Healthy Heart

How do I change my behavior?

Most cardiovascular disease is preventable. Most heart attacks and strokes can be prevented, and even after they have occurred there is little doubt that with doctor and patient working together we can stop the progress of cardiovascular disease and prevent future events, dramatically reducing the risk of death or disability. But to do this requires altering those risks that led to disease or risk of disease in the first place. What those risks are is well known: smoking, high cholesterol, high blood pressure, diabetes, obesity, sedentary lifestyle, poor diet, and excessive stress. What is common to altering each of these risks is that they are each related to behavior and therefore require changes in behavior. Physicians often think that behavior change is hard, and prescribe more pills instead, thinking that taking pills is easy. But we know that many patients do not take medications as prescribed, and that the ability to stick with taking pills day in and day out for the long-term is also a behavior that is sometimes difficult to achieve.

So how do we change behavior?


People often see this as a very difficult task and it can be for some. We can be "fixed in our ways", and we are used to the way we live and find it comfortable. It is important to know that behavior can be changed. Here is an overview of some of the basic principles and steps of behavior change. We will use smoking as a model but the same principles apply to all behavior change.

  • First, and most important, ask yourself - Do I really want to change the behavior? And if so, why? The doctor may say you need to quit smoking (or lose weight, change what you eat, ….), but are you motivated to do so? And if you are, why? I may say you should quit smoking to prevent another heart attack, but for you a more powerful motivation may be to set a good example for your children. We are always better convinced by the reasons that we come up with ourselves than by those given to us by others.
  • Do I think I can do this? What can I do? Some people need to set small goals.It is always important to not set goals that we cannot possibly reach. Better to switch from cream in coffee to milk than to strive to become a complete no-animal-products vegan vegetarian if the first goal is more realistic for you. Certainly there are people who when properly motivated (often after a heart attack!) can make dramatic changes in their lives - lose a lot of weight, quit smoking, start running, and make major dietary changes - but many need to take it more gradually. That is okay - the important thing is to assess your own level of ability to change at this time and set a goal that will not set you up for failure.
  • The next step is to ask yourself - Do I have past experience with change? What have I done before and what can I learn from it? The overwhelming majority of smokers, for example, have quit before, often for fairly long periods of time. Likewise, all of us have attempted to make some change in our lives, be it exercise, weight loss, dietary, or for that matter spending more time with our children. These experiences have taught us a great deal, and specifically, as we look back on them, help us to answer the following two questions:
    • What was hard about this experience and what were the barriers to success? and
    • What was helpful (resources) and made the attempt easier?

This assessment of past experience is very important and allows us to take the next step in a more prepared fashion and use the knowledge we have.

  • The next step then, after thinking about your level of motivation and confidence that you can change, and after thinking about resources for and barriers to change, is to make a plan for the manner in which you will change to a more desired behavior. This plan will depend on your own answers to the questions above, and on the resources that you can bring to bear to the task in hand. Resources include family and friends and substitute behaviors such as exercise, and also include professionals, such as doctors, nurses, psychologists, dietitians, and all those who make up the medical team available to help.

This link will take you to an algorithm (a guide) that we developed for physicians to use in helping patients to stop smoking. You will see that the steps in this algorithm follow the path outlined above. Although specifically intended for smoking, the steps described apply equally well to almost any form of behavioral change.

This outline is just the beginning of a description of how one changes behavior. Behavioral change is a complex task, and although there are basic principles involved in all behavior change there are also specifics about the type of behavior to be changed, and of course every human being is different. What you need to do should certainly be discussed with your physician or other provider, but I do hope that this outline will be of some value to you. In future discussions we will go into greater detail with regard to specific areas of behavior.

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