Dr. Trevor Smith

Guest Post by Dr. Trevor Smith, Executive Director of the Intermountain Healthcare Office of Health Promotion & Wellness (RMUoHP Health Promotion & Wellness PhD Alumnus)

Forget crash diets, trendy fitness solutions that promise magical outcomes, and overall unrealistic expectations often associated with many new year’s resolutions. Rather than looking to completely change your life in the first few weeks in January focus on long-term behavior change that supports more than the desire to fit into a dress at your daughter wedding but focuses on how you want to feel, act, and experience the world in the coming decades. Remember the moments in your life that were the most meaningful were often difficult, required a struggle, and created a shift in your overarching behaviors to remain consistent. As you plan what 2019 looks like for you, consider a few of the tried and true evidence-based solutions that can support you on your journey to get well, stay well, and live well not just in 2019 but for the rest of your life!

1. Focus on one behavior change at a time.

Rome was not built in a day… It started with one pillar, one person, one dream. It’s often difficult to make long-term lifestyle changes that require a shift in your fundamental behaviors, much less multiple behavior changes at a time. Realizing what behaviors, we need to change is often not the primary problem, we all know we could eat better, we could walk more, we could call our sister in Minnesota that is painful to talk with, however, changing behavior is a multistep process that requires contemplation, deliberation, action, and maintenance. When we try to change too many health behaviors at once we often find ourselves unsuccessful, discouraged, and even angry at our inability to modify our behaviors. In these situations, it is important to give yourself credit for what you are doing right. When was the last time you looked in the mirror and congratulated yourself for brushing all your teeth as compared to just one, when was the last time you patted yourself on the back for sleeping 7-8 hours, when was the last time you high fived your coworker for taking the stairs. Truth be told we are often doing better than we realize. One of my favorite quotes I use when considering behavior change is related to positive self-talk “If I talked to my friends how I talk to myself would I have any friends?”.

Rather than viewing behavior change as an all or nothing game start to think of it as an experimental process. For example, rather than saying I am going to go to the gym every day for two hours until I die, consider setting up a tiny experiment that allows you to explore and be successful while evaluating what you learned. The goal could be restated as I am going to get up at 7:00 am three days a week and work out for 30 minutes. After eight weeks I will reassess and see what I learned for the experiment. Trying to change too many of your behaviors at once, especially going “cold turkey” on bad health habits, can lead to fatigue and “cheating”.  Alternatively, giving into one temptation (eating that breakfast doughnut you said you weren’t going to eat) may lead you to think, “To heck with it, I’m just not going to worry about my sugar intake today.” By the end of the day, you may consume several treats. You’ll end up feeling stressed about failing at multiple of your behavior change goals, leading you to further “cheat” to make yourself feel better.

Focus on one small or attainable change at a time. Once you’ve made the change into a habit (like going to bed by a certain time every night), you can focus on your next goal.

2. Pick a behavior you have full control over.

In the Theory of Planned Behavior, predictors of health behavior, or at least of intention toward a behavior, include our attitudes toward the behavior, social norms (what people around us think about the behavior), and perceived behavioral control (what control we have or think we have over the behavior). When setting a new health goal, pick a behavior that you feel you have full control over.

Theory of Planned Behavior: (Ajzen, 1991)

Social Cognitive Theory: (Bandura, 2001)

For health reasons, you may want or need less stress in your life, but the occurrence of stressful events may not be under your control. You may not have control over a work environment that demands you spend multiple hours at a computer. You may feel like you don’t have control over whether your family members bring unhealthy foods into the house, or what a family member cooks you for breakfast when you didn’t ask, and social norms may compel you to not to “get upset” over these things.

But you can control how you react to stress, or when and how you eat the breakfast your family member prepared for you, for example. You could decide to begin a 10-minute mindfulness or meditation practice every morning when you wake up or before you go to bed, to blunt the negative impacts of stress on your body. You could decide to save the breakfast your family member cooked for you and eat it for lunch instead, giving yourself a potentially metabolically beneficial prolonged overnight fast, or decide to exercise early every morning in anticipation of having to sit in work meetings until lunch. You can also ask for friends, family members and work colleagues to honor your healthy behavior changes, by not enabling your problem behaviors or looking at you funny when you ask a coworker to walk with you for a one-on-one meeting.

3. Identify your motivation to adopt a healthy behavior.

Both Social Cognitive Theory and the Health Belief Model of behavior change incorporate factors related to motivation. In Social Cognitive Theory, a mix of personal and environmental factors influence our behavior, including our belief that we can change, the outcomes we anticipate if we do engage in the behavior, the knowledge, and skills we have or need to have to engage in the behavior, and the rewards or punishments we run into along the way. In the Health Belief Model, our personal beliefs directly

Health Belief Model: (Becker, 1974)

Health Belief Model

Influence our health behaviors, including perceived benefits (“Exercising will reduce my risk of heart problems.”) and perceived barriers. Perceived benefits can be externally focused (“I’ll look better. My friends will approve.”) or internally focused (“I’ll feel better.”). While our personalities may dictate which perceived benefits are most motivating to us, internally focused benefits and goals are typically more powerful and longer-lived.

“ I want to be around to enjoy my kids and learn new things with them.”

“ I want to be fit enough to enjoy my retirement and travel the world.”

A strong motivation for health behavior change is best when closely related to one or more of our core values. Before starting a new nutrition plan, exercise program,  or sleep schedule, ask yourself why you want to engage in this particular health behavior, what you expect to gain, and what stands in your way (Glanz, Rimer, & Lewis, 2002). If you can’t find a strong internally focused motivation for doing it, or if you find that you can think of more things that stand in your way than things you expect to gain, it may be best to focus on a different health behavior goal for now.

4. Work toward small and attainable goals.

Self- Efficacy can influence motivation levels, mood, and attitudes regarding behaviors that promote health, despite disconfirming experiences (Davis, Campbell, Hildon, Hobbs, & Michie, 2015).  Self-Efficacy explains our health behaviors in terms of what we think we can do. We don’t try what we think we can’t do, which includes overly ambitious goals that may not only feel unattainable but also cause us to feel anxiety or even fear when we think about them (Marcus & Forsyth, 2003).

Self-Efficacy involves three conceptual domains:

  • Having tactic task knowledge and skills
  • Having an explicit sense of confidence in one’s ability to mobilize the motivation and cognitive resources required to perform a task or skill
  • Having confidence in one’s ability to successfully execute a specific task or skill in a given context.

You may know that you should sleep 7-8 hours per night to be at your best, having a predisposition to diabetes that demands a low-sugar diet, need to lose 100 pounds, or want to hike the great wall of China before you turn 50. But to someone who regularly must stay up late after the kids go to bed to get work done, someone with a sweet tooth, someone who can’t easily exercise or someone who has never hiked a trial, these goals might at best seem to be aspirational at best, furthermore, they might cause stress and anxiety.

But what if you instead set a challenge of going to bed five minutes earlier every night? Or decided to cut out just one of your sugary snacks per day, or put one less teaspoon of sugar in your coffee? These goals are much less daunting, and in achieving them, you will build up the confidence and positive past experiences needed to tackle larger goals and behavior changes. This is self-efficacy at its best.

5. Celebrate success.

Find JOY in the journey…don’t forget to stop and celebrate your small successes! Plan to reward yourself as you progressively hit the incremental goals you’ve set for yourself to attain healthy behavior change. Share your successes with others, too — call up a friend and share your good news.

Just try to avoid rewarding yourself by indulging in any “problem behavior” you are trying to change. For example, you may not want to reward yourself with cookies if you are trying to cut out sugar, or a late night of movies if you are trying to go to sleep earlier every night and making progress. Try rewarding yourself with something you enjoy that maintains the progress you’ve made so far. If you’ve successfully reached your goal this month of replacing a fourth of the processed foods you normally eat with fresh vegetables, reward yourself with that new outfit you’ve been eying, a movie night or a delicious, healthy meal out with friends. Reward yourself while staying on the path to healthier living.

Bibliography

Davis, R., Campbell, R., Hildon, Z., Hobbs, L., & Michie, S. (2015). Theories of behaviour and behaviour change across the social and behavioural sciences: a scoping review. Health Psuchology Review, 323-344. doi:10.1080/17437199.2014.941722

Glanz, K., Rimer, B. K., & Lewis, F. M. (2002). Health Behavior and Health Education: Theory, Research and Practice, 3rd edn. San Francisco, CA: Jossey-Bass.

Marcus, B. H., & Forsyth, L. H. (2003). Motivating people to be physically active. Champaign, IL: Human Kinetics.

The Wellness Wire is a series designed to provide evidence-based strategies to improve the wellness of our readers.