Autonomy, Belief and Choice: The ABCs of Decision Making in Wellness and Healthcare

Introduction

Shared decision making. Patient engagement. Collaborative goal setting. Motivational interviewing. Readiness to change. How are healthcare providers making sense of and applying all of these principles toward a more psychologically-informed and person-specific practice? Perhaps it is as simple as ABC: autonomy, belief, and choice. Consider how easy it might be to apply these principles and actually achieve precision medicine (rehabilitation or wellness) by allowing the person themselves to ensure that a plan is person-specific.

Consider adding autonomy (space and freedom to choose), belief (the opportunity to gather information and form and opinion) and ultimately and choice (committing in a direction consistent with beliefs). Making choices in healthcare and wellness are not easy. People can easily become overwhelmed by having too many options, a phenomenon known as choice burden. Consider an anxious patient that does not know which direction to turn, combined with a strained provider. There is no wonder that healthcare outcomes in the United States are substandard. Providers are experiencing expanding constraints leading to compassion fatigue (some refer to this as burnout) due to reducing time with patients, decreasing reimbursement, increasing liability and litigious culture, as well as a sense of eroding expertise (artificial intelligence internet sources).

Perhaps providing patients with a reasonable set of options that are paired-down for (personalized for) them, is a start. This start is followed by the ABCs, giving the patient an opportunity to further personalize the plan. Nearly every variable that we can manipulate to improve our own health will benefit from belief, we see this in the literature on the placebo effect and in self-efficacy. While the why this works and how does this work is beyond the scope of this very short perspective article, a brief summary includes:

1. The placebo network, including our reward systems and a cascade of physiologic responses that actually makes our belief more likely to heal that wound, sleep more soundly, or have a greater sense of energy.

2. When we make a choice for ourselves, we are more likely to stay with that option and deliver value to ensure that our choice works. These inherent differences when we believe include increased intensity (effort), attention and consistency. Most any variable that could work, will work better due to these factors alone.

When the decisions at hand involve lifespan and health span-related decisions, we need all of these elements (intensity, attention and consistency) in order to see changes over time, to be reinforced that this pathway is working for us. No matter whether you are making food choices, a sleep routine, a marathon-training plan, a cold-immersion experience, or even attempting to learn something new for brain health – the ABCs matter. The autonomy to decide what aspect of life you want to change, the ability to coalesce information and formulate an opinion (belief) and finally making a choice – will benefit ALL of these areas, and ultimately benefit your health span. Imagine just the differences in perceived stress (cortisol, inflammation, blood pressure, immune system health) just from being allowed to follow your choice. It should be clear that there are both physiological and psychological (mental health) benefits to be realized from implementing the ABCs.

Recall that when two or more options are equally as healthy for you (forms of exercise, diet strategies, or medications), the option that you choose will be more successful because of your belief in that option. Your decision to consume or start something that feels healthy: “I choose to do this, this is my plan” will be received quite differently by the body and mind than something that is not of your will but you must do by coercion, guilt, or fear of negative reinforcement. In time, a series of choices made consistently can become a habit and even more permanent still - an identity.

Consider these word pairs and look for a throughline. Is there a commonality between all of the first words listed? Would we expect there to be a difference in physical and mental health outcomes from each experience of the respective word pairs?

a) Loneliness – Alone time

b) Food insecurity – Time-restricted feeding

c) Forced labor – Workout

d) Sleep deprivation – All-nighter

e) Blizzard – Cold immersion

f) Heat advisory – Sauna

You have guessed it, the difference in each pair of conditions listed is choice. The first word/condition in the pairing is most often experienced without choice. The second is (most) often voluntary. The same conditions (lack of food, sleep, intense work, company) can be received or perceived as positive or negative – all based on choice. The long-term health and wellness results and how to make these choices for our health span benefit. Healthcare providers should read on in this article, to learn additional tools that will help you work with others to actualize these opportunities. Ultimately, what resonates with you will be more effective for you. There is extensive evidence for the benefit of belief and autonomy, inherent in health-based choices. Some of the most often cited articles in this space include Wulf & Lewthwaite, 2016; Pink, 2016; Dunn et al., 2018; Lynn et al., 2022; and Parra et al., 2019. Once you have committed to a pathway, you are more likely to gamify and challenge yourself to continue to excel; more likely to participate consistently (staying power or “grit”); participate with intensity and receive a better dosage; participate with belief and benefit from confirmation bias as well as the placebo effect. This should lead you to seeing results, reinforcing your choice and ultimately pivoting your self-efficacy and identity.

Perhaps most importantly, the ABCs may inform your life beyond that of healthcare provider. In your role(s) as a health care provider, a supervisor, a parent or a partner, providing the people that you are living or working with? In almost every working and personal relationship, the individuals involved in making a decision will benefit from autonomy, belief, and choice.

Dr. Studer is a practicing clinical physical therapist, world-renowned expert on motor control and neuroplasticity, an internationally invited speaker, and author of The Brain That Chooses Itself.