Maggie McKay (Host): Welcome to Total Health Talks, your Cook County Health podcast, where we empower your journey to better health. I'm your host, Maggie McKay. And today, we're going to talk with Dr. Bethany Rosner, clinical psychologist, about lifestyle goals. Thank you so much for being here. It's great to see you and I can't wait to hear more about this.

Bethany Rosner, PsyD: Thank you so much for having me.

Host: Absolutely. So, let's just start with when is the best time to commit to lifestyle changes? Can you explain why and if there's a better time of year to start?

Bethany Rosner, PsyD: The best time to start is when we're feeling motivated. It's a really important thing to ask ourselves is when motivation is happening for us. Some of the things we can think about are ways that we want to make changes, the daydreams we're having about things we wish we were doing, what activities we've always wanted to try. It's important to take note of those things and then explore them a little bit further.

Host: And can you explain why it's so easy to fail to keep New Year's resolutions or even Monday resolutions? I got nine days in to the year and broke it already. Nine days, doctor.

Bethany Rosner, PsyD: That's a great question. I often say I'm not a fan of New Year's resolutions. Not that wanting a clean slate is a bad idea, but it can lead to something that we call unhelpful thinking. Our brains are so complex and capable, yet they can be really simplistic. We take in a lot of information, our brains try and make sense of it really quickly, and it can lead to flawed thinking.

One of these examples of unhelpful thinking styles is called all-or-nothing thinking. It's like seeing things as either a success or a failure. So when I have January 1st coming up and I see it as a clean slate, that's great. I might feel hopeful and engaged. But then, January 3rd comes and I had to work late or I felt sick, and then I don't make it to the gym and I have the thought of, "Hmm, maybe I should wait until 2026." This is a perfect example of all-or-nothing thinking. It makes us uncomfortable not being able to label our behaviors in simple terms. And that is something that we often face when it comes to the start of the year.

Host: I usually don't do resolutions. And I don't think I will after this year, but how can people reframe commitments so they stick to it?

Bethany Rosner, PsyD: Yeah. One of the things that I have found to be most helpful in working with my patients is doing something that we call SMART goals. It's an acronym for how we set up goals. SMART goals, the acronym can be different, but the variation that I really like is where S stands for specific. So, we want to make sure that the actions we're going to take are really, really laid out and detailed, right? We want to know what we're going to be doing, when we're doing it, where we're doing it, who we're doing it with. So instead of saying, "I want to spend more time with my kids." The specific version of that could be, "I will take my kids to the park on Saturday and play baseball." We're much more likely to move forward if it's a specific plan.

The M is meaningful. The hope is that your goal is going to be very meaningful to you. So, it has to matter to you, we're more likely to stick with it. A stands for attainable. Make sure that we can achieve this goal. Avoid overly complicated goal setting. We have so much social media coming in and telling us get the most complex workout machines and supplements and all these things, and we're so much less likely to do it if it is this complex oversaturating experience.

Relevant means pick something relevant and something that is a goal within reach. And then, time-based, we want to set really clear time, whether it's with the start date and the end date. This way, it also keeps you to doing just one thing at a time, and it allows you to kind of know when you can check it off and say, "This is something I've been able to do and now I can move on to my next goal."

Host: So, how do you stay motivated when the challenges arise? Like, let's say you gave up ice cream and you're going to a birthday party and they have it. How can people overcome willpower fatigue? Is this common in your line of work? Do you see this a lot?

Bethany Rosner, PsyD: It is really, really common, and it's a really tricky issue. I see patients getting stuck in that all-or-nothing thinking as I had mentioned, which can lead to these really negative self interactions. So back to that January 3rd example, if you don't go to the gym, you may engage in something we call negative self-talk. You say to yourself, "I knew I wouldn't follow through," or "I can't believe how weak I am," or I've had some patients who will be very adamant that bullying themselves into pushing through is going to be the way to do it. And it's just not. It's not going to last in the long term. So, I always like to encourage some self compassion.

One of the examples I think of is imagine you're talking to a small child, and they tell you, "I can't go out to play, I feel sick." Hopefully, right, we're not going to say, "You're so lazy. I can't believe you." We're going to be able to address what they're going through, and then game plan around it. This is also allowing us to be a little bit more flexible with our goals. If you don't make it to the gym, and you're meeting yourself with compassion, can we then explore what it looks like to take a walk instead, right? It's a little bit more of an adaptive approach, and it also doesn't create such a burnout that we can feel when we're constantly beating ourselves up.

Host: And why is change so hard? How can you have fun while making a difficult change?

Bethany Rosner, PsyD: Change is hard for a lot of reasons, and sometimes they're personal. I think we share a lot of those challenges, right? So, it could be a busy life, busy work schedule, taking care of children. All these things can be really tough, especially when our goals are taking up time or energy that we feel really spread thin with already.

So, we want to make things a little bit more exciting by creating rewards. Rewards are things that we often use for children. We use them for pets. They're incredibly effective, and yet we often don't use them for ourselves. So, creating some form of reward for yourself that you get immediately after the activity that you do, something that is not going to go against your goal, right? If you're trying to save money, don't reward yourself with a shopping spree, but doing something immediately afterwards, like using a special candle or lotion or spending time with a friend afterwards, those are all really meaningful ways that you can increase fun in some of these more challenging changes.

Host: And there are a lot of stats out there about how many times you need to do something to form a habit, maybe 30 times or a month, whatnot. What are your thoughts about that?

Bethany Rosner, PsyD: This is a question I often get from patients who want to make changes. We do form habits over time, like brushing teeth, right? Those are things that we don't think about as much when we're doing them, it's kind of automatic. Unfortunately, the number of days vary greatly depending on the person or the activity that we're trying to make a habit.

And I encourage patients to not focus on the habit. Because when we're doing activity and really hoping it becomes autopilot, we've all probably skipped brushing our teeth, right? There are times where even when we are so used to doing something, if we step back and lose that intentional thinking, we're more likely to lose the habit even in and of itself. So, I really encourage people to continue with the behavior over time and catch when they're falling away from it rather than hoping there's one day that autopilot's gonna happen.

Host: In terms of holding yourself accountable, Dr. Rosner, is it better to put it out there in the world that you're trying to achieve a certain goal? Which is the better way to go, keep it to yourself or share?

Bethany Rosner, PsyD: I think of social media in this example because I think a lot of people will post when they want to make changes happen. For example, someone who's trying to quit smoking. They may really benefit from posting on social media. People in the comments are cheering them on or they're sharing their own experience of trying to quit smoking, and I think that can be a really beneficial experience.

What I see less of is when people are struggling with meeting those goals, right? Sometimes we go inward, we don't share that stuff, especially on social media. So in a perfect world, if someone's comfortable going and putting it out there, also have someone that you feel like is a good support system. Someone that you feel like you can go to for the success, but also the times that you're struggling. And if you don't want to put it out there, I don't blame you. Making sure that you have some support, even if it's one person that can be your cheerleader, I think that's a route that can be really effective in making changes.

Host: Right. I always tell my best friend because you know they're never going to judge you. Maybe my husband, but... What type of services are available at Cook County Health to support someone with their lifestyle goals?

Bethany Rosner, PsyD: There are so many great resources at Cook County Health. The primary care doctors are happy to discuss any of these types of changes. And I often encourage it, going back to some of the SMART goal elements, making sure that, especially if it's health related, you're using your medical team to build that support, making sure that the changes you want to make are going to be healthy and keeping you in mind. We have registered dietitians, social workers, psychologists. We're all really well versed in helping people make changes.

Host: So in closing, give us three or four or five tips that people can take away to make their resolution stick.

Bethany Rosner, PsyD: Some of the themes of what I've already talked a little bit about and what I really like to stress to patients are making sure we're doing those SMART goals, those specific, meaningful, attainable, realistic, and time-based goals. We want to keep things simple. I think simple is probably the thing I say the most when talking about this. We get so excited sometimes and burn ourselves out really quickly, so making sure we move slow.

Self compassion, as I've mentioned before. Progress is not linear. We like to think it's up and up and up and up and that's it. But we go backward and then we have to recalibrate. So, making sure that you give yourself grace when that shows up and that allows you to return to your goals a little bit faster as well.

One of the last pieces that I think can be really helpful for people is creating something that I talk about with patients quite often called routine disruptors. So, back to those automatic behaviors. Sometimes we are leaving the workday. And before we know it, we blink and we're on the couch in our sweatpants already. That was all autopilot, right? So, creating something that's going to make us feel pause a little bit is going to be really helpful.

One of the examples, I have a patient who has put a blanket over their TV. It's so silly and ridiculous that they have a blanket on their TV that when they see it or when they go to pull it off, it just slows them down for that small amount of time so that they can remember, "Oh, I know why it's on the TV because I'm supposed to be working out right now," or changing into workout clothes or things like that, that will allow you to have that reminder.

And one of the other pieces is making sure we're sticking with rewards. So, we are really allowing ourselves to feel the benefits. If it's a long-term goal, it's hard to feel benefits straight away. So, give yourself something that's going to feel like that benefit immediately.

Host: I love the rewards, and I love the intentional thinking. And so many good tips that you gave us today. I mean, I personally have learned so much. Thank you so much for sharing your expertise. This has been a lot of fun.

Bethany Rosner, PsyD: Thank you so much for having me.

Host: Of course. Again, that's Dr. Bethany Rosner. As we wrap up another insightful episode of Total Health Talks, make sure to visit cookcountyhealth.org/podcast and subscribe to our podcast, share it, and connect with us on social media. Stay tuned for more engaging discussions. This is Maggie McKay signing off from Total Health Talks. Stay well.