I’ve been thinking lately about why we change.
What is the most effective approach for people to change their behavior?
This question goes to the engine of Conscious Medicine. This is where the rubber meets the road.
A fundamental tenet of Conscious Medicine is that we will not bend the healthcare cost curve down without helping people achieve lasting changes in their health habits. And if we don’t have effective, measurable, reproducible, and sustainable methods to improve health habits, then Conscious Medicine goes nowhere, at least not on a large scale.
Stanford professor and industry innovator BJ Fogg has been meticulously studying this question for many years. What he’s learned may surprise you.
Fogg distills behavioral change down into three simple elements: motivation, ability, and a trigger. All three must converge in a given moment for a behavior to occur. When a behavior doesn’t occur, at least one of the three elements is missing.
In Fogg’s view, motivation is the least reliable of the three elements. Motivation, through tapping the hot buttons of pleasure/pain, hope/fear, and social acceptance/rejection, might work in getting someone to take a one-time action. But motivation naturally waxes and wanes, and approaches that attempt to unnaturally amp up motivation to attempt lasting behavioral change ultimately fail.
Fogg defines ability as how easy or hard a behavior is to do. Ability is directly linked to simplicity, which Fogg says represents the minimally satisfying solution at the lowest cost. Ability/simplicity has six sub-elements: time, money, physical effort, brain cycles, social deviance, and non-routine. These sub-elements influence a given person in a given context differently.
Let’s say you want to incorporate more plant-based whole foods in your diet, for example. You may find this task hard if you come home too late from work to cut up the vegetables (time), can’t afford to buy fresh fruit (money), or find yourself too exhausted to prepare the meal (physical effort). Or you may find the recipes too complicated (brain cycles), too different from what the rest of your family wants to eat (social deviance), or too outside of your daily rhythm (non-routine). In either case, because you perceive the action to be hard, you will not adopt it or sustain it when your motivation wanes.
According to Fogg, the trick then is to take advantage during periods of high motivation to set up conditions that later make the desirable behavior easier to do when motivation inevitably runs low. He calls this “harnessing the motivation wave,” and he illustrates this in the video below:
If you want to incorporate more fruits and vegetables in your diet, for example, you could pre-prepare the meal when you’re more highly motivated and have it easily accessible. You could then more easily grab this meal rather than the first food you crave, especially when your motivation tanks.
Fogg believes in two ways of changing behavior for the long-term: changing your environment and making the behavior change tiny enough. He’s created Tiny Habits, a surprisingly simple method to create new habits in your life. The keys to the method are to anchor the new habit to come right after an existing behavior and to make the new habit very tiny at first (for example, flossing one tooth — and only one tooth — after brushing your teeth). The idea is to program your brain to make the new behavior automatic, so that it’s no longer dependent on motivation to succeed.
Fogg’s Tiny Habits method is ingenious and immediately applicable to the future of healthcare. But I personally believe Fogg underplays motivation somewhat.
In discussing “push” and “pull” forms of motivation, Jonathan Fields says that motivation can push us away from something undesirable or pull us to toward a deeply desired end. I think Fogg would agree with Fields that motivation that is sourced in the pull of a higher, deeper purpose can be much more intense and sustained than motivation that pushes us away from pain. (I would put forward that Fogg’s self-acknowledged obsession with studying behavioral change is itself a demonstration of motivation’s powerful pull on his actions.)
This form of motivation adds a vertical dimension to the map. If Fogg’s motivation wave is on the x-y plane, this motivation involves the z axis. Its gravitational pull depends on this:
How big is your recognition of your unique calling in life?
What does this have to do with the future of medicine? Please stay tuned…