I am aware that as we come into the last few days of Dry January I have not really provided anything helpful in terms of how you can make changes and stick to them, be it in relation to drinking, smoking, dieting or exercising. I will try to redress the balance over the next couple of posts or so. Some of the material can then be replicated in the main body of this website as static pages that people can more easily access. It is after all a self-help website, although I do have problems with that terminology. It does carry (unintentionally) undertones of “pull yourself together” and “I did it and therefore so can you“. What works for one person may not work for another, and everyone has a different starting point.
It is probably evident from all I have written in these posts and elsewhere on the site that I come from a strong behavioural background. The roots probably lie in my hospital work with people who had severe learning difficulties, and was then reinforced (!) by the strong emphasis placed on learning theory on my psychology undergraduate course. Later, when I did my clinical training, I was introduced to thinking – hence my allegiance now to cognitive-behavioural approaches. These ideas are briefly outlined in the Home page, and developed in the latter workshops. Other psychological theories and models are available. I just found that my academic background and clinical experiences seemed to lend themselves well to the areas of addiction and eating disorders.
Let’s start with motivation, because that is exactly why you are here reading this and why I am here writing this. In essence, motivation is the reason you are doing whatever it is you are doing at any given point in time. It is the unseen engine that keeps us chugging along. Not surprisingly, our motivational systems have evolved to increase the chances of our survival. We have the basic drives that ensure we eat, drink, procreate, flee or fight danger, avoid pain and seek pleasure. That’s basically Saturday night sewn up. Then we have the more complex motivations around being loved, accepted by others, achieving stuff, becoming better people, making the world a better place and so forth. I usually attend to that stuff on Sundays.
Motivation is very mercurial, shifting all the time. You wake feeling ready to go to the gym, put in the hard work, come home and have some kind of broccoli smoothie (why would you?!) and then open your books to study ancient Greek philosophy (again, as the Greeks might have said, why?!). But on your way to the bathroom you notice that it looks a bit wet outside, and your knee has a bit of a twinge, probably give the gym a miss. Making a smoothie is a bit of a palaver, so just pour yourself some of the kids’ cereal. Books on Greek philosophy? What does it all mean? Never mind, there’s a great series on Netflix to catch up with. Familiar? That’s motivation!
The behavioural sequence described above has a cognitive and emotional soundtrack – it was changes in your thinking and feelings that led to the day taking a completely different turn. You thought yourself out of going to the gym, having that smoothie, studying Greek philosophy. Relaxing with a bowl of sweet cereal while watching Netflix won the day. Will those choices – because that’s what they were – help you meet your personal goals? What did you tell yourself? What knowledge or information led to that kind of decision-making? Are your personal goals no longer important to you? Or maybe you think the goals are too unrealistic, or that you lack the confidence or ability to achieve them. Or maybe you believe you don’t deserve to achieve those goals. Motivation was probably simpler when we were hunter-gatherers. Certainly didn’t have the smoothies then.
We looked in earlier posts at the Stages of Change Model and its links with Motivational Interviewing. To recap, it is proposed that people making health-related changes in their behaviour pass through a number of stages. The first is known as pre-contemplative – the person is not even thinking about making changes, may not have noticed any links between their behaviour and negative things in their lives. The second stage is contemplation – starting to think that if maybe they reduced their smoking/drinking/fast food, then their health might be a bit better. The seeds of change have been sown but not yet germinated. The third stage is action – putting a plan in place to effect change and acting on it. The fourth stage is maintenance – having made the changes, this is about keeping it going. It is in theory the longest stage, but also the hardest.
Which brings us to the fifth stage – relapse. While this is described as a stage in the model, I prefer to see it as a counter-force to change, a kind of headwind you have to continually battle against. It can be tiring and it can sap hope and ambition, so it is no surprise that relapse is the norm in health-related behavioural change. And it can occur at any point in the change cycle – it is possible to move from contemplative back to pre-contemplative. It can sometimes be helpful to distinguish between lapses (like having a day off) and relapses where the person really has gone back to an earlier stage. There is a phenomenon known as the abstinence violation effect. Here a small lapse turns into something more dramatic. The single scoop of ice-cream signals complete failure with the diet, so the person dives into a litre tub of chocolate chip ice-cream. How the person reacts to this can spell the difference between a complete relapse and just a lapse. If the person makes internal attributions regarding stable and/or global factors such as personal failings or lack of willpower, then a full relapse is most likely. If the person makes external attributions to unstable and/or local factors (e.g., a particularly stressful or tempting situation) then a lapse is the most likely outcome.
I asked in the title if your cogs are dissonating. Cognitive dissonance theory was developed by Festinger in 1957 and it has begat a huge amount of academic literature over the years. The basic tenet of the theory is that where we notice a conflict (dissonance) between two thoughts or beliefs we hold, or between our beliefs and behaviour, then we experience this dissonance as unpleasant. And returning to our earlier thoughts on motivation, we are motivated to resolve the dissonance because it is uncomfortable. If I drink while knowing it is harmful to my health, then I can stop drinking. End of dissonance! Motivational Interviewing in part aims to create this cognitive dissonance (especially to help people to move from contemplation to action). However, we must remember the words of Henry Youngman…
When I read about the dangers of drinking I gave up reading.
Thus dissonance can be removed by changing the behaviour or the belief. There is some evidence to suggest that drinking actually reduces the discomfort of the dissonance, thus alcohol use becomes negatively reinforced. Which rather defeats the object. Another strategy is to lessen the dissonance by finding evidence to undermine the belief that the behaviour is harmful or by finding reasons why it is important to continue with the behaviour – such as the positive benefits it might bestow.
Like a good whisky maker, I will now try to distill from the above ramblings some wise spirit that can be sipped at leisure. Today I will mostly focus on the early stages of change, and tomorrow I will look in more detail at maintenance and relapse.
- Think about a health-related behaviour that you might want to change.
- What are the most important things in your life at present?
- How does your current behaviour relate to these priorities?
- What would be different if you made changes? [Impact assessment]
- Do you feel confident about making changes?
- How will changes affect those closest to you?
- Do you have goals which the behaviour is preventing you from achieving?
- Can you identify any cognitive dissonances – incompatible beliefs and behaviour?
- Is the change about stopping a behaviour or starting a new one? [Matter of perspective]
- Set yourself goals, but they need to be realistic.
- Make small changes and build on them. Don’t rush it.
- Examine your daily habits and identify those that are helpful and those that are not.
- Develop alternative habits that are compatible with your goals.
- Make a note of the positives of changing vs the positives of not changing.
- Make a note of the negatives of changing vs the negatives of not changing.
- Evaluate your notes – maybe put them in tabular form.
- Examine your unhelpful thoughts and beliefs – the above notes will give you some insight into these.
- More info here on helpful thinking.
I hope you have found this post enjoyable and helpful. Until tomorrow, keep safe and well.
Alcohol Trivia Quiz
Yesterday’s answers:
1. The Archers
2. Ernest Hemingway
3. Oasis
Today’s questions:
1. What brewery had the famous red barrel logo?
2. Under what age is it illegal to give a child alcohol in UK?
3. What is Pisang Ambon?
Understand Yourself Better 