Creating SUSTAINABLE Behavioral Change Part 6
Why WE as wellness professionals need to know Prochaska’s Stages of change.
I’ve always appreciated knowing about Prochaska’s stages of change. I usually have to coax and cajole myself every step of the way whenever I decide to make a behavioral change. (Unlike Dr. David Hunnicutt, former president of WELCOA, who once told me: “For me there is just one stage of change: I make up my mind and I do it.”) I, on the other hand, tend to shift back and forth between maintaining the behavior and falling off the wagon. But understanding that this is all just part of the process helps me keep going when the going gets tough.
For example, I remember when my dentist first told me I had some gum issues and, in order to correct those issues, I needed to start brushing BETWEEN my teeth with a tiny “interdental” tooth brush. I remember thinking NO WAY am I doing that BUT I still knew he probably was right. In Prochaska’s stages of change, that’s pre-contemplation where you are aware of the problem but are not planning to do anything about it anytime soon. My dentist kept bringing this up again at every check-up and, after a year or two, the problem still hadn’t gone away so I had to start to consider, what I was going to do about it.
At this point in time, l was well into stage 2, the contemplation stage where I was learning all the reasons WHY making this change – taking better care of my gums - would be beneficial. Probably the most motivating thing I’d learned during this period was about the link between gum disease and heart disease. I’d read all kinds of disquieting theories as to why these two conditions might be related (mostly having to do with inflammation, spreading from the gums down to the heart through bacteria in the mouth entering into the blood stream). It was scary thought to say the least.
This moved me into stage 3, the preparation stage, where I was starting to look at WHICH changes I could make to resolve this problem. I was already flossing, and that wasn’t helping this particular issue go away and I had tried increasing my intake of fruits with vitamin C and that DID help, but it didn’t eliminate the problem, either.
At my next appointment, the dentist said he was going to recommend a $1000 antibiotic treatment. OR I could still try using the inter-dental toothbrush he had recommended previously along with an “under the gum irrigant” he would recommend BUT he said it might already be too late for that option. I had switched to this dentist specifically because he was into wellness and billed himself as a “holistic” dentist and the fact that he suggested this alternative treatment to the standard antibiotic treatment had me intrigued. (Since he would be losing money if this idea worked.)
So that little talk moved me into stage 4, the action stage where I was finally ready to start DOING something to resolve the problem. Until Prochaska came along, most behavioral change programs just dumped you right into the action stage. But according to his research, we are much more likely to STICK WITH the change when we move through the initial stages first.
And this proved to be true. I don’t think I would have made it over the bumps and hurdles along the way, if I hadn’t learned about the connection between gum disease and heart disease prior to taking action. For example, when the dentist told me this tiny 3-once bottle was going to cost $35 I nearly fainted but I still bought it. (Cheaper than the $1000 procedure I reckoned.) When I went to the pharmacy to get the tiny inter-dental toothbrushes I said, “you’ve got to be kidding me!” but I still put them in my shopping basket.( Not that much worse than flossing I figured.)
The first time I poured a little of the Irrigant into the bottle cap and dipped my tiny brush into the solution, per my dentist’s instructions, I nearly gagged it tasted so bad. As I did this new behavior for the first time, I would say to myself, I’m NEVER doing this again. No way.
But knowing the stages of change and knowing what Prochaska says about step two got me through all this self-doubt: The more time you spend learning about WHY you need to make a change in stage 2 the more likely you are to stick with the program. So I kept thinking about what I’d learned about all the bacteria in my mouth and how it could find its way into my blood stream through my “periodontal pockets” and that would bring me back to the bathroom sink with the irrigant in one hand and the tiny toothbrush in the other, every time.
In other words, it took a TON of motivation to get me through all these changes but in the very next installment of this 14-part series, we’ll see how motivation isn’t always the best weapon for inspiring behavioral change.
Even when I stopped using the inter-dental toothbrush for a month, after using it religiously for 6 months, I knew even this late stage relapse was as predictable as rain. This is stage 5, the maintenance stage, where, no matter what behavior you are trying to change, you are likely to fall off the wagon up to 3 or 4 times before taking on the new behavior permanently. (Unless you are like David Hunnicutt, of course!)
When I saw my dentist for a check-up six months later, and when he said OK rinse (after he had just spent 15 minutes rooting around my gums with that ghastly metal pick), what I spit out of my mouth was as clear as the water I had just put in it. And – excuse my gross references here – that was the first time in my entire adult life that had EVER happened. I thought all the previous disgusting episodes were NORMAL. So –CLEARLY –as the water I was expectorating - I didn’t have a problem with my gums any more. That was the moment where I’m quite sure I transitioned to Prochaska’s final stage of change The Termination stage where you are no longer at risk for going back to your old behavior. And this is why I always say that as wellness professionals, we must teach our clients about the stages of change. It will help them navigate the difficult waters of behavioral change.
But guess what? A Stanford Professor, named BJ Fogg – who is the hot topic in the world of behavioral change - has an entirely different model for creating behavioral change that isn’t nearly so reliant on motivation. What he tells us about change is SO different from Prochaska’s approach it will rock your world. Ironically, given the fact that we are talking about dentistry here, Fogg’s approach is often described as “flossing one tooth.” In other words, his advice is about making the change so EASY to do, it’s impossible to fail. In the next seven installments, we’ll show you how.
James Porter
Author