I love Riva Greenberg. We are all so fortunate that she is able to devote herself to helping people with diabetes. She has much wisdom and many gifts to share with us.
She wrote a post recently (A Valentine’s Gift of Health and Happiness) about her experience with Divabetics (another group I’d like to write more about – Max is awesome), and there was a section that jumped out at me.
Many healthcare providers unknowingly try to motivate diabetes patients to manage their condition through fear — specifically, fear of diabetes complications, which indeed are scary. But fear motivates behavior temporarily — you jump to protect yourself from harm. Fear does not motivate sustainable behavior change because you do not want to stay focused on your fears.
You jump to protect yourself from harm.
Fear motivates behavior temporarily.
Fear does not motivate sustainable behavior change because you do not want to stay focused on your fears.
Wow.
Riva goes on to recommend “focusing instead on what you want, and enlisting your positive emotions, which creates an energy within you that is vibrant, viable, and more enduring as it is tinged with excitement, hope, purpose and pleasure.”
I love this.
Thank you Riva!
Funny I read this post today. I wrote on the Joslin FB page, where they were telling about a class for caregivers of juveniles, that I hoped they taught this class the way they did in the 70’s (when I was diagnosed at age 12).
Essentially, I told them I hoped they aren’t teaching fear (which seems to be the education method of choice these days) and instead are teaching the way they used – to respect it (a low) and how to treat it without panic.
When I was a patient in the Joslin in November, 1976, they kinda initiated a middle of the night low and then CALMLY came in and instructed what to do. No fear. No scare tactics. No rushing around on the part of the nurse as if she thought I was going to die. No 40 ounce glass of juice that then induced a follow-up high hangover. A normal slze glass of juice and then back to sleepy time.
If they could manage this approach without glucose meters in the 70s, they can manage it now.
Riva is sooo right. Fear is not a motivating factor. Using the exact opposite emotions of fear, people who hear me speak about diabetes, hear exactly what Riva describes … “energy” … “that is vibrant, viable, and more enduring as it is tinged with excitement, hope, purpose and pleasure.”
First time looking at your blog, Scott, but it won’t be our last. It is now bookmarked. Some great thoughts here. Just when we think we’ve read every angle about diabetes we come across another thought provoking blogsite.
A lot of professionals seem to believe that fear is an effective tool in their healthcare tool belt. Perhaps they’ve come to believe that because a high percentage of their patients are not motivated, so fear might force them into making major lifestyle changes. But is it more effective? Not for us it isn’t. Diabetes is a lifelong disease and educating the patient, not scaring them, is the approach that is needed. Being scared straight about diabetic complications tends to leave one feeling powerless, rather than aware. That sense of helplessness can only be overcome by learning how to take control of diabetes. Instead of telling a patient, “If you don’t eat better and exercise more your eyes will explode and your legs will fall off” they might make better use of that brief office visit by encouraging their patients to learn more about the disease and explain to them that they have the power to prevent or delay those complications by making some changes.
One of the main reasons we created our characters was to offer a different approach to getting out the information people with diabetes need. We feel that by presenting it in an entertaining and informative way it just might have more of an impact than scaring them into doing so.
Shirley MacLaine once said, “Fear makes strangers of people who would be friends.” She probably wasn’t talking about healthcare, but it is applicable to the subject at hand. We’re also not sure during from which of her many lives the quote was taken. 🙂
Your pals,
CG & MB
Great Post Scott. Certainly, I was all too familiar with fear. After diagnosis, I initially saw an phycisian who was all about the scare tactics. Being 7 years old, it messed me up for a good period of time. Even after switiching doctors, I was afraid of going to appts, even “forgetting” my meter at times to prevent the possibility of being yelled at.
And, to build off what Jeff said, using to fear to increase what has historically been referred to as “patient compliance” or “adherence” is inherently garbage. As we are all quite aware, diabetes is truly a self treated condition. To have an environment that sets roles that do not match the situation is not only ineffective, but damaging. It gets to the point that you run the risk of wasting all your energy on feeling guilty, ashamed etc. So yes indeed, focus on the positive, as Scott has mentioned many times we are all amazing at what we do!
thanks riva . and scott.
Kudos! There’s evidence out there that fear is no more effective in prompting behavior changes than the soft sell. What the researchers found is that focusing on engagement and empowerment is much more likely to work than emphasizing “compliance.” So there’s hard data out there to go along with what we patients have been saying to each other for a while. I’ve certainly seen the positive effects of engagement recently in my own life.
I’d like to offer Zazzy some advice. What helps us change is not only moving toward the positive but having our desired change be rooted in something bigger than ourselves. In other words, what you want must be meaningful to you because it also helps others. For instance, you may want to lose 10 pounds because you’ll look better, but if you really dig down and see you want to lose 10 pounds to be healthier, and have more years for your kids or spouse, the act of losing weight acquires a whole different feeling and energy.
I wrote about it here if you want to read more: http://www.huffingtonpost.com/riva-greenberg/why-i-dont-make-resolutio_b_803200.html
Thank you Riva, that’s a lot to think about – and a challenge. It’s a real perspective change.
Thank you Scott. I love you too!
Fear has never done much for me. The need for structure and discipline in my life keeps me motivated at times but mostly it’s love. Love for my wife and children and the love I have for life itself.
I feel like I bounce back and forth between the two. Right now, I’m trying to focus on how great I feel when my next A1c comes back a little lower, and not on how crappy I’ll feel when (or if) it comes back high.
Hey…being tinged with pleasure sounds better than fear any day 🙂
I love this post, Scott (and Riva). 🙂 I would take hope over fear any day of the week. Even on weekends. I’m full-time hope like that.
I can relate to fear being a motivating factor. Only for so long. I tend to get really scared about things that can happen to me + get in my head “get your sh*t together or else this or that will happen to you”. But then I don’t want to constantly be scared so I put that fear in the back of my mind. For a lot longer. This piece from Riva is totally on point!
I used to work at a place that tried to motivate by fear and it destroyed my spirit. Never again will I accept fear as a form of motivation.
We have talked before about my feelings about fear. If it’s not from a loving place then I will have nothing to do with it.
Wow. That is so exactly what I’ve been thinking about for the past few months. So many of the changes I try to make are based on fears. But even when I rephrase my goals to be moving toward positive change instead of away from fear, the fear really seems to still be at the foundation. I don’t know how to make that shift.