Figure 1. Behavioral change can be considered according to a hierarchy of behavioral challenge, ranging from those that are least difficult (i.e., the initiation of new practices in which there is no preexisting habit that needs to be broken) to the most difficult (i.e., breaking addictive habits which satisfy physiological drives). Cardiologists’ common involvement in the management of behaviors that are the most difficult for patients to maintain helps explain why nonadherence to behavioral intervention is so commonly experienced in cardiac practice.