Behaviour Change Approaches

Avatar for Hadyn Luke Hadyn Luke posted this on Tuesday 14th of November 2023 Hadyn Luke 14/11/2023

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Behaviour Change Approaches

The prevailing theories today regarding motivation and ability to change habits can be found in Prochaska and DiClemente’s “Transtheoretical Model”, a behaviour model that classifies how people make changes, The model construes change as a process involving progress through a series of changes as shown below.

Prochaska & DiClemente Transtheoretical Model of Behavioural Change

Movement across the stages is thought to be cyclic as the diagram above shows, and not linear. This is because many do not succeed in their efforts in establishing and maintaining lifestyle changes and move in and out of the cycle at different stages, and different times.

Pre-contemplation Stage

The easiest stage to achieve – here individuals may start to think about exercise. This may be as a result of reading a magazine article, a book, seeing something on television about exercise, or talking to a friend or colleague about exercise. Through these mediums individuals gain education, awareness of different types of exercise, and the health related benefits to be gained from each. Putting up posters, distributing leaflets and just talking to potential clients can make an individual really think about doing something about their fitness. The goal at this point should be to help the client recognize the existence of a problem. It sows the seed.

Contemplation Stage

During this stage individuals start to really think seriously about exercise weighing up the pros and cons. They actively seek more specific information on types of exercise, and the health related benefits to be gained from each [to help them weigh up pros and cons]. This could be for many reasons; some examples are weight loss, looking better, feeling less tired and achieving a feeling of well-being. Giving clients specific articles, books, flyers, videotapes and talking with them as to what they need to do and the options available will help them to move through this stage. The pros and cons are weighed up and the balance starts to favour the pros, motivation starts to rise.

Preparation Stage

This is the stage where the decision to change has been taken. Conduct a consultation with the client. Include health-screening, informed consent, personal profiling; agree SMART goals [short and long] and carry out a fitness assessment. Use the information to design an exercise programme to achieve the wants and needs of the client. Conduct an induction [if necessary] in order to get them started on their programme. The pros are clearly dominant and motivation is very high.

Action Stage

The most difficult stage for most people – It is during this phase that about half of all new exercisers stop [Berg EdD]. Exactly why is not clear. It could be that a barrier such as time constraints, family commitments, dislike of the programme, lack of motivation and achievement has developed. Think about moving clients through this stage by encouraging self-evaluation, helping relationships, providing exercise variety and change of programme. Whatever the reason, the weighing up of the pros and cons can alter its balance.

The pros and cons may become more evenly balanced and motivation can decline. The cons then start to become overriding if intervention strategies are not implemented.

Maintenance Stage

Once at this stage a high level of commitment has already been shown. However, this does not mean that relapse is unlikely – it can happen at any stage. Employ a variety of strategies to maintain interest and commitment; for example, exercising with a friend, rewards of achieving goals and programme variety.

Relapse Stage

A relapse can happen for many reasons, e.g. change in season, change of job or family commitments, physiological factors, low motivation and stress. It is important that the client understands that relapse is a natural part of the changing process and it is not the same as failure but a part of the learning process. Identifying high-risk situations may reduce the likelihood of a relapse occurring in the first place. The goal of relapse prevention is to help individuals anticipate problems and have strategies ready to cope with high-risk situations. Establishing the reason for the relapse is an important feature in helping individuals move back into the cycle.

Many studies have been undertaken to establish what people perceive are the main reasons, or barriers, to beginning and maintaining a change in lifestyle and exercise habit. One such study [The National Dunbar Fitness Survey 1992] reported the following in order of the largest to smallest:

  • Not enough time
  • Not being the sporty type
  • Work pressure
  • I need to rest in my spare time
  • Lack of support
  • Not having enough energy
  • An injury or other physical disability
  • I would never be able to keep up

Because one stage typically progresses to the next, all steps are equally important. You are more likely to effectively assist individuals in making behavioural changes by developing strategies that best work with each stage. Matching treatment strategies to an individual’s stage of change will improve adherence, motivation and reduce the possibility of failure to change.

Processes Of Change

The process of change depends on a person’s stage of change.

Strategies are divided into two categories: cognitive and behavioural.

Cognitive is the name given to “mental” functions, such as thinking, remember, perception and language. An Individuals’ thinking and perceptions about exercise can be a learned process either from experience, or from listening, talking, and observing other’s actions towards exercise.

The cognitive processes for exercise are:

  • Consciousness rising
  • Dramatic Relief
  • Environmental Re-evaluation
  • Self-evaluation
  • Social liberation

Use of the above cognitive processes tend to peak in the preparation stage.

Behaviour is an action, reaction or function performed in a certain way, or in a particular pattern. Often there is a need to change an individual’s action, reactions and behaviour patterns towards exercise.

The use of the following processes can be useful in this.

The behavioural processes for exercise are:

  • Counter conditioning
  • Helping relationships
  • Reinforcement management
  • Self liberation
  • Stimulus control

The use of the above behavioural processes tend to peak in the action stage.

Cognitive Processes

Conscious Raising/Consciousness Raising

Consciousness raising is a cognitive process that involves increasing one’s awareness of the causes and effects of one’s thoughts, feelings, and actions. It is often used as a strategy for social change, especially by marginalised groups who seek to challenge the dominant narratives and structures that oppress them.

Consciousness raising can involve various methods, such as sharing personal experiences, reading and discussing relevant literature, engaging in critical reflection and dialogue, and taking collective action. The goal is to empower individuals and groups to recognise their own agency and potential, and to transform their situations through knowledge and action.

Consciousness raising can also have emotional and affective aspects, such as eliciting empathy, compassion, anger, or hope. These emotions can motivate people to change their attitudes and behaviours, and to join or support social movements.

Dramatic Relief

Dramatic relief is a cognitive process that involves experiencing emotional arousal or relief about one’s health behaviour, whether positive or negative. It is one of the ten processes of change in the Transtheoretical Model (TTM), which is a model of intentional behaviour change that describes how people move through different stages of readiness to change their behaviour.

Dramatic relief can help people to become more aware of the consequences of their unhealthy behaviour, such as smoking, drinking, or overeating, and to feel fear, anxiety, shame, pain, or guilt because of it. It can also help people to feel inspired and hopeful when they learn about how other people have successfully changed their behaviour and improved their health.

Some examples of dramatic relief are:

  • Watching a documentary or a movie that shows the harmful effects of smoking on one’s health and the benefits of quitting.
  • Reading a testimonial or a story from someone who has overcome an addiction or a chronic disease by changing their behaviour.
  • Listening to a motivational speaker or a counsellor who provides feedback and encouragement for changing one’s behaviour.
  • Participating in a support group or a workshop where one can share their feelings and experiences with others who are going through the same process of change.

Self Re-evaluation

Self-re-evaluation is a cognitive process that involves assessing how one’s self-image and self-esteem are affected by one’s current behaviour, and how they would change if one adopted a new behaviour. It is one of the ten processes of change in the Transtheoretical Model (TTM), which is a model of intentional behaviour change that describes how people move through different stages of readiness to change their behaviour.

Self-re-evaluation can help people to realize the discrepancy between their actual self and their ideal self, and to envision the benefits of changing their behaviour to align with their values and goals. It can also help people to overcome the barriers and challenges that prevent them from changing their behaviour, such as fear of failure, lack of confidence, or social pressure.

Some examples of self-re-evaluation are:

  • Writing a pros and cons list of one’s current behaviour and the desired behaviour, and weighing the costs and benefits of each option.
  • Imagining how one would feel about oneself and how others would perceive one if one changed or did not change one’s behaviour.
  • Seeking feedback from others who have successfully changed their behaviour or who support one’s change efforts.
  • Reflecting on one’s personal values and beliefs, and how they relate to one’s behaviour.

Social Liberation

Social liberation is a cognitive process that involves noticing and increasing the availability of environmental and social opportunities that support a healthy behaviour change. It is one of the ten processes of change in the Transtheoretical Model (TTM), which is a model of intentional behaviour change that describes how people move through different stages of readiness to change their behaviour.

Social liberation can help people to realise that society is more supportive of their new healthier behaviour, and that they have more choices and alternatives than they previously thought. It can also help people to overcome the social norms and pressures that discourage them from changing their behaviour, such as stigma, discrimination, or peer influence.

Some examples of social liberation are:

  • Joining a community or an organisation that promotes and advocates for the healthy behaviour, such as a fitness club, a support group, or a social movement.
  • Seeking out role models or mentors who have successfully changed their behaviour or who encourage one’s change efforts.
  • Finding or creating new environments or situations that facilitate the healthy behaviour, such as a smoke-free workplace, a vegetarian restaurant, or a bike-friendly route.
  • Taking advantage of new policies or laws that support the healthy behaviour, such as a ban on smoking in public places, a tax on sugary drinks, or a subsidy for renewable energy.

Environmental Re-evaluation

Environmental re-evaluation is a cognitive process that involves reassessing how one’s current behaviour affects the environment and society, and how changing one’s behaviour would have positive impacts. It is one of the ten processes of change in the Transtheoretical Model (TTM), which is a model of intentional behaviour change that describes how people move through different stages of readiness to change their behaviour.

Environmental re-evaluation can help people to become more aware of the environmental and social consequences of their unhealthy or harmful behaviour, such as smoking, littering, or wasting energy, and to feel concern, responsibility, or guilt because of it. It can also help people to feel inspired and hopeful when they learn about how other people or groups have successfully changed their behaviour and improved the environment or society.

Some examples of environmental re-evaluation are:

  • Watching a documentary or a movie that shows the negative effects of one’s behaviour on the environment or society, such as climate change, pollution, or poverty.
  • Reading a testimonial or a story from someone who has changed their behaviour and made a positive difference in the environment or society.
  • Listening to a motivational speaker or a counsellor who provides feedback and encouragement for changing one’s behaviour.
  • Participating in a community or an organisation that promotes and advocates for the healthy behaviour, such as a green club, a charity, or a social movement.

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