Habituation; the rhythm that we dance to

Most of us have a daily routine which we repeat unwaveringly, completing tasks we have completed a hundred time before, it's regularity depending on the reliability of our habits. We do these tasks automatically without thinking and they bring familiarity to our world. These routines carve out and cement our identities and are referred to as habituation. Our semi-autonomous routines are cyclical; repeated in known sequences and supported by the rhythms of nature (day/night, the seasons), complemented by social convention (working hours, work days, days set aside for leisure and worship) and affected by our biology and physiology. Biologically our circadian rhythms shape our sleep and wake cycles, while physiology determines our levels of fatigue after exertion and concentration demands certain temporal rhythms of activity and rest. Furthermore, our habituated behaviours are impacted by our capabilities and performance capacities, how we interact with our familiar physical and social environments and how this enables or constrains our participation.

Habits are defined as acquired tendencies and are how we respond and perform in certain, consistent ways in familiar environments or situations. While, habituation is an internalised readiness to exhibit consistent patterns of behaviour which are guided by our habits and roles and fitted into the characteristics of routine temporal, physical and social environments (Kielhofner, 2002). Habituation allows a person to appreciate their environment when participating in their routines. Whereas, our habits preserve ways of doing things that we have internalised through repeating the same actions, in the same context in order to establish a pattern; actions and occupations that initially required attention and concentration eventually become automatic. Sometimes we acquire these patterns because we have made volitional choices and sometimes it is the environment that influences our habituation.

Habituation involves a strategy of action and these strategies are preserved as habits and roles. Therefore, much of what we do in our day to day life is guided by habits; our daily routine, how we go about completing almost anything we do and our idiosyncrasies. The regularity in our habituated behaviour depends on the reliability of our habits. The recurring temporal patterns (day/night, workweek/weekend) provide a stable structure, while social order guides in how to respond and the regularity of our environment grounds us, meaning that we can move unconsciously. Habits regulate our behaviour by providing a framework, or set of flexible rules of action so that we are able to continue to perform if we experience environmental changes.

When we appreciate our environment and the impact that it has on our habituation we refer to the use of familiarial cues. For example, being able to cook in a new kitchen when we move homes or visit a holiday let. Even though the environment is novel in its layout, there are recognisable elements; a cooker, kettle, sink and maybe a toaster or microwave. We can appreciate what we will cook our meal and where we will wash up but, we will have to attend to our previously automatic routine to allow for adjustments i.e. timings, who sits where, what we use to prepare the food - gas vs. electric stove, grill vs. oven, plug in kettle vs. hob kettle etc etc. As long as there are familiarities our habits will operate smoothly and there will be little disruption to our habituation, it is completely unfamiliar territory that we do not have internalised rules for that disrupt our habitation. For example, when we go on holiday and there are no cooking facilities in the accommodation, or you go camping.

The regularity of habituated behaviour depends on the reliability of our habits. So what are habits? Habits are automatic and help to regulate behaviour by providing a regulated manner of dealing with environmental contingencies. They serve to preserve the way that we have learnt to do something from continued practice and trial and error to find the most efficient way of doing something. Their aim is to decrease the effort required for occupational performance by reducing the amount of conscious attention required. Habits have rules that guide automatic behaviour, "these rules are flexible, more like grammar than a particular sentence" (Young, 1988, p. 91). They are in essence the rules to the game, enabling players to know how to play the game without dictating in advance everything that they will do. They give us a way to appreciate and construct action appropriate to what is going on in the world around us. When we learn habits, we learn a set of rules for how to simultaneously appreciate and act in the world and therefore, similarly to habituation, as long as our environment remains consistent, our habits operate smoothly and without need of attention. It is unfamiliarity, for which we do not have internalised rules (habits) that interrupts our routine way of doing things (habituation).

The habitual organisation of our daily routine enables us to perform in a consistent and effective manner thus, meaning that they provide a momentum that allows action to unfold, enabling two or more behaviours to occur simultaneously and free conscious attention for other purposes. This enables us to perform other tasks while completing habitual behaviours i.e. taking a phone call while making a cup of tea, listening to the radio while we cook dinner, planning our day when we shower. Habits also serve a purpose for society, they form our social customs and are often influenced by the expectations of others and depended on by others, serving as cues for those within our social setting to participate in their own habits. As we acquire habits, we carry and transmit messages regarding customs that make up our way of life as a particular group of people, our own habits an important factor enabling one to be integrated into the smooth functioning of society (Wook Lee and Kielhofner, 2017).

When our capacity is diminished either temporarily (i.e. due to injury, planned surgery, relapse of a remitting condition) or in the longer term due to a life changing event or degenerative condition, previously established habits can be severely disrupted. One may be forced to develop new habits for many or most aspects of their everyday life. Adaptations our habituation and the need to learn new habits can be as tangible as learning to navigate life in a wheel chair or, more the learning of conscious strategies to compensate for a degenerative condition. Not only will we have to work with service users to find new ways to work within their environment but, also ways to manage their time as often everyday tasks become longer to perform and recover from. We must support our service users to develop new routines to allow for this additional time to allow for new self care habits and need to rest and recover.

When working with our clients and services users we need to establish if they have well established habits and what they are, or wether this routine has been negatively impacted in the short or long term. We need to ask what kind of routine they currently have, how it has recently change and is it effective and do they want/need to change it. We need to spend time with the person to unpick what their characteristic style of performance, assess whether is it effective and consider the quality of life provided by their current habitation.

Problems that we may identify with our clients/service users may include difficulty completing a specific occupation due to lack of habitual structure or, difficulty internalising the habitual use of a new object or, a new way of completing an occupation. You may also come across disorganised routines that make it difficult for the person to complete required and chosen occupations and maintain balance within their life. Assessment should not focus only on limitation, but should also serve to identify strengths such as; having a routine that allows for the completion of specific occupational forms/tasks, they are able to internalise the habitual use of a new object or a new way of working or, their routine may already be organised and provide opportunities for participation in essential and chosen occupations.

When working with those who have difficulty with their habituation due to chronic illness or, with someone who needs to learn a new pattern of life due to an acquired impairment, a new environment and/or a change in circumstance we need to accommodate for that change. Our aim is to enhance occupational performance and occupational participation and increase their effectiveness so that they are able to complete a specific occupation by altering their habitual way of doing. We enable our clients and service users to acquisition new habit patterns that incorporate new objects, tools, equipment or, ways of completing their chosen and essential occupations for example, energy conservation techniques, environmental adaptation, using adaptive equipment and/or teaching new skills. Ultimately, we work with them to increase organisation of daily routines, to improve effectiveness, improve their ability to manage their role related responsibilities, provide opportunities for engagement and encourage the exploration of new occupations and facilitate social inclusion.

So, what do we need from our clients/service users? We need a commitment to change, a desire to explore new ways of working, organising oneself and their environment to support habit formation. They will have to be prepared to re-examine the usefulness of their previous and current habituation and habits as well as, identify new habitual ways of completing occupational forms/tasks. They will also need to negotiate options for altering methods of completing occupational forms/tasks or, organising occupational forms/tasks into a new or, alternative routine. With negotiation will come choice and the need to choose new ways of doing or, new routines of doing and with new ways, comes learning to perform these new skills. Skill acquisition requires a cognitive and physical ability as well as, a desire to learn, commitment to practise, a want to change or adapt.

How do we promote and enable change in habituation? We can:

• Structure the therapeutic environment to support habit training within an occupation and/or routine and offer to facilitate repetitive opportunities to engage in the routine.

• Structure the usual environment with ways to support habitual routine i.e. have a person in the social environment reinforce habits.

• Facilitate choice by providing ideas and options for altering how occupational forms/tasks are completed.

• Work with the service user/client to create an alternative routine.

• Validate that it is hard to change habits.

• Advise new habits around a particular occupational form/task or routine.

• Coach by giving consistent verbal prompts to reinforce habit.

• Encourage sustained effort until the person is able to complete the occupational form/task and or routine.

References:

Kielhofner, G. (2002) Model of Human Occupation Third Ed. Baltimore, MD: Lippincott Williams & Wilkins

Wook Lee, S. and Kielhofner, G. (2017) Habituation: Patterns of Daily Occupation In Taylor, R. (Ed.) Kielhofner's Model of Human Occupation. Philadelphia, PA: Wolters Kluwer Health

Young, M. (1988) The metronomic society: Natural rhythms and human timetables. Cambridge, MA: Harvard University Press