1
Q
Three tenets of behavioral change
A
- reduction or elimination of destructive behaviors
- promotion of healthier lifestyles
- adherence to medical regimens
2
Q
what is positive reinforcement
A
reward to INCREASE behavior
3
Q
what is negative reinforcement
A
-removal of noxious stimulus to INCREASE behavior
4
Q
what is punishment
A
-APPLY something NEGATIVE to DECREASE a behavior
5
Q
pavlov’s dogs:
Food –> salivation
Food is the _______ and salivation is the________
A
food = unconditioned stimulus salivation = unconditioned response
6
Q
Dog paired bell to food.
When bell presented by itself,
bell =?
salivating = ?
A
bell = conditioned stimulus salivating = conditioned response
7
Q
List models of behavior change
A
- transtheoretical model = stages of change model
- self-efficacy model
- health belief model
8
Q
What intervention technique does behavioral medicine teach/ rely on?
A
motivational interviewing
9
Q
basic behavioral principles include… (list 5)
A
- behavioral antecedents
- behavioral consequences
- counter conditioning
- baseline measures
- reinforcement
10
Q
behavioral antecedents
A
come before a behavior; trigger a behavior
11
Q
behavioral consequences
A
after a behavior
reward or punishment
12
Q
counter conditioning
A
replace the bad behavior with good behavior
13
Q
baseline measures
A
- measure before you start a change plan
- how often you do the behavior trying to change
14
Q
reinforcement
A
-immediate vs. delayed
-positive vs negative vs. punishment
schedule of reinforcement: intermittent or fixed
15
Q
which type of reinforcement is more powerful
A
immediate reinforcement
16
Q
“People will only try to do what they think they can do and won’t do what they think they can’t”…
describes what model of behavior change
A
self efficacy model
17
Q
4 factors that influence self efficacy
A
- mastery experience
- vicarious experience
- verbal persuasion
- somatic & emotional states
18
Q
mastery experience
A
- self efficacy model
- providing opportunities for ppl to gain mastery on simple and difficult tasks helps develop self efficacy
19
Q
What’s a good way to incorporate mastery experiences into behavior change?
A
build mastery experiences into change plan and build them up continually higher and closer to the goal
20
Q
Vicarious experience
A
- self efficacy model
- observation of successes and failures of others who are similar
- ex: weight watchers
21
Q
verbal persuasion
A
- self efficacy model
- persuaded verbally that they CAN do it
- like coaches, trainers
(vs. being told they CAN’T do it)
22
Q
somatic & emotional states
A
- self efficacy model
- physical & emotional states that occur when you contemplate doing something
- stress, worry, anxiety, fear - if emotional state improves, self efficacy is possible
23
Q
Who developed the Health Belief Model and why?
A
- social psychologists
- find out why people would or wouldn’t use health services
24
Q
What are the theoretical constructs of the Health Belief Model?
A
- Perceived Threat
- Perceived Benefits
- Perceived Barriers
- Cues to Action
- Self Efficacy
- Modifying Variables
25
Thoughts from the Health Belief Model on how to create behavior change
- cost benefit analysis (threat vs benefits vs barriers)
- need a cue to action
- need the self efficacy to take action
26
2 parts of perceived threat
1. perceived susceptibility
- opinion of chance of getting a condition/disease
2. perceived seriousness
- opinion of seriousness of condition & its consequences
27
perceived benefits
one's opinion of the efficacy of the advised action to reduce risk
-how advantageous it's going to be to reduce the risk
28
perceived barriers
- if you think there are barriers, you're less likely to try
| - one's opinion of the cost to overcome the barriers
29
cues to action
triggers needed to activate readiness
| -like dad getting dx'd with cancer
30
self efficacy
confidence in one's ability to take action
31
modifying variables
culture, education, past experiences, skill, etc
32
Health Belief Model Summary
| In order for behavior change to occur, one must:
- weight the threat of the disease against the benefits and barriers
- be presented with a cue to action
- have confidence to take action
33
What's the most important construct of the Health Belief Model?
Perceived Barriers
| **has the most to do with whether or not a person changes
34
Transtheoretical model =
stages of change model
35
Why is the transtheoretical model useful to providers
- brings understanding that not everyone is ready for change right now
- assessment can be made about a patient's readiness
- can match your interventions to the various stages of change
- can better prepare at-risk persons for action
36
What are the stages in the stages of change model?
1. precontemplation
2. contemplation
3. preparation/planning
4. action
5. maintenance
6. relapse
37
Patients will minimize or deny the existence of a problem behavior in which phase?
precontemplation
38
Process of change in pre contemplation stage:
- consciousness raising
- dramatic relief
- environmental evaluation
39
Goal of the Precontemplation stage?
to increase the patient's willingness to contemplate the connection b/t behavioral health and physical health
40
Strategies of pre contemplation stage
- ask for permission to discuss problem
- explore patient's awareness
- GENTLY point out discrepancies
- express CONCERN that goal may not be achievable without addressing behavior
- ask pt. to think or read about situation b/t visits
41
Patient is thinking about the problem and the cost vs benefits of continuing with the problem vs trying to change in what stage
contemplation
42
process of change at contemplation stage
self evaluation
43
Goal of Contemplation stage
to help patients resolve their ambivalence to a point where they are enabled to commit to a specific plan and timetable for taking action
44
Strategies of contemplation stage
- ask for pt's perspective before offering advice
- identify pros & cons of change
- identify obstacles and possible solutions, to consider making a commitment
- suggest a trial run
45
Patient experiences a sense of urgency at which stage of change?
preparation
46
process of change at preparation stage
self-liberation
47
goal at the preparation stage
encourage patients to set a date to start action on the problem
48
strategies at the prep stage
- summarize pt's SPECIFIC reasons for change and their plan
- help them choose a specific approach
- make sure plan is CLEAR to follow
- assess conviction & confidence
- reassurance
- follow up
49
4 steps to enlisting the patient in the preparation stage
1. share decision making about problem and treatment plan
2. assess conviction & confidence to follow through
3. identify barriers and problem-sove to remove/diminish them
4. Agree on simple regimen and write it out
50
How to share decision making about problem and tx plan
- explore pros and cons
- agree on best option for pt.
- tailor to individual habits and routines
51
How to assess conviction and confidence to follow through
- conviction = 1-10, how convinced you need to do this?
| - confidence= 1-10 how confident are you that you can carry out the plan
52
How to identify barriers and try to diminish them
what would get you from a 6 to a 7
53
how to agree on a simple regimen and write it out
- preprinted forms
- highlight specifics
- can pt. read?
- follow up and ask
54
patient makes daily efforts to overcome the problem in which stage?
action
55
process of change at action stage
- reinforcement management
- helping relationships
- counter conditioning
- stimulus control
56
goal at the action phase
to anticipate what might be needed to maintain initial changes in behavior
57
strategies at action phase
- ask how efforts are going
- reinforce efforts!
- modify plan if not working well
- give helpful suggestions to reduce risk of early relapse
- arrange follow ups for support
58
patient has overcome the problem and remains vigilant to backsliding at what stage
maintenance
59
process of change at maintenance stage
- reinforcement management
- helping relationships
- counter conditioning
- stimulus control
60
goal at maintenance stage
-emphasize that the new behavior can become an integral part of a more healthful and satisfying lifestyle
61
strategies of the maintenance stage
- how is pt. maintaining changes made in action stage
- show support/admiration
- ask about slips and how pt responded
- ask what pt. has learned about change process
- discuss this as permanent change
62
patient has gone back to the problem on a regular basis after a period of successful resolution..what stage is this?
relapse
63
process of change at relapse stage
depends where patient has fallen back to
| -which stage did they fall back to?
64
goal of relapse phase
to assist patient in learning how to ANTICIPATE and CORRECT these vulnerabilities when patient takes action again
65
strategies at relapse stage
-dont get frustrated or judge patient
-IDENTIFY STAGE OF RELAPSE
-reframe relapse = valuable learning experience
-
66
individuals resist coercion, why?
| this is why_____ doesn't work
Motivated to maintain sense of autonomy, so "pushing" doesn't work
67
it is better to build on a patient's ________ to change vs. pushing them
self motivation
68
What is the goal of motivational interviewing?
-identify what maintains behaviors, including ambivalence to change, and support people in adopting new behaviors
69
motivational interviewing is _____ centered
client
70
5 principles of motivational interviewing
1. express empathy
2. avoid argument
3. support self efficacy
4. roll with resistance
- behaviors in opposition to desired change
- use reflection
5. develop discrepancy
- mixed feelings about change
- help pt. ID ambulance and move towards change
71
9 Strategies of Motivational Interviewing
1. initiating change talk
2. motivation ruler
3. asking about extremes
4. continuing change talk
5. identifying ambivalence
6. double-sided reflection
7. discuss past success
8. establish clear cut, specific goals
9 .create a plan with follow up
72
motivation ruler
why not a 1 or 2? how could we move up to 6 or 7
73
asking about extremes
best and worst possible outcomes
74
continuing change talk
ask for more detail, reflect pt's thoughts
| -encourage change talk to continue
75
double sided reflection
reflecting both sides of ambivalence
| -on the one hand i hear you saying...
76
change is a process, not an ______
event
77
remember to use mostly_______
questions
Behavioral Medicine Final
flashcards
Decks in class (3)
# Cards
