Behavior Mod fails 97% of the time. I’ve designed a model to change habits without trying to change a behavior by trying to change a behavior.
Currently, doctors tell us we need to eat differently and exercise to create and maintain health. We read articles that tell us to lose weight and walk more. We all want to live longer and be healthier. But we’re stuck in our old habits and have difficulty making habit changes when our old ones aren’t working.
There are two issues here:
- How can we make permanent changes?
- How can we accomplish the change our docs or healthcare providers request, especially when we find ourselves resisting?
I’m going to begin with a case study of what happens when docs (or anyone) work from a Behavior Modification concept and why it doesn’t help us change. Then I’ll explain what behaviors are, how brains change habits, and the How of Change™ model I developed to facilitate systemic brain change for permanent habit formation.
My neighbor Maria came to my house crying one day. Her doctor had told her she was borderline diabetic and needed to eat differently. He gave her a printed list of foods to eat and foods to avoid and spent time persuading her to stop eating whatever she was eating because his list of foods was essential to her health.
She told me she’d been trying for months, lost some weight, but finally gave up and went back to her normal eating habits and gained back the weight. But she was fearful of dying from diabetes like her mother did. She’d tried to listen to her doc, she didn’t want to be sick, but she just couldn’t do what the doc requested. She asked if I could help, and I told her I’d lead her through to finding her own answers. Here was our exchange:
SDM: I know your doc wants you to change your eating habits for health reasons. I’ll ask you some questions that might lead you to ways to help you figure out how to eat healthier. I’ll start at the very beginning. Who are you?
Maria: I’m a wife, mother and grandmother.
SDM: As a wife, mother and grandmother, what are your beliefs and values around food?
Maria: I believe I’m responsible for feeding my family in a way that makes them happy.
SDM: What is it you’re doing now that makes them happy?
Maria: My family all live nearby. Every morning I get up early and make 150 tortillas. When they go to work and school in the morning, they stop by and I hand them out to each for their breakfast and lunch. I always make enough for me and Joe to have for breakfast. The doctor says they’re bad for me with all the lard in them and that I must stop eating them. I’ve tried to stop, but they’re a big part of my diet. When the doctor said to stop eating them, it felt like he doesn’t want me to love my family.
SDM: So I hear that tortillas are a way you keep your family happy. Could there be any other way you could keep your family happy by feeding them without putting your own health at risk? Do you have any other options?
Maria: Hmmmm… I could make them enchiladas. They don’t have lard, and my family loves them. And my daughter Sonia makes tortillas almost as good as mine.
Then we figured out a terrific plan. Maria invited her entire family for dinner and presented Sonia with her tortilla pan outfitted with a big red bow. She told her family she couldn’t make tortillas any more due to health reasons, but Sonia, the new “Tortilla Tia,” would make them tortillas every day just like Maria did, and she’d make them enchiladas once a week instead. Maria then lost 15 pounds, kept the weight off, and is no longer pre-diabetic.
BEHAVIOR MODIFICATION DOESN’T WORK
What happened sadly happens far too often. A healthcare provider, a doctor in this case, believes new/different behavior is necessary and proceeds to tell a patient what to do. When the patient doesn’t do it, the patient gets blamed for being resistant. But it was the doctor’s fault.
By giving the patient a ‘to-do’ as a prescription, he assumed she would merely comply. By not accounting for her lifestyle choices and values, without trusting she could come up with a perfectly acceptable solution that matched her values and achieved the same results, he unwittingly instructed her to act outside her comfort zone and beyond her neural circuitry. Worse, he had no tools to help her manage her health in her own way.
I recently had a similar experience.
My mother – long deceased – died from a blocked artery. I’ve spent my life as a lifelong health and fitness advocate, but when I ended up in the hospital with a 99% arterial blockage, my doc said to thank my mom.
After my procedures, the nurse came in with a statin for me to take. I refused. Seemingly immediately afterwards, the doctor came in lecturing me on the importance of statins, why I had to comply with his wishes because he knew more than me, who was I to make that decision etc. He scolded me as if I were a small child. When I finally was able to get a word in, I had this conversation:
SD: Just curious. Have you tested my cholesterol?
Doc: No. But usually when patients end up here they need statins. (I have only genetic risk factors.)
SD: Did you know my cholesterol is quite low?
SD: Did you know that I take Red Yeast Rice twice a day?
Doc. No. But that’s a statin! It’s just a natural one. I’d prescribe that for all my patients but it goes against protocol.
SD: So you assumed I had a cholesterol problem AND I was not taking a statin AND you never checked. And you’re scolding me because I didn’t heed your orders.
Doc: You’re right. I’m just used to people with diabetes or are obese.
Too often, medical professionals offer directives based on protocol and not necessarily addressing a patient’s specific and personal needs and values. Not only is this potentially dangerous but makes it pretty difficult to obtain compliance. Indeed, they’re they’re pushing behavior change without enabling the necessary precursor – the belief change and are destined to get resistance.
BEHAVIOR CHANGE FOLLOWS BELIEF CHANGE
Behaviors don’t show up out of nowhere, but are representations – the demonstration – of our mental models, values, history, experience, and personal norms. In other words, we act out who we are.
Thinking a behavior change is needed, being told a behavior change is needed, will not cause a permanent behavior change.
A behavior is an outputThe change must first occur at the beginning, in the input, in the values. “I’m going on a diet” will provide one behavior; “I’m a healthy person seeking to find the best nutrition that will enable my body to find its best weight and maintain it permanently,” will produce a wholly different set of behaviors.
To change a behavior, doctors must help patients figure out how to use their own norms rather than push their traditional protocols and require compliance. For me it’s about respecting patients’ ability to act using their own motivations.
So 1. Why don’t patients just follow the doc’s orders? Are they really resisting when they don’t? 2. How can healthcare providers help patients figure out how to make better choices and put plans into action? 3. How can people change their behaviors and maintain the motivation necessary to create a healthy habit?
I’ll take these one at a time.
- Why aren’t patients compliant? It’s not resistance, it’s a brain thing. Over the course of our lives we develop habitual neural pathways that get triggered by a word, a thought. Even when we try to go on a ‘different’ diet, just the ‘diet’ concept triggers us down pathways that end up with the same results we had before. Patients aren’t resisting, they’re just not provided a model to create a new superhighway that leads to new behaviors.
- Why don’t healthcare providers help make new choices? The conventional model is to just tell patients, give them data that explains why, or just assume patients are supposed to do what they’re told. Obviously wrong. It’s possible to train all healthcare professionals, but it’s just as easy to train patients to achieve new neural circuitry.
- How can we change and maintain motivation? Again, it’s a brain thing. I’ve unpacked the steps necessary for systemic brain change. All people can learn this and change behaviors/create new habits at will. it’s not been possible before.
Let me explain my process of changing habits/behaviors.
A behavior is a belief in action – the output of an input, and all input goes through our values-based filters to create the brain signals that end up as behaviors.
Everything we do starts off as an idea, a thought, a need that ends up with us acting in a specific way. Over time, this trajectory of ‘idea/input -> filter/signal -> choice of similar circuits to translate signals -> output, becomes a superhighway. So when we tell ourselves it’s time to go on a diet, our brain knows exactly where to go, what to do, to do what we’ve always done…..and end up where we’ve always ended up regardless of how hard we try to ‘do it differently’ this time.
In order to end up with something different, we must input something different.
HOW DO WE CHANGE BEHAVIORS?
Unfortunately, the fields of science, medicine get us to try to change behaviors by merely trying to change behaviors. To me this makes little sense. If you purchase a forward-moving robot it won’t move backwards because you want it to, or because you explain how much more effective it will be if it can. You must send it back to the factory and reprogram it.
Same with our brains. We must reprogram them. And it’s not as simple as telling ourselves to do anything different because we will only get directed to our superhighways if we can even get past the resistance from attempting to alter the status quo.
How, then, do we change? By creating a new superhighway, new neural pathways, we can create new behaviors.
I broke down the steps involved with change. Here’s a one hour video explaining.
To learn more about the HOW of Change™ model I developed for habit change, go to: https://sharondrewmorgen.com/the-how-of-change/