Week 3 - Behavior Change Theory Flashcards
Social Cognitive Theory was invented in
1960’s by Albert Bandura
Social Cognitive Theory is called Social Cognitive Theory because it emphasizes-
1-The role cognition plays in constructing reality and regulating behavior.
Social Cognitive Theory asserts that humans learn within a social context and that human behavior is determined by 3 factors-
1-Personal
2-Environmental
3-Behavioral
Social Cognitive Theory personal factors include-
1-What we believe
2-How we feel about our own capabilities
Social Cognitive Theory environmental factors include-
1-Support Networks
2-Mentors
3-Role Models
Social Cognitive Theory behavioral factors include-
1-What we actually experience and accomplish
Social Cognitive Theory works based on-
1-A belief that a task is doable
2-A task must present a certain degree of healthy challenge
3-It is easier to stay focused or in a flow state
Social Cognitive Theory will not work if-
1-A person feels it is beyond their capacity
2-Get too stressed or anxious
3-Task is too easy or causes boredom
Social Cognitive Theory ideal connection can be expressed by a simple formula-
Flow or formula occurs when both challenges and skills are high and equal to each other. Source Czikszentmihalyi, 2003
Goal here is to challenge people to step out of current capabilities. This requires brain thinking and mental capability.
Social Cognitive Theory is based on a Flow State and requires the following-
1-Task difficulty
2-User capability
3-Most avoid boredom and present a challenge
4-Needs to line up with change at an individual’s level to rate or pace
5-It is based on perspective and is individualized
6-Need a balance between anxiety and boredom, a balanced flow zone
With Social Cognitive Theory and Self Efficacy the goal is-
1-To help clients achieve a Eustress state of optimal challenge that is still within their capacity.
2-The goal here is to work ourselves out of a job by helping the client internalize their own health and well-being coach
3-Concept is to increase self-efficacy and to help an individual believe in his/her capacity to execute behaviors necessary to produce specific performance attainments. (Bandura).
4- Promotes the idea of a coach not pushing, instead provoke an idea they can work on and change.
5-Ideally we use this to help teach a man to fish for themselves which increases confidence, capability and …
What are Albert Bandura’s 4 outlined sources for self-efficacy-
1-Physiological States
2-Verbal Persuasion
3-Vicarious Experiences
4-Mastery Experiences
More in detail about Albert Bandura’s 4 outlined sources for self efficacy-
1-Physiological States-
1-Physiological States-Butterflies in stomach, dry throat, message of nervousness, unease that undermines our confidence about what we are doing.
Mind body dialogue is going both ways. HC use this to advantage to use bottom up practices that cultivate relaxed, confident states that begin during the session.
Goal is help clients feel comfortable with feelings through coaching awareness, LABELING, feeling, help them to learn what bring them to energy or drains energy, also helps them be more comfortable with change.
No need to run from, react to, or overly identify feeling states.
Example: This mindful meditation this AM as we checked into class, Q- Did you get up and do too much or too little? The check in helped with positive to allow physical body and mind to connect.
Another example: Butterflies in neck, HC Q- What is this message from your body telling you?
More in detail about Albert Bandura’s 4 outlined sources for self efficacy-
2-Verbal Persuasion
2-Verbal Persuasion-The things people say to us impact our self-efficacy. It may take many repeated inputs of verbal persuasion, but over time a sincere, heartfelt belief in client’s capability to change can impact their view of themselves and what’s possible.
The believe must be authentic and realistic or it is a set up for failure.
IMPORTANT-This hinges on credibility of coach and coaching relationship. Create a safe space, safe container for self-awareness, growth and transformation.
Live it as a role model. Example: Someone in a person’s childhood may have a voice that is still in their head, ie. a mother. This negatively impacts the client sometimes.
HC look for good in people even when they can’t see it. In creating a safe place HC might state things like “I see courage, I see perseverance, I see a dedicating lifelong learner or I notice when we talk about… that your face lights up or I notice that you cringe when we talk about.
Give client/patient time to reflect back and self-evaluate. Do not praise. Give them space to allow change and a new environment.
More in detail about Albert Bandura’s 4 outlined sources for self efficacy-
3-Vicarious Experiences
3-Vicarious Experiences-Watching others, role models of what we would like to do increases confidence and self-efficacy.
HC in something you have experienced and overcome/accomplished, have a belief in is very useful.
If client relates to HC success they will develop the I can do that too attitude.
Sharing positive change stories can increase self-efficacy.
Provide space for client to share success stories and re-write their narrative ie. A Hero’s Journey, A Resiliency Story, Overcoming, Healing Story.
In appreciative inquiry, we ask clients to conjure positive examples of when they utilized strengths to overcome similar challenges in the past. This will reinforce self-efficacy.
Examples: Ponder my history, the what, why and success. Be own role model. Ask Q Is there someone in your life that motivates you? Is there someone in your life that inspires you? What people build you up? How do you want to achieve this?
More in detail about Albert Bandura’s 4 outlined sources for self efficacy-
4-Mastery Experiences
4-Mastery Experiences-Mastery is the MAIN behavioral component of self-efficacy and what HC should focus on to help client achieve.
Example: Mind is software, HC installs experiences of being successful, to find art of that flow zone, healthy stress challenge.
Quote from Tshannen, Moran states “What we actually accomplish ourselves does more than anything else to cultivate successful, perseverant effort…Masterful HC assist clients to achieve quick wins and to stay on the winning path from week to week.
Positive outcomes lead to increased self-efficacy.
Negative outcomes lead to decreased self-efficacy.
Find appropriate zone that heavily hinges on whether coach can accurately assess what stage of change the client is at.
Examples: Before coaching, think about coaching not problem solving. Client needs to come up with goals, coping mechanisms.
Some are not willing to set goals.
Others commit and need accountability.
Foster in the moment.
Ponder didn’t fully succeed but tried, still capable, can set new goal, fall off horse get up and ride again attitude.
Allow person to master skills at the flow level.
Another example: Body weight issues, don’t want to go do aerobics at gym with perfect bodies. Help cope. New gym clothes might increase confidence. Getting on treadmill may be a good entry point for gym.
Science states we will make mistakes, but we can learn from them.
Remember not to give a fish on a golden platter.
Remember before asking questions, thinking about coaching, not problem solving.
Self-Efficacy is the goal and can be affected by the following factors-
1-Personal-HC helps a client’s beliefs about themselves, what’s possible and what they are capable of.
2-Behavioral-HC helps install experiences of accomplishing a goal that is hard but meaningful and that they perceive is within their capacity.
3-Environmental-HC can role model healthy living and provide support. We can also inquire and help clients to build their own support networks and to reach out and build these resources.
Key Takeaways for excellent coaching to build self-efficacy=
1-Study, know and learn stage of change in Transtheoritical model and assess where the client is at when determining appropriate goals that help land client in Eustress or Flow Zone.
2-Encourage clients to approach their lives as an ongoing experiment, or a living laboratory.
3-There are no win/losses, only win learning experiences. A new experience is to help a client to remember they are always learning, encourage clients to develop a larger vision for their life so that there is meaning and effort.
4-Encourage Flow Zone that are in the client’s capacity so that they avoid boredom or anxiety.
5-Be a role model of healthy living to continuously learn, grow and change in an upward spiral.
6-Use bottom up, mind body coaching strategies to help cultivate calm states and a message of safety for clients to use between sessions.
7-Evoke stories of past successes and build on the client’s strengths. Stay realistic, authentic when expressing confidence in the client and their ability to change.
Main takeaways for supporting autonomy-
Listen deeply
What are client’s motivation for change?
What do they value?
Continually remain curious about the why.
Notice WHY externally/extrinsically vs internally/intrinsically motivated. Seek to explore the client’s interior motivations for change. (This can be tricky when family or MD pushing them).
Get client back into the driver’s seat, to the center of their health care choices. Get them to say I choose to vs I have to.
Learn to reframe with client. Example: I have to go to the gym today. Oh you get to go to the gym today. Shows autonomy and choice. I have to meet work deadline by 2 AM to keep boss happy. It sounds like you are choosing to get up early to meet the work deadline which may interrupt your sleep.
Help create a new narrative and allow for self-efficacy.
Remember teach how to fish, learn from failure, build confidence on own timeline, create safe space for choices and goals.
Do not force instead empower to increase change from within.
Cultivate SO THAT statements, such as I am eating protein so that my BS is more stable throughout the day. I am more focused on the day so that my mood will be stable.
I am eating protein at bfast so that my metabolic health will improve so that I can be present with my kids so that role model a balanced, healthy, self-nourishing way of being for them.
Language is one of your best friends in helping to cognitively restructure the client toward a more autonomous way of being.
Remember I have to choose needs to change to why I want to change mode behavior.
Remember to ask SO THAT statements to provoke thoughts and buy in to change.
More from lecture-
Body has the innate ability to heal itself, physically, emotionally, mentally.
Create space for individuals to believe in change.
Help client gain new skills, to self-actualize, to become action oriented, to live to their capability.
Don’t tell them what to do. Inspire them to find it themselves.
Validate this is hard, you are…
Go back to why questions and don’t unpack for client. Let them unpack.
HC avoid why statements because it produces shame. What held you back might be okay.
Example: Don’t tell a 2-year-old to calm down. They don’t get it. Instead take a deep breath, talk, start setting goals.
Need to teach client, I chose to vs I have to.
Stay curious, use the word I am curious to provoke talk. This will help us get to the work of changing behavior. A starting point is mental, one needs to have it in their mind to want to change the physical. Get to know the human being you are working with.
Provoke a change in feelings, family, demographics, culture, how to fit in and be accepted. Build a person up, validate their experiences to see what is possible.
Avoid problem solving. Let the client problem solve.
Get to know the person, not the problem.
More provoking questions:
Is there anything you enjoy?
I am curious why you dread working out?
Tell me why you dread exercise?
What are some positive outcomes you want to get from exercise?
Curious, tell me what good health looks like?
Scenario with a client-Come to HC with desire to exercise. Dread the thought of working out, have never had consistent, healthy habit yet they know they should.
Ask simple questions, leave it to that!
Do not say you should. Don’t give and/or comments with PSA or will fail.
More tips-Not too much or too little, need challenge with flow state, but not too difficult. .
Be mindful of what a client believes will be helpful to their choice to change.
Only 3% of US population adheres to nutrition, sleep and lifestyle on a regular basis.
Try to build client confident with Goldilocks statements… It is similar to flow statements, easier terminology.
Be curious about other habits in life that might surround reason to not exercise. This gets the why without asking why.
An example of Eustress is positive stress
We all need some stress to stay balanced. Do not perceived + stress as a threat. Learn from each experience.
Question/Answer-What are some bottom up practices?
Breathwork, grounding, being mindful. Be careful with new client. Avoid breathwork, grounding unless they allow this practice. Some may be triggered.
Ask how are you feeling today?
What color are you feeling today? If dark or red, this could be a lead in to do relaxation, meditation moment.
HC can provoke + in past week by asking what are you grateful for this past week? This will decrease nervous system response.
Ask what brought you joy this week? Help client tap into body even if uncomfortable.
Create safety.
With verbal persuasion, fine line between coach and cheerleader.
Try to avoid statements like I am proud of you or I applaud you. Instead use a nuance of words, like WOW, you are doing it.
Put it in your statements, not I statements.
Create authentic, realistic partnership.
Say How did that feel?
Shift their self-talk.
Celebrate success, celebrate wins, let it sink in. How did that feel?
Reframe words like as if a preschooler. Validate and see more desire to do good and change, helps client reflect and think.
Vicarious Experiences-
See past things that the client overcame for good.
What are ways to elicit this information from your client?
We are HC not friend.
Stay professional.
Ask, provoke and initiate client to think. What was a pivot in your life?
Q/A students in this course, what made you register for this course? What brought you here? Why did you pay for this course?
Note increase compassion=
Increased truth, decreased avoidance and will increase change.
In regards to self-efficacy
Build client beliefs to want to buy into owning their experiences.
Our goal as HC
To talk as little as possible.
What supports autonomy?
Listen deeply.
What brings them to life?
Want to walk to… go on vacation.
Patient/client scenario-My doctor keeps getting on me to exercise. When I get home from work I am so exhausted and don’t want to do anything. Try this quick win-My day is off if I don’t do a short walk, take the stairs instead of the elevator, walk the dog, short walks count. Inspire client to come up with own ideas.
Gym-If you had the energy what would you do? Agree with movement, any movement is good.
Q/A-What are some things you hear if client is intrinsically motivated?
I want to, I get to.
What are some things you hear if client is extrinsically motivated?
I have to, I have no choice.
Q/A from lecture-
What are reasons why individuals don’t live a healthy lifestyle?
Ideas from class chat, note there could be more-Culture, family, conforming, fitting in, learned behavior, too difficult, beliefs, obstacles, self-esteem, limited access, fear of change, money, too busy, time constraints, addiction and more.
More on Autonomy in Health-
HC and medical professionals who are autonomy supportive-
Improve patient adherence to treatment programs.
Will see improved motivation.
For example: Regulating BS can lead to better HbA1C outcomes. Or being autonomy supportive leads to autonomous reasons for weight loss and better outcomes at 2 year, better outcomes with smoking cessation at 6 months.
Being autonomy supportive doesn’t mean withholding information. Delicate dance.
Medical team, family and others need to understand client perspective, feelings, offer choices, and allow clients to make informed decisions with autonomy.
All clients to make choice. Don’t force them. Ask!
What are 3 things you want to do to support change?
Continually improve patient self-competence in managing their condition or improving their well-being.
Questions to pose-I want to be a support to you. These are some things I have learned about….
Make statement to support their change.
HC goal is to get client to support internal motivation.
Ask What is important about a healthy diet? What is your vision. What is your goal?
Constantly reconnect with why as a word.
Do not make client dependent upon us. HC seek to work self out of a job and evoke client own internal health and well-being.
Self Determination Theory- SDT
Two things about SDT include controlled behavior vs autonomous behavior.
Autonomous=Client experiences sense of self volition, self-initiation, in touch with intrinsic motivations, and personally endorses their behavior. Example: I get to, I want to.
Controlled= Patient/client externally coerced, pressured to change by family, MD, social, cultural environment.
Example- patient taking a medication because they believe it will help is autonomous but if they feel they are being forced/pressured that is controlled.
