Do Scare Tactics Work for Asthma?
Have you ever been to the doctor and heard them say things that are meant to "scare" you into changing your lifestyle? Your doctor may have given you suggestions about:
Weight
A doctor may have said something like; "You are overweight. If you do not lose weight, you are going to end up with diabetes, heart problems, problems with your back and knees, and many more side effects from the extra weight you are carrying around!"
I may have muttered under my breathe "Wow - thanks for letting me know I'm fat. I still thought I was a size 5!" Then I turn to my husband and say "How could you let me get so fat? Why didn't you say something?!" *husband changes name and moves to a new country*
Smoking
Or you may have heard something like: "Do you know what smoking/vaping does to your lungs? Do you know how much money you are wasting each week on cigarettes/vape juice? Do you know what this is doing to your family?" You may also want to mutter, "Yeah, genius – do you know how many times I have tried to quit?!"
Asthma
There are also well-meaning doctors who say, "Don't you know that you are supposed to take your controller inhaler EVERY day?! That is why it's called a controller inhaler – it controls the swelling in your lungs! If you don't use your controller inhaler every day, you will get permanent scarring in your lungs, progress to COPD, and be stuck using oxygen!"
Is there a better way?
While doctors really do want us to be healthy and strong, I'm not sure this approach is working for patients. In fact, it can make people angry and defensive. I would be tempted to NOT listen to my doctor if she lectured me like that.
Enter motivational interviewing!
What is motivational interviewing?
Motivational interviewing (MI) is a way of communicating that walks a fine line between listening and telling people what to do. It is somewhere in the middle. It's a way to guide people so they are empowered to make a change based on their own decisions, how important it is to them, and their capacity to change.
It's a respectful way of talking to people to help them with change while honoring their independence. One expert explains it this way: "It is important to note that MI requires the clinician to engage with the client as an equal partner and refrain from unsolicited advice, confronting, instructing, directing, or warning. It is not a way to 'get people to change' or a set of techniques to impose on the conversation."1
MI has core skills known by the acronym of OARS:1
- Open-Ended Questions – It's hard for most people to phrase their questions in a way that will get a good answer. Instead of saying, "How is your asthma today?" I might ask, "What bothers you the most about your asthma?"
- Affirmation – What are the person's strengths, efforts, and successes have they had in the past?
- Reflection – Careful listening (emphasis on careful). After they are done speaking, repeating back to them what they said to see if you understood them correctly.
- Summarizing – Reviewing key points made by the person and making sure you are both on the same page.
There is a lot more to learn about MI. It's a great way to communicate (especially with those pesky teenagers and their one-word answers!) You can find videos and workshops online.
Have you found that scare tactics work for you? Have you found a better way to communicate and help someone become healthier? Share your ideas in the comments below!
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