Nutritional Counseling for Behavioral Change Flashcards Preview

DEMS: Unit IIb > Nutritional Counseling for Behavioral Change > Flashcards

Flashcards in Nutritional Counseling for Behavioral Change Deck (15)
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Stages of change (7) and example responses from patients in those stages

  1. Pre-contemplative
  2. Contemplative
  3. Planning
  4. Action
  5. Maintenance
  6. Relapse
  7. Identification


Utility of "stages of change" model in clinical practice

  • Individuals go through sequential steps in thinking before making a behavior change
  • Avoid temptation as provider to give advice
  • Encourage person to talk about what they are doing and why
  • Consider what they might do differently
  • Lets patient do most of the talking
  • Patients can be in different stages at the same time


Primary goal of motivational interviewing

  • Get the patient to realize their own motivation and make a behavior change from that motivation
  • Motivation does not come from the provider or other outside influence
  • Have the patient assume responsibility for their progress, help them build a sense of self-efficacy


Key principles of motivational interviewing (10)

  • Motivation to change is elicited from the individual, cannot be imposed from outside
  • Most people do not change because they are ambivalent about the proposed change
  • Primary task of conversation is to have patient articulate and work towards resolving ambivalence
  • Direct persuasion not an effective method for resolving ambivalence
  • Quiet, eliciting counseling style rather than directing/advice giving
  • Counselor focuses on ambivalence (not teaching specific skills)
  • Readiness/resistance to change provide feedback about counselor's demands
  • Therapeutic relationship = partnership
  • Patient responsible for their progress
  • Help patient build sense of self-efficacy and competence that they can solve the problem themselves


3 important steps in values-based counseling

  • Look for/understand a person's core values
  • Verify with the person that this is a core value
  • Relate the core value to the health behavior that needs changing


Core hypotheses of health belief model

  • Most patients don't believe what we tell them
  • Change and adherence occur when the patient:
    • Perceives themselves to be at risk for illness
    • Believes that the problem they are at risk for is serious
    • Is convinced that treatments being proposed are effective, do not have substantial side effects
    • Is exposed to compelling cue to take health action
    • Has confidence that they can perform the specific behaviors being proposed


Basic principles of cognitive behavioral therapy (CBT)

  • Undesired behaviors are result of unconscious or unhelpful ideas
  • Behaviors are inexplicable, even to the patient
  • Have patient work backwards in time to see how event occurred
  • Come up with specific strategies to counteract the behavor (alternative thoughts)


Situations where CBT might be most useful

  • A patient feels like if they don't eat they will get hungry
  • When they get hungry, they may feel desperate, feel the need to eat
  • Patients ccan consciously use other thoughts to combat natural urge to eat
    • Tell themselves they will be able to eat in a few hours
    • Health is actually better by eating less
    • Hunger is undermining their efforts at weight loss


Example statement of a person in pre-contemplative stage

  • Pre-contemplative:
    • "a problem? I don't have a problem with my diet"
    • don't see/accept need to change


Example statement of a person in contemplative stage

  • Contemplative
    • "oh my diet is terrible, but I just can't change it"
    • see need to change, but no confidence


Example statement of a person in planning stage

  • Planning
    • "my diet is terrible and I have been thinking about trying one of those new diets"
    • see need, with some level of confidence - try to increase/encourage that confidence



Example statement of a person in action stage

  • Action
    • "my diet is a problem for me, but I have been on the Dr. Oz diet for two months and I am having great success"
    • identified need and made change, help them with possible future challenges even if you don't necessarily agree with the action they took


Example statement of a person in maintenance stage

  • Maintenance
    • "oh I have been on the Dr. Oz diet plan for 6 months now, it is sometimes very hard for me to follow through with but I think it's going well overall"
    • trying to incorporate new diet into long-term lifestyle
    • 2 outcomes: relapse or retain long-term changes (relapse or identification)



Example statement of person in relapse stage

  • Relapse
    • "oh I have tried diets before, but they never work. I don't want to talk about diets anymore because I just can't succeed"
    • patient feels depressed and like a failure, talk about past need to change and actions taken



Example statement of person in identification stage

  • Identification
    • "I have been on my diet plan for a year now and it's going really well" 
    • Ideal! Patient achieves long-term success with diet plan