Understanding Change Part II: Are You Ready for Change?

“Those that cannot change their minds cannot change anything”
— George Bernard Shaw

Many years ago, researchers looked into how to understand why some people engaged in behavior change when others didn’t. These researchers, Prochaska and DiClemente, found that not everyone who needed to change, or even wanted to change, were in the same starting place.

The thing about change is you can only start where you are. Through their work and research Prochaska and DiClemente established the Transtheoretical Model (or Stages of Change) of change. This model describe how people go through various stages as they move through change—and most importantly that at any given time only about 20% are in place of action around change—which flies in the face of a lot of what we believe and understand about change. This small bit of information should help all of us stop lecturing people about change: stop lecturing our clients or patients, stop lecturing our family members and loved ones, and even stop lecturing ourselves. What we all need is a good dose of curiosity…”I wonder what would happen if?”

The stages of change are Pre-Contemplation, Contemplation, Preparation, Action and Maintenance. Each of these stages of change has its own needs and is best served by different supports. This is often why some people do really well with one sort of program or book or support and others don’t. It’s often not a matter of motivation or willpower—it’s a matter of the resources matching the stage of change.

Pre-Contemplation

Pre-Contemplation is the stage where you actually aren’t interested in changing something. Often others around you are more interested than you are. In this stage the best support is information you can take in on your own terms: books, videos, stories. Action oriented programs often backfire, and the frustration of not being ready can prolong your own resistance. This is a good time to just take in information and begin to imagine the possibility of change. Or even just to reconnect with goals that are important to you, which might be served by such change.

Contemplation

In the Contemplation stage you have moved to thinking about changing in the next six months. You have gotten enough information to know about the pros of changing, but you are also very aware of the cons. This is still a time of gathering information, but also a time to explore your values, your passions, your motivations. It’s a time to question what will be gained if you change, and what will be lost. And perhaps most importantly—what is the cost of doing nothing? This is important time to gather energy and motivation for the long process of change. People do get stuck here, but it is also important to take the time you need to.

Preparation

In the preparation stage, you intend to change in the next month. Often you are moving towards action. You are finding the right resources: a course, a gym, a nutritionist, a therapist. Perhaps you have experimented with change and pulled back. In the preparation stage you would be well served to gather as much information as you can, not about the impact of change as you did earlier, but about what supports the process. Talk to others who have tried—what worked and didn’t work for them.  Think about what might support your work as you begin to change—do you have what you need? In this stage you don’t have the work or stress of change, so you have more energy and resources to do some of the prep and building work.

Action

This is the stage that everyone recognizes as change: in this stage you are making the change: you are going to the gym, you are changing your diet, your are in the process of quitting smoking. In this model you are in the Action stage until the new health behavior is habit (or until the old behavior is gone, ie. you no longer smoke at all). In this phase it is important to value your strength and courage to continue in your efforts and to experience confidence in your continued work—to get the sense that “I am a person who can make changes like this.”

Maintenance

Depending upon the behavior change—Maintenance can last from six months to five years—and maybe even longer for some. In this stage you are attending to the new habits and working to keep them solid. You are likely even working on other goals and other things that you want to change. And to support the maintenance stage you are consistently working on increasing other behaviors and habits that support you so that there is less likelihood that you need the old behavior that you worked so hard to change. If you used to smoke to relieve stress, you are consistenly working on stress management strategies so you have a wide range of options that doesn’t include smoking.

So, take amoment to think about that New Year’s Resolution again in the light of stages of change. Where are you? What can you do to support yourself in the stage that you are in so that when it is time for the action stage you have you feet solidly beneath you to spring from? You can read more about Transtheoretical Model here, they have lots of descriptions and an entire section on their research. And below you can get the link to their book.


Understanding Change: 3 Critical Success Factors for Preparing for Change

It’s resolution season. The season of change.  The season of saying “I am going to do it differently this year.” Every year around this time people make commitments to change their behavior, especially their health behavior. It’s a new year, a clean slate, and “this year is going to be different!” I thought it might be helpful this week to look at different ways to understand and think about behavior change. There are different theories in psychology about how and why people change and there has been a lot of research about what works and doesn’t in terms of behavior change. I think that the more information you have and the more you can understand what works for you, the more successful you can be with your own behavior change.

Understanding behavior change is important because it actually is one of the most difficult things you can do. Most health behavior change has an 80% relapse rate: diet, exercise, smoking cessation, quitting alcohol—all the big ones -- 80% at best.

These are not great odds. But most people head into these changes without much information or support. And most people don’t understand that behavior change requires different behavior and support depending upon where you are in the lifespan of the change.

So before you even begin your change plan, let’s look at 3 things you can do to support your efforts before you even begin to tackle your new year’s resolution in earnest.

1. Monitor. WRITE IT DOWN. Or take pictures. Just Keep Track!

Whatever you want to change. First find your baseline. Take a week and just pay attention to the behavior. What are you currently doing? Where are you starting? How many times a day or week are you doing it (or not doing it). Use a sheet of paper, a spiral notebook or a cool app to track your behavior. Research shows that the method of tracking your baseline or your behavior change doesn’t have an impact—so paper or high tech will work the same—the main agent of change is the self-monitoring itself. So whatever helps you do that is the best tool for you. When they have done research on behavior change, those people who kept track of the behavior they were trying to change actually were way more successful than those people who didn’t write it down.  Even if both groups were doing the same thing and had access to the same cool behavior change program from experts.

Once you actually start your work on changing—then you will continue to track. Monitoring helps you with your awareness because most things we try to change are habits of one sort or another and it is often hard to catch yourself in the act of a habit. So monitoring is really a self awareness exercise—because you have to be aware of it enough to track. And it can also be a self-management exercise because it can force you to slow down enough to write.

2. Social support. Birds of a feather change together.

Social support—relationships that support our change—are one of the biggest factors in behavior change. Whether it’s a group dedicated to the change you are trying to make, like a smoking cessation group, or an on-line forum, or colleagues from work you are sharing your goal with: you are more likely to not only reach your goal, but also maintain your change if you have support doing it. The best athletes have a team of people who support them.  Team Lemond. Team Nyad. Everyone needs a team to take on a big challenge. Whether you are trying to change your diet or trying to heal from trauma, or both, everyone would benefit from a team. The team can be real, or virtual. You can talk to them, you can create a FaceBook page, you can send them email. You can find a group, or you can create a group.

3. Motivation. What is motivating your change? What’s the driving force? Why change? Why now?

It’s really important before you launch into action to really have a deep well of motivation. Why do you want to change? How will the change impact your life? What are the benefits of the change? What might be some losses? How will the change help you with other things in your life? Your relationships? Your work? Your passions? Your goals? How is the change you are trying to make connected to your values? Your mission? How will it serve your bigger goals in life?

Really play with these questions. You can play with them imagining a future if you were successful with the behavior change. And you can play with them imagining if you didn’t change anything in your life.

Play with the questions to locate the source of your motivation so you can use that power and energy to sustain your efforts as you go through the change process. 

© Gretchen L. Schmelzer, PhD 2016

 

Understanding Change Part IV: Trauma and Change

For the past three days I have been focusing on the elements of any change process—the success factors for preparing for change, readiness for change and resistance to change, mostly in anticipation of the biggest ‘change week’ of the year: New Year’s.

I have focused primarily on the aspects of change that anyone would encounter and now want to add in some thoughts about change and how surviving trauma affects your connection to change.

Yesterday when I was talking about resistance to change I talked about how the behaviors or habits that we have that are hard to change are often a form of protection. The industry term for these protections is “defense” but it is simpler to think of it as something that makes you feel better or less anxious in the short term, though often you feel worse in the long term.

These habits exist for people who have lived through trauma and those who have not. Most people have habits and behaviors they are trying to change. That’s normal. What I have found is that for people who have lived through trauma, the habits are way more entrenched—and it can feel like more of a life and death struggle to give them up.

This is not because they are necessarily more destructive habits or that people who have lived through trauma have less motivation to change. Most of it lies in the experience of anxiety. The experience of trauma creates a level of terror and fear that can come back at a moments notice and the protections or defenses that trauma survivors create to get through the trauma become the talismans against that terror and fear. It is hard to untangle giving up the habit with the old terror:  at the neural level they are inextricably linked.

So when you have lived through trauma and you want to make changes, it can often feel like you are giving up the very thing that had you feel safe. YES, I know it doesn’t sound logical. And YES, I know that your present life isn’t filled with that terror. But your brain still links them, so change can be more tricky than for people who have not lived through trauma. Which is bad news because change is hard, period. And it's even harder for you.

What I have found is that trauma survivors are well served by smaller and more structured increments in change. They are well served by having better supports in place. Really, most people are. Small changes are absorbed better by our systems and we build self-efficacy for change through the repetition of successful actions. So regardless of what change program you are using as a survivor, or you are using with the survivors you are treating, three things are really important: be respectful of pace, be respectful of ‘dosage’ and be respectful of the role that the habit was playing.

Pace: Go slowly. Trust your pace of change. Imagine that your inner wisdom really knows how fast you can change and just trust it. Take time to talk about the pros and cons of change. Take time to prepare so that you are creating a stable environment for change. Take time to get the resources you need. Take time to make small changes, talk about them, absorb them and move to the next small piece. Trust lulls in the change process and trust moments of moving ahead.

Dosage: What is the smallest increment that you can change and try that. Then shift it only a bit. Remember that each experience of doing it differently is exposing you to experience both a bit of the old horror/anxiety and a bit of a new experience. Both of these can be overwhelming emotions—and so you want to be mindful of the pace you are moving and the amount you are taking on so that the experience is tolerable. There is an old adage in working in residential treatment that growth only happens at a point of struggle, but you want it to be challenging not overwhelming. Because if you get to the point of overwhelm you are more likely to relapse and go back to the old behavior because that old behavior made you feel better. Overwhelm doesn't lead to change. Overwhelm leads to relapse. So titrating the amount of challenge is key to success

Respect the Role the Habit Played: Yesterday when I was talking about the Immunity to Change work with resistance, I was essentially outlining their program which was designed to illuminate your hidden competing commitment—the thing that is more important to you than the stated behavior change you are trying to make. It is a great exercise and it can and likely will illuminate the survival behaviors that you used. I remember doing the exercise for the first time—and the behavior I was trying to change was to have a cleaner house, have less clutter in my work areas. And I eventually came to a place where I realized through the exercise that clutter was my way of remaining invisible. I used my messes to ‘hide.’ And hiding made me feel safe. Insight is great. But it isn’t what makes change. Practice make change. And I had to find ways of experiencing ‘being visible’ and ‘not hiding’ in small, incremental ways that I could tolerate. I had to respect that protection and not just bust it up all at once. I think that all of this is true for anyone who is trying to make change. But it is crucial for trauma survivors.

© Gretchen L. Schmelzer, PhD 2016

 

5 Important Ways to Honor Anniversaries of Loss

Many anniversaries mark the happy moments in our lives, but many also mark the sad or frightening. Life happens in cycles and on anniversaries we cycle back to the event—the loss—the fear—the experience. We see it in hindsight, we see at as we saw it, we see ourselves then and we see ourselves now. Whether the anniversary is of a trauma, like the Marathon Bombing, or 9/11, the Moore tornado, Sandy Hook, or the death of a loved one—anniversaries are important for our healing and our growth. They help us integrate what was lost, what was found, and where we are headed.  But there needs to be attention paid to the ‘how’ of anniversaries. You can’t just live in the old story—and thanks to a 24 hour media cycle—this is a dangerous possibility. To just live in the traumatic event or loss is to be re-traumatized for a day. Anniversaries need more than just re-living the event or the loss, they need five aspects to create the ground for healing and growth. These five tasks are: Creating a Caring Environment, Honoring the Experience, Mourning What was Lost, Acknowledgment for What was Found, Envisioning the Future.

Creating a Caring Environment: People always forget that emotional work requires preparation. Anniversaries are tough days. You need to be extra kind to yourself on these days and make sure that you have more resources available to yourself than usual: more sleep, good food, lowered stress (perhaps fewer appointments or commitments if possible). You need to over-support yourself if you can—let loved ones know you need more support, have a friend ‘on-call,’ do those things that lower your stress: go for a walk, play with your kids, dog or cat, meditate, listen to music. Bring a picture to put on your desk at work, or have on your phone. The tasks of healing and growing through an anniversary will require a lot of you. It is important to create an environment where you feel supported through this day and this work.

Honoring the Experience: The first task is to honor what was experienced. What happened? What is the narrative of the event? What was I thinking? Feeling? Doing? Who was with me? Ideally you could honor your experience in a conversation with someone else, or with others to have your story witnessed and witness others. Do what you can to let others know that this is an anniversary for you. Let others help you honor it too. Be kind to yourself as you remember the story and tell the story. Trauma and loss can make us feel helpless and helplessness can make us feel shame. Honoring your story and your experience can be healing, but you need to be kind to yourself –knowing that in surviving you did the best you could.

Mourning What was Lost:  Grieving is an intermittent experience. It can come and it can go. It is like the weather—one minute calm, the next minute a gale force wind. Anniversaries heighten this experience because it creates its own schedule of mourning. It brings us back to the loss and we are caught again in the storm of the experience. Mourning helps us see what happened, what we lost. But mourning is often bigger than the loss we can initially see. Mourning can be about what did happen, but it can also be about what didn’t happen—the things that couldn’t happen because of the loss or traumatic event. Allow yourself to acknowledge these things and hold them close to your heart—rock them inside you like an inconsolable infant. Everyone has their own rhythm and pace of mourning. Trust yours.

Acknowledgement for What was Found: This is what makes trauma so complicated. Just when you want to completely hate something in your life or your experience, you find something as well. Sometimes it is small, and sometimes it is large—but there is always something new in the experience of surviving a trauma or a loss. You come to know yourself or your community differently. You learn about a capacity you didn’t know you had. You grow bigger than you were. Your heart can hold more than you thought. What do you know about yourself that you didn’t know before? What do you see in your life that you didn’t see before? What might you even be grateful for now after having come through this experience? How has this changed over time?

Envision the Future. Anniversaries are focused on the past—but just the fact that the year has gone by is the proof that time marches forward. What are your hopes for the future? How do you want to honor the past in the next year? How can you bring the wisdom of what you have learned through this difficult experience to benefit your life and the lives of others? What do you still need to do to support your healing and growth?

© 2015 Gretchen L. Schmelzer, PhD