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Lifestyle Medicine > Fundamentals of behavioral health change > Flashcards

Fundamentals of behavioral health change Flashcards

1
Q

what is the health belief model?

A

a theoretical model that proposes that personal beliefs or perceptions mostly influence health behavior. The HBM explains that before seeking preventive measures or adopting a specific health behavior, people must believe there is a threat to their health and that there is a preventive measure that is accessible and low risk.

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2
Q

What is the social learning theory?

A

social learning theory assumes that learning occurs by observing the behaviors of another person and the consequences of that behavior.

this model suggests that patients are more inclined to replicate the behaviors of someone with whom they identify, or in whom they see similarities.

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3
Q

What is the social cognitive theory?

A

this theory evolved from the social learning theory. this theory explains that behavior does not occur in isolation but is a product of the influence that personal factors, environment, and human behavior exert on one another.
creditable role models are important in producing behavior change in a population.

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4
Q

Transtheoretical model

A

originally developed to help patients with smoking cessation. Describes the process of change for other health behaviors. Recognizes that behavior change is a process that unfolds over time through a series of stages in which different interventions are more effective.
behavior change is individualized, non-linear process.

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5
Q

What are the stages of change?

A

precontemplation
contemplation
preparation
action
maintenance
termination

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6
Q

Precontemplation stage

A

the patient is not ready for change and does not intend to take action in the foreseeable future

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7
Q

contemplation

A

patient is considering making a change in the next 6 months

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8
Q

preparation

A

patient has determined that behavior change is beneficial and intends to take action within the next month

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9
Q

maintenance phase

A

patient has sustained the health behavior change for at least 6 months without relapse.

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10
Q

termination phase

A

patient is no longer tempted to return to their old unhealthy behavior. a general guide would be if the patient has followed the behavior change for 5 years without relapse

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11
Q

What is the self determination theory?

A

focuses on the belied that individuals are naturally motivated to pursue activities and goals in which they are interested or form which they believe they will obtain some benefit.

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12
Q

What are the 3 primary psychological needs that influence motivation?

A

autonomy
competence
relatedness

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13
Q

What techniques should providers use when addressing patients in the precontemplation stage?

A

listen, open ended questions, reflection

Ex of patient statements in this phase, i dont need to change, i cant change, i wont change

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14
Q

What techniques should providers use when addressing patients in the contemplation stage?

A

Weighing the pros and cons.
should not be rushed into action without preparation
needs time to discuss motivation, strengths, barriers, challenges and strategies.
“I may change”

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15
Q

What techniques should providers use when addressing patients in the preparation stage?

A

aware they need to make a change
the pros for making the change outweigh the cons
needs goals to be specific and clear
“i will change”

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16
Q

What techniques should providers use when addressing patients in the action stage?

A

started making changes but has not yet hit a target goal.
needs supportive resources
successes should be celebrated
“I am changing”

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17
Q

What techniques should providers use when addressing patients in the maintenance stage?

A

goal behavior is achieved
should be encouraged to reconnect to their reason for behavior change and continue to set specific and clear goals.
“I have been doing this for years now, even through many difficult personal challenges”

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18
Q

What techniques should providers use when addressing patients in the termination stage?

A

no temptation to return to previous unhealthy behavior
“ I wont return to my old habit.”

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19
Q

if the patient is not yet considering making a change what should you do?

A

they are in the precontemplation phase.
provide information about diseases, risks associated with maintaining the status quo, and benefits of healthy behavior.

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20
Q

If the patient is considering making a change what should you do?

A

ask if they are considering making a change in the next month or before their next visit. if they say no they are in the contemplation stage
encourage them to evaluate the benefits of the change and the perceive barriers.

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21
Q

if a patient is in the preparation stage what should you do?

A

co-create an action plan
ask the patient to write it down
assess the patient’s confidence level
make a note of it in the chart
schedule and perform follow-up

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22
Q

what should you do if the patient is in the action phase?

A

be aware that that they are extremely vulnerable to relapse
structure a plan with the patient
problem solve through obstacles
reframe unhealthy thought patterns using cognitive behavioral techniques
establish systems of accountability and self- monitoring
enlist help from social support

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23
Q

define the coach role in behavior change

A

using collaborative communication style that positions patients as leaders and collaborators in the direction of their own care

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24
Q

define the expert role

A

conducting medical assessments, making specific recommendations and prescribing treatments.

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25
Q

Strategies to foster self-motivation and self-confidence in patients

A

hold on to the possibility that the patient can commit to change and master change.
clear one’s mind of “noise” in order to listen to the patient with full attention
be empathetic and adopt a warm, caring, accepting, open and compassionate attitude.
focus on and affirm the positive thoughts as much as possible.
share personal or other anonymous examples that would be beneficial to the patient
encourage the patient to take charge, decide on and commit to a wellness plan
view obstacles and setbacks as necessary parts of the path to change
look for learning moments.

26
Q

what does the SMART acronym stand for with goal setting?

A

specific
measurable
attainable
relevant
timebound

27
Q

what should you do at a follow-up visit after you created an action plan?

A

1.reiterate the provider’s role in supporting the patient’s efforts to improve health and work on the action plan.
2. review and update the diagnosis and lifestyle recommendations
3. revie the patient’s action plan from the prior visit
4.listen intently, reflect, and summarize to show understanding
5. use positive psychology and affirm the patient’s strengths and any progress made
6. summarize and clarify the new goals just like the initial goal: create a new action plan

28
Q

what is the definition of motivational interviewing?

A

defined as a collaborative, goal oriented style of communication with particular attention to the language of change. It is designed to strengthen the personal motivation for and commitment to a specific goal

29
Q

what stages is MI most helpful in?

A

precontemplation
contemplation

30
Q

what are the 4 general principles of MI?

A

Express empathy and show an understanding of the patient and their situation.
support self efficacy
roll with resistance
discuss the discrepancy btwn where the patient is and what the patient wants

31
Q

what are the 4 core skills of MI, also known as OARS?

A
  1. Open ended questions
  2. affirmations
  3. reflections
  4. summaries
32
Q

what is cognitive behavioral therapy?

A

based on theory that the way individuals perceive a situation is more closely connected to their reaction than the situation itself. an individual’s perceptions are often distorted and unhelpful, particular when they are distressed.

33
Q

what stages are CBT most helpful in?

A

preparation
action
maintenance stages

34
Q

What are basic principles of CBT that all providers can apply?

A

recognizing and reframing nonproductive thinking, building awareness of underlying beliefs and emotions, and working through the “ABCDE” method

35
Q

what are examples of the 10 most common cognitive distortions and reframed thoughts?

A

all or none thinking
overgeneralization
mental filter
mind reading
fortune telling
magnification/minimization
personalization and blame
emotional reasoning
labeling/mislabeling
disqualifying the positive

36
Q

What does ABCDE stand for to counter unproductive thoughts?

A

what ACTION event occurred?
what BELIEFS do you have about what happened?
what are the CONSEQUENCES of those beliefs?
how can you DISPUTE those beliefs that seem to be distorted or unhealthy?
what EFFCT does this new way of thinking have on how you feel and how you will move forward?

37
Q

What are the elements of PERMA in positive psychology?

A

P: positive emotion
E: engagement
positive Relationships
M: meaning
E: Accomplishment

38
Q

What is a gratitude journal?

A

This helps with positive emotions
patients write down 3 things each day that went well and why. This helps them connect to the sources of the positive outcome, including their internal resources, and builds hope for future positive consequences

39
Q

What is a “flow” experience?

A

this comes from strengths and talents leading to flow, which is complete involvement in an activity and doing it for its own sake.

40
Q

What has the greatest impact on one’s satisfaction with life?

A

positive relationships. particularly relationships that include authenticity, empathy, and positive regard.

41
Q

In which areas of lifestyle medicine do you see the most consistent effects of health and wellness coaching?

A

exercise and nutrition behavior

42
Q

How many hours of empathy skills can result in positive effects on the consultation process and the patient’s perception of the provider’s attentiveness

A

10 hours can achieve similar empathy results in providers as those who had longer training on empathy.

43
Q

How do provider empathy scores impact patient’s A1Cs?

A

providers with higher empathy scores are more likely to support good a1c control compared to low empathy skills

44
Q

What can behavior change coaching lead to/ have an impact on?

A

lowers BMI, weight. reduces binge eating
lowers a1c
leads to smoking cessation

45
Q

what type of reflection questions are there?

A

simple reflections
amplified
double-sided

46
Q

what is a simplified reflection?

A

paraphrases or restatement of what the patient has said without added opinion or interpretion.

47
Q

what is an amplified reflection

A

provider an accurate, direct, and more exaggerated form of the patient’s words to evoke statements of the desired change

48
Q

what is a double sided reflecion?

A

these are reflections that reveal more than one perspective at the same time.

49
Q

What can positive emotions do?

A

the improve attention, open-mindedness, creativity, and the ability to reach a strategic perscpective

50
Q

How can positive psychology principles be utilized in all stages of change?

A

pre-contemplation- focus on the areas where the patient is ready to make a change
contemplation: examine the patient’s strengths and motivations to change
preparation: explore past success stories
action: celebrate successes
maintenance: reconnect goals to the patient’s meaning and purpose

51
Q

what is the definition of a lifestyle perscription?

A

prescriptions are brief, clear instructions for care or treatment pertaining to an individual patient

52
Q

What is the difference btwn an lifestyle medicine prescription vs action plan?

A

In an action plan a lifestyle medicine prescription is adjusted and personalized for the patient’s ability, readiness, and confidence

53
Q

What is the step by step collaboration with the patient for developing the action plan?

A
  1. explain your role as “expert” and “coach” and agree on an agenda as part of collaborative care.
  2. share diagnoses and potential outcomes if no lifestyle or conventional medical treatments are initiated.
  3. describe the lifestyle prescription and potential outcomes when lifestyle behaviors are mastered.
  4. identify current areas of progress and use positive psychology to support and encourage the patient’s changes and progress.
  5. identify new areas for action
  6. discuss success strategies
  7. set specific behavioral or learning goals.
54
Q

What does a relapse prevention plan address?

A

when a lapse might occur?
under what circumstances a lapse might occur?
with whom?
how does one notice a lapse before it becomes a relapse?
who to turn to during a lapse? relapse?

55
Q

why should providers practice mindfulness?

A

to increase awareness, positivity and creativity

56
Q

What are the factors that support sustained behavior change?

A

develop growth promoting relationships
actions should be fueled by the patient’s own motivation
build patient confidence in trying new behaviors
have a clear plan of action

57
Q

what is the righting reflex?

A

attempts to use an expert stance to urge patients into change. Such challenges are likely to evoke a self-defensive reaction rather than further discussion about the possibility of change.

58
Q

what are the central tenet of social cognitive theroy?

A

Mastery experiences are a central tenet of Social Cognitive Theory (SCT)

59
Q

what does the patient do in the preparation stage for change?

A

the patient realizes a change is beneficial, begins preparing to make the change and plans to begin the new behavior within the next 30 days.

60
Q

Social determinants of health account for what percentage of health outcomes?

A

30-50%

61
Q

What is important to sustaining behavior change?

A

Supportive relationships, internal motivation, improved self-efficacy, clear plan of action

62
Q

what are cues to action?

A

cues to action are events or stimuli that prompt a patient to change their behavior. Examples of cues to action may include but are not limited to mass media content, social marketing, and health education.

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