ALL IN THE TIMING:CREATIVE STRATEGIES FORENGAGING AND WORKINGWITH THEPRECONTEMPLATIVE PERSON   Association for Medical Edu...
“TIMING HAS A LOT TO DO WITH THE           OUTCOME OF A RAIN DANCE”                                    OLD WEST WISDOMThe ...
“REALIT Y IS THAT WHICH,       WHEN YOU STOP BELIEVING IN IT,        DOESN‟T GO AWAY.” P H I L L I P K . D I C K “The pop...
“THERE IS A TIDE IN THE AFFAIRS OF MEN                  WHICH, TAKEN AT THE FLOOD,                        LEADS ON TO FORT...
CHANGE IS A PROCESS THAT PROCEEDS        IN STAGES OR STEPSBut change is not a lateral process.
ADDICTION ANDCHANGE:Understandingand Interveningin the ProcessCarloC.DiClemente,Ph.D. ABPPUMBCPsychologywww.umbc.edu/psych...
THE PREPARED MIND “At certain moments in history, there are individuals whose  minds are prepared to recognize the import...
INTERVENTIONS THAT DO NOTMATCH THE PERSONSREADINESS ARE LIKELY TO:DAMAGE RAPPORTBLOCK RECEPTIVITY TO THEMESSAGEIMPEDE CHAN...
THE PRECONTEMPLATIVE PERSON The precontemplative  mind set is operating  from a protective  network of defenses.  These d...
tread                      lightly                      or SELF-PROTECTION IS   theyHEIGHTENED FOR THE    will PRE-CONTEMP...
TO AN ACTIVE SMOKER, E.G., SMOKING IS        A FORM OF SELF-CAREAll effective             “There must bestrategies must re...
CHANGE CAN BE PERCEIVED AS ATHREAT AND TRIGGER THE “STRESS         RESPONSE” --
FEAR-BASED INTERVENTIONS REINFORCE THE  SUBCONSCIOUS PERCEPTION OF THREAT
PSYCHOLOGICAL BARRIERS TOCOMMUNICATION IN PRE-CONTEMPLATION  All information about the addictive behavior and its   conse...
THENEUROSCIENCE OF BONDING
REWIRING ONE‟S BRAIN  IS UNCOMFORTABLE,ANXIETY-INDUCING AND  REQUIRES TIME AND         PERSISTENCE,
SUCCESSFUL SUSTAINED BEHAVIOR       CHANGE: ALL IN THE TIMINGThe will to change and the skills/tools to navigate change mu...
DESIRE AND COMPETENCEWhen a person has the desire to change and at the same time the tools, skills and knowledge to get t...
PROCESSES OF CHANGEExperiential Processes              Concern the person‟s thought processes              Generally see...
PRECONTEMPLATION AND THE        PROCESSES OF CHANGE Consciousness-raising     Counter-conditioning - – reframe problems ...
MORE PROCESSES OF CHANGEEnvironmental re-           Helping evaluation – “My kids        relationships –  are upset that...
SOCIAL NETWORKS INFLUENCE            BEHAVIOR CHANGEEvery facet of health examined so farappears to “spread” from person t...
EMOTIONAL INTELLIGENCE IS THE               FOUNDATION FOR EFFECTIVE                   COMMUNICATION Self- Awareness and ...
EMOTIONAL INTELLIGENCE:         AN EXPRESSION  OF THE RICH INTERPLAY OF CONSCIOUS FEELINGS,   THOUGHT- ACTION REPERTOIRES,...
EMBRACE THE “WOBBLE”The first rule of intervention in a behavior change process is thesame as the first rule in improvisat...
EMBRACING THE “WOBBLE” IN A   WORKPLACE SMOKING CESSATION            PROGRAMWhat is:                Employees who smokeA w...
WHO WANTS WHATThe employer‟s          The employees‟ objectives :             objectives: Reduce the number of  employe...
EMPLOYEES ACHIEVE THEIR OBJECTIVE BYATTENDING SMOKING CESSATION CLASSES.    CHANGES IN SMOKING BEHAVIOR        CANNOT BE M...
PRE-CONTEMPLATIVEPEOPLE IN A WORKPLACESETTING SPENDING THEIROWN TIME TO TALK ABOUT   WhatSOMETHING THEY DO NOT    is   WAN...
IF WHAT IS: LITTLE OR NO DESIRE TO      CHANGE SMOKING BEHAVIOR                         Talk around the closedWhat works...
ASSERTIVE ENGAGEMENT:                      IT‟S ALL IN THE TIMING“This is not for the faint -hearted but nor is it for the...
HOW TO “EMBRACE THE WOBBLE” BET WEEN  EMPLOYER AND EMPLOYEES‟ OBJECTIVES:Focus on developing competence in otherareas that...
CHANGE CAN MAKE A PERSON FEEL LIKE A FISH OUTOF WATER – IT HELPS TO UNDERSTAND THE TENSIONS  OF CHANGE AND OUR OWN APPROAC...
Reduce the                          reactive,   INCREASE EMOTIONAL     fear-based                          “threat”       ...
EXPLAIN THAT NICOTINE CHANGES THE BRAIN AND        IMPACTS THE FREEDOM TO THINK FOR OURSELVES 3 Brain Regions are involve...
EXPERIENCES CHANGE THE BRAIN
YOGA BREATHINGMINDFULNESSCHAIR YOGABREATH WORK      Teach                 Breath                 Work and                 ...
SELF-KNOWLEDGE PROMOTES EMOTIONAL INTELLIGENCE            Emotional             intelligence grows             through in...
“Through increased self-awareness, individuals are moreable to detach themselves fromevents and regulate theiremotions in ...
PROVIDER RELATIONSHIP SKILLS:EMPATHY COMMUNICATION BOUNDARIES• Everyone has blind spots – if we are open to seeing our own...
Training in effective approaches to workingwith precontemplative clients is available foryour staff, organization or confe...
All in the timing: How To Understand & Connect With the Precontemplative Person
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All in the timing: How To Understand & Connect With the Precontemplative Person

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To change habits - e.g. smoking or eating the wrong foods in personal life, or introduce new processes in a workplace - we need a combination of desire and competence. Health care providers and educators can unintentionally sabotage change efforts when information and interventions designed for people ready for action are applied to people who are precontemplaitve - which research shows may be as many as 85% of those who present for help with a problem. This presentation explores how to understand and connect with a precontemplative person.

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All in the timing: How To Understand & Connect With the Precontemplative Person

  1. 1. ALL IN THE TIMING:CREATIVE STRATEGIES FORENGAGING AND WORKINGWITH THEPRECONTEMPLATIVE PERSON Association for Medical Education and Research in Substance Abuse Annual Conference Lifestage, Inc. www,lifestage.org
  2. 2. “TIMING HAS A LOT TO DO WITH THE OUTCOME OF A RAIN DANCE” OLD WEST WISDOMThe “action” paradigm of behavior change is a model thatenrolled clients in relatively brief programs designed toconquer smoking, weight, alcohol, spending or otherproblematic behavior and expected them to take action withinweeks. Failure to maintain the action is attributed to theclients‟ lack of will power or motivation.90% of behavior change programs are designed for peoplewho are ready to take action and change their behavior.20% of people who present for help are ready to take action orchange their behavior.Prochaska, Norcross & Clemente, Changing For Good, HarperCollins Books, 2006.
  3. 3. “REALIT Y IS THAT WHICH, WHEN YOU STOP BELIEVING IN IT, DOESN‟T GO AWAY.” P H I L L I P K . D I C K “The popular concept among behavioral therapists is that no time is better than the present to take action against an addictive habit. In theory, it sounds right. But the cold light of reality presents a dif ferent picture. I am convinced that there is a tremendous advantage in a well -prepared, pre-emptive attack against the smoking habit.” D r. B a l a s a P r a s a d S to p S m o k i n g Fo r Good
  4. 4. “THERE IS A TIDE IN THE AFFAIRS OF MEN WHICH, TAKEN AT THE FLOOD, LEADS ON TO FORTUNE; OMITTED, ALL THE VOYAGE OF THEIR LIFE IS BOUND IN SHALLOWS AND IN MISERIES. ON SUCH A FULL SEA ARE WE NOW AFLOAT, AND WE MUST TAKE THE CURRENT WHEN IT SERVES, OR LOSE OUR VENTURES.”W M S H A K E S P E A RE , J U L I U S C E S E AR , AC T 4 , S C E N E 3 , 21 8 - 2 24 .
  5. 5. CHANGE IS A PROCESS THAT PROCEEDS IN STAGES OR STEPSBut change is not a lateral process.
  6. 6. ADDICTION ANDCHANGE:Understandingand Interveningin the ProcessCarloC.DiClemente,Ph.D. ABPPUMBCPsychologywww.umbc.edu/psych/habits
  7. 7. THE PREPARED MIND “At certain moments in history, there are individuals whose minds are prepared to recognize the importance of things that unprepared minds ignore or throw away.” P r o c h a s k a , N o r c r o s s & C l e m e n t e , Changing For Good, HarperCollins Books, 2006: 17 With pre-contemplative people, information about addictive behavior – or any other health-threatening behavior pattern – has to transcend the psychological barriers that allow the behavior to continue despite its negative consequences.
  8. 8. INTERVENTIONS THAT DO NOTMATCH THE PERSONSREADINESS ARE LIKELY TO:DAMAGE RAPPORTBLOCK RECEPTIVITY TO THEMESSAGEIMPEDE CHANGE“ M O T I VAT I O N A L I N T E R V I E W I N G A N D T H E S TA G E S O F C H A N G E ”S U B S TA N C E A B U S E A N D M E N TA L H E A LT H S E R V I C E S A D M I N I S T R AT I O N ,W W W. S A M H S A . G O V / C O - O C C U R R I N G / T O P I C S / T R A I N I N G / C H A N G E . A S P X
  9. 9. THE PRECONTEMPLATIVE PERSON The precontemplative mind set is operating from a protective network of defenses. These defenses inhibit cognitive awareness of consequences to behavior and block the capacity to absorb information about it.
  10. 10. tread lightly or SELF-PROTECTION IS theyHEIGHTENED FOR THE will PRE-CONTEMPLATIVE run the PERSON. other way
  11. 11. TO AN ACTIVE SMOKER, E.G., SMOKING IS A FORM OF SELF-CAREAll effective “There must bestrategies must really pragmatic acceptancestart where people that people are whereare, with their unique, they are, as well ascomplex, subjective compassion for anyexperience. struggles and suffering linked to the problem behavior.” The Smoke -Free Smoke Brea k: Stop Smoking Now With Mindfulness & Acceptance , Pavel Somov, PhD & Marla Somova , PhD
  12. 12. CHANGE CAN BE PERCEIVED AS ATHREAT AND TRIGGER THE “STRESS RESPONSE” --
  13. 13. FEAR-BASED INTERVENTIONS REINFORCE THE SUBCONSCIOUS PERCEPTION OF THREAT
  14. 14. PSYCHOLOGICAL BARRIERS TOCOMMUNICATION IN PRE-CONTEMPLATION  All information about the addictive behavior and its consequences is communicated over some kind of barrier, like speaking to someone through a closed door. These defenses include:  Denial: “I don‟t see anything wrong here.”  Rationalization: “I know that what I‟m doing might be bad for me but I couldn‟t handle my stress without it.”  Projection: “You‟re not so perfect. You are judgmental. You have no right to criticize me.”  Blame: “Ever y time I try to quit my spouse sabotages me.”  Internalization: I feel guilty and shameful about doing this, so that‟s something….”
  15. 15. THENEUROSCIENCE OF BONDING
  16. 16. REWIRING ONE‟S BRAIN IS UNCOMFORTABLE,ANXIETY-INDUCING AND REQUIRES TIME AND PERSISTENCE,
  17. 17. SUCCESSFUL SUSTAINED BEHAVIOR CHANGE: ALL IN THE TIMINGThe will to change and the skills/tools to navigate change mustoccur at the same time.Desire: “I want ” – necessary for change to occur; but without the tools and skills needed to achieve some degree of success leads to repeated, frustrating attempts that do not succeed and produce more shame, anxiety and demoralization.Competence: “I can”- tools, skills and knowledge are key to making a behavior change; but desire ignites the energy to use them.
  18. 18. DESIRE AND COMPETENCEWhen a person has the desire to change and at the same time the tools, skills and knowledge to get through the tensions of change action is possible.
  19. 19. PROCESSES OF CHANGEExperiential Processes  Concern the person‟s thought processes  Generally seen in the early Stages of ChangeBehavioral Processes  Action oriented  Usually seen in the later Stages of ChangeA D D I CT I ON A N D C H A N G E : U n d e r s t a n d i n g a n d I n te r ve n i n g i n t h e P r o c e s sC a r l o C . D i C le m e n te , P h . D . A B P P U M B C P s yc h o lo g yw w w. umb c . e d u/ p s yc h / h a b i t s
  20. 20. PRECONTEMPLATION AND THE PROCESSES OF CHANGE Consciousness-raising  Counter-conditioning - – reframe problems to provide alternatives for integrate new the behavior that provide information with the something that person‟s stated approaches it‟s perceived perspective, e.g. “when benefits, e.g. medication, I take a smoke break I relaxation, emotional am breathing deeply intelligence skills, and taking care of mindfulness, myself – what happens if I take the break and breathe without the  Cancer Prevention Research Center Transtheoretical Model, smoke?” http://www.uri.edu/research/cprc/TTM/Processe sOfChange.htm
  21. 21. MORE PROCESSES OF CHANGEEnvironmental re- Helping evaluation – “My kids relationships – are upset that I smoke Encourage social and are always on me to quit” and interpersonal “It is very inconvenient relationships with to take a smoke break people who do not now that we have to go smoke – educate so far from the about the role of building” social networks in health behavior change;
  22. 22. SOCIAL NETWORKS INFLUENCE BEHAVIOR CHANGEEvery facet of health examined so farappears to “spread” from person to person.The strength of a network effectdepends on the strength of a friendship.“Friendship as a health factor” Science, Volume 323 23 January2009, www.sciencemag.org
  23. 23. EMOTIONAL INTELLIGENCE IS THE FOUNDATION FOR EFFECTIVE COMMUNICATION Self- Awareness and Self-Control – an accurate understanding of how one‟s behavior and words affect others Emotional and inner awareness – an accurate understanding of how one‟s emotions and thoughts affect behaviors Accurate self-assessment of skills and abilities – an honest assessment of strengths and weaknesses Conscious planning of communication – the ability to plan the tone of a conversation to achieve the best results Respectful listening – listen deeply and seek to understand what others are saying Creativity and sense of play – the ability to take one self lightly and engage with serious situations in a creative wayD a n G o l e m a n , E m o t i o n a l I n te l l i g e n c e , B a n t a m D e l l , 2 0 0 6
  24. 24. EMOTIONAL INTELLIGENCE: AN EXPRESSION OF THE RICH INTERPLAY OF CONSCIOUS FEELINGS, THOUGHT- ACTION REPERTOIRES, AND ATTITUDES“Emotional Intelligence(EI): Our ability toengage our emotionalityin effective ways inorder to facilitatepositive outcomes in ourrelationships.”D r. M i c h a el E . Ro c k . o n e o f a fews pe c i alist s i n t h e wo rl d c urre n t l yl i c ensed to c e r t i fy pro fe s s ion als i n t h eun de r s t a nding o f, t h e s t a t i st ic alre s e arc h ba c k g ro un d i n , a n d t h ei n te rpret a t ion a n d us e o f t h e B a rOnE Q- i
  25. 25. EMBRACE THE “WOBBLE”The first rule of intervention in a behavior change process is thesame as the first rule in improvisation: Accept what is; Accept people as they are; Listen; Take in what is being expressed and build on it; Notice the facts – both spoken and unspoken;“Improvising has much in common with riding a bicycle, surfing orskiing. Things are not stable, linear, or predictable. The situation isalways in flux. Our footing keeps changing. This approach may beuncomfortable or unsettling at first, and it is natural to seek outsecurity. ..We can stop trying to flee from the wobble.”Patricia Ryan Madson, Improv Wisdom, Crown Publishing Books, 2005: 82 .
  26. 26. EMBRACING THE “WOBBLE” IN A WORKPLACE SMOKING CESSATION PROGRAMWhat is: Employees who smokeA workplace wellness must take all theprogram in which classes otheremployees earn points employees take plus athat reduce their series of 6 90-minutemedical deductible by smoking cessationincreasing amounts classes.based on theircompletion of All classes andrequirements. exercises hours must take place on employees‟ own time.
  27. 27. WHO WANTS WHATThe employer‟s The employees‟ objectives : objectives: Reduce the number of employees who smoke;  Reduce insurance co- Reduce health care pays; costs related to  In most cases, continue smoking; to smoke while Provide tools and fulfilling the employer‟s knowledge to help mandate to attend employees who smoke smoking cessation achieve cessation. classes;
  28. 28. EMPLOYEES ACHIEVE THEIR OBJECTIVE BYATTENDING SMOKING CESSATION CLASSES. CHANGES IN SMOKING BEHAVIOR CANNOT BE MANDATED.
  29. 29. PRE-CONTEMPLATIVEPEOPLE IN A WORKPLACESETTING SPENDING THEIROWN TIME TO TALK ABOUT WhatSOMETHING THEY DO NOT is WANT TO TALK ABOUT
  30. 30. IF WHAT IS: LITTLE OR NO DESIRE TO CHANGE SMOKING BEHAVIOR  Talk around the closedWhat works: doors by connecting Acceptance that the through open defenses associated pathways: with pre-  Emotional connection contemplation will disrupt and distort  Empathy messages that  Respect for a person‟s directly challenge humanity, individuality smoking behavior. and freedom to think for him/herself
  31. 31. ASSERTIVE ENGAGEMENT: IT‟S ALL IN THE TIMING“This is not for the faint -hearted but nor is it for the indelicateand insensitive. We are seeking to unbalance someone, to pullthe defensive carpet from under their feet. This is a role that inany ideal scenario would sit with a skilled therapist in aperfectly crafted environment. But as we‟ll say a thousandtimes, assertive engagement is about working in an imperfectenvironment and still seeking change. It is okay to challengedefenses but be mindful that the client rarely is in a safe spaceand even more rarely will return to a safe space after havingmet with you. So we proceed with care but we proceednonetheless.”“Precontemplation and Assertive Social Intervention” Assertive Engagement Resource
  32. 32. HOW TO “EMBRACE THE WOBBLE” BET WEEN EMPLOYER AND EMPLOYEES‟ OBJECTIVES:Focus on developing competence in otherareas that can impact health: Identify stressors at work and home; Teach about the stress response and its ef fects on health and ability to cope with change; Identify and build on individual strengths, e.g. perseverance, resourcefulness, humor, social skills; Cultivate competence in getting through stressful situations and states of mind through the processes of change;
  33. 33. CHANGE CAN MAKE A PERSON FEEL LIKE A FISH OUTOF WATER – IT HELPS TO UNDERSTAND THE TENSIONS OF CHANGE AND OUR OWN APPROACH TO CHANGE
  34. 34. Reduce the reactive, INCREASE EMOTIONAL fear-based “threat” response to RECEPTIVITY change. Give only THROUGH EMOTIONAL small bits of information that are CONNECTIONS; easily digested and appliedFOCUS ON: WORKING THE SOIL & PLANTING SEEDS
  35. 35. EXPLAIN THAT NICOTINE CHANGES THE BRAIN AND IMPACTS THE FREEDOM TO THINK FOR OURSELVES 3 Brain Regions are involved with nicotine dependence and cravings BLUE: the thalamus, the brain region critical to ones ability to calm down when stressed. RED : the striatum, a region implic ate d in the pleasure system of the brain. GREEN : the anterior cingulate cor tex, a region vital to self -control and concentr ation. Credit: Image courtesy of Duke University Medical Center
  36. 36. EXPERIENCES CHANGE THE BRAIN
  37. 37. YOGA BREATHINGMINDFULNESSCHAIR YOGABREATH WORK Teach Breath Work and Why It Matters
  38. 38. SELF-KNOWLEDGE PROMOTES EMOTIONAL INTELLIGENCE Emotional intelligence grows through increasing connections between emotions and higher cognitive functions.
  39. 39. “Through increased self-awareness, individuals are moreable to detach themselves fromevents and regulate theiremotions in order to preventthem from becoming „immersedin‟ and „carried away‟ byemotional reactiveness.”Mark Slaski and Susan Cartwright, “Emotional intelligencetraining and its implications for stress, health andp e r f o r m a n c e ” S t r e s s a n d H e a l t h Vo l u m e 1 9 2 0 0 3
  40. 40. PROVIDER RELATIONSHIP SKILLS:EMPATHY COMMUNICATION BOUNDARIES• Everyone has blind spots – if we are open to seeing our own ambivalence toward change we will be more open to acceptance of others‟ ambivalence;• Compassion and understanding toward self is the doorway to empathy toward others;• Recognize and respond to the ef fect that role hierarchies have on perception and communication;G o l e m a n , D a n i e l ( 1 9 9 8 ) Wo r k i n g w i t h E m o t i o n a l I n te l l i g e n c e , B a n t a m B o o k s
  41. 41. Training in effective approaches to workingwith precontemplative clients is available foryour staff, organization or conference. Jude Treder- Wolff, LCSW, RMT, CGP Nicholas Wolff, 496 SMITHTOWN BYPASS SUITE 202 LCSW, SMITHTOWN, NY11787 BCD, TEP 631-366-4265 WWW.LIFESTAGE.ORG

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