Behavior Change: What works – and what doesn’t

Dr. Cooper

Welcome to the latest episode of the catalyst health and wellness coaching podcast. I’m your host, Dr. Bradford Cooper, and today we’re going to jump into the very latest research on one of the most essential keys to health and wellness behavior change. Now, if you were with us two weeks ago, our guest Dr Stephan Guyenet noted that essentially we already know what needs to be done with our health and wellness, but it’s the behavior change piece that’s the key. So we are pretty excited that it worked out to have Dr Nadia Walter join us this week as that is the focus of her research. Dr. Walter is a postdoctoral researcher at Lipsig University in Germany. Her research, as I said, focuses on behavior change in diet and exercise and the psychological aspects that drive those changes. Now, I heard her speak when we were both presenting at a conference in Germany and while she did express a little concern about English being her second language in terms of joining us as a guest, I think you’ll agree she did a fantastic job.

Dr. Cooper

For those of you who are looking to earn your wellness coach certification before the NBHWC national board exam requirements change. Our next fast track is February 8th and 9th in Colorado. That’s the weekend after the Superbowl and the week prior to the physical therapy combined sections meeting in Denver, if you’re a PT. You can find all the details and registration at catalystcoachinginstitute.com and as always, feel free, reach out to us with any questions you have related to coaching, national board exam or anything else along those lines at results@catalystcoachinginstitute.com thanks for joining us. Now let’s listen in on the conversation with Dr. Walter on the latest episode of the catalyst health and wellness coaching podcast.

Dr. Cooper

Dr. Walter, it is a pleasure to have you here. Got to hear you in Germany at the conference. You did a fantastic job there and I mentioned during the introduction that this is your second language speaking in English. So you sound great to me, but the audience will know as we go through this that they wouldn’t do any better. So thank you. Thank you. Thank you for jumping in. Very excited about the topic today. Behavior change is at the core of what wellness is all about. So the fact that you’re spending and have spent years studying this, it’s just a pleasure to have you join us.

Dr. Walter

Thank you Brad for these nice words and this nice introduction. Thank you very much. And yes, sometimes it’s hard for me to find the right words because I’m always thinking in German, German language, so please be patient when I have a lot of ums and ehs and yeah, I try my best.

Dr. Cooper

You sound great. And you’re doing a lot better than I do in German, so we’ll just go with that. Give us a little overview of your research, just kind of the wide angle view of some of the things you’ve been looking at. And then we’ll take a deeper dive as we move forward.

Dr. Walter

Yeah. I’m a post doctoral researcher at the Lipsig University since 2015. And, my main research focuses on behavior change and on developing routines, strategies and habits in exercise and diet. And, that’s what I’m working most. But I also investigate the dark side of exercise and physical exercise addiction or eating disorder. And I work as an applied sports psychologist with young athletes. But the most I focused on was on behavior change and I tried to find out what we really need to change behavior because we, I think the most of us have made the experience that we are with a new behavior. We want to maintain this new behavior and we’ve had the experience that this works well for the first week. And then at some point we can be bored or we forget to practice all behavioral or whatever and I’m interested in what kind of behavioral and what kind of psychosocial requirements are needed to maintain a new behavior in a sense of a habit. Yeah. Not only to be a strategy, more in a sense of a habit that we won’t miss this behavior in our life and that we want to do it frequently and want to do it, let’s say automatically.

Dr. Cooper

Perfect, it’s so timely. We just interviewed Dr. Guyenet who wrote the hungry brain a couple of weeks ago and he literally said, the missing link is the behavior change. He said, we know all the things to do. We know the information, it’s the application piece that’s missing. So having you join us today is fantastic. How did you get to the point of studying behavior change? What was the, what was the driver? What was the initial catalyst that took you that direction?

Dr. Walter

To be honest. Just research topics have fallen into my lap. When I first, when I started my work at Lipsig University in 2015, my former boss asked me to hold a lecture, with the topic learning theories. And I was preparing and I read a really, really good book about this and there was this really interesting study. The study was by a colleague in the UK and her name is Phillip allele. And the study was conducted in 2010, or it was published in 2010. And, it was an intervention study and she asked, around 100 students to choose one eating, drinking or activity behavior which should be carried out daily, in the same context for four weeks. And they had to fill out several questionnaires every day and they found out that it only takes 84 days to maintain or to stabilize this behavior in the sense of a habit.

Dr. Walter

And when I read this article, it was fantastic. It was like, hey, I would like to do this as well. And let’s say my overall vision is to formulate the sentence, you know only have to do to the behavior for three months, every day, every, always in the same time or in the same context. And then it will become a habit. And that would be the greatest sentence you can say to somebody who maybe is obese or overweight or really wants to lose weight. That’s the perfect message. I would say that’s my overall vision.

Dr. Cooper

Yeah, that’s fascinating. And I like what you’re saying there about, you know, it’s not, you’re not saying to the person, okay, you need to figure out a way to do this for five years before it sticks. You’re saying 84 days, like literally a quarter from now it’ll be established if you stay with it. Right?

Dr. Walter

Yeah, it’s less than three months. So it would be great to have this sentence.

Dr. Cooper

Absolutely. Okay. So that came from her study and that was the catalyst or the lead in for you. What are some of the most fascinating discoveries you’ve made in your research that maybe our listeners haven’t heard before when it comes to behavior change or some of the things that have grabbed your attention?

Dr. Walter

At first? What I said before was that I am not only focused on the development of habits, I also have an eye on strategies and routines and we had a cross sectional study with a questionnaire, the online questionnaire where we collected, altogether 47 strategies in the field of diet and physical activity. And these were typically eating strategies like chewing every bite 32 times or use smaller plates or turn off the TV while you are eating. These typical strategies you use to maybe, eat less or eat less sugar or to be more physically active. For example, listen to music or take your sports wear to work, something like that. And we’ve collected these strategies in our online questionnaire we asked all participants to rate these strategies they had to rate if they are using these strategies or if they ever had heard about these strategies.

Dr. Walter

And then the second step they had to write if these strategies they were using or they are already used or they are still using these strategies, they have to rate if these strategies were effective just for a short time or long, had a long lasting effect. And what we found out is that action planning strategy are used most and more frequently and they were rated as more effective than strategies for their barrier management. We categorize the strategies into different categories and these categories we’re actually planning an acute barrier management and precaution area management points and writing occurrences and goal setting. And we found out that there’s a big difference between acute barrier management and precautionary or barrier management between strategies in diet and physical activity. That was quite interesting. We found out that more people use precaution area barrier management more for diet. Let’s say something, don’t go to grocery hungry and don’t buy sweets, so that you can’t, that you don’t fall into temptation and that they were rated as quite effectively.

Dr. Cooper

So can we take a step back because this is really fascinating and I’m trying to jot some notes down. So the four categories are action planning, acute barrier management, precautionary barrier management, and then what was the fourth?

Dr. Walter

And consequences. So what consequences will my behavior have. For example, when I lose weight, I will be more, I will get into shape, and we had another, goal setting.

Dr. Cooper

So there are actually five categories then. Okay, very good. And what would be an example of the action planning? I think we understand acute barrier management is in the moment, and I’ll say this and you can correct me, acute barrier management would be in the moment things that you’re doing to make adjustments. Is that accurate? And then precautionary barrier management, you’ve talked about that. That’s the planning, not to buy cookies, not having ice cream in the house. Consequences is almost future self seeing this is how it’s going to influence my life. And then the last one is goal setting, which people are probably relatively familiar with. Can you walk us through the action planning piece?

Dr. Walter

Yeah. For example, know what your appointments are or use apps. For example, if you work and there’s the elevator and there are also stairs, extra planning would be used everyday on the stairs. Or write your appointments down, like a reminder if your schedule is written down that you have an appointment for physical activity there will be no other appointment.

Dr. Cooper

Gotcha. So you’re planning for those things in advance, different from barrier management in advance.

Dr. Walter

Yeah, implementation, of all of that information.

Dr. Cooper

Perfect. Okay. And I interrupted you. Sorry. Keep going with that. I just want to make sure the audience had their arms around those five categories.

Dr. Walter

Yeah. And in these five categories, we have several strategies. Participants had to rate this strategy in two steps. The first step was to say if they ever used the strategy or if they are still using the strategy. And the second step was to rate the efficiency of the strategies. We found this big difference between precautionary and barrier management and acute barrier management between eating and behavior and physical activity strategies. And the results showed that the acute barrier management was used more frequently for diet strategies and acute barrier management was used more for physical activity strategies. And regarding the efficiency it was vice versa. The acute barrier management strategies were less effective for eating strategies and the precautionary barrier management strategies, were less effective for physical activity behaviors. And putting that with the emotional feeling when you’re eating because one acute barrier management strategy for the eating activity was for example, switch off the TV while you are eating or use smaller plates.

Dr. Walter

So, imagine when you’re in a nice restaurant and you are at an all you can eat restaurant and you are in a really nice conversation with your friends. The food smells and looks really delicious. There’s something that happens to you or to people who want to eat less sugar or less food, that they won’t use this smaller plate. Or imagine you are sitting with your friends together together in front of the TV and you were watching the finals of a soccer match or a NFL match and um, then pizza, the pizza is there and we don’t switch off the TV because there’s this special moment in the last, last minute in game, all the people would say, are you kidding me? We can’t. Now there’s an emotional aspect while you are eating, particular when you’re in company.

Dr. Cooper

Very interesting. Very interesting.

Dr. Walter

The other interesting thing was the first time we conducted an online questionnaire was with healthy people. And they were quite active at least once a week and then we conducted a really similar questionnaire of people with medical indication and they recall actually the same thing. And it was quite comparable to these two samples.

Dr. Cooper

Really. Why do you think that was?

Dr. Walter

Here’s a real human and we all like to eat and sometimes we have this, or at least in Germany we have to think a little pig. We want to get over it to, when we want to exercise more days. Always just a little tick inside us who says come home, stay on the couch.

Dr. Cooper

I think we have that in America too. That’s funny. Okay, so let’s, let’s pop in when I heard you speak in Germany, you talked about the difference between what we do in the first few weeks of attempted change and then what we do or usually don’t do a month or more into the process and fall back into our old habits now you’ve talked about the 84 days. So if we can get three weeks going, we get that ball rolling, we’re making progress and then suddenly we fall off. Can you walk the audience through some of the things you shared at the conference with that?

Dr. Walter

Yeah, we conducted in 2016 and 2017 an intervention study or I would say it’s more an experimental study because we have no intervention group and control group. They conducted a study where we ask participants to choose one healthy behavior. They haven’t practiced so far. Let’s say I’m eating a banana for breakfast.

Dr. Cooper

Ok, something new.

Dr. Walter

Something new. Yeah. What you haven’t done before. So what do you want to establish in your life as a daily routine, as a habit. So, and we ask all our participants who choose one of these eating, drinking or a physical activity behavior. They were asked to carry out this daily behavior, this behavior for 12 weeks. And then we had a look at how often have they did this behavior per week. How consistently, in the sense of, always at the same time, always at a random time. And we’ll also ask them how they felt during the week, like activated, depressed. And we found out that all the participants who practice their behavior less often and less consistent, compared to participants who practice their behavior more often and more consistently, they dropped all it by week four or five and participants in practice, every behavior always at the same time, let’s say for lunch or before dinner or after getting up and they practice at least three or four times a week. They established a habit in the first five to eight weeks. And that was the thing that was quite new for us that it is not only the behavior we choose, it’s also the behavioral requirements that obviously develop a habit. And that was our results.

Dr. Cooper

Okay. So circle again, I’m jotting notes down here just to reset what you said there. So the same time mattered. If I did whatever it is, I start to exercise the fact that I exercise at the same time every day, doesn’t matter when it is, but it’s if it’s the same time that improved my odds of continuing it. Is that part A of what your findings were?

Dr. Walter

Yeah, that’s right. It is, the environment plays a critical role in the development of process. It’s like an environmental cue and it’s a time cue. It’s one of these is typical and to see them to develop a habit.

Dr. Cooper

Very interesting. Okay. And then the frequency you said was the other piece, three to four times a week was significantly better than one or two times a week.

Dr. Walter

Yeah, that’s right.

Dr. Cooper

And with that, you then found they were able to establish a habit within this kind of four to six week period versus the 84 days that we looked at in the previous study from 2010. Is that, did I hear that right?

Dr. Walter

Yeah, that’s right. We have used to assess the habit formation process. We’ve used a specific questionnaire, it’s called the self report habit index. It’s a 12 item questionnaire asking a specific behavior. Let’s say exercising in the morning is something, with 12 items for example, that I do frequently or that I do automatically or that makes me feel weird if I don’t do this behavior. And you had to rate these 12 items on a five point likert scale from do you disagree to agree and the higher the report habit, the more stable is the behavior. And we have seen that in the first five to six weeks. The self report habits in next increased significantly for those people who practice that behavior always at the same time and at least three to four times per week compared to those practiced behavioral less consistently. And the thing is, after you use the six week, people reach like a stable plateau from this time. So let’s say about six or seven, they reached a score. What the original of self report habits and next that, that this is can be created as a habit.

Dr. Cooper

Hmm. Wow, that’s so exciting.

Dr. Walter

Yeah. So, and the thing is, we only had 12 weeks. It would be really interesting and that is the next intervention study or experimental study I want to conduct, how does it work for more than three months for a half a year. How does it work for a longer time?

Dr. Cooper

Right. Okay. Well you’ve partially answered my next question, but I’ll just throw it out there to see if there’s anything else you’d like to add. Cause I think you’ve already given the audience a huge cue here with the same word actually the time cueing and then that frequency being so important. Are there other critical aspects to effectively changing our behavior and sustaining it? Because that’s what we’re all about. Everyone listening, almost everybody listening to this podcast, that’s what they’re about. They’re either helping others with behavior change or they’re interested in creating their own behavior change and sustaining it. So you gave us a couple of great nuggets. Anything else that you’d want to throw out there for them?

Dr. Walter

Yeah, what I explained was the process when I already have chosen my behavior. There are a few things to consider before you start with your behavior and I don’t want to talk too much about the theoretical basis and the theoretical background, but there are about four to five psychological factors, um, that should be considered to be successful in setting up on maintain the new behavior. And that is, on the one hand, this trend of your goal, intention of your goal is so-called self concordance of this goal and your actions. Concordance means how does the goal fit to my own goals, is it a goal that is given from my partner or from my employer. For example, if your partner says to you, I want you to lose weight and you don’t want to lose weight at all because you feel fine and you don’t have depression or something like that, um, your self concordance is not high enough.

Dr. Cooper

Essentially intrinsic motivation.

Dr. Walter

Yeah. It’s a part of intrinsic motivation and you have to find a goal, and you have to formulate your goal. And your plans with the smart criteria are always, have you ever heard of smart criteria?

Dr. Walter

Yeah. And I think most of our folks are relatively familiar with that just in terms of being measurable and having a timeframe and those types of things.

Dr. Walter

Yeah. And that is one of the most important effect because if you only have global intention, you will only practice global, global behavior.

Dr. Cooper

Very interesting.

Dr. Walter

Global intentions lead to global behavior. And the more specific, the more attractive, the more realistic and time bound that your goal is, the more is it likely to be maintained.

Dr. Cooper

Hmm. That’s very good reminder.

Dr. Walter

That is one of the most, important things. And, I think most important before you start with your behavior, you also have to think about potential barriers. What kind of alternatives you can prepare for these barriers. Let’s say your goal is to run every day or let’s say every Tuesday, for 40 minutes around the park or the block or whatever. And then you have Tuesday and it’s six o’clock and it is raining. So the most people would say, okay, it’s raining. I can’t run, because it’s raining I don’t like to run in the rain. Then you have to find alternatives for bad weather. In the field of diet, for a munchie or whatever. And that’s also a big factor in our experimental studies. We also assessed the barriers because we have asked our participants, how often did they practice their chosen behavior? And they, rate between zero times a week and seven times a week. They rated their behavior only five times a week. We ask them immediately what barriers they had to face. For example, I couldn’t be bothered or I had appointments or whatever, more the barrier. And the thing is when they have too many appointments and they had too many distracting things in their life, they did not pursue their behavior as intended. So these barriers you have to think about prior to the beginning.

Dr. Cooper

So I’ve got strength of goals, self concordance, which is a portion of intrinsic motivation, smart goals, thinking about potential barriers and working through those. Did I miss any?

Dr. Walter

And at the end you have to think of your outcome experience as well. And that’s what we’ve assessed in the first study I’ve mentioned with the consequences if you want to practice in your daily routine has no good outcome experience, you won’t pursue it. And that’s why that’s also one of the antecedents of habits. When you, let’s say you exercise for 40 minutes, then you go out of the exercise or I’ll often wake up with a really good feeling and you’re proud that you’ve done this exercise or this work out. Even if it was raining and this good feeling means you to do the same behavior again. Do you know what I mean? It’s like a positive learning theory like classical conditioning. You know, when you are rewarded with something nice, you want to have this feeling again and then you, you, you do the behavior regularly more thoroughly because you want to have this feeling again.

Dr. Cooper

Okay. This is so good. You’ve really answered my next question as well. I think you’re reading my mind here, but anything else for people that are trying to help others? So these would be coaches or somebody who’s trying to help a friend or a family member or something like that. You’ve given us a lot of tips. You’ve given us these five things you need to think about. You’ve talked about the importance of time cueing and frequency. You’ve walked us through the idea of, you know, it’s five to six weeks, 84 days at the most, anything else that if you were coming alongside someone else that you might include in the conversation?

Dr. Walter

I also work as a personal trainer and I’ve had the experience that clients are interested in reasons why we do these things. And I would suggest that if your clients has a lot of questions in his or her head, you have to explain why you give him this strategy or this method or you suggest, sometimes they need a little bit of scientific aspects, that’s what I have seen as my experience as a personal trainer. That’s the more practical thing. And then the things I already said that you have to be self confident if you want to change your behavior. Because if you’re not confident enough that you will overcome the barriers, then it would not happen. It will not happen. And you have to set your own goal.

Dr. Walter

It’s useless to take somebody, another goal from your partner or from media or from wherever. It should be your own goal and it should be connected. It should be something you can identify with when you say that’s typical me. Right? So you should ask your clients for patience and they should be patient because it’s a long time and when we talk about behaviors, you want to get rid of it, that’s another really interesting field I want to be more active in. Stable behaviors, we have practiced for a long time and a long time for me that are months and years. You can’t assume that you can get rid of them in between one to three weeks or five months. And that’s, please be patient with yourself.

Dr. Cooper

Okay, good. All right, let’s turn the mirror around a little bit here. How have you, or are you applying your research in your own behavior change efforts? Is there something that you’re working on now because we’ve all got our stuff. I can give you a long list for me, but we’ve all got our stuff. Is there something that you’re working on now that you don’t mind sharing with us and talking through how you use your research in your own life?

Dr. Walter

Yes. I’ve actually got two behaviors that I started with because I’ve read that it’s healthy. For example, I, I always eat one boiled eggs for breakfast, because a few years ago I’ve read that one boiled egg for breakfast is quite healthy. Because of all the protein in it. And it keeps you going until till lunchtime. That’s why I thought for myself. Okay. One boiled egg every day. Okay. And, I did this for a long time and now when I have breakfast and I don’t have a boiled egg with me, it feels weird and I really want to have this boiled egg. Sounds weird, but it is nice.

Dr. Walter

I also have a physical activity behavior. What I see as a habit. I have to drive my car to work. There’s a little distance between my home and my work and I have a home office day every Thursday to avoid the typical traffic in the morning I get up, every day at five o’clock to avoid traffic. And I’m always around six in the city where my, my office is and because I have long working hours, I can’t be bothered to do my exercise or my workout afterwards. So I always do my exercise and my workouts before I go to my office. And, that’s why I always exercise in the morning and that has another positive effect that I guess fresh air and that I have already done my exercise and my workout and driving my car from my home to Lipsig, the university I work for is like preparing for my exercise on my home base. I don’t exercise because I don’t have these these way to truly exercise. You know what I mean?

Dr. Cooper

Very interesting.

Dr. Walter

You need, you need to sit and stay with context and stable time and that was also my motivation. Yes, it works. It works. If you, if you are patient and if you do really, you really do your exercise regularly at the same time in the same context, it will be stabilized in the sense of a habit. I don’t want to be selfish and say, yeah, I’m the best practice, but it works for me.

Dr. Cooper

Yes, that cueing is very interesting. Very interesting, huh? All right. Well good. Thanks for sharing that with us. So now the phone genie question. The phone genie comes to your office tomorrow and says, all right, Dr. Walter, you get to put a message on everybody’s phone home screen tomorrow morning. What would that message be?

Dr. Walter

Hmm, that’s a really tough question. I know when I presented my findings this year at the conference, I had these, the slogan for the stand that means four times a week for 12 weeks with the same stable context at the same time and a positive reward the positive connect afterwards helps you to establish a habit but this sentence may be too long and more than 140 characters for twitter. So maybe something like be smart and start.

Dr. Cooper

Oh there we go. Be smart and start and then dial in the cues. Yes. I really appreciate it. This is fantastic. Thank you for taking a jump with us in terms of the language and I think you did an awesome job. I appreciate you doing that.

Dr. Walter

Thank you very much. Yes. It’s not the best grammar.

Dr. Cooper

No, you did a great job and I think people are gonna love the information cause you gave us a lot of new insights that probably most people weren’t familiar with many of these.

Dr. Walter

Yeah. And that’s why most people feel connected with it because they’ve made a similar experience and feel addressed. When I say, have you ever tried to change your behavior and it works best for the first two weeks and then there comes this big hammer and then you can’t be bothered or you forgot what you have done or something like that and you can apply it to actually every setting that is the athletes setting to to develop routines and competition strategies and competition habits and you can implement it in the medical setting as well as in school. That’s why it’s so interesting.

Dr. Cooper

Thank you. This was fantastic. I appreciate you jumping in.

Dr. Walter

Thank you.

Dr. Cooper

Fascinating. After 30 years as a PT and 15 years in health and wellness, I thought I heard it all when it came to behavior change. Great reminder. There’s always more to learn, isn’t there? Thanks again to Dr. Walter for joining us. Wonderful insights. Quick note about the Rocky mountain coaching retreat and symposium. Some of you know about it. We launched it this year in 2019 for the first time. Our goal was to go beyond the typical conference to provide the CEU’s to provide the chance to enhance your skill set, but do it as setting and with a schedule with some gaps, some chances to breathe and get re-energized and rejuvenated, all those kinds of things. The feedback from this last year’s event, so encouraging, we decided we’re going to do this every year, so it is scheduled for September 18th to the 20th, 2020 in Estes park, Colorado. Beautiful setting, beautiful time of the year.

At a minimum, you may want to just pencil the data in as you’re planning your year in the coming weeks and months. If you know you’re coming and you want to save some money, we do have what we’re calling a super early registration discount available through December 31st you can check out all the details, CatalystCoachingInstitute.com or contact us anytime results@catalystcoachinginstitute.com. In the meantime, let’s go get better and let’s help those around us do the same. After the conversation with Dr. Walter, we all have some new tools in our toolbox, but they don’t do any good if they remain in the toolbox. It’s up to us to put them to use. Thanks again for joining us. This is Dr. Bradford Cooper signing off. Make it a great rest of your day, and I’ll speak with you soon on the next episode of the catalyst health and