumption beyond the parent's needs."
Ms Menzies says encouraging her clients to think about whether or not the habit is promoting self-care is an effective way to help foster the desire to change. She says we can be guilty of putting our health needs last – particularly if we are at a busy phase of our lives – raising children, working, caring for elderly parents, for instance.
When making changes, Ms Menzies says it is important to understand we are individuals and there is no 'one size fits all' approach. Working with clients to tailor goals that are realistic and sustainable is the first step.
"It's not about a quick change," she says. "Rather, it's about sustainable goal-setting and giving the person the opportunity to establish a new habit for the long-term."
Change can be difficult, as it takes us out of our comfort zone. We're also driven by the way we talk to ourselves, which can often be quite negative, says Ms Menzies. "I like to encourage my clients to take an inventory of their language and if we notice that the self-talk is shaming, we need to flip the conversation around," she says.
"I also want people to practise self-care. Ultimately, I want my clients to live by the mantra 'I'm worth it'."
Set an overarching goal. Also be sure to set smaller targets that will help you reach your goal.
Address psychological and physical barriers. How are you going to think differently? What are you going to do differently?
Be flexible and adaptive. If things are not going to your plan, review and tweak it to make success more likely.
Listen to our podcast on making positive changes here.
This article was originally published in Volume 2, 2018 of the Jean Hailes Magazine.
