Behaviour Change, Motivation & Chronic Pain: A Nervous System Perspective

Description

In this video I unpack why behaviour change is so hard – especially for people living with persistent or chronic pain.

We’ll cover:
• How motivation actually works in the brain and body
• Why people get “stuck”, even when they really want to change
• How past treatment failures and fear of pain shape behaviour
• Practical principles for creating small, sustainable changes in movement and rehab

This is aimed at people living with pain and the clinicians who work with them.

2. Outline / chapters

1. Intro – “Why can’t I just do the thing?”

2. What your system is trying to do (safety & prediction)

3. Behaviour change: a reductionist overview

4. Where motivation breaks down (four common traps)

5. How this shows up in chronic pain

6. Practical principles for change (for patients & clinicians)

7. Closing summary

INTRO

Hey everyone, welcome back.

Today I want to talk about a question I hear all the time, from both patients and clinicians:

“Why can’t I just do the thing I know I should do?”

Or,

“Why do my patients say they’re motivated, but then nothing changes between sessions?”

We’re going to look at behaviour change and motivation from a reductionist, biology-first perspective, and then link it directly to chronic pain.

So if you:

• live with ongoing pain and feel stuck, or

• you’re a physio or health professional wondering why your patients get stuck,

this one’s for you.

PART 1 – What is your system actually trying to do?

Let’s start with the basics.

Your body isn’t trying to make you fit, productive, or “disciplined.”
Biologically, it’s trying to do a few core things:

1. Keep you alive and intact

   • Avoid catastrophic injury or illness.

2. Keep you in a safe physiological range

   • Heart rate, blood pressure, temperature, blood sugar, oxygen, etc.

3. Keep you “safe enough” emotionally and socially

   • For humans, feeling completely unsafe, rejected, or out of control is a big threat signal.

4. Reduce nasty surprises

   • The nervous system prefers being able to predict what’s coming next.

Your stress and pain systems are part of how your body manages those priorities.

• Stress helps mobilise energy to deal with challenges.

• Pain works as an alarm to get you to protect, rest, or change what you’re doing.

They’re not moral judges. They’re not there to make you a better person. They’re protection systems.

PART 2 – Pain as a behaviour-change alarm

From a reductionist standpoint, pain is:

A perception generated by the brain when it believes the body (or a body part) is under threat, and that you need to do something differently.

Pain is influenced by:

• signals from tissues (nociception),

• stress levels,

• immune and hormonal signals,

• past experiences,

• beliefs and expectations,

• the current situation.

When the system thinks,
“Continuing like this is unsafe,”
it can turn the pain alarm up.

In acute situations – you twist your ankle; you touch something hot – that’s super useful.
In persistent pain, the alarm system can become overprotective. It starts to ring:

• with less and less provocation,

• in more and more contexts,

• often long after tissues are reasonably healed.

So pain becomes a very strong behaviour change signal, but the behaviours it drives might be:

• avoidance,

• guarding,

• moving less,

• or sometimes pushing too hard and then crashing.

From the outside it looks like “self-sabotage.”
From the inside it’s the nervous system doing its best to protect with the information it has.

PART 3 – Behaviour change: how it works biologically

Let’s talk behaviour change in a really mechanical way.

You can think of behaviour as a policy:

“When I’m in situation X, I tend to do action Y.”

For example:

• “When my back hurts, I lie down.”

• “When I’m stressed, I scroll on my phone.”

• “When I feel sore after exercise, I stop for a week.”

To change behaviour, your nervous system has to update that policy. Three key pieces are involved:

1. Predictions and value

The brain is constantly predicting:

• “If I do this, what’s likely to happen?”

• “How good or bad will that be?”

It attaches a value to different actions:

• Some feel worth it.

• Some feel pointless.

• Some feel dangerous.

2. Error signals (learning signals)

When you try something and the outcome is:

• Better than expected → positive learning signal → “do that more.”

• Worse than expected → negative learning signal → “do that less.”

A lot of this runs through dopamine and circuits in the cortex and basal ganglia.

3. Updating and repetition

Over time, with repeated experiences:

• Synapses change,

• Certain actions are more likely to be selected in certain situations,

• Some patterns become habits – automatic and cheap.

So “motivation” isn’t magic. It’s basically:

The current balance of expected benefits vs expected costs and threats for changing,
compared with the expected benefits vs costs of staying the same.

If your brain predicts:

• “Trying something different will probably hurt, fail, be overwhelming, or make me feel stupid,”
  and

• “Doing nothing is uncomfortable but at least familiar,”

…then staying the same wins.

PART 4 – Where motivation breaks down (four common traps)

Let’s go through four big biological reasons people get stuck.

1. Learned helplessness

If you’ve had lots of experiences where:

• You tried things and they didn’t help,

• You were dismissed or not believed,

• Treatments made things worse,

• Pain kept flaring for no clear reason,

your system can learn:

“My actions don’t make a difference.”

This isn’t about being weak or dramatic. It’s literally neural learning from repeated uncontrollable stress.

The result:

• New actions don’t feel “worth” the effort.

• Hope feels risky.

• Doing nothing can feel safer than trying again and being disappointed.

In chronic pain this looks like:

• “Exercise always makes it worse.”

• “No one can help me.”

• “What’s the point?”

From a nervous system perspective, the policy “don’t try, don’t hope” is a protection strategy.

2. Threat-driven reflexes

Under perceived threat, the nervous system defaults to simple patterns:

• freeze,

• avoid,

• fight,

• or push through in a panic.

These are fast, automatic, and don’t require much thinking.

If your system has tagged certain movements, activities, or environments as dangerous, then:

• Avoidance and guarding will feel like the only sane options.

• Graded exposure or exercise – even if you intellectually believe in it – can feel wrong in your body.

So you end up with a clash:

• One part of you wants to change,

• Another part feels like changing is literally dangerous.

If you’re a clinician, this is that patient who nods and agrees in session, but then can’t bring themselves to do the exercises at home. It’s not just “non-compliance” – it’s a nervous system caught in a threat loop.

3. Identity stories and strong priors

The brain doesn’t just store “this movement hurts.”

It builds stories like:

• “My back is fragile.”

• “Pain means damage.”

• “I’m not the kind of person who sticks with exercise.”

• “My body is broken.”

These stories live in higher-level networks and act like strong priors – strong expectations about what’s true.

When a prior is very strong, new evidence that doesn’t fit – like:

• one good day,

• a walk that went surprisingly well,

• a session where pain didn’t flare –

gets discounted as “just a fluke.”

So the story doesn’t change, and behaviour doesn’t change.

For chronic pain patients, this can sound like:

• “Yeah, it felt better that one time, but that doesn’t count.”

• “Any improvement won’t last.”

• “I just know it will go bad again.”

Again, this isn’t stubbornness. It’s the brain trying to maintain a coherent model of the world.

4. Allostatic load and low capacity

Behaviour change is expensive for the nervous system.

To try something new you need:

• some energy,

• some attention,

• some emotional regulation,

• some spare “bandwidth.”

If you’re already running at 95–100% just to:

• manage pain,

• get through work,

• care for family,

• deal with poor sleep and stress,

you have very little left over for experimentation.

In that state, the system will naturally pick:

• low-effort,

• high-immediate-relief behaviours

like lying down, scrolling, eating comfort food, or avoiding anything that might flare symptoms.

Again – not a character flaw. A rational choice for an overloaded system.

PART 5 – How this shows up in chronic pain

Let’s pull this together specifically for chronic pain.

Typical pattern:

1. Pain appears.
   You rest, protect, seek help. Totally sensible.

2. Multiple attempts to fix it don’t work, or only partially work.

   • Different treatments, scans, opinions.

   • Some flare-ups feel random and scary.

3. The nervous system starts to learn:

   • “Movement is dangerous.”

   • “I don’t have control.”

   • “Nothing really helps.”

4. Avoidance and guarding become the default policies.

   • Less movement,

   • Lower confidence,

   • More sensitivity.

5. The person is often told:

   • “You just need to exercise” or

   • “You need to push through.”

   But:

   • their threat system is on high alert,

   • their energy is low,

   • their belief in change is fragile.

So now, behaviour change – like starting a graded exercise program – is not a simple “choice.”

It’s asking the nervous system to:

• go against its learned protection strategies,

• risk more pain,

• spend limited energy,

• and trust a process when trust is already battered.

No wonder people get stuck.

PART 6 – Practical principles for change

So what can we do with all this?

Whether you’re the person in pain, or a clinician, here are some core principles.

1. Start by updating the story (a little)

You don’t have to go from “I’m broken” to “I’m invincible.”

But you can work towards:

• “My system has become overprotective.”

• “Pain is real, but it doesn’t always mean damage.”

• “My body is capable of adapting, slowly.”

Good pain education, metaphors, and honest conversations can soften those rigid priors just enough that new experiences can sink in.

2. Engineer small, safe wins

This is huge.

Instead of:

• “You need to walk 30 minutes every day,”

try:

• “Could we experiment with a 2-minute walk, once, and see what happens?”

You want experiences where:

• the person expects it to go badly,

• you keep it tiny and safe,

• and it goes slightly better than expected.

That creates a positive learning signal:

“Maybe this isn’t as dangerous as I thought.”

Repeat that enough, and the policy starts to shift from “avoid” to “approach gently.”

3. Reduce the “threat load” where you can

You can’t fix someone’s entire life, but small adjustments help:

• Improving sleep routines a bit,

• Planning around flare-ups instead of panicking,

• Breathing or relaxation practices to bring the system down a notch,

• Social support – not being alone with it.

Lower background threat = more capacity for change.

4. Respect learned helplessness, don’t fight it head-on

If someone has a long history of failed treatments:

• Acknowledge that reality.

• Validate that it makes sense they’re cautious.

• Position new experiments as curiosity, not “this will fix you.”

The goal is to create just enough hope with honesty that trying feels emotionally safe.

5. Think in terms of experiments, not perfection

For patients:

• “This week, I’ll experiment with this exercise twice and pay attention to what happens,”
  rather than

• “I must do this every day or I’ve failed.”

For clinicians:

• Each session is a chance to run one or two tiny experiments that:

  • shift a belief,

  • show a new capability,

  • or reduce fear around a specific movement.

Every successful experiment is a deposit in the “I can influence my body” bank.

PART 7 – Closing summary

Let’s pull it all together.

1. Your body and nervous system are primarily trying to keep you safe and in a workable range, not make you “disciplined” or “strong-willed.”

2. Pain is a behaviour-change alarm – it pushes you to do something differently when the system perceives threat. In chronic pain, that alarm can become overprotective.

3. Behaviour change and motivation are not just about willpower. They’re about:

   • predictions and value,

   • learning signals,

   • repeated experiences,

   • and how much capacity your system has left.

4. People get stuck because of:

   • learned helplessness,

   • threat-driven reflexes (freeze/avoid),

   • rigid identity stories (“I’m broken”),

   • and sheer overload.

5. Real change, especially in chronic pain, often starts with:

   • slightly updating the story,

   • creating small, safe wins,

   • lowering background threat,

   • and treating everything as an experiment.

If you’re living with pain and feeling stuck, the invitation isn’t:

“Just push harder.”

It’s:

“Let’s find one small, safe experiment that shows your system you might be more capable and less fragile than it currently believes.”