Nudge Tactics for Performance and Health

Written by Christopher Kelly

June 28, 2019

[0:00:00]

Christopher:    Well, Simon, thank you so much for joining me this morning. I am very excited about your new training course, Nudge Tactics for Health Coaching: A Health and Wellness Coach's Guide to the Science of Behavioral Economics. That's a very grandiose title, Simon.

Simon:    It is, isn't it, and it's so long-winded that I really am probably guilty of the worst behavioral science of all which is having a terrible call to action and a terrible name.

Christopher:    Well, can we start by talking about -- and I say, we, like it's the real we. Can you start by talking about the science of decision-making. What's the problem? Why make a training course like this in the first place?

Simon:    That's a good question. In fact, psychologists have struggled with how people make decisions and under what circumstances, for years. It really wasn't until probably the last five to ten years where some of the research in neuroscience really started to advance our understanding of what's happening at the brain level when people are put in context or situations or asked to ponder context or situation and then tell us how they feel about them or tell us to make decisions in hypothetical tasks.

    One of the things that we've learned, and most people have known this fairly intuitively, is that we're not very rational decision-makers. When we look at the evidence, for example, on -- we can take health behavior is a really good example of this -- when you look at the evidence on when people are trying to lose weight and the strategies that they do so to try and lose weight, they do things that defy logic. They try things that go against not just the scientific evidence but even some popular wisdom. For example, only about a third of people actually try to increase their activity and reduce their caloric intake when trying to lose weight. 

    So, one thing we know is that people appear to make decisions in the moment based on circumstances that aren't always reflective of the facts of the moment. This has been a bit of a mind-bender for cognitive psychologists and neuroscientists researches. So, we're now learning a little bit more about why that is. That's a really interesting avenue of research. 

    Of course, this burgeoning field is called behavioral economics which is a really long-winded way of saying that we defy boundaries to how rational we are. We often make decisions that aren't very rational. So how can we leverage some of those things so that we can end up doing things that are serving the purpose for improving our health and things like keeping us healthy and happy and solvent and so on.

Christopher:    Can you talk a bit about traditional economics then? That's where this field of study originated. Why is it that they didn't just call it economics now? Why behavioral economics? Why other type could there be?

Simon:    Yeah, because isn't all economics, at some level, behavioral? Well, it comes out of an off spin of a rational economic theory because up until the '60s, most theories in economic thinking were based on that humans make fairly rational decisions. When you're faced or confronted with evidence, humans will weigh up the evidence and then make decisions that are in accordance with, sometimes it's the greatest net gain to them. It might be for some other goal if you're working towards a specific goal. Ultimately, that you're weighing up the evidence in a fairly balanced manner and acting accordingly. We now know that that isn't the case.

    So, this field of behavioral economics came out because it's really looking at the behavior part, the things that we actually do, not just think about and cogitate on, but the things that we actually do that drives -- there's the window to that decision-making process. So, why is it that people often act against their own self-interest when it comes to their health? Why do we sabotage our own health sometimes by doing things that we know are wrong or bad for us yet we do them anyway?

    Although it started in trying to understand financial markets and transactions, it has bled over into so many other fields, particularly in the social sciences, of saying, well maybe not having a theory of decision-making is grounded in rational thought, might be helpful for understanding other context or other domains. 

Christopher:    Okay, so let's talk about some of the symptoms that my listeners might be experiencing. We've surveyed people in the past. We had this seven-minute analysis on the front page of our website, and there was an open-ended question at the end. I asked the question, when it comes to health and fitness, what's the number one thing that you've been struggling with?

    To our surprise, what we heard over and over again was that people had the knowledge that they needed in order to maintain their health or gain performance, but the thing that they were struggling with the most was motivation and consistency. That's how we found out, oh, these are the types of symptoms that people might be experiencing. Is there anything else, behaviors that people might recognize that could possibly be helped by this new field of behavioral economics?

Simon:    Well, one is procrastination, of course, which is also very interesting topic when it comes to health. It's putting off things that we know might put us into some discomfort or pain or even being forced to confront an emotional state that we don't want to have to deal with. So, we put things off. Behavioral economics helps us understand why that is. 

[0:05:11]

    One of the concepts is called hyperbolic discounting or again a really awkward way of saying that our relationship with reward depends in part on how close to the reward is to us at that time. The humans have a remarkable ability to take shorter term but quick payoffs in place of bigger goals that are further down the line. So, if you offered me, for example, $100 tomorrow or $120 in a year's time, the vast majority of people will choose $100 tomorrow. I don't want to wait for a year, but I'm going to get an extra $20 and so on.

    This is a fairly robust finding with regard to many things about people's health. We might know it as, we've got to die from something, right? I need a few vices in life, and I'll cross that bridge when I come to it. Or we somehow hope that medical science has advanced that they'll be able to fix the problem that I'm behaving my way into right now. When I really need the help, there will be a much quicker, shorter term, faster fix for it. So, procrastination is a good example of that.

    Another is people get bogged down in thinking that they have to be motivated to change. One of the other things that we've learned is that motivation is only half the picture of changing your behavior. Commitment is far more important. We often differentiate between those two. I think we might have even spoken about this on another podcast where commitment is showing up. Commitment is doing. Whereas, motivation is the urge or the wanting to do something.

    What we often say is that, well, listen, we're not doubting that many people might be motivated to change, and motivation does cycle throughout the year. Come January the 1st, motivation is at an all-time high usually for many of us for health behaviors, but it's the actual showing up and the doing part. This really implies that it's neither a motivation deficit or a knowledge deficit that really is standing in the way of eventually having the health or the lifestyle that we want. What insights can behavioral economics help us with that. It's not actually just behavioral economics, per se. It's behavioral science as a broader topic that can help us with some of those questions.

Christopher:    Can you talk about some of the old versions of behavior change? In your course, you had this rather nice analogy of Windows 95 and Windows 97. I really wanted the new version of behavior change to be Unix because everybody listening to this knows that that is the superior operating system. Still, it's a good analogy. Can you talk about the Windows 95 of behavior change?

Simon:    Yeah. We've learned a lot about what works and what doesn't work over the years, actually since probably the Second World War, I should say, when public health and public health communication became a thing. One of the first starting points was that we assumed that, what psychologists refer to as, fear appeals -- this is scaring the bejesus out of you in an effort to get you to change your behavior -- seemed to be, on paper, a useful strategy.

    Unfortunately the research shows that not only is that ineffective. In other words, when fear appeals is showing you the terrible consequences we're putting in front, dead center in your face to say, if you don't change, this is what could happen to you. A whole host of theories are based around that principle. One of them is called protection motivation theory that we're motivated to protect our own health. We'll do things if we're confronted with sufficiently visceral scenarios that really affect us on a fundamental level that we'll be kick-started into change.

    We now know that that doesn't happen. People, A, we make them smarter about their problem or they become a little bit more anxious about, oh, my God, now I'm worried that this is going to happen to me, but that is very short-lived. The net result for long-term behavior change is virtually nil. So, scaring people into change or threatening them with all the terrible consequences, that is a largely ineffective strategy.

    That principle, that scaring people into changing and it doesn't work, is a fairly robust finding across most health behaviors, whether you're talking about increasing condom use for safe sex to wearing seat belts, for texting and driving, for having a healthy diet, for exercising, whatever. I was going to say putting sunscreen on there, but I know that that's a little bit of a trigger point for you, Chris. Regardless, this is a fairly robust finding.

    Once these models started to be replaced by, okay, if we can't scare people, what would work? Well, maybe it is an education problem. If we want to change attitudes and beliefs, we want to make people smarter about their health. We want to teach them. This is health education. We also now from research and years of research and meta-analyses of studies about attitude change and education-based approaches, is that also doesn't work for changing behavior. What it does do it makes people a lot smarter about their health. Now they know probably a bit more about the whys and the hows, but it remains very much a mental, internal experience for them. It doesn't seem to translate very well into actual change. 

[0:10:00]

    This represents one of the fundamental findings in psychological research about wanting to do something or planning to do something and actually doing it, the motivation and commitment part. We often talk about this as the intention-behavior relationship. What that means is that when I intend to do something, so the statements like I will, I plan to, I'm going to, the relationship between those sorts of intentions and actual action, the correlation is about 0.2. If you know anything about statistics, a correlation of 0.2 is timing, so we know that just because people say they're going to, they want to, isn't enough to turn those intentions or good intentions into action. 

    So, knowledge deficits are also not the thing that we should be focusing on, in fact to the point where even some public health campaigners now, to say, educating customers and clients and patients is a luxury. Yes, we're going to make them smarter, but if we're trying to budge the needle on tangible things that you do for your health then education shouldn't be that high on the list in terms of things that we should be throwing money into and hoping that we can get people to change. 

    So, scaring people isn't really effective. We know that, obviously, reducing knowledge deficit isn't very effective. Surely there are some other things that we can do. That's really where we find ourselves now in terms of, okay, what are some of these newer insights? Some of them stem, again, they relate to understanding that we are primarily emotional decision-makers and so theories of rational thinking go out the window, as most of the theories are based on, knowledge deficit and scaring were based on, and so on.

    We're now at a point where, whatever, Windows 10 or whatever the latest operating system of your choice is, we're really saying that we have to take an approach that reflects the fact that we often do act against our own self-interest. The important point is one that's a fairly normal thing to do, because it's normal in the sense that it's again one of the most robust findings across cultures and context, but how can we leverage some of those weird biases and weird, irrational patterns of thinking so that we can ultimately do things that are in our own self-interest?

    This is that libertarian paternalism, I think, is the phrase that, well, I know you use that quite frequently, Chris. 

Christopher:    Yeah, you better explain it now. I think it's a fantastic term.

Simon:    You'll probably do a better job of explaining to -- the way I operationalize something like this is to say, listen, there is an element of autonomy-snatching directiveness when it comes to health. Don't keep doing that, it's not good for you. Do this instead. This is the paternalism part we do have, but really we want to reflect that people do want to make their own decisions. They want to have some self-agency in their process. People are free to die of diseases that they wish to desire or not do behaviors that are good for them. That's their choice.

    I think libertarian paternalism is really saying, listen, we've got a suite of things that we think are going to be helpful for you. We're not going to force you to do one or the other, but try to do one of these because these are things that are really going to be helpful for you, as opposed to the strategies that delay, procrastinate, that just increase your knowledge about something or whatever, whatever. That's where I see this as fitting.

Christopher:    Yeah, I thought libertarian paternalism is just a sensible default. It's paternalistic in that I think I know what's good for you, just like your mom thinks she knows what's good for you, but still you're going to have the freedom to choose. I'm going to choose a sensible default and then if you really want to exercise your free will then you can do so. You can choose whatever you want, but I'm just going to make the default a very sensible option.

Simon:    This ties into psychological needs theory. We've spoken about this in the past. One of my huge would-be campaign slogans if I'm ever going to go on the road to, say, behavioral science, should be from dead center in health, discussions about health, is that, listen, if you want to ultimately have people start things that are difficult, persist in them, keep going and enjoy the process to a certain extent, you have to support people's core psychological needs.

    One of those is their need for autonomy. This is the self-agency. I'm doing it because I said I'm going to do it or because I want to do it, not because someone else is telling me. It's not controlling. There's a sense of competence. I want to feel successful along the way. I want to feel as though I'm making some progress and mastering things. The third is relatedness, the ability to give and receive encouragement, love, liking and so on.

    Those three things really have to be embedded in all programs designed to change people's behavior, whether they are libertarian paternalistic or not. So, what you'll find is that when people drop out, they refuse, they push back against; it's often because one of those core psychological needs is not only not being met, it's probably actively being thwarted along the way, meaning, squished, marginalized, crushed or ignored.

Christopher:    I think the first few years of NBT and pretty much every podcast I've ever listened to is using education as the tool to create change, and we know that's not enough. I think that led to an existential crisis just after you joined us, Simon. Oh, shit, what have we been doing? We've just been educating people via the podcast and other media, thinking, oh, people are going to change their behavior the moment they find out about this stuff. That's pretty much what everyone else is doing too, but we know that's not enough. That's why I think that this work that you're doing is so important because knowledge doesn't necessarily translate into behavior change. That's exactly what we're seeing with our clients. Right?

[0:15:34]

Simon:    I think it's really important to emphasize that it's not enough versus it isn't important because one of the things that we know, the segment of the population, in behavioral science terms, we call them the precontemplators, again, a wonderfully, overly complicated -- 

Christopher:    These are the people that don't know they have a problem yet, right? 

Simon:    Well, they may know, but they don't care.

Christopher:    Oh, okay. 

Simon:    These are the proud couch potatoes. This, we think, is around a quarter of the population. Take any particular health behavior in mind, losing weight, stopping smoking, whatever, it's about a quarter of the population who either have no idea that it's damaging for them or they know that it's not very good for them, but they don't really care. They're going to do it anyway. These are the people that are hardest to reach because they're the ones that are going to see you but ignore you in terms of your messaging. 

    So, what we try and do, we know that pretty much the only thing that you can do for those people is start with knowledge, increasing knowledge. Education becomes the critical component or the key intervention component for nudging people from a precontemplative state to a contemplative one. In other words, I'm not asking you to change. I'm just asking you to think about what your life might be like without this thing that's currently -- you're dealing with or whatever. You're not asking other people to change at all. You're just simply asking them to contemplate or cogitate on what they're doing for their health. 

    

    Psychologists have found, they call it consciousness-raising which is basically making people smarter, have found that that is probably the best thing that you can do for those people. There might be some other strategies that now have come online when we have more online social communities, for example, the role of pester power. In other words, people are motivated to stop being precontemplators because they want the nagging to stop. That is negative reinforcement in behavioral science terms. So, they still don't want to do it, but now they've decided to do it just because someone is getting on at them so much.

    It could be because of a loved one, a family member is saying, "Come on, Dad or Mom, you can't smoke anymore and think about," blah-blah-blah. So, there is a strong role for education in those things, but once you get to the point where you're contemplating or you're preparing to change or you're actively changing, education slips way down the priority list of things you should be doing.

Christopher:    I think that's what we've got now. Yeah, I certainly wouldn't want to discount the education part is obviously very, very important. I'm not arguing against that. Rather I'm arguing for all the behavioral science that you are now teaching in your course. Of course, the education part is also important for forming a value system. 

    As you alluded to earlier, I think that the advice to apply sunscreen every time you go outside is possibly the worse medical advice ever. I think Tommy has done a really good job of explaining why that's the case. Now I'll link to his installment of the highlight series where he gave all the references on this. I'll resist the temptation to get into that now. Of course you have to have a value system before you start using the behavioral science. It's going to accelerate you in the wrong direction surely.

Simon:    Yeah, that's right. Ultimately there has to be some sort of North Star in your view, attitude at least about health. Then the strategies that you use to work towards that are hopefully consistent with your values as a human. We know, for example, that it's really difficult to try and get people to change their behavior if it's at odds, in some sense, with their value system.

    One example of this is we've been studying how to reduce obesity in Mexican-American families who live on the US-Mexico border where rates of diabetes, pre-diabetes and obesity are through the roof. When you focus on interventions there are family-based interventions, there are around food preparation and diet in general, but you ignore the culture and the role that food plays in the family. You're really on a path to ineffectiveness.

    So, unless you have strategies that tie-in with the role of certain behaviors in a culture and what it means and how, they're not going to be effective. So, yeah, absolutely, we have to have this identity-based or value-based goal direction system in place.

Christopher:    Talk about the new taxonomy of behavior change. Unix is here and it's not any of the things that we talked about up until now. There are new things that we know work better.

Simon:    Yeah, the behavior change taxonomy, even just that language came out of the behavioral science research community out of sheer frustration in fact. Because we look at all these intervention trials and they are doing things to people in an effort to get them to be more active, change their diets and so on. When we go and try and ask the eternal question, okay, rather than doing another study, what do the studies we already have tell us about what works and what doesn't?

[0:20:19]

    What the most frustrating finding was that we don't know because it's really hard. Because when people write academic papers that describe their trials, they don't do a very good job of describing what they did or how the intervention staff, the health coaches were educated or what they're actually doing in session to session and so on. It became a big mess. We couldn't actually start to build a little nice edifice out of the bricks of knowledge that were being thrown onto the pile.

    So, a group in London actually, headed by Professor Susan Michie from UCL, launched this international initiative among the behavioral science community to say, let's start to change the way that we describe and talk about behavioral intervention so that not just we're using the same terminology but when you come to write up your findings, they can be coded and tagged with things that were done in a fairly cost-effective, time-efficient manner. 

    That led to this, what they called the BCT Taxonomy, the Behavior Change Taxonomy, which is a collection of evidence-based behavior change techniques that have been used by researchers to try and get people to change their behavior. They even built a little app around it which describes -- there are 93 of them, 93 behavior change techniques that have been coded, operationally defined with examples to help us think about what works and what doesn't.

    When you go back over the research literature, you code for all of these 93 techniques and then you start to use those statistical meta-regressional techniques that were able to combine disparate findings with disparate effects and so on and, say, okay, what does this tell us about what's important? A few really important conclusions were drawn. One of those was that a family of techniques that come out of self-regulation which is the ability to say, okay, to think about what I'm doing and how so that I can act on change, seemed to be really important.

    For example, the most potent strategy -- the nice thing about this meta-regression is you can rank order the strategies by their potency which have the strongest influence on change. The top of the list was self-monitoring which is tracking. Even if I don't intervene on the tracking, I just ask you to record things or I have a gadget to record for you and then you look at how you're doing. I don't need to give you any more information other than that.

     That alone gives us a nice little bump in behavior change because the human mind has a tendency to say, when confronted with data about one's self, our first question that we ask ourselves is, what does this mean? The second question we ask, well is that any good? Those softwired or probably hardwired, inquisitive parts of reason lead us to use and leverage or act on information given about us, about our self-tracking. That's really important.

    The next few techniques that seem to be really critical are around setting goals, having, what we call, implementation intentions, which is again a terrible way of describing something that's quite simple, that's saying, okay, once I now know I have a goal, tell me how and when you're going to implement this. If I say I want to exercise for 30 minutes every other day, what days in particular are you going to do this? Are you going to start on Tuesday? What time? Thursday at what times? You're actually getting into the if and then statements about it.

    Then providing some level of review or goal autopsies. Okay, you've tried this. It didn't work or it did work. Let's figure out why and then do we need to adapt and change the way that we attempted that to change based on this new information? Those core self-regulation skills seem to be fairly critical and consistently bubble up to the surface for pretty much any behavior change problem that you've got. Those, I think, should always be from dead center.

Christopher:    Do you think that self-monitoring can ever backfire on you? I know there has been a lot of push back on the sleep trackers recently. Do you think it can ever backfire? Is it context-specific? Do we need to know when it's appropriate to self-monitor?

Simon:    Yeah, I think it's not just context-specific. It's probably person-specific as well, like temperament and personality-specific. At what point, for example, if thinking or over-analyzing a problem or a health complaint is going to actively get in the way of you reducing that complaint or finding a solution. 

    So, if you have a tendency, for example, if you don't sleep very well and one of the reasons that you say that you don't sleep very well is because you're engaged in a lot of either nocturnal rumination which is the plight we're saying, worrying at night, waking up having these disastrous thoughts to everything is going terribly, or you just have trouble switching off at night as you're lying there trying to go to sleep. 

 

[0:25:02]

    Obviously, the more that you focus on tracking and analyzing, you're going to probably force people to go into their own heads even more about the problem which probably will make the problem worse. So, undoubtedly, there are some behaviors, and for some people, where self-monitoring, if done excessively, may actually be getting in the way of the solution.

Christopher:    Let's talk about the science of self-control. Most people will know this as willpower. Working with clients, I've seen this. It wasn't until I met you and I'd read some of your book recommendations that I started to understand what was going on here and that willpower is a limited resource. Can you talk about the way that willpower works?

Simon:    The whole topic is somewhat, contentious is probably the wrong word. We don't have enough scientific evidence to really know for sure what's happening and how willpower works. Maybe that's the better way to put it. One of the studies that started this all was this marshmallow study. I'm not sure if you're familiar with that.

Christopher:    Yeah, of course, it's one of those studies that's in every single book that I read. What is that?

Simon:    I know. The notion that somehow if I can resist a short-term payoff, a temptation for some longer term gain then somehow that ability to be able to resist a temptation should serve me quite well in terms of things that I do for my health. The corollary there is fairly obvious is that if you have cravings for sugar, for smoking or for alcohol or even a craving to just sit on your ass and not exercise, then how do I overcome those? What do I do in the moment to be able to do that? Is there anything about what's happening on a neurological level and brain world that helps me understand why I find this so difficult?

    One of the key psychologists, a guy called Roy Baumeister who wrote quite a good book called, Willpower, on this, books called Willpower, and one of the concepts is this notion of ego-depletion as a way that we think about willpower. The metaphor here -- sometimes I'm a little bit reluctant to use metaphors because they do oversimplify the problem. 

    In this sense, if we take the metaphor of your willpower muscle, a part of your brain that is primarily control -- or regulating impulse control and generally not giving into temptation, we know that it is a little bit like a bank account. When it's full of money, when it's full of resources, to be able to resist is not that difficult. When certain things deplete that bank account quite quickly, if we're spending money from the willpower bank account, our ability to resist temptation becomes impaired. One of those things is as simple as the time of day. 

    The moment we get up out of bed, our willpower, in terms of when we look at the extent to which we are ego-depleted, seems to be at its greatest. It declines almost precipitously throughout the day. There are some biological hypotheses about why that is but suffice to say, it fits in with what most people can relate to, is that if I say first thing in the morning, "I'm going to put something off that I don't want to do at the moment, but I'm going to put it off until the end of the day or near the end of the day," the likelihood of you actually doing it at the end of the day is pretty slim. This is certainly true of exercise.

    Again, there are some explanations about why that might be but suffice to say, is that if you want to do difficult things, do them first or early on. This doesn't just apply to the rather obvious one of get some exercise out the way as early and as quickly as you can versus leaving it until we get home from work. It also means things like, okay, when am I most likely to be tempted to make bad food choices or to give into a cigarette craving or temptation? I know that the witching hour might be between 4 to 9 pm, for example. I've had a stressful day at work. I've had to make a lot of decisions during the day.

    We know that one of the biggest contributors of giving you willpower fatigue or driving down that ego-depletion is not just time of day. It's the number of decisions that you've had to make. The reason is that every time that you make a decision, at some point you are repressing a level of emotion. Because emotions are things that we get to drive us to get to make decisions. Most decisions we make in life have two sides to it. There's a pro and a con side. 

    When we eventually choose what we think is the right course of action in that moment, something is taking a hit or suffering because of it. It could be an internal emotion about guilt or frustration. It could be something that's very tangible. Either way, that having to constantly manage the emotional pull and push of making decisions has an effect of diminishing our willpower or our self-control. You put those two things together. You've got near the end of the day and I've had a long stressful day or I've had to make tons of decisions or do a lot of mental, heavy intellectual heavy lifting, boom, I'm going to be probably pretty receptive to giving into temptations or craving them. 

[0:30:00]

    One of the findings from some of this research was that well maybe you can store up willpower by not making decisions. If I have a day where I'm just on my own, I can do whatever I want, my time is my own, I don't have any sense of obligation, I can do whatever I want when I want; and for some people, they do have, luckily enough, they do have days like that. Most of us, even on the weekends, we still have some level of imposed control over what we can and can't do. 

    Suffice to say that weekends, generally we have less ego depletion. We have less willpower diminishing. So, Monday morning might be a great time where we have most willpower. It has been saved up over the weekend if we haven't been working. We haven't had to make many decisions. It's early in the day. So, you're primed almost to make some really good decisions then.

    You take the opposite of that, Friday afternoon or Friday evening, where probably, and this is a hypothesis I would have here, is that we're most vulnerable to making really crappy decisions about our health. So that's some of the science.

Christopher:    Yeah, I think that will resonate with people. All the bad decisions happen after 7 pm. That's when the Haagen-Dasz ice cream comes out. That's when the booze comes out. That's when Netflix gets going. It's all the things that you probably know are not going help you meet your health and performance goals, but they all happen at the end of the day. I think another thing that would resonate with my listeners is the idea that willpower can be strengthened like a muscle. I think that's true, isn't it?

Simon:    Some of the science suggest it is. Some of the other studies suggest we haven't been able to replicate that or we don't know. The view I take on much of this research is to say, okay, what are the consequences of doing nothing or ignoring this, the fact that I could be in effect there? Well, they're usually pretty slim or inert. There's no danger or harm in trying to improve my willpower. There's not like we're exposing ourselves to these terrible circumstances that may actually hurt us in the long run.

    One of the principles of being able to train your willpower is to try and do things that actually tax it and then try and act against your temptations. Does that make sense? It might be, for example, that you create a little experiment for yourself and you are deliberately taxing the part of your brain, the frontal cortex where you're making decisions, you're planning, you're thinking. You're trying to pre-fatigue your willpower muscle, you can do that metaphor, and then you try and stick with the behavior change rather than just leave it to circumstance.

    You're actually now trying to deliberately and perhaps even overloading your intellectual fatigue and then you're trying to do the actual behavior itself. You're actually building that into your routine. Now it doesn't feel very nice in the moment. In fact it feels awful because you're making it even harder to resist. What we think might be happening is that some parts of our brain might be physically changing in response to being in that environment, the parts of our brain that are connected or at least we think are related to willpower.

    One of those, for example, is called the anterior cingulate cortex. Its role is in error detection. It's really recognizing when something doesn't match what I see versus what's happening. One of the ways that we test for this is called the Stroop test. I don't know if you've ever heard of that. The Stroop test is when you're presented a series of words that are written, words describing colors, the word blue, the word red.

Christopher:    Oh, yes, I know that.

Simon:    But that word red is actually colored in blue. You have to say the color of the word not the word. It's forcing our anterior cingulate cortex to go into overdrive to figure out what's wrong here and what the solution is. Meaning, what is the actual color of the word that's being described? So, by doing stuff like that, little cognitive tests, imposing a cognitive load prior to having a tempting situation is probably going to help your ability to overcome that in the future.

    In fact athletes are now using this and in fact some of these techniques were described quite beautifully in the book Endure by Alex Hutchinson, one of my favorite books, where athletes are saying, "Actually if I want to be able to harden up mentally, in other words, not quit when I'm really suffering or I'm in the hurt locker; one of the things I can do using this model is to say how can I pre-fatigue my cognitive abilities or preload them by doing a Sudoku puzzle or a crossword or something, like doing some math before I get on the bike for my intervals?" 

    One of the quirky findings is that, particularly when it comes to things like the anterior cingulate cortex, is this part of our brain not only seems to be implicated in willpower but seems to also be implicated in processing effort-related cues, so discomfort, physical discomfort is processed in part by this part of our brain. Social discomfort, social distress, having an argument, having financial worries, having things that are on your mind are also in part processed by the anterior cingulate cortex.

[0:35:01]

    Now you've got this one structure that's really playing, both, helping, tell you how something feels physically but also how the emotional toll or burden or stress something is for you, some event, some circumstance. This is why, for example, athletes -- most people can relate to this.

    If you are really emotionally gassed, you're taxed, you're exhausted, stressful at work, had to make lots of decisions, got tons of ego depletion and then you try and go and do a physical act, an exercise, the effort feels harder. The perceived exertion of those sessions is higher, and there's research evidence to document this.

    The reason they think is because the same part of your brain, that bank account has been writing checks to cope with and deal with the social discomfort. Now it's having to write checks for the physical discomfort and guess what. Some of those checks are going to start bouncing.

    So, if I somehow ratchet up the cognitive load before or while I'm exercising, maybe that will improve my ability to tolerate physical discomfort because of parts of our brain adapt. They get stronger. They get denser. They physically change. Neural connections strengthen in response to those environments. That's one of the hypotheses anyway.

Christopher:    Before we leave this topic, I wanted to ask if you had an opinion about that marshmallow experiment. I've seen some articles that describe a problem with the experiment that was they didn't control for socioeconomic status. In fact the famous marshmallow experiment was just a poverty test. Do you have any thoughts about that?

Simon:    I do. I get a little smirk about those sorts of critiques, I mean, a smug smirk because I think that they're probably true. These experiments that were done in the '50s and '60s were not just an understanding of methodologies, and analyses capacity were often driving how we did studies, so it was a lot harder to do more sophisticated studies back then.

    Yes, is that a potentially fatal flaw in the marshmallow experiment is the fact that those kids that were able to resist the marshmallow really weren't food insecure. They had free access to other things that were rewarding on a regular basis. Versus someone who perhaps doesn't have that, and I'm rather now seeing it as a test of willpower, see as a chance for food because I'm hungry.

    So, yes, I don't know where the truth lies in that. That experiment has been attempted to be replicated unsuccessfully. Also there have been some more recent studies in the last 12 months that have shown that, well, there might be something because we have part replicated it. I don't think we know for sure. 

    As a general rule, I would be cautious about leveraging any solution or strategy on the back of a single study anyway. I try and always look at the combined, the cumulative wealth of evidence that we have that points towards this might be something that we need to explore.

Christopher:    There may be another way out of this willpower problem, and that is the formation of a habit. Wouldn't you agree? Either I can use high order reasoning and willpower in order to get this health behavior or training goal done, or I can just make it a habit.

Simon:    Exactly, and so I think this really leads us into what does work and how, if I'm trying to change. Because clearly willpower, no matter how much willpower you have, you're able to train it and be a ninja temptation-resister, eventually it won't be enough. It's exhausting as well. It's constantly having to fight back against temptations or do things that are really difficult or challenging. This is really a nice way where the tiny habits or the small steps approach takes over. Maybe if we make the thing that we're trying to do much smaller and we build a system that supports us doing that, maybe we don't need that much willpower. 

Christopher:    Well, let's talk about this SEEDS method that you've been using with our clients that I've been very impressed with. I just wish I had your skills. The way that you could get people to get it done is quite extraordinary. I'm so glad that you're teaching some of these methods. One of them is the SEEDS strategy. Can you talk about SEEDS?

Simon:    It's a very simple concept, is that for most people the pillars of good health can be distilled down into a series of domains like exercise and diet and stress management. The SEEDS is simply an acronym for those things; sleep, exercise, eating, drinking and stress management.

    The reason that I use the SEEDS analogy, not just because it's a cute little acronym, but it's because the metaphor of what we're actually doing behaviorally, we're trying to take each of these domains in turn, trying to plant a tiny behavior change that we can do that edges us closer towards what we want to be able to do in that particular domain, in sleep, in diet and exercise.

    We try and create a system in place that helps us cumulate these tiny little changes so they add up into a much bigger goal or much bigger change. This is really where the behavioral science of habit formation and making tiny, tiny changes really kicks in.

[0:40:03]

    There has been some really wonderful research and self-books based on much of this research have been written. A few of my favorites, one is written by a guy called James Clear called Atomic Habits. It's really a must-have for any health coach but especially folks who have struggled with changing their behavior which is most of us. 

    Most of our histories are littered with failed attempts to stick with a diet, to stick with an exercise regime and so on. Some of these resources give us some great little insight in how to do that, and that's really what the SEEDS process or protocol is really based on.

Christopher:    Can you walk me through the process then? Perhaps we need to get specifics. We start with the sleep pillar since it comes first. Can you talk about what might be an appropriate tiny seed for someone that's looking to improve their sleep to plant?

Simon:    The first goal is the way that I think of SEEDS is for each of those domains, sleep is a good example, is to try and think of three things that you could do that are small that you can start to incorporate into your daily routine. Why three? Well there's nothing magical about three.

    We do know that many of these little habits or these little changes, they fit together like jigsaw pieces. Some of them, if you're able to do -- for example, if you're able to really turn your phone off at 7 pm or leave it outside of the room, we know, for example, that reducing your exposure to blue light and probably being less likely to ruminate or stay up is going to be improved. The next thing that we do once we know that you're free of technology after 7 pm is easier to implement another tiny seed and so on.

    We can habit-stack or we can build up a series of these tiny little seeds over time. I always recommend starting, trying to identify three and then prioritizing one of those as the one that you're going to start with. This is something that you'd be doing on a daily basis that works towards improving the outcome of, for example, getting better sleep. 

    So, I would say, you start off with a small behavior. How small? One of my recommendations, and others have said this too, is that if you can do that thing, the behavior, in under two minutes, it's probably small enough. If it takes you longer than two minutes, it's probably too big.,This is where we're now saying, well how much willpower does it take? 

    The SEEDS approach is not for these grandiose, big gestures of sweeping huge change. We're talking about tiny little things, things that can be done in a very short period of time, even when it comes to things like exercise. If you have a history of not being able to walk or not being to do any aerobic exercise then make two minutes your target of doing something.

    People are, silly, that's not going to affect my health. That's not going to have much long-term benefit to me. The important point here is not about two minutes, per se. It's about the system that you're building to get these tiny, little marginal gains that will gradually build up, like the analogy of building a wall out of a pile of bricks, so that you're actually going towards a sustainable model that you've folded into your routine one tiny step at a time.

Christopher:    Is it not overwhelming for people? You said there were five pillars and then you're going to define three tiny things that you could do to contribute to that pillar, for each. Now you've got a total of 15 things that you need to think of. Is that not overwhelming for people

Simon:    For many people it is. The logic behind this is, first of all, let's have a road map of where we're trying to get to, initially. Ultimately I'd like to be able to be living my life where I'm doing these 15 things that are helping my health in a truly holistic way across multiple domains. That's what I'm trying to get to.

    The first thing, however, might be to say, okay, there are 15 things, but that's too overwhelming. So, I'm going to take the top one. I'm going to prioritize them. Turning my phone off at 7 pm might be the number one thing that I'm going to focus on in sleep. In exercise, it could be I'm going to simply try and walk around the block. It might take me slightly longer than two minutes, but I'm going to do that after dinner or before dinner or what have you, so, a tiny little thing.

    You start off with what you think that you can handle or manage. As a nice little starting point, and this goes for any self-monitoring, self-regulation strategy, is always do less than you want to. Anyone who has ever kept a journal knows this. Whenever you start keeping a gratitude journal, a journal for the first time, we write pages and pages our first night and then we realize that this isn't very sustainable. After the end of a week, we've stopped doing anything at all or stopped writing anything at all.

    The logic here is let's not try and do too much too soon. If it takes longer than two minutes, find something else or break it down. If you feel you want to do more or you can do more, don't. Force yourself to stick to these little tiny habits. We're trying to build a system that's sustainable rather than have these big grandiose gestures early on that will probably not persist over time.

Christopher:    Talk about your choice of drinking as a pillar. I'm not the first person to find that somewhat curious. I think maybe the listeners will find that curious as well. How can drinking be a pillar of health?

[0:45:03]

Simon:    Drinking really refers to liquids that we put in our mouth. There are plenty of really reasonable health goals around liquids that we put in our mouth, ranging from how much water we should be drinking during the day, to how much alcohol we should or shouldn't be consuming. Most people, to believe the public health data, probably could do with drinking a little bit less alcohol and drinking a little bit more water.

    There are two drinking-related goals that most people can somehow connect to or find as something to action on. Obviously as well, it fits in -- I should say that the SEEDS concept started because I spoke to many clients in NBT, and one of the overwhelming themes that they wanted help with was to cut down the amount they drink. It doesn't mean that they necessarily were objectively drinking excessively. They had perceived, they had recognized that they wanted to drink less than they currently are, alcohol-wise, so it became a de facto seed.

    Then it said it isn't just about reducing alcohol consumption because many people don't drink, or they don't have a problem with drinking, or they don't want to reduce their drinking at all. Then it's about their water consumption, the timing and the volume and so on. So, it was really about liquids.

Christopher:    Yeah, I think that was a very good observation of yours to spot that. I never really picked up on it, and I was somewhat surprised. Maybe me questioning the idea of drinking as a pillar of health is just revealing that I don't really understand our clients quite as well as I should.

    Another one which I've definitely been called out by is caffeine. I think I've lost count of the number of clients that I've worked with who'll get six months into the program, and we've uncovered literally every rock that you could think of that could be worsening somebody's sleep. 

    At the sixth month mark, they'll come back to you and say, "You know what, I did this little experiment by myself where I just stopped drinking coffee altogether and then sure enough, my sleep is perfect." You may have done some important work elsewhere but really the elephant in the room was caffeine. I wonder whether that might fall into the drinking pillar as well.

Simon:    Absolutely, it does. Of course there are lots of -- we also consume caffeine in solids as well but certainly, caffeinated beverages, that's a great example of a seed of drinking that we could operationalize and turn into a little tiny two-minute habit.

Christopher:    Talk about your traffic light system. It's a natural extension of this SEEDS Journal. You have a traffic light system. Can you talk about that?

Simon:    Yeah, so it comes out of some of the stress management research literature that tells us that when people struggle to maintain healthy habits, instead of just -- because when life gets in the way, family and work and sickness and travel and a whole bunch of stuff, it just stops us from being able to keep all of our health plates spinning at once.

    Rather than humans making these very perfectly rational decisions, oh, today just is a day that I won't be able to continue. I'll just pick up tomorrow, and everything will be fine. Now what usually happens is people don't do that. They have a tendency to engage in catastrophic thinking when people relapse, and catastrophic thinking takes the form of catastrophizing or awfulizing change. Everything is ruined. I've worked so hard for this. 

    Instead of just climbing back on when the barrier or the obstacle or the stressor removes, they end up actually doing quite the opposite and saying, well, if I'm off my diet, I might as well go all in and really go to town with XYZ, whatever the thing of choice is that person is stuck trying to keep planning. People have a tendency to engage in all or nothing thinking when things don't go according to plan.

    So, the traffic light system is an attempt to remedy that. Really it's about teaching setback and relapse skills, so one of the ideas is that, okay, we've got 15 of these little seeds. We hopefully can get to a point where we're doing all 15. Again, if they're taking two minutes, remember that's only 30 minutes per day of behavior change. We're not talking hours and hours I'm having to invest in this, and if they become automated and part of your routine, they don't even feel like you've had to add on an extra task to your day.

    

    So, what we're trying to do is to say, well, when you're in a green light moment, everything is cooking on gas, everything is fine, work stress is manageable, family life ticking along, I'm going to travel, I'm not sick, I can do all of these things and things are great. These are green light moments.

    When we enter into an amber light phase, which is now something is rushed up. The kids, they're on their summer break, so they're home more, so I have to modify my life, balance a bit more now. Or that I have to travel for work so I can't stick with my CrossFit class. I'm going to be in a hotel for three days or I'm having to entertain clients at restaurants, so I can't always have healthy choices or something.

    Rather than trying to say, oh, screw it, because I'm off the plan, I've broken that rule, I might as well go in; is to say, okay, well what version of this 15 little seed pod can I actually sustain under these new circumstances? What we say to people is that, okay, now let's try and prioritize, of those 15, if you could only do five or ten of them, which would they be? Which would you be willing to say, you know what, I'm going to let that go because it's just an added stress. I'm worrying that I can't. I don't want to feel guilty that I can't do all these things when things go well.

[0:50:11]

    I'm just now, instead of focusing on some aspects of my diet, I'm really going to make sure that I still get all of my big sleep SEEDS in place. Or exercise, great, I would usually do this many times per week, but now I'm going cut back when I'm in one of those amber moments. So, you think about your life in terms of, most of us have fairly routinized or habitual life so that we know there are times of the year or even the month when things are easier or harder to do.

    Then the next step along is what we call a red light period which is where really things are now -- the example here is if you're an accountant and it's tax reason, you might even literally be sleeping in the office or working 12, 14-hour days or all of your attempts to eat well or sleep properly have gone out of the window. So, which of those 15 seeds am I saying, you know what, my health is so important, I'm never going to give those up. I might only be out of focus on five of them or three of them, and I'm always going to do those.

    What you're doing is you're really thinking, you're pre-planning how to change your behavior according to external circumstances, to stresses in your life. This fits really nicely with what we know about the stress management and the coping literature, is that you have to have some psychological and behavioral flexibility when things get difficult, to avoid the tendency to think in catastrophic or nothing terms.

 

Christopher:    I can definitely relate to that. I hesitate to draw myself as an example for reasons we've discussed on the podcast earlier, Simon. I was away traveling last week and was staying in an Airbnb. Like most places you stay in, the lighting set up is far from optimal, shall we say. It's like an underground basement with only one window that's at the door and then the lights are all these 200-watt halogen spotlight things that are just everywhere. There's no way that I'm going to be able to light this place at night in any way that's not going to disrupt circadian rhythm.

    I also know that getting bright light first thing in the morning is going to be super important in the absence of normal light cues and in the absence of normal food timing, for me. I'm eating a bit later. I'm going to be exposed to a ton of artificial light at night. 

    The thing that's under my control is going outside first thing in the morning. Especially with the kids, I could put blue-blocking glasses on and that would work, but my sleep is only as good as the kids sleep. That's within my control. I can take the kids outside first thing in the morning while we're away traveling, and I know that everything is probably going to be all right.

    It actually was all right but in the past, years ago, that would have been an utter catastrophe. I would have thrown my toys out the pram and I don't know what have done. I might have done what you just said actually. I'll say, fuck it then, I'm just going to have pizza. 

Simon:    Exactly. It's giving us permission to not be always great at adulting. It's giving us permission to say, occasionally, life is going to get in the way. I won't be able to do all these things for my health. You know what? That's okay. I've got a plan in place for when those moments come.

    So, you're preemptively removing the tendency to catastrophize or giving yourself permission, and you've got some strategies in place for coping with life's shit balls it throws at you. Again the emphasis here is that when it comes to changing our behavior, the problem isn't usually you. It's the system that you're using.

    The system, if you want to ultimately get a handle on long-lasting change, you have to build a system that's sustainable and that it's fairly simple and easy to do. Meaning, it's folded into your overall lifestyle or routine rather than this thing that you have to tag on because that is not the way, as we found by personal experience and also some of the research, that's not the most effective way to go about it.

Christopher:    Speaking of systems, I'm a software guy. When I saw that PDF handout that you've been giving to our clients and had been getting great results for them, I thought, hmm, this is interesting. This looks like a piece of software that I could create. That is exactly what I've done. You can find the software that I've built over at seedsjournal.net, and that is an implementation of this SEEDS exercise that Simon has been using with our clients.

    There's an important piece that we didn't talk about here, and that's the ability to record your progress with these tiny health habits. Can you talk about why that might be important, Simon?

Simon:    Yeah. This really comes back to that cornerstone of changing behavior which is some self-monitoring with some feedback. When you're able to breakdown your change challenge into these tiny little things, we call them SEEDS, but then I also want to have some way of quantifying. Am I doing it? What parts, what behaviors, which of my SEEDS do I consistently fail at, or so on.

    Having a little tally of them is a really helpful strategy. Again, the tally, when I use with clients, I don't think of a tally as a feedback as you would like getting a report card from a teacher. You're waiting to have your wrist slapped that you only managed six of them out of the 15. The goal always with trying to provide some quantifiable feedback is to say, how am I doing, what things need to be modified?

[0:55:23]

    Because if you're consistently not able to do a good proportion of them, the system is letting you down, not you. So, what is it about the system? Are the things that you've chosen as your SEEDS too lofty, too big? You don't have the ability or the skills or the finances to actually do them or so on. So, we can diagnose where the problems are, but only once we know which or we're able to quantify what you're currently struggling with consistently.

Christopher:    Which is why I’m very excited to announce the SEEDS challenge that will take place for four days starting Sunday July the 7th. I’ve already been onto the NBT forum and I have the support of several of our coaches and graduates of our Elite Performance Program. These wonderful people will lead breakout groups on Zoom where we’ll talk about how to choose tiny habits to create better health and performance. If you're interested in joining the challenge, head over to seedsjournal.net and sign up there. Now if you're interested in digging into the science of behavior change and if you're a health coach or have aspirations of becoming a health coach, I would suggest that understanding some of the science of behavior change is going to be perhaps the most important asset that you have.

    Simon has just produced a brand new training course. Simon, can you tell us a little bit about the training course?

Simon:    Yeah, so the course is designed primarily for people who are agents of change themselves. They're health coaches. They might be patient educators. They might be nurses, health care professionals or even family members who are trying to help someone that they love, change.

    Of course they also apply to individuals. They might not be a health coach, but they have interest in what the latest science is telling them and some strategies they can use along the way. So, depending on which hat that you're wearing, it does work for both, but it is geared primarily towards people who are trying to help others change.

    The course, a fairly short two to three hours of instruction. It's available on a website called teachable.com. The course, I think Chris will maybe post a link to where to find the course, but it's really a combination of, one, what does the latest evidence say in behavioral science about how people make decisions? How does this impact directly real tangible decisions I'm making about my health? When I say that, I'm saying, okay, we might now know about the science of behavioral economics, but how does that translate into me changing? Well, the SEEDS method is one such direct actionable thing that we can do that's built on the behavioral science. 

    So, I'll review the science, provide some tangible strategies that most people will probably not be familiar with because they're all fairly recent findings and research to show -- even for health coaches because most health coaching curricula were designed probably with a five to ten-year window in mind, and they certainly don't reflect most of the science that's happening in the last few years. So, there's probably something available that's new or novel for most people who are interested in the science of health behavior change.

Christopher:    It was fantastic. I really enjoyed the course. Simon didn't give it to me. I paid full price on this, and it was worth every penny. I'm amazed at the range of prices that you see for training courses. It's quite extraordinary. The amount of work that goes into all of them is more than I could possibly imagine, I'm sure. This one is particularly cheap for how much value it delivers. So, yeah, I'd like to thank you for that, Simon. It has been great. 

Simon:    As you know, in behavior change, you can't be in it for the money. I think creating some tools that are affordable and skills-affordable and also reflect the current science. There's a real gap in health care education and also just general client patient consumer education. Much of it we can see as, I hate to use the word hack because I know that we frequently talk about what that means to people, but it's really an attempt to say, how do I leverage some of the newer science to help me finally get a handle on things that I've struggled with for years and years? This course is designed, in part, to address that gap.

Christopher:    Yeah, and the software that I created is a way for me to implement what you're teaching. I'm just tired of acquiring knowledge from books or courses or PubMed or wherever else, and I'm thinking, that's super interesting. Two weeks later I've totally forgotten it, and I've not done anything with it. I'm constantly thinking, what is the implementation intention? How am I going to use this on Monday morning? For me, to systematize this stuff means to write code. This is the application that we're going to use in order to implement some of these ideas.

Simon:    I think one of the things that we're trying to do with SEEDS is to give people what good or useful SEEDS are, so you're not always having to think yourself about what they are. We're trying to provide ultimately a menu of things that you can do, of tiny little two-minute actions that you can take to improve your sleep.

    Again this reminds me of a great little quote that I think James Clear talked about a lot, is that you've got to remember, if we focus only on intentions or goals or what we're trying to accomplish, and we can go down rabbit holes of how to SMART, measurable, achievable, realistic, the SMART goal acronym; but you've got to remember, in the sport analogy, winners and losers have the same goals. Or self-changes, people who suck at it and people who eventually end up doing it successfully have the same goals. 

[1:00:24]

    That's not the problem. What we're trying to do is to reduce the serious case of survivorship bias that's prevalent in that statement, is to say, okay, here are some simple tools to help you enact or implement this goal. So, goal-setting itself is not the place to start and finish.

Christopher:    I'm really excited to get people into this challenge and then have a conversation with both the coaches and the people who are struggling to make these health behaviors happen and find out, what are the tiny health behaviors that are most effective? What are the things that people are getting done? What are the things that people are struggling the most with? Can we start collecting a data set that will help inform people in the future that are going along this same path?

Simon:    The implications of this are quite profound in the sense that if my health can be fundamentally redirected in a positive way by me doing tiny little things that I probably might have dismissed as irrelevant or not going to really make much of a difference, what if we could actually turn the tides of many of the things that we struggle with for years by simply doing a series of tiny, tiny things? That alone as a proposition is really quite -- I find that quite remarkable and motivating.

Christopher:    That's fantastic. Thank you, Simon, I really appreciate you. The training course is called Nudge Tactics for Health Coaching. I will of course link to that in the show notes for this episode that you can find over at nourishbalancethrive.com/podcast. Or if you poke around inside of your podcast app, press a little info button somewhere, you'll find all the notes for this podcast. I will of course link to the training course there and the SEEDS Journal where you can sign-up and join our challenge.

    Simon, is there anything else that you'd want people to know about?

Simon:    I think that's quite a lot to cover, so I think that should itself be a SEED.

Christopher:    That's right, yeah. Perhaps this interview is just a jumping off point. I should follow up with you and dive into some of these areas more deeply. I was torn. You covered so much material in the training course. I'm like, which of the bits we could talk about on the podcast? How much depth could we go into? The answer is we can't really cover everything. We definitely can't go into very much depth. So, perhaps this is just the first of a series of interviews, and perhaps we'll get some more ideas as people go through the challenge and you get more feedback from people who are completing the training course.

Simon:    Absolutely, that will be great. Obviously it's best when the directions that we take or things we talk about are directed and led by real challenges and real problems that people are having who are out in the wild. They're my favorite kind of discussion items.

Christopher:    Absolutely. That's great. Thank you, Simon.

Simon:    Thank you.

[1:02:56]    End of Audio

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