Interpersonal Skills of the Helper - Theories and Models of Health Behavior Change (Lecture transcript notes)

Motivation and Behavior Change

• Behavior change is a crucial aspect of working with clients facing health-related or mental health issues.
• The goal is to facilitate changes in behavior or circumstances that contribute to their current situation.

Session Objectives

• Explore and recognize different types of motivation (intrinsic and extrinsic) and their impact on treatment outcomes.
• Further develop interpersonal skills, self-reflection, and cultural competence.
• Increase awareness of self-determination theory and its application to health practice.
• Discuss the purpose and application of the Transtheoretical Model of Change to facilitate change in clients.

Self-Determination Theory (SDT)

Motivation

• Motivation is a key underlying driver for clients.
• It is important to tap into the client's underlying motivation for seeking help and to understand what motivates them to think, feel, and act in a particular way.
• Without tapping into motivation, facilitating change becomes difficult.
• Questions to consider:
  • What is motivation?
  • What motivates us to do the things we do?
  • Why are we more motivated to do some things than others?

Types of Motivation

• Intrinsic Motivation:
  • Driven by the enjoyment or satisfaction derived from the activity itself.
  • Examples include running, going to the gym, eating healthy, relaxing, watching TV, gardening, or spending time with loved ones.
  • It's important to consider the underlying motivation for pursuing a particular course of study or action.
• Extrinsic Motivation:
  • Influenced by external factors such as rewards, punishments, or social pressure.
  • Rewards can include greater income or recognition from others.
  • People are more likely to be motivated when they perceive a reward or benefit associated with the behavior.
  • Consider instances where you participated in an activity you didn't enjoy and identify the reasons for your continued participation.

Self-Efficacy

• Belief in one's ability to succeed at a task significantly influences motivation.
• People are unlikely to pursue a task if they don't believe they can succeed or if they perceive no benefit.
• High self-efficacy leads to increased motivation, especially when facing obstacles or barriers.

Goal Orientation

• Focusing on learning and improving skills increases motivation to engage in challenging activities that promote growth.
• Having a clear goal or objective is important.

Social Context

• Social environment, norms, expectations, and social support influence motivation.
• People are more likely to participate in difficult tasks when they feel supported.
• Group therapy is effective because people feel connected and supported by others.
• Even if individuals are hesitant, they may be motivated to participate due to the presence of others.

Motivation as a Complex Combination

• Motivation is complex and depends on various factors, including intrinsic and extrinsic motivation, self-efficacy, goal orientation, and social context.
• Motivation is rarely purely one or the other; it's usually a combination of these factors.
• Underlying drivers of motivation can change over time, from initiating a task to encountering obstacles.
• Think of motivation as the fuel that drives you forward. Identifying motivational reasons and factors is important, especially when facing difficulties.

Self-Determination (SD)

• Self-determination refers to an individual's ability to make choices and manage their own life.
• People generally dislike being told what to do; this is an ingrained characteristic.
• Example: Toddlers often learn the word "no" early and demonstrate determination when using it.
• Self-determination plays a significant role in well-being and psychological health. Believing we are in charge of our own lives leads to a healthier mental and emotional state.
• Self-determination applies to various areas, including education, work, parenting, exercise, and health.
• Consider examples of when you were told to do something versus when you made the choice yourself; you are more likely to pursue a task if it's your choice.
• SD has a significant impact on motivation.
• SD grew out of the work of psychologists Edward Deci and Richard Ryan, who introduced the ideas of self-determination and intrinsic motivation in human behavior.
• They developed a theory of motivation suggesting that people are driven by a need to grow and gain fulfillment.

The Drive for Growth and Fulfillment

• People make choices with the best intentions for their own benefit, growth, reward, and fulfillment.
• Consider choices such as going out on a Friday night knowing you'll have a headache the next day; the immediate rewards and benefits drive the decision.
• Choices in relationships, purchases, and activities are driven by the need for fulfillment and growth.
• People choose courses of study, pursue activities, and seek employment opportunities that offer greater financial rewards and fulfillment.

Understanding Others' Motivations

• Instead of asking "Why were you doing this?", try to determine the benefit, reward, or positive aspect they were trying to gain.
• This provides a better understanding of the underlying motivations for people's behavior.

Key Assumptions of Self-Determination Theory

• The need for growth drives behavior.
• People are goal-oriented and seek challenges and opportunities to gain mastery and experience new things.
• Gaining skills, knowledge, and capabilities is essential for well-being and a sense of self.
• Intrinsic motivation is extremely important; internal sources of motivation help create a sense of autonomy, which is vital to our well-being.
• Even though external rewards such as money, duty, or fame influence us, feeling a sense of self-worth and recognition also affects us.
• Intrinsic motivation is the inherent tendency to seek out novelty and challenges to extend and exercise one's capacities to explore and learn.
• Without this characteristic, people would not be driven to learn basic skills or pursue education.

Overcoming Challenges

• Remember how, as toddlers, we persisted in learning to walk despite falling thousands of times.
• This drive to improve one's capabilities and succeed after challenges is essential.
• Neuroscience research suggests that brain growth and health are also driven by completing difficult or annoying tasks.
• Striving to do things that we might not fully enjoy encourages brain growth and may have implications for preventing dementia and Alzheimer's.
• Our brains and bodies have evolved to be tested and strained, and it is important to push through those challenges.

CAR: Essential Elements for Psychological Growth

• Competence: People need to gain mastery of tasks and learn different skills to achieve their goals and feel effective.
  • This leads to a sense of fulfillment, reward, and the release of dopamine (the "happy hormone").
• Autonomy: People need to feel in control of their own behaviors and goals; we generally dislike being told what to do.
• Relatedness: People need to experience a sense of connection and belonging to others, feeling understood and cared for.
  • Humans are social creatures, and isolation is a form of torture.
  • Even having animals provides valuable benefits for mental health and well-being.

Maslow's Hierarchy of Needs

• Physical needs, safety, social needs (connection with others), and self-esteem are all important.
• Our opinions of ourselves, self-esteem, and confidence are influenced by how we perceive others see us.
• It's hard to develop strong self-confidence when surrounded by negative influences.

The Power of Connection

• We sometimes do things we don't like for the sake of others, such as for our family or children.
• This connection and the need for connection can drive our behaviors.

Working with Clients - Asking Probing Questions

• Ask probing questions to uncover a person's motivators for making healthy life choices.

• Tap into the concept that to care for their dependents, the client needs to care for themselves first.

• Connect the changes to goals already important to the client.

Key Components of Self-Determination Theory

• Types of Motivation:
  • Intrinsic: Internal rewards, personal values, interest, identity, morals, and ethics.
  • Extrinsic: Rewards or punishments that drive behavior, perceived from others, financially, and so forth.
• Basic Human Needs: Autonomy, competence, and relatedness.
  *Amotivation:
  *Absence of Motivation
  *A continuum from amotivation to intrinsic motivation exists
  *Actions because of Extrinsic motivation, gradual transition to becoming an intrinsic motivation, making motivational factors more internalized.

Types of Motivation Definitions:

*Intrinsic motivation: due to inherent enjoyment (I exercise because it is enjoyable).
*Integrated regulation: behaviors in congruence (harmony, agreement) with the self (I exercise because I consider it part of who I am).
*Identified regulation motivation: personal value of behavior's outcome (I exercise because I value the benefits).
*Interjected: Internal pressures (guilt, shame), I exercise because I would feel guilty if I didn't.
*External: Physician says I should exercise.
*Amotivation: I can't see why I should bother.

 *Fuel that drives the car, finding out the driver of behavior

Important Questions for Reflection

• Write down activities in your life that you do regularly with ease. Consider the role of competence, autonomy, and relatedness.
• Write ten activities in your life that you do reluctantly. Reflect on how competence, autonomy, and relatedness are met in these activities.
• Reflect on how this is all important in your work with your clients.

Transtheoretical Model of Change (TTM)

• Reflect on two different personal changes you have made or attempted in the past, and also a change you have considered but not yet made.
• Consider how change is not easy and can take time, even years, depending on the task and motivational factors.
• The TTM was proposed by Prochaska and DiClemente.
• It's applied in counseling interventions, behavioral sciences, prevention programs, and policy-making settings.
• A critical component of behavior change lies within readiness to change.
  *Psychosocial approach, including: biological, psychological, and social aspects.
  *Designed to understand and facilitate a process of intentional behavior change.
  *Trying to create the intention there for change, and to make sure that the motivational factors maintain that thought.
  *emphasizes the individual's decision-making capacity.

Stages of Change

• Precontemplation: Not thinking about change.
• Contemplation: Thinking about making changes.
• Preparation: Preparing to make changes.
• Action: Making the changes.
• Maintenance: Maintaining the changes.
• Stable Change: If all works out well.
  Relapse Can occur in between any of these points!

Stages Described in Detail:

• Precontemplation: The client has not even considered changing at all.
• They're fully engaged in their behavior.
• They're unmotivated.
• No intention of change whatsoever.
• Contemplation: Clients are considering changing, they're thinking about it. We've definitely identified that there is a problem. Doesn't necessarily mean that they've accessed it. Identified that there is a problem.
• Preparation: Determination and preparation stage is where the client is my decision to change, and starts making plans to change for argument's say it could be. You know you're altering your shopping list for argument's. Say, you're thinking, okay, I'm not going to be buying these things. It could be your, going to buy yourself some running shoes, or you're looking around you're preparing to find a gym that best suits your needs as well. These type of things, that this is important. So we're preparing (altering environment and context).
• Action/Trying stage: The client begins to change engage actively.
• Will power stage.
• Utilize the relapse concept and say, Look, it's it's expected you were going to relapse. That's also part of the process. Push Through.
• Maintenance Where the clients achieve the change and is maintaining it. So it's a consolidation stage. We've got to be careful that clients then get complacent. We need to still, again, feed the motiva motivational drivers as well. This is important.
  *Relapse: Can happen at any time.
  Termination advocacy/transcendence stage: Where a new stage can be added later by researchers include awareness and the old unhealthy behaviors are no longer conceptualized as appropriate.

Core Tenets:

*Complexity: Simplify behaviour change to the smallest most easily maintained unit.
*Progress: As individuals progress through the stages of change they undergo a range of emotional,( straight forward feelings around change manifests into self-talk),cognitive (start thinking differently about self), cognitive. self evaluation processes.

Stages:

*Consciousness Raising
*Self-Reevaluation
Environmental reevaluation re: how behavior affects others.
*Social liberation - identifies sociocultural oppourtunities.
*Self liberation- belief in being able to do something, need to be committed and hopeful.
Helping relatinships.
*Conditioning.
*Contingency management - Rewarding positive behaviors.
*Stimulus control to reduce triggers, removing triggers.

Limitations of TTM

*Lack of Scientific basis - merely a theoretical model
*Does not incorporate:
*Sociocultural differences
*Criteria around stages
*.Doesn't calculate time around stages change.
*Assumes decisionmaking is clear cut, rational and unemotional way.
Linear Process.
Does not allow for nuance client context.

Summary of stages / approaches.

Pre-contemplation

*Ignorance & no readiness
Practitioner approach
*Validate lack of readiness
*Decision needs to be the client's, encourage re-evaluation of current behavior
*Explore consequences, gain analysis (profit and loss)
*Explain + personalize risk
encourages self-exploration + no action!

Contemplation:

Ambivalent about change,
sitting on the fence
Practitioner approach
focus on decision and readiness (that stage) and the pros and cons
ID New positive outcomes (expectations)
Get client to visualize changes (embracing the change)
Personal benefits
Ask clients to feel and think how things will be.
This step is very valuable.

Preparation

Testing the waters
"Dip toes in" and show it as not that scary
Problem solving of likely obstacles
Careful of naïve optimism
Counterplans
What goes wrong and plan to solve it
Get help from support networks Verify skills for behavior change
encourage small steps
Easer to find small steps

Action

Restructuring cue and social cue supports
Bolster Self -Efficacy
Combat feelings of loss / and show the long-term benefits.
Long-Term benefits maintenance
Self Belef
Continue with commitment for follow-up from support-Reinforce internal rewards-Discussion of with and how to cope with relapse
*High set expectations =Relapse
It's a constant action of progress

Relapse

Resumption of Behaviors
Fall from grace.
*Take a look at the Triggers
Reaccess Motivations and barriers (Why vehicle stopped).
*Make a Plan for stronger cop strategies.
Strong Coping strategies, but the client through as a more skilled and closer person.
*Positive Reinforcements.
*It's very important for you AND your audience and clients.

####Summarizing Reminders
What is self determination (And why do you think it's important?--Own control to make good decisions)?? Differences vs Extrinsic / Intrinsic?
What are the different stages in the trans Theoretical model?
take a look at the short summareis, Youtube, Review videos etc

Most useful idea for today's discussion is that Telling people to make a change is not enough.
Change is a bus. Must refuel (taping the person) to make the drive (change).
Always continue re-feeding the Motivation, the fire motivation.