Lecture 2: Behavior Change/Counseling for Change

Question 1

What are the six stages from the Transtheoretical Model and Stages of Change?

Answer 1

1. Precontemplation (not ready)
2. Contemplation (getting ready)
3. Preparation (ready)
4. Action
5. Maintenance
6. Relapse (a natural and expected stage of change)

Question 2

What are the components of the Elicit-Provide-Elicit technique used to assess a pt’s knowledge between behaviors and health conditions?

Answer 2

Elicit: Find out what pt already knows by asking him/her directly (i.e., “I’m curious about what you already know about reducing your risk of coronary heart disease. Do you mind telling me?”

Provide: Fill in gaps and/or correct any misconceptions the pt may have (i.e., “You are exactly right about diet and exercise playing a big part, even though it can be hard. I’d like to add how important medications can be.”)

Elicit: Find out what this information means to the patient’s life (i.e., “Of everything we just mentioned, what is the biggest challenge for you? What could help you in this area?”

Question 3

Motivational interviwing is a directive, client centered counseling style for eliciting behvaior change by helping client explore and resolve what?

Answer 3

Ambivalence = state of having mixed feeling or contradictory ideas

Question 4

With motivational interviewing who determines the treatment plan?

Answer 4

The client

Question 5

What does it mean to develop discrepancy with the client during motivational interviewing?

How does this help a pt realize their goals?

Answer 5

• Change is motivated by perceived discrepancy between present behavior and important personal values and goals.
• Pts are more motivated by what they hear themselves say than what a physician says
• The pt, rather than physician, should provide arguments for change

Question 6

During motivational interviewing how should the doc approach resistance from patient?

What does resistance signal?

Why does resistance imply a relationship?

Answer 6

• Roll with resistance = avoid arguing and invite their perspective
• Resistance is a signal to respond differently!
• Resistance is something that occurs only within te context of a relationship

Question 7

In the Transtheoretical Model and Stages of Change what is consciousness raising?

Answer 7

Provide info, point out benefits of changing behavior, cons of sticking w/ behavior

Question 8

In the Transtheoretical Model and Stages of Change what is dramatic relief?

Answer 8

Pay attention to feelings

Question 9

In the Transtheoretical Model and Stages of Change what is self-reevaluation?

Answer 9

Creates a new self-identity

Question 10

In the Transtheoretical Model and Stages of Change what is enviornmental reevaluation?

Answer 10

Identify your effect on others

Question 11

In the Transtheoretical Model and Stages of Change what is social liberation vs. self-liberation?

Answer 11

- Social = notice social support

- Self = make a commitment

Question 12

In the Transtheoretical Model and Stages of Change what is counter conditioning?

Answer 12

Use substitutes

Question 13

In the Transtheoretical Model and Stages of Change what is reinforcement management?

Answer 13

Use rewards

Question 14

In the Transtheoretical Model and Stages of Change what is stimulus control?

Answer 14

Manage your enviornment

Question 15

In behavioral counseling for change what are the 5 A’s?

Answer 15

1. Assess = ask about factors affecting choice of behavior change goals/methods
2. Advise = give clear, specific, personalized behavior change advice and information
3. Agree = collaboratively select appropriate tx goals and methods based on pt’s interest in and willingness to change behavior
4. Assist = counsel, prescribe, support
5. Arrange = schedule follow-up to provide ongoing assistance