Why changing our behaviour feels so hard

A while ago I had a patient who was a chronic smoker and had gone for acupuncture for a pain complaint and had come away from treatment not only with an improvement of her pain complaints but also with a sudden, intense disgust for cigarettes. She suspected that the acupuncturist had also needled the locations associated with smoking addiction without her knowing about it.

But this post is not about acupuncture or smoking.

It's about this: this patient was angry that the acupuncturist had made her stop wanting to smoke. "I never wanted to stop smoking!" she complained.

Maybe if you're a smoker yourself you can relate to this, but most healthcare providers would be absolutely baffled at this reaction. Surely every smoker wants to quit smoking?? It's so clearly unhealthy for you!

Unfortunately, behaviour change is not that simple.

Even though this patient knew that smoking wasn't good for her, she wasn't yet at the point where she both wanted to and intended to change (yes, those are two different things) let alone had the tools and skills to do so.

She also had deeper motivations for her behaviour related to her identity, community or social factors and that it functioned as a coping mechanism for emotional distress.

She also, of course, was angry at the lack of autonomy as the decision was made for her without consent.

Here's something that might surprise you: your patient is less likely to change an unhealthy behaviour and experiences more resistance the more you as the clinician push, direct or give "helpful advice".

​The reverse is also true: the less you try and persuade or convince your patients to change their unhealthy behaviours, the more likely they are to do so.

Ambivalence and resistance to change are entirely natural and normal. We can both want something and at the same time not want it or be unsure about it.

So instead of getting judgemental of patients when they do something that's so obviously unhealthy for them, remind yourself that behaviour change is complex; it doesn't have to mean anything about the person themselves.

And you can also reflect on your own life. You may not struggle with the exact things your patients do, but my bet is you struggle with other things (you're on this mailing list after all!).

Maybe you struggle to set boundaries around your work hours even though you know you'd be less stressed if you did.

Or you keep repeating the same unhelpful patterns when you and your partner have a disagreement.

Maybe you don't do much physical activity even though you're fully aware of the benefits of it.

Or maybe you stay up late scrolling social media even though you know it's affecting your sleep.

Reflect on what makes these things difficult for you to change. Explore the resistance and think about what the reason might be that you struggle, with the assumption that all behaviour makes sense. Think about whether you even want to or intend to change the things you struggle with.

As healthcare providers, our job is not to convince or persuade our patients to make changes; we can fill in gaps in knowledge where these exist and support them on their journey where we can.

We need to practice providing a safe and compassionate space for patients to explore how they're struggling and wrestling with change without making character judgements. To give them the dignity of their own journey and choices.

After all, if you were having trouble with a change yourself - think about how you'd want your healthcare provider or someone in your support system to be.

I'd love to know: what change are you wrestling with in your own life?