A conversation with Emmett Miller about his medical self-help tapes that help promote behavior change.
Medical Self-Care: Emmett Miller's Medical Self-Help Tapes
This issue's column is an edited version of a discussion I had recently with Dr. Emmett Miller. Emmett's a tall, graceful man with a ready laugh and a soothing voice. But those aren't the only reasons, as you'll soon realize when you read his practical advice, why Dr. Miller's series of self-care cassette recordings is so popular, or why his practice in Menlo Park, California—where he specializes in psychosomatic medicine, hypnotherapy, performance optimization, and stress management—is so busy.
Dr. Miller, how can people use cassette tapes as self-care tools?
Oh, there are several ways.
Relaxation tapes of various kinds, for example, can be very
effective in reducing stress levels. But I've found an even
more profound way to use cassettes as aids in making
Could they, for instance, help an individual stop smoking?
Sure . . . or control his or her temper, or eat more sensibly, or correct any number of other undesirable behavior patterns.
Don't all of those uses pretty much parallel the services that you provide for your private clients?
Yes. In fact, the idea for producing our cassettes sprang from my practice of recording initial sessions with patients. I'd attempt to guide the person into a deeply relaxed state and then lead him or her through a specific five-stage thought process that I've found helps promote behavior change. Afterward, I'd give the tape of the session to my patient to play at home. More often than not I'd find out later that, after successfully using the recording to break a particular habit pattern, the person had passed the tape on to a friend . . . who, in turn, had used it—with minor modifications to my instructions—to deal with a completely different problem. This discovery led me to realize that I could probably make a general kind of tape, based on the same deep-relaxation principles I applied in private practice, which people could use to change any of a whole range of health habits.
I wonder if you could elaborate a bit more on the five-stage thought process you mentioned.
Certainly. Let's invent four fictitious people with varying self-care concerns, and then guide each of them through all the steps. Jerry, for one, wants to stop smoking . . . Ella hopes to lose weight . . . Betty would like to undertake a regular exercise program . . . and Linda—a nurse who works in an emergency room—feels the need to be more assertive in her professional relationship with doctors.
OK, so the initial step would be . . . ?
Well, first, each of those people needs to learn how to go into a deeply relaxed state.
Is that the same as being hypnotized?
Yes, pretty much . . . each is a state of tranquil attentiveness. And the ability to achieve such a level of consciousness is a skill that's fairly easy to acquire . . . but most adults do need to learn it. Youngsters, on the other hand, can often pick it up almost immediately. The trick to this kind of relaxation is to let go of the critical, analytical aspect of your mind and allow a very childlike, trusting part to emerge.
And your tapes actually help people do this?
Well yes, either mine or several other commercially produced recordings that are currently on the market will do that. However, a person could simply use a book on self-hypnosis and accomplish the same thing.
All right. So the first step is deep relaxation. Then what?
Step Two is to picture yourself the way you really want to be . . . and to do so in as much detail as possible. Jerry might see himself as a healthy nonsmoker with pleasant breath, clean lungs, more stamina, and fewer colds and sore throats. Ella could envision herself, slim and trim, out shopping for a new wardrobe. Perhaps Betty would imagine jogging in the park on her way home from work . . . and Linda might visualize herself calmly stating her opinions to a group of attentive, respectful physicians.
I can see how picturing the kind of person you'd like to be might help reinforce that desire.
Well, it gives you an opportunity, at least, to examine what your life could be like. And that brings me to Step Three, which is often especially important: While still in a relaxed state, the patient should seriously question whether he or she is really ready to give up the to-be-changed behavior.
In other words—when push comes to shove—some people aren't truly prepared to make the necessary sacrifices?
Exactly . . . and that's perfectly understandable. Every habitual behavior pattern, even one that seems to be completely without purpose, provides us with something we want or think we want. Perhaps smoking gives Jerry a way to vent his nervous energy, for example. Being overweight may protect Emma from having to cope with men who might otherwise be sexually attracted to her. Linda's reluctance to speak her mind could be her way of avoiding having to deal with any resentment that might arise if she were more assertive.
And if a person discovers that he or she does have serious reservations about wanting to make a change?
That individual should pay attention to those reservations. If the doubts are strong, the person should be thankful not to be trying to give up a habit that—at the moment—he or she is not really ready to do without.
Let's say Jerry and Linda and Betty feel clearly committed to making a change . . . but Ella feels such inner resistance that she realizes her real problem isn't overeating so much as feeling insecure with her sensuality. Perhaps, as a result of this revelation, she'll decide to focus her efforts on understanding her sexual self. Maybe she'll do some reading on the subject, or join a woman's support group.
Also, a patient will often find it possible—although he or she isn't comfortable giving up all of a certain behavior pattern—to make at least a partial trade-off. For example, Ella might decide that while she's exploring these other issues, she's willing to cut down on some of her binge eating. Then, in another few weeks, she may well be ready to modify her habits even more.
And you must recognize that such a course of action wouldn't be in any way a failure for Ella . . . in fact, it'd be quite the opposite. For many people it's in this third stage, exploring resistance to change and getting in touch with their true feelings, that the real breakthroughs occur.
But once a person has made a commitment . . . what then?
Step Four is next. The individual envisions challenges to the newly chosen behavior . . . and imagines meeting those trials head-on. Jerry, for example, might picture a friend offering him a cigarette . . . Linda might see a physician making unreasonable demands on her . . . and Betty might conjure up a scenario in which she's asked out for a drink after work, when she was planning to jog.
In each instance, the person rehearses an appropriate response: Jerry says "no thanks", Linda stands up for herself, and Betty takes a rain check and goes for her usual run.
In fact, this mental playacting is really just a warm-up for Step Five. At the end of each day the patient looks back over the previous 24 hours and reviews all the real challenges that presented themselves. If he or she would've liked to respond differently to a given situation, then that person imagines doing so. On the other hand, if the individual reacted in the way he or she wanted to, it's time to celebrate that success. In this way any response—whether it's true to the goals at hand or not—serves to encourage positive behavior.
And this five-stage process works?
Definitely. I use the same basic technique in most of my clinical work, and usually see at least a start toward good results within the first couple of weeks. And I incorporate the same process in the tapes we produce and sell.
And the cassettes are just as effective as a series of personal visits might be?
Well, let me put it this way. For years I tried to quit smoking . . . and then I produced a two-tape set, called Smoke No More.
And you're a nonsmoker now?
You guessed it.
EDITOR'S NOTE: The series of self-care cassette recordings produced by Dr. Emmett Miller features a diversity of titles, including Rainbow Butterfly (a meditation tape with harp music) . . . Running Free: Imagery for Athletes . . . Changing Your Behavior Patterns (which follows the principles described in this interview) . . . Imagine Yourself Slim . . . Letting Go of Stress . . . The Sleep Tape . . . and Preparing Your Mind and Body for Surgery and Pain Control. For a complete catalog and price list, send $1.00 to Emmett Miller Tapes, Dept. TMEN, Stanford, California.
Dr. Tom Ferguson's quarterly journal, Medical Self-Care, is available for $15 per year from Medical Self-Care, Dept. TMEN, Inverness, California. A sample issue costs $4.00. Dr. Ferguson's book, also titled Medical Self-Care, can be ordered for $8.95 plus 95¢ shipping and handling from Mother's Bookshelf, Hendersonville, North Carolina.