Smoking Cessation Program Psychology of Behavioral Change

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Smoking Cessation ProgramPsychology of
Behavioral Change

• Isabel E. Melgar, Ph.D.
• Executive Director, Ateneo Wellness Center
• Faculty Member, Psychology Department
• Ateneo de Manila University

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Overview

• Usual Framework of Change
• Modes of Change
• Stages of Change
• Processes of Change
• Self Efficacy
• Clinical Implications

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Dyad Exercise

• One positive change that happened in your life in
  the past three years

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The Usual Framework for Change
Direct Intervention
Unhealthy practice
Individual Chage
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Old framework assumes that

• Behavior change only has to happen once
• People change at the same time
• Others determine the decision to change, not the
  people wanting to change
• Relapse is a failure
• Rarely focus on interaction between Knowledge,
  Attitude, Behavior and Practices

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Health Belief Model (Becker Rosenstock)

• Perceived Susceptibility
• Perceived Severity
• Perceived Benefits
• Perceived Barries

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Theory of Reasoned Action(Ajzen Fishbein)

• Behavior is determined by intentions
• Intention is influenced by subjective norm and
  attitude toward the behavior

Norms
Intention
Attitudes
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Theory of Planned Behavior

• In addition to attitude and norms, intentions are
  influenced by Perceived Behavioral Control

• DYAD Think of the immediate future. A habit
  you want to change

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The STAGES OF CHANGE(DiClemente Prochaska,
1982)
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Pre-contemplation Stage
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Contemplation Stage

• A person starts thinking about change

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Preparation Stage

• The person prepares to undertake change by

• Gathering information
• Finding out how to achieve change
• Learning skills
• Consulting other people

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Action Stage

• Making Change
• Modifying Behavior

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Maintenance Stage

• Once behavior is familiar and occurs without
  requiring active thinking, it can be said that
  the behavior is maintained

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THE REVOLVING DOOR MODEL OF THE STAGES OF CHANGE
Addiction Free
Maintenance
Action
Relapse
Contemplation
Enter Here
Addicted Life
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THE COMMON EXITS FROM THE STAGES OF CHANGE
Exit 1
Choosing not to change
Maintenance
Action
Exit 2
No desire
Relapse
Contemplation
Exit 3
Avoid further failure
Enter Here
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STAGES OF CHANGE AS A CURVE
Maintenance
Action
Preparation
Contemplation
Pre-contemplation
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ONGOING SPIRAL OF BEHAVIOR CHANGE
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FULL SPIRAL OF STAGES OF BEHAVIOR CHANGE
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HOW PEOPLE MOVE THROUGH THE BEHAVIOR CHANGE SPIRAL

• DYAD What were the motivating factors that
  helped bring about change?
• Record 2 3 words to summarize motivators

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PROCESSES INFLUENCING MOVEMENT THROUGH THE STAGES
OF CHANGE
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Precontemplation - Contemplation

• Becoming aware Consciousness Raising

Becoming aware of the issue, the impact of this
on the person as well as its relevance
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Precontemplation - Contemplation

• Emotional Response Catharsis

Experiencing and expressing feelings about the
issues, the situation and possible solutions
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Precontemplation - Contemplation

• Environment analysis

Assessing how the issues relate to physical
environment
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Contemplation - Preparation

• Thinking through the issues Reevaluation

Reassesing feelings and thoughts about the issue
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Preparation - Action

• Seeing other options

Reassesing feelings and thoughts about the issue

• Self - Efficacy

A sense of being able to do something

• Social Support

Support from significant others, community
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Action - Maintenance

• Helping Relationships

• Reinforcement
• Seeing other options
• Being in control
• Social Support

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THE ROLE OF SELF-EFFICACY BELIEFS (Bandura)

• Self-efficacy is

• Situation specific
• Confidence that one can perform necessary
  behaviors
• To produce desired outcomes

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Efficacy beliefs

• Affect the intention to change behavior
• Affect amount of effort to attain goal
• Affect persistence to continue in spite of
  barriers and setbacks

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Smoking and Self-efficacy Findings

• Quitting requires optimistic self beliefs
• Efficacy beliefs to resist temptations to smoke
  predict reduction if cigarettes and the amount of
  tobacco per smoke
• Pretreatment efficacy does not predict relapse
  but post-treatment does

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Which is the best predictor of intention to smoke
less or to quit smoking?

• Past Behavior?

Risk Perception?
Self-Efficacy Beliefs?
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Types of Self-Efficacy (Marlatt, et al)

• Resistance Self-efficacy
• Harm Reduction Self-efficacy
• Action Self-efficacy
• Coping Self-efficacy
• Recovery Self-efficacy

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Self Efficacy affects every phase of change
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Bandura (1991) noted

• Entrenched habits rarely yield to a single
  attempt at self-regulation. Success is usually
  achieved through renewed efforts following failed
  attempts. Human attainment, therefore,
  necessitate a resilient sense of personal
  efficacy

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Clinical Implications

• S-E theory can guide treatment
• S-E ratings can be used to identify clients at
  greater risk for difficulty
• S-E judgments can assess which particular times
  or places pose high risk

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Health Action Process Approach
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