Creating sustainable, lasting health-related behavior change is not a simple, cause and effect process.
by Steve Feyrer-Melk, Ph.D. M.Ed.Chief Science Officer at Nudge, Director of Lifestyle Medicine at Optimal Heart Center
Think about it. Changing behavior from time-to-time is manageable, however, long-term behavior change requires a deeper and more grounded process that strengthens our decision making at times when it is most difficult to do so.
In my ongoing effort to gather pearls of wisdom on the subject of health-related behavior change, a common issue consistently has risen to the top.
This key factor is one that requires our attention, and I am confident that when we attribute greater significance to this concern, long-term, lasting health-related behaviors will grow exponentially.
Christine’s Depletion Story
Christine is a 46-year-old mid-level Customer Service Representative at a major payroll services company.
Throughout the day, Christine answers calls from often disgruntled customers who have issues regarding running payroll, setting up garnishments, adjusting payroll taxes, correcting calculations, recovering accounts, finding missed items, etc.
Needless to say, Christine’s day is filled with problem solving and making confident decisions under pressure and with professionalism. In other words, if willpower is a limited resource, then Christine may have a problem.
When I first met Christine she was very defeated by her inability to lose body fat, an issue that has plagued her all of her life. As a result, Christine found herself with serious health problems and an ongoing daily struggle with food and physical activity.
As Christine deals with making important decisions and providing correct answers for customers, a process that compounds stress throughout the day, by the time she arrives home in the early evening her energy to make the best choices has weakened and she finds herself giving in to her old “unhealthy” behaviors.
As you would agree, this is a common theme with so many people. So the question that we must pose is...
"Why do highly successful and confident decision makers find it nearly impossible to make the same level of decisions later in the day when it is about personal health?"
Addressing Depletion
As with many of the people I coach, including Christine, making counter-intuitive health-related behavior choices goes well beyond the physical feeling of exhaustion from a busy day. The root cause is deeper and a largely more sinister influencer that will diminish our ability to be successful over the long haul.
As fate would have it, securing lasting health-related behavior change requires us to have the ability to make positive choices at all times, even after a day filled with compounding high stress and high decision-making requirements.
It is at these times that we are much more likely to make rash decisions and sabotage our progress, a condition that Marshall Goldsmith (2015) calls depletion.
“It’s not like engaging in strenuous physical activity where we expect to feel the weariness in our muscles—and take time out to rest. Depletion, like stress, is an invisible enemy. How do we behave under the influence of depletion?” (Goldsmith, 2015)
As health professionals we successfully use structure and planned physical activity to train the body to decrease risk of disease. Interestingly, this same strategy can also be applied to health-related behavior change as we learn to maintain positive choices even when we are depleted.
Specifically, we can use structure as a “training” protocol that can slow down how fast discipline and self-control disappear, and in turn, help to overcome depletion.
Think about it this way. If you sign up to run a marathon in 6 months and can only train on weekends for a total of 5 miles, what would happen on race day?
Well, the unfortunate result would certainly be negative no matter how good your intentions would be. Physiologically speaking, your VO2max would not be adequately developed, your lactate threshold and glycogen stores would be low, and your ability to utilize fat during the race would be limited.
Basically, your energy level would run out very soon in the race and no matter how hard you try, you couldn’t run the race.
On the other hand, if the appropriate structured training program is implemented and followed, the physiological adaptations that occur will provide the ability to overcome the negative aspects of the 26.2 miles run, allowing for successful completion.
According to Goldsmith (2015), once our eyes are open to the impact of depletion, new courses of action immediately come to mind. A simple technique that can be used to provide structure and awareness starts with tracking our days in terms of depletion.
A day off relaxing in a park with no worries, problems, or demands, and with your cell phone off, would not have many depletion events and be considered a low depletion day.
However, a day like Christine’s filled with 15 stressful phone calls, 10 high-pressure decisions, and 3 meetings with her supervisors, would be considered a high depletion day.
This is a day filled with compounding depletion and unless we have a clear understanding of the impact on diminishing our will-power at the end of the day, we are setting ourselves up for failure.
For Christine, starting by tracking her depletion events throughout the day made her realize how certain days had a greater potential to negatively impact her health-related choices at home.
As a result, she structured her evenings more closely, having her meals planned the weekend before, eliminating unhealthy food choices from her pantry, and planning her walk before work.
Get To Self-Realization & Intrinsic Motivation
Of course, all of these items are common sense to health professionals, however, Christine needed to realize for herself in a personal and quantifiable way that being in a high state of depletion negatively impacted her personal ability to follow her fat loss plan.
As health professionals it is incumbent upon us to guide individuals with the power of self-realization and intrinsic motivation if we are to truly help them reach lasting health-related behavior change.
The use of a HIPAA-secure coaching platform like Nudge Coach that allows customizable tracking - like for example, "depletion events" - is very efficient, effective and powerful for the participant and the health professional.
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Goldsmith, Marshall. (2015) Triggers: Creating Behavior That Lasts-Becoming the Person You Want to Be. Crown Publishing, New York.
