ISSA CPT EXAM
What are the client cues for Pre-contemplation stage?
( Not ready for change) "I won't." "I can't in the next six months."
What are the client cues for Preparation ?
(Preparing to make change) "I will in the next month."
The underlying aim of MI is to elicit the client's own __________.
Change talk
Preparation
Committed to make a change in the target behavior within 30 days; engages in preparation activities
Contemplation (think about it)..in the air
Contemplate making a change in the next 6 months but reluctant to commit
_________________is the ability to understand and share in the feelings of others. Listening with empathy involves looking at the situation from the client's point of view.
Empathy
Action
Engaged in change behavior for less than six months; new behavior is not fully stabilized
Counterconditioning
Making substitutions. Making substitutions. Finding healthier alternatives for unhealthy behaviors
Stimulus control
Managing the environment. Avoiding stimuli that trigger the unhealthy behavior and intentionally creating cues that trigger the healthy behavior (placing an apple on the table)
What is a key indicator for Maintenance
New behavior becomes second nature Greater confidence in ability to maintain the new behavior Greater sense of control over their behavior
Open-ended questions (OAR Model)
Using "what" or "how" questions instead of "why" questions to gain clarifying information and avoid the client responding with justification for behavior example "How important is it for you to make a change?"
Physical Activity Behavior
the movement of the body that requires energy expenditure,
What are practical suggestions for reinforcement management ?
Helping clients create a plan to celebrate small and big successes, such as using rewards for accomplishing short-term goals; providing feedback and positive reinforcement when client engages in positive behaviors; teaching clients to capitalize on self-monitoring techniques (e.g., smart apps, journaling)
What are practical suggestions for Counterconditioning ?
Helping clients identify healthier behaviors that can be substituted for less healthy or problem behaviors
What are practical suggestions for Stimulus Control ?
Helping clients identify purposeful cues in their environment to trigger the healthy, desired behavior (e.g., creating implementation intentions); helping clients identify ways to restructure their environment to remove or overcome stimuli that trigger the unhealthy, undesired behavior
What are practical suggestions for Social Liberation?
Helping clients realize how the desired, healthier behavior is valued within their social communities and society at large; helping bridge the client's motivational need of a sense of connectedness to others who actively engage in the target behavior, such as societal role models and/or people within the client's social circle
Minimizing pressure(Autonomy Supportive Behavior)
Helping the client minimize self imposed pressure (focusing on process oriented goals over outcome goals) Helping the client cope with perceived pressure from others (e.g., family member, sports coach, physician) Setting and communicating realistic expectations of the client
What are practical suggestions for Helping Relationships?
Helping clients connect to social groups or individuals with similar goals and values, virtually and/or in-person; encouraging clients to recruit accountability partners or small support groups (birds of a feather flock together)
Motivation
includes two key components: direction of effort and intensity of effort. Direction is what a person is drawn to or trying to achieve, such as the target behavior. Intensity is the amount of energy and effort put forth toward the target. reason one has for behaving a certain way
Experiential processes
influence behavior indirectly by focusing on the thoughts, perceptions, or feelings that an individual might have about the target behavior. (intrinsic)
outcome goal
is a goal that is associated with a specific end result. Example: "I want to lose 15 pounds before December 20" is an outcome goal. Clients should set both process and outcome goals for long-term success.
implantation intentions
is a preset plan that specifies when or where to act on the goal behavior. link critical situations (e.g., anticipated obstacles or opportunities) to goal-directed responses and, thus, leverage the power of cues. Example: The general framework of implementation intentions is stating the situation (e.g., "When _______ arises")
Relatedness (self determination theory)
is the need to feel connected to and supported by others, as well as a sense of belonging within a group or community. example CrossFit and Peloton. Both fitness regimens capitalize on connectedness, community, and a sense of belonging.
Competence(psychological need of SDT)
is the need to feel effective when operating within the environment. Clients will be more motivated to take actions that help them achieve their goals if they believe they have the knowledge, skills, and abilities for success. Lack of perceived competence can impact the behavior change process by decreasing motivation. example: a new client going to the gym may be intimidated by the environment
What behaviors improve sleep?
nutritional intake.. avoid caffeine and high caloric intake before bed exercise
Lack of sleep (behavior) increases your risk for ?
obesity type 2 diabetes high blood pressure.
Exercise Behavior
often defined as movements or actions that are planned and executed routinely for the purpose of increasing physical fitness.
What are the 5 stages of change?
precontemplation contemplation preparation action maintenance
Similar to short-term goals, a___________is a smaller goal that must be achieved in an attempt to reach a larger result.
process goal example: "I want to exercise for 30 minutes per day for the next six months."
Process of change
the factors influencing how a person transitions from one stage to another
Decision Balance
determination of whether the person deems the change process worth pursuing
T/F MI can be used for selling purposes (e.g., sell training services or gym memberships).
False
Empathy
The ability to understand and share in the feelings of others.
T/F The focus of MI is to elicit change talk (e.g., pros) rather than place emphasis on counterchange talk (e.g., cons); for some clients, constructing a decisional balance can reinforce their own reasons to not make a change.
true
What are the client cues for Maintenance ?
(maintaining positive behaviors) "I've been doing ____ for at least 6 months."
What are the client cues for Action ?
(taking action to change) "I'm doing ____ now."
What are the client cues for Contemplation?
(thinking about changing) "I may in the next six months."
T/F MI is a natural communication style; it doesn't take effort.
False
T/F MI is a technique with prescribed steps.
False
To effectively help a fitness client make lifestyle changes that support their goals and promote longevity, a personal trainer should be able to:
1. Determine their client's stage of change(readiness) 2.Identify the next steps to support healthy behavior change 3. Understand the 3 underlying components of self-determined behavior to support program design and training session execution (the why) 4. Use the motivational interviewing (MI) technique to foster internal motivation
How many process of change are there?
10 It is broken down in 2 categories: Experiential & Behavioral
Transtheoretical Model (TTM)
A behavior change model focused on the stages of change, the process of changing behavior, self-efficacy, and the decision balance.
Motivational Interviewing (MI):
A collaborative, client-focused method of guiding a client toward a self-identified motivation for change. (your why)
OARS MODEL:
A communication model for motivational interviewing that includes open-ended questions, affirmations, reflective listening, summarizing.
Self-determination
A general theory of human motivation that suggests a person is motivated to change by three basic psychological needs of autonomy, competence, and relatedness.
OUTCOME GOAL:
A goal where the end result is a specific desired outcome.
Process Goal
A goal where the focus is on the process or action that will lead to the desired end result.
Type 2 diabetes
A long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.
T/F Trainers can use MI to convince or persuade a client to make important changes to their health.
False
What is a key indicator for Preparation?
Begins to take small steps toward the target behavior change (e.g., buys exercise apparel or equipment, signs up for a gym membership, collects information, initiates the hire of a personal trainer)
______________________ have been strongly associated with enhancing healthy behaviors, such as increasing physical activity.
Behavioral processes
if a personal trainer encounters a client whose primary challenges are related to the client's environment, choices, or habitual responses, then the personal trainer may find that _________________. will be most effective in aiding the client's progress.
Behavioral-based processes
What is an example of Providing Structure Routine from competent supportive behaviors?
Being consistent with the structure and routine of training sessions so clients know what to expect Encouraging clients to adopt routines into their exercise regiments
What are the psychological needs
Autonomy, relatedness, competence
What is a key indicator of Contemplation stage?
Aware of potential benefits of making a change but perceive the costs, time, effort, and sacrifices outweighs the benefits Procrastinating making efforts toward the behavior change
What are practical suggestions for Self Reevaluation?
Helping clients clarify their core values, identifying healthy role models(Megan the stallion body...motivation..dream body), and visualizing oneself reaching and maintaining the desired behavior change
what is a key indicator for Action?
Actively doing things to change or modify behavior Structures their environment in ways that support their healthy behavior (e.g., avoids temptations that trigger the undesirable behavior)
Affirmations (OAR Model)
Affirming a personal strength or ability of the client; affirming what the client has already done or done well example "I am so glad you came to the gym today—it isn't always easy to prioritize your health."
List the Relatedness supportive behaviors(SDT)
Allowing for meaningful interpersonal interactions Promoting positive emotions to strengthen connections Promoting camaraderie and cohesion Engaging in effective communication
Acknowledging The Client's Feelings
Allowing the client to express their emotions or feelings Listening with empathy and acceptance Validating their feelings
Behavior
An action that can be observed, measured, and modified.
What are practical suggestions for Environmental Re-evaluation?
Asking the client to reflect on how their behaviors are impacting others around them; asking the client to consider another person's perspective on the impact of their behavior (e.g., increase empathy)
Allowing for meaningful interpersonal interactions(relatedness supportive behavior)
Building rapport with the client; getting to know one another within professional bounds Allowing for informal socialization between clients or between client and trainer before and after the workout Introducing the client to others (i.e., gym staff members, other clients)
Avoiding Controlling Behavior
Coaching the client to be an active participant in the goal-setting process Avoiding the use of "guilt" or "shame" as a tool to motivate behavior Minimizing the use of external rewards
Self-liberation
Committing with confidence. Committing to take action with the belief that change is possible
Fundamental Components of Effective Goal Setting
Complementary long-term and short-term goals SMART goal intentions Implementation intentions Monitoring Feedback
List the Experiential Process(es) of Change
Conscious Raising Dramatic Relief Self Reevaluation Environmental Reevaluation Social Liberation
Self-reevaluation
Creating a new self-image Rethinking one's self-image to include the possibility of a successful behavior change
How can a personal trainer determine which process(es) will have the greatest impact on the client's progress?
Depends upon both the target behavior and the individual.
T/F 4. Constructing a decisional balance (e.g., pros and cons) is an essential step of MI.
False
Promoting camaraderie and cohesion(relatedness supportive behavior)
Encouraging clients to join social groups (social media or in-person at the gym or within the community) that support the target behavior or relate to the client's goals and values Avoiding making social comparisons; using competitive tactics sparingly
What are practical suggestions for Self Liberation?
Ensuring the training program accounts for motivational needs of autonomy(self governing) and competence; for example, enhancing autonomy(self governing) by providing multiple choices or options within the behavior change plan, and enhancing competence by engaging in self-efficacy strategies (create exercise plan that they are excited about can do, and that also meets their goals)
(The Elicit-Provide-Elicit Approach)Elicit: checking for understanding
Example: Trainer: "How does that sound?"
(The Elicit-Provide-Elicit Approach)Provide: providing information using common, relatable language and in small, manageable chunks
Example: Trainer: "Increasing your water intake may be a good place to start for you; sometimes, the hunger sensation is a sign of dehydration. Consuming adequate water may help decrease your caloric intake."
(The Elicit-Provide-Elicit Approach)Elicit: exploring the gaps in the client's knowledge on the relevant health or fitness topic and asking permission to provide information to determine if the client is interested and open to receiving it
Example: Trainer: "Would you like me to give you some strategies to support your goal to improve your body composition?"
If a personal trainer encounters a client whose predominant barriers to committing to the behavior change stem from the way they think, feel, or perceive the behavior or their ability to successfully change their behavior, then the most effective processes to help the client progress may be ________________________
Experiential processes
____________________have been found most effective in the early stages of change for individuals who are quitting unhealthy behaviors
Experiential processes
Helping relationships
Generating social support. Establishing relationships where one feels safe to share personal challenges and receive support such as encouragement and guidance (support group)
Consciousness-raising
Getting the facts Increasing information about self and of the unhealthy, undesired behavior (current state of behavior) and/or their potential new behavior (self aware)
Pre-contemplation
In denial, or ignorant, that a change is necessary, possible, or worth the effort within the next 6 months
Dramatic relief
Invoking emotions Experiencing and expressing emotional reactions to the idea of continuing the unhealthy behavior (e.g., staying the same) and to the idea of initiating a change (e.g., enacting the healthy behavior) (sick of the old self)
What is a key indicator for Pre-contemplation?
Lacks the belief they could change Lacks belief they can quit a behavior or start a behavior, even if they wanted to Perceives no control over their behavior Defeated by failed prior attempts to change
Reflective listening (OAR Model)
Listening with the intent to understand, observe client body language and behavior, and offer a reflection of what was said example "You're feeling upset because you didn't achieve your nutrition goals last week."
________________ refer to the desired outcome the client wishes to achieve. _______________ can have a timeline of one year or more. Identifying a meaningful ___________or _____________ provides a sense of purpose.
Long term goals Long term goals Long term goal outcome goal
The goal of ________is to guide someone toward solving their own ____________and uncovering their reasons for any mixed feelings or contradictory feelings (ambivalence). A personal trainer gives them ___________over the process but does NOT come up with a solution for them!
MI problems autonomy
What is an example of Providing the Optimal level of challenge from competent supportive behaviors?
Matching skill level with task difficulty to provide opportunities for success Encouraging performance goals that are challenging yet feasible Breaking down complex movements into manageable parts
what is Autonomy(psychological needs of SDT ) Supportive behavior?? key word supportive
Minimizing pressure Avoiding controlling behavior Acknowledging the client's feelings
4 guiding principles of MI that can assist a personal trainer :
Not trying to "fix" a client or their behavior Understanding the client's motivations Listening to the client Empowering the client
Social liberation
Noticing societal acceptance. Increasing awareness of how the healthy, desired behavior is supported by society (embracement)
The perceived competence(when client thinks they can not do a certain exercise) can be conditioned through consistent and specific _____________ feedback and asking the client to ___________ what they did well.
Positive feedback self identify
Scenario: Sue, the client, has set a goal to be able to accomplish 10 strict pull-ups by the time she turns 30, which is in 12 weeks. She currently can do five strict pull-ups. Sue and her personal trainer, Coach Molly, have developed a training program that incorporates pull-ups twice a week into her strength training regimen. Sue shows up for her training session with Coach Molly and says that she does not want to do pull-ups, even though it is on the training plan for the day. What should Coach Molly do? How can Coach Molly ensure Sue makes progress toward her goal while also honoring Sue's need for autonomy?
Possible solutions: There is no one-size-fits-all solution to this scenario. The best solution will depend upon many factors such as the trainer-client relationship and the trainer knowing when and how to push their client past their comfort zones and when to adjust plans to accommodate the client's requests. In this scenario, Coach Molly engaged Sue in conversation about her resistance to do pull-ups. Coach Molly asked why Sue was not wanting to do them on this particular day, showed empathy, and then gave Sue some alternative exercises to choose from that could target the same muscle groups and keep Sue on track for progressing toward her goal of 10 strict pull-ups. Fundamentally, the key for personal trainers is to care for the client and let their voice be heard. Allowing the client a greater sense of control over their actions can lead to more enjoyment and satisfaction and sustain motivation over time.
List Competence(sdt theory) Supportive Behaviors
Providing Structure Routine Providing the Optimal Level of Challenge Providing the Opportunity 2 learn & master new skills Providing Feedback
Summarizing(OAR Model)
Providing a collective summary of what was talked about, making connections between client's own responses, or summarizing the plan of action moving forward example "So let's go over what we have talked about so far."
What is an example of Providing feedback from competent supportive behaviors?
Providing constructive and informative feedback when correcting behavior Providing effective praise to reinforce positive behaviors
What are practical suggestions for Consciousness-raising?
Providing factual information and data relevant to the client's current behavior and target behavior
Engaging in effective communication (relatedness supportive behavior)
Providing positive feedback Clearly communicating expectations and boundaries Using active listening
Environmental reevaluation
Realizing the effect on others. Reflecting on how one's current behavior affects the physical environment and people around them to include those they care about (public figure, Kim K)
Promoting positive emotions to strengthen connections(relatedness supportive behavior)
Starting and ending each session with a positive tone Inline-image Making training sessions "fun" Inline-image Engaging with a sense of humor
Maintenance
Sustaining their new, healthy behavior for more than six months
What is an example of Providing the Opportunity to learn and Master new skills from competent supportive behaviors?
Teaching proper physical technique (e.g., strength training exercises, running, stretching) Teaching proper mental techniques (e.g., where to focus or what to focus on, how to cope with failed reps)
Extrinsic Motivation
The drive to perform certain behaviors based on external factors such as praise, recognition, and money.
Relatedness(self determination theory)
The basic need to feel a sense of belonging and connection to others
Competence
The basic need to feel effective and capable in ones action
Autonomy
The need for self government and control over ones own behavior
GOAL SETTING
The process of identifying the client's ideal state, determining their current state, and defining the actions that must be taken to close the gap.
MONITORING:
The process of observing and taking notice of routine behaviors that impact goal progress and achievement.
Define Stages of change
The series of temporal stages of readiness that a person progresses through during the behavior ( an action that can be observed measured and modified) change process.
T/F MI does not generate a client's motivation; it reveals the motivation that already exists within the client.
True
T/F MI is a method that involves a set of communication skills to engage in to effectively respond to the moment-to-moment changes in what the client says.
True
T/F MI is a skill that is learned and mastered with consistent practice over time.
True
What are practical suggestions for Dramatic relief?
Using MI techniques to engage the client's emotions (e.g., engaging in supportive, empathetic listening to allow clients to express emotions without judgment or insinuating a need for them to stop or change the emotion) (be a mute counselor)
Reinforcement management
Using rewards and feedback. Using rewards and feedback strategically to reinforce positive behavior and acting on one's values (buying lingerie every 5lbs you lose)
Along with empathy, clients may be seeking (or needing) ____________. _________is a response that shows acceptance of the other person's feelings and point of view.
Validation Validation Example: It can be done even if you don't agree "I can see how that could be so difficult for you,"
Intrinsic Motivation
When a person participates in a task or activity because they find it inherently enjoyable (the drive to execute behaviors that are driven by internal or personal rewards)
MOTIVATIONAL INTERVIEWING
a collaborative, client-focused method of guiding a client toward a self-identified motivation for change.
Self Efficacy
a person's belief in their capability to enact the goal behavior
Stages of change
a person's stage of readiness to engage in the healthier/desired behavior
Behavioral processes of change focus on:
active strategies and influence behavior directly by manipulating environmental, social, or situational cues to encourage the desired behavior.
SUBJECTIVE GOAL:
based on a subjective outcome that will be dependent on the interpretation of the individual client. Example:(e.g., "I want to feel better about my weight")
OBJECTIVE GOAL:
based on objective, quantifiable data that can be measured and evaluated. (e.g., "I want to improve my body composition by 3 percent within three months").
_____________ is self-motivating speech; it is the verbal expression of one's desire for change, ability to change, or reasons one needs to change
change talk
Experiential processes include:
consciousness-raising, dramatic relief, self-reevaluation, environmental reevaluation, and social liberation.
Using the______________________ can help clients be more receptive to the expert advice offered by a trainer and, thus, have a better likelihood of the client acting on the advice.
elicit-provide-elicit technique
What are the two categories of the process of change
experiential and behavioral.
The quality of _____________ matters too. For clients to be willing to explore their innermost motivations and verbally express them to the personal trainer requires more than just active listening; it requires listening with __________.
listening Empathy
what is the difference between self efficacy and competence?
self-efficacy can be trained by targeting one's cognition's (or perceptions), but competence is a need that is met by personal trainers engaging in competence-supportive behaviors.
Behavioral processes of change include:
self-liberation helping relationships counterconditioning reinforcement management stimulus control.
There are various mechanisms that can be used to monitor progress, such as
self-monitoring and using technology (e.g., smartwatches or mobile applications).
_______________ are those that a client wants to achieve in the near future. _________________ can have a timeline from a few days to weeks to months or up to a year. Establishing ___________ provides direction and effort toward actions that will lead a person closer to realizing their outcome goal.
short term goals short term goals short term goals
How, can a personal trainer help a client to act upon the goal? The answer is to leverage the client's _____________ and automate goal behavior. This can be done by incorporating _________________ within the goal-setting process.
situational cues implementation intentions
What is the Transtheoretical Model (TTM) 4 key points?
stages of change process of change self efficacy decision balance
Using MI for selling purposes is unethical and compromises trust and respect between the trainer and client, which damages rapport.
true
self-monitoring
which is the process of documenting one's own daily actions and behaviors that influence goal progress. Example: a personal trainer may ask the client to record the work performed between training sessions, such as the frequency of training (e.g., days per week) and the amount of work performed (e.g., number of repetitions and sets; the weight used for each exercise). Another example is asking the client to keep a daily nutrition log. monitoring helps with accountabilty
