In physical therapy school, the vast majority of one’s time is spent learning about the anatomy and physiology of the human body and how to most effectively rehabilitate patients from injury. A much smaller percentage of time is spent on how to effectively communicate with patients. Yet, so much of our time is spent communicating. When I was in school, I didn’t think much on this subject. I was already pretty good at communicating with others – couldn’t I just develop this skill on the job? As it turns out, depending on the patient population, communicating can get really difficult. This is especially true for patients who aren’t quite ready to change. 

There’s a well known model that helps us categorize people according to how ready they are to change. Known as the Transtheoretical Model, people described as being in one of five stages: precontemplation, contemplation, preparation, action, or maintenance. In my experience, most patients tend to be in the preparation stage. They’ve got an issue and are seeking my help. They’re open to advice on how to rehabiliate themselves. However, there is a good chunk of patients who are somewhere between the precontemplation and contemplation stage. They know that something they’ve done has clearly led them to injury, but they don’t quite know what exactly. They recognize that their behavior may be problematic, but aren’t quite ready to change yet.

If you’ve been in patient care, you’ve probably encountered these types of people. Heck, if you’ve worked in customer service, you’ve encountered this. It doesn’t even need to relate to a problematic behavior. You’re at a café with your friend who knows they want something, but can’t seem to decide on what. You’ve got a family member who knows they need to handle their finances better but can’t seem to take the first step. What do we do in these situations? Sometimes, all these people need is a little nudge to push them in the right direction and develop new habits to succeed.

In Atomic Habits, author James Clear discusses four strategies to facilitate creating new habits: make it obvious, make it attractive, make it easy, and make it satisfying. Let’s dive into them.

Make it Obvious: We want to make our intent as clear as possible: we want our patient to participate in an exercise rehab program. This could mean printing multiple copies of their home program to have in several rooms in the house, placing a set of therabands at the patient’s bedside so that they see it first thing in the morning and right before they go to sleep, or having the patient setting daily reminders on their phone. “Habit stacking” is a great strategy, where the new habit (exercising) is performed before or after other daily routines, such as teeth brushing or making coffee.

Make it Attractive: Ideally, we want our patients to like what we give them. Prescribing exercises that they enjoy will make developing the habit that much easier. However, this is not always the case. In these situations, you can try “motivation stacking.” Similar to habit stacking where exercise is linked to daily routines, motivation stacking involves linking exercise to something the patient enjoys. Do they enjoy streaming movies? Why not do a few sets of exercise in between each episode of the series they binge watch. Do they enjoy going to the beach? Exercising at the beach can be fun – AND you get to tell your patients how they can develop their beach bod!

Make it Easy: The idea here is to reduce friction that may be preventing the new habit from forming. In a fast paced world where we can now buy groceries in less than ten taps of our phone, decreasing the number of steps required to perform the habit is invaluable to our patients. Can you teach your patient’s home program with as little instruction as possible? This may make it easier for them to recall how to perform their exercises. Out of the infinite list of exercises you could possible prescribe, can you make it easy and distill them down to just three? Turns out, less than four exercises leads to higher adherence. 

Make it Satisfying: Remember in Psychology 101 when you learned about Ivan Pavlov’s dogs and classical conditioning? Pavlov inadvertently connected a seemingly benign stimulus (a bell) with an automatic response (drooling). If you set up your patient’s home program so that it’s easy and attractive, they are more likely to enjoy doing it. Connect the action of exercise with the feeling of satisfaction, and you have a recipe for success. If they like the exercise you give them, they may develop a liking toward exercise in general AND release those satisfying feeling endorphins in the process. Oh, and not to mention they are likely to live with less pain! Need a little extra push? Follow up exercise with a habit they enjoy, like watching an episode of their favorite series or reading a few extra pages of their book. Suggest crossing off days on a calendar when exercises are performed. For the more tech savvy patients, a mobile habit tracker may be another way to do this.

As one can imagine, many of these strategies do not strictly fall under their aforementioned categories. A lof of them can be interchangeable – it’s the intent that defines what category they fall under. What I love about these strategies is that they give a solid framework from which to help those patients that need a little bit of a push. Chances are, you may already be practicing one or two of these strategies. Try out ones that you’re not familiar with, or try combining several of these strategies with one patient. You never know how successful you will be with these tools!

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