▪ While you wait, discuss the following with your neighbor:
1. Have you ever set a goal outside of your personal or academic/professional comfort zone?
2. What sort of effort did you have to exert to work toward your goal?
3. What sort of psychological and social challenges (if any) did you have in reaching your goal?
4. What habits did you have to form (or break) in order to achieve your goal?
5. What roadblocks (if any) did you face in sticking to your habits to reach your goal?
6. Ultimately, did you fail or succeed? In either instance, what did you learn about yourself?
HEALTH COACHING, SETTING GOALS, AND ESTABLISHING HABITS
SARAH TOROK-GERARD, PH.D., CHC
WHAT IS HEALTH COACHING?
Behavioral Science
Exercise Science
Nutritional Science
Facilitative NOT Prescriptive
WHY IS HEALTH COACHING NEEDED?
President’s Council on Fitness, Sports & Nutrition
(http://www.fitness.gov/resource-center/facts-and-statistics/)
Obesity-related illness, including chronic disease,
disability, and death, is estimated to carry an annual
cost of $190.2 billion
Projections estimate that by
2018, obesity will cost the U.S. 21 percent of our
total healthcare costs - $344
billion annually
More than one-third (34.9% or 78.6 million) of U.S. adults are
obese
CDC: Ogden et al., 2015 (https://www.cdc.gov/nchs/data/databriefs/db219.pdf)
BEHAVIORAL MODEL OF TREATMENT FOR OBESITY (THORPE & OLSON, 1997)
Common treatment components
Self-monitoring
Stimulus control
Modification of eating behavior
Modest calorie
restriction
Self-reinforcement
Exercise Cognitive
restructuring
GOAL SETTING… IT’S NOT THAT SIMPLE…
TRANSTHEORETICAL MODEL OF BEHAVIORAL CHANGE (TTM; PROCHASKA & DICLEMENTE, 1984)
For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.
Do you have a particular goal you would like to achieve?
What habits would you need to form to achieve it?
What stage are you at in the TTM when considering this goal?
SOMETIMES WE “FAIL” IN PURSUING OUR GOAL OR MAINTAINING HABITS…
Lapses Short term/”fall of the wagon” from
“good” habits
Temporary loss of control; Self-efficacy
still in tact
Easier to come back from
Relapses More long-
term/sustained departure from “good” habits
Loss of control = Loss of self-efficacy +
Locus of control that is global and stable
Harder to come back from
Have you ever lapsed or relapsed? What did you do to successfully return to your goal and
resume your habits?
GOAL SETTING IS IMPORTANT…
Goals benefit the goal-setter because they
Motivate change during the entire
process
Provide clarity that aids the client in
directing action on a daily basis
Help reduce relapse and enhance
program adherence
Help people overcome obstacles they will face during
change process
S.M.A.R.T. GOALS (DORAN, 1981)
Specific
• Goal should be clear, easy to understand
• Sub-goals = Easier to manage
Measurable
• Track progress
• Measurable goal = Quantified outcome
Attainable
• Goal should be realistic for timeframe set
• Decide the level of difficulty at the start
• Goal too extreme OR too easy ≠ Motivating
Relevant
• Goals should be important to where you are in life right now
• Goals forced upon you ≠ Motivating
Time-Sensitive
• Include a realistic end-date
• Deadlines = Motivating
MY OWN S.M.AR.T. GOAL
S.M.A.R.T. GOALS
▪ Think about a goal. It could be something you have already achieved, are currently achieving, or want to achieve in the future.
▪ How would/did/will you turn YOUR goal into a S.M.A.R.T. goal?
IT SEEMS SIMPLE ENOUGH…
▪ S.M.A.R.T. goals allow us to envision our goal in a manageable way, but many factors can interfere with committing to them in the long run…
▪ How we address those factors will either facilitate or hinder our eventual success!
PSYCHOLOGICAL & SOCIAL FACTORS THAT IMPACT GOAL ADHERENCE
GOAL ADHERENCE: SELF-EFFICACY (BANDURA, 1977)
Sense of competence
Task choice
higher SE = more challenging task
choice
Effort
higher SE = more concentrated focus
and consistent effort at task
Persistence
higher SE = more persistence in face of task
challenges, even when repeated “failures” occur
GOAL ADHERENCE: LOCUS OF CONTROL (ROTTER, 1954; ABRAMSON, SELIGMAN, & TEASDALE, 1978)
Attributing our level of control over our successes
and failures
Internal vs. External
Stable vs. Unstable
Global vs. Specific
GOAL ADHERENCE: MOTIVATION
GOAL ADHERENCE: SELF-REGULATION (TOERING ET AL., 2009)
Heightened awareness of task-specific demands
Flexibility and creativity in planning and strategizing
Better use of metacognitive skills (e.g., planning, self-monitoring, and evaluation)
Emphasize mastery learning rather than performance-based outcomes
Ability to choose appropriate self-regulatory strategies in the face of task failure
Ability to engage in a maximal amount of effort and persistence during their learning
GOAL ADHERENCE: MOTIVATION & SELF-REGULATION DECI & RYAN’S (1985, 1996) SELF-DETERMINATION THEORY
Intrinsic Motivation
Internalization & Integration as
Intermediary Processes
Amotivation
Loss of Motivation
due to Negative
Internalizations or
Sense of Autonomy
GOAL ADHERENCE: MINDSET (DWECK, 2006) & GRIT (DUCKWORTH, PETERSON, MATTHEWS, & KELLY, 2007)
▪ Dweck (2006)
▪ Growth mindset vs. fixed mindset
▪ Praising or emphasizing “natural ability” harms: ▪ Motivation and effort
▪ Performance and performance appraisal
▪ “I’m so smart.” vs. “I put a lot of hard work into doing well and it paid off.”
▪ Duckworth et al., (2007)
▪ Grit: passion and perseverance for long-term goals ▪ Growth mindsets ARE related to grit
GOAL ADHERENCE: FAILURE
Mindsets & failure
(Dweck, 2006)
Strong message from society about how to boost people’s self-
esteem: Protect them from failure!
Growth mindset (and Grit)
• Failure = challenge; opportunity for persistence and learning
Fixed mindset
• Failure = threat; permanent; something that should be abandoned or avoided
Myelination & failure (Coyle,
2009)
Failure facilitates neurological refinement
We “fail” our way to skill acquisition
during deep practice
HABIT FORMATION…
THE NEUROPHYSIOLOGY OF HABIT (PRICE, 2017)
“OLD BRAIN”
▪ Doesn’t require too much conscious thought
▪ Inner more, primitive parts of our brain
▪ Limbic system
▪ Associated with emotional processing
▪ Basil ganglia
▪ Remembers whether a behavior creates good or bad outcome
▪ Assists in behavior automation
▪ Work to determine whether to perform behaviors again
“NEW BRAIN”
▪ Uses more conscious, rational thought
▪ Outer regions of the brain
▪ Cerebral cortex
▪ Complex cognitive processing
▪ Planning ahead
▪ Learning new behaviors
▪ Prefrontal cortex
▪ Inhibition, judgement
▪ Critical thinking
▪ Create goals/strategies for creating habits
When forming habits, if the outcome of the new behavior isn’t pleasant, the old brain can override the new brain’s plans to continue the behavior and revert back to more rewarding, bad behaviors.
Ex., Failed New Year’s Resolutions
THE NEUROPHYSIOLOGY OF HABIT (PRICE, 2017)
New Brain Old Brain
MYELINATING THE BRAIN FOR HABITS
Coyle’s (2009) Model from The Talent Code
“PRACTICE MAKES MYELIN, AND MYELIN MAKES PERFECT.” (COYLE, 2009, P. 44)
The cycle of deep practice, myelination, and skill development (Coyle, 2009)
Engage in deep practice
of a skill
Neural circuits for
skill are activated
Neural activation increases myelin
insulation
Neural insulation facilitates
automacity
Neural automaticity leads to skill improvement
HOW DO WE ENSURE OUR SUCCESS IN ADOPTING HEALTHY HABITS?
BEHAVIORAL APPROACHES TO HABIT FORMATION (FOGG, 2014)
▪ Habit
▪ Automatic behavioral response
▪ Certain situational cues
▪ Behavior performed repeatedly, consistently
▪ Tiny Habit
▪ A personal behavior
▪ Perform at least once, daily
▪ Takes short amount of time (under 10 minutes)
▪ Requires little motivation or cognitive effort
▪ Remember the old brain?
BJ Fogg, Stanford Behavior Design Research Scientist
HOW TINY HABITS CAME TO BE (FOGG, 2014)
▪ Fogg’s Insights
▪ Simplicity > Motivation
▪ Emotion impacts habits
▪ Small is better
▪ Celebrate every victory
▪ New habits should be linked with existing routines
An
cho
r M
om
en
t Existing routine or event; serves as a reminder to perform habit
New
Tin
y B
ehav
ior A simplified
version of the new habit; should be performed after the Anchor Moment
Inst
ant
Cel
ebra
tio
n
A way to create positive emotions after performing the tiny habit
Anatomy of Tiny Habits
*This is also referred to as a “habit loop” by some psychologists
CREATE YOUR OWN TINY HABIT (FOGG, 2014) ▪ On your sheet of paper, write the following statement and fill in the blanks with
your own anchor moment and tiny habit:
▪ “After I ___________ I will _____________.”
▪ Examples:
▪ “After I brush my teeth, I will floss one tooth.”
▪ “After I check my work email, I will meditate for five breaths.”
▪ “After I watch one episode of the Walking Dead, I will do 10 sit-ups.”
▪ How will you instantly celebrate the completion of your habit?
HOW TINY HABITS GROW (FOGG, 2014)
▪ tiny habit = automaticity
▪ Starting small helps
▪ sequencing leads to more complex behaviors
▪ Motivation plays a smaller role
▪ If your automatically succeeding, that will drive the habit forward
Three Types of Tiny Habits
Blade Shrub Tree
TINY HABITS (FOGG, 2014)
B- Behavior M- Motivation A- Ability to perform T- Trigger
BAD HABITS (PRICE, 2017)
▪ Must address the habit loop ▪ ID the cue, the behavior, and the reward
▪ Change the behavior to be “good” while keeping the same cue and reward
▪ Ex., Instead of eating dessert with your romantic partner after dinner, replace that shared experience with taking a romantic walk, or watching a good TV show together
▪ Cue = Your partner after dinner
▪ Behavior= Eating dessert- REPLACED by walking or otherwise interacting with your partner
▪ Reward = Emotional fulfillment/connection with partner
▪ Must address “disruptors” that interfere with adherence to new habits
▪ What excuses or environmental factors are interfering with engaging in the habit?
▪ Once ID’ed then you can create strategy to prepare for the “disruptors”
HABIT FORMATION: THE ROLE OF SOCIAL SUPPORT
• Empathy, concern, acceptance
Emotional support (Willis, 1991)
• Educational services, direct methods of assistance
Tangible support (Heaney & Israel, 2008)
• Problem solving ideas, advice, suggestions
Informational support (Krause, 1986)
• Creating a sense of belonging and feeling of comfort
Companionship support (Uchino, 2004)
FINAL CONCLUSIONS ▪ Health coaching
▪ Emerging field precipitated by rise in obesity
▪ Blends exercise science, nutritional science, and behavioral science together
▪ Facilitative, not prescriptive
▪ Goal setting ▪ Should be systematic process in order to facilitate success
▪ S.M.A.R.T. goals are the best goals
▪ Many psychological and social factors relate to goal adherence
▪ Failure doesn’t = termination of goals
▪ Habit formation ▪ Important part of goal setting
▪ Heavily impacted by our neurophysiology
▪ Tiny habits facilitate long-term success
▪ Behavioral interventions can help to override bad habits
▪ Social support comes in many forms
REFERENCES
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QUESTIONS?
Sarah Torok-Gerard, Ph.D., CHC Associate Professor of Psychology University of Mount Union [email protected] ACE Certified Health Coach Healthy Transitions Health Coaching, LLC [email protected] Website: http://healthytransitionshealthcoaching.com/