Counseling Strategies to Promote Behavior Change

Question 1

4 key elements in effective counseling

Answer 1

1. change needs to come from patient: not imposed from outside
2. see a compelling need for change
3. confidence that they can do the new behavior
4. be empathic and demonstrate it

Question 2

2 requirements to change a behavior

Answer 2

1. see a compelling need for change

2. feel capable o making change suggested

Question 3

7 stages in trans theoretical model

Answer 3

1. Pre-contemplative
2. contemplative
3. planning
4. action
5. maintenance
6. relapse
7. identification

Question 4

pre contemplative

Answer 4

Patient:
-not considered possibility that diet is affecting their health

You:
-suggest to them that health problem is related to their diet

Question 5

contemplative

Answer 5

patient:
- sees compelling need for change but doesn’t feel capable of changing

You:

• reinforce that you agree that there is a compelling need to change behavior
• help them if they pick a small achievable goal

Question 6

planning

Answer 6

Patient:

• compelling need to change
• some confidence that they can make the change

You:

• troubleshoot the plan
• increase level of confidence that they can succeed in achieving their chosen goal

Question 7

action

Answer 7

Patient:

• identified problem behavior
• made behavior change

You:

• should be supported in behavior change
• help them look toward the future

Question 8

maintenance

Answer 8

Patient:

-tries to incorporate new diet into long-term lifestyle

Question 9

Two outcomes of maintenance

Answer 9

1. relapse
   - patient feels hopeless
   - you should encourage review of previous experience; relapse is common
2. identification
   - incorporate long term changes into lifestyle
   - you should help patients achieve long term success

Question 10

problems with trans-theoretical model

Answer 10

-very few patients in action or maintenance phase

• different stages for different lifestyle change
• move through stages quickly and non-sequentially

Question 11

role of counselor in motivational interview

Answer 11

1. direct persuasion does not resolve ambivalence
2. counseling style is quiet and eliciting, not directing/ advice giving
3. counselor focuses on ambivalence as opposed to teaching specific skills
4. readiness to change/ resistance provides feedback to counselor’s demands
5. therapeutic relationship is a partnership more than an expert/recipient role

Question 12

patient in motivational interviewing

Answer 12

1. patient responsible for their progress
2. goal: build self-efficacy and competence so they can solve problem themselves
3. motivation is from the person and cannot be imposed from outside
4. people don’t change because they are ambivalent; so goal: patient clearly articulate and work toward resolving ambivalence

Question 13

It is unlikely that a person will make a lifestyle change if they don’t rate their behaviors as a problem at what level?

Answer 13

7 out of 10

Question 14

confidence

Answer 14

• dramatic lifestyle changes undermine a person’s ability to make any change at all
• encourage the patient to make very small lifestyle changes and increase their confidence that the change can actually be made
• assist patient in coming up with strategy that works for them

Question 15

patient rating level of confidence

Answer 15

7 or greater to increase likelihood that behavior change will actually occur

Question 16

5 strategies that are part of MI

Answer 16

1. reflection
2. role with resistance: not ready for change
3. highlighting discrepancies
4. alternative futures
5. Pro’s and Con’s to current and future behaviors

Question 17

role of good reflexion statement

Answer 17

1. shows patients that you are hearing what they said
2. sincerely puts you in patient’s shoes to allow you to see them more clearly and a way forward
3. person can hear their own words coming back at them

Question 18

advantage of using alternative futures

Answer 18

• consequences of current behavior vs alternative behavior

- helps perceive adverse consequences that are distant

Question 19

Health Belief Model

Answer 19

provides checklist for why patients are not taking your advice

Question 20

Health Belief Model 5 factors

Answer 20

1. perception of risk to self
2. risk is serious
3. treatments are effective and lack substantial SE
4. exposed to compelling cues to health action
5. confidence to perform behaviors that are proposed

Question 21

values based counseling

Answer 21

–do not produce behavior change if they do not see it as a high priority

-relate core value to health behavior

Question 22

cognitive behavior therapy

Answer 22

• have individual work backwards in time to see how even occurred to gain insight into how they might break chain of events
• identify specific idea that lead to undesired behavior and come up with specific strategies to counteract it so behavior change will be more effective

Question 23

CBT uses

Answer 23

techniques directed at changing behaviors instead of focusing on values, motivation or ambivalence

Question 24

overall approach

Answer 24

ask a question
-->
listen
-->
reflect
-->
Empathize
-->
Work w/ person to decide what they want to do