2013 behavior change

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  • The goal is not so much to reach the Action stage in one session but rather to move the patient from his present stage to the next one. ideal context--a continuing relationship
  • The goal is not so much to reach the Action stage in one session but rather to move the patient from his present stage to the next one. ideal context--a continuing relationship
  • The goal is not so much to reach the Action stage in one session but rather to move the patient from his present stage to the next one. ideal context--a continuing relationship
  • The goal is not so much to reach the Action stage in one session but rather to move the patient from his present stage to the next one. ideal context--a continuing relationship
  • The goal is not so much to reach the Action stage in one session but rather to move the patient from his present stage to the next one. ideal context--a continuing relationship
  • 2013 behavior change

    1. 1. Health Behavior Change: Stages of Change Model AILEEN B. PASCUAL, MD, FPAFP 11 JULY 2013
    2. 2. CHANGE INTERVENTION • Important role of physicians • Useful in addressing lifestyle modification for disease prevention, long-term disease management and addictions. • Understanding patient’s readiness to make change and appreciating barriers to change and helping patients anticipate relapse
    3. 3. Transtheoretical Model •Stages of Change Model •Prochaska & DiClemente •Change is a process involving progress through a series of stages •Five stages of change
    4. 4. GROUP ACTIVITY • 12 groups • Each group will be given 1 manila paper, masking tapes and set of clipnotes • There are major categories of the clipnotes which your group will match
    5. 5. MATCH STAGES of CHANGE GOAL PATIENT PHYSICIAN ? ? ? ? ? ? ? ? ? ? ? ? ACTION ? ? ? ? ? ? ?
    6. 6. 10 minutes
    7. 7. Transtheoretical Model Prochaska&DiClemente •Stages of Change Model •Change is a process involving progress through a series of stages •Five stages
    8. 8. STAGES OF CHANGE Prochaska&DiClemente •Pre-Contemplation •Contemplation •Preparation •Action •Maintenance
    9. 9. Pre-Contemplation •Patient is not even thinking about changing the behavior. •They may not see the behavior as a problem at all.
    10. 10. Pre-Contemplation •Resistance to change can be summarized in 4 R’s • Reluctance • Rebellion • Resignation • Rationalization
    11. 11. Pre-Contemplation: Reluctance •Don’t want to consider change because of lack of knowledge or inertia •Approach: • Provide feedback and information in a sensitive and empathic manner
    12. 12. Pre-Contemplation: Rebellion • They have a heavy investment in the problem behavior and in making their own decisions • Resistant in being told what to do. • Approach: • Offer choices • Shift some energy used to resist into contemplating change
    13. 13. Pre-Contemplation: Resignation • Characterized by lack of energy and investment • They have given up on the possibility of change and seem overwhelmed by the problem. • Approach: • Instill hope • Explore barriers to change
    14. 14. Pre-Contemplation: Rationalization • Many reasons why the problem is not a problem or is a problem for others but not for them. • Session feels a debate • Approach: • Empathy and reflective listening
    15. 15. Pre-Contemplation Goal Patient Physician Patient will begin to think about change. Not thinking about change May be resigned Feeling of no control Does not believe it applies to himself Believes consequences are not serious Use relationship building skills Personalize risk factors Give data about patient’s vitals, labs and compare with norm. Express caring concern rather than scare tactics Educate in small bits over time
    16. 16. Contemplation • Person acknowledges that she/he has a problem and begins to think seriously about solving it. • Stage marked by ambivalence  Giving up an enjoyed behavior causes them to feel a sense of loss despite the perceived gain. • Contemplation does not mean commitment
    17. 17. Contemplation • APPROACH • Provide information and incentives to change • Deal with the hidden “benefits” of maintaining the behavior (“decisional balance technique”) • Deal equally with the pros and cons of CHANGING the behavior
    18. 18. Contemplation • APPROACH • Explore problems with previous attempts to change. • Reframe failures into “partial successes”. • Emphasize the cyclic nature of change in the stages-of-change model.
    19. 19. Contemplation Goal Patient Physician Patients will examine benefits and barriers to change. Weighing benefits and costs of behavior, proposed change. Elicit from patient the reasons to change and the consequences of not changing. Explore ambivalence, praise the patient for considering difficulties of change. Restate both sides of ambivalence. Question possible solutions for one barrier at a time.
    20. 20. Preparation/Determination: Commitment to Action • Hallmark: deciding to take appropriate steps to stop a negative behavior or start a positive one • Assess strength and levels of commitment • Anticipate problems and pitfalls • Use appropriate techniques.
    21. 21. Preparation Goal Patient Physician Patient will discover the elements necessary for decisive action. Experimenting with small changes Encourage the patient’s efforts. Ask which strategies the patient has decided on. Ask for a change date
    22. 22. Action •People make drastic lifestyle changes •Requires greatest commitment of time and energy
    23. 23. Action APPROACH • Provide support • Provide external monitoring of progress • Focus on successful activity (“Progress, not perfection.”) • Reaffirm their decision • Offer information about successful models • Usually lasts 3-6 months
    24. 24. Action Goal Patient Physician Patient will take decisive action. Taking a definitive action to change Reinforce the decision Affirm small successes View problems as helpful information Ask what else is needed for success.
    25. 25. Maintenance • New behavior is becoming firmly established • Threat of relapse becomes less frequent and intense • APPROACH • Provide feedback about length of time needed for change • Help patient become aware of “triggers” • Help the patient learn from the relapse • Remind them of the cycle of change
    26. 26. Maintenance Goal Patient Physician Patient will incorporate change into daily lifestyle Maintaining new behavior over time Continue reinforcement Ask what strategies have been helpful and what situations are problematic.
    27. 27. Relapse Goal Patient Physician Learn from the temporary success and re- engage the patient in the change process Experiencing normal part of the process of change Usually feels demoralized Remind the patient that change is a process, that most people “recycle”. Reframe from failure to successful for a while plus new lessons for continued success.
    28. 28. Termination •Stage where individuals have zero temptation and 100% self-efficacy
    29. 29. Decisional Balance Technique: Motivational Counseling Prochaska and DiClementi
    30. 30. How is Decisional Balance Technique done?
    31. 31. Question 1: What do you get out of it?
    32. 32. Question 2: What are the disadvantages?
    33. 33. Question 3: What are your goals in life?
    34. 34. Question 4: How does the behavior fit into your goal/s?
    35. 35. Question 5: If you could change, what would happen?
    36. 36. Decisional Balance Technique 5 Questions in series: 1. What do you get out of it? 2. What are the disadvantages? 3. What are your goals in life? 4. How does the behavior fit into your goal? 5. If you could change, what would happen?
    37. 37. References Zimmerman GL, Olsen CG, Bosworth MF. A 'stages of change' approach to helping patients change behavior. Am Fam Physician 2000;61(5):1409-16 Dr. Allan Dionisio Dr. Cherry Bernardo-Lazaro

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