Five Reflections on Adherence
Okay, so you’ve started a new phase of your life – the “new you” who gets up early in the morning to exercise, who says “no” to sugar, and who plans on staying consistent.
You promise yourself, “I’m not falling off the wagon this time!”
Monday and Tuesday are fantastic. Wednesday gets wobbly. Thursday brings an extra work crisis that you weren’t expecting, so you pick up takeout and have a few drinks afterward. On Friday, you skip your workout because you don’t feel great from Thursday night, and it’s so busy that you don’t stick to your planned meals. By Saturday, you promise yourself you’ll start over again on Monday and decide to ride out the weekend.
But on Monday, the magic is gone.
Sometimes this only takes a week. Sometimes, you can stick with a diet and exercise plan for weeks or months before teetering from “new you” back into “old you.”
Many different types of obstacles and distractions can play a role:
- Extra work meetings or projects
- A child’s school event or trip
- A cold or flu
- An emotional crisis
- A holiday or vacation
But the common denominator is that something throws you off and then it’s really hard to get back on. Plus, people often find that trying to buckle down again on a discarded plan is harder the second time around – it’s a little bit of a letdown to try to reinvigorate a plan that, after all, stopped working for you.
It’s Easier to Stay On – Than to Get On – The Wagon
So how do we stay on the wagon, since it’s easier to stay on than to get back on?
I’m not in love with the phrase “off the wagon” – to me, it suggests perfect adherence vs. complete failure. But for today’s post, let’s use that image. How do you stay on the wagon when the road get really, really bumpy?
I’m going to share with you five thoughts about adherence, the way I coach it with my clients.
#1 What is adherence, anyway?
“Adherence” is a very important word in the behavior change community, whether we’re talking about weight loss, quitting smoking, or just a simple exercise habit. As George Santayana said, “Repetition is the only form of permanence that nature can achieve.” In other words, if you want to actually change, repeating a behavior over and over and over again is the only way to do it.
So it stands to reason that adherence – sticking to a plan – is key. In fact, it’s even more important than what the plan is. You could lose weight by doing yoga daily, by doing CrossFit daily, or by running daily. As long as you hit certain targets – usually at least 150 minutes of exercise a week and some kind of dietary change – you’re going to see results. Adherence is the secret sauce.
But…
Adherence Does Not Mean Perfection
This is where I usually take issue with the “off the wagon” phraseology – people associate consistency with being 100% absolutely adherent. But really, adherence is more about diligently adding up lots and lots of repetition and behaviors over a long period of time, not about doing something without exception.
For example, if your child gets the flu and you’re sleeping in their bed with a bucket for a night or two, obviously you can’t expect yourself to adhere to your exercise plan without exception. But if we approach adherence from the repetition model instead of the perfection model, we can see that there’s an opportunity to resume workouts as soon as possible, instead of creating a magical re-start date. This way, interruptions become blips on the radar instead of seismic shifts in habits and routines.
#2 To promote adherence, choose manageable goals.
As my client Sarah said, “Rachel has taught me that I do not need to be perfect, but if I am ‘pretty good most of the time’ I can still see results.”
This is a phrase that I use a lot with clients – particularly those who struggle with perfectionism:
“Pretty Good, Most of the Time”
Staying on the wagon means choosing smaller goals, and then doing them a lot.
By the way, this doesn’t mean that you’re choosing a smaller long-term goal. For example, if you want to lose 50 pounds, I’m not saying you should downgrade your goal 10 pounds. It means to make your short-term behavioral goals smaller instead.
So instead of running three miles a day, plan to do any kind of exercise for 30 minutes a day. Instead of completely quitting sugar, swap out your most frequent sugary treats with a healthier alternative (i.e., regular soft drinks for sparkling water). Instead of eating perfectly Paleo, aim to eat more protein and vegetables at every meal.
Manageable goals are more malleable for life’s curve balls – it’s easier to “check the box” for exercise if your goal is a 30-minute walk than if you must attend a Barre class, or to stick with your diet when you eat out.
#3 Plan for your worst when you’re at your best.
Planning is crucial for success.
Moreover, it’s a great strategy to plan your healthy lifestyle habits (and prepare for them) when you are not in the moment.
When we are stressed, our smart, rational, logical front brain (the prefrontal cortex) gets hijacked by our more primitive, reactive hind brain (the limbic system). The front brain wants you to exercise and make good food choices so that you will be healthy long-term, but your hind brain wants you to soothe yourself with food and chill out on the couch now. When you’re facing stress at work or at home, the hind brain usually wins.
We can help support our success by doing our planning and preparing when the prefrontal cortex is most active – for example, meal prepping for the week on the weekend. Then, at moments when the limbic system just wants to reach for whatever’s easy (like after a stressful work meeting), what’s “easy” is the healthy meal you’ve already prepared.
Similarly, I encourage clients to exercise in the morning instead of in the afternoon or evening whenever possible. In the morning, the stress of the day hasn’t kicked in yet – nothing is competing for your attention (other than your bed and your morning coffee!). But by the evening, it’s quite likely that your kids, your work projects, housework, and your own stress are all going to be weighing on you, and feeling much more important (and relevant) than your workout.
In other words, plan for your worst when you’re at your best. Then, you can just go with the flow.
#4 Make a “relapse prevention plan.”
This is a phrase from the world of alcohol and drug addiction recovery – but it’s something that hugely benefits people who struggle with implementing their healthy habits (including weight loss goals).
You know how your bank sends you an e-mail or a text notification when your balance gets too low and you’re about to overdraw?
It would be nice if you had that for your physical well-being – a little push notification that says, “You are drained to zero! You are about to start making bad decisions!”
But we often don’t catch it before it’s too late, and sometimes even when we’re aware that we’re in the red, we don’t know what to do at that time (remember the limbic system?).
It helps to put a relapse prevention plan in place in advance – a process of just a few steps that helps us identify the mounting triggers that threaten our consistency, and re-connect us to our intentions before we “fall off the wagon.” Here’s what a relapse prevention plan could look like for someone who struggles with exercise consistency:
When I have missed two days of exercise, I will:
- Check in with my trainer/friend/therapist
- Make a written plan (by hand) for what I am going to do today and tomorrow to reintroduce exercise
- Put out my exercise clothes tonight for tomorrow morning
Or for someone who is trying to avoid overeating:
When I am feeling the urge to overeat, I will:
- Check in with my dietitian/friend/trainer/therapist
- Change my environment (go for a walk, take a shower, go shopping)
The key to relapse prevention is two-fold: you make the plan in advance, and then you implement it immediately when you recognize the warning signs. It’s important to ask yourself, “What can I literally do right now?” instead of projecting into “I will start over again tomorrow (or on Monday).”
If you are struggling (or suspect you’re struggling) with an addiction or an eating disorder, it’s essential that this relapse prevention plan is implemented in collaboration with a therapist. Click here to get more information.
#5 Exercise Self-Compassion.
Finally, an essential component of consistent adherence is self-compassion.
People often think that being tough on themselves is the best strategy for keeping themselves scared straight.
But… the research doesn’t agree. As Dr. Kristin Neff says,
People are often very hard on themselves when they notice something they want to change because they think they can shame themselves into action – the self-flagellation approach. However, this approach often backfires if you can’t face difficult truths about yourself because you are so afraid of hating yourself if you do. Thus, weaknesses may remain unacknowledged in an unconscious attempt to avoid self-censure. In contrast, the care intrinsic to compassion provides a powerful motivating force for growth and change, while also providing the safety needed to see the self clearly without fear of self-condemnation.”
It’s important to make the distinction that self-compassion does not mean indulging in your most counterproductive behaviors and cutting yourself slack while doing so. Self-compassion simply means that you can maintain a realistic perspective and a kind mental tone towards yourself while you work on changing.
Cultivating self-compassion is a habit in itself, and while meditation is a key practice for improving mindset, I also encourage clients to simply “catch” themselves when they stray into self-condemnation. If you find thoughts popping up like:
- “I always mess up.”
- “I just can’t stick with this.”
… have some phrases ready to help you re-frame this thinking, like:
- “Everybody has times when exercise is tough. I know I can get through this.”
- “I had a hard day, but ice cream isn’t necessarily going to make it better. I’ll feel better tomorrow.”
Keeping your mental tone kind, realistic, and affirming doesn’t mean you’re repeating “I am beautiful” to yourself over and over. It means that you can give yourself an understanding, smart pep talk when you’re feeling down – just like you would for a kid who struck out at baseball.
These five strategies take practice, but they can help you stay on the wagon even when the ride gets bumpy. Which one speaks to you the most? Leave your thoughts in the comments!