Stages of Change
The first stage.
What is Precontemplation?
Three basic psychological needs.
What are autonomy, competence, and relatedness?
OARS
What are Open-ended questions, Affirmations, Reflective listening, and Summarizing?
One common psychological barrier to behavior change.
What is fear of failure (or lack of self-efficacy)?
"I'm too old to change my diet now." The stage of change, and one strategy that might help.
What is Precontemplation? Strategy = raise awareness with respect and empathy.
A person intending to take action in the next 6 months.
What is Contemplation?
The difference between intrinsic and extrinsic motivation using an example from healthy eating.
What is Intrinsic = enjoys healthy meals; extrinsic = eats healthy for praise or weight loss.
One of four MI processes that involves helping a client identify their own reasons for change.
What is Evoking?
A structural barrier someone a low-income community might face when trying to eat healthier.
What is food access or affordability?
Marsha, a 35-year-old teacher, expresses interest in yoga for stress, but hasn't taken any steps yet. Stage of Change?
What is Contemplation?
Characterized by concrete steps taken within the past 6 months.
What is Action?
This form of motivation occurs when a behavior is aligned with personal values but still externally regulated.
What is Identified Regulation?
A complex reflection to this statement: "I want to stop eating late at night, but it helps me relax."
What is "Part of you really values relaxing after a long day, and you're wondering how to find a better way that aligns with your health goals."
Possible barrier cultural values may pose in adopting a Western-style exercise program.
What is conflict of the program with communal or modesty-based norms (eg. exercise wear or choice of music)?
Devon started walking 3x/week two weeks ago. What stage of change is he in, and what can you do to sustain progress?
What is Action? Reinforce benefits, troubleshoot barriers, support accountability.
Smoking after 9 months of abstinence, and what should be the clinical focus?
What is Relapse; focus on support and re-engagement in change strategies?
How a coach supports autonomy when helping a client adopt a plant-based diet.
What is offering choices, respecting preferences, and affirming the client's reasons?
A change talk-focused response to: "I've failed every time I tried to quit smoking."
What is "You've had some tough attempts, and you're still here thinking about it, that tells me you haven't given up."
One intervention strategy to address time constraints as a barrier to physical activity.
What is introduction of micro-workouts or integration of movement into daily routines?
Ana lost 20lbs in the past year and has kept it off. She now leads a walking group. What stage is Ana in?
What is Maintenance?
"I've already joined a gym and cut out soda." Stage and one effective intervention strategy.
What is Preparation; intervention = reinforce and plan for barriers?
The motivation level of a patient that says "My doctor wants me to lose weight, but I don't really care and a SDT strategy that might help.
What is amotivation? Strategy = explore values, increase relatedness and internal reasons.
Two possible strategies to elicit change talk in a resistant client.
What is ask evocative questions, explore pros and cons, use importance/confidence rulers?
A client expresses guilt and shame after multiple failed weight loss attempts. How should a health coach address this barrier?
What is use empathetic MI techniques, reframe setbacks, normalize relapse as part of change?
Raj is diabetic but refuses to take insulin or adjust his diet. How would you use MI to begin a conversation?
What is use open-ended questions, affirm concerns, reflect resistance, and gently evoke values?