Habits – Friends and Foes

I was lucky to attend this year’s annual meeting of the Consortium of MS Centers, held in late May in New Orleans. There were a lot of interesting talks, and you can read about highlights here, browse slide presentations here and summaries (abstracts) here.
One presentation that really hit home for me was a talk about habits by Gabe Byars, an occupational therapist from the Salt Lake Community College in Utah. Habits are behaviors we do without having to think too much about them -- like walking into the house and always putting our keys in the same spot. Gabe said that habits make up about 43 percent of our daily actions. That sounds like a lot of time -- maybe that is where the saying “we are creatures of habit” comes from.

A couple of weeks ago, I was driving to work in Baltimore. I was almost halfway there before I realized I wasn’t supposed to go to work – I was planning to drive to the grocery store! That shows how strongly habits affect our every move, and can be positive or negative, good or bad. Habits can be good because they free up our brains for other tasks. But habits can also get in the way of positive changes in our behaviors (and not to mention the occasional missteps while we are on autopilot).
People with MS often consult with me for rehabilitation to address a particular problem, such as tripping. In these cases, physical therapy, or specific stretches, exercises, or the use of an ankle brace are needed. This means to get maximal benefit from the rehabilitation plan, the individual has to find a way to comfortably fit new routines into daily life.

It takes a conscious choice to remember to exercise, to exercise using the proper form and intensity, to remember to put the ankle brace on, and to adjust it the right way so it feels comfortable. That’s a lot of deliberate thought, and it takes extra energy for anyone, let alone someone who is likely dealing with MS fatigue. That’s why it’s important to continually do these new behaviors consistently so they become habits that are part of the daily routine.
Neuroscientists are still working out the details of the tug of war in our brains: the interplay between automatic habits and deliberate actions. Ingrained habits involve complex brain chemistry and wiring, so it’s no wonder that, according to Gabe, the average time it takes to form a new habit is 66 days!  Wait, I’m not saying this to dishearten anyone! Every day we have the ability to change our habits and strive to be healthier. Some tips I give my patients, and that I practice myself when I’m trying to change a habit, include:
  • Don’t be afraid to use reminders – in my family sometimes we use sticky notes on the refrigerator, or set up a reminder message in my cell phone.
  • Repetition helps to make the action automatic and less effortful.
  • Engaging in the habit at the same time and place and in the same way – often called “each time, every time.”
  • Exercise in the morning, before challenges of the day prevent you from carrying out your plans.
There is a lot of deliberate thinking involved in changing our routines. It’s hard, but it’s also rewarding. Eventually, the payback is that your optimized daily habits provide you with extra energy to do the things you enjoy.
Yes, we are creatures of habit. But the good news is that with work, we can retrain ourselves to improve our ability to adjust and cope with the ever-changing challenges of MS.
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Kathleen Zackowski

Dr. Kathleen Zackowski has conducted research on rehabilitation approaches for MS and other disorders for more than 15 years. She just joined the Society’s research team as senior director of patient management, care and rehabilitation research after working as a clinician and researcher at the Kennedy Krieger Institute and Johns Hopkins University School of Medicine. She is working to grow the Society’s research focused on clinical care and rehabilitation, and wellness strategies.