The neuroscience of engagement – my chemo/exercise Ulysses contract #medx

This weeks presentation in the Patient Engagement course was on the neuroscience of patient engagement. I really liked how the presenter – David Eagleman provided a concrete tool to support patient engagement.

Through this course, I’m learning that for at some people, patient engagement equals patient compliance – that is, patient engagement is being equated with patients doing what they are told, more specifically along the lines of lifestyle changes (e.g. exercise more, lose weight). I dislike the over simplification of that model of patient engagement, however, that is a discussion for another time. In this post I want to explore the tool that Eagleman presents and how I have applied that in my chemo treatment.

Eagleman’s insight to behaviour change is that “in a moment of sober reflection, put structures into place so that you will follow through with your desired behaviours”. He calls this a Ulysses contract and it involves:

  • minimize temptations
  • put something on the line (like money)
  • recruit social pressure
  • involve emotion
  • establish habits

When I started chemotherapy, I knew that exercising regularly was important, but would also be challenging. Exercise has been shown to improve outcomes and reduce side effects. I was already an active person before cancer, but I knew that chemotherapy would make getting out to exercise more difficult. It isn’t easy to get up when you are fatigued – when your body is telling you to sleep – but you know that you need exercise. My moment of sober reflection came at diagnosis, before starting treatment. I employed some of the strategies in the Ulysses contract.

Minimize temptation doesn’t really apply when you are looking at a positive behaviour change – it applies more to avoiding negative things (e.g. eating too much sugar, stopping smoking, etc). When the goal is positive behaviour change, I believe the equivalent it to put things in place to make it easier to be successful. In my case, I bought new walking shoes. I make sure my bikes were tuned up. I bought an iPod for under water (for swimming). I made sure that I had the things I needed to enjoy exercise.

Next was to ‘put something on the line’. I find this one interesting. In the video Eagleman mentions Stickk – a website where you put money on the line to help you stay motivated. My husband uses a tool similar to the one mentioned – Beeminder – somehow, having a little money on the line helps you stay motivated. I cannot say that I’ve done this. I’m not sure it would help to motivate me in any way. For me, the equivalent was to set a stretch goal. I announced my stretch goals on my blog. This made them more real – but also put it out there. My stretch goals include walking 39 miles in the Avon walk in June 2015. In order to do this, I both need to fundraise, and to exercise so that I’m in good enough shape to do it. Because friends and family have sponsored me, I’m committed to it (perhaps this is also a form of social pressure). I cannot back out – other people have showed their faith in me by putting something on the line. So, again, this is positive motivation for me.

What does work for me is to recruit social pressure. I asked all my Facebook friends and acquaintances who were interested in kicking my butt to be part of my exercise accountability team. Those who were interested joined my Facebook group, where I posted daily polls asking ‘what’s your exercise today’? This turned into a great initiative that both encouraged me to keep exercising even when I didn’t feel like it, but also helped my friends exercise more too … a win-win for everyone involved.

I’m struggling a bit with the “involve emotion” bit in the model. One might argue that the entire process involves emotion – the emotion that I’m involving is that of basic survival. I feel that my chances of survival will be greater (I’m more likely to have a positive outcome) if I can stay physically strong. So, I guess, my emotions are fully involved in this goal.

I want to say that he used the term habit and rule interchangeably. I like the ‘rule’ idea better than the habit idea. In the video he gives examples of how we might create rules that make it easier for us to make decisions. If you have a rule that you never eat dessert at a restaurant, then you don’t need to look at the dessert menu. You have made a rule that you just follow. Somehow the whole concept of creating rules for myself resonates a whole lot better than trying to form habits.

For me, the rule is that I need to do at least one kind of exercise every day – except on chemo days. This means that I either walk, bike, or swim every single day. In addition to chemo day, I allow myself one day off per week (which I rarely take). For the most part, I’ve been very good at keeping this up.

So, I can see how the concept of a Ulysses contract can be used to help motivate and maintain a positive behavior change. What do you think?




One response

  1. scottx5 Avatar

    I’m missing this week of the course so thanks for update and the video. Good tips on motivation. Was doing my consultation with the oncologist prior to my chemo yesterday and the guy was all over me for tying up resources with requests that other patients didn’t seem to need. My first unspoken response was maybe YOU should wonder why I need answers why it’s MY fault not getting them.

    Instead I clammed up and and let him work out his dislike for me as being a “problem” and now work out a lower stress solution for both of us. My original idea was to try and redo my history with this person. A lot of trouble for a minor player in my care who’s decided about me and I don’t need to please. So now my goal is to become a listener and drop all the urge to correct a person disrupting my healing.

    I find it strangely comforting to withdraw from defending myself but also motivated by the fact that dropping my guard suddenly reveals help all around me.

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