Last partial update: July 2016 - Please read disclaimer before proceeding

 

Adopting healthy lifestyle options

The aim of this book is to discuss the causes of preventable illness in our community and in doing so, help people live a longer, healthier and happier life. Achieving this aim involves adopting healthier lifestyle options. Most Australians are well aware that such options would benefit them. However, many do not apply this knowledge to their own lives. The issues underlying this unfortunate state of affairs are complex with most being mental rather than physical in nature. Inadequate knowledge is also a reason, although it is not applicable to the people who read this web site!

This chapter will initially outline the important lifestyle changes that people need to consider making if they are to improve their health and the benefits they can expect from such changes. It will then discuss in detail the how our thoughts govern the way we address problems in general and lifestyle issues in particular and how changing the way we think about problems can increase our chances of success in overcoming all problems including achieving long tem lifestyle change. A general plan that can be used for approaching most lifestyle problems is then outlined. This plan is used to help solve specific problems such as achieving weight loss and quitting smoking later in other sections of the web site.

What lifestyle changes are important?

The behaviours that are important to overall health include the following.

These are the important areas that people to address if they are to become and remain physically and mentally healthy and all of them are expanded upon in this web site.

What benefits can accomplishing such change in behaviour bring?
To some people, some illness prevention recommendations may seem too restrictive and appear to signal the end of many of life’s pleasures, such as smoking, or regular high-fat meals. However, there are real benefits to be had for those that do (and unfortunate consequences for those that do not), such as:

A longer life: A significantly improved life expectancy enables people to live a longer and fuller life with their partner, family and friends and provides more time to spend doing the things that they enjoy. Neither of my children had the chance to meet either of their grandfathers.

A healthier life: The disabilities that accompany disease can often be avoided or delayed by a healthy lifestyle. For example, the psychological and physical trauma that accompany coronary by-pass surgery are not trivial matters. Neither is living with the diabetic complications of blindness or kidney failure.

A financially wealthier life: Avoiding illness also enables people to avoid the expenses that accompany illness, such as payment for expensive treatments and medications and the significant loss of time from work, or even the loss of job, that can accompany long-term illness.

A sense of achievement: This comes from doing something worthwhile and will positively influence all aspects of the person’s life.

Improved fitness: An improved level of fitness enhances your general feeling of well-being.

New activities and friendships: Increasing physical and other activities can introduce people to a new range of enjoyable activities, such as sports or an appreciation of Australia’s natural environment through bush walking, and with these new activities comes the chance to make new friendships.

Helping family and friends by setting a good example: People who show concern about their own physical and mental well-being are acting as good role models for friends and family. They can also actively teach those around them these good habits. Helping others is probably the most beneficial thing that people can do for their own feeling of self-worth.
Finally, remember that an active, healthier lifestyle is a journey, not a destination. To be successful, it is important that the journey is a pleasant one! With all the above benefits, how could it be anything else!

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Some lifestyle choices make all change difficult 

Some of the detrimental behaviours make any sort of lifestyle change difficult because they reduce motivation to change and also reduce resolve when attempting change. They include:

Poor problem solving ability: The most important of these is poor problem solving ability and this is the main focus of this section of the web site. Everyone needs to read this section on achieving change as most readers will benefit from learning about how to think about problems more constructively.

Other lifestyle choices that adversely influence our ability to make life changes

The above issues should be given priority when deciding on lifestyle changes. Sorting out these issues first will improve a person’s life, both physically and mentally, and maximise the chance of successfully modifying other important lifestyle problems.

 

Problems associated with making lifestyle changes

Changing lifestyles is very difficult. Many of the patterns that require changing have evolved throughout life. They are complexly interwoven into a person’s daily routines. They are part of the person.

On top of this there are the problems of everyday life that take up our time and resources. Difficulties arising from relationships, family, work, chronic physical illness and chronic mental illnesses such as depression impact on us all every day. They make achieving change even harder and it is easy to understand how people can become overwhelmed by the factors acting against them. Luckily, many of these problems can become much less of a burden if we can change the effect they have on us by thinking about them differently. (We are about to discuss how to go about this process.)

In the end, however, achieving change will always require adequate motivation and the allocation of adequate time, energy and resources to plan and implement change. It will need to be given adequate priority. (Remember there are always people, such as a GP or family and friends, who will be happy to help.)

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‘Faulty thinking’ is the reason many problems upset us

Everyone is faced with problems in their lives each day. There are millions of them out there. People act unkindly or irrationally or selfishly. Work is difficult. And, bringing us back to the subject matter of this web site, almost everyone has a few medical problems.

How we respond to these problems has a very large impact on how we cope with life in general and on how healthy we are. Some people are good at sorting out the important from the unimportant and are sensible enough to only spend time trying to fix important problems that they are able to change.

“God give me the serenity to accept the things that I cannot change, the courage to change the things that I can and the wisdom to know the difference.”
                                                                                                                                                                                                      The Serenity Prayer

Most people however have difficulty with this task at certain times or in conjunction with certain issues. And a few people get upset about all manner of insignificant matters and their inappropriate responses to these feelings can dominate their lives, making them miserable. So what is going on? How can people think and act more apppropriately when faced with life’s problems and how can such practices be applied to the problems associated with achieving the lifestyle changes that are necessary for people to become healthier? Hopefully, the following section will help solve this dilemma.

It is how we think about the problem that matters most, not the problem itself.
Generally speaking, it is the way people think about a problem, rather than the problem itself, that determines their feelings towards the problem, and together, these thoughts and feelings dictate their response. These thoughts and feelings are based on beliefs the person has about the circumstance in which the problem arose. For example, most people get upset about watching someone being bullied because they believe that it is unjust. The beliefs that determine our thoughts and feelings have usually developed from a multitude of life experiences that have spanned many years and thus they are so deeply felt that they are just part of who we are. For this reason, we often give them little attention or don’t notice them at all.

Beliefs can be good and bad:
Sometimes these beliefs are helpful and allow us to feel the best we can about a problem and to respond in the manner that will benefit us most or minimize the harm we experience. Other beliefs do the opposite, making us unnecessarily upset and resulting in inappropriate or exaggerated responses that do us harm and / or don’t resolve the problem. And the act doesn’t even need to affect us directly to make us upset. Look at the effect that talk back radio can have on people.

While most of us suffer to some degree from less than helpful beliefs, the good news is that these beliefs can be identified, challenged and changed, enabling us to think differently about problems when they occur and enabling us to feel less upset about the problem and find more helpful responses. Being less upset about relatively minor problems also means that we waste less time on them and thus have more time to devote to the things that are important. After all, the majority of problems we face are of little consequence in the context of what really matters in life.

This of course does not mean that we can avoid all distress by thinking differently. Some problems are serious and distress is an unavoidable and appropriate response; although hopefully this process will help avoid excessive upset which is never helpful.

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Cognitive Behavioural Therapy (CBT) - Changing the way we think.

Acknowledgement: Much of the information in this section on CBT is based on my study of material written by Sydney-based psychologist Sarah Edelman. I believe her book Change your thinking  should be read by everyone. I have certainly given it to my daughters.

Psychological therapy that aims to favourably change the way we perceive and react to problems is called Cognitive Behavioural Therapy (CBT) and over the past 20 yeas it has become the main form of psychological therapy used to treat many important mental health problems, especially anxiety and depression. This is because it is easy to use, takes relatively little time and, most importantly, it works.

Luckily, CBT is just as useful in solving the everyday problems of all people (not just those with anxiety and depression) and it is a method of coping that everyone should consider incorporating into their lives. CBT does not rely on looking into the past to try to identify abnormal or harmful past experiences that might be the cause of the problem in thinking. (While past experiences certainly do affect the way we think, there is no proof that identifying such causes actually helps improve current maladaptive thinking or helps reduce depression and anxiety symptoms.) Rather, the emphasis in CBT is on changing present thinking irrespective of its cause.

Education about CBT
People wishing to use CBT techniques need to receive education about its proper use. For people who do not have mental health problems and who just wish to use CBT in their everyday lives, reading a book such a 'Change your thinking' by Sarah Edelman (ABC books) is an appropriate starting point. However, most people will benefit considerably from getting some initial help with using the technique. (It is worth mentioning that, as many people are unaware they have mental health problems, it is probably wise for most people to get some tuition in using CBT.) Obviously doing some study before seeing a therapist will be a great help and save time and money.

People with mental health problems such as anxiety and depression need to get professional help, usually from a psychologist or doctor, regarding how to use CBT (and their treatment in general) as their problems are difficult to treat and an outsider's view is often very beneficial.
(See section on 'Anxiety and depression') This section has information about other psychotherapy treatments for anxiety that are not relevant to this section on changing behaviours, such as graded exposure to fears.

All psychologists are well trained in CBT, as are many GPs. (As there is a shortage of trained psychologists / psychiatrists in many regions, especially in the country, GPs often find themselves as a community’s primary CBT resource. The fact that they often have a long-standing and trusting relationship with the person and know their social circumstances well means that they are usually very well placed to fulfill this role. Together, the therapist and patient can decide where CBT can be useful.

The material below is intended to only give an overview of the topic.

 

Methods of implementing CBT

CBT is implemented in two broad ways.

  1. Thinking strategies. These rely on learning to recognise thoughts and beliefs that make us feel bad and substituting more helpful ones that cause us less upset. There are three parts to this process.  

2.   Behavioural strategies. Inappropriate beliefs usually lead to unhelpful responses to problems and situations we face. For example, people avoid trying to quit smoking because they believe it will be too difficult. Undertaking behaviours that challenge unhelpful beliefs about a problem can be used as a technique assist in undoing these beliefs. For example, in people fearful of public speaking, making a short speech about a well known topic in a non-threatening environment can show that the task is not so difficult.

This type of behavioural strategy is particularly useful in people who have very rigid beliefs. In these people cognitive therapy (thinking about the problem) is not enough to make them change their belief. They need to see their belief tested (and disproved) in the real world.

Just as a specific behaviour strategy can be used as a technique to change the way we think about a specific problem, the use of more general behaviour strategies can change the way we feel generally in everyday life. For example, doing positive things such as exercising or finishing a job or just contacting a friend can make us feel good generally and our improved overall mood may make us less likely to automatically adopt a negative attitude when a problem arises. Such general ‘activity scheduling’ is often used when a person’s response to a situation has led to reduced activity generally. (It is often used in depressed people who commonly stop doing pleasurable activities.)

These two techniques are discussed in more detail below.

 

1. Thinking (cognitive) strategies

The appropriateness of our thinking and feeling in response to a particular situation can be assessed in three ways; the nature of the response itself (e.g. sadness verses annoyance), the intensity with which the feelings and thoughts are experienced, and their duration.

CBT asks us to confront and question the beliefs that have caused the thoughts, feelings and responses that regularly disrupt our lives. Are there more helpful beliefs that I could adopt that would prevent me thinking, feeling and acting like this? This is the most important process in CBT.

With practice many people become very good at using CBT to help solve their daily dilemmas. However, as stated above, some initial tuition is beneficial for most people.

It is very important to realise that CBT is not the same as positive thinking. Rather, CBT involves assessing how realistic and helpful a particular thinking pattern is for that individual (i.e. how appropriate it is) compared to other alternative ways of thinking. Being positive and just assuming that everything will be fine when it is obvious to all around that it will not is not helpful.

As we grow up we gradually develop different beliefs about life that depend on the experiences we face. These beliefs shape the way way we act and in the end determine who we are. Each individual has the right to believe in what they choose, so long as it does not adversely affect others. However, there are some types of beliefs that promote negative thinking and unhelpful responses that adversely affect people's lives. Often the beliefs are general in nature and are an irrational response to events that happened in the person's life and, if examined carefully, the beliefs are not well founded in fact. For example, the belief that we should always obtain a prefect result is obviously not possible to achieve. As a group, the thoughts that surround such 'irrational' beliefs tend to be negative type thinking patterns and are termed ‘ automatic negative thoughts’. Here are the most common ones.

Challenging your beliefs

When people have thoughts about a certain situation that upset them, they should logically assess their thoughts to see if they have any of the above features. If they do, then the person needs to see if a more appropriate thought can be substituted. It is necessary to do this in writing (or on a computer) as there are several stages to this process and it is easy to forget ideas unless they are written down. This also allows people to add to thoughts later on and refer back to them when they need to rather than relying on memory. The best way to do this is via a thought-monitoring form and a hypothetical problem is worked through in the form below. 

There will obviously be occasions when using such a form will not be possible or the problem too minor to warrant such effort. In these cases, the person’s beliefs about the problem faced can be mentally disputed by such statements and questions as the following.

Questioning deeply held beliefs

Some negative beliefs are easy to identify as being unhelpful and easy to change. However, many beliefs have been held for a long time and are very difficult to change. These require more thorough consideration when being confronted. Here are a few suggestions that may help this process.

 

Short term and long term goals

Some problems and goals only exist in the here and now. They are short term and dealing with them requires only that we look at the short-term consequences of our actions.

On the other hand, many long-term goals require performing numerous tasks that in themselves are not rewarding and are at times difficult or unpleasant. In fact, almost all that is worthwhile achieving involves repeated sacrifice and hardship, often over a prolonged period. This applies to both positive attainment goals, such as gaining a higher educational qualification, and goals that are directed at removing us from an unwanted situation, such as an unrewarding job or an unhappy marriage.

Unfortunately, when confronted by the obstacles that are part of attaining long term goals, many people choose to avoid these sacrifices and hardships and adopt the easier, ‘short-term focused’ option of not leaving their perceived ‘comfort zone’. This is partly because people in western countries have become used to getting what we want in the short term; life is relatively easy and we like to keep it that way. However, when dealing with long-term goals, this attitude often comes at a high price as it will result in failure to achieve important life ambitions.

Often we are aware that an issue needs addressing but we delay the process excessively; we procrastinate. This acts to delay the long-term benefits that may be achieved and such delay may result in opportunities being lost forever.

Therefore, when confronted by a difficult situation, it is important to ask whether there is a long term consequence that outweighs the short term gain achieved by avoiding confronting a problem. If a problem needs to be faced, it is best done quickly, although with proper planning. There are numerous ways to solve a problem and selecting the best may take some time. Just don’t leave it festering for an excessive period.
  

2. Behavioural strategies

The second method of implementing CBT is though asking people to actually change their behaviour out in the real world to see whether their beliefs are justified. As stated above, this technique is a very useful additional therapy in people who have very rigid beliefs, as in these people cognitive therapy (thinking about the problem) is not enough to make them change their belief. They need to see their belief tested (and disproved) in the real world. It is also very useful in people with catastrophic thinking who believe that the worst-case scenario will always eventuate.

The technique involves designing a practical experiment in the person's real life that will challenge their belief and this usually means that the person has to temporarily abandon their safety or avoidance behaviours; they have to 'leave their comfort zone'. This can be difficult, especially for people with significant anxiety. For this reason, the initial challenge should be a gentle one, with subsequent experiments becoming more challenging as it becomes increasingly obvious that their belief is unjustified.

The experiment challenging the belief needs to be designed so that a definite outcome can be tested; if the person does this, then that will or will not happen. For example, 'If I do not go back to recheck that I locked the front door once I leave the home, then the house will get broken into.' or 'If I don't do hourly checks that my new baby is OK while she is sleeping, then she will die in her sleep.'  General outcomes such as 'I will get worried' are not specific enough to be of use in behavioural experiments. However, it is usually possible to make such general outcomes more specific by asking questions such as, 'If I get worried, what will happen?'

Unreasonable beliefs are often based in truth and it is the response that is inappropriate. For example, houses are sometimes broken into. Thus, in testing, very occasionally the unreasonable behaviour is proved justified; the home might be broken into. If this happens, it is important to point out that it was not the behaviour that caused the incident; the house was not robbed when the person did not go back and check the door.

It is best to write done these experiments; an example follows.

Behavioural experiment plan

Before experiment
Belief
My daughter will be injured or abducted if I let her come home on the bus by herself from school.
Alternative belief
My daughter is old enough to catch the bus with her friends from school.
Experiment
I will let her catch the bus home for a week.
Specific prediction
She will be injured or abducted.

After experiment
Results of experiment
She arrived home safely each day and enjoyed being with her friends on the bus.
Conclusion

Worrying about my daughter travelling home by bus was unnecessary and unhelpful.

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Structured Problem Solving: Another problem solving technique

Structured Problem Solving is a method designed to work logically through problems. It is particularly useful for people who feel overwhelmed by life’s problems and is a useful therapy for all manner of psychological problems, especially anxiety and depression, and general life problems (e.g. relationship, financial, employment, medical, drug and alcohol problems etc). It is often used in conjunction with CBT when a person's thoughts are very rigid and not easily challenged.

The Structured Problem Solving approach to problem resolution follows this general format. Firstly, with the help of the therapist, the person is asked to list the problems that are worrying or distressing them. These problems are written down and the problem that is causing the most stress is identified.

The person then works out what possible options are available to deal with the problem (brainstorming) and these are listed as possible solutions. The advantages and disadvantages of each possible solution are then also listed, taking into account the resources the person has, such as friends, other people to talk to, finances, health etc. Doing this actually helps the person identify what has caused feelings about a problem and the supports and personal strengths available to him / her for resolving the problem. It can also show how the person coped with similar problems in the past.

Having done this, the best solution is selected and a list of the steps needed to carry out this option is made. This includes setting out an acceptable time frame for their implementation. Having carried out this solution, a reassessment is made at a subsequent consultation. If it hasn’t worked out, the process can be done again (with the benefit of hindsight) and another solution tried out. Initially this process needs to be done in conjunction with a counselor. However, the person can soon learn this way of problem solving and they can then use it to help with future difficulties. This increases the person’s feeling of control over their life.

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A staged program for approaching changing lifestyle behaviours

As stated in the beginning of this chapter, becoming healthier means changing detrimental lifestyle habits. These develop over many years and the challenge to achieve change should, therefore, not be underestimated. The best way to successfully change is to approach each individual lifestyle problem with a well-thought-out plan. It is important to be involved in the planning process as just being told what to do by a doctor rarely translates into meaningful change.

Presented here is an overall problem solving plan to assist in achieving lifestyle changes. There are five stages to the plan and the sections on treating obesity, lack of physical activity and smoking closely follow these five stages.

Write it down!!
Writing down thoughts during the planning process is critical to successful problem solving and should include; strategies to overcome a problem, the final desired outcome(s), and the goals set to achieve these outcomes. It should include a check-list of the things that need to be done each day to achieve goals. Putting a plan on paper allows the person to:

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Stage 1 - Recognising the problem

The first stage in changing behaviour is to recognise personal health / other problems and then to decide that changing these problems is an important life priority. Making this decision can take some time and involves learning about the problems being faced. Information about the common health problems confronting Australians today are covered in this web site. It is important to be fairly specific about the problem that needs to be overcome. Vaguely defined problems, such as I need to be healthier, are not very helpful when it comes to trying to sort out goals. Being specific, such as identifying the problem as not exercising enough, is much more helpful. 

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Stage 2 - Understanding the causes of and solutions to the problem

Once a person has recognised that a problem exists and decided to do something about it, it is essential that he or she understands the nature of the problem and all its possible causes. For example, with regard to weight, the possibilities include lack of exercise, poor eating habits, lack of knowledge about the energy content of foods, medical problems that cause obesity etc.

Whatever the problem, different people will have different causes for it. Identifying possible can be complicated and is best done with the help of a health professional. This process will lead you into identifying possible solutions.

Most problems will have several possible solutions and it is a matter of deciding on the one that most suits your available skills and time. It is important to realise that because different people have different skills at their disposal, the best solution will vary between individuals.

To decide on the best achievable outcome, a fairly detailed assessment of the person’s day-to-day life activities and skills is required so the areas where change may be achieved can be identified. People need to accurately assess their available time and other resources when setting goals, otherwise they may end up being too optimistic about planned changes. This could lead to giving up due to guilt caused by missing goals. On the other hand, being too pessimistic only reduces the possible benefits that can be achieved.

People need to remember that they are individuals with different needs and limitations to everyone else and how people define success and what they are able to achieve will be different. For example, the optimum exercise level is at least 30 minutes of exercise each day. This amount of time may not be available to a person due to other important commitments that also have a high priority, such work or spending time with a physically disabled child; so a compromise of 20 minutes each day may be this person’s best achievable option. That is ‘their success’ in your present circumstances!!

Often people will have several problems and it may not be possible or wise to address them all at once. Taking on too much is often a cause of failure.

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Stage 3 – Goal setting - Planning solutions for the problem

Once a person has identified their preferred ways of overcoming a problem, the next part of the process is to define goals. Usually multiple goals are needed to achieve a final aim. Even the seemingly simple goal of increasing physical activity may require new physical skills to be learned, getting up earlier to find extra time, changing the going to work routine  etc.

Goals need to be significant enough to make a difference. Having said this, an acceptable balance needs to be achieved between worthwhile achievement and goals becoming a detrimental obsession. For example, becoming overly obsessive with regard to weight loss could lead to developing anorexia.

It is also important that goals are well defined so that they can be easily followed. Just saying I will eat better is not a very helpful goal whereas ensuring that there is always have a piece of fruit for morning tea, thus cutting out the usual cake, is.

Planning not to fail
Designing goals so that the chance of failure is minimized (while still providing adequate achievement to be worthwhile) is one of the most important principles of goal setting. The best way of ensuring a final aim is not achieved is to constantly fail at meeting goals along the way. Self-belief takes a beating every time a person fails and this can impact on the ability to solve future problems, not just the one presently faced. On the other hand, every goal successfully achieved enhances self-confidence, increases the chance of ultimate success and helps increase self esteem.
Several ways of reducing the risk of failure will now be outlined.

a.  Goals need to be appropriate and realistic
The outcomes we desire and the goals we set to achieve those outcomes need to be appropriate and realistic given our available resources (e.g. time, skills). Perfectionism and chasing unattainable goals is a recipe for failure. People who succeed aim for excellence but are intuitive enough to realise that their outcomes will be limited by obstacles that they have to accept and work with. Also, many solutions to problems need to be practiced for the rest of our lives to be of significant benefit (e.g. increasing physical activity). Scheduling an excessively tough task workload that is possible only keep to for a short period will lead to failure in the longer term.

When setting goals, people should remember that they often need a significant period of time to be achieved. Do not set unrealistic time limits for goals. Be patient. Beneficial change usually occurs slowly and the changes that are needed are for the long term.

If it seems that the goals needed to achieve an outcome are not possible, the person needs to go back to stage two and rethink their possible outcomes. Don’t start something there is no hope of finishing.

b.  Behaviour oriented goal setting
When setting goals, it is usually best to focus on achieving the change in the behaviour itself and rather than on achieving a specific outcome. This may seem obvious, but many people fall into the trap of concentrating on an outcome rather than the way to achieve it. For example, with weight loss it is important to set goals that focus on a changes in behaviour such as eating less take away food or going for a walk each morning rather than on a specific weight goal.

c.  Step-by-step goal setting
Optimum behavioural change is often best achieved by setting a series of goals. This has the benefit of reducing the chance of initial failure and its associated guilt and loss of self-esteem/self-confidence. It also provides a source of success (and extra motivation) along the path to ultimately achieving the final outcome. In any case, some goals need to be addressed gradually. For example, if a person does not exercise at all, it is necessary to increase their exercise level in stages in order to avoid injury. Also, people will usually have different types of goals that do not all need to be addressed at the same time.

d.  Grade tasks according to their difficulty and attempt the easier ones first
Attempting the easier tasks early on will increase chances of initial success. The skills learned and confidence gained from successfully completing these easier tasks will mean the person is better prepared for the harder goals that need to be faced later on. The exception to this rule is when the difficult problem is limiting chance of the person’s success with all the problems being face. A good example would be harmful alcohol use that is impairing motivation for change. Another would be excessive tiredness due to lack of sleep. These problems were outlined earlier in this section. 

e.  Flexibility in goal setting
Circumstances change and even if set goals were initially achievable, life changes that can occur while implementing these goals may make them impossible to fulfill. For example, an illness or injury may significantly disrupt initial plans. Thus, it is important to allow appropriate ‘goal modification’ to be part of planning strategy.

Obstacles to achieving goals

There are many types of obstacles that people face when trying to overcome a problem. A few of the common ones are mentioned below. Most occur because of beliefs we have about our own limitations, many of which are unreasonable and possible to overcome.

  • Looking at the short term: Many people in Western society are used to getting what they want, when they want it, and think / believe that they should not have to suffer short term sacrifice in order to attain a longer term goal. This leads to ‘putting off’ change (procrastination or indecisiveness) or giving up all together.

Solution: Such beliefs can be challenged observing that other people in the community who have denied themselves pleasurable activities in the pursuit of goals. Forgoing wages and leisure time in order to gain a higher qualification is a classic example. Another would be the extra trauma suffered while exiting an unhappy relationship in order to hopefully find happiness with a more compatible partner at a later date.

  • Changing difficult / long term habits: Many of the problems we have are founded in poor habits that we have developed over many years. They are part of who we are and what we do and change is difficult. An added problem is that some of these habits are chemically addictive, for example harmful alcohol use. Possible underlying beliefs here include that things should be easy or that I do not have the ability to do hard tasks or that I should avoid tasks that are too hard. An example might be giving up smoking.

Solution: The ‘it’s too hard for me’ belief can be questioned by recalling previous hard tasks that have accomplished or listing previously attained skills that will help in dealing with the problem. Thinking of friends who have similar skills / are in a similar situation and who have successfully addressed a similar task is also beneficial, as is adding to skills / knowledge by seeking help from others such as a GP.

  • Indecisiveness: When there is more than one possible course of action that can solve a problem, it can be difficult to choose and often it can be beneficial to delay a decision until more information is available. However, undue delay is often the worst of all choices.

Solution: People who are having trouble deciding can give themselves a definite cut off date and adhere to it no matter what. Challenging a belief that a task is too difficult or risky by just getting starting is often enough to demonstrate that success is possible. This increases self-belief and gets real momentum going. (This process is termed 'behavioural disputing' and was mentioned previously in this section.)

  • Past failure: Many people, having failed at previous attempts at solving a problem, feel they now have no chance of success. The underlying belief is an obvious one; that if I have failed once I will fail again. This is an example of 'catasrophic thinking'.

Solution: The belief past failures will be repeated can be challenged by looking at the people who have failed previously and then succeeded. Stopping smoking is a good example with the average person requiring four quitting attempts before succeeding. Seeing failures as learning experiences will help the person realise that their chances of success should be better this time. Going over past mistakes with a friend or expert in the area (a GP when it comes to health problems) with the aim of identifying ways of preventing their future recurrence can be helpful in this process.

  • Poor self-esteem: While many people lack a belief in their ability to do a specific task, for some people inadequate self confidence is a constant burden that limits their ability to solve almost every problem they face. They have low self esteem. Low self esteem is the fundamental problem that causes people to cope poorly with life’s problems and counselling is usually needed to overcome this problem.
  • Problems of circumstance: For many people, the ability to solve a problem is, in part at least, restricted by their circumstances. Such restrictions include limited time, limited finances, illness, lack of skills, the needs of others, hindrance by others, and conflicting needs / goals. 

Solution: ‘Problems of circumstance’ should be identified when thinking about the steps needed to achieve original desired outcomes and some of the goals set will need to be directed at overcoming ‘problems of circumstance’. Sometimes they will be significant enough to cause the desired outcome to be modified, hopefully without too much of a compromise. It might just take longer for the outcome to be reached. Very occasionally, they will mean the person cannot solve the problem and acceptance is the only recourse. (It is worth remembering here that circumstances beyond the person’s control can always change for the better, allowing problems to be solved at a later date.)

Time management

The allocation of adequate time is probably the most important factor restricting ability to change. For most people, time is limited and must be rationed according to numerous daily commitments.

One way of generating more time is to reduce the relative priority given to some areas of life and allocate this time to healthier activities. For example, a person can reallocate some passive leisure time, such as watching television, to active leisure time, such as walking. Extra time can also be gained by doing necessary tasks more efficiently. Finally, time can be gained for healthy activities by changing the nature of your present commitments. For example, rather than doing administrative work for a child’s sporting team, the person can try being the team coach.

Getting help

Most people require the assistance of health professions, such as GPs or dietitians, to plan, achieve and maintain their desired changes. Remember that change is difficult and people should not be afraid to seek help, especially if they have been previously unsuccessful in achieving change. Health professionals are used to dealing with issues that are unfamiliar to many people and will be a great help in defining necessary goals and identifying obstacles. Friends can also provide support and behavioural change is often achieved more easily when family and friends participate in the change. For example, quitting smoking is often much easier with a ‘quitting partner’.

How can your GP help?

GPs are always looking for oportuniies to intervene in peoples lives to improve their health. It is part of every consultation and there is a general plan they have for doing this called the 'Five As', as follows.

  • Ask: Ask about the health issue to identify whether a problem exists
  • Assess: Assess whether the patient is motivated regarding fixing the identified problem.
  • Advise: Advise the patient that change would be of ebenefit.
  • Assist: Provide information regarding treatment options and help with treatment. .Assist the patient in initiating and maintaining change
  • Arrange: Arrange a programme of follow up to support the patient in ongoing attempt at change.

Most GPs are delighted when their patients inform them that they want to improve their health and will be very happy to Asssess, Advise, Assist and Arrange.

 

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Stage 4 – Implementing change

People should not just start a behavioural change when they think of it. Behavioural change requires careful planning if it is to succeed. Setting a specific ‘start day’ for changing a behaviour enables the person to allocate enough time to prepare properly for the change. People should try to choose a low-stress day that is not too far away.

In order to reduce the chance of failure, people need to understand the potential problems that are likely to arise and develop strategies to avoid them. For example, weight gain is often a problem when stopping smoking and gaining prior dietary counselling will help avoid this problem when quitting.

Failure is most common in the early stages of behavioural change and people need to be especially vigilant during this period. However, remember that a single departure from the plan does not always cause failure. Alcohol tends to reduce resolve when implementing change and consumption should be carefully watched and perhaps reduced for the first few weeks. Writing a daily ‘to-do’ list can help remind people of their goals and will help quickly indicate when goals are not being met. The factors causing a departure from a person’s plan can then be identified and dealt with quickly before too much damage is done. For example, it might be that nightly exercise keeps being interrupted by phone calls. Taking the phone off the hook while exercising will solve this issue.

It is important for people to be rewarded regularly during this initial period of change; going to the pictures or buying a new CD. Also useful are regular reminders of why change is being sort and the advantages being gained. Such reminders can be displayed at work and at home. A picture of children or grandchildren can act as a reminder that change will allow being with them longer.

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Stage 5 - Maintaining change - Preventing relapse

Having implemented change, people need a program for assessing their progress. Remember, this should be an assessment of the behavioural change rather than a specific outcome. Performing these assessments regularly, preferably with the help of a health professional, will give positive reinforcement where success is occurring, identify areas where the plan is failing so appropriate changes to be made, and allow discussion of appropriate plan modification, if needed.

As stated above, behavioural changes should not be ‘cast in stone’. All ‘lifestyle plans’ are unlikely to be perfect and even if they were, personal circumstances continually change and these impact on the ability to achieve the set behavioural goals. Therefore, don’t be afraid to change behavioural goals, both up and down.

It is worthwhile displaying achieved goals so that they remain a focus in your life. Displaying reminders of achieved goals reminds people that they can overcome problems and acts as a good motivator for addressing new problems or staying on track with current as yet unfulfilled goals.

Talking about goals with family, friends and work mates makes them aware of what is trying to be achieved and hopefully they will try to help.

Relapse: The risk of failure reduces with time. Those with an increased risk of failure include people who cope poorly with life stresses, sleep poorly, drink excessive amounts of alcohol or use other drugs.  Remember, these problems are usually best addressed before attempting other behavioural change.

 

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