Behavioral Health Minute

January 2008 - Supporting people maintaining life changes

The short summary

Most people can make life changes short-term.  We can help people to make longer term changes by talking about how they can maintain those changes in the face of whatever challenges they can anticipate.

The modestly longer reflection

You will probably recall Mark Twain’s comment that “stopping smoking is easy; I’ve done it a hundred times.”  For most of us, it is not too hard to change some behavior; the challenge is to stay changed.

This is good news and bad news.  The good news is that people usually have some experience with making successful life changes, even briefly, from which you and they can extract wisdom about making changes going forward.

Oh, so you put a lot of energy into eating in a healthy way for a few weeks last fall… how did you pull that off?  Do you think you could get going on that again?

The bad news… or I’d prefer to say “challenge,” is that people do tend to relapse.  Most surveys will predict that the people who take up exercise programs this week with the elliptical trainers they got for Christmas are unlikely to be working out in April.

The literature on maintenance of change suggests some helpful clinical approaches.

1. Help people to anticipate triggers to relapse and to develop some plans about how they could handle them.

When you’ve been off alcohol for 3-4 days, what do you think will be the hardest thing for you?  How will you handle it?

When you’ve been going to the gym again like you did last winter, what do you predict would push you to get off track and stop going?  How do you see yourself dealing with that if it happens?

Triggers, by the way, can be external (“everybody around me smokes”) or internal (“I’m just going to get tired of it and say ‘why bother?’”).

2. Make sure people understand that if they back off on some life change, this does not mean that they need to throw in the towel and stop trying.  Rather than viewing relapse episodes as a confirmation of their inability to change, people can do well if they view relapse episodes as learning opportunities, and then get back on track. 

3. Encourage people to keep focused on why they wish to make changes, and how their lives will be better as they persist.

Follow-up

Have some conversation with people not only about making changes, but about developing plans for maintaining changes.

Fred Craigie, PhD