Making health habitual: the psychology of ‘habit-formation’ and general practice
ADDRESS FOR CORRESPONDENCE Benjamin Gardner Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK. E-mail: [email protected]
Patients trust health professionals as a source of advice on ‘lifestyle’ (that is, behaviour) change, and brief opportunistic advice can be effective. 2 However, many health professionals shy away from giving advice on modifying behaviour because they find traditional behaviour change strategies time-consuming to explain and difficult for the patient to implement. 2 Furthermore, even when patients successfully initiate the recommended changes, the gains are often transient 3 because few of the traditional behaviour change strategies have built-in mechanisms for maintenance.
Brief advice is usually based on advising patients on what to change and why (for example, reducing saturated fat intake to reduce the risk of heart attack). Psychologically, such advice is designed to engage conscious deliberative motivational processes, which Kahneman terms ‘slow’ or ‘System 2’ processes. 4 However, the effects are typically short-lived because motivation and attention wane. Brief advice on how to change, engaging automatic (‘System 1’) processes, may offer a valuable alternative with potential for long-term impact.
Opportunistic health behaviour advice must be easy for health professionals to give and easy for patients to implement to fit into routine health care. We propose that simple advice on how to make healthy actions into habits — externally-triggered automatic responses to frequently encountered contexts — offers a useful option in the behaviour change toolkit. Advice for creating 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.
How long does it take to form a habit – what does the science say?
So how long did it take for your to starting punching out a packet of cigarettes a day. How long did it take you make going to the gym part of your weekly routine. How long did it take you to get addicted to eating cookies? All of these simple habits that everyday people have but how does it take to form a habit according to the science?
So you’ve probably heard the 21 days to build a habit spun in many places. You know its that time of the year again, new years resolution time. So you decide you are going to turn your life around because well its another year, so why not. I mean it only takes 21 days, should be a breeze right? Alas 21 days comes along and well you’re already struggling to keep this new habit of yours. That’s because it takes much longer that 21 days to build a habit. Where did this 21 days come from then?
This number comes from a super popular book called Psycho-Cybernetics [efn_note]Psycho-Cybernetics Full Text[/efn_note] from 1960 by Maxwell Maltz. In this book the plastic surgeon noticed that the patients who undertook surgery would take around 21 days before they were in tune with their look. Hardly a measure of forming a habit, when you actually don’t have to do anything.
In 2009 another study [efn_note]How are habits formed: Modelling habit formation in the real world[/efn_note]showed that it really is not clear how long it does take a habit to form. Researchers at the University College of London looked at new habits formed by a group of 96 people over a 12 week period. They found that on average these new habits took 66 days to actually stick. The habit in each determine how long it would take to form, some took as long as 254 days to be formed as a new habit.