"Everyone knows they are going to die but nobody believes it. If we did, we would do things differently."
-- Morrie Schwartz from Mitch Albom's book Tuesdays with Morrie

You may have thought about changing a behavior that you know is bad for your health. Or you may have had an unsuccessful try in the past and are contemplating another attempt. Very few of us need to be educated about the value of eating habits, exercise, not smoking, regular check-ups and getting enough sleep. In fact, you may feel anger, inadequacy or guilt when pushed by your physician or loved one to do something about one of your bad habits. They may see you as unmotivated; in fact, you may actually think this about yourself.

However, this article, based on scientific research, is designed to help you become acquainted with the process of how people successfully change a behavior. It will serve as an umbrella for what you need to do to change a behavior based on research by psychologists. Yet, no one can tell you exactly what will work for you once you get ready to change. Your success with any program will be determined by how ready you are to embark upon the process.

Readiness is just another way of thinking and talking about motivation. Think of readiness as levels along a continuum from low to high. Your readiness to change will determine what strategies you will use to move yourself from lower levels of readiness to higher ones. Studies show that your level of readiness is very much related to two important factors. One, how important is the behavior change to you? And secondly, how able or successful do you believe you can be? A person who appears unready may actually feel a particular behavior change is not very important, by thinking or saying, "I don't really think getting eight hours of sleep is very important for me." Or, a person who appears unready may fear she won't be successful: "I just don't think I'll really be able to get eight hours of sleep even though I want to."

To begin the process of change, let's first look at the importance of behavior change.

The level of importance you place on changing a behavior has to do with the value of that change to you. Take an example from your own personal situation and ask yourself how important it is to change that behavior on a scale of zero to 10, from "no importance" to "extremely important".

Maybe you're thinking about stopping cigarette smoking and on a scale from 0 to 10 you believe that this is about a six. Then ask yourself why you chose a six rather than a one and list all the reasons:

1. I know it can cause lung cancer.

2. It will make me more susceptible to heart disease.

3. It's costing too much.
   
   Psychologists call the statements that you listed self-motivational statements. Staying with this example, next ask yourself what you need to do to take yourself to a higher level of importance, say an eight or nine. You may then come up with more reasons to quit smoking such as:
   
   

4. My life might be shorter if I don't quit and I'll be cut off from enjoying my family too soon.

5. I get shortness of breath when I smoke and this limits my enjoyment in the activities that I do.

After finishing this exercise you might experience what many people feel when they  make an attempt to expand their self-motivating statements. That is, you begin to see the other side of the issue. It's what we call ambivalence. We want to value behavior change but we begin to recognize the difficulty of breaking unhealthy patterns of behavior. It just may cost too much to change. Unless the benefits outweigh the costs, change is not likely to occur. For some people, it may be only one benefit or cost that holds a strong emotional component that either motivates or inhibits an important change.

One of my patients who had a  heart attack and then learned he was diabetic decided to change his diet radically. He stated to me, "The cost of losing my eyesight or my feet to an amputation (he had already experienced numbness in his feet prior to the heart attack) is a far greater cost to me than giving up the enjoyment I get from soda pop, white potatoes and pasta."

One way to work with resolving ambivalence is to first consider the pros and cons of the current behavior you are trying to change and then consider the pros and cons of changing. Start with asking yourself honestly to list the advantages or benefits that you are currently experiencing by your unhealthy behavior. For example, an overweight man said that the benefits of his unhealthy behavior included being able to eat foods he likes, being able to follow established routines and being able to eat whatever he chooses without having to think about what to eat. On the other hand, he said that he was unhappy with his appearance, he felt lethargic and lacked energy, and he was concerned about developing diabetes or heart disease.

When he examined changing his unhealthy behavior, he listed that he would be able to wear better-fitting and more stylish clothing, he'd have more energy, and he'd have a feeling of success. The disadvantages of changing were that he'd have to give up his favorite junk food, he would be compelled to keep a diary and he'd have to make time to learn how to prepare new foods.

After you list the benefits and the costs of your unhealthy behavior, review with two sets of pros and cons to each and consider how strong you feel about each by ascribing a value from a low of one to a high of five. Give yourself the opportunity to quietly reflect on your answers. Be honest in your evaluation. The goal is not to convince yourself of the need to change. You already know you should change. This exercise, however, may help to tip your ambivalence toward a higher level of importance for change. If that doesn't happen, re-work it periodically. Ultimately, the scientific research suggests that the pros of changing and the accompanying emotional intensity need to outweigh the cons for you to answer affirmatively to the question, "Am I able to change?"

The ability to change isn't about willpower but is more about your experience of feeling confident about your ability to make a specific change in behavior. Psychologists call this self-efficacy. You need to have a high level of confidence or self-efficacy to develop and use new skills and strategies to bring about a change in your behavior.

If, for example, your overall goal is to lose weight, you might develop the strategies to eat less fatty foods, increase the number of fruits and vegetables you eat, increase the number of low fat/high protein foods you consume and get more exercise. Your confidence in implementing these strategies will be enhanced if you can specify targets for change within each of these strategies that are within your reach. For instance, you might decide to work on the target of only eating red meat once a week as part of the strategy to eat less fatty foods. You would choose this target only if you felt it was a reasonable and reachable goal to accomplish.

You need to feel a high degree of confidence that your target is reachable for success in implementing the change. It is important to start small with reachable targets and to avoid feeling overwhelmed to begin with. By selecting small, reachable goals, you will build confidence to work on additional targets as time goes on. Trying to do too many targets or choosing difficult-to-reach targets may only set you up for frustration.

Remember you are embarking on a journey that will involve progressive steps built on past successes over time.

Furthermore, you can advance your confidence about changing by using the process described above for enhancing self-motivating statements. On a scale from zero to 10, how confident do you feel about accomplishing your goal? If you scored a four, why wasn't it a one? If you scored a four, what would it take for you to raise your confidence level to a six? This approach can help you build confidence by focusing your thinking on what you have mastered and what challenges are ahead of you.

It is not uncommon for individuals using the scaling process described above to think about past failures. When you concentrate on past failures, your confidence shrinks as regrets and even self hatred appears. It is extremely important to understand that failure is a common experience in making a behavior change. However, failure also serves as an opportunity for learning. You won't be able to self-correct when you fail to reach a goal if you punish yourself with negative self statements and wind up feeling hopeless and worthless. Remember, failure is the seed for a more effective approach in reaching your goal.

Finally, this article is a brief explanation of a complex subject. You may find yourself stuck in trying to work with the recommendations made in this discussion. As an example, I have worked with individuals who place high importance in changing a health behavior but find that other values or circumstances serve to get in the way. One woman wanted to attend a weight loss class but as a single parent felt her responsibility in helping her children in the evening was more important. Another individual who considered change important found his depression too great of an obstacle to developing confidence with his action plan. Make your best effort, but if you get stuck consider talking to a psychologist.

This article was authored by Dr. Arthur Luz, of the Michigan Psychological Association Public Education Committee and based on the book, Health Behavior Change by Steve Rollnick. All rights reserved.