Wednesday, September 18, 2013


It’s a glorious day here in my neck of the woods.  The summer is on its way out, and the mornings are becoming crisp.  The kids are back in school and in a few days, autumn will officially be here.  The changing seasons are one of the things I love about living in North Carolina.  Each season is unique, and the transitions from one to another always bring a sense of anticipation for the upcoming time of year right alongside a yearning for the waning season and all the gifts it brought.  Every change is like this, it seems – both a beginning and an end.

The past few months have been full of changes for me personally and professionally, and I’ve been thinking a lot about the way we relate to change.  Some changes aren’t choices and so we may seek to develop skills for managing them with some degree of resiliency and good humor.  Other changes are things that we initiate, and even though they may be challenging, we feel as if we have a little more control on how and when they are implemented.

In my work as a nurse practitioner and a health coach, I help people who want to make changes that will enhance their health and well-being.  Before they begin behavior change, though, each client must ask themselves:  “Am I ready?” 

What makes someone ready to make a change?  This question has been researched and studied extensively.  One of the more well-known theories of behavior change, Prochaska’s Stages of Change, describes behavior change as a progressive process made up of five distinct steps:

1)  Precontemplation – The individual is not considering any type of change to his or her behavior. 
Example:  Jeff is a high achiever who gets 5-6 hours of sleep a night.  He keeps himself energized with coffee and energy drinks, and has no intention of slowing down any time soon.

2)  Contemplation -- The individual is considering making a behavior change.  He or she is weighing the pros and cons, but isn’t ready to take action.
Example:  Mary has a very busy life and has noticed feelings of tension, irritability, and fatigue.  She has wondered about trying meditation as a tool for stress management, but she isn’t sure that she can find the time.

3)  Preparation
– The individual wants to make a change and has decided the time is right.  He or she starts to gather information and resources to prepare for the change successfully.
Example:  Steve has just sent his last child off to college.  Next summer, the family is planning a big hiking trip.  Steve wants to be physically fit for the challenge so that he can fully enjoy this time with his family.  He is doing a lot of reading and gathering information about resources that will help him prepare.

4)  Action --  The individual initiates action on the desired behavior change.  This is where the rubber hits the road!
Example:  Lisa has decided that she wants to increase the amount of vegetables in her diet to at least three per day.  She has researched some recipes, made a trip to the farmer’s market, and has menu plan ideas for the week.  She is keeping track of her progress via an app, and the first week is going great!

5)  Maintenance --  The individual has successfully integrated the change into their lifestyle.  They are “keeping the change!”
Example:  David is an enthusiastic gardener and has a big commitment to taking good care of the Earth.  Last year, he started composting as a way to reduce food waste and enrich the soil in his garden.  He tried a few different methods before he found one that worked for him.  He now keeps a small container in his kitchen and has developed a habit of putting his scraps there and adding those to his outside compost bin regularly.

As you can imagine, an individual could be at different stages in the change process for different health behaviors.  People don’t move through the stages at a predictable pace.  Some folks may get “stuck” or may relapse.  In my work, I help clients learn from the challenges they encounter so that they can create an action plan that is sustainable for them.  The whole process, though, is dependent on their willingness to commit to a change.

Here’s an example of how the change process has been at work in my own life:

In a recent newsletter, I shared that I had challenged myself to a goal of being able to do a chin-up by my next birthday.  In my youth, my favorite physical activities were dancing and hiking, and upper body strength didn’t seem that important (precontemplation).  I learned to appreciate the importance of upper body strength as I became a mom and also developed an interest in gardening (contemplation).  As I approach my 50th birthday, I decided to devote more energy to building my strength since I want to be strong and active for many years to come (preparation).  I tried doing body-weight exercises and using a chin-up bar at home, but this wasn’t enough to help me reach my goal.  In working with a medical massage therapist, I became more aware of which muscles were weak points for me.  I also started working with a trainer who helped me identify the specific exercises that I needed, and showed me how to do them effectively (action).  I can now do a chin-up and am using the chin-up bar to maintain the strength that I’ve gained! (maintenance).

As I noted in the beginning, any change is both a beginning and an end.  Taking on my birthday goal has meant that I have had to give up letting myself off the hook for this aspect of my fitness.  On the other hand, accomplishing this goal has given me new strength, a sense of satisfaction and momentum to take on other goals.  It has also helped me fulfill my commitment to being a strong role model for my daughters.

What are the changes that you’ve been contemplating or have already undertaken?  How did you know when you were ready?  I look forward to hearing anything you’d like to share! 

Special Thanks:
In addition to my family, I’d like to extend a special thank-you to two other partners in my health journey -- Christi-Anne Holder of Moonshadow Medical Massage and Tom Davis, originator of the GRAB strength training program at Whole Health Solutions.