Women’s health articles

How to make life changes — becoming the person you want to be

by Marcy Holmes, Women’s Health NP

“If we don’t change, we don’t grow. If we don’t grow, we aren’t really living.”
— Gail Sheehy

• When “failing” is a good thing
• Reality check: a sense of urgency to make a change
• Making changes: getting started
• Prochaska’s six stages of change
• Strategies for each stage of change
• Clearing your path to change

Patients frequently tell us they want to change something in their lives. Maybe they have gained a lot of weight, or have been struggling with a bad habit like smoking. Others are fed up with certain relationships that have become toxic, or they have emotional issues that have made them miserable for years.

So if we want to change our lives so badly, why can’t we just do it, and morph into the person we want to be?

The fact is that lasting change is possible, when we understand the emotional, mental, and physical steps we will need to take. We still need to commit to the idea of changing, and follow through with our efforts, knowing that it will be better for our overall health and wellness. But if we get the lay of the land before starting our journey toward change, it multiplies our chances for success.

Naturally, there will be barriers to overcome before you embark on the change process. As adults, many of us fear life changes and the uncertainty it brings. But understanding and analyzing fear is the first step towards dissolving it. When you aren’t scared anymore, the idea of changing suddenly becomes much more appealing.

Often, people find that problem behaviors are rooted in parental messages from childhood. Our patterns are remnants of old coping mechanisms that served us well as children, but in adulthood, they’ve turned into an endless loop of negative self-talk: I’m too weak to quit smoking, or, I’m already so unattractive, what’s the point of trying to lose weight?

Sometimes people feel trapped in a cycle of behavior, perhaps with a spouse who is resistant to the idea. Or maybe it’s just hard to picture ourselves without the problem behavior. I tell my patients who feel hopeless about changing, that they can do it — when they are ready to commit and do the work to prepare for the obstacles they will encounter along the way.

When “failing” is a good thing

On New Year’s Day, thousands of people resolve to change something about their lives. They start off strong, but as February approaches, many begin to lose steam, quietly dismissing their well-intentioned resolutions. This happens a lot when people try to quit smoking — which isn’t just a bad behavior, but also an addiction. Smokers want to stop, but they often fall off the wagon quickly and feel like giving up altogether.

But surprisingly, the most successful changers are the people who have already “failed” several times. The willingness to keep trying — persistence — is a common trait of successful changers. At Women to Women, we know this is true because of our experience helping women through important changes in their lives.

Some women think that all they need to do is to muster enough willpower to change. In reality, at any given time, only 20 percent of us are truly prepared to take action toward changing. And no amount of willpower can help if you’re not genuinely ready to change.

Another key element for success is staying optimistic which can be hard — or even impossible — to do unless you have support. Support is certainly one of the “secrets” of success, and research bears this out. For example, if a hundred people try to quit smoking, only five will succeed if they quit alone, cold turkey. But that number jumps to 20, if the quitters have someone to counsel them and offer additional support strategies.

Reality check: a sense of urgency to make a change

After living with a problem behavior, it’s easy to become complacent about it. We might think, What’s the big deal? Everything’s fine just like it is. And you can go on thinking that way for a long time — until a major event forces you out of your comfort zone. If you want to lose weight, it may be a health scare that gets your attention, or the realization that you can’t walk up a flight of stairs without being short of breath.

I know someone who recently quit smoking after many years. Louise had known about smoking’s health risks, but the “sudden” decision to quit finally came when Louise sat by her mother’s bedside, watching her die of lung cancer. For Louise, that was the end of smoking cigarettes.

You too may experience a “last straw” event that propels you into taking the first tentative baby steps toward change.

Making life changes: getting started

In life, we learn that change is inevitable. But the real revelation comes when we are able to embrace change — instead of resisting it, which helps ease the transition into a new behavior. Making a change is often a courageous act, especially if it affects others, perhaps family members or coworkers. But just knowing you need to change is actually the first step.

Big life changes occur in stages, over time, as part of an ongoing process that can ebb and flow like life itself. Change is a nonlinear process that sometimes requires us to take a step back before we move forward.

Change also involves us totally which is why planning for change can help push us through the rough spots as we evolve into the person we hope to become.

Just as Elizabeth Kübler-Ross defined the classic stages of grief (denial, anger, acceptance, hope), so can the stages of change be identified. These phases are not consciously chosen but occur naturally, sometimes at an unpredictable pace or sequence. Just being aware of how the change process works — and then preparing for its stages — is critically important for success.

Prochaska’s six stages of change

In their pioneering book, Changing for Good, James Prochaska, PhD and colleagues report on the experiences of successful self-changers. They found that the stages of change are universal and quite clear, but that you cannot control how quickly you move through the stages, nor can you skip any of them.

At Women to Women, we often use this change model, both at the Clinic and during our support calls for the Personal Program. Learning how to recognize the stages of change helps women make plans that help overcome difficulties along the way.

The six stages of change

1. Precontemplation: Problem? What problem?
You are still resistant to the concept of changing, and could be deeply in denial, even as those around you are able to see your problem easily. It’s common for people to stay in this stage for long periods.

Maryann: “Since I was diagnosed with multiple sclerosis, I’ve thought about trying some small things to see if it might help. For months I argued with myself about how nothing could possibly work. Then I said, okay. I’ll change my diet for a week and see how it goes. Well, one week turned into two, and I started to feel better and more alert. That gave me the faith to keep going. I still have MS but I feel a lot better.”

2. Contemplation: Thinking it over.
You begin to acknowledge the problem and accept that change is in your future, perhaps prodded by another person.

My patient, Liz, refused to admit she had diabetes. She had very poor nutrition and her blood sugar levels were scarily unstable. Liz had several close calls, which she had told me about. Finally, she came in one day and said that because I had nagged her so much, she had bought a glucometer to measure her blood sugar. This was a major contemplation step for her.

I frequently see people “dance” back and forth between precontemplation and contemplation. It can be an integral part of the process as you get ready to take on the responsibility for changing.

3. Preparation: Putting your ducks in a row
You begin to widen your thinking about all the things you need to do to make your change. If you are going to quit smoking, perhaps you “go public” with your goal and throw away your secret stash of cigarettes.

Margaret: “I smoked on and off for about 20 years. I knew I should quit for good, but I didn’t really want to. But then one day my 3 year old son asked me if smoking cigarettes kills you and I had to answer ‘yes.’ I was at a party a few days later and told my friends about it. I told them it was to going to be hard, but that I really wanted to quit for my son. It wasn’t long after that I officially stopped smoking.”

4. Action: Diving in
This is the most exciting stage, though you may be nervous about moving forward. Action is often confused with actual change — which, surprisingly, comes much later. I find that it takes about 45 days to change a habit so I always tell people to start by working on one or two things at a time, so you don’t get overwhelmed. As time passes, it gets easier and that gives you more confidence to keep going.

Barb: “At first it felt really great. I was proud of myself for making the commitment to eating differently and remembering to take my vitamins. Then the novelty sort of wore off and I was so distracted one day that I impulsively ate a cupcake and thought that I had destroyed all my good work up ‘til then. But my friend said, ‘Barb, it isn’t the end of the world. It’s just a cupcake! You can get back on track right now.’ And I did.”

5. Maintenance: Living with change indefinitely
This stage is commonly overlooked, and that’s a mistake. Maintenance is the act of living with your change and practicing your new behavior day after day. You will hit some rough spots that may last for days, weeks, or months — or even longer. But with support, you can avoid reverting to your old ways.

Jennifer: “When I was preparing for a new weight loss program, my husband took a “before picture” but I filed it away and forgot about it. A few months later, I got really frustrated and my husband brought out that “before” picture. I was so shocked to see how much I had already changed that it helped get me over the hump. Now I keep that picture where I can see it to remind me of how far I have come.”

Choose helpers who are consistent and strong, but don’t push you, nag you, or enable you as you work through the stages. The most important qualities for helpers are empathy and warmth.

6. Recycling: Staying aware
At this point, you are free and clear of your old behavior, and never find yourself tempted to revert. Fair warning: for many, this stage never really arrives, and they stay in maintenance. Some people relapse years later. You need to keep nurturing the delicate balance you’ve created. This is real change, however tentative it might feel.

I tell my patients that relapsing is the rule, not the exception. Your old behavior will continue to entice you for a while. Even if you relapse, it’s just a matter of returning to your new “normal” after a setback.

Techniques for each stage of change

James Prochaska and his associates determined that self-changers rely on many proven techniques that support them through the stages of change. Many are well-established methods used by therapists and psychologists, but self-changers often employ them naturally.

You may use consciousness-raising to expand your understanding of the behavior you’re trying to change. Social liberation helps you create genuine choices, perhaps by joining a support group, or frequenting nonsmoking areas.

Emotional arousal is found in a cathartic event that generates a sudden realization about the seriousness of a behavior. For example, a popular Australian internet blogger says that she knew she was ready to lose weight when she saw her “enormous white knickers” billowing on the clothesline next to her sister’s “impossibly teeny pair.”

Self-reevaluation can help you picture who you will be when you change. Commitment shows that you — and only you — are responsible for your change. Countering replaces the negative behavior with something positive. Environment control happens when you take steps to remove temptations from your daily life.

Reward is patting yourself on the back for incremental changes. (I recommend using this strategy a lot!) And helping relationships are the buddy systems we form to help us through each stage. At Women to Women, we recommend putting the helping relationship strategy in place as early as possible.

Using the right strategy at the right time increases your ability to affect change, though it is common to toggle back and forth between techniques as you negotiate your way through each stage. The change process is fluid, and your forward motion may have a few fits and starts, but there will be smooth sailing as well.

Clearing your path to change

The path to change is individual, and can be peppered with obstacles and detours. At the Clinic, we listen to each woman’s story so we can understand how her life and history influence her journey towards change.

From these experiences, I’ve created a “tip sheet” to help you start down your path to change.

Believing in change

Envisioning yourself as the person you want to be can be very powerful. This method is used by elite athletes who create vivid mental images of themselves accomplishing their goals. As they do this over and over, the picture sinks in and eventually they believe their goals are possible, perhaps even probable.

Consider one other idea when you are beginning the change process: loving kindness. Treat yourself gently and lovingly, rewarding your victories, and comforting yourself when you have setbacks. This practice can help you finally become the woman you want to be.

Related to this article:

References & further reading on how to make life changes

Original Publication Date: 03/30/2009
Last Modified: 02/16/2010
Principal Author: Marcy Holmes, Women’s Health NP