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ASLMBCE > Section 2: Fundamentals of behavior change (10%) > Flashcards

Section 2: Fundamentals of behavior change (10%) Flashcards

1
Q

Name at least 3 health behavior change theories

A
  1. HEalth belief model
  2. Theory of planned behavior
  3. social learning (cognitive theory)
  4. stages of change (transtheoretical model)
  5. other models
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2
Q

With regards to HEALTH BELIEF model theory of behavior change: what is it used for `and what principles is it based on?

A

Used to explain and predict people’s behavior in failing to adopt disease prevention strategies or comply with screening for early disease detection . 1. One must believe that there is a threat to one’s health before they seek preventative measures. 2. there is a preventive measure that is accessible and allows to avoid health threat

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3
Q

With regards to HEALTH BELIEF MODEL of behavior change, what are its key constructs? (6)

A

6 key constructs describe the thought process for behavior change:

  1. PERCEIVED SUSCEPTIBILITY: one’s subjective perception of the risk of acquiring or being susceptible to health threat
  2. PERCEIVED SEVERITY: one’s subjective FEELINGS about seriousness of having the health threat (inc. feelings on potential health outcomes like death or disability and SOCIAL OUTCOMES like relationships and activities
  3. PERCEIVED BENEFIT: ones beliefs about the effectiveness of preventive measures available to avoid, reduce, or cure health threat
  4. PERCEIVED BARRIERS: one’s perception of the negative aspects of a preventive measure that may impede adopting the recommended change
  5. CUES TO ACTION: events or STIMULI THAT TRIGGER one’s READINESS to change and adopt behavior change or preventive measure
  6. SELF EFFICACY: one’s confidence in his ABILITY to act and SUCCEED in completing the behavior change or preventive measure
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4
Q

with regards to THEORY OF PLANNED BEHAVIOR, what is it used for?

A
  • helps predict ones LIKELIHOOD OF ENGAGING in a SPECIFIC MODIFIABLE BEHAVIOR , at a SPECIFIC TIME AND PLACE
  • behavioral achievement is based on MOTIVATION (intention) and ABILITY (behavior control)
  • helps explain one’s intention to engage in a health beh. and how engaging in that health beh. is influenced by one’s beliefs and attitude about the risks, benefits and capability of achieving the desired health outcome
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5
Q

with regards to THEORY OF PLANNED BEHAVIOR, what are its MAIN CONSTRUCTS? (6)

A
  1. ATTITUDE: one’s positive or negative evalueation of a beh of interest and its outcomes
  2. BEHAVIORAL INTENTION: motivational factors for a beh of interest: MOST IMPORTANT FACTOR IN PREDICTING beh.
  3. SUBJECTIVE NORMS: one’s perception of the beliefs of others (peers and people of importance) concerning the beh. and whatever they approve or disapprove
  4. SOCIAL NORMS: customary codes or standards of behavior
    PERCEIVED POWER: one’s perceived control over factors that may help of not performing the beh of interest
  5. PERCEIVED BEHAVIORAL CONTROL: one’s perception about the ease or difficulty one will have in completing the beh of int. and the control he has to accomplish it : CHANGES WITH DIFFERENT SURROUNDINGS
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6
Q

with regards to SOCIAL LEARNING (COGNITIVE THEORY), what main belief is it based on?

A

that ones behavior DOES NOT OCCUR IN ISOLATION but rather is a PRODUCT OF: 1, PERSONAL FACTORS, 2. ENVIRONMENT, 3. OTHER PEOPLE’S BEH. => credible ROLE MODELS may be important in producing beh change

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7
Q

with regards to SOCIAL LEARNING (COGNITIVE THEORY), what are its MAIN CONSTRUCTS? (6)

A
  1. RECIPROCAL DETERMINISM: the PERSON, the BEHAVIOR and the ENVIRONMENT all influence each other in a DYNAMIC AND RECIPROCAL way
  2. BEHAVIORAL CAPABILITY: one’s personal ability through KNOWLEDGE AND SKILL to complete a beh.
  3. OBSERVATIONAL LEARNING: people learn from their OWN experience as well as experiences of OTHERS
  4. REINFORCEMENTS: behaviors are maintained/ omitted due to the INTERNAL and external SOCIAL reinforcement
  5. EXPECTATIONS: anticipated conseq. of beh., based on prior experience
  6. SELF-EFFICACY: one’s level of confidence to successfully perform a beh., influeneced by OWN BEH CAPABILITY and ENVIRONMENTAL facilitators or inhibitors
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8
Q

With regards to the STAGES OF CHANGE model (transtheoretical) of beh change, briefly describe it and outline how is can be used.

A
  • originally developed for smoking cessation, later expanded to describe wider beh change
  • change =PROCESS; different STAGES
  • cyclical, dynamic
  • each pt different; can skp stages, move fast through, stay stuck in one stage, etc.
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9
Q

outline the different stages of change as described by the transtheoretical model of beh change (6)

A
  1. precontemplation
  2. contemplation
  3. preparation
  4. action
  5. maintenance
  6. relapse (oft included but not in the orig model)
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10
Q

what are the things that key behavior theories have in common? (4)

A
  1. beliefs about risks and benefits
  2. motivation
  3. self-efficacy
  4. environmental influence
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11
Q

what are the main factors that influence health behavior? (3)

A
  1. intrapersonal: knowledge, attitutes, beliefs, personalities
  2. interpersonal: influence of family, friends, peers, health providers
  3. institutional: rules, regulations, policies:
    a) community factors (soc networks and soc norms)
    b) public policies
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12
Q

what are the key elements (giveaway signs) for spotting precontemplation stage of change in a patient?

A

Precontemplation

  • no awareness of problem behavior “not thinking about it”
  • not planning of making a change in the next 6mo, “ not planning change in the next 6 mo”
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13
Q

what are the key elements (giveaway signs) for spotting contemplation stage of change in a patient?

A
  • considering change or ambivalent about change

- considering change in the next 6 mo

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14
Q

what are the key elements (giveaway signs) for spotting preparation stage of change in a patient?

A
  • aware of needing to make a change in a problem beh

- preparing to make a change in the next month

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15
Q

what are the key elements (giveaway signs) for spotting action stage of change in a patient?

A
  • i have started a change within the past 6 mo

- making change but not yet hit the target/ goal, or not hit it consistently for 6 mo

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16
Q

what are the key elements (giveaway signs) for spotting maintenance stage of change in a patient?

A
  • goal beh achieved and maintained for 6 mo or more
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17
Q

what are the key elements (giveaway signs) for spotting relapse stage of change in a patient?

A
  • goal beh or action no longer happening
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18
Q

how can one improve adherence to change in a patient?

A
  • match stage of readiness with the prescribed treatment
  • emphasise working on areas where the pat will see QUICK SUCCESS with little to some effort
  • begin with SMALL BUT IMPORTANT SUCCESSES AND BUILD UP ON THEM
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19
Q

define non-adherence and its role in chronic disease management

A

= NOT FOLLOWING THROUGH W/ PRESCRIBED TREATMENT

- 50-80% non-adherence w/ prescribed meds for chronic illness

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20
Q

describe the process of building effective relationships w/ patients

A

provider = EXPERT (conducting medical assessment, making specific recommendations, prescribing treatments) & COACH (discuss dealing w/ beh change)

  1. assess READINESS for change
  2. offer stage-matched brief intervention (ideally patients own idea)
  3. EMPOWER patient: help them make change successfully
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21
Q

in the course of beh change, when is it recommended to use motivational interviewing techniques?

A

early stages

  • most helpful in precontamplation and contemplation stages
  • express EMPATHY (affirmations and reflective listening)
  • support self-efficacy
  • roll w/ resistance (can avoid or deflect resistance by being NON-JUDGEMENTAL, listening wll and encouragig the pat tp continue to share
  • develop DISCREPANCY between WHERE THE PAT IS AND WHAT THE PAT WANTS; hold this up to the patient without being judgemental, allow them to draw their own conclusions
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22
Q

in the course of beh change, when is it recommended to use CBT techniques?

A
  • later stages
  • most useful during preparation, action and maintenance stages
  • assists w/ problem solving and deeper understanding of underlying challenges
  • generally performed by beh. change specialists
  • RECOGNISE AND REFRAME NON-PRODUCTIVE THINKING, being more aware of UNDERLYING BELIEFS and EMOTIONS, working through ABCDS of beh change
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23
Q

in the course of beh change, when is it recommended to use positive psychology techniques?

A

all stages

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24
Q

name red flags of non-productive thinking:

A 
"all or nothing" 
catastrophising
discounting the positive
overgeneralising
mind reading
fortune telling ("this will never work"
"should" and "must" statements
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25
Q

how can you help your client re-frame non-productive thinking using CBT strategies?

A

ADJUSTING THOUGHTS CAN LEAD TO A CHANGE IN EMOTIONS, WHICH CAN CHANGE ONGOING BEHAVIOUR

a) examine evidence for and against (socratic questioning)
b) explore non-judgementally: “is it possible that thoughts affect behaviour?”
c) elicit patients ideas about specific thoughts that can lead to nonproductive emotions and be impeding beh change
d) “I have noticed you said…”
e) is there a defferent way the situation could be seen?
f) help the pat substitute more realistic interpretations in place of non productive thinking
g) ask patient for ideas about SELF-TALK that can be used during difficult moments
h) practice self talk and other strategies (e.g homework)
i) help pat become aware of nonproductive emotions and thoughts and help him consciously choose different thoughts

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26
Q

how can you identify underlying beliefs that can interfere with behaviour change (using CBT principles)?

A

ABCD
antecedent (what action/ event ocured?)
belief (what beliefs do you have about it?)
consequence (what are the conseq. of these beliefs? How did they make you feel?”)
dispute (how can you dispute these beliefs that may be distorted or unhealthy?)

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27
Q

What is the ABCD of CBT and what is it used for?

A 
identify underlying beliefs that can interfere with behaviour change
Antecedent
BElief
Consequence
Dispute (the above)
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28
Q

What are the known benefits of POSITIVE PSYCHOLOGY

A
  1. builds patients confidence
  2. emphasises patients CURRENT skills and abilities
  3. reinforces AUTONOMY & SELF-EFFICACY (key to a sustanable beh change)
  4. ephasises the POSITIVES of patient’s ACTIONS:
    - what did the patioent achieve?
    - what successes have been seen with each step
  5. enhances RESILIENCY &abd helps undo negative feelings
  6. inbcreases positivity of the PATIENT-PROVIDER INTERACTION
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29
Q

What is the foundation of POSITIVE PSYCHOLOGY?

A

ability to flourish as a human depends on one’s fundamental ability to experience positive emotions like affection, love, enjoyment, happiness, playfulness, contentment and satisfaction

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30
Q

list potential sources of social/ environmental support for a patient

A
  1. family, friends with whom the pat has good relationship
  2. support groups: spoorts teams, clubsm classes, workplace, faith-based, social networks (incl. soc media)
  3. behaviour change “working groups”- peer modeling strategies (e.g “sponsors”), peer to peer programs (e.g. group classes)
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31
Q

what can social support achieve for a patient during beh change?

A

support patient’s autonomy, accountability and self-efficacy

32
Q

how can a practitioner practically enlist and enhance support for a patient during beh change?

A
  • encourage to maximise their use of social/ environmental support (e.g. using a support analysis tool)
  • refer patient to com resources she is interested in
  • help the patient develop a WRITTEN ACTION PLAN
33
Q

how does a practitioner assesses readiness for change in practical terms?

A
  1. assess STAGE of readiness and provide stage MATCHED INTERVENTION
  2. identify and/ or ADAPT assessments and interventions to your patients literacy level and cultural background
  3. help create a WRITTEN ACTION PLAN based on results of the patient’s readiness to change, the perceived level of IMPORTANCE and patient’s CONFIDENCE that change can be accomplished
  4. FOLLOW UP after implementing action plan
34
Q

describe a matched intervention to a patient’s statement “ I am not thinking about making a change at all now or within the next six months”

A

(precontemplation)

- discuss health risks assoc w/ spec behav. (e.g. smoking and lung ca)

35
Q

describe a matched intervention to a patient’s statement “ im thinking about making a change within the next six months”

A

(contemplation)
- personalise health risks, weight risks and benefits and the impact on personal goals (e.g. highlight smoking and risk of heart attack if the patient has fa ho heart disease)

36
Q

describe a matched intervention to a patient’s statement “ im thinking about making a change within the next month, and/ or preparing to make a change”

A

(preparation)

assist w/ commitnent, plan spoecific changes and discuss ways to modify environment

37
Q

describe a matched intervention to a patient’s statement “ I have started a change within the last six months. I have not hit the target change goal or have hit it consistently fo six months”

A

(action)
structure the plan, identify source of frequent contact, identify social support, problem solve obstacles, use CBT, reframe unhealthy thought patterns (e.g. I can’t walk in winnter” changes to “I can dress for the weather”)

38
Q

describe a matched intervention to a patient’s statement “ i have been successfully making the target change for more than six monhts

A

(maintenance)

continue reinforcement and CBT

39
Q

describe a matched intervention to a patient’s statement “ i made a change for more than six months but am not now doing so”

A

(relapse)

- problem solve like in the contemplation, prepartation and action stages

40
Q

true or false?

every change that is being made and coached, a readiness level should be assessed

A

true

41
Q

outline the differences between a LIFESTYLE PRESCRIPTION AND an ACTION PLAN

A

LIFESTYLE Rx: actions needed to treat or prevent a condition based on the scientific evidence and the poatients medical condition (e.g. 150min of moderate activity a week)
ACTION PLAN: = the lifestyle prescription ADJUSTED to patients ability, readiness and confidence (e.g. start w/ walking 5 min / day 5 days a week, increase as tolerated to …)

42
Q

outline the most important principles of creating and implementing action plans for beh change

A
  1. COLLABORATE w/ the pat. +/- their support to deve4lop EVIDENCE BASED, ACHIEVABLE, SPECIFIC, WRITTEN action plan
  2. REVIEW the action pln during each visit (can be done by anopther team member)
  3. emphasise the IMPORTANCE OF WRITING it down, not just talking about it
  4. KEEP A COPY of the action plan in patient’s medical record
  5. work w/ your team to FOLLOW UP on their progress
  6. encourage TRACKING progress (e.g. apps/ written record)
43
Q

Describe the principles and stages of developing an ACTION PLAN with a client.
What are the key elements of an action plan for behaviour change?

A 
collaborative approach
written
SMART (as detailed and concrete as possible) 
confirm commitment (copy to patient and in their records)
follow up on progress
involve team
enlist support
encourage tracking progress
44
Q

scoring confidence and importance levels

A

> 7/ 10 = more likely to succeed

help identify ways to increase importance/ confidence

45
Q

correlation of confidence/ importance level w/ stages of change

A 
precontemplation 0-3
contemplation 4-6
preparation 7
action 8-10
maintenance 10
46
Q

Describe practical steps of creating an ACTION PLAN with a patient.

A
  1. explain your role as an EXPERT and COACH and AGREE ON AGENDA as part of COLLABORATIVE CARE
  2. share DIAGNOSIS and potential OUTCOMES if no medical/ lifestyle treatments are initiated
  3. describe lifestyle PRESCRIPTION (describe behaviour) and potential OUTCOMES when ls beh are mastered
  4. identify CURRENT AREAS OF PROGRESS and use POSITIVE PSYCHOLOGY to support and encourage the patient’s current changes and progress
  5. identify new areas for action
  6. identify patients confidence and importance for each area of change (these show correlation w/ stages of change)
  7. ask the pat to summarise the GOALS, RESOURCES and how will stay focused on the goal
  8. set SMART goals
  9. connect pat w/ supports
  10. confirm pat. commitment to the action plan (e.g. shake hands/ sign the plan, given them copy, and keep one
  11. follow up on progress next visit
47
Q

outline an example of an action plan

A
  1. what
  2. how much/ intensity
  3. how long
  4. with whom
  5. where
  6. when
  7. support system
  8. biggest barrier
  9. solution to barrier
  10. confidence level
48
Q

describe strategies to help patients maintain healthy behaviours

A

during subsequent visits:

  • reiterate role your dual role as expert and coach
  • review and update dx
  • review the pat action plan: first discuss success, then challenges
  • finish w/ “which of the behavioural goals are you ready and willing to master by our next visit in 3-6 months?”
  • summarise, clarify nuew goals, just like the initial one , create a new action plan
49
Q

describe the process of follow-up for ongoing ls progress

A
  • f/u F2F/ video/ phone
  • build a SUPPORTIVE relationship: LISTEN, AFFIRM the pat’s perspective and situation, emphasise SELF-EFFICACY, put the pat in the drivers seat, assist and keep her accountable, with her permission
  • focus on THE SPECIFIC action plan
    • if action plan achieved: congratulate, ask for barries and how they were addressed? ; check the patients progress against their ideal lifestyle prescription
    • if not achieved: discuss and congrat on any successes; discuss barriers and develop solutions
  • develop a REVISED ACTION PLAN (7/10 confident)
  • establish accountability and support
  • check in more frequently
  • connect her w/ resources/ supports that can help
  • encourage tracking progress
50
Q

Define self efficacy

A

patient’s confidence in her ability to succeed; influenced by one’s own behavioural capability and environmental facilitators or inhibitors

  • is at the core of a successful beh change
  • self-motivation and self-confidence play essential roles in developing self efficacy
51
Q

what are 5 A’s

A

ASSESS - practices int context of health risks
ADVISE - to change practices w/ clear, specific and personalised advice for beh change
AGREE - on the focus of counselling and reatment based on pat’s interest and willingness to change
ASSIST - in setting and achieving goals to change practices:
1. address motivational barriers via counselling and self-help techniques
2. determine whether the pat needs additional information
3. refer the patient to a dietician (etc.)
ARRANGE - regualr follow up and support

52
Q

What is the role of 5A’s and what are their potential benefits?

A
  1. brief approach to health beh counselling
  2. to improve pat. motivation and intention to change (shown to improve motivation in wt loss)
  3. patient centered
  4. help encourage motivation for change
  5. use collaborative approach (patient provider interaction essential)
53
Q

briefly discuss key constructs for effective, sustainable self-management

A
  1. CBT techniques: esp helpful when pat diealing w/ outside pressure, failures or being out of control
  2. social support strategies
  3. community and employee programs
  4. support w/ digital technology, telehealth, etc.
  5. RELAPSE PREVENTION PLANNING
54
Q

what should a good RELAPSE PREVENTION PLANNING involve?

A
  • should be constructed for each ongoing beh change
  • address potential triggers for lapses and situations that may lead to ongoing lapses
    1. WHEN MIGHT IT OCCUR?
    2. UNDER WHAT CIRCUMSTANCES?
    3. WITH WHOM?
    4. HOW TO NOTICE A LAPSE BEFORE IT BECOMES A RELAPSE?
    5. WHO TO TURN TO DURING A LAPSE/ RELAPSE?
  • identify and enlist SUPPORT
  • establish a WRITTEN PLAN
55
Q

define a lapse

A

short-term period when action plan not followed; easier to address as unhealthy action hsn’t yet become a habit

56
Q

define a relapse

A

sustained period when action plan is not adhered to
addressing is similar to creating a new action plan; address thoughts and emotions that can arise from a potential feeling of failure

57
Q

cite evidence base for effective coaching that promotes health behaviour change and improves health outcomes

A
  • Griffin et al. 2004 (Ann of Fa MEd) Systematic review - 35 studies identified (most in N America), only 4 satisfied incl. criteria
    interventions:
    1. helping pat have a more active role (encouraged q’s/ elicit concerns)
    2. enhance provider’s approach: paying more attn to pat emotions, adjusting consulting style to the patient’s personality/ emotions, etc. providing more information
    3. combination of above
    results: health outcomes positively affected in 11/25 trials (44%) and negatively affected in 5/25 (20%)
    overall health outcomes poorly assessed: MORE RESEARCH NEEDED
  • when provider approach enhanced: greateer collaboration acheived
    *Hojat et al 2012 (Acad Med): PHYSICIANS EMPATHY level correlated w/ better HbA1c (65% vs 40%)
  • 10 hr empathy training similar results to longer training
  • better outcomes (BP, glucose, functional status) w/ better pat-prov relationship
58
Q

define self motivation, how can it be enhanced?

A

= autonomous / internal motivation

  • based on one’s needs, perceived benefits of beh., values, vision, purpose and meaning in life
  • coaches can help to connect to deeper values, meaning and purpose to desired health beh. to increase self-motivation
59
Q

define self confidence and how can it be enhanced?

A

= trust in own reasoning, capabilities and qualities

  • enhanced by
    1. eliciting positive emotions,
    2. leveraging one’s strengths,
    3. developing strong support systems,
    4. appropriate education at each step of the journey
    5. improving self-efficacy
60
Q

Describe how can a coach foster self-motivation and self-confidence?

A
  1. hold the POSSIBILITY that the pat can commit to change and master change; understand tht even BABY STEPS build SELF-ESTEEM and MOMENTUM
  2. be PRESENT with the pat. (clear his mind of noise, listen w/ full attention)
61
Q

Describe how can a coach foster self-motivation and self-confidence?

A
  1. hold the POSSIBILITY that the pat can commit to change and master change; understand tht even BABY STEPS build SELF-ESTEEM and MOMENTUM
  2. be PRESENT with the pat. (clear his mind of noise, listen w/ full attention)
  3. EMPATHY
  4. focus on and affirm the POSITIVES as much as possible
  5. share personal or other anonymous EXAMPLES
  6. encourage the PATIENT TO TAKE CHARGE, decide on and commit to WELLNESS PLAN
  7. look for TEACHABLE MOMENTS; view obstacles and setbacks as necessary parts of behav change nec to success
62
Q

Describe the 5 step cycle in coaching model.

A

cycle of change: EMPATHY –> ALIGN MOTIVATION –> BUILD CONFIDENCE –> set SMART goals –> set ACCOUNTABILITY plan

63
Q

describe the main steps of the coaching process

A
  1. develop AWARENESS and ASSIST with ANALYSIS of current beh. and desired future health through REFLECTIONS
  2. co-create an ACTION PLAN
  3. CELEBRATE achievements
  4. build a RELATIONSHIP
  5. set GOALS, refine goals
    6 feed back and help reflect
  6. ongoing coaching
64
Q

list the coaching questions for each stage of change: precontemplation

A

Are you considering making a change in …? NO:

  • “Did you know that [x behavior] is one of the leading causes of [y results]?
  • consider sharing a personal example e.g. I used to [x beh] but I quit when I learned how much it affected my [y result]
  • develop awareness and assist w/ analysis;
  • reflections
65
Q

define REFLECTIONS

A

= common tool in coaching

  • coach makes a statement back to the client using the same phrases or a summary of what the client stated
  • help the pat. create connections, tap into emotions, bring awareness to what he has vocalised
    1. simple reflections (paraphrase/ restatement)- without added opinion
    2. amplified reflection (maximise or minimise what pat said in order to generate disagreement and evoke desire to change
    3. double sided reflections - more than one perspective (e.g. cop[arison of pat verbalised readiness to change w/ contrasting resistance)
    4. shifted-focus reflections - redirect attn from a statement of resistance to a new area, in order to generate more space for change talk
66
Q

define simple reflections

A

(paraphrase/ restatement)- without added opinion

67
Q

define amplified reflection

A

amplified reflection (maximise or minimise what pat said in order to generate

68
Q

define double-sided reflection

A

more than one perspective (e.g. cop[arison of pat verbalised readiness to change w/ contrasting resistance)

69
Q

define shifted-focus reflection

A

redirect attn from a statement of resistance to a new area, in order to generate more space for change talk

70
Q

list the coaching questions for each stage of change: contemplation

A

see flow chart

71
Q

describe principles of counselling an overweight or obese patients using behavioral strategies.

A
  1. use CBT techniques (evidence = > wt loss and > success in maintaining wt)
    A) SELF-MONITORING (most helpful skilll for lifestyle change)
    b) GOAL SETTING : CONTINUED INCREMENTAL CHANGES
    - SMART goals
    - assess obstacles and optimal time to start, the more detail the better
    C) NORMALISE HEALTHY DIET
    d) PROBLEM SOLVING
  2. address STIMLUS CONTROL
  3. encourage EATING AT A SLOWER PACE
  4. BEHAVIOUR CONTRACTS (evidence inconclusive); can help provide accountability and help and assist in self-monitoring
  5. ENLIST SOCIAL SUPPORT (> wt loss w/ fa support, gp support = additional incentive -m accountability, friendly competition, encouragement), better long term success
  6. focus on SKILL POWER, not will power : create an external system and guidelines for the patient until her new beh become the default choice; long term succes = combination of skill and will power
72
Q

Define stimulus control

A

power to have improved control over choices, esp re food, despite environmental challenges

73
Q

describe psychological needs of people who are obese

A
  1. beh counselling can help understand how wt influenced by lifestyle choices, e.g.
    a) SLEEP HYGIENE (shorter sleep duration = more wt gain)
    b) STRESS MANAGEMENT (more percieved stress= more wt gain), wt loss may be increased by participating in a stress management program
    c) STRESS EATING (foods eaten to manage anxiety are driven by chronic stress response)
    d) SMOKING CESSATION: incr risk of wt gain during sm cess (usu less then 10 pounds; 4.5kg), slightly more among women; best to start wt loss after smoking cessation completed
74
Q

describe the levels at which the psychological needs of obese people need to be addressed

A
  1. macro/ public policy level: funding for health initiatives, public policies (eg taxes)
  2. community / institution : bike and walking trails, access to healthy food
  3. interpersonal: support from fa, friends, community
  4. intrapersonal: reframing negative thoughts, healthy coping strategies
75
Q

name the areas where caution needs to be applied when addressing life style interventions in the obese

A
  1. most have made numerous prior attempts; acknowledge these and her investement in her health
  2. be aware that the cause of obesity is complex, the treatment ongoing
  3. sensitive and personal topic; ask permission to check wt and check it in private
  4. use MI techniques
  5. use specific guidelines (AHA/ACC/TOS: Jensen et al. 2013)

ASLMBCE (13 decks)

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