Behavior Change Models Flashcards
What is behavior change?
Reduction or elimination of destructive behaviors.
How are behavior changes achieved?
- Promotion of healthier lifestyles (exercise, safe sex, leisure activities, stress management, time management)
- Adherence to medical regimens (taking medications, check glucose, regular screenings)
What are the three models we have covered thus far?
- Transtheoretical Model/Stages of Change Model
- Self-efficacy Model
- Health Belief Model
Father of Classical Conditioning?
Pavlov
Father of Operant Conditioning?
Skinner
Define classical conditioning.
a learning process in which an innate response to a potent stimulus comes to be elicited in response to a previously neutral stimulus; this is achieved by repeated pairings of the neutral stimulus with the potent stimulus.
Define operant conditioning.
A learning process in which the likelihood of a specific behavior is increased or decreased through positive or negative reinforcement each time the behavior is exhibited, so that the subject comes to associate the pleasure or displeasure of the reinforcement with the behavior.
Define positive reinforcement. What is its effect on behavior?
Addition of an award following a positive behavior. Positive reinforcement increases the likelihood a behavior will be repeated.
Define negative reinforcement. What is its effect on behavior?
Removal of a noxious stimuli following a positive behavior. Negative reinforcement increases the likelihood a behavior will be repeated.
When should positive reinforcement/reward not be used?
Following an undesired behavior as it will reinforce the behavior and increase the likeliness it will occur again. Ex. child having a temper tantrum in a store and a mother buying him/her candy to try to calm them.
Define positive punishment. What is its effect on behavior?
Addition of a negative stimuli following an undesired behavior. Punishment serves to decrease unwanted behaviors. Ex. spanking a child after cursing
Define negative punishment. What is its effect on behavior?
Removal of a positive stimuli to decrease the likelihood of a behavior recurring. Ex. grounding a child for staying out too late
What are the different stimuli/responses associated with classical conditioning?
Unconditioned stimulus, unconditioned response, conditioned stimulus, conditioned response (always the same as unconditioned response)
Thomas has wet hands after washing them. He rubs them in the towel and the water is now removed from them. He knows that every time he doesn’t want his hands to remain wet he can use a towel to get rid of the water. He now uses a towel every time he wants to remove the water from his hands. What is this an example of?
Negative reinforcement. The water on his hands was present before he rubbed them in the towel. His behaviour of rubbing his hands in the towel removes the water and he uses a towel every time he wants this to happen. Therefore negative reinforcement is occurring.
Johnny comes running into his mother after being outside in the hot sun playing with his friends. He exclaims “I’m really thirsty! Can I have some coke please Mam?” His mother says “Of course you can Johnny!” and promptly gets a bottle of coke from the refrigerator and pours him a glass. He gulps it down. What is this an example of?
Positive reinforcement. In this example, Johnny had no coke but wanted some, his behaviour (asking for coke) led to him getting what he wanted. Johnny’s request for coke was positively reinforced by him being given some. By being given what he wanted he is also more likely to ask this question again at a later time when he is thirsty and so there will be an increased future frequency of that behaviour.
A toddler hits his baby brother. The toddler is not allowed to watch Sesame Street. What is this an example of?
Negative punishment.
A student talks back to her teacher. The student loses recess. What is this an example of?
Negative punishment.
A woman goes to work early so she doesn’t hit commuter traffic and arrive late. What is this an example of?
Negative reinforcement.
A child cleans up a messy table so that his mother doesn’t yell. What is this an example of?
Negative reinforcement.
Because you’re late to work one morning, you drive over the speed limit through a school zone. As a result, you get pulled over by a police officer and receive a ticket. What is this an example of?
Positive punishment.
Your cell phone rings in the middle of a class lecture, and you are scolded by your teacher for not turning your phone off prior to class. What is this an example of?
Positive punishment.
After you execute a turn during a skiing lesson, your instructor shouts out, “Great job!” What is this an example of?
Positive reinforcement.
The child initially showed no fear of a white rat, but after the presentation of the rat was paired repeatedly with loud, scary sounds, the child would cry when the rat was present. What is this an example of?
Classical Conditioning US: Loud noise UR: Fear CS: Seeing rat CR: Fear
Describe behavior antecedents.
A stimulus that cues an organism to perform a learned behavior. It comes before the behavior, triggering the behavior.
Describe behavioral consequences.
A stimulus that occurs after a behavior. Ex. reward/positive reinforcement, negative reinforcement, or punishment.
Counter conditioning
Replacing the bad behavior with a good behavior
What does your behavior baseline measure?
How often you participate in a behavior before you begin to change it. Take this measurement before attempting behavior change.
What is better… immediate or delayed reinforcement?
Immediate. If delayed the reinforcement must be large enough to be worth the behavior change.
Schedule of reinforcement… fixed or intermittent?
Fixed: good for learning new behaviors
Intermittent: good for maintaining new behaviors
What type of reinforcement works best for inducing behavior change and what type works best for maintaining learned behavior?
Negative reinforcement works best for inducing behavior change and positive reinforcement works best for maintaining learned behavior.
What idea is the self-efficacy model founded on?
People will do what they think they can do; they won’t do what they don’t think they can do
According to self-efficacy model, how will greater self-efficacy affect a behavior change?
Increased likelihood of change.
What is self-efficacy?
Belief in one’s own ability to successfully accomplish something.
What are four factors that influence self-efficacy?
- Mastery experience
- Verbal persuasion
- Vicarious experience
- Somatic & emotional states
What is a mastery experience? How does it affect self-efficacy?
When someone has been successful at doing something. It increases self-efficacy because the individual is more likely to think they can accomplish similar tasks.
How can you increase self-efficacy with a mastery experience?
Provide opportunities for people to feel successful on both simple and difficult tasks. Build these experiences into a behavior change plan and build on them as you move closer to goal.
Ex. Want pt to exercise more; ask them to walk 2x a week.
What is a vicarious experience?
Observation of the successes and failures of other who are similar to you.
Ex. Weight Watchers
What is verbal persuasion?
People are more likely to do a task when persuaded verbally that they can achieve it. People tend to give up more easily when they are told they can’t do something.
Ex. coaches & trainers
What is somatic and emotional states and how to they relate to self-efficacy?
States that occur when one contemplates doing something, they provide clues as to likelihood of success or failure.
Ex. stress, worry, anxiety, fear: negatively affect self-efficacy; improving emotional state can improve self-efficacy
Why was the health belief model developed?
To explain why people would or would not use health services.
What are the theoretical constructs of the health belief model?
- Perceived threat
- Perceived susceptibility
- Perceived severity and seriousness - Perceived benefits
- Perceived barriers
- Cues to action
- Self-efficacy
- Modifying variables
How do you create a behavior change using the health belief model?*
- cost benefit analysis (threats vs. benefits vs. barriers)
- cue to action
- self-efficacy/confidence to take action
What is perceived susceptibility?
One’s opinion of the chance of getting a disease/condition. It is a part of perceived threat. Ex. COPD in the future, have time to fix smoking habits later.
Health belief model.
What is perceived seriousness?
One’s opinion of the seriousness of a condition and its consequences. It is a part of perceived threat.
Ex. immediate adverse effects are taken more seriously than future adverse effects
Health belief model.
What are perceived benefits?
One’s opinion of the efficacy of the advised action to reduce risk… how advantageous is change going to be?
Health belief model.
What are perceived barriers?
One’s opinion of the cost to overcome the barriers, belief that one is capable.
What is the most important construct of the health belief model? This construct has the largest influence on whether a person changes behavior or not.
Perceived barriers.
What are cues to action and what model are they involved in?
Triggers needed to activate readiness to change. Health belief model. Normally these cues induce fear; sometimes they can be positive.
Ex. parent died of related disease to a negative behavior or wanting to be active enough to play with grandchildren
What is self-efficacy and how does it relate to the Health belief model?
Confidence in one’s ability to take action.
What are modifying variables? How do they affect health-behaviors?
Culture, education, past experiences, skill indirectly affect health-related behaviors by affecting perceived seriousness, susceptibility, benefits, and barriers.
Health belief model.
How many theoretical constructs make up the Health belief model?
6
What is another name for the transtheoretical model?
Stages of Change Model
Why is the transtheoretical model useful to healthcare providers?
- provides understanding when pt is not ready for change
- determine patient’s level of readiness
- match interventions to stage
- better prepare at-risk ppl for action
How many stages make up the transtheoretical model? What are they?
6; pre-contemplation, contemplation, preparation/planning, action, maintenance, relapse
Tell me some things you are doing to get or stay health? What do you think about your smoking? and, what are you doing to control your weight? Are all examples of…
Assessment of readiness
What is pre-contemplation?
When pt minimizes or dies the existence of problem behavior.
What is the goal of pre-contemplation?
to increase the pt willingness to contemplate the connection between behavioral and physical health.
What are the processes of change during the pre contemplation state of transtheoretical model?
- consciousness raising
- dramatic relief
- environmental evaulation
Asking permission to talk about the behavioral problem is a strategy of what stage of change?
Precontemplation
Explore patient’s awareness, is a strategy of what stage of change?
Precontemplation
Gently point out any discrepancies, is a strategy of what stage of change?
Precontemplation
Expressing concern that patient may not achieve the desired improvement without addressing behavior that contributes to it, is a strategy of what stage of change?
Precontemplation
Ask patient to think, talk, or read about the situation between visits, is a strategy of what stage of change?
Precontemplation
What is contemplation during stages of change?
pt is thinking about problem, assessing cost vs. benefits of continuing the problem behavior or changing it.
What processes of change are present during the contemplation stage of change?
self-evaluation
What is the goal of contemplation?
To help pt resolve their ambivalence to a point where they are enabled to commit to a specific plan and time table for taking action
During what stage of change do you hope to have your pt commit to a specific plan and time table for change?
contemplation
Asking pt’s perspective before offering advice is a strategy of what stage of change?
contemplation
identifying pro’s and con’s of change, is a strategy of what stage of change?
contemplation
Identifying obstacles and solutions, to consider making a commitment, is a strategy of what stage of change?
contemplation
Suggesting a trial run, is a strategy of what stage of change?
contemplation
What is preparation in relation to stages of change?
When a pt experiences a sense of urgency and commitment to change.
What processes of change are occurring during the preparation stage of change?
Self-liberation
What is the goal of the preparation stage of change?
To encourage the patient to set a start date to start action on the problem.
What is dramatic relief? What stage of change is it involved with?
the process in which the individual needs to experience and express his or her feelings and emotions relating to the problem behavior; pre contemplation
Ex. life events: death of loved one can trigger pre-contemplation stage
Summarize the patient’s specific reasons for change and their plan, is a strategy of what stage of change?
Preparation
Help them choose a specific approach and understand clearly the program they are to follow, including structured activities or referrals, is a strategy of what stage of change?
Preparation
Assess conviction and confidence, is a strategy of what stage of change?
Preparation
Reassurance, is a strategy of what stage of change?
Preparation
Follow-up, is a strategy of what stage of change?
Preparation
During what stage of change do you incorporate one of the four “E’s”? Which E is it?
Preparation; enlisting
What is the first step of enlisting a patient during preparation stage of change?
Sharing decision making about problem and Tx plan.
- one the pt can agree to follow
- explore the pros and cons of each
- agree on the best option for this patient
- tailor to individual habits and routines
What is the second step of enlisting a patient during preparation stage of change?
Assessing conviction and confidence to follow through.
How do you assess conviction; during what stage of change do you focus on this assessment?
Preparation; grading on a scale of 1-10, 10 being the hight, how convinced is the pt that they need to do this because it will help them?
How do you assess confidence? what stage of change do you focus on this assessment?
preparation; 0-10, 10 highest, how confident are you that you can carry out this plan?
What is the third step of enlisting a patient during preparation stage of change?
Identifying barriers and problem solve to remove or diminish them.
Ex. how do we get you from a 6 to a 7?
What is the forth step of enlisting a patient during preparation stage of change?
Agreeing on a simple regimen and writing it out.
- preprinted forms highlighting specifics
- be sure pt can read
- always F/U and ask about it
What is the action stage of change?
Pt. makes daily effort to overcome their problem.
What processes of change are occurring during Action stage of change?
- Reinforcement management
- helping relationships
- counter-conditioning
- stimulus control
What is the goal of the Action stage of change?
Anticipate what might be needed to maintain the initial changes in behavior.
Ask how the efforts are going and how patient is doing?, is a strategy of which stage of change?
Action
Reinforce the efforts at change, is a strategy of which stage of change?
Action
Help modify action plan if not working well, is a strategy of which stage of change?
Action
Give helpful suggestions to reduce the risk of early relapse, is a strategy of which stage of change?
Action
Arrange additional follow-up contacts for support, is a strategy of which stage of change?
Action
What is involved in the maintenance stage of change?
The pt has overcome the problem and remains vigilant to prevent backsliding.
What processes of change are occurring during the maintenance stage of change?
- Reinforcement management
- Helping relationships
- Counter-conditioning
- Stimulus control
What is the goal of the maintenance stage of change?
To emphasize that the new behavior can become an integral part of more healthy and satisfying lifestyle.
Inquire about how well patient is maintaining the improvements made in Action stage, is a strategy of which stage of change?
Maintenance
Show support and admiration, is a strategy of which stage of change?
Maintenance
Ask about slips that have occurred and how patient has responded, is a strategy of which stage of change?
Maintenance
Ask what patient has learned so far about the change process, is a strategy of which stage of change?
Maintenance
Discuss this as a long-term or permanent change, is a strategy of which stage of change?
Maintenance
What is the relapse stage of change defined as?
Pt going back to the problem on a regular basis after a period of successful resolution.
What is the process of change during the relapse stage of change?
Depends on which stage the patient fell back into.
What is the goal of the relapse stage of change?
To assist the pt in learning how to anticipate and correct these vulnerabilities when patient takes action again.
Manage your own frustration and don’t leave the patient judged and ashamed, is a strategy of which stage of change?
Relapse
Identify which stage patient has relapsed to, is a strategy of which stage of change?
Relapse
Ask the patient to describe exactly how the initial success was achieved and how the slips led to a full blown relapse, is a strategy of which stage of change?
Relapse
Reframe relapse—a valuable learning experience, is a strategy of which stage of change?
Relapse
“What next step will enable you to move again toward change?”, is a strategy of which stage of change?
Relapse
T/F: change is an event.
F; it is a process.
Why does the “pushing” method of interviewing not work to instill behavioral changes?
Individuals resist coercion and are motivated to maintain a sense of autonomy. It is best to build on a pt’s self-motivation to elicit change.
What is the motivational interview entail?
empathy, curiosity, acceptance, praise, expects and explores ambivalences about change, and uses pulling behaviors rather than pushing behaviors; client-centered approach
What is the goal of motivational interviewing?
identify what maintains behaviors, ambivalences to change, and support people in adopting new behaviors
What are the 5 principles of motivational interviewing?
- Empathy
- No arguing
- Support self-efficacy (the belief they can do it)
- Roll with resistance (behaviors in opposition to desired change)
- Develop discrepancy
What is one method for rolling with resistance during motivational interviewing?
using reflection
What is a discrepancy?
mixed feelings about a change’
How do you develop a discrepancy?
by helping pt to recognize ambivalence and head towards a change
What are the first 4 strategies of motivational interviewing?
- initiating change talk
- motivation ruler
- asking about extremes
- continuing change talk
What are the last 5 strategies of motivational interviewing?
- Identifying ambivalence/barriers
- Double-sided reflection
- Discuss past successes
- Establish clear cut, specific goals
- create a plan, with F/U
What is change talk?
pt talking positively about changes they want to make
What is the motivation ruler?
Asking about low scores regarding confidence and conviction; and how to increase them.
What are examples of asking about extremes relating to motivational interviewing?
- If you continue smoking, what is the worst thing that could happen in next 5 years?
- what is the best possible outcome for you?
How do you continue change talk?
- Ask for more details
2. Reflect pt thoughts
What is double-sided reflection regarding motivational interviewing?
reflecting both side of the ambivalence
What is important to include in clear cut, specific goals during motivational interviewing?
A plan to overcome barriers.
