Change is Possible, But the Hard Part is Sustaining It

I’m a psychotherapist and an addiction counselor. I’m frequently asked whether change is possible. The short answer is yes, but sustaining change is the hard part.

The rate of relapses among people who set goals is high. Perpetrators of domestic violence are reported to be violence free up to three years after treatment. Figures vary on substance addictions, but approximately 40-60% will relapse. 97% of dieters regain what they lost within 3-5 years. How many New Year’s resolutions have never taken root? How many of your life aspirations have never been fulfilled? It is human nature to return to our set point, or comfort zone.

As a species, we don’t adhere to professional treatment recommendations. 30-50% of people with type 1 diabetes fail to stick with their treatment plan. 50-70% of people who suffer from asthma fail to take their medicine. 50-70% of people with chronic high blood pressure don’t take their hypertension medication as directed. Medication non-adherence leads to worsening of disease, death and increased health care costs. The extent of non-adherence is 10-92%. There are three types of medical non-adherence. First, are prescriptions that are never filled. Second, is non-persistence, in which the patient’s stop a medication after starting it without professional guidance. Third, is non-conforming in which medications are not taken as prescribed.

Whether it is medical non-adherence, or behavior change, we are all at risk of failing. Here’s what doesn’t work.

• Intentions alone are not sufficient to sustain change. Excitement fades.
• Negative emotions such as fear-based behavior change doesn’t work. We all experience negative emotions such as regret, shame, fear and guilt when we don’t live up to our ideals. These emotions may serve as a reminder of what we’d rather be doing, but negative emotions are the least effective change strategies. For example, scolding a heavy drinker won’t cause them to stop drinking.
• Feeling overwhelmed by a desired change leads to all-or-nothing thinking. Break down your goal into achievable components. Don’t try to change too much at one time. Change is rarely just one thing; it’s a lot of connected things, and sustained change doesn’t happen without a consideration off all the steps.
• Information is not sufficient. Information is only as useful as what you do with it. You can know something and still do nothing. Well-intentioned advice does not produce motivation for change.

How long does it take to change a habit? We’ve all heard that it takes 21 days to create a new habit but in reality, no one knows. Some things stick after you’ve done them once, others take more persistence. Complex goals are more difficult to achieve than simple ones.

There is a saying that if you fail to plan, you plan to fail. Here’s what does work.

• Commit yourself to a change program. If that program is not working any longer, recommit to another method that has the same end goal.
• Make your goal known and be accountable to your support network.
• Create a relapse prevention plan. Look ahead to any scenarios that could lead to relapse and have a step by step plan for how you will handle it.
• Make a list of your relapse triggers. Triggers are the things that could get you off track. Catch slips before they become larger losses.
• Have a list of tools that will get you back on track.
• If you fail badly, assess the damage and find ways to correct it.

If you have lost your motivation, do the things that keep you interested in your goals. Review the reasons you wanted to achieve this goal. Or, immerse yourself in the topic by reading material about the desired change. Talk to your support network.

Sustainable change requires time, self-discipline, and energy. For example, I can teach couples new communication techniques and help them understand each other’s beliefs, perspectives and emotional pain. But couples who make changes in their relationship need a plan in order to sustain their changes. I ask them to set tasks that will serve as a reminder to stay on track. Perhaps they schedule a date night weekly, put it on the calendar, and take turns finding a babysitter. Or, have a scheduled “state of the marriage” conversation monthly. Or, attend a marriage retreat yearly. I even recommend that they keep post-it notes on their refrigerators to remind them what they need to work on. Without these tasks, they will likely return to their old behavior.

If you continue to fail at your desired change, you may benefit from a coach or therapist to keep you on task.