If you have been into a book store either virtually or online recently, you may have come across the book ‘Atomic Habits’ by James Clear. I recently read this book, and many of the techniques and practices described in the book relate well with helping patients manage their pain.
A habit is a routine or behavior that is performed regularly and automatically. When performed regularly, these habits can compound on each other, creating incredible results.
The key to creating incredible results is to regularly perform good habits. And the way to do that is by using the following system: cue, craving, response and reward. This system can help make habits easier and more automatic to perform. Having a good system is important because:
Step 1: Cue
Cue is the trigger that causes you to act and initiate a behavior. Our brains are programmed to seek out actions that will result in a reward. We are constantly scanning our environment looking for cues or signals that will lead us to rewards such as more food, water, power, status, recognition and approval. If your phone is left close to your bedside, you are more likely to pick it up to check Instagram. A cue can also be leaving your vitamins beside your toothbrush as a reminder to take them in the morning.
Step 2: Craving
Most behaviors are generally not pleasant to do, however associating them with something that is pleasurable can make the habit more attractive to perform. For example, if you are a coffee lover, and are planning on going for a walk in the morning, you can associate that with a warm cup of coffee at the end of the walk. This association will help you stick to your habit and give you something pleasurable to look forward to as a reward upon completion.
Step 3: Response
This step is the actual habit that is performed, which can be a thought or an action. Whether an actual habit is performed depends on how much effort is involved, and how much willpower there is on behalf of the doer. This is where techniques such as simplifying the habit, setting up the right cues, and making it easy will determine if a habit is performed or not.
Step 4: Reward
Rewards are the goals of every habit. The cue helps us notice the reward, the craving makes us want the reward, the response helps us attain the reward, and the reward itself is what we are seeking. For example food and water help give us energy, working out helps to make us stronger, and getting a promotion helps us attain a higher salary and respect. Rewards can also help teach us which actions to continue doing and which to avoid.
In summary, a cue can trigger a craving which can trigger a response that leads to a reward, which itself can be associated with a cue. This positive feedback loop can help build strong habits (or bad ones) depending on how this loop is used.
Now to relate this back to pain: a patient suffering from a back injury can have pain. Pain is the cue, the craving is the desire to get better. The response is the exercise or stretch program the Chiropractor provided, and the reward is the reduction in pain symptoms. Feeling better helps facilitate the cue, so the next time the patient is in pain, there is a higher chance they will perform the stretch or exercise routine.
Unfortunately, once a patient feels better and the pain is resolved, the cue to perform the exercises is no longer present. This is why most patients will stop exercising or stretching once they feel better.
I would highly recommend reading this book. It is a quick and easy read, with tips on how to implement these techniques right away.