Understanding the Power of Habits: The Psychology of Habit-Formation

1. Understanding the Power of Habits: The Psychology of Habit-Formation Cris Cannon, D.Min., LPC/MHSP, CCMHC, ACS

2. Learning Objectives • Understanding a “habit” from a different perspective • Conceptualizing habit-formation as a tool for change • Distinguishing the steps involved in the habit-formation process • Clarity regarding the length of time it takes someone to create a habit • Perceiving habit-formation as a process • Considering habit-formation as useful to our patients

3. Defining “Habit” • A usual way of behaving: something that a person does often in a regular and repeated way • A recurrent, often unconscious pattern of behavior that is acquired through frequent repetition • A settled or regular tendency or practice, especially one that is hard to give up • An acquired behavior pattern regularly followed until it has become almost involuntary • A learned behavioral response that has become associated with a particular situation, especially one frequently repeated

4. Basic Understanding: Habit “An action done frequently.”

5. Why We Must Be Careful About Our Habits . . .

6. My Favorite Definition The automatic behavioral engagement in an activity that serves to promote well-being.

7. Why is this Important for Coaching? Consider . . . Behavioral change may be achieved through the creation of new habits.

8. Where Might Habit-Formation Be Useful with Our Patients? • Medication adherence • Emotional/personal management • Healthy eating • Exercise • Positive self-care

9. How Does Habit-Formation Work? Habit-formation is relatively simple: Repeat an action consistently in the same context

10. Habit-Formation Process: Three Phases Initiation Phase – defining the new behavior and the context in which it will be practiced are selected. Learning Phase – the new behavior is repeated in the chosen context to strengthen the context-behavior association. Stability Phase – the habit has been formed and its strength has plateaued, so that the habit persists over time with minimal effort.

11. Initiation Phase • Requires sufficient motivation to attempt habit-formation • An appropriate context in which to perform the action must be chosen • The context - any “cue”: an event “when I get up in the morning”, a time of day “after dinner”; some daily connection • The habit-forming action is performed in a daily context that is both frequent and consistent

12. Learning Phase • Repetition, repetition, repetition, repetition, repetition, repetition, repetition, . . . and more . . . REPETITION • Contextual Education - learning from the repetition of the action in the context of the time of day, cues, motivating thoughts, times the action was not carried out, feelings around the process, etc.

13. Being Faithful to Repetition when Repetition ISN’T Fun . . .

14. Stability Phase • The habit forming action becomes second nature . . . • The patient notices when the habit is not performed • There is a sense of a need to recover when the habit has not been performed

15. How Long Does it Take for A Habit to Become Automatic? First, let’s dispel the myth . . . 21 days is not true!

16. Dispelling the “21 Day” Myth “Psycho-cybernetics”, a 1960 book by Dr. Maxwell Maltz, a plastic surgeon: ‘It usually requires a minimum of about 21 days to effect any perceptible change in a mental image. Following plastic surgery it takes about 21 days for the average patient to get used to his new face. When an arm or leg is amputated the “phantom limb” persists for about 21 days. People must live in a new house for about three weeks before it begins to “seem like home”. These, and many other commonly observed phenomena tend to show that it requires a minimum of about 21 days for an old mental image to dissolve and a new one to jell.’ (pp xiii-xiv)

17. Dispelling the “21 Day” Myth How anecdotal evidence from plastic surgery patients came to be generalized across culture remains unclear . . .

18. So How Long DOES It Take to Form A Habit? 2010 research: • Participants performed a self-chosen health-promoting dietary or activity behavior (e.g. drinking a glass of water) in response to a once-daily cue (e.g. after breakfast), and gave daily self-reports of how automatic (i.e. habitual) the behavior felt. • Participants were tracked for 84 days

19. So How Long DOES It Take to Form A Habit? Range: some persons maintained their habit in 18 days; it took others 254 days for their action to become habitual. On average, it takes 66 days for a habit to be formed and become automatic. About 10 weeks!

20. Acquiring A New Habit Requires TIME . . .

21. Creating/Managing the Process • Patients should choose the behavior they want to become habitual; we may assist, but they must own their choice. • Encourage small and manageable behavior changes; simpler actions become habitual more quickly. • Failure is discouraging, thus, momentum must be maintained and failure normalized as a means of continuing towards habit mastery. • Once smaller changes have been sustained, larger issues may be considered. • Throughout the process, offer encouragement; success builds self-efficacy.

23. Replacing A Bad Habit with A Positive One The process is much the same: • Identify a positive habit and behavior you want to adopt. • Identify the habit you want to break. • Recognize the sensory impulses experienced in your body that occur before you act on the negative habit. • Instead of acting on the negative habit, refocus your conscious thoughts and attention on the positive habit. • Substitute the new behavior based on the positive habit.

24. A Patient Example . . . Sarah: 42 year old teacher; overweight and sedentary. She knows she needs to exercise, and discusses her many “hit and miss” attempts to make exercise habitual.

25. A Patient Example . . . Sarah states that she “wants to get back on track but doesn’t know where to start.” • How do we get Sarah back in the habitof regular, planned exercise? • Sarah has gotten out of her former habit of taking long walks.

26. A Patient Example . . . Sarah is asked to make a simple list of three actions she wants to accomplish towards her goal of walking: Her responses: • Walk everyday with her dog • Create reminders to walk • Walk immediately after work

27. A Patient Example . . . Sarah creates a checklist - kept on “Post-It” note on bedroom mirror which she sees each morning: • Change clothes immediately after work for walking. • Leave walking clothes, shoes, and dog leash on her bed as reminders. • Walk her dog for a half-hour.

28. A Patient Example . . . Goal: Working towards habit creation Week 1: successful 4 out of 7 days Week 2: successful 5 out of 7 days Weeks 3 & 4: successful 2 out of 7 days – (relapsed after being ill with sinus infection) Week 6: successful 6 out of 7 days Week 15: successful 7 out of 7 days

29. A Patient Example . . . Sarah said she wanted to “get back on track” with exercise; which becomes her goal. • “Have you ever made lists?” • Coaching aided Sarah to define issues on the list • Jointly we decided that she would check her first thing in the morning while she dressed

30. Habit-Formation Process: Sarah’s Three Phases • Initiation Phase: Defining the new behavior: Making a list; following tasks Context in which it is practiced: Checking list every morning and upon awakening; acting on tasks • Learning Phase: REPITITION, REPITITION, REPITITION • Stability Phase: Habit largely in place and sustained at 15 weeks

31. Why This Is Important to Our Work with Patients . . . Instead of: • Becoming upset with them • Lecturing • Using “oughts” and “shoulds” • Berating Encouraging patients to identify the changes they want to make and see if we might help them create new habits!

32. Supporting patients in the creation and use of positive habits is hopeful, optimistic, and reassuring. Assisting what “might be” rather than “what isn’t”

34. And Remember . . . Repetition Leads to Success!!

35. Reference Gardner, B., Lally, P., & Wardle, J. (2012) Making health habitual: the psychology of ‘habit formation’ and general practice. British Journal of General Practice, 62, 664-666.