A Practical Guide to Leading Patients to Healthy Behavior Change

In this age of chronic disease, we know all too well the importance of a healthy lifestyle, yet many people still struggle to break free from unhealthy habits.
While the "what to do" is clear—eating a balanced diet, getting regular physical activity, getting enough sleep, forming positive social relationships, avoiding harmful substances, and managing stress—the challenge remains how to put it into action and maintain it.
Although medical professionals can sufficiently explain to patients 'what to do' based on their expertise, they often feel at a loss when it comes to actually guiding patients to change and maintain their behavior.
This book is a practical tool to bridge the gap between 'knowledge' and 'practice'.
This is a practical guide to help medical professionals and other healthcare providers effectively lead healthy behavioral changes in patients in real-world settings.

In the 'coaching approach,' coaches and patients work together to find solutions to problems related to chronic illness or behavior change.
In this case, the solution is not a one-sided directive, but a multifaceted approach from various perspectives.
In the 'coaching approach,' coaches and clients work together to explore ideas for solving problems.
Of course, coaches are not without solutions to offer patients, and they may have useful and appropriate ideas.
The key is for patients and coaches to brainstorm together to explore various solutions, and for patients to be empowered to choose the one that best suits them.
Problem solving is the patient's responsibility, and the clinician is a companion who helps with the conversation and provides direction in the process.
Ultimately, it is up to the patient to decide which solutions to try and when.
--- p.67~68

We forget that we are constantly asking our clients to take the next step or change their behavior: take a pill, lose weight, exercise, go to the doctor.
For some, change comes relatively easily, but for others, attempting change requires an attitude of vulnerability, humility, and a willingness to enter unknown territory.
As clinicians, we may not fully understand the feeling of vulnerability we feel when we are forced to commit to something without knowing the outcome or take action we truly do not want to take.
Recognizing that we are experts in a specific health field and that our clients are experts on themselves—that is, acknowledging their own vulnerability—can help us achieve balance in our interactions with clients.
The key to motivational interviewing is to combine these two.
That is, the clinician brings expertise in ‘health’, and the client brings expertise in ‘themselves’.
--- p.176

Autonomy means that an individual feels that he or she has choice and control over his or her own actions.
This innate need to feel “in the driver’s seat” of one’s own life is essential to achieving lasting behavioral change.
Clinicians can support patient autonomy by acknowledging patients' feelings, respecting their values ​​and interests, and using collaborative communication skills to enhance patients' choices.
This autonomy support has been shown to positively impact various lifestyle habits and clinically important behaviors, such as improved medication adherence and increased fruit and vegetable intake in patients with diabetes.
--- p.224

Clinicians who utilize a coaching approach view patients not as "objects to be fixed," but as individuals with the ability and resources to create healthy behavioral changes.
Patients are not simply people with illness or problems, but rather individuals who can take meaningful action based on their own values ​​and beliefs.
Patients have basic psychological needs: 'competence' in the actions they perform, 'relatedness' in feeling connected and cared for by those around them, and 'autonomy' in making their own decisions about their lives.
With this in mind, clinicians treat patients as the experts who best know their own lives, respecting them as individuals with the potential to enhance their health and well-being by expanding their valuable insights and awareness and exploring their possibilities.
In exploring patients' values, coaching becomes a powerful tool for eliciting autonomous motivation for change.
--- p.234

Being 'open' or 'ready to receive' means the ability to remain in a state of readiness to recognize and accept what is present in the present moment, and to be ready to detect all signals coming from the client.
This is an attitude of openness without preconceptions, accompanied by a tone of unconditional positive regard and respect.
At this time, the medical professional listens empathetically without interrupting, and uses open-ended questions and reflections to ensure that communication with the client is taking place properly.
True openness involves recognizing that factors such as a client's ethnicity, sexual orientation, economic and social status, and physical appearance can interfere with the therapeutic alliance through unconscious biases or attitudes of the practitioner.
Practicing openness means having the opportunity to recognize moments when entrenched beliefs on both sides, such as those that might hinder meaningful interaction, emerge.
Conversely, in a 'closed' state, factors that interfere with the presence of the healthcare provider mentioned above (e.g., the healthcare provider's biases, stereotypes, fears, boredom, fatigue, etc.) are at play, increasing the likelihood of missing important signals from the client.
This can lead clients to question whether the healthcare provider is a trustworthy partner who truly understands and cares for them, and as a result, their motivation to maintain behavior change is weakened.
--- p.318~319

Many people believe that change requires methods such as education, coercion, threats, advice, fear-mongering, and pushing, but this is not the case.
Education, information, and sometimes advice can help, but other methods that involve coercion or fear are ineffective.
This approach not only fails to elicit spontaneous change in people, but also fails to inspire or motivate them, and can actually foster rebellion.
So, what are effective ways to inspire change in people? Some behaviors that empower people to make change include consideration, listening, respect, trust, guidance, brainstorming ideas together, identifying and leveraging strengths, acknowledging them, and believing in them.
As Dr. Dean Ornish said, love is one of the most powerful motivators.
Fear-mongering may work in the short term, but it doesn't lead to sustainable change.
On the other hand, love is a driving force that sustains change and a powerful force that induces people to change voluntarily.

--- p.595