Intrinsic Motivation And Behavior Change
One of the things I really enjoy about going to wellness conferences is meeting the experts that attend them and finding out what the next big trend in wellness is going to be. This year two subjects that have come up a lot are intrinsic motivation and the (new found) importance stress management. As I mentioned in my last blog, at the American Journal of Health Promotion Conference (AJHP) in March, Dr. Michael Roizen (head of Wellness for the Cleveland Clinic) made a big point of encouraging people to teach stress management before tackling weight loss or smoking cessation because, as he pointed out, you won't have much luck with the second two if you haven't tackled stress management first. Intrinsic motivation was another hot topic as well.
The American Journal of Health Promotion (AJHP) conference is ALWAYS in the nicest places. This year it was at the Westin Hotel in Hilton Head, North Carolina. Next year it will be at the Broadmoor Hotel, in Colorado Springs, Co. WELCOA has now combined their summit as part of the preconference activities for AJHP. A hot topic at this year's conference was intrinsic motivation.
Dr. John Weaver presents at both Wellness and AJHP and The Psychologically Healthy Workplace and we bump into each other at these conferences quite often. I really enjoyed listening to a story he told me over lunch at AJHP about a personal change he made and kindly gave me permission to retell here. It's a story about intrinsic motivation.
After a recent physical, John's blood test revealed that his cholesterol was high and his doctor suggested that he start taking a statin. In this internet age, John likes to point out, doctors need to realize that by the time their patients get back to their car (assuming they are carrying a smart phone) they can probably find several other credible sources of information that may tell them to do the exact opposite of what the doctor is recommending.
John's point here is that physicians and their assistants need to fully embrace this fact and learn to coach and guide their patients in this information age. For example, if one looks up statins on the Mayo Clinic website the possible side effects include muscle pain, kidney damage, digestive problems, rashes and even the potential to develop type 2 diabetes! The website hastens to remind the reader that these side effects are rare BUT if you do start taking statins (and they lower your cholesterol) you better be prepared to keep taking them for the rest of your life. So this is not a commitment that John wanted to make without thinking about it carefully.
There's some other very interesting information about statins that I learned from my own doctor, Peter Rabinowitz, M.D., MPH (who is an Associate Professor in the Environmental and Occupational Medicine department at the Yale School of Medicine). Yes it lowers your cholesterol AND reduces the risk of heart disease but in population studies of large groups of people - even when you control for other risk factors - taking statins doesn't lower your overall risk of dying prematurely. In other words, you're just as likely to die prematurely (when all causes of mortality are considered) whether you take the statin or not. No one is quite sure why.
So as an educated consumer, John was not about to jump in and just start taking statins without considering other alternatives for lowering his cholesterol, first. So John asked his doctor to work with him to devise an alternative plan of action. This is exactly what Norman Cousins, author of ANATOMY OF AN ILLNESS, did in the late 1970's. Having been diagnosed with an incurable illness - Cousins convinced his doctor to let him check out of the hospital and into a hotel room where he proceeded to watch lots of humorous movies and take mega-doses of vitamin C. (This first act alone - of checking out of the hospital and writing a best-selling book about it - helped to jump-start the movement that turned hospital rooms from stark places more like operating rooms and into the homey and nicely decorated places you actually now find at most hospitals today.)It was a plan that his doctor agreed to carefully monitor but never fully endorsed. Cousins did recover though, and as a journalist - with no medical credentials - was later appointed to the faculty of the UCLA School of Medicine. Needless to say, Cousins, was a pioneer in wellness and the rights of the patient.
"Let me try losing weight and eating more healthily and see what happens," John Weaver asked his doctor. Like Cousins' doctor, John's doctor didn't necessarily endorse the plan, but was there to check on him and see if the new strategies were working. What John told me next seems like the perfect way to create intrinsic motivation: In other words, to motivate oneself from within to make a healthy behavioral change. What John did was, instead of dieting, he mindfully keyed into how the foods he ate affected his body and his mood.
He avoided the foods that made him feel overly tired or stuffed or uncomfortable. By simply eating the foods that truly agreed with his digestive tract and his nervous system, he found himself choosing lighter, healthier options like salads, legumes and other whole foods and less red meat and less in the way of unhealthy white breads and pastas. By simply following his mood as a cue for behavior change, he managed to lose over 20 pounds during the next six months.
What John brilliantly describes here is a way to intrinsically motivate oneself by eating mindfully: To eat healthy because eating healthy feels good. Of course, eating gobs of ice cream and candy and cake and white bread and pasta feels good going down, but John wanted to continue feeling good long after the meal was over. By focusing on how the food felt in his body over time, he was able to motivate himself to make healthy changes that really made a big difference in his life. When he went back to see the doctor in six months, his cholesterol was down into an acceptable range.
Right now I'm really promoting this idea of intrinsic motivation. While the debate rages over whether extrinsic motivation really works, there's no debate about intrinsic motivation. We know it works, we just don't always know how to activate it at will. And Dr. John Weaver's story gives us just one example of how to do this using mindfulness. In mindfulness there's a concept that states: don't take my word for it, try it out for yourself. This mindfulness concept reminds us that talk is cheap but your own results are worth a lot. And that's how intrinsic motivation is activated. Empirically. Over time.
I have struggled making lifestyle changes over the years just like everyone else. But so far I have successfully taken up exercise, yoga and meditation on a regular basis. None of these changes were easy to make, but in each case, I have always let my own internal sense of well-being, be the motivating force behind making the change. In other words, I've tried out each change long enough to see how it felt. And so far this method has worked like a charm.
As I wrote in my book, STOP STRESS THIS MINUTE, for me exercise isn't something I need motivation to do any more. It's like taking a shower or brushing my teeth. I feel out of sorts when I DON'T EXERCISE. And whenever I go two days in a row without exercising, I get so crabby and subject to stress, I can barely stand to be around myself!
Of course this kind of intrinsic motivation takes time to cultivate, so one has to be patient (and sensitive to the changes that are happening internally) in order to make it happen. But once you settle into the changes and you start feeling better as the result of those changes, the behaviors happen on autopilot and require virtually no extra effort at all to maintain.
James Porter
Author