Doesn’t It Take 21 Days to Break a Habit?

In treating clients with eating disorders, I hear a tremendous amount of negative and hostile thoughts about their bodies. Often, especially with young clients struggling from anorexia nervosa, they will report that the frequency and intensity of these negative body thoughts were not as prevalent prior to onset of the disorder, and in fact many will report body satisfaction or neutrality before the disorder. When I attempt to explain that recovery will involve getting their bodies back to the weight it was before the disorder, remind them that at one time they were satisfied or neutral at that weight, and suggest this likely will happen again, I usually receive a look as if I have nine heads. Typically, a client’s rebuttal includes, “Although I was once okay with my body at a heavier weight, at the time I did not know what it was like to struggle with food and body and I did not know what it was like to experience a lower weight. I am afraid I will never be able to think like that again.” Generally, it can be problematic for motivation in treatment if a client has uncertainty and lack the understanding that their thoughts, perception, or behavior can actually change.

Overall, this is quite understandable. Change is often hard to imagine. Not only for those struggling with a mental illness who maybe knows no other way of thinking, but any habit can just simply be hard to break. The quote, “It takes 21 days to break a habit” was a motto that was popularized in the 80s with the rise of self-help books. The specific marker of 21 days is arbitrary and there really is no time-frame that can be pinned down because there are many different types of habits that all hold different levels of complexities in addition to all human brains being different. Just age alone for example can be a variable in the time it takes to gain or break habits. In educating my clients on how the brain works and how treatment (like Cognitive-Behavioral Therapy, CBT and Dialectical-Behavioral Therapy, DBT) can assist in re-wiring our brains, often a greater understanding and a stronger hope for change arises.

In Cognitive-Behavioral Therapy we talk frequently about automatic thoughts. These are inner thoughts that are not constructed but happen spontaneously as fragments or images throughout the day sometimes without our knowledge (similar to behaving on autopilot i.e. driving). These automatic thoughts can influence our emotions as well as be influenced by our emotions. For example, if I constantly experience the world as an unsafe place and people are out to hurt me or abandon me, my automatic thoughts are going to be pretty negative or suspicious about people therefore likely triggering an emotional response like anxiety. One can imagine the interpersonal and mental health consequences that would ensue if anxiety and suspicious thoughts about people were my thought-emotion-autopilot combo regardless of the situation. CBT treatment can assist in changing this habitual thinking and shift to a more calm and evidence-based autopilot.

How does this work? Let’s look at the science. The brain is full of nerve cells called neurons which communicate with each other. Learning is based on the level of strength the neurons have in their connection or adding new cells to those existing connections. Brain ‘plasticity’ refers to how easy or quickly these connections can be shaped or formed. In the video below, we are reminded that children are like sponges or their brains are very plastic and can easily pick up new skills like languages or riding a bike. This hardwiring web of neurons can be rewired by altering communications between cells. Altering our neuroplasticity or entire brain structures can happen in a number of ways including training and injury (ie stroke). Reinforcement is a type of training. If a child is given a treat because she is crying, her brain may strengthen a connection in the brain and she may learn that crying equals treat. Last, practicing healthier ways of thinking and habits repeatedly will strengthen connections and eventually imprint new healthy pathways and weaken older unhealthy ones. In a simple metaphor, the brain can be looked at as a snowy hill, your automatic thoughts are the sled, and the neural pathways would be the trail the sled leaves. If you have been thinking or reacting negatively to certain stimuli for a long time, the trail your sled leaves is going to be etched deep into the snow. If you are on the top of the hill and force yourself to think positively, you’re going to create an additional trail or pathway however that trail is only shallow compared to the first one and it’s much easier or automatic for your sled to fall into the deeply etched trail because there is little effort to take the old route. By consciously practicing repeatedly healthier habits and using more evidence-based thinking, you will slowly create a healthier trail that is etched more deeply than the previous unhealthy trail or pathway. Below there is a video illustrating this phenomenon of brain changing and neuroplasticity with learning, unlearning, and relearning the skill of bike riding as an adult. Despite the skill being as straightforward as bike riding, leaving out all the complications and complexities of emotions and perceptions of the world, it took much longer than 21 days to change his neuropathway connections in his brain. Check it out!