Behaviour walking as I could Change: I definitely feel more - - PowerPoint PPT Presentation
Ive become aware that maybe Im not doing as much Behaviour walking as I could Change: I definitely feel more confident, Conversations I have more energy and Im & Techniques more driven That Work! Im more motivated
DR AMANDA PITKETHLY
I’ve become aware that maybe I’m not doing as much walking as I could I definitely feel more confident, I have more energy and I’m more driven I’m more motivated and happier
u What gets in the way for our clients when they try to change their
behaviour?
u What gets in the way for you as practitioners when working with
clients?
u Important theories of behaviour u How do we actually support our clients behaviour change?
Influences on PA are complex and PA is a complex behaviour ...
Reasons for Not Exercising
(Willis and Campbell, 1992)
and fitness.
exercise
Foresight obesity systems map demonstrating at its centre ('core') the imbalance between appetite regulation and sedentary
social; , psychological; , economic; , food; , activity; , infrastructure; , developmental; , biological; , medical;-c, positive influence;-&, negative influence.
https://www.researchgate.net/fi gure/Foresight-obesity-systems- map-demonstrating-at-its- centre-core-the-imbalance- between_fig1_40441706
Why are some people physically active and others not? (The Lancet;
Bauman et al. 2012).
u
‘Physical activity is a cornerstone in the primary prevention of at least 35 chronic conditions (Booth et al., 2012).
u
Exercise or PA as a first-line treatment of 26 chronic diseases (Pederson & Saltin, 2015), including:
u
The hippocampus Show pics … hippos (horse) kampus (sea monster) is involved in the formation of new memories and is associated with important aspects of learning, and also emotions as it seems to be involved in severe mental illnesses.
u
Exercise also upregulates growth factors in the brain like brain derived neurotrophic factor (BDNF) which stimulate the growth of neurons (brain cells) and also repairs them … it’s like miracle growth for your brain which can be stimulated by lifestyle choices … MOVING…THINKING …EATING
u
Exercise up also regulates various neurotransmitters like serotonin and dopamine
u
This understanding helps to explain why we see exercise improving mood, self-esteem and performance of different types… including academic performance for example …It helps our children develop physically and also has been shown to improve cognitive control and academic achievement (Hillman et al 2009)
u
…but the benefits are not just for the young …also its contribution to improved skill learning and neuroplasticity which enhances cognitive and emotional function even in older adults (Erickson & Framer, 2009)
u
And so there is a lot of evidence to show that if you exercise regularly you are smarter, happier, less anxious, less depressed, get better sleep, and so on
http://www.independent.co.uk/news/uk/home-news/a- centenarian-marathon-runner-thats-nothing- 2372037.html?action=gallery
http://farm1.staticflickr.com/34/166360343_0c7338e9b8_z.j pg?zz=1
Fauja Singh, born 1911 https://religionnews.com/2019/04/22/w
model-of-more-than-simply-stamina/
1: Not thinking about doing more physical activity 2: Starting to think about doing more physical activity 3: Being physically active
4: Being regularly physically active for less than 6 months 5: Being regularly physically active for longer than 6 months
u
Consciousness-raising (Get the facts) — increasing awareness via information, education, and personal feedback about the healthy behaviour.
u
Dramatic relief (Pay attention to feelings) — feeling fear, anxiety, or worry because of the unhealthy behaviour, or feeling inspiration and hope when they hear about how people are able to change to healthy behaviours.
u
Self-re-evaluation (Create a new self-image) — realizing that the healthy behaviour is an important part of who they are and want to be.
u
Environmental re-evaluation (Notice your effect on others) — realizing how their unhealthy behaviour affects others and how they could have more positive effects by changing.
u
Social liberation (Notice public support) — realizing that society is more supportive of the healthy behaviour.
u
Self-liberation (Make a commitment) — believing in one's ability to change and making commitments and re-commitments to act on that belief.
u
Helping relationships (Get support) — finding people who are supportive of their change.
u
Counter-conditioning (Use substitutes) — substituting healthy ways of acting and thinking for unhealthy ways.
u
Reinforcement management (Use rewards) — increasing the rewards that come from positive behaviour and reducing those that come from negative behaviour.
u
Stimulus control (Manage your environment) — using reminders and cues that encourage healthy behaviour as substitutes for those that encourage the unhealthy behaviour.
Stage Task Precontemplation Raise doubt, increase the perception of risks and problems with current patterns of behaviour. Contemplation Decisional Balance – evoke reasons for change, risk of not changing, developing self-efficacy. Preparation Planning – determining the best course of action. Consider and anticipate road blocks. Action Implement plan – support the newly formed behaviours so they can turn into habits – develop self-efficacy. Maintenance Identify and use strategies to prevent lapse and relapse.
Self-regulated learning is a systematic method that can help people take
i.e. through planning, self- monitoring, effort, self-efficacy, self- evaluation and reflection.
u Self-efficacy (confidence) sources u Self-efficacy refers to an individual's belief in his or her capacity to
execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997).
u Self-efficacy reflects confidence in the ability to exert control over one's
u When you know your clients are struggling with confidence, ask them:
‘think about something that you do/have done well, tell me about that …’ then use reflective listening which a) shows you respect and hear them, and b) help them clarify their thinking
Performance Accomplishments Vicarious Learning Social Persuasion Emotional Arousal Persistence Approach Versus Avoidance Improved behaviours Perceived Self- efficacy Influences Possible Outcomes
There are predictable outcomes when we try to change the behaviour of others by confrontation or offering unsolicited advice, i.e. the harder we push – the harder they push back.
‘People are generally better persuaded by
the reasons they themselves discover than by those that enter the minds of others’ Blaise Pascal (1623-1662)
u We are here because we care about helping others change for the
better, that is a good thing.
u With the best intentions, we want to share what we know and when
we see someone going in the ‘wrong’ direction, who can benefit from what we know we want to tell them
u Ironically, this selfless motive can be overly directive and often an
ineffective or counterproductive way of helping people change
u The righting reflex, is the desire to fix what seems wrong with people
....
u What could be wrong with that? .... Ambivalence gets in the way ...
More on that soon ...
The ‘ambivalence see- saw’:
Hmm ... I’ve had such a busy day, I’m tired and it’s raining outside, I really want to chill
… ah, but I know I feel so much better ... If I could just get out for a 15 minute walk/jog/cycle ...
Sustain talk…………Ambivalence………..….Change Talk
I’m not motivated to become more physically active ... The question isn’t ‘why aren’t you motivated?’ It is “What motivates you?”
A lot of research across a broad range of behaviour change contexts shows that this is very powerful technique to help empower people to make their own changes successfully. MI is a directive, client centred counselling style that enhances motivation for change by helping the client clarify and resolve ambivalence about the behaviour change. “…a collaborative conversation style for strengthening a person’s
2012)
u You don’t have to make people change. u You can’t! u You don’t have to come up with all the answers u You probably can’t – or don’t have the best ones! u You’re not telling or persuading… u You’re collaborating
u Partnership - consciously collaborative – and goal directed. Non-authoritarian unlike most health / medical interventions. u Empathy - the ability to understand and share the feelings of another. Reflective listening shows acceptance & helps develop rapport enhances self-esteem (important in building confidence to change) u Acceptance - the process or fact of being received as adequate, valid, or
(Autonomy – link to SDT) u Compassion - sympathetic pity and concern for the sufferings or misfortunes of
u Evoking – through questioning (OARS skills) high levels of ‘change talk’ and low levels of ambivalence. Emphasis on why to change – not how to change.
Good reflective listening:
u Shows you have interest in what the person has to say u and respect for the person’s own strengths, desires and wisdom about their own
life that you don’t have
u The opportunity for your client to clarify their thinking as they hear how you hear
them What you think a person means may not be what they really mean so …
u A good reflective listening response tests an hypothesis. It asks, in a way, "Is this
what you mean?"
u
Simple Reflection - essentially a repetition or slight rewording of what the client said
u
____________________________
u
Complex Reflection - moving beyond what the client said, by paraphrasing meaning, continuing the paragraph, or otherwise reflecting a level of content or feeling beyond that which the client voiced
u It can be helpful when coaching
to help someone clarify their values.
u This can help them see if their
current life is in harmony with their values, and explore ways in which they might use their values to decide what to do in the future, to live more of the life they want to live.
u You can get an idea of what is
important to a person when you explore their typical day, help them look forwards and describe a desired future, and as you hear them talk about their personal reasons for wanting to become more active.
Ø Values are basic and fundamental beliefs that guide or motivate attitudes or actions. Ø They help us to determine what is important to us. Ø Values describe the personal qualities we choose to embody to guide our actions; the sort of person we want to be; the manner in which we treat
interaction with the world around us. Ø They provide the general guidelines for the way we behave.
u I used to really enjoy exercise, but I’m just too busy these days ... u Why should I bother being more active, I don’t have much going for me
...
u I have too much pain in my knees to take up exercise ... u I suppose if I was taking it seriously I had better pay attention to what I
am eating. Which might also be good for the family I suppose ...
u I’ve taken out gym memberships 3 or 4 times before but after a few
weeks I stop going. It’s been a bit of a waste of money for me ...
u What do you
understand to be the benefits of ...
u Tell me more about
...
u Can you give me
some examples of ...
motivational interviewing relies on the patient’s strengths and efforts in order to bring about change
around intention to change. ****Remember a time when you received a deeply meaningful compliment about from someone you trusted and respected.
u Pulling threads together – to reinforce the change talk that has been said. u Show you have been listening carefully. u Leave gaps for further elaboration. u Allowing your client to hear their own change talk in different ways. u Summary may be collection of statements or links of statements, (this, then
that, then that) or stepping stones onto new topics.
u Permission to share when someone doesn’t have enough
information to understand the benefits of making an uncomfortable change Example:
1.
Elicit - What do you understand to be the benefits of ...?
2.
Provide - (then if some useful knowledge is missing) can I tell you about this research/technique/thing that worked for someone else etc
3.
Elicit - What do you think about that?
u O – open questions u A – affirmations u R – reflective listening u S – summarise u +I – provide information (E-P-E)
Processes
Engaging with client ‘shall we work
together?’
Establish rapport: non-judgemental, open questions, empathy, DON”T ASK TO MANY QUESTIONS, TELL HOW TO FIX THINGS, BEI AUTHORITATIVE, LABEL
Focusing ‘what to change?’ -
issues important to client
Resist the ‘righting reflex’ – ie the urge to tell them what they should do
Evoking change talk ‘why
change?’
Careful use of questions can evoke the client’s
Planning ‘how to
change?’
Client chooses & takes action
Evoking change talk ‘why
change?’
Careful use of questions can evoke the client’s
u
Asking DARN ‘evoking’ questions! What do you ...
u
D: Want, wish, like
u
A: How could, might, can
u
R: Reasons, good things about change
u
N: Need, how important?
u
C: Commitment, I’m going to do this for my family!
u
A: Actions: I bought new trainers!
u
T: Taking steps: I have planned a weekly walk with my neighbour Respond to this change talk by using your OARS – focus on reflective listening as you get used to doing this.
Ask them to list specific behaviours, that you believe are achievable. When will you have done this by? What can be seen that shows you are progressing? Who else will be involved in meeting the goal? Relapse prevention OR ‘If-then’ planning. If ‘X’ happens (that prevents each broken down piece of the bigger goal being achieved) then I will do ‘Y’. 1. e.g.
week so that I can walk back from work
some new trainers… Tuesday 11th July I will have a sticker chart up on the kitchen wall, with stickers ready to add to the days that I will walk home My partner/mother/frie nd/sister etc e.g if I forget I will ask friend to remind e.g. If it is raining, I will make sure that I check the weather and have the right coat/umbrella e.g. If I can’t be bothered I will think of how small things add up over time and how chuffed I/someone else will feel 2. 3.
note it incorporates SMARTER goals. Think about a long term goal e.g. to complete sponsored 4km walk, now take the first goal in that direction e.g. walk back from work (10 minutes) at least 3 days a week, now break this down into smaller pieces e.g. ‘in order to walk back from work 3 times a week, what would you need to do first ? … continue with more smaller goals according to the if-then planning sheet below ...
People in general without health conditions ...
u goal setting of behaviour and self-monitoring of behaviour important at
short and long term
u Autonomy supportive and person-centred methods as in Motivational
Interviewing, the BCTs goal setting of behaviour, and receiving feedback on the outcome of behaviour, powerful for long term.
With overweight and obese adults ... Confidence and PA
u Four BCTs were significantly associated with positive changes in self-efficacy; ‘action
planning’, ‘time management’, ‘prompt self-monitoring of behavioural outcome’ and ‘plan social support/social change’. These latter two BCTs were also associated with positive changes in physical activity. https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868- 10-29 With overweight and obese adults ... PA
u In the short term, the BCTs ‘Biofeedback’, ‘Demonstration of the behaviour’, ‘Behaviour
practice/rehearsal’, and ‘Graded tasks’ were associated with increased effectiveness.
u In the long term, interventions were more effective if they included ‘Action planning’,
‘Instruction on how to perform the behaviour’, ‘Prompts/cues’, ‘Behaviour practice/rehearsal’, ‘Graded tasks’, and ‘Self-reward .... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5370453/
u Electronic health (eHealth) is the use of information and communication
technologies (ICTs) for health. Including the use of a tracker with your clients if you are doing this already according to latest research is a good idea. We can think of computer-based support we can think of wearable technology apps and so on when we think of this type of stuff.
u The top three most frequently used BCTs included information about health
consequences, goal setting (behaviour), and joint third, self-monitoring of behaviour and social support (practical).
u https://www.jmir.org/2017/8/e281/
u Some of the gains that people struggle to make could be found in reducing their
gym is great but getting their heads around reducing that sitting time during the day is where they might find a bit more success for their overall health.
u Research shows that a pedometer can be just as good as a fancy gadget, so think
about this for your older clients.
u Which BCTs ... “prompts and cues”, “self-monitoring of behaviour”, “social support
(unspecified)” and “goal setting (behaviour)”.
u https://link.springer.com/article/10.1186/s12966-017-0561-4