CHANGING FOR GOOD

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CHANGING FOR GOOD

By James Prochaska, PH.D., John Norcross, PH.D., Carol Diclemente, PH.D. Only I can change my life. No one can do it for me. –Carol Burnett We all have big changes in our lives that are more or less a second chance. Harrison Ford (1942 - ), quoted by Garry Jenkins in 'Harrison Ford: Imperfect Hero Things do not change; we change. Henry David Thoreau (1817 - 1862), Walden (1970) Change has a considerable psychological impact on the human mind. To the fearful it is threatening because it means that things may get worse. To the hopeful it is encouraging because things may get better. To the confident it is inspiring because the challenge exists to make things better. King Whitney Jr. Purpose: I have summarized the key points in this wonderful book. In order to gain the greatest good purchase your own copy and read it thoroughly. Do the exercises and selfassessments. Create a journal or notebook and really give it your highest priority. Wanda J. Bedinghaus, MD Change is unavoidable, part of life. Few changes are under our control. But some things we can intentionally change…our behaviors, thoughts, feelings…habits. Successful, self-changing individuals follow a powerful and, perhaps most important, controllable and predictable course. Know what stage you are in for the problem you want to overcome. Even if you are not ready to act, you can set the change process into motion. The key is successful change is to use the right strategy for the right time. There are no magic pills, pins or plans. You can learn new skills, draw upon your inner strength, enhance your self-sufficiency, and avoid becoming dependent on others for solutions; thus building your self-confidence for the future. Failure is often due to a lack of guidance. You don’t have to reinvent the wheel. Be willing and open to learn. This book can help. Your wellness team at Healing Unleashed™ can also help. We are passionate about your wellness!

HOW YOU CHANGE. Self-changers. A change process is any activity that you initiate to help modify your thinking, feeling or behavior. In change, timing is everything.

2 SUMMARY OF NINE PROCESSES OF CHANGE:
1. Consciousness-raising, awareness. Making what is unconscious conscious.
2. Social liberation: any new alternatives that the external environment can give you to begin or continue your change efforts: No-smoking areas, low fat menus items. You can advocate for yourself and others.
3. Emotional arousal: become aware of your defenses against change. Emotions arousal works at a deep, feeling level. Important in early stages of change. Dramatic release/catharsis..sudden emotional experience related to the problem at hand. Can come from real life tragedies. Drunk driving accident. Easier to generate emotional arousal through film, public education spots,. The goal is to increase awareness and depth of feeling and to move individual toward action.
4. Self-reevaluation: thoughtful, emotional reappraisal of your problem…an assessment of the kind of person you might be once you have conquered the problem. Enables you to see how and when your problem behavior conflicts with your personal values. How do you see yourself if you change your behavior? What are pros and cons of overcoming your problem?
5. Commitment: Once you choose to change, you accept responsibility for change. You are the only one who is able to respond, speak, act for yourself. The 1st step is private. 2nd step is going public...announcing to others your firm decision to change. Even if you fail or fear embarrassment, public commitments are powerful.
6. Countering: Substituting healthy responses for unhealthy ones. Find the one that works for you. Going for a walk outside instead of a walk to the frig.
7. Environmental control: action-oriented. Restructure the environment...removing drugs, alcohol, cookies from your home.
8. Rewards: Punishment is rarely used for successful self-changers. Self-praise. Giving yourself a special present when you reach your goal.
9. Helping relationships: You don’t have to go it alone. You can ask for help from family and friends to provide support, caring, understanding and acceptance. There are many techniques for these 9 processes of change. Having 3 or 4 choices increases success.

WHEN YOU CHANGE

Change unfolds through a series of stages. It is key to know what stage you are in for the problem at hand. If you aren’t ready for change, you set yourself up for failure. If you spend too much time “understanding” your problem, you may delay taking action indefinitely. You can’t skip stages. Most successful self-changers follow the same road for every problem.

CONTEMPLATION

We desire to change but sometimes we are resistant to change. It’s easy to stay stuck in contemplation. Sometimes we prefer a familiar self to one that is more real and true to our ultimate nature. We postpone and procrastinate, continually reading, researching about our problems rather than moving into action. We become anxious about change. Being aware of ambivalence can prevent us from falling into one of the many traps that are negative responses to contemplation. The search of absolute certainty. If we are obsessive, we think we have to explore every aspect of an issue until we achieve an absolute certainty of its origin. We may hope that just thinking about the problem, it will go away. Obsessives may search for years…going from one thing to the next until we find the perfect solution. Eventually, we must make a decision and go forward. Waiting for the magic moment. We tell ourselves we will change “when the time is right.” But, when will you be ready? 7 Wishful thinking. We want our cake and eat it too, to go on living as we always have, but with different consequences. Examples: I wish I could eat whatever I want and not gain weight. I wish I could drink as much as I want and not lose control. I wish I could work a 72 hr week and spend lots of time with my children. (Exercise: What are your wishful thoughts?) It’s easier to wish for change than to work toward it. How often have important, desirable changes occurred as a result of your wishing thinking? Premature action. Friends/family can push us into change before we are ready…just sets us up for failure.

THE 6 STAGES OF CHANGE:

1. Precontemplation: There is no intention of changing, may deny having a problem….can’t see it. Resist change. Don’t want to be nagged by family, friends, coworkers about the problem. May place the problem outside of their control or responsibility. You may feel hopeless or demoralized. If you systematically take yourself through the stages of change, you can change. 3
2. Contemplation: Acknowledge the problem and begin to seriously consider changing it. You know the goal, but you may not be quite ready to get there. Many remain stuck in contemplation for long time. Fear of failure. You are ready for next stage when you focus on the solution rather than the problem and when you think more about the future than the past.
3. Preparation: Most are planning to take action within the next month. Important to now make public your intended change. But may not have resolved their ambivalence. May still need convincing. Plan carefully, develop a firm, detailed scheme for action, Make sure you learned the change processes you need to carry you through to maintenance and termination.
4. Action: Now you make the move for which you have been preparing. Requires greatest commitment of time and energy. Changes made in this stage are most visible to others and receive greatest recognition. Support is most needed in precontemplation and contemplation and the crucial stages following action. Action is not the first or last stop in the cycle of change.
5. Maintenance: Work to consolidate the gains you attained during the action and other stages…struggle to prevent relapses or lapses. If you are not strongly committed to maintenance, relapse is inevitable.
6. Termination: The ultimate goal. Relapses are common and most people go through various stages not in a linear fashion but more in a spiral. Feels like going in circles, but the circles are spiraling upward. As we say in the Wellness Inventory program: “Excuses are valid.” Shame shuts you down. Recycle is probably a more accurate and compassionate term than relapses. Recycling gives us opportunities to learn.

Helping Relationships During Action.

Don’t assume your spouse or anyone else will intuit your plans…go public and do it clearly. This is a very active stage of change, and you will need help from those who care about you. Let them know that even if you become anxious, irritable, confused or difficult, you still need and want their support. Ways your helpers can assist you in the action stage: • Exercise together. Ask them to join you in your countering technique. • Buddy up. Work with someone who is also trying to change. • Rearrange your home. Helpers can play a role in controlling your environment so you can avoid tempting cues. • Put it in writing. Write a contract with specific start date, your goals and the countering techniques and rewards you will be using. 16 • Get stroked. Verbal praise, monetary rewards, extra hugs, small presents, back massages give you a sense of positive feedback. • Don’t take guilt trips. Write in your contract that you are asking helpers not to scold, nag, preach and embarrass you if you momentarily lapse.

A Strategy for Success

The action stage lasts for several months. The first month or two is the most likely time for relapse. Maintenance takes all the work begun in the action stage and builds on it. To truly overcome our problem behaviors, they must be replaced with a healthier lifestyle. For all of us, former problems, especially addictive one, will hold some attraction long after the habit is broken. You need to acknowledge this vulnerability. Developing new desirable habits helps keep the temptations at bay. The most common threats to maintenance are social pressures, internal challenges and special situations. It is impossible to remain free of tempting cues forever. And extremely stressful situations like an illness in your family, stress at work, losing your job, and financial downturns can ultimately lead to relapse. There are three common internal challenges that are closely related to slip, or brief lapses: overconfidence, daily temptation, and self-blame. Awareness and vigilance is the key to successful maintenance. “I can handle just one drink or one cigarette, or that one banana split with extra whip cream”. Stay mindful of this overconfidence because it can cause daily temptation. The severity of selfblame is one of the best predictors of failed maintenance.


Keep a healthy distance. Commitment is not enough to maintain change, you must also monitor your environment and stay away from situations where you might be tempted to lapse back into the old habitual behavior. Continue to avoid people, places or things that could compromise your change. Create a new lifestyle. Learn to reduce stress with exercise and relaxation. Create alternative behaviors that do not involve your prior behavior pattern. This is an excellent time to explore and implement a hobby or an activity that will bring you greater joy, inner peace, self-confidence and happiness. Go ahead and learn a new skill or participate in creative art. Check your thinking. This is time for self-observation. What are you telling yourself? What are the negative thoughts about yourself and others that threaten to crowd in on your new life? Be observant of minimizing your previous problem behavior. Denial, distortion and rationalization are the enemies of maintenance. Check your thinking to be sure you are being consistent and honest with yourself. Review your reasons for changing.


RECYLING-LEARNING FROM RELAPSE

Most people who relapse will go back to the contemplation or preparation state and get read to take action again. Any experience with change actually strengthens you. Relapse is never desirable, but change is often circular and difficult. Relapse is a time for self-reevaluation where you learn from your recent mistakes. Ten important lessons of relapse.
1. Few changers terminate the first time around. Rare to overcome a problem the first time. This is an unrealistic expectation. Without professional help or understanding the processes and stages of change that this book provides, most people try to change by trial and error.
2. Trial and error is inefficient. It’s frustrating to try to change only to relapse in spite of your best efforts. Learn from your relapses but use guided learning to assist you.
3. Change costs more than you budgeted. You may fail to budget enough time, energy or money. It took years for the problem to develop; it will take time to change it. Sheer willpower is not enough. What is needed is a commitment over time to an action plan that uses all that the processes of change have to offer.
4. Using the wrong processes at the wrong time. There are 3 major ways in which the basic processes of change are often used incorrectly: a. Becoming misinformed. If information on self-change is scarce or incorrect, consciousness-raising techniques may backfire. You need accurate information to avoid misguided strategies. b. Misusing willpower. Some problems do not respond to using willpower. c. Substituting one bad behavior for another. Example: countering anxiety by drinking alcohol. Or using eating to counter smoking. 19
5. Be prepared for complications. Change seldom involves only one problem. Problems coexist and changing one can exacerbate another. Learning to use the processes of change can help you deal simultaneously with several problem behaviors.
 6. The path to change is rarely a straight one. Change follows a cyclical pattern. You are progressing up a spiral staircase of change.
7. A lapse is not a relapse. One slip does not make a fall. Many give up as soon as they lapse. Guilt and self-condemnation cripple change efforts. Guilt can turn a lapse into a relapse. Take lapses as signs that you must redouble your self-change efforts.
8. Mini-decision lead to maxi-decisions. You may make any number of “mini-decision” that ultimately have negative consequences. Like buying cookies for your kids; easing up on your exercise program because you feel good. Mini-decisions lead you away from maintenance and toward full relapse.
9. Distress precipitates relapse. This includes anger, anxiety, depression, loneliness and other emotional problems. Emotions are a high-risk factor in relapse because you cannot avoid your emotions, and they weaken you psychologically. Most of us don’t know how to deal with intense feelings. Social pressure is another major cause of relapse. If your social network contains mainly people who share your problem behavior, you may experience intense pressure against changing.
10. Learning translates into action. Have you learned from relapse? Here’s a simple self-assessment: • Have you identified the major cause of your previous relapse(s)? • Do you have specific, action-oriented processes to counter the situations and emotions that induced your relapse? • Are you more informed about the cycle of change and how it relates specifically to your problem? • Can you tolerate a slip (lapses) without a total fall (relapse)? • Are you planning to make change one of your highest priorities for the next three to six months? • Have you prepared yourself for the possibility of complications and for more than one change at a time? • Can you put your newfound learning into action? If you honestly answer, “yes” to all of the above, you are well prepared to recycle through the action and maintenance states. If one or more of your answers is “no”, you may not be ready YET for renewed action. Just realize you have more to learn…and be patient, gentle and loving with yourself.