Behavior Change Models Flashcards
Three tenets of behavioral change
- reduction or elimination of destructive behaviors
- promotion of healthier lifestyles
- adherence to medical regimens
what is positive reinforcement
reward to INCREASE behavior
what is negative reinforcement
-removal of noxious stimulus to INCREASE behavior
what is punishment
-APPLY something NEGATIVE to DECREASE a behavior
pavlov’s dogs:
Food –> salivation
Food is the _______ and salivation is the________
food = unconditioned stimulus salivation = unconditioned response
Dog paired bell to food.
When bell presented by itself,
bell =?
salivating = ?
bell = conditioned stimulus salivating = conditioned response
List models of behavior change
- transtheoretical model = stages of change model
- self-efficacy model
- health belief model
What intervention technique does behavioral medicine teach/ rely on?
motivational interviewing
basic behavioral principles include… (list 5)
- behavioral antecedents
- behavioral consequences
- counter conditioning
- baseline measures
- reinforcement
behavioral antecedents
come before a behavior; trigger a behavior
behavioral consequences
after a behavior
reward or punishment
counter conditioning
replace the bad behavior with good behavior
baseline measures
- measure before you start a change plan
- how often you do the behavior trying to change
reinforcement
-immediate vs. delayed
-positive vs negative vs. punishment
schedule of reinforcement: intermittent or fixed
which type of reinforcement is more powerful
immediate reinforcement
“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
self efficacy model
4 factors that influence self efficacy
- mastery experience
- vicarious experience
- verbal persuasion
- somatic & emotional states
mastery experience
- self efficacy model
- providing opportunities for ppl to gain mastery on simple and difficult tasks helps develop self efficacy
What’s a good way to incorporate mastery experiences into behavior change?
build mastery experiences into change plan and build them up continually higher and closer to the goal
Vicarious experience
- self efficacy model
- observation of successes and failures of others who are similar
- ex: weight watchers
verbal persuasion
- self efficacy model
- persuaded verbally that they CAN do it
- like coaches, trainers
(vs. being told they CAN’T do it)
somatic & emotional states
- 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
Who developed the Health Belief Model and why?
- social psychologists
- find out why people would or wouldn’t use health services
What are the theoretical constructs of the Health Belief Model?
- Perceived Threat
- Perceived Benefits
- Perceived Barriers
- Cues to Action
- Self Efficacy
- Modifying Variables
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
2 parts of perceived threat
- perceived susceptibility
- opinion of chance of getting a condition/disease
- perceived seriousness
- opinion of seriousness of condition & its consequences
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
perceived barriers
- if you think there are barriers, you’re less likely to try
- one’s opinion of the cost to overcome the barriers
cues to action
triggers needed to activate readiness
-like dad getting dx’d with cancer
self efficacy
confidence in one’s ability to take action
modifying variables
culture, education, past experiences, skill, etc
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
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
Transtheoretical model =
stages of change model
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
What are the stages in the stages of change model?
- precontemplation
- contemplation
- preparation/planning
- action
- maintenance
- relapse
Patients will minimize or deny the existence of a problem behavior in which phase?
precontemplation
Process of change in pre contemplation stage:
- consciousness raising
- dramatic relief
- environmental evaluation
Goal of the Precontemplation stage?
to increase the patient’s willingness to contemplate the connection b/t behavioral health and physical health
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
Patient is thinking about the problem and the cost vs benefits of continuing with the problem vs trying to change in what stage
contemplation
process of change at contemplation stage
self evaluation
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
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
Patient experiences a sense of urgency at which stage of change?
preparation
process of change at preparation stage
self-liberation
goal at the preparation stage
encourage patients to set a date to start action on the problem
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
4 steps to enlisting the patient in the preparation stage
- share decision making about problem and treatment plan
- assess conviction & confidence to follow through
- identify barriers and problem-sove to remove/diminish them
- Agree on simple regimen and write it out
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
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
How to identify barriers and try to diminish them
what would get you from a 6 to a 7
how to agree on a simple regimen and write it out
- preprinted forms
- highlight specifics
- can pt. read?
- follow up and ask
patient makes daily efforts to overcome the problem in which stage?
action
process of change at action stage
- reinforcement management
- helping relationships
- counter conditioning
- stimulus control
goal at the action phase
to anticipate what might be needed to maintain initial changes in behavior
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
patient has overcome the problem and remains vigilant to backsliding at what stage
maintenance
process of change at maintenance stage
- reinforcement management
- helping relationships
- counter conditioning
- stimulus control
goal at maintenance stage
-emphasize that the new behavior can become an integral part of a more healthful and satisfying lifestyle
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
patient has gone back to the problem on a regular basis after a period of successful resolution..what stage is this?
relapse
process of change at relapse stage
depends where patient has fallen back to
-which stage did they fall back to?
goal of relapse phase
to assist patient in learning how to ANTICIPATE and CORRECT these vulnerabilities when patient takes action again
strategies at relapse stage
-dont get frustrated or judge patient
-IDENTIFY STAGE OF RELAPSE
-reframe relapse = valuable learning experience
-
individuals resist coercion, why?
this is why_____ doesn’t work
Motivated to maintain sense of autonomy, so “pushing” doesn’t work
it is better to build on a patient’s ________ to change vs. pushing them
self motivation
What is the goal of motivational interviewing?
-identify what maintains behaviors, including ambivalence to change, and support people in adopting new behaviors
motivational interviewing is _____ centered
client
5 principles of motivational interviewing
- express empathy
- avoid argument
- support self efficacy
- roll with resistance
- behaviors in opposition to desired change
- use reflection - develop discrepancy
- mixed feelings about change
- help pt. ID ambulance and move towards change
9 Strategies of Motivational Interviewing
- initiating change talk
- motivation ruler
- asking about extremes
- continuing change talk
- identifying ambivalence
- double-sided reflection
- discuss past success
- establish clear cut, specific goals
9 .create a plan with follow up
motivation ruler
why not a 1 or 2? how could we move up to 6 or 7
asking about extremes
best and worst possible outcomes
continuing change talk
ask for more detail, reflect pt’s thoughts
-encourage change talk to continue
double sided reflection
reflecting both sides of ambivalence
-on the one hand i hear you saying…
change is a process, not an ______
event
remember to use mostly_______
questions
