Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions
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When KFF Health News published an article in August about the “prior authorization hell” Sally Nix said she went through to secure approval from her insurance company for the expensive monthly infusions she needs, we thought her story had a happy ending.
That’s because, after KFF Health News sent questions to Nix’s insurance company, Blue Cross Blue Shield of Illinois, it retroactively approved $36,000 worth of treatments she thought she owed. Even better, she also learned she would qualify for the infusions moving forward.
Good news all around — except it didn’t last for long. After all, this is the U.S. health care system, where even patients with good insurance aren’t guaranteed affordable care.
To recap: For more than a decade, Nix, of Statesville, North Carolina, has suffered from autoimmune diseases, chronic pain, and fatigue, as well as a condition called trigeminal neuralgia, which is marked by bouts of electric shock-like pain that’s so intense it’s commonly known as the “suicide disease.”
“It is a pain that sends me to my knees,” Nix said in October. “My entire family’s life is controlled by the betrayal of my body. We haven’t lived normally in 10 years.”
Late in 2022, Nix started receiving intravenous immunoglobulin infusions to treat her diseases. She started walking two miles a day with her service dog. She could picture herself celebrating, free from pain, at her daughter’s summer 2024 wedding.
“I was so hopeful,” she said.
But a few months after starting those infusions, she found out that her insurance company wouldn’t cover their cost anymore. That’s when she started “raising Cain about it” on Instagram and Facebook.
You probably know someone like Sally Nix — someone with a chronic or life-threatening illness whose doctor says they need a drug, procedure, or scan, and whose insurance company has replied: No.
Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients.
However, critics worry that prior authorization has now become a way for health insurance companies to save money, sometimes at the expense of patients’ lives. KFF Health News has heard from hundreds of people in the past year relating their prior authorization horror stories.
When we first met Nix, she was battling her insurance company to regain authorization for her infusions. She’d been forced to pause her treatments, unable to afford $13,000 out-of-pocket for each infusion.
Finally, it seemed like months of her hard work had paid off. In July, Nix was told by staff at both her doctor’s office and her hospital that Blue Cross Blue Shield of Illinois would allow her to restart treatment. Her balance was marked “paid” and disappeared from the insurer’s online portal.
But the day after the KFF Health News story was published, Nix said, she learned the message had changed. After restarting treatment, she received a letter from the insurer saying her diagnoses didn’t actually qualify her for the infusions. It felt like health insurance whiplash.
“They’re robbing me of my life,” she said. “They’re robbing me of so much, all because of profit.”
Dave Van de Walle, a spokesperson for Blue Cross Blue Shield of Illinois, said the company would not discuss individual patients’ cases.
“Prior authorization is often a requirement for certain treatments,” Van de Walle said in a written statement, “and BCBSIL administers benefits according to medical policy and the employer’s benefit.”
But Nix is a Southern woman of the “Steel Magnolia” variety. In other words, she’s not going down without a fight.
In September, she called out her insurance company’s tactics in a http://change.org/ campaign that has garnered more than 21,000 signatures. She has also filed complaints against her insurance company with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and Illinois attorney general.
Even so, Nix said, she feels defeated.
Not only is she still waiting for prior authorization to restart her immunoglobulin infusions, but her insurance company recently required Nix to secure preapproval for another treatment — routine numbing injections she has received for nearly 10 years to treat the nerve pain caused by trigeminal neuralgia.
“It is reprehensible what they’re doing. But they’re not only doing it to me,” said Nix, who is now reluctantly taking prescription opioids to ease her pain. “They’re doing it to other patients. And it’s got to stop.”
Do you have an experience with prior authorization you’d like to share? Click here to tell your story.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Make Your Saliva Better For Your Teeth
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A new study has highlighted the importance of lifestyle factors in shaping the oral microbiome—that is to say, how the things we do affect the bacteria that live in our mouths:
Nepali oral microbiomes reflect a gradient of lifestyles from traditional to industrialized
Neither the study title nor the abstract elucidate how, exactly, one impacts the other, but the study itself does (of course) contain that information; we read it, and the short version is:
In terms of the extremes of “most traditional” to “most industrialized”, foragers have the most diverse oral microbiomes (that’s good), and people with an American industrialized lifestyle had the least diverse oral microbiomes (that’s bad). Between the two extremes, we see the gradient promised by the title.
If you do feel like checking it out, Figure 3 in the paper illustrates this nicely.
Also illustrated in the above-linked Figure 3 is oral microbiome composition. In other words (and to oversimplify it rather), how good or bad our mouth bacteria are for us, independent of diversity (so for example, are there more of this or that kind of bacteria).
Once again, there is a gradient, only this time, the ends of it are even more polarized: foragers have a diverse oral microbiome rich with healthy-for-humans bacteria, while people with an American industrialized lifestyle might not have the diversity, but do have a large number of bad-for-humans bacteria.
While many lifestyle factors are dietary or quasi-dietary, e.g. what kinds of foods people eat, whether they drink alcohol, whether they smoke or use gum, etc, many lifestyle factors were examined, including everything from medications and exercise, to things like kitchen location and what fuel is predominantly used, to education and sexual activity and many other things that we don’t have room for here.
You can see how each lifestyle factor stacked up, in Figure 5.
Why it matters
Our oral microbiome affects many aspects of health, including:
- Locally: caries, periodontal diseases, mucosal diseases, oral cancer, and more
- Systemically: gastrointestinal diseases in general, IBS in particular, nervous system diseases, Alzheimer’s disease, endocrine diseases, all manner of immune/autoimmune diseases, and more
Nor are the effects it has mild; oral microbiome health can be a huge factor, statistically, for many of the above. You can see information and data pertaining to all of the above and more, here:
Oral microbiomes: more and more importance in oral cavity and whole body
What to do about it
Take care of your oral microbiome, to help it to take care of you. As well as the above-mentioned lifestyle factors, it’s worth noting that when it comes to oral hygiene, not all oral hygiene products are created equal:
Toothpastes & Mouthwashes: Which Kinds Help, And Which Kinds Harm?
Additionally, you might want to consider gentler options, but if you do, take care to opt for things that science actually backs., rather than things that merely trended on social media.
This writer (hi, it’s me) is particularly excited about the science and use of the miswak stick, which comes from the Saladora persica tree, and has phytochemical properties that (amongst many other health-giving effects) improve the quality of saliva (i.e., improve its pH and microbiome composition). In essence, your own saliva gets biochemically nudged into being the safest, most effective mouthwash.
There’s a lot of science for the use of S. persica, and we’ve discussed it before in more detail than we have room to rehash today, here:
Less Common Oral Hygiene Options
If you’d like to enjoy these benefits (and also have the equivalent of a toothbrush that you can carry with you at all times and does not require water*), then here’s an example product on Amazon 😎
*don’t worry, it won’t feel like dry-brushing your teeth. Remember what we said about what it does to your saliva. Basically, you chomp it once, and your saliva a) increases and b) becomes biological tooth-cleaning fluid. The stick itself is fibrous, so the end of it frays in a way that makes a natural little brush. Each stick is about 5”×¼” and you can carry it in a little carrying case (you’ll get a couple with each pack of miswak sticks), so you can easily use it in, say, the restroom of a restaurant or before your appointment somewhere, just as easily as you could use a toothpick, but with much better results. You may be wondering how long a stick lasts; well, that depends on how much you use it, but in this writer’s experience, each stick lasts about a month maybe, using it at least 2–3 times per day, probably rather more since I use it after each meal/snack and upon awakening.
(the above may read like an ad, but we promise you it’s not sponsored and this writer’s just enthusiastic, and when you read the science, you will be too)
Enjoy!
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Wasting Your Vitamins?
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Are you flushing away your vitamins?
Most likely…but you don’t have to.
We all know what a wasteful expense supplements can sometimes be, but you can optimise your intake to get more bang for your buck!
Top Tips for Getting Your Money’s Worth:
- Liquids are better than tablets—the body can’t absorb nutrients from tablets anywhere as easily as it can from liquids, with some saying as low as a 50% absorption rate for tablets, so if your supplement can come in drinkable form, take it that way!
- Capsules are better than tablets—capsules, depending on the kind, contain either a powder (true capsules) or a liquid (softgels). Once the capsule/softgel is broken down in the stomach, it releases its contents, which will now be absorbed as though you took it as a drink.
- Stay hydrated—on that note, your body can only make use of nutrients that it can easily transport, and if you’re dehydrated, the process is sluggish! Having a big glass of water with your supplements will go a long way to helping your body get them where they’re needed.
- Take with black pepper—studies disagree on exactly how much black pepper improves absorption of nutrients. Some say it improves it by 50%, others say as much as 7x better. The truth is probably that it varies from one nutrient to the next, but what is (almost) universally accepted is that black pepper helps you absorb many nutrients you take orally.
- Take with a meal—bonus if you seasoned it with black pepper! But also: many nutrients are best absorbed alongside food, and many are specifically fat-soluble (so you want to take a little fat around the same time for maximum absorption)
- Consider split doses—a lot of nutrients are best absorbed when spread out a bit. Why? Your body can often only absorb so much at once, and what it couldn’t absorb can, depending on the nutrient, pass right through you. So better to space out the doses—breakfast and dinner make for great times to take them.
- Consider cycling—no, not the two-wheeled kind, though feel free to do that too! What cycling means when it comes to supplements is to understand that your body can build a tolerance to some supplements, so you’ll get gradually less effect for the same dose. Combat this by scheduling a break—five days on, two days off is a common schedule—allowing your body to optimise itself in the process!
- Check Medications—and, as is always safe, make sure you check whether any medications you take can interrupt your supplement absorption!
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Is stress turning my hair grey?
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When we start to go grey depends a lot on genetics.
Your first grey hairs usually appear anywhere between your twenties and fifties. For men, grey hairs normally start at the temples and sideburns. Women tend to start greying on the hairline, especially at the front.
The most rapid greying usually happens between ages 50 and 60. But does anything we do speed up the process? And is there anything we can do to slow it down?
You’ve probably heard that plucking, dyeing and stress can make your hair go grey – and that redheads don’t. Here’s what the science says.
Oksana Klymenko/Shutterstock What gives hair its colour?
Each strand of hair is produced by a hair follicle, a tunnel-like opening in your skin. Follicles contain two different kinds of stem cells:
- keratinocytes, which produce keratin, the protein that makes and regenerates hair strands
- melanocytes, which produce melanin, the pigment that colours your hair and skin.
There are two main types of melanin that determine hair colour. Eumelanin is a black-brown pigment and pheomelanin is a red-yellow pigment.
The amount of the different pigments determines hair colour. Black and brown hair has mostly eumelanin, red hair has the most pheomelanin, and blonde hair has just a small amount of both.
So what makes our hair turn grey?
As we age, it’s normal for cells to become less active. In the hair follicle, this means stem cells produce less melanin – turning our hair grey – and less keratin, causing hair thinning and loss.
As less melanin is produced, there is less pigment to give the hair its colour. Grey hair has very little melanin, while white hair has none left.
Unpigmented hair looks grey, white or silver because light reflects off the keratin, which is pale yellow.
Grey hair is thicker, coarser and stiffer than hair with pigment. This is because the shape of the hair follicle becomes irregular as the stem cells change with age.
Interestingly, grey hair also grows faster than pigmented hair, but it uses more energy in the process.
Can stress turn our hair grey?
Yes, stress can cause your hair to turn grey. This happens when oxidative stress damages hair follicles and stem cells and stops them producing melanin.
Oxidative stress is an imbalance of too many damaging free radical chemicals and not enough protective antioxidant chemicals in the body. It can be caused by psychological or emotional stress as well as autoimmune diseases.
Environmental factors such as exposure to UV and pollution, as well as smoking and some drugs, can also play a role.
Melanocytes are more susceptible to damage than keratinocytes because of the complex steps in melanin production. This explains why ageing and stress usually cause hair greying before hair loss.
Scientists have been able to link less pigmented sections of a hair strand to stressful events in a person’s life. In younger people, whose stems cells still produced melanin, colour returned to the hair after the stressful event passed.
4 popular ideas about grey hair – and what science says
1. Does plucking a grey hair make more grow back in its place?
No. When you pluck a hair, you might notice a small bulb at the end that was attached to your scalp. This is the root. It grows from the hair follicle.
Plucking a hair pulls the root out of the follicle. But the follicle itself is the opening in your skin and can’t be plucked out. Each hair follicle can only grow a single hair.
It’s possible frequent plucking could make your hair grey earlier, if the cells that produce melanin are damaged or exhausted from too much regrowth.
2. Can my hair can turn grey overnight?
Legend says Marie Antoinette’s hair went completely white the night before the French queen faced the guillotine – but this is a myth.
It is not possible for hair to turn grey overnight, as in the legend about Marie Antoinette. Yann Caradec/Wikimedia, CC BY-NC-SA Melanin in hair strands is chemically stable, meaning it can’t transform instantly.
Acute psychological stress does rapidly deplete melanocyte stem cells in mice. But the effect doesn’t show up immediately. Instead, grey hair becomes visible as the strand grows – at a rate of about 1 cm per month.
Not all hair is in the growing phase at any one time, meaning it can’t all go grey at the same time.
3. Will dyeing make my hair go grey faster?
This depends on the dye.
Temporary and semi-permanent dyes should not cause early greying because they just coat the hair strand without changing its structure. But permanent products cause a chemical reaction with the hair, using an oxidising agent such as hydrogen peroxide.
Accumulation of hydrogen peroxide and other hair dye chemicals in the hair follicle can damage melanocytes and keratinocytes, which can cause greying and hair loss.
4. Is it true redheads don’t go grey?
People with red hair also lose melanin as they age, but differently to those with black or brown hair.
This is because the red-yellow and black-brown pigments are chemically different.
Producing the brown-black pigment eumelanin is more complex and takes more energy, making it more susceptible to damage.
Producing the red-yellow pigment (pheomelanin) causes less oxidative stress, and is more simple. This means it is easier for stem cells to continue to produce pheomelanin, even as they reduce their activity with ageing.
With ageing, red hair tends to fade into strawberry blonde and silvery-white. Grey colour is due to less eumelanin activity, so is more common in those with black and brown hair.
Your genetics determine when you’ll start going grey. But you may be able to avoid premature greying by staying healthy, reducing stress and avoiding smoking, too much alcohol and UV exposure.
Eating a healthy diet may also help because vitamin B12, copper, iron, calcium and zinc all influence melanin production and hair pigmentation.
Theresa Larkin, Associate Professor of Medical Sciences, University of Wollongong
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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10almonds Tells The Tea…
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Let’s Bust Some Myths!
It’s too late after puberty, hormones won’t change xyz
While yes, many adult trans people dearly wish they’d been able to medically transition before going through the “wrong” puberty, the truth is that a lot of changes will still occur later… even to “unchangeable” things like the skeleton.
The body is remaking itself throughout life, and hormones tell it how to do that. Some parts are just quicker or slower than others. Also: the skeleton is pulled-on constantly by our muscles, and in a battle of muscle vs bone, muscle will always win over time.
Examples of this include:
- trans men building bigger bones to support their bigger muscles
- trans women getting smaller, with wider hips and a pelvic tilt
Trans people have sporting advantages
Assuming at least a year’s cross-sex hormonal treatment, there is no useful advantage to being trans when engaging in a sport. There are small advantages and disadvantages (which goes for any person’s body, really). For example:
- Trans women will tend to be taller than cis women on average…
- …but that larger frame is now being powered by smaller muscles, because they shrink much quicker than the skeleton.
- Trans men taking T are the only athletes allowed to take testosterone…
- …but they will still often be smaller than their fellow male competitors, for example.
Read: Do Trans Women Athletes Have Advantages? (A rather balanced expert overview, which does also cover trans men)
There’s a trans population explosion; it’s a social contagion epidemic!
Source for figures: The Overall Rate Of Left-Handedness (Researchgate)
Left-handed people used to make up around 3% of the population… Until the 1920s, when that figure jumped sharply upwards, before plateauing at around 12% in around 1960, where it’s stayed since. What happened?! Simple, schools stopped forcing children to use their right hand.
Today, people ask for trans healthcare because they know it exists! Decades ago, it wasn’t such common knowledge.
The same explanation can be applied to other “population explosions” such as for autism and ADHD.
Fun fact: Mt. Everest was “discovered” in 1852, but scientists suspect it probably existed long before then! People whose ancestors were living on it long before 1852 also agree. Sometimes something exists for a long time, and only comes to wider public awareness later.
Transgender healthcare is too readily available, especially to children!
To believe some press outlets, you’d think:
- HRT is available from school vending machines,
- kids can get a walk-in top surgery at recess,
- and there’s an after-school sterilization club.
In reality, while availability varies from place to place, trans healthcare is heavily gatekept. Even adults have trouble getting it, often having to wait years and/or pay large sums of money… and get permission from a flock of doctors, psychologists, and the like. For those under the age of 18, it’s almost impossible in many places, even with parental support.
Puberty-blockers shouldn’t be given to teenagers, as the effects are irreversible
Quick question: who do you think should be given puberty-blockers? For whom do you think they were developed? Not adults, for sure! They were not developed for trans teens either, but for cis pre-teens with precocious puberty, to keep puberty at bay, to do it correctly later. Nobody argues they’re unsafe for much younger cis children, and only object when it’s trans teens.
They’re not only safe and reversible, but also self-reversing. Stop taking them, and the normally scheduled puberty promptly ensues by itself. For trans kids, the desired effect is to buy the kid time to make an informed and well-considered decision. After all, the effects of the wrong puberty are really difficult to undo!
A lot of people rush medical transition and regret it!
Trans people wish it could be rushed! It’s a lot harder to get gender-affirming care as a trans person, than it is to get the same (or comparable) care as a cis person. Yes, cis people get gender-affirming care, from hormones to surgeries, and have done for a long time.
As for regret… Medical transition has around a 1% regret rate. For comparison, hip replacement has a 4.8% regret rate and knee replacement has a 17.1% regret rate.
A medical procedure with a 99% success rate would generally be considered a miracle cure!
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The Best Form Of Sugar During Exercise
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝What is the best form of sugar for an energy kick during exercise? Both type of sugar eg glicoae fructose dextrose etc and medium, ie drink, gel, solids etc❞
Great question! Let’s be clear first that we’re going to answer this specifically for the context of during exercise.
Because, if you’re not actively exercising strenuously right at the time when you’re taking the various things we’re going to be talking about, the results will not be the same.
For scenarios that are anything less than “I am exercising right now and my muscles (not joints, or anything else) are feeling the burn”, then instead please see this:
Snacks & Hacks: Eating For Energy (In Ways That Actually Work)
Because, to answer your question, we’re going to be going 100% against the first piece of advice in that article, which was “Skip the quasi-injectables”, i.e., anything marketed as very quick release. Those things are useful for diabetics to have handy just in case of needing to urgently correct a hypo, but for most people most of the time, they’re not. See also:
Which Sugars Are Healthier, And Which Are Just The Same?
However…
When strenuously exercising in a way that is taxing our muscles, we do not have to worry about the usual problem of messing up our glucose metabolism by overloading our body with sugars faster than it can use it (thus: it has to hurriedly convert glucose and shove it anywhere it’ll fit to put it away, which is very bad for us), because right now, in the exercise scenario we’re describing, the body is already running its fastest metabolism and is grabbing glucose anywhere it can find it.
Which brings us to our first key: the best type of sugar for this purpose is glucose. Because:
- glucose: the body can use immediately and easily convert whatever’s spare to glycogen (a polysaccharide of glucose) for storage
- fructose: the body cannot use immediately and any conversion of fructose to glycogen has to happen in the liver, so if you take too much fructose (without anything to slow it down, such as the fiber in whole fruit), you’re not only not going to get usable energy (the sugar is just going to be there in your bloodstream, circulating, not getting used, because it doesn’t trigger insulin release and insulin is the gatekeeper that allows sugar to be used), but also, it’s going to tax the liver, which if done to excess, is how we get non-alcoholic fatty liver disease.
- sucrose: is just a disaccharide of glucose and fructose, so it first gets broken down into those, and then its constituent parts get processed as above. Other disaccharides you’ll see mentioned sometimes are maltose and lactose, but again, they’re just an extra step removed from useful metabolism, so to save space, we’ll leave it at that for those today.
- dextrose: is just glucose, but when the labeller is feeling fancy. It’s technically informational because it specifies what isomer of glucose it is, but basically all glucose found in food is d-glucose, i.e. dextrose. Other isomers of glucose can be synthesized (very expensively) in laboratories or potentially found in obscure places (the universe is vast and weird), but in short: unless someone’s going to extreme lengths to get something else, all glucose we encounter is dextrose, and all (absolutely all) dextrose is glucose.
We’d like to show scientific papers contesting these head-to-head for empirical proof, but since the above is basic chemistry and physiology, all we could find is papers taking this for granted and stating in their initial premise that sports drinks, gels, bars usually contain glucose as their main sugar, potentially with some fructose and sucrose. Like this one:
A Comprehensive Study on Sports and Energy Drinks
As for how to take it, again this is the complete opposite of our usual health advice of “don’t drink your calories”, because in this case, for once…
(and again, we must emphasize: only while actively doing strenuous exercise that is making specifically your muscles burn, not your joints or anything else; if your joints are burning you need to rest and definitely don’t spike your blood sugars because that will worsen inflammation)
…just this once, we do want those sugars to be zipping straight into the blood. Which means: liquid is best for this purpose.
And when we say liquid: gel is the same as a drink, so far as the body is concerned, provided the body in question is adequately hydrated (i.e., you are also drinking water).
Here are a pair of studies (by the same team, with the same general methodology), testing things head-to-head, with endurance cyclists on 6-hour stationary cycle rides:
CHO Oxidation from a CHO Gel Compared with a Drink during Exercise
Meanwhile, liquid beat solid, but only significantly so from the 90-minute mark onwards, and even that significant difference was modest (i.e. it’s clinically significant, it’s a statistically reliable result and improbable as random happenstance, but the actual size of the difference was not huge):
Oxidation of Solid versus Liquid CHO Sources during Exercise
We would hypothesize that the reason that liquids only barely outperformed solids for this task is precisely because the solids in question were also designed for the task. When a company makes a fast-release energy bar, they don’t load it with fiber to slow it down. Which differentiates this greatly from, say, getting one’s sugars from whole fruit.
If the study had compared apples to apple juice, we hypothesize the results would have been very different. But alas, if that study has been done, we couldn’t find it.
Today has been all about what’s best during exercise, so let’s quickly finish with a note on what’s best before and after:
Before: What To Eat, Take, And Do Before A Workout
After: Overdone It? How To Speed Up Recovery After Exercise
Take care!
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When You Know What You “Should” Do (But Knowing Isn’t The Problem)
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When knowing what to do isn’t the problem
Often, we know what we need to do. Sometimes, knowing isn’t the problem!
The topic today is going to be a technique used by therapeutic service providers to help people to enact positive changes in their lives.
While this is a necessarily dialectic practice (i.e., it involves a back-and-forth dialogue), it’s still perfectly possible to do it alone, and that’s what we’ll be focussing on in this main feature.
What is Motivational Interviewing?
❝Motivational interviewing (MI) is a technique that has been specifically developed to help motivate ambivalent patients to change their behavior.❞
Read in full: Motivational Interviewing: An Evidence-Based Approach for Use in Medical Practice
It’s mostly used for such things as helping people reduce or eliminate substance abuse, or manage their weight, or exercise more, things like that.
However, it can be employed for any endeavour that requires motivation and sustained willpower to carry it through.
Three Phases
Motivational Interviewing traditionally has three phases:
- Exploring and understanding the issue at hand
- Guiding and deciding importance and goals
- Choosing and setting an action plan
In self-practice, maybe you can already know and understand what it is that you want/need to change.
If not, consider asking yourself such questions as:
- What does a good day look like? What does a bad day look like?
- If things are not good now, when were they good? What changed?
- If everything were perfect now, what would that look like? How would you know?
Once you have a clear idea of where you want to be, the next thing to know is: how much do you want it? And how confident are you in attaining it?
This is a critical process:
- Give your answers numerically on a scale from 0 to 10
- Whatever your score, ask yourself why it’s not lower. For example, if you scored your motivation 4 and your confidence 2, what factors made your motivation not a lower number? What factors made your confidence not a lower number?
- In the unlikely event that you gave yourself a 0, ask whether you can really afford to scrap the goal. If you can’t, find something, anything, to bring it to at least a 1.
- After you’ve done that, then you can ask yourself the more obvious question of why your numbers aren’t higher. This will help you identify barriers to overcome.
Now you’re ready to choose what to focus on and how to do it. Don’t bite off more than you can chew; it’s fine to start low and work up. You should revisit this regularly, just like you would if you had a counsellor helping you.
Some things to ask yourself at this stage of the motivational self-interviewing:
- What’s a good SMART goal to get you started?
- What could stop you from achieving your goal?
- How could you overcome that challenge?
- What is your backup plan, if you have to scale back your goal for some reason?
A conceptual example: if your goal is to stick to a whole foods Mediterranean diet, but you are attending a wedding next week, then now is the time to decide in advance 1) what personal lines-in-the-sand you will or will not draw 2) what secondary, backup plan you will make to not go too far off track.
The same example in practice: wedding menus often offer meat/fish/vegetarian options, so you might choose the fish or vegetarian, and as for sugar and alcohol, you might limit yourself to “a small slice of wedding cake only; coffee/cheese option instead of dessert”, and “alcohol only for toasts”.
Giving yourself the permission well in advance for small (clearly defined and boundaried!) diversions from the plan, will stop you from falling into the trap of “well, since today’s a cheat-day now…”
Secret fourth stage
The secret here is to keep going back and reassessing at regular intervals. Set your own calendar; you might want to start out weekly and then move to monthly when you’re more strongly on-track.
For this reason, it’s good to keep a journal with your notes from your self-interview sessions, the scores you gave yourself, the goals and plans you set, etc.
When conducting your regular review, be sure to examine what worked for you, and what didn’t (and why). That way, you can practice trial-and-improvement as you go.
Want to learn more?
We only have so much room here, but there are lots of resources out there.
Here’s a high-quality page that:
- explains motivational interviewing in more depth than we have room for here
- offers a lot of free downloadable resource packs and the like
Check it out: Motivational Interviewing Theory & Resources
Enjoy!
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