▪ While you wait, discuss the following with your neighbor:

1. Have you ever set a goal outside of your personal or academic/professional comfort zone?

2. What sort of effort did you have to exert to work toward your goal?

3. What sort of psychological and social challenges (if any) did you have in reaching your goal?

4. What habits did you have to form (or break) in order to achieve your goal?

5. What roadblocks (if any) did you face in sticking to your habits to reach your goal?

6. Ultimately, did you fail or succeed? In either instance, what did you learn about yourself?

HEALTH COACHING, SETTING GOALS, AND ESTABLISHING HABITS

SARAH TOROK-GERARD, PH.D., CHC

WHAT IS HEALTH COACHING?

Behavioral Science

Exercise Science

Nutritional Science

Facilitative NOT Prescriptive

WHY IS HEALTH COACHING NEEDED?

President’s Council on Fitness, Sports & Nutrition

(http://www.fitness.gov/resource-center/facts-and-statistics/)

Obesity-related illness, including chronic disease,

disability, and death, is estimated to carry an annual

cost of $190.2 billion

Projections estimate that by

2018, obesity will cost the U.S. 21 percent of our

total healthcare costs - $344

billion annually

More than one-third (34.9% or 78.6 million) of U.S. adults are

obese

CDC: Ogden et al., 2015 (https://www.cdc.gov/nchs/data/databriefs/db219.pdf)

BEHAVIORAL MODEL OF TREATMENT FOR OBESITY (THORPE & OLSON, 1997)

Common treatment components

Self-monitoring

Stimulus control

Modification of eating behavior

Modest calorie

restriction

Self-reinforcement

Exercise Cognitive

restructuring

GOAL SETTING… IT’S NOT THAT SIMPLE…

TRANSTHEORETICAL MODEL OF BEHAVIORAL CHANGE (TTM; PROCHASKA & DICLEMENTE, 1984)

For each stage of change, different intervention strategies are most effective at moving the person to the next stage of change and subsequently through the model to maintenance, the ideal stage of behavior.

Do you have a particular goal you would like to achieve?

What habits would you need to form to achieve it?

What stage are you at in the TTM when considering this goal?

SOMETIMES WE “FAIL” IN PURSUING OUR GOAL OR MAINTAINING HABITS…

Lapses Short term/”fall of the wagon” from

“good” habits

Temporary loss of control; Self-efficacy

still in tact

Easier to come back from

Relapses More long-

term/sustained departure from “good” habits

Loss of control = Loss of self-efficacy +

Locus of control that is global and stable

Harder to come back from

Have you ever lapsed or relapsed? What did you do to successfully return to your goal and

resume your habits?

GOAL SETTING IS IMPORTANT…

Goals benefit the goal-setter because they

Motivate change during the entire

process

Provide clarity that aids the client in

directing action on a daily basis

Help reduce relapse and enhance

program adherence

Help people overcome obstacles they will face during

change process

S.M.A.R.T. GOALS (DORAN, 1981)

Specific

• Goal should be clear, easy to understand

• Sub-goals = Easier to manage

Measurable

• Track progress

• Measurable goal = Quantified outcome

Attainable

• Goal should be realistic for timeframe set

• Decide the level of difficulty at the start

• Goal too extreme OR too easy ≠ Motivating

Relevant

• Goals should be important to where you are in life right now

• Goals forced upon you ≠ Motivating

Time-Sensitive

• Include a realistic end-date

• Deadlines = Motivating

MY OWN S.M.AR.T. GOAL

S.M.A.R.T. GOALS

▪ Think about a goal. It could be something you have already achieved, are currently achieving, or want to achieve in the future.

▪ How would/did/will you turn YOUR goal into a S.M.A.R.T. goal?

IT SEEMS SIMPLE ENOUGH…

▪ S.M.A.R.T. goals allow us to envision our goal in a manageable way, but many factors can interfere with committing to them in the long run…

▪ How we address those factors will either facilitate or hinder our eventual success!

PSYCHOLOGICAL & SOCIAL FACTORS THAT IMPACT GOAL ADHERENCE

GOAL ADHERENCE: SELF-EFFICACY (BANDURA, 1977)

Sense of competence

Task choice

higher SE = more challenging task

choice

Effort

higher SE = more concentrated focus

and consistent effort at task

Persistence

higher SE = more persistence in face of task

challenges, even when repeated “failures” occur

GOAL ADHERENCE: LOCUS OF CONTROL (ROTTER, 1954; ABRAMSON, SELIGMAN, & TEASDALE, 1978)

Attributing our level of control over our successes

and failures

Internal vs. External

Stable vs. Unstable

Global vs. Specific

GOAL ADHERENCE: MOTIVATION

GOAL ADHERENCE: SELF-REGULATION (TOERING ET AL., 2009)

Heightened awareness of task-specific demands

Flexibility and creativity in planning and strategizing

Better use of metacognitive skills (e.g., planning, self-monitoring, and evaluation)

Emphasize mastery learning rather than performance-based outcomes

Ability to choose appropriate self-regulatory strategies in the face of task failure

Ability to engage in a maximal amount of effort and persistence during their learning

GOAL ADHERENCE: MOTIVATION & SELF-REGULATION DECI & RYAN’S (1985, 1996) SELF-DETERMINATION THEORY

Intrinsic Motivation

Internalization & Integration as

Intermediary Processes

Amotivation

Loss of Motivation

due to Negative

Internalizations or

Sense of Autonomy

GOAL ADHERENCE: MINDSET (DWECK, 2006) & GRIT (DUCKWORTH, PETERSON, MATTHEWS, & KELLY, 2007)

▪ Dweck (2006)

▪ Growth mindset vs. fixed mindset

▪ Praising or emphasizing “natural ability” harms: ▪ Motivation and effort

▪ Performance and performance appraisal

▪ “I’m so smart.” vs. “I put a lot of hard work into doing well and it paid off.”

▪ Duckworth et al., (2007)

▪ Grit: passion and perseverance for long-term goals ▪ Growth mindsets ARE related to grit

GOAL ADHERENCE: FAILURE

Mindsets & failure

(Dweck, 2006)

Strong message from society about how to boost people’s self-

esteem: Protect them from failure!

Growth mindset (and Grit)

• Failure = challenge; opportunity for persistence and learning

Fixed mindset

• Failure = threat; permanent; something that should be abandoned or avoided

Myelination & failure (Coyle,

2009)

Failure facilitates neurological refinement

We “fail” our way to skill acquisition

during deep practice

HABIT FORMATION…

THE NEUROPHYSIOLOGY OF HABIT (PRICE, 2017)

“OLD BRAIN”

▪ Doesn’t require too much conscious thought

▪ Inner more, primitive parts of our brain

▪ Limbic system

▪ Associated with emotional processing

▪ Basil ganglia

▪ Remembers whether a behavior creates good or bad outcome

▪ Assists in behavior automation

▪ Work to determine whether to perform behaviors again

“NEW BRAIN”

▪ Uses more conscious, rational thought

▪ Outer regions of the brain

▪ Cerebral cortex

▪ Complex cognitive processing

▪ Planning ahead

▪ Learning new behaviors

▪ Prefrontal cortex

▪ Inhibition, judgement

▪ Critical thinking

▪ Create goals/strategies for creating habits

When forming habits, if the outcome of the new behavior isn’t pleasant, the old brain can override the new brain’s plans to continue the behavior and revert back to more rewarding, bad behaviors.

Ex., Failed New Year’s Resolutions

THE NEUROPHYSIOLOGY OF HABIT (PRICE, 2017)

New Brain Old Brain

MYELINATING THE BRAIN FOR HABITS

Coyle’s (2009) Model from The Talent Code

“PRACTICE MAKES MYELIN, AND MYELIN MAKES PERFECT.” (COYLE, 2009, P. 44)

The cycle of deep practice, myelination, and skill development (Coyle, 2009)

Engage in deep practice

of a skill

Neural circuits for

skill are activated

Neural activation increases myelin

insulation

Neural insulation facilitates

automacity

Neural automaticity leads to skill improvement

HOW DO WE ENSURE OUR SUCCESS IN ADOPTING HEALTHY HABITS?

BEHAVIORAL APPROACHES TO HABIT FORMATION (FOGG, 2014)

▪ Habit

▪ Automatic behavioral response

▪ Certain situational cues

▪ Behavior performed repeatedly, consistently

▪ Tiny Habit

▪ A personal behavior

▪ Perform at least once, daily

▪ Takes short amount of time (under 10 minutes)

▪ Requires little motivation or cognitive effort

▪ Remember the old brain?

BJ Fogg, Stanford Behavior Design Research Scientist

HOW TINY HABITS CAME TO BE (FOGG, 2014)

▪ Fogg’s Insights

▪ Simplicity > Motivation

▪ Emotion impacts habits

▪ Small is better

▪ Celebrate every victory

▪ New habits should be linked with existing routines

An

cho

r M

om

en

t Existing routine or event; serves as a reminder to perform habit

New

Tin

y B

ehav

ior A simplified

version of the new habit; should be performed after the Anchor Moment

Inst

ant

Cel

ebra

tio

n

A way to create positive emotions after performing the tiny habit

Anatomy of Tiny Habits

*This is also referred to as a “habit loop” by some psychologists

CREATE YOUR OWN TINY HABIT (FOGG, 2014) ▪ On your sheet of paper, write the following statement and fill in the blanks with

your own anchor moment and tiny habit:

▪ “After I ___________ I will _____________.”

▪ Examples:

▪ “After I brush my teeth, I will floss one tooth.”

▪ “After I check my work email, I will meditate for five breaths.”

▪ “After I watch one episode of the Walking Dead, I will do 10 sit-ups.”

▪ How will you instantly celebrate the completion of your habit?

HOW TINY HABITS GROW (FOGG, 2014)

▪ tiny habit = automaticity

▪ Starting small helps

▪ sequencing leads to more complex behaviors

▪ Motivation plays a smaller role

▪ If your automatically succeeding, that will drive the habit forward

Three Types of Tiny Habits

Blade Shrub Tree

TINY HABITS (FOGG, 2014)

B- Behavior M- Motivation A- Ability to perform T- Trigger

BAD HABITS (PRICE, 2017)

▪ Must address the habit loop ▪ ID the cue, the behavior, and the reward

▪ Change the behavior to be “good” while keeping the same cue and reward

▪ Ex., Instead of eating dessert with your romantic partner after dinner, replace that shared experience with taking a romantic walk, or watching a good TV show together

▪ Cue = Your partner after dinner

▪ Behavior= Eating dessert- REPLACED by walking or otherwise interacting with your partner

▪ Reward = Emotional fulfillment/connection with partner

▪ Must address “disruptors” that interfere with adherence to new habits

▪ What excuses or environmental factors are interfering with engaging in the habit?

▪ Once ID’ed then you can create strategy to prepare for the “disruptors”

HABIT FORMATION: THE ROLE OF SOCIAL SUPPORT

• Empathy, concern, acceptance

Emotional support (Willis, 1991)

• Educational services, direct methods of assistance

Tangible support (Heaney & Israel, 2008)

• Problem solving ideas, advice, suggestions

Informational support (Krause, 1986)

• Creating a sense of belonging and feeling of comfort

Companionship support (Uchino, 2004)

FINAL CONCLUSIONS ▪ Health coaching

▪ Emerging field precipitated by rise in obesity

▪ Blends exercise science, nutritional science, and behavioral science together

▪ Facilitative, not prescriptive

▪ Goal setting ▪ Should be systematic process in order to facilitate success

▪ S.M.A.R.T. goals are the best goals

▪ Many psychological and social factors relate to goal adherence

▪ Failure doesn’t = termination of goals

▪ Habit formation ▪ Important part of goal setting

▪ Heavily impacted by our neurophysiology

▪ Tiny habits facilitate long-term success

▪ Behavioral interventions can help to override bad habits

▪ Social support comes in many forms

REFERENCES

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American Council on Exercise. (2013). ACE Health Coach Manual. The ultimate guide to wellness, fitness, and lifestyle change. San Diego: ACE

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Heaney, C.A., & Israel, B.A. (2008). Social networks and social support. In Glanz, K., Rimer, B.K., & Viswanath, K. (Eds.). Health Behavior and Health Education: Theory, Research, and Practice (4th ed.). San Francisco: Jossey-Bass.

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QUESTIONS?

Sarah Torok-Gerard, Ph.D., CHC Associate Professor of Psychology University of Mount Union torokse@mountunion.edu ACE Certified Health Coach Healthy Transitions Health Coaching, LLC STG@healthytransitionshealthcoaching.com Website: http://healthytransitionshealthcoaching.com/