Lecture 3: Behavior, Motivation, Communication

Lecture 3 Behavior, motivation, communication Challenges of Behavior Change 35% of men and 40% of women in the US with listed BMI >30 kg/m2 Among overweight/ obese adults who successfully lose 10% of their initial body weight → 33.5% will regain it within the first year → within 5 years,...

Lecture 3 Behavior, motivation, communication Challenges of Behavior Change 35% of men and 40% of women in the US with listed BMI >30 kg/m2 Among overweight/ obese adults who successfully lose 10% of their initial body weight → 33.5% will regain it within the first year → within 5 years, approx 95% of people regain their weight just below baseline Why is it so difficult to change a behavior? Behavior has been a part of an individual’s life for a significant amount of time and is reinforced and maintained by one’s environment Theories to Behavior Change Framework that describes how and why behavior changes for a given population in a particular setting Allows for replicable, sustainable, and generalized interventions Over 70 behavior techniques identified in literature Theories we will be covering: ○ Transtheoretical model (TTM) ○ Health Belief Model (HBM) ○ Theory of Planned Behavior (TPB) ○ Social Cognitive Theory (SCT) ○ Goal Setting Theory (GST) ○ Small Changes Model ○ Socio Economical Model The Transtheoretical Model Integrates constructs from social learning theory and the social cognitive theory Adapted specifically address physical activity research Strengths: Helps those at all stages of readiness (no required readiness); reduces friction Limitations: Research shows mixed results. May be more effective for some behaviors than others 10 processes of change once you determine the stage→ The Health Belief Model Widely used and supported Behavior change is predicted by one’s feeling of susceptibility to health consequences, and the belief that making changes will reduce risk Strengths: clients have a greater understanding of health Limitations: may not be as effective for clients who do not have identified health risks Theory of Planned Behavior Intention to engage in a behavior will ultimately result in that behavior, and the level of intent is shaped by his or her attitudes toward the behavior ○ How helpful and enjoyable the behavior is perceived to be, subjective norms, and perceived behvioral control (self-efficacy and controllability) Strengths: TPB treatment significantly increase intention Limitations: “intervention-behavior gap” - intention does not always lead to behavior Social Cognitive Theory Outcome expectations and self efficacy are the most important factors in behavior change Strengths: considers clients environment, thoughts and feelings toward behavior change Limitations: many factors to consider in one treatment program Goal Setting Theory Common construct in several theoretical models Strengths: gives clients a concrete plan for change. May be utilized within other theories Limitations: may not address factors such as thoughts emotions and 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 Combines components from goal setting, feedback, and self-monitoring to yield achievement of initial goals and increase self efficacy Strengths: promotes gradual and cumulative behavior change while increasing self efficacy Limitations: new theory with only a handful of studies to date. Moreover little is known about its effectiveness for certain groups of people Socio Ecological Model Behavior change is a result of not only the individual factors but also the social structure, environment, community, policy and law Strengths: recognizes that clients are affected by their greater environment Limitations: the environmental structure (including community, policy, and law) can be very difficult to change and change is slow at best Sample Eco-Map Building Theory into Intervention Self-monitoring Feedback ○ Research shows behavior change is more ○ Defined as 2-way communication between successful with self-monitoring than 2+ parties without ○ Need to be kept in mind so the we do not ○ Increases client awareness impose their views without taking their ○ Offers accountability views into consideration ○ Provides info for us and in understanding ○ Not only necessary for effective goal their behavior outside of sessions setting but has also been labeled an ○ Allows for goal setting and tracking important component of physical activity progress behavior change ○ Provides an opportunity for feedback ○ Is a skill that a client can use on their own, after intervention Goal Setting, Smart Goals, feedback Goal-setting SMALL Goals ○ Important tool to promote increased ○ Specific and maintained activity ○ Measurable ○ More successful if personally ○ Action oriented selected ○ Linked to your life ○ Short term or long term ○ Long term SMART 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 to Exercise Factors related to adherence: Perceived barriers ○ Numerous factors that impair individual’s Self-efficacy: belief that they can exercise ○ individual’s confidence to successfully Self-regulation complete exercise ○ Strategies for planning, organizing, and Motivation managing exercise activities to “stay on ○ Extrinsic: exercising for weight loss or track” appearance ○ Self-monitoring ○ Intrinsic: exercising for enjoyment or Social support accomplishment ○ Exchange of aid or assistance among Self-worth individuals or groups within a social ○ Satisfaction individuals have with network themselves Factors related to adherence Environment Type of physical activity ○ May include access to facilities, weather, ○ Type of physical activity the individual neighborhood environment, or where the takes part in exercise takes place Major life events Self schemata ○ Events in a client’s life that impact his or ○ Individual’s self-image about exercise her daily routine Outcome expectancy values Program tailoring ○ How much the individual values the ○ Having a program that is in accordance expected outcome with the client’s TTM stage of change Duration and intensity ○ Length of time spent active and how hard individual works Barriers to Exercise Impair individual’s belief that they can exercise Personal ○ Individual-level barriers that may be internal or behavioral Examples: ○ Lack of time ○ Lack of motivation ○ Lack of knowledge ○ Lack of energy Barriers to Exercise – Social Social ○ Arise in relation to an individual’s social network Examples: ○ Lack of social support ○ Sociocultural barriers Barriers to Exercise – Environment Environmental ○ Physical barriers often outside of the individual’s control, that prevent him/ her from being active Examples: ○ Lack of access ○ Weather ○ Safety concerns Social Support Exchange of aid or assistance among individuals or groups within a social network Emotional support ○ Refers to the encouragement or acceptance of others Tangible support ○ Material aid in order to provide an individual with the opportunity to exercise Information support ○ Advice or information given in regard to exercise Appraisal support ○ Constructive feedback and accepting their beliefs and values Coaching techniques Need strong oral and nonverbal communication Active listening Empathy Developing rapport Appreciative inquiry Motivational interviewing Coaching Techniques – Active Listening Communication form that is described as a set of verbal and nonverbal skills necessary for communication in successful family, business, and therapeutic relationships Nodding head, making eye contact, and restating important info Observing others nonverbal communication 4 main elements: ○ Listening to spoken statements ○ Observing nonverbal cues ○ Understanding contextual anxiety ○ Identifying statements that indicate teaching and learning opportunities Coaching Techniques – Empathy Warm responsiveness or 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 ○ Refers to sense of trust, respect, or confidence, which a client holds for you Involves active listening and empathy Be attentive, regularly monitor progress Strong self-awareness Coaching Techniques – Appreciative Inquiry 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 Overall goal is to resolve any ambivalence from the individual, to encourage change of talk, and reduce the amount of resistance talk Important to be direct, client-centered Encourage talk about what needs to be changed in the context of their desires and abilities The 5 As model of Behavior Change Counseling Assess Advice Agree Assist Arrange Methods of communication