Your client has adhered to the exercise and nutrition coaching you have provided for the past six months and has consistently demonstrated healthy responses to unhealthy thinking. Exercising and healthy lifestyle choices have started to become a habit, and the client is clearly in the "maintenance" stage of the well-studied "Stages of Change" model.
All is looking well until a sudden, unanticipated life event strikes—your client's company is closing and job loss is likely. What is your role in helping your client stay on track in the face of a life setback?
Voltaire said, "Life is a shipwreck. Still, we must learn to sing in the lifeboat." It is likely that, as a trainer or health coach, you've been a lifeboat—or "PLS" (personal life support)—for your client. But what if your client doesn't see this, feels overwhelmed and gives in to the setback, essentially derailing the progress the two of you have made?
Although the goal of the maintenance stage is to prevent lapses from occurring, life doesn't always comply, and with new babies, illness or a death in the family, job and economic pressures, relationship conflicts, and plain 'ole stormy weather, stresses and distractions do occur.
A lapse is a single "slip," while a relapse is a series of backward steps away from the goal. Relapse is often referred to as the unofficial sixth stage of the stages of change model. Clients who experience relapse will describe feelings of disappointment, failure and extreme frustration.
From a cognitive perspective, they often carry "SACS":
- This shouldn't happen.
- It's awful it did.
- I can't stand it.
Of course, this type of thinking is inaccurate and erroneous. They really mean:
- It would have been better for me if this didn't happen.
- It's not really "awful" but rather unfortunate and regrettable.
- I can stand it, but I just don't like it.
There are several behavioral change models that may explain setbacks and point to methods trainers and coaches can use to assist clients in overcoming them. The Health Belief Model, Theory of Planned Behavior and the Stages of Change Model are all invaluable in understanding relapses. (For more information, refer to page 64 of the ACE Personal Trainer Manual 4th Edition.) Motivational interviewing techniques provide a framework for helping a client regain momentum through empathic listening, creating a discrepancy between the client's present relapsed behavior and where the client wants to go, assisting the client in his or her own problem solving, and supporting the client’s belief in his or her ability to move forward.
I often tell clients that the greatest threat they can face is thinking that a relapse won't happen to them. I encourage clients to remind themselves that a lapse, even a relapse, does not mean they've "blown it." It is important to help them avoid the "all or nothing" thinking that commonly sits at the source of unhealthy behaviors.
Here are some common strategies that you can use with clients in the maintenance stage of the Stages of Change Model to help prevent lapses and relapses from occurring:
- Identifying triggers that lead to relapse
- Spotting blocks to goal achievement
- Taking steps to overcome these hindrances
- Re-endorsing goals and rededicating to change
Clients often restart at an earlier stage, preparation or action, and reexamine their resources (time and money are the most common), reevaluate their goals, review their motivation and begin moving through the necessary steps to once again reach the maintenance stage. The key is for you to identify what triggered the relapse, what new motivation is available and what abilities your client has to renew the effort.
In identifying the triggers that can lead to a relapse, one key danger sign is thinking, "I've got nothing to worry about," or "It's ok to eat this because (it won't matter, it's free, it's just crumbs, it's a special occasion, it'll go to waste, etc.)." Believing that a life-event setback "completely derails my efforts" or "I'll have to start all the way from zero point," are also common triggers.
Barriers to success include "fooling yourself thoughts" that sabotage and undermine a client's continued success. Overcoming automatic negative thoughts (ANTs) with automatic rational/realistic thinking (ART) is necessary. For example, an ANT like "Now that we have a new baby, I'll never have time to come to the gym," can be replaced with "It's going to be tricky, but with some good planning and time-management scheduling help from my coach, I know I can still meet once a week. People with newborns still are able to come to the gym."
Reaffirming one's commitment in writing by reasserting SMARTER goals: specific, measureable, attainable, realistic, timed, enthusiastic, and rewarded, is invaluable. This may include:
- Reconnecting with exercise buddies
- Joining support groups
- Reading inspirational books or essays
- Looking at goal images on Pinterest or other vision boards
- Continually reminding oneself that relapse is normal and will not completely undo months of good work
Remind your clients that there is no room for negative self-ratings, negative beliefs about being a loser or failure, or negative self-talk about lack of ability. Of course, rushing into exercise or weight-loss activity to make up for lost time may lead to overdoing it and failure. Keep in mind John Galbraith's famous observation, "Given a choice between changing and proving that it is not necessary, most people get busy with the proof."