We’ve heard it time and again that “change is hard” but why is this the case? Humans have a basic drive to seek safety and predictability. Uncertainty in any form can threaten our sense of safety, leading to anxiety and motivation to restore it. Therefore, any behavior (dysfunctional or not) that produces this basic sense of safety (i.e. washing hands, checking locks) is prone to be repeated and more immune from changing. For some, these safety behaviors can produce as much distress as the uncertainty itself. Particularly if they are performed excessively. This distress usually plays a role in the motivation to change.
In addition to our basic drive for safety, we also have a tendency to seek homeostasis (balance). Consider the air condition unit in your home or apartment, when the internal temperature departs from the setpoint, a process kick-starts to bring it back to the desired temperature. Humans work in similar ways. For example, when we experience changes to our emotions or daily habits, we engage in certain behaviors (dysfunctional or not) to bring our emotions/habits back to our baseline. When homeostasis is restored, we feel “normal”.
Despite the uphill battle required to change behavior/s, over time, many people that want to change, do so. No matter the problem, change often occurs in 5 predictable stages. It is common for patients to cycle through these stages multiple times before it is maintained. Consider the case of a patient with agoraphobia (fear of leaving the house):
- Pre-Contemplation Stage: The patient does not recognize or believe that his/her inability to leave home is a problem, despite feedback to the contrary. They actively avoid leaving the house and this does not create distress.
- Contemplation Stage: In this stage, the patient begins to recognize that his/her avoidance has pros AND cons. They recognize that staying inside contributes to a sense of safety, however, they also dislike that they miss out on important life events. Typically, patients spend a great deal of time stuck in this stage (months, if not years). They may continue to stay inside, but this is experienced with more distress.
- Preparation Stage: The patient has resolved much of their ambivalence regarding the pros and cons of their agoraphobia. While they may still recognize the benefits of avoidance, it does not outweigh the benefits of venturing out. They actively begin planning strategies for change.
- Action Stage: At this point, the patient has learned and is actively engaging in new strategies that help him/her leave the house with minimal to no anxiety.
- Maintenance Stage: Typically, a patient is in this stage when they are symptom-free for about 6 months. They are cautious of relapse and actively practice relapse prevention.
Miller, R. M., Rollnick, S., (2002). Motivational Interviewing: preparing people for change. The Guilford Press; 2nd edition.
