“I know what I have to do but I don’t do it”. Even when a diagnosis is serious, every practitioner knows how difficult it can be to get patients to change - especially for the long term.
Which is why we’ve invited two experts in habit change to share tools and strategies you can use to support your patients toward a healthier future. Our guides today are Dr Jonathan Prousky, ND and author and habit change expert Angie DeGeronimo.
Dr Jonathan Prousky, ND is a psychotherapist, author, educator and professor at the Canadian College Of Naturopathic Medicine. Over the last two decades, he has focused his medical practice on mental health.
For over 25 years, Angie DeGeronimo’s healthy habit change strategies have worked for hundreds of her clients in Silicon Valley. She is a consultant to the Stanford School of Medicine and the Palo Alto Medical Foundation. Her book is called the Little Wonders Playbook: Simple, daily habits that change everything.
Why Is It So Difficult To Get Patients To Change Their Habits?
People get used to being stuck and they don't feel that they can actually make a change. Even if they have a serious illness, it actually increases their sense of defeat and demoralization.
Patients struggle with a lack of belief in themselves and then also an external locus of control. They're putting change on other people as opposed to themselves.
Even people who have a track record of being able to drive change in their professional lives, struggle with “I know what I have to do but I just don't do it”. They approach habit change as another project with deliverables, KPI’s and timelines.
Change is not a project, it's a process.
The Biggest Mistake People Make When It Comes To Habit Change
People set their change goals too high. They set lofty goals that require big lifestyle changes and tight deadlines.
They focus on the goals instead of the smaller habit changes that are going to support the big goal. When people focus on daily habits they can achieve their goals almost effortlessly.
Techniques To Support Patients In Healthy Habit Change
Finding The Why
It’s important to establish the WHY behind habit change with your patient. When patients have a clear reason to change, such as the impact of their ill-health on the people they love, that often gives them the motivation they need to shift their habits.
Envisioning A Better Future
To motivate patients, envision a future where they are in control of their daily habits and are enjoying the fruits of their new found health. Then work on how to actualize that future together.
Ask them “So what would you be doing then that you're not doing now?”
They might start thinking about things they can change, such as sleeping more regularly, eating better and exercising. That builds the idea that working with a practitioner they can start making some progress forward.
Ask them a scaling question
Ask them a scaling question like what they would do to improve their mood from a two out of ten to an eight out of ten. You can then focus on a few of those ideas together, negotiate those goals, making sure they're realistic and doable, and then you could hold them accountable for those goals later on.
The Five Whys Exercise
Taking responsibility for our choices is an important concept in habit change. The Five Whys exercise can help patients take 100% responsibility by understanding why they make the decisions they make every day.
- Why did you eat the cookie? Because I was feeling irritable.
- Why were you feeling irritable? Because I was tired.
- Why were you tired? Because I brought my work home and went to bed late.
- Why did you bring your work home? Because I am worried I will lose my job.
- Why? Because I don’t feel good enough.
Once people understand what is driving their behavior, they can take steps to change.
Getting In Sync With Circadian Rhythms
A simple technique to support people in habit change is to sync their daily routine to natural rhythms. When we live closer to our circadian rhythms, we give ourselves more bandwidth to achieve our goals. For example, changing the main meal to lunchtime is an effortless way to lose weight as it syncs with the body’s natural rhythms.
When you pair any change with the natural rhythms of our body, it's likely to optimize the outcome.
Practitioners can use several techniques to assist people in habit change, including Habit Stacking, which is connecting a new habit to an existing habit. For example, put your running shoes next to the dog leash. That reminds you to go for a longer, more strenuous walk with the dog after dinner.
Another key idea is to adapt your new habits to fit your lifestyle. If one iteration of your new habits don’t work then adapt and find a way to make it work - don’t just give up.
People want to see that they are making progress. Highlighting a quick win can have cascading effects.
For example, getting up 10 minutes earlier in the morning. Highlight how that change is going to be very good for you, and then build on that momentum.
What we want to do is get people to start living differently so they can start feeling immediately the change within themselves. And then as a practitioner, you want to then feed off of that positive shift by being very encouraging yourself.
Action statements help us to get to the heart of the matter by connecting patients to the What, When and How.
- What are you going to change? I am going to get more exercise everyday.
- How are you going to change? I will go for a walk everyday
- When are you going to change? I will walk everyday at 5.30pm. I will put it in my calendar.
The Mighty Post-It
Encourage your patients to use Post-its to set their intentions and reiterate their goals on the bathroom mirror, in the car, in the pantry, on their desk at work.
The Post-It can intervene at the precise moment when the patient is making a decision about what to do next.
How To Stay Strong When Things Go Wrong
People relapse into their old habits because it's impossible to never fall back, to always be on, to never make a mistake. However, the more you've been able to make these changes, the easier it will be to come out of the relapse back into living differently, which is a good reason to start small. And go slow!
Relapse can also be understood as a learning tool, so they can come into their next fall a little smarter. Prepare patients for relapse by developing a “relapse signature”. This list helps them recognize when they're slipping so they can make changes in advance of a full relapse.
“What I do first is engage patients in a talk about their values, so I know what matters to the patient, in terms of their own values. And there are values in our life that are creative, which involves work. There are values that are spiritual, which involve love and things that give us a sense of awe. And there's attitudinal values, which is basically our mindset. But you have to ask a patient what is it that they care about? And then once you understand that, you can engage them”. Dr Jonathan Prousky ND
“I will say that when you live closer to your circadian rhythms, you actually give yourself more bandwidth. So it just means you are going to be able to do more. And to start small might just be to set that alarm 10 minutes earlier in the morning. It could be I'm going to just start with a bigger lunch. We typically want to eat our biggest meal when the sun is at the highest in the sky. Our metabolism is at its best at that time. So little things like this can make all the difference in clarity and focus and have a ripple effect in terms of our goals”. Angie DeGeronimo
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