Neuroscience and Engagement Strategies for Positive Outcomes

In this episode of Lymphoedema Insights, Maree speaks with neuroscientist Dr Izelle Labuschagne to explore how the brain shapes patient engagement and clinical outcomes. Drawing on her background in psychology and clinical neuroscience, Izelle explains how stress, emotional load, attention, and mental health can influence how patients process information, make decisions, and respond to treatment. 

Together, they unpack why engagement is about far more than motivation or compliance. The conversation offers practical insights to help clinicians recognise when neurological and emotional factors may be affecting a patient’s ability to absorb information or follow through with care. 

If you’ve ever wondered why some patients struggle to engage despite your best efforts, this episode provides a fascinating neuroscience perspective and practical strategies to support more meaningful and effective clinical interactions. 

About our guest speaker: Dr Izelle Labuschagne – Neuroscientist | Research Mentor | Founder, Complete Thesis Support  

Dr Izelle Labuschagne completed her PhD in clinical neuroscience at Monash University in 2011 and holds accredited training in psychology from Monash University and Swinburne University of Technology. Her work is grounded in neuroscience, with a particular focus on social cognition and emotion, and how mental health, stress, and ageing influence brain–behaviour relationships. Through Complete Thesis Support, she now works closely with PhD candidates, research students, and early-career researchers, supporting them to navigate the demands of research with clarity, confidence, and sustainability. 

Izelle has extensive experience leading human neuroscience and neuropsychopharmacology research, including randomised double-blind placebo-controlled clinical trials involving antidepressants, serotonergic agents, and neuropeptides such as oxytocin. She has worked across academic and industry-sponsored research, with strong expertise in ethics, regulatory processes, and Good Clinical Practice. Today, she integrates this scientific rigour into her mentoring and entrepreneurial work, supporting researchers in navigating complex systems, producing high-quality research, and building sustainable academic or industry careers.

 

Sponsor

This episode is proudly sponsored by Medi Australia, a global leader in compression therapy and a trusted partner to lymphoedema clinicians

Medi understands that effective lymphoedema care relies on evidence-based compression, patient comfort, and long-term adherence. Their German-engineered flat-knit and circular-knit garments provide effective compression, durability, and wearability, supporting outcomes across early intervention through to chronic, complex presentations.

Medi backs clinicians with education, product support, and responsive customer service, helping improve patient solutions. Through clinical rigour and innovation, Medi continues to improve quality of life for people living with lymphoedema.

For more information, go to mediaustralia.com.au 

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LES offers a diverse range of professional learning opportunities – including online self-paced courses, face-to-face workshops, and accredited training modules – to help you build confidence in your lymphoedema management skills.

🌐 Visit the LES website to explore upcoming course dates and learn more: https://lymphoedemaedu.com/

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Transcript

SPEAKER_01 0:05

Today we're exploring the role of neuroscience in understanding patient engagement and how clinicians can support positive outcomes. Welcome to Lymphedema Insights for Health Professionals. I'm Marie O'Connor, physiotherapist at Lymphedema Education Solutions, where we empower health professionals with the tools and knowledge to manage lymphedema confidently and effectively. This podcast is for educational purposes and is intended for health professionals only. It does not replace individual clinical judgment or medical advice. So please consult appropriate guidelines and qualify professionals when making decisions in practice. Today's episode is supported by MIDI Australia. Engagement is often discussed in terms of motivation or compliance, but neuroscience shows us that decision making, attention, stress, emotional regulation, and mental health all influence how people process information and engage with care. Mental health challenges, whether anxiety, depression, trauma, or the emotional impact of living with a chronic condition, can significantly shape how someone shows up in a consultation and responds to treatment recommendations. To help us explore this perspective, we're joined by Dr. Azelle Labochane, a neuroscientist with training in psychology and a background in clinical neuroscience. Her work focuses on how stress, emotion, and aging influence brain behaviour relationships and how these insights can inform both research and practice. Welcome, Azelle. From a neuroscience perspective, what is happening in the brain that can influence a patient's ability to engage with their care, particularly when stress or mental health challenges are present. What do you think, Azelle?

SPEAKER_00 2:02

Hi Marie. Thank you so much for this opportunity to speak. And it's just such a fabulous topic to bring into this into this field. And I think you know, it's so important to assess what's what goes on inside, right? And we often disconnect from what we see externally compared to what actually goes goes on internally. And the brain is is constantly scanning for safety and threat. You know, it's one of the things that even as a neuroscientist, I still we're trying to understand why is safety and threat such a sensitive marker or sensitive trigger in the brain. And, you know, it really is, it's quite sensitive at the moment. A small little threat or danger or fear, um, and even perceived fear can really trigger our safety and our threat system in the brain. And if you think about a new diagnosis or being given a chronic condition, it can really activate this threat system that we see in the brain. And it doesn't take much for the system to be activated, and it puts us into a fight and flight response where basically your brain wants to protect you, it wants to keep you safe either from real danger or from this perceived threat, you know, and perceived threat in this um in this sort of topic could be things like overwhelm and uncertainty. And when when you get into the fight and flight response, you just want to get out. Your brain wants to keep you safe, and really it wants to physically and mentally and emotionally keep you safe. And so when overwhelm and uncertainty or a new diagnosis um increase stress, there's a lot that goes on inside our beautiful brains. And one is is that our internal threat alarm system, which is really driven by a small part inside the brain called the amygdala, that becomes more active. So the minute we feel stress or the minute there's a bit of threat or danger or perceived threat, our amygdala activity goes up, and that's basically our internal threat detector system. At the same time, our prefrontal cortex, which is really important for our thinking and our planning and our decision making, that becomes less efficient, right? And I really want to emphasize that when we're under stress, our key thinking part, the part of the brain, our prefrontal cortex that makes us humans, becomes less active. And that's a really fundamental thing to understand as clinicians that when we don't have prefrontal cortex engagement, a lot of things are affected because the prefrontal cortex is involved in things like planning, remembering instructions, um, decision making, and even things like sticking to a routine, right? So when we're stressed and we're anxious and we feel overwhelmed, that capacity then to process information and follow through can really, really significantly drop off. And this is where I love always connecting brain and behavior because what might look like a lack of motivation is often internally represented in a way that you know it could be the brain being under pressure. And so I think you know it's it's such a beautiful question to to bring in because there's often stress involved in so many things that we do. And stress doesn't just affect how we feel, but it does affect also a brain system that can support engagement with care, with treatments, and and so forth.

SPEAKER_01 5:34

So if we think about how cognitive overload or emotional overwhelm affects the way patients process information during their clinical consultations, can you relate that to the brain?

SPEAKER_00 5:49

Yeah, absolutely. And and you've said it, Marie, with cognitive overload. You know, cognitive overload happens when the brain is given more information that it can comfortably process in that moment. And as I said earlier, when we're under stress, there's some fundamental shifts that happen in the brain. The amygdala goes up, our threat activating response system is the one that goes on when you want to be in that fight and flight mode, and our prefrontal cortex reduced. So, um, you know, in these healthcare consultations, patients are often processing a ton of things, right? Especially day one, right? It's it's the medical information, it's the treatment instructions, um, it's the emotional roller coasters that they go through. There's a whole lot of lifestyle changes, and then there's the big uncertainty of really what all this means, right? And so when the brain is overwhelmed and stressed and face this uncertainty or perceived threat, attention goes down. Like we're talking about prefrontal cortex disengagement, so attention narrows, your memory retention can drop, and people might only remember fragments of the conversation. And there is a fair bit of research showing that patients often forget a large proportion of the medical information shortly after the consultations, especially when that patient is stressed. And so this means that engagement isn't just about providing information, it is about how that information is delivered, how it's paced, and really how it makes the patient feel in that moment. And you know, and that's where you know we have to be aware the cognitive overload is something that really again happens internally. And when the brain is overwhelmed, learning and decision making can be become a much, much harder process for those individuals.

SPEAKER_01 7:44

And I can really understand that from an initial consultation. I was just talking, thinking about what you were saying about how they have to process so much information, but they also have to recall it. So we ask them lots of questions. We then, you know, have a look at their limbs, whatever, if it's if it's to do with swelling, and they're it's bombarded. So we honestly need to think about what sort of things that we're doing at the end of our consultation, the take-home messages, because they're probably not taking on in much at all.

SPEAKER_00 8:16

Yeah, that's right. And it is, you know, there's there's so much that we can just keep in mind with what we say and do in those first minutes, you know, in the process deering and how we then close that off so that not everything that we say in those meetings or in those consultations has to make sense for them now or has to be processed right away. Like we can keep it really real for them that hey, all this will make sense as we work through this together, right?

SPEAKER_01 8:44

I often say work in progress. That's my take-home message. It's a work in progress. I like it, I like it. Because when they say, but what's gonna happen? What's gonna happen? Well, I say, well, listen, it's not a clear at the moment, but it's a work in progress. We just got to take one step at a time. So on that note, what practical strategies can clinicians use to support lowering threat and reducing cognitive load when there's lots of mental health factors or stress responses that are influencing the conversation?

SPEAKER_00 9:14

Yeah, and I and I love this. I think these there's a few small things that we can do, or any one of us that's in these positions with working with people that, you know, I call them small upgrades that can sit can significantly impact the outcomes, right? And if we're aware of these small little upgrades or small things that we can do, um, and then witness just what the impact is, it's really, really exciting for for both the clinicians and the people leading these conversations as well as for the person receiving these conversations as well. And so a few um a few key practical strategies, you know, always for me it starts with, you know, when we meet people, when we interact with people, it's keeping it very, very real for those individuals. And if we can start with some empathy and some validation, patients engage more when they are feeling that they are understood, you know, and I remember working with various mental health and clinical disorders as well. And you know, from a research perspective, you know, you do the researchy stuff with them, but there's often this other level of um appreciation that they bring to say, just thank you for just listening to me and thank you for just hearing me out. And even though I was kind of bombarding them with all the researchy stuff, you know, time and time again, they would leave our rooms just so grateful that they had someone that they could talk to for the first time or just could share stuff. And I think that's really key because us humans, you know, doesn't matter what's go what goes on for you and what your health status is, we crave interactions and we crave genuine, authentic, real interactions. And people want to talk, people want to share, people want to feel understood, right? And that's all of us. And you know, I worked with the neurochemical, the the hormone um oxytocin, which is produced in the brain, and it's well known for its pregnancy effects, where it really regulates and helps with the contractions and the milk ducts contractions as well, but it really promotes the bonding between the mum and the baby. And so we've done a lot of work to understand how that social connection or that bonding or some of these affiliative behaviors are really, really to do with oxytocin. And so empathy and genuine connections and things like um eye contact and you know, getting a bit tactile, like just touching, hugging people, that really stimulates the oxytocin hormone, and that can make us feel good and really significantly help reduce the stress as well. So, you know, always with you know these strategies, you know, step into the room and bring some empathy and validation. Make the patient feel heard and understood rather than just always going in there straight up and trying to fix a problem. Um, a second strategy is to really simplify the information, right? And that's to focus on you know the most important steps rather than just giving too many instructions, or we can give the instructions, but then really just say, hey, look, that's a lot, but we're gonna start with these things. And I think you said this too, Marie, with you know, if we can chunk down the information, you know, it's a work in progress. You know, we're gonna work through all the stuff that needs to happen, but we're gonna chunk it down into small steps. And I think that's really again, if we want to lower that threat perception, you know, it's again, it's it's it's helping this person not getting too overwhelmed with saying, here's all the things that needs to happen, but to help to understand that their steps involves. And that can really help the brain process, um, stay calm, and then that can really encourage us to retain that information a bit better as well. A third strategy is really support the patient's autonomy and giving people choices is really and just some, you know, some say and some mutual input into how things are going to go can really increase a sense of control and and reduce stress as well. And you know, it could be just something like you know, whatever you are asking them to do with wearing their compression stockings, maybe you can say there are two ways we can get you to put these stockings on. Which way do you like? Right, and we give them a choice in terms of some of these processes and some of the goals and some of the activities that needs to happen. And that can really again boost engagement, um, make them feel like they are in control as opposed to not in control and in chaos and overwhelm. Um, and so that's a really, really good point, as well as um patient autonomy. Another strategy could be to normalize that emotional response, right? And I think that's part of making the person just feel like they've understood. Tell them this could be, you know, this is gonna sound like a lot and there is gonna be a sense of overwhelm because yeah, a lot of things needs to happen here, and just that emotional connection can really contain their state as well. Um, you know, and tell them that this could be a little bit unknown, and there are unknowns, and as Marie was saying, you know, it's a work in progress. We're gonna figure this out together, right? And the fact that they have you there together in their pocket and there to support them, I think that's that's the way that we want to again from a language perspective, want to help regulate that emotional response that could happen in that room that you may not see happen, but it absolutely happens undercover, right? In the brain and in the body. A final thing that I love is to encourage small achievable actions, right? All this success is really key to building confidence and motivation. So, you know, if we can break things down and give them these small wins or these small achievements, we are really tapping into the brain's reward system. And when we tap into the brain's reward system, the brain just wants more of it, right? And if the brain wants more of it, you're gonna have a patient that's gonna come back more easily, or they're gonna do the work more easily, and they're gonna do their appointments, they're gonna do their homework. And so small achievements and small wins are absolutely fundamental. And even if it's not like real practical wins, it's in the sessions, us clinicians, um, we can share just how much progress they've made, you know, because as a patient, you know, when you live with a condition like this, you don't see the progress as easily because you see it every day, right? But those that are coming in, you know, at certain points in time, we can see a shift and a change quite easily. So if we can verbalize that there's been some progress made and just you know recognize that achievements, we are stimulating a reward pathway system in the brain as opposed to that that threat system. And so I think the take-home here with these strategies is that if if we um when we reduce the threat and we simplify information and we tap into an award, um a reward pathway system, we give the brain the best chance to engage. And I think that's really fundamental that all of this taps into creating a state in that individual where they can receive and do well and then create outcomes that really align with um the shared goals.

SPEAKER_01 16:05

And I was just listening to you about the compression garments, because depending on what age you are, it can be quite difficult to put on a compression garment. And sometimes, you know, we go through a whole variety of ways to put it on, but each time I think sometimes people think, Oh, I didn't achieve it that way. Gosh, I'm never gonna get this on. But I was just listening to what you were saying, and if we started off by saying there's many ways to put this on, we just need to work out the right one for you. It's not a right or wrong for this, it's just what's for you. You're unique, you know. We we are just working out the best way for you to get this on would be really important. But the other thing that you said was I think really important was it's the way you say things. Now, I had a practitioner I was training who was dealing a lot with aged care, and one of the things she said used to say to her clients is, oh yeah, it's gone down a centimetre. And I said, Is that how you said it to them? Yeah, it's gone down a centimetre. I said, Well, you know, a centimetre is not a lot for you and I, and probably Iselle, you're probably thinking, you know, circumference, that's not a lot, but but for this person, it's huge. So you say, Wow, goodness, it is going down. It hasn't gone up, it's going down. You know, this is actually working. Now we're not lying to the person because there's actually the truth, but doesn't that sound a lot better if you're actually, you know, and and they say, Okay, I can do this. So we can keep going on this. And um, in some instances, they say, Well, how do I get more? I said, Well, there's a couple of options. We can look at going down a size or increasing the compression or or something like that. And some of them say, Yeah, I'm ready for it, or some say, No, I'm happy with what I've got, that's where I'm at. But you can you can feel that sort of sense that they're achieving something. And I think it's so important. I've I always say that is the win. The win is important. They have to walk out the door with a win. It's all negative, for goodness sake, we've had it.

SPEAKER_00 18:04

Yeah, and I think that's, I mean, just picking up on the wording as well, like there's so many words that we all use every day that can really add to the cortisol increasing and and then triggering that threat system. And I don't know if you do this, Marie, but I I've really caught myself so many times. Like I always go into the I need to do this and I should do this, and you need to do this right now, and it's gonna have to happen twice a day, and you need to, you need to, but the word need and should and all those things are incredibly cortisol stimulating, right? And that's gonna that's gonna add to triggering that threat system, right? But things like like you said, look, there's no wrong here. We're just gonna do our best, and hey, we're gonna figure this out together. And you know, I think yeah, not boxing it into here's exactly what you need to do, and then this is only one way, but give them this like, hey, we're gonna work together, we're gonna be a team here, and if it doesn't work, hey, we figure it out. You know, there's many different ways, right? And I think normalizing that, hey, if it doesn't work for you leaving today and you go home and it doesn't work, then hey, all good, then we adjust, right? And I think it is, it's that sort of precedence that we set in terms of you know the instructions and the tasks that we give them, but tell them, hey, there's room here, there's room to move, and there's room to change and shift, and we're here to make it feel good for you at the end of the day. But yeah, wins are everything. I think we forget that you know, our brain just craves dopamine and those kind of chemicals. And you know, there's a reason why sometimes it's so hard to come back to a Monday because we often finish our week so you know on a negative, and it's like, oh, you know, but if we can find a way to finish on a positive, you know, people will come back, right? It makes the Monday bit better as well if you finish a Friday on a good note and recognizing your wins from the week. And and the same here, you know, I think we have to identify those wins because as individuals and and patients, we don't see it, right? We're so in it, right? But there's always wins, and I think we have to share that as often as we can in these sessions.

SPEAKER_01 20:00

Before we continue, I'd like to take a moment to acknowledge the sponsor of this episode, MIDI Australia. MEDI Australia is a global leader in compression therapy and a trusted partner for lymphedema clinicians. MEDI understands that effective lymphedema care relies on evidence-based compression, patient comfort and long-term adherence. Their German engineer flat knit and circular knit garments provide effective compression, durability and wearability, supporting outcomes across early intervention through to chronic complex presentations. Medi backs clinicians with education, product support and responsive customer service, helping improve patient solutions. Through clinical rigour and innovation, Medi continues to improve quality of life for people living with lymphedema. For more information, go to mediaustralia.com.au. The word need have to is something that I've only really recognised since you've been bringing it up because I'm doing it uh for those that don't know, I'm doing a PhD, and as Earl is supporting me in this process through Thesis Mastermind. Uh, and it is important because a need and a is is negative to some extent, isn't it? Really? It's a word that you know, if I had swelling in my limb, I I have to see. Look, look, I'm saying it already. If I wear the garment, it's gonna help control the I'm trying to be careful, the swelling. So you do perceive straight away, I have to, I need to, and that becomes in a chronic disorder. You know what I mean? I gotta put it on every day. So switching that words around and us being really careful, and I need to be better at this too. So some of the can you tell me a few. You switch out words as well, please.

SPEAKER_00 22:02

Yeah, I mean, if you think about the energy attached to words, you know, sometimes it's not so much the word, but it's the energy attached to it as well, right? And I think, you know, you you got to think about whether what you're saying is gonna compress that person or you're gonna make them expansive, right? And if I say I need you or you need to, you should, you're gonna have to do this every day, um, you know, all those kind of things, then that's that's really compressing, all right. That's a very small energetic frequency band that we tap into from energetic level um vibration. And that's a small compression type frequency that we work in, and that's really hard to then create from that, right? Whereas if we use, instead of saying you need to do this, it's say, Hey, you get to do this, right? You now get to wear sexy stockings that's gonna make you know a bit of a difference, but let's embrace this, right? And let's see, you know, because it maybe there's an alternative option that's not all that great these days with where we are with treatment and care and research means we only have to wear stockings to really make a significant difference, right? You know, it doesn't mean surgery, it doesn't mean other more invasive processes. And it's that kind of, you know, again, it's the energy around the words that really, really helps, you know. But for me, it's always, you know, it's not I need to do this, it's I get to do this, right? I get to support you with this and you get to wear stockings. You know, this is a really good opportunity or a less invasive way to treat. And we've seen a lot of really positive outcomes from wearing these stockings, right?

SPEAKER_01 23:28

And so it's I think that's the difference, isn't it? Putting the get to with the potential outcome or what's happened, we know that's going to be the success. Because I know from some of my patients' clients, they would say, I don't want to get to do this at all. So, and it is hard, do you mean? Because I don't want this, I don't want this problem. So I don't want to get to do it. But I think also that education, isn't it? To to really not just throw things at them, to make sure they really understand why they're doing it. And I often say to to therapists, don't deny people understanding anatomy and physiology.

SPEAKER_00 24:07

I I love that. I think Marie, we we tend to hold back on explaining certain stuff. But people are information, our brains just want information, right? And I think I think that's beautiful in terms of you know, if if there's a reason why they need to put the stockings on and they understand why it's important to wear them, right? And what it could mean and how it's gonna achieve their goal, like, you know, I think that's you know, exactly what you're saying is connecting this little activity that they have to do every day, or they get to do it, with their goal and seeing that if you do this, which is literally just putting a stocking on every day, we can make this much ground in terms of shifting your outcomes. This is gonna make you feel better, right? So it is connecting with the purpose, and then the education helps them understand why you know you're not just saying you now have to do this every day, right? People don't connect with this, and I think um stuff that we talked to you about, Marie, as well, is that if we can get emotionally connected with a certain thing at the right energy, like the good energy, the the expansive energy, then you know, then we're gonna take the actions, right? Because what we think really feeds into how we feel, right? And or if you think about what we emotionally get attached to, um, is then what's gonna drive our actions, right? So if we're emotionally attached to the fact that, oh my goodness, now I have to wear these stockings every day, and oh my goodness, it's just not what I want, that's a really negative energy, and that's gonna drive a certain type of action, right? It's gonna drive the hesitation that I don't want to do this to refuse all those kind of things, right? Whereas if I'm emotionally attached to wearing these stockings because I can see that there's research behind it, then there's outcomes that are promising, and it's really gonna help me achieve this goal, then my actions will be very different. Then I'm more likely to do it, right? And and follow through and all those kind of things. And it is that we tend to withhold information, and perhaps it's that balance between you know, there's overwhelm that can happen because of how we deliver the information, but that doesn't mean we hold back on information either, right? You know, it's it's the way that we deliver these information, right? So then and I never want to hold back to say, you know, don't go into overwhelm by withholding information. People love understanding, and they have to understand. If they can't see why they need to do it, you're not gonna get compliance.

SPEAKER_01 26:29

Yeah, you're not gonna get buy-in, etc. And often the visuals things too. So sometimes there's fantastic YouTube videos and bits and pieces on how lymphatics work, you go, I want to show you something really exciting. Do you know what I mean? Because this has only been around for the last 15 years that we've been able to see these little lymphatic vessels and how they work. People are really excited about this. Oh, this is under my skin. Um, which I think really gets them to say, okay, so now this is not happening for you, and this is the sort of things that we can we can go with. What about drip feeding information? Because sometimes important things get missed. You said that you only take in so much, and the research is there definitely around that. But when would you do that? So if you've I'll give you a scenario. So we'll often see people, we'll reassess them, ask them, say it's their second appointment or whatever, is ask them how they've been going and do some measurements, reassess, then maybe talk about you know what they've been doing and then go from there. When when's the best way, I suppose, to either revisit what you've done before and how to do that in small, I think you're going to talk about small chunks of information, but drip feeding it without being a bit condescending that you just keep replaating the same thing.

SPEAKER_00 27:48

Yeah, I mean, I think it's explaining, you know, that some of this will take time, right? Like our best way of learning is through repetition, right? And and repetition is huge, like that's the way that we build connections and use on neuroplasticity and all those kind of things. Um, and I think with the drip feeding, you know, it comes down to again chunking it down. So what are the what are the one or two key things you really want them to do, right? And then hey, if they if they've got the capacity to do it, here's the other things, right? And I like I always work on a two-level process when it comes to, you know, if we want to work towards a goal, there's one or two things you you should try and do every single day, right? And then there's this extra things that, hey, it would be really nice if if we can do this as well, because then it's going to really accelerate your outcomes, right? And then you you allow them to master the one or two fundamental stuff, right? And then we can start to hone into the other things and say, well, now I really want you to do this one as a priority because the rest then becomes a habit, right? It becomes a bit more automatic at that stage, right? And I think it's a big part is that some of this stuff takes a bit of time, right? People, compliance doesn't happen overnight. People don't shift who they are and how they behave and how they act over time, right? Or you know, overnight. It takes, it takes time.

SPEAKER_01 29:07

Um so when you're building those treatment plans, you sort of need to consider that and be honest with them. You know, I mean it's a dual treatment planning, you know, they they have a role in it as well. It's a bit like getting your best bang for your buck, isn't it? To some extent. Not I'm talking about money, but you know, impact, I suppose, that um, you know, these are the things that we can start with. We're going to see how the effects are, and then we're going to add in. And one of the things I often talk about with compression is sometimes you will say, look, we might need to look at compression, but let's try this first and see how we can, you know, supercharge your lymphatics to work a bit harder. It's okay if they can't, that's fine, but then we know, and then we will, you know, go to the next bit and add in. And and most people sort of appreciate that, I think.

SPEAKER_00 29:57

That yeah, sort of taps into that personalised care at the end of the day, right? Is that you know, and that's where for clinicians and anyone that treats people, you know, you've got to have your library of options here because one way doesn't fit everyone. And you know, we've learned this in so many ways that yeah, it's gonna be different for every individual, and we're just gonna have to figure that out. Now, sometimes we get that right straight up, and other times, you know, you know, it's a bit of trial and error, right? Um, and again, setting that up is that, hey, we're gonna work through a process that's really good for you, right? It may take us a bit of time, but hopefully we we nail it early on, right? Um, and I think you know, it taps into, you know, how do we keep this sustainable, right, in the best way? And you know, it's kind of, you know, I always work with capacity, right? I don't work with time and effort, I work with capacity. Capacity for me is, you know, is this person in a position to do this work well? Do they have to energetic capacity, the emotional state, the mental, the mental, you know, space to do this work, right? And then I'm very aware of habits, right? And if we bring in a new thing to these people, then we have to understand that we're working with habits. We are asking them to change a habit or to bring in a new habit, right? And again, we know habits. Some of us try to do create new habits, you know, every now and then it takes a bit of time. You know, we're talking about 30 days, 66 days to really conquer a new habit, right? That depends on the intensity of how you work on it. And then it's the state, you know, what state do these individuals come in with and how how can we manage that internal state in order for them to be receptive to what we say, right? And you know, and that's where, you know, again, from a sustainable point of view, you know, it's how does this fit in for them? You know, where does this fit in from a capacity point of view in their daily routines? You know, how can we again minimize that load, make them feel achievable and all those kind of things?

SPEAKER_01 31:51

Um fantastic. Well, thank you, Iselle. I think it's a powerful reminder that engagement isn't just a behavioural issue, it's a neurological one. When we support the brain by reducing stress, simplifying information, and building small achievable routines, we make it much easier for patients to engage with their care. When clinicians understand the brain behind behaviour, patient engagement stops being a mystery and becomes something we can actively support. Stay tuned for future podcasts to empower you with the tools and knowledge to manage lymph edema and chronic edema confidently and effectively. Until next time, keep supporting your clients with evidence informed care.