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Editor's Note: Obesity expert Dr. Martin Binks contributes regular guest posts to the dailySpark. Changing hard-to-change habits or behavior is among the greatest challenges we humans seem to face. In our modern society we tend to call anything that falls into the category of "hard to change" and or "damaging" an addiction. Apparently, as a society we are 'addicted' to everything from Facebook to shopping, to cheating on our partners or staying in bad relationships. I even heard a famous mother of 14 describe herself as "addicted to having babies." Rather than debate this newfound tendency to label everything an addiction, let's look beyond the label and speak to what we are really trying to say when we label a behavior an addiction. What we are saying is we are feeling stuck in a pattern of behavior that is in some way damaging to ourselves, our way of life, our health or our happiness. We are saying that despite being rational, well-accomplished, intelligent and loving individuals, some thing that we are doing has a hold on us and despite persistent effort to change, we feel we are failing. All human behavior is a consequence of the interaction between our physiological selves (our body/brain) and the overall behavioral environment. What I mean by that is yes our neurotransmitters do in fact respond to our world and the brain's reward centers are activated when we experience pleasure, however biology is not always destiny. That is why with proper help and persistent effort, many who are addicted to alcohol or drugs or nicotine and so forth are able to stop. This also explains why even long after the direct physiological influence of that substance has left our body (withdrawal) we continue to struggle with staying stopped. If addiction was purely physical, once you got through physiological withdrawal, then it would be done. So what we can conclude from all this is that even for things like those I mentioned, where there is a clear and well-defined physiological addiction, a huge portion of why we overindulge or abuse these things is determined by learning, emotions, and psychological factors. This is likely even more true when it comes to damaging behavior for which the physiological links are less clear like eating, gambling, shopping, sex and so on. Sure the 'reward' systems are activated by some of these things, but the science around just how much of this activation is just normal brain activity vs. a sign of a physiological addiction and/or a target for possible medicine to assist is far less clear than for those things we mentioned earlier. Furthermore, even when a physiological component is a part of the picture, it is never sufficient to account for the whole problem we experience. What is clear about all of these is that we likely learned to use these things to serve some useful purpose like to feel good, to fill an emotional void or just to cope with daily life. In order to succeed at changing the behavior we will need to unlearn this faulty coping and replace it with new and less damaging strategies. This is why the tendency to call everything "an addiction" can be disturbing, as it can inaccurately imply that damaging behavior is somehow ingrained in our biological roadmap and by extension, unchangeable. The bottom line is that even when there is a physiological component, the lion's share of the problem in terms of long-term change lies in learned behavior. The good news is that anything that can be learned can be unlearned, and we are all capable of learning more effective strategies. So what does it take to change a bad habit? You will hear all kinds of bold statements like "it takes 28 days to change a habit." Interestingly, there is no scientific support whatsoever for this; just the opposite. The scientific evidence on learned behavior to oversimplify a bit, typically shows that time to alter a behavior is a variable function of the amount of time you have been repeating the behavior (learning) and the strength of the reinforcer (reward) and that this is also influenced by the strength of any punishment that is applied simultaneously or as a consequence of the behavior (negative consequences). What is also important in the equation is the amount of time that passes in between behavior, reward and consequences. Further complicating the picture is that for the average human living our daily lives, there is not just one of each of these (learning, reward, consequences) involved in the behavior you are trying to change. In fact for every habit, whether it is overeating, drinking, smoking or gambling, there are many combinations of these, all of which are interacting with one another in the context of your entire life. This really complicates things. So basically, the scientific answer to how long it will it take to change a damaging behavior is ... (drum roll, please)... as long as it takes. It will depend on how hard you work at it, how consistent you are in applying the strategies you are being taught to change your behavior, and how realistically you are able to view/experience the negative consequences of your behavior at the moment you are making the decision to act (denial). For example, if we look at weight control. At any point in time, during any day, we are faced with dozens of mini-decisions that will impact our weight. These range from things that are loosely related to those that are more obvious. For example, the decision to roll over for an extra 15 minutes in the morning, may cause you to be a little late, which leads to skipping packing a healthy lunch, which also adds stress to the start of your day and so on. This is very likely to build up towards making a less healthy decision at lunch. This is an example of subtle. A more obvious example might be when you make that decision to eat a fast food burger in your car for lunch. Most of us know this will not help our effort to lose weight – or do we. In fact it would seem that we are very skilled at denying even this obvious connection to interfering with our goals "in the moment." Why? Because we have through repetition learned that the immediate reward of simplicity, reducing time pressure, and the emotionally (and possibly physiologically) rewarding experience of eating pleasurable high fat food choices all outweigh the potential for longer-term consequence (weight gain). Add in the denial factor ("I will make up for it later") and we appear doomed. Lack of awareness in the moment of exactly what is going on with each of these mini-decisions, in my opinion is a major contributor to lack of weight loss success and lack of success with changing most troublesome behavior patterns. Now often people look to an article like this one to provide in 1,500 words or less, THE answer. Well of course it's not that easy. However there are so many wonderful resources available that take scientifically developed approaches to behavior change and teach very reputable strategies for changing behavior. My rule of thumb is find reputable help then consistently apply as many of the strategies as you can on a daily basis. There is not one answer; however I do feel that there is ONE core strategy that can aid you in at least considering "in the moment" using some of the strategies available: Try this as you go through your day and face the multitude of difficult decisions that impact your health and well-being. In the moment, before making a decision and acting on it, pause briefly and answer the following questions: What am I feeling RIGHT NOW? Why is doing this so important to me RIGHT NOW? What are the consequences NOW? What are the consequences LATER? Using a strategy like this is a simple way to pause and become more aware "in the moment" and is step one in changing what may have become very automatic behavior patterns. Finally, since you will need to have access to all sorts of skills to apply to the various situations once you have become aware, here are some ways to weed through the sea of available information and locate reputable information:
Dr. Martin Binks is Clinical Director and CEO of Binks Behavioral Health PLLC (www.DrBinks.com). His professional activities include consultation services for the development of evidence-based obesity and health promotion programs in healthcare, research and corporate wellness environments. Dr Binks also offers psychotherapy, psychological assessment, and motivational and life coaching services to adult and adolescent patients at his Durham, NC, offices. Dr. Binks received his Ph.D. in clinical psychology from Fairleigh Dickenson University, trained at the Bronx VA Medical Center and completed pre and postdoctoral training in behavioral medicine at the Medical University of South Carolina. He is formerly Assistant Professor, Division of Medical Psychology, Department of Psychiatry & Behavioral Sciences, at Duke University Medical Center where he served as Director of Behavioral Health, Research, and New Business and Strategic Alliances at the Duke Diet & Fitness Center. Dr Binks has worked extensively in the areas of obesity, health & wellness promotion, neuropsychology, substance abuse treatment, issues of adolescence and family dynamics, post-traumatic stress disorder and spinal cord injury. Dr. Binks has authored and co-authored multiple research publications and the book "The Duke Diet." Dr Binks has an ongoing funded research program. His research interests include internet and other technology-based healthcare delivery, obesity treatment, non alcoholic fatty liver disease, and overall health promotion. He serves as a reviewer on several scientific journals and is a regular contributor to multiple health websites and media outlets. Dr. Binks contributes to healthcare provider education through his work with students and trainees and by lecturing nationally in the areas of obesity management and behavioral medicine. Dr Binks is currently active in several leadership positions at the national scientific organization The Obesity Society. Dr Binks has also been a contributor with the Army National Guard Decade of Health and Wounded Warriors programs and is a member of several corporate advisory boards. |
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