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Can You Change The Unwilling? Motivating the Unmotivated

Shannon Harvey
There is something monumentally heartbreaking about having to sit by and watch someone you love suffer with health problems that they can do nothing about. It’s a palpable kind of helpless hurt that squeezes your heart when you watch them in pain, or when medicine has no solution, or when the pronouncement is that “it’s just bad luck.”

Then, there’s another kind of heartache. The kind that comes when you have to sit by and watch a loved one who is plagued with health problems that they can do something about… but won’t.

I’ve written a lot on this blog about the phenomenon of the intention-behaviour gap, where people intend to make a healthy change, but for various reasons, don’t actually follow through. (Check out my post Easy Techniques To Make Healthy Changes Last for more.) These people are known by researchers as the “inclined abstainers” or the “unsuccessful intenders.” But in this blog post I’m talking about those who have no intention to change, whatsoever. I’m talking about the ones who just don’t want to hear it. The ambivalent, the unwilling, the resistant. The 90 percent of smokers who report they don’t want to quit and the 23 percent of people have no plan to exercise. The people that researchers call the “amotivated.”

If you’re anything like me, you’ve fallen into the trap of thinking that if you just give more information to your amotivated beloved, it will be the catalyst they need. You might give them a book, email them an article, or drag them to a talk in hope that you will inspire them. But no doubt, like me, your efforts are futile. This is because simply giving people information isn’t the key to motivating them. One of the most disappointing studies I have ever read found that in an age where experts can give people a genetic test to tell them how “at-risk” they are of developing certain diseases such as cancer or diabetes, having this knowledge generally makes no difference to the likelihood that they will change their unhealthy behaviours.

You might also think that there’s no stronger source of motivation than a cataclysmic diagnosis or a near-death experience, and certainly, popular media is full of inspirational stories of people who turned over a new leaf after facing their own mortality. But in the real world, often this isn’t enough either. For example, many survivors of heart attacks or stroke don’t make the changes needed to improve their health. A study which tracked 7,519 people around the world found that just 4.3 percent of people who had a heart attack or stroke made changes in all three of the key healthy behaviour areas of stopping smoking, eating better and exercising. Only 10-20 percent of patients in the study who were eligible for cardiac rehabilitation programs that would help them to make the necessary lifestyle changes, actually signed up for them.

I’ve seen this in my own life too. The overweight friend with type two diabetes, the smoker with heart disease, the stressed-out friend with insomnia. I can’t bear to think how frustrating it would be working as a medical professional at the coal-face of the chronic disease epidemic when 30 to 50 percent of patients don’t follow through with your recommendations. You can lead a horse to water, but you can’t make it drink.

Fortunately, this is a problem that health behaviour researchers the world over are trying to solve. In a paper called Motivating the unmotivated: how can health behaviour be changed in those unwilling to change? Professor Martin Hagger and his colleagues from Curtin University highlight that it’s not all bad news. A technique called Motivational Interviewing, which is a counselling style originally developed to get alcoholics to quit drinking, has promise across a range of other behavioural problems and diseases as well. A review of randomised controlled trials found that Motivational Interviewing outperforms traditional advice giving to galvanise people to quit smoking, loose weight, increase exercise, and in the treatment of drug addiction, asthma and diabetes.

So what do these researchers know that we don’t?

The main idea behind Motivational Interviewing is to create a conversation around change, without attempting to convince the person of the need to change or instructing them about how to change. It involves resisting the urge to give advice, argue, lecture, or even provide solutions. Most importantly, the overall aim of Motivational Interviewing is to increase a person’s intrinsic motivation so that change arises from within themselves, rather than being imposed from someone else. There are no promises of external rewards such as trophies, medals, money, discounts, presents, or outer praise, which can backfire and have been shown to only work the short term. When people are intrinsically motivated, they are doing things for their own satisfaction. They build their own goals, enhance their own knowledge, and follow through on their own action plan. Rather than an “ I should,” or an “I must,” it’s an “I want to.”

I’ve had many ups and downs, and stops and starts in my own attempt to live a healthier life. It sometimes seems like the world is against me and it’s hard to keep it up. But I’ve found that this central idea – that change has to come from within – is one of the keys to maintaining the motivation. It has to feel like a choice.

If there’s one thing I’ve learned since I began publicly talking about my recovery from a chronic disease that was worsened by my lifestyle, it’s that no matter how many films I make, no matter how many books I write, and no matter how many podcasts I produce, I cannot, and will never be able, to motivate the unwilling. Having said that, while I can’t motivate someone else to make a change, perhaps I can inspire them to change by facing my own health challenges head on.

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