Sarah asks, ‘Nancy, what exactly is behavior change is and why it is so difficult?’
I launch into excruciatingly boring detail of the theories of behavior change and techniques until I see Sarah check her watch three times. I promptly switch gears and say, ‘Sarah, think about any desired behavior change as a mix of three things: 1) a rider on 2) an elephant along 3) a path. Can you picture it? Cute little elephant with a guy on top on a tree-lined path? Great, so all three of these together are all the elements to be addressed when you want to change a behaviour. Here, let me introduce you to them.
‘Let’s meet our little cast of characters. Try and picture your rider, Sarah. The rider is your brains, your ability or knowledge behind any specific change you want to make. The rider knows all the information you might have about a problem behaviour you want to stop or a good behaviour you want to start. The rider knows the reasons why changing your behaviour is good or needed. But the rider is the smallest part of this puzzle, and while very smart and fact-filled, he is the smallest piece of our puzzle.
‘OK, so that little rider in sitting on your elephant. Ahh, let’s look at that elephant, the strongest element in the puzzle. That elephant is our motivation or our heart or the reasons we do what we do. She is big and heavy and strong and powerful and goes where she wants to go. The rider might try to distract the elephant and push her to go in the direction where he wants to go with all of his facts and theories, but the elephant will always end up doing what the elephant wants to do because motivation is the most powerful of all.
‘OK Sarah, so your rider and elephant are walking along a Path. Can you see it? That Path is the environment or conditions where the Elephant and the Rider live, work and play. The things that line or litter that Path includes the people, communities and institutions we interact with and are influenced by, the policies and laws that affect our life, all the pieces of the puzzle that help to shape us into who we are.
‘Anytime that you want to change a behaviour, Sarah, you need to:
make sure the Rider has the information he needs about the problem and the target behaviour, our true motivation to change and the environment around us including how we will seek support when we most need it or when we want to give up.
understand what really motivates us to change. By knowing our motivation or our elephant, we can apply her as the impetus or reminder for why we are doing the hard work of change.
Adjust what is on our Path by removing obstacles blocking our way and to add things on our path that will help us such as supportive people or groups, tools that will remind us of our motivation and build further knowledge and skills.
Sarah nods and looks down at her hands nervously. She tells me that one day recently, she woke to a bleary-eyed view of the world. She explains how terrified she felt, her eyes looking out at the world as if through a layer of gauze, prompting a visit to the doctor. The doctor ran some tests and assessed her eating habits and daily physical activity with Sarah admitting that both were poor. One blood test result later and the doctor had declared Sarah to be pre-diabetic, scolding her for her poor eating habits and telling her to simply stop eating sugar or she would need to go on insulin.
Sarah says that she tried so hard but while she had all the information, she just couldn’t stop her daily intake of candy bars and liters of soda. On her next doctor visit, her doctor put her on insulin at the tender age of 23.
Sarah begins to cry, saying that she is afraid to die, she wants to do so many things in her life, but now she feels held back by having to stick a needle into her arm with insulin everyday all because she can’t stop putting sugar in her mouth. She looks up at me with tears welling in her eyes and utters one word, ‘Help?’
I talk to Sarah’s rider and show her studies and videos of what happens to sugar in the body, how her body receives it, processes and stores it, how it affects her blood and insulin levels, why insulin is required for her overworked body. I teach her rider how to make healthy meals and teach her how the nutrients in healthy food are used by her body as fuel and helps her blood and regulates her insulin.
I then ask Sarah’s elephant so many questions about the things she wants in her life, about the people and things in her life that she loves and what makes her smile, what makes her want to get up everyday. Sarah’s elephant talks with incredible love for her baby boy who she loves with every cell of her body and whom she very much wants to watch grow up and become an awesome young man. Sarah’s elephant is incredibly strong, far stronger than her sugar addiction. Like all elephants, she is a force to be reckoned with.
Sarah and I take an exploratory stroll along the Path and see that it is cluttered with Sarah’s family who eat so many sweets and drink sugary soda all the day long, I see some of Sarah’s friends who make fun of her when she chooses to drink plain water or eat a piece of broccoli instead of a brownie. Her Path is also blocked by the obscenely high cost of vegetables in her village while junk food costs so little. I also meet one incredibly helpful guide on Sarah’s Path - her best friend - who calls Sarah each day to encourage her, ask after her son, thus helping to clear some of that debris which threatens to block the progress of Sarah’s elephant and rider towards reducing sugar.
Sarah looks down at her bottle of insulin and her box of sharps and glances at her baby boy, asleep in the bassinet in the room and she decides to clear her Path, to empower her elephant. I nod once and we work out a plan for Sarah to remove the obstacles on her Path. Her elephant is strong that day, planning and strategizing ways to throw out the sugar lurking in her kitchen, to plant a vegetable garden in her yard and post a huge picture of her baby boy on the refrigerator to remind her elephant when she is tempted to have a bottle of soda. She tells her family that she needs their support or she will need to take a break from them for awhile and surprisingly, they agree. Sarah and her best friend work together to clear the Path to allow Sarah’s elephant and rider progress along that path with as few distractions and obstacles as possible.
Not long after the plan is in motion and her elephant and rider make their careful way down that path, Sarah’s doctor smiles as he tells her that she no longer needs insulin. Her smiles at her, noting her healthy skin, her body 10 kilos lighter, her blood regulating insulin all on its own. The rider, elephant and their path reach their goal.