HOW TO CHANGE OUR BEHAVIOR REGARDING PAIN

I've been watching a series of lectures on mind-body medicine by Jason Satterfield, PhD, a professor of behavioral medicine at the University of California, San Francisco. One of his lectures, which looks at the importance of changing behavior to reduce or prevent pain, offers some advice and guidance on how to change.

Satterfield says making a lasting change in behavior is rarely a simple process and usually involves a substantial commitment of time, effort, and emotion. Trying several different techniques is usually necessary, often through a process of trial and error. It is during this period that many people become discouraged and give up on their behavioral change goals. He says the key to maintaining the goals is to try new techniques and find ways to stay motivated.

Change might not come easy, but psychologists have developed a number of ways to effectively help people change their behavior. Many of these techniques are used by therapists, physicians, and teachers. Researchers have also proposed theories to explain how change occurs. Understanding the elements of change, the stages of change, and ways to work through each stage can help you achieve your goals.

In order to succeed, you need to understand the three most important elements in changing a behavior:

• Readiness to change - Do you have the resources and knowledge to successfully make a lasting change?
• Barriers to change - Is there anything preventing you from changing?
• Expect relapse - What might trigger a return to a former behavior?

One of the best-known approaches to change is known as the "Stages of Change" model, which was introduced in the late 1970's by researchers James Prochaska and Carlo DiClemente who were studying ways to help people quit smoking. The Stages of Change Model has been found to be an effective aid in understanding how people go through a change in behavior.

In this model, change occurs gradually and relapses are an inevitable part of the process of making a lifelong change. People are often unwilling or resistant to change during the early stages, but eventually develop a proactive and committed approach to changing a behavior.

Making healthy lifestyle changes affects not only our risk for pain or disease and the way we feel today but also our health and ability to function independently in later life. What we do for ourselves is often more important than what medicine can offer us. Yet making healthy changes is easier said than done. Even when we’re strongly motivated, adopting a new, healthy habit — or breaking an old, bad one — can be terribly difficult.

One obstacle to changing our behavior is that we’re motivated too often by a sense of guilt, fear, or regret. Experts who study behavior change agree that long-lasting change is most likely when it’s self-motivated and rooted in positive thinking. In October 2006, the Economic and Social Research Council, a British research group, released findings on 129 different studies of behavior change strategies. The survey confirmed that the least effective strategies were those that aroused fear or regret in the person attempting to make a change.

Studies have also shown that goals are easier to reach if they’re specific (“I’ll walk 20 minutes a day,” rather than “I’ll get more exercise”) and not too numerous (having too many goals limits the amount of attention and willpower you can devote to reaching any single goal). Another recurring theme is that it’s not enough to have a goal: You also need practical ways to reach it. For example, if your goal is to stick to a low-calorie diet, have a plan in place for quelling hunger pangs (for example, keep a bottle of water or cup of tea nearby, or chew sugarless gum).

Research has also produced models that help account for success and failure, and explain why making healthy changes can take so long. The expert conclusion is that any effort you make in the right direction is worthwhile, even if you encounter setbacks or find yourself backsliding from time to time.

Most of the evidence for this model comes from studies of alcohol, drug abuse, and smoking cessation, but it’s also been applied to various health behaviors, including exercise and dieting. Clinicians and health educators use TTM to counsel patients, but you don’t need to be an expert to try this approach. Anyone motivated to change can use it to assess her situation and formulate strategies. Below are the TTM stages of change and some ideas about how people move through them:

• Precontemplation. At this stage, you have no conscious intention of making a change, whether through lack of awareness or information (“Overweight in my family is genetic; it’s just the way we are”) or because you have failed in the past and feel demoralized (“I’ve tried so many times to lose weight; it’s hopeless”). You tend to avoid reading, talking, or thinking about the unhealthy behavior, but your awareness and interest may be sparked by outside influences, such as public information campaigns, stories in the media, emotional experiences, illness, or a clinician’s or family member’s concern. To move past precontemplation, you must sense that the unhealthy behavior is at odds with important personal goals, for example, being healthy enough to travel or to enjoy your children or grandchildren.
  
  
• Contemplation. In some programs and studies that employ TTM, people who say they’re considering a change in the next six months are classified as contemplators. In reality, people often vacillate for much longer than that. In this stage, you are aware that the behavior is a problem and are considering doing something about it, but you still aren’t committed to taking any action. Ambivalence may lead you to weigh and re-weigh the benefits and costs: “If I stop smoking, I’ll lose that hacking cough, but I know I’ll gain weight,” or “I know smoking could give me lung cancer, but it helps me relax; if I quit, stress could kill me, too!
  
  Health educators use several techniques to help people unstick themselves and move on to the next stage. One is to make a list of the pros and cons of making a change, then examine the barriers — the “cons” — and think about ways to overcome them. For example, many women find it difficult to get regular exercise because it’s inconvenient or they have too little time. If finding a 30-minute block of time to exercise is a barrier, how about two separate 15-minute sessions? Could someone else cook dinner so you can take a walk after work? If you feel too self-conscious to take an exercise class, how about buying an exercise tape to use at home?
  
  
• Preparation. At this stage, you know you must change, believe you can, and are making plans to change soon — say, next month. You’ve joined a health club, purchased a supply of nicotine patches, or added a calorie-counting book to the kitchen shelf. At this stage, it’s important to anticipate potential obstacles. If you’re preparing to cut down on alcohol, for example, be aware of situations that provoke unhealthy drinking, and plan ways around them. If work stress triggers end-of-day drinking, plan to take a walk when you get home. If preparing dinner makes you want a drink, plan to have seltzer water instead of wine. If social situations are a problem, make a list of alternatives, such as going to the movies instead of having drinks or dinner with friends.
  
  At the same time, create a realistic action plan with achievable goals. If you’ve been sedentary and want to exercise more, start by making it your goal to avoid using the elevator for two-, three-, or four-story trips. Or plan to walk 15 minutes every day. This can help you work your way up to more ambitious goals.
  
  
• Action. At this stage, you’ve changed — stopped smoking, for example (according to Prochaska, cutting down would not be “action” but preparation for action) — and you’ve begun to experience the challenges of life without the old behavior. You’ll need to practice the alternatives you identified during the preparation stage. For example, if stress tempts you to eat, you can use healthy coping strategies such as yoga, deep breathing, or exercise. At this stage, it’s important to be clear about your motivation; if necessary, write down your reasons for making the change and read them every day. Engage in “self-talk” to bolster your resolve. Get support. Let others know you’re making a change.
  
  
• Maintenance. Once you’ve practiced the new behavior change for at least six months, you’re in the maintenance stage. Now you’re working to prevent relapse and integrate the change into your life. That may require other changes, especially avoiding situations or triggers associated with the old habit. It can be tough, especially if it means steering clear of certain activities or friends while you work to fully assimilate your new, healthier habit.

The path from one stage to the next is rarely straightforward. Most people relapse at some point and recycle through certain stages, like a spiral. One study found that smokers trying to quit cycled an average of three or four times through the “action” stage before they succeeded. When relapse occurs during the maintenance stage, you may find yourself back at the contemplation or preparation stage — or perhaps all the way back to precontemplation if the relapse was so demoralizing that you don’t even want to think about changing.

Relapse is common, perhaps even inevitable. Experts urge people not to be derailed by it but to think of it as an integral part of the change process. You learn something about yourself each time you relapse. For example, you may find that the strategy you adopted didn’t fit into your life or suit your priorities. Next time, you can use what you learned,

Making healthy lifestyle changes affects not only our risk for disease and the way we feel today but also our health and ability to function independently in later life. What we do for ourselves is often more important than what medicine can offer us. Yet making healthy changes is easier said than done. Even when we’re strongly motivated, adopting a new, healthy habit — or breaking an old, bad one — can be terribly difficult.

Considerable research has been aimed at identifying factors that contribute to successful lifestyle change as well as more effective tools for clinicians — especially in the context of a brief office visit — to counsel their patients on adopting healthier habits. One problem may be that we’re motivated too often by a sense of guilt, fear, or regret. Experts who study behavior change agree that long-lasting change is most likely when it’s self-motivated and rooted in positive thinking. In October 2006, the Economic and Social Research Council, a British research group, released findings on 129 different studies of behavior change strategies. The survey confirmed that the least effective strategies were those that aroused fear or regret in the person attempting to make a change.

My own experience with changing my behavior regarding TMS pain has been to work on modifying my perfectionist and “goodist” personality. I can’t totally change who I am and have been for 84 years, but TMS knowledge has helped me to live healthier and without pain and also happier. I exorcised myself and my inner bully from thoughts and repressed emotions I had carried since I was a boy. It’s really great to be free of them, at last.

Have you tried to change your emotions so you can be healthier and happier? Sharing your experiences on the subject can help you and others. Psychologists such as Dr. Satterfield can give us an opportunity to learn about subjects like changing our behavior, but the examples that come from non-academics or non-psychologists can be the most helpful. Pleases join us in this conversation.