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Evidence Based

This article is based on scientific evidence, written by experts and fact checked by experts.

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This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.

Using the Psychology of Behavior Change to Create Healthy Habits

Written by Dr. Ruscio on March 15, 2023

Written by Dr. Ruscio on March 15, 2023 — Reviewed by Aimee Gallo

Dr. Michael Ruscio is a DC, Naturopathic Practitioner, researcher, and clinician. He serves as an Adjunct Professor at the University of Bridgeport and has published numerous papers in scientific journals as well as the book Healthy Gut, Healthy You. He also founded the Ruscio Institute of Functional Health, where he helps patients with a wide range of GI conditions and serves as the Head of Research.

Behavior change isn’t easy, but there are ways to set yourself up for success

• The Basics: Healthy Habits|
• Newer Concepts in Developing Healthier Habits|
• How to Start Developing Healthy Habits|
• What Does the Evidence Say?|
• Healthy Habits: A Team Sport|

It’s never too late to start developing healthy habits. The challenges arise when it comes to long-term shifts in how you prioritize your health and well-being that lead to permanent lifestyle change. “Exercise more, eat less,” or “sleep more, stress less” are all well and good, but the how is where a lot of health professionals fall short.

I’ll venture to say that we all know most of this stuff, right? So the question of how is a lot more relevant than the what. And the how may surprise you. No matter what your circumstances, no individual is truly an island. Your environment, your social circumstances, and your state of mind are all far more important factors than you think when it comes to actually taking real measures to develop good habits and improve your health.

For the sake of providing a thorough and responsible answer to the question of “how do I develop healthy habits?”, I will run through some basic examples of what that looks like and the why, but the meat of this article will be all about setting yourself up for success: how you can shift your mindset, how to be mindful of your inputs, and how to find support to make lasting change.

And lastly, I will go over the parts of this process to beware of: those that can create shame due to the socially conditioned pressures that we as a society (and especially many people in health care) can perpetuate, even if we all mean well. I assure you that anyone can start making changes at any point in life. Here’s how.

The Basics: Healthy Habits

The what of healthy habits are a lot of the things many of us learned in high school health class. These are the lifestyle pieces that cover the physical inputs and outputs of our bodies to help them run properly and function well. These include:

• Move more and sit less to avoid many chronic diseases. Try to elevate your heart rate with different forms of activity every day [1].
• Work your muscles to keep your bones and muscles healthy and stay strong, flexible, and independent (needing less help from others) as you age [1].
• Eat nutrient-dense food to satisfy your hunger and lower your risk of heart disease, type 2 diabetes, and some forms of cancer [1].
• As you age and your metabolism changes, eat more wisely and move more to avoid muscle loss and excessive weight gain [1].
• Avoid stressors like smoking, excessive drinking, and high-stress situations to have a better quality of life, avoid chronic diseases, and live longer [1].
• Take measures to ensure adequate quality and quantity of sleep. Sleep is a huge factor in many facets of health, including gut health. 
• Consider adding mindfulness meditation into your daily routine to support mental health and reduce emotional stress.
• Maintain a healthy weight to avoid chronic diseases related to excessive weight and improve your self-esteem [2].*
• Quit smoking to improve your brain, hearing, vision, dental health, skin, heart and blood health, lung health, cancer risk, blood sugar, diabetes risk, fertility, sexual function, immune system, muscles, and bones [3].

You’ve likely heard all of this advice before, but understanding the why can sometimes be the first step in a mindset shift that makes the how feel more achievable. The why is multifactorial, and much is self-explanatory from this list, but let’s quickly break down a few of these bullet points.

*The conversation around healthy weight, weight loss, and obesity is a fraught one. While it’s true that certain chronic diseases are associated with certain forms of excessive body weight, body fat in and of itself is not necessarily unhealthy.

Middle body weight (visceral fat) that takes the form of a more “apple” shape or a “beer belly” is a dangerous form of body fat that’s associated with cardiovascular disease, metabolic syndrome, and type II diabetes. This type of fat can occur in an individual of any size. In fact, there’s an acronym TOFI (thin outside, fat inside) that refers to those individuals who do not present as overweight but still exhibit the chronic diseases I just mentioned [4].

The reverse is also true. Extra weight on the arms and legs or rear end don’t have the same negative health associations. There are plenty of healthy people who would be categorized as obese who don’t show any signs of chronic disease.

Healthy Diet: The Why

Nutritious foods provide the macro- and micronutrients your body needs to perform basic functions. Macronutrients are carbohydrates, fats, and protein, and micronutrients are things like vitamins, minerals, and antioxidants. Fiber from carbohydrates feeds the good bacteria in your gut to help boost your immune system and support all the systems of your body. Protein helps you build muscle, and fats provide fuel and the building blocks for important constituents of the body like hormones. The micronutrients support every cell in your body in metabolic function, healthy cell turnover, and much more.

Drugs and Alcohol: The Why

Controlling alcohol and drug consumption is not only important for reducing the likelihood of disease and addiction, but it’s also important for maintaining impulse control. In addition to damaging your liver and kidneys, excessive alcohol reduces your inhibition, adds extra empty calories to your daily intake on its own, and can be the excuse for excessive late-night snacking, which almost always consists of unhealthy foods. 

Alcohol and drugs also disrupt your sleep, and getting enough sleep (and good quality) is essential not only for healthy functioning, but for healthy decision-making. Good sleep and proper gut function are also linked, and a healthy gut is key to metabolic health, mental health, immune health, cardiovascular health, and hormonal health.

Exercise: The Why

You can really start small with this one. The American Heart Association credits a simple daily walk with reducing the risk for heart disease, stroke, diabetes, and several cancers. It can improve blood sugar/insulin response, blood pressure, and cholesterol levels.

Moving every day is also linked to improved mental health and brain function. It helps reduce anxiety and can actually help improve your overall sense of purpose, which has been linked to a healthy lifestyle [5]. Exercise also improves your gut microbiota, which has innumerable health benefits.

Sleep: The Why

Proper sleep is key for nearly every healthy function of the body. We can survive with poor quality sleep, but we certainly won’t thrive. During sleep, your body performs healthy cell turnover, your brain organizes and stores memories, processes the day’s experiences, and sets your up for success the next day [6, 7]. Research has shown that we need at least seven hours of sleep every night for appropriate cognitive function, learning, and behavior [6].

Sleep is also critical for metabolism regulation, detoxification, and immune system function [6, 8]. 

Mindfulness: The Why

Mindfulness meditation is a practice that can increase your awareness and presence throughout the day. In literal terms, a practice is preparation for a future event. So by setting aside even five to ten minutes a day to practice mindfulness through a simple meditation that brings awareness to various parts of your body, to your relationship with the world around you, and that encourages simple noticing without judgment can massively impact the way you interface with the world. 

The mind-body connection is a well-documented physiological and psychological phenomenon. It’s a feedback loop in which your body and your mind affect each other on a two-way street. So the more you nourish your mind and mental health, the better off you’ll be when it comes to physical health—and vice versa.

Overall Healthy Lifestyle: The Why

Developing healthy habits around eating healthy amounts of nutritious foods, exercising your heart and muscles, keeping your weight healthy, reducing stress, sleeping enough, and moderating or eliminating your use of substances has been linked to having a greater sense of purpose in life [5]. A 2020 observational study evaluating this concept and association found the differences between each group to be statistically significant. In other words, those who adopted the most healthy habits had a greater sense of purpose in life [5]. 

Having a sense of purpose and meaning in life isn’t just a “nice to have” idea. On the contrary, it’s directly connected to a reduction in all-cause mortality rates [9]. A sense of purpose doesn’t just make your life better. It makes your better life longer.

Newer Concepts in Developing Healthier Habits

There are a few ideas around healthy lifestyle habits you may not have learned in health class. These concepts might seem less obvious than the nuts and bolts of physical health, but they’re actually the bridge between the old way of thinking (calories in, calories out) and the new way of approaching healthy living. They are the building blocks to actual long-term behavior change (the how) because they are helping you shift your inputs. The how will flow from here.

• Limiting screen time [10].
• Staying connected (in real life) [11, 12].

Of course, there are physical benefits in addition to the mindset shifts that come with these changes. Limiting screen time reduces a sedentary lifestyle, and staying connected to supportive people helps reduce depression risk as well as chronic disease risk, such as cardiovascular disease, type 2 diabetes, and cancers [10, 11, 12].

But this is just the beginning. The ills of spending tons of time on the internet and social media are vast, especially when it results in comparing yourself and your life to those depicted there. Whether you’re looking at celebrity lifestyle, fitness influencers, traveling bloggers, or even the best knitter you’ve ever seen, aspiration can turn to discouragement and a hit on your self-esteem shockingly quickly.

Contrary to what the Metaverse may proclaim, it’s also true that excessive screen time and social media addiction can create a sense of isolation and dejection rather than connection and meaning. Surface-level interactions through a screen with strangers doesn’t necessarily accomplish the same sense of belonging, purpose, and community that it does IRL. This isn’t always the case, but staying connected to those who know you, support you, and even love you can make all the difference when it comes to setting up a sustainable structure to support your behavior change efforts.

How to Start Developing Healthy Habits

Question to ponder: do healthy people make healthy choices, or do the healthy choices lead to a healthy person?

This proverbial “chicken and egg” question is at the root of what will actually create lasting behavior change when it comes to sticking to healthy eating habits, committing to an exercise routine, setting reasonable goals, and finding queues to trigger positive activities. The answer to the question isn’t so simple—it’s both, and. It completely depends on the individual and the circumstances of that individual, but that doesn’t mean that this is just a thought exercise, and nothing useful can come of it.

In some cases, when a person starts exercising, she realizes she feels better in her body (more energy, better sleep, better digestion, etc), and it motivates her to keep going (healthy choices >> healthy person). Conversely, sometimes a person is so bogged down (emotionally, mentally, or even due to life’s circumstances) that the prospect of even starting to change doesn’t feel attainable (an unhealthy person can’t make a healthy choice).

In the second example, this person’s mindset and life circumstances stood in the way of making any positive changes. Sometimes it’s low self-esteem stopping us. Sometimes it’s the sense that the challenge is insurmountable. Sometimes it’s a failure to focus on the useful and productive goal (see my comments about weight loss above).

Recognizing your own mental and emotional state is a huge piece of understanding what kind of help you’ll need when it comes to creating lasting healthy changes in your life. Oftentimes it can mean hiring a coach, finding a friend who’s on the same path to be an accountability partner, or asking for support from a loved one in a capacity that enables you to make time for your goals. That could be babysitting, helping you re-organize a space in your house for exercise, or even just being a good listener.

For those who don’t have an accountability partner and need ways to hold themselves accountable, there’s habit stacking/habit pairing. This model helps you stay consistent by pairing a new habit with an existing one you’re already great at. For example, you brush your  teeth every day, so if you use that as a trigger to remind yourself that you have a daily meditation goal, you can “stack” meditation onto that already established habit. As soon as you rinse out your mouth, you head to your meditation mat and set the timer for 5 minutes of meditation.

Use Episodic Future Thinking to Set SMART Goals

Whether you choose to employ a wellness coach or want to work on goal-setting on your own, using the SMART goal method can really help you break down big goals into smaller things that feel doable in a sustainable way. Episodic Future Thinking (EFT) consists of asking yourself to vividly imagine your future and how it changes if you choose the healthy option over the unhealthy option [13].  

For example, if your doctor has told you your cholesterol is too high, a goal of “I want to lower my cholesterol” is a starting place for EFT. It’s a big, general goal with no action steps. Start with a visualization (this is the EFT part). Imagine the future you feeling amazing as you age, continuing to do the things you want to do without having to take cholesterol medication or worrying about heart disease. This visualization provides your target, but now you need the bow and arrow to help you aim for it. That’s where SMART goals come in.

SMART goals are:

1. Specific
2. Measurable
3. Achievable
4. Relevant
5. Time-bound

The larger goal of lowering cholesterol involves all the healthy behaviors I listed in the first section of this article, but trying to make all those changes at once is super overwhelming and might feel impossible. So we’ll pick one to start with. Let’s play this out, starting broad and narrowing in until we can create a SMART goal.

I want to lower my cholesterol, and the first thing in my life I’d like to change is my diet. I want to eat more veggies and stop late-night snacking.

How will I add more veggies in? I have to buy them, prep them, cook them, and eat them. What does my schedule look like to be able to do that?

I will plan my meals on Sunday night after dinner. I will go grocery shopping on Monday after work and get veggies for the week’s meals. I know I have plans on Tuesday and Wednesday, Monday night, I will cook at least three meals worth of vegetables so that I’m prepared, and I’ll make the rest on Thursday after work.

How will I stop late-night snacking? I have to have an alternative activity to snacking. What will that activity be? Is it realistic?

Oftentimes, thirst is mistaken for hunger, so I will buy a delicious herbal tea or bone broth to drink when I’m craving a late-night snack. I will keep these items visible in my kitchen to remind me to choose these things first. This way, I’ll get some nutrients in and rehydrate to assess whether I was hungry, thirsty, or bored.

How will I hold myself accountable? Visualizing the healthy future I want and prioritizing future me over the immediate gratification of the present me when it’s time to make a decision about snacking will help hold me accountable (EFT).

I will set calendar reminders on my phone for meal planning, grocery shopping, and meal prep each week so that those things are prioritized as commitments to myself. I will also keep a food journal that chronicles each meal, including what happens at night when I crave a late-night snack (SMART).

What Does the Evidence Say?

Research is still young when it comes to understanding how most people can effectively change their habits over the long term. Some things work for some but not others, and it’s hard to pin down what we should all aim for [14]. What we know for sure is that lasting behavior change is hard, and we don’t all respond to the rewards the same way. 

If behavior change weren’t hard, we’d all be in perfect health and making only healthy choices every day of our lives. But life happens. Stress happens. Stress can affect sleep and mood, and it can also affect the way our bodies deal with calories—how they’re stored, how well we metabolize them, etc. Having healthy practices for stress management, including mindfulness and a sense of awareness around your own challenges, is a key ingredient to maximizing your chances of developing and sticking to a new habit.

When a healthy mindset is paired with a supportive community and a good understanding of SMART goals, you can really start to make strides in the right direction.

The scientific evidence suggests that if you want to replace old habits with healthier ones, you increase your odds of success by incorporating these tools:

• Self-regulation through Episodic Future Thinking (EFT) [13, 14, 15, 16]. 
• React to and cope with stress differently by learning to recognize and accept physical and mental experiences of fear and anxiety; that can help make healthier decisions in moments of stress or anxiety [14, 17, 18].
• Get social support by asking someone you love and trust to make a habit change with you or at least support you in making it happen (14, 19, 20).

Healthy Habits: A Team Sport

I really hope this discussion of healthy habits has allowed you to begin the shift in mindset necessary not only to take the first step, but to see your new habits through. The development of new habits requires not only personal responsibility, but finding and setting up structural support and accountability within your own community of friends, loved ones, and allies. Getting more hours of sleep, increasing physical activity, replacing bad habits with good ones, stocking healthy foods in your refrigerator—all of these things are building blocks to a healthier lifestyle (the what).

But the foundational support of those around you, getting off your phone, finding a coach or accountability partner, and asking for help are the hows when it comes to creating lasting change. It’s about a shift in mindset and awareness, the conscious interruption of old patterns, and the sense of purpose that can all be self-reinforcing when it’s time for the rubber to meet the road.

We’re here to help. Reach out to our clinic to book a time with us. We’d love to go over your health goals with you and provide the support you need to formulate an achievable set of goals and a plan of action.

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