MODULE 2B - Fundamentals of Healthy Behavior Change |
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Objectives:
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cognitive behavioral therapy
COGNITIVE BEHAVIORAL SKILLS
Most useful for later stages of change: preparation, action, and maintenance stage
- Recognize non-productive thinking
- All or none
- Catastrophizing
- Discounting the positive
- Overgeneralization
- Mind reading
- Fortune telling
- Should and must statements
- Reframe non-productive thinking
- Identify underlying beliefs that can interfere with behavior change
THE ABCD METHOD
WHEN IS COGNITIVE BEHAVIORAL THERAPY USED?
- A - what Action or event occurred
- B - what Beliefs do you have about what occurred?
- C - what are the Consequences of those beliefs?
- D - How can you Dispute those beliefs that seem to be distorted or unhealthy
WHEN IS COGNITIVE BEHAVIORAL THERAPY USED?
- Adjustment disorder, anxiety, depressive symptoms
- Lifestyle changes (problem solving in diet, exercise or medication compliance, mental health issues associated with a medical condition, coping with a chronic illness or new diagnosis.
POSITIVE PSYCHOLOGY
Positive psychology is basically a thought behavior change process to build patient's confidence. As the physician coach, this is where we emphasize our patient's current skills or abilities and successes achieved with every step of behavior change. Sustainable self-management is the goal for patients and it will be achieved through autonomy and self-efficacy.
We have to build on small steps for developing self-confidence. We have to assure that patient has a confidence level of 7 or higher on a scale from 1 (least confident) to 10 (most confident) that he/she will achieve the action plan.
PERMA - SENSE OF FLOURISHING
Positive emotions, Engagement, Relationships, Meaning, Accomplishments (Seligman, 20110) increasing positive emotions, engaging with the people in your community and society with our selves, and our work or passion, maintain and form deep and meaningful healthy relationships, find our greater meaning and purpose in life, and fulfilling our aspirations in life through discovering our strengths and gifts. Flourishing is finding contentment and discovering our purpose and connecting with others in deeper level that is living the “good life” (Seligman, 2010).
GOALS
- Impact the patient’s life positively- main coaching goal is to improve our patient’s life
- Increase the patient’s experience of positive emotions
- Help clients identify and develop their strengths and unique talents
- Enhance the client’s goal setting and goal-striving abilities
- Build a sense of hope into the patient’s perspective
- Cultivate the patient’s sense of happiness and well-being
- Nurture a sense of gratitude in the client
- Help the client build and maintain healthy, positive relationships with others
- Encourage the client to maintain an optimistic outlook
- Help client to savor every positive moment
FLOURISHING
Flourishing is one of the most significant concepts in positive psychology as it encompasses and extends to so many positive concepts. We flourish when we cultivate our talents and strengths, develop deep and meaningful relationships, feel pleasure and enjoyment, and make a meaningful contribution to the world. Flourishing is a process that requires action, you either have it or do not have. It does not come easy but encouraging to note, anyone can flourish. Enhance own sense of authentic happiness and well-being:
Flourishing is one of the most significant concepts in positive psychology as it encompasses and extends to so many positive concepts. We flourish when we cultivate our talents and strengths, develop deep and meaningful relationships, feel pleasure and enjoyment, and make a meaningful contribution to the world. Flourishing is a process that requires action, you either have it or do not have. It does not come easy but encouraging to note, anyone can flourish. Enhance own sense of authentic happiness and well-being:
- Experience more positive emotions: do more of the things that make you happy and enjoyment into your daily routine
- Pursue your hobbies or develop new skills that interest you or look for a job more suited to your passion
- Improve the quality of your relationships with others
- Seek out meaning, of you do not find it through your work, do volunteering jobs, or you can act as mentor to others
- Keep your focus in achieving your goals- but keep the balance in your life to accommodate other important things in your life.
Applying positive psychology in the behavioral intervention is useful in making clear one’s life goals, develops trusts between the patient and the coach.
Tips:
- Work to expand one’s social support system
- Set goals to have fun experiencing the good life and finding meaning in life. Savor the moments in the process of achieving progress.
- Focus in enjoying the simple pleasure of life, laugh more, notice little things like the dewdrops, the tiniest ants, etc.
- Enhance your sense of purpose and discover what is important to you and focus on the things that of value to you.
Step by step development of an action plan
- Explain your role as expert and coach
- Share diagnosis and potential outcomes
- Describe lifestyle prescription
- Identify current areas of progress and use positive psychology
- Identify new areas for action
- Identify the patient’s confidence and importance level
- Ask the patient to summarize goal (SMART goals)
- Connect the patient with available programs or referrals to support her efforts.
- Confirm the patient’s commitment to the action plan
FLOW
Flow is an intense and focused attention in the present moment, merging action and awareness or being fully present in your actions, loss of reflective self-consciousness, a distorted sense of time passing, experiencing the activity or situation as intrinsically rewarding.
When we have high skills but low challenge, we are bored. When we have high challenge but have low skills, we are overwhelmed. When we have low skills and low challenge, we are apathetic. If our skills and challenges are high, then we enter a flow state- enjoyable and rewarding, flow is linked to greater happiness and well-being, more academic success, and more positive and healthy relationships.
Flow is an intense and focused attention in the present moment, merging action and awareness or being fully present in your actions, loss of reflective self-consciousness, a distorted sense of time passing, experiencing the activity or situation as intrinsically rewarding.
When we have high skills but low challenge, we are bored. When we have high challenge but have low skills, we are overwhelmed. When we have low skills and low challenge, we are apathetic. If our skills and challenges are high, then we enter a flow state- enjoyable and rewarding, flow is linked to greater happiness and well-being, more academic success, and more positive and healthy relationships.
coaching
PHYSICIAN "COACH" MINDSET
Not all physicians are trained to use a coach mindset in dealing with patient's way to behavior change. Most health care providers act as expert rather than a coach. A physician coach would encourage patients to decide, commit and take charge of their own health. And engaging to a lifestyle program should come from the willingness of patient to change. A physician-coach would view obstacles and setbacks as necessary stepping stones on the behavior change path and look for underlying learning opportunities.
5 step coaching model for creating a collaborative coach-client relationship
- Be empathetic
- Align motivation
- Build confidence
- Set SMART goals
- Set accountability
- Restart empathy
EXPERT v.s. COACH APPROACH
(Frates, 2019) (Moore M., 2016)
EXPERT |
COACH |
Treats patients |
Helps patient help themselves |
Educates |
Builds motivation, confidence, and engagement Facilitator for change |
Relies on skills and knowledge of expert |
Relies on patient self-awareness and insights |
Strives to have all the answers |
Strives to help patients find their own answers |
Focuses on the problem |
Focuses on what is working well |
Advises |
Collaborates |
Defines agenda |
Elicits agenda |
Feels responsible for patient's health |
Client is responsible for health |
Solves problems |
Fosters on what is right |
Focuses on what is wrong |
Focuses on what is right |
Has the answers |
Co-discovers the answers |
Interrupts if off the topic |
Learns from client's story |
Works harder than client |
Client works as hard as coach |
Wrestles with client |
Dances with clients |
ARTICLE REVIEW
- Long-Term Adherence to Health Behavior Change
- Definitions, variants, and causes of nonadherence with medication: a challenge for tailored interventions
- Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight?
- Physicians' empathy and clinical outcomes for diabetic patients
- Motivational interviewing as a counseling style
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High yield Board exam questions:
A 42 year old man visited your center for consult. He said he already started a new exercise program. Basing on the TTM how long would the patient need to continue the new exercise program he's engaging with before you can say he moved from the action stage to maintenance stage where relapse is more likely to happen.
a. 3 months
b. 6 months
c. 12 months
d. 24 months
Positive psychology has 2 domains of study that includes positive affect that talks about contentment with the past, happiness in the present, hope for the future. What other domain describes positive psychology?
a. Virtues and strength
b. Commitment to goals
b. Balance in spending time on self and others
a. Affirmation of others
A 57 year old, male patient visited your center for consult. He is a diagnosed case of diabetes type 2 and expressed his intent to change his diet and purchased a cookbook as a guide. What stage of change the patient is in and what would be your appropriate response for this specific stage?
a. Precontemplation stage. Reinforce how changing his diet can be beneficial in his condition being Diabetic.
b. Contemplation stage. Reinforce how changing his diet can be beneficial in his condition being Diabetic.
b. Contemplation stage. Discuss some recipes in the cookbook he bought and discuss how he could start.
c. Preparation stage. Encourage using the cookbook and discuss on food preparation that can assist him.
Which behavior change theory that became famous as it emphasize a person's intention for behavior change as consequence of his attitude toward the behavior, perceptions of social norms and perceived control.
a. Social learning theory
b. Health-belief theory (HBT)
c. Theory of Planned behavior
d. Social-ecological theory
A 42 year old man visited your center for consult. He said he already started a new exercise program. Basing on the TTM how long would the patient need to continue the new exercise program he's engaging with before you can say he moved from the action stage to maintenance stage where relapse is more likely to happen.
a. 3 months
b. 6 months
c. 12 months
d. 24 months
Positive psychology has 2 domains of study that includes positive affect that talks about contentment with the past, happiness in the present, hope for the future. What other domain describes positive psychology?
a. Virtues and strength
b. Commitment to goals
b. Balance in spending time on self and others
a. Affirmation of others
A 57 year old, male patient visited your center for consult. He is a diagnosed case of diabetes type 2 and expressed his intent to change his diet and purchased a cookbook as a guide. What stage of change the patient is in and what would be your appropriate response for this specific stage?
a. Precontemplation stage. Reinforce how changing his diet can be beneficial in his condition being Diabetic.
b. Contemplation stage. Reinforce how changing his diet can be beneficial in his condition being Diabetic.
b. Contemplation stage. Discuss some recipes in the cookbook he bought and discuss how he could start.
c. Preparation stage. Encourage using the cookbook and discuss on food preparation that can assist him.
Which behavior change theory that became famous as it emphasize a person's intention for behavior change as consequence of his attitude toward the behavior, perceptions of social norms and perceived control.
a. Social learning theory
b. Health-belief theory (HBT)
c. Theory of Planned behavior
d. Social-ecological theory
Task - Reflective Journal |
Topics covered:
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