Changing for Good

by James O Prochaska

  Be sure to consult your physician before beginning an exercise program. Work up gradually to your aerobic threshold. And do not confuse recreation with exercise. As much fun as they are, bowling, golf, and sex definitely do not qualify as aerobic exercise.

  Relaxation

  In many situations, there is no way to counter a problem cue with exercise. If the work day is tense, for instance, and you feel the need for a cigarette, you are unlikely to counter the urge with a quick jog. There are times, too, when a recent injury temporarily suspends exercise. Relaxation is one technique that can rescue you at a time like this.

  In recent years, researchers have found that deep relaxation produces a mildly altered physical and mental state. Ten to twenty minutes of deep relaxation each day can give you:

  Increased energy

  Increased rate of alpha (pleasurable) brain waves

  Decreased blood pressure and muscle tension

  Decreased anxiety

  Improved sleep

  Improved health

  Improved concentration

  There are many popular and effective ways to evoke the deep relaxation response. Watching television is not among them! Transcendental meditation, prayer, autogenic training, yoga, and progressive muscle relaxation are the best-known methods, and all share these four elements:

  A quiet environment

  A comfortable position

  An internal focus

  A “letting go”

  Police officers who have been trained to relax when rushing to emergency calls are better prepared to cope with physical turmoil or domestic violence. On the other hand, if they arrive at the scene with their adrenaline pumping, they are more likely to intensify the situation than pacify it.

  You can give yourself the same advantage. When you practice deep relaxation regularly, you can call on a milder form of the response when you need it most. Instead of taking a cigarette or coffee break to relax, just sit back, breathe easy, let your muscles and mind go for a while, and tell yourself to be calm. Relax those muscles that you are not using. At a tense meeting, for example, you don’t need your knees to bounce nervously. Thinking of a favorite, quiet place—perhaps the one you use for deep relaxation at home—can also help you to evoke the relaxation response.

  Counterthinking

  Freeing yourself from rigid behavior patterns often requires that you also free yourself from rigid thought patterns. Just as exercise substitutes healthy for unhealthy behavior, counterthinking replaces troubled thoughts with more positive ones. Successful self-changers often rely on counterthinking more than on relaxation because this technique is quick, covert, and takes relatively little energy. It can be used under almost all the conditions that trigger problem behaviors.

  Many people make themselves anxious by allowing distressing thoughts such as “It will be awful if my dinner party doesn’t go well,” “It will be terrible if she gets the promotion instead of me,” or “I will be crushed if he is angry at me” to get the better of them. The effective countering of irrational self-statements requires practice, since such statements tend to be automatic, subconscious, and compelling. Consciously practicing counterthinking prepares you to challenge the self-statements that trigger your problem.

  Irrational thoughts are best countered with a dose of reality. An airplane crash is awful; the sinking of the Titanic was terrible. Although burning the dinner may be inconvenient, it is far from a disaster. An angry spouse is unpleasant, but not terrible. By counterthinking in this way, you become freer to cope with genuinely troubling situations. Molehills can remain molehills, instead of becoming mountains.

  To counter other types of negative thoughts, first ask, “What am I telling myself that is getting me so upset?” A problem drinker, for example, might go through a thought process something like this:

  What am I telling myself that makes me want to drink? If I tell myself I can’t stand going to a cocktail party without drinking, then I have only two choices: Drink or don’t go.

  A more rational self-statement could help this person counter these negative thoughts:

  Realistically, there are very few things that I cannot stand if I have to. If I tell myself, “It’s harder to go to a cocktail party without drinking, but I can stand it,” then I can go to the party without having to drink. I can respond to the internal and social pressures to drink with relaxation and counterthinking.

  Counterthinking makes sense. Many of us could substitute healthier thoughts for some irrational self-statements* such as these:

  I must have everyone like me.

  I can’t stand it if someone doesn’t approve of me.

  I should be thoroughly competent at everything I do.

  It’s awful when I make a mistake.

  I can only feel good about myself when I am doing well.

  I can’t control my anxiety (anger, despair, or other feelings).

  I can’t resist the urge to smoke (drink, eat).

  I can’t stand the tension and craving that occur when I am withdrawing.

  I can’t stand it when the world doesn’t treat me fairly.

  I need to drink (smoke, eat) in order to cope with life’s stresses.

  Common to these self-statements is a mode of thinking that is absolutist, rigid, and closed to questioning. When you are absolutely sure of something, then you cannot question yourself. If you must do a thing, then there are no logical alternatives for you. This type of thinking is the equivalent of painting yourself into a corner. Although all humans have a propensity to think in absolutes, some do it more than others (especially individuals raised by dogmatic or overcontrolling parents).

  To become more aware of your own tendency to think absolutely, take note of the number of times you say, “I have to…” or “I need…” or “I must…” in a day. How many of these declared needs are truly imperative? If we deny biological needs for sleep, nourishment, bodily relief, and protection from the elements, we can suffer irreversible harm. Otherwise, the vast majority of our “needs” are desires. Whenever a desire is expressed as a need, and it is not met, we become agitated, like a child who cries, “I need this toy.” But if we recognize desires as desires—“I would like this toy”—our distress diminishes.

  In Slouching Towards Bethlehem, Joan Didion puts the point more eloquently:

  Because when we start deceiving ourselves into thinking not that we want something…but that it is a moral imperative that we have it, then is when we join the fashionable madmen, and then is when the thin whine of hysteria is heard in the land, and then is when we are in bad trouble.

  All human beings have the ability to think rationally and realistically. We all can realize, “Even if I am probably correct, there is still room for questioning.” Thus we can allow discussion, disconfirmation, and new evidence to change our minds. Changing your mode of thinking isn’t easy. But the very act of questioning and challenging absolutist thinking is a valuable start. And by repeatedly practicing counterthinking, you begin to increase your mental flexibility and your capacity for self-change.

  Assertiveness

  Problem behaviors can be expected, supported, and triggered by other people in your life as well as by internal forces. Self-changers sometimes feel despondent and helpless in the face of external pressures to maintain their problem behaviors. However, by being assertive, you are exercising your right to communicate your thoughts, feelings, wishes, and intentions clearly, thereby countering feelings of helplessness.

  Unlike exercise and deep relaxation, assertiveness is not an activity that must be scheduled. It is a technique that you can use whenever you feel you are not being heard or respected. The benefits of exercising your right to be heard, and to change, are:

  Decreased anxiety, anger, and neuroses

  Increased self-respect, communication, and leadership abilities

  Increased satisfaction in all personal relationships

  Most people can be assertive, but many become inhibited beca
use they do not believe they have the right to be powerful. You may not realize that you have all of the following rights, and may be depriving yourself by not acting upon them:

  The right to be heard

  The right to influence other people

  The right to make mistakes

  The right to bring attention to yourself

  The right to change your mind

  The right to judge your own thoughts and feelings

  The right to resist other people’s judgments

  The right not to have to justify yourself

  The right to have limits—limited knowledge, limited caring, limited responsibility for others, and limited time

  The right to have your limits respected

  When you accept and act upon these rights, you are more likely to be assertive. And when you acknowledge that all people have the same rights as you, you will not confuse assertion with aggression. If nonassertive, passive behavior says that “you count, but I don’t,” and aggressive behavior says that “I count, and you don’t,” assertiveness respectfully communicates that “I count just as you do.”

  These are important but frequently overlooked distinctions. Assertion does not accomplish goals at the expense of another person, as aggression does, nor does it deny your own rights, as does passivity. Rather, assertiveness grants all parties their rights.

  Whenever your response is more assertive than a situation warrants, it will probably be experienced as aggression, and it will generate counteraggression rather than compliance. If you are unsure whether your action is assertive or aggressive, complete the following mental checklist:

  Did I express my rights?

  Did I respect his or her rights?

  Was I specific about a behavior change?

  Affirmative responses to these questions means that you were being assertive rather than aggressive. Of course, assertion doesn’t guarantee that other people will honor your feelings or requests. What effective assertiveness does assure is that others will have an opportunity to understand your objectives, and hence you will have increased your chances of meeting them. If you don’t make it clear how you want others to help you change, this pretty much guarantees that they won’t do it.

  Rhonda had always had a morbid dread of doctors. A critical situation was approaching; she had to enter the hospital for a minor operation. Rhonda was learning to be assertive about the process. Rhonda asked for a nurse who was willing to help her through her phobia of having blood samples taken, which were needed before the surgery. With the nurse’s help Rhonda also found an understanding surgeon. In a pleasant but assertive style Rhonda set the following conditions:

  She was free to reschedule the surgery if her anxiety became too great;

  She would get to wear her own nightgown, rather than the standard hospital gown (the thought of wearing the kind that opened in the back made her feel vulnerable and exposed); and

  Her husband would be present to provide support.

  While Rhonda’s physician was unused to a patient setting the conditions of surgery, given the circumstances he welcomed her assertiveness. Fortunately, the operation went well, and Rhonda was able to function better both physically and psychologically.

  Countering self-assessment

  Here is a self-assessment to check your progress in using the process of countering. 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:

  _____ I engage in some physical activity when I am tempted to engage in my problem behavior.

  _____ When I feel the onset of my problem, I try to relax.

  _____ I find that other activities are a good substitute for my problem.

  _____ When I feel my problem behavior coming on, I think about or do something else.

  _____ = Score

  A score less than 12 means that you have more work to do in countering. A score of 12 or more on this self-assessment indicates that you are ready to move into the maintenance stage, provided the other self-assessments in this chapter also indicate your readiness to proceed.

  THE EIGHTH PROCESS:

  ENVIRONMENT CONTROL

  You can do all the countering in the world, but if you go out to a bar every night, you will not be able to control your drinking; if you head to a fancy restaurant when you get hungry, you will fail in your attempts to control your eating; if you say yes to every new project at the office, it will be difficult to avoid overworking. Unlike countering, which involves changing one’s responses to a given situation, environment control involves changing the situation itself. Both are necessary for successful change.

  Earlier in the twentieth century, behavioral psychologists demonstrated that much of our behavior depends upon our surroundings. Most of us, for example, are more on edge in noisy environments than in quiet ones, and more distressed when alone than when in the presence of supportive people. Behaviorists also discovered that to a considerable extent we can change our environment to control behavior, making and unmaking it so as to fit our needs and desires.

  Environmental change involves restructuring your environment so that the likely occurrence of a problematic stimulus is significantly reduced. The changes can be quite simple. When I was a graduate student, I developed an anxiety about driving. It began after my car started shaking violently one day. Before long a universal joint broke with a startling noise, and luckily I managed to pull the car over to the shoulder. After I had the joint fixed, this event occurred two more times. A mechanic finally discovered and fixed the real problem (a bent drive shaft) but it was too late: I had developed a morbid dread of driving. I stopped driving, which did reduce my anxiety, but which made daily errands more difficult. Finally I used the environment control process and sold the car. And since my anxiety did not extend to the new car I purchased, the problem was solved.

  Not every solution is quite so obvious. But there is always some way in which you can modify your environment. Like active diversion, control can take many forms, especially if you use your imagination. Spending time in a gym rather than at a bar is an example of control. I knew an eighty-five-year-old widow who devised a novel control technique. She would walk to a nearby funeral home whenever she felt alone. She would tell the deceased’s family, “He was such a nice man,” and help them as she helped herself!

  Most of us already work hard to create a comfortable environment at home and at the workplace. Now it’s time to put these environments to work for you. Here are some control techniques that will help you do so:

  Avoidance

  Many people believe that they must rely on willpower alone to resist temptation. However, avoidance, because it helps eliminate temptation, is a key technique of the control process. Avoidance is not a sign of weakness or poor self-control; in fact, effective self-control includes the ability to prevent a problem from starting.

  Avoiding avoidance is foolhardy and dangerous. We have heard many unsuccessful changers say, “I need to have alcohol around for company,” or “I need to have junk food around for the kids,” or “I hate to throw a whole carton of cigarettes away.” Such statements are self-defeating. If you are quitting drinking, it makes sense to avoid keeping liquor in the house. Smokers are equally smart to remove cigarettes or ashtrays from their homes, and overeaters to get rid of fattening foods.

  Avoidance needn’t be limited to objects. If you are an adult and your parents upset you, you may feel justified in avoiding them for a time. If being inactive depresses you, don’t lie on the couch watching television. If going to rock concerts causes you to hanker for drugs, steer clear of those stressful situations.

  Cues

  Avoidance is not a permanent solution; eventually you will experience the cues that trigger your problem behavior. To prepare yourself to meet the challenge, you must gradually expose yourself to
those cues as you progress through the action stage. Practicing cue exposure without responding in self-defeating ways will gradually increase your resistance.

  Many successful self-changers have found that it helps to first confront problem cues in their imagination. For example, if your parents are a source of distress, imagine that you are visiting them, and the first thing they do is criticize you for avoiding them. Visualize yourself breathing deeply, relaxing, and saying, “I understand why you’re upset, but I’ve needed more time to myself lately.” Plan how long you are going to remain with them, under what conditions you will leave, and how you will continue to counter troubling cues.

  As you successfully imagine your effective responses to problem cues, you will become better prepared to deal with problematic situations when you confront them in real life. It’s a good thing, too—sooner or later you may want to visit your parents, attend a cocktail party, dine out on a special occasion…in short, engage in activities that have historically cued your problem behavior. But you will already have taken the necessary steps to counter whatever situation arises.

  Reminders

  Everyone uses clocks and calendars to help control their behavior. These simple tools remind us of how we are to respond next—when it’s time to eat, go to work, take a break, or leave for vacation. We take these cues for granted; we find it natural to control our lives by reminders.