Lasting Motivation: Supporting Sustainable Change among Patients and People

Lifestyle Behaviors, Sustainble Behavior Change

We call it “motivation.” But what does this concept really mean and how does it actually help us maintain our drive to achieve our goals every day?

Part 1

What are the “best” and “worst” types of motivation and how can this knowledge be leveraged to help YOU achieve sustainable health-related and self-caring behaviors (more movement, sleep, better eating, etc.)? This discussion applies to individuals, practitioners and organizations, as you will learn below.

While I use it in my work, I’ve come to believe that the term “motivation” is unhelpful for most individuals.

  • Motivation refers to the drive and desire we feel to pursue our goals and values. While “motivation” is tossed around by everyone under the sun, this term doesn’t really get at its core meaning and the crucial role it plays in our long-term success, health, and well-being.
  • I believe that a more helpful way to think and talk about “motivation” is that it is the fuel we all need to persist toward our goals. No fuel = no energy to pursue what is most important to us.


 We All Need Fuel

Think about automobiles. Without gas or another type of energy, our car won’t go – whether it’s a Ford or Porsche, right? If we are not energized to persevere toward our goals, then we won’t be able to realize what is most important to our lives. It’s that simple.

For most people, the common thinking is that it makes no difference if our energy source is external or internal. However, research clearly shows that whether our fuel for our goals is sourced externally or internally has tremendous implications for our success in achieving them.

Does it take a clinician’s admonition or Nutrisystem’s® new “Fresh Start” advertising to spark your energy for making a change or initiating a new goal? If so, you can consider yourself as having an external source of fuel.

Part 2

In contrast to being externally fueled, when we are internally fueled toward change and goals, it’s OUR fuel.  We own it. We generate it.

Let’s briefly return to the analogy of a car I used in the last newsletter. When the origin of our fuel resides inside us it is also renewable! We don’t have to fear running out of “gas” or spend time seeking out stations to refuel and reenergize ourselves.

The framework that has most informed our understanding about the superiority of having an internal source of fuel for sustainable behavior is called “self-determination theory.”

We Need the Right Kind of Fuel      

There has been an abundance of research using self-determination theory across many different types of behaviors, including:

  • losing weight
  • adhering to medications
  • controlling glucose
  • smoking cessation
  • exercise
  • academic success
  • among many others

Drive, an interesting book by bestselling author Dan Pink, reviews some of this research and persuasively reports studies showing that intrinsic “drive” (or fuel) trumps extrinsic in a whole host of areas.

This research consistently shows that when we are internally-fueled (self-determined) we are more likely to persist toward our goals in the face of challenges. Because of that stronger drive, we are more likely to sustain our target behaviors over time.

Initiating change out of a sense of ownership injects that behavior with authenticity and positive feelings. This transforms what was once a mundane chore into a behavior symbolizing purpose and meaning.

Part 3


A Necessary Conversion: From Important to Essential

Converting an external source of fuel into an internal one is necessary if you want lasting behavior. This conversion transforms a dreaded chore into an authentic and meaningful behavior. Thus, our drive for this behavior has to become fueled by an inner integrity that will be supported by our core purpose and values.

This takes a behavior from being “important” to being “essential” to fit in.

So, how can individuals, practitioners and organizations help people shift externally fueled behaviors into an internalized and renewable source of energy? I describe strategies below by each group. Feel free to skip the sections that don’t interest you and go right to one that does.

Individuals: Make the Behavior Your Ally

One month from now, I will be in Lincoln, Nebraska delivering a keynote to the public about how to make physical activity an ally and use it to “Move Toward Happiness.” If you live in the area I hope you can attend.  But, if you don’t, below are some key strategies that you can use in your own life.

  1. Assess whether, in general, your motive for adopting this new behavior feels like something you are trying to force into your life or as a specific strategy that can help improve your life in very real ways.
  2. If your purpose for doing this behavior feels external and forced it is important for you to recognize. Decide whether you want to convert this behavior into a trusted ally that will enhance your daily life.
  3. To create an internal source of fuel it’s important that you start to perceive this behavior as a reliable ally. You should acknowledge that it will help you take better care of yourself and foster the kind of life you want to live.
  4. Consider very specific ways you might benefit each day by choosing this behavior.
  5. Toss out “gold standards” for this behavior and create realistic goals. Plan it into your day like any other important activity. This will create space for the behavior and also serve as a reminder when life gets busy.
  6. Start tracking how your daily well-being and success benefit from this behavior.
  7. Acknowledge that this is a learning process, and not something you can just “turn on.”  We let our kids take time to learn important skills, like math or swimming. How about giving ourselves the same opportunity?
  8. If you’d like to read a previous post I wrote about making this behavior an “ally,” check out this post.

Behavioral and medical practitioners: From a Chore to a Gift

Next week, I am training University of Michigan Hospital System’s physical and occupational therapists the steps to transform a health behavior from a “chore” (“extrinsic motivation”) into a “gift” (“intrinsic motivation”) with patients. For those who can’t attend this training below are some key strategies that anyone can use with their patients. For those who can’t attend this training below are some key strategies that anyone can use with their patients.

  1. Understand that the way your patients and clients perceive and approach any behavior change is simply the way they’ve been taught. This includes how we’ve been taught to change our behavior (“exercise 30 minutes 5 days/week,” “eat 9 fruits and vegetables/day,” etc.), and also the purpose for which we’ve been told to change our behavior (“reduce cholesterol,” “lose weight,” etc.)
  2. Ask your patients directly about what they’ve learned regarding the behavior under consideration and where they learned it. Their answers are their mental model for the behavior. At this juncture, help them identify if their model is accurate. (For interesting reading on how people construct their lives through mental models, see Michael Bergeisen’s interview with Srikumar Rao’s here).
  3. Help them identify “black and white” thinking and “gold standards” that demand perfection. However, to do this you must become aware of your unrealistic beliefs that get passed on to the people you are coaching.
  4. Have them list and assess the reasons they think they should make this change to help them assess whether they have an “external” or “internal” source of fuel.
  5. Start fresh! Help them create reasons for change that THEY care deeply about.
  6. One week is a good time period for experimenting and assessing. Help them identify if these new internal reasons for behaviors enhance their daily life.  This should be done weekly for a period of time. (Remember, it’s a learning process.)
  7. Talk explicitly about how the “gifts” from doing this behavior can continue as long as they keep doing it. One subtle but important perk to ask them to notice is  the feeling of pride from making choices that favor self-care over immediate gratification. (Also, ask them to notice how they feel when they don’t do it. This helps them really understand the relevant ways in which this behavior is an ally to their daily life.)
  8. When we help patients shift their mindset for self-care behaviors from “chores” to “gifts,” it changes the emotional charge they feel toward that behavior.  (How people feel about the behavior is an unconscious source of motivation so their feelings about the behavior matter a great deal.)

 Organizations: Bypass Health to Thrive

At my keynote for the National Business Group on Heath’s Leadership Summit on Workforce Well-being in Washington DC on May 23, 2013 I will be discussing how organizations can achieve improved outcomes by replacing “health” promotion with “thriving” promotion. If you are not a member or can’t be there, below are some key strategies for use by organizations.
 

Don’t forget to set up ways to evaluate whether and/or how these creative changes are influencing people’s lives and the behavioral outcomes you seek. Consider this a path that doesn’t end, and keep innovating and learning as you go.

  • Assess the specific benefits your organization has been promoting to end users (for participation, membership, and/or enrollment in programs).
  • Evaluate the effectiveness of these rewards to engage your target population and motivate ongoing behavior. Hint: Are you fostering internal or externally sourced fuel? Are the benefits from these behaviors compelling to your busy target audience?

The next steps depend on whether your organization, or an outside vendor, is providing your wellness/health communications strategy and programming.

If a vendor, ask them how their strategies are fostering internally sourced fuel among your end users.

If you are in charge of your organization’s initiative, talk to the employees/end users about what they care MOST about every day. Develop new messages and program strategies to link self-care behaviors with these outcomes. (We health promoters are extremely fortunate that the “health” behaviors we want to promote actually do double duty and are also levers for thriving.)

It’s time for health promoters to stop promoting health. Why? Health is competing with too many other, much more, compelling goals to win.

It’s time to get creative and have fun doing it. Think energy. Think strength. Think humor. But please, please please stop talking about these powerful self-care behaviors as if they are bitter pills to take! This is marketing 101, folks.

Feel free to share this post with others who share your interest in the science-based how-to’s of creating lasting changes that can survive in the real world.

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Copyright © Segar, Michelle.