Chapter 4 Basics of Behavior Change and Health Psychology

List 3 behavioral theory models.

1. Health belief 2. Self efficacy 3. Transtheoretical model of behavior change (TTM)

Describe the fifth stage of change in TTM, goal and strategies.

Maintenance: regular physical activity for more than 6 months. Goal: prevent relapse and maintain continued activity Strategies: a.) maintain social support from family, friends, exercise environment; b.) continued education about barrier identification; c.) keep exercise enjoyable and switch it up to fight boredom; d.) create reward systems for continued adherence; e.) identify early signs of staleness to prevent burnout.

Describe the strategy of stimulus control in changing behavior.

Make adjustments to the environment to increase the likelihood of healthy behaviors. Hang around with other people who exercise.

Describe the health belief model.

People engage in a health behavior based on the perceived threat they feel regarding a health problem and the pros and cons of adopting a new behavior. the perceived threat is influenced by: a.) perceived seriousness; b.) perceived susceptibility; c) cues to action.

Describe the third stage of change in TTM, the goal of this stage and strategies for achieving the goal.

Preparation: some physical activity, but sporadic, ready to adopt and live an active lifestyle. Goal: work towards doing exercise on a regular basis. Strategies: a.) provide opportunities to be active; b.) provide support, feedback and reinforcement; c.) allow client to express concerns and triumphs; d.) introduce new exercises to find out which ones client enjoys; e.) support groups

What is part of the trainers job with respect to behavioral change?

Provide guidance and support to help change client behaviors by influencing attitudes, motives, emotions and performance.

Define: relapse

Return of the original problem after many lapses (slips or mistakes).

How should a trainer begin to understand the self efficacy of the client with respect to exercise?

Through conversation, ask about client's prior exercise experience, how they feel about starting a new program, concerns or worries about being involved in an exercise program, what are the barriers for program adherence. The assessment of self-efficacy of the client is an ongoing part of the client/trainer relationship. If information on self efficacy is ignored, then trainer may be creating a barrier to long-term success for their clients.

What are 4 methods or techniques for initating behavioral change?

1. Operant Conditioning: process by which behaviors are influenced by their consequences, examines the relationship between antecedents, behaviors and consequences. 2. Shaping: use reinforcements to gradually achieve a target behavior 3, Observational Learning: watch people around you, if my friend can do this, so can I. 4. Cognitions and Behavior: Thoughts lead to action, can be either position or negative.

What are the important components a trainer should understand and utilize to create behavioral change in clients?

1. Past activity experience, feelings and perceptions about that experience. 2. Social support network 3. Clients' attitudes, opinions and beliefs about physical activity, use these to manipulate client decisional balance and self efficacy, teach client about making lasting change 4. Effective goal setting 5. Self monitoring strategies.

What are the 6 sources of self efficacy?

1. Past performance 2. Vicarious experience 3. Verbal persuasion or feedback, especially if come from a credible, respect and knowledgeable source 4. Physiological state appraisals, i.e. client may perceive pain or fatigue, need to understand the types of appraisal the client is making about their physiological state as these beliefs may lead to judgments about their ability to participate successfully 5. Emotional state and mood appraisals; negative moods and emotions are related to reduced levels of self efficacy 6. Imaginal experiences: does the client have a preconceived notion of what exercise will be like?

What are the 4 components of the TTM?

1. Stages of change 2. Process of change 3. Self-efficacy 4. Decisional balance

List 3 behavioral change strategies.

1. Stimulus control 2. Written agreements and behavioral contracting 3. Cognitive behavioral techniques

Describe the fourth stage of change in TTM, goal and strategies.

Action: engage in regular activity, but less than 6 months Goal: maintain regular activity Strategies: a.) continue support and feedback; b.) identify barriers to adherence; c.) identify high risk individuals and situations; d.) educate clients about the likelihood of relapse and things that may trigger relapse; e.) teach skills to deal with potential barriers; f.) provide continuous opportunities to be active, plan to maintain activity during changing seasons, vacations and various schedule changes. (setting goals)

What are the basic techniques of the cognitive behavioral change method?

Cognitive behavior change theory requires identifying the beliefs that are barriers to change, then change the obstructive thoughts. Techniques include: 1. Goal setting - use SMART goals 2. Feedback, either intrinsic or extrinsic 3. Decision Making - the ability to control a situation and choose appropriately, can teach effective decision making skills by giving clients control over their own program participation. 4. Self monitoring - only committed clients will be to self monitor, requires honesty and self reflection, best done in journal keeping.

How does self efficacy correlate to motivation?

Correlates positively, higher levels of self efficacy linked to greater levels of motivation.

Define: health psychology

Examins the causes of illnesses, studies how to promote and maintain health, prevent and treat illness, improve the healthcare system; started with the traditional biomedical model and added the individual to the equation, resulting in a broader picture of the correlates of health and illness.

Describe the process of change in TTM

Figure out the current stage of the client, figure out strategies to move client to the next stage. Use strategies appropriate for the current stage.

What is the focus of the TTM and what is its alternative name?

Focus is on the individual's readiness for change. Also called the stages of change model.

Describe the different approaches to exercise that may be taken by people with high self efficacy versus low self efficacy.

High: choose challenging tasks, set goals, display commitment, maximum effort and will increase effort when challenges arise, recover from setbacks, strong adherence. Low: choose non-challenging tasks, non-threatening, easy to accomplish; display minimal effort to protect themselves in the face of a challenge, since failing when not working hard will be a lesser blow to their self efficacy than failing when doing their best, if faced with too many setbacks, likely to give up and drop out of the program.

Describe the process of using operant conditioning for making behavioral changes.

Learning the consequences of specific behaviors under certain circumstances. The stimuli that precede a behavior are the antecedents. These stimuli can be manipulated to help you achieve your goal - these manipulations are called "stimulus controls". For example, setting your alarm to remind you to go to the gym. Your behavior after the stimulus can be either: a.) positive reinforcement; b.) negative reinforcement (removes aversive stimuli); c.) extinction (remove positive stimulus; d.) punishment (averse stimulus); least effective method as it increase fear and decreases enjoyment, use sparingly and only when appropriate)

Why is self efficacy a component of exercise behavior change and how does a person get self efficacy?

Self efficacy is a component of behavioral change because there is a circular relationship between self efficacy and behavior change; self efficacy is both a determinant and an outcome of behavior change. To develop self efficacy is to engage in a positive exercise experience as past performance experience is the most important and powerful predictor of self efficacy.

Describe the first stage of change in TTM, the goal of this stage and the strategies to achieve the goal.

Stage 1: Pre-contemplation - people are sedentary, not even considering activity, don't see it as relevant in their lives, may discount the importance or practicality of exercise. Goal: make inactivity a relevant issue, start thinking about being active Strategies: a.) provide info on the risks/benefits, provide information from multiple sources, more effective from multimedia than from family or friends; c.) make inactivity a relative issue.

Describe the second stage of change in TTM, the goal of this stage and strategies for achieving the goal.

Stage 2: Contemplation - still sedentary, but starting to consider activity as important and beginning to identify the implications of being inactive. Still not ready to commit to making a change. Goal: to get involved in some type of activity Strategies: a) provide opportunities to ask a lot of questions and to express apprehension; b.) provide info about exercise in general; c.) info on activity options, fitness facilities, programs; d.) provide cues for actions, passes to nearby facilities, invitations to open houses, tours, info sessions.

Describe the process of using written agreements and behavioral contracting.

Start with a written agreement which outlines expectations. Then create an effective behavior contract which outlines a system of rewards for maintaining the program and maximizing adherence, rewards must be meaningful to client.

Describe the process of using shaping in behavioral change.

Start with the performance of a basic skill the client can currently do. Gradually raise the skill demands and provide reinforcement. Continue to increase the demands at an appropriate rate, accompanied by positive reinforcement. This leads to the execution of the desired behavior and is a powerful behavior control and teaching technique. Helps build self efficacy. Have to find the right starting point, not too easy or too hard.

Define: self-efficacy

Subjective perception of one's own ability to succeed.

Describe the decisional balance concept in TTM.

Weighing the pros and cons of changing. In helping someone through this decisonal process, remember the processes of change related to moving from one stage to another. For example when working with a pre-contemplator or contemplator, emphasize the benefits of physical activity and avoid arguing about the cons of exercise. Often the cons are the result of misinformation and lack of experience. Important to discuss both short and long-term benefits.