I actually read Atomic Habits by James Clear when it first came out. I wrote a post about my first impressions back then, and it’s been on my re-read list ever since. I finally finished it again last week. I’ve rarely read a book that resonated so much with me, and which provided so much obvious, immediately usable advice. In particular, since my crash, the concept of developing better habits has been essential to my recovery.
I’d almost refer to the habits I have been developing as coping strategies. Along with creating new neural pathways to relearn things, you have to develop new habits to improve your chances for success.
I’ve decided to write up how I am applying the book to my recovery and rehab, as I feel it is an excellent blueprint for success.
1% better every day
I never really understood the power of 1% improvements before my crash. I had been trying unsuccessfully for years to develop better habits around sleep, fitness and reading, among others. Brain injury / stroke rehab and recovery is literally nothing but small, incremental improvements, compounded over time, and you find a way to do it or you whither. I’ll have more to say about this throughout this post.
Who do I wish to become?
Habits absolutely change your beliefs about yourself, and the first step is reframing who you are, or want to be. I used to struggle to both read and write with any regularity, though I enjoyed both. And while I was a good drummer before the crash, since then I have been … not so good. All of them and more suddenly became a lot harder because of the crash, but I found I had to do them (and stick with them) for my recovery.
I am a musician
In particular, as my strokes affected only my right hand, I had to do a lot of focused work to regain functionality and dexterity. Since then I’ve simply had to adjust my expectations of drumming, and accept my limitations, of which I continue to push the boundaries. Oddly, I enjoy it more now in a way, because I have to work at it, and any small gains are more precious to me. I won’t ever be as good a drummer as I was and that’s OK, because I can still do it reasonably well, and it was not pretty when I first came home from the hospital. As of this writing, I’m slowly transitioning to piano, mostly because it’s a new challenge and will force even more dexterity, while still working the musical muscles.
I am a writer
Even more than typing, printing has been very slow to return, but I also got lazy for a while because I expected to return to work and mostly type. Now that I’m not going to be, I’m writing daily by hand in a paper journal. This really has its own rewards because the volume isn’t important, as just a paragraph or two is fine. I’m still writing longer pieces like this one by typing on my laptop, but I won’t let the printing lapse again.
I am a reader
Reading was just slow more than anything, though in the very early days they wondered if I was going to have permanent brain damage and / or be blind. Now, thankfully, my reading is on par with where it was pre-crash. For whatever reason, I have stuck with reading nearly every day since I came home from hospital, and now I almost feel like I’m letting myself down if I don’t do any reading for even one day.
Cue, craving, response, reward
I’d say this was more obvious than most concepts from the book. The feedback loop steps are what happens in the process of creating a habit, and the rules are the ways you can evaluate your habits. Or, put another way, the steps are the psychological aspects of habits, while the laws are the ways you can set yourself up for the best chance of success in adopting them. And really, the reward step of the feedback loop is like a rule, too. Any habit will need a reward, or it won’t become a habit.
Even very early in my recovery, I had to develop one simple habit that I still use. I was constantly misplacing things and forgetting where I put them, particularly as they pertained to going out for my morning coffee and reading. So, I committed to always putting my keys, wallet, BT ear buds, iPad and book in the same backpack and hanging it by the front door, in the same place. Simple, but effective, as I’ve rarely misplaced those things since, and I still use them daily. The cue is that I have finished using them (whether together or individually), the craving is wanting to not forget where I put them, the response is to do it when I come in the door, and the reward is the pleasure of knowing where they’ll be when I need them again.
Law #1 – Make it obvious (and automatic)
One thing I’ve found I’ve had to do in recovery is to do absolutely everything with more intention and attention. I used to take my peripheral vision for granted and would always notice cars coming into my field of vision. One of the problems I had in the early days, was left side ignored. It’s a well documented condition that often accompanies brain injuries, where you actually don’t perceive things on the left side of your vision (or the right side if a stroke more affected the left side of your body).
Whether riding my bike, or running ,or driving, I’ve spent months going out of my way to triple check every corner I approach to make sure nothing is coming. As my visual perception has improved I really haven’t change this habit at all, as it has served me very well. In other words, knowing my visual perception was faulty, I went out of my way to verbalize what I was doing, even to the point of talking aloud when I was running or on the bike. At this point, I’ve done it so much that it’s now completely automatic, and no longer requires the verbalization.
Starting a new habit
If the 1st law of behaviour change is to make it obvious, and time and location are the most common cues, then unwittingly, the simple habit of putting my stuff away when I was back from coffee, and in the same backpack by the door, combined all of those things into one implementation intention, the formula of which is, I will [BEHAVIOUR] at [TIME] in [LOCATION].
Similar to, but different from, the formula above, is habit stacking. Simply put, it’s about connecting two habits together. After [CURRENT HABIT] I will [NEW HABIT]. I do this all the time, and I’ve found the easiest way to succeed is to make the second habit one you can’t do until after the first. For example, it doesn’t make much sense to do yoga before a run or a ride, so I always stack yoga after I run or ride. Sometimes there’s a sizeable gap between them, but because I know yoga makes me feel good, I always want to do it after the cardio, and I do either a run or ride AND yoga virtually every day. I say virtually, because I make Mondays a flex/rest day where I’m not as regimented, so maybe I’ll do something and maybe I won’t. Even then, I rarely skip yoga.
Environment over motivation
Much like tiny, incremental improvements add up to big changes over time, so do small changes in context lead to big changes in behaviour. It’s not just things like time or location that trigger habits, but the context associated with the behaviour that matters a lot. If every habit is triggered by a cue, then cues that stand out as the most obvious are more likely to be noticed by us. We can manipulate our environment to our advantage, by making the cues for good habits stand out the most.
Gradually our habits become associated with the entire context surrounding the behaviour, and not just a single trigger. For example, one of the things I really wanted to do was ride more on the road, and not just get on the trainer. While trainer workouts are usually harder than a road ride, they aren’t nearly as enjoyable, but they are far safer, and that was the biggest barrier to me riding on the road more. Forcing myself onto the road was crucial for my recovery, but since being hit again was my number one fear, I made some changes. While both my e.bike and the trainer are in the garage, I’ve kept my road bike in the dining room so that I’m always looking at it. Victoria has a lot of protected infrastructure, and it’s pretty easy to ride up to 100k without seeing many cars. So, I committed to riding as much as possible on car-free routes. Seeing the bike all the time induced mild guilt, and knowing I wouldn’t be exposed to many cars made it easier to actually start riding. In this case it wasn’t just seeing the bike, or needing to ride, but rather the entire context associated with it, that made the habit easier. One thing that definitely helps, is that I never have to find the motivation to get off the couch, as I’m just wired to be active, because I know I’ll feel better about myself after I exercise.
Self-Control
Lest you think I’ve got it all figured out, I assure you nothing could be further from the truth. Particularly, early in my recovery (while there was a lot of downtime), it was easy to sit in front of the tube way too much. Between two streaming options and a cable package that includes nature, sports, late night talk shows and news stations galore, we are inundated with options for 24-7 passive sedentarism. Add to that, courtesy my days working in theatre and playing music, I’m wired to stay up late. Watching too much TV not only saps your productivity for better things, but it’s very unhealthy for your body.
I still have a ways to go, but I’ve begun doing a couple things that really help. The biggest change I’ve made (most of the time) is to simply turn the TV off by 10pm, earlier sometimes. I’ve actually developed a routine around TV and bed that is starting to really take hold, which goes something like this:
- TV off by 10pm
- 30 minutes of Yoga (if I haven’t done it yet)
- Quick paper journaling
- Read
- Bed by 11:30
Sleep hygiene is extremely important to brain injury recovery, and screens in general (laptop, phone, iPad, gaming) are some of the worst things you can expose yourself to late at night. Before the crash, I had horrible sleep habits, mostly because I watched TV too late. Now we simply record the shows after 10pm to watch the next day, and we often forget to do that, and are no worse off for it. There are a whole bunch of cues late at night that make it too easy to just watch one thing after another, beginning with the news. So, avoiding the news by shutting off the TV when 10pm comes is simple and effective. This is also the inversion of the 1st law of behaviour change in the book, make it invisible.
Law #2 – Make it attractive
The 2nd law of behaviour change is make it attractive, and this is all about the chemical reaction we have to attractive things. The more attractive something is to us, the more likely it is to become a habit. Habits are a dopamine-driven feedback loop; when dopamine rises so does our motivation to act. Ironically it is the anticipation of the reward, and not the reward itself that motivates us to action. The greater the anticipation, the greater the dopamine spike.
This makes a lot of sense to me. In fact, our anticipation of something can be so high that when we actually get the reward, it’s a bit of a letdown. Going back to our trip to mainland Europe in 2023, one place I simply had to visit was Bruges Belgium. Primarily due to the Brendan Gleeson / Colin Farrell classic In Bruges, I had built it up into a fairy tale setting which the visit couldn’t possibly live up to (and didn’t). Thankfully it was only a day trip from Brussels for us.
In my recovery, one strategy I probably haven’t employed much is temptation bundling, where you pair a habit you want to do with a habit you need to do … after [CURRENT HABIT/HABIT I NEED] I will [HABIT I WANT]. This is primarily because I viewed pretty much all my therapy homework and practice as necessary for my recovery. Whether hand therapy exercises like drumming, running for vestibular therapy, cycling, or reading and writing for cognitive improvement, none of them have felt optional to me. However, I think it’s more about giving yourself permission to indulge after you’ve done something you need to do, and I’ve done that lots. From time to time, I’ll watch a little TV during the day, but never before I’ve done some reading and writing. Even without being in recovery, for the most part I always viewed things like having a beer as something to indulge in after I got some exercise.
Family and friends shape our habits
Culture has a powerful impact on our habits. For example, the easiest way to run or cycle regularly is to join a club, particularly if you tend to lack motivation. We adopt habits more easily that are praised and approved of by our culture, or tribe. I used to belong to both kinds of clubs and I’d say that the habits I developed during those times are largely why I still get pangs of guilt if I’m not getting out for regular runs and rides, though my volume is definitely lower as I’ve aged. Whether about exercise or not, building and maintaining habits is always easier when we connect with like-minded people – chess, books, creative writing, cooking … almost anything you want to do will be easier with other people.
This is, in part, what makes a healthy habit like regular exercise, attractive. I’m still looking for the right clubs in Victoria since my crash and subsequent retirement, but even without a club, I have no problem getting motivated for a run or ride because I still see recovery benefits from exercise (a litany of research has established a strong connection between exercise and stroke / brain injury recovery).
We also tend to imitate the behaviours or habits of three groups – the close (friends, family), the many (tribe), and the powerful (status, prestige). I feel like I’m not swayed too much by this, but there’s no question that social acceptance is preferable to social pariahism. For me, though, the motivation has always been health, and never more so than during recovery over the past 15 months. Simply put, one of the most effective ways to build a habit is to join a culture where that habit is the norm.
Find and fix bad habits
This is really a misleading heading, as it’s more about reframing our associations with habits. Just as we can make a habit we want to quit (like smoking) unattractive by highlighting the benefits of avoiding it, we can also reframe habits we want to take up or improve by focusing on the positive impacts they’ll have on us. The inversion of the 2nd Law of behaviour change is to make it unattractive.
I’ve applied both strategies, particularly since I’ve been recovering. When I was first coming home overnight, and then finally released from hospital, the last thing I wanted to do was practice printing, but I also knew that the only hope I had for being able to communicate with writing was to practice. So, as opposed to drudgery, I changed my relationship with printing practice to focus on the skills I would regain and the renewed confidence I would have. I used to take cabs to my therapies in Vancouver, and I couldn’t even sign my name for the ICBC taxi account. Even now, at 15 months, I still have a ways to go until I’ll be happy with my printing, but it’s a lot better than it was. Where it was pure chicken scratch back then, it’s now legible. Where it was once torture to form the letters due to a completely uncooperative right hand, it’s now slow but acceptable, and like the joy I get from improving upon the reduced skill I have drumming, I’m finding an odd joy in the incremental improvements I can see with printing practice.
Similarly, everything to do with my sleep hygiene routine is about associating a waste of time, less reading, and poorer health and recovery (sleep is essential for TBI recovery) with watching TV late at night.
Law #3 – Make it easy
Forming a new habit takes somewhere between 18 days and 36 weeks, but that’s really the wrong way to look at it. It’s more important to consider how many repetitions of something are required to make it automatic. Frequency is the key to making a habit stick. Sometimes this means taking it slow and working at it, but the important thing is to keep doing it.
I certainly didn’t become a decent drummer because of talent. Rather, between playing in numerous bands, going on the road and playing countless small clubs (aptly named sewer tours), rehearsing for hours on end, getting comfortable on stage, etc, I gained the experience to become competent, and confident in the skills I had. As the crash has diminished my abilities somewhat, there is still enough there to focus on relearning and improving. If I didn’t have the habit from before, it never would have dawned on me that the act of drumming would be excellent hand therapy.
It’s the same thing for running, which if I’m being totally honest, I’m naturally better at than cycling. However, I’m not imbued with elite running talent or exceptional VO2 max. The difference is, through hours of varied workouts (always with a purpose, even if the purpose is “easy recovery 5k”), and many races across several distances, I became a decent runner. In the case of anything you want to become a habit, practice really does make … if not perfect, then better. A habit forms when a behaviour becomes more automatic through practice and repetition. The mantra of just sticking with it has really come into play in my recovery. If I wasn’t stubborn, I may well have given up. The first months were very hard. My vestibular symptoms were off the chart and doing as little as 2k was a brutal slog. Then I edged up to 5k, then 6, then 8, and so on. The progress was slow and incremental. The speed is still a work-in-progress, but I’m close.
The path of least resistance
You might wonder how what I’ve described above has anything to do with Law #3, making it easy. This is where reducing the friction in developing new habits is important. Humans are wired to be lazy and do what is convenient, or put another way, to get maximum return for minimum effort. So, when beginning a new habit or trying to improve on an existing one, making it as easy as possible to succeed is crucial.
For example, if I was trying to learn the drums now, I’d start out playing for a few minutes a day and do the simple, more boring things to develop, then play longer as my skill grew. If I was trying to become a runner, I’d look at a doing a 10-1 program (for every ten minutes of jogging, you walk for one minute), as it’s easier than trying to run for an extended period to begin with. If you want to start going to the gym, it’s easier if it’s on your way to, or back from, work. No matter what behaviour you want to change, making it easy to begin is important. This is also the main reason why I turn off all screens by 10pm, if not earlier. I know I’m more likely to succeed with sleep hygiene if I remove the temptation to watch TV late at night.
Similarly, since I want to write more, I leave what I’m working on open and on my desk so I’ll be more likely to write daily – written journal, laptop, or both. Path of least resistance.
Stop procrastinating
While I admittedly haven’t used it much, Clear suggests adopting the two-minute rule, which says when you start a new habit, it should take less than two minutes to do. In essence, it’s about reducing the habits you want to start to bite-sized pieces, since we tend to think too big when we decide to make a change. Running becomes tie my runners. Meditating before bed becomes meditate for one minute before bed and read becomes read for five minutes. It can work for anything. Gateway habits are the small changes we make for habits to become easier to adopt, and help us to stop procrastinating.
I know this is something I’ll have to do to get better at in my transition to piano. While I’m taking a break from drumming for the most part, I haven’t taken the next step of actually starting piano, even though I have everything I need to do so. I feel a two-minute rule coming soon. I know bite-sized changes really work too, because early in my recovery, literally everything I wanted (or needed) to do fell into this category. Running, vestibular physiotherapy, cycling, weights, drumming, reading, writing … all were small changes focused on just doing the activity for a short period of time as a gateway to the anticipated bigger returns later.
Automating habits
A commitment device is a choice you make in the present that controls your actions in the future. It is a way to lock in good behaviours and avoid bad ones in the future. I’ve made liberal use of commitment devices without even knowing it, throughout my recovery. In addition to the backpack habit I created very early on, I’ve put recurring calendar entries and alarms in place for almost everything I need or want to do. My days are fairly regimented with a time set aside for reading, writing, bike/run, resistance and music. I’ve become solid enough with the habits that I don’t always follow my calendar religiously, because I know I WILL do the things on my agenda. I often wonder if I would be so good at following my calendar if my recovery had not gone as well as it has, but luckily I don’t really have to answer that question.
At first, this was more a survival strategy because I had several therapy sessions per week which generated a ton of homework, and I was dealing with three different insurers for income replacement. I couldn’t depend on my brain to remember all my appointments, so reminders literally saved my life at times. Thankfully the habits I wanted to create have largely become muscle memory, and my brain memory has improved a great deal. As you may have guessed, the inversion of the 3rd Law of behaviour change is make it difficult. Wherever possible, I try to make bad habits nearly impossible.
Law #4 – Make it satisfying
There’s no real magic or mystery to this rule. While there may be some counter-intuitive examples, for any habit to stick it has to provide a reward, and in almost all cases, the reward should be satisfying. I guess there are edge cases, where a habit (particularly one you have to, but don’t necessarily want to do) isn’t satisfying, but I suspect even those cases are more about how you frame your relationship with the task. Satisfaction is often derived from things that are hard, and not necessarily pleasant at first. This rule is a little different too, in that the first three laws increase the odds that a habit will be performed this time, while making it satisfying increases the odds that a behaviour will be repeated next time, thus completing the habit loop.
It isn’t just any kind of satisfaction that we’re looking for though. We want it immediately. This goes back to the earliest humans, as historically we were most worried about finding something to eat or avoiding predators, so we’re hardwired to do things that satisfy an immediate need. Adapting to a more delayed-return environment has occurred in the last five hundred years or so, and even more starkly so in the past hundred years, give or take. The development of the car, air travel, TV, personal computer, and other modern conveniences has made it easier to plan for a return longer into the future, but we remain oriented toward quicker payoffs. We smoke, eat unhealthily, have unsafe sex and drink to excess not because we aren’t aware of the potential long-term consequences, but because the drive to seek immediate reward overrides our judgement.
Now that I’m in my 60’s I’ve found this to be very true. In my recovery, particularly, I’ve consciously tried to make choices and develop habits that I won’t necessarily see the benefits of for quite some time, but which I know will help my recovery months, or even years, down the road. These choices are always in a tug-o-war with what I’d like more immediately. I couldn’t drink for a year after my crash, and while I did have a couple drinks to celebrate milestones (birthday, a year since the crash, etc), I stuck with it. I would have much preferred to have a beer or two now and then. Even with regard to regular health, like many of us, I lean toward sweets and fat, but I know what consuming too much of either is likely to cause down the road. I’m not sure what mechanism allows me to listen to my internal delayed-reward voice instead of my immediate-reward voice, but I’m glad I do.
One thing I think that helps, is that, having just retired, I know my income will be going down in a couple months. As such, if we have any hope of still taking the odd trip and continuing the travel we’ve recently been doing, then being pragmatic with our expenses is essential. As we also plan to buy a place in retirement, putting off rewards until later isn’t optional, but mandatory. However, since we still have the need to feel immediately rewarded, the benefits of seeing our savings grow can’t be understated.
Habit tracking
The last thing I’m going to touch on is habit tracking, and it’s probably the single biggest change I’ve made to how I approach the act of building and maintaining habits in crash recovery. Not only do I use my Google Calendar and reminders for planning everything, but I’m an incessant tracker. I always have been, but since progress has become so important to me since the crash, tracking progress has become essential in my mind. For the longest time after the hospital my weight was low, and tracking my weight became a simple way to see if I was gaining. My weight is good now, but tracking told me if I needed to bump up my denser calories or just take in more. I also have mild to moderate hypertension, so I’m used to tracking my health data. Particularly with blood pressure, knowing if your current medications are working is crucial to your future health. You can’t really tell where your blood pressure is by how you feel in the moment, so monitoring can be a matter of life and death down the road, if left unchecked.
This goes for everything in my recovery too. As I’ve done my therapies over the past 15 months, I have not only tracked things, but noted and celebrated small victories (the only kind you typically have in TBI recovery). I’m probably a bit more geeky for data than most people, but I always know how fast my runs or rides were, or how much weight I lifted, or how long I did yoga for.
For a guy like me, habit tracking is its own reward, as the act of accomplishing anything is very satisfying for me. Luckily, I’ve always enjoyed the work for its own sake.