Welcome to Issue 353 of Institute Inbrief
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Issue 353 // Institute Inbrief
Dear <<First Name>>,

Welcome to Edition 353 of Institute Inbrief. This edition's featured article offers practical actions/advice that can help your clients improve their habits (by creating good habits and eliminating harmful/unproductive ones).

Also in this edition:
  1. Pandemic Telehealth: What Have We Learned?
  2. Revisiting Subpersonalities for Internal Conflict
  3. Suicide: Warning Signs and Prevention Tips
  4. Quotations, Seminar Timetables & More!

Enjoy your reading!



Sandra Poletto
CEO, Australian Institute of Professional Counsellors.
 
Diploma of Counselling
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Our Diploma of Counselling is a journey of self-discovery, providing deep insight into why you think and behave as you do. And when you graduate, you will be extremely well prepared to pursue a career in counselling – employed or self-employed – enjoying our strong industry reputation and linkage.

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Pandemic Telehealth: What Have We Learned?
Lessons from 12+ months of the pandemic.

Last year, safety precautions and restrictions brought on by the COVID-19 pandemic caused most counsellors’ in-person interactions with clients, colleagues and students to come to an abrupt halt. To continue treating clients, many clinicians shifted to conducting counselling sessions through video or other digital media. For some practitioners (and clients too), it was a “like it or not” change with a steep learning curve, especially if they had not been offering any telebehavioural health services prior to the pandemic. Now, some counsellors are beginning a return to in-person sessions or a blend of in-office and virtual sessions. What did practitioners learn - about themselves and the process of counselling - while using and adapting to telebehavioural health?  

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Strategies for Creating (or Destroying) Habits

“The chains of habits are too weak to be felt until they are too strong to be broken” (Samuel Johnson, in Oppong, 2018)

In a previous article (click here to read it), we defined habits, looked at how they are formed (through the lens of Duhigg’s and Clear’s models), and then outlined the science behind them. According to James Clear’s Four Laws of Behaviour Change (2018), there are four steps to establishing a habit: cue, craving, routine, reward (Clear, 2018). This article is about how we turn the above steps into practical actions/advice that can help clients not only alter the way they do things, but also make the changes stick.

Clear’s model offers a simple set of rules for creating good habits and breaking bad ones. Changing behaviour, in any field of endeavour or any challenge, begins with asking oneself four questions, each of which pertains to one of the laws. Each law, in turn, pertains to a stage in the habit loop model:
  1. How can I make it obvious? (Cue)
  2. How can I make it attractive? (Craving)
  3. How can I make it easy? (Response)
  4. How can I make it satisfying? (Reward)

We also note how, by inverting the laws for making a habit, we have the four laws for breaking one: that is, making cues invisible, unattractive, difficult, and unsatisfying (Clear, 2018).

First Law: Make it obvious (cue)

Given that 40 to 50% of what we do is automated by habit (Flynn, 2019; Clear, 2018), we probably all underestimate just how much our brains and bodies do without us consciously telling them to. For instance, we know when we are hungry or sleepy and should enact a habit of eating or sleeping. We don’t need to be consciously aware of a cue for a habit to begin. That our system can enact a habit loop without us actually paying attention to the cue(s) that started it makes habits extremely convenient.

Gain awareness of your habits

It also makes them extremely dangerous. For example, take the American – who has to drive on the right side of the road – going on a road trip through the U.K., New Zealand, or Australia, where people drive on the left. At first, his pre-frontal cortex helps him think through the new circumstance, and he pays attention, but at some point he begins to relax and – with his basal ganglia having automated the new behaviour a bit – he finds himself driving on the right again: probably just as a huge truck rounds the bend and comes straight at him! Hopefully he makes it in time back to the proper (left) side of the road, and – pulse racing – resumes aware, rather than habit-driven driving. The latter is dangerous because his stronger habit is to drive on the right.So here’s a suggestion for helping a client change a habit: How many habits can you (or your client) name? Have the client list them all out onto what Clear calls a “Habits Scorecard”. For each habit, decide whether it’s a good habit (which earns a “+” next to it), a neutral habit (which gets an “=” sign), or it’s a bad habit (which attracts a “-“). Changing habits begins with noticing what we are actually doing (Clear, 2018).

Do habit-stacking

Research (Milne, Orbell, & Sheeran, 2002) has shown that when we form an “implementation intention” – a plan and commitment to changing our behaviour/habit in a particular time and place on a particular day – we are much more successful at making the change. The formula for it goes something like: “I will (behaviour) at (time) in (location).” The specific time/location makes the cue more obvious.

Moreover, you can advise your clients to do a variant of this through the strategy known as habit-stacking, in which we “stack” a new habit on top of a habit that is already in place. Rather than pairing the new habit with a particular time and location as with an implementation intention, it is paired with a current habit. Thus, the current habit functions as a cue to perform the new habit – and the client can keep stacking. An example of a habit-stacking chain could be: “After finishing my morning shower post-jog, I will do mindfulness exercises for five minutes each day.” Once the mindfulness becomes habitual, the person could “stack” a good work habit on top, by using completion of the mindfulness as the cue to, say, review the day’s work tasks and prioritise their sequence.

Utilise the environment

We can help ourselves “buy in” to desired habits by making the cues stand out. The cues that trigger a habit may initially be very specific, but over time our habits become associated not just with a single trigger, but with the whole context surrounding the behaviour. This means that we can profitably turn environment to our favour by training ourselves to link a particular habit to a particular context. Hence, sleep experts tell those with a sleep disorder that, for sleep hygiene, they must do nothing but sleep in bed. When the only activity associated with bed is sleeping, people begin to feel sleepy as they climb into bed; the behaviour of sleeping is linked with the cue triggered by the environment of the bed (Mental Health Academy, n.d.). 

And we can use the inverse to break a bad habit. Habits can be easier to change in a new environment, because we can escape the subtle cues that move us along toward a current habit; hence, the serious proposal to go on holiday if one desires to change a habit. In a new environment, we are not competing with old cues, and it is easier to associate a new habit with a new context (Duhigg, 2012). 

Eliminate ‘cue-induced wanting’ to break a habit

Given the above, what is the role of self-control in breaking a bad habit? Think of those you know with seemingly great self-control (self-regulation); perhaps they’re never seen drunk, overeating, or with a messy house. Neuroscience now suggests that, rather than mastering themselves, they may have mastered the environment, such that – rather than making cues for good habits obvious – they have rendered cues to bad habits invisible. In other words, rather than imposing harsh self-control to resist temptation, they have changed the environment so that temptation can be avoided. This could mean hiding the chips and lollies for those who wish to eat in a healthier way, or literally putting the electronic devices away in a drawer when “viewing” time is up. Note, though, that the new habits “cover over” the brain wiring for old, bad ones, but the latter don’t actually “die”; they are still in the hardwiring of the brain in “sleep mode”, and can re-trigger the person if their behaviour changes (i.e., they stop hiding the lollies in the highest shelf of the pantry) (Clear, 2018). 

Second Law: Make it attractive (craving) 

In addition to making cues for desired new habits obvious, we can strengthen the tendency to implant them by making the cues attractive, so that we desire them more.

Supernormal stimuli and temptation bundling: Work these to your advantage

We’ve been referring to the stimulus in psychology as the cue by which someone may start a habit loop that ends in a reward. Now we look at how to make a habit attractive so that it “sticks”, and in this context we discuss the notion of a supernormal stimulus, defined as an exaggerated, more intense version of a natural stimulus which elicits a stronger behavioural response than the natural stimulus would have (APA Dictionary of Psychology, 2018). For examples, look to the beautiful, glistening bodies of models on the covers of fitness or beauty magazines, or the brightly coloured, beautiful packaging on children’s vitamins. The supernormal stimuli here make us want to buy the magazine in order to look like the model, or they elicit in children the desire to eat whatever is in such an attractive bottle. By way of contrast, note how the broccoli or onions in the fresh food part of the grocery store are always the same: no exaggerated versions here – and how much do you crave broccoli on a normal day? The food industry spends multiple millions every year trying to get just the right sensation in your mouth of that cookie you love, or the right sense of texture on the pizza you order, with attention to contrasts between creamy and crunchy, gooey and smooth, and so on (Clear, 2018; Duhigg, 2012). We are thus enhanced to keep eating!

Moreover, we get that pre-historically wired dopamine hit (mentioned above) just by seeing – and coming to crave – such pleasurable stimuli. What that means for survival becomes clear; if we get a rewarding, habit-forming, sense of pleasure just as much thinking about eating those foods (say, pizza or cookies) as actually eating them, we will crave them and be motivated to work towards acquiring them – possibly surviving when we otherwise would not. 

Making habits attractive through temptation bundling

So how can we make the new, desired habit attractive? Given that supernormal stimuli exist, and they elicit a strong, dopamine-permeated, habit-forming response, we are likely to have such a response as much in anticipation of a reward as when receiving the reward. We know, then, that we can motivate ourselves to earn the reward by figuring out how to get the dopamine spike in anticipation. We learned that when our brains repeatedly register behaviours together in a chain, the brain forms a habit for that chain of behaviours, viewing it as a single (chunked) event/behaviour, and we also found that, when a behaviour occurs repeatedly in conjunction with another behaviour, the other behaviour functions as a cue for the first one. 

The fortunate conclusion is that, if we can put a new behaviour we are trying to make habitual (that is, something we need to do) together in a chain or bundle with something that we are already doing (something that we like doing) the desired habit behaviour, now associated with something positive, will itself become more attractive (Clear, 2018). As an example, one man had a lot of continuing education material to read on the computer for his profession, and he felt bored by it. He habitually went out for a coffee, though, and soon began insisting to himself that he would not allow himself to order the coffee until, computer at the cafe table, he was logged on and reading the procrastinated documents. He could absorb the coffee and the ambiance as he got through the less agreeable chore of professional reading. The continuing education was soon a reasonably pleasant habit, bundled as it was with the coffee outing.

Here is the habit-stacking and temptation-bundling formula for your clients:
  1. After (current habit), I will (habit I need).
  2. After (habit I need), I will (habit I want).

Use social contagion and the herd instinct to make a habit more attractive

As human beings, we have an ingrained herd instinct. In fact, negotiating inclusion with the “herd” or “tribe” – in the first instance, our family – is a strong survival instinct (Myss, 1997). Positive psychology experts have developed this notion, completing studies showing the incredible power of social contagion to shape our behaviours even when we aren’t aware of the influence and don’t personally know the influencer (Langley, 2017). 

Because the people and groups around us affect us so much – we may use notions of social contagion to strike up and maintain good habits. What is needed is to expose ourselves to the people who are habitually employing the actions we wish to make into a habit. We imitate the habits of three types of groups in particular:
  1. The close: meaning those proximate to us, such as partners, colleagues, and friends.
  2. The many: meaning, the general social milieu in which we find ourselves.
  3. The powerful, meaning those who have power, privilege, status, or are “influencers.” 

And the inverse: making a bad habit unattractive

The way the Second Law works to get rid of a bad habit is to make it unattractive. Social marketing campaigns through the years have sometimes done this quite pointedly. We are reminded of the pictures that cigarette sellers were forced to put on their packages showing smokers the effects of smoking. Does your client have a food intolerance and wish to give up eating a food that they crave (such as gluten or dairy)? Help them by getting a linkage going between aspects of ingesting the food and the stomach ache they will later feel. 

In some cases, it may only be a matter of re-programming our brains to understand things in a new way by re-framing. Every craving has a deeper, underlying motive: probably related to survival if we go deep enough. Thus, most habits are a modern solution to an old problem. They are associations in which we receive a cue (let’s say, the aroma of freshly-baked bread) and determine, based on past experience (say, eating and enjoying hot bread) whether we predict that the habit is worth repeating or not. Once we realise the link we have made between the cue and the habit, we can make a different prediction (in the case of gluten intolerance: “You won’t be happy and full; you will be sick”) and re-program, finding a different solution/reward to the problem (i.e., a gluten-free bread or another type of food entirely). 

Thus, satisfying a craving is an attempt to address a basic underlying motive. When the habit successfully addresses the motive, we develop the craving to do it again. To be successful in changing a habit, then, we must find a new solution for an existing (probably ancient) need. The new solution, to be effective in changing the habit, must make the old habit unattractive but still meet the need that the old habit was trying to meet (Clear, 2018).

Third Law: Make it easy (response) 

With the First and Second Law we saw the problem half of Clear’s habit formation cycle in the injunction to make the cue obvious and the craving attractive. With this law we come to the solution half of the cycle: response, which is followed in the Fourth Law by reward. Here we understand the factors that help us to make it easy to formulate a response solution that will develop or maintain a good habit. 

How long for a new habit? Looking at long-term potentiation

People ask, “How long does it take to form a new habit?” The answer is another question: “How long will it take you to repeat this behaviour so much that the structure of your brain changes to become efficient at the activity?” When the forming of a habit is tracked, behaviour is seen to change and habits form as a function of frequency, not time (Clear, 2018; Calbet, 2018). Thus, the easier we make the action we are trying to make habitual, the greater the chance that we will perform it with frequency and the sooner, therefore, that we can turn it into a habit. Here are some strategies for making it easier.

Reduce friction for new good habits; increase friction in to-be-eliminated habits

Recall that the brain is rather lazy. It likes things easy, so it tends (we tend) to adopt those habits which reduce a bit of friction in our lives. Examples here include: joining the gym that is closer to work or home to reduce the hassle of just getting there or getting the grocery store to deliver the groceries after you shop and pay for them online. We can likewise increase friction by putting the chocolate we are trying to give up WAY out of reach (ditto the console for the video games). The basic idea is to set up the environment where doing “the right thing” (whatever habit we are trying to inculcate) is as easy as possible and doing the “wrong thing” is more difficult.

One percent better, the Two Minute Rule, and habit-shaping

We can make it easier on ourselves to do the hard part of getting started on a habit by initially making it small enough that we can be unfailingly consistent from the very beginning. No one really feels motivated by a goal to, say, floss just one tooth, or do just one push-up each night, but once consistency (read: frequency) is gained, the habit-maker can add length of time spent in the activity (Fogg, in Oppong, 2018).
 
Similarly, James Clear (2018) advocates following the Two Minute Rule, in which he notes that if you want to, say, run a marathon, it is a worthy but very difficult goal. Running a 5-kilometre run is still hard. Walking 10,000 steps is moderate in difficulty. Walking 10 minutes is easy. And putting on your jogging shoes? Ah, that, says Clear, is very easy. You can do it in two minutes. It can be the start of the eventual completion of the marathon. Putting on your shoes is a “gateway habit”: one which leads as a small action to a bigger piece of action. The small action begins to shape your behaviour. That is, you expect to put your jogging shoes on each day. Clear notes that, what happens after the two minute “gateway” behaviour may be challenging (e.g., doing a whole run today), but the first two minutes should be easy, so that you can “buy in” fairly small, and start wiring together the neurons that lace up your jogging shoes with the ones that see you step out onto the jogging track (Clear, 2018). 

By doing something for just two minutes, you are establishing a habit that can later be improved. In terms of neuroscience, you are then free to shape the habit, retraining your neurons to expect the daily jog, journalling session, tooth-flossing, or whatever. Eventually, you are able to recognise the initial two-minute habit as a ritualised routine that is part of a larger, successfully installed, habit. And even small behaviour change achievements increase self-efficacy, which stimulates pursuit of further changes, so forming one ‘small’ healthy habit may increase self-confidence for working toward other or larger health-promoting habits (Gardner et al, 2012).

The Third Law inverted: making it hard to do the wrong thing

You can also consider how you might make the “bad” habit harder to do. We’ve noted the possibility of hiding away undesirable items (e.g., food, technology toys, etc.). How can you extend this idea to other realms of life? For instance, if you want to save money for retirement, have the designated amount deducted from your pay check before you ever see it. Want to lose weight? Buy smaller plates, so that they are full with less on them. Actions like asking Payroll to automatically deduct the savings or buying small plates are one-off actions that pay habit “dividends” over and over again because they “automate” the routine, making it difficult to continue the “bad” habit (Clear, 2018).

Fourth Law: Make it satisfying (reward)

To understand this last law, let’s go back to the basics of behaviourism. Behaviour that is reinforced – rewarded – is likely to be repeated, and behavioural responses that are not rewarding in some way drop off over time. Moreover, behaviour tends to be governed by what happens right after it, rather than later on (e.g., the cake tastes great now, but remorse for the failed diet comes later). Caving into immediate rewards is a hangover from cavemen days, when people lived in an immediate-return environment. That is, the outcome of the hunt provided the day’s dinner – or it didn’t. Fast forward to the opposite in modern life: a delayed-return environment. We work assiduously for several weeks for a single pay cheque. We save for years for our own home. We work out hard for months in the gym to attain a future vision of a lean body. Yet we are still wired in the same way as our ancestors! 

And there is more. The immediate results of behaviour are often just the opposite of the long-term results. We have fun staying up late watching videos now, but eventually get sleep disorder. We splurge on the designer shoes now and don’t meet our savings deadline for the summer holiday. As French economist Frederic Bastiat observed, “The sweeter the first fruit of a habit, the bitterer are its later fruits” (Oklahoma Council of Public Affairs (OCPA), 2010). So the question at the Fourth Law of Behaviour Change is this: being aware of the brain’s tendency to prioritise the present moment, how can we make new habits satisfying, knowing that behaviour that is immediately rewarded is repeated, but behaviour that is immediately punished is avoided? 
The answer is to turn immediate gratification to our advantage. Here are some techniques for how to do that.

Find a way to feel successful right away

Let’s say you’re saving for a new car. You walk by that camera you have been coveting and don’t buy it; maybe it cost $700. Now you have $700 that you can put toward the car. Transfer it right away to the “new car savings account” to feel successful immediately by making the reward visible, and thus more satisfying. 

You can also create identity-based habits.

Change your identity, not your desired outcome

Let’s say a woman goes to the gym to become lean and fit. In essence, she is saying that she would like to have a new identity: one as a fit, slender person. The gym workout is aligned with the long-term goal to become that person. But let’s say she comes home from the workout and gorges on chips. Brain wiring being what it is, she succumbs to the temptation to have an instant reward: the chips after the workout. Chips would not necessarily be a poor reward for all behaviours, but in this case, they run counter to her new desired identity: that of a fit, slender person. How successful can it be, long-term, to install a habit where part of the habit loop has an identity conflict with the other part?
Many people start with the outcome they want to achieve, figure out what processes they need, and hope to thereby arrive at a new identity. Figure 4 shows the sequence for outcome-based habits.

Figure 4: Outcome-based habits
 


The problem is that many will never arrive at that layer of identity (the layer closest to the self), so Clear (2018) advises starting with identity. Achieving identity-based habits starts in the opposite direction: with a focus on who we wish to become, followed by the seeking of processes to assist that, and ending with an outcome which has a chance to “stick”. It looks like Figure 5.

Figure 5: Identity-based habits
 


Habit expert Nir Eyal observes that we can think of this shift as “don’t” versus “can’t”. Aligning with a certain identify (i.e., “I don’t drink) makes it easier to stay on track than relying on willpower (i.e., “I can’t drink alcohol; I’m trying to give it up”). Our choices become what we do because of who we are.

Keep habits on track by tracking them

While a good habit is quietly becoming “installed” in our brain’s hardware, we can rely on extrinsic rewards to make it satisfying and obvious. One way to do that is by tracking or measuring the days on which we have performed the new habit. Do you suffer from a sleep disorder and you’re seriously trying to get to bed earlier? After affirming your new identity as a good sleeper, start marking on the calendar every day that you manage to get lights out by 10:00, or whatever your sleep start goal is. (New technology can help tremendously here. Some tracking devices, with all that they can measure, track progress for you as you gradually improve your sleep hygiene and capacity to sleep early, sufficiently, and well.)

Find an accountability partner, sign a habit contract

As we invert the Fourth Law of Behaviour Change – make it satisfying – we get the injunction to make unwanted behaviours unsatisfying. Note that, given our mental wiring to prioritise immediate effects of an action over later ones, we should make the behaviour immediately unsatisfying. Remembering that we repeat bad habits because they serve us in some way, we can ask how we make them unsatisfying.

Want to be well thought of and approved by many, if not most, who know you? Then you will be loath to go back on a habit contract you made to an accountability partner. It is a promise you made – even if you made it about actions that you will take (such as exercising every day) which affect only you. The bottom line is that, if someone is watching, you don’t want to be seen as a person who is not reliable and does not keep their promises (even to themselves), so you are more likely to put up with the pain of the newly-forming habit (e.g., the effort and sweat of exercise, the food restrictions of a diet) than if you were left to your own devices. 

An accountability partner could be an intimate partner, a friend, a mentor, a fellow exerciser, or just about anybody. The critical factor is that the person does, indeed, hold you accountable. Perhaps you promise to donate X dollars to their favourite charity if you light up after deciding to quit. Maybe you agree to clean the person’s toilets or wash their car if you abandon your new good intentions more than twice in a fortnight. There are endless variations here; they just need to make it instantly painful for you to not go ahead with your chosen habit.

The bottom line on applying the Fourth Law is that we need to make (or help clients make) good habits as satisfying and rewarding as possible, while rendering the old, bad habits unrewarding.

Concluding statement

“We first make our habits; then our habits make us” (Dryden, 2017).

These four laws, quite simple and well-articulated, form an excellent framework for looking at habit formation and elimination in general. Ultimately, the joy of neuroscience for counselling may be that it deepens our appreciation of the complex, superbly-designed organ we call the brain, and through that, the package of thoughts, emotions, and behaviours we call human functioning. 

As mental health helpers, we don’t just want to reduce our clients’ symptoms; we want clients to positively thrive. To that end, what began as a seemingly superficial enquiry into mere habit formation has delivered us to the most basic level of existence – our cells – and simultaneously to our highest level of our existence: that of ever-growing beings attempting self-transformation. We literally try to “get it together” as our neurons re-learn through habit formation how to fire and wire in harmony with each other (or apart, in the case of bad habits). The endgame is that all of us – especially including our clients – experience the sense of integration, unity, and wellbeing that affirms our assiduous efforts and opens wide the doors to a kinder, more joyful, more compassionate existence: for ourselves and all who enter our life sphere.

References:
  1. APA Dictionary of Psychology. (2018). Supernormal stimulus. American Psychological Association. Retrieved on 21 December, 2018, from: Website.
  2. Calbet, J. (2018). Hebb’s Rule with an analogy. Psychology and neuroscience. Neuroquotient. Retrieved on 16 December, 2019, from: Website.
  3. Clear, J. (2018). Atomic habits: An easy and proven way to build good habits and break bad ones. London, United Kingdom: Random House Business Books. 
    Dryden, J. (2017). 17 motivational quotes to inspire successful habits. Success.com. Retrieved on 20 December, 2019, from: Website.
  4. Duhigg, C. (2012). The power of habit: Why we do what we do in life and business. New York: Random House Trade Paperbacks.
  5. Eyal, N. (2015). Can’t kick a bad habit? You’re probably doing it wrong. Psychology Today. Retrieved on 17 December, 2019, from: Website.
  6. Flynn, B. (2019). The neuroscience behind habit change. Key Step Media. Retrieved on 11 December, 2019, from: Website.
  7. Gardner, B., Lally, P., & Wardle, J. (2012). Making health habitual: The psychology of ‘habit formation’ and general practice. British Journal of General Practice. Retrieved on 17 December, 2019, from: Website (PMID: 23211256)
  8. Langley, S. (2017). Lecture for Masterclass day on positive psychology topics for Mental Health Academy. Langley Group: Australia.
  9. Mental Health Academy (MHA). (n.d.). Educating clients about physical wellness (continuing education course). Fortitude Valley, Queensland, Australia: MHA.
  10. Milne, S., Orbell, S., & Sheeran, P. (2002). Combining motivational and volitional interventions to promote exercise participation: Protection Motivation Theory and implementation intentions. British Journal of Health Psychology, 7 May, 2002: 163-164.
  11. Myss, C. (1997). Anatomy of the spirit: The seven stages of power and healing. Moorebank, New South Wales, Australia: Transworld Publishers, Ltd./Bantam Books.
  12. Oklahoma Council of Public Affairs (OCPA). (2010). What is seen and what is not seen. ocpathink.org. Retrieved on 17 December, 2019, from: Website.
  13. Oppong, T. (2018). The neuroscience of change: How to train your brain to create better habits. The Startup; Medium.com. Retrieved on 4 December, 2019.