stages in behavior change

7/25/2019 Stages in Behavior Change

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Why its hard to change unhealthybehavior and why you should

keep tryingMany of us think about changes wed like to make in our lives. When it comes to healthrecommendations, we mostly know the drill: Exercise most days of the week; eat a varied

and nutritious diet; kee your body mass index between !".# and $%.&; get enough slee;

kee u with medical screenings for blood ressure, cholesterol, and blood sugar; get

mammograms and 'a smears at recommended intervals; dont smoke; and limit alcohol to

seven drinks a week. (educing stress, imroving relationshis, and develoing new

interests or hobbies also contribute to healthy living.

Making healthy lifestyle changes affects not only our risk for disease and the way we feel

today but also our health and ability to function indeendently in later life )see *+ifestyle

factors reduce the need for nursing home care-. What we do for ourselves is often more

imortant than what medicine can offer us. et making healthy changes is easier said than

done. Even when were strongly motivated, adoting a new, healthy habit / or breaking an

old, bad one / can be terribly difficult.

What helps?

0onsiderable research has been aimed at identifying factors that contribute to successful

lifestyle change as well as more effective tools for clinicians / esecially in the context of abrief office visit / to counsel their atients on adoting healthier habits. 1ne roblem may

be that were motivated too often by a sense of guilt, fear, or regret. Exerts who study

behavior change agree that long2lasting change is most likely when its self2motivated and

rooted in ositive thinking. 3n 1ctober $445, the Economic and 6ocial (esearch 0ouncil, a

7ritish research grou, released findings on !$& different studies of behavior change

strategies. 8he survey confirmed that the least effective strategies were those that aroused

fear or regret in the erson attemting to make a change.

6tudies have also shown that goals are easier to reach if theyre secific )*3ll walk $4

minutes a day, rather than *3ll get more exercise- and not too numerous )having too many

goals limits the amount of attention and willower you can devote to reaching any single

goal-. 9nother recurring theme is that its not enough to have a goal: ou also need ractical

ways to reach it. or examle, if your goal is to stick to a low2calorie diet, have a lan in

lace for uelling hunger angs )for examle, kee a bottle of water or cu of tea nearby, or

chew sugarless gum-.


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(esearch has also roduced models that hel account for success and failure, and exlain

why making healthy changes can take so long. 8he exert conclusion is that any effort you

make in the right direction is worthwhile, even if you encounter setbacks or find yourself

backsliding from time to time.

Lifestyle factors reduce the need for nursing home care

A study published in the May 8, 2006, issue of theArchives of Internal Medicinefollowed

nearly 6,500 middle-aged and elderly people for 20 years. Among the more than 3,500

partiipants ages !5"6! when the study began, those who were obese, were physially

inati#e, smo$ed, or had diabetes or unontrolled high blood pressure at the start of thestudy were muh more li$ely to be admitted to a nursing home.

Middle-age smo$ing inreased the hane of a nursing home admission by 56%, physial

inati#ity by !0%, and unontrolled high blood pressure by 35%. &iabetes more than

tripled the ris$. 'Middle-age obesity was also assoiated with higher ris$, but the

assoiation wasn(t statistially signifiant ) that is, the numbers ould ha#e resulted fromhane.* All of these onditions, of ourse, an be modified with lifestyle hanges.

Change is a process, not an event

8here are several models of behavior change, but the one most widely alied and tested in

health settings is the transtheoretical model )88M-. irst develoed in the !&"4s by

alcoholism researchers


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genetic; its >ust the way we are- or because you have failed in the ast and feel

demorali?ed )@3ve tried so many times to lose weight; its hoeless-. ou tend to avoid

reading, talking, or thinking about the unhealthy behavior, but your awareness and interest

may be sarked by outside influences, such as ublic information camaigns, stories in the

media, emotional exeriences, illness, or a clinicians or family members concern. 8o moveast recontemlation, you must sense that the unhealthy behavior is at odds with

imortant ersonal goals, for examle, being healthy enough to travel or to en>oy your

children or grandchildren.

Contemplation.3n some rograms and studies that emloy 88M, eole who say

theyre considering a change in the next six months are classified as contemlators. 3n

reality, eole often vacillate for much longer than that. 3n this stage, you are aware that the

behavior is a roblem and are considering doing something about it, but you still arent

committed to taking any action. 9mbivalence may lead you to weigh and re2weigh the

benefits and costs: *3f 3 sto smoking, 3ll lose that hacking cough, but 3 know 3ll gain

weight, or *3 know smoking could give me lung cancer, but it hels me relax; if 3 uit, stress

could kill me, tooA

Bealth educators use several techniues to hel eole unstick themselves and move on to

the next stage. 1ne is to make a list of the ros and cons of making a change, then

examine the barriers / the *cons / and think about ways to overcome them. or

examle, many women find it difficult to get regular exercise because its inconvenient or

they have too little time. 3f finding a C42minute block of time to exercise is a barrier, how

about two searate !#2minute sessionsD 0ould someone else cook dinner so you can take

a walk after workD 3f you feel too self2conscious to take an exercise class, how about buying

an exercise tae to use at homeD

Preparation.9t this stage, you know you must change, believe you can, and are

making lans to change soon / say, next month. ouve >oined a health club, urchased a

suly of nicotine atches, or added a calorie2counting book to the kitchen shelf. 9t this

stage, its imortant to anticiate otential obstacles. 3f youre rearing to cut down on

alcohol, for examle, be aware of situations that rovoke unhealthy drinking, and lan ways

around them. 3f work stress triggers end2of2day drinking, lan to take a walk when you gethome. 3f rearing dinner makes you want a drink, lan to have selt?er water instead of

wine. 3f social situations are a roblem, make a list of alternatives, such as going to the

movies instead of having drinks or dinner with friends.

9t the same time, create a realistic action lan with achievable goals. 3f youve been

sedentary and want to exercise more, start by making it your goal to avoid using the


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elevator for two2, three2, or four2story tris. 1r lan to walk !# minutes every day. 8his can

hel you work your way u to more ambitious goals.

Action.9t this stage, youve changed / stoed smoking, for examle )according

to 'rochaska, cutting down would not be *action but rearation for action- / and youve

begun to exerience the challenges of life without the old behavior. oull need to ractice

the alternatives you identified during the rearation stage. or examle, if stress temts

you to eat, you can use healthy coing strategies such as yoga, dee breathing, or

exercise. 9t this stage, its imortant to be clear about your motivation; if necessary, write

down your reasons for making the change and read them every day. Engage in *self2talk to

bolster your resolve. et suort. +et others know youre making a change.

Maintenance.1nce youve racticed the new behavior change for at least six

months, youre in the maintenance stage. Fow youre working to revent relase and

integrate the change into your life. 8hat may reuire other changes, esecially avoiding

situations or triggers associated with the old habit. 3t can be tough, esecially if it means

steering clear of certain activities or friends while you work to fully assimilate your new,

healthier habit.

stages in behavior change

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