Nutritional Counseling for Behavioral Change

Question 1

Stages of change (7) and example responses from patients in those stages

Answer 1

1. Pre-contemplative
2. Contemplative
3. Planning
4. Action
5. Maintenance
6. Relapse
7. Identification

Question 2

Utility of “stages of change” model in clinical practice

Answer 2

• Individuals go through sequential steps in thinking before making a behavior change
• Avoid temptation as provider to give advice
• Encourage person to talk about what they are doing and why
• Consider what they might do differently
• Lets patient do most of the talking
• Patients can be in different stages at the same time

Question 3

Primary goal of motivational interviewing

Answer 3

• Get the patient to realize their own motivation and make a behavior change from that motivation
• Motivation does not come from the provider or other outside influence
• Have the patient assume responsibility for their progress, help them build a sense of self-efficacy

Question 4

Key principles of motivational interviewing (10)

Answer 4

• Motivation to change is elicited from the individual, cannot be imposed from outside
• Most people do not change because they are ambivalent about the proposed change
• Primary task of conversation is to have patient articulate and work towards resolving ambivalence
• Direct persuasion not an effective method for resolving ambivalence
• Quiet, eliciting counseling style rather than directing/advice giving
• Counselor focuses on ambivalence (not teaching specific skills)
• Readiness/resistance to change provide feedback about counselor’s demands
• Therapeutic relationship = partnership
• Patient responsible for their progress
• Help patient build sense of self-efficacy and competence that they can solve the problem themselves

Question 5

3 important steps in values-based counseling

Answer 5

• Look for/understand a person’s core values
• Verify with the person that this is a core value
• Relate the core value to the health behavior that needs changing

Question 6

Core hypotheses of health belief model

Answer 6

• Most patients don’t believe what we tell them
• Change and adherence occur when the patient:
  
  • Perceives themselves to be at risk for illness
  • Believes that the problem they are at risk for is serious
  • Is convinced that treatments being proposed are effective, do not have substantial side effects
  • Is exposed to compelling cue to take health action
  • Has confidence that they can perform the specific behaviors being proposed

Question 7

Basic principles of cognitive behavioral therapy (CBT)

Answer 7

• Undesired behaviors are result of unconscious or unhelpful ideas
• Behaviors are inexplicable, even to the patient
• Have patient work backwards in time to see how event occurred
• Come up with specific strategies to counteract the behavor (alternative thoughts)

Question 8

Situations where CBT might be most useful

Answer 8

• A patient feels like if they don’t eat they will get hungry
• When they get hungry, they may feel desperate, feel the need to eat
• Patients ccan consciously use other thoughts to combat natural urge to eat
  
  • Tell themselves they will be able to eat in a few hours
  • Health is actually better by eating less
  • Hunger is undermining their efforts at weight loss

Question 9

Example statement of a person in pre-contemplative stage

Answer 9

• Pre-contemplative:
  
  • “a problem? I don’t have a problem with my diet”
  • don’t see/accept need to change

Question 10

Example statement of a person in contemplative stage

Answer 10

• Contemplative
  
  • “oh my diet is terrible, but I just can’t change it”
  • see need to change, but no confidence

Question 11

Example statement of a person in planning stage

Answer 11

• Planning
  
  • “my diet is terrible and I have been thinking about trying one of those new diets”
  • see need, with some level of confidence - try to increase/encourage that confidence

Question 12

Example statement of a person in action stage

Answer 12

• Action
  
  • “my diet is a problem for me, but I have been on the Dr. Oz diet for two months and I am having great success”
  • identified need and made change, help them with possible future challenges even if you don’t necessarily agree with the action they took

Question 13

Example statement of a person in maintenance stage

Answer 13

• Maintenance
  
  • “oh I have been on the Dr. Oz diet plan for 6 months now, it is sometimes very hard for me to follow through with but I think it’s going well overall”
  • trying to incorporate new diet into long-term lifestyle
  • 2 outcomes: relapse or retain long-term changes (relapse or identification)

Question 14

Example statement of person in relapse stage

Answer 14

• Relapse
  
  • “oh I have tried diets before, but they never work. I don’t want to talk about diets anymore because I just can’t succeed”
  • patient feels depressed and like a failure, talk about past need to change and actions taken

Question 15

Example statement of person in identification stage

Answer 15

• Identification
  
  • “I have been on my diet plan for a year now and it’s going really well”
  • Ideal! Patient achieves long-term success with diet plan