Five Crucial Steps to Reprogram Your Life

Five Crucial Steps to Reprogram Your Life

By Cathy Cassata 05/16/14

The Fix Q&A with John Norcross, author of Changeology: 5 Steps to Realizing Your Goals and Resolutions.

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Changeology - the self-help book by Psychologist John C. Norcross, PhD - is backed by the author’s 30 years of research on ways to overcome behavioral challenges and understand how they can be successfully modified. He also has more than two thousand professionally published studies that have been done on the stages of change. The book lays out, much like Elisabeth Kubler-Ross's stages of grief, how Norcoss and his colleagues have identified four distinct stages of behavior change: contemplation; preparation; action; and maintenance. Contemplation is thinking about making a change. Preparation is intending to make a change and taking small steps toward change. Action is actually modifying behavior and the environment in order to overcome problems. Maintenance is working to prevent a relapse.

Based on those stages, Norcross created five steps for change: psych (get ready/contemplation); prep (plan before leaping/preparation); perspire (take action/action); persevere (manage slips/maintenance); and persist (maintain change/maintenance). Throughout, he describes each step and provides accompanying exercises and instructions. While Norcross says you can change any voluntary behavior using the formula in this book, he addresses popular ones such as enhancing relationships, losing weight, quitting smoking, and reducing alcohol consumption. 

What made you want to write this book?

Seemingly unending requests for an update on the stages of change for the general population. My colleagues and I wrote Changing for Good in 1994, and since that time, a lot has happened in terms of research and what we’ve learned. The web also provides all kinds of possibilities, and you don’t even have to buy the book to use our webpage. Go to ChangeologyBook.com and click on the exercises. We have a dozen self-help activities and six assessments all for free.

The introduction states that this book is different from other self-help books because it’s based on science. Can you explain the science?

The self-help market is unregulated. Anybody can publish a book, launch a website, and offer workshops. Many people are astonished to discover that there is no regulation of self-help. It’s all protected by free speech. So if someone  wants to create something out of the air, they can do so. The more outrageous a book title and the simpler its recommendations, the better the sales because miracles sell even without a scintilla of evidence.  

For instance, with addictions, we’ve gone through aversive treatments that were going to be the miracles. Hypnosis was going to be the miracle. Then it was going to be ultrarapid detox. We go through fads and fashions, many of them propagated and advertised without research as to their effectiveness or safety. By contrast, for three decades, colleagues and I have been researching what actually works. We don’t put things in the book that don’t have scientific standing.

You state that you used to think that modifying a drinking or smoking habit was different than treating relationship dysfunctions, but now you’ve changed your view on this. Why?

The first large research grants were done with smoking and alcohol abuse, so for years, this is what we researched. I used to think that how people changed those problems was significantly different than how people changed depression, relationships, and the like. What you are changing, of course, is quite different, but the steps of change and what you need to do to get there are incredibly similar. 

You state that “following the scientific program outlined in the book can dramatically increase your chance of success without drugs or other types of formal treatment.” Is this possible for people struggling with substance and drug addiction?

We have two sections in Changeology where we specifically explain the contraindications for self-help alone. Changeology can be used with or without professional treatment, with 12 step and without 12 step. For severe disorders that compromise one’s reality testing and ability to execute change, we encourage people to not rely only on self-change.  

Would this include conditions like schizophrenia, bipolar disorder, and other conditions of that nature?

Yes. The caveat here is do not rely alone on professional treatment. There is good research that shows people who read about their disorders, attend self-help groups, and make changes in concert with treatment profit more. The book is no substitute for professional treatment alone. By the way, that’s a another feature of research-supported self-help - instead of promising that something is effective for all disorders or all people, good self-help materials will specify the contraindications, what will not work.

Who else shouldn’t read this book?

This is a self-change program. By all means, read it if you want to understand how people change, but this is not a book to change others. We are strong advocates of self-change, but as a practicing clinical psychologist, I certainly know there are times when people should be securing treatment.

What about people with an underlying mental health issue that is affecting the need for change? For instance, if someone turns to alcohol to deal with memories of being abused as a child, can simply following the steps to change his alcoholic tendencies be enough or does he need to undergo therapy to come to terms with the abuse?

That’s a great question that psychologists have been studying for years. Do you treat the underlying problem or is the presenting problem a problem itself? The answer is yes, both. For some people, one needs to go deeper and to tackle the underlying cause, in which case the depression or addiction is a symptom of an untreated problem. For other people, treating it as a problem behavior works. In fact, trying to decipher what each person needs is what stepped care is all about. Most psychologists try to start with the least intrusive option. Some people do well with a self-help program, others benefit from group therapy, still others need AA, some require medication, or detox.

I was surprised to learn that 90% of people who stop smoking and 90% who gain control of problem drinking do so without formal treatment.

We’re talking about problem drinking, not hard core alcoholism. There’s a huge debate in our field on this topic. Research is pretty clear that there are some people who get into problem drinking and can stop on their own. For all addictive behaviors, like shopping, pornography, and smoking, the vast majority of people change on their own, without professional treatment. The research is on that is quite compelling.

Do they use self-help techniques to make the change?

It’s a combination. When we ask people what they use to change behavior, their answers are all over the map. They might get the advice from others, from a support group, maybe they saw something on Oprah, or picked up a self-help book, or just decided one day to stop.

Does someone need to be in the contemplation stage to get anything out of Changeology?

You can start in contemplation, and most people are in contemplation. In fact, in our studies, people stay there for years. For example, think of 10 people you know who smoke. At this point, how many of the 10 are actively trying to stop? Cutting down? Taking nicotine replacement? The answer is nearly always 1 or 2. Others will say “I’m not ready,” “I don’t know how,” or “I failed in the past.” Anybody in contemplation, preparation, action or maintenance can certainly profit from the book.

Can you explain how a person who needs to cut back on alcohol, might tackle the five steps? 

In contemplation, they become aware they have a problem, but they’re not ready to change it. Then, maybe an incident occurs like a DUI, elevated liver enzymes, or behavioral indiscretion, and they say “I need to start taking small steps to do something.” That leads to preparation and action with starting 12 step, cutting back, thinking of rehab, starting therapy, or reading self-help books. When they achieve short-term sobriety, they know it’s not long-term maintenance. So at that point, the book takes over and shows people how to persevere through the early slips; it’s quite a new science. Then it’s not only avoiding slips, but taking it to the long run whether that’s a lifetime of recovery or potentially termination.

You discuss some “myths to change,” and I was particularly struck by your explanation for debunking “it’s all in my genes.” Can you address this to someone who is struggling with addiction?

It’s a subtle distinction between a genetic predisposition and a genetic disease. We know that, if you have a first degree relative with a drinking problem, you’re more likely to develop an addiction, but the overall probability of developing an addictive disorder yourself is below 50%. An increased chance doesn’t translate into a guarantee that you’ll have a disorder. Many people are wandering around feeling they are doomed by their genes. It doesn’t work that way. You inherit a predisposition to the disorder, which is real and people need to know about that. But you don’t inherit a lifetime of it, and you don’t get it automatically. 

What about drug use?

The stages of change apply there as well. What you change is different and the urges for some are going to be far more intense. However, how you can deal with those urges, as anyone who has been to an AA meeting will attest, is pretty much the same. The section in Changeology dealing with urges and maintenance has been the most frequently reprinted and requested part of the book.

Why’s that?

Because most people don’t know about those skills. Most are good about getting motivated in the beginning, and that’s what most self-help books help them with, but most people and programs aren’t aware of the particular skills. Early on in change, it’s about encouragement and motivation. As we proceed into change, it’s more about using skills to maintain. 

Why is the maintenance stage a life-long process for some people, particularly those with addiction?

Maintenance does last more than 90 days. There are those disorders and those personalities for whom this is a life-long battle. Addiction leads the list for lifelong recovery. But not all addictions and all people are destined to a lifetime of recovery. There are those people who get up and get out. 

In your studies, 58 to 71 percent of  people slip at least once in the first 30 days of the Perspire/Action step, with the average number of slips being six. However, you state that the number of slips doesn’t predict whether nor not a person will eventually reach his or her goal.

It immediately points to the value of slip busters. You can’t just sit back and think people aren’t going to slip. That’s just magical thinking. In the addictions, this point is frequently misunderstood. Most people will slip and we should honestly tell people about it, so when they do slip they know how to get out of it. We’re preparing people realistically. 

You talk about how you want to be careful of a slip not turning into a relapse.

And there are ways to do that by having your slip card [which you can create on ChangeologyBook.com]. As soon as you slip, out of your wallet or purse comes the slip card stating what to do: call my sponsor; get busy; admit it; remind myself of the 99% of the times I didn’t slip; identify the high risk triggers; get out of the situation; and so on. All of the things we know work. 

Can your list of 10 Proven Ways to Resist the Urge apply to any urge?

You bet. Now, that’s an individual matter. This is a menu of 10 possibilities. Which one will  work with you is a matter of experience. For example, I have learned that getting out of the situation works for me with desserts. Looking at them and then pretending somehow I have the will power doesn’t work, but if I don’t look at a dessert menu or keep it out of our house, that proves quite effective. We encourage people to practice the 10 ideas and see which ones work for them.

You state that persistence and self-efficacy are big factors for maintaining change. Can you explain this?

Self-efficacy is confidence that you can resist. We know that that’s a great predictor of success. In our study on New Year’s resolutions, we found that the best single question we could ask someone is not if they’re motivated - motivation does not predict. Instead, if we ask, “what’s the realistic confidence that you can conquer this behavior?” That’s the single best predictor of who will succeed. This is so important when it comes to long-term maintenance. If you see a lapse as a common slip because we’re all human rather than evidence of your failure, you still feel you’re going to make it in the end.

Why is it necessary to follow the program for 90 days?

Because both behavioral and brain research suggest that’s about how long it takes to go from thinking about a problem to having enough self-efficacy for long-term maintenance. Some self-help programs will try to tell you that it’s a couple of weeks, but that’s not true. Not surprisingly, 90 meetings in 90 days fits the Changeology advice.

In the section on perspiring, you mention Thomas Edison’s quote, “Genius is one percent inspiration, 99 percent perspiration.” And you follow it with “Achieving your goals will require work and commitment, but following the steps of Changeology will markedly decrease the amount you sweat and enable you to work smarter rather than harder.” Seems like that is a great summary of the book.

Definitely. That’s what we call step matching. Our research focus has been about telling people what works best at each step. It’s not just figuring out which step you’re in, which can be interesting, but the take home message is: Now that you know where you are in the cycle of change, here’s how you can work more effectively.

Is there anything else you’d like to add?

Addicts understandably become frustrated and resigned by going through sobriety and relapse many times. In fact, the average number of attempted times for a change to be successful is between three to five. You CAN learn what you need to do differently next time. Don’t simply do the same failed thing again and again. Harness the science of change and get it right.

Cathy Cassata is a regular contributor to The Fix. She last wrote about video game addiction and how to tell if your doctor is an addict.