behavior change models

6 behavioral change models

1. health belief model 2. self efficacy model 3. social learning model 4. transtheoretical model 5. motivational interviewing 6. health behavior change method AND TRAUMA ACCOMMODATION MODEL

why is importance important in behavior change?

1. is it worthwhile 2. why should i 3. how will i benefit 4. what will change 5. at waht cost 6. do i really want to 7. will it make a difference

summary of motivational

1. knowledge of consequences 2. self-efficacy 3. perception that course of actoin was chosen freely 4. recognition of discrepancy between present conditions and desirable state of being 5. social support 6. feeling accepted

what is the basic presence of the trasntheoretical model?

behavior change is a process, not an event and as a person attempts to change a behavior he moves through 5 stages, model is circular not linear

what are the 5 basic principles of motivational interviewing?

1. express empathy 2. develop discrepency 3. avoid escalating resistance 4. roll with resistance 5. support self-efficacy

open ended questions

1. ask about pros/cons of current health patterns and the contemplated change 2. ask about the extremes related to the problem, what worries you most 3. ask client to envision the future after the change has been accomplished 4. ask about priorities in life, what is more important to them in life?

based off HBM.. people are ready to act if they:

1. believe they are susceptible to condition 2. believe condition has serious consequences 3. believe taking action would reduce their susceptibility or its severity 4. believe cost of taking action outweighs benefits 5. are exposed to factors that prompt action (TV add, postcard from MD to get mammogram) 6. confidence in their ability to perform action

how and what for confidence in behavior change?

1. can i? 2. how will i cope with x, y, and z? 3. how will i do it 4. will i succeed in it? 5. what change?

what are the 5 stages in the trauma accommodation model?

1. diagnosis 2. psychological stress/physical change 3. denial/avoidance/confusion 4. recognition/preparation/action 5. accommodation/acceptance/maintenance

how should you develop discrepencies for motivational interviewing?

1. encourage client to vocalize important goals, reason for change, explore consequences or potential consequences of present behavior 2. this will hopefully help create discomfort for the patient and make them want to change more

what are 5 ways to promote self-efficacy in counseling session?

1. let clients know options/strategies are available to deal with problems 2. point out client's strengths 3. set achievable goals 4. relate success stories 5. express optimism for the future

how should counselors impact motivation?

1. patient centered counseling 2. encourage patients to resolve ambivalence about behavior change 3. reduce resistance 4. encourage action

what are the 5 stages of the transtheoretical model?

1. precontemplation 2. contemplation 3. preparation 4. action 5. maintenance

what are characteristics of an effective counselor?

1. self aware 2. solid foundation of knowledge 3. ethical integrity 4. communicate clearly 5. sense of cultural awareness 6. sense of humor 7. honest and genuine 8. flexible 9. optimistic 10. respectful 11. accurately feel what clients feel from their frame of reference

in the social learning theory what are the 3 main factors that affect the likelihood that a person will change a health behavior..

1. self-efficacy 2. knowledge and skills 3. learning occurs through taking action, observing others taking action, and evaluating the results of those actions

readiness in behavior change, when?

1. should i do it now? 2. what about other priorities?

what is the most common time for relapse during the action stage?

3-6 months AFTER action stage

how many stages in trauma accommodation model?

5

what health care professional should use trauma accommodation model?

PT, OT, RN's

health belief model invented because..

Public Health Service was sending mobile Xrays for tuberculosis out to neighbrohoods offering free chest xrays, location was convenient, but very little interest so they needed to find out why -theorized people's beliefs about whether they were susceptible to disease and their perceptions of the benefits or trying to avoid it- ALL INFLUENCE READINESS TO ACT

social learning theory

a dynamic, ongoing process in which personal factors, environmental factors and human behavior exert influence upon each other

action stage

actual change occurs and clients have altered their target behavior for one day to 6 months and continue to work on it, new behaviors are not viewed as permanent yet

general definiton of action phase

actual change occurs, made behavior change for at least 1-6 months, most people don't view this as permanent we know people have relapses

Health Behavior Change Model

approaches the "spirit of motivational interviewing but takes less time! 2 concepts: 1. importance 2. confidence: self efficacy

self efficacy

basic component of behavior change -our personal belief of how capable we are in exercising control over events in our life

preparation stage

begin to believe that advantages outweight disadvantages of changing and are committed to take action with in the next 30 days

summary of 5 stages of trauma accommodation model

begin with life altering diagnosis and brings patient to point where they are accepting idea of living life as normally as possible with their condition

how should you support self-efficacy in motivational interviewing?

belief and the confidence to change, this is very important motivator

maintenance stage

client has been engaging in new behvios and works to consolidate the behavior into a new lifestyle, and works actively to maintain the changed behavior and prevent a relapse

how should you ask open ended questions for motivational interviewing?

communicate curiosity, concern and respect

what stage do most patients come to you as?

contemplation

motivational interviewing

counseling style should rely heavily on reflective listening skills, if given time limit make it hours rather than days

why was motivational interviewing developed?

developed to address addictive behaviors

the 5 stages of the transtheoretical model shows that this model is..

dynamic

how did the transtheoretical model come about?

evolved out os studies on smokers, in 1984 by international gathering of researchers and therapists in scotland, and goal was to develop a more comprehensive model of change for treatment of addictive behaviors

social learning/cognitive theory

good for groups of people, everyone influences eachother, active process not passive, actively going to do something if they are in a group

how should you elicit self motivational statements during motivational interviewing?

have client make arguments for change rather that you making arguments to change

an individual may feel that the change is worth while which shows IMPORTANCE, and even make motivational statements indicating importance, BUT if person has little confidence in ability to make change, then implementation will be unsuccessful.. this can be related to what method?

health behavior change method

example of cognitive-problem recognition from patient

i really have serious problem here

example of affective-expression of concern

i'm so worried about my diabetes. i don't know how this could have happened to me

example of behavioral-intention to change

in the past i always enjoyed eating fruit. i just have to make a plan and start eating them again

how should you avoid escalating resistance?

inadvertantly escalate the client's condition by arguing, judging, persuading or discounting feelings DON"T DO THIS

social learning theory of social cognitive theory

individuals acquire information, values, attitudes, moral judgments, standards or behavior and new behaviors through observing others

general definition of transtheoretical model

intentional change and decision making in an individual

the 6 reasons that people are ready to act from HBM...

interact with each other to determine a client's willingness to take action

example of cognitive-optimism for change

lots of people take insulin, i can too!

what does the fact that relapses are normal in the change process allow for clients and counselors with?

maintaining realistic perspective

a person in the precontemplation stage will show...

no awareness, denies problem, lack of understanding, aware by unwilling to change or feeling hopeless after attempting to change

trauma accommodation model

outlines stages a patient goes through when dealing with a diagnosis that is sudden trauma, trauma is defined as life changing even such as spinal cord injurt, loss of limb, HIV diagnosis

disease, threat, and susceptibility are..

percieved belief in the benefits of prevenetative action in HBM

what did prochaska say about the maintenance stage?

perhaps most important is the sense that one is becoming more of a kind of person one wants to be

precontemplation

person has no intention of changing and resists any efforts to modify problem behavior

what is more important usually, the confidence in ability to accomplish a behavior change or the actual skill?

persons' confidence in ability to accomplish behavior change, self efficacy -WE believe in our ability to change

contemplation

recognize need to change but ambivalent regarding reasons to change and reasons not to change, they are concerned that long term benefits do not compensate for short term costs

how should you listen reflectively?

reflect back what the client is saying, encourages client to keep talking

what is important during the preparation stage?

set up gradual goals and keep increasing confidence

how should you roll with resistance for motivational interviewing?

should expect ambivalence and reluctance to change - you should make the counseling environment comfortable allowing clients to express fears about changing without feeling judged and pressured

how should you express empathy?

show acceptance and understand the client's perspective, need to have acceptance in facilities change, but counselor may not have the same perspective but still conveys that the patient is ok

the examples that infants as early as 7 months model behavior with competency and continue to do so throughout their lives is an example of what model?

social learning theory or the social cognitive theory

clients in preparation stage show what..

that they have taken small steps to prepare for a change, such as making an appointment with a PT or inquiring about membership in a gym

what was the biggest problem that counselors were making when treating clients when counseling?

they thought every patient had readiness to change, but every patient is not in theis stage

what is the common problem with people in the contemplation stage?

they will be stuck in this stage waiting for absolute certainty or just wishing for different consequences without changing behavior

what is overall goal of the transtheoretical model?

to achieve the change in behavior which will be a vital component toward long term adherence to the change you want to propose

from the time someone becomes aware a problem exists, through all the actions involved to solve the problem, and then to the point where the problem no longer exists is part of what model?

transtheoretical model, a comprehensive model of change that needs to cover the full course of change

what model do patients frequently revisit previous stages due to set-backs in the rehabilitation process?

trauma accommodation model

reflective listening

use basic listening skills and make your best guess as to what was in the heart of your client's message and reflect that guess back to your client, this will keep your client talking

if a client reports a lack of motivation for backsliding on change, what should you do?

use motivational interviewing, works to reduce resistance

can people get stuck in a particular stage?

yes

should education be implemented during the precontemplation stage?

yes, because some people dont have a clue about their illness or disease, but don't give too much informatoin

do people in the contemplation phase have perceived barriers?

yes, economic, inconvenience, unacceptable

should education be implemented during the contemplatoin stage?

yes, patients want to hear it