In primary care we are besieged with patients who very much need to make lifestyle changes in order to pivot their health status for the better. There are those that are given the facts of their poor health (labs, BMI, new symptoms, etc.) and firmly decide to do something about it, while the vast majority of others appear to be stuck in a toxic lifestyle leading to a downward cascade of preventable chronic illnesses.
A simple idea born out of decades of research may explain this very familiar pattern, and it has a direct application in the primary care setting. According to Carol Dweck, there are two implicit views that people have of themselves. One is a fixed mindset in which people believe they are born or endowed with basic qualities and are given a fixed amount, such as intelligence. They worry about how much they have and spend much of their time trying to document their endowment. It is often characterized by deep discouragement and resignation with setbacks, a lack of resilience, a high degree of defensiveness and a lack of control of what they can accomplish. Fixed mindset people tend to feel that strengths are static; they avoid challenges and often deny the existence of problems. Athletes with a fixed mindset are often not successful because they link their success to their talent and not to hard work and practice.
(by Carol Dweck, graphic by Nigel Holmes)
The other is a growth mindset in which the person does not feel endowed with qualities but believes that with hard work, they can learn and develop skills that they need. They believe they can get better at anything over time and they have a high degree of control over their lives and what they can accomplish. They respond to setbacks by learning about what went wrong and approach it differently next time. They may seek mentors and do not feel threatened, rather they adapt and are open to feedback. Growth mindset people tend to take on challenges and welcome them. Olympian level athletes have learned that they have to work hard and practice and manage setbacks to get to be number one.
Primary care providers can foster resilience and move people along the continuum towards a growth mindset. Remind patients that changing a habit is hard but not impossible, show them the diagram. Likely there may by 2 or 3 very specific behaviors that they are doing/not doing that are contributing to their poor health trajectory, those behaviors can be named, isolated and remedied one at a time. Ask them what they need to learn so they can be successful. Ask them what they intend to do when (not if) the setback occurs. Hard yes, but doable with a growth mindset. People who are successful in turning their lives away from a lifetime of debilitating chronic illness are not born, they are made. Nudge your patients by noticing their mindset and instilling hope towards this expanded growth mindset. Encourage them to learn about their obstacles in taking excellent care of their bodies so they don’t succumb to preventable illnesses, disabilities and a constricted life.
Dr. Eileen T. O’Grady is a certified nurse practitioner and wellness coach who specializes in getting people unstuck from lifestyles that do not support wellness. She can be contacted at www.eileenogrady.net
References:
1. Stanford University’s Carol Dweck on the Growth Mindset and Education. June 19, 2012. Retrieved from:
2. Job, V., Dweck, C. & Walton, G. Ego-depletion – Is it all in your head?
3. Implicit theories about willpower affect self-regulation
Retrieved from: https://www.stanford.edu/dept/psychology/cgi-bin/drupalm/system/files/Ego-Depletion%20-%20Is%20It%20All%20In%20Your%20Head.pdf
