Behavior Changes To Better Your Health

WEALTH OF HEALTH

In the late '90s, together with a retired general, a prominent attorney and several professors from the University of Hawaii College of Business, I became a partner in an IT startup, East-West Telehealth. Our vision, based on available technology, was that a physician specialist in an urban setting would peer into the screen of a powerful workstation and render advice not only to distant locations, but also into the home of those unable to present to clinic.

We also imagined offering telehealth services to busy executives through their office desktops.

Today, with smartphones that sport screens with retinal displays, Facebook, text messaging and Twitter, the potential for telehealth, rather "mobile health," has expanded exponentially. In recent years HMSA launched a program titled "On-line Care" in which patients can interact by phone and screen with their own physician or an on-call physician. Many electronic medical record systems offer a "patient portal" enabling a limited view of one's own medical records and an opportunity to query a provider.

Consider the implications for psychiatric and psychological services. Historically, psychotherapy always meant that patient and therapist sat together in an office and interacted face to face. That business model is changing. Psychiatrists and psychologists are increasingly using electronic communications, including videoconferencing and Internet telephonic applications, to provide psychotherapy to their clients. Patients can access smartphone applications that follow mood changes, remind them to take medications and track completion of psychotherapeutic homework assignments.

A local psychologist recently remarked, "I used Skype to provide therapy to my patient who had to travel to Brazil for a family emergency. I am planning sessions with another patient — via Skype — who is moving to Los Angeles. The potential is great. Both patients paid cash for this service because we were unclear as to the reimbursement policies of HMSA and other carriers. I anticipate this type of practice will grow."

How well do these technology-based interventions work? Research assessing the effectiveness of videoconferencing in the Veterans Health Administration demonstrated that videoconferencing is just as effective as face-to-face therapy. In fact, there may be situations in which videoconferencing is more beneficial. Consider an individual undergoing treatment for compulsive hoarding. Without having to visit the client's home or workplace, the mental health provider is able to view the physical environment: "Let me see the sink, please," or "Are you able to point the camera under your bed?

Behavioral Change: The Science Behind MeYou Health

Psychologists James O. Prochaska, Ph.D. , John Norcross, Ph.D., and Carlo DiClemente, Ph.D., developed one of the seminal theories of behavior change in the 1970s and 1980s, when they wrote that change is not an event but rather a process that occurs in five stages: precontemplation, contemplation, preparation, action, and maintenance . MeYou Health’s Daily Challenges, for example, raise awareness of problem behaviors, get you to weigh the benefits of change, and encourage you to take small actions toward lasting change — the “action” stage where people “have made specific overt modifications in their lifestyle, and positive change has occurred,” according to Prochaska.

Of course, how ready we are to change varies widely from person to person. “What is unique about Daily Challenge is that the challenges we offer up on a daily basis may touch on a new or an existing behavior, depending on the user, but it helps to move all users to make positive impacts on their well-being — whether they’re doing the action for the first time or repeating and reinforcing a behavior they’ve attempted before,” says Josée Poirier, Ph.D., director of program design and research at MeYou Health. “In either case, the completed challenge influences the user, regardless of what stage he or she is in.”

Just as there are many paths to enlightenment, there are many pathways to change, as well. Researcher B.J. Fogg , Ph.D., of Stanford University describes behavioral change in terms of “dots,” “spans,” and “paths”: dot behaviors are those that take place one time, span behaviors take place over a duration of time (a month, for example), while paths are lasting changes.

“Our Daily Challenges are all ‘dot’ behaviors” points out Poirier. “We believe in focusing on the present: what can you do today .”