Mobilizing Motivation: Basic Concepts

Steven Jonas

INTRODUCTION

As mentioned in the Introduction, the United States is awash in information about both what to do in exercise and how to do it. If those were the key factors in helping people to become regular exercisers, the country would be awash with regular exercisers, too. However, it has become quite obvious, as the U.S. population becomes heavier and less active, the “what” and “how,” although important, are not the central factors in helping people to make health-promoting personal behavior changes. Over time it has become clear that it is the motivation to make changes and how to go about mobilizing it that are the central factors. No one is going to be able to make a health-promoting behavior change and then stick with it indefinitely if they are not properly motivated to become healthier and stay that way, have not mobilized their own motivation to do so, cannot maintain their motivation indefinitely, and cannot first gain control of the process and then stay in control of it.

THE NATURAL HISTORY OF HEALTHY BEHAVIOR CHANGE

If one is leading a sedentary lifestyle and is not engaging in job-related or leisure-time extraneous physical exertion, then becoming a regular exerciser will obviously mark a big change. However, can a person simply say, at any given time in life, “OK, I’m going to start a program now, I will stick with it indefinitely, and a lifetime pattern of regular exercise will be the result,” and be assured of success?

First of all, each person’s health status changes over time. It is a rare person who can be entirely healthy at any one time. A sound aphorism that applies to all health-promoting lifestyle or behavior changes is: “We can never be perfect; we can always get better.” In the course of our own lifetimes, each of us will engage in some particular aspect of “getting better,” such as becoming a regular exerciser; but when this happens varies widely from person to person. We will repeat this because it is an important premise of our whole approach: Perfection is not the objective here; becoming healthier and thus happier
is. Different people change at different rates at different times in their lives. Different people achieve different goals at different times in their lives. But if they do make changes and change successfully, motivation and their ability to mobilize it are at the center of the effort. Therefore, we are going to spend a fair amount of time and space in this book discussing the subject.

MOTIVATION: BASIC CONCEPTS

Definition

Most people know in general terms what they are thinking about when they say, “I’ve got to get motivated,” “My motivation is high for this one,” or, alternatively, “Gee, I just can’t seem to get motivated.” But few of us can immediately put into words exactly what we mean when we use the term. Indeed, even among health professionals, many who use it frequently don’t define it in so many words. However, for this discussion, it is helpful to have a written definition. Our definition is:

“Motivation is a state of mind (characterized as an emotion, feeling, desire, idea, or intellectual understanding; or a psychological, physiological, or health need mediated by a mental process) which leads to the taking of one or more actions.”

Or, briefly:

“Motivation is mental process that connects a thought or a feeling with an action.”

Thus, motivation is based in the mind. It is a thought or set of thoughts. It is not something tangible. In other than psychopathologically self-destructive persons, motivation is always potentially there, even if inactive, for it is essential to self-preservation and the underlying human striving to be healthy. Thus, “getting motivated” is not a question of developing or importing the mind-state. It is rather a matter of activating a presently quiescent process, of mobilizing it, of removing barriers to its expression. If a patient is having a hard time “getting motivated” but seems ready to start (see the Stages of Change, which follows), the clinician’s task is to help the patient locate these barriers and then help him or her to mobilize the mental process needed to remove them.

Among the common barriers to effective motivation mobilization are: “I really don’t want to do this”; “I know I’ll just never be able to get started”; “I just know I don’t have the time”; “One day I want to and the next day I don’t”; and fear of failure once one does get started, that “I-know-that-I-just-won’tbe-able-to-do-it” feeling. Throughout the rest of this chapter, you will find suggestions
for helping patients work through these types of internal obstacles to mobilizing motivation. Central to doing that is considering the question, “What patient needs are being met, what function is being served by the patient’s not exercising on a regular basis?” As one wag once put it, “Are your risk factors in such tip-top shape that you can get through life staying healthy, without exercising?”

Motivation: Mental Process and Action

When we talk about either “being motivated” or “lacking motivation,” we are referring to various states of mind that will either impel us to undertake an action or hinder us from doing so. There are three phases in “finding” or “developing” motivation: first, experiencing an emotional and/or intellectual thought processes of the motivational type; second, establishing a clear mental pathway between those thoughts and the potential for taking the related action; and third, taking the action as the result of being motivated.

EFFECTIVE MOTIVATION ALMOST ALWAYS COMES FROM WITHIN

The scientific literature is clear that in most cases, to be effective, motivation must be inner-directed, e.g., “I want to do this for me, to look better, feel better, feel better about myself, for me, not for anyone else” (1). External motivation—“I’m doing this for my spouse (or significant other or friend or children/parents or employer/co-workers)”—almost invariably leads to feelings of guilt, anxiety, anger, and frustration and then, often, to injury and/or quitting. If your patient wants to look better, feel better, be fitter, and feel better about himself or herself, for himself or herself, for no one else, then he has inner motivation. If the patient views simply as an extra benefit whatever good the changes do for her in others’ eyes, then she has inner motivation.

With inner motivation your patient will be able to take control of the way he exercises and eats (and smokes or not, and drinks out-of-control or not, etc.). With inner motivation, the chances are excellent that he will become a regular exerciser, slowly, gradually, and carefully. The one exception to the inner-directed rule is when the person can honestly say, “I’m doing this for someone else because it will make me feel good and feel good about myself if I make them happy.” However, even in this case, the motivation is still coming from inside. Because no one can effectively motivate anyone else, you must be able to clearly see your role as a clinician, with its natural limits.

You can guide your patient through the processes of internal motivationmobilization and goal-setting leading to self-discovery and action, provide positive reinforcement, model the role, offer technical assistance—but that’s all. You cannot motivate other people for lifestyle behavior change. You can only help patients locate their own motivation and mobilize it within themselves by taking control of the process.

TAKING CONTROL

Taking control is a critical concept to stress in the process of helping patients to locate/unblock/mobilize motivation. Indeed, it is the fifth and final step in the wellness motivation mobilization pathway described in detail in Chapter 5. When your patient takes control, she is deciding what she wants to do with his or her body; she is deciding to engage in physical activity regularly, perhaps to do some things, let’s say in a sport, that she has never done, or ever contemplated doing.

Taking control is central to both starting a regular exercise program and sticking with it. And there is much to take control of: whether to undertake a change process at all; what goals to set; which sport(s) and/or activity(s) to engage in. Making choices, of course, as we said in the Introduction to this book, means taking responsibility oneself, for oneself. Taking control and taking responsibility are both mental processes known to psychologists to be powerful motivational tools.

THE PROCESS OF CHANGE: PSYCHOLOGICAL CONSIDERATIONS

The Stages of Change

In helping patients to mobilize their motivation and then engage in behavioral change, it is important for both of you to understand that, in most people, such change does not occur overnight. In fact, programs that focus solely on the behaviors without attending to the motivational process that underlies behavioral change, are more likely than not to fail.

A psychological model of the gradual process that underlies the mobilization of motivation for change, originally developed by Prochaska and DiClemente (2) and updated in the 1990s (3,4,5,6), is widely used. (There are others that are valid, too. We are simply most comfortable with this one.) This description and analysis of the change process is helpful in understanding how and why motivation is successfully mobilized, as well as in understanding the factors that lead to failure to do so. In their revision of the original model, Prochaska, DiClemente, and Norcross identify what they call “The Six Stages of Change”: precontemplation, contemplation, preparation, action, maintenance, and termination. As Prochaska pointed out in terms that are still valid, “In this stage approach to change, taking direct action to change one’s behavior is only one of six stages. What people do in the stages preceding action and what they do in the stages following action are at least as important as the action they take” (4).

And so, the stages (see the summary at the end of this section, in Three-Minute Drill 4-1):