Changing for Good
Page 15
The Strong Principle of Progress states that progression from precontemplation to action involves approximately a 1 S.D. increase in the pros of making a healthy behavior change. The formula is:
PC → A = 1 S.D. ↑ PROS
The Weak Principle of Progress states that progression from precontemplation to action involves approximately a .5 S.D. decrease in the cons of making a healthy behavior change.
PC → A = .5 S.D. ↓ CONS
What are some of the implications of these principles? First, if you are in the precontemplation stage with a particular problem, you are going to have to increase your perception of the pros by 1 S.D. in order to be adequately prepared to take effective action. This is like raising your behavior change IQ by 15 points. Fortunately, we are confident that by reading this book, the average person can raise his or her behavior-change IQ by at least 15 points. You may not be gifted when you’re finished, but you may become a much brighter self-changer!
Second, you’ve always known that you have to be highly motivated if you’re going to change a chronic problem behavior. But you’ve never known how high your motivation should be. The principles of progress will help you to assess your level of motivation, though we prefer the term “preparation.” It’s hard to imagine consciously and willfully increasing your motivation. It’s much easier to imagine consciously and willfully improving your preparation. The assessments in this book are designed to give you feedback about your efforts at preparing for change.
Preparation lies in the balance between your perception of the pros and cons of changing. If you are currently in the precontemplation stage, you are likely to perceive the cons of changing as outweighing the pros. You will need to increase your pros of changing twice as much as you will need to decrease the cons. Furthermore, the processes of change applied in the early stages have the greatest impact on the pros. The processes you apply in the preparation and action stages have the greatest impact on the cons.
We have placed this section on the principles of progress here, immediately before the chapter on action, as a kind of Do Not Pass Go warning. By all means, read the book once through, to give yourself an overview of the stages. But once you’re ready to embark on the journey of change, be sure to work methodically through the stages. Many people will be tempted to head straight for the action techniques before they are fully convinced of the pros and cons of changing. According to our model, if you bypass the contemplation and preparation stages, your change efforts are highly likely to fail. The preceding section gives you an example of the strong mathematical evidence that lies behind our model.
We use the metaphor of people who would like to run the Boston Marathon. Those who aren’t prepared at all are probably in the precontemplation stage and don’t intend to enter this year’s race. Those who are more prepared and are in the contemplation stage may intend to enter this year’s race, but because of ambivalence about the pros and cons of running, they sign up for the race but do not show up. Those who are adequately prepared are most likely to sign up, show up, and finish up the race. They will certainly find at times that they want to give up; some surely will give up, and save their energies for another day. However, those who are best prepared, who have increased their pros of changing by 1 S.D. and have decreased their cons of changing by .5 S.D., are most likely to keep going even when they hit the infamous Heartbreak Hill.
Let’s evaluate your cons of changing, and see how much you have still to do to prepare yourself to finish your race the next time you start.
Decisional balance
Answer the following questions in terms of a problem behavior. Rate each item as to its importance in deciding to take action. Rate each item as accurately as you can. Fill in the number that most closely reflects the importance of each item.
PROS AND CONS OF CHANGING
1 = Not important, 2 = Slightly important, 3 = Somewhat important, 4 = Quite important, 5 = Extremely important
Some people would think less of me if I change ____
I would be healthier if I change ____
Changing takes a lot of time ____
Some people would feel better about me if I change ____
I’m concerned I might fail if I try to change ____
Changing would make me feel better about myself ____
Changing takes a lot of effort and energy ____
I would function better if I change ____
I would have to give up some things I enjoy ____
I would be happier if I change ____
I get some benefits from my current behavior ____
Some people could be better off if I change ____
Some people benefit from my current behavior ____
I would worry less if I change ____
Some people would be uncomfortable if I change ____
Some people would be happier if I change ____
PROS ____
CONS ____
Add up your scores on the odd-numbered items; this is your current score on the pros of changing. Add up your scores on the even items; this is your current score on the cons.
For people in the precontemplation stage the mean score on the pros of changing is approximately 21. One standard deviation on this test is 7. If your average score is 21, then you will need to raise your pros by approximately 7 points in order to become adequately prepared for action.
If your pros score is below the mean of 21, you will need to apply the processes of change at each stage even more diligently before you progress to the action stage. If your score is above the mean by less than 1 S.D., you will need to apply the processes of change but you will probably be prepared more quickly than many of your peers.
For people in the contemplation stage the mean score on the cons of changing is approximately 21. One standard deviation on this test is 8. If you have an average score of 21, then you will need to decrease your cons by approximately 4 points if you are to become adequately prepared for action.
If your cons score is above the mean of 21, you will need to apply the processes of change even more diligently before you progress. If your score is below the mean but less than 4 points, you will need to apply the processes but you will probably be prepared more quickly than most of your peers.
Only if you have scored both 1 S.D. or more above the mean on the pros (28 points) and .5 S.D. or more below the mean on the cons (17 points) are you ready for action. If you are ready for action, begin your change efforts with the techniques described in the next chapter.
CHAPTER 7
Action—Time to Move
WHEN GEORGE RELAPSED, he blamed his friends and family, just as he always had. He desperately wanted to deny any personal responsibility and return to the precontemplation stage, where he could drink without conflict and without controls. But George had become too sensitized to regress that much. He knew that his drinking would eventually destroy him and that sobriety was going to cost him more than he had expected. Originally, George had hoped to change his drinking habits without having to change the context in which they occurred. There are a few people who can change a problem behavior without restructuring their lives. Such changes are simple, and cost less than more extensive efforts; but for George this approach didn’t work.
George realized he was going to have to give up his drinking buddies, for now at least. And he couldn’t continue to be so close to his extended family, whose intimacies were largely dependent upon beer. George wept. He grieved for the losses he was facing, not only of his friends at his neighborhood bar, but of his personal chair there as well. He grieved too for his family—more for the one he wished he had than for the one with which he had to drink to be a part of. Most of all he grieved for the loss of his old persona, big bad George, who could raise hell and then walk away from it unscathed.
He devised a new computer program, and called it DAD.1 for Damn All Drinks (the number .1 is traditionally given to a new edition of an existing program). The new program paralleled
his old one, rewarding him, for example, when he reached his goal for the day. But George was aiming now for total abstinence from alcohol, rather than for controlled drinking. Alcohol-free beer was still an item on his shopping list, but only for when he felt particularly tempted at home, and he stopped going to bars entirely.
George also reprogrammed his computer to reward him for the processes of change he applied. Going to the gym instead of his local bar brought kudos from the computer. Asserting himself at a family gathering by insisting that he would drink soda without any sauce was reinforced by DAD. 1 messages: “Someday they will see the light, George.” George’s children would type in affirmations: “Do you realize you have been sober for 25 days? That’s terrific!”
George also had DAD.1 suggest alternatives for his temptations to drink. Whenever he was at a loss, his computer spit out things like “Listen to [M. Scott] Peck’s recording of The Road Less Traveled,” “Talk to your children,” “Go for a walk by the ocean,” “Visit a friend,” or “Call your sponsor.”
Conscious that his old friends and family supported his alcohol abuse rather than his sobriety, George restructured his social life and sought out sober support. Alcoholics Anonymous offered alcohol-free social interactions and helping relationships. Going to A.A. meetings helped him not only at home but when business took him on the road. In the past being anonymous in strange cities had given George an excuse to act out. Now he could be anonymous with others who cared about staying sober and healthy.
These acts marked George’s entrance into the action stage. He purposefully modified his life in order to alter his behavior. He made his strongest commitment ever to quitting drinking, and made sure his home and social environments supported his efforts.
Real, effective action begins with commitment. Once the commitment to change is made, it is time to move; in the action stage the focus is on the processes of control, countering, and reward, with a continuing emphasis on the importance of helping relationships. The use of these processes continues throughout the action stage, which usually lasts for months.
Even if you have done all the necessary preparation, there are no guarantees that your action will be successful. Awareness of the pitfalls will greatly increase your chance of success. The four following approaches to action all leave self-changers spinning their wheels, unable to proceed.
Taking preparation lightly People too often equate action with change. This attitude ignores the need for adequate preparation. After a day or weekend of eating, drinking, or fighting too much, people feel the need for emotional relief. To assuage their guilt and anxiety, they promise themselves to take action the next day. And quite often they do; the morning is rarely a time for indulgence anyway. So temporary, convenient action becomes the rule. More often than not, action without preparation lasts only a day or two. Without the necessary groundwork, the temptation to return to problem behavior is too strong.
Cheap change Some people are unwilling to make any sacrifices in order to change. Cheap change isn’t worth much. Real change takes work, and the more effort you put into contemplation and preparation, the more likely it is that action will bring success. Quitting a habit can require not only an enormous sacrifice of energy, but the pain of others’ disapproval of the anxiety and anger that self-changers can temporarily experience.
Kay, for example, had tried to quit smoking three times. She had been to Smokenders, a hypnotist, and a bioenergetic psychotherapist, but she still smoked heavily. Her husband and four adult children promised they would do anything to help her quit. Their promises were halfhearted: As soon as she became irritable, her family pressured Kay to return to her “regular” self. Since Kay used cigarettes to control her anxieties, of course her “regular” self included smoking.
Kay made a new vow to make quitting her top priority. This time, if her family did not like her aggressive feelings, she wasn’t going to stifle her anger with cigarettes. Kay knew in advance that change would not be easy, or cheap, and she made her plans accordingly.
The myth of the “magic bullet” There are no simple solutions to complex behavioral problems. Yet people continue to fantasize that there is a “magic bullet,” a single “right” technique, that will make it easy to change. Some are attracted to our work because they hope we have discovered just such a miracle cure. When members of the media call us, they often want us to reduce our findings to a single, pithy sentence. According to them, the public demands simple answers; people are used to thirty-second commercials promising lifelong change. “Can’t we just tell them to use relaxation or willpower?” they ask.
We always answer, “No.” Relying on any single technique during action makes no sense. The belief in the “magic bullet” leaves only one, defeating conclusion when success is not immediate: that you are not doing enough and must do more of the same.
More of the same This deceptively simple idea* leads to the stubborn retention of methods that may have been partially successful in the past. Partial success, however, does not guarantee validity forever; situations change. Using “more of the same” techniques often leads to more of the same misery.
Of course, the techniques we apply to our problems make a difference. But by clinging to old methods, we fail to realize that other, perhaps better, techniques exist. Our research consistently demonstrates that no single method is so effective that its use guarantees success. In the action stage, as in all other stages, combining a variety of techniques at the proper time is more likely to bring the desired results. Let’s look now at the different change processes that are especially useful in this stage.
THE SEVENTH PROCESS:
COUNTERING
For decades, research has shown that countering—substituting healthy responses for problem behaviors—is one of the most powerful processes available to changers. Many undesirable behaviors have benefits, for example, helping people cope with emotional distress. When unprepared self-changers get rid of one problem, such as drug abuse, they replace it with another—often the very distress they began taking drugs to avoid. Now these self-changers find that they need to cope with renewed distress, and the easiest way to do that is to return to taking drugs.
When you remove troubled behaviors without providing healthy substitutes, the risk of returning to old patterns remains high. Countering finds preferable substitutes. Five effective countering techniques that self-changers often employ are:
Active diversion
The most common, healthy alternative for problem behaviors is called “active diversion.” Our patients call it “keeping busy,” or “refocusing energy.” Whatever the label, the technique remains the same: Finding an activity that precludes a problem behavior.
The possibilities for active diversion are endless. They include cooking, piano playing, cleaning, doing crossword puzzles, knitting, walking, reading a book, having sex, even calling a friend. In selecting your own diversion, your priority should be one that is enjoyable, healthy, and incompatible with your problem. Watching television obviously does little to prevent overeating; it’s much harder to eat when you’re chopping firewood or exercising.
Exercise
There is no more beneficial substitute for problem behaviors than exercise. The cues for our problems are often physical urges; many successful self-changers learn to transform these urges into cues for exercise. Instead of reaching for an unwanted piece of chocolate cake, for instance, go for a walk. You spare yourself the calories, and you gain the benefits of a good workout.
Omitting exercise from a self-change plan is like fighting a foe with one hand tied behind your back. You may still win, but the odds are against you. Inactive people are not only in poor condition for dealing with physical problems, they are frequently also in poor psychological condition for coping with the distress that can accompany change. Still, a majority of Americans—self-changers included—do not engage in regular exercise.
If you are too busy to exercise, you are simply too busy. You do
not have to become a marathon runner to overcome your problem. A sound program of routine aerobic exercise takes as little as twenty minutes every other day. An aerobic exercise regimen produces a compelling list of benefits:
Improved body image, self-image, and self-esteem
Increased energy, metabolism, and heart function
Increased endorphins (self-produced painkillers)
Decreased anxiety and depression
Decreased body fat and cholesterol
Decreased physical and emotional pain
Although some of the rewards associated with aerobic exercise can be gained from nonaerobic exercises (such as walking, golf, or tennis), the maximum return on your time is achieved by exercising at your aerobic threshold for twenty minutes. The most popular methods are jogging, fast walking, aerobic dancing, swimming, bicycling, and rowing.
To determine your aerobic threshold, subtract your age from the number 220, then multiply the remainder by .7. The result is the heart rate that you should sustain for twenty minutes while exercising. If you are forty years old, for example, you should sustain a heart rate of 126 (220 - 40 = 180 × .7 = 126).