By Hedy S. Wald

Take two Tootsie Rolls and call me in the morning. Self-prescribed for sweet tooth me. Not such a blasphemous “drug of choice” (I’m not even using caffeine!) but it’s New Year’s, that infamous time of resolutions. And I’d like to “kick the habit,” do all that stuff the nutritionist advised and ramp up the gym visits. Jogged 2 miles and took a 1/2 mile swim today to start the new year “right” – hopefully burned off the chocolate high. Fueled by endorphins and feeling oh so optimistic, I’m writing this blog. The question is – what happens on January 2?

The ongoing effort to implement and sustain behavior change has given me a profound appreciation for some of the struggles our patients (and even our colleagues and students) endure. Harnessing motivation can be tough and self-flagellation for not following through can make it tougher . . .  this is where some self-compassion with an attitude of kindness and acceptance toward ourselves may make a difference (1). Self-compassion can promote self-improvement motivation given that it encourages us to confront mistakes or weaknesses without either self-deprecation or defensive self-enhancement. (2) According to Breines and Chen, “resolving to make changes can be scary, as roadblocks and setbacks are inevitable along the way. From a self-compassionate perspective, however, there is less to fear.” (2)

More broadly, research has shown that gratitude, compassion, and an authentic sense of pride (not hubris) in the skills that we have propel us to behave in ways that show self-control. (3) Furthermore, gratitude and compassion have been tied to better academic performance, a greater willingness to exercise and eat healthily, and lower levels of consumerism, impulsivity, and tobacco and alcohol use. (3) Such research findings encourage these qualities rather than undue pressure to exert “willpower” which can have a psychological and physical toll (3).

Consider this: How’s our self- and other awareness when we rattle off those motivational interviewing (4) questions aimed at lasting behavior change with our patients? Are we intentionally present (5) with compassionate (and empathic) sensitivity to factors that may impede dietary changes, smoking cessation, or more time at the gym? If someone is working two jobs, having financial strain and/or managing stress with cigarettes can we think with them about taking reasonable steps, even if “baby steps” toward a healthier lifestyle? Short term goals, long term goals?  The experience of joining with another person within such striving and encouraging them can be gratifying. In this vein, a third year medical student wrote about reflecting upon the clinical experience of a successful smoking cessation intervention over multiple medical visits as a “nidus for a broader shift” in his perspective on personal/professional satisfaction. Through reflective writing, he wrote, “I realized I was beginning to draw satisfaction from patient interactions instead of purely from successful medical treatment/patient outcomes.”(6) Are we able to still derive professional satisfaction from the work we do within a therapeutic relationship when a patient does not follow through on desired behavior change? There but for the grace of G-d go I…

And speaking of which…must we walk the talk or “practice what we preach”? Can “do as I say not as I do” fly? IOW “Oy the pressure” of being a role model for our patients. Regardless of one’s answer, self-reflection on healthy lifestyle choices in general may be helpful not only for cultivating and maintaining physician mental and physical health but also to support quality patient care.

Indeed, behavior change CAN be rocket science.

So back to the Tootsie rolls and gym rat me. Resisting temptation and all that jazz. Seems that the Las Vegas odds aren’t so great. “By Jan. 8, some 25 percent of resolutions [New Years’] have fallen by the wayside. And by the time the year ends, fewer than 10 percent have been fully kept.” (3). Don’t be fazed. Let’s embrace new opportunities for self-improvement within the new year, yet do so with compassion for our patients and compassion for ourselves.

References:

1. Kristin D. Neff (2003). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude toward Oneself. Self and Identity 2: 85-10.
2. Juliana G. Breines, Serena Chen (2012). Self-Compassion Increases Self-Improvement Motivation. Personality and Social Psychology Bulletin 38(9): 1133 –1143.
3. David DeSteno (2017). The Only Way to Keep Your Resolutions. New York Times. December 29. https://www.nytimes.com/2017/12/29/opinion/sunday/the-only-way-to-keep-your-resolutions.html
4. William R. Miller, Stephen Rollnick (2013). Motivational Interviewing: Helping People Change, 3rd Edition. Guilford: New York, NY.
5. Hedy S. Wald, Aviad Haramati (2015). Hineni – I am Here: On Presence and Sacred Space. Special Section: Spirituality in Medicine-Creating Sacred Space. Journal of Alternative and Complementary Medicine 21(6): 247-250.
6. Grayson W. Armstrong, Hedy S. Wald (2013). Fostering Reflective Capacity with Interactive Reflective Writing in Medical Education: Using Formal Analytic Frameworks to Guide Formative Feedback to Students’ Reflective Writing. Medical Teacher 35(3):258.

Hedy S. Wald, PhD is Clinical Professor of Family Medicine at the Warren Alpert Medical School of Brown University and Director, Resident Resilience & Wellbeing, Residency Programs in Child Neurology & Neurodevelopmental Disabilities, Boston Children’s Hospital-Harvard Medical School.  She presents internationally on interactive reflective writing-enhanced reflection & promoting resilience and wellbeing in healthcare professions education and practice.