As patients with diabetes participate in new activities they are training their brains to create new neural pathways and when the action is repeated, the pathway gets stronger until the behavior is the new normal.

I find it fascinating that our brains can change. I was raised with the belief that “you can’t teach an old dog new tricks.” However, I have always questioned this and, not too long ago, neuroscientist discovered that creating new behaviors can be done by rewiring the brain.

Diabetes is a chronic disease that requires lifestyle behavior changes. As clinicians, it is very useful to provide information and education about diabetes to our patients, but in order to elicit positive behavior change, it is important to understand the science of behavior change. I have been able to personally achieve my health goals and professionally empower my patients to reach their health goals by understanding the neuroscience of behavior change.

What does behavior change look like in the brain?

Neural pathways, comprised of neurons connected by dendrites, are created in the brain based on our habits and behaviors. The number of dendrites increases with the frequency a behavior is performed. I picture these neural pathways as deep grooves or roads in our brain.  Our brain cells communicate with each other via a process called “neuronal firing.”  Psychologist, Deann Ware Ph.D. explains, that when brain cells communicate frequently, the connection between them strengthens and “the messages that travel the same pathway in the brain over and over begin to transmit faster and faster” (Daily healthy habits, Deann Ware Ph.D.). With enough repetition, these behaviors become automatic. Reading, driving, and riding a bike are examples of complicated behaviors that we do automatically because neural pathways have formed.

Just because patients have formed neural pathways, does not mean that they are stuck with those habits forever. As patients participate in new activities, they are training their brains to create new neural pathways and the pathways gets stronger with repetition until the behavior is the new normal.

The importance of repetition

In terms of repetition, it is estimated that it takes 10,000 repetitions to master a skill and develop the associated neural pathway. As clinicians, we can encourage and support repetition when our patients are working to achieve their health goals. It is estimated that it takes 3-6 months for a new behavior to become a habit, though this estimate varies by person. As clinicians, we can encourage patients that, with time, their repetition will pay off when their behavior becomes natural. As coaches, we can continue to provide strategies for overcoming barriers, help create back-up plans and provide support while our patients take on new goals towards better health.

Every brain is different

It is important to understand that every brain is different. Each person has their own unique experiences that have shaped their brain and continue to shape their brain throughout their lives. Therefore, it really is important to listen to the patient individually to understand their unique experiences and values in order to help them develop a clear plan toward achieving their health goals.

Developing new neural pathways

Connecting a new behavior to as many areas of the brain as possible helps to develop new neural pathways. By tapping into all five senses, we can create “stickiness” that helps form new neural pathways. We all have experiences that changed us. We can recall the sensations: the images, smells, how we felt, etc. When working with patients consider having patients connect their successes or health goals to as many senses as possible. Visualization can be a very powerful sense that can help patients build new neural pathways toward behavior change.  For example, ask patients to visualize what their optimal health looks like, feels like, and what they would be doing if their diabetes was managed.  Another example is to ask patients to recall a positive experience with diabetes. Have them elaborate on as many emotions and senses as possible. Ask what they learned about themselves and how they can apply those learnings to achieve their desired health goals.

Modifying the brain to stay positive

In Dr. Rick Hanson’s “Hardwiring Happiness,” the neuropsychologist, explains that our brains are wired toward the negative.  For example, if we have ten experiences during the day, five neutral every-day experiences, four positive experiences, and one negative experience, we are probably going to think about that one negative experience before going to bed that night. Knowing this tendency, how can we change our brains to focus on the good experiences? “Hardwiring Happiness” gives practical advice to maintain the positive. One strategy is to focus on the good for 10-20 seconds, really absorbing and storing the memory in our long-term memory.  Personally, after reading his book and practicing his 4 suggested steps, I am convinced that I have developed strong neural pathways from “taking in the good” and my life has changed for the better.  I practice mindfulness of good experiences and spend 20-30 seconds really absorbing the good not just in my mind, but in my body by focusing on sensations and emotions. For example, when I see a rainbow or the wildflowers on the side of the highway, I used to simply notice, then say, “wow, how beautiful” and then move on.  Now, I stop, spend 20-30 seconds taking in the beauty and absorbing it so that the experience lands in my long-term memory.

According to Barbara Frederickson from the University of North Carolina, people are much more likely to make changes when new behaviors are associated with positive emotions. We like positive reinforcement which enables us to be creative and open to trying new things.  Helping patients develop SMART goals with small action steps can lead to positive emotions towards success.  “Taking in the good” with our patients by celebrating with our patients when they are successful with their SMART goals helps reinforce positive emotions.

Any change can be unsettling, even a desired one. It is essential to understand the patient’s vision of success in order to set SMART goals. Throughout the process of behavior change and neural rewiring, it helps to encourage hardwork and celebrate success, so that patients can obtain sustainable progress towards their health goals.

By Julie Hani, RN, BSN, BA, CDE
Cecelia Health Certified Diabetes Educator



“The Cognitive Neuroscience of the Mind”, MIT Press

Barbara Frederickson’s research on positivity. Dr. Frederickson’s website  is and she wrote a book called “Positivity”

Duke Integrative Medicine

Dr. Rick Hanson Hardwiring Happiness Ted Talk

Hardwiring happiness- Dr. Rick Hanson – TEDxMarin 2013
Published on Jan 31, 2017

Hardwiring Happiness: The Hidden Power of Everyday Experiences on the Modern Brain. How to overcome the Brain’s Negativity Bias.