Evidence-Informed Habit Change

Coaches, as well as other professionals such as nurses, dieticians and fitness trainers are concerned with changing unhealthy (or unresourceful) habits into healthy ones. Medical literature is full of studies about habit change, also known as behaviour change. Behaviour change interventions come in many disguises including motivational interviewing, client-centred approaches, tailored advice, health coaching and so on. Knowing that the terminology can vary is key to unlocking the literature. Coaching approaches are being aimed at everything from increasing physical activity, stopping smoking, healthier eating and even dental flossing.

In the 1950s plastic surgeon Maxwell Maltz observed surgical patients becoming accustomed to a change in their body (e.g. an amputation) starting at around 21 days post-op. This has been widely quoted as the minimum time it takes to change a habit. We now know that most habits take more time, stamina, strategy and motivation to transform.

Phillippa Lally and her colleagues have investigated the psychology of habit formation. They have found that it can take longer to change a habit than you might have thought. Ninety-six people attempted to change an eating, drinking or behaviour habit found that it could take anywhere from 18 days to 254 days to do so! In a 2012 article published in the British Journal of General Practice Gardner and colleagues propose 10 weeks (66 days) as a realistic time frame for behaviour change.

Ryan Rhodes, presenting his research at the recent Canadian Cancer Society volunteer summit, has found evidence that a physical activity habit can be formed in 6 weeks to 3 months if the new behaviour is repeated at least 4 times per week (the study is awaiting publication). De Bruijn, Rhodes and van Osch have observed that, of course, the positive intention to do exercise does not guarantee successfully engaging in exercise – that’s where habit strength and action planning – the what, where, when, and how – come in. High levels of action planning and habit strength act both independently and together as a catalyst to build stronger motivation to exercise.

Noting that habit strength increased for simple actions (e.g. drinking water) more so than for elaborate routines (e.g. a fitness regimen), Gardner and colleagues champion the ‘small changes’ approach. Evidence from a weight loss study bears this up – the intervention group (given simple advice and a self-monitoring checklist) lost 2kg compared to the wait-listed control group which lost 0.4kg at 8 weeks. Future studies might consider a more realistic control scenario (how about giving them conflicting, constantly changing advice?).

Besides repetition, duration, planning and simplicity, are there any other critical aspects of habits? Gardner and Lally (2013) assessed the level of intrinsic motivation of 192 adults in relation to habit strength and their past behaviour. Self-determined regulation (high motivation) drove stronger habits, independently of past behaviour, than lower motivation. This supports the golden vision of coaches – highly motivated people breaking free of their past to build healthy habits for the present and future.

Outstanding concerns include best practices when reporting behaviour change research – is what the researchers did completely clear to the reader? Often the intervention, the presumed driver of behaviour change being studied, is a ‘black box’ that is not adequately described. It might be a cornucopia of different things – an assessment, an information booklet, coaching sessions, reminders, phone calls, text messages, group sessions, etc. How long was the intervention? And what was the setting? These factors will impact how effective the change is and how permanent it is.

If the intervention was effective, to what should that be attributed – which component was the key driver (or was it due to all components)? Perhaps it was the smiling volunteer who conducted the assessment at the beginning! This question is often impossible to answer as it involves untangling the different components of the interventions. Coaches are welcoming and hospitable – can we also put a value on each question or tool we use?

Who benefits from what sorts of interventions? Tailoring is increasingly important in many areas of health research where historically an intervention was replicated across many people. Individual characteristics are now important. It is a core value of coaching to be both client-centred and tailor our approach to establish and maintain rapport. Mainstream health is starting to take note.

Given the steady flow of coaching-related articles being delivered by PubMed to my inbox (10 to 20 per week, though not all relevant), it is clear that coaching is an important theme in behaviour change and health research. It is unclear though whether this research impacts the approach used by non-health coaches. I’m curious, what is the role of behaviour change research in your coaching practice?

 

Danielle Worster

 

Danielle Worster, BA, MLIS, Erickson graduate

Danielle is a life coach working with individuals seeking to navigate change and build healthy habits. Danielle has previously worked with scientists and clinicians to find, appraise and communicate health evidence in Canada and the UK. To look into coaching with Danielle, visit her website Active Ingredient Coaching.