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
long-term, self-directed changes in health habits.
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
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
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,
I can see how picturing the kind
of person you'd like to be might help reinforce
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
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
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
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
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
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
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.