by Jim Broadbear, PhD, CWP, NBC-HWC and Barbara Broadbear, Ph.D., MPH
The Big 3 of Behavior Change
Here’s a challenging question: Based on all you have learned, what are the three most effective strategies for health behavior change? The volume of information on this topic is staggering but if you were to distill what you know and have experienced to the essentials, what would those be? Your response is a Pareto Principle style thought experiment with significant implications for wellness practice. The essential few strategies, instead of the trivial many, would be deeply woven into wellness programs and services to maximize impact. Unaligned approaches would be reduced or eliminated. It is a very debatable question but in the spirit of accepting the challenge, we offer our response. The most effective strategies are to be self-directing, to focus on the positives, and to be ruthless with the environment.
To be self-directing
Until a person genuinely chooses to change, success will be elusive. The type of choosing we mean is not a one-time decision but rather a continual process of directing oneself toward the formation of a desired identity. Broader and more foundational than goal setting, self-directing is both developmentally necessary and continuous throughout life (Siegel, 2017). As we volitionally form a desired healthful identity, we link with and differentiate from elements of our past, present, and future. In other words, certain experiences of our past and imaginations of our future are more central to our identity (linking) than others (differentiating).
The Self-Determination Theory (SDT) is instructive. Originators Richard Ryan and Ed Deci described that SDT examines “the inherent human capacities for psychological growth, engagement, and wellness” (2017, p. 3). These capacities arise from satisfaction of the basic psychological needs of autonomy, competence, and relatedness. The word ‘basic’ here means essential, rather than simple. They are essential nutriments of wellness, like soil, water, and sunlight are to plants.
The implications for wellness practice are immense. Wellness services would be designed and delivered so people become more autonomous, competent, and connected (Seifert, & Hart, 2017). Given the centrality of autonomy to the formation of a desired identity, providing people repeated opportunities to choose and affirm priorities for their wellness is critical. We can do this by helping people explore and articulate personally meaningful wellness visions and goals (Rojas Saldana, 2021).
Increased competence and genuine growth in abilities happens through deliberate practice. Ericsson and Pool (2016) described that the most effective practice to develop competence and mastery includes evidence-based training techniques, a highly effective teacher/mentor, practice at boundaries of one’s abilities, target goals, mentally focused practice, individualized and helpful feedback, and a clear mental representation of desired performance. Wellness services with these practices in place optimize skill development and a growth mindset. Clients experience the nexus of competence and confidence where they are free to try, learn, and grow.
A focus on relatedness helps connect people with others and to a purpose beyond self, allowing for kinship. Deep yet simple, kinship is about simply being with others (Boyle, 2010). In kinship, we hope to free people from the pernicious effects of comparison, including the unhelpful expectations we absorb from others and those we place upon ourselves. Comparison is particularly detrimental to the balance and wholeness of wellness. When we focus too much on the gap between where we are and where we could be, doubt and shame creep in. We risk doing things for the wrong reasons, from a place of inadequacy. Instead, a balancing act of “I am enough” yet “I am becoming” is needed.
To focus on the positive
Behavior change is hard. This is especially true when unhealthy behaviors are entrenched and the environment discourages healthy alternatives (O’Donnell, 2017). Even in supportive environments, sustaining the difficult day-in, day-out work requires substantial effort and focus while the disruption of behavior change contributes to high rates of failed attempts. To counterbalance this, people need good reasons to do the hard work, and not just a few. Anticipating potential benefits and recognizing actual gains are both helpful. Early in the behavior change process, brainstorming or other idea generation techniques help clients anticipate benefits. This is exciting and engaging because it is about imagining positive outcomes rather than finding solutions to a problem. Providing prompts across the dimensions of wellness generates dozens of potential benefits. As the journey continues, journaling or other tracking strategies help clients become more conscious of the benefits they are achieving. Our work with people suggests that there is an overlap between anticipated and realized benefits although it is common for experience to be a wise teacher. People often do not anticipate benefits they realize through experience. Some version of, “I didn’t see that coming” is common.
The more specific the perceived benefit, the more salient they become. For example, instead of “If I get better sleep, I will be more patient” a positive could be “If I get better sleep, I will be more patient when helping my daughter with her homework.” A general benefit can be personalized with a simple follow up question such as, “When would (patience) be especially beneficial?”
Multiple theories support a focus on the positives. From SDT, positive perceptions of the behavior and positive feedback combine to enhance autonomy and competence (Ryan & Deci, 2017). In the Transtheoretical Model, the concept of decisional balance emphasizes that the pros for changing need to significantly outweigh the cons as a person moves from contemplation to action (Prochaska, Redding & Evers, 2015). Social Cognitive Theory demonstrates that when an outcome of behavior change is desirable (expectancies) and we identify with positive role models (observational learning) success is more likely (Kelder, Hoelscher, & Perry, 2015). In the Health Belief Model, adoption of healthy behavior is more common when people perceived multiple benefits from the behavior (Skinner, Tiro, & Champion, 2015).
In addition to a theoretical foundation, a focus on the positives is a brain-based approach to behavior change. The tendency to perceive negatives has evolutionary and socio-cultural roots. Evolutionary neurobiology shows that threat detection is a fundamental part of the default brain mode (Barrett, 2017). Focusing on what could go wrong in situations comes naturally to us. This is exacerbated in contemporary culture where exposure to negative information is voluminous and pervasive. Threats appear more eminent which is ironic because risk, as measured by all-cause mortality (https://www.cdc.gov/nchs/data-visualization/mortality-trends/index.htm), is actually profoundly lower than at any point in human history, despite the uptick in the winter of 2020-21.
A focus on the positives cultivates generalized and momentary advantages to behavior change. In a general sense, a more positive affect emerges about behavior change efforts and our identity. In the moments before, during, and after performing the desired behavior, attention on the positives alters the experience. Iain McGilchrist described that, “Attention changes what kind of (original emphasis) a thing comes into being for us: in that way it changes the world” (2009, p. 28). This is profoundly important. When we focus on the positives, we elevate behavior change to a deeply personal place of prominence.
To be ruthless with environment
…because the environment is ruthless with us. Habit formation is a perpetual human concern and gained wide attention in recent years with popular books like The Power of Habit and Atomic Habits. The research upon which they are based affirms an essential truth about habits. Environment matters a lot, and it is often hostile to healthy behavior and makes unhealthy habits easy to form.
When behavior change is a person’s focus, the environment encompasses a dynamic interplay of mental activities (e.g., being self-directing and positive) and physical spaces. It provides possibilities or what Dan Seigel (2017) described as the plane of possibilities from which consciousness arises. Behavior happens within familiar planes and results in a self-limiting scope of awareness. New, novel healthy behaviors must fight against the limitations of familiar time and space.
Once the intent to change behavior has arisen within a person, being ruthless with the environment means changing it to align with the intention. We can engage clients with environmental evaluations and experiments. To evaluate, a simple two column list of things to add and subtract from the environment works well. Consider material objects, technology, and relationships. While clients have limited but significant control over small parts of their environment, the goal is to optimize time and space for performing healthy behavior.
Given the difficulty of healthy behavior change, simple and more radical experiments with physical spaces are needed. Simple examples are abundant. Remove unhealthy foods from the fridge or panty. Set workout clothes out the night before. Place blackout curtains on bedroom windows to enhance sleep. Automate retirement savings.
Ruthlessness goes deeper. Environmental experiments can be more radical. Here are examples we have seen people try. Store the recliner in the basement and put the exercise bike in its place. Replace the picture on the wall with a whiteboard used to track behavior. Take televisions out of shared family spaces. Remove all social media apps from phones.
A special mention about phones is warranted because they are so pervasive. It is a complex issue, but mobile phone apps designed to assist in behavior change may be of limited utility, functioning best in combination with personal wellness coaching (McKay, Wright, Shill, Stephens, & Uccellini, 2019). Being ruthless with the phone means setting it up to support and enable behavior change. Make it a tool that reminds, affirms, tracks, and rewards behavior. It can still perform other essential functions but delete distracting features. Be ruthless with phones.
The simple rule of ruthlessness is, if it serves the healthy behavior, make it visible and easily available in the environment. More radical experiments are not permanent but, if helpful, can be left in place until the healthy behavior becomes a genuine habit.
Amazing progress is possible when we pursue behavior change using the Big 3. Parker Palmer (1998) explained how our world is full of divisive structures, “but blaming them for our brokenness perpetuates the myth that the outer world is more powerful than the inner” (p. 36). Indeed. With a focus on the essentials, change happens and shifts a person’s identity. But, what do you say? Based on all you have learned, what are the three most effective strategies for health behavior change?
About the Author: Jim Broadbear is a Professor of Health Promotion & Education at Illinois State University. He is a Certified Wellness Practitioner and a National Board Certified-Health & Wellness Coach. Barb Broadbear is an Associate Professor in the Department of Exercise Science & Sport at Millikin University.
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