Behavior Change Counseling Flashcards Preview

DEMS Unit 2 Part 2 > Behavior Change Counseling > Flashcards

Flashcards in Behavior Change Counseling Deck (18):


- The Boss
- In Control
- Decision Maker
- Responsible
- Authority
- Accountable


Consultant/Coach **

- Expert
- Advisor
- Not in control
- No authority
- Not the decision maker
- Good listener
- Problem solver
- Filter/explainer/observer


Key elements of effective counseling

- Ultimately the behavior change needs to come from the patient
- Compelling need for change
- Confident that they can/will do what is suggested and that change will help
- Be empathetic and demonstrate it


General approach to coaching

- Understand pt beliefs and motivations. you cannot create motivation, you can only identify and redirect existing motivations
- Put the ball in the patient's court
- Don't give advice
- When in doubt, reflect back what the patient has been saying
-Try to bring the convo to specific, measurable, achievable goals


Steps for coaching

1. Ask
2. Listen
3. Reflect
4. Empathize
5. But what do you want to do?


Initiating the conversation

- Ask the person how if they are concerned about their weight or physical activity
- Give them time to answer
- Have them draw a weight history


Behavioral models

1. Transtheoretical model (stages of change)
2. Health belief model
3. Values based counseling
4. Motivational interviewing
5. Cognitive behavioral therapy


Transtheoretical Model

1. Model of time ordered steps leading to sustained behavior change
2. Focuses on the decision making process of the individual
3. Relies on self report


Stages of Change

1. Precontemplative
2. Contemplative
3. Planning
4. Action
5. Maintenance
6. Relapse
7. Identification


Health Belief Model

- Willingness to change relates to the perception of vulnerability for illness and the possible effectiveness of treatment

- @ risk for illness
- Identifies the problem as serious
- convinced the Tx is effective and not overly costly
- Exposed to a cue to take action
- Have confidence that they can perform specific behaviors that will be helpful.


What is a compelling need for change?

Core values
- Maybe health is not top priority
- for men: health is not even on the list
- for women: family is top, but health is not on the list

- How can you link core values and health behavior change?


Motivational Interviewing

- Examination and resolution of ambivalence is its central purpose
- Direct persuasion is not an effective method for resolving ambivalence
- Readiness to change / resistance provide feedback about couneslor's demands
- Build a sense of self-efficacy

- Many people see the problem but don't feel confident/competent/capable of change


What does it take to get behavior change?

- Probably about a 7
- Small changes
- High likelihood of success that will build self-efficacy
- Concrete goals that are measurable: what, where, when, how?


Cognitive Behavioral Therapy

- Focus is on actually changing unwanted behaviors, not motivation
- Self monitoring
- Stimulus control: identify trigger events and deal with them
- Cognitive restructuring: change unhelpful thinking


Sample Behavior Chain

1. Buy cookies
2. Leave cookies on counter
3. Home in the afternoon, tired and bored
4. Urge to eat
5. Go to kitchen
6. Eat cookies and watch TV
7. Eat rapidly until full
8. Feel guilty/like a failure
9. Restraint weakens further
10. More eating


Set goals

- the more specific, the better
- small achievable goals are better than big difficult goals



- intrinsic drive to eat results in chronic drive to consume unhealthy food
- intrinsic drive to be sedentary acts against the goal to be more active
- Goal is to develop skills of acceptance to let the feelings just be there without the bad behavior


Best things to do when talking

- have pt do most of the talking
- have pt come up with approach, keep goals small and measurable
- keep the tone positive for them and you
- understand what has worked and what hasn't and why
- Self monitoring is KEY - not just what eating, but what feeling