Negative reinforcement vs negative possibilities

Several of us are clinicians. We've seen the studies that describing negative consequences of disease does not lead to behavior change, while teaching the patient to find positive outcomes of behavior change does work, and we've practiced that same technique (called motivational interviewing) with our patients and find it much more successful.

It's possible that the patients who would change because of negative possibilities have already changed (thus any reminders are not helpful) but I think it's a stronger thing than just that, I think it's something intrinsic to the psyche.

I'll use myself as an example. I am all too aware of the negative outcomes of being overweight, but that didn't keep me from getting overweight. The problem is not intent, it's not lack of knowledge, it's the need to stick consistently to a goal all the time. I finally took a page from my own book and started to think of positive things I want to do, like hike isle royale with my kids. I signed up for a flight for us and listed a weight 40 lbs lighter than I was, with the intent of getting to that weight. I've lost most of the 40 already in under 2 months so by the time this summer rolls around, I'll be both lighter and stronger than i originally anticipated. My diet and exercise are easy, because I have something I want to do. Before, it was too nebulous. So seeing desirable positive outcomes is a successful strategy, it's been well studied.

Now an actual negative consequence, like a heart attack, might have also kicked my butt in gear, but thankfully I didn't wait for that. What I will say is simply that negative consequences are experienced, whereas negative possibilities are only imagined, and most people struggle to imagine vividly enough to change our everyday behavior, ESPECIALLY when we don't really want to.