I think this post is an appropriate continuation from my last one Don’t Let A Bad Day Ruin Your Training, albeit, unintentionally. I suppose it’s a reflection of how much I’m fascinated by this psych stuff and how it relates to training.
Another recent interest (read: obsession) of mine has been digging into the health psychology literature that studies the efficacy of the biopsychosocial approach in regards to the prevention and treatment of humans with physical pain, mental illness, and chronic disease. Many folks in the worlds of medicine/psychology/pain who are much smarter than I will already know and understand this stuff but for me, this is new and exciting – especially considering the profound implications for me as a coach, which I’ll explain later.
The biopsychosocial model views health and illness as a complex combination of biological characteristics , psychological factors , and social conditions as opposed to a more conventional biomedical model that is more one-dimensional and reductionistic (Havelka, Lucanin, & Lucanin, 2009). The holistic consideration of an individual’s unique genetics, belief systems, personality, and socioeconomic status allows for a more productive strategy in treating and preventing pain and chronic illness over the long-term. A big reason this approach may be more sustainable over the long-term is because of its focus on patient education and behavioural interventions that foster self-efficacy, confidence, and independence.
It was my extended period of time spent down the health psychology rabbit hole that lead me to eventually stumble upon Social Cognitive Theory (SCT). SCT theorizes how and why individuals begin and maintain a certain behaviour through the collective consideration of their capabilities, past experiences, past repercussions, observations, expectations, and self-efficacy as it relates to the specific behaviour at hand (Bandura, 1989). Understanding this concept has very powerful implications for a coach or trainer whose job consists entirely of working with folks who are embarking on new health challenges and subsequently changing rigid behaviour patterns. The importance of cultivating confidence and self-belief in our clients to maximize their long-term success cannot be understated and I think that understanding how to apply SCT with this intention can be an incredibly powerful tool.
While surfing PubMed, I came across some studies that reinforce my speculation that aspects of SCT may be a valuable resource in helping our clients make sustainable changes to their health. One of my favourites is a randomized controlled trial that compared the efficacy of traditional patient education methods and positive affect (PA) intervention to motivate patients to achieve a sustained increase in physical activity following an angioplasty operation (Peterson et al., 2013). PA is essentially the degree to which an individual experiences prevailing positive moods, such as joy and interest, and through how much of a positive lens they perceive different aspects of life (Fredrickson, 2001). The control group received patient education (PE) and signed a behavioral contract for physical activity. Whereas, the PA intervention group received the same patient education and behavioral contract for physical activity, as well as a combination of PA and self-affirmation coaching and received a small, unexpected gift twice a month. The PA self-induction training reminded patients to think about things that make them feel good and take a moment each day to enjoy positive thoughts. The self-affirmation induction training prompted them to think about “proud moments” in their lives when they found it difficult to exercise.
The outcome was a sustained increase in physical exercise (mostly walking) and nearly double the calorie expenditure in the PA intervention group, compared to the PE control group at 12 months. We know that in most people, the challenge is in maintaining an exercise program – not necessarily in starting one. Most people know the feeling of starting off a new fitness routine with gusto but eventually finding themselves falling off the wagon sooner than they had hoped. Interestingly, both groups had similar increases in physical activity upon beginning, but at 6 months the PA group continued to increase caloric expenditure while the PE control actually decreased their caloric expenditure.
Also, those in the PA group who reported significant depressive symptoms at baseline were twice as likely to experience improvement in symptoms, compared to those in the PE control who also reported depressive symptoms. This is not surprising given the established body of research that demonstrates the beneficial effects of physical activity on depression (Dimeo, Bauer, Varahram, Proest, & Halter, 2001; Schuch et al., 2018) and overall quality of life (Anokye, Trueman, Green, Pavey, & Taylor, 2012; Gill et al., 2013). However, it appears that the addition of PA intervention has significant implications for patient adherence and success with their exercise plan.
In my opinion, the take-away for myself and fellow coaches and trainers (and any other person in position of influence or authority) is twofold: first, to be aware of how we communicate with those who’ve entrusted us with their health and second, to foster a tendency towards positive expectations and self-belief in our clients. Our words and actions certainly shape our clients’ mental attitudes and perspectives, which affect their rates of compliance, and ultimately determine their levels of long-term success. If they don’t believe they can succeed, how is success even possible? The study above demonstrated how useful a positive mindset can be in maintaining adherence to a physical exercise plan. So, if you’re a coach who finds it challenging to get clients to stay on track, it may be helpful to reflect on your ability to invoke self-efficacy within them. Promoting a positive mindset, bullet-proof confidence, and strong belief in the plan is crucial for continued development of each individual and is a potent tool that reaches far beyond physical fitness.