What Gets People to Change?

What change have you been desperate to make, knowing that it would improve your life, yet have struggled to execute? Whether it's dropping a bad habit or implementing a good one, why haven't you succeeded? And when you have succeeded, why did it work? It's almost like we've accepted that it is our human nature to want to change, yet sometimes we simply won't. But what if there was a simple framework for change? A framework that most do not know, but could unlock the change they have been seeking. As a psychiatrist-in-training, I am fascinated by the question, 'What gets people to change?' Working with people who have overcome addiction recently led me to an answer I believe is worth sharing: You change when continuing how you are costs you more than it gives you. This insight is based on research about overcoming alcohol problems without treatment. Fifty-seven percent of people who recovered described their turning point the same way: an honest evaluation of what drinking was giving them and what it was costing them.[1] Source: Dr Manu Sidhu (author) We also need to consider what making the change will give you and cost you, in this case: Source: Dr Manu Sidhu (author) Notice how we have two weights on each side of the weighing scales: Source: Dr Manu Sidhu (author) Laying the facts out on both sides of the scale does three things: It acknowledges why you do the action—in this case, what drinking alcohol is the solution for, to understand why you do it in the first place. It opens the question of whether those same needs could be met another way, even if it requires more effort. It's like going to the gym to build muscle: You may prefer to build that muscle naturally—even though it takes more effort and skill—rather than by taking steroids, which come with a whole range of serious side effects (much like alcohol). It means you're not resisting something you want—instead, you're declining something you can now see costs you more than it gives you. The temptation stops being one you fight and becomes one you've simply lost the appetite for. Even though we're learning from the extremes here—using data about those recovering from a substance use disorder—the framework can be applied to any behaviour, even the most seemingly innocent ones, like not brushing your teeth at night, buying biscuits from the supermarket, or staying up late to watch TV. Source: Dr Manu Sidhu (author) Ultimately, it's the realisation that the costs outweigh the benefits that leads to stopping something you've been meaning to stop, or that the benefits outweigh the costs for something you've been meaning to start. Often, realising the cost is more obvious when it's felt acutely—a health scare, injuring yourself, hurting someone else, or losing something. And realising the benefits is more obvious when something new becomes contingent on changing—a new job, a mortgage, a child on the way. To explain how a decision to change becomes a sustained behaviour, Chip and Dan Heath split the process of change into three dimensions in their book Switch: the Rider, the Elephant, and the Path.[2] The Rider—your rational self: Your rational self will weigh up the pros and cons using a method like the one above, and go further to figure out how you can better meet the needs that the undesired behaviour was meeting. Instead of drinking alcohol for relief, your rational self may think of going to the gym. Instead of watching TV late at night to unwind, you may treat yourself with a massage. Taking each "benefit" one by one and listing healthier ways to experience them gives you plenty of better solutions to try—but without an alternative solution, you're likely to fall back into old habits to meet those needs. The Elephant—your emotional self: It's not enough to just make the change on an intellectual level—knowing what change will give you and cost you is not the same as feeling it. The change has to be tried and tested so the benefits can be experienced to be truly felt. Likewise, the costs have to be felt for them to be fully internalised. The problem is when we feel the cost, it fades over time. The point of writing the benefits and costs down is that you do it calmly, when nothing is pulling at you—so that it's there to hold you steady when something is. You're not removing emotion from the decision—you're making sure the impulsive emotion doesn't get its way over the steady emotion simply because it occupies the forefront of your mind in the moment. As Anthony de Mello said in his book "Awareness": "It's only when you're sick of your sickness that you'll get out of it." The Path—your environment: Your environment either makes it easier or harder to execute your desired behaviour. By removing access to something you want to stop, or making more accessible something you want to start, you determine how much of a fighting chance you give yourself. Your environment also includes the psychological environment within your mind—most lapses happen when this psychological environment is depleted: hungry, angry/stressed, lonely, and tired (known as the HALT states). Preventing these states, or at least being extra mindful when in these states, will help you resist temptation at its most tempting. Together, your rational self sets the direction, your emotions supply the fuel, and your environment determines the barriers and facilitators to progress. However, there is something that influences all three: your relationships. Someone you trust can give you the insight that change is needed, the inspiration (or fear!) to change, and the accountability to stick with it. At a time when we feel increasing pressure to become our best selves, let us leverage the power of relationships to support each other through the process of change. Whether by seeking support from someone to facilitate your own change or offering your support to facilitate another person's change—be informed about the framework of change, be empowered to apply it, and be kind enough to help others through it.