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Shen, Behavior, and Motivation

Shen disturbance is a common condition that many of us encounter daily in the clinic. In addition to anxiety and depression, shen disturbance can play a role in eating disorders, digestive problems, headaches, fatigue, trauma, addictions, insomnia, pain, and more. A holistic approach to shen disturbance includes an evaluation of how physical, energetic, psychological, social, and environmental factors may contribute to the condition. Also important in many shen disturbance disorders is an assessment of habitual and behavioral patterns.

As acupuncturists, we typically emphasize and identify energetic factors, imbalances, and patterns such as liver qi stagnation, heart fire, damp depression, and more. While the energetic approach offers tremendous insights and guides our use of acupuncture and herbs, it often does not adequately account for emotional and psychological factors. In some of my previous posts and courses, I have discussed how somatic therapies can play an adjunct role with the use of acupuncture. Somatic therapies include four major categories including breath work, touch and movement-based therapies, as well as sensory-orientated processes such as guided imagery and body awareness practices.

In my last post on lifestyle changes, I discussed the role of using SMART goals in treating conditions requiring changes in behavior and habits. While acupuncturists may not often consider behavioral and habitual contributors to the disorders they treat, it is essential to address these forces for many common conditions. For instance, obesity, addictions, trauma, anxiety, depression, diabetes, and heart disease often have maladaptive habits and behaviors that contribute to the disease. “Emotional eaters” often suffer from anxiety and depression and eat to soothe and regulate their emotions; over-eating and obesity are contributing factors to diabetes and heart disease. People with trauma and addictions also suffer from shen disturbance and can benefit from positively changing their beliefs, habits, and behaviors.  

Many common disorders seen in the clinic can benefit from

making changes in habits and setting health goals.  

While acupuncture can often release emotions being held in the body, and herbs can help to soothe emotions with physical supplementation, herbs and acupuncture are often not enough to provide the tools to shift behaviors, feelings, negative thoughts, and habits that contribute to shen disturbance. For the emotional eater to lose weight, they must be aware of their habits, triggers, and routines that are related to their over-eating. The same is true of smoking, drug use, and other forms of addiction. Patients who remain unaware of their behavioral patterns and environmental cues that contribute to their conditions, will not have the awareness they need to make the required changes.

Acupuncture can help to reduce the cravings that occur with overeating, smoking, and addiction; however, it does not inform patients about cues and triggers that cause them to overeat or indulge in the addiction. Without an awareness of internal and external cues, it can be next to impossible to change the bad habits that are a part of these patterns.

Motivators for Change

When working with shen disturbance and conditions related to it, identifying the clients’ motivations for change is essential. For the clients who want to lose 30 pounds or stop smoking, there is some underlying motivation for them to seek your professional help. Do they want to lose 30 pounds to look good in a summer bathing suit or because they recently had a heart attack and are afraid of dying? The client who wants to look good in a bathing suit has different motivating factors than the patient who is fighting for their life.

Understanding a patient's motive for change is a foundational need for both the therapist and the client. Additionally, setting SMART goals can assist in identifying the client’s motives for change and guide the process of them achieving what they want when they step into your office.

As I elaborated on SMART goals in my last post on lifestyle changes, I want to now discuss how we can help keep the client motivated as they navigate their way through making the changes required to get the results they want.

While a SMART goal is being established, we can inquire into WHY the client wants to change. Simply asking why they want to give up cigarettes or lose weight is a starting question, but we also must understand some of their deeper motives.

Do they want to lose weight to increase their energy, preserve their health, look good, lower blood pressure, or for some other reason?

Is their desire to lose weight related to their self-confidence in any way?

Are there any social factors that may contribute to or sabotage their desire to lose weight?

What are their values in relation to making the changes? Do they value their health enough to make the changes?

What are the top things that motivate the client to lose weight or overcome the addiction?

While this way of thinking may not be familiar to many acupuncturists, it is often necessary to identify the patient’s underlying motives, values, and goals if they are to stay the course of treatment. This line of thinking may also be applied to working with many other conditions we see in the clinic. For a client with a complex chronic condition and good mental health, what will motivate them to complete a series of treatments that may need to last several months? Is their motivation to stay out of pain strong enough to complete the treatment plan you suggest?

When we ask ourselves and our clients questions like this, it can help us to develop better rapport and keep patients engaged and focused on their treatment plans. Understanding the deeper motives they have for visiting our office and communicating with them on these levels, greatly assists in developing better relations and helps ensure patient compliance and completion of care.

For any condition requiring a long-term treatment plan, how will you keep your client engaged and motivated to achieve their health goals?

I look forward to hearing your responses and continuing our discussion on vital matters that relate to clinical practice and are adjacent to our practice of acupuncture and herbal medicine.

James Spears

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