Help Patients Harness Habits

review by Jacob Schor, ND, FABNO

The Power of Habit: Why We Do What We Do in Life and Business , by Charles Duhigg

Random House

© 2012*

All our life, so far as it has definite form, is but a mass of habits, – practical, emotional, and intellectual, – systematically organized for our weal or woe, and bearing us irresistibly toward our destiny, whatever the latter may be.

• William James, Talks to Teachers (1899)

I was late to work this morning, and I can’t blame anyone but myself. I’ve driven the same route for 20 years. Driving to work is a habit, and I don’t think twice about where I’m going once I click my seatbelt on until I unlock my office door. Denver is installing new light posts on Monaco Boulevard, necessitating lane closures, mergers, and traffic coming to a total standstill. Of course I should take another route to work; Quebec would certainly be faster, yet I never think of this while I’m driving. Habit takes over, I make the turn onto Monaco, and the next thing I know I’m stuck in traffic and late to work again. I am a creature of habit.

Habits and how much they control our lives has been on my mind this summer as I’ve slowly worked my way through a fascinating book called The Power of Habit. Written by Charles Duhigg, it is an important book to read, understand, and incorporate into our practices.

I make a list for each patient at every visit of things that I think they should do in regard to exercise, diet, and supplements, under the assumption that because I told them to do these things, they will. How ludicrous. What I should be doing instead is to reinforce my patients’ good habits and shifting their bad habits to be less harmful. Duhigg’s book explains how to do this.

Here’s one example from the book of how habits work. Scientists implanted probes into the brains of rats to monitor brain activity and then placed these rats one at a time at one end of a maze with some chocolate at the far end. On its first time in the maze, a rat would slowly meander its way though until finding the chocolate. The brain probes revealed this seemingly lackadaisical behavior on the part of the rat was a false impression. The neurosensors recorded intense neural activity; the brain was furiously at work with every sniff. Each time the rat was placed back in the maze, it found the chocolate faster. As the rats learned their ways through the maze, something happened in their brains; the faster they ran, the less brain activity occurred. As the path through the maze became automatic the brain worked less. As the habit was formed, the brain had less work to do and the rat thought less and less about what it was doing.

The process when the brain converts a sequence of actions into automatic behavior is called chunking, and we rely on chunking to get us through the day, from brushing our teeth, to making our coffee, to driving the car; these complex sequences of activity and thought have become automatic. Chunking and habit forming occurs so naturally, we rarely notice that it is going on.

As Duhigg writes, “Left to its own devices, the brain will try to make almost any repeated behavior into a habit, because habits allow our minds to conserve energy. It feels good to conserve brainpower; it feels good to be lost in the routine of a habit.

We’ve devised a clever system to determine when to let a habit take over. It happens whenever a chunk of behavior starts or ends. Our brains look for cues that tell it when to turn on or off the automatic program.”

Our brains create habits in a three-step loop. First, there is a cue, a trigger that tells the brain to go into automatic mode and which habit to use. Then there is the routine, which can be physical, mental, or emotional. For the rat, it is running through the maze. For my morning commute, it’s driving the car. Finally, there is a reward, the end gain that lets your brain know that this particular automatic behavioral loop is worth remembering for the future.

This loop of cue, routine, reward; cue, routine, reward, becomes automatic, so neurologically intertwined, that a sense of craving emerges. The rat wants its chocolate as soon as the door to the maze clicks open. Most cues and rewards are so quick and so subtle that we are rarely aware of them in day-to-day life. But our brains do notice them and build neural pathways that reduce effort in every way that they can. Once a habit is established, your brain stops participating in the decision making; it’s riding on cruise control. No wonder it is so hard to change people’s habits.

It’s easy enough to make a list of lifestyle changes for patients that will make them healthier, but we should be focused on how to turn these lifestyle behaviors into habits?

Simply understanding how habits are formed helps people gain better control over their lives. Duhigg reviewed a study in which 256 participants took part in classes on the importance of exercise. Half the participants took a second class on the theories of habit formation. The study participants who took the habit class identified the cues and loops in their lives that affected their exercise and in the end spent twice as much time exercising.

If you want to start running each morning, choose a simple cue (like leaving your running clothes next to your bed) and a clear reward (like a midday treat or ritually recording your distance or times in a log book). Your brain will anticipate that reward, either the treat or the sense of accomplishment, and that’s how the habit is formed.

Habits may be deeply rooted in the mind but they aren’t destiny. People can choose their habits. They have to figure out what their cues and rewards are and then make the decision to change.

Duhigg writes in a style reminiscent of Malcolm Gladwell. Each has a way of weaving multiple stories together into a single narrative that slowly builds on an idea from a variety of angles, that creates a complex story that is pure pleasure to read, but in the end takes you to the conclusion he is hoping you will reach.

Duhigg provides a valuable resource, a body of knowledge that can help you do a better job with your patients. Having read this book, I see my job a bit differently; my task is to help my patients identify, preserve, and strengthen the positive habits in their lives and to alter their bad ones.

* Long in the habit of being a cheapskate, I held off purchasing this book until I found it in paperback