The Hidden Struggle to Embrace What Is Best for Us

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What could be more important than relief from pain? If we wanted relief from physical and emotional pain, we would follow evidence-based steps to overcome problems and build a better life. Couples would stop fighting, the sleepless would rest peacefully, and the ill would regain their health. Acting sensibly would be the norm if it were not for the fact that we may not be ready for change or fully appreciate our self-defeating tendencies.

Recently, a friend who works as a physician shared the fascinating story of her mother's recovery and relapse from a serious health problem. Her mother had been diagnosed with psoriatic arthritis and was suffering from inflammation and severe pain. The woman did not want to take medications and agreed to make several changes in her lifestyle. My friend encouraged her mother to follow the evidence-based treatment approach of diet, exercise, and improved sleep.

Not only did this nonpharmacological approach help reduce her symptoms, but her mother also regained lost strength, energy, and vitality. End of story—or maybe not.

Even though her mother enjoyed good health and functioning for more than one full year, as time passed, she resumed her former unhealthy lifestyle. Her arthritis symptoms returned, which required her to start taking several medications.

When her daughter asked why she gave up on her lifestyle changes after such a fantastic transformation, her mother said, "Your father does not want to eat ice cream alone."

Readiness to Change

Healthcare providers daily face the reality that not all people are ready to change, even though change is possible. One patient will carefully follow diet and exercise recommendations and reverse their diabetes, but another individual will not make any lifestyle changes and falsely believe that if they take medication, they will be fine.

To better understand behavior change, Prochaska and DiClemente developed the Readiness for Change Scale to help identify the motivational factors for adherence to change recommendations and nonadherence behaviors. They believe that change takes place over time and typically progresses through five stages: precontemplation, contemplation, preparation, action, and maintenance.

To assess where a person is at on the Readiness for Change Scale, Stephen Rollnick developed the Readiness Ruler. The Readiness Ruler helps healthcare providers talk with patients about their beliefs about change, interest in change, ambivalence about change, plans for change, personal strengths that facilitate change, and confidence in their ability to change.

Assessing a person's readiness for change, the importance of change, and confidence in their ability to change is critical when recommending any type of treatment to a patient.

When I hear a patient with chronic pain patient say, "Physical therapy is going to just make things worse. I had PT before and couldn't move for a week!" I know that this person is in a precontemplation stage of change. To help facilitate change, I will listen to their concerns, ask about their experiences, and look for strengths and personal goals that may help motivate change. I want to help shift the individual from a precontemplation to a contemplation mindset. It would not be helpful to lecture about the benefits of physical therapy.

The Hidden Enemy

A lion will never use its strength and power to be violent and destructive unless it is hunting or protecting—only humans act in dangerous and self-destructive ways that make things worse. Rational emotive behavior therapy (REBT) gives us some insight into the self-defeating nature of the human mind.

Our thinking is both rational and irrational. According to Albert Ellis, we are prone to thinking irrationally partly because of our ego. We protect our ego, an ideal version of ourselves, as if we are protecting something vital to our existence. We don't just want to be good; we want to be superhuman in our performance and possess the desirable qualities associated with prestige within our social circles.

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Ellis referred to this struggle to perform well and be perfect as an "ego disturbance." An ego disturbance means that when we focus on looking good for the sake of our ego, we will develop the irrational belief that we should be a special, superhuman person who does well all the time. And if we are not perfect, we will either punish ourselves for our failures or punish those who withhold their approval of us.

Like the ego disturbance, Ellis stated we also have a discomfort disturbance; we assume a threat occurs when life does not go as we expect. Rather than accepting life as a mixture of good and bad, we insist that life ought to be as we would like it, not as we don't. Others should approve of us, change should not be difficult, and life should unfold according to our desires.

Unfortunately, no rule states life should be a certain way. Life can be incredibly difficult, mildly inconvenient, and everything in between.

Another term Ellis used for discomfort disturbance is low frustration tolerance. Put simply, we want life to be as comfortable as we want it to be. We tell ourselves that change should not be hard work, take effort, or require sacrifice—change should be easy, and if it is not, we cannot bear it.

First Steps Toward Change

You are likely in the middle of one or more self-improvement projects. You started a diet, joined a gym, enrolled in an online class, or maybe began to take sleep hygiene seriously. If so, here are five things to remember about change and overcoming your self-defeating tendencies.

1. There are reasons to change and reasons not to change. No one is ever perfectly motivated to change. Take an assessment of the positive reasons you have for change. Also, list some reasons for keeping things the way they are. Change always comes with sacrifice. You will lose something to gain something better. Ambivalence is normal.
2. You have overcome many challenges before. We are experts at identifying our flaws, faults, and failures. We are not so good at identifying our strengths and how we have used our strengths repeatedly to overcome problems. You are stronger than you think.
3. Relapse is a normal part of change. However, due to our ego, we look at relapse or breaking a commitment as a failure rather than a normal part of change. We see failure as an indication that we are no good, rotten, and horrible. Remind yourself that you are not superhuman but a mixture of good and bad. You are unique but not special.
4. Create a plan and then modify the plan once you start following it. You will find that any plan you create before starting a change process does not work as expected. You will have to change your plan once you discover the reality of your circumstances.
5. There is no magical way to change yourself or your strong tendencies to upset yourself. You will likely beat yourself up when you believe you have failed. You will likely upset yourself when others do not approve of you. Changing these stubborn patterns occurs only through hard work, practice, and viewing yourself with unconditional self-acceptance as a flawed and fallible person.