Updated: May 11, 2020
Understand the science of habits and why occupational therapists (OTs) are uniquely positioned to address them.
According to the Occupational Therapy Practice Framework: Domain and Process (3rd Edition), habits are defined as: "...specific, automatic behaviors; they may be useful, dominating, or impoverished." In looking at an individual's daily occupations, OTs are able to identify and analyze the habits that impact the individual's participation in occupation and management of their health. OTs possess the knowledge and skillset to help clients both terminate detrimental habits and form health-promoting ones.
Occupational therapists identify and analyze individuals' habits and possess the knowledge and skillset to help clients terminate detrimental habits while forming health-promoting ones.
In order to eliminate 'bad' habits, and subsequently form healthy ones, it is helpful to understand the science behind habits. The following is derived from The Power of Habit: Why We Do What We Do In Life And Business.
First things first. You can’t just get rid of a bad habit. The reason we form habits is because the habit, or specific action we engage, in results in some sort of positive reward -- so we repeat that action over and over again, until it becomes unconscious and automatic. This process is known as the habit loop.
The Habit Loop
There are four components of the habit loop: (1) The cue: this is a prompt that initiates the action or routine. Cues are typically one of the following: time of day, location, emotional state, preceding action, other people, or some other physical cue. (2) The routine: this is the behavior or action that is initiated after encountering the cue. (3) The reward: this is the positive outcome that is a result of the routine. (4) A craving is formed: once you engage in the cycle (cue, routine, reward) enough times, your brain develops a
craving for the positive outcome, thus driving continued engagement in the habit loop.
Satiate Cravings Through Change
Habits fulfill a craving, and if you simply try to stop engaging in an unwanted behavior that has been ritual to you for weeks, months, or even years, chances are you won’t find much success and that bad habit will be back before you know it. The key to truly eliminating a bad habit? Replace it.
We all know cravings are nearly impossible to ignore -- which is why once you have developed a habit loop and craving, you won’t be able to cut a bad habit unless you find an alternative behavior to replace it. By simply trying to eliminate an unwanted behavior (the routine), you are creating a void: you encounter a cue and have a craving to fulfill, but no action to satisfy it. This means, to successfully get rid of an unwanted behavior, you must actually change it to fill the void and satisfy the craving.
An Example: Stress Eating
You are starting to feel stressed as midterms or a major project come up (your cue: emotional state), so you start snacking on junk food (your routine) as your go-to coping mechanism. The comfort and the distraction you get as a benefit from munching on potato chips is the reward. Over time, as you engage in this routine and it becomes your go-to action whenever you begin to experience signs of stress, your brain starts to associate this snacking as a “stress reliever” and a craving is formed.
"Breaking" the Habit
The next time you are stressed, you wholeheartedly resist the urge to snack. Maybe it works out once or twice around, but you are still stressed (and it is continuing to build). You re-engage in the behavior of stress-snacking and the bad habit lives on.
The next time you are stressed, you try deep breathing (as you have heard this is such an effective stress-reducer!) instead of reaching for the potato chips. Your stress level lowers, leaving you relaxed and relieved. You try this method again, and again, each time you become stressed. Deep breathing (not the unwanted, maladaptive snacking) now becomes your go-to, automatic stress reliever. Congratulations, you have formed a new habit!
Creating New Habits
Now, say you don't have any bad habits you want to replace, but there are some health-promoting activities you would like to regularly incorporate into your day. This might be exercise, meditation, drinking the daily recommended amount of water, or going to sleep at a reasonable hour. How can you make these things happen? This is where the habit loop comes into play once again, and now you know what it takes to form a habit: you need a cue, a routine, a reward, and ultimately a craving.
You already have your goal routine in mind (e.g. exercise), so now you need to identify your cue to engage in the wanted routine. Some cues to hit the gym might be:
Time of Day: You go to the 8AM yoga class.
Location: You walk past the gym each day on the way back from class or work.
Emotional State: You have discovered exercise is your best stress reliever.
Preceding Action: You walk out of work or finish your last class of the day.
Other People: You have a workout buddy.
Physical Cue: You leave your running shoes by the front door.
These are only a few examples and you may have many more ideas in mind. It may take a few rounds of trial and error to find which cue works best for you, but once you have identified that cue, it makes the routine easier to do. Cue, check. Routine, check. The reward? There are many: the rush of endorphins, the boost of energy, the increase in focus, the improved quality of sleep, and the conviction that you are improving your health and wellbeing through exercise. And as you now know, when you continue to engage in the cue--routine--reward cycle, you form the craving, and thus, a new habit.
All of this is easier said than done -- I get that. Know that habit formation takes time and effort, but hopefully by understanding how habits are formed, you can better tackle the challenge of eliminating bad habits and forming healthy habits.
A Final Tip
Always keep in mind why you want to replace a certain behavior -- is it negatively affecting your health? Your relationships? Your work performance? Having a reason to change your habit(s) will help keep you motivated to practice new routines long enough to make them automatic.
Occupational therapists can do the following (and more!):
Facilitate self-analysis to help individuals identify specific cues leading to 'bad' habits or routines that are detrimental to one's health
Help individuals discover new health-promoting routines to replace the bad ones
Assist individuals in identifying sources of motivation to change habits and routines
Act as a regular source of accountability or help individuals to identify other reliable sources of accountability