Have you ever started to make a change in lifestyle because "it seemed like a good idea"?
You know; "I want to start losing weight, I'll start Keto on Monday?" or "I'm signing up to a gym and that will get me exercising regularly because ..."I know I should""?
And then later you find out that you weren't actually ready to make the required change/commitment to change yet.
Well, that's what I'm talking about today. I will take you through the transtheoretical model of change which is something I use with a lot of my "big lifestyle change" clients.
I will talk about what it is, how it works and how you can be successful.
And why, sometimes, you're just better off not changing anything just yet because it will work against you in the long run.
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For clarity; this is not a straight transcript from this podcast episode but I based that episode, and most things I said, on a series of blogs I wrote about this so have copied information from those blogs over.
Today I’d thought I’d share a bit of mindset- and decision-making methodology with you that I like to use with my clients. See, I firmly believe that a PT should not just be excellent at creating a program of physical exercise for his clients but should also try to steer them in the right direction for mental fitness. This stuff can be applied to every aspect in life but I’m going to focus on diet and weightloss for this particular episode.
The methodology is called The Transtheoretical Model (Stages of Change), so TTM for short, and I believe it can really help someone make the right changes to their lifestyle and, more importantly, maintain those changes. This does require some level of self-awareness that some might not yet have but, since you’re reading this, I’m thinking it’s a pretty safe guess that you’re not in that category with regards to Health and Fitness.
Over the next few weeks I will go in depth on each stage, give examples etc. but for now I will just quickly summarise the model.
The model, developed by Dr. Prochaska, Ph.D. and Dr. Di Clemente, Ph.D. acknowledges that people change behaviours gradually in a cyclical series of phases.
That’s an important sentence as it confirms that real behavioural change happens gradually. There is no such thing as a quick, easy fix that lasts a life-time. You don’t go from living a sedentary, sitting on your bum, lifestyle to becoming a fitness fanatic from one day to the next. You don’t go from having an unhealthy diet to eating healthy all the time without a struggle and going through a process.
The good doctors have determined that INTENTIONAL change is key to changing habitual behaviours; in other words, you have to want to change your behaviour and be ready to do so. If you don’t really want to change your behaviour, for reasons we’ll come to later but denial is one of them, then there is little chance of success when you change your diet.
These are the six stages of change:
Most people are not solid in one stage, it’s not uncommon to jump about a fair bit from one day to the next, but it is very useful to know which stage you are at. Obviously the ideal stage is “Maintenance” but it takes a while to get there and it’s not uncommon to be in that stage only to have a relapse back again. The key is to understanding that going from the Maintenance – to the Relapse-stage does not equal failure.
I feel it’s important that the Personal Trainer/Dietician/Nutritionist you work with understands the psychology behind change and has a decent working knowledge of it.
It is one thing to tell an obese person to eat healthy for a month and then show them the results. Sure, they are going to have lost weight and inches. That however does not mean that that person’s mindset automatically changes. A lot of my PT colleagues, and some clients, say things like; “When my clients/I start seeing results I’ll be fine and I’ll be motivated to keep X up forever” and that is simply not true. A lot of people with weight issues took years to get obese, hardly anybody becomes fat overnight, and the mindset that comes with a certain lifestyle is not going to change permanently within 30 days.
If the professional you’re working with can recognise where on the model you currently are they can really help you move forward by suggesting the right course of action and helping you stay, or get back, on track.
As I mentioned previously; I shall mainly relate this to obesity and weightloss but the methodology goes for any change, really.
I’ll try to keep it all as straightforward as possible, so if you’re a psychology major, please don’t send me emails saying “but you forgot about the effects of XYZ” etc. Unless, of course, you have some very cool ideas on the subject, in which case I’d love to read them.
Blog one deals with stage 1; Precontemplation.
People in the Precontemplation stage have no intention of changing in the next 6 months. Quite often the person is in denial or actually unaware that their behaviour is problematic. In the case of the obese person it’s mainly down to denial rather than being unaware. I have yet to come across an obese person who does not know deep down that they are too heavy for their health, they just deny that there is a problem as a coping mechanism.
Denial is a simple way to minimise and rationalise any problem. It’s a defense mechanism that shifts the blame away from the denier, in this case the obese person, and hands it off to anyone accepting responsibility.
“I would eat healthy but my partner always buys biscuits” is a statement I hear a lot. This sort of comment is common from someone who is not accepting that they, ultimately, are responsible for eating the biscuits. Yes it’s easier to not eat rubbish if it’s not readily available, but you are the one who chooses to eat the stuff. The same goes for alcohol, fast food etc. What you put in your body is your responsibility and not somebody else’s.
Here’s another thing I come across regularly; “I’m not as big as some of my friends are, so I’m OK”. With most of the population of the UK now being overweight, and an astonishing 28% being obese, it’s easy to point at other people and pretend you don’t have a problem. But that sort of thinking doesn’t really stand up to any scrutiny.
Denial is nothing more than an ego defence mechanism and it wards off feelings of discomfort but it’s also a major obstacle on the journey to making a permanent positive lifestyle change. It, most definitely, is not a long-term solution to any problem.
Most people in the Precontemplation stage are inwardly focused and mainly think about how changing their behaviour will negatively impact their lives. Very little consideration is put into the idea that change might bring about positive effects.
“But if I start cutting out alcohol and fast-food, I will become a social pariah” is an often heard cry. This sort of statement only focusses on a, potentially, negative aspect of change. Note how often the fears associated with change are imagined rather than real. There is no reason why you can’t socialise when not drinking, only an alcoholic would not accept that sober people too can be quite entertaining.
When we come across someone in the Precontemplation stage we work a lot on making people see the positive side of the changes they make; You will feel better, stronger and healthier. You can wear nicer clothes, you are much less likely to get a whole host of horrible diseases. You know, stuff that REALLY matters.
Obviously it’s important to acknowledge that change is scary and dificult and that, for most obese people, there are often one or two emotional issues that have to be dealt with to enable them to decide to take real action and move on to the next stage, Contemplation.
People in the contemplation stage are no longer in denial about their behaviour. They see that the behaviour is problematic and are able to look at the positive and negative effects. They are thinking of changing their behaviour in the foreseeable future, 6 months, but are not just yet actively pursuing it.
Because they keep looking at both the negative and positive aspects over and over again it can seem like ordinary procrastination to the outsider and that can seem like a negative thing. Bare in mind that the alternative is Stage 1 and that, just because someone isn’t ready for change yet, that doesn’t mean they don’t really want to change their lifestyle. They just “don’t know it yet”.
Especially with obese people it is essential to keep stating the positive effects a change in lifestyle will bring. This is not the time to start banging on about the negative aspects of their current lifestyle as that is much more likely to set them back to Stage 1.
This is where words really matter.
I speak to quite a few people who can be classed as being at Stage 2. They are, tentatively, enquiring about how to lose weight and change their lifestyle. A typical question might well be “Are carbs really bad for me? I can’t imagine living without carbs”. If I then barge in with a “Yes, low carb is definitely the only way to lose weight” not only am I then being factually incorrect but I would also be likely to scare someone off from moving on to the next Stage as I’m throwing up another hurdle.
So this means we have to discuss future goals and positive aspects of quitting their unhealthy behaviour, aswell as realistically address some disadvantages that come with a change.
We’ll also look at any potential barriers to success and the level of resistance to change. The barriers can include many things but include defiance, fear of failure, fear of success, personal circumstances such as work environment and family, ignorance etc.
So one thing that we can do is list all the Pros and Cons of their current behaviour and then list the Pros and Cons of a change in that behaviour. Most people tend to make a list in their mind but I find that writing it out takes things to a whole new level and might offer some clarity for those sitting on the fence.
As most people with weight issues will have a history of trying to lose weight we also have to look at some of their history. Establishing why someone has not been able to make a permanent change, note how I didn’t say “Fail” here, is often very useful as it can often give us a good insight into the psyche of an individual and help us come up with way to make it stick this time. I have to make clear though that people in Stage 2 are not ready for an action plan so there is no point plotting out their road to success yet, they have’t yet decided to make a change.
Key in the contemplation stage is reassurance that changing behaviour will be a positive, and worthwhile, experience and that will hopefully help them move on to Stage 3 (Preparation).
Stage 3; The Preparation (Determination) Stage.
People in the Preparation stage are ready to take action and plan to do so within the next 30 days. They start taking small steps towards change and genuinely believe that behavioural adjustment is a positive thing to do.
For a PT like me, this is where the fun begins.
Watching someone move from sitting on the fence to deciding for themselves that change is required, change is a good thing and seeing them determined to take Action, is a beautiful thing.
People at this stage need support and encouragement to help them commit to action. Having a clear positive message about the necessity of changing their lifestyle is key. This is also the time when working with someone when they were in their earlier stages can really help as that will help us come up with the correct strategy that best fits the individual’s lifestyle. We have to come up with a structured plan of attack at this stage.
I bump in to several Personal Trainers who take a laissez faire approach to PT and coaching. They kind of just go with it and will “see what they should do on the day”, this approach does not work with anyone who is obese. This is why so many people fail at sticking to a diet. It’s not that the diet is terrible, any diet in which you’re in a calorie deficit will have you lose weight, it’s that the message isn’t positive and there is no tight structure behind it.
You can’t just roll with the punches here; you have to have a structured plan and a positive, tight, message and you have to stick to the message like a government minister on a bad news day. I train several GPs and they all “recommend diet and exercise” to obese people but they will all admit that their message is falling on deaf ears. There is no clear message there, there are no specifics that take a person’s personal situation into account. Just “move more and eat less” and that is never going to be effective when dealing with someone in a destructive cycle. A side note; Someone who is obese, and heading towards clinical obesity, is definitely on a destructive cycle in the same way that an alcoholic or drug user is. They are likely to die early because of their lifestyle, and you wouldn’t tell an alcoholic to “just drink a bit less, mate”.
When you have a clear message and program, tailored to the individual; “This is what you shall eat and this is how much” and “This is what you will do on this day and that’s what you will do on that day” and “Be accountable to someone, often the professional, and face up to your issues” then people have a great chance of success. There has to be a program in much of the same way that my Post-natal clients have a very strict program. You can not just make this stuff up on the fly.
The reason the program has to be tailored to the individual is that you have to aim to remove the personal hurdles people have. It’s no good telling someone to “eat only healthy home-cooked food” if they don’t know how to cook. Flinging a couple of recipes their way does no-one any good, other than maybe make the professional feel a bit better about their effort. It’s no good giving people a general exercise program if they struggle to walk and it’s no good telling someone to “make sure they get 8 hours sleep a night” if they have a new born baby.
Make no mistake, it is very easy for someone in Stage 3 to slip back into Stage 2.
I get a lot of emails from people asking if they can start with me in the next month, or even week, and I’ve had meetings with people and we agreed start dates only for them to back out late in the day because of an “unexpected hurdle”.
The reason/excuse I’m most often given is a change in financial or personal circumstances. Now I’m not saying that the reasons given are not legit but quite often an unexpected hurdle is used as an excuse to kick a change of lifestyle into the long grass and move back into the comfort zone of Denial. It is a real shame to see someone who is clinically obese, and who desperately needs to change their life around, fall back into their old habits as it can take a long time for them get back into it again and they will, inevitably, always be in a worse state. Often fear is the real reason for people slipping down from Stage 3 to Stage 2. I’ve said it before; Change is a scary thing, especially when you’ve been in denial about your lifestyle for such a long time.
Another factor for people who have gone from Stage 3 to Stage 2 staying there for a long time is shame and embarrasment. They feel like they can’t go back to the professional they were in touch with at the time, even though they know he/she is by far the most qualified and best suited to help them out. I always try to make sure people know my door is open. If something happens and you decided you can’t proceed at this point in time then there’s no shame in coming back at a later date and jumping straight back into it.
Stage 4; Action
Our client has started to change their behaviour. We’ve decided on a way of eating that will work for them, we have a healthy living routine and continue to move forward. Their lifestyle is constantly being modified to add healthy actions and subtract problematic ones. They are no longer engaging in the problem behaviour and are actively changing for the better.
When I say “Constantly being modified” I mean we can add things like; cooking classes, add a daily exercise routine, ask them to watch less TV, eat an extra bit of fruit each day, join a walking club, get a dog etc. etc. Anything that’s a positive and that’s available as an option is a good thing. We can also remove problematic behaviours and do that by offering swaps; If someone always goes out to a pizzeria for a weekly night-out and then drinks a lot when they do we can look for better/healthier places to eat and drink. Drinks can be swapped, cut down on.
The big thing is that we are geniunely changing the standard behaviour in such a way that a healthy option becomes the norm.
This is a beautiful stage to be in and to witness other people being in. Almost immediately people feel better, stronger, fitter, mentally more astute, their complexion changes and they become more and more positive as they keep seeing results. Usually this carries through to their work place and into their family life as well, they become more active and productive. Everybody benefits from 1 person making a geniune positive change.
People in this stage, first 6 months of behavioural change, still need support to maintain their progress. Standing still is not an option at this stage, standing still means falling behind and, inevitably, back into old behaviours as we’ve not yet established a natural healthy living routine. It’s not yet second nature to make the healthy choice when presented with 2 options.
Exploring the problem behaviour is also important as identifying potential triggers for relapse is key. Awareness, Desire and Discipline means we keep adding value to their life.
Being Aware of potential triggers for relapsing into problem behaviour means we can do something about it.
Maintaining the Desire for change by constantly reinforcing the positive message and not being scared to be proud of progress already made.
Discipline; having a created a solid, well-structured, program in the previous stage will help us stick to it.
Just having a good plan and some desire is not enough, it has to be a program of Action. Steps have to be taken every single day, a new routine has to be established, and it is going to be hard work for most, but the pay-off is enormous.
Stage 5; Maintenance
6 months after last indulging in destructive behaviour the client has seen some amazing results and making healthy lifestyle choices comes, almost, naturally to them. This is the ideal stage of change; positive behaviour is, almost always, the norm and is being maintained and negative behaviour is being kept at bay. People in this stage fully intend to keep up their healthy lifestyle.
It is essential for people in this stage to work on themselves daily, some days even hourly, to prevent a Relapse back to one of the earlier stages.
I’ll deal with what I see as a Relapse in the case of someone who is/used to be clinically obese in the next blog but let me say for now; Having a pizza for dinner every now and again is NOT a relapse. I would never advocate a strict clean approach for most people, unless of course they are “all or nothing” kind of eaters but that really is rather rare.
As I’ve stated in one of the earlier blogs, you can use this change model for any area in which you display problematic behaviour; procrastination, dealing with stress, alcohol, drugs etc. but for the purpose of this series we’ll be focussing on lifestyle choices that lead to obesity and everything that comes with that.
Everybody does their maintenance stage differently but there are some similarities between all of those who are successfully maintaining their healthy lifestyle.
Some people like to start the day by taking 5-10 minutes to have a quiet meditation/prayer/moment of mindfullness to just calm everything down a bit and set themselves up properly for the day. Others might just go out for a 10 minute walk at the start of the day and remind themselves of how far they’ve come, plan their day in a positive way. One of my clients takes her 5 minutes with a cup of tea every morning and then throws her breakfast and lunch in her bag to take into work with her. Others do not take 5 minutes every morning, but most find it beneficial to at least have a point in the day where they can look at the things they are doing right and the things they can improve upon.
As a side note; I am a big fan of writing things down as the day progresses, everything you’re doing right and everything you can improve on, just so you can see for yourself what’s actually happening. The easiest thing for someone with problematic behaviour to do is to tell themselves that their behaviour is fine. Writing it down gives us a chance to see that we’re doing things that are actually not healthy or even unacceptable.
A lot of obese people I’ve dealt with like to train in the morning rather than the evening, it sets them up for the day. Getting into a positive “can do” frame of mind early on in the day really helps as you get that nice post-workout feeling.
Although someone in the maintenance stage has not displayed problematic behaviour for the past 6 months they still need to pin-point self-defeating behaviour and explore what goals they want to achieve. Goals in life should be constantly changing, there are many small goals you can focus on even when you have one overarching goal, and reflecting on your own behaviours, and the actions you need to take, is a daily ritual that many people would benefit from.
The final blog in this series, other than the occasional case-study that I might write about, will be up soon and it deals with the last “Stage” Relapse. This is one not everybody needs to go through but, realistically, a lot of people will.
Stage 6; Relapse
To be honest, this is a bit of a tricky one when it comes to people who are using the model to help them with weight management issues. You can imagine that it’s easy enough for an alcoholic or someone dealing with an addiction to narcotics to establish when they’ve had a relapse, 1 drink is enough. But for people who are using the model to help them have a healthier lifestyle, and relationship, with food it’s not as clear cut.
So we have to establish what a Relapse is first and this is open to some debate.
For me a relapse is when the individual falls back into their old behaviour and the old mindset and emotions become part of that. So attending a birthday party and having a pizza and some icecream does not necessarily constitute a relapse. If however that pizza is followed by a “feck it” attitude and a slip into old habits then I would class this as a Relapse. So, as with much else in life, context matters.
You can go into the Relapse stage from any of the 3 “action” stages, Preparation, Action and Maintenance and you can drop back into any of the 5.
People in the relapse stage are often overwhelmed by negative emotions; shame, guilt etc. The instinct is therefore to return to some form of comfort zone. This is important to realise as it means that, if we create a comfort zone that is supportive and helpful, this does not need to lead to someone going back into Denial.
Relapse does NOT equal failure. This is the single most important message to get out to someone in the Relapse stage, and is probably best addressed before they ever find themselves in the Relapse stage.
Going through all the stages several times is a normal part of creating lasting change. We are not interested in using this model to create a change of lifestyle for 3-6 months, it is about creating a healthy lifestyle for the rest of someone’s life.
Individuals in the Relapse stage need help to reduce the feelings of guilt and shame. We also need to look at the triggers that caused them to Relapse and deal with them and the barriers to success. If we learn lessons from the relapse then, in the long run, it can be a valuable experience. Just saying “Oh well, get back on the horse” is no good as it means you just pretend it didnt’ happen and that means you didn’t learn from the experience. It is also a false way to support someone as the professional/sponsor (Personal Trainer, Dietician, medical professional or personal sponsor etc.) often, subconsciously, uses that phrase in an effort to sound supportive and non-judgemental but it actually means they too don’t need to put the hard work in to help the individual recover and create lasting change.
We have to get back into the Determination and Actionstage, identify the triggers and find the motivation to create the lasting change that soo many people are actually looking for.
It might not be an easy journey but it will be one that’s worth it.
That brings to an end the series about the The Transtheoretical model. Again, I would just like to state that you can use this model for ANY problem behaviour; workaholism, procrastination etc. Other models are of course available and I’m not saying there’s anything wrong with any of the other ways; the point of the series was mainly to point out that you have to have a plan when it comes to change. Change does not just happen, behavioural change has to be a conscious decision or it’s never going to stick. If you take anything from this series then I hope it’s that.