Behaviour Change

One way of helping you to be more sure about trying to change is by doing a decisional balance activity. This means working out the pros and cons of not changing your behaviour, then the pros and cons of making changes to your behaviour and weighing these up against each other. It is important to think about the real advantages and disadvantages of your behaviour and what impact these are having on, or could have on your life.

• See the download section for Balance Sheet 1: looks at the advantages and disadvantages of changing behaviour. Balance Sheet 2: to use as a follow-up exercise if the disadvantages of changing behaviour outweigh the advantages.

Balance Sheet 1: this will encourage you to think through the pros and cons of your behaviour change. If you can think of more disadvantages than advantages, move on to balance sheet 2.

Balance Sheet 2: this will make you think of ways of reducing the disadvantages of behaviour change, and look at the pros and cons of not changing your behaviour. You may be surprised when doing this list for a behaviour that is thought of as ‘bad’; remember that you wouldn’t do the behaviour in the first place if there were no benefits in it for you. It’s important to understand why you are doing something, so you are able to think of ways to challenge this and to make changes.

By using these balance sheets to look at the behaviour change, you can now see the risks of carrying on as you are and the benefits of making a change. Let’s think about these risks and benefits in more detail.

Bear in mind that, when weighing up the pros and cons of changing a behaviour, it’s not just about how many things you have listed in one column compared to another. Think about each point you have written down and how important this is to you. You might have only thought about one benefit for changing your behaviour, but the importance might outweigh all of the reasons you have listed to carry on; this is called a decisional balance. If you are struggling with making this decision, then think about what your life would be like if you did/didn’t change the behaviour, based on each thing that you have listed.

Think about your own personal reasons for wanting to make a change and use this to help with motivation. However, it is also important to remember all of the things you like about your current behaviour, so that you know what to expect to come up against when you make a change. With all of this in mind, it is important that you have realistic expectations of what will happen if you do change your behaviour. if the reality of changing your behaviour doesn’t meet your expectations you may feel upset and will be more likely to suffer setbacks,

Please see the ABC form in the document download section.

At first (before)

Behaviour (the action or non-action)

Consequences (after)

To decide how best to change our behaviour, it can help if we understand what is in play leading up to or ‘triggering’ us to perform a behaviour in the first place, and how this makes us feel afterwards. Behaviour (the action or non-action) is usually linked to a habit or routine; this usually includes what happens before the behaviour (At first) and what happens after the behaviour (consequences). ABC forms can be useful in helping you to figure out when you are more likely to do the chosen behaviour (e.g. where, with whom, feeling like what…). The behaviour can be doing something (e.g. walking upstairs) or not doing something (e.g. not having a biscuit at the tea break). On every occasion where you perform the chosen behaviour, make a note of what led up to that moment, that is; what you were doing, who you were with or what you were feeling before you performed the chosen behaviour. Also record the action or non-action (the behaviour) in the middle column.

Next you need to record the consequences of your behaviour: that is, what happened afterwards. What did you feel like? What did you do next? An ABC form gives you the opportunity to review the patterns of your behaviour – what situations make the desired behaviour more likely and what situations make the desired behaviour less likely. This information is very helpful in making action plans, setting goals and in identifying situations that are difficult and make setbacks more likely (see the guide to setbacks section below).

Increasing confidence to change

Some people want to change but decide not to change because they don’t think they can do it. People with a high level of confidence in their ability to change are more likely to achieve their goals and are more likely to solve problems that get in their way. Therefore, it is important to know how to measure your confidence level to understand your ability to change your behaviour, and how to increase it if needed. People’s confidence in their ability to change their behaviour can change depending on their situation and over time.

How to measure your confidence level

A useful tool for assessing confidence levels is the confidence ruler. When assessing your confidence about a goal or a small part of your goal, look at the below scale numbered 1 to 10.

Not confident 1----2----3----4----5----6----7----8----9----10 Very confident

Ask yourself the following question: “On a scale of 1 to 10, how confident do I feel that I can achieve this goal? If 1 was not confident and 10 was very confident, what number am I at?” If give yourself a score of less than 7, your level of confidence needs to be improved.

How you can increase your confidence in your ability?

As your level of confidence plays such an important part in the success of behaviour change, it is important to increase it, so let’s have a look at what you can do to help this.

Making use of confidence scores:

Once you have got your score, you can use this number to get more information about how to improve your confidence. There are two types of question you can ask yourself:

1. 1.      Why not a lower number? Ask yourself why you chose that number rather than a lower number?

Try to explain why you gave yourself that score. For example: If you rated yourself as fairly confident that you’ll be able to go to the gym twice a week, giving yourself a score of 5 out of 10. What helped you to score 5 rather than 1? Maybe you have a friend to go with or you have used the gym before so feel more confident about going?

Also ask yourself ‘what else?’ to see if you can think of any more ideas you could work on in the next step.

2. What would help you to be a higher number? Or how could you move up the scale? Ask yourself what would you need to do? Or what is stopping you from feeling more confident? Thinking about the reasons you have chosen these numbers and what you need to do to change them, can increase a person’s sense of confidence in their own abilities.

i) Remembering previous successes – Think about any times in the past when you have succeeded in changing their behaviour (even if it didn’t last!).

How did you do it? What was helpful? The idea is to get thinking about what you’ve done in the past that worked, and to look at how you could try them again. Work out what skills you already have, and (if necessary) how you can improve these. If you can’t think of any occasions on which you were successful, think about change in any area of your life, e.g. learning to cook, or to play a sport or a musical instrument etc.

ii) Watching other people – seeing others successfully change their behaviour can increase a person’s confidence in their own abilities, the ‘if they can do it then so can I’ idea. There is also the possibility that you can pick up hints and tips for successful behaviour change by observing or talking to these people. Do you know of anyone who has been successful in changing their behaviour? (if possible, someone like you) and try to find out how they did it. If you can’t think of anyone or don’t have any examples, then try looking on social media to find inspiration of someone similar to you who has made the same changes.

iii) Persuasion – support and encouragement from friends and family, can increase your level of confidence. Tell friends and family what you are thinking of changing and ask them what they think. The more support you can get the more likely you are to make a lasting change. Try to surround yourself with positive people, who are good at boosting others’ confidence by giving praise and encouragement.  Confiding in people also makes it less likely that they will put you in situations where you are likely to fail.

Have another look at importance If you gave yourself a low score on the confidence ruler and you are struggling with all the above strategies for increasing your confidence levels, perhaps it is time to have another look at your goal/ reasons for wanting to change.

Is this goal really important to you? One way to check this is to use the confidence ruler, but instead look at “How important is this goal to you?”

Not important 1----2----3----4----5----6----7----8----9----10 Very important

If you give a low score for importance, try doing a cost‑benefit analysis. (see the ‘Deciding to change’ section) Think about the reasons why you want to change this behaviour and use the reasons to see how important this is for you to do.

SMART goals:

Specific

Measurable

Achievable

Relevant

Timely

Once you have decided on a health behaviour you’d like to change, you need to set your first goal, to help you to plan how to change your behaviour. It is important to set a goal that is detailed and that you are likely to achieve. Goals should be SMART, that is:

Specific – some goals can be unclear and hard to measure.  It is important to set goals that are clear and detailed. For example, an unclear goal would be ‘being fit and athletic’, whereas a clear, specific goal would be “I will work out at the local gym for at least 30 minutes three times a week at 7pm on Monday and Thursday and 10am on Saturday.” To help you make your goal more specific, ask yourself the following:

What am I going to do?

How am I going to do it?

Where am I going to do it?

When am I going to do it?

With whom am I going to do it?

Measurable – making the goal specific means that it should be easy to measure whether or not you manage to achieve the goal. The example above, “I will work out at the local gym for at least 30 minutes three times a week at 7pm on Monday and Thursday and 10am on Saturday,” is measurable. You can record the number of times you went to the gym in one week, and also how long you worked out for each time. It would be hard to measure an unclear goal like ‘being fit and athletic’.

Achievable – try to set goals that are within your reach.  If you set yourself a really hard goal and don’t achieve it, it can make you feel bad and you may want to give up. For example, an unrealistic goal could be ‘eat no chocolate or sweets for the next seven days’. A more realistic goal could be ‘eat no more than three portions of chocolate or sweets in the next seven days’. It is important to make your first goal quite easy to achieve to help boost your self‑confidence, small steps are easier to achieve than big jumps. Remember that the best way of changing behaviour and sticking with the changes is to build on each small success.

Relevant – Is this an important goal for you? Is it a behaviour that you really want to change? Can you see a clear link between this goal and what you want to change about your health/ the way you feel about your health? You are much more likely to succeed in reaching your goal if you can see the important difference that changing this behaviour will make to your health. If you answered no to any of these questions, then you might want to re-think the goal you are setting and choose something more important to you.

Timely – is this the right time to try to achieve this goal? Give yourself a set amount of time in which to complete your goal. If you don’t give yourself a target date, it’s easier to keep putting off actually starting to change your behaviour, and you may never reach your goal. For example, give yourself a week or two to try out a new change before going back and setting a new goal. If you think your goal will take longer than a week or two, try breaking it down into ‘mini goals’ (using SMART). This way you can achieve something each week, helping you to achieve this goal in a manageable way. For example, if your goal is to eat five portions of fruit and veg a day, a mini-goal could be to eat at least one portion of fruit or veg each day.

You might not have thought about rewarding yourself with a treat, but this is an effective way of changing behaviour. This is sometimes called ‘positive reinforcement’. Adding a system of rewards into your action plan can have a positive effect on your motivation to change your behaviour, and on making it more likely that the behaviour change will last.

Giving yourself little treats to reward yourself when you’ve made progress towards your goal can encourage you to keep going and make more progress. You don’t have to wait until you’ve achieved your goal to reward yourself – remember that a big long term goal can be broken down into smaller mini-goals. Reward yourself for any mini-goals you reach, and any other small successes that you have along the way.

What are rewards?

A reward can be anything that you value having or do, e.g. praise or treats. Ask yourself what kind of things you would like as a reward for achieving mini-goals and main goals, or any other little successes along the way.

Rewards don’t have to cost money, but you can also ‘save up’ for rewards. For example, save £1 every time you do some physical activity, then at the end of the week or the month spend the money on a reward for yourself. If you can’t think of many rewards, here are some examples:

Rewards that don’t cost money

• Having a nice relaxing bath

• Borrowing a book or magazine

• Inviting friends round

• Having some ‘me’ time when you can do whatever you want to

• Listening to music

• Going for a walk

• Watching your favourite TV programme

• Doing some gardening

• Asking friends or family to look after your children so you can have some time for yourself

• Asking friends or family to notice and praise you when you have achieved something.

Rewards that cost money

• Buying yourself a CD/magazine

• Buying yourself new clothes

• Going to the cinema

• Buying yourself flowers

• Buying yourself sports equipment

• Going to a football match

• Going out for a meal

• Renting a DVD

• Booking a holiday or weekend break

• Buying yourself some perfume/ aftershave.

Warning!

Some types of reward can be unhealthy. If you are trying to change your eating habits, a reward of a chocolate bar every time you eat three or more portions of fruit and veg in a day would not be a good idea. Try to choose healthy rewards that don’t affect your progress towards your goal.

Use the rewards sheet in the document downloads to make this part of your action plan.

Behaviour change is helped by having a detailed action plan of how you are going to change your behaviour.

What are you going to do?

Where are you going to do it?

When are you going to do it?

With whom are you going to do it?

‘If-then’ rules

‘If-then’ rules (if situation Y arises then I will perform behaviour X) can be used to help you remember to do your new chosen behaviour. The situation (place, people, feelings) can be a trigger, or a reminder, to perform the behaviour. For example, “If it is a weekday morning, then I will prepare a healthy lunch to take to work.” It requires you to say exactly what you are going to do and when you are going to do it. The idea is that eventually the behaviour will become automatic, a habit, so that, for example, the act of getting dressed for work in the morning will prompt you to prepare a healthy lunch.

Try using the If/Then Plan in the document downloads.

Barriers and facilitators

In order to achieve goals, it is important to think what might make it hard for you to achieve your goal (barriers) and what will make it easier for you to achieve your goal (facilitators). Try filling in the Barrier and Facilitator sheet in the document downloads section.

Barriers, for example:

• Lack of facilities/equipment

• Unsupportive friends/relatives

• Situations that make it especially difficult to perform the behaviour.

Have a think about any barriers and try to come up with possible solutions to them. For example, you want to increase the amount of physical activity you do, but there is no one who could look after your children while you exercise. Try thinking about choosing something that could include the children (for example, cycling together, playing in the park, walking to the shops), it is no longer a barrier.

Situations that are likely to cause setbacks are also barriers. For example, a person trying to give up smoking may find that when they drink alcohol it is a high-risk situation as they feel really tempted to smoke. Try to think of any situations where the risk of a setback would be high, now think about some strategies for managing them. For example, going to a place where smoking is banned, or asking friends not to smoke around you.

Facilitators, for example:

• People who encourage/prompt you

• Having access to facilities, for example, local sports centre, internet access in local library, local smoking cessation services

• Reminders or situations that can trigger you to do the behaviour.

These include anything that makes it easier for you to perform the behaviour. Think about what is likely to encourage the behaviour. Do you already do the behaviour? What actions, reminders or situations trigger this behaviour? What can you do to increase these positive reminders?

Getting support

Planning where you can get support for your behaviour change is also important.  Think of people who are likely to be supportive and encourage you to change. Think of ways that you can get the most benefit from these people, for example, spending more time with them, having a specific person to phone when you need encouragement. The community can also be a source of support, for example, self-help groups, community groups, exercise/sports teams etc. Can you identify any useful sources of support you may be able to use as help?

Contracts

Complete a Personal Health Guide in the download section and sign. This is a behaviour change ‘contract’ – making contracts has been shown to help people stick to their action plans and achieve their goals.

Mini-goals

Once you have filled in the Personal Health Guide, try to work out what your mini‑goals could be. For example, if your main goal is to be able to walk to and from work three days a week, a mini-goal could be walking to and from work on one day a week. Use the Rewards section to list possible mini-goals and rewards for completing. Not having to wait until you’ve achieved your main goal to get a reward can encourage you to persist with the behaviour change. It is important to remember that the Personal Health Guide should be reviewed regularly and revised in the light of experience. You won’t necessarily stick to your first plan, but your experience of trying to do this will give very helpful information that can be used to revise the plan to make it work better for you next time you try to make a change.

It is important that you measure and record your progress. This can motivate you when you are doing well or tell you something may be wrong with the plan if you aren’t doing so well. Examples of self‑monitoring include making charts, records and diaries. People will usually think they are either doing better than they are or they will be too critical of themselves – such as putting less for the number of unhealthy foods actually eaten or over counting the time they spend exercising. Self-monitoring gives people a realistic picture of their health behaviour.

Behaviour change is usually full of ‘ups and downs’ and not a smooth process; looking back at past records can help people keep going when they feel they are on a ‘down’ section. The Behaviour Change Diary will help you to monitor your behaviour.

This diary can be used for three things:

1. To keep a record of behaviour before change is planned. This can be useful for people who are not sure what changes to make. Just recording behaviour (for example, number of biscuits eaten a day) can help to change it in a good way (this is called self-monitoring).
2. When a goal has been set, the diary can be used to record behaviour to see whether it is changing things for the better.
3. Using the diary can make people more aware of when they do well, or when they don’t do so well, at changing a behaviour (for example, what setting their in; times of day, how they felt, who they were with etc.). This can help them to decide what to plan ahead for in the future to make the behaviour change easier.

Please see a Behaviour Change Diary in the download section. It is designed to help you to keep an up to date record of your behaviour. The comments box may be a useful tool for you to judge how hard you are finding it, and to think about what could make it easier. This will work best if you make an action plan before you start the change process and think about where and when to write this diary, and how you can use it to help.

How to use your diary?

It’s really important to fill in a diary to keep a check of how well you are doing or to find out why you might not be doing so well with making the new change. Remember, if you don’t fill it in each day then you might find it hard to remember exactly what you did in the past week and this can cause some things to be forgotten or recorded wrongly, e.g. forgetting successes, especially if you were not feeling good on that day. If you find it hard to write a diary then try and think of other ways you can keep track of what you are doing. Could you use your phone to note down what you have done or text a friend instead, you could even try using sticker charts or pictures of how you felt on that day to track your behaviour.  

You can find a Food Diary, a Physical Activity Diary, a Smoking Diary and an Alcohol Diary in the downloads section on this page. They are fairly simple and can be changed to help you to record the behaviour of choice.

You can use these diaries in a similar way to the Behaviour Change Diary to help with making your changes:

• Make sure you are using a diary. If not, what is making it difficult? Is there a different way you could record your behaviour in a way that can help you?

• Remember to use rewards when your diary shows you have managed to change something which helps you reach your goal.  

• Ask yourself:

What does your diary tell you about your behaviour?

Can you use this information to help make plans to avoid or come up with coping strategies in the future?

Did you feel that you don’t have enough time?

Is the goal important enough to you?

Did you have a plan for when to fill it in?

Did you find it hard to write? - could you record your progress on your mobile phone (if you have one) or can you ask family or friends to help you to fill it in?

Review the diary each week

Firstly, look at your diary and pick out at least one thing you have done well. Using this example, think about what you did that made it easier for you? if anything, what was hard and what did you do to overcome it? If this example has helped you to reach your goal or mini goal then remember to give yourself a reward.

Secondly, try to find something in your diary that you could have done differently. Using this example, think about what made you do that behaviour? Why did you not choose a different behaviour? What could you do differently next time to help move this behaviour?

Using the diary to think in this way can really help you to understand why you do certain things and help you to make a plan for next time you face the same situation.

What can the diary tell you?

How well you’ve done in reaching your goal will tell you what you need to think about next. For example, if you struggled, do you need to change the goal or change the Personal Health Guide? Or could you make some more If/ Then plans to help you for the next week?

If you did well and found it easy, do you need to set yourself a new goal?

Using the diary

If you are unsure about what you want to make a change in or whether making a change is the right thing for you at the moment, filling in a diary can be a really helpful way to help you to understand more and make your mind up either way.