I’ve been thinking a lot about the power of images this week.  The sight of George Floyd on the ground with a knee on his neck will forever haunt me, as it does a nation.  Nothing captured my heart regarding global warming like the image of a starving polar bear in an article posted on Earth Day.  While statistics and charts actually relay more information, they just can’t move us the way an image can.  As it is said, a picture is worth a thousand words.  But what is it that makes an image so effectively grab our hearts and our imagination?

We are very visual beings, in fact a large percentage of our brain is dedicated to visual processing.  Images draw our attention and we process images so quickly, we’re not even consciously aware of it most of the time.  When we see a picture we can recognize a familiar object within 100 milliseconds and we can recognize a face within 380 milliseconds.  Our brains are wired to react to images, as quick processing of visual information would have benefited our ancestors in gathering food and hunting or providing information about a threat or danger.  Images that evoke emotions are given high priority in our central nervous system as a way of avoiding danger or tending to loved ones, both critical for survival.

In studying our emotional responses to images, psychologists have discovered a phenomena that is particularly powerful in capturing our attention and our empathy.  It is called the “identifiable victim effect,” and refers to research showing that we humans respond most intensely to images of an individual victim.  It is explained that in order to feel the tragedy, we must identify with an individual person (or even animal) experiencing it.  In doing so, it becomes personal.  There is a saying that one death is a tragedy, one million deaths is a statistic.  According to psychologist Paul Slovic, “The mind is very much geared to respond to a single person in need – whether it’s ourselves or a single person in front of us.”  In one study, Slovic and his collaborators put volunteers in an MRI scanner and watched how they made decisions about donating money to orphans in need.  They found that subjects chose to donate much more when they saw a photograph of a particular child than if they were presented with names.  The researchers found the extra generosity was attributable to increased activity in the nucleus accumbens, a brain area associated with pleasure and reward.  They concluded that images have a special power to generate the identifiable victim effect by triggering arousal in the brain.

History shows many examples of this effect.  Certain photographs have made a difference in changing people’s attitudes and behaviors in historic ways.  An image of a nine year old Vietnamese girl running after being burned by a napalm attack is credited with changing public opinion that helped to end the Vietnam War.  Another example is the photo of a Syrian boy whose body had washed up on a beach that captured the world’s attention to focus on the Syrian refugee crisis.  The Obama Administration began to protect African lions under the American Endangered Species Act when images of the lion “Cecil” were posted after being killed by an American hunter. The commonality of these photographs and others like them are that they show an individual victim.  In some way, in viewing individuals, we are able to see them in their vulnerability and are moved.  We are more likely to experience emotions when we focus on a single tragedy than when we feel overwhelmed by a large mass of people.

As we view body camera images from police officers involved in shootings and cell phone images taken by bystanders, we can now be witnesses to what used to happen in private.  These images not only illicit emotional outcry but can serve to bring accountability if we use them for justice.  Images are a way of showing the world what happened and preserving the story in its rawness.  With that, images are powerful agents of change.  And with any tool of such great power, we need to use them carefully.  Images can mislead if not given the appropriate context or can exploit subjects by those who own the power of the image. So when our hearts are opened by an image, we need to also use our heads.  Images can provide emotional motivation, but it’s the thoughtful commitment to action in response to our emotional reaction that creates lasting substantial change.

As one of my client’s put it this week, “The good news is I got my vaccine and soon things will be back to normal.  But the bad news is I got my vaccine and soon things will go back to normal.”  What she talked about is exactly what I think a lot of people are feeling right now.  That after over a year of being isolated and in various forms of lock down, it’s kind of scary to go back to the hustle and bustle of life.  Even if there are things we couldn’t wait to do, longed to do, even dreamed of doing, it’s a bit awkward to come out of our cocoons again.  It’s a natural part of being human.  We adapted when things locked down, and now we must adapt to things opening up and re-enter the world of driving in traffic, eating at restaurants, going to gyms, and maybe even a movie theater.

I’ve been working at home for over a year now.  Since my co-workers are mostly all vaccinated, my boss asked me to come into the Health Center to give a training to front line staff members.  Although I’ve worked at my Center for over 6 years, I was nervous!  I couldn’t sleep the night before, I left the house super early so I wouldn’t be late, I worried I wouldn’t know where to park or where the office they wanted me to work from was, and worried about who I would know and how things had changed.  And as I pulled up and used my ID Badge (which took me time to find) it all felt so familiar and yet so strange.  

For many people, the slower more isolated life was actually more comfortable.  Especially people I know who have some anxiety or social phobia tendencies.  The longer they’ve been away from social interactions and venturing out of the house, the harder it feels to go back.  And things have changed, there are new rules and new protocols that make us nervous about going somewhere familiar that is now unfamiliar.  It’s been an extremely stressful year with a lot to be anxious about, so most of us have been anxious in some way for a long time.  We worked to cope by finding joys in small things, mostly more quiet and calm, that we found solace in.  It’s hard to think of suddenly letting go of our safety nets and rushing out to embrace the wide world again.  I have heard so many parents complain about their kids acting out and not wanting to go back to school.  Especially for children, the last year has been a big portion of their young lives!

In examining this re-entry phenomena (a term often used to describe soldiers coming back from war or explorers coming back from an expedition), Julia Samuel, author of This Too Shall Pass writes:  “Most of us have an uncomfortable relationship with change because familiarity gives us a false sense of security and control – its an evolutionary defense mechanism.”  It took a lot of effort to get ourselves used to a strange world of Zoom calls and social distancing, reading facial expressions behind masks and finding new things to do on Saturday nights.  It’s unreasonable to expect that we can just jump right back into the life of our old social selves again without discomfort.  For one thing, we aren’t the same people we were before the pandemic began.  According to one study by the UCL, only 9% of people surveyed planned to return to living exactly as we did before COVID hit.  Many have re-evaluated aspects of life and how we want to live it. There is no way that we can go through the experience of having life so suddenly shut down without forever being changed by this effect on our perceptions of predictability and vulnerability.

So be easy on yourself and take it slow.  It helps to acknowledge your anxiety as a first step to taking back some control.  Plan some small outings with people you tend to feel safe with or places you have enjoyed and felt comfortable.  Ease yourself back into life and note what felt good and what was uncomfortable for you.  Keep doing these small things until they become much less stressful before you move on to bigger outings or larger gatherings.  It will be much easier to get overstimulated as you are re-entering, so don’t expect yourself to make up for lost time by making too many plans or promises.

If I take a step back, it’s almost amusing at how many of the simplest skills I have to relearn!  I’ve had a lockdown wardrobe that is pretty much a comfort based selection and a routine that moves much more slowly.  I forgot what outfits I used to wear to go out, what jewelry was my go to, what route I took to get to the coffee shop and what to say to people even in the simplest of circumstances.  It just shows how our brains work that after so many years of my life, after just one year of doing it a different way, I have unlearned so much!  But the good news is generally how easily it will come back.  I did feel a great sense of relief after my day at work, knowing the next time will be easier.  In fact, I’m planning to ask if I can book office space (the medical staff are now using most of the offices to socially distance with patients) once a week, just to build up my professional muscle again.  This muscle has definitely gotten a bit soft in the past year, working from the comfort of home with my kitten sitting in my lap all day.  If only there was a way to take him with me as my re-entry emotional support animal!

My last post left us in the Action Stage (Stage 5) where we had finally made our change.  But no matter what you’re trying to do, if the change you’re making is challenging, you will have slip ups.  That’s precisely why Stage 6, Relapse, is actually considered a stage of change, because it’s such a natural part of  the long term process of change.  Although it’s listed as the final stage in the Transtheoretical Model, the model is actually a circle, where Relapse flows directly back into Stage 1.  This circular shape is in recognition of the continual cycle of falling off and then getting back up on the change horse, so to speak. Change will always have its ups and downs and backs and forths. Today’s post is about how to cope with relapse in order to minimize its detrimental effect on your long term goals.  In other words, how not to give up after a setback!

In most cases, it’s not the relapse behavior itself that is so costly, but the negative effect of the relapse on your self esteem and confidence.  After a backslide into old behavior, it’s natural to feel disappointed, frustrated, and like you’re a failure.  But it’s these exact feelings that actually perpetuate the relapse behavior, research indicates.  People get so down on themselves, they give up, labeling themselves as too weak or too lazy, or some other character flaw that is permanent.  This negativity actually fuels the relapse behavior, as you get into an “Oh, **** it” mindset and punish yourself with harsh self criticism.  This continued self criticism further sinks you down into the dark hole of relapse.  

The biggest factor in how well people overcome a relapse incident or episode is how quickly they can get back on track.  The longer the old behavior continues, the harder it is to get out from under its grip.  An important factor is your perception of your relapse and what you attribute it to.  If you declare it happened because you are a no-good loser who will never be able to be successful, it will be harder to get back on track.  If, however, you attribute it to a bad choice, a stressful event without the proper coping tools available, or a slip due to a temporary situation you can keep the problem to a fixable solution rather than a character flaw that dooms you.

When and if you do have a relapse, try to distance yourself from it as if you were a scientist investigating a problem.  Create reasonable hypotheses regarding what happened by looking at the evidence, such as what triggered the behavior, what coping was needed, and what could have prevented the behavior from happening.  As best you can, develop a rational explanation to counter your emotional self sabotage. Begin to problem solve and plan for the future. Understanding what happened is about creating forgiveness so that you can let go and move on, not about making an excuse so that you can keep going in your relapse.  Think of relapse as a good time to evaluate your self care.  We tend to be most vulnerable to slipping back into old habits when we are stressed, tired, lonely, depressed, or too busy to be thinking about our values and our choices.  Sometimes it helps to think about emotional relapse as separate from the actual relapse behavior.  When we stop caring about ourselves, we emotionally give up and slip into circumstances that make us more likely to engage in the behavior we have been careful to avoid.  In AA there is a saying, you take your first drink before it ever crosses your lips.  Warning signs might be isolation, avoidance, rationalizing, and romanticising how life used to be.

And this is how we get back to the beginning, by reaffirming our need and desire for a change, reassessing our motivation and our skills.  Try to use your relapse as good energy to recommit yourself rather than a drain on your energy in self punishment.  While relapse is never pleasant or desired, by incorporating it as a part of the change process, you can take the powerful sting out of it that may lead you to give up.  If it’s planned for and an expected part of the process, it makes it easier to move past it.  Letting go of shame is critical to moving into a recommitment.  This is why it’s often important to tell someone about your setback, airing it out in a way that tends to take the secrecy and darkness out of the incident.  It also allows you to gather support and guidance in getting back on track.

After a relapse incident, it’s often a good idea to write a letter to yourself about what happened.  It helps to clarify how you are feeling and to let go of the negativity.  It’s also a great reminder of what it feels like to be in the situation.  There is nothing better than reading your own words to remind yourself about the pain of relapse as a tool to keep it from happening again!  For example, now that I am older, I motivate myself to keep moving by remembering how hard it is to get back into shape!   It’s often the thought of what it takes to start over that can keep us from having the need for it.  So think of your Relapse Stage as an opportunity for learning.  Like most things psychological, the more you can name it, the better you can tame it!

RELAPSE (stage 6) – reengaging in old behavior pattern. Task: Learning from relapse what will help deter or minimize a relapse the next time.

So congratulations! We did it! In my last post we took Action and made our change after time spent avoiding, deliberating, and preparing. And now we are in Stage 5, the Maintenance Stage. Sounds so easy, doesn’t it? Just maintain, keep the status quo, as if the work is done. But unfortunately, as we all know from past attempts at change, it ain’t all that easy. The Maintenance Stage is hardly a passive “just keep it up” phase. It actually involves a lot of work and a continued hypervigilance to avoiding the dreaded relapse. So in this post, we’ll take a look at some strategies to keeping on keeping on.

Maintainers must learn to successfully navigate temptation.  It helps to remind yourself of the progress you’ve made and acknowledge the time that’s gone by as a way of keeping the momentum.  Mark milestones, such as days of the new pattern – the first week, the first month, etc.  Reminding yourself of the work already put in helps to avoid the temptation to break the chain.  It’s also important to remind yourself of the importance of the change, as this may tend to fade over time.  Keeping tangible reminders of the meaning and significance of your change can be good motivation.  Sometimes just having a bracelet with a word on it, posting a list of why you are changing on your desk, or having a meaningful photo in your line of site can be a good pick me up at a low point.   

Maintainers need to be adaptable. You must be able to reformulate the rules of living and acquire new skills as needed to deal with unexpected challenges as they present themselves.  For example, a vacation or a change in routine can throw you a curveball.  In order to maintain a change, it requires planning ahead, anticipating where you will most likely face challenges, and then coming up with workable strategies to adapt to them. You might need to pack some of your own food, some coping tools (such as a book, a knitting project, or other distractions), or do some research about resources that will be available in your new environment.  For example, you may want to find a place you can go to get exercise or attend an AA meeting on a trip. Whatever the need is, to maintain your change, how can you take care of you in your new situation? 

Maintaining requires a lot of patience with yourself, as it takes time to let go of old habits and replace them with new ones.  It can be discouraging when you’ve stuck to a plan for so long to  be so easily pulled into desires that you thought you had put behind you.  There are some definite warning signs to look out for in order to Maintain.  Beware of the word “just.”  It usually represents some sort of way you are trying to fool yourself.  “I can have just one cigarette,” or “I can skip my medication just for a few days,” are some examples of how our own mind can play tricks on us!  Just really?  And also beware of romanticizing your old behavior.  “Remember when I drank tequila?  I was so funny!”  Or “I was able to get so much more done when I went to bed at 2 am.”  You tend to remember a distorted image and forget what led you to need to make the change in the first place.  It wasn’t worth the cost, whatever the habit was, as you had decided to make a change.  Remind yourself about the flip side of the coin and why you had decided the old way didn’t work.  

And finally, Maintaining requires assertiveness skills.  There will be countless people who will pressure you to go back to your old habit.  “Oh, you don’t like my cooking?” or “Come on join us, what’s the harm.”  It can be hard to say no and risk feeling like you are rejecting someone or refusing a kind gesture.  But Maintenance involves a commitment to yourself.  It involves internalizing permission to put what you determine is healthiest for you above what someone else may want.  Maintainers have to navigate how to set boundaries that are flexible enough to get along in the world, but firm enough to keep true to their goals.  See what I mean?  Maintaining is indeed a lot of work, but the good news is, you get a big reward.  Not only do you get the change you desired, but you get the confidence and pride that comes along with being successful at it!

Maintenance (Stage 5) – having reached a goal now taking steps to maintain it Primary Task:  Developing necessary skills to keep the change and avoid relapse

So, after all the thinking, considering, avoiding, and then making plans in the process of change, the time comes when you are ready to take Action.  Stage 4 of the Transtheoretical Model is all about that first plunge into actual behavior change and beginning the journey to accomplish your goals.  But as many people find in Stage 4, finally taking the leap may come with some surprises, and this week’s post is about how to help you begin your actual change with the highest chance of continued success.  

Often the build up to change is so filled with anxiety that finally doing something may actually bring a bit of relief.  For so long you may have avoided a change, constantly living with the fear it would be too difficult to maintain and/or that you wouldn’t be able to do it at all.  Often people find that when they do make the change, it feels pretty good.  For example, many people who want to quit smoking or drinking feel tremendous anxiety about what a nicotine or alcohol free life will be like.  They imagine all sorts of scenarios involving attempts in the past that had gone awry.  The anticipation of how bad it will be is itself really uncomfortable.  So by the time they actually have their first taste of smoke free or alcohol free living it feels better to actually face it than to worry about it.

One strategy that may be useful is to pick a start date.  Quite often people moving into the Action Stage are too nervous to commit. Fearing failure, they try to ease into it, by saying things like, “tomorrow I’m going to try to go the whole day without a cigarette.”  Human nature being what it is, we leave ourselves too much wiggle room for the ambivalence we have been fending off to sneak back in.  After a few days of “trying” but not fully committing, we unfortunately prove to ourselves that we can’t do it.  So picking a start date is a very important psychological step to cementing our commitment and calling in all the coping when we reach that milestone.  A start date provides the structure to your plan and signals that the beginning of your new way of being has completely begun. 

Once you take the action toward your goal, reward yourself and congratulate yourself.  Reinforcement and support are extremely important in maintaining the confidence and motivation required in a change.  Use the people who you had identified as support people and let them know what is helpful. The Action Stage typically involves making some kind of public commitment to your change.  People may notice you doing things differently or you may have to announce it.  Declining an offer of a drink,  dessert, or a cigarette can feel uncomfortable at first.  You may find yourself awkwardly explaining or even in the role of needing to make an excuse for suddenly being different than other people, especially in your social circle.  It’s important not to feel you have to justify yourself or make others feel better.  Each of us are entitled to make our own choices and your change is not a comment on other people’s habits.  

Depending on the goals you set in the Contemplation Stage and the plans you made in the Preparation Stage, the Action Stage can be either a series of small steps or one big life change.  It may feel strange or even empty to be living without a habit or way of life that you have done for so long.  And while the initial success may be exciting, it may take time to see the long term desired results.  It is natural to have a period of grieving and a transition time to adjust to a new normal.  Identifying effective ways of coping with stress are crucial during this action phase. Of course the better prepared you were with your plan, the easier it tends to be, but you will inevitably encounter circumstances you had not prepared for.  Don’t be afraid to continue to ask for help and to problem solve and tweek your plan as needed.  Sometimes we need a little extra help to break through a barrier or to face an unexpected road block.  

Repetition is one way to help in the early stage of Action.  Doing the same thing each day tends to help make any change a new habit more quickly.  Reviewing your list of motivations each morning and your successes each evening is a good way to keep in touch with your goals and what you may need to help support yourself.  

Often the fear of failure keeps us from wanting to tell people we are making a change.  But by not telling anyone, you rob yourself of their support. And you will need it.  Because at some point during the Action Stage, the realization will  kick in that not only do you have to do this new change today, but you may in fact have to keep doing it every day.  And this, my friend will tend to bring a bit of shock and fatigue and even regret.  But have no fear, my dear change agents in action, this will be a perfect sign that you are moving into the next stage…Maintenance. A sure indicator you are creating success!

Action: Taking steps toward change but hasn’t stabilized in the process 

Primary Task:  Help implement change strategies and learn to eliminate potential relapse

So, you’ve gone through the process of deliberation and have decided change is needed and/or desired.  Now that the scale has tipped toward making change, the topic of this post is how to get ready.  Stage 3, or the Preparation Stage, is all about the plan.  It’s easy to underestimate the importance of this stage, as it tends to be the quickest of the stages, as Preparers are on the verge of and are motivated for change.  But having the right strategy for change is so important for success and if not done well, can undermine your efforts and quickly zap both your confidence and motivation.

While Preparers still experience ambivalence, the quality of this is more along the lines of not whether change is needed, but if it will be possible.  Preparers are eager, but wrestle with fears and self doubt.  They tend to start making small changes to prepare for the bigger change and can be excited or discouraged based on how these smaller steps go. For example, they may switch to lower fat foods if the goal is weight loss, or begin smoking an hour later in the morning if being nicotine free is the change desired.  The important outcome of this stage is to make a realistic plan.  Commitment to change without a good long term game plan can undermine your efforts and lead to disappointment and frustration.

In the Preparation Stage it helps to gather information both externally and internally.  Externally, doing a good search for structures and strategies that can guide you is a great idea.  For example, if weight loss or eating healthier is your goal, you can find a lot of information about different options such as Whole 30, Weight Watchers, or Intermittent Fasting.  You can also look for groups or communities that will be a good source of information and ongoing support and encouragement.  It’s good to find resources not only to help in the transition of change, but also thinking ahead to maintaining the change.  For example Nicotine Anonymous is a great resource for quitting smoking and has a wide range of meeting times and locations.  Or finding a local hiking club if your goal is to get more active.

But don’t get lost in the planning, Preparers.  It can be overwhelming to research all the possibilities and options.  This is where the internal preparation is so important, asking yourself what plan seems best suited for your lifestyle and personality.  To be successful at change, you need a realistic assessment of the difficulty of the desired change and the strategy you are going to use to make it.  It helps to look at past efforts and where they were derailed as well as potential barriers that might get in your way.  For example, increasing exercise in the winter in cold climates during a pandemic will be especially difficult, with gyms closed and storms on the way.  This may be a good time to ask for help in creative problem solving, either from trusted people or a professional who may have ideas and experience you have not considered.  

During this stage, journaling is a great tool.  It gives you a chance to reflect and play with ideas.  Some questions that are helpful to explore:

What possible obstacles or conflicts may arise?

What mindsets, habits, or behaviors might sabotage your efforts?

How will achieving your desired change affect others in your life (family, friends)?

Are there any sacrifices you will need to make? Are you ready to make them?

How will your life need to change in order for you to achieve your end result?

Is the end result aligned with your core values and beliefs?

Asking yourself these important questions before you begin a significant life change can save you time, effort, and heartache, and allow you to make any necessary adjustments ahead of time.  In addition, it’s a good time to take stock of your assets.  It can help build your confidence to see that you already have a number of things in your favor that can be called on when needed.  Make a list of your resources, such as money you can invest in your change, skills you already have, people in your life who can support you, or any other special skills, training, or experience you can draw on.  For most of us, we may also find we have some missing pieces in our arsenal of assets.  Preparation is a great time to also assess the assets you will need and begin to build them.  You may need to adopt new mindsets, obtain training to have a new skill, create a physical space for your endeavor and a calendar of time commitment in your schedule.  Planning for how to be prepared is about breaking down your big change into its component pieces.

Finally, once you have created your multi step plan, you need to create a Plan B…or C…or D.   No matter how well you prepare there will always be obstacles and bumps in the road.   Of course you can’t anticipate everything, but having an overall strategy can help you ride through any setback.  For example, if you get off course, who can guide you?  If the people in your life are not supportive and they resist your change, how can you address it?  A good part of the preparation for change is to accept that it will not be a straight journey toward your destintion, but an uneven series of hills and valleys, lefts and rights, and frustrating detours.  Anticipating this will help keep you from being upended by any particular unexpected pothole!

Stage 3 Preparation:  Commitment to change is achieved, but still considering what to do and how  Primary Task– Identify the best strategy for you and create a plan

While my last post focused on the Pre-Contemplation phase of change (Stage 1), when you tend to avoid and deny the need for change, a shift into Stage 2, Contemplation,  is achieved when you gain an awareness and acceptance of this need.  But now that you’re considering the change, the pros and cons are in constant consideration.   The hallmark of Contemplation is ambivalence, a back and forth of conflicting emotions regarding whether or not it’s worth taking action toward the change you now accept should be made.  Like riding a swing, Contemplators go back and forth and back and forth, spending a lot of energy, but not actually going anywhere just yet. 

Contemplators are more aware of the personal consequences of a bad habit and are able to think about the possibilities of change.  They may be more open to seeing the negative aspects of their behavior and the positives that would come with a change, yet, they doubt if the long term benefits will be worth the cost.  As the desire for change gets more real, so does the awareness of what may get in the way.  The good news is that Contemplators increasingly are open to information about their specific problem, such as reading books or going to websites, and are more open to discussing and reflecting on their conflicting thoughts and feelings.

The challenge to Contemplators is getting stuck in “all talk and no action.”  How many times have we made a plan, talked with our friends about it over and over again, but never put the plan into action?  We get stuck in the ambivalence, wanting change but not having the confidence or motivation quite up to breaking the impasse.  Contemplation can be thought of as the thinking phase, where we think and think about doing something.  For some people the thinking may lead to eventual doing, but for some people, thinking is as far as they may ever get.

This can be frustrating, both within ourselves and with others.  When you’re with a Contemplator, it’s natural to want to push them into action.  Enough already, we want to tell them, or tell ourselves: “Stop talking and do something!”  In order to support someone in Contemplation, it’s best not to become judgmental, but to ask questions that aim to build confidence and highlight the benefits.  For example it may be good to ask about why change is desired, what is preventing change, and what could help them make a small step in the direction of the change.  In Contemplation, supporting a person in gathering more information, exploring answers to any questions, and tipping the balance toward the benefits of change vs the cost is most helpful.  Supporting  a Contemplator look at change as a process of gaining something, emotional, mental, or physical, rather than giving up something may encourage them to move them past their ambivalence.

Riding the back and forth of whether or not to make a change is uncomfortable.   And yet, at this point, it may feel more comfortable than taking the risk of actual change.  As I look at journals about my News Year’s Resolutions over the past years, I can clearly see my own pattern of Contemplation.  In just reading them I want to strangle the part of me that blabs on and on about all I’m going to do, clearly not doing it, as there it is again in next year’s goals. At some point I hope to get up enough speed with my efforts to launch myself off the swing!  But until I do, at least I have a fancy name for my process.  I’m not doing nothing…I’m Contemplating.

Stage 2: Contemplation – Sees the possibility of change but is amivalent and uncertain. Primary Task:  Resolving ambivalence, choosing change.

In my last post I made a case for change as a process. I outlined the Transtheoretical Model’s Stages Of Change which describes the evolution of “readiness thinking” that is necessary to put change into action. This week I’m starting with Stage 1, Precontemplation, and highlighting what the characteristics of this stage are and how to help yourself or someone you care about with the particular tasks of this stage. In Precontemplation, just as it sounds, change is not even in the realm of possibility yet. People in this stage have no plans for change, even if they wish for it. In other words, Precontemplation is the very beginning. But just like a seed hidden in the ground during winter, although you can’t see it yet, the potential for a flower is there.

In Precontemplation, a person completely lacks motivation or confidence (or both) to change. People may not be fully aware of the potential benefits of a change, or they may be demoralized from failures in the past. Generally, the hallmark of this stage is a general lack of awareness and/or an annoyance or avoidance of the need for change. According to Dr. Prochaska, who developed the model, “In Precontemplation, people underestimate the benefits of changing and overestimate the costs or cons. But they’re not particularly concious of that, so it’s not a focused rational decision making process.”

So how do I know if I’m in this stage if it’s not conscious?  Chances are you’re a Precontemplator if you’ve heard plenty of times from your partner, your doctor, your friends, or your own conscience that you should make a change.  And when these people, including yourself, try to talk to you about it, you tune out, shut down, withdraw, or change the subject.  You may even find yourself annoyed and wishing they would mind their own business.  Precontemplators often are represented by the four “Rs.”  Reluctant precontemplators lack knowledge or inertia to consider change.  The impact of the problem hasn’t become fully conscious.  Rebellious precontemplators have a heavy investment in their current behavior and in making their own decisions.  They’re resistant to being told what to do.  Resigned precontemplators have given up hope about the possibility of change and are overwhelmed, perhaps having failed before.  And finally, rationalizing precontemplators have all the answers. They have plenty of reasons why they have no problem and or why the problem is a problem for others but not for them.

Supporting a person to move through Precontemplation involves mostly increasing their tolerance for awareness (it’s painful to think you need to change!).  Therefore, it’s so important to approach the issue in a way that is as collaborative as possible, showing love and compassion, even within yourself.  Often out of frustration, we lecture, nag, or confront in a way that may actually increase resistance.  Often it’s out of shame and embarrassment that a person avoids a topic and becomes irritated when the subject is even mentioned.  It’s important to remember that we can’t make anyone change and that the best way to support change is to allow the person to take responsibility in whatever way they feel possible.  Oftentimes it takes a scary test result, a major life event (such as the birth of a child, the death of a loved one) or a health crisis that opens the door for people to get motivated.  

It’s also important to remember that even just thinking about change is in fact a change in and of itself and is the first necessary step.  According to Dr. Lickerman at the University of Chicago, “thinking about making a change is what gets people used to the idea of actually making it.”  Some tools for addressing the Precontemplative dilemma are to ask permission to address the topic with someone and be flexible to what is a good time and place for the discussion.  It’s also good to acknowledge and commend the person to being open to the conversation and be a good listener.  It’s usually more helpful to ask questions than to provide answers.  Check in with the person during the conversation and when you are finished, be open to feedback.  Watch for body language that indicates someone is overwhelmed and/or feeling shame.  

Power struggles can be strong barriers to change, even within yourself.  Compassion and curiosity are truly the best tools you can acquire for the process of change.  Remember, the seeds of change need nurturing. You can’t make a flower bloom by demanding that it does or assuming it doesn’t love you if it doesn’t.  

Stage 1: Precontemplation – Not yet considering change or unwilling or unable to change. Primary Task:  Raising Awareness

“Good riddance to 2020!” so many of us said this past New Year’s eve.  Unfortunately, when we woke up in 2021, little had actually changed.  But our expression is a good sign that we have hope that things can be better and carry within us the belief that it will.  I remind myself that for most significant things, change is slow and actually happens in small steps, little by little, day by day, week by week.  It got me thinking back to one of my very first posts about change being a process.  I thought now might be a good time, at the start of this much anticipated new year, to look more closely at one of the most popular models of how change happens and what we can do to support it.  Over the next few posts I will review each stage of change, starting with today’s overview of the change process.

Nature provides such wonderful examples of change as a process.  A caterpillar turning into a butterfly or the changing of the colors of the leaves remind us of slow transformation that usually involves a complex series of small changes.  But caterpillars don’t worry whether life as a butterfly will be better than life as a caterpillar, and trees don’t have to decide if they want to keep their leaves this year.  As thinking beings we have the capacity for refection, and thus bear responsibility to make choices in how we live.  Therefore, our thought processes are a major focus of understanding the change process and form the lens through which readiness for change is evaluated.

Also called the Stages of Change Model, the Transtheoretical Model was first developed by Prochaska and DiClemente in the late 70’s while studying smokers who were successful in quitting.  The researchers found that people quit smoking when they were ready to do so (surprise!).  They focused their model on the decision making that occurs in the process of becoming ready to change and assumes that people don’t change behaviors quickly and decisively, even if it may appear so to others.  Rather, change, especially of habitual behavior, occurs continuously through a cyclical process.  In order to help support change, understanding the stage of change in which a person is currently in helps to match the intervention to the period of time in which it should be most effective.  For example, giving someone the nicotine patch is not going to be very effective if they’re still wondering if it’s worth the effort to quit smoking.  Conversely, when someone’s in nicotine withdrawal, listing pros and cons of smoking may not be good timing, either (and bears a risk of getting clobbered).

One thought process that proves to be extremely helpful in the change process is motivation.  In order to make sacrifices or endure the discomfort of change that usually happens, either physically or emotionally, we have to have a significant level of motivation and desire for the change.  But motivation is not enough, it turns out.  We also have to have confidence and skill.  We need to know how we will make the change, so that when we apply our motivation, we can succeed.  If we don’t believe we’ll be successful, it’s hard to keep up our effort.  If we don’t have the skill, we’ll lose the confidence.  As you can see, it is indeed a cycle and a complex emotional and mental feedback loop to make and maintain change!

Understanding the level of readiness for any change is so important in keeping perspective about the change process.  Whether it’s on a very personal level of a change within yourself, or for a person you care about, or our society at large, change necessarily involves risk.  By having a better understanding of where things are currently for any change, it helps to identify more specifically what we can do to move it along most successfully.  Reminding myself that change is a process that takes time and sequential steps, moving forward and at times backward, helps me keep up my confidence and motivation.  And Lord knows we need both of these to get 2021 off to the good start we’ve been hoping for.

As we head into the New Year (finally!) we typically set goals for weight loss, financial status, and career aspirations.  With a year so full of losses and loneliness, I think it’s especially important to be attending to the well being of our moods and mental health and providing ourselves with the care we deserve. So for my last post in this strange and challenging year of 2020, I hope you’ll take the time to watch to an inspiring video first posted to The NY Times Op Ed on December 7th (link provided below).  After watching this video, I hope you’ll give equal attention to setting some mental health goals for 2021. 

Alexi Pappas is an elite athlete.  After the 2016 Olympics, she experienced a severe major depressive episode.  She felt alone and lost.  Even though she had powered through injuries and setbacks her entire running career, she found she was not well equipped or supported in facing her mental health injury.  This brave woman shares how she began to approach her mental health with the same amount of resources and attitude of healing as her physical health.  

According to the Center for Disease Control and Prevention (CDC) approximately 1 in 5 adults in the US or 43.8 million people experience mental illness in a given year and 1 in 5 youth ages 13-18 will experience a mental health disorder at some point.  Suicide is the 10th leading cause of death in the US and is the only one in the top ten on the rise.  Among those 10 to 24 years of age, suicide is the third leading cause of death.  Mental illness occurs indiscriminately across race, gender, ethnicity, sexual orientation, or culture.

With the uncertainties and stresses of 2020, I am sure these numbers will rise, unfortunately.  One silver lining this year has been an effort to publicly reduce the stigma of mental illness and encourage people to speak up.  One such noted effort is the “I’m Listening” campaign, where celebrities including musicians and athletes have opened up and shared about their struggles with anxiety and depression (see Radio.com) and stressed the importance of both talking about your experiences and the benefits of being heard by someone.  

So as you make your list of goals for the New Year, please include some goals for your mind as well as your body.  This can be a great year to try a new meditation app (Insight Timer or Calm), educate yourself (read books like Ambiguous Loss, The Anxiety and Phobia Workbook, The Body Keeps the Score) and/or even reach out to see a therapist (we are only a phone call away, especially while we work via telehealth!)  But the main goal I encourage for you to set this year, to be done with people you love and trust, is to talk about how you are feeling and ask someone else how they are doing.  Whenever we share what feels like a dark secret, we most always feel a little better by bringing it to the light.  Remember, you are not alone!!!

Please watch this beautiful account of growth and healing:

https://www.nytimes.com/video/opinion/100000007372207/alexi-pappas-depression.html?campaign_id=9&emc=edit_nn_20201207&instance_id=24780&nl=the-morning&regi_id=83086246&segment_id=46245&te=1&user_id=2d09d4cb91922563a691ccabdbe83abc

Some resources:

Text Line (741-741) Text to Talk 24/7 crisis counselors

The American Foundation for Suicide Prevention 1-888-333-2377

Depression and Bipolar Support Alliance  1-800-826-3632

Psychology Today : Website for Therapist Referral

Substance Abuse and Mental Health Services Administration (SAMHSA) 1-800-662-4357

The Trevor Project (LGBTQ 24/7 hotline) 1-866-488-7386