Change or Die

How difficult is it for people to change their normal way of life? Change to be a better husband or father, to be a better boss or employee, to be fitter or healthier person. No problem you may think. Think again…and again.

FAST magazine in May 2005 published an article titled ‘Change or Die’. This is what Dr. Edward Miller, the dean of the medical school and CEO of the hospital at Johns Hopkins University has to say "If you look at people after coronary-artery bypass grafting two years later, 90% of them have not changed their lifestyle. And that's been studied over and over and over again. And so we're missing some link in there. Even though they know they have a very bad disease and they know they should change their lifestyle, for whatever reason, they can't." In other words, your chance of changing is nine to one against you, even if your life depends on it.

The conventional wisdom says that crisis is a powerful motivator for change. But severe heart disease is among the most serious of personal crises, and it doesn't motivate -- at least not nearly enough. Nor does giving people accurate analyses and factual information about their situations. What works? Why, in general, is change so incredibly difficult for people? What is it about how our brains are wired that resists change so tenaciously? Why do we fight even what we know to be in our own vital interests?

Dr. Dean Ornish, a professor of medicine at the University of California at San Francisco and founder of the Preventative Medicine Research Institute, in Sausalito, California, provides some answers in his successful program. "Providing health information is important but not always sufficient," he says. "We also need to bring in the psychological, emotional, and spiritual dimensions that are so often ignored." Why does the Ornish program succeed while the conventional approach has failed?

For starters, Ornish recasts the reasons for change. Doctors had been trying to motivate patients mainly with the fear of death, he says, and that simply wasn't working. For a few weeks after a heart attack, patients were scared enough to do whatever their doctors said. But death was just too frightening to think about, so their denial would return, and they'd go back to their old ways. The patients lived the way they did as a day-to-day strategy for coping with their emotional troubles. "Telling people who are lonely and depressed that they're going to live longer if they quit smoking or change their diet and lifestyle is not that motivating," Ornish says. "Who wants to live longer when you're in chronic emotional pain?"

So instead of trying to motivate them with the "fear of dying," Ornish reframes the issue. He inspires a new vision of the "joy of living" -- convincing them they can feel better, not just live longer. That means enjoying the things that make daily life pleasurable, like making love or even taking long walks without the pain caused by their disease. "Joy is a more powerful motivator than fear," he says.

Pioneering research in cognitive science and linguistics has pointed to the paramount importance of framing. George Lakoff, a professor of those two disciplines at the University of California at Berkeley, defines frames as the "mental structures that shape the way we see the world." The big challenge in trying to change how people think is that their minds rely on frames, not facts. "Neuroscience tells us that each of the concepts we have -- the long-term concepts that structure how we think -- is instantiated in the synapses of the brain," Lakoff says. "Concepts are not things that can be changed just by someone telling us a fact. We may be presented with facts, but for us to make sense of them, they have to fit what is already in the synapses of the brain. Otherwise, facts go in and then they go right back out. They are not heard, or they are not accepted as facts, or they mystify us: Why would anyone have said that? Then we label the fact as irrational, crazy, or stupid."

Reframing alone isn't enough, of course. That's where Dr. Ornish's other astonishing insight comes in. Paradoxically, he found that radical, sweeping, comprehensive changes are often easier for people than small, incremental ones.

For example, he says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they aren't eating everything they want, but they aren't making big enough changes to quickly see an improvement in how they feel, or in measurements such as weight, blood pressure, and cholesterol. But the heart patients who went on Ornish's tough, radical program saw quick, dramatic results, reporting a 91% decrease in frequency of chest pain in the first month. "These rapid improvements are a powerful motivator," he says. "When people who have had so much chest pain that they can't work, or make love, or even walk across the street without intense suffering find that they are able to do all of those things without pain in only a few weeks, then they often say, 'These are choices worth making.' "

Another vital factor is to give people the multifaceted support they need. That's a big reason why 90% of heart patients can't change their lifestyles but 77% of Ornish's patients could -- because he buttressed them with weekly support groups with other patients, as well as attention from dieticians, psychologists, nurses, and yoga and meditation instructors.

Neuroscience, a field that has exploded with insight, has a lot more to say about changing people's behavior -- and its findings are guardedly optimistic. Scientists used to believe that the brain became "hardwired" early in life and couldn't change later on. Now researchers such as Dr. Michael Merzenich, a professor at the University of California at San Francisco, say that the brain's ability to change -- its "plasticity" -- is lifelong.

What lessons do we have here on changing ourselves? And also for managers on strategies to help their reps improve their performance. How do we reframe the issue of getting out of poverty into achieving a grander lifestyle by helping others. How do we perform radical, widespread changes rather pursue small, incremental changes in our behavior. And let’s not forget the support infrastructure that needs to be in place to ensure feedback and positive reinforcement to our efforts to improve.