If you have ever felt exasperated at the resistance to change in personal behaviour that would alter the trajectory of someone’s choices, health and wellbeing, you are not alone.
Hundreds of books, thousands of articles, millions of consultations and trillions of frustrated inner thoughts have been presented as solutions, explanations and disillusionment. So, what we are saying, is you are not alone. Indeed, you may be someone that finds internal rationalising easy and yet finds the momentum needed to change your own behaviour to alter your life’s trajectory impossible – so how do we engage people we have been asked to help to make and sustain positive change?

In part this possibility and aim needs to be reflected by the understanding that health behaviour and associated change or pattern development are not simply regulated by conscious intention – i.e a deterministic set of objectives, but rather that many of these actions are driven by non-conscious and nonintentional processes. Which to simplify greatly means that a desire or intent to beneficially alter behaviour is then disrupted due to a tempting alternative.

We propose that the potential for information-based interventions or simply knowledge driven determinants is fundamentally limited, given that it is based on a view of human behaviour that is at odds with psychological and neuroscientific evidence that much of human behaviour is not actually driven by deliberation upon the consequences of actions, but is automatic. Cued by stimuli in the environment, resulting in actions unaccompanied by conscious reflection.

Here is the crux….. to make change requires the outcome to be achieved without the easy, tasty or socially engaging option getting in the way, in effect the process needs in part to be managed by developing automatic behaviour patterns. Sounds great doesn’t it, simply switch into auto health mode and all adverse distractions will fade away.

You see, whilst  intentions have important effects on behaviour, their influence is limited by nonconscious processes that are particularly important in health behaviour, such as habits and impulses, which are hard to control and are triggered by specific situations in one’s daily life. In other words, an action previously performed in a certain context can be triggered automatically by a contextual cue, leading to nonconscious effects on behaviour that may inhibit or prevent change.

You will have observed that throughout our day, we shift between two broad categories of behaviour. On the one hand, we may act in a reflective manner, directing ourselves toward particular goals, aware of our motivations and actions and able to halt or modify them should the need arise. But in other instances, we act without reflection, responding to our surroundings in complex ways while our thoughts may be far removed.

Our current environments tend to expose us to cues that activate short-term hedonic goals, such as indulging in tempting food or drink that provide immediate pleasure. This is often at the cost of long-term investment goals, such as optimising health, introducing and maintaining exercise or stress reduction or controlling alcohol intake for the sake of health later in life. In order to improve the nonconscious regulation of health behaviour, situational cues need to activate situated conceptualisations of long-term investment goals, rather than of short-term hedonic goals only – in effect an unconscious decision-making process that facilitates change in behaviour that is sustainable.

So how can this be applied in the context of a clinical process, where time is short, objectives often wide and inputs highly variable?

The following 5 principles that help convert actions into habits will likely already form part of the motivational engagement you use, but revisiting them in the context of clinical and behavioural objectives may help you and your patient to progress to self-generation of patterns that favour long term health.

  1. Target the individuals who value the primed goals – by which we mean seek out clear objectives from the person seeking help rather than overlaying your perceived goals on them.
  2. Tap into the right reasons – seek to connect with emotive and sustainable objectives and then apply intent and establish patterns of change.
  3. Use effective cues – align their intentions and goals with others who have achieved or are achieving change that fit contextually into their social and environmental circumstances.
  4. Attract attention at the right time – by which you will help them identify where unconscious triggers currently exist and need goal orientated plans to reset the unconscious experiential events into new positive and beneficial actions.
  5. Ensure the health goal is possible and desired. – choose an outcome beyond reach or capability and you will set up to fail, build in steps and small positive outcomes that can be measured and qualified.

Turning healthy actions into habit is a desirable target for behaviour change interventions because their well-entrenched and situated cognitive structures allow us to perform a variety of behaviours in our daily lives in an efficient manner, without requiring conscious intentions and awareness. – In simple terms look at your consultations as a habit inducing dynamic, and whilst goal setting is a target, the process of attaining it should, where possible be embedded in the determination of creating persistent supportive habit generation.