The Age-Old Secret Of Behavior Change

The Age-Old Secret Of Behavior Change

Earlier today, I was speaking with a friend of mine about habit formation. In the middle of our conversation, he paused and told me: “The trick is to keep on going. You’ll make steps forward. Then you’ll fall back. But the trick is to keep on going — keep doing what you need to do.” Truer words could not be spoken. Sometimes in the midst of hype and complexity, you need to re-state old truths. This is one of them.

Outside of the medical world, where an intervention can instantly solve your problem, things are much messier. Things take time. A headache can be solved in 10 minutes by an aspirin. An infection can be quickly conquered with some antibiotics. But gambling addictions, or an inability to stick with an exercise plan, cannot be solved so readily. Behavior change is unpredictable. People are infinitely complex. The environments people live in are infinitely complex. Trying to predict how two complex things will interact is a daunting task.

This is one of the reasons that diets and exercise plans fail so often. When they do succeed, it’s often due to a committed and intelligent coach or therapist who can adapt to the complex situations of their clients in real time. Not everyone, however, has this luxury.

This is one of the reasons why simple instructions and principles work so well. No matter what environments people are in, they can use simple principles or instructions as their guides. For example, if you want to become healthier, you can vow to always stand over sitting. Instead of sitting on the bus, you stand. Instead of slumping back in a chair at work, you use a standing desk. This instruction, stand over sitting, is so simple that it can be applied in almost every context. 

For every goal, there are sets of these simple principles or instructions that can get you there. If you want to learn more about psychology, you could decide to read on the topic for 15 minutes each day. You could also create and review five new flashcards each day. If you want to go to bed earlier, you could decide to get in bed 15 minutes earlier each day. You could also vow to stop drinking coffee after noon. Simple. In due time, both instruction sets would likely get you where you would need to be.

This approach is very similar to BJ Fogg’s Tiny Habits program, where he has students determine the smallest behavior they can do toward their goals. Since the behaviors are so small, his students quickly form strong habits around them. But the changes don’t stop there. Once someone is consistently exercising each day, they’re much more likely to then do other exercises and related activities. For example, let’s say someone chooses “Do 10 pushups each morning” as their Tiny Habit. After a couple weeks, they might decide to up the number of pushups they’re doing, since doing 10 is now incredibly easy. They get up to 100 pushups each morning. Witnessing their new muscle definition and increased stamina, they decide that it’s time to sign up for a gym after all. As you can see, the small pushup habit can balloon into a larger set of fitness habits and behaviors.

This is why, in the world of human affairs, sticking to simple principles and prescriptions is usually the best path forward. When you’re taking small steps forward, it takes a while to get to the end of the road. You might fall one step, two steps back, but if you keep on walking along, you’ll still get there. It’s the old fable of the tortoise and the hare. This time, the tortoise still wins.

Image: Charly W. Karl

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The therapy appears to be astonishingly effective, editing nearly every cell in the liver to stop a disease-causing mutation.

The challenge: CRISPR gives us the ability to correct genetic mutations, and given that such mutations are responsible for more than 6,000 human diseases, the tech has the potential to dramatically improve human health.

One way to use CRISPR to treat diseases is to remove affected cells from a patient, edit out the mutation in the lab, and place the cells back in the body to replicate — that's how one team functionally cured people with the blood disorder sickle cell anemia, editing and then infusing bone marrow cells.

Bone marrow is a special case, though, and many mutations cause disease in organs that are harder to fix.

Another option is to insert the CRISPR system itself into the body so that it can make edits directly in the affected organs (that's only been attempted once, in an ongoing study in which people had a CRISPR therapy injected into their eyes to treat a rare vision disorder).

Injecting a CRISPR therapy right into the bloodstream has been a problem, though, because the therapy has to find the right cells to edit. An inherited mutation will be in the DNA of every cell of your body, but if it only causes disease in the liver, you don't want your therapy being used up in the pancreas or kidneys.

A new CRISPR therapy: Now, researchers from Intellia Therapeutics and Regeneron Pharmaceuticals have demonstrated for the first time that a CRISPR therapy delivered into the bloodstream can travel to desired tissues to make edits.

We can overcome one of the biggest challenges with applying CRISPR clinically.


"This is a major milestone for patients," Jennifer Doudna, co-developer of CRISPR, who wasn't involved in the trial, told NPR.

"While these are early data, they show us that we can overcome one of the biggest challenges with applying CRISPR clinically so far, which is being able to deliver it systemically and get it to the right place," she continued.

What they did: During a phase 1 clinical trial, Intellia researchers injected a CRISPR therapy dubbed NTLA-2001 into the bloodstreams of six people with a rare, potentially fatal genetic disorder called transthyretin amyloidosis.

The livers of people with transthyretin amyloidosis produce a destructive protein, and the CRISPR therapy was designed to target the gene that makes the protein and halt its production. After just one injection of NTLA-2001, the three patients given a higher dose saw their levels of the protein drop by 80% to 96%.

A better option: The CRISPR therapy produced only mild adverse effects and did lower the protein levels, but we don't know yet if the effect will be permanent. It'll also be a few months before we know if the therapy can alleviate the symptoms of transthyretin amyloidosis.

This is a wonderful day for the future of gene-editing as a medicine.


If everything goes as hoped, though, NTLA-2001 could one day offer a better treatment option for transthyretin amyloidosis than a currently approved medication, patisiran, which only reduces toxic protein levels by 81% and must be injected regularly.

Looking ahead: Even more exciting than NTLA-2001's potential impact on transthyretin amyloidosis, though, is the knowledge that we may be able to use CRISPR injections to treat other genetic disorders that are difficult to target directly, such as heart or brain diseases.

"This is a wonderful day for the future of gene-editing as a medicine," Fyodor Urnov, a UC Berkeley professor of genetics, who wasn't involved in the trial, told NPR. "We as a species are watching this remarkable new show called: our gene-edited future."