Change that Feels Good Now, and Self-determination Theory

“We often think of adopting good healthy practices for the future. But what you come to realize, is that abiding by health habits can feel good now. Doing good feels good.” @drsanjaygupta

A few weeks ago I had the good luck to attend Mad*Pow’s Health Experience Design conference and hear Dr. Sanjay Gupta. His explanation of health habits that “feel good now” reminded me of Self-determination Theory, a theory of motivation that many people recognize as “extrinsic and intrinsic motivation.”

External motivation and Pokemon Go

The first time I remember hearing about external motivation was in 2015. Pokemon Go made big news on its July 5th launch, and within days people were planning their walks around Pokémon. Friends attended Pokémon hunting get togethers. My cousins even asked if my wedding venue had been scoped for Pokémon.

It seemed as though this funny little game was changing the world. But a month later the game dropped from 45 million daily users to 30 million. Suddenly the only person I knew still playing was one cousin, who had found her arthritis felt better after the Pokémon-hunting walks.

As I learned more about external and internal motivators, this anecdote fit right in. External motivators (like the rewards found in games) rarely last longterm. But intrinsic motivators, like feeling less arthritis pain, is much more enduring.

Connecting external and intrinsic motivators

The key to any successful behavior change is finding a change that feels good now. That immediate boost will keep someone engaged long enough to feel the longer-term effects. But that boost alone is never enough. Let’s take a few examples:

• In the workplace: you have an idea for a new scheduling system. It will keep people more organized and save them time. But initially it feels complicated. No one wants to deal with the learning curve. You know you can build intrinsic motivation, but that will require a leap of trust. What’s missing? You need to find a solid external motivator (a reward or competition) to get people interested.
• At home: you want to get better about leaving the house on time. You know you’ll be happier and less stressed, but it’s hard to make it happen when you enjoy the extra sleep (damn the snooze button!). What’s missing is again an initial “feels good now” external motivator.
• In apps: often apps look for ways to draw people in. Rewards are a big way to do that. But over time (Clubhouse also found it was 6-7 weeks) the rewards become less powerful. Here, what’s often missing is the intrinsic motivation. When the rewards begin to wane, if people don’t see value they will not stick around.

Healthy change that feels good now

In healthcare the challenge can be even more complicated. Healthy behaviors can take anywhere from months to years to have an impact. So even with external motivators, they may wear off before the intrinsic motivators kick in.

For healthy behaviors we need to fully understand Self-determination theory, and consider the middle ground:

• What quick wins can we provide?
• How can we connect the rewards to healthy, happy feelings?
• How can we show progress in health before someone sees their blood pressure or their blood glucose level shifting to a healthier place?

There are many answers here. As Dr. Gupta says, “what you come to realize, is that abiding by health habits can feel good now.” It’s our job to speckle that learning curve with rewards. We must blend the external and intrinsic. We can create change that feels good now – and in the future.