Why Health Coaching?€¦ · Summarize the latest thinking about the brain and behavior change...

The Emerging Science of Health Behavior Change© 2016, CKD Associates, LLC 1

THE EMERGING SCIENCE OF HEALTH BEHAVIOR CHANGE

Cynthia Knapp Dlugosz, BSPharm, ACC

Certified Integrative Health Coach

1

Accreditation Information

► “The Emerging Science of Health Behavior Change” is accredited by ACPE for pharmacists and technicians ACPE #0154-0000-16-011-L04-P

ACPE #0154-0000-16-011-L04-T

► Cynthia Knapp Dlugosz has not disclosed any financial or conflicts of interest in relation to this program

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Learning Objectives

► Summarize the latest thinking about the brain and behavior change

► Identify elements of an effective behavior-change strategy

► Explain what is known about habit formation and habit change

► Recognize how information about successful behavior change can be applied to pharmacists’ interactions with patients

3

Why Health Coaching?

“…people rarely made positive changes in lifestyle behaviours after they had been diagnosed with a chronic condition.”

4

Newson JT et al. Health Rep. 2012 Dec;23(4):49-53.


5

Transtheoretical Model

► Maintenance: “I still am”

► Action: “I am”

► Preparation: “I will”

► Contemplation: “I may”

► Precontemplation: “I won’t” or “I can’t”

MI

Coaching

nursing.buffalo.edu/Research/TranstheoreticalModel.aspx

“…hope-filled periods of temporary success that are

soon followed by a return to old behaviors.”

The Yo-Yo Change Cycle

Integrative Health Coach Professional Training Program Manual, Duke Integrative Medicine

7

The Undertow

► “…the mysterious force that sabotages our best efforts when we’re on the edge of victory”

Richard O’Connor, PhD

Rewire: Change Your Brain to Break Bad Habits, Overcome

Addictions, Conquer Self-Destructive Behavior

8


CYNTHIA’S PRINCIPLES OF CHANGE

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Change Is Personal

► Every brain is different What works for you may not work for me

My solution is better than yours

10

Change Involves Actions

CurrentBehaviors

NewBehaviors

► “Lose weight” is an outcome

► To lose weight, we must change actions—individual decisions and behaviors

Fogg Behavior Grid

Green

Behavior

Blue

Behavior

Purple

Behavior

Gray

Behavior

Black

BehaviorDo new unfamiliar

behavior

Do familiar behavior Increase behavior

intensity or duration

Decrease behavior

intensity or duration

Stop doing behavior

Dot BehaviorDone one time

Try eating dried

seaweed for a

snack today

Eat vegetables at

dinner tonight

Eat two green

vegetables at

dinner tonight

Eat only half of a

hamburger

tonight

Don’t buy ice

cream this time

while shopping

Span BehaviorHas duration

(e.g., 30 days)

Substitute quinoa

for rice for 1

month

Drink water each

morning this week

Eat more

vegetables at

dinner for 2

months

Eat fewer

carbohydrates for

1 week

Don’t use sugar in

coffee for 2 weeks

Path BehaviorDone from now on;

permanent change

Adopt a vegan

eating pattern

from now on

Take a daily

multivitamin from

now on

Increase health

eating options in

home

Decrease fried

foods in diet from

now on

Stop eating fast

food forever

Source: http://bjfogg.com/fbg.html

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Change Requires Choices

► Behavior changes compete for time and attention with many other daily priorities

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Change Is Rarely Urgent

ImportantNot Urgent

ImportantUrgent

Not ImportantNot Urgent

Not ImportantUrgent

Stephen Covey, The Seven Habits of Highly Effective People14

WHY DO WE DO WHAT WE DO?

15

Motivators

Pursue

► Pleasure

► Hope

► Social acceptance

Avoid

► Pain

► Fear

► Social rejection

16

Fogg BJ. A Behavior Model for Persuasive Design. http://bjfogg.com/fbm_files/page4_1.pdf


OUR TWO BRAINS, PART 1

17

Our Two Brains, Part 1

Automatic self

Conscious self

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Automatic vs Conscious Self

Automatic Self

► Limbic system

Conscious Self

► Neocortex

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Automatic Self

► Reflexive

► Works without attention or effort Instinct

Habits

Routines

► Reacts quickly

Conscious Self

► Reflective

► Thoughtful, deliberative

► Can only focus on one thing at a time

► Processes information slowly

20



Automatic Self

► Directs much of what we do on a daily basis

► Helps the brain save energy

Conscious Self

► Reflects on, challenges, corrects the automatic self

► Requires more energy

21

It takes more effort to think about and do something new than to

react out of habit

UNDERSTANDING HABITS

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► The Power of Habit

► Charles Duhigg

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“…the choices that all of us deliberately make at some

point, and then stop thinking about but continue doing”

http://charlesduhigg.com/the-power-of-habit/

The Habit Loop

• Physical

• Mental

• Emotional

24

Dopamine!

Craving


How Habits Form

Attention-directed behavior

Activity in prefrontal

cortex

Repetition

Activity in basal ganglia

Automated response

25

Working memory glucose requirements

Working memory freed up glucose requirements

“…when habits become entrenched in the neurons of the

basal ganglia, our current intentions or goals cease to have

much impact on them.”

Wendy Wood, PhDDuke University

26

UNDERSTANDING PLASTICITY

27 28

The brain's ability to reorganize itself by forming new neural connections throughout life

http://www.medicinenet.com/script/main/art.asp?articlekey=40362


29

Neurons that fire together, wire together

30

Old habitsNew habits

31

Our old habits become the brain’s default circuits when

we are faced with temptation, fatigue, or

stress

UNDERSTANDING WILLPOWER

32


► The Willpower Instinct

► Kelly McGonigal, PhD

33

“…the strength or willingness to do

what matters most to you”

34

Willpower is the most

commonly cited barrier tomaking

lifestyle changes

32%

0%

5%

10%

15%

20%

25%

30%

35%

Source: Stress in America 2015, American Psychological Association

“I will” power

Do what you need to

“I want” power

Remember what you really

want

“I won’t” power

Say “no” when you need to

35

Left prefrontal cortex

Right prefrontal cortex

Ventromedial prefrontal cortex

McGonigal K, The Willpower Instinct

Automatic Self

► Limbic system

Conscious Self

► Neocortex

36


Willpower can be

depleted

Willpower can be

strengthened

37

OUR TWO BRAINS, PART 2

38

39

Our Two Brains, Part 2

Emotional brain

Rational brain

40

Automatic self

Conscious self


41

Image: Shutterstock.com

Emotional Brain: The Elephant

► Limbic system

► Directs much of what we do on a daily basis

► Concerned primarily with pleasure (vs. pain) and safety (vs. danger)

► Values instant gratification over long-term gain

► Prefers the status quo

42

Rational Brain: The Rider

► Neocortex

► Reflects on, challenges, corrects the automatic self

► Plans, directs, decides

► Prefers analyzing to doing

► Paralyzed by too many choices

43

Change attempts usually originate with the Rider


44


Change happens because of the Elephant


45

The behavior change dilemma


46

Whenever the Rider and Elephant disagree,the Rider is going to lose

47

Behavior change typically involves short-term sacrifices

for future rewards


48

The Elephant prefers the status quo and immediate gratification



Temporal Discounting

► The longer you have to wait for a reward, the less it is worth to you

49

Choice 1:Get two

right now

Choice 2:Wait 2 minutes,

get six

Rosati AG et al. Curr Biol. 2007;17(19):1663-8.Image: Shutterstock.com

KEYS TO BEHAVIOR CHANGE

50

Keys to Behavior Change

► Whenever possible, create replacement behaviors

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Changing Habits

► Identify the routine What is the specific behavior you want to change?

52

Get up from desk in the afternoonWalk to cafeteriaBuy chocolate chip cookieEat it while chatting with friends


Changing Habits

53

► Identify the routine

► Isolate the cue Location (where are you?)

Time (what time is it?)

Emotional state (how are you feeling?)

Other people (who else is around?)

Immediately preceding action (what action preceded the urge?)

Changing Habits


► Isolate the cue

► Experiment with rewards What craving drives the habit?

What other reward would satisfy the craving?

54

Hungry?Need energy?Seeking distraction?Seeking socialization?

Changing Habits


► Isolate the cue

► Experiment with rewards

► Insert a new routine

55 56

At 3:30 pm, every day, I will walk to a friend’s desk and talk for 10 minutes

At 3:30 pm, every day, I go to the cafeteria, buy a cookie, and chat with colleagues while eating it


Formula for Changing Habits

When [cue]happens…

Instead of [old behavior]…

I will [new behavior]

57



► To create new behaviors, think tiny

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Fogg Behavior Model

► For behavior to occur, three elements must converge at the same moment: Motivation

Ability

Trigger

► If a behavior does not occur, at least one element is missing

Source: http://www.behaviormodel.org/index.html

BJ Fogg, PhDbjfogg.com

59


60


Solution #1

Target Order Motivation Ability

1 √ √

2 √ Too difficult

3 Unmotivated √

Find a trigger

61


62

Fogg Behavior Model


63

Tiny Habits®

64

http://tinyhabits.com/


Tiny Habits Defined

► A new habit that: You do at least once a day

Takes <30 seconds

Requires little effort

65

Tiny Habits Formula

After I[existing habit/anchor]…

I will[new tiny behavior]…

I will celebrate by…

66

Tiny Habits Examples

► After I brush my teeth, I will floss one tooth

► After I turn on the shower for the water to get warm, I will step on the scale

► After I push the start button on my coffee maker, I will put a piece of fruit in my purse/brief case

► After I turn on my computer, I will close my eyes and take 2 deep breaths

67

Celebrate!

► Fist pump

► Thumbs up

► Victory dance

► “Yay me!”

► “You rock!”

► “Awesome!”

► Song

► Cheer

68


69www.moti.io




► Find the right motivation

70

► No Sweat

► Michelle Segar, PhD

71

Vicious Cycle of Failure

72http://michellesegar.com/2013/10/the-4-steps-to-move-past-behavior-change-to-behavioral-sustainability-its-not-what-you-think/


Sustainable Cycle of Success

73http://michellesegar.com/2013/10/the-4-steps-to-move-past-behavior-change-to-behavioral-sustainability-its-not-what-you-think/

From “Should” to “Want”

► Make it your choice

► Make it personally meaningful Relevant to our most important daily roles, priorities,

sense of self

► Make it essential to daily life Immediate benefits

Noticeable benefits

► Make it something you like

74

Examples of “Right” Whys

► Improve your mood

► Get more energy

► Reduce your stress

► Be a better parent

► Enjoy your work more

► Take better care of yourself

75

Intrinsic motivationWhat’s in it for me?





► Make the most of willpower

76


Willpower Can Be Depleted

► Make changes early in the day Self-control is highest in the morning

Deteriorates over the course of the day

► Don’t rely on willpower for long-term change Use willpower to help create new behavior

► Build your willpower muscle

77

…that strengthens willpower but doesn’t overwhelm it completely

78

Look for a small wayto practice self-control…

Turn an immediate reward into a future

reward

• “I will” challenge: do 10 minutes

• “I won’t” challenge: wait 10 minutes

Creating distance makes it easier to

say “no”

79





► Make the most of willpower

► Expect failure

80


What Derails Behavior Change?

► Change in environment

► Emotional states Temptation

Fatigue

Stress

81 82

New habits

Old habits

Our work is never wasted!

83

What can I do to get back in the right direction?

Questions?

Cynthia Knapp Dlugosz

[email protected]

84

Health Behavior Change Resources Books Better Than Before: Mastering the Habits of Our Everyday Lives Gretchen Rubin Crown Publishers, 2015 No Sweat: How the Simple Science of Motivation Can Bring You a Lifetime of Fitness Michelle Segar, PhD AMACOM, 2015 One Small Step Can Change Your Life: The Kaizen Way Robert Maurer, PhD Workman Publishing, 2014 Rewire: Change Your Brain to Break Bad Habits, Overcome Addictions, Conquer Self-Destructive Behavior Richard O’Connor, PhD Hudson Street Press, 2014 Switch: How to Change Things When Change Is Hard Chip Heath and Dan Heath Broadway Books, 2010 The Power of Habit: Why We Do What We Do in Life and Business Charles Duhigg Random House, 2012 The Willpower Instinct: How Self-Control Works, Why It Matters, and What You Can Do to Get More of It Kelly McGonigal, PhD Avery, 2012

Websites Charles Duhigg The Power of Habit http://charlesduhigg.com/additional-resources/ Kelly McGonigal, PhD The Willpower Instinct www.kellymcgonigal.com Chip Heath and Dan Heath Switch http://heathbrothers.com/books/switch/ Michelle Segar, PhD No Sweat http://michellesegar.com/books/no-sweat/ BJ Fogg, PhD www.bjfogg.com www.tinyhabits.com Apps/Devices The Habit Factor Equilibrium Enterprises, Inc. HabitClock Lifesetter MOTI www.moti.io

http://charlesduhigg.com/additional-resources/

http://www.kellymcgonigal.com/

http://heathbrothers.com/books/switch/

http://michellesegar.com/books/no-sweat/

http://www.bjfogg.com/

http://www.moti.io/

1

Health Behavior Change Action Plan

What health behavior change would you like to make?

Why do you want to make this change?

2

Change a Habit

1. Identify the routine

• What is the specific behavior you want to change?

2. Isolate the cue

• Location (where are you?)

• Time (what time is it?)

• Emotional state (how are you feeling?)

• Other people (who else is around?)

• Immediately preceding action (what action preceded the urge?)

3

3. Experiment with rewards

• What craving drives the habit?

• What other reward would satisfy the craving?

4. Insert a new routine

• When CUE, I will ROUTINE in order to get REWARD

When

I will

in order to get

4

Create a New Tiny Habit

1. Envision a tiny version of the new behavior

• What is a small, simple version of the new behavior, or a small first step?

2. Identify an anchor

• What small, reliably recurring event could logically trigger the new behavior?

3. Think of a way to celebrate whenever you pair the anchor with the behavior*

• How will you celebrate in the moment?

*After I [anchor], I will [tiny behavior]

5

Find Your Right Why

How could you make this health behavior change enjoyable?

Think about some things that matter most to you right now (for example, decreasing stress, having energy to play with your children, or spending time with friends). What is one very important way in which the health behavior change could make a difference?

What are some specific, immediate benefits you are likely to experience every time you engage in this health behavior?

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Why Health Coaching?€¦ · Summarize the latest thinking about the brain and behavior change...

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