Changing for Good

by James O Prochaska

  The search for absolute certainty, waiting for the magic moment, wishful thinking, and premature action are all “negative processes,” delay tactics that retard movement through the cycle of change. Despite these traps of the contemplation stage, a period of contemplation prior to preparing for action is essential for lasting and meaningful self-change.

  There is a certain level of awareness of both problem and solution that must precede action. Without it—and the accompanying commitment that takes place during the preparation stage—maintenance of change proves very difficult indeed. Many successful self-changers have informed us that awareness preceded action in their cases, and psychotherapy patients also express a definite preference for awareness and insight into their difficulties before modifying them. In a recent major clinical study in Sheffield, England, clients found the awareness-behavior change therapy sequence quite comfortable, whereas the behavior change-awareness sequence felt all wrong.

  This helps explain not only the high rate of failures associated with premature action, but the problems inherent in those action-oriented programs that ignore awareness. It also explains why so many self-help books fail to assist people to develop an awareness of their problem before encouraging them to take action. Techniques without awareness behind them don’t have a chance to make any real impact on our inner selves, and so have little lasting effect.

  Awareness is developed during the contemplation stage, which need not involve ponderous study or intense psychoanalysis. As we shall see, it may require no more than a few weeks of honest self-appraisal, using the now familiar techniques of consciousness-raising. In addition, it can be helpful to use a little self-administered scare—the time-honored tradition of catharsis, or emotional arousal.

  THE FOURTH PROCESS:

  EMOTIONAL AROUSAL

  Emotional energy is a powerful force. You can harness it to give you the impetus and resolve you need to make the decision to change. As you know from life experience, the rational thing to do is not always what you want to do. Emotions, however, can provide a burst of energy that allows you to supersede procrastination, and determine what is really in your best interests. Used correctly, the stirring techniques of emotional arousal will get your adrenaline flowing and help move you from contemplation to preparation and action.

  Although simple facts are sometimes all that are needed to change a problem behavior, more often it takes a dramatic, emotionally charged event to do so. Emotional arousal is not the same as fear arousal. In discussions of smoking cessation techniques, someone often suggests showing vivid pictures of diseased lungs to the smokers. This is an understandable concept, but it is rarely effective—fear arousal is easily diverted by defense mechanisms. “That could never happen to me,” “This is an extreme case,” “I did not smoke as long or as much as this person,” are the kinds of comments that such photos provoke among smokers.

  Contemplators who are already seriously considering changing can use emotional arousal effectively. Don’t make the mistake of confusing emotions with change. Like blood in surgery, emotions in self-change are necessary and inevitable, they serve a cleansing function, and they must be respected, but they are not the object of the endeavor. Emotions must be related to all parts of the effort to change, and must be used as you move forward into more advanced stages of change.

  There are a variety of emotional arousal techniques that can be useful. Here are three:

  Go to the movies From the patriotic propaganda movies of World War II to the three-hanky tearjerkers, films stir our emotions more readily than any other art form. They can be a wonderful way to arouse your emotions as you decide to change. There are many commercial films, documentaries, and television specials that dramatically portray the consequences of almost every problem there is.

  The trick is to use these helpers nondefensively. Seek out films that focus on your problem. Although informational videos can be helpful, they most often offer advice and “how to” information. The riveting emotional messages that dramatic materials provide are preferable. Jack Lemmon’s portrayal of an alcoholic in Save the Tiger cannot fail to move you, nor can Yul Brynner’s final interview, in which he talks about lung cancer and cigarette smoking. Similarly, a film like Clean and Sober portrays the denial, relapse, and recovery cycles typical among cocaine addicts.

  Video rental stores will make your search a lot easier, as will local referral centers that can recommend and sometimes rent films about specific problems. Television stations can be persuaded to make news specials available, and there are self-help distributors that offer specialized videos and materials. There is plenty of material out there. If you make the effort to obtain, view, and consider dramatic video messages, they can help you make a firm decision to change.

  Make your own propaganda If you find that watching movies made by others does not get your adrenaline flowing, try creating your own scenario, one that arouses your disgust, disappointment, and distress. There are a number of ways in which you can do this.

  We frequently sensitize smokers to the problems caused by cigarettes by taking a clean white handkerchief and blowing the smoke of one entire cigarette through it. If you do this, don’t inhale; just puff and blow the smoke so that all the tar and residue ends up on the handkerchief. Examine the hanky and you’ll see what goes in your mouth and lungs twenty, forty, or sixty times a day. Or try filling a jar with cigarette ashes and butts from a day’s smoking—add a little water to the jar and keep it around to remind you just how filthy smoking is.

  If you have a problem with alcohol, have a friend videotape you after you have been drinking. Nothing is more effective in capturing the slurred speech, the poor coordination, and the semicoherent conversations drinkers exhibit. Such a video invalidates the denial that people with alcohol problems so often demonstrate. Watch the video the morning after; a hangover will increase your emotional distress about your drinking.

  Similar tactics can be used for most other addictive or behavioral problems. Overweight people, for example, can use mirrors to encourage them to change. It’s no coincidence that most gyms and health and exercise facilities have mirrored walls.

  There are two things you should be aware of before going ahead with this technique. First, remember the goal is to create helpful emotional arousal, not to overwhelm yourself with disgust and disappointment. You don’t want to become discouraged, nor do you want to blame yourself for the problem. Second, be aware of timing. It is extremely helpful, even important, to focus on the negative aspects of your problem behavior during the contemplation stage. However, in the preparation and action stages, concentrating on the negatives seems to hold self-changers back, by keeping them concentrated on the problem rather than on the solution.

  Use your imagination If renting videos is impossible and creating your own home experiments seems too difficult, you can arouse your emotions simply by using your imagination. Make your own “mental movie.” Concentrate on the negative aspects of your problem, and confront your defenses within the confines of your mind; allow yourself, even force yourself, to imagine distressing scenes and scenarios. This is the opposite of relaxation; the objective is to create negative images that will sensitize you to the dangers and the drawbacks of your problem behavior.

  Fast forward through the years and visualize the consequences of not changing. Picture your high-fat diet clogging your arteries, shortening your breath, producing pain in the chest, and panic too, that the heart you failed is failing you. Imagine that your passive or depressive approach to life is leaving you isolated in your reclining chair. Your children stop coming around; your friends find more active associates; your spouse starts talking about leaving.

  Construct a scene in which people who know you well are confronting you about how your constant need to control alienates them. Some are angry that you always have to have your way. Others resent your stubbornness and your sense that you’re always right. Few want to get close lest they lose their right to choose.
Feel yourself getting defensive, and rationalizing about the virtues of being so responsible. But also experience how inferior or inadequate you can make others feel when you treat them like children.

  This is not a time for wishful thinking. This is not a time to let your defenses turn faults into virtues, problems into preferences. This is a time to picture in your mind’s eye the troubling consequences that can come from waiting for the magic moment. You do not need a psychic to forecast where your unchecked negative behaviors will lead.

  A critical barrier to changing many problem behaviors is that serious consequences seem too distant or long-term to matter. By using your imagination to bring the future into the present you can effectively overcome this barrier, and arouse your emotions to the point where you are ready to make a firm commitment to take action. This will be of critical importance during the preparation stage.

  Emotional arousal self-assessment

  Here is a self-assessment to check your progress in using the process of emotional arousal. Be honest and realistic. Fill in the number that most closely reflects how frequently you have used the method in the past week to combat your problem.

  1 = Never, 2 = Seldom, 3 = Occasionally, 4 = Often, 5 = Repeatedly

  FREQUENCY:

  _____ Dramatic portrayals about my problem affect me emotionally.

  _____ I react emotionally to warnings about the consequences of my problem.

  _____ Remembering reports about illnesses caused by my problem upsets me.

  _____ Warnings about hazards of my problem move me emotionally.

  _____ = Score

  Your score indicates the extent to which you are emotionally aroused by portrayals, warnings, and hazards connected with your problem. In this self-assessment, a score of 10 or more indicates that you are ready to begin moving forward to engage in the preparation stage. If your score is 9 or less, we recommend that you redouble your efforts at emotional arousal.

  THE RETURN TO CONSCIOUSNESS

  If you progressed from precontemplation to contemplation, through consciousness-raising you have already become aware of your defenses and resistances; this change process remains important now as you gain more knowledge about the problem you are defending. Since you are less defensive, you are freer to process information about your problem in general, and about how it affects you in particular.

  Many people attempt to solve a problem when they have minimal information about it, and the results are predictably dismal. You would never try to fix a car without understanding how it works beyond that it starts when you put gas in the tank and turn the key; it equally makes no sense to tackle change if you know little more about your body than that you need to rest it at night and put food in it several times a day. When physical disorders arise, most people rely on physicians to help fix them. But when psychological disorders emerge, most rely on their own resources, without first gathering the necessary information.

  Fortunately, there are several consciousness-raising tech niques that can help us “fix” ourselves. These are especially useful to successful self-changers:

  Ask the right questions Albert Einstein said that the key to solving problems is asking the right questions. Emphasize asking the right questions in your search for powerful knowledge. Don’t look for magic information or miracle cures, like the dieters who purchase an endless number of fad diet books, but ignore factual information about nutrition, calories, and exercise.

  Here are a few sample questions that may help you get started on solving some problems. Use them as a guide for developing questions specifically geared to your situation, and remember to ask yourself these questions without getting defensive:

  How many calories does an average forty-year-old male (or female) need to consume in an average day?

  How long must you jog to lose one pound?

  How does your body adjust to dieting in order to conserve calories?

  What effects do nicotine and nicotine withdrawal have on your body and your behavior?

  How can you tell if you are addicted to nicotine?

  What type of mood changes are you likely to experience two days after drinking too much?

  How can you tell if you are a problem drinker?

  What effects does alcohol have on your brain and behavior?

  The answers to these and similar questions can generate important information that will assist you in changing. Armed with this information, you will be better prepared to fight the battle of the bulge, the bottle, or anything else.

  Define your own goals Vague objectives, such as “I want to become a better person,” or “I want to feel good,” beget vague self-change attempts. Lewis Carroll summed it up nicely in Alice in Wonderland:

  ALICE: Would you tell me, please, which way I ought to go from here?

  THE CHESHIRE CAT: That depends a good deal on where you want to go.

  One of the first steps in becoming more aware is to specify your goals. Ask yourself: Exactly what behavior(s) do I wish to change? How can I measure and track my progress? If you cannot think of a way to measure your progress, the chances are good that your goal is too vague.

  Don’t let others dictate what is important to you. This is a trap that everyone falls into from time to time. Your goal can relate to almost any behavior, even if it seems unimportant to others around you. For example, in one of our weekly research meetings a few years ago, when I was discussing difficulties in maintaining regular teeth flossing, John Norcross called these concerns “silly” and “insignificant.” Shortly thereafter, John was informed by his dentist that he was in danger of losing his teeth to periodontal disease if he didn’t floss. The lesson has stayed with us both: Define your own goals regardless of what others think or say.

  Collect the right data From contemplation right through the maintenance stage, monitoring your problem is critical. Most self-changers rely only on informal monitoring, such as estimating their intake of drinks or calories each day. It pays to be precise and constantly hone your awareness about your behavior. Informal monitoring can easily be misleading, especially with overeating, drinking, and smoking, since even well-intentioned people underestimate how much they consume.

  For example, I counseled a sixty-two-year-old physician who was certain that he only drank two martinis a day; that had been his pattern for years. When he monitored his drinking more formally, however, he was shocked to discover that his self-made martinis contained eight to ten ounces of gin, or the equivalent of six to eight regular-sized martinis a day. The moral: Don’t assume you know your intake—measure it.

  Monitoring yourself for a week or more not only gives you a baseline to assess your progress once you take action, it can also make you more aware of exactly what needs changing.

  Different problems should be measured with different yardsticks. Consumption problems—overeating, drinking, smoking, or spending money—are usually best measured by the amount consumed or spent. Recording your daily food intake and counting calories, for example, is a more sensitive measure of change than a daily weigh-in. Although decreasing your calorie intake from 2,000 calories to 1,500 calories per day is a 25 percent improvement, it is unlikely to lead to a loss of more than I percent of your body weight during your first week or two of action. Despite a highly significant cut in intake, weigh-ins may not initially show you any improvement!

  With emotional problems, measure the frequency, duration, and intensity of distress episodes. Take the case of the thirty-six-year-old golf pro who was trying to control his ugly and abusive rages against his wife. He focused primarily on changing the intensity of his outbursts. Several months after he had taken action to control his temper, he blew up just as intensely as ever, and immediately became discouraged about his progress, until he realized that the frequency of his rages had declined from several times a week to just once in the past two months.

  With most problem behaviors, the frequency of the episodes changes before their intensity does. What we choose to monito
r, then, can make a major difference in our feeling of progress. For some habits, like swearing, spitting, and nail biting, frequency can suffice. The general rule in behavioral research is that multiple measures are better than single measures. When in doubt, measure more rather than less.

  Functional analysis: learn your ABC’s In addition to monitoring, try to track the events that immediately precede and follow your problem behavior. Do you drink more when something makes you feel angry? Lonely? Happy? What happens right after an angry outburst? Does the other person give in? Do you have a drink? Or do you withdraw to be alone? What makes you crave a piece of cake? How does eating it make you feel?

  This “functional analysis” can illuminate what is controlling the parts of your life that seem out of control. It is easy as A (antecedents) B (behavior) C (consequences). Antecedents can trigger a problem behavior, while the consequences reward or strengthen it, no matter how maladaptive it is. There is a psychological principle that states that every human behavior is goal-directed. Functional analysis helps you identify the goals of your problem behavior.