Week 3 Human Behavior

Question 1

MI: Stage vs. Action

Answer 1

(Pre-contemplation) Discuss previous quit attempts and cons of quitting

(Contemplation) Provide information on consequences of smoking and benefits of quitting

(Preparation) Target quit date, self-monitoring, relaxation training

(Action) Stimulus control, substitution, self-help, therapy

(Maintenance) Relapse prevention, support group

Question 2

MI: Core Skills (4)

Answer 2

Ask-Provide-Ask
Assess readiness to change
Sharpen the focus (simplify/narrow)
Elicit change talk (desire, ability, reasons, need, commitment, action)

Question 3

Righting reflex

Answer 3

MD’s natural desire to inform patients that they are doing something wrong

Question 4

Summarize the research base for use of motivational interviewing in health care settings

Answer 4

increases treatment engagement
increases treatment adherence
promotes behavior change
observed effect sizes were larger with ethnic minority populations

Question 5

PIC/NIC analysis

Answer 5

Functional analysis
Positive Immediate Certain
Negative Future Uncertain
PIC & NIC&raquo_space;»> PFU & NFU

Question 6

Describe how the following therapies work: biofeedback, cognitive restructuring, relaxation, exposure therapy, Problem-Solving Therapy, and Cognitive Behavior Therapy

(Chapter 36: Emotion and Learning)

Answer 6

biofeedback – physiological monitor that provide patient with information

relaxations – teaches how to modulate physical symptoms of stress response

exposure therapy – to reduce fear reaction and avoidant responses

problem-solving therapy

cognitive behavioral therapy

Question 7

Define and describe clinical applications of fading, shaping, stimulus control

(Chapter 36: Emotion and Learning)

Answer 7

fading – gradually reduced

shaping – reinforcing

stimulus control – use of anticipatory cues to guide behavior toward more rewarding consequences

Question 8

Define and describe clinical applications of conditioning therapy, aversive conditioning, and contingency management

(Chapter 36: Emotion and Learning)

Answer 8

Applications of classical conditioning:
- Chemotheraphy + nice odor
(pairs desirable behavior with reward)

Applications of aversive conditioning:
- Alcohol + noxious substances
(pairs undesirable behavior with punishment)

Contingency management

1. increase desired behaviors
2. extinguish undesirable behaviors
3. avoid undesirable consequences via negative reinforcement

Question 9

Define the Law of Effect, the Premack Principle, negative reinforcement, and stimulus generalization; identify how these principles can be applied to the medical setting

(Chapter 36: Emotion and Learning)

Answer 9

Law of Effect – if a behavior is followed by positive consequences that behavior will increase in frequency

Premack Principle – If an individual engages repeatedly in an activity, it implies that the activity is rewarding.

Negative reinforcement –avoiding an unpleasant or punishing experience

Stimulus generalization – process by which a response can be elicited by other stimuli in a common context.

Question 10

Describe classical conditioning and relationships between the US, UR, CS and CR

(Chapter 36: Emotion and Learning)

Answer 10

Classical conditioning reflects the ability of the organism to learn from increasingly complex interactions with the environment.

Unconditioned Stimulus (Chemothrepay)
Unconditioned Response (Nausea)
Conditioned Stimulus (Hospital)
Conditioned Response (Nausea)

Question 11

Describe the roles of various brain structures (hippocampus, amygdala) in explicit learning

(Chapter 36: Emotion and Learning)

Answer 11

limbic system (hippocampus, amygdala, basal forebrain, and thalamus) receives and integrates incoming sensory information.

Amygdala = records “emotional” significance of an event

Hippocampus = assigns a temporal and spatial context

Question 12

Define explicit learning

(Chapter 36: Emotion and Learning)

Answer 12

Def: involves more abstract association between diverse stimuli and events that vary across time and space.

e. g. insight (immediate) or reflections (delayed)
* requires activation and coordination of structures in the cortex, especially the temporal lobe for long-term processing

Question 13

Define and give examples of types of implicit learning

(Chapter 36: Emotion and Learning)

Answer 13

Def: The association of immediately sequential sensory and motor system responses via lower levels of cortical mediation. The information stored is limited to predictive relationships between events.

e.g. reflexive (immediate) or cumulative over time

Question 14

Define behavior modification and incentive modification

(Chapter 36: Emotion and Learning)

Answer 14

Behavior modification – involves altering behavior associated with events contiguous in time and space

Incentive modification – involves anticipating outcomes and altering future goals based on “lessons learned” from past experience

Question 15

Define self-efficacy and describe how physicians can empower patients

(Chapter 36: Motivating Healthy Behavior)

Answer 15

Confidence in their ability to achieve a behavioral goal.

Empowering:

• incremental goals with achievable outcomes
• linking patients’ strengths and successes to goals
• blocking self-defeating thoughts
• focusing on solutions rather than problems

Question 16

MI: Tools OARS

Chapter 36: Motivating Healthy Behavior

Answer 16

Open-ended questions
Affirmations (appreciation or understanding)
Reflections (hypothesis - paraphrase)
Summaries

Includes empathy collaboration, autonomy-supportiveness, directness, and evocation.

Question 17

Phases of motivational interviewing

Chapter 36: Motivating Healthy Behavior

Answer 17

1. Building motivation to change

2. Strengthening commitment

Question 18

MI: principles

Chapter 36: Motivating Healthy Behavior

Answer 18

(no telling) Express empathy
(risk behaviors) Identifying discrepancies between where patients are not doing well
(no forcing argument)Avoiding argumentation
(no arguing) Rolling with the patient resistance rather than challenging it head-on
(self-efficacy) Supporting self-efficacy, instilling hope, and encouraging patient’s belief that they can change

Question 19

Summarize motivational interviewing

Chapter 36; Motivating Healthy Behavior

Answer 19

Motivational interviewing

“a collaborative, person-centered from of guiding designed to help patients elicit and strengthen motivation for change”

Question 20

Define the difference between a lapse and a relapse

(Chapter 36: Motivating Healthy Behavior)

Answer 20

Lapse: is a temporary setback
Relapse: is complete reversion to a previous pattern of behavior

Question 21

MI: Stages

Chapter 36: Motivating Healthy Behavior

Answer 21

Pre-contemplation: has no intention of changing within the next 6 months

Contemplation: intends to make change within the next 6 months

Preparation: intends to change within the next 30 days

Action: has changed for 6 months

Maintenance: continued for at least 6 months

Question 22

Describe the decisional balance technique and how it is useful in promoting behavior change

(Chapter 36: Motivating Healthy Behavior)

Answer 22

An effective practitioner acts as a consultant or coach in motivating patients to participate in and take charge of their decision-making process.

Question 23

List the leading causes of preventable death associated with lifestyle

(Chapter 36: Motivating Healthy Behavior)

Answer 23

Tabacco
Poor diet & physical inactivity
Alchohol

Question 24

Identify direct methods of measuring adherence, and their advantages and disadvantages

(Read)

Answer 24

Direct and Indirect

Question 25

List some technological solutions to deliver patient education and enable self-monitoring

(Read)

Answer 25

Self-monitoring by
Mobile health tech
Electronic monitors
Pill monitors
Online resoruces

Question 26

Barriers / Solutions to adherance

Answer 26

patient education
wait time
communication between physicians and patients
addressing confusion or uncertainty
counseling
accountability 
cost
self-monitoring
simplicity
feeling (not) sick
side effects
embarrassment
depression
belief system
lifestyle

Question 27

Decreasing negative behaviors

Answer 27

• Extinction – ignoring a previously reinforced behavior in order to reduce the frequency of that behavior
• Time out – negative punishment in which child who engages in negative behavior loses access to positive reinforces for a brief period
• Over-correction and restitution – positive punishment in which child who engages in negative behavior is required to engage in effortful activity for a brief period
• Desensitization – feared stimulus is gradually presented using a hierarchy of least to most feared and relaxation is paired with each stimulus until it no longer evokes fear
• Punishment – negative behavior is followed by a consequence that results in a decrease of the probability of that behavior in the future

Question 28

Build a new behavior or increase a behavior

Answer 28

• Reinforcement – any consequence that increases the rate of behavior it follows
• Task Analysis – break down a task into smaller steps and reinforce after each step
• Shaping –like task analysis for a specific behavior
• Premack – making access to a highly valued reinforcer contingent on engaging in a low probability behavior
• Cueing – giving a signal that sets off a chain of behavior

Question 29

Functional Analysis

Answer 29

A scientific, systematic approach to understanding the individual case.

Antecedents (Triggers)
Behavior
Consequences (Payoffs)

Question 30

Nocebo

Answer 30

The nocebo effect is the negative reaction experienced by a patient who receives a nocebo.

Question 31

Adherence

Answer 31

The extent to which a patient takes a medication as prescribed by their health care providers.

Question 32

Compliance vs. Adherence

Answer 32

Implies that the patient passively follows the doctor’s orders and that the treatment plan is not based on a therapeutic alliance or contract established between patient and physician.

More of a collaborative model, with health care providers having some responsibility in creating the treatment contract.