The Process of Change

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The Process of Change

• Dr. Terry Hagan
• February 27, 2002
• OST 505

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What Are the Three Top Causes of Death in the
U.S.?

• 1 Heart Disease (34)
• 2 Cancer (24)
• 3 Cerebrovascular Disease (7)

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• What are the three leading actual causes of
  death in the U.S. according to Drs. McGinnis and
  Foege in their review article published in JAMA?
  (Vol. 270, No. 18, 1993)
• Tobacco
• Diet/activity patterns
• Alcohol

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What Percent of Patients Symptoms Are Not
Clearly Organic in Nature?

• Dr. Herbert Benson, M.D, from Harvard reports 75
  of patients visits are related to mind/body and
  stress induced conditions.(Timeless Healing,
  1997)
• Drs. Mayou, bass, and Sharpe agree putting the
  number at about 80(Treatment of Functional
  Somatic Symptoms, 1995)

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• What is the common solution to these mind/body,
  stress induced, or self-inflicted symptoms?
• A Change in behavior

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A physician can help his or her patients change
their self-defeating behaviors by

• Understanding how humans accomplish behavior
  change, and.
• Supporting what works and avoiding what does not
  work.

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• According to Social Learning Theory, what causes
  behaviors to increase or decrease?
• Reinforcement
• Punishment

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Positive Reinforcement

• Positive reinforcement - anything that is added
  () following a certain behavior that tends to
  increase that behavior

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Negative Reinforcement

• Negative reinforcement - anything that is taken
  away (-) following a certain behavior that tends
  to increase that behavior

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Punishment

• Something added or taken away following a
  behavior that tends to decrease the probability
  of that behavior.

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Social Learning Theory

• What is rewarding for one person is not
  necessarily rewarding for others.
• Short term, certain rewards tend to be more
  attractive than long term, uncertain rewards.

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What Works Best?

• When people accomplish behavior change on their
  own they tend to use reinforcement rather than
  punishment.

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Health Belief Model

• Perceived Susceptibility
• Perceived Severity
• Perceived Benefits (Pros of changing)
• Perceived Barriers (Cons of changing)
• Perceived Self-Efficacy

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Stages of Change Model

• Individuals are at varying levels of motivation
  or readiness to change.
• People at different points in the process of
  change will benefit from different stage matched
  interventions

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Stages of Change Model

• The basic premise is that behavior change is a
  process and not an event.

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Precontemplation

• Has not thought about changing before
• Surprised that it is an issue
• Wants to know why you think change is necessary
• Sees some of the pros of changing

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Contemplation

• Is starting to consider some of the pros but is
  worried about the cons of changing
• Talks about the difficulties that would have to
  be confronted.
• The power of the cons must be dealt with and the
  perceived importance must be decreased in light
  of the pros of changing

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Determination

• Self-efficacy and the potential for help must be
  stressed - you can do it and you dont have to
  do it alone
• Sorting out best course of action
• Referral is often appropriate here

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Action

• Patient begins a change strategy
• Physician provides support and reinforcement
  where possible
• Physician continues to support self-efficacy

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Maintenance

• Identify and use strategies to prevent relapse -
  anticipatory guidance
• Review pros of changing at each visit
• Provide reinforcement on an ongoing basis
  whenever possible

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Relapse

• Having a relapse is a normal part of the change
  process
• Begin again at the contemplation stage and work
  with patient to reduce the power of the cons
• Encourage patient to continue program

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