Cognitivist Perspectives

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Cognitivist Perspectives

• Behaviour is determined by thought
• Behaviour is governed by goals
• Few (if any) instincts
• Emotions, feelings, motives trace back to
  thoughts
• Human beings start out as flawed thinkersbut
  we can be salvaged!

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Attribution Errors

• Fundamental Error
• Self-serving Bias
• Halo Effect
• Labeling (the self-fulfilling prophecy)
• The Catastrophizing Effect
• Thought-Feeling Distinction

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Cognitivist Strategies

• Foot in the door
• Door in the face
• Low-balling
• Ingratiation
• Guilt/Fear

4
Health Care Providers Roles

• Patient centered
• Information exchange, not information download
• Patients must save themselves
• Negotiate, dont dictate, behaviour
• Understand and accept, dont coerce and
  manipulate

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Health Care Providers Roles

• Patients resistance is nothing more than a
  source of information that must be dealt with
• Assess the patients motivation and level of
  readiness rather than presume it

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Model for Describing Change

• Prochaska et. al.
• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

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Precontemplation

• Individual is not seriously considering change
  and isnt interested in discussing it
• Characteristics
• - unawareness
• - unwillingness
• - too discouraged

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Contemplation

• Individual begins to seriously consider making a
  change (within six months)
• Characteristics
• - open to information, education
• - perceived temptation risk is high
• - often motivated by self-esteem issues

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Preparation

• Individual begins experimenting, making small
  changes and a resolution to change
• Characteristics
• - actually taking baby-steps
• - bargaining with self for rewards
• - highly reliant on external support

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Action

• Individual is actively involved in making change
  and experiments with techniques
• Characteristics
• - bigger steps but most stressful stage
• - actively fighting against coercive forces
• - developing sense of autonomy and esteem

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Maintenance

• Individual must learn to successfully cope with
  temptations
• Characteristics
• - has been adherent for at least six months
• - able to identify self-defeating behaviours
• - higher level of self-worth

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Health Care Providers Behaviours

• Precontemplation
• patient not ready for argument
• open to knowing information is available, not
  necessarily open to information itself
• cheerleader tactic not useful
• understanding and acceptance most important

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Health Care Providers Behaviours

• Contemplation
• Information and education best accepted
• emotional support
• help enlist significant others for support
• planning important
• environmental re-organization

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Health Care Providers Behaviours

• Preparation
• need praise, encouragement, support
• need external monitoring
• need to test-drive behavioural changes in a
  safe, non-threatening environment
• need assistance with environmental control

15
Health Care Providers Behaviours

• Action
• continued emotional support necessary
• need close monitoring and someone to call out
  relapses
• constant counter-conditioning required
• external stimulus control gradually replaced by
  internal stimulus control

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Health Care Providers Behaviours

• Maintenance
• less encouragement, more criticism (but
  supportive!)
• internal, not external, motivation

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Key Features of Adherence

• Patients are
• interested
• believe their health care providers
• understand and accept interventions
• have made an internal cost-benefit analysis
• in control of decisions
• recognize their own responsibility

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Stages of Change

• Recognize patients readiness for change
• Provide continuous support, but modify based on
  stage
• Education isnt enough
• Identify personal triggers to motivate
  behavioural change
• Time, time, time

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12-Step Method (AA)

• 1) Admit our lives are unmanageable
• 2) Believe in Power greater than self
• 3) Decide to turn over life to greater Power
• 4) Searching and fearless moral inventory of
  self
• 5) Admit to self and to one other exact nature
  of wrongs committed

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12-Step Method (AA)

• 6 7) Able to want to have character defects
  removed
• 8) List all persons harmed by actions
• 9) Make amends to all who are harmed
• 10) Continue to take personal inventory
• 11) Prayer, Meditation
• 12) Carry the message to others - teach

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The Culture Shock Model

• 1) Euphoria, expectation
• 2) Irritation
• 3) Rejection of host culture
• 4) Idealization of home culture
• 5) Projection onto host culture
• 6) Adjustment
• 7) Adaptation

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Model for Stages of Death and Dying

• Kubler-Ross
• Denial
• Anger
• Bargaining
• Depression
• Acceptance

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Maslow (Hierarchy of Needs)
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Strengths/Limitations of Cognitivist Perspectives

• Strengths
• - useful, practical, goal-oriented
• - clear, reasonable, concrete
• Limitations
• - incomplete view of human nature
• - does not explain more complex issues
• - no theory for more complex cases