Three years ago, my husband and I were flying home from a trip when he had his first panic attack. The plane was small, my husband was large, the attendant had her cart parked right next to him in the aisle so it ended up to be the perfect storm for claustrophobia to trigger a major case of anxiety. As a good wife (and nurse) would do, I checked his pulse which was seemed to be okay and asked him a few questions to see if he felt he was having a heart attack or a panic attack. He felt pretty sure he was freaked out more than anything so I tried my best to give him some ideas to calm down (which he really did not want to hear). As soon as we got home, I told him that I felt he really needed to go get checked out to make sure he didn’t have a heart attack because “you are 50 you know…”.
Off he went to see our family doctor who thought the episode was most likely a panic attack but he ordered a stress test because he was “50” you know. The stress test came back inconclusive so off he went to a cardiologist who ordered an angiogram, because he was “50” you know. All of the docs were pretty sure that he did not have anything major going on but the cardiac surgeon told us that if he had a blockage or two, they would “just stent” it right away and he would be home after a day.
You can probably guess where this story may be going…if you guessed triple bypass here we come – you are correct! He had a “90% blockage here…, an 85% blockage there… and an 80% right there…” A few weeks later, his chest is “filleted like a fish” (as he describes it), and he is fortunate to come out of the surgery with a new lease on life.
The interesting part of this whole story is that just shortly before this, he had committed to a very intense weight loss program because he was very overweight. He had decided that he was tired of living a life in which he could not walk more than a short distance because he get short of breath and his calf muscles would cramp up so severely that he would have to sit down immediately.
Thankfully he had quit smoking a few years prior to this time so his post-cardiac surgery focus could be on losing the excess weight so he could start walking which is an important part of cardiac rehab. However, what if he had to make several significant changes at the same time? We all know the drill to promote heart health: stop smoking, eat healthy, exercise, manage stress and get a good night’s sleep. If one has to do all of those things, which one should be tackled first?
My suggestion is to focus on one thing at a time and choose the behavior change that creates the biggest risk to you…the biggest risk to your health and/or the biggest risk of what you have to give up in order to be successful. Why do I say that?
- Because it is the one we fear the greatest so why not deal with the hardest one and get it out of the way first?
- Because the biggest risk will be the one that will give you the biggest return on your investment (ROI)…the investment into YOU. This ROI may be emotional, psychological, physical or a combination of any or all three.
- The benefits (pros) outweighs the pain of changing (cons).If you do not see that the benefit will be much greater compared to the pain of having to change your behavior, you probably are not ready to make that change. In the smoking example, if the pain of not being able to light up that heater is too much to bear and you can rationalize “oh my Grandpa smoked into his 90’s and never had a problem…”, you may need a bit more time to determine if you really are ready to commit. Jumping into action without being committed and prepared will probably lead to failure which leads to feeling crappy about ourselves, which leads us back to the behavior we are trying to change to be comforted, which leads us back to feeling crappy about ourselves, which lead us back to…it is a vicious cycle.
Once a decision is made, then what?
In his book Changing for Good, Prochaska tells us that the Preparation phase is very important for successful “self-changers”.
- Do your homework before jumping into action. For example, if you want to quit smoking, talk to your doctor about various smoking cessation programs or medications. Research the various options in terms of cost, time and success rates.
- Determine what specific change program will work best for you. Everyone will have an opinion (your significant other, your parent(s), your co-worker(s), or your neighbor). What worked for someone else may not be a good fit for you due to the personal strengths you may need to tap into to be successful. You want to create a change action plan that will be one that you will most likely stick with.
- Determine What support system you need in place. Family, friend, doctor or consider hiring a personal health coach who specializes in supporting people who are going through change.
- List out all of the items that may create sabotage points in your change behavior. What factors in your environment will most likely trigger you into lighting up or polishing off that whole pizza by yourself? Are there emotional triggers (i.e. a bad day at work) that may trigger you to stop at the local convenience store to pick up a pack of smokes, or that king size candy bar you have been eyeing for a few days?
- List out a healthy alternative by each scenario listed in number 4 above. Is it deep breathing exercises, going for a walk, chewing a piece of gum? If you have the alternative action thoughtfully planned out, you won’t have to take the time to wrestle with trying to figure out what to do when you are tempted to go back to your old behavior.
“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change”.
Do you agree that we should tackle our hardest change first?
What was one of the most difficult changes you felt you had to make and how did you do it?