Motivation

My most recent Chronic Illness/Chronic Pain Support Group meeting was on 'motivation'. I only had two people there that day, and neither could identify anything that motivates them. Living day after day after day with pain and illness can be very wearing. I have taught this topic on the inpatient psych units where I work, and have never gotten this response.

I generally spend 6-8 hours preparing for my support group meetings, doing research, and putting together a 2 page handout defining and discussing the topic, with suggestions for applying it in life.  In researching the topic of motivation, most of what I found was on the level of motivating yourself to write your next book, or run a marathon. I searched for info on motivating yourself when you are depressed, and even much of that was on a different level from what I needed. 'Find something that excites you' is a great idea, but how do you do that when just getting up to pee is too much trouble or causes so much pain that you don't do it until absolutely necessary?

At its very basic, we are motivated to increase pleasure or decrease pain. There are several reasons for lack of motivation, the one we focused on was 'The benefits of staying put outweigh the benefits of moving (at least in our mind)'. One way to counteract this is to 'List the benefits of each option. Don't forget such benefits as comfort, and not having to take responsibility. How can you decrease the benefits of staying put, and increase the benefits of moving?'

Here are some excerpts from my handout on motivation:

Strategies

• Set up if/then propositions. 'If I get up, I will walk.' 'If I see a Starbucks, I will ignore it.' This takes the decision making out of the loop, and the most likely option is to following through.
• Plan ahead for slip-ups. 'If I can't ignore the Starbucks, I will change my route to avoid it.'
• Beware of the 'what the heck' factor: eg- “I ate one cookie, I already ruined my diet, so what the heck- I might as well eat the rest of them.” Plan ahead for how to handle such situations.
• Record your successes, and what you can learn from your failures.
• Get an exercise or diet partner (or partner for whatever it is you want to pursue). Having someone else involved makes you more accountable.
• The more you do what you set out to do, the easier it gets, and it becomes habit.
• Treat depression- it saps energy, motivation and hope.
• 'Just do it'. Do anything- wash the dishes, clean off your counter, anything that will get you moving and accomplishing something. The feeling of accomplishment is motivating.
• Make a list. Prioritize and choose one small task to work on. Focus on completing that task before taking on the next. Set a goal that will be quick and easy to reach, and go for it. Reward yourself for reaching it, to motivate yourself to take on the next goal.
• Break a large goal up into smaller, more manageable steps. Just focus on the current step. Give yourself appropriate rewards for each step, not just for reaching the full goal. eg- everyday that you stick to your diet, put a quarter in a jar. At the end of 6 months, you will have lost some weight, and will have $45 to buy yourself some new clothes.
• Visualize the benefits of working on and reaching your goal. Act as if you are there.
• Work on your goal at least a little bit every day. Remember the 'what the heck' factor: If you miss one day, don't use this as an excuse to miss another, or to quit.
• Exercise will give you more energy and improve you mood and focus.
• Set up your environment to avoid triggers for habits you want to quit, and to encourage habits you want to acquire. 

Willpower requires active focus. It will not work to break a habit, because the active focus on the issue makes it more likely you will do it, not less likely.  In order to stop a bad habit, you need to replace it with something else. It is much harder to change a behavior if you feel deprived.

I hope these ideas help.  We never did solve the problem of how to motivate yourself when even getting up to pee was difficult.  I think the key is that you have to decide that you want to do whatever it is, and then find a way to make doing it more attractive than not doing it.  Look at the benefits of doing it.  Then do it, and praise yourself for doing it.  Even if it is just getting up to pee.  Ahhhhhhh!