top of page
  • Dr. Lalit Chawla

E#3: The Four Core Areas that Creates Lasting Change or Impedes it


In this episode I talk about how our Inner Psychology, our Physical Body, External Environment and our "People" Environment affects People’s behaviours. We as clinicians and individuals can leverage those areas to create meaningful change.

Fig.1: The 4 Core Areas to Creating Lasting Change

(This is the core of the transcript from the podcast. The Intro has been removed and some areas improved for reading ease.)

If there is one thing I've learned both in my personal life and my professional life, is that helping facilitate behavioural change in others, or myself, can be very challenging; yet it can be one of the most rewarding things I ever do. Have you ever personally struggled to make a change, or improved something in your life? Whether it's eating better, exercising, getting to sleep on time, or cutting back on Netflix. And then after a few days or weeks of making that change, you noticed a positive impact in your life? Did you feel more vibrant and alive, coming a little closer to your potential? Did you see ripple effects in other areas of your life, and that just made you feel empowered?!! I think that's probably the reason why people get so excited about a New Year's Resolutions. It's a new beginning unburdened by the unrealized success of past efforts. It's a clean slate that contains infinite possibilities and a unique opportunity to live their best life.

Other healthcare professionals that I've spoken with agree that the clinical setting presents a real challenge as well. Trying to make an impactful and sustainable change in another person can be a rewarding experience. Just knowing that I had some role in helping someone live better and become healthier, and knowing it will have an critical cascading effect on other people in their lives, frankly, feels great! I think that's one of the draws for people who go into the helping professions such as doctors, nurse practitioners, nurses, occupational and physiotherapists, and teachers.

Have you ever personally struggled to make a change, or improved something in your life? Facilitating a behavioural change that lasts is challenging.

But it can be equally dejecting when we miss the mark and meaningful improvement cannot be achieved. Trying to figure out how to connect with another individual, such as a patient, can be challenging and frustrating, not only for you but also the person you are trying to help since many of them come in for some guidance. I have to admit, there have been times when I thought that the approach that I was using was helpful, but in reality, it wasn't. I could have done better. But I have taken the time to learn from great professionals, seasoned mentors and to no small degree, my own mistakes. As a friend of mine once put it, "If you're not going to learn from your mistakes, they're not worth making."

One of the common mistakes I made when I was a younger physician was, trying to impose a change in patients in terms of what 'I' thought was necessary for the patient to improve in their life, versus understanding where 'they' were in terms of actually being capable of making a change possible. Clearly, what works for me doesn't necessarily work for them. Now having said that, I know changes can have a considerable impact on all areas of a person's mental, emotional, spiritual and physical health. Some easy examples are when a person quits smoking, starts exercising, gets rid of negative self-talk or adds a morning ritual of gratitude. Those types of changes are like the big domino or piece of the puzzle that makes an almost immediate impact in a person's life in a beneficial way. But, as you know, life is not simple. Everybody is different, and different leverage points can create that impactful change. What works for one person doesn't necessarily work for another person. And frankly, some people just aren't ready for it. So what do you do? That's what today's podcast is all about.

There are four core areas that are always influencing a person's life, and what happens in one area affects the other area.

So what I want to talk about today is something that I use, and I wish I had learned earlier in my career. Not just to have helped patients, but to have helped myself. This model is something I'd put on my epitaph. There are four core areas that are always influencing a person's life, and what happens in one area affects the other area. I'd like to first explain it like this (refer to Fig.1):

In anybody's existence, I believe that there are two areas that are always influencing a person's behaviour, thoughts, and overall wellbeing. The first is a person's Internal World ( which is comprised of two core elements that impact wellbeing and self-concept). The second is a person's External World which consists of two core elements which affect their health, the way they are experiencing their life and how they contribute to the world.

The first core sphere of our Internal World is our inner psychology. This core sphere consists of our values, beliefs, emotions, rules, memories, imagination, and philosophies. Essentially, this makes up our view of the world as we believe it to be.

We know people have very different rules and value systems. Conflict or disagreements occur when we encounter people that are very different from ourselves, because we are seeing them through our lens of understanding, or we choose not to agree with theirs for a multitude of various reasons.

The second sphere consists of our physical body; our brain patterns, immune system, ability to heal, the number of limbs, eyes, ears, muscles, nerves etc.

The type of physiology we have determines how we can carry out what we want to do. We all come into this world with varying degrees of physical ability and limitation. And, if you've ever been sick or have injured a body part, you know that it can affect your psychology or' state of mind' as well. Conversely, you can have all the winning attitude, the right psychology, beliefs etc. but if you don't have the physical energy or you are sick, you know you can't do what you want or what you need to do. It is clear to see how these two elements, the mind and body, are intimately connected.

That's why, when we change our physical being, an actual change takes place in the way you mentally think and feel as well. So, for instance,

When we alter a physical movement, breathing, smiling, etc. that signals our brain to change our thinking, and we rise to the challenge

I remember the first time I had to perform as an illusionist for an audience of about 1000 people, and I started getting all panicky and saying, "what am I doing here?". At that moment, I heard my dad's voice say, "You just have to rise to the occasion and physically believe you can do it." So, I changed my posture and stood more confidently, slowed my breathing down and presto; I noticed a natural change in my mindset! An example that we can all relate to is the dreaded school exam! You may recall a time when you were so nervous or anxious that your body would hunch over and you would rest your head in your hand and wonder how you have forgotten information that you knew so well just a few hours before. I have had that myself several times! But, if you recall, once you straightened up your posture, took a deep breath and took on the role as a confident student, you started to feel better mentally. Your mind would clear and the answers returned!

So many studies have been done that shows the benefit of exercise in terms of decreasing anxiety and depression. One study even showed that exercise had just as much benefit, as an SSRI (an anti-depressant) in helping improve depression. I know clinicians can forget to tell patients the importance of physical conditioning to creating higher mental states. Our physical body and our inner psychology are intimately connected. One can be used to affect the other.

We have all heard of people who may not have a tremendous physical advantage, but mentally, they had a determined mindset, (inner psychology) that elevated their physical performance. The classic example is Roger Bannister, who broke the four-minute mile. He was so persistent in visualizing that he was breaking the four-minute mile that he did break the four-minute mile! He believed it was realistically possible. Subsequently, many people broke it afterwards after they saw that it could be done. I think that's why Einstein said "Imagination is more important than knowledge" and imagination/visualization is part of our inner psychology that we can train and leverage.

How do you feel when you've been through a dark, cold winter and then you open the door and all of a sudden it's a beautiful sunny day with a nice gentle breeze?

The third core sphere is part of our External World. One thing I'd like to ask you is, "how do you feel when you've been through a dark, cold winter and then you open the door and all of a sudden it's a beautiful sunny day with a nice gentle breeze? I don't know about you, but that immediately changes my state of mind, and I feel spectacular, and I am over the moon with relief and happiness! Or, another example, you're bored, down in the dumps and you eat something that you love, like some chocolate or comfort food, and you momentarily feel better. These are examples of how our physical environment influences our thought patterns and wellbeing, which ultimately affects our behaviours. Our physical environment consists of things like weather, physical space, air quality, pictures on the wall, what we eat, our water intake, nutritional food vs. junk food etc.

I know that I am influenced by the physical space and the environment around me. I'd like to share with you a story about a friend of mine who worked in a hospital setting.

When he was promoted, he moved to a different part of the hospital. He was given a bigger office, which was in many ways more beautiful than his last office. He was very excited about the move and he thought this was the best thing that happened to him thus far in his career. When I visited him one day, I asked him, "how's it going?". He replied, "it's okay, but I find I'm not as productive as I used to be. I feel distracted and I can't figure out why. I should be happier. I'm in a bigger office." Then I asked him, "I noticed you don't have any windows in here, and I'm surprised the humming coming from that vending machine isn't bothering you. Don't you hear it?" He said, "yeah, I guess, but I stopped paying attention to it."

These elements were having a subconscious effect on his mood and energy. When he sat and thought about it, he realized that his new physical environment was detrimental to his productivity and overall state of mind. He asked if he could move back to his old office in the older part of the hospital. Everybody thought he was crazy, but he loved having the windows and letting the sunshine in. He could look outside and see the weather changing. It was also a much quieter and peaceful place. He subsequently noticed a tremendous increase in his productivity and ability to perform. All of this was because he had tuned into how the physical environment was influencing him.

Millionaires hang around millionaires; musicians hang around musicians; birds of a feather flock together, and misery loves company

Personally, I've followed the lead from some of the secretaries and nurses I've worked with, with how they'd spruce up their work area by putting up photos of their children, or inspirational quotes etc. When I implemented that strategy, it improved how I felt in my workspace as well. There are a couple of photos I have of my family that instantly vitalizes me when I see them, and I have some inspirational quotes that help lift my spirits and keep me focused on a bigger vision and purpose.

Additionally, I've noticed that if I'm not conscientious of the way I am feeling, I might drink extra caffeine or eat sugary snacks simply because I'm bored. At some level, I know it will perk me up a bit and change my physical state. But unfortunately it will only be momentary, and my energy will inevitably plummet. The better choice for me at those times is to have a drink of water (which I do more consistently now), or I'll get up and walk around for a quick 30 -60 seconds or I'll close my eyes and do some deep breathing exercises.

The fourth sphere is our "People" Environment:

Millionaires hang around millionaires; musicians hang around musicians; birds of a feather flock together, and misery loves company. So, more often than not, this area is easily neglected. That's why parents are so rightfully concerned by who their children's friends are. When you surround yourself with negative influence, it will affect your psychology and belief system.

One thing my dad ingrained in me before he passed away, was to always hang around people who will make you better. He always said, "You might want to hang around people who stroke your ego, but you will never improve as a person." There are so many people that have difficulty leaving an unhealthy state primarily due to the people that are in their circle.

Sometimes we have little choice with the type of people we have around us, whether it's a relative or a work colleague, but a great deal can be done by how much time or energy we give them. I remember one fellow who used to do house repairs in my home. He was one of the most cynical people that I have ever come across. He was always in a state of complaining about how bad the world was, and it was either too hot outside, too cold, too rainy etc. I found myself feeling worse just by being around him and it took me several months to realize how his doom and gloom view of the world was affecting my outlook, so I was so glad when he finished that particular project in our house.

Health care providers deal with many people who have stressful and complicated lives. Now, the challenge we face is to make sure we are aware of how their energy is affecting our ability to be optimistic and helpful, and that we don't take that energy home with us. Over time, unmanaged, this can contribute to burnout. So it's essential to make sure you are surrounded by great people in your own life both personally and professionally. It's essential to cultivate and develop those friendships. Make the time to connect with people who lift and recharge your mental, emotional and spiritual energy. Also, remember to be that person for someone else. I have two super duper friends who I connect with for at least an hour each week, and we have scheduled times to help each other become better. We focus on elevating our conversation, and neither of them lives near me, so it's all done via the wonders of technology. I consider them my growth friends.

So let's extend this concept of the Four Core Spheres into the clinical setting. One thing that makes it easier for me when I'm listening to the patient, is to determine what area in their life is a substantial pulling factor, positive and negative and how I can leverage that for them? So, for instance, if they have great personal support, I know they should use that more to their advantage. If they sit at home and aren't moving their body, I'll look at how they can get moving around physically by incorporating their friends, children, partner etc. If I identify in their conversation that they have such an abundance of negative self-talk, I'll discuss that with them. I'm always looking at the four core areas and evaluating with the patient how can we/they use one of those aspects to improve their life.

Our conversations build a great framework to help organize an approach to figuring out what domino can we move and to where must it be moved, to make things a little easier. And of course, this also applies in our own life as well. At any given time, there is one factor that leverages and changes everything. I'll also explain this model to them so they can start thinking about their four core areas that they can change that is affecting them.

As an extension of this podcast, in my next episode, I want to share with you a valuable concept called 'trigger points' that exists and how they can help change behaviour. You may have an idea now about what I'm talking about, but there's a lot more to that, and I'll share that with you next time.

So here is the summary and remember, the show notes can be found on the website


Four areas/spheres in a person's life significantly impact a person's thoughts, which ultimately affects their behaviours. Any change, positive or negative in one area affects the other areas.

The first two spheres make up a person's Internal World.

1. Their Inner Psychology; which consists of their values, beliefs, imaginations, memories, visualizations as an example.

2. Their Physical Body; brain patterns, the quality of their immune system, ability to heal, number of limbs, eyes, ears, muscles, nerves etc.

The next two spheres make up a person's External World.

3. Their External Environment; air quality, weather, physical space, food quality for example.

4. Their "People" Environment; the quality of people in their life and quantity of time they spend with them

I hope this podcast served you in some way, if you've enjoyed listening to this podcast, please share with a friend or colleague and subscribe to us in Spotify, Breaker, Apple Podcasts, or your favourite podcast app. And please don't forget to leave a rating, I know it' seems like a small thing, but it makes a difference in terms of helping others find this podcast. I'm Dr. Lalit Chawla and thank you so much for listening. Let's together make a greater more effective community and inspire people to live with Greater Harmony, Joy and Magic in their lives.

Tell me what you liked about this podcast and what would you like to hear in future episodes. I'd love to hear your comments and feedback.

Thank you and Have a Great Week!

Lalit Chawla

(A special thanks to the talented William Brown who edited the above transcript)


bottom of page