July 2007
by Vicki Rackner MD
Question: How many psychiatrists does it take to change a light bulb?
Answer. Just one. But the bulb’s gotta want to change.
If you have ever tried to support a loved one who is trying to lose weight or stop smoking or start exercising, this joke may resonate with you.
How do we motivate and support health-related behavior change in others - and in ourselves?
I doubt that there’s one formula that fits all, or we would all know it and do it!
I reflected on my own observations with the tens of thousands of patients I’ve had the honor to treat over my career as a surgeon. I noticed that some patients and their families answer their health wake-up calls with transformative lifestyle changes: The man who religiously takes his medication after his heart attack. The colon cancer survivor who dedicates herself to healthful eating. The man newly diagnosed with diabetes who gets out for his daily exercise.
Others hang up on their health wake-up call. I clearly remember the patient who was diagnosed with lung cancer luckily at an early stage in which cure was possible. I asked him to quit smoking before his cancer operation. He was smoking again at the six-week follow-up.
I wondered: What sets apart those who translate their good intentions into behavioral changes and those who are on the couch instead of the gym? Those who turn around their health stories share a common program I call CAB - compassion, alternatives and a buddy. Although there is tremendous individual variation, most successful patients implement an approach that has all three elements.
First, those successful in embracing health-related behaviors start with a healthy dose of compassion. They recognize that there’s a reason for everything they do, even when it’s not obvious. They’re willing to say, "Smoking works for me because..." The truth is that smoking is a terrific stress management tool; the only problem is that it could kill you.
Many resist giving up old and familiar ways because they fear the loss of the benefits of the habit. It’s like throwing out the baby with the bath water.
That leads to the next element: alternatives. What is the alternative way for a hopeful ex-smoker to leave a stressful environment, have something to do with their mouth and hands, get a social connection, take a deep breath and induce a neurochemical change? It means replacing a habit that impairs health with different habits that serves health. Individuals are incredibly resourceful in creating alternative lists. Maybe it looks like leaving the desk every two hours for a ten-minute walk, or putting on headphones and taking deep breaths or carrying worry beads. The actions need to change.
Some people need alternative stories they tell themselves and others before change is possible. Change will not happen if the story reads, "I can’t stop smoking. I tried many times before and failed." Or "I won’t get lung cancer or heart disease; that just happens to other people" Or "If I get heart disease or lung cancer, it won’t be for decades, and by then there will be cures."
I am convinced that the "health decision-maker within" does not reside in the analytic left hemisphere of the brain. It’s a rare person who will give up smoking because it makes good health and economic sense. I believe that ultimately health is directed by emotional choices made in the integrative right brain. If the language of the left brain is facts, logic and consequences, the language of the right brain is the story. Stories are powerful in offering alternative beliefs and supporting alternative behaviors. So, often being in the presence of stories of people who have done it can be transformational.
Last, successful people have an accountability buddy. They make commitments, often put it in writing and have to stand accountable for their actions.
I believe that the many unhealthy habits medicate loneliness. Paradoxically our technology that allows us to connect so effortlessly has left us lacking in meaningful human connections. Maybe that’s one reason the buddy system is so important. It’s a way of connecting.
Connect with someone. Tell your stories. Maybe you’ll both be motivated toward behavior change.
Copyright © Vicki Rackner MD, 2007
See the Light of Change