Stages of Change Legends -100th episode special event!

Dr. Cooper

Welcome to the 100th episode of the Catalyst Health, Wellness and Performance Coaching podcast. I’m your host, Dr. Bradford Cooper. And do we have an incredible surprise for you today to mark this momentous occasion. You’re probably familiar with the concept of the stages of change, which describes how behavior change occurs in our lives. Today’s guests includes the lead developer of that model. Dr. James Porchaska along with his wife of 53 years. Dr. Janice Porchaska who in herself is one of the most published authors on the planet in the field of social work. They are the coauthors of the health and wellness must read book, Changing to Thrive. Let me give you a brief overview of the six stages of change so we can focus the interview on some deeper discussion rather than having to simply review that during the conversation. So, number one is pre-contemplation. You’re not ready. You’re not intending to take action over the next six months. Number two is contemplation. You’re getting ready. You’re intending to take action sometime in the next six months. Number three preparation, you are ready to take action in the next 30 days. Number four action. You’ve made the behavior change, but it’s been going on for less than six months. Number five maintenance. You’ve been doing the new healthy behavior for more than six months. And finally, number six, termination. You’re confident with the change. You’re not tempted to relapse. So those are the six stages of the change. I thought you can come back and review this or Google it or whatever, but we want to focus the conversation on the greater depth, rather than focusing on just going through these six. So there you go. Speaking of contemplation, if you’ve been in the contemplation stage about pursuing your wellness coach certification, I’m encouraging you, please don’t wait. The requirements, and I’ve mentioned this, you know, this already, the requirements for the national board exam changed this fall. And that’s going to mean more time. It’s going to be more cost for you to pursue that. So no reason rushing into it, just to rush into it. But if you’re planning on doing it in the next six, eight months, you might as well save some money and time in the process. Our two most recent programs to qualify you for the national board exam filled a full month early. So we added one more extra program in July. If you just realized the deadline is here, you’ve been sitting on that fence, this is it, folks. This is your last one. So it will fill early based on what happened in May and June. So don’t wait if this is important to you. Always feel free, if you want to talk it through, if you want to visit about it, talk about how it fits in your career, et cetera, our email is, Results@CatalystCoachingInstitute.com. Happy to set up some time to discuss your specific situation, answer questions, et cetera. You can also go to the website CatalystCoachingInstitute.com. There’s a new ebook we put up there that walks you through all those requirements for the national board. That might be helpful. Now it is time to jump in with our extra special episode number 100 with doctors, Janice and James, Porchaska on the latest episode of the Catalyst Health, Wellness, and Performance Coaching podcast.

Dr. Cooper

Well that’s for a later interview, that’s for you interviewing me. All right. Well, it is such such a privilege to welcome the Porchaskas today, Dr. Janice and Dr. James Porchaska. Most of you know them, they’ve had a huge impact on our field, on our industry on, on many people far beyond that. You’ve heard my introduction, the two of you, thank you so much for joining us, special 100th edition, and it’s just such a pleasure to have you today.

Dr. James Prochaska

Special for us too.

Dr. Cooper

I appreciate it. Um, so behavior change. It’s at the heart of so much in life. Maybe a good place to start would be discussing a difference between why people think they are failing to change versus the real reason they’re failing to change.

Dr. James Prochaska

Well, first of all, most people have an action model of behavior change, and they believe change happens when they quit smoking when they quit, uh, alcohol, when you quit junk food. And so, uh, they end up with, uh, attribution’s like, I don’t have enough willpower because that’s an action paradigm. We’ve got a will it, I don’t have enough motivation. And those kind of attributions are demoralizing. You know, if I don’t have enough willpower, why should I try motivation? Maybe I’ll wait till I hit bottom, which is, I mean what an awful philosophy but it’s so common. I think the thing is too, most people don’t know how to change and that’s what we’ve really been working to help people to learn how to change.

Dr. Cooper

Well, and that’s the exciting part about the stages is it literally gives you those steps. You, you don’t have to, you don’t have to guess anymore. You, you can literally say, where am I? Okay. There I am. Now, what is the next piece of the piece of the puzzle?

Dr. James Prochaska

Yes. Yep. And what’s great about it. It’s it’s inclusive, you know, I mean 40% of the people with the biggest risk behaviors, are in pre-contemplation. But, most programs leave them out or exclude them. And you can get a higher rate of return if you just stay with the 20% that are most prepared. Uh, but you know, you exclude 80% of the people.

Dr. Cooper

So true. So true. All right. So the transtheoretical model of behavior change, first of all, really cool name, uh, but the more common term stages of change, that’s probably the one that people recognize more. Did you have any idea when you first published this research back in, I think it was 83, that it would have this level of impact 37 years later. What did, kind of walk us through what that journey has been like.

Dr. James Prochaska

Well, believe it or not, as soon as we discovered, uh, stages of, you know, just interviewing like 50 ordinary people, I grew up in a factory neighborhood and I knew the wisdom of ordinary people, but what I had been working on was how can we take this fragmented area of counseling and psychotherapy that just had so many different approaches, how we could, re-integrate the processes of change that are used. And when we heard that it’s like, Whoa, this is a new paradigm. This is going to be a scientific revolution it’s so, you know, and then it’s like, Whoa, the anxiety, you know, the burden of responsibility to make it so it’s available.

Dr. Janice Prochaska

Jim was interviewing people who had stopped smoking on their own and when he would say, but what were you doing? What helped you. And they said, it depends. It depends where we were in the process of working on changing it.

Dr. James Prochaska

Yeah. So like we would say, uh, did you reinforce yourself for the steps you would take to say? Yeah. Yeah. That’s more, when I was quitting, did you take and look to understand more in terms of about your, uh, uh, smoking and, well, that was early on. And so, you know, again, listening with the third ear of a clinician, you know, we heard them talking about stages and then it was like, that’s the missing link that pulls it together.

Dr. Cooper

Wow. So you, you did have a sense right out of the gate, you felt like this could be something that will help for generations.

Dr. James Prochaska

Yeah. Since I first started, I mean, it was, it was basically based on those 32 people and, uh, it was American psychologists, and I’m proud to say out of 10,000 studies on tobacco, across all fields, that’s the number one article most cited.

Dr. Cooper

Wow. That tells you something right there. So we provide our listeners with a brief overview of the six stages of the change from your book. And I’ve got it right here, changing to thrive, uh, during the introduction. So they have the foundation and they can rewind and hear it, if they’re going, wait, what were those again? Uh, are there common misconceptions about one or more of the stages that now might be a good time to help clarify?

Dr. James Prochaska

Yeah. So one of the most common is that people in pre-contemplation don’t want to change. And, uh, when you look in terms of, you know, millions of Americans tried to lose weight too many times, and too many ways, their history says they want to change, but they get the demoralized about it and, and give up on it. With contemplation, uh, there’ll be seen as procrastinator. It’s just putting it off, you know, someday I’m going to change kind of thing. Well they are characterized by profound ambivalence, the pros and cons of changing absolutely tie. And you know with wall street, you know, and so they have real doubt. Is it worth it? Is it not? But when you talk about wall street, you know, if you have doubts, you don’t act, you know, you don’t invest. And so, uh, again, it’s, it’s like attributing to them, things from an action paradigm that they’re making mistakes about, but once they start to learn and they get that, you know, we say the first thing you have to change if you’re going to change your life is change and learn and change your mental model that you have, you have an action that’s going to get in your way, a great deal. And once they get it, it’s like, wow, how come nobody ever taught me that?

Dr. Janice Prochaska

I think too what can happen is that a health coach, once they get their person they’re working with to action figures, oh, got my work done. And the reality is that there’s a lot of work that needs to happen to stay in action and the importance of really working hard for at least six months so that you can get to maintenance. So there, the coach really needs to stay with the client and really help them use the processes of change, they’re important to use when you are working to stay in action.

Dr. Cooper

I love that you brought that up because so often we hear from coaches well do I work with someone for a month? Do I work with them for three sessions? Do I? And our model has always been, it’s a relationship, it’s a lifetime. It, you know, you may work with them for, in some cases, it might only be a year period, but oftentimes it can be five, six, seven, eight years because life’s a moving target. And so it’s encouraging to hear you talk about that process and the time it takes and those kinds of things. You’ve spoken about the inaccuracy of the 21 day myth. We always hear that around, especially around January and new year’s resolutions and all in terms of habit formation. And as you just said, Janice, it’s probably closer to six months, 21 days makes for a lot better headline. Why, why, why is it, or how did you discover that the six months is so much more accurate than the 21 days? And does anything of value really happen in that first 21 days?

Dr. James Prochaska

That 21 days comes from, uh, research, uh, John Norcross, former student myself, did on new year’s resolutions. And what we found was that about 50% of the people relapsed in the first 21 days in the first three weeks. And so media always flaunted new years stories. And so they interpret it is also a 50% relapse in the first 21 days, the rest are successful. The relapse curve keeps coming down and, and it doesn’t level off, but not until around six months. And that’s why we also talk about action as six months, because we want to see that flatten up, just like with the epidemic we wanted to see it flatten out in terms of number of infections and all, and before we take other action.

Dr. Cooper

So is that, have you seen when people step into utilizing the stages of change, that that timeline is sped up a little bit, or are there certain places where you say, well, if you step in and you’re already at the preparation stage, you’re probably looking at three months or do we need to be in that action section for that six month period?

Dr. James Prochaska

Well, in the six months, it is a guideline and because in terms of what the flattening out. Uh, but yeah, so many people typically, we’re not encouraging people to go to action unless they’re in the preparation stage. Uh, but yeah, some people can, can move more quickly. You know, it’s like yourself as an athlete, you know, the more effort you put in, uh, the faster you can get through it. But we also don’t want to take people that feel like they’re being pressured, you know, more quickly to get through it. Uh, and so it’s, uh, there is an arbitraryness, but when we say, okay, like cholesterol, what levels should we have? Well, that’s arbitrary, but it’s a guideline so that, you know, and we use this kind of thing. If you are going through life saving surgery, would you give yourself six months to recover? Think of this as life saving behavior change. And would you look for support from other people, right. And would you look to do what, you know, you can to recover more quickly and more easily?

Dr. Cooper

That’s a great example. Um, okay. So as you’re talking about this, uh, I mentioned Suzanna, our chief learning officers. She’s the one that knows this so much better than I do. She jokes about certain people seem to race through, and she’ll sometimes joke with me about, Brad, this is your issue where you just like are boom, the pre-contemplation to contemplation the preparation, and the action are all like squeezed into 12 minutes. And then all the time is spent on the action and the maintenance. Do you see the different, almost like personality styles come out or backgrounds or histories where some people they sit in that pre-con phase for a really long time. Other people go from one to four in a matter of a minute. And then they spend a bunch of time on the last three. What, any patterns with that, that you can give us some insights on?

Dr. James Prochaska

The biggest challenge we find within the stages of change is to help people get out of pre-contemplation mode. The action model says the biggest problem is relapse, but what we find is just moving out of pre-contemplation, that’s a small change, but it becomes a big change later on.

Dr. Cooper

And tips on that. I’ve got a question a little bit later that we’ll touch on this, but just some guidance on, because some people are told if they’re in pre-contemplation you just wait until they’re ready. And you would say, no, no, no, no, no, no. So any tips for that person that is in that pre-contemplation phase, how somebody can help them?

Dr. James Prochaska

Well, first of all, uh, you know, unfortunately the free lines for smoking, they are action oriented, and when you call up, you know, you got, are you ready to set your quit date in the next 30 days? If not, call me back when you’re ready. Well, thanks a lot.

Dr. Janice Prochaska

And I think one of the things that we often say is wherever you’re at, we can work with that, and it’s okay that you’re in pre-contemplation and what we would like you to just consider is what your life could be. If you weren’t smoking all the time and you would become a non smoker, how would that be different for you? And also to think of some of the advantages of not being a smoker.

Dr. James Prochaska

Yeah. The latter, what we know in the meta analysis of 125 study some 10 countries, nine languages that the pros of changing need to go off. And so we might say, you know, share with me, what do you, what do you understand in terms of the benefits, some regular exercise, and typically they’ll give five or six, and then we’ll say, you know, there’s over 60 scientific benefits. And I wonder if you, if you would take on this challenge, see if you can double your list between now and the next time that we talk.

Dr. Cooper

Okay. So you’re not giving them the list. You’re not saying here’s the 60 reasons. You’re asking them to start reflecting on those.

Dr. James Prochaska

Right now, these days, you could say, well, you could go to change into thrive. And you’ll find that the reasons are really important for you. And then when you’re checking, you know, later on, you can use them, you know, this week I’m walking for my heart, next week for my depression and for my grandkids.

Dr. Cooper

Beautiful love it. So the reflection piece that that’s a big deal. That’s a big part of, especially this pre contemplative, uh, stage is reflecting on my life. What I’d like it to look like, what it could look like, those kinds of things. Anything else that you can flesh out in terms of reflection?

Dr. James Prochaska

Oh, I, I think, uh, becoming aware, and one of the things we would share with them is becoming aware that change is not action. Change is progress. Now, when you dealt with your pros, you’re progressing, you want to have feedback with that because otherwise people can get demoralized in terms of, if they’re waiting until they take action, it can be hard to keep them with us. And we know we, we, we show, we were able to get over 90% of the dropouts from psychotherapy, with therapists that were not stage based. And, uh, and it was that they were in pre-contemplation state.

Dr. Cooper

So talk me through that a little bit. I it’s fascinating. So you can literally predict 90% of the folks that will drop out. And this was in a counseling setting, but it would probably be just as applicable to coaching based on the route that the counselor was taking basically, or based on where that individual was in those stages.

Dr. James Prochaska

Yeah. If, if, if they weren’t seeing benefits, okay. If they weren’t getting reinforcement, you know, feedback, Hey, you know, congratulations you’ve doubled, you’re progressing. It’s not, it’s like seeing a cholesterol come down. You don’t expect them to go from a 300 to under 200. Right. Right. It’s a gradual kind of thing. And that kind of progress. Otherwise they’ll discontinue the medication. Just like, they’ll discontinue the coach.

Dr. Cooper

I love what you’re talking about. Change is not action. I’ve got double lines here. Change is progress. We have a little saying, we call hashtag better than yesterday. And it’s the same concept that the goal is not to become you. The goal is not to become me. The goal for me is not to become Suzanna. The goal is for me to be just a slight bit better than yesterday. And that’s what you’re talking about, change is progress. That is so good. Midway through your book, you reference something called rule control, moving towards stimulus control. Can you flesh that concept out for us a little bit and how it applies to what we might be doing?

Dr. James Prochaska

Yes. Uh, rule control when we’re dealing with somebody with a long-term habits or addiction or compulsion habits. Uh, it’s, it’s really understanding this control. Okay. It’s like automatic. I mean, uh, I know with myself, I, you know, if I had ice cream and potato chips in the house, they were not going to last long. Okay. So I had to take, in what’s the stimulus in terms of what we’ll eat. The most common stimulus for us is what’s on the shopping. So if I take that away, then, you know, so, uh, but when in early on the progress is more under decision control, is it worth it? Is it not? Should I keep progressing? Should I put it off? And decision control is much weaker than real control. And so, uh, for myself, I have had some, sometimes that I had trouble with my drinking. You know, I set a rule for myself, you know, I’ll never drink more than three drinks and that’s the rule I could live by, but I also had trouble in terms of going into casinos. And so I would set a rule for myself, leave my wallet in the car, take $20 in when I lose I go home. And then you want to end up with stimulus control and the new behavior is, is much more automatic.

Dr. Cooper

Okay. So we’ve got decision, rule, stimulus.

Dr. James Prochaska

No stimulus control, I’m sorry. Stimulus control. Yeah. That’s what you want to end up with that, you know, now eating healthy is this much more automatic. And, uh, and, and in terms of drinking and how much to drink, you know, it’s, it’s like I don’t have to make a decision about it. Uh, and I don’t even have to worry about the rule.

Dr. Cooper

So the, so the process, basically, it’s essentially three levels. It’s decision control, which is the weakest rule control, which provides you some self guidelines. And then stimulus is when it’s essentially natural for you.

Dr. James Prochaska

Yeah. I mean, it, Janice, she takes us out hiking and we, you know, we do a lot of walk and hiking and she’s got the stimulus, you know, the app it’s got to get to 10,000 steps.

Dr. Cooper

I love it. I love it. So those obviously overlap, like for example, I’m training for a triathlon and I’ll have a rule that I want to get about two hours a day in. And that allows me to not have too much waiting for me on the weekend. If I get up early, get on the bike by 5:30 or whatever. Can the rule control, I don’t find it hard to get that going. It’s just a guideline for me. Do you find those overlap with things that people are doing? Is it a, a mobile kind of integration between those three or do they tend to generally be pretty succinct?

Dr. James Prochaska

Well, let me just say, I mean, during the first one, test questions about the stimulus control rule control, uh, and, and just frankly, we have not done nearly the research on it. It’s really interesting. It’s, it’s more, let’s say a kind of a metric that helps us in terms of, so people, people just make more sense because it keeps under decision control, right? I’m in as much risk of going backwards as going forward. And decisions are really,

Dr. Janice Prochaska

And depending on the day and how stressed or distressed you are.

Dr. Cooper

Yes, did you sleep last night? Yeah. I love that. Excellent. Okay. So this question might fit into the pre-contemplation phase. So you can, you can tell me about it, but what about the person that you’re talking to, there may be an, an employee wellness program. So they’re forced to talk to a coach or a parent talking to somebody and they say, you know, I’m good. I, I don’t have any areas I want to change. For the coach who may be working with somebody like that. Is there any value in moving forward or different questions you can ask to prime the pump a little bit, or does this kind of create a brick wall if you will, in terms of behavior change, when they say, you know, I’m good, I’m fine the way I am.

Dr. James Prochaska

Well, a couple of things, uh, one is, is that we would typically give the person, uh, health risk intervention not the health risk assessment, and that tells us where they are with like the big four plus one behaviors, that account for the most, uh, chronic disease and disability and lost productivity, premature death. Um, and so, uh, that can help us. And then it shows what stage you’re in and I can give feedback. So that that’s one of the tools.

Dr. Janice Prochaska

Hopefully not being too sarcastic, like one idea is, wow, you must be in the top 3% of our population. In other words, you don’t smoke. Don’t drink more than one drink a day if you’re a woman, you walk 10,000 steps you do some stress reduction about 20 minutes a day, and you eat 5 fruits and vegetables a day. Wow, you’re amazing.

Dr. James Prochaska

You’re a behavioral athlete, but the other thing more seriously, I do really feel that financial incentives can, can work, can work for those folks. We have an article where we compared our clinical trials to, uh, the standards, from centers for disease control across all 55 studies for worksite, uh, you know, health, uh, wellness programs. And, um, we then also had our case study where this was with a nationwide company and they had financial incentives. In this case, it was, uh, health insurance is going up. If you participate, your insurance won’t go up. Right. And what we showed was is that they were outperforming the other 50 some companies by far, and they were outperforming our best results as well. We’ve also just completed a study where, uh, that financial incentives, just to produce outcomes that we’ve been trying to do for decades. So, and, you know, I, I like the fact you’ve got a PhD in performance science. Well, what we do is, you know, it’s like you had a personal best, you can now perform your personal best. Well, now we saying, we shouldn’t be worried about outperforming no treatment or placebo can we outperform our best. Okay. And when we do that, then we know we have something really worthwhile writing about and disseminate.

Dr. Cooper

I love that. So, and that, that fits perfectly. And I think that can prime the pump in a lot of ways. What about that person that just says, yeah, I’m overweight or I don’t walk much or, yeah, I know my cholesterol is high. I just don’t care. Like, I’m just fine with life. Just, can you just leave me alone? Like, is that, are we not even entering the stages of change here? They’re not even pre contemplating at that point? Or are there some things you can do in that case that, that might just help the process?

Dr. James Prochaska

Well, uh, in Europe, they came up with a, a stage before pre-contemplation, they call it amotive and we use that sometimes that is without motivation. And I, I might say, you know, my usual rule is I won’t care about, uh, somebody’s health and wellbeing more than what they care, but I want to let you know. I mean, I do care and, and, uh, I, I’m not going to coerce you. I’m not going to pressure you. I will want to help influence you. And so I will respect where you’re at. And if you continue to not want to change, I’ll stay with you.

Dr. Cooper

I love that wording. I love that. That’s excellent. Okay. So page 43 of your book you state, and here’s a little quote, our goal is to be a positive influence without becoming a negative source of pressure. That is so well said. I don’t know if you guys spent three hours on that one sentence, but that, that is a beautiful sentence for the coach, the counselor, the clinician, the parent, the friend, whoever it is, listening to this, what guidance can you provide that will help us walk that line? Because that’s a fine line. That’s a tough line. You, you want to be that positive influence without feeling like you’re creating this negative pressure, which obviously can send people the other direction. Walk us through that a little bit. That is so beautiful, but how do we walk that line?

Dr. James Prochaska

Well, okay. We you know, we talk about the, one of the first processes is to increase awareness. Well, I want to, you know, help the increase the awareness about the difference between coercion and influence and the thing that as a coach or as a parent, or as a partner that we need to be aware of is somebody is in pre-contemplation. They aren’t likely to experience what we’re saying as coercion. And so I’d like to be open. It’s not, I do not want, and let me know. It reminds me of this fellow who was in with a drug problem, marital problem, career problem. And I said to him, you know, if you feel me pressuring you to do things that you don’t want to do, will you let me know? He says, I’ll let you know, I say how will you let me know? He said I’ll get angry as hell. Well, I can work with that, but what I can’t work with is you’re not coming back. And so, um, again, to, to be to the same, cause typically you’ll get signs, you know, they’ll back up, you know, they’ll go show those show signs of defensiveness. And I might reflect, you know, I feel like I’m making you feel defensive. I feel like you might be feeling pressure. And again, uh, I’m respecting where you’re at, but I, I do influence you because I think that can make a difference in your life. And I don’t want to waste this opportunity.

Dr. Cooper

That’s good. So many good tips here. Um, all right. So on page 259 of your book and folks are gonna have to take a look at this. Uh, you’ve got something called a life evaluation as a figure, the feeling today versus the functioning today. I thought that was really interesting, and I think it’s a very, very valuable distinction. Can you tell us a little bit more about how and why that specific tool was developed and how you’ve utilized it?

Dr. James Prochaska

Is it okay to do an open book test? I have my book right here.

Dr. Cooper

Yes, absolutely! I can’t expect you to know what page 259 is.

Dr. James Prochaska

I was going to say, you know, the book better than I do, uh, well, um, one of the things that we found was that, that, uh, when we assess people on a scale of one to 10, um, and on two questions, how am I feeling today? And how am I functioning today? We found that the higher they were, uh, the further in the stages they were likely to be or the more practiced they were, uh, progress that we’re likely to make. And what we like is to try to get it down to, you know, like two questions. Uh, and it’s a good way to track progress because, you know, if, if they’re saying I’m looking at today in terms of people, how many people are feeling well, right. Oh my gosh, how many people are functioning well? You know, I mean, it’s like the world collapsed on them and, you know, if they were starting to, in terms of assess, okay, what am I going to do to help me increase how I’m feeling to help me increase functioning, then you know, that also helps counter the helplessness that so many are feeling. And I hate feeling helpless and a major cause of depression and distress. So having that, you know, like, you know, and the other way, so if we take a temperature right now, it’s a monitor and we hope it’s not over 101, but here we’re taking the temperature of feeling and functioning. And we want that to, you know, to be gradually improving means, I’m also, I’m not feeling so helpless.

Dr. Cooper

And is the functioning piece. I’m just imagining, I’m trying to put myself in this situation in some examples, but with the functioning piece, the longer I’ve been doing it, the further along in the stages, I am, the more consistent the functioning is, regardless of what the feelings are today?

Dr. James Prochaska

Well, let, let’s just say there certainly are times where we get a fever, right. We don’t want to at these times. Okay. So there are times, there are times, I mean, clearly at times where we’re going to be distressed and we’re not going to function as well. I mean, frankly, we shouldn’t be putting pressure on ourselves right now to be functioning as well as we would in a different world. And so we kind of, you know, it’s a model like the acceptance that, yeah, and I’m not feeling as well, and that’s that’s can be very much healthy, but if I’m progressing and doing some things, Jan, you have some questions about in terms of what you’re doing.

Dr. Janice Prochaska

So we, um, had some quarantine questions that a psychologist was sharing with us and a couple of those questions that are very helpful. I think, what are you doing to move today, to move your body today? And what are you doing to bring some beauty into your life, either creating it or seeing it going out and experiencing it. And those kinds of things, again, can help you feel better, which in turn can help you function better and gain to really in a sense, improve your wellbeing

Dr. James Prochaska

Just as a side, uh, to share with you, uh, the behaviors that we emphasize the most, the big four plus one, no smoking, alcohol abuse, unhealthy eating, and all it turns out that a researcher from Stanford is being able to measure, to measure our biological age for immune system and then our functional age immune system. And so I could have, uh, age 60 and my immune system is like a healthy 40 year old, functioning well, or I can have it like an 80 year old. And what are the behaviors that affect immune system? It’s the same ones we use, uh, uh, you know, for chronic disease prevention.

Dr. Janice Prochaska

Which are so important right now to ward off COVID-19 to have a better immune system so that we wouldn’t be as susceptible.

Dr. James Prochaska

But it also, it prevents more the worst parts of the virus because you know, so many people have the virus, but no symptoms, right? So it’s, you know, it’s more the, the, uh, the sickness and, and the really the worst parts of it because your immune system is helping you to keep from getting worse. And it’s why, you know, people with, you know, in New York, they found people had two chronic conditions that they have in the U S as Jan was indicating 90% have two or more of the big four plus one. And so it’s like, you know, that’s why, when she was saying it’s, this person doesn’t have any of those.

Dr. Cooper

Totally. So I’m looking at what we were talking about with the decision rule and stimulus control. And I’m trying to lay that over the top of the feeling today, functioning today, it seems like the more you are in the, on the scale, if, if decision, rule and stimulus as a scale, if we’re further to the decision side of trying to make choices in our daily life, then the feelings are going to cause that to vary all over the place. Whereas if we’re in the stimulus control, the feelings won’t have as much of an influence. Am I hearing that correctly? Am I making that overlap accurately? Or are they really very distinct?

Dr. James Prochaska

Well, no, I liked that. I like that, remember you’re quizzing me about stuff that I wrote. I love having data when I answer questions, now I have to turn to reason and feelings. Um, but, um, you know, the further I am in terms of, you know, in terms of stage, in terms of stimulus control, the better I’m likely to be functioning. You know, if I am really stuck on making decisions, whereas it is not, you know, like in literature dare I eat a peach, you know, it’s like those kinds of decisions you get stuck and you’re not functioning well.

Dr. Cooper

Analysis paralysis. Is that what they call that?

Dr. James Prochaska

Yeah. Chronic contemplators I have not heard that one. I liked that. I liked that. That’s what I accused for Freudians of being, chronic contemplation.

Dr. Cooper

I might steal that one. I love it. All right. Let’s have some fun with this next one. We just got two questions left. Uh, you’ve been married 54 years as of the September. If I did the math, right. There can not be a better testimonial to the value of the whole trans theoretical model of change than that. Any fun stories about the role it’s played either in your marriage or raising your kids or combination of the two?

Dr. James Prochaska

Well, again, keep in mind, we were in love and we were married before we discovered the stages, but we didn’t need that. I would say, I mean, for, for myself, um, you know, I have felt blessed all my life, you know, I don’t know how, and I don’t know why, but in spite of what ever the discoveries I’ve had and the recognition, uh, that does not make me privileged. Okay. You know, privilege means I’m entitled to whatever I want. Being blessed, blessed means I have responsibility to give back, to give back personally, to give back professionally and to give back like your coaches will do to be, you know, helping people to be happier.

Dr. Janice Prochaska

And I get a kick out of my friends using the stages of change. One of my friends says, you know, I’m really in preparation to buy a couch, my husband is in pre-contemplation. So I need to outline to him all the benefits that a new couch would do for our marriage and our home and our living. And I need to reduce all the cons, put it in the way of him moving to contemplation and preparation. So it’s fun to hear other people use it in that kind of way.

Dr. James Prochaska

You know, I used to do a lot of marital therapy and, uh, with an audience, I’d say, okay, I have a husband and wife come in for marriage counseling. What stage is the husband at? And the audience will yell out pre-contemplation and what stage is the wife in? Action. Okay. And what are the attributions they make? You know, he is so stubborn, like a mule. You can’t get them to change. And what does she say about her? She is so controlling. And then I said, that’s maybe understand that you’re in different stages of change. Okay. And that’s a place where you might find some common ground to be able to pull together. So sometimes we use that in our marriage.

Dr. Cooper

Do you catch each other? Almost overusing it? Like I’ll accuse Suzanna, cause she’s so good. She’s just so naturally good at all. This intrinsic motivation, motivational interviewing stages of change, all those kinds of things. I’ll sometimes accuse her as using her Jedi mind power tricks on me. Um, do he two of you see that, joke with each other kind of look at each other, go, not today, honey. That’s not, you can’t use that one.

Dr. James Prochaska

Uh, you know, it was like being a clinical psychologist and stuff that, you know, at social gatherings, people say, Oh no, you’re going to read my mind. You know, are you going to analyze no, I, you know, I don’t do that with my family. I don’t do that with my friends. You know, I do it myself. I do it with clients, you know, who encouraged me to do that.

Dr. Cooper

How about something going on in your lives now? You’ve, you’ve started this whole thing again. How many years did I say? 37 years or so ago? Um, is there something in your life now that you’re, we’re, we’re all works in progress that you’re working on and you’re kind of see yourself moving through those stages of change right now with something?

Dr. James Prochaska

Janice took me to a, a meeting, uh, to support friends of 8 people with a nutritionist leading it and he goes, and he’s, you know, showing us terms of here’s what you can eat in the first week. And I’m saying, Oh, no what has Janice got me into, an elimination kind of diet. I said, all I can eat are things I don’t like, you know, well, I, I went with it and believe it or not. I mean, my goal became to get free from my sugar addiction. But without intending to, I lost 10 pounds, it stays off. I lost two inches around the, you know, the tire on the stomach, which is the most important. It’s like, you know, at 77 you can continue to change. You can continue to improve your health and your wellbeing.

Dr. Janice Prochaska

And the nutritionist gave us many, many rules that we had to buy for six or seven weeks, but then they became more stimulus control. You know, we saw that eating the sugar. Just wasn’t a good thing. Which is my particular change.

Dr. Cooper

Nice, that’s great. Love it. All right. Last question. Just wide open, take this any direction you’d like. Both of you, any final words of wisdom for those who are looking to help either improve their own lives or maybe their coaches, counselors, physicians that are trying to help people around them. And I should throw parents and friends in there too.

Dr. James Prochaska

Well, I would say in terms of the wisdom from my own life is put friends and family first. Okay, have fun and playing and games first. Okay. A friend from Princeton professor taught me, put your tennis and your golf into date book first, your work won’t have any problem finding it’s way.

Dr. Cooper

Big rocks first. Yep. Love that.

Dr. Janice Prochaska

And you know, I really liked your signature thing. Optimize reality. I love that as a concept. And I, I, I really identify with that and think how important it is even now with COVID-19 and all this sheltering in place, how to optimize the reality as much as possible, rather than giving up, throwing up your hands and giving up and not doing anything much at all.

Dr. Cooper

Thank you. Beautiful. Well, you two, this was such a pleasure. Thank you for taking the time. I know everybody probably wants to have you in their corner and walking them through this process and help them understand it, but you’ve had such a huge impact and it’s truly an honor to have you join us.

Dr. James Prochaska

Great, great being with you. And, and again, I’ll, I’ll, I’ll be a little bold here. If you like what you’re hearing, you can follow up and lots of folks are telling us, it really, really is, you know, making such a difference personally and professionally.

Dr. Cooper

Absolutely, excellent book. There’s no doubt about it. And we’ll add the title. We’ve mentioned it here in the interview and I’ll add it to the, uh, intro exit as well. So they have easy access to it, but thank you so much. Fantastic job. And again, great honor.

Dr. James Prochaska

Oh, good being with you and all the folks we can’t see.

Dr. Janice Prochaska

And thank you for your enthusiasm. It’s great.

Dr. Cooper

Yeah. I appreciate that. Thanks so much. Wow. What a fantastic way to celebrate our 100th episode. We are grateful to the Porchaska’s for their willingness to join us for the special landmark occasion. Thank you as well for tuning into the number one podcast for health and wellness coaching that is due to you. So thank you. Thank you. Thank you for continuing to share it with others. Next week episode features Alan Pease, a world renowned expert in the area of body language. We thought that with all the masks blocking our smiles body language is now more important than it’s ever been. So who better than the guy known as mr. body language to provide us with some key tips. You might also enjoy checking out some of the free resources over on the new YouTube coaching channel, which you can literally find at youtube.com/coaching channel. Now no more excuses folks. We have an in-depth understanding of the stages of change, right from the developers right at our fingertips. Now let’s put it into practice one step, one day at a time as we move toward this concept of better than yesterday in our lives. And in helping those in our community do the exact same thing. This is Dr. Bradford Cooper, signing off, make it a fantastic rest of your week. And I’ll speak with you soon on the next episode of the Catalyst Health, wellness, and performance coaching podcast.