Six Tips for Forming—and Sustaining— Positive Habits

By on March 10th, 2018

Continuing on the theme of positive habits, let’s consider the best ways to ensure you develop habits that stick as you work to become stronger and straighter. The following six tips are courtesy of the U.S. Defense Centers of Excellence for Psychological Health & Traumatic Brain Injury.1 These tips are supported by research on how our brain motivates us to habituate new behaviors. Below, I explore each tip and put it in a “back pain treatment” context.

1. Link the new behavior to a routine or environmental cue.

Sometimes people think that willpower is the key to adopting new habits and breaking bad ones. But actually, recent research shows that strength of will is just part of the answer, and habits can be used to prompt behavior. In his book The Power of Habit, Charles Duhigg describes a “habit loop model” that links a new routine to certain times of day or in response to specific cues.2

In fact, Starbucks was able to effectively counter the tendency of its teenage employees to fall apart in the face of angry customers by instituting a new routine where baristas automatically repeated every customer order, explained that an order had been entered, and politely thanked customers. By using each new customer as a reminder for the routine, servers essentially adopted a new and automated routine that ensured courtesy and politeness to customers and replaced the tendency to respond rudely to unhappy or unfriendly customers.

I have found that a standard doorframe can serve as just such a cue for my patients who suffer from neck and upper back pain, tightness, and poor posture. By placing their hands on the side of the doorframe as they advance their chest through the threshold, they can stretch a tight chest and reposition their shoulders in one easy movement. In time, as they invariably are reminded by the multiple doorframes they meet in the course of a day, they are rewarded with better posture and relief of pain
in the neck, upper back, and arms.

2. Reward yourself.

By linking the performance of a difficult task to a reward—an “if-then” plan—you can associate a new and possibly uncomfortable behavior with something positive that you like so that the difficult task becomes associated with pleasure. Research shows that this linking creates a positive feedback loop that ensures repetition of the new behavior in the future, thus creating a positive spiral of success.2 So put your thinking cap on: What would you enjoy for a job well done?

For many of my patients, timing the stretches they do at home to TV commercials seems to work well, with the viewing of a favorite TV show or sports event serving as the reward factor. There are usually at least four commercial breaks per hour, each lasting at least three to four minutes. By integrating home exercises and stretching routines into TV watching, it’s efficient and easy to get it done consistently.

For example, I find that alternating strengthening (crunches, transverse abdominis activation, the superman pose, oblique abdominal strengtheners, and isometric neck exercises) and stretching (hamstring, adductors, anterior chest, neck, bridges, and
hip flexors) at each commercial break is easily tolerated and seems to work well. Please visit www.takebackcontrol.com for details on these stretches and exercises.

3. Repeat new behaviors and keep track of progress.

While repeating a behavior increases the likelihood for developing a new habit, research shows that what helps even more is to log how many times you perform the new behavior and if you are successful.3 In one study on obesity, college students were asked to repeat a behavior daily, then log on to a website to report whether they performed the behavior, and also self-report how automatic the behavior had become. The average time until the habit became automatic was 66 days. Applications such as Nike Training Club or the activity application on iPhones are good ways to log and track your exercises.

For patients who regularly visit our clinics, we promote participation in their home exercises and posture program, often using text reminders and phone calls for forward momentum. We have improved our compliance rate and have kept patients in the program longer with these tools. In fact, we believe that by developing a patient portal with enhanced digital monitoring techniques, we have significantly improved our patients’ likelihood to “hardwire” new habits.

4. Keep it simple.

In the same study, behaviors that were more complex were found to take longer to become habits. Stanford psychologist B.J. Fogg believes that tough habits stick when you can simplify behavior: “Goals are harmful unless they guide you to make specific behaviors easier to do. Don’t focus your motivation on doing Behavior X. Instead, focus on making Behavior X easier to do.” For those not accustomed to regular exercise and activity, waking up 20 minutes early or carving out time at lunch and simply adding a walk (either outside or treadmill) or bike ride (stationary or outside) will kick-start the process.

Once you get moving, it is important to add an element of strengthening to your routine. In patients unaccustomed to strength training, supervised high intensity exercise, performed for a short period of time only a few days a week, has resulted in large strength gains. At SpineZone, we’ve learned that patients are most compliant when they have a simple, effective, and focused spine strengthening session that is between 30 and 40 minutes and is sustained twice a week for 10 weeks.

Similarly, by shortening and simplifying your gym workouts, you can increase the probability that you will comply with them. If performed with appropriate intensity, strength training can be very beneficial even when performed only once or twice
a week.

Using your gym’s exercise with single sets and maximal intensity for up to 20 to 25 repetitions—or doing slow motion repetitions—are good ways to simplify your workout. These methods improve compliance, yet we are still able to incrementally increase the resistance to obtain the desired muscle growth and strength improvement.

5. Make a detailed plan.

Just as you tend to lose weight when you have a weight loss goal or save more money when you have a budget, so too do you perform better when you have a plan or goal as you work to cultivate new habits. Studies show that making a goal-oriented habit will lead to more likely success than one that focuses on methods to create the new habit.4

Our patients are asked which functional goals are most important to them. By outlining a plan to restore normal strength, alignment, and flexibility, we pave a pathway for them to attain those specific goals. (This is called a patient-centered outcome, since the goal is defined by the patient and not by some arbitrary standard.)

I would suggest adopting the same strategy for yourself. Define three functional goals and break each into components. For example, if you want to be able to play tennis longer, you can separate the components that will help you attain your goal by improving your hip and knee strength, core rotational strength, and flexibility.

6. Be accountable.

Research also shows that habits are most effective when they are announced to one or more people because these individuals can be a source of encouragement, motivation, or even create a little peer pressure to reinforce your new habit.

There are many ways to achieve this. You can talk with friends and family members, or seek out others who are also working on back strengthening for mutual accountability, perhaps even committing to a dedicated accountability buddy whom you check in with on a regular basis.

Pastor Rick Warren at Saddleback Church in Orange County, California, had great success teaching his parishioners a diet-lifestyle program using this principle. The psychiatrist Daniel Amen, who helped to develop the plan, explains that: “The secret sauce of Saddleback is we do this as a community. It’s very different from most health plans where you do it with yourself and your wife. You get to do this with a whole community.”

Along the same lines, there is an old adage, “A problem shared is a problem halved.” In a study published in the journal Social Psychological and Personality Science, researchers found that levels of stress hormones were significantly reduced when participants were able to vocalize how they felt about public speaking with others in the same situation.5 In this study, people discussed how they felt about public speaking with others who either felt the same way about public speaking (emotionally similar) or very different (emotionally dissimilar), while others were told not to discuss their feelings.

Interacting with emotionally similar participants decreased stress compared to not discussing fears. (Interestingly, interacting with a person who is emotionally dissimilar may actually be damaging to those who feel most threatened by the situation.)

At SpineZone, we have experienced the power of social networking and have adapted the concept to our cause. We’ve found that when patients suffer from similar problems in the same clinic, they can help each other gain confidence. Those who feel desperate and lonely in their battle with back pain are significantly helped by those who have successfully triumphed over their fear. In addition to the natural encounters that happen between these patients in our clinics, we actively match patients with similar diagnoses and goals so they can help motivate each other, especially in the early stages of therapy when extra motivation is needed.


  1. Moore, Monique and Wendy Nilsen. “6 Empirically supported Tips for Forming Positive Habits.” Defense Centers of Excellence. Accessed March 7, 2015. http://www.dcoe.mil/libraries/documents/6_empirically- supported_tips_for_forming_positive_habits.pdf.
  2. Duhigg, C. 2012. The Power of Habit: Why We Do What We Do in Life and in Business. New York: Random House, Inc.: 76-8, 144-53.
  3. Prochaska, James O., John Norcross, and Carlo DiClemente. 2009. Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: William Morrow Paperbacks: 211.
  4. Neal, David T., Wendy Wood, and Jeffrey M. Quinn. 2006. “Habits—A Repeat Performance.” Current Directions in Psychological Science 15 (4):198-202.
  5. Townsend, S. S. M., H. S. Kim, and B. Mesquita. 2014. “Are you feeling what I’m feeling? Emotional similarity buffers stress.” Social Psychological and Personality Science 5 (5):526-533.


Kamshad Raiszadeh, M.D.

Dr. Raiszadeh's completed medical school at UC San Francisco, orthopedic surgery residency at UC Davis and his Pediatric and Adult Spine Fellowship at the Hospital for Joint Diseases/NYU in New York City. He has 20 years of experience with the broad range of spine surgery including minimally invasive surgery, complex spinal disorders such as scoliosis and kyphosis, and cervical spine disorders. During this 20 years he has noticed a dramatic increase in patients turning to surgery for treatment of neck and low back pain, but many of them not getting their desired long-term result. He therefore became increasingly interested in improvement and standardization of non-operative treatment. By developing the best aspects of non-operative treatment in an atmosphere of empowerment to maximize the body’s own healing capacity, he noticed that many fewer patients required surgery, and the ones who underwent surgery had much better long term results.

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