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VOL. 6 • NO. 10
Why do we continue unhealthy behaviors knowing that they are detrimental to our well-being? Former first lady Nancy Reagan’s slogan “Just say no” was a simple, but ineffective solution. Economics, environment and culture are powerful stimuli. And so are habits.
© June 2012
Researchers funded by the National Institutes of Health (NIH) are taking a closer look at what happens in the brain as habits form. “Understanding the biology of how we develop routines that may be harmful to us, and how to break those routines and embrace new ones, could help us change our lifestyles
and adopt healthier behaviors,” Dr. Nora Volkow, director of the National Institute on Drug Abuse, recently wrote in the NIH News in Health. Generally, we are creatures of habit. We perform daily routines, such as bathing and combing our hair without giving them a thought. We’re on auto-pilot as we drive to work. In one sense, these habits are good, according to Volkow, as it frees up the brain to concentrate on other matters. Habits form not only from repetition but also from the stimulation of the brain’s reward centers. Often these habits are not particularly good. When we indulge in behaviors that bring us pleasure, such as smoking, using drugs or eating too much food, the brain releases dopamine, a chemical responsible not only for motivation, compulsion and perseverance, but also for pleasure. In other words, our brains become hardwired to crave and continue bad habits. That does not mean that it’s impossible to change. It means that change is just not easy. There is not one set of rules for change. One size does not fit all, but there are some rules that apply across the board. One must first recognize and accept the habit and acknowledge that change is necessary. In addition, goals for change should be specific. Instead of vowing to exercise, be more exact. How often will you exercise? What type of exercise? There are several models of behavior change, but one of the most applied and tested in the health care field is the transtheoretical model (TTM) developed by psychologists James Prochaska and Carlo DiClemente in 1983. TTM has been successfully applied to health related behaviors such as smoking, diet, exercise and safe sex practices. Practitioners have also used it to change mental health
related behaviors, including alcohol, drug abuse and stress. The theory behind TTM is that at any given time, a person is in one of five different stages: precontemplation, contemplation, preparation, action and maintenance. People move from one stage to the next without skipping since each stage offers preparation for the one following. The time frame to remain in each level depends on the individual. In precontemplation, a person has no conscious intention of making a change, while in the contemplation stage the person is considering a change, but has not made a commitment to a particular action. In preparation, people acknowledge the need to change and are developing an action plan, such as membership in a health club. Action occurs when the person has actually modified behavior, such as to stop smoking. Maintenance occurs once the person has practiced the new behavior for six months. Counselors readily admit that it can take several rounds of these stages for a permanent change to occur. Smokers quit, then quit again. Many new health center memberships go unused. That’s to be expected. Relapse is common, perhaps even inevitable. Experts often look at these relapses as partial successes. People know why they failed and can hopefully avoid that response the next time around. Some make the mistake of relying solely on willpower to change unhealthy habits. Mental health professionals warn that willpower is like a muscle and fatigues when used too much. A recent issue of Mayo Clinic Health Letter cites examples of how self-control may be more effective in changing certain behaviors. For example, a person using sheer willpower to curtail drinking will decide to keep Habits, continued to page 4
Take the first step … again and again Sonia Booker, 79, is good at keeping secrets. She was able to keep her cigarette smoking hidden from the parishioners at Holy Tabernacle Church where she was a choir member and usher. She even tried to keep it from her doctor. “I was ashamed,” she admitted. But she couldn’t keep the secret from herself. The constant hacking cough and the escalating cost of cigarettes finally got the better of her. She did answer truthfully when the doctor asked her about her smoking habits. She thought the answer “now and then” would do, but the doctor’s quick response was “Stop.” Like most people, it was hard for Booker to change this behavior. She started smoking around the age of 25 because her friends did. At one time she was up to two packs a day. Even the health warnings that began to surface 50 years ago did not have an impact. “We can hear and not pay attention,” she explained. Eventually, circumstances changed. Though Booker had not made the decision to stop smoking, certain events began to get her attention. The doctors found a spot on the lung of her sister, who was also a smoker. The health
warnings began to scare her. Booker quit — again, and again and again. Therapists warn that relapses are common. Booker started again after the death of one of her sons. She noticed, however, that she began to taper off without even trying. “I could be out most of the day and not even think about smoking,” she said. “When I came home and saw the pack sitting there, I automatically grabbed one.” The first step toward healthier habits is to recognize and accept the unhealthy behavior — without recriminations. “Don’t judge yourself,” explained Dr. Nicole Christian, a resident in psychiatry at Massachusetts General Hospital (MGH). “We are indeed creatures of habit.” Motivation to change is key — and individual. Outside encouragement is helpful, but the need to modify a habit comes only from within and is particular to each person. Generally, the biggest impetus to change is that people get tired of their behavior and its ramifications. “When they get to the point that ‘enough is enough’ that’s when the change begins,” she said.
Sonia Booker (left) and her son, Carl, formed a buddy system to support each other in their efforts to stop smoking. (Ernesto Arroyo photo)
And change should be measured in small victories. “Many people try to do too much at one time,” said Christian. “Take small steps.”
For instance, if you smoke 10 cigarettes a day, cut it down to nine. If you are trying to exercise, a vow to exercise five
Booker, continued to page