Friday, February 25, 2011

From Weight Loss to the Treatment of Depression: The Importance of Understanding "Rate of Change"

Of the many factors that influence change, one's expectation or understanding of how change occurs is significant among them. People can vary considerably in their understanding of how change occurs - specifically, rate of change. Rate of change can be defined as the speed and consistency of improvement when trying to eliminate a problem. For example, if you are trying to lose weight, there are different patterns of change. You might:



(a) lose 2 pounds each week consistently over a period of two months (a total weight loss of 16 pounds), or

(b) you might lose 5 pounds the first week, 6 pounds the second week, gain 3 pounds the third week, then gradually lose 8 pounds over the remaining 5 weeks (a total weight loss of 16 pounds).

Both paths to weight loss netted the same end result - a loss of 16 pounds. However, the paths themselves looked very different. Each path has the potential to carry different psychological consequences. In essence, some paths may be more conducive to failing than others because of the unique psychological challenges associates with them.

In the example given above, the first path to weight loss was consistent and at a moderate rate of speed. This type of change is linear, meaning it is fairly even and consistent across time. Linear change is shown in the following figure:


Conversely, the second path to change was nonlinear -- there was improvement, followed by a "failure," followed by a return to improvement. Psychologically, this path is different from the first because there is some adversity (a setback) along the way. The increase in weight following week three can be interpreted in different ways. One person might think "This is just a bump in the road - I'll keep moving forward." However, another person might think "This is evidence that I cannot do it." There are a variety of factors that determine an individual's interpretation of setbacks. For example, what if someone has failed to lose weight several times in the past? This might make the setback more intense and potent.

The path to change for many people involves peaks and valleys. The problem is that when you're in a valley, it can be hard to see the progress to come ahead, as well as lose sight of the gains that are now behind you. The following figure represents the path of change for many people:


In this figure, although there are a number of valleys, the overall trend is positive improvement. This is easy to see when all is said and done - in other words, when you get to see the entire picture of change at once. Unfortunately, such a neat and clear graph is not available when in a valley, which can leave people seeing only the "trees" and not the "forest."

When you find yourself in a valley along the path of change, it is important to recognize that it is a normal part of the process. Indeed, it is probably unhealthy to embark on any major health change with the expectation that change will be linear. Holding such an expectation increases the likelihood of failure. Setbacks are probably the norm and should be seen as a challenge - not proof of imminent failure.

The example I used here is that of weight loss. However, the same issues and principles apply to other health problems involving change - such as depression, anxiety or chronic pain management. In fact, depression research has revealed that for some people, their depression gets worse before significant improvement is realized. Dr. Adele Hayes, a psychologist who researches change in psychotherapy, refers to this as a "depression spike." The following figure shows this path of change:


In this figure, the person became worse while in treatment before they improved. If someone experiencing a depression spike interpreted their experience as representing a failure, instead of seeing it as part of a larger process, they might be tempted to quit therapy out of a sense of hopelessness.

One of the interesting findings on change in general (psychological; political; biological), is that periods of challenging stress and turmoil are often needed as a precursor to significant change(1). Think of the uprising that is currently ongoing in Egypt. In order for change of that magnitude to unfold, there needed to be significant stress to the existing system, which then demanded that a reorganization follow. The same process works in humans as well - when something that is very stressful or aversive happens to us, it may require that we change or reorganize something about ourselves (ex: beliefs; behaviours) in order to adapt to the stress. For example, imagine you are someone who is naive and overly trusting in relationships. A serious break-up or betrayal might be helpful in the long run if it allows you to develop a more realistic set of beliefs toward people and relationships.

Although the prevailing mentality in North America is that happiness is partly defined by the absence of stress, it is probably more accurate to conceive of stress and negative emotions as being a necessary part of growing and becoming a stronger and happier person.

References

(1) Hayes et al. (2007) Change is not always linear: The study of nonlinear and discontinuous patterns of change in psychotherapy. Clinical Psychology Review, 27, 715-723.

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