We’re always supposed to be ready to change aren’t we? What’s so magical about January 1 in terms of starting a new exercise routine, anyway (Truth bomb: It’s not - 80% of New Year’s resolutions have been forgotten by February)? Our healthcare system makes the poor assumption that when your doctor tells you, for instance, that you need to eat better and move more, that, starting tomorrow, you are going to implement her recommendations. Never mind that you have already known this for years and haven’t done it on your own yet, but now? Now’s supposed to be the time. Rely on your willpower, they say. You can do it! And six months later at your follow up visit, you dread even going because feel guilty for not implementing said recommendations yet.
What all of these well-meaning people, and maybe you, don’t realize is that we’re not always ready to make big changes yet. I know that sounds like a no-brainer, but here’s the surprising part: there is actually a process that we must go through before we’re ready to take action on a change. And the process doesn’t involve action on a behavior until way down the line of readiness. One must progress through each stage of change for the change to actually stick.
Now, I’m not giving you a copout to say, “Well, Doc, I read that there’s this process for change and I’m just not ready for action yet, so I’m going to wait until that time comes.” No, but what I will do is help you see two things: 1) it is OK to be in whatever stage of change you’re in currently and 2) there are things that you can do to move from one stage of change to the next. Well, ok, maybe three things, 3) it’s completely normal to cycle back to a stage from time to time, but more on that later.
So, I’m not giving you permission to rest forever on your contemplation around changing your diet, for instance. I’m empowering you to be aware of your contemplation and start taking steps to help move you forward slowly, but surely, eventually progressing into the next stage of change toward greater readiness, and then eventually action. Sound reasonable? Great, keep on reading…
So what are these stages of change? I’m glad you asked. James Prochaska developed the Transtheoretical Model of behavior change using decades of research evaluating and measuring behavior change for various health behaviors. This is the framework we can use to effect self-change in areas of our health that are important to us. And, it helps us understand how and when new behaviors might be adopted and sustained. The process goes like this: we go from not thinking about change, to consciously thinking about a change, on to planning for the change, taking action on the change and then sustaining the change. Prematurely, advancing to a later stage will not translate into sustainable change, so knowing this model offers insight and understanding into why we may have struggled in the past or quit altogether. It also offers hope that we can be successful working through each step.
It’s important to recognize that you may be in various stages of change for different behaviors. For instance, your eating habits may be on point and in the maintenance phase, but perhaps your physical activity is still in the contemplation phase. Interestingly, success with achieving maintenance in one area increases the likelihood that you can also achieve progress in another area. Always start building a new habit based on the behavior that is farthest along on the readiness spectrum. Success breeds success.
So with that, let’s dive into each of the stages of change:
Pre-Contemplation (“I won’t” or “I can’t”)
In pre-contemplation, you’re not yet thinking of adopting a healthy behavior. This occurs for one of two reasons:
“I won’t”: You’re not interested in changing because you do not believe you have a problem.
“I can’t”: You would like to change, but you don’t believe it’s possible for you. Perhaps it’s too complicated. Or, perhaps you’ve tried and tried and not seen success.
So, if you find yourself in pre-contemplation, what should you do? Here are a few thoughts to explore. You can journal about each of these, or simply just think about how might respond to each of these:
Accept that you feel like “you won’t” or “you can’t.” Don’t fight against it. It’s OK and it’s normal. Show some compassion toward yourself. I promise you are not the only person who is at this stage of change for at least one health behavior. Know that you have full control of your life- change or not.
If “you won’t,” where is this feeling coming from? Is it perhaps from other people nagging you about what you “should” do? Do you want to make the change for yourself and not be changed because of the opinions of others? If so, good. This change is only for you, not anyone else! You’re in control of your future. You get to make the call.
If “you can’t,” think about other areas of your life where you may have felt like you couldn’t do something in the past, but you did it despite that feeling. Or perhaps you’ve tried time and time again, but each time, you feel as though you fail. How did that process work for you? What helped you initiate change at that time? What strengths did you use during that time? What worked well then? What may not have worked so well?
Regardless of whether you feel like “you won’t” or “you can’t,” what barriers exist for yourself? Are they real or perceived? Do they feel large or unable to be overcome? Is there fear involved? Can you reframe any of these thoughts or feelings to be more positive or self-accepting? At this point, just notice and become aware of the barriers. There’s no need to strategize about working through them, removing them or fixing them.
What are your positive sources of motivation for you in other areas of your life? What is going well for you? How did it get to be that way?
Explore what’s most important to you in your life. Why do you wake up every day? What’s your greatest priority in this life?
Identify your greatest source of strength. Do you find strength in solitude, in company with others, in prayer or meditation, or perhaps another way? How do you rely on this source of strength on a daily basis?
Are there other health behaviors that you feel more ready to change right now? If so, what stage of change are you in with it? Perhaps you’re not considering quitting smoking anytime soon, but you are interested in changing your diet. Focus first on the change that you are furthest along with on the readiness spectrum. This experience can drive your confidence to eventually tackle the ones where you’re earlier on the change spectrum.
Contemplation (“I may”)
When you’re in the contemplation stage, you’re thinking “I may” change. You’re thinking about changing either unhealthy behaviors or perhaps, adopting new healthy behaviors. You still have a fair amount of ambivalence though. You know you need to change and you want to change, but you’re just not sure how or even if it’s possible for you. You’re on the fence, so to speak. But you’re hoping to take some form of action in the next six months.
If you’re in contemplation, give some thought to or even journal about the following:
Recognize that you will have ambivalence about this particular change. It may feel like it will be incredibly difficult, even impossible to succeed with it. And that is completely normal at this point in the change process. You’re allowed to see both sides of the change. In fact, seeing both sides helps you strengthen your motivation to change.
How long have you been thinking about the change? Sometimes, people find themselves stuck in contemplation for years. If this sounds like you, know that you may just not know how to change yet. And that’s the point of this article. I want to help free you from chronic contemplation and show you that progress is possible.
Explore the pros and cons of change. What are the reasons to change? What are the reasons to stay the same? Are the pros and the cons equally balanced, or not? In order to move forward, eventually the pros of making the change will have to outweigh the reasons for staying the same. But know that this takes time!
In order to continue considering reasons for change, can you think of your very best experience with change? Can you imagine yourself after you’ve made the change? What would that look like or feel like? What are reasons that would compel you to behave in the way you desire in the future? What are values you hold deeply and how might this change align with those values? What strengths do you have that you can leverage with this change? What are your hopes for the future and how would this change factor into those hopes? Why is this important to you? The point here is to connect the dots between the exciting possibilities that exist for you and how this change benefits that future.
Create a strong vision for your future based on what you do want for yourself, as opposed to what you don’t want. Revisit your positive vision for health regularly and watch it grow and change over time.
Learn about or connect with people who have made the same change you hope to make. What is their story and what can you learn from it? What worked for them may not work for you, but what could work after hearing from several people who have made the change? What are the gold nuggets you can take away from their experience to contribute to your own? Why reinvent the wheel? Learn from their mistakes too. What would they have done differently if they could do it all over again?
What are the scientific facts about the health benefits of the change you’re trying to make? I assure you, there’s plenty of research out there on any number of lifestyle changes whether related to quitting smoking, eating, movement, sleep, stress or most other health-related behaviors. Good sources of reliable, evidence-based health information are the CDC, Healthy People 2020, Mayo Clinic and Harvard Health.
Goals at this stage can include reading, learning, listening, thinking, talking, discovering and deciding about your intended change.
A stepwise approach can be an incredibly useful in establishing micro-goals in this stage too. For instance, if your goal is to start exercising, but you’re still in contemplation about meeting the exercise recommendations of 150 minutes per week, you may find that building in a 5-minute walk each day or even a few minutes of stretching is totally do-able and builds your confidence to scale up from there later. You may not be ready to tackle the whole goal as envisioned right away, but you can start small. Small successes, with consistency, lead to large victories over time!
Preparation (“I will”)
In the preparation stage, you’re thinking “I will” make this change. You’re committed and are within 1 month from initiating the intended behavior. At this point, you have largely worked through any remaining ambivalence and you see the benefits of making the change very clearly in relation to the “future you.” You’ve identified your sources of strength and your primary motivators. You have grown and strengthened your motivation from the “thinking” phase of contemplation into creating your own, unique plan.
In the preparation phase:
Experiment with some possible solutions. Try it on for size and see how it works for you. If it works, great! Keep it. But if not, throw it away quickly and try another approach. There are no failures during this process, only learning. You’re learning what may work and you’re uncovering what’s not going to be a good fit for you.
Once you’ve discovered some potential solutions, develop your plan. It’s incredibly helpful to structure your plan as SMART goals during the preparation phase. SMART stands for Specific, Measurable, Attainable, Realistic and Time-Bound. What specifically will you do and how often, how will you know when you’ve reached your goal, is it realistic, yet aggressive enough to stretch you, and when will you start/stop? A smart goal might be structured this way: “I want to walk twice a day 3 times per week. I will walk for 15 minutes each of these mornings at 7:00am and evenings at 7:30pm, starting on the first of October.”
You are aware of your barriers and have considered some ways to navigate either through or around them. Make sure to develop contingency plans to address these during the preparation phase. Think about situations that could be problematic and get a plan in place right now for how you might deal with it. For instance, using the goal above, what if it rains for a week straight? Clearly, this is something you cannot control, but it would interfere significantly with your goal. So your contingency plan might be “If it rains or it’s too hot to be outside, I will go to the mall or to the YMCA inside track instead.”
Your goal may not be quite where it needs to be. You may have underestimated what you’re actually capable of or you may have overshot the time that you actually have available to work on your goal. Not to worry, goals can be fluid and change over time. Don’t lock yourself into something that’s not going to work. Readjust and keep moving forward.
Remember that you’re going to have obstacles. One of my favorite quotes from Ryan Holiday is “the obstacle is the way”. If we want to avoid obstacles, we’ll never meet our goals, but in order to be successful, you have to deal with the obstacles as they arise. It’s an absolutely vital part of the journey toward your goal. Overcoming obstacles helps us build resilience, confidence and self-efficacy, the exact attributes that will make sustaining your goal for the long-term even more likely.
Action (“I am”)
When you’re in the action stage you’re practicing your new behavior consistently. This stage of change generally lasts for 6 months or more because not only are you practicing the new behavior, you’re also creating a new mindset and building a new habit. You’re in the “I am” stage, as in, I am doing it!
You may have to focus very intently on your new behavior in the beginning. You’re likely going to consciously make the choice to do it each and every time. What you’re actually doing by consciously and intentionally making the choice though, is building your brain chemistry to support your habit. Each time you make the choice, the neurons in your brain fire. The more they fire, they eventually wire together to create a new neuronal pathway in your brain to support this new choice. Over time your behavior will become more and more automatic, until eventually it’s your new normal. Your brain can support the change you want to see. Oh, and great news on that front, your brain is capable of growing and changing our entire lives, so it’s never too late to start. Just ask the 60+ year old group of research volunteers who integrated 1 hour of exercise three times per week for 8 weeks in a research study and whose brains actually grew in volume!
What can you do consistently right now? Once you’re consistent doing your chosen behavior, for instance, 2 days per week, you can eventually move to 3 days a week and then up to your target of 5. Start small and build from there. Rome wasn’t built in a day. Research shows that it takes at least 66 days to start to build a habit.
Revisit the section above under Preparation on SMART goals. Refine your SMART goal. You can even make it SMART-ER by continually Evaluating and Readjusting it. You don't have to stay locked into a goal that’s not working for you. When you learn new approaches that work better, use them! Refine your goals. It’s not only OK, it’s ideal to consider how your goals can be structured better than they already are!
Don’t rely on your willpower to ensure that you’re engaging in your new behavior. As Benjamin Hardy, PhD so aptly says in the title of his book, “Willpower Doesn’t Work”, he explains, through a great deal of supporting research, that, rather, restructuring your environment ensures your success. So, if you’re goal is to eat a whole food diet, relying on your willpower to keep from eating the potato chips you see every time you open your pantry, will not work. Eventually, you’re going to have a rough day, feel that salt/fat craving coming on, and BOOM, there goes the rest of the bag. Restructure your environment instead. Don’t even buy potato chips and store them in your pantry. Better yet, place some raw almonds in the place where the potato chips used to sit for a wholesome alternative.
Keep your values, your strengths and most importantly, your vision for health at the forefront of your mind during this time. This helps you to remember your why; why you’re doing this in the first place, as well how you can stay on track using the strengths that come naturally to you. Keeping your values top of mind can also help you realize when you get off track. You might start to feel friction between your path and your values. If that occurs, it might be time to re-evaluate your approach.
Engage in or create new supportive relationships with people who share your values and goals. Research shows that we pick up behaviors from the people we spend the most time with, so ensure you’re creating an environment of success by choosing your company wisely.
Leverage self-compassion. Make sure your self-talk sounds like something you would say to a good friend who’s in the same boat. There will be times where you slip up, when things don’t go as planned or you fall off of the wagon altogether. Lapses happen and will continue to occur. Be understanding with yourself, identify what you can learn from it and start back strong tomorrow. There is no such thing as failure. Ever. There is never a time where you can throw your hands up in the air and give up. This is too important to you. Just dust yourself off and start back strong tomorrow. Consistency over time is what matters when it comes to any healthy behavior.
Perhaps you could benefit from a planned lapse to practice getting back on the horse? Maybe you could schedule a day to go off of your eating plan or a couple of days off of exercise routine? This can help you build new mental strength and practice how you might deal with an actual lapse.
Develop your relapse-prevention plan. What specifically will you do when the time comes that you experience a lapse in your new behavior? Write it down. Put it somewhere for safe keeping. The moment you become aware of a lapse, pull it out and put your plan into motion. Lapses can be physical, emotional, and mental. Your relapse-prevention plan should take each of these areas into account. As part of your relapse-prevention plan, make sure to continue to envision yourself in the future having established this new behavior. This is your best self. What are the rewards and benefits you envision? Reconnect to your original vision for health and your why.
Maintenance (“I still am”)
The maintenance stage begins when your new behavior becomes a habit and is done automatically, without thinking about it. In most cases, this is approximately 6 months after beginning the action phase. Your confidence in maintaining your habit is solidified and your motivation is sustained and self-reinforcing.
Lapses can still occur at this point in the process and are quite common, so it’s important to continue to refine and engage your relapse-prevention plan when necessary. Many times in the maintenance stage, lapses can be brought about simply by boredom. Expansion of your view of maintenance can sometimes be beneficial. Luckily, lapses during the maintenance phase, when addressed early, generally do not cause significant changes to health or fitness levels long-term.
What have you discovered about yourself during this time of change? What are things that have excited you or encouraged you? On the flip side, what has caused either boredom or discouragement? Why are each of these important to the process and how have you navigated them during this time of sustaining your habit?
What are ways that you’ve developed to stay engaged in your new habit? How have these ways been helpful or not helpful? How can you mix up your routine to add newness and novelty to your behaviors? How can you expand this behavior to either encompass new areas or even other areas of your life?
Who are you a role model to? What do you think this person sees in you that perhaps you don't see in yourself? Why is being a role model important to you?
How have you learned to hold yourself accountable to your relapse-prevention plan? What have you learned about the times that you may have started to lapse, but engaged your plan to stay the course? How can you leverage this learning for future moments where you might sense a lapse coming on?
To reverse a relapse, even if you’ve moved into a previous stage of change during the lapse, revisit your vision for wellness, your strengths, goals, values and the many personal resources you have at your disposal to get back on track. More than anything remember to use self-compassion and kindness, not judging yourself for the for the lapse. Lapses are normal. Learning to identify it and reverse it is the key.
Sometimes, you may need external support to help you see blind spots or identify patterns of behavior that are not serving you. You may need quite a bit of support navigating through each stage of change, particularly if you’ve tried before and not experienced success yet. Health coaches can be an especially important ally to engage for further support, as they are experts in the behavior change process and can support you to navigate through each phase in a way that works best for you. A health coach can help you create your goals, stay accountable and provide the support that’s missing from many of the lifestyle change prescriptions that are given by healthcare providers.
Counselors can be especially helpful if you identify patterns of behavior that hinder you from achieving success in multiple areas or if you are concerned about your mental health. Mental health is a priority when embarking on a lifestyle change program. Sometimes, mental health treatment and behavior change can be done concurrently; however, do check in with your physician or mental health provider on their recommendations in this regard. Coaching can be initiated once you feel as though you have adequate support for your mental health.
Always seek the professional advice from a licensed healthcare provider before engaging in any form of lifestyle change whether eating habits, exercise, relaxation, stress management, sleep, or any other form of lifestyle change.