The Cycle of Change: Progress not Perfection

Why do so many healthy changes fail, even when our intentions are good?

 

In her latest blog, our GP Dr Vicky Carre reflects on the psychology of behaviour change and why trying to make the “perfect” change can sometimes stop us making any change at all.

 

From stopping smoking and improving fitness to losing weight or cutting down on alcohol, the blog explores why progress is rarely straightforward and why setbacks are often a normal part of building healthier habits that last.

I particularly enjoyed listening to “Thought for the Day” on BBC Radio 4 this Monday as I drove into work. The Rt Revd David Walker was discussing last Friday’s football match between Grimsby and Salford City. Two Grimsby goals were allowed that it later transpired might have been overturned if VAR had been available. Not being a fan of VAR, the Rt Revd Walker said that even as a Salford supporter he did not particularly resent the situation.

His point was broader than football: he reflected that “there comes a stage where the pursuit of absolute perfection starts to interfere with the ability to do good.” He went onto discuss the famous quote from G. K. Chesterton: “If a thing is worth doing, it is worth doing badly.” Not carelessly or lazily, but imperfectly. The point is that worthwhile things are often abandoned because people feel they cannot do them perfectly.

The problem with “starting properly”

Health behaviour change is full of this trap. As a GP I have conversations every day advising people about stopping smoking, losing weight, weaning off potentially addictive medications or cutting down on alcohol. The problem is that doctors and patients often approach change as an all-or-nothing exercise. Patients may leave the consultation with plans for the perfect diet, an intense exercise regime, or an agenda to quit smoking or alcohol as soon as the next Monday comes around. Then life intrudes: a stressful week, a skipped gym session, a cheeky takeaway, a weekend cigarette after a smoke-free week…

Very quickly the thinking becomes: “I’ve failed.”

The change cycle: why relapse is normal

Psychologists sometimes describe behaviour change using the “stages of change” model - not as a straight line, but as a cycle people move around repeatedly.

The first stage is precontemplation: not yet recognising there is a problem, or simply not ready to change. A smoker may know smoking is unhealthy but feel stopping is impossible or irrelevant right now.

Then comes contemplation: beginning to think seriously about change. This is the stage of “I know I probably should…” People may spend months here weighing up pros and cons.

Next is preparation: buying nicotine replacement, joining a gym, downloading a couch-to-5k app, or deciding to reduce alcohol intake. The intention is there, but the new behaviour is not yet fully established.

After that comes action: actually making the change. Stopping smoking. Walking regularly. Improving diet. Taking medication consistently.

Finally comes maintenance: sustaining the new behaviour long enough for it to become part of normal life.

The important point is that relapse is built into the model. It is not viewed as failure, but as a common and expected part of the process. Most people do not move neatly from stage one to stage five in a straight line. They circle back, regroup and try again. Research has shown that the average smoker makes seven to ten attempts before finally quitting long term. The same is true of weight loss, exercise habits and addiction recovery.

 

Ten practical strategies for successful change

So, what can we do to help us with making sustained healthy changes?

• Make changes small enough to be realistic and compatible with day-to-day life.

• Break the goal down into small, hyper-specific actions.

• Write your goals down – the act of moving a goal from your brain to paper is powerful.

• Find a supportive person or group - your “cheerleaders”- and keep yourself accountable to them.

• Aim for consistency over intensity – small changes, repeatedly daily.

• Cultivate your environment to work with you – think about how to set up your living and working places to make your change easier.

• Track your progress – for example in a diary or on an app.

• Expect setbacks in advance rather than treating them as disasters. Reframe slip-ups as learning opportunities – assess what triggered a slip, adjust your strategy and jump back into the cycle again.

• Always focus on direction of travel rather than daily perfection.

• Celebrate your milestones!