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Making Health Habitual - The Psychology of Habit-Formation' and General Practice
Making Health Habitual - The Psychology of Habit-Formation' and General Practice
Making Health Habitual - The Psychology of Habit-Formation' and General Practice
MAKING HEALTH HABITUAL cues that have been associated with their 10 simple diet and activity behaviours and
The Secretary of State recently proposed performance:5,6 for example, automatically encouraging context-dependent repetition,
that the NHS: washing hands (action) after using the toilet or a no-treatment waiting list control. After
(contextual cue), or putting on a seatbelt 8 weeks, the intervention group had lost
‘... take every opportunity to prevent poor (action) after getting into the car (contextual 2 kg compared with 0.4 kg in the control
health and promote healthy living by making cue). Decades of psychological research group. At 32 weeks, completers in the
the most of healthcare professionals’ consistently show that mere repetition of intervention group had lost an average of
contact with individual patients.’ 1 a simple action in a consistent context 3.8 kg.14 Qualitative interview data indicated
leads, through associative learning, to the that automaticity had developed: behaviours
Patients trust health professionals as action being activated upon subsequent became ‘second nature’, ‘worming their
a source of advice on ‘lifestyle’ (that is, exposure to those contextual cues (that is, way into your brain’ so that participants
behaviour) change, and brief opportunistic habitually).7–9 Once initiation of the action is ‘felt quite strange’ if they did not do
advice can be effective.2 However, many ‘transferred’ to external cues, dependence them.10 Actions that were initially difficult
health professionals shy away from giving on conscious attention or motivational to stick to became easier to maintain. A
advice on modifying behaviour because they processes is reduced.10 Therefore habits randomised controlled trial is underway to
find traditional behaviour change strategies are likely to persist even after conscious test the efficacy of this intervention where
time-consuming to explain and difficult for motivation or interest dissipates.11 Habits delivered in a primary care setting to a
the patient to implement.2 Furthermore, are also cognitively efficient, because larger sample, over a 24-month follow-up
even when patients successfully initiate the the automation of common actions frees period.16 Nonetheless, these early results
recommended changes, the gains are often mental resources for other tasks. indicate that habit-forming processes
transient3 because few of the traditional A growing literature demonstrates the transfer to the everyday environment, and
behaviour change strategies have built-in relevance of habit-formation principles suggest that habit-formation advice offers
mechanisms for maintenance. to health.12,13 Participants in one study an innovative technique for promoting long-
Brief advice is usually based on repeated a self-chosen health-promoting term behaviour change.13
advising patients on what to change and behaviour (for example, eat fruit, go for a
why (for example, reducing saturated fat walk) in response to a single, once-daily MAKING HEALTHY HABITS
intake to reduce the risk of heart attack). cue in their own environment (such as, after We suggest that professionals could
Psychologically, such advice is designed to breakfast). Daily ratings of the subjective consider providing habit-formation advice
engage conscious deliberative motivational automaticity of the behaviour (that is, habit as a way to promote long-term behaviour
processes, which Kahneman terms ‘slow’ strength) showed an asymptotic increase, change among patients. Habit-formation
or ‘System 2’ processes.4 However, the with an initial acceleration that slowed to a advice is ultimately simple — repeat an
effects are typically short-lived because plateau after an average of 66 days.9 Missing action consistently in the same context.12
motivation and attention wane. Brief advice the occasional opportunity to perform the The habit formation attempt begins at the
on how to change, engaging automatic behaviour did not seriously impair the habit ‘initiation phase’, during which the new
(‘System 1’) processes, may offer a valuable formation process: automaticity gains soon behaviour and the context in which it will be
alternative with potential for long-term resumed after one missed performance.9 done are selected. Automaticity develops
impact. Automaticity strength peaked more quickly in the subsequent ‘learning phase’, during
Opportunistic health behaviour advice for simple actions (for example, drinking which the behaviour is repeated in the
must be easy for health professionals to give water) than for more elaborate routines (for chosen context to strengthen the context-
and easy for patients to implement to fit into example, doing 50 sit-ups). behaviour association (here a simple
routine health care. We propose that simple Habit-formation advice, paired with ticksheet for self-monitoring performance
advice on how to make healthy actions into a ‘small changes’ approach, has been may help; Box 1). Habit-formation
habits — externally-triggered automatic tested as a behaviour change strategy.14,15 culminates in the ‘stability phase’, at which
responses to frequently encountered In one study, volunteers wanting to lose the habit has formed and its strength has
contexts — offers a useful option in the weight were randomised to a habit-based plateaued, so that it persists over time with
behaviour change toolkit. Advice for creating intervention, based on a brief leaflet listing minimal effort or deliberation.
habits is easy for clinicians to deliver and
easy for patients to implement: repeat a
chosen behaviour in the same context, until
it becomes automatic and effortless.
“Advice for creating habits is easy for clinicians to
HABIT FORMATION AND HEALTH deliver and easy for patients to implement: repeat
While often used as a synonym for frequent
or customary behaviour in everyday a chosen behaviour in the same context, until it
parlance, within psychology, ‘habits’ are becomes automatic and effortless.”
defined as actions that are triggered
automatically in response to contextual
Benjamin Gardner,
Lecturer in Health Psychology, Health Behaviour
Research Centre, Department of Epidemiology and
Public Health, University College London, London.
Phillippa Lally,
ESRC Postdoctoral Research Fellow, Health
Behaviour Research Centre, Department of
Epidemiology and Public Health, University College
London, London.
Jane Wardle,
Professor of Clinical Psychology, Health Behaviour
Research Centre, Department of Epidemiology and
Public Health, University College London, London.
Provenance
Freely submitted; externally peer reviewed.
DOI: 10.3399/bjgp12X659466