Ch 3 - Behavior Change TTM

Question 1

What is the Transtheoretical Model?

Answer 1

A model of how individuals make intentional changes in behavior

People who are successful at self-change were found to follow a predictable course through stages of change

Each stage requires a different approach to change

The process is not linear. Most people making change slip up at some point returning to contemplation or even precontemplation. Most successful changers go through the states 3 or 4 times before they make it to the maintenance stage for good.

Developed by Prochaska and Diclemente.

From his research on behavior change in smoking cessation, exercise adoption, and diet and other areas

Question 2

List the 5 stages of change?

Answer 2

Precontemplation (I won't or I can't)
Contemplation (I may)
Preparation (I will)
Action (I am)
Maintenance (I still am)

Question 3

What attitude to change is common for someone in the “I won’t” precontemplation stage for a behavior.

Answer 3

They are not thinking about making a change in this behavior.

They are not interested in making a change because they don’t think they have a problem.

They are resistant to change and they may also deny they have a problem.

Question 4

What attitude to change is common for someone in the “I can’t” precontemplation stage?

Answer 4

They are aware of the problem and the need to change but they believe that change is too difficult or too complicated.

They would like to make a change but they don’t think it is possible.

They are not thinking about making a behavior change in the next 6 months.

Question 5

What attitude to change is common for someone in the contemplation (I may) stage?

Answer 5

They are thinking about making a change in this behavior in the next 6 months.

They may be ambivalent and may think success will be difficult

Their cons may still out weigh their pros

They are more aware of the benefits of making a change and less satisfied with their present health and well-being than the precontemplators

They may not have identified a compelling reason to change

They are unaware of their barriers and have not thought of any possible solutions

They lack self-efficacy for this change

Question 6

What attitude to change is common for people in the preparation (I will) stage of change?

Answer 6

They are planning to start doing the behavior in the next 30 days and some type of action has been attempted.

Ambivalent feelings have been largely overcome

They have a strong motivator

They know what their barriers are and have come up with some possible solutions

During this stage clients experiment with their possible solutions, discard the ones that do not work, and think up new approaches

Question 7

What attitude to change is common for a person in the action (I am) stage of change?

Answer 7

They have begun doing the behavior and are building up to a target level (they have sustained it for less than 6 months).

They have fully taken action and are doing healthy behaviors.

Lapses are possible in this stage.

Gradual change leads to permanent change.

Heart of coaching program is focused on areas where client is in action stage.

Question 8

What attitude is common for a person in the maintenance stage of change?

Answer 8

The person has begun doing the behavior and has maintained it longer than 6 months.

The client is confident they can maintain the behavior and rates their confidence at a level 8 or 9 out of 10

Self-efficacy is high and self-reinforcing

Risks in this stage are boredom and slipping back into old, less-healthful habits

During this stage clients may lapse temporarily and then return to the behavior.

A relapse is the abandonment of a new behavior.

Question 9

A client who is not thinking about making a change is in which stage?

Answer 9

precontemplation

Question 10

A person who is thinking about making a change in the next 6 months are in which stage of change?

Answer 10

contemplation

Question 11

A person who is thinking about making a change in the next 30 days are in which stage of change?

Answer 11

preparation

Question 12

A person who has begun doing a new behavior and has maintained it for less than 6 months is in which stage of change?

Answer 12

action

Question 13

A person who has begun doing a new behavior and maintained it for longer than 6 months is in which stage of change?

Answer 13

maintenance

Question 14

Why is it important to identify the stage of change a client is in for a particular behavior?

Answer 14

Clients may be in a different stage of change for each behavior.

The stage of change that a client is in for a behavior determines which coaching skills should be used.

Question 15

What stage of change will most coaching clients be in?

Answer 15

Contemplation and/or preparation
For at least one area

Coaching can help them reach the maintenance stage for within 3 to 6 month

Question 16

What is a lapse and what stage does it usually occur in?

Answer 16

A lapse is a temporary abandonment of a behavior with a quick return to it.

It does not lead to a significant alteration in the health and fitness benefits of the behavior change because the return to the behavior is quick

Also defined as a single slip in a desired behavior that may or may not lead to a relapse.

A lapse can occur in the action stage or the maintenance stage.

Question 17

What is a relapse and what stage does it usually occur in?

Answer 17

Relapses are extended abandonments of new behaviors

leads to a reduction or disappearance of benefits.

a return to an earlier stage of change.

It is most common in the maintenance stage.

To reverse a relapse it is important to explore what happened and then to return to the preparation and action stages.

Question 18

In which stage is the risk of lapse and relapse back to preparation high? What should be done to prevent this?

Answer 18

In the action stage.

It is important for the client to develop strategies for coping with potential challenging situations. (called a relapse prevention plan).

Question 19

How can a coach help a client overcome a lapse?

Answer 19

Help them set new goals to get refocused.

They may need to identify a new motivator or try something new

Question 20

How can a coach help a client overcome a relapse?

Answer 20

Help the client reconnect with their strengths, values, resources, vision, goals, and motivators

Restart the preparation and action stages with judgment-free listening, inquiries, and reflections

Question 21

What is a chronic contemplator?

Answer 21

Someone who is stuck in the contemplation stage. They are still weighing the benefits of change against the effort it will take (their pros don’t out weigh their cons).

Or they cannot imagine themselves behaving differently or they do not know how to change.

Question 22

True or False: Coaches should never work with clients in the precontemplation stage?

Answer 22

False
Coaches may be able to help clients move forward in areas where they are precontemplators when openings emerge in the coaching conversation

As people make changes, they develop more self-efficacy and may then be ready to move forward on behaviors where they were previously in the precontemplation stage

Question 23

What are some strategies you would use to help a client in the precontemplation “I won’t” stage get ready to take action?

Answer 23

Show empathy: use reflections to show that you understand and respect their feelings and needs.

No judgment

Communicate “I understand that you are not ready to make a change right now. That is fine. Here is how you can contact me if you decide at some point that you are ready.”

Question 24

What coaching strategies are used in the “I won’t” precontemplation stage?

Answer 24

Express empathy
Connect with positive core (AI)
Don’t judge; Understand and respect their feelings and needs
Let them know how to contact you when ready to change

Question 25

What coaching strategies are used in the “I can’t” precontemplation stage?

Answer 25

Sort barriers: help them to look at the barriers in a positive and rational way so they can learn from them rather than being overwhelmed by the negative emotions generated by past failures.


Express empathy
Connect with their positive core
Help them sort barriers
Decrease emotional response and increase rational response

Question 26

What coaching strategies are used in the contemplation stage?

Answer 26

Explore their best experiences with change in the past
Explore their positive reasons for doing a behavior in the future
Focus on their values and vision so they can appreciate how change would improve their life.
Share scientific facts about the benefits of a behavior
Assist clients to discover pros that might serve as positive and powerful motivators for change

Express empathy
Connect to positive core
Identify pros (compelling reasons to change)
Connect with others who have successfully made the same change
Identify barriers and possible solutions
Develop small cognitive (thinking and feeling) goals (getting information, thinking about or clarifying feelings, not doing a behavior)

Question 27

What coaching strategies are used in the preparation stage?

Answer 27

• Help clients to concretize their plans for change: write down a statement of what they are committing to

Brainstorm and identify small steps they can take that are actionable and realistic

Help clients to think through potential problem situations and to develop coping strategies they can use when the situation arises
 • Connect with positive core
  
  • Identify pros (compelling motivators to change)
  • Examine barriers or challenges
  • Brainstorm possible solutions to challenges (including coping strategies in anticipation of problem)
  • Make commitment
  • Identify and record achievable short-term goals
  • Encourage joining of groups that will supply positive norms
  • Enlist support from others
  • Design other forms of environmental support (information systems, physical environment, financial plans)

Question 28

What coaching strategies are used in the action stage?

Answer 28

• Connect with positive core
  
  • Develop relapse prevention plans
  • Commitment: Write down formal statements of commitment
  • Substitution: substitute healthier behaviors for old less healthy behaviors
  • Cues: identify achievable short term goals and post them
  • Rewards: create goals to provide quick wins, positive steps
  • Social support: enlist support from family, friends, and colleagues
  • Social Norms: encourage joining of groups that will supply a positive group norm
  • Environmental support: design other forms of environmental support (information systems, physical habitats, financial plans)

Question 29

What coaching strategies are used in the maintenance stage?

Answer 29

• Connect to positive core
  
  • Rewards: appreciate the intrinsic value of continuing to achieve goals and maintain behaviors
  • Lapse recognition: encourage early recognition of lapses and develop strategies for challenging situations
  • Substitution: substitute a new motivator or behavior for one client is becoming bored with
  • Role modeling: encourage person to assist someone else who may want to start living a healthier life
  • Social support: establish social support mechanisms

Question 30

What are some examples of weekly goals that someone in the contemplation stage might set?

Answer 30

Small cognitive, thinking and feeling, goals

These may involve reading, thinking, talking, listening, discovering, and deciding

They do not including action goals or doing a behavior

Question 31

What are some examples of weekly goals that someone in the preparation stage might set?

Answer 31

Small actions that are realistic and will give the client quick successes to help build their self-efficacy

Question 32

To move from the contemplation to the preparation stage what steps must a client complete?

Answer 32

1. Identifying strong motivators
   
   2. Understanding their challenges
   3. Identifying possible solutions.

Question 33

What are the early and late stages of change and what is the key difference between them?

Answer 33

The early stages are 
Precontemplation
Contemplation

The late stages are 
Preparation
Action
Maintenance

Goals in the early stages focus on cognitive tasks (thinking, feeling, goals)

Goals in the late stages focus on action steps

Question 34

What are the three key things needed for to move from the early stages of change to the late stages of change?

Answer 34

To move from contemplation to action the client must 1. Idenfity their motivators (personally compelling reasons to change)

2. Understand their challenges
3. Think of some strategies to work around their challenges

Question 35

True or False: We want clients to tell us (rather than for you to tell them) what stage of readiness they are in.

Answer 35

True

Question 36

What is the optimal time frame initially set for coaching?

Answer 36

A 3- to 6- month coaching program of weekly, bi-weekly, or monthly coaching sessions is usually ideal for most clients to establish new behaviors or habits.

Most clients who come to coaching are in the contemplation or preparation stages of change

Helping clients move from early stages of change to the maintenance stage can take from 3 to 6 months or longer. If the behavior is more challenging, 12 months may be required to help the client reach the maintenance stage.

Question 37

What is decisional balance?

Answer 37

Helping the client identify their pros and cons for their behavior change.

Important when the client feels ambivalence about making a change

Pros: gains for self or others, approval from others and self
Cons: losses for self or others, disapproval of others or self

Question 38

What three questions can coaches ask when people are ambivalent about making a behavior change?

Answer 38

1 Why do I want to try and change the behavior? (Pros)

2 Why shouldn’t I try to change the behavior? (Cons)

3 What would it take for me to change the behavior ?(What’s my strategy to overcome my cons?)

Question 39

What is the optimal ratio of pros and cons for someone to do a new behavior successfully?

Answer 39

Pros have to outweigh the cons for someone to successfully make a behavior change

It is important for people in the early-stages of change to find a personally relevant, specific and positive pros or motivators and to honestly sort out their cons

Question 40

What is self-efficacy?

Answer 40

The belief that one has the capability to initiate or sustain a desired behavior.

Question 41

How does self-efficacy impact behavior change?

Answer 41

The more you believe you can do something, the more likely you will do it; the more you do something successfully, the more you believe that you will be able to do it again. (opposite is also true)

As a coach it is important to help clients set appropriate goals that they can succeed at.

Question 42

To help client’s increase their self-efficacy, it is important to help them set appropriate goals that they can succeed at. How can the coach determine if the goal is appropriate for the client at this time?

Answer 42

After the client sets a weekly goal, ask them: “On a scale of 0 to 10, how confident are you that you will be able to accomplish this goals this week?

If they answer a 7 or above you can be reasonable confident that the client will succeed.

Question 43

To be reasonably confident that the client will achieve their weekly goal, what score would you like to see on their confidence ruler?

Answer 43

A 7 or above.

If the score is lower, you may want to ask the client what it would take to increase their confidence to a 7 or above. They may want to modify the goal to increase their confidence level.

Question 44

Why is it important not to “over-promise and under-deliver” when helping a client to increase their self-efficacy.

Answer 44

The relationship between self-efficacy and successful action is circular.

Successful goal achievement increases self-efficacy, which makes it more likely they will continue to be successful

And lack of success decreases self-efficacy, which reduces the chance of future success.

Question 45

What are the processes of change?

Answer 45

Prochaska and his colleagues identified the process of change that worked best for people in each stage of change. 

10 Total
5 Cognitive
5 Behavioral

Question 46

List the 5 cognitive processes that promote behavior change.

Answer 46

The 5 cognitive process are
Getting information: finding out about the benefits of doing a behavior

Being moved emotionally: using positive feelings about the benefit of change to ignite motivation

Considering how your behavior affects others

Self-image: seeking congruence between one’s vision, values, and behaviors to enhance integrity

Social Norms: connecting with like minded people who are working on the same behavior

Question 47

List the 5 behavioral processes that promote behavior change.

Answer 47

The 5 behavioral processes are

Making a commitment: writing down exactly what new behavior will be done and when

Using cues: designing environmental reminders to do what is planned

Using substitution: replacing an old unhealthy behavior with a new health-promoting behavior

Social Support: recruiting family and friends to provide support with your behavior change

Rewards: setting up ways to reward yourself for completing your weekly goals

Question 48

Define operant conditioning.

Answer 48

Learning through positive and negative reinforcement. It takes place when an instance of spontaneous behavior is either reinforced or discouraged by its consequences.

Successful operant conditioning looks for the antecedent conditions that may trigger an undesired behavior.

Question 49

Give an example of an antecedent condition.

Answer 49

An antecedent condition is something that may trigger an undesired behavior

Examples: 
A long drive to get to the gym
Driving by a favorite ice cream shop
A stressful day
Negative self-talk

For example: Missing breakfast leads to overeating at lunch, which leads to feelings of guild, which leads to irritability, which leads to abandonment of any improved eating habits for the day with the end result an ice cream binge after dinner.

Question 50

How can coaches help their clients with antecedent conditions?

Answer 50

When a behavior chain is identified, they can assist the client with altering a behavior earlier in the chain.

It is often easier to manipulate the antecedents than to modify the consequences or behaviors.

Question 51

What is the mount lasting change pyramid?

Answer 51

The behavior change pyramid provides a guide to what it takes to make lasting changes in behavior, self-awareness, and self-image.

The pyramid has 15 building blocks that take the client to the top - being their best self

Question 52

How many blocks in the Mount Lasting Change Pyramid are about cognitive matters? Why is this important?

Answer 52

13 out of 15

If we prematurely jump into action (the third level of the mountain) we proceed on a shaky foundation.

Question 53

What are the 15 blocks in the Mount Lasting Change Pyramid?

Answer 53

Vision (base level: foundation for change)
Self-awareness and responsibility
Strengths
Values
Benefits and Information
Challenges and Strategies

Preparation Level
Confidence
Commitment
Support
Plan

Action Level
Behavioral steps
Problem Solving
Rewards

Results
Lasting Change
Relapse Prevention

The Real Me
Best Self

Question 54

How does the Mount Lasting Change Pyramid help a client reach their best self?

Answer 54

It helps them see and understand all of the steps and processes that are involved in making a change.

Question 55

How can you tell if your client has developed internal motivation?

Answer 55

They can honestly say “I am doing this because it will help me feel good and feel good about myself”

Question 56

Why is it important to help client develop their internal motivation and focus less on external motivation?

Answer 56

When client’s focus on external motivation (making a change because someone else wants them to) it can lead to guilt, frustration, anger and quitting.

Question 57

How should the coach deal with the client’s ambivalence to change?

Answer 57

Feeling ambivalence is a normal part of change.

If not addressed, it can inhibit a client’s motivation to change.

The coach can help the client accept their ambivalence and to work their way through it rather than to fight it.

Ambivalence does not need to be completely resolved for clients to get started and be successful with change.

Question 58

True or false: A client’s ambivalence must be completely resolved before they can get started with change?

Answer 58

False.
Ambivalence does not need to be completely resolved for clients to get started and be successful with change.

Question 59

What should the coach do if after 3 to 4 weeks the client has not made any progress on their goals?

Answer 59

If the goals are realistic, it may be time to honestly question whether the client is truly committed to those goals.

The client may want to change their goals or their approach.