HealthPsyc3 Flashcards
Individual approaches to behaviour change
Informing people of their risks for certain
diseases may lead to them engaging in long
term risk protective behaviour
• E.g. showing an overweight man in his 60’s- smoker with high cholesterol- a heart disease calculator which displays high risk of a heart attack
• Some people strive to change behaviour once aware of health risk, HOWEVER many will not, or the changes will not be sustained
• Being aware of risk may not be enough to foster behavioural change
• More targeted interventions have been developed to change behaviours- taking into account people’s differing levels of motivation
3 INDIVIDUAL APPROACHES TO BEHAVIOUR
CHANGE
- Motivational interviewing
- Problem solving approaches & implementation planning
- Modelling and behavioural practice
- Motivational interviewing
Is a person-centred method for enhancing intrinsic motivation to change by exploring and resolving ambivalence (Miller & Rollnick 2002)
• The intervention generally considered most likely to be effective for people who are reluctant to engage in change
• Motivational interview (MI) is collaborative, non-confrontational, non-authoritative
• Key questions within the interview are:
• ‘What are some of the good things about your present behaviour?’
• ‘What are the not-so-good things about your present behaviour?’
The spirit of motivational interviewing: Collaboration
Collaboration: patient-practitioner
partnership; joint decision making.
Practitioner acknowledges patient’s expertise
about themselves
vs Authoritative Therapeutic Style:
Confrontation: practitioner assumes patient
has an impaired perspective and imposes the
need for ‘insight’. Practitioner tries to persuade
and coerce a patient to change
The spirit of motivational interviewing: Evocation
Evocation: practitioner activates patient’s own
motivation for change by evoking their reasons
for change- connects health behaviour change
to things patient cares about
vs Authoritative Therapeutic Style:
Education: patient is presumed to lack the
insight, knowledge or skills required to change.
Practitioner tells the patient what to do
The spirit of motivational interviewing: Honoring Patient Autonomy
Honouring patient autonomy: Whilst
informing the patient, practitioner
acknowledges the patient’s right and freedom
not to change. ‘It’s up to you’
vs Authoritative Therapeutic Style:
Authority: practitioner instructs the patient to
make changes
- Motivational interviewing
- Key elements and strategies include:
- Expressing empathy by the use of reflective listening
- Supporting self-efficacy and optimism for change
- ‘Rolling with resistance’ rather than confronting or opposing it
- Developing an awareness of the discrepancies between the client’s current behaviours and their values/goals
- Is motivational interviewing effective?
Goal of MI is to motivate people to consider change
• Most studies focus on whether it can alter behaviour
• Meta Analysis: Smedslund et al. (2011)
• MI in drug abuse setting more successful (substance use behaviour) than no intervention
• Limited differences with other active treatments
• Schneider, Casey, & Cohen (2000)
• Compared MI with confrontational interviewing in persuading substance users to enter treatment
• At 3 & 9 months- equal % of groups had completed their treatment program and had made similar gains in reduced drug use
• HOWEVER» MI was more acceptable and less stressful for both counsellors and clients than confrontational approach
- Problem focused counselling
• “Problem oriented”
• Focused specifically on the issues at hand and in the ‘here and now’, and has three distinct phases (Egan, 2006):
• Problem exploration and clarification: detailed exploration of problems individual is facing; breaking ‘global insolvable problems’
into carefully defined solvable elements
• Goal setting: Identifying how individual would like things to be different; setting clear, behaviourally defined, achievable goals
• Facilitating action: Developing plans and strategies through whichthese goals can be achieved
Role of counsellor NOT to act as expert solving person’s problems –
• Rather to mobilise the individual’s own resources to identify problems and arrive at solutions
• Important to deal with stages sequentially and thoroughly
- Effectiveness of problem focused counselling
- Despite generally acknowledged effectiveness of problem focused counselling styles- surprisingly little examination of effectiveness
- Gomel et al. (1993) risk factors for heart disease study
- 3 groups: risk education; problem focused counselling; no intervention
- Problem solving intervention had greatest effect»_space; greater reductions in blood pressure, BMI, smoking than in education only or no intervention groups
- Problem focused counselling- applied example
Many behaviour change programs have an element of problem identification and resolution
• Most smoking interventions use combination of nicotine replacement therapy and problem solving approaches
• Example: smoking cessation strategies eg. sit with non-smokers during coffee breaks
- Implementing plans and intentions
Egan’s (2006) last stage of problem focused counselling may be key therapeutic element:
• Facilitating action: Developing plans and strategies through which these goals can be achieved
• Similarly, HAPA (Schwarzer & Renner, 2000) & implementation intentions (Gollwitzer & Schaal, 1998) identified planning as important determinant of behavioural change
• Approaches encourage individuals to plan how they will engage in their behaviour of choice
• Positive results in interventions for: Increased fruit intake (DeNooijer et al., 2006); Cervical screening (Sheeran & Orbell, 2000); Quitting smoking (Armitage, 2007); Weight loss (Luszczynska et al., 2007)
- Modelling change
Problem focused and planning strategies can help- BUT achieving
change can still be difficult
• Particularly where individual lacks skills and confidence in their ability to cope with demands of change
• Potentially overcome by learning skills or appropriate attitudes from observation of others performing them- vicarious learning
• Optimal learning and increases in self efficacy can generally be achieved through observation of people similar to the learner succeeding in relevant tasks
Modelling Change Experiment
• Sanderson and Yopuk (2007)
• 220 University students assigned to receive either:
• 30 min condom promotion video (positive attitudes about condom
use, modelling appropriate strategies for negotiating their use; male
presenters version; female presenters version)
• Waitlist control
• Intervention (video) participants reported:
• stronger intentions to engage in protected sex
• higher self efficacy in refusing to have unprotected sex
• higher levels of condom use four months after seeing the videos
• Both male and female students benefited more in terms of
condom use behaviour from viewing the female presenters
version
- Modelling & Behavioural practice
- Actual practice of a new behaviour
- Solutions to problems and skills needed to achieve change can be worked out and taught in an educational program
- > > Increasing skills and self efficacy
- E.g. Study by Kelly et al. (1994) reducing risky sexual behaviour
- Women at high risk of HIV infection attending an STI clinic
- Program included risk education, training in condom use, practicing sexual assertiveness skills such as negotiating condom use
- More effective than standard education based intervention in improving rates of condom use
