Understanding Behavior Change Models

Challenges of Behavior Change

• 35% of men and 40% of women in the US have a BMI >30 kg/m2.
• Approximately 33.5% of overweight/obese adults who successfully shed 10% of their initial body weight will regain it within one year.
• Roughly 95% of individuals regain their weight, and it returns to just below the baseline within five years.
• Behavior is maintained and reinforced over time by the environment, contributing to the difficulty of changing it.

Theories to Behavior Change

• Provides a framework for understanding how and why behavior changes within a specific population.
• Allows for replicable, sustainable, and generalized interventions.
• More than 70 behavior techniques have been identified in the literature.
• The course will cover the Transtheoretical Model (TTM), Health Belief Model (HBM), Theory of Planned Behavior (TPB), Social Cognitive Theory (SCT), Goal Setting Theory (GST), Small Changes Model, and Socio-Economical Model.

The Transtheoretical Model

• The model integrates constructs from social learning theory and the social cognitive theory.
• It helps individuals at all stages of readiness and reduces friction.
• Research has shown mixed results regarding this model, and it might be more effective for some behaviors than others.
• There are 10 processes of change once one determines the stage

Cognitive Strategies in Behavior Change

• Consciousness raising (increasing awareness) is appropriate for precontemplation, contemplation, and preparation stages.
• Dramatic relief (understanding emotions) is appropriate for precontemplation, contemplation, and preparation stages.
• Environmental reevaluation (awareness of the impact on others) is appropriate for precontemplation, contemplation, and preparation stages.
• Self-reevaluation (creating a new self-image) is appropriate for precontemplation, contemplation, and preparation stages.
• Social liberation processes (support from others) is appropriate for precontemplation, contemplation, and preparation stages.

Behavioral Strategies in Behavior Change

• Self-liberation (making a commitment to self) is appropriate for preparation, action, and maintenance stages.
• Counter conditioning (using substitutes) is appropriate for preparation, action, and maintenance.
• Helping relationships (finding support, trust, and acceptance) is appropriate for the action and maintenance stages.
• Reinforcement management (using rewards) is appropriate for the action and maintenance stages.
• Stimulus control (managing the environment positively) is appropriate for the action and maintenance stages.

The Health Belief Model

• Behavior change can be predicted by one's feeling of susceptibility to the health consequences.
• The belief that making changes will reduce risk is also a factor in behavior change.
• It may not be as effective for clients who have not identified health risks.

Health Belief Model Constructs and Strategies

• Perceived susceptibility is beliefs about chances of getting a disease/condition if one does not exercise, which can be addressed by explaining risk information based on current activity, family history, and other behaviors.
• Perceived severity involves beliefs about the seriousness/consequences of a disease/condition as a result of inactivity.
• Perceived benefits refer to beliefs about the effectiveness of exercising to reduce susceptibility and/or severity.
• Perceived barriers encompass beliefs about the direct and indirect costs associated with exercise.
• Cues to action are factors that activate the change process and get individuals to start exercising.
• Self-efficacy involves confidence in the ability to exercise.

Theory of Planned Behavior

• Intention to engage in a behavior will ultimately result in that behavior.
• Strengths: TPB treatment significantly increase intention
• Limitations: There is an "intervention-behavior gap," because intention doesn't always lead to the behavior.

Social Cognitive Theory

• Outcome expectations and self-efficacy are the most important factors in behavior change.
• This approach considers clients' environment, thoughts, and feelings toward the change.
• There are many factors to consider in one treatment program.

Goal Setting Theory

• Common construct in many theoretical models
• This process gives clients a concrete plan for change and may be utilized along with other strategies.
• This process may not address factors such as thoughts, emotions, and the environment.
• 4 different mechanisms play a role in goal-related behavior: -Goals direct attention and energy toward desired behaviors. -Goals lead to greater effort. -Goals extend the time and energy devoted to a desired behavior. -Goals increase the use of goal-relevant skills.

Small Changes Model

• It combines components from goal setting, feedback, and self-monitoring to yield achievement of initial goals and increase self-efficacy.
• This approach promotes gradual and cumulative behavior change.
• This is a new theory with few studies backing, and little is known about its effectiveness for certain groups of people.

Socio Ecological Model

• Behavior change results not only from individual factors but also from the social structure, environment, community, policy, and law.
• Recognizing that clients are affected by their environment is a strength.
• The environmental structure can be very difficult to change, so change can be slow at best.

Building Theory into Intervention: Self-Monitoring

• Research proves that behavior change is more successful with self-monitoring.
• Increases client awareness
• Offers accountability
• Provides information to understand their behavior outside sessions.
• Allows for goal setting and tracking progress
• Provides the opportunity for feedback
• Is a skill that a client can use on their own after intervention.

Building Theory into Intervention: Feedback

• Defined as 2-way communication between 2+ parties
• One must keep in mind not to impose views without taking others' views into consideration.
• It is necessary for effective goal setting and is an important component of physical activity behavior change.

Goal Setting, Smart Goals, Feedback

• Goal-setting is an important tool to promote increased and maintained activity, and is more successful if personally selected.
• Goals can be short term or long term.

S.M.A.L.L. Goals

• Specific
• Measurable
• Action-oriented
• Linked to your life
• Long term

S.M.A.R.T. Goals

• Specific
• Measurable
• Achievable (action-oriented)
• Realistic
• Time-oriented

Tips for Avoiding Arguments and Reducing Resistance

• Listen.
• Make it hypothetical.
• Acknowledge the resistance.
• Emphasize personal choice and control.
• Emphasize success.
• Acknowledge ambivalence.
• Match the participant's readiness.

Adherence Factors: Self-Efficacy, Motivation, Worth

• Individual confidence to successfully complete exercise.
• Motivation can be either extrinsic (exercising for weight loss/appearance) or intrinsic (exercising for enjoyment).
• Self-worth: Satisfaction individuals have with themselves.

Adherence Factors: Barriers, Self-Regulation

• Perceived Barriers: Factors that impair the individual's belief that they can exercise.
• Self-Regulation: Strategies for planning, organizing, and managing exercise activities. Self-monitoring.
• Social support: Exchange of aid or assistance among individuals or groups within a social network.

Adherence - Environment, Schemata, Values

• The environment may include access to facilities, weather, the neighborhood environment, and where the exercise takes place.
• Self schemata: Individual's self-image about exercise.
• Outcome expectancy values: How much the individual values the expected outcome.
• Duration and intensity: length of time spent active and how hard individual works.
• Type of physical activity.
• Major life events: Events in a client's life that impact his or her daily routine.
• Program tailoring: Having a program that aligns with the client's TTM stage of change.

Barriers to Exercise

• Impairs an individual's belief that they can exercise
• Personal: individual-level barriers that may be internal or behavioral
• lack of time, motivation, knowledge, energy and social/environmental factors

Barriers to Exercise – Social

• Arise in relation to an individual's social network
• Lack of social support and sociocultural barriers

Barriers to Exercise – Environment

• Physical barriers often outside the individual's control, prevent active behavior.
• This includes a lack of access, weather concerns and safety concerns.

Types of Social Support

• Emotional Support: encouragement or acceptance by others.
• Tangible Support: material aid to provide an individual to exercise.
• Information Support: providing advice or information regarding exercise.
• Appraisal Support: giving constructive feedback and accepting individuals' beliefs and values.

Coaching Techniques

• This involves strong oral and nonverbal communication skills.
• Active listening
• Empathy
• Developing rapport
• Appreciative inquiry
• Motivational interviewing

Coaching Techniques – Active Listening

• This involves communication skills for communication within successful family, business, and therapeutic relationships.
• One should nod, make eye contact, and restate info.
• Key elements:
• Listening to spoken statements
• Observing nonverbal cues
• Understanding contextual anxiety
• Identifying statements that indicate teaching and learning opportunities

Coaching Techniques – Empathy

• Showing warm responsiveness and understanding of the individual's needs and concerns
• Being affective and cognitive
• "Feeling into” another person's experience
• Honesty, mutual respect, and effective communication

Coaching Techniques – Developing Rapport

• Rapport has a sense of trust, respect, or confidence, which a client holds for you.
• Involves active listening and empathy.
• The coach should be attentive, regularly monitor progress and have strong self-awareness.

Coaching Techniques - Appreciative Inquiry

• An approach used for motivating change that focuses on exploring and amplifying strengths.
• 5 phases of development (5D):
• Define, Discover, Dream, Design, Deliver.

Coaching Techniques – Motivational Interviewing

• Resolve any ambivalence from the individual, and encourage a change of talk to reduce the amount of resistance talk.
• The coach should be direct and client-centered.
• Encourage talk about what needs to be changed in the context of desires and abilities.

The 5 As Model of Behavior Change Counseling

• Assess
• Advise
• Agree
• Assist
• Arrange