Podcast: Behavior Change #2 with David Schlundt
In this episode of the Well-Being Experts podcast, we’re discussing behavior change. We sat down with Dr. David Schlundt, Scientific Advisor at Onlife Health, to talk about the psychology of change and successful strategies to changing behavior. We discuss obstacles to behavior change and how health coaches work with individuals to help them overcome those obstacles.
“I would say that the process of behavior change really begins with analysis. You really have to understand the behavior and you have to understand the function or role that that behavior plays in a person’s life.”
Want to dive deeper into this Well-Being Experts podcast? Here's the full transcript from our discussion with David Schlundt, Ph.D., Scientific Advisor for Onlife Health.
Dr. Schlundt: I would say that the process of behavior change really begins with analysis. You really have to understand the behavior and you have to understand the function or role that that behavior plays in a person’s life.
Host: This is the Well-Being Experts podcast. You just heard from Dr. David Schlundt, Scientific Advisor at Onlife Health. This conversation is about behavior change.
Dr. Schlundt: At the system level, the ROI is really reducing healthcare costs because we have a tsunami of poor health that’s being driven by behavior and lifestyle.
Host: On our tenth episode of the Well-Being Experts podcast, brought to you by Onlife Health, we’re discussing the psychology of change and successful strategies to changing behavior.
Dr. Schlundt: At the individual level, it’s about pulling people out of the sort of guilt and shame, helping them see that there is hope and really starting to connect them with the immediate positive benefits of doing something a little differently.
Host: For more content like this, go to onlifehealth.com/resources. Enjoy the conversation!
Dr. Schlundt: I’m David Schlundt and I’m an Associate Professor of Psychology at Vanderbilt University. I’ve been there for 30 years and I love what I do. I get to study people and their behavior and how to change their behavior to help them improve their health.
Host: When we look at an instance where someone, they don’t want to change, what are the common kickbacks that they’re pushing to those that are telling them, “Hey, you should try to live your life differently and do this differently?” What are they typically saying and what types of barriers are those creating?
Dr. Schlundt: I think they’re often not being really articulate about it. When they’re pushing back, it’s, “Don’t bother me, leave me alone.” I think some of it is the frustration that people feel, the helplessness that people feel. “Every two years, I have to buy a new wardrobe because I keep gaining weight. Don’t tell me I’m fat. It upsets me too much. I don’t want to talk about it.”
For some other people, it’s they are afraid that they’re going to have to give up things that they really like. “You’re going to tell me that I can’t eat bacon, and I love bacon.” So often it’s a fear of losing something. It’s the long-term frustration. Often, I don’t think people can articulate even why they feel like, “it’s just too hard to do this. Leave me alone.”
I’m a social scientist, so I actually think I have some insight into why it’s too hard to do this. So we spent many years in the Vanderbilt Diabetes Center doing counseling skills training with nurses and dietitians. And I developed a list of what I called the obstacles to behavior change, and it’s really kind of a checklist that you can use when you’re working with somebody and helping somebody to get them to identify what’s making it hard for them.
So I start out with knowledge and skill. If you don’t know what to do or you don’t have the skills to do it, then that’s where you’ve got to start. So the person has to be able to – let’s say if it’s carbohydrate counting in diabetes, they really have to have a certain level of numeracy in order to be able to do the calculation. So you may have to overcome that as a barrier.
Cost. How much does it cost in money, time, and effort? Very often, people have overestimated those costs. Very often those costs are real. Again, if I’m going to start exercising, I’m going to have to give up doing some other things.
That leads us to the third one, which is what I call competing priorities, and I think this is really big. People have lots of demands in their life. They have their job. They have their family. They’ve got their hobbies, their interests, and all of these things compete for your time and your interest and your energy and your behaviors, and very often people don’t change because they’ve got all these competing priorities.
Lack of social support. The quintessential one is the woman who’s going to change her diet and her husband and children say, “We ain’t eating that rabbit food.” So, all of a sudden, that lack of social support becomes a really big barrier. So, she’s now going to have to fix two meals for the family.
Really important one, stress and emotions. When people get under pressure – they’ve got deadlines, they’ve got financial issues, they’ve got interpersonal conflict, they’re going through a divorce – all of these stressful things begin to take up the time and energy they have where they could be devoting it to making healthy choices. Sometimes it’s just very obvious why. “Well yeah, you’re going through a divorce and you just lost your job, I guess you’re not going to be marathon running now, are you?”
And then the last one, I call inappropriate cognitions. And probably the easiest way to illustrate that one is the all or nothing thinking. So, you walk into the break room. There’s a doughnut box there. Nobody’s looking. You eat one doughnut. “Oh, no. I’ve just failed. All is lost, I might as well eat another doughnut.”
Host: I’m just going to take the box back to my desk.
Dr. Schlundt: Exactly. Yeah. So, when people are trying to change their behavior, you set out that daily pattern and you begin to try to follow it. I’m going to tell you the rules of thumb, too, for behavior change. One of them is to be consistent. So you set up a pattern, you’ve got these goals. You really get into a groove where on most days you’re able to sort of follow this pattern, it begins to become a habit.
When you can’t be consistent, be close. So eating three doughnuts is a worse choice than eating one doughnut. If you can’t be close, find some way to compensate. So, “I sort of messed up and ate three doughnuts, I guess I’m going to go for a walk. I’m going to have a salad for dinner.”
The last rule is stay away from the all or nothing thinking. So that when you do make mistakes, instead of saying, “I failed, what’s the use of trying?” Say, “Well, let me see. That puts me over my goal for the day, what can I learn from that and how can I handle this differently? Maybe I’ll bring an escort the next time I go to the break room so I’m accountable for the number of doughnuts.” So problem solving instead of feeling bad about yourself and like you failed.
Well-Being Experts is supported by Onlife Health. With 20 years of industry experience and over 10 million covered lives, Onlife knows how to drive the ongoing engagement needed to create real results. Find out why health claims and large employers nationwide trust Onlife Health as their comprehensive wellness provider. Visit onlifehealth.com to learn more.
Host: Now, some of the barriers you just talked about a moment ago – knowledge, cost, priorities, lack of social support, stress of the motions – so there’s a lot in the way. Is there a solution beyond just trying to stay consistent and staying away from all or nothing?
Dr. Schlundt: That’s where the coach comes in. That’s where, if you’ve got a coach that’s working with somebody, the coach – we used to print them on these little cards that nurses could put in their white coats or the dietitians could carry with them and say when you get stuck with somebody, pull it out and here’s the barriers to behavior change. Just start asking them some questions about it. What you’re doing then is you’re personalizing the strategies. You’re zeroing in on your lack of social support really has to do with what your spouse, your children, somebody that you work with. Let’s talk about ways that you could handle that differently. I’ll go back to my social skills training, let’s practice how you could approach that person and sort of respectfully and nicely ask them to do something different to support your efforts to be healthier.
So again, these are sort of a road map for the coach to begin to ask questions about and find out, “What are your barriers? Oh, you have been going through some stress lately? Oh, there’s something with your health that’s getting in the way?” And then begin to help people find alternative strategies for overcoming them or help them. Sometimes it’s even reframe it in their thinking: “Well, giving up bacon and switching to turkey bacon, maybe that wouldn’t be the worst thing in the world.” Lots of ways that you can go with this, but this gives you sort of some mental hooks to hang things on, and some ways that you can, as a coach, you can begin to ask questions and say, “Well, let’s talk about how busy you are. What seems to be getting in the way? What’s challenging you right now?”
One of my favorite things is exercise for transportation. Now I have the wonderful opportunity of working at a university, so I often have meetings all over the place. So I have this concept that I call spending ten minutes to get thirty minutes of exercise. So if I had a meeting somewhere and it would take me twenty minutes to walk to my car, drive there, find a place to park and walk to the meeting, and if I could walk that distance in thirty minutes, it’s costing me just ten minutes to get thirty minutes of activity. But again that’s just a little bit of a reframing of the issue and putting it really in terms of costs and benefits and helping me see that, “Well, maybe I am willing to take ten extra minutes today to get closer to my goal of 10,000 steps.”
Host: When you talk about the benefit of having a coach, how much – if you had a percentage – how much easier is it for someone else to see and help you guide yourself out of those challenges?
Dr. Schlundt: I think it’s often easier for somebody else to talk to you, to get you to give some information and then reflect back to you what they’ve learned from that. Very often people, because of the shame or the guilt or the anxiety or the feelings of helplessness, it’s really hard for them to put two plus two together and see the patterns. So that’s a very useful part about it. Ultimately, what you want to do is you want to empower people to take charge of it themselves.
So again, if I’m trying to get fit, I’m going to set goals. I’m going to find a way of tracking my progress. I’m going to make that visible with a graph or an app on my smartphone. I’m going to then engage in the process of finding out where I succeed and where I hit barriers and then start to actively problem solve to say, “Well, okay. So every Friday, it looks like I only get 2,500 steps. What is it about Fridays that’s making it so hard for me to be active?” And then, “I don’t need the coach because then I’ve learned sort of how to problem solve myself.” But sometimes it takes help to get started on that, too.
Host: What do you think is a smart way to think of the ROI of all of this? From different perspectives of all the individuals at the table.
Dr. Schlundt: So at the system level, the ROI is really reducing healthcare costs because we have a tsunami of poor health that’s being driven by behavior and lifestyle. At the individual level, it’s about pulling people out of the sort of guilt and shame, helping them see that there is hope, and really starting to connect them with the immediate positive benefits of doing something a little differently.
Again, thinking you have to lose 100 pounds and nothing is good until you do that, that’s impossible. Let’s see if we can’t get you to where you’re eating 1,800 calories a day and are losing a pound a week. “Maybe I could do that.” And then all of a sudden you’re saying, “Oh, I’m so proud – look at this. I made my goal six out of the last seven days. The seventh day, I went to a party. I understand parties are a really hard situation for me. I’m going to think a little bit more about how to handle that the next time.”
So it’s getting people connected to the fact that motivation is costs and benefits, and helping them see that there really are some benefits to doing things differently, embarking on this process of trying to make your behavior a little healthier.
Host: This has been a fantastic conversation. Thank you so much. I really appreciate you sharing your insights.
Dr. Schlundt: Oh, thank you.
Host: This has been really enjoyable.
Dr. Schlundt: Thank you. I love talking about this.