Written by Christopher Kelly
Sept. 22, 2017
Christopher: Hello and welcome to the Nourish Balance Thrive podcast. My name is Christopher Kelly and today I'm joined by Dr. Simon Marshall. Simon is a former Associate Professor of Family and Preventative Medicine at the University of California, San Diego. I first met Simon through his wife Lesley. Remember, Lesley Patterson is the triathlete I interviewed and we talked about The Brave Athlete, the new book which is absolutely phenomenal. Simon, thank you so much for joining me today.
Simon: Oh, thanks for having me, Chris. It's good to be on with a fellow Brit too.
Christopher: Yeah, absolutely, absolutely. So I went and stayed with Simon in San Diego. Lesley, after our interview, she very graciously invited me to stay with Simon for the weekend.
Simon: Yeah, she was gracious in inviting you while she wasn't there, and I had to deal with you.
Christopher: It's true, and it turned into a great big therapy, stroke coaching session for me and my business and sports endeavors, which I very much appreciated, Simon, thank you very much.
Simon: No, no, I just appreciated that you came with enough ready meals for your entire stay, so that was perfect. No cooking needed on my part.
Christopher: Julie is unbelievable at doing that. There's really no reason, see, any bars, any kind of fast food or anything with her. She packs me off with all of this incredible food in Pyrex containers with silicon lids, and I travel with all of it. So I flew down to San Diego and I swear to God, I didn't eat another thing that Julie had not prepared for me. I did the Belgian Waffle Ride which was nearly nine hours on the bike, and I still have enough food for everything which is fantastic.
Simon: That's probably because you didn't share any with me.
Christopher: Exactly, exactly, but you looked as if you were pretty competent. You're like you knew your way around the kitchen. I didn't feel sorry for you.
Christopher: But that was a great weekend. I learned so much from you. In fact I went onto Mastermind Talks, an entrepreneurial event which I spent a fortune on, thousands and thousands of dollars, and I feel like I definitely got better value for money from the weekend from you. Honestly, if I had to spend thousands of dollars on that weekend with you, I would have been just as happy.
Simon: I would have just settled for a small slice of your meatloaf.
Christopher: But, yeah, you introduced me to the concept of Radical Candor. That was absolutely fantastic.
Simon: Oh, yes, yes.
Christopher: Yes. Tommy and I did a podcast on that and then I missed the most important bit. So Tommy and I did a coaching call with Simon after we recorded the interview, and you said you've got to criticize in private and praise in public. Of course we didn't talk about that, and we realized we had done it all wrong.
Simon: That's right, while you're busy laying onto someone in the public arena of all the things they've got wrong.
Christopher: Oh, my goodness, sorry about that, everyone.
Simon: No, we've all done it.
Christopher: Yeah. Well read the book. That's what maybe my recommendation should be, just read the book Radical Candor by Kim Scott. I'll link to that in the show notes. Oh, I didn't mention. You are a sports psychologist, and you work with Team BMC. So you're doing sports psychology at the very highest international level, which I think is very, very cool. Talk to me about how you got involved in psychology in the first place. Obviously you had an undergraduate degree that was in a somewhat unrelated field. Am I right in thinking that? So how did you become so interested in psychology?
Simon: Well, no, I did my undergraduate degree in the Sports Sciences in the UK, and you specialize in the biomechanics and exercise physiology and psychology. Then in your final year, you specialize in one of those, and mine was psychology. I've been a cyclist, a competitive cyclist since the age of, I don't know, ten or 12 or so on, and I was always fascinated by the mental side of sport probably because I was trying to figure out the reasons for my own mediocrity, convinced that it was just something that I was missing and once I learned that, I'll be -- so I got really interested in it and started to study a bit more. So I did a Master's degree and then eventually led onto a PhD.
But the interesting thing about Sport Psychology is that -- well not interesting but one of the features of it -- it's really, sport is just the environment in which you're studying psychological approaches to approaching things in life that are stressful or cause concern. It applies to lots of different areas. So my academic life ended up branching off into more health psychology and working in public health departments. That was my faculty position at UCSD, but I've always had an interest in Sport Psychology as an academic interest but also, more recently, in a practical interest. Yes, I'm working with -- I'm married to a professional athlete, and if there's one thing that will help any sports psychologist be better at their job is marry into it because you get to peek behind the curtain of what actually goes on. Up until that point, you rely on athletes telling you the truth or telling you how they see the world, and you rely on their ability to -- or you're trusting them that they're doing the things that you're asking and discussing. That may not be the case, and you may never know this. It was really only until I married a professional athlete that really my approach, the whole philosophy to mental training for athletes changed in quite a significant way.
Christopher: Is there anyone else on the planet that's quite like you? You are quite a unique combination.
Simon: No, I don't think I'm that unique. Obviously it's quite a niche-y area anyway, sport psychology and public health or behavioral medicine which is how it's dressed up to make it academically credible. No, there are a few of us. There are not that many. I think I'm mainly driven by a really strong intellectual curiosity about why we make decisions the way we do and why we think and feel the way we do, and sport is a lovely environment to study that because it has all the ingredients of feeling like a million dollars and also feeling like a total loser and all within the hour. I think that's what a lot of psychologists who are attracted to it -- it's an achievement domain, as they call it. It's a great avenue for not just being able to learn about how you think and feel about things but also to develop some resilience and training with adversity and without having to do it in more traumatic and hurtful ways.
Christopher: What did you learn about yourself? Did you become a much better athlete after you had become an expert in the domain?
Simon: It depends on what you mean by better. I think I became a more grateful athlete. I think that one of the things that it helped me do was to be able to, one, not get too burdened by social comparison and expectation and pressure, and really learn about how to engage with the sport for its own sake. This is the ultimate challenge for all athletes is that the goal is to get really lost in the process, not the outcome of executing the skill. Once you're able to do that, you don't give a shit anymore about who's there or how fast other people are or whether you're perfectly prepared for this A race. You just see it as another experience. As I've picked up along the way, so few of my ideas are actually my own. We inherit them. We read about them and internalize them and integrate them into your own way of thinking. Some of those are like Radical Candor. It's about how you define failure and actually seeing as guidance and seeing as opportunities to learn more about how to be better next time. It's remarkably freeing once you're able to do that. My wife Lesley is able to do that now. I think it's no coincidence. When that shift happened, she won three world titles after being an average pro athlete and she went to being quite remarkable simply by having that new mindset and so it's quite powerful.
Christopher: Interesting. What about athletes on Team BMC? You make me think that they don't care about results. Is that how it works, like they don't really care whether they get good results or not?
Simon: Obviously all athletes care about results and if they tell you they don't care, they're lying. The higher you go up in the sport, meaning if it becomes not just part of your identity but part of your survival, well not physical survival but financial and social survival, then it absolutely means everything because it drives your contracts and your negotiations to further contracts and performances and how you fit into teams and stuff. So it is important. The paradox of it is that the best way to get the outcome you desire is to not focus on it. It's to focus on the elements that lead you there and at the core of that is having a very much -- this process focus on what can I do in the here and now? When we say that we often mean in the next minute or in the next five minutes, to be the best athlete I can be, what do I need to focus on? Winning that battle is pretty universal, whether you're riding the Tour de France or whether you're doing the first 5K and struggling to get through it.
Christopher: Do you think this is also applicable for other areas? For example, weight loss, I feel like that has been -- a trap that I've seen is people who are unhappy with their current body composition and they believe that they're going to be happy once they reach this new desired composition and of course once you get to that new desired composition, there's something else to be unhappy with, so you have to be happy now before you can be happy later, if that makes sense.
Simon: Exactly, and I think it's the human condition is to be predominantly horizon-seeking. One of the probably most consistent themes in the age group athletes I work with is this notion that I'm not enough. It's not articulated as that, but it's a thematic thing that runs through the way they talk about what they do and what drives them. It's always once this happens, once I get there, I'll be happy and then everything will be enough, and I'll feel enough. The cruel reality of course is that that rarely happens if ever because we know there have been studies on lottery winners. If you think you have what you believe is the -- you've reached the nadir of happiness then you're equally unhappy or you're striving for the next thing. So it's this cyclical reasoning or cyclical process that tortures us. Lesley is a good example is that she won a World Title in her professional sport, off-road triathlon, and you think that this is the pinnacle of everything you could achieve and you celebrate. You do, but within a few hours, it was not probably within a few hours but within a day or two, it then becomes, but if that might have been a fluke, to be a real champion, I have to defend it. Then when you've won two World Titles, people say, they're the real deal. Don't you know, on a day or you got lucky, so and so wasn't there. It's never enough, and we know that. Coming to grips with that and the sooner we can learn that, it doesn't mean that you cease to strive but it looks like a little hamster's treadmill that has the wheel. There will always be something more that you strive for.
Christopher: Yeah. You reminded me, I just had a really good time reading The Subtle Art of Not Giving Up. Have you read that book?
Simon: Yes, yes, it's great, isn't it?
Christopher: Absolutely. He's -- who was it? I'd forgotten the name of the -- Mark Manson, Mark Manson is the name of the author. He talks about there's no such thing as the end of problems, only better problems. He demonstrates this example with a homeless man on the street and Warren Buffet. They've both got money problems. It's just that Warren Buffet has got better money problems. I think the same might be true with Lesley. Before, her problem was she hadn't won the World Championship and then once she won the World Championship, she just had other better problems.
Simon: I know, and the problems, you level up, but the striving is still there, that fire in the belly. I think psychologists have studied, not just psychologists but neuroscientists and cognitive psychologists have studied why they think this is. It's a pretty universal feeling, and it's the source of much of our mental anguish in life. One of the things I love about Manson's conclusion is this notion that getting more mindful or process thinking or staying in the moment is a useful way to live, and he always talks about the subtle art of not giving a fuck is when you have no more fucks to give. It's not saying that you don't care, but it's not occupying all of your thoughts at that moment about what hasn't happened yet or what's happened in the past. It's just about the experience of it in that moment. We give lip service to this a lot because it's easy to say, and it's very hard to do, to be truly mindful or whatever you want to call it. It's really hard to do on a daily basis because you do get pissed off or you get elated on a moment by moment basis and learning how to control some of that is difficult.
Christopher: Simon, since we've already gone there and done some swearing.
Simon: Oh, sorry, yes, I've already been --
Christopher: No, no, I don't want you to apologize. I want you to talk about the use and abuse maybe of swearing. I did have one listener complain that they listened to the podcast in the car and sometimes their granddaughter is present and they're worried about the swearing. I have to say, my daughter is three-and-a-half, and I swear in front of her all the time. I've been to see other friends in England here and they do the same. In fact one friend said to me, it's important that you do swear because if you don't, it becomes forbidden fruit and that encourages them to do it even more. I know that you had some really interesting insights on the use of swearing and how it can change meaning. Can you talk about that?
Simon: Yeah. I'm not sure if it's a deep insight, but I come from family of swearers as well, and I like to consider myself a prolific swearer. I'm married to a Scotswoman so that's obviously DNA anyway as you know. I think linguistic scientists or language scientists, they study about why do people swear and the value it -- I'm interested in it professionally as a sport psych person. We know the studies show that swearing improves your pain tolerance. When you're doing short, sharp, explosive activities or actions that are quite difficult in terms of intensity-wise or effort-wise, swearing seems to ameliorate some of those and enables you to perform better. That's quite a robust finding in the psychological science. So clearly it has a function because we all do it, but what I find interesting is the taboo part of it. Again I'm not sure if I have any real deep insight here but what we know is a myth, for example, that the people who swear a lot is a sign of stunted or limited vocabulary. In fact the opposite is true. There might be some selection bias on how they study this, but the notion that people swear because they don't have a sufficient vocabulary to use words that are less taboo is false.
So it becomes then a very personal thing about what you do and how you do it. I don't know who said this but I always like it because they say that offense is taken at the ear, not just at the mouth, so it means that the perception of that word, it means different things to different people. Some people will be outraged by it. We had just written a book that has the F-word in the title with one of the letters redacted, so I suppose that saves us somewhat, but we have complaints and people in the media refuse to review the book because it has swearing. It's setting a bad example and so on. I'm not sure that's the case. I don't know if there's any evidence behind suggesting that young people are corrupted by hearing F-words in their childhood. They probably hear a lot more worse than that. So it's partly to do with how, if you've got young kids, how, once they're old enough, to have a discussion about it, what swearing means and when do we do it, if it's not gratuitous or if it's used to inject some levity into a conversation. I've spent ten or 12 years teaching undergraduates and graduate students. Not that I swear prolifically in that, I don't want to get thrown out of the university, but I do know that when you can inject some humor, and swearing is a great way of injecting levity and humor, then it does assist in learning. So I will make the case for use it selectively and appropriately and responsibly but also don't hold back. I find it strange that people will say, "What the frick," or they'll just substitute when everyone knows what the other word is. I don't know how that recluses you from all those things, so I just say, fuck it.
Christopher: Yeah, the reason I do it is because that's how I speak in real life. When I record the podcast, I bring my whole authentic self to the interview. I guess if I really tried harder, I'd imagine my mom was here or your mom was here, I could probably do it without swearing, but I figure that's probably not what people want to listen to.
Christopher: I wanted to talk to you about behavior change. I really wanted to talk to you about this. We started this business where we're trying to improve people's health, and I think we're doing a really good job of that in the current population that we're working with which is athletes. I'm worried that as we get bigger and expands, the problem of behavior change is going to get much more serious. Maybe I should give you my story as an illustrative example. I was just doing what I was told with the whole sports performance thing. The cardiologist told me that I shouldn't be eating fat. It was Teflon everything. My coach told me that I needed the maltodextrin gels on long rides and hard rides, so I'm slamming on these maltodextrin gels.
I realized with hindsight, I made some really bad decisions by following expert advice. Then later on when things stopped working for me, I found some different experts that gave me different advice. It wasn't so much about evidence as it was credibility to me. They sounded like they knew what they were talking about, and they'd seen this problem before. So I followed their advice, and I got fantastic results. The same was true with my wife, she said, "Well you've done this elimination diet, and you got rid of dairy and gluten. Now you're eating a ton of nuts and seeds, and those are also common food allergens, so maybe we need to rethink that." For me the behavior change was as simple as it could possibly be. Once she said, I just didn't know. It was just the lack of information. As soon as she gave me that information, it was the diet, the nuts and the seeds, we've gone the next stage. Do you see what I mean?
So for me, I've never had a behavior change problem. If you tell me the right answer, I can just start doing it tomorrow, but I know that's not true for everyone else. So if we ever expand out of this niche of working with athletes, I'm worried that we're going to be unable to change behavior because I feel like that's where the bulk of improvements is coming from is changing behavior. So can you talk about the importance of behavior change in not just the athlete community but the people that you've been studying as an academic?
Simon: Yes. Behavior change is quite a complex issue. On the face of it, we're told and marketed that it's quite simple. The obvious example that people trot out is Nike's just do it. Your experience, I should say, is pretty unusual because we know that providing or increasing education or knowledge is not a very effective strategy for behavior change. It might change things in the short term but even that, it rarely does. It makes people smarter. It just doesn't usually change their behavior. And has now become almost a consensus in the behavioral science literature that knowledge, education and even attitude change is not a sufficient prerequisite for actual changing your behavior. It isn't just changing your behavior, like we said, for athletes so it might be dietary habits or training habits. It could be anything. For example, we, the collective we, scientists, have studied how improved bacterial infections in hospital and how you change through hand hygiene habits, getting people to wash hands frequently, recycling, energy conservation and all of these challenges are, at the heart of them, a behavior change problem.
One of the things that I think about is there's really no one-size-fits-all for it because if you're in public health which is the field I was in, is that you're trying to influence as many people as possible for most of the time. You lose your ability, just through scaling and cost, to actually have an interpersonal interaction or a meaningful exchange with one on one which is potent but is really expensive to do that and it's not very effective for large scale. So in clinics where people are coming, and you might be similar in this sense, that people are coming with some level of motivation already, we know that motivation to change or intention to change is a really big starting point. But you also need the capacity or capabilities to change. You need to know what you should do or how you need to do it and then obviously context is important, or an opportunity. If you don't have someone say, "You need to have this diet," but it's going to cost you an extra $500 in order to do that and someone doesn't have the resources, it makes the behavior change problem even harder. Or you live in a food desert and it's really difficult to get fresh fruits and vegetables and so on. So context matters and environment matters too. But at the heart of the behavior change problem, I like to draw on one sort of method called motivational interviewing, and I don't know if you're familiar or you've had any discussions on this in your podcast in the past about this on motivational interviewing.
Christopher: I am familiar with it, and I've spent the morning watching presentations on motivational interviewing and just having --
Simon: Oh, God, have you?
Christopher: Yeah, a tremendously good time with it. I realized that some of it, I've learned just from working with so many clients. So we've got it so easy that people come to us, and at the moment it's a $8,500 program. When you drop that much cash on solving a problem or meeting a goal then you're sure as hell committed, so the behavior change thing is so much easier.
Simon: It's a bit easy and, yeah, I think this gets back to, before motivational interviewing, it's about someone's readiness to change. One of the models that we've been using for many, many years now called the stasis of change or sometimes called the transtheoretical model of change or [0:21:59] [Indiscernible] has come up with that. There are some limitations to that and the new science of that, but the essence is that behavior change is a bit like buying a house in the sense that it's not one day you decide, I want to buy a house, and the next day you're in your new house. You go through a series of stages whereby you're contemplating, do I want to move or is this right for me? I like my -- and then as you're get nearer and nearer to getting a mortgage and looking and putting a deposit down, motivationally, you're shifting. You're building momentum for it. So one of the disservices that we've done in the past, pre having a scientific approach to this, is that we've treated everybody as they're ready to change. All they need is the right information or the right [0:22:43] [Indiscernible] and they're ready.
Of course you've only got to look in for people with current diseases or people who really struggle to make these changes, and some of them are not just resistant to change but they're proud of not being changes. Some of my relatives are like this where you've got to die from something, and what's the point of having an extra five years if it's going to be spent in a nursing home, the way that it's rationalized or so on. So there's a lot of people who aren't even contemplating it. All the messaging and appeals to get people to do it, whether we're extolling the benefits of a good diet or activity or so on, are just lost on those people. The advertising campaigns that there's so much money is wasted because it's going to screen out or the people aren't even going to give attention to it, the people who need it most. The other extreme, you've got fitness programs in corporations and they're the worried well. We're training people or we're giving access, we're giving resources to people who are already motivated and ready but they're not the people who need it.
So thinking of readiness to change is the continuum, you're in these different stages, moving towards when you're ready to commit, helps you to think about what someone needs from any one particular point. So the logic is that the goal as a behavior change person or a health coach, whatever is just simply to nudge people along that continuum. Even if that nudging isn't yet at the ability to you actually going to sign up, do it, start changing your habit. It might just be getting you to contemplate about what the advantages and disadvantages are and think about it. So I think that that is quite an important principle. Then tying it back to this motivational interviewing concept which is an approach to how you talk to people about changing, well getting into the weeds of it, but one of the fundamental principles is that we all have some ambivalence towards any change that we have in our lives, which means that we live with thoughts that are both in favor of changing and the opposed changing. I've only got to think about my own life, not just training but things like, oh, I really probably should cut down on my alcohol consumption or wine or beer consumption. I know I need to. I can list the five reasons why I need to. I can also list the five reasons why I love drinking. So we all walk around with opposing thoughts in our heads, and psychologists often refer to this as cognitive dissonance, meaning, you have dissonant or competing ideas or values or thoughts in your head about things. That's why most people who smoke know that it's probably going to give them lung cancer, there's a higher risk, but they still do it.
Most behavior change problems, we have some ambivalence towards. When there is no ambivalence, change can be very quick and that might explain your ability to change overnight about cutting because you didn't see any -- there was nothing hanging onto these old thoughts and feelings about why [0:25:34] [Indiscernible] or fear of the unknown or cost or what have you. But if you're driven by, I'm so uncomfortable the way I am and I'll do anything to stop then it does become a different behavior change problem. So motivational interviewing tries to just pick away at people's natural ambivalence. It's part of the human condition or the brain, is to have to think about two sides to every argument or change problem in your own head and recognizing that we play tricks on ourselves all the time to downplay one side and up-play the other so we don't have to live with a constant fight in our heads. So we all use dissonance-reducing strategies. Some us know this as procrastination or denial or you're going to die of something. You rationalize in such a way that it makes you able to live with those two competing thoughts. What motivational interviewing is doing as a strategy is rather than go out with a big finger wagging approach, is to actually approach it more to say, "Okay, let's find out what the natural ambivalence is in you."
You talk about what are the advantages and disadvantages of staying the way you are and changing. We're not asking you to change. We're just going to have that discussion. Then gradually you're just picking away at the advantages and the disadvantages so that change ends up being motivated from within. That's the most powerful form of change, when it's intrinsic, when it's self-motivated. It's not prescriptive or finger waggy. I think that's one of the hallmarks of most behavior change challenges is to find out what that ambivalence is and then use a whole suite of techniques that we know in behavioral science that help you move you closer towards action.
Christopher: Do you think ambivalence could be a source of anxiety?
Simon: Absolutely. That's really what ambivalence or I should say, that dissonance creates and because the human brain does not like to have competing, I should say, opposing thoughts because having opposing thoughts create anxiety and create emotion to try and resolve that. Emotions are there to, ultimately, to drive decision-making then that's one of the little signals or the nudge in the ribs to get us to do something. But people deal with anxiety in different ways. Some people confront it head on and try and unpack what it needs and what they can do to get out. Other people use denial as a strategy or they use procrastination as a strategy. So the ambivalence part is, using procrastination as an example, is to say, wouldn't it be nice if you didn't have to procrastinate anymore? You just knew what you needed to do and you did it. You get people to experience, even if it's fictitiously, thinking about what it would be like to live without this anxiety that's caused by this. So, yeah, absolutely, it does cause it.
Christopher: Wow, yeah, that has been so insightful. One thing I did recognize in watching some presentations on motivational interviewing this morning was this idea that you're not being counseled by an expert but rather there's a peer-to-peer relationship. So when I'm on a call with a client doing a coaching thing, it's -- I'm a computer programmer, I'm not a doctor or a psychologist or someone else. I'm just a guy that rides bikes just like you, and I've solved some of the problems that you're trying to solve. I feel like it's obvious that I'm not an expert and when we talk about things, it's almost like talking with friends rather than me being the expert, handing down the expert advice, the prescription, so to speak.
Simon: Right, yeah, absolutely, and this is what empathy is, being able to just put yourself in someone else's shoes and recognize that it's hard. When people and their coaches -- all coaches are notoriously guilty of this -- they'll say, "If an athlete doesn't do the training," or they're just like, "Listen, I can only help you so much. If you're not going to do the work, you need to find another coach because I'm not the coach for you." It's that prescriptive model really, when you enter into a relationship, a facilitated one, you're trying to nurture change. I think if someone does not feel judged or evaluated or criticized, and that's really what we're saying. If we want to unpack the non -- if you want to say why the peer approach works, it's because ultimately, you're removing those things that you're feeling criticized or judged. When you're in a position of power, you can do that if you have the skills to do it. It's all about framing and context rather than just the fact that you're in a position or you're a health coach or what have you.
Some people have the personality for it, their upbringing and their general disposition, is that they're able to communicate on a very fundamental level. We know, for example, one interesting finding in the psychological research is that people form trusted relationships based especially in moments of vulnerability and weakness. In other words, we bond on vulnerability and weaknesses. We don't bond on strengths. So being able to open up and share -- this is why therapists are trained to use self-disclosure, to say, "I struggle with this too," and if you don't struggle with it, you can create or invent scenarios where you're empathic to it. At least they don't feel judged or evaluated. That's one of the secrets of doing it. You feel organically or you just feel naturally like that. It's a skill that we can all learn to be better at.
Christopher: A really cool example of the exact opposite was highlighted in one of the presentations I watched. I should thank Tere Rodriguez who is a coach and close personal friend. She first sent me this video. You've probably seen it. It's Bob Newhart, Stop it. Have you seen that video?
Simon: Yeah, yeah, yeah.
Christopher: It's the most fantastic thing. I'll link to it in the show notes so that people can find it.
Simon: Yeah, that's hilarious.
Christopher: In a nutshell, it's the therapist who is giving therapy to this woman who is claustrophobic. She says, "Do you think I should write down this advice?" He says, "No, it's only two words. Most people can remember two words." The two words are stop it. The whole sketch goes on for six minutes, very, very, very funny, I should link to it.
Simon: I know. Snap out of it, therapeutic advice. Listen, we all find ourselves doing it. I'm not a parent, but I know many friends who are parents. They find themselves, just don't argue, just don't do it. We all do it. It's not something that is necessarily even that has to be monitored. It's life. But it's recognizing when we're doing it and learning, well how could I approach this in a different way? You can learn that if it doesn't come naturally to you.
Christopher: I'm sure that it's driven in part by the clinician or the coach or whoever it is that's giving the advice or trying to create the behavior change is they've seen these problems so many times before and they're too anxious to get to the solution to stop it. I know how to solve this problem, just do this. Because the clinician has seen it before, they're really anxious to get to the solution.
Simon: It's interesting. One of the areas that have been studied fairly consistently is counseling for diet and exercise change in primary care, how doctors do it when they do it or if they do it all and for whom do they do it. What we know is that it rarely happens. I want to say rarely for patients who are showing, who have conditions, who happens in which diet change and exercise change would help, it's only done about 30% of the time. There are also reasons for that. It's not always that the physicians are trainees. It's time when you look at the length of clinical visit and so on, and there are programs designed, research programs. I've been involved in one of them. It's called PACE. It's how you train physicians to counsel for diet and exercise in under two minutes. So it is difficult. We know that physicians generally don't do a very good job of it, and that's partly time but also training. If you just peek at medical education, and I've been involved in preventative medicine residency programs and undergraduate medical education, you see the lack of behavioral science training or exercise counseling [0:33:27] [Indiscernible] in there. So we shouldn't be too surprised when that doesn't happen.
I think some clinicians just feel also, if you're overweight or obese as a physician and you're counseling a patient, you'll be embarrassed about it because you're not [0:33:41] [Indiscernible]. They're going to look at you and all -- one of their findings in the research is that they have a fundamental assumption, it's anecdotal but it's based on their own experiences that what I say never seems to matter or make any difference because when I see them in 12 months and I could tell them all that and I've done it all my professional life and they still come back and it hasn't made any difference then it becomes the nuts and bolts of how you do it. That's one of the reasons that what they're saying is education doesn't really matter. It doesn't really help that much, and we know that.
Christopher: So what do you do if you've only got two minutes? You summarize that research. What's [0:34:13] [Indiscernible].
Simon: No, no, you can't. One of the core elements was thinking just educating clinicians in terms of this stage is mortal so being able to ask certain questions so that you have a good sense of their readiness to change and rather than just assuming that everyone, all they need is this missing piece and they're ready to step over the threshold and do it, and to be consistent in the delivery of that information. One of the things that we also know from the research, for example, is that -- and it's not just physicians but people in the primary care setting who in that environment, it might be a one-off piece of advice or a pamphlet or a little reminder, but it's not followed up so the next time they see him, "I remember, in our last time, we talked about this. How has that been going? Or did you try," and it's not reinforced. So having the ability to know where people are at and to provide some skills at the moment, so one of the fundamental skills is awareness, self-monitoring, in psych parlance, and probably 50 to 60% of the battle is getting people to be aware of what they're actually doing. Because we may call it these wonderful, all these cognitive acrobatics that we do in our own heads to convince us that our problem isn't as bad or as serious as we think because we've been on this dissonance-reducing, calm, self-medicating approach, some being able to know exactly what the issue is. So that's where getting people to use some measurement technology, whatever activity it might be, pedometry or just getting testing or something and then following up.
So having people have a fundamental assumption of what the issue is, is critical and then having some goals and ways that you enact those goals. The PACE program is really based upon staging people, getting them to move one stage forward which doesn't always mean that you need to be exercising the next time I see you, but it's just getting them to contemplate and then reinforcing that discussion as they go on. But as you know, the touch points in primary care are few and far between and people are rushed. It's really difficult to do well.
Christopher: Do you think it could be ever done by technology?
Simon: Yeah, there are lots of attempts to try and do that, in fact, now. One of the great findings in the self-monitoring research -- I know that you're interested in quantified self stuff, is a very allied field here -- is the frequency at which you monitor yourself that's important, not the quality. In other words, we've become, academics, we've become so bogged down in the accuracy of our measurement tools just simply to convey feedback. That's important. You want a good, valid and reliable measures, otherwise, how do you -- but all accurate. But what we know, from the psychological research, is that the more often you do it, meaning, you try and find feedback about how you're doing, even if that feedback is slightly biased or not very precise, it doesn't matter as much as the fact that you're bringing into conscious attention and thinking about it. So the frequency of monitoring is really important in fact and so technology lends itself really well to that.
There's a whole movement in using digital platforms or mobile technologies to improve health outcomes and the interventions are called just in time interventions. I don't know if you've ever come across those, JIT interventions. What this means is that usually they revolve around smart phones with data that's ever-present and passive to the user, that we're getting valuable information about when is the right time to intervene and prompt in such a way that it's not obtrusive and annoying. It can be subtle but is sufficiently frequent to keep people, keep it on their radar because most of our bad habits are exactly that. They're habits. They're not actually in our conscious thoughts. So when you need to break a bad habit or even start a new one, before we can chuck it down into our procedural memory or the place that runs our auto pilot on habits is that we have to put it into conscious thinking, we have to dissect it by the cue, routine and reward neurological loop, as it were, for creating habits. We have to think about it, and engineer our circumstances to do that. So digital and mobile technologies are wonderful tools for doing that because they're both simultaneous harvesters of data about that person. It's very individualized and personalized, and people always have these devices with them. It's the most valuable real estate is probably your home screen on your phone at the moment.
Christopher: Can you name any apps that are doing this?
Simon: Most of them that are really embedded with good behavioral science rather than they're just start-ups and throwing eggs on the wall and seeing if they stick, are still in the academic world, meaning, they're being tested with randomized controlled trials and so on. There are some really good self-monitoring apps like Breadcrumbs. I don't know if you've heard of that.
Simon: It's really using your phone to give you -- in fact this is built-in to a lot of mapping apps now or tracking apps, I should say, in our phones that will tell you where you've been today without really you entering any other information, just it has got hard fixes on your location and it logs it with a time stamp and it tries to put some context around it. So you can learn about what you do and when, and there's no surprise that most iPhones, the iOS phones and android phone now that will have built-in apps that have a health component to them that will measure your steps, not very well, but that may not matter if it's frequency that's important. It can ping you and give you feedback to tell you how you're doing. I think it's still very much in the infancy phase but things that are actually going to be rolled out and useful. Apple watches now have a hat tick feedback, vibration feedback if you've been sitting for too long and it will just remind you to get up and walk for three minutes or so on. These are all technologies that are available now. We're going in the right direction. They're just basic at the moment.
Christopher: Do you think it's going to make a difference whether these are qualitative measures or subjective? Personally I feel like I've really gotten really good results by staying away from my smart phone, making a habit out of noticing. The first person to make me think really hard about this was Ellen Langer. I go on about this all the time in the podcast. The reason I go on about it all the time is because I've made a habit of it. I always think about how my ankles don't hurt anymore because I do tons of walking. I got laser eye surgery and now I notice that I can see things far into the distance whereas before I needed glasses or contact lenses. Maybe I'm walking down the street and listening like I was today and holding my daughter's hand, and I think about how lonely I was before when I didn't have a girl friend. I really wanted to start a family, and it wasn't happening for me. Now I have what I want. She's holding my hand right now as we walked. So I'm noticing these small things. It's not high tech. It's not a bunch of biofeedback. Maybe it's all effective. Do you think that's a good strategy or do you think I'm better off counting steps with my smart phone?
Simon: I think that's what's called a leading question.
Christopher: It's somewhat of a loaded question. If you were to tell me, "No, you need to be tracking something. Here's the evidence that suggest the real numbers are going to make a difference for you, this will lead to a better outcome," I will totally do it.
Simon: No, I think this is one of those good examples of we have to be very careful in how we interpret the science here because when scientific studies are done on self-monitoring through remote sensing and so on, it's that they're very clean, clinical environments. We can try to distill down into what the essential elements are that are driving change. It's still a study of averages, right? I've been involved in interventions to reduce weight, body weight that are delivered entirely through text messaging and just through Facebook. We know that some people just do not engage or do not enjoy those technologies. It's not about technological literacy at all. That's a separate issue. It's just about that that's not a medium that they find helps them. So it is very individualized. I would say that the best use of technology is more facilitative or supportive of how you already enjoy that or, not enjoy, what you already find that works for you.
So I would say for you, the smart phone or sensing, remote sensing can still work, would still be effective for you, but it has to support ways that you find are already helpful. So trying to switch you over to just a qualified self-nerd where you're measuring 27 bio markers in real time may not actually be what does it for you, but a device that can help you have more instances where you remember that you're enjoying walking down the road, holding your daughter's hand is really powerful. Our memories are associative and motive-driven, so the more we can hang experiences or the more we can hang our behavior changes experiences on things that we feel are important, our value system and connected to emotions that we like, the better so it doesn't always have to be either-or.
Christopher: Right, right. Yeah, and I should explain. The reason why that's so powerful for me, thinking about holding my daughter's hand, was it was behavior change that led to meeting the woman that then became my wife that led to having kids. A large part of that was changing my diet, changing how much I was prioritizing sleep and all the other things that we talked about on the podcast. That's what keeps me going, is knowing that I've achieved that incredible goal.
Simon: Again, humans are goal-driven. The reason that self-monitoring works is it forces us, it gives us feedback about how we're doing for that goal. That's all the theories about why that works and how. That's it in essence. For folks who don't have problems setting goals or find it quite easy to set implementation -- goal plans on how am I going to do this, when and where; feedback may not be as critical. But those of us who struggle with that, feedback in a timely way, in the moment when you need it, when you're about to make that quart of ice cream purchase or whatever it happens to be for you that you struggle with, then that's quite important and that's when context awareness of advice can help us make really better decisions because most of our decisions are made, if you just leave them to themselves, they're either guilt-driven, like, oh, my God, I can't believe I've done this again. I'm not going to do it tomorrow. Okay, tomorrow, the whole New Year's resolution concept is based on that. But if you've got something that knows that you're in Aisle 4 of wherever and telling you that you're vulnerable to making a purchase, an emotional purchase that you're probably going to regret later and being able to be pinged at that particular time, that could have an important effect on your behavior.
Christopher: That could be cyclical. Yeah, that's a really, really good idea. I wanted to talk to you about the methods that we've been using to facilitate behavior change in our practice. It is rather tech-heavy although to be fair, it doesn't have to be. Maybe you're familiar with it, but I'll explain anyway. Are you familiar with the Agile Scrum Sprint?
Christopher: You are familiar with that, all right. Okay, for the listeners, I'll explain what we do. I meet with a client and we're communicating one-on-one over Zoom. Maybe I should talk about an example that just happen to come up yesterday was somebody was only able to find, I think it was either five or six hours of sleep because they thought they had to get up early in order to run so that they could qualify for this marathon. I thought, well maybe the sleep is more important, and we did the motivational interviewing thing where it's all about change talk, are the keywords. You get the person to suggest that maybe they will be a better runner if only they could get some more sleep. We talked about what they had to do in order to make that happen. So what do you do in the morning? Well I've got to take the kids to school. How far away is the school? Is there another way that you could get the kids to school other than driving? It emerged that they like to ride bikes and there was a kid seat that they could put on the bike. Maybe that person could get fitter by riding the kids to school with the kid in the car seat. Okay, now what do we need to do in order to make this happen? Well the kid seat doesn't fit on the bike anymore.
So the whole time we're speaking, I'm looking at this thing that we call a Kanban board, and there are columns; to do, doing, review and done. We use a piece of [0:46:52] [Indiscernible] to implement the Kanban board. Equally you could do it on a whiteboard. You could have these columns on a whiteboard. Then as we're talking, we're thinking of things. Well this needs to be done in order for this to happen. So I'll write on a sticky note: Take bike to bike shop to get kid seat fixed, and that goes into the to-do column. Obviously we talk for a while and at the end of the session, there's a whole bunch of these sticky notes. I'm very careful about how many sticky notes I put in the to-do column because if you put in too many then nothing tends to happen. Then we say, "Okay, what are you doing in two weeks?" Then we meet again in two weeks' time and then we repeat the process. So if something has gone wrong in that two-week period, we can then reassess fairly early on rather than I'll see you in -- so in the beginning, what we used to do is I would write down things on a piece of paper, like a series of bullet points so you would just hand it to the person. Guess what. Nothing happened, absolutely nothing happened.
So I feel like we've been getting really great results with the Scrum system, and I should recommend, there's a really good book. It's called "Scrum: The Art of Doing Half the Work in Twice the Time" by Jeff Sutherland, that I will link in the show notes. What do you think about this, Simon? Am I doing it wrong? Could I be doing it better?
Simon: No, this is great. In psych speak, these would be called implementation intentions. We know, for example, that if there's one phrase that would summarize about how we work towards goals is that goal-setting is not your problem. For most people, they know pretty much -- assuming there's not some real esoteric area or something that they totally -- when we're talking about lifestyle change, most people know what they need to do. There might be a little bit of education problem, but it's not that. It's how you implement a goal. So implementation intentions is one of the most potent ways, techniques that you change behavior is that you're really thinking through how, okay, I want to be able to get my exercise in but not having to substitute time for this. I'm going to do it. I'm going to try and combine my commute with my exercise. How do you do it? You're listing all the ways, the problems that might be along the way or what if this doesn't fit, how can we work towards that? So you're implementing or teaching people how to implement a strategy that's going to help them meet that goal. That's a really powerful technique. In fact this is a good point to have, a little bit of a selling point of a resource for readers in the science.
In behavioral science, one researcher in particular who has done a wonderful job of saying, well what's important and when and for whom, in terms of behavioral science, which implementation intention is one, is a woman called Dr. Susan Michie. She's at UCL in London, and she's a health psychologist, actually a clinical psychologist. She leads up, it's called the "Human Behavior Change Project." It's a consortium of experts in behavioral science to figure out what the core elements of behavior change are. They call them BCT, the Behavior Change Techniques. What does the literature, what does the scientific literature tell us about what's effective for changing people's behaviors across a whole host of different behaviors? They've come up with this taxonomy, this list of things that have evidence behind them. There are 93 of them now which all have evidence behind them. They've been grouped according to things like how you set goals and so on.
What the goal of the Human Behavior Change Project is to then use artificial intelligence, machine learning, natural language processing to automate the process of mining the new scientific studies for when something comes on to tell us, has this dropped down in importance or is it less important? 200 studies a day are being published [0:50:37] [Indiscernible]. It's impossible for us to keep up with this and we -- the dictum of the meta analyst or the person who statistically reviews studies is to say, listen, we know a lot more than we've actually proved. Because there are all these studies out there, so we need help. So the goal is to try and learn from the studies we have at the moment. Out of this taxonomy, we've been able to do some quite remarkable analyses to say, "Listen, if you do have limited time and you are to invest in one of the key things I need to focus on, we can learn from these studies. So helping people have good implementation intentions like exactly what you're doing, is one of the top five things that we know that we can do to help. Self-monitoring is another. You have to be aware of it. It doesn't always have to be technology-driven.
So things like that are really quite powerful. By learning from what the scientists are telling us and how we implement those and how we provide good quality feedback or how we review what went wrong when we set goals or couldn't perform them, these things are potent behavioral strategies and there's good evidence to show that they work. So that science is evolving, but I think that's a long-winded way of saying, what you're doing, however you found that strategy or why it works, it's supported by evidence and I would say, keep doing it.
Christopher: Well that's great. I can't take credit for it obviously. It was just something that I learned from my previous life as a software engineer. Software engineers, in my experience, I'm sure there are exceptions and people who listen to this will take exception if you are a software engineer, are some of the laziest people I've ever met, almost by definition. Because if you were not lazy, you would do it by hands. Say you've got some data entry tasks, you want to put a load of numbers in a spreadsheet and it's a series of numbers, and somehow you can write an algorithm that corrects the series automatically, where maybe a non-programmer will do that manually, but a programmer would find a way to automate it. That's because they're lazy. Of course this is positive for some tasks and then it has this downside that they tend not to get things done. I think the Scrum method is a fantastic way of getting lazy programmers to get shit done and it's just what it's used to.
Simon: Exactly, and it's also a kind of a simile, I suppose, for the human brain. This is what our brain does is when we find tasks that are initially quite complicated and if we have to think about them all the time in our conscious thought, it would paralyze us because we have to make, whatever, 30 or a thousand decisions a day. That's the purpose of habits. So we're always trying to find shortcuts, but the challenge is when those shortcuts start to kick us in the ass because we're doing things out of habit and we're not realizing, because they're no longer in our conscious thought, we're not actually just being -- one of the most common is helping people cut down on alcohol abuse. We know that habits, pouring a second glass or whatever, we've become so habituated to our environment, the cues in our environment that trigger us to over-drink. We can help that by changing or trying to eliminate those triggers rather than just try and have willpower to fight against them. Staring at a bottle that's already open is not as nearly a good strategy as hiding the bottle or not having the bottle in the house to begin with. It's the same for being productive. Eliminating the cue or the trigger for productivity is turn your phone off, simple, for that hour you're trying to do that, or close your email program down so you're not being distracted. So, yeah, I think that's a good metaphor for what the brain does naturally anyway.
Christopher: Awesome. How do you do it with your coaching? Is behavior change an issue when you do the sport psych stuff? Do you ever have this problem where you just really need that client to just stop doing something?
Simon: Yeah. Our entry point for athletes is, do you ever have thoughts and feelings that you don't want? If anyone is human, they'll say, "Yes." If they say, "No," they're either lying or on psychotropic meds. So the starting point is, yes, and so really, behavior change is how do I have fewer of those thoughts? It becomes a behavior change problem. One of the most common examples is all athletes, they kind of go through this cycle of they enjoy the training, some of it is hard obviously, and they enjoy the racing when it's over. But the morning of a race, when their stomach is churning and they're sweating and they're like, why do I do this to myself? This is not a fucking fun experience. Or they have those thoughts of escape. Psychologists call this the first hour. "I'm never going to do this again. Who said this was a good idea? What was I thinking? I just want to be gone." You're hoping that you get a flat tire to end your misery. We all do on a fairly consistent basis. I forgot what the train of thought I had there. I lost it.
Christopher: How do you [0:55:35] [Indiscernible] How do you do it?
Simon: This is an ambivalence issue, right? I want to race, but I don't enjoy this part of it. I want to race but I don't enjoy -- that becomes, what can I do to make the experience a bit more enjoyable? Often the behavior might be learning a skill so that you start to reframe some of the symptoms or feelings that your body is giving you. It's not about nervousness, nausea and heaviness. It's about feeling light and ready, these endocrinological changes that are really helping you be the fastest athlete you can be on the day. We want your knee to crack five times. We want your palms to be sweaty because this is helping your grip and this is making you as light as possible. So a lot of it is learning those strategies to reframe. Or it could be that you're learning the ability, learning a physical skill, I mean, a physical skill in the sense that you have to listen to something and develop mindfulness. Meditation is a great example. A lot of our athletes use the headspace. You may have heard of that.
Christopher: Of course, yeah.
Simon: Just as a skill for learning how to have positive attention or stay in the here and now. They're the building blocks of having a process focus during sport. Learning that skill, that's a behavior change. Mediation, you say meditation to an athlete, and their eyes spin around like a one-armed bandit at a casino. So we never mention the word meditation.We talk about creating headspace for you.
Christopher: It's one of the best-named apps, it really is.
Simon: It is and it works for lots of reasons. Andy Puddicombe, the main guy behind it who has also -- a British guy -- also has just a wonderful voice for it. So it's a lot of elements of come together and the packaging of it. You don't feel stupid, and there's no spiritual or ethereal Kumbaya or Enya listening, drum circle to it. It's just bow -- listen, wouldn't it be nice just to step away out of your day, just clear some of the shit, just have some time for yourself just to chill out, create some headspace for yourself? What you're doing is learning skills of meditation, but we don't call it that. So that skill is one of the things that -- getting people to start to learn that is a behavior change problem for athletes because they're too fidgety, I've tried it in the past or that's not for me. So how do you get someone to try something that they don't like doing? That's a behavior change problem.
Christopher: How do you solve it?
Simon: So one thing is how you frame it. We zero in on headspace and why it's important, what it is, and you talk about what meditation is or what it isn't. You get people to set very short-term goals. One of the things that's great about headspace is that I want you to practice for ten minutes a day for ten days. People say, "Well I can do that." You say, "I want you to start taking a few yoga classes or going to a mediate -- God, I've got to find out where they are. I've got to go up. I feel like a bit of chump. I don't know what I'm doing. What if they ask me to do it? So you can do it in the comfort of your own home. I've given them a very small, tangible goal. Ten minutes a day for ten days, we're going to check-in in ten days time and see how you're doing. So I'm giving them implementation intentions. I want you to download this app. I want you to find the time where you're quiet, you're not trying to sleep, you don't sleep when you practice it here, so they can do it; setting them some goals. I want you to do some self-monitoring of it that the app has built in. It says, "Congratulations, you've now done 37 minutes of headspace training." Then you have a goal autopsy. In ten days time, we talk about how they've done. So that is behavior change is embedding those principles into the technique or the skill that you're trying to get them to work on.
Christopher: One thing you taught me which I think is critically important when working with the athlete is it has to be about performance. I'm not sure you made that crystal clear there but perhaps you intended it, is that the athlete, they care about the time. How long does it take me to finish this event? So if you frame it -- or power-to-weight ratio for cyclists, for example. You could say to that person, "Okay, if you get through this program of doing headspace for the next ten days, I think it's going to improve your power-to-weight ratio. Athletes are like, "Really?" Yes, really, here's the evidence if you like. It's so powerful when you say that to an athlete. "This is going to make you faster. This is going to make you better."
Simon: It is, it is, yeah. When you're selling, for want of a better word, these techniques to athletes, they're all driven by, our goal is to make you faster and happier. Just making you happier and not making you any faster, most athletes are like, "Nye." Or just making you happier and not faster, they're like -- professional athletes, just being faster but I'm even more miserable. My relationships are even worse now. That doesn't work either. So we're trying to combine the two. Obviously, at all points, the goal is to help you become the better athlete and that involves often becoming faster, more efficient or so on.
Christopher: Do you have space in your coaching practice to help people that might be listening to this podcast, or are you just working with Lesley Pattersons or Team BMCs of this world?
Simon: No, not at all, in fact most of -- so Lesley and I, we run an endurance sport coaching business together. Lesley does the physical coaching and I do the mental coaching, although that is actually more integrated than that sounds. We also have our own separate clients. Some folks don't want to do anything with mental training or they might already have things down and they only work with Lesley or folks have their own coaches. They only work with me on shoring up their mental game which for them is having fewer thoughts on things that they want. We do all. That ranges from folks who have -- obviously from my background in working with people with chronic disease, is starting a new lifestyle that's very different than the one they have now when it might be just doing your very first 5K or something or just getting off the couch a bit more often, right through to professional world champions. It really runs the gamut, and the principles are amazingly consistent. They work consistently across all groups. It's just the focus and the goals change slightly but absolutely.
Christopher: Persuade me why I should read The Brave Athlete.
Simon: Okay, so The Brave Athlete is essentially a guide, a workbook to help you have fewer thoughts and feelings that you don't want. These apply to you as an athlete but they also apply to your other human life as well. We perform as a little window to how we are as people, in terms of how you are in your relationships, in your job. It wasn't designed for that, but the principles are all the same. So the first thing is it will help you have thoughts on things you don't want. The second real big piece is that we've met athletes where they're already at. Unlike a lot of the psychology self-help book which are very technique-focused, here's a book about stress management; we found that real people don't come to you and say, "I need more psychological and emotional strength to run a half-marathon." They say, "I need to harden the fuck up. What's wrong with me? I find I throw the towel in too -- so the chapters are framed around how athletes experience different areas that at the root of which are thoughts and things they don't want. So somewheres about, I feel fat or having thoughts that might be on a weekly or a daily basis about your body image, somewhere about I just can't get out of my comfort zone. I don't do things that scare me. Others, it's about coping with pain tolerance. Others are about improving my identity as an athlete. I want to look in the mirror and not just see an athlete. I want to feel like an athlete, but I don't feel I'm enough. I don't feel deserving of being called an athlete.
So all of these issues, we've tried to meet the athlete where they're at, but unpack the science of it and show, here are some real world examples and the case studies of athletes we worked with. This is what it looks like in practice about how we help you with that. There are case studies, there are worksheets, there are exercises for each of these 13 problems, the most common that we found athletes tell us that they have.
Christopher: How did you get the worksheets done? I found this to be a problem in general, and I know you know about it, is the problem of the online course. In the beginning I did all these online courses, and I got fantastic results with that because I really needed to start a business. I quit my job at a hedge fund and the pressure is on. I had a six-month-old baby and a mortgage to pay. I got shit done when it came to online courses. Nowadays I feel like the technical side of our business is not really a problem. It's more about sales and marketing actually. So when I do these functional medicine training courses or biochemistry or physiology or whatever it is, there's very little pressure on me to get stuff done. So guess what, nothing happens. I find the same, when books contain these worksheets and I want you to do this and I want you to write down five things that you're grateful for this morning, maybe I'll get it done for one or two days and then I very quickly fall off the wagon. So how do you make that happen consistently?
Simon: Well the challenge is much harder if you're communicating through a printed book. There's very little interaction, if any. So interpersonal or in-person coaching either on the phone or Skype in combination with these exercises are always going to be more powerful. But I think it's a behavioral science problem itself, getting you to do stuff, so having exercises that are in small manageable chunks that there is some outcome or performance, tangible performance improvement that you can show in the scientific literature. So the gratefulness is a good example. Gratefulness, for athletes, is one of the things that we try and get people to work towards. There are a lot of reasons why that is but in essence, what the research shows, for example, is that if you write down three things that you're grateful for, every day for three consecutive weeks, in a randomized controlled trial around this, indicates that mental health improved. Three weeks, not two weeks, not one week, not ten days, it's like the ten minutes a day for ten days.
So you're trying to tie it to this is a threshold where we know this stuff will start to work and you'll start to feel it rather than this open-ended, try this and if you don't, move on; so wherever possible to try and do that. But in the printed form it's really difficult. We can be engaging. That's one of the reasons that why we try and use a bit more irreverent language. The way we write and communicate is fun, is an exercise. It might be packaged in a way or explained in a way that's a bit more fun than a dry, academic exercise, so, I think all of those things. But at the end of the day, you've got to be taking the stasis of change approach. You've got to be motivated to want to do it. You've got to have the capability and opportunity. So we're saying, listen, we're teaching you the skills, that's the capability, we're giving you an opportunity. We've actually printed a book with a worksheet. You can write in it so you don't have to find a piece of paper or type. Then you have to be motivated. The fact that you bought the book, to begin with, tells us that you're probably motivated. So you try and combine those things in turn and then once it really encourages people to share their success stories of trying this stuff and that really is far more powerful than having a world champ or a PhD noggin to explain about it, when real people say, "I've created an alter ego and I used it on Saturday and this is what it did and this is what happened," we love seeing those stories because we don't know these people who have done, but they've tried it and they found that it works and they're telling other people about it. That's ultimately a huge source of behavior change for others. You're seeing other people be successful with it.
Christopher: I have one last question for you, I promise. I could keep you on Skype all day long, but I have one last question and that's, when will there be an audible version of the book? I'm very much in awe --
Simon: Yeah. Lesley and I are recording that actually which will be funny for seven reasons. We're recording it in two weeks time actually. It has taken us a while to get it done because, one, generally, audio books, as I've learned, publishers don't generally like the authors recording their own work.
Christopher: Oh, really, I didn't know that.
Simon: Yeah. Well there are lots of reasons for that, diction is one, maybe, whatever. There are some voices that are more pleasing on the ear than others and so on. But we felt it was really important for us to be the ones to narrate it. This may bite us in the ass when people listen to Lesley or me and can't understand a fuck anything she's saying, but we're trying to enunciate as much as possible. So, yes, we're recording it in a couple of weeks and then it will probably be out in November time, early December, I imagine, on all the usual audible channels.
Christopher: I will very much look forward to that. Where is the best place to send people? Is it -- you do an athlete smog on braveheartcoach.com, correct?
Simon: We do. On our braveheartcoach.com athlete's site, we have what's called a smog test or an MOT test, if you're British. What this is that athletes or anybody I suppose who are interested in trying to change their behavior for sport or health, they email us and they tell us -- there are some questions on it. Just, what are you doing at the moment, and what are you trying to improve on, what do you want to get better at? Then Lesley or I, depending on what the focus is, gives you a call for ten minutes, and it's a no-strings-attached chance to just talk about what it is you're struggling with. Originally, our goal there, okay, in a very selfish way, we're trying to help people understand and if they want to sign us up as coaches, but that's not really the goal, the main goal. It was to get people to think about their training in a new or different way. Sometimes it means that we're pointing them in directions that will help them that don't involve us at all. So the Smog Test is a nice opportunity to have a talk about what you're doing at the moment and how you might do things differently if you find that you're stale or you're struggling to meet your goals or so on.
Christopher: Awesome. Well, Simon, this has been fantastic, an absolute pleasure, and I hope that I will be able to get you back onto the podcast at some point in the future because I [1:09:44] [Indiscernible].
Simon: Yeah, I'd love that.
Christopher: Awesome. Well thank you so much. Thank you.
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