Welcome back to the Healing Pain Podcast with Stephanie Hooker, PhD

Do you ever find yourself pondering the question: “What’s my purpose in life?” Amidst life’s trials, purpose becomes the bridge that carries us from pain to newfound strength, igniting a remarkable transformation. In this episode, we have special guest Stephanie Hooker, PhD, Research Investigator at HealthPartners Institute. Today, she explores how having a sense of purpose can go beyond simply giving life direction—it’s an elixir for the heart and body, too. Stephanie demystifies the concept of purpose—what it truly means and how it varies from person to person. She unpacks the symbiotic relationship between purpose and behavioral activation, how purpose can change throughout different phases of life, and more. Tune in and get ready to view pain through a different lens—one that turns it into a stepping stone toward wellness.

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How A Sense Of Purpose Transforms Pain Into Wellness With Stephanie Hooker, PhD

In this episode, we’re diving deep into the fascinating world of how a sense of purpose can truly reshape our relationship with pain and elevate our overall sense of well-being. Joining us is a guest whose expertise bridges the fields of clinical health psychology and public health, Dr. Stephanie Hooker. Dr. Hooker is a seasoned research investigator as well as an adjunct assistant professor at the University of Minnesota in the Department of Family Medicine and Community Health. With a focus on understanding the intricate interplay between behavioral and psychosocial factors in health, Dr. Hooker is at the forefront of pioneering research that aims to uncover the connections between purpose, health behaviors, and our overall wellness.

We’ll also explore the important relationship between purpose and physical activity and how these principles can be applied to navigate the challenging terrain of living and recovering from chronic pain. Whether you’re seeking insights into enhancing your own well-being, supporting others in their pain recovery, or simply curious about the science behind a purpose-driven life, this episode is sure to offer a wealth of knowledge and inspiration. Without further ado, let’s dive into the captivating world of purpose, pain transformation, and wellness with the brilliant Dr. Stephanie Hooker.

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Stephanie, thanks for joining me.

Thanks for having me.

It’s great to be talking to you about this topic. As we were talking about before this episode, we’re doing some research on purpose and how that relates to things like living with a chronic health condition, living with chronic pain, and being mobile and physically active. Lo and behold, some of your amazing research popped up. We’ll point people to the research and how to find you.

You have a great article that’s in the Journal of Health Psychology, which talks about purpose and physical activity. Purpose is one of these words that people throw around. They are like, “You have to have a purpose in life. You have to find your purpose in life.” It’s a poorly defined word in a way. A good way to begin is to give us your idea of what purpose is and what that means.

Purpose probably means a little bit different thing to everybody. The way we define purpose in the research literature is that someone’s orienting or guiding aim. It is an ultimate goal or thing that somebody is striving towards. Generally, we think that that’s outside of themselves in some way. For example, somebody might be contributing to society in some way, or they might be helping other people, creating art, having a career, or something that contributes to the world. When people find their sense of purpose, it helps them figure out, “What am I doing? Where am I going? What’s the purpose of me?” It is an individual purpose.

In that case, you’re looking at purpose almost as a behavior in a way.

It’s almost like driving behaviors in a lot of ways. We assume that when people have a strong sense of purpose, they are going to act in ways that are in accordance with that purpose. You can tell what somebody’s purpose is, but if you were observing them, how do they spend their time? What’s important to them? You are right. Purpose is very linked to behavior.

You can see what someone’s purpose is or maybe what it was at one time by looking at the things, activities, or behaviors that they do on a normal daily, weekly, monthly, or yearly basis. I like that. Give us an idea of what purpose means for health outcomes. I don’t know if you can talk to both, and I hate to separate these two things because they’re inseparable, but the physical as well as the mental health outcomes that we might see with a purpose-driven life.

This is a fun topic because research is emerging in this area. In the last several years, there have been several studies that show that people who have a stronger sense of purpose live longer. That is the first marker of health that we look at. It is longevity. Are you living a longer life? The evidence supports that. When we break that down to why people are living longer, we see that people are less likely to have cardiac events. They are less likely to develop Alzheimer’s disease or dementia. They’re also less likely to have chronic illnesses. It’s like, “What’s happening?”

That is where I like to play in my research. It is understanding what are the factors that are predicting these improved health outcomes. We think that one of the things that’s also happening is people with purpose are engaging in healthier behaviors. They are more active. They’re out there. They’re sleeping better. They’re taking care of their bodies. From the mental health side, we also see people with purpose are less likely to have depression. They have lower levels of anxiety. They ultimately have better well-being. They feel better. Purpose is underlying all of the health outcomes that we’re seeing. We are trying to understand what’s happening.

Purpose is associated with, let’s say, a decreased risk or incidence of cardiovascular disease, heart attack, stroke, high blood pressure, and things like that you’re talking about.

That’s what we’re seeing.

Purpose is good for your heart. You’re talking about some of the mental well-being impacts. You mentioned, if I was tracking with you right there, things like cognitive decline and mood disorders. Purpose is good, in some way, for keeping our minds healthy.

It’s giving people something to focus on that maybe is not the day-to-day grind of what we have to deal with, like our stressors and the little tasks that come up every day. It is keeping the big picture in mind. That’s why it helps with our mental well-being as well.

It can alleviate some of our stress in some way. We talked about purpose in the heart and mind. Some of the research that I found online from you specifically spoke about purpose and physical activity itself. Maybe we can dive into that. Why was it important for you to first start to look at that area of the literature?

I am a clinical health psychologist by training. My real interest is in how we help people develop and maintain healthier behaviors and, in particular, physical activity. We know that physical activity is important for health for a variety of reasons. All of those outcomes I mentioned for purpose, physical activity is an important behavior there. We want to make sure people are engaging in activity regularly for their health and their well-being.

I was trying to figure out, “How do we help people be more active?” When this literature on purpose came up, it made me think, “Is purpose a factor that is related to physical activity? People who are more purposeful or experienced more purpose in their lives, are they also engaging in more activity? Can we harness that if it’s true?”

The article you mentioned was in the Journal of Health Psychology. We first looked at whether purpose is related to an objective measure of physical activity. We strapped accelerometers on people. Accelerometers are fancy devices that measure activity on three planes. We wanted to see whether we could show a relationship between purpose controlling a lot of other factors with this objective measure, and we did. We found that purpose was positively related to activity in that study.

A reason that was important to do that project was that up to that point, people who have looked at purpose in relation to physical activity have used self-report measures of activity. It might be that people who are more positive and have more purpose in life report that they also do more activity. This was an important step in the literature to say we can show that it’s objectively related to activity. That’s the start of my research in this area.

 

There was somewhat of a bi-directional relationship, if I remember it correctly.

It was a cross-sectional study. We couldn’t tell what happened first. Do people who are more purposeful choose to engage in more activity or is it the opposite way around? Do people who engage in more physical activity experience more purpose? You can think about it both ways because physical activity, we know, boosts mood, and reduces your stress. That benefit is there. It might be that being more physically active gives you more of a mental well-being that you can engage and feel like you have a sense of purpose.

On the other way, we also think that people who have a sense of purpose might have more motivation to be active. Taking care of your life with health behaviors, like physical activity, presupposes that you have a life you believe is worth taking care of. It’s almost like you have to believe that you are worthy to be able to put in the effort and engage in these behaviors.

I love the bi-directionality of that. It does make you think about the chicken or the egg. Oftentimes, there’s not a clear-cut answer for people. It’s specific to their life. I was reading some research that as far as exercise or physical activity goes, we place a lot of emphasis on, “If you exercise, you won’t have a heart attack. If you exercise, you’ll lose weight.” They’re important goals, but they tend to be longer goals, which are difficult for people to maintain the motivation for because they’re long-term goals.

In some of this research, we’re saying that we can point people to the idea that being physically active boosts your mood, so to speak, and most people feel a sense of some euphoria, so to speak, from little bouts of exercise. If you point people toward that, they’re more likely to maintain that for a long time. As I’m listening to your research, I also think that when we have a sense of purpose in life, we also get that same mood boost. You almost have all these things coming together in this wonderful mix to help people stay physically and mentally active as well.

I love that research is shifting. We can get people to be more active if we emphasize immediate outcomes versus distal outcomes. At the moment, when you’re making a choice about doing an activity, that choice is going to be more related to your immediate outcomes. It is like, “Am I going to get up and move? Sitting and watching my favorite show is quite pleasurable. How am I going to feel after I do the activity? I’m probably going to feel a lot better.” Most people can’t imagine their lives 30 or 40 years down the road and what they’re going to be wishing that they did. What we’re finding is it’s better to focus on immediate.

We touched on this probably a little bit. How can a practitioner start to use some of your research findings in a way that informs their practice and helps their patients and clients with these types of behaviors that we’re talking about?

The best advice is to get to know your patient. We say that a lot, but what’s important to them in their life? What is their sense of purpose? You can get at that by asking questions like, “What are the things that are most important to you in your life? What do you value? How do you want to be spending your time?” Those things can be good, meaningful, open-ended questions to get a sense of what’s important.

It is making that connection more explicit for them about why you’re suggesting these behaviors. For example, when I first got into this work, I heard a story about a veteran at the local VA who was participating in a weight loss program. He had told the leader of that group, “I don’t know why I’m here. This doesn’t make any sense. I’m only here because my doctor told me that I needed to lose weight.” He was coming to all the groups but not making any changes.

Until she sat him down and said, “Tell me what’s important to you in your life,” he pulled out a picture of his granddaughter from his wallet. He was like, “She’s important to me. She’s the reason that I want to be healthy. I want to be with her when she walks down the aisle.” It was that connection. All of a sudden, he flipped a switch and was like, “I am going to do this.” He lost 80 pounds. What happens is sometimes, people forget the bigger picture. As a practitioner, helping people make that connection about, “Why do you even care about doing these behaviors?” is important because some people don’t make that connection on their own.

As I’m listening to you talk, I hear the importance of the behavioral activation components that have been around for so long and have wonderful research behind things like mood and chronic pain as well. I also hear more of the values clarification exercises that you get more on acceptance and commitment therapy or another acceptance-type approach. There are many out there that include values in them. It’s great to see those overlap. Does it matter what someone’s purpose is? Solving our nation’s oil crisis seems pretty big, right?

Yeah. The literature is pretty agnostic to type. You can have whatever your purpose is, and I should maybe qualify this. We don’t net all the way. If your purpose is militian, like you’re going to do something bad, that’s probably not a great purpose. If your purpose is generally socially acceptable, it’s probably okay. It doesn’t matter if your purpose is to be a strong person in your family. Maybe you’re a mom, a dad, or a cousin. It doesn’t matter. If you have a career, then that is your purpose. Maybe it’s volunteering. It doesn’t matter as long as you feel like that is consistent with who you are and your identity. That is where we are. More research might emerge that suggests that type of purpose matters, but I don’t think that that’s true.

We’re talking about the importance of purpose. People get excited when they hear people like yourselves who are highly credentialed. They have research supporting this. They share this information with friends, family, and patients of things that are zeitgeist and they become popular. Finding purpose can be hard for people. We have to approach this in a way that is unique for where the person is, maybe what their condition is, and a whole lot of other psychosocial factors that go into this topic.

In general, most people find their lives to be meaningful. They have a sense of purpose. There is a minority, probably 20% or less, of people who struggle with this. That search for meaning or purpose is a big part of their lives or they feel like their life is not meaningful at all. There are some people who struggle. With those people, it takes a lot of searching and work.

Psychotherapy can be helpful for people to figure that out. For the everyday practitioner, it might be beyond what you can do. We do need to recognize that there are some people who struggle. Pushing them if they feel like they can’t identify might not be helpful. The majority of the people you can talk to have a sense of purpose but probably don’t think about it very much.

Does it start to overflow into things like post-traumatic growth? I believe when you look at that model of literature somewhere and the factors of post-traumatic growth, there is an idea of purpose in life or starting to recognize some type of purpose that comes out of, not to be tongue-in-cheek, the pain, so to speak. We’re talking about pain in this show. Trauma and pain are similar in some ways.

The literature on post-traumatic growth and meaning-making is that people do find benefits from traumatic experiences in their lives. Most people don’t even regret that those things happen to them because they feel like they have shaped who they are as a person. It often can change the trajectory of their lives in meaningful ways. Your purpose might be different now if something happened to you traumatic tomorrow. It’s important to recognize that it might not be a constant for some people. It can change depending on their life experiences. We expect that based on what we know about how people cope with traumatic events.

It's important to recognize that purpose might not be a constant for some people. It can change depending on their life experiences. Click To Tweet

It’s not a static thing. Purpose can change throughout your life. If you’re in college and busy with university, your purpose may be different than if you are newly married and have your first child.

It changes with our seasons of life.

It takes the pressure off of us to have the idea of, “My life has to be 100% purposeful at all times. If it’s not, then potentially, there’s something wrong with me.”

In late adolescence and early adulthood, people struggle with this a lot. They are like, “What am I going to do with my life? How am I going to contribute?” It’s okay not to know right away. As people age, they grow into that. Especially in older adulthood, we see that most people figured it out. They can look back on their life and say, “This is what I did.” That meaning-making at the end of life is an important developmental milestone for people.

The idea of having curiosity, exploring some of these things, and realizing that you’re probably not going to tune in to this show and you’re like, “I have my purpose now.” It could take everything from curiosity, exploration, personal development, and psychotherapy. All those could be important parts of someone’s journey.

I know a lot of the research is building in this area, but I want to dial it down probably a little bit along the lines of the post-traumatic growth part. Not to be a little more tongue-in-cheek, but is finding a purpose in your pain or health condition, whether that’s an acute or a chronic health condition, is there some research there to support that? What does that mean to all of us who are reading?

I don’t necessarily call it purpose when we bring it down to a chronic pain condition or something like that. We think about your identity as a person with this illness. Research has shown that people who identify with their illness a little bit more are more likely to take care of it and manage it. It generally generates better outcomes. I know that research a little bit more in diabetes. People who identify with diabetes are more likely to check their blood sugar or take their medications. They do the other behaviors that they are supposed to do to take care of themselves.

Research has shown that people who identify with their illness a little bit more are more likely to take care of it and manage it. Click To Tweet

What we can see in chronic pain, and you mentioned the behavioral activation literature, is that when people recognize chronic pain as something that they have control over, they’re able to break out of that chronic pain cycle. Often, we disengage from activity because of fear that it’s going to cause pain and that it leads to immobility. Therefore, immobility causes more pain. It’s this vicious cycle. If you can step out of that, activate, and engage with your purpose, and engage with things that you find meaningful in your life. Ultimately, we think that is going to be beneficial to improving your experience with pain and reducing the effect that pain interferes with your life.

Could purpose be a missing link in the behavioral activation literature?

It is something that I’ve been exploring. We published one study in a pilot with people with chronic pain where we looked at values-based behavioral activation. We tried to help people identify more of a purpose-driven behavioral activation model. We’ve been exploring that with people with opioid use disorder as well.

Trying to get people to engage with purpose is something we’re hoping would enhance a general behavioral activation. Behavioral activation is designed to get people out and get people moving and doing pleasurable activities. We think that when you’re engaging with activities that are connected to what you value and you find purposeful and meaningful in your life, that’s even going to have a more powerful effect.

 

There’s a key difference between engaging in pleasurable activities like listening to music versus engaging in purposeful activity. Is that paper available for our readers to access?

It is. It was published in the Journal of Clinical Psychology in Medical Settings.

I love the interplay there. I haven’t read the study, but it sounds like you’re bringing in more of the traditional behavioral activations and CBT components with more of the contextual behavioral aspects of purpose and things you might find in ACT and other types of approaches, which is great. I’m always encouraging providers to try to start to synthesize all these things together. It can be difficult at first, but things can blend nicely once you start to explore them.

It’s very consistent with the idea of committed action in ACT, which is getting people to engage in activities that they value and find meaningful regardless of how they feel. That’s the same approach.

It has been great speaking with you about purpose in life and how it impacts our physical, mental, and overall well-being. I’m excited to hear that it could also impact our longevity, which I learned here, and how it impacts our mind, our heart, and our body. We love all that. Bringing the mind and body together is something that we love to do on this show, so we appreciate and thank you for that. Let all of our audience know how they can learn more about you and follow your work.

I am a Research Investigator at HealthPartners in Minneapolis. I have a profile on our HealthPartners Institute webpage. I have ResearchGate and Google Scholar. Feel free to email me or reach out if you have questions.

I want to thank Stephanie again for joining us and talking about purpose. Make sure to share this episode with your friends, family, and colleagues on Facebook, LinkedIn, Twitter, Instagram, or wherever you’re hanging out, talking about purpose. It has an impact on health and well-being. We’ll see you in the next episode. Take care.

 

Important Links

• Dr. Stephanie Hooker
• ResearchGate – Stephanie Hooker
• Google Scholar – Stephanie A. Hooker
• https://www.HealthPartners.com/KnowledgeExchange/display/person-Hooker-S-A
• https://Journals.SagePub.com/doi/abs/10.1177/1359105314542822

 

About Stephanie Hooker

Dr. Stephanie A. Hooker, PhD, MPH, is a Research Investigator at HealthPartners Institute with a background in clinical health psychology and public health. She also holds an academic appointment as an Adjunct Assistant Professor at the University of Minnesota in the Department of Family Medicine and Community Health.

Dr. Hooker’s research interests are in behavioral and psychosocial influences on health and disease. The long‐term goal of her research program is to develop interventions for health behavior change and well‐being that can be delivered in healthcare and community settings.

Specifically, her research has focused on understanding theory‐based psychosocial determinants of health behaviors (e.g., physical activity, sleep). Then, her work uses these observational findings to develop behavioral interventions for health behavior change and behavioral health concerns to prevent and treat a variety of health conditions, including obesity, type II diabetes, cardiovascular disease, and opioid use disorder.

Dr. Hooker completed her PhD and MPH degrees at the University of Colorado Denver. Prior to joining the Institute in 2019, she completed a postdoctoral fellowship in Primary Care Behavioral Health at the University of Minnesota Department of Family Medicine and Community Health. She is licensed to practice psychology in the state of Minnesota and is board certified in behavioral sleep medicine (DBSM) and lifestyle medicine (Dip.ACLM).