One of the toughest endeavors: Changing health behavior

Beacon Health Options’ mission is to help people live their lives to the fullest potential. It’s a simple, yet extraordinarily complicated, goal because it requires changing behavior at all levels – system, provider and individual.

Beacon has myriad programs to help improve individuals’ mental health, and ultimately, wellbeing. Programs range from pharmacy management to home-based therapy to opioid use disorder (OUD) treatment to intensive case management. All of the programs, to one degree or another aim to change health behavior, whether it’s addressing prescribing patterns, medication adherence or developing strategies to deal with an OUD issue.

The New England Journal of Medicine’s Catalyst series produced a segment on this most challenging of tasks – changing health behavior. Featuring Gary Foster, Chief Scientific Officer for Weight Watchers International, the segment distills this puzzle into four fundamental principles that apply to behavioral health as well as physical to make care less frustrating, less alienating, and ultimately more effective.

Stick to the basics

Principle #1: Simplicity

Clinicians are highly trained professionals who possess a lot of knowledge related to their specialty. It’s natural to impart that deep knowledge to help a patient. However, Foster warns that doing so can be counterproductive to treating patients when communicating with them about treatment goals. Simplicity trumps detailed knowledge every time when delivering information.

Don’t say: Buprenorphine is a partial opioid agonist, which means it is an opioid medication that activates the opioid receptors in the brain, but to a much lesser degree than a full agonist, like heroin.

Do say: Buprenorphine is a partial opioid agonist, which means that it is an opioid medication that lessens cravings and controls withdrawal symptoms, allowing for normal daily functioning.

Principle #2: Specificity

Specificity always wins over platitudes, not only because it is clear but also because it is more measureable, says Frost. Specificity leads to how a goal is going to be reached and consequently allows a patient to feel progress – or not. Specificity sets real parameters as to whether a certain activity was achieved.

Don’t say: Stay away from triggers that might prompt you to try opioids again.

Do say: You said that when you’re alone, you feel the urge to misuse drugs, so this is one of the triggers helpful for you to identify. Try not to be alone as much as possible. Call a friend or family member and ask to get together. If no one is available, go to the movies or go to your local coffee shop to be around people. A back-up plan is having a hotline number with you at all times so you have someone to talk to, 24/7.

By asking “how” something happened, a clinician is better able to get to the bottom of exactly what happened, providing “therapeutic leverage”.

Principle #3: Ask how, not why

The difference between how and why may be subtle, but it is critically important. By asking “how” something happened, a clinician is better able to get to the bottom of exactly what happened, providing “therapeutic leverage” says Frost. Asking why invites interpretation from the patient. For example, a patient might say that he started misusing drugs again because he lacks willpower or motivation.

Don’t say: Why do you think you started taking drugs again?

Do say: How did you start taking drugs again? Where did the drugs come from? Where were you when you took them? What time was it?

By asking the “how” of the situation, a clinician can find the links in the behavior chain and provide insight on where in that behavior chain things could go better in the future.

Principle #4: Promote self-compassion

Two myths about self-compassion is that it is selfish and requires tough love, asserts Frost. Regarding selfishness, if you can’t take care of yourself, you can’t take care of others. Tough love only leads to self-incrimination and undermined confidence, which deplete motivation faster than anything.

Don’t say: The next time you get the urge to take drugs, dig deep and find that willpower to say no.

Do say: You are not alone in taking drugs again on your path to recovery. Most people do it. In fact, many people learn from the experience, helping them to reach their recovery goals. Don’t beat yourself up over it, but let’s talk about how it happened.

Most clinicians agree that empowerment is one of the most important factors in changing health behavior, and the four principles supplied here all lead to that empowerment. What a difference a word can make.

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