How can close interpersonal family relationships motivate others toward positive, healthy lifestyle changes?

Many of us have witnessed family members make poor decisions, sometimes to the point of spiraling out of control.  According to the CDC’s Behavioral Risk Factor Surveillance System, 72% of U.S. adults report having one or more unhealthy behaviors (Baily, 2019)!   It breaks our hearts to watch someone that you love get addicted to drugs, develop a bad drinking habit, gain excessive weight, become very sedentary, fall down a conspiracy theory rabbit hole, get depressed and suicidal, develop a gambling problem, or not take care of pressing health issues.  We often feel helpless, and despite our best efforts to help them, our assistance is not successful, and their troubles become more severe.  Lifestyle changes are not easy, but there are some proven ways to help motivate others toward positive, healthy lifestyle changes.

Percentage of Adults with Zero Unhealthy Behaviors*, United States (BRFSS 2014)
 

*Multiple unhealthy behaviors is any combination of three or more of following five unhealthy behaviors: smoking, physical inactivity, excessive drinking, obesity, and insufficient sleep.

Theory of Planned Behavior

Social Psychologists developed the Theory of Planned Behavior indicating that the factors that directly influence a person’s intentions to engage in healthy behavior include the person’s attitude toward the behavior, the person’s perception of their social group norm, and the extent to which the person perceives their ability to have control of the concerning behaviors. It is believed that it is a combination of those three factors that influence behavioral intentions (Kan, 2017).  If a person’s family or social circle engages in heavy drinking or binge eating behaviors and these behaviors are the norm, and their attitude is that these activities are no big deal, then that socially acceptable unhealthy behavior will persist.  When a person loses control and becomes addicted to alcohol or obese, they may perceive that they have no ability to control their behavior.  They might say, “My whole family is overweight so it must run in the family, and I can do little to change that.”  This theory does not explain all unhealthy behaviors but does show that social influence and perceived ability to control a behavior plays an important role in healthy behaviors.

Nagging vs. Encouraging

When dealing with behaviors that are not part of the normative social structure within a family, a person’s perceived ability to control their behaviors are important, and that is where we come in.  Nagging a person or angry discussions about their behavior may exacerbate the issue and serve to further lower their self-esteem and perceived self-efficacy in changing the behavior. The term “self-efficacy” refers to your beliefs about your ability to effectively perform the tasks needed to attain a valued goal (Maddux, 2022).  In other words, if someone believes they can make a change, they are more likely to do so. According to Psychologist Dr. Robert Myers, nagging does not work and can be a form of criticism focused on what a person is not doing that may serve to reinforce their feelings and beliefs of their inability to overcome their unhealthy behavior choices (2011). Instead of nagging, we ought to use positive reinforcement words like “You can do it”, or “I believe in you”.  Helping a person change their beliefs about their abilities to overcome a challenge may contribute to their first step in positive, healthy lifestyle changes.

Evidence Based Strategies

Beyond giving social support and helping a person believe in their ability to overcome challenges, there are some additional evidence-based strategies that are effective in encouraging health behavior change (Hooker, 2018). Three interventions that seem to be useful across all behavioral change efforts are:

1. ‘SMART’ goal setting wherein we would help our loved one visualize what they need to attain their goals in Specific, Measurable, Achievable, Realistic and Timely ways.

2. Helping someone understand perceived or actual barriers that might make it difficult for them to achieve their goals, and problem-solving with them to overcome those barriers.

3. Encouraging them to self-monitor their behaviors via journaling or with a digital device like a FitBit, SuperTracker, or Chronometer.

Self-Determination Theory

We can give someone we care about social support, encourage their self-efficacy, and provide them with some tools to goal set and self-monitor.  The adage that you can lead a horse to water but can’t make them drink may be somewhat true here.  Beyond that, it begs the question: Is there anything else we can do to truly motivate someone when it seems their motivation for change is nowhere to be found? Self-Determination Theory indicates that our three innate needs for autonomy, competence, and relatedness need to be met to motivate self-initiated behavior. In other words, we desire to be the causal agents in directing our own life and not be told what to do, we need to control the outcome and experience the mastery of any desired behavior, and our satisfaction or frustration and meaningful connections with others while doing that activity determines our behavior (Ryan, 2000).  Attempting to control or nag someone is not going to work in motivating them toward healthy behavior change as they need to feel like they are directing their own life.  We can give someone some of the tools needed to increase competence and confidence to master changes.  We can provide social support and show them how pleasurable healthy behaviors can be.   What we can’t do is provide the internal motivation needed to make changes. 

Internal / Intrinsic Motivation

Internal motivation, sometimes called intrinsic motivation (Ryan, 2020) are brought about in a person by combining autonomy, mastery, and purpose. In other words, any activity that a person is motivated to do must be inherently interesting and enjoyable to them, chosen by them, challenging enough to them so that it promotes a sense of mastery and accomplishment, and must give them a sense of purpose which is a general feeling of contribution to the greater good along with social connectedness (Fischer, 2019).  We can facilitate rather than undermine intrinsic motivation by creating a supportive environment that is conducive to change by giving choice and opportunities for self-direction which enhance intrinsic motivation by allowing for personal autonomy.  But what may be missing for a person is not knowing what they want and once they figure out what they want, they may not know how to achieve their goals.  This is where a supportive partner can play an important role: drawing out the answer with the right question(s).  This is sometimes referred to as evoking or eliciting their own thoughts about their internal motivation to change.

Evoking – Motivational Interviewing

Evoking is a ‘Motivational Interviewing’ technique often used by clinical psychologists that can be utilized by a supportive partner to help draw out change behavior (*see side note). According to psychology researcher Jennifer Hettema, “Motivational interviewing is a client-centered, directive therapeutic style to enhance readiness for change by helping clients explore and resolve ambivalence” (2005). This approach helps to reinforce a person’s own reasoning for change. It is also thought that when a person speaks of change out of their own free will, they will feel more favorable about making a change (Miller, 2014). To better understand Motivational Interviewing, there is a brief overview on YouTube by Dr. Bill Matulich titled Introduction to Motivational Interviewing. Watch Video Introduction to Motivational Interviewing.

Summary

In summary, behavior change is not easy, and it is heartbreaking to watch a loved one spiral out of control with unhealthy behaviors.  It is equally frustrating for someone to be caught up in unhealthy behaviors while not knowing how to make positive, healthy changes. Our approach to encouraging healthy lifestyle change ought to come from a place of empathy knowing that 7/10 people engage in unhealthy behaviors.  Empowering our loved ones by affirming your belief in their ability to overcome challenges is the first step in encouraging lifestyle change, but some need a little more assistance in overcoming those obstacles.  Creating a socially supportive environment, helping with SMART goal setting, helping problem solve overcoming barriers, and encouraging self-monitoring are proven strategies to encourage healthy lifestyle change.  However, internal motivation for change needs to come from them, but our understanding of the importance of autonomy, mastery, and purpose, along with utilizing appropriate questioning and evoking techniques can help your loved one with positive, healthy behavior change.  We cannot force a person to want to conquer something or find their purpose. But I am delighted to know that we may be able to draw out the best in them, and when they find what they want, we can be there to support their mastery.

Thinking Questions:

• If you could master one thing like a sport, skill, instrument, Mount Kilimanjaro, an art, writing a book, etc. – what would it be?
• If you could do any one thing to help humanity, what would it be?
• What is the reason you get up every day?  What is your why?
• What things can you find to be grateful for every day?

More Resources:

• For more information on Self-Determination Theory, visit the Center for Self-Determination Theory at https://selfdeterminationtheory.org/ or Positive Psychology at https://positivepsychology.com/self-determination-theory/
• For more information on evidence-based strategies to encourage behavior change, please visit https://www.aafp.org/fpm/2018/0300/p31.html
• For more information on Motivational Interviewing, please visit https://motivationalinterviewing.org/

*A Side Note:

Evoking techniques for chronic depression and drug or alcohol abuse have a low quality of evidence for its efficacy.  Cognitive Behavior Therapy, along with learning gratitude may be life changing for individuals suffering from depression or addiction.

References:

Bailey, R. R., Phad, A., McGrath, R., & Haire-Joshu, D. (2019). Prevalence of five lifestyle risk factors among U.S. adults with and without stroke. Disability and health journal, 12(2), 323–327. https://doi.org/10.1016/j.dhjo.2018.11.003

Fischer, C., Malycha, C. P., & Schafmann, E. (2019). The influence of intrinsic motivation and synergistic extrinsic motivators on creativity and innovation. Frontiers in Psychology, 10, Article 137. https://doi.org/10.3389/fpsyg.2019.00137 Retrieved from https://www.frontiersin.org/articles/10.3389/fpsyg.2019.00137/full

Hettema, J., Steele, J., & Miller, W. R. (2005). Motivational interviewing. Annual review of clinical psychology, 1, 91–111. https://doi.org/10.1146/annurev.clinpsy.1.102803.143833

Hooker, S., Punjabi, A., Justesen, K., Boyle, L., & Sherman, M. D. (2018). Encouraging Health Behavior Change: Eight Evidence-Based Strategies. Family practice management, 25(2), 31–36.  Retrieved from https://www.aafp.org/fpm/2018/0300/p31.html

Kan M.P.H., Fabrigar L.R. (2017) Theory of Planned Behavior. In: Zeigler-Hill V., Shackelford T. (eds) Encyclopedia of Personality and Individual Differences. Springer, Cham. https://doi.org/10.1007/978-3-319-28099-8_1191-1

Maddux, J. E. & Kleiman, E. (2022). Self-efficacy. In R. Biswas-Diener & E. Diener (Eds), Noba textbook series: Psychology. Champaign, IL: DEF publishers. Retrieved from http://noba.to/bmv4hd6p

Matulich, B. (2013, May 30) Introduction to Motivational Interviewing [Video]. YouTube. https://youtu.be/s3MCJZ7OGRk

Matulich, B. (2013, May 30) Introduction to Motivational Interviewing slide screenshot [Online Image]. YouTube. https://youtu.be/s3MCJZ7OGRk?t=930

Miller, W. (2004). Motivational interviewing in service to health promotion. The Art of Health Promotion, American Journal of Health Promotion, 18(3), 1–12. https://doi.org/10.4278/0890-1171-18.3.TAHP-1

Myers, R. (2019, July 23). Why nagging doesn’t work. Child Development Institute. https://childdevelopmentinfo.com/parenting/why-nagging-doesnt-work/

Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68

Unhealthy Behaviors State Map [Online Image]. (2016). America’s Health Rankings and Spotlight: Impact of Health Behaviors. United Health Foundation website https://www.americashealthrankings.org/learn/reports/spotlight-impact-unhealthy-behaviors/national-insights-prevalence-zero-unhealthy-behaviors