Behavioral Health Tools
Despite the best of intentions, many of us develop lifestyle habits that over time can erode our health and potentially lead to medical as well as emotional problems. Well-known healthy behaviors that have been repeatedly linked to improved health and increased lifespan include 1) not smoking, 2) exercising regularly, 3) avoiding or limiting alcohol use, 4) getting 7 or more hours of sleep, and 5) maintaining a healthy weight. However, these behaviors are easier to list than to follow: according to a recent CDC report (2013), only 6% of Americans report following all five of these healthy habits; only 35% engage in even three of these behaviors consistently.
Many have noticed a frustrating feature of these healthy behaviors: if we get off track for one of the healthy behaviors, we tend to find it harder to continue or begin the others. For example, feeling overwhelmed and stressed by work leads some people to sleep poorly, which can make it more difficult to get up and exercise in the morning, or have the energy to exercise in the evening. It also makes us more likely to buy low-effort but high-calorie foods rather than preparing meals that help keep us at a healthy weight. Former smokers may find themselves starting up their smoking habit again when stressed, and after doing so, it becomes all the more difficult to return to healthier habits. Once started, simple behavioral intertia can result in a person becoming sedentary, gaining weight, sleeping poorly, drinking more alcohol, and in some cases, smoking.
Other healthy behaviors can also fall by the wayside when we are stressed by the demands work or family. These include regular social interactions with friends and family; engaging in activities that are meaningful or enjoyable; moderating caffeine; and effectively managing stress.
Smoking Cessation
By far the most powerful health-enhancing behavior is for smokers to stop smoking. This is often quite difficult, and the majority of those who try to quit end up returning to smoking after their first attempt. In fact, the average number of attempts at quitting smoking before permanent success is five. The good news is that each attempt at quitting smoking provides more information about what helps and what gets in the way of quitting, and helps smokers become more successful each time, until they are finally done with smoking for good. For those who are smokers, nothing is more important to avoiding serious medical problems and a shortened lifespan than quitting smoking. If discouraged by previous failures, try the attitude of getting through the failures quickly to reach the point where one finally becomes a permanent non-smoker.
Regular Exercise
The benefits of regular cardiovascular exercise are so wide-ranging and powerful that it is nearly impossible to overstate them. For nonsmokers, regular exercise has the most impact on health. However, many people find it difficult to start or persist in regular exercise. Some blame a busy lifestyle, where exercise is the first thing to be pushed off the schedule. Others feel too tired to get up and run 5 miles, and so instead go online, watch tv, or do any number of sedentary activities. Those who are out of shape, overweight, or both, often avoid starting exercise because they dread the huffing and puffing, the rapid fatigue, and perhaps the anticipation that others may look down on them for appearing overweight or out of shape. These are all examples of avoidance behaviors—letting the short-term discomfort of starting to exercise stand in the way of enjoying the long-term benefits of regular exercise. Fortunately, one of the marvels of the human machine is how quickly it responds to exercise. After starting out with even a brief, moderately paced walking routine, most people quickly find that they are able to go further the next day, at a quicker pace, and that they feel more energized after doing so. Because the first 2-4 days of starting an exercise habit tends to be the most difficult, a great strategy is to try to commit seriously to exercising on those first 4 days no matter what—rain or shine, whether tired, unmotivated, stressed, or discouraged. Committing oneself to simply putting on exercise shoes, making it to the door, and then stepping outside, can create a behavioral momentum that overcomes the inertia of remaining sedentary. For most people, after the first few days of beginning the exercise routine, they have much less difficulty getting started, and begin to look forward to it, feeling energized and more positive during and after the exercise.
In addition to improvements in cardiovascular fitness, weight management, and muscle tone, regular exercise has been identified as one of the most important factors in maintaining memory functioning and preventing dementia. Regular exercise has also been shown to increase serotonin levels, which improves mood so effectively that regular exercise is a scientifically supported treatment for depression, as effective as antidepressant medication or psychotherapy.
It bears repeating: for nonsmokers, starting or continuing with regular cardiovascular exercise is the single most powerful activity for improving overall physical and emotional well-being..
Moderating Alcohol
The consequences of excessive drinking are well-known and include life-threatening illness such as cirrhosis, high blood pressure, and increased risk of cancer. In addition, alcohol is implicated in many physical injuries through motor vehicle accidents, physical aggression, and accidental falls. Guidelines from medical associations range from advising using no alcohol to drinking no more than 1 drink per day for women, and no more than 2 drinks per day for men. Regularly drinking more than these amounts has been associated with numerous medical, psychological, and interpersonal problems, and the more alcohol consumed, the greater the number and severity of problems.
For those who have had alcohol-related problems, such as blackouts, fights, alcohol-related arrests, or impaired work performance, seeking professional help is the best next step to take on the road to improved health. For those who are unsure about whether their drinking is problematic, simply recording the number of drinks consumed is a useful way of gathering information. If the number is higher than recommended guidelines, it could be worth noting when and where the excessive drinking occurs, and developing strategies to either avoid those situations, or to make a plan in advance for limiting alcohol intake. For example, intentionally planning to drink a glass of water before and after an alcoholic drink lengthens the amount of time without alcohol, making it easier to keep alcohol intake lower. If it is difficult to keep alcohol intake below recommended guidelines, speaking with your physician or a mental health professional may be useful.
Adequate Sleep
Busy people may treat sleep as a low priority, but there can be physical, cognitive, and emotional consequences from insufficient sleep that may reduce one’s effectiveness. People who frequently sleep less than 7 hours per night are at increased risk for infectious diseases, including colds and influenza. While it may make you feel productive to stay up late or get up early to complete more work, being sick for days or weeks with cold or flu can more than offset the extra hour or two of late-night work. In the long run, work productivity is stronger and steadier in those who engage in focused work through the day, but then switch off and ensure they get to bed in time for 7-8 hours of sleep. Research has also shown repeatedly that much of our memory consolidation occurs during sleep, and that memory performance is significantly worse when sleep is interrupted or too brief. So, staying up late reading for work may result in poorer memory for what was read, making those extra hours less efficient. Similarly, concentration and learning abilities are significantly worse when we don’t get enough sleep, making each hour of the work day less efficient and less productive. And finally, it is well known that sleep-deprived people are more irritable, and may be prone to dysphoric or even depressed moods, all of which affect quality of life, interpersonal relationships, and work productivity.
To achieve the important goal of getting 7-8 hours of sleep most nights, one helpful approach is to establish a sleep routine. Set a specific time to be in bed, based on when you need to wake up, to allow 7-8 hours of sleep. Develop a brief, simple, and regular routine that is followed each night before bed, such as making tomorrow’s lunch, laying out clothes, and brushing teeth. For those who tend to be restless or worriers at bedtime, a meditation or relaxation exercise may be a useful part of the routine.
Some have difficulty going to bed on time because they feel the need to unwind by watching movies, going online, reading, or playing video games, and feel that they will be depriving themselves if they go to bed too early. It may be useful to make a list of the advantages and disadvantages of staying up late for fun, and the advantages and disadvantages of going to bed on schedule. This often helps make clear that the long-term benefits of refreshing sleep outweigh the short-term enjoyment of watching yet another cat video on Youtube, and enhances resolve to get into bed on time.
Taking steps to sleep 7-8 hours per night consistently will repay the effort in the long run through less frequent illnesses, greater cognitive abilities, and better emotional status.
Social Engagement
When busy, stressed, or in a low mood, many are tempted to skip social activities. However, research has demonstrated repeatedly that regular interactions with friends and family helps to maintain both physical health and emotional health. Regular interactions with others can provide enjoyment, a sense of social support and engagement, and emotional support when distressed. Those who prioritize work may decline social invitations and skip family gatherings; but as with failing to get enough sleep, the emotional and physical consequences of being socially disengaged, such as depression and stress-related illness, can interfere with work productivity in the long-run, negating the extra hours put into work instead of socializing. Making a conscious decision to widen and deepen relationships with family, friends, and co-workers can improve not only physical and emotional, health, but also one’s quality of life.
Stress Management
People differ substantially in their responses to life stressors. Some feel overwhelmed and distressed, become less effective, and begin to have physical stress responses including elevated blood pressure and insomnia. In such cases, there are many brief and simple techniques for maintaining physical and emotional health in the face of stress. These are described more fully on the Stress Management article on this site. The main targets of stress management techniques include reducing physical responses to stress, through such techniques as guided relaxation, modifying unhelpful stress-related thoughts through techniques such as cognitive reappraisal, and coming up with an effective response to stressful situations through problem-solving techniques.
Mindfulness Techniques
Mindfulness involves intentionally and non-judgmentally paying attention to the present moment as it unfolds. When engaged in a mindful state, the worries, anxieties, and lists of tasks to be completed are experienced from a neutral, observer perspective, similar to watching clouds as they drift by. In practicing mindfulness, one allows experiences to unfold, whether pleasant or negative, desired or painful. Doing so undermines such habits as feeling resentful or disappointed that things are not better than they actually are, or guilty or defective because of one’s abilities or characteristics. Many practice mindfulness meditation as a way of incorporating mindfulness principles, and practicing mindfulness meditation has been shown to improve both emotional and physical health. More resources on mindfulness can be found here.
Yoga
Regular yoga practice has been shown to improve fitness, reduce stress, and improve emotional well-being. Whether attending yoga classes or practicing on your own time at home using a yoga video, making the choice to schedule time to practice yoga can result in noticeable improvements in physical and emotional well-being.
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