Behavior Change Counseling

Question 1

6 stages of change based on the Transtheoretical Model

Answer 1

1. Precontemplation (not ready)
2. Contemplation (getting ready)
3. Preparation (ready)
4. Action
5. Maintenance
6. Relapse (a natural and expected stage of change)

Question 2

10 processes of change based on the Transtheoretical Model

Answer 2

1. Consciousness raising (provide information, point out pros/cons of changing behavior)
2. Dramatic relief (pay attention to feelings)
3. Self-reevaluation (create new self-identity)
4. Environmental reevaluation (identify effect on others)
5. Social liberation (notice social support)
6. Self-liberation (make a committment)
7. Helping relationships (get support)
8. Counterconditioning (use substitutes)
9. Reinforcement management (use rewards)
10. Stimulus control (manage environment)

Question 3

_______ interviewing is a directive, client centered counseling style for eliciting behavior change by helping clients explore and resolve ______

Answer 3

Motivational; ambivalence

[designed to produce rapid, internally motivated change by mobilizing the client’s own change resources]

Question 4

Discuss 5 A’s and how they are used in behavior change counseling

Answer 4

1. Assess — Ask about factors affecting choice of behavior change goals/methods
2. Advise — Give clear, specific, personalized behavior change advice and info
3. Agree — Collaboratively select appropriate tx goals and methods based on pts interest in and willingness to change
4. Assist — counsel, prescribe, support
5. Arrange — schedule f/u to provide ongoing assistance

Question 5

Who determines the treatment plan with motivational interviewing?

Answer 5

The patient! — avoid giving unsolicited advice; express empathy, use nonverbal listening skills, and become problem-solving partners

Question 6

Steps to motivational interviewing

Answer 6

Get permission to proceed

Ask open ended questions to get the ball rolling

Use reflective listening throughout

Develop discrepancy — difficult part!

Summarize (stop, assess, move on)

Elicit self-motivational statements from pt

Question 7

What does it mean to “develop discrepancy” with motivational interviewing?

Answer 7

People are more motivated by what they hear themselves than by what a physician says — thus the patient should be the one that provides arguments FOR the change

Change is motivated by perceived discrepancy between present behavior and important personal values and goals

[in other words, they must reach conclusion that the change will resolve the discrepancy]

Question 8

Physician methods for developing discrepancy

Answer 8

Ask if they are interested in exploring change

Ask their confidence levels for change; can give on scale of 1-10

Ask what it would take for them to increase their confidence level or desire to change. If they give high number but have not changed, ask why they think this is the case

Question 9

What are the 4 behaviors of resistance often encountered when counseling for behavior change?

Answer 9

Arguing

Interrupting

Negating

Ignoring

Question 10

How do you respond to resistant behavior when counseling for change?

Answer 10

Respond differently — ask evocative questions, explore values, summarize, find and reinforce change talk

Offer a menu of what has worked for others and have them pick what they think might work

Question 11

4 elements of “change talk”

Answer 11

Explore
Affirm
Reflect
Summarize