Extreme Change vs. Incremental Change

Jon Guerrera
Living for Improvement
5 min readMar 21, 2011

For those of you who have read Unlimited Drive, my e-book on motivation for top performers, you will recall that the intro chapter mentions a statistic that approximately 90% of heart patients can’t change their lifestyles for the better, even when the decision is one of life or death.

I recently have come across another article that references this statistic, but found something completely unexpected. They found that forcing patients into extreme change gave significantly better results than slow, steady, and incremental changes. Here’s the key excerpt from the article:

That’s where Dr. Ornish’s other astonishing insight comes in. Paradoxically, he found that radical, sweeping, comprehensive changes are often easier for people than small, incremental ones. For example, he says that people who make moderate changes in their diets get the worst of both worlds: They feel deprived and hungry because they aren’t eating everything they want, but they aren’t making big enough changes to quickly see an improvement in how they feel, or in measurements such as weight, blood pressure, and cholesterol. But the heart patients who went on Ornish’s tough, radical program saw quick, dramatic results, reporting a 91% decrease in frequency of chest pain in the first month. “These rapid improvements are a powerful motivator,” he says.

That’s a big reason why 90% of heart patients can’t change their lifestyles but 77% of Ornish’s patients could — because he buttressed them with weekly support groups with other patients, as well as attention from dieticians, psychologists, nurses, and yoga and meditation instructors.

Huh?? Every single research study, case study, and book I’ve read on motivation and psychology shows, very clearly, that we tend to resist extreme change, which is why incremental changes are so effective for long-term goal achievement. I’ve used this step-by-step strategy multiple times in my life and it has ALWAYS worked better for long-term progress. With so much research and anecdotal evidence pointing towards incremental change, I was shocked to see Dr. Ornish’s results with his patients using extreme lifestyle changes. Was there a way to reverse engineer his process?

I decided to investigate further.

First and Foremost: Extreme Change Works When Maintained

The first point that needs to be discussed is that extreme change, planned and maintained correctly, will give better results than incremental change. Extreme changes designed in the wrong way can be very harmful. For example, extreme, short-term dieting can screw up your body’s metabolism. Using the example of weight loss, a well planned, extreme change would be doing a program like P90x or Insanity over the course of many weeks.

Extreme change gives better results when measuring based on time invested, making it a superior option once the goal is achieved. However, the challenge of extreme change is maintaining it. Since the research is VERY clear about our resistance to extreme change, you will be fighting an uphill battle the entire way through. Those who make it through will find very beneficial change in a short period, such as Dr. Ornish’s patients, whereas those who quit will be back at square one, as shown by yo-yo dieters who gain all of the weight back shortly after quitting a diet.

So the issue with extreme change isn’t that it doesn’t work. The issue with extreme change is that most people can’t maintain it, which causes backtracking and quitting. Because of the failure rate of dieting and other extreme changes, I’ve never recommended extreme change as a method of achieving your goals. So what was Dr. Ornish doing to make sure his patients maintain the diet, whereas 90% of patients in these same circumstances will often choose to face death, rather than face a lifestyle change?

More Support, More Extremes

The answer is so simple, that I pretty much skipped right over it the first few times I read the article. The key lies in the last sentence in the excerpt I posted above: “That’s a big reason why 90% of heart patients can’t change their lifestyles but 77% of Ornish’s patients could — because he buttressed them with weekly support groups with other patients, as well as attention from dieticians, psychologists, nurses, and yoga and meditation instructors.

As it turns out, social support is perhaps the greatest source of external motivation that exists (internal motivation is generated by you, whereas external motivation is sourced somewhere in your environment). Think about how influential peer pressure can be. Think about the average of five rule. Think about the communities that gather both online and offline to help each other reach their goals. Dr. Ornish recognized how motivating a support group can be and made sure that his patients were constantly supported by various professionals and other patients going through the same types of changes.

Think about it this way. Who will have any easier time overcoming their phobia of heights? The person who shows up to Six Flags alone with the challenge to ride every single roller coaster in the place? Or the person who shows up to Six Flags with a group of close friends, a few of which are overcoming the same fear and a few of which who are there to be supportive? Obviously, the second guy will have a much easier time because:

a) The challenge doesn’t seem as insurmountable since he has others around him experiencing the same challenge.

b) If his friends are making progress, it shows him that it’s possible to do, which can undo limiting beliefs and mental blocks.

c) In case there is a big challenge up ahead, the friends who are there for support can help push him through with encouraging words and guidance.

Support Groups Give You Choice of Method

Extreme change will give more powerful results in less time. But unless you have a VERY powerful support group filled with a community of people achieving the same goals and people who can offer guidance and support, your odds of quitting or backtracking from extreme change is unacceptably high.

I will always recommend that people start with incremental change, but if you can rally a huge support group behind you, I encourage you to rise to the challenge and see how much change you can make in a given period of time. Dr. Ornish’s patients aren’t the only people in history to rise to the challenge and face extreme change head on. Just be realistic and don’t delude yourself into thinking you can bite off more than you can chew.

If the topic of motivation interests you, Unlimited Drive addresses support groups, the power of community, proper goal planning, and much more. And it’s free, so you don’t need to worry about that.

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