Pain-Free Living

The Secrets to Successful Behavior Change

by Martin Binks, PhD

If you’re like many people, you probably made some New Year’s resolutions. Perhaps this is the year you decided to finally quit smoking, to get more exercise, or to change your eating habits so you can lose the weight your doctor recommends losing to lessen the pain of your knee osteoarthritis. Perhaps you were doing pretty well at the beginning of the year, but now your motivation is waning, and old habits are starting to creep back in. This is a common scenario. Behavior change is one of the most challenging and universal issues we face in trying to improve our health and quality of life.

Part of what makes behavior change so difficult is the way we think about health. Modern medicine has been, for the most part, very good at targeting specific diseases and developing cures and remedies. As a result of such magnificent strides, as a society we tend to focus more on treating diseases we already have than on preventing disease in the first place. It may seem easier to just take a pill for diabetes or high cholesterol than to commit to a healthful eating plan and regular exercise. We know it’s wiser to stay healthy, but somewhere in the back of our minds we convince ourselves that illness won’t happen to us. We don’t always recognize this thinking in ourselves, but it has a powerful influence on our behavior.

Another disadvantage of the medical model of disease management is that as a society, we tend to gravitate toward “disease-specific” solutions, meaning that as we treat pain, follow a diet or exercise plan, and try to stop drinking or smoking, we look at these issues as separate and distinct from one another. In fact, there is a lot of overlap in terms of the way we need to act to improve any or all of these issues. The same changes that help you to eat more healthfully or improve your mood can help you stop smoking, manage your pain better, and so on.

As a result of the factors described above, as well as an environment that isn’t always conducive to healthy living (think of the abundance of fast-food restaurants and the amount of time many of us spend sitting at work), our lifestyles often don’t serve the best interests of our health. That is where behavioral medicine comes in. Behavioral health professionals work to help people to identify long-standing barriers to living healthy lifestyles. We help people to follow the behavioral recommendations that accompany many medical treatments, take action to prevent diseases, and develop a road map that moves you toward health, and not away from it, with each decision you make. The goal is to develop a strategy to improve the overall quality of your life, not just to target one specific issue.

Over many years of working with people who were trying to improve their physical and emotional health, I’ve developed a comprehensive approach to change. Many factors in your life converge to influence your health and your ability to commit to improving it, and these factors are all part of what I call the Health Commitment Matrix©. A matrix is a framework that supports a structure or a system, as a wooden frame supports a house or a network of minerals and collagen supports bone. So the idea behind the Health Commitment Matrix is to ask, How is your life structured, and does that structure support your commitment to living healthfully?

The first thing I do with new clients is to analyze each part of their matrix and help them identify the areas that need work. When we have identified areas to work on, we go through a number of steps to create short-term and long-term goals and set up the conditions for success. Finally, I help clients visualize what they want their lives to be like so that they can stay motivated to stick with their plan through life’s ups and downs. In the pages that follow, I’ll walk you through the phases of this process so that you can apply it to your own life. Because this approach is holistic in nature, it can help whether you are trying to manage pain, lose weight, quit smoking, become more active, reduce stress, improve your mood, or simply enhance the overall quality and comfort of your life.

Identifying areas
for change

Seven areas make up your Health Commitment Matrix, and each one has an effect on how healthy your lifestyle is. Let’s examine each area and identify possible problems and solutions.

Physical health. Oddly enough, this is an area that is often overlooked when we think about self-improvement. We may notice the major impacts of serious health issues on our lives, but we tend to overlook the more subtle and pervasive influences of both major and minor health problems on our emotional health, our work productivity, our relationships, and the joy we take in living. By examining this area of the matrix, you can not only ensure that you have the right type of medical help in place, but you can start the process of reducing the negative influences your health has on your overall quality of life. Think about how your arthritis and other medical conditions affect you: Does pain keep you up at night? Are you unable to play with your grandchildren because of fatigue? Do arthritis flares cause you to miss work or social events? Make a list of such issues, and talk with your doctor about how to address them.

Health environment. This area includes your access to healthful options such as nutritious food, exercise, medical care, and so on. Take a look at your daily life and how it affects your ability to pursue good health. For example, is there a lot of junk food in your home? Do you travel a great deal? Do you have to do a lot of manual labor or housework, and does it often increase your pain? Once you see what these situations are and how they affect your health, you can set some clear goals to start improving them.

Health knowledge. Good health requires understanding what makes us healthy, but even those of us who consider ourselves well-informed about health sometimes have misconceptions. We see so much conflicting information in the media. Sometimes what is presented as fact is merely a sales pitch when you read the fine print, and we are often bombarded with self-proclaimed experts telling us what to do. Strengthening your health knowledge involves locating truly reputable sources of information.

Try to identify specific areas of knowledge that may be lacking. For example, you may not know the best way to exercise without worsening your arthritis pain, or whether going “cold turkey” is an effective way to quit smoking. Write down the questions you have and the topics you want to know more about. Then seek the answers from trustworthy sources such as your doctor, the Web sites of government agencies such as the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and reputable organizations such as the Arthritis Foundation.

Work and financial life. This area covers all things related to your finances, including your sources of income (work, unemployment insurance, pensions, etc.) and any other finance-related stressors, such as bills, mortgages, and retirement planning. Do you feel as though you aren’t bringing in enough money? Do you feel that you are constantly under stress at your job? Figuring out a plan to live within your means or reduce your work stress can address these issues and strengthen this part of your matrix.

Let’s take another example: Many people put off planning for their child’s schooling. You may delay starting that college fund because it seems easier to wait until times are better and more money is coming in. But knowing that you should be saving is always in the background as a low-grade stressor. Over time, it may become larger than life in your mind, especially given all the other financial strains you face. However, if you sit down, take a realistic look at the situation, and decide on a small first step to take, you can turn your stressor into an accomplishment. Just setting up an account to put a few dollars in now and again can help you take control.

Social and recreational life. What we do socially and whom we do it with can have a meaningful impact on our health, quality of life, and overall well-being. In considering this section of the matrix, look at how you spend your free time. Do you take part in activities that allow you to socialize? Do you spend “quality time” with friends and family members? Do you spend a lot of time fulfilling obligations that you don’t particularly enjoy? Think about your activities and ask yourself whether or not they promote health and enhance your life. Set goals to add activities that are “health positive” — and subtract activities that aren’t.

Personal support system. Beyond our social connections, a deeper layer of support is necessary for healthy, emotionally balanced living. For many people, this network includes family members, and for some it also includes a best friend, a trusted mentor, a health-care provider, or a coworker. Ideally, your network would include as many of the above as possible.

In our fast-paced, electronically social world, we risk seeing what many might consider casual relationships as a replacement for deeper personal relationships. Perhaps we mistake quantity (we may be communicating with numerous folks daily) for quality. It is important to look at how our deepest, most personal needs are being met by those around us and to try to build support systems that address those needs. Think about whether you have people in your life whom you can talk to about the issues you face and who can give you the practical and moral support you need. If you don’t have this type of support, consider reaching out to a life coach, therapist, clergy member, or peer support group.

Emotional coping and stress management. How do you deal with the struggles you face? To some degree, the answer lies in your attention to the various segments of the matrix we already discussed. Attending to each of these areas successfully is likely to reduce stress, improve emotional coping, and create a better-quality daily life. In addition, it’s very important to identify other sources of stress, to learn stress-reduction strategies such as relaxation and meditation techniques, and to improve your communication and organizational skills. It is also important to understand whether larger emotional-health issues, such as poor self-confidence or self-esteem, depression or anxiety, past emotional trauma, or substance use, play a role in your health and quality of life.

Steps to achieving
your goals

Now that you have examined the different areas of your Health Commitment Matrix, you should have a good idea of the kinds of changes you’d like to make. Next, follow the steps below to set and achieve specific goals.

 

• Identifying barriers and strengths.

 

For each area above, think about what barriers there are to making improvements. You want to be aware of anything that will make change difficult for you. Just as important is to think about what strengths exist in each area — what is currently going well and contributing to good health. These strengths can be built upon and expanded to make each element of the matrix most supportive of your health commitment.

When identifying barriers and strengths, it is helpful to ask, “Does this particular thing move me closer to good health, or farther away from it?” For example, some common barriers include being overscheduled or finding it difficult to ask for help. Examples of strengths include being organized, managing your time well, and communicating effectively with others. Different people have different barriers and strengths, and yours will be specific to you and your situation.

 

• Making a realistic plan.

 

Now it’s time to come up with a plan for developing your strengths and eliminating barriers. The idea here is to take a “business planning” approach to improving your life and health. Once you have identified a particular strength in your matrix, you need to set goals to keep that strength moving forward, growing and building it in a way that will last. I recommend an approach to goal setting in which you have a main plan (Plan A) and a plan for tough times and setbacks (Plan B). Think of Plan A goals as “highway” goals — those you feel you can realistically pursue most of the time, assuming there are no roadblocks. Plan B goals, then, are the “city” goals — the ones you can pursue when the road isn’t as smooth.

For example, let’s say your Plan A goal for exercise is to walk or jog after work three days a week, but you find yourself skipping your workouts because your workload is keeping you late at the office. In the long term, you may need to find ways to lighten your workload so you can meet your Plan A goal. In the short term, your Plan B goal might be to take a short but brisk walk at lunchtime during days that don’t allow for a full workout. Short walks may not be ideal, but at least you get some exercise. On a good day, you might even end up getting both the lunchtime walk and the longer after-work exercise session.

To address the barriers you’ve identified, you will need to take a problem-solving approach that reduces or eliminates the barrier and helps you build strength in that area.

 

• Find your motivators and milestones.

 

You may hear all kinds of experts telling you not to set New Year’s resolutions because they don’t last. You may also hear you shouldn’t use other special occasions (such as weddings, anniversaries, or swimsuit season) as motivators. I am not one of those people. The way I see it, changing habits is hard enough without throwing out perfectly good motivators! Instead, we need to grab all the motivators we can and use them to our best advantage. As you may have experienced, the problem with event-related goals is that once the event passes, you tend to go right back to your old habits. But that doesn’t mean the motivator was bad — it simply means the plan wasn’t something you could stick with. As long as you put a healthy, realistic, and sustainable plan in place to achieve your goals before the event, and then develop a well-thought-out “next step” plan for afterward, you will be fine.

Think about competitive athletes: They follow a fairly intensive fitness and training regimen to prepare for specific competitions. Then they transition to a realistic “off-season” fitness effort that keeps them moving in the right direction until their next contest or season. You may not be a professional athlete, but you can apply this ongoing self-improvement cycle to the goals you are trying to achieve.

 

• Practicing self-awareness.

 

We are so busy and so distracted by the way we choose to live our lives these days that being present in the moment appears to be as obsolete as eight-track cassettes. We multitask to the point of absurdity at times. I see three friends walking down the street; one is sending text messages and the other two are talking to other people on their cell phones while all three are window shopping. It seems as though they are missing the actual moment together.

This style of living may have some advantages, but the path to health and well-being requires us to pause occasionally and become aware of ourselves without distraction. We need the opportunity to self-examine and to understand what we truly need emotionally, intellectually, and spiritually. So, for example, the next time you are feeling overwhelmed or stressed and are tempted to grab that cigarette or doughnut, skip that workout, or distract yourself on the Internet or with social media, pause and ask yourself, “What do I really need right now?” A moment of self-reflection can help you understand why, in that moment, you are so deeply in need of a distraction or are about to make a decision that moves you away from health. Perhaps, rather than reaching for a quick fix, what you really need is to pay attention to an emotion, to sit with a negative thought, or to process some problem you are struggling with. If you practice self-reflection regularly, you may find you are no longer so tempted to make unhealthy decisions.

In addition to moment-by-moment self-reflection, there are deeper levels of self-awareness that some people find helpful. Many people find that the regular practice of mindfulness techniques, meditation or prayer, or explorative therapy (psychotherapy in which you delve a little more deeply into longstanding behavioral or emotional patterns) helps them to build a deeper, stronger sense of self. This allows people to become more aware of how to meet their needs in healthful ways.

 

• Expanding your horizons.

 

This step is a fun one. List all the ways in which you spend your time: hobbies, modes of entertainment, sports, and so on. You did something similar when you considered your social and recreational life above, but this time the focus isn’t on whom you’re spending time with so much as what specific activities you are doing. Do you enjoy your activities? Are you in a rut? How can you shake things up and make your life more exciting, more interesting? How can you explore new things and think outside the proverbial “box”?

Some people go so far as to reinvent their lives in this step, and others simply add one or two new and fun activities to their routine. There are so many things to do in our free time, yet many of us have not tried anything new for many years. Maybe it’s as simple as exploring your local parks and recreation department Web site and choosing one new thing to try each month, whether it’s an exercise class, a “Shakespeare in the park” performance, new walking trails, or a paddle-boat rental. Just commit to doing the activity once. If you like it, go back; if you don’t, then simply try something different next time. One activity I personally find rewarding is going to local historic sites. I find they frequently amaze me and make me feel like an explorer. Sometimes I discover an intriguing and enriching historic village or museum, and other times it turns out to be a fancy sign in a cornfield—but either way, it gets me out and about. The whole point is to find activities that expand your world, get you away from the TV and computer, and really add to the quality of your daily life.

Envisioning a
healthier life

Now, take a moment to reflect on all the problems and solutions you have identified through your use of the exercises outlined above. Reflect on what you have learned about yourself, your life, and your strengths and barriers. Here is where you bring it all together and try to picture a newer, healthier version of yourself. Try to imagine yourself acting differently in the face of your most common barriers.

For example, if you have trouble saying no and find yourself overcommitted as a result, close your eyes and picture yourself confidently and realistically setting limits, delegating tasks, or asking for help. If you always seem to be struggling to “fit in” exercise, imagine yourself as someone for whom exercise is not a daily negotiation but rather a way of life. Envision yourself as a healthy person who makes healthy choices. As you practice this sort of visualization, your new outlook on your health will begin to feel more like a part of you. Old patterns are tough to break, but with effort, you can make changes over time.

As you carry out your plan to strengthen your commitment to good health, you will notice that there is overlap among the areas of the matrix, and that progress in one area influences the others. You will see how your goals may be fine-tuned and interwoven to create a smooth plan for living your life comfortably, productively, and happily. And as you combine all you discovered, you may find that you have arrived at a new philosophy of living.

You may want to start keeping a journal to record what you have learned about yourself. This way, you can look back on your progress at various points along the way, such as when you accomplish goals and set new ones. The process I have outlined here is not a one-time deal. You can come back to it as often as you like, perhaps on a monthly or quarterly basis, as suits your needs. Find ways to build and strengthen your Health Commitment Matrix, and you’ll be on your way toward better health

Last Reviewed May 30, 2012

Martin Binks is Clinical Director and Chief Executive Officer of Binks Behavioral Health, PLLC. He is a psychotherapist in private practice and offers health and life coaching via telecommunications to people worldwide. Dr. Binks is also a consultant in the development of evidence-based obesity prevention and health promotion programs in health-care, research, and corporate wellness settings.

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