Behaviour Change

If you scored high in the Behaviour Change section of the Health Score Assessment then please read this resource as it contains some useful information and resources to help you.

Change can be complex

Creating change is often far less about a lack of knowledge, in fact we have so much information available to us now and the majority of that information is available to us at a touch of a button. Yet behaviour change seems to be harder than ever before.

Some of the challenges can be the sheer overwhelming amount of information given to us that leads to confusion. Any time we are confused about something or unsure then this often creates a feeling of ambivalence and thus we decide not to make any changes. This is how the tobacco industry has prevented change in so many individuals for so long. Even though the health evidence was clear many moons ago that smoking cigarettes is harmful to health, it took much longer for people to accept that message. Conflicting advertising to what the health authorities where saying created a state of confusion that delayed the clear message that smoking just aint that cool and certainly isn’t good for you.

With lifestyle change, we can often feel in the middle of these mixed messages. Media reports one week that something is bad for us and may pose a risk to your health, followed up the next week by reports of the same food being a superfood!

If you are expecting mass media to give you a clear idea on what to do and how to change you are greatly mistaken. It’s not just mass media either, scientific journals will send mixed messages as well. Whilst I applaud the growth of research into nutrition and lifestyle habits and their impact on health, we also have to be careful how we interpret that information as well. Study design, study funding, sample size, population bias and our own biochemical individuality mean that whilst we can use well designed research as a guide, it may still not be totally relevant to our own personal circumstances.

The truth is, so much about changing behaviour and changing your health is about how you interact with the external environment and your internal signals and inner voice.

Behaviour change needs to come from within. Having someone tell you what to do is far less powerful than you coming to that conclusion yourself. This doesn’t mean you cannot be guided, far from it, what I am saying here is that you cannot be forced into something, you must feel empowered in that decision yourself. This is why I gravitated towards the practice of functional medicine, which is a more patient centred approach that has the patient involved in the decision-making process.

We are not robots, therefore we cannot simply be programmed to do something just because someone says so. “go and lose weight”, “go on a ketogenic diet”, “eat more oily fish”, “do 10,000 steps per day”. Whilst recommendations can come from a place of wanting the best for the individual, the skill in getting long term results with clients is more about how we as professionals engage with our clients, and how we teach our clients to engage with themselves.

In my forthcoming book Sleep, Eat, Move, Breathe, Repeat, it covers my five foundations of optimal health:

• Sleep – All things sleep
• Eat – How, Why, What & When you eat
• Move – Exercise & daily movement
• Breathe – Impacts of stress, solution/management of stress, mindfulness etc
• Repeat – Behaviour change, motivating change, scheduling, long term success

For the behaviour change section, I will be reviewing areas such as:

• The complexities of lifestyle change
• Goal setting & establishing focus
• Determining values
• Stages of change
• Helping to evoke behavioural change
• Planning for behavioural change
• Affirming change behaviour
• Scheduling, prioritisation & general time management
• Reflection practice
• How to manage perceived “failure”

Build your self-empathy

We can all have great intentions, but often we struggle to be consistent with those intentions. New Year’s resolutions are a great example of this. Now, I am not saying there is an issue with New Year’s resolutions, in fact amazing things can come of setting an intention for change in the new year. However, we often overlook what it takes to create the longer-term change, or we approach things in such a black and white/good vs bad manner that we set ourselves up to “fail” at some point. We then struggle to know how to cope with what we perceive as failure, because most of us have never been given the skills to reflect, adapt and even turn that failure into a positive. Things come up like a change in job circumstances and your work schedule, a new baby, taking a holiday, lack of support from those that surround us and these often act to derail our efforts.

To create change we often have to develop empathy towards ourselves and a level of flexibility as well. No one is perfect and it’s highly unlikely that whatever you choose to change is going to work out perfectly.

What I find extremely interesting is that most of us can be very empathetic towards others and their situations, we can offer advice to support someone in a time of need, yet the self-talk that so many people express is often one that lacks in empathy. I have witnessed clients speak about themselves openly in third person in unbelievably negative and derogatory ways. I wonder if they would speak to a loved one the same way that they speak to themselves?!

I often recommend clients to engage in learning mindfulness and meditation. The main reason is that we can build the skill of observing our thoughts and guiding them. Often, we get caught in our thoughts and they can run away with us. The ability to see and guide your thoughts also creates a more empathetic eye to oneself.

You are already excellent at behaviour change

Most people don’t realise it, but they are already excellent at changing behaviour. Think of some of the most autopilot behaviour patterns you already have.

Taking a shower each day in the morning or evening, brushing your teeth each day without fail, helping your children with their homework, mowing the grass throughout the spring and summer months, making the bed every morning, cleaning the house once a week, calling a loved one every Sunday, clearing your emails every day and so forth. Why do you do these things? It’s is likely because the benefit of the behaviour outweighs the cost and over time you have developed habits in these areas. You might not have been great at these things at the start, but over time these have become fairly engrained habits. Draw on your ability to make changes in other areas to build your confidence in making changes in other areas.

Some of my most motivated clients, when it comes to lifestyle change, are those that have recently experienced a significant health scare or those that have a very clear and motivating short term goal. Often this is about the change in how much one values something. Health scares can often make us reflect and take stock on what is important. As a result, we increase the energy and effort required to make the changes that reduce the risk of that health scare.

This isn’t to say you need to have such a significant life event to create change. Far from it, you just have to drill down into the changes that you are looking to make, perhaps prioritise them and look at how you can add more value to the changes that you are looking to make, as well as build your confidence around those changes and come up with practical ways in which those changes can happen.

The Change & Confidence Ruler

One approach I use with clients is the change and confidence ruler. I use this as a way of increasing one’s motivation to change as well as building their confidence in their ability to change.

Here is how it works. Take a behaviour change that you want to make, now score yourself from 1-10 in terms of how motivated you are in making that change.

If you scored yourself a 5, ask yourself why you did not score yourself a 2 or a 3. List these reasons down and reflect upon them.

Perhaps after listing down all the reasons, consider ranking yourself again, has it changed?

You can do the same with a confidence score. This is ranking yourself from 1-10 in terms of how confident you feel about making the change you have decided on.

Let’s say you scored yourself an 8, now list why you didn’t give yourself a lower score, like a 3 or a 4.

This practice helps you look at the reasons that you want to change and also allows you to list the skills and positive traits that you have to be able to follow through on those changes.

Stages of Change

It has been hypothesised that there are different stages of change (Prochaska & Di’Clemente, 1984). We don’t just decide to make a change and then that change happens, and we successfully maintain it.

These stages of change are known as the Transtheoretical Model (TTM). There are 5 stages of change presented by this model:

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

Precontemplation is where an individual is either unaware or in denial about a change that is necessary or warranted. In the world of lifestyle change, I might see this when someone steps in my office and says, “I’m here because X told me I need to see you”. Often with these individuals there will be a lot of resistance to change talk.

Contemplation is where an individual is aware that some sort of change is required. Often that individual has mixed feelings about change or is quite ambivalent about change, meaning they see both positive and negatives to making changes. The individual does not have any plans as yet to change and is therefore sitting on the fence.

Preparation stage is where you are expressing a desire to change in the near future, and you are displaying ideas around what you might do to make changes and the benefits of the changes that you are looking to make.

Action stage is as it says on the tin, this is the point where you actually take action and to expend both physical & mental energy, whereas prior to that the focus is on mental energy. This is where you put into action what you have been preparing for. For example, my doctor told me last week I have diabetes, so I have stopped eating sugary breakfast cereal and instead I now fast in the morning or eat a low carbohydrate breakfast.

Maintenance stage is where you have managed to create change consistently for 6 months. According to Prochaska & Di’Clemente a client that maintains change for this period is still at risk of reverting to old patterns of behaviour, however the likelihood of maintaining the change is higher than reverting to old patterns because the change is now part of everyday life.

The art of failing well

Making change is not a linear improvement, things derail us all the time and having a way of reflecting on those challenges to turn it into a positive for the future is critical.

Please take a moment to read The art of failing well – an article written by my colleague Dr Albert Viljoen that discusses the importance of turning our perceived failures into lessons.

Additional Resources

Books / Audiobooks

• The One Thing – Gary Keller
• The Compound Effect – Darren Hardy
• Pebbles of Perception – Laurence Endersen
• Atomic Habits – James Clear

Relevant Services

• Behaviour Change Specialist Dr Albert Viljoen.
• Mindfulness and Meditation to support behaviour change with David Behrens.