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75 Cards in this Set

  • Front
  • Back

5 A's description of method -- (not the 5 A's)

Communication method used to increase motivation to change.

Most often used in the healthcare settings for counselling about health behaviours.

The 5 A's

*Ask what you can do for your client.

*Advise client on healthy steps to take.

*Assess client interest in changing behaviour.

*Agree with approach client selects.

*Assist client in modifying behaviour and arrange services for client and follow-up.

characteristics of health coaching

Goal-oriented and resource focused to help guide clients to make changes based on agreed-upon goals.

Often relies on biometric or health information to set goals and targets (e.g.., BMI, cholesterol, etc.).

intrinsic elements of coaching

Uses coach-mediated questioning and guidance to focus on intrinsic motivation.

Relies on client input and feedback of personal beliefs and values to make positive changes.

characteristics of motivational interviewing

A powerful method for helping clients achieve positive behaviour changes through thoughtful interviewing and support.

Focuses on self-efficacy, intrinsic and extrinsic motivation, and personal cognitive dissonance.

Helps clients contrast behaviours with awareness of the behaviour's negative consequences.

Empathy and objective constructive feedback help clients see change as positive and motivating rather than difficult and depriving.

definition of motivational interviewing

A client-centered counselling approach that increases internal motivation to change and resolves ambivalence towards change.

Differences between MI and TTM

One is used in conjunction with the other and both address readiness for change, but MI provides strategies for moving people forward.

What motivational interviewing is not

Telling a person that she or he has a problem and needs to change.

Offering advice without the client's permission.

Doing most of the talking.

Giving a prescription.

spirit of motivational interviewing



*honors autonomy


A guiding principle of motivational interviewing.

*Resist the righting reflex.

*Understand your client's motivations (why & how).

*Listen to your client.

*Empower your client.

General principles of motivation interviewing (brief)

*Avoid argumentation.

*Express empathy.

*Support self-efficacy.

*Roll with resistance.

*Develop discrepancy.

Three core communication skills used in motivational interviewing

*Asking: Develop an understanding of client's problems.

*Listening: Reflect on meanings.

*Informing: Convey knowledge and choices.

4 core principles of ecological approach to behaviour change

There are multiple levels of influence on health behaviours. The influences on behaviours interact across different levels.

Ecological approaches should be behaviour specific.

Multi-level interventions may be most effective in changing behaviour.

Ottawa Charter for Health Promotion -- most likely conditions for health behaviour change

Environments and policies are supportive of health behaviours.

When individuals are motivated and educated to make changes.

Strategies for individual level behaviour change: focusing on behavioral skills

Goal-setting and self-monitoring.
Developing social support.
Behavioral reinforcement.
Problem solving.
Relapse prevention.

Why use theory?

Increases efficacy of interventions.

Identifies known targets for intervention.

Allows for tailoring of the PA programs.

Provides a framework for understanding how to guide behaviour change, which is complex.

Definition of learning theories

Learning occurs through human responses.

Includes behaviorism, cognitive theory, cognitive-behavioral theory, social learning theory, and contructivism.

Self-efficacy is key.

Applications of learning theories

Teach how to do healthy behaviours.

Reinforce learned behaviours.

Practice, practice, practice.

Observation and modelling.

Major constructs of the transtheoretical model

*Stages of change -- examines an individual's readiness for behaviour change; therapist can match intervention approaches.


*Decisional balance

*Processes of change: 5 cognitive and 5 behavioral

TTM precontemplation stage of change

No intention to take action in the near future (6 months).

"I won't."

"I can't."

TTM contemplation stage of change

Thinking about changing behaviour within the next 6 months.

"I might."

TTM preparation stage of change

Intends to take action in the immediate future (30 days). Plan of action and small steps.

"I will."

TTM action stage of change

Has made specific overt change in lifestyle within the past six months.

"I am."

TTM maintenance stage of change

Maintained healthy lifestyle change for more than 6 months.

"I have."

TTM termination stage of change

No temptation to return to unhealthy behaviour and 100% self-efficacy for maintaining change.

Where TTM stages of change fit in terms of decisional balance

Pros < Cons: Precontemplation and contemplation

Pros = Cons: Preparation

Pros > Cons: Action and maintenance


One's perceived confidence in their ability to perform.

Situation specific confidence that people can cope with high risk situations without relapsing to former behaviours.

Changes with movement through TTM -- most present at action and maintenance stages.

Processes of change

The covert and overt activities (behaviours, cognitions, and emotions) people use to progress through the stages.

Provide important guides for intervention programs -- the independent variables people need to apply to change stage.

5 cognitive processes of change

Consciousness raising.

Dramatic relief.


Environmental reevaluation.

Social liberation.

consciousness raising

A cognitive process of change.

Gathering information / increasing knowledge.

dramatic relief

A cognitive process of change.

Being moved emotionally / warning of risk.


A cognitive process of change.

Assessment of self image with and without health behaviour.

environmental reevaluation

A cognitive process of change.

How one's personal health behaviour affects one's social environment.

social liberation

A cognitive process of change.

Taking advantage of social mores / increasing healthy opportunities.

Why use cognitive processes of change in precontemplative and contemplative stages?

Need to get these clients thinking about changing behaviour -- will resist actual changes in behaviour if pushed.

5 behavioral processes of change

Self liberation.

Contingency management.

Helping relationships.

Counter conditioning.

Stimulus control.

self liberation

A behavioral process of change.

Making a commitment.

contingency management

A behavioral process of change.

Being rewarded.

helping relationships

A behavioral process of change.

Getting social support.

counter conditioning

A behavioral process of change.

Making substitutions.

stimulus control

A behavioral process of change.

Using cues and reminders.

Processes of change for precontemplative and contemplative stages

Consciousness raising.

Dramatic relief.

Environmental reevaluation.

Social liberation.

(cognitive processes)

Processes of change for contemplative and preparation stages


(cognitive process)

Processes of change for action stage


Also counter-conditioning and helping relationships.

(behavioral processes)

Processes of change for maintenance stage


Helping relationships.

Reinforcement management.

Stimulus control.

(behavioral processes)

Definition of Health Belief Model

Proposes a person's health-related behaviour depends on person's perception of 4 critical areas: severity of potential illness, person's susceptibility to illness, benefits of taking preventive action; barriers to taking action.

Health Belief Model: How to move through behaviour modification

People believe what they are doing is beneficial for their health.

Focus on compliance and preventative health practices.

Health Belief Model: individual perceptions

Perceived susceptibility to disease.

Perceived severity of disease.

*basis for perceived threat of disease

Health Belief Model: modifying factors

Demographic variables.

Socio-psychological variables.

Structural variables such as disease knowledge.

*Contribute to perceived threat of disease.

Health Belief Model: Cues to action (modifying factors)

Mass media campaigns.

Advice from others.

Reminder postcard/calls.

Illness of loved one.


Health Belief Model: Factors contributing to likelihood of taking action

Perceived benefits minus perceived barriers of preventive action.
+ perceived threat of disease
+ cues to action

Health Belief Model: practical application

Help person understand the connection between PA and health outcomes (short term and long term).

Describe own lifestyle & benefits.

Use anecdotal stories.

Help person identify barriers and how to overcome them.

Work with client to set up cues to action.

Definition of Self-Regulation Theory

Personal regulation of goal-directed behaviour or performance.

May lead to increased self-efficacy for PA.

Six ways self-regulation is achieved

Goal monitoring.

Goal setting.




Enlistment of social support.

Practical application across theories

Goal setting.

Regular feedback and self-monitoring.

Shaping outcome expectations.

Providing choice.

Enlisting social support.

Relapse prevention.

SMART goal setting






Checking SMART goals

Self-monitoring: Use tools such as activity logs and pedometers.

Regular feedback: Counselling sessions or phone consultation.

Self-rewards: Rewards given for successive approximations towards the target behaviour (important for shaping).

Shaping outcome expectations

Work with clients to help them understand what they can realistically attain.

Don't overstate benefits and be sure to inform them of possible initial negative impacts such as pain, stiffness, soreness and of when they should expect improvements.

Provide choices

Encourage variety in exercise routine.

Let client choose different types of exercises they perceive as fun and enjoyable.

Provide different options for exercise settings.

Build PA into person's lifestyle.

Definition of relapse

Symptoms return after a period when no symptoms are present.

Definition of relapse prevention

In advance of symptoms presenting themselves, strategies or treatments are applied to hinder relapse.

Moving through behaviour modification to prevent relapse



Relapse education.

Warning sign identification.

Warning sign management.

Recovery planning.

Inventory training.

Family involvement.


Enlist social support

Suggest they ask others to exercise with them.

Set up exercise buddy programs.

Walking clubs.

Telephone exercise buddies.

Relapse prevention: practical application

Assess potential to relapse into old behaviours.

Anticipate and identify warning signs and behaviours.

Identify environmental influences likely to increase chance of relapse.

Identify personal influence.


Key Motivational Interviewing skills
*Open-ended questions
*Reflective listening
*Elicit self-motivational statements



Dealing with Ambiguity

*Develop discrepancy

*Empathize with ambivalence

*Avoid Arguments

*Roll with Resistance

*Support self-efficacy

Develop discrepancy

Compare positives and negatives of behavior, and positives and negatives of changing, in light of goals; elicit self-motivational statements.

Empathize (context of OARS)

Empathize with ambivalence and pain of engaging in behavior that hinders goals.

Avoid arguments

Don't push for change; avoid labeling

Roll with resistance

Change strategies in response to resistance.

Acknowledge reluctance and ambivalence as understandable.

Reframe statements to create new momentum.

Engage client in problem-solving.

Support self-efficacy

Bolster responsibility and ability to succeed.

Foster hope with menus of options.

Informing in MI

*Ask permission.

*Offer choices/options.

*Talk about what others do/have done.




Give info.

Check on understanding/perspective.



*What does client know of new info

*Provide info

*Elicit client's response to info provided (What do you think of that?)

Six types of change talk

*desire: statements about preferences for change

*ability: statements about capability to change

*reasons: specific arguments for change

*need: statements about feeling obligated to change

*commitment: statements about likelihood of change

*taking steps: statements about actions