Received date: June 30, 2018; Accepted date: July 18, 2018; Published date: July 23, 2018.
Medical professionals advise patients on changing unhealthy behavior, yet often do not practice what they preach. Choose three behaviors you need to change and discover your unique motivations. Negative visualization is an intense behavior modification tool placing yourself in a critical “Near-Death Experience” to emphasize the risks we ignore.
health motivation; wellness behavior, near-death experience; illness prevention
Imagine yourself a few years from now. You have worked hard in your career and achieved some of your dreams. You have friends, a good family, a happy life. Then it happens - just when you have reached that stage in life to sit back and relax. You start to feel an intense pressure building in your chest, and it's hard to breathe. As suddenly as that you can lose it all to a heart attack or cancer or imagine a stroke that leaves you paralyzed. But your plan was a long, happy retirement with golf or travel, not an early death or chemotherapy. What went wrong? Positive thinking people prefer not to think about such uncomfortable ideas however those potential destinies are out there waiting. You need a detailed plan for your health and longevity, otherwise your gambling you will ever reach a happy retirement.
I work in the intervention side of healthcare as an emergency physician, however I believe more in the prevention side. I love my job, but sadly more than half of everything I treat is preventable. Health care is unfortunately skewed toward intervention. Why do we wait for heart attacks or back pain to start, and then offer pills and therapy? Drug companies spend millions to advertise their new block-buster drugs, and putting a stent in your heart is great, but there is no profit in telling us how to prevent disease from happening with lifestyle changes.
The diseases we fear with aging don’t have to start when we are fifty. There are a few extensively studied “longevity cultures” where the elderly live to be more than 90 years old, and they are healthy. Our goal of course is not just a long life, but a healthy, active, mentally alert and happy long life. The simple key is in reducing our health risk factors, and at the same time model those better habits for those we care about.
We don’t need more studies to tell us smoking is bad, exercise is good and what we eat is important. Instead we need to figure out human motivation and behavior change. Make healthy behavior an easier choice, more attractive, and less expensive. Obviously, some patients are just lazy, and others don’t want to pay for a health club, but junk food, beer and laying down watching television is easy. We need to help them get started.
This is a new era of understanding motivation and behavior. However, as healthcare providers we need to look at ourselves first and ask: Is the philosophy of prevention part of your own behavior? Examine your personal health risk factors, where do you need to make changes and how do you do it? It sounds cliché but it’s true. How can you effectively advise patients if you don’t practice it yourself. If your health habits are poor, or you lack motivation to improve yourself, your ability and desire to inspire patients is minimized. For example, patients will tend to ignore weight reduction information from an obese health provider.
How do you change?
Making a list and setting goals is essential, however we think changing behavior has to be difficult. Although change itself can be easy, it’s often difficult to maintain. I want to give you some new ways to think, some motivation, some inspiration, but let’s not just plan another to-do list. We also need to change ourselves a little and “love the idea” of living a healthy lifestyle.
A few years ago I did an emergency room project to help cigarette smokers quit during the critical time while they are near death from a heart attack or difficulty breathing. Those hours can be an extremely motivating time to end the smoking habit, and everyone magically becomes a great listener during the crisis. I call it the “near-death experience” which I have seen work many times (because the alternative of course is the “real-death experience”).
Join me in a brief example of a different type of negative visualization. (This can also be viewed in a 15 minute TedMed talk: https://www.youtube.com/watch?v=iPrE8S3YFEk - or use the Youtube search bar with my name). Usually we prefer to visualize positive images. We like to think positive, yet will often do more to avoid pain than to obtain pleasure. To permanently change unhealthy behavior we need to maximize both sides. We want to use the carrot and the stick. Yes visualize the wonderful benefits of healthy living, but also the sad, negative results if you don’t.
Sit and close your eyes for a few minutes to visualize. Take a deep breath and slowly imagine yourself lying in an emergency room bed, sometime in the future - having a big heart attack. Add some details to make it seem real: hear a heart monitor beeping in the background, your nurse looks worried, and nearby a family member is saying a silent prayer for you. You feel like you just climbed up five flights, you’re sweating and can’t get enough air, your heart is racing with intense pain. Visualize vivid details and emotions. You are perhaps as frightened as you’ve ever been. You think: “If I can just get through this I’ll quit, I’ll change” or “Please God, help me, I don’t want to die”.
Then you hear: “We’re going to get you through this. But you need to decide, commit right now to change the bad habits that brought you to this crisis, whether it’s obesity, lack of exercise, smoking, cocaine use, or not taking care of your blood pressure or diabetes. Next week you’ll realize, that was a close one. It scared me to death, but right now promise yourself. Guarantee yourself that behavior is over”.
I call this the Motivational Moment. In times of absolute crisis it’s actually easy to motivate, and change behavior. Now ask yourself: why do I need to wait for that for that near-death experience? It’s just a thousand times better to make the changes years ahead of the crisis. Many times a year I have a newly diagnosed lung cancer or heart attack patient who is able to quit smoking. Congratulations, yet I’m also thinking, too bad you didn’t do it five years earlier.
Those of us working in patient care often become numb to the sadness of the unhealthy lives around us. We subconsciously avoid thinking that we may also end up in that condition and allow our behaviors to conflict with what we know is right.
So let’s begin. Draft it on paper today. Make your list - you need to do it. Set a goal, make a plan and incorporate health and fitness in the rest of your life. But don’t think of it as changing behavior because most of us don’t like “change”. Instead begin a new project, just as if it's a hobby, or challenge. It's a good thing, it doesn't need to be painful and then you can make it long-lasting.
Make your health list: Choose 3 things
Let’s start with exercise. I know some will instantly groan at the thought of exercise, and many have no plan to do any exercise at all this month. If you don’t enjoy “exercise” you need to alter your perspective. Don’t call it exercise. Call it increased activity, or play-time. Make it fun, use sports, hiking, dancing, music, have a partner, get a personal trainer, multi-task and watch TV if you want, but you must invest time in being physically fit. If you don’t have time in your day, then start with just 10 minutes, 3 times a week. Make the habit simple to begin and gradually increase. Is there anyone who honestly does not have 10 minutes available, 3 times a week? We need physical fitness.
Begin your health list today and put down the top three issues specific to you. Why choose three? Health issues are typically connected, and you are less likely to have lasting success if you only work at one aspect. Obesity for example, requires nutrition and fitness, and may also need attention to depression or stress. (More than three is too difficult to change at one time for most people. In the same way however, for some people just achieving success with one issue such as smoking or alcoholism, may truly be enough of a challenge by itself). Maybe these are behaviors you have tried to work at for years and given up. If you know you need to change it then put it down, because this is your life we are talking about.
Is it your weight? Obesity, and now childhood obesity is a preventable epidemic. What should you model for your family to follow? Show them how it’s done. What percent of your diet is fruits and vegetables, and is your kitchen full of fat, sugar, and low-quality food? It’s easy to find meals with two days’ worth of unhealthy fat. For those with mild obesity sometimes the starting secret is quite simply “just eat less” and less junk. Start every meal with a full glass of water and a salad to fill the stomach and help decrease your hunger sensation. Nutrition is of course essential, and there is always controversy on what the best diet is. Ask ten nutrition experts and you will probably get ten different opinions, but a plant-based diet is clearly a healthy choice.
The four well-known longevity cultures all had diets that were largely vegetarian, and low in calories and fat. The Okinawa (Japan) Centenarian Study was a rigorous 30-year study by scientists and physicians. Their diet was 11% fish, 3% meat/eggs, and 2% dairy. The Abkhasian (Caucasus Mountains, Georgia) was lacto-vegetarian with nuts as the primary source of fat. Vilcabambans (Ecuador) and Hunza (Pakistan) consumed fat and protein almost entirely from vegetable origin . However, new generations have lost this longevity, presumably by adopting a "western" lifestyle with less physical activity and processed foods. Multiple other lifestyle factors were also likely important to their longevity and disease rarity: community involvement, nutritional growing conditions and a lack of pollution.
Now the questions get a bit harder. Do you miss out on joy in life because of depression, grief, childhood or family problems, and do you perhaps need professional help? Think about how many hours you spend watching TV or the internet, often listening to negative stories. We know 1 out of 5 of us will die with some form of cancer. We can reduce our cancer risk with diet and fitness, and we need to worry about environmental pollution. Some cancers can be detected at an early curable stage. Breast exams and rectal exams are simple, effective, and frequently ignored even by healthcare professionals. There are also simple things you can do to lessen your chance of developing Alzheimer’s disease. One person out of seven develops some degree of it. If you have diabetes or hypertension, are you compliant with lifestyle changes and medications that help? In addition, we used to say “you can’t change the genetics you were born with”, but now it does appear that lifestyle and environment can turn on or turn off some of the genes we are born with, for example with type 2 diabetes.
If you have a problem with alcohol, pills or sexual behavior, I don’t want to minimize the difficulty in stopping. Addiction can be another level of difficulty for change. You will definitely need to replace it with something: meditation, religion, a new purpose in life, or professional help.
In the E.R. we also see preventable injuries with long-term disability. Many people drive while distracted by their cell phone, or perhaps just driving too fast or after alcohol. Many children don’t wear bicycle helmets. Preventable back pain can affect your work, play, sex, sleep, and lead to pain pill dependence and depression. What can you do now? Of course, weight reduction and fitness, but also your posture, lifting correctly, assisting patient movement, and how are you sitting in your chair right now? In addition to a health list, some people may have the opposite problem and should consider a “stop-doing-it” list. Are you involved in high-risk behaviors? Alternatively, are you just too much of a type AA personality and neglect other parts of a balanced life? Maybe you exercise too much and are slowly damaging your joints. Perhaps incorporate an occasional, slow walk through the woods with a friend instead of your next ten-mile solitary run.
So, choose the three health issues most important to you. But you need to begin your healthy life plan; and if you’ve tried before and given up, you need to re-start.
Once you begin healthier behavior, how do you maintain it?
Sometimes we’re impressive. With the right inspiration we can just flip a switch in our brain and make permanent changes. Maybe it will happen to you. Maybe you are ready for an amazing change. However, don’t be upset if it doesn’t happen that way. Don’t give up on your plan if it doesn’t work immediately, or if you fall back to old habits. It’s ok. Use the “near-death experience” concept and really visualize yourself lying in the emergency room or having chemotherapy. Make your visualization longer and more detailed. Feel the sadness of a preventable disease. Repeat it daily for the first week to make it part of your way of thinking.
Of course, you also want to visualize the positives. Visualize success after one week, and in one month a new feeling of confidence. This is a new era of understanding how we can control our behavior, make new neural connections and extinguish old ones.
Many people permanently change after they realize they almost died; but many people don’t. We get lazy. Well, begin again - - and this is important: most people need repeated attempts before they make permanent changes. That’s just the way it is. After desire, you need effort and persistence. Commit to put real effort into this, and you need to promise yourself that you will be persistent. If it’s not working in a few months you don’t give up, you reassess and adapt.
Health, if you are blessed in having it, is a gift and it’s your responsibility to maintain it. No one is going to do it for you, until after you get sick. Then we will give you lots of pills and therapy.
Take some time today to identify why you want to change. What will motivate you to action, and what will keep you going long-term? Example: maybe lung cancer from smoking is not meaningful while you are young. Perhaps annoying your friends or bad breath, or the money you waste is motivating. Discover what your triggers are, because that knowledge is power. One patient told me his motivation was thinking that after death, all that hard-earned retirement money would be spent by his spouse - with a new partner, or his kids wasting it all on a few years of wild partying. Yes, inspire yourself! It’s powerful. Also “love the idea” of a healthy, robust long life by planning your future and the type of person you want to be. Be honest with your goals. They should include just being happy with progress you make, because we don’t all want to become athletes.
There are many, successful behavior modification methods available. You can go cold turkey or use the gradual “baby steps” method, use the "pain/pleasure" model, aversion therapy, substitution, meditation, hypnotism, peer support, or belief in a higher power. Obviously one method does not work for everyone. Each of us fit into one of a few personality types and will have a different degree of success depending on the method you use. Probably you already know what works well for you. Take time to recall in detail what worked in past attempts and how it could have worked better. If you are a past smoker or accomplished a major change, excellent, how did you do it, what worked for you? Also read about behavior modification. Find a self-help book that speaks to you at your level of interest. Read some independent reviews and also beware of the abundance of medical-junk information.
We all want a guarantee to inspire us to change. If you persist in healthier habits you have a 100% guaranteed increased likelihood of a longer, happier life, and a decreased risk of cancer, heart attack and stroke.
The mind-body connection
How you think and feel is part of preventing a heart attack or cancer. For a few thousand years we have known about the mind’s influence on health, and we still neglect how important it is. A placebo pill, a blank pill with no medicine, can relieve pain and cure illness. It proves the mind’s ability to change biology. Use this to your advantage.
Unhealthy stress weakens your immune system and ability to heal, making you susceptible to infection, inflammation and cancer. There is a simple relationship between stress, exercise and sleep. If you don’t get adequate sleep, you have less enthusiasm and energy to exercise, and won’t handle stress well. But six months after you begin regular exercise - all those things you want: you will definitely handle stress better, have more energy, more resilience, you will sleep better, react better – and probably look better too. Stress is also helped by meditation and prayer, and so is your heart, intestines, arthritis, cancer. If you’re too stressed, put it on your list and try it.
We all have unique abilities to manage stress. “Burnout” in the healthcare profession can be sudden, or result from years of accumulated stress. In the emergency room we deal with high stress every day: ugly sights, listening to pain, and making rapid life and death decisions. That’s our routine. It’s how you manage stress that makes it healthy or unhealthy. Yet deeply destructive stress can happen to any of us. Continue learning how to manage your stress; get yourself ready. Wherever you are in life’s journey, I hope it’s wonderful for you now, but you need to mentally prepare yourself for an occasional disaster.
At the same time you also want to have more optimistic thoughts, not pessimistic. As you already know, how you look at life is a choice. Focus on the good, be hopeful, and you can choose to look at other people in a positive way. You will be a happier person, less stress, people enjoy being with you more, and you will be more successful maintaining your new and healthier behaviors.
Finally, somewhere on your health list, some of us need to put down love and giving to others, beyond what we do at work. Love and giving helps your immune system, helps depression, and helps other people. Think about where in your life you want to love more: Is it at your job? Love just being healthy and love the people and family close to you. Your relationships are precious. Honor them and repair damage when you see it. Perhaps even more important than giving, is forgiving. Forgive others and forgive yourself – for whatever you did or didn’t do in life. Part of becoming healthier means to be mentally healthy. We can all benefit from this. After using it to reduce your own health risk behavior, share it with friends and patients that need motivation.
You can really do this
Today choose 3 things. Write them down and some reasons why. Tomorrow wake up happy and energized. Add detail and motivation to your plan. Set a start date when you do not anticipate other major issues that could interfere with success. Make short and long-term goals. Review my TedMed talk on Youtube to help visualize the positives and negatives. Also understand there is often stress with change during the first weeks, which can affect your sleep and mood.
Today, create the “healthy life plan” that you want in your future. Do you need to change everything overnight? No, of course not but change your direction today, away from the preventable heart attack, lower your risk of cancer, feel healthy, happy, energetic and optimistically looking forward to every year. Yes, get started, inspire yourself!
Robbins J (2006) Healthy at 100. New York: Random House 56-58.