Changing for Good

by James O Prochaska

  Reminders are equally important for people who are in the action stage. Put NO SMOKING signs in your office, STOP signs on your refrigerator door, or RELAX signs by the phone. These reminders may seem artificial and unnatural, but they are like stop signs at busy intersections, useful for controlling behavior.

  One of the best reminders is a “To Do List.” During periods when self-change is not a priority, this list might read:

  Call John, 10 A.M.

  Tennis, noon

  Pick up milk on the way home

  Put out trash, P.M.

  Adding action goals is a natural extension. If, for example, you are working on losing weight, you might simply add Eat low-fat foods and Exercise to the list. If you are working to reduce anxiety, add:

  5. Relax

  6. Exercise

  7. Counter thoughts

  You can also use the list to reinforce yourself by scratching off the positive techniques you used during the day; checking something off a list is one of life’s little pleasures.

  Environment control self-assessment

  This self-assessment measures your progress in using the environment control process. Once again, 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 remove things from my home that remind me of my problem behavior.

  _____ I leave places where other people are encouraging the problem behavior.

  _____ I put things around my home or workplace that remind me not to engage in my problem behavior.

  _____ I relate less often to people who contribute to my problem.

  _____ = Score

  A score of 8 or less means that you should concentrate more on your use of environmental controls. Taken in conjunction with the other self-assessments in this chapter, a score of 9 or higher indicates that you are ready to move into the maintenance stage.

  THE NINTH PROCESS:

  REWARD

  Environment control modifies the cues that precede and trigger problem behavior; reward modifies the consequences that follow and reinforce it. Historically, rewards have been used to reinforce desirable behaviors, and punishments to discourage undesirable ones. Since even the most ardent behavioral psychologists now believe that punishment tends only to suppress troubled behavior temporarily, we will concentrate on rewards.

  We have met many unfortunate self-changers who argue that they should not reward themselves for changing problems, because they should not have been abusing alcohol, food, or tobacco in the first place. By failing to reinforce their positive self-change efforts, they are essentially punishing themselves. This is a mistake.

  Reward would be unnecessary if resisting temptation were its own reward. If it felt good to decline fattening foods or avoid cocktails, self-change would require little effort. We need to be reinforced when we substitute carrots for chocolate, jogging for cigarettes, relaxation for anger, assertiveness for fear. Successful but naïve self-changers have learned the benefits of reward: They praise themselves for not getting angry, they buy themselves new outfits with the money saved from quitting smoking, they seek family recognition for losing weight.

  There are three invaluable techniques for rewarding positive behavior:

  Covert management

  No matter what behavior you are changing, when cues arise, breathe deeply, tell yourself to be calm, and immediately follow your relaxation response with a private word of congratulations: “Nice job of relaxing,” or “It feels good to be in control,” or simply, “Way to go.” These healthy self-administered pats on the back are examples of covert management.

  If after relaxing or asserting yourself, you immediately begin to feel upset for not indulging your behavior, you are effectively punishing your resistance to temptation. Over time this will weaken your resistance and increase your risk of relapse. Substituting alternatives are self-change exercises that should be rewarded.

  Suppose you slip and give in to temptation. Should you berate yourself? We think not. Although punishing yourself for slips may temporarily suppress undesired behavior, it does not alter it in the long run, because it does not offer suitable alternatives. Calling yourself a fool the morning after you drink is too long after the fact to be effective. Besides, you have already rewarded your slip by having a couple of favorite drinks. The same goes for overeating: If you say, “I shouldn’t have eaten the whole thing,” it’s not only too late, but you have already reinforced yourself by eating the whole thing (and probably enjoying it). If delayed punishments worked, then hangovers and bellyaches would be natural cures for overindulgence.

  Furthermore, covert punishments decrease self-esteem and increase emotional distress. Both of these are barriers to the change process. At this time, you need to believe in yourself, you need to be patient and calm; getting angry at yourself does no good.

  When you correctly reinforce yourself, your self-statements will sound like echoes of positive role models from your past. Private kudos like “Nice going, pal,” or “Good work” make you feel as though you are “reparenting” yourself to learn more mature behavior. Self-reinforcements such as “You can handle it,” or “Don’t give up; you can do it” are reminiscent of teachers or coaches who encouraged you to do your best and to feel good about yourself in the process.

  If you had too much negative parenting, teaching, or coaching in the past, all the more reason to reinforce yourself in the present. Remember, you are in the process of changing your self-image and self-esteem, not just specific behaviors. It is important to feel good about the entire process of change, not just the planned outcome.

  Contracting

  Contracting, whether formal or informal, is used during the action stage. One teenage boy bets another one $10 that he’s going to ask a girl out whom he likes, in order to pressure himself into it. A wealthy father promises his overweight teenage daughter that he will put $100 in an account for every pound she loses; if she loses twenty pounds, she will have enough to buy the horse she has always wanted. Some insurance companies offer $100 discounts to teenagers who make the honor roll; others grant $100 rebates to customers who quit smoking. With a fair contract, both parties gain from desirable changes.

  Not everyone has an individual or company who is willing to contract for a change in problem behaviors, but anyone can make a contract with himself or herself. Written contracts tend to be more powerful than spoken ones, so write out your agreement. For example: “For every pound I lose I agree to put $10 [or whatever you can afford] into a shopping account.” Whenever you need reinforcement, you can draw on your account and reimburse yourself.

  It is important to remember the dual objectives here. You want to reinforce yourself for not engaging in problem behavior, and also reward yourself for substituting a healthier alternative. Consider adding another sentence to the contract in the last paragraph: “I will also deposit $5 for every 30 minutes I spend exercising.” It is often easier to promote a new behavior than to eliminate an old one, and, as we have seen, countering is key to self-change.

  A wealthy woman, who had plenty of extra money for shopping and vacations, wrote a contract stating that for every pound she lost she would donate $20 to CARE. It was a powerful reward for her to know that by doing this the food she did not eat might be used to support a starving child. When she felt tempted to indulge, she thought of how she could help someone besides herself by exercising self-control. This was a brilliant contract, and it truly helped this woman conquer her overeating.

  One problem with contracts, of course, is that they can be unilaterally broken. No one is there to enforce them, so you must be unerringly honest with yourself when you enter such a contract. Although your honor may not be at stake, some of your self-esteem is on the line.

  Shaping up

  Overcoming problems requires that
you gradually shape your behavior in a new, desirable direction. A person can’t overcome agoraphobia, for example, all at once.* Using willpower to plan a vacation may be well intentioned, but panic reactions at the first bend in the road, or even the first step over the threshold can drive the agoraphobic back to the security of home. Setting yourself an immediate goal that is ambitious but unreasonable virtually guarantees failure.

  A step-by-step approach, with reinforcement following each successive movement, is much more likely to be successful. A phobic person might begin by walking to the end of the block; the next step might be to walk part of the way around the block. Each step takes the person farther from the safety of home, each step is reinforced, and any feelings of anxiety are countered with relaxation.

  The first step on your own personal path may seem simple and unworthy of being rewarded, and many people withhold rewards until they make more visible progress toward their goals. But the more difficult steps of the action stage must be built on a solid, well-reinforced foundation. When you slip (and most of us do), you want to ensure that you don’t fall all the way. Well-practiced, well-rewarded earlier steps are good insurance that any slips will be brief lapses rather than complete relapses. Overcoming a problem is hard enough without depriving yourself of well-deserved reinforcements along the way.

  Reward self-assessment

  Here is a self-assessment to gauge your progress in using the reward process. 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 do something nice for myself in return for not giving in to my problem.

  _____ I counter the temptation to punish myself with covert reinforcements.

  _____ I reward myself for small self-change steps.

  _____ Other people in my daily life try to make me feel good about changing.

  _____ = Score

  Taken in conjunction with the other self-assessments in this chapter, a score of 9 or higher on this self-assessment indicates that you are ready to move into the maintenance stage. A score of 8 or less means that you should devote more time to thinking of helpful rewards for yourself.

  HELPING RELATIONSHIPS DURING ACTION

  Action is the busiest period of change. Now more than ever, you need to depend on your helping relationships. Think of your problem as an old piano that needs to be carried down a flight of stairs. There is no way you would undertake such a task without calling on a few friends for assistance. Use the same strategy here and let several people help you to bear your problem away.

  We hope that you began to share your burden by going public during the preparation stage, and by discussing your plans and goals with significant people in your life. We have heard countless self-changers complain about family members who did not care or support their change efforts. In many instances, however, the accused responds, quite honestly, that he or she was never told about the change. The changer then snaps, “Well, you should have known it!”—an overused variation on the if-you-really-loved-me-you-would-read-my-mind complaint.

  Don’t assume that your spouse or anyone else will intuit your plans; go public and do it clearly. Remember, too, that change is a life-saving operation; let people know that even if you become anxious, irritable, confused, and difficult, you want and need their support.

  There are other ways in which helpers can assist with the change processes you will be using in the action stage:

  Exercise together Running, walking, aerobic dancing, even relaxing are easier and more fun with a loved one or a friend. Ask one or more of your helpers to join you in your countering techniques.

  Buddy up There are times when two people, working as a team, are able to change themselves more effectively than either can alone. John and Nancy Norcross, for example, are more successful maintaining a healthy diet together than separately.

  Rearrange your home An agreement with your family to ban high-fat foods, smoking materials, or alcohol from your home gives you a terrific advantage. Helpers can play an important role in controlling your environment so that you can avoid tempting cues.

  Put it in writing As any lawyer will tell you, written contracts are the most binding. In order to bind yourself—and your helpers—to your self-change contract, write it down and distribute it to all concerned parties. The contract can specify your starting date, your goals, and the countering techniques and rewards you will be using. Make sure, too, to specify your helpers’ commitments. This will not be an easy time for them either.

  Roy, a bank auditor, constructed the following contract to control his angry outbursts:

  Starting Saturday, December 4, I will do my best to keep from blowing up:

  a. I will talk with Becky about my frustrations and stresses before they get the better of me.

  b. I will let my daughter know if I’m in a bad mood.

  c. If I slip up, I will catch myself as soon as possible and apologize for any outburst.

  2. In return, Becky will do her best to be more positive and less critical:

  a. She will let me know she appreciates it when I handle a frustrating situation without blowing up.

  b. She will try to be more supportive when I am having a bad day.

  c. She will help me to explain to our daughters that I am working on my temper.

  Get “stroked” Many of our research participants complain of a lack of steady reinforcement. We encourage them—and you—to elicit rewards from helpers for even small amounts of progress. Tell your helpers that “strokes” come in many guises: Helpers can brag to others about your progress, or take on a dreaded chore for you. Verbal praise, monetary rewards, extra hugs, small presents, back massages, and the like are all useful rewards.

  Don’t take guilt trips Scolding, nagging, preaching, and embarrassing are not forms of support. Write in your contract that helpers should not use these “methods,” even if they are well intentioned, because they increase distress and eventually backfire on the helper.

  Keep it positive Many family members are mute supporters for seven consecutive days of progress, but become vocal critics the one day you slip. Tell them at the start that reinforcement is superior to punishment in behavior change, and ask them to monitor the ratio of their positive to negative comments; we recommend at least three compliments for every criticism.

  Seek support for life If you are short on significant others, or if family and/or friends cannot give you the support you need, find a local support group. People who are struggling with the same problems can reinforce you, guide you through the rough spots, and remind you of the benefits of changing.

  Group support need not come from formal organizations. One of the most successful support groups I’ve ever known involved seven women who worked in the same office. They met twice a week to share their dieting concerns. They ate a low-calorie lunch together on Tuesdays, and coffee (no doughnuts) on Friday mornings. Successful as they were, they resented being called a “group” they were, they said, “just a bunch of women talking.”

  Whatever the source of your helping relationships, they are of vital importance during the action stage, and will remain extremely potent as you transform your short-term changes into long-term revisions during the maintenance stage.

  GAIL TAKES ACTION

  Once she started taking action, Gail’s morale ran high for several weeks. She exercised regularly. She ate what she considered to be a low-fat diet. Gail felt good about focusing on being healthier and eating better rather than on looking better. She liked being more active and getting into shape. She hoped she would learn to like fat-free foods. She reminded herself that she had come to love skim milk and found that she disliked 2 percent milk, which to her tasted like coffee cream. By considering these positive feelings, Gail reinforced herself for the actions she was taking.

  After about
four weeks her morale fell when she discovered that she wasn’t losing any weight. She found herself focusing too much on weight loss again, and knew she needed to do something to keep herself from relapsing to this old and narrow goal. So Gail determined to redo her decisional balance. She reevaluated how she was living and who she was becoming. Fortunately Gail was able to reaffirm the many values that her new lifestyle reflected: She had taken more responsible care of herself and was helping prevent a whole range of chronic diseases; she had more energy, was in better condition, and felt less sluggish; her stress level was lower; and she was becoming less preoccupied with her appearance.

  Now she could counter defeating thoughts with the realization that regardless of what happened to her weight she was winning. She was feeling better and eating better even if she didn’t weigh less. Gail also drew support from her helping relationships. Friends encouraged her to trust that her weight would soon respond to a healthier lifestyle. So Gail decided to reaffirm her commitment to her diet and exercise regimen.