1 / 56

Promoting Change to Facilitate Self-Management

Promoting Change to Facilitate Self-Management. Chapter 6. Key Terms. ABC’s of Behavior Barriers Behavior Chains Cognitions Cognitive Restructuring Contract Countering Cue Management (Stimulus Control). DASH Food Plan Exchange Lists Journaling Modeling MyPlate Problem Solving

mason
Télécharger la présentation

Promoting Change to Facilitate Self-Management

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Promoting Change to Facilitate Self-Management Chapter 6

  2. Key Terms • ABC’s of Behavior • Barriers • Behavior Chains • Cognitions • Cognitive Restructuring • Contract • Countering • Cue Management (Stimulus Control) • DASH Food Plan • Exchange Lists • Journaling • Modeling • MyPlate • Problem Solving • Reinforcement or Rewards • Thought Stopping

  3. Food Management Tools • A variety of tools are available to aid in the management of eating behavior • Nutrition professionals need to become familiar with a variety of strategies • Tools differ in their degree of structure and amount of work needed on the part of clients to use the approaches • See Table 6.1 for “Advantages and Disadvantages of Food Management Tools”

  4. Food Management Tools • Meal Replacements • Detailed Menus and Meal Plans • Exchange List for Weight Management • MyPlate • DASH Food Plan • Goal Setting

  5. Meal Replacements • Long-term weight and health benefits have been observed in studies using meal replacements • Can take the form of shakes, bars, or portion-controlled frozen meals • Advantages: Simplify food choices, reduces exposure to temptation, portion sizes clear • Disadvantages: Maybe some concerns with taste acceptability or may interfere with social plans

  6. Detailed Menus and Meal Plans • Very structured plan that may include grocery lists, menus, recipes. • Reduces stress of making choices • Software programs and websites are available • Should be planned to include client preferences • Advantages: Clearly defined, provide structure, useful with complex dietary requirements • Disadvantages: Does not allow for spontaneous events, food items needed may not be available, difficult to design to complement client’s lifestyle

  7. Exchange List for Weight Management • Provides some structure but also freedom to make some choices (Appendix C) • 2 versions: • 1) diabetes meal planning • 2) weight management and more general needs • Exchange lists are organized into 4 main groups: • Carbohydrates, Meat and Meat Substitutes, Fats, Alcohol • Advantages: Offers choices, provides structure, allows for variety, meal pattern is individualized • Disadvantages: May be too complex for some individuals

  8. MyPlate or DASH Food Plan • Provides guidance with some structure, but also allows freedom to select foods • MyPlate.gov provides individualized downloadable food group plans • DASH has additional food group consisting of legumes, seeds and nuts; developed for individuals with high blood pressure • Advantages: Easy to understand, flexible • Disadvantages: Requires computer technology (MyPlate), some foods may not be part of client’s usual intake (nuts, seeds, beans – DASH plan)

  9. Goal Setting • For clients that do not want any type of structured eating plan, lifestyle changes can be made solely through goal setting • Complements non-dieting programs for weight management • See Chapter 5 for goal setting guidelines

  10. Tracking Progress • Clients should be encouraged to track progress, regardless of method selected • Difficult to evaluate goals without self-monitoring method • Method selected should depend on the client’s ability to work with structure and details • There are several options available

  11. Tracking Methods • Journaling • Checking off • Messaging • Using art • Empty bowl • Electronic note pads

  12. Journaling • Shown to be effective in altering behavior and food habits • Effective tool by increasing awareness and providing a “time out” for making a decision • Intake should be recorded immediately before or after eating…. Don’t wait! • Requirements can be simple: list of foods consumed with portion sizes, physical activity • Requirements can be complicated: time, place, mood, thoughts, concerns, degree of hunger, other behavior management details

  13. Journaling • Analysis of records helps counselors and clients develop new goals • The following procedures are successful in guiding clients to help manage their food intake: • Provide training on how to keep journal • Use estimates or approximations • Set meaningful and achievable goals • Provide a variety of record keeping options • Provide nonjudgmental feedback

  14. Checking Off • For clients following food group plans or the exchange system, checking off boxes throughout the day can be used • Names of exchanges or food groups could be listed on form for client to “check off” • Information collected for evaluation is limited with this procedure • May appeal to those who resist writing

  15. Messaging • Hand held, voice-activated recorders or leaving messages on a confidential voice mail system has been reported to work successfully

  16. Using Art • Drawing pictures, scribbling or choosing colors has been used to assist clients in getting in touch with feelings or moods while consuming food

  17. Empty Bowl • Put desired food objectives in a visible spot such as a bowl • Can be in the kitchen or other frequented area • Objectives are put in bowl at beginning of the day or week • Goals are assessed according to the amount in the bowl at the end of the day or week

  18. Electronic Note Pads • ipad, cell phones, tablets, laptops, etc. • Good for clients that are comfortable with the technology • Can take pictures and review with counselor • Various applications available for cell phones

  19. ABC’s of Eating Behavior A: Antecedent (stimulus, cue, trigger) • Focus on cues that trigger unconscious eating or eating large quantities • Behavior change strategies concentrate on physical availability of food, social, emotion or psychological • Ex/ cookie jar, parties, stress, destructive thought patterns • Behavior change can focus on avoiding or altering the cue • Ex/ remove cookies from the house or cover a piece of cake with pepper

  20. ABC’s of Eating Behavior B: Behavior (response, eating) • May address the actual act of eating (speed), physical (eat in one place), emotional (do not clean your plate), awareness (pay attention to eating - no TV) or attractiveness (sparkling water in a wine glass with a lemon slice) • Behavior change may focus on providing a substitute for eating C: Consequence (punishment, reward) • Can be positive reinforcement (reward) or punishment (losing privileges)

  21. Behavior Chain • Behavior Chain: Sequence of events from antecedent to consequence • See examples in Exhibit 6.1 • Behavioral strategies can address all aspects of a behavior chain or can zero in on one aspect • Eating behavior journal or diary can give clues as to what behaviors are in the greatest need of change • See Form 6.1 in Appendix D

  22. Behavioral Strategies • Cue Management (Stimulus Control) • Countering • Reinforcement and Rewards • Contracting • Encouragement • Goal Setting • Modeling • Problem Solving

  23. Cue Management (Stimulus Control) • Deals with the “A” (antecedent) component of a behavior chain • Identifying and modifiying social or environmental cues that trigger undesirable eating • Prearranges those cues to increase a desired response or to suppress a detrimental one • New scheme should include reminders to perform the new activity • Ex/ post-it note, note on calendar, entry on daily to-do-list, cartoon posted on refrigerator • Best if focuses on producing beneficial behaviors

  24. Countering • A technique of exchanging healthy responses for problem behaviors • Deals with the “B” (behavior) component of behavior chain • Substituting one behavior for another behavior, or a food for a food • Ex/ riding an exercise bike instead of eating 2 cups of ice cream each night in front of TV • Ex/ baked chicken in lieu of fried chicken

  25. Reinforcement: Rewards • Provides incentives by addressing the end of the behavior chain • Some clients need added incentive to regulate and strengthen behavior • Deals with the “C” (consequence) component of behavior • Rewards provide positive consequences • Can be tangible, especially in the initial stages of making lifestyle changes • Should be individualized, well defined • Should be timed to come after the behavior • as soon as possible after, and not before!

  26. Contracting • An agreement between a counselor and a client to implement a particular goal • Can be short or long-term goals • Used for clients who want structure and accountability; should be recorded in writing

  27. Contracting • Factors to consider: • Clients should define their intended behavior change • Behavioral goals should be clearly defined • Time limits should be delineated - What will happen, how often and when? • Reinforcers should be stated • Rewards have greater impact than punishment • Signing and dating the contract to reinforce client’s commitment

  28. Encouragement • Usually well received, however, impact can be influenced by a client’s past experiences • The effect will vary with the credibility, trustworthiness and prestige of the person giving the words of encouragement • Can be done using email, cards, notes, voice mail, personalized signs, notes, or recorded tapes

  29. Goal Setting • Provides a pathway to actually performing the new behavior • Break down desirable behavior patterns into small achievable steps • Allows for success and improvement in self-efficacy • “Nothing breeds success like success”

  30. Modeling • Observing others accomplishing a similar goal can increase a client’s belief in their own ability • Can be videotapes, written testimonials, success stories, counseling buddies, role playing • Models with prestige, status or expertise are more likely to influence behavior • Clients are more likely to imitate an individual who is similar in age, gender, and culture • Modeling has greatest impact if client can practice the behavior under supervision and receive immediate feedback

  31. Problem Solving • A process that involves a counselor and client working together to: • Identify a behavior chain • Detect barriers to change • Brainstorm possible options • Weigh the pros and cons of the alternatives • Objective is to design an action plan by selecting as many breaks in the behavior chain as possible • Should include a reward • Once the plan is implemented, the counselor and client should evaluate the outcomes and make any adjustments needed

  32. Problem Solving: Barriers • Barriers are obstacles or roadblocks to achieving a desired lifestyle change • 4 major obstacles to reducing barriers have been identified by Danish and Laquatra: • Lack of knowledge -Lack of risk taking • Lack of skill -Lack of adequate social support

  33. Problem Solving • Glasgow et al. describe a specific technique called STOP for systematically analyzing a problem and developing a solution • This problem solving method involves the following: • S-Specify the problem • T-Think of options • O-Opt for the best solution • P-Put the solution into action

  34. Cognitive Restructuring • Focuses on identifying irrational thoughts and modifying them • Challenges destructive thoughts, beliefs, and internal self-talk and substituting self-enhancing cognitions • Based on the idea that cognitions are learned thinking behaviors, so they can be relearned • Thinking patterns are categorized as: • Opportunity thinking • Obstacle thinking

  35. Cognitive Restructuring • Opportunity thinking allows finding constructive ways to deal with difficult situations • Obstacle thinking leads to self destructive behavior-making a difficult situation worse or giving up/retreating from problems

  36. Dysfunctional Thinking • 3 components of changing dysfunctional thinking: • Internal dialogue: Ever-constant dialogue that influences our feelings, self-esteem, behavior, and stress level; clients can cope better by influencing this dialogue to provide self-enhancing messages • Mental images: Helps produce desired performance and helps clients to visualize accomplishments of intended tasks • Beliefs and assumptions: Core beliefs are deeply ingrained, leading to assumptions that trigger automatic thoughts • Exercise 6.8 “Core Belief Activity”

  37. Changing Cognitions & Interventions • Steps of changing patterns of thinking: 1. Education 2. Identify dysfunctional thinking 3. Explore validity of self-destructive statements 4. Stop destructive thoughts 5. Prepare constructive responses to substitute automatic dysfunctional cognitions 6. Substitute constructive thought for destructive ones

  38. 1. Education • First step is to educate your clients that their thoughts are “controllable” • Do not want self-destructive thoughts and irrational messages to remain as they will influence our actions • Written by a leading psychologist: “One of the most significant findings in psychology in the last twenty years is that individuals can choose the way they think”

  39. 2. Identify dysfunctional thinking • Analyze existing beliefs and assumptions, self-talk messages, and mental imagery patterns

  40. 3. Explore validity of self-destructive statements • Ask self-evaluating questions; can provide a template for clients to challenge their irrational beliefs on their own • Use humor; popular technique used by (REBT) rational emotive behavior therapy practitioners to illustrate absurdity of certain self-destructive behaviors

  41. 4. Stop destructive thoughts • Thought stopping technique was developed to put an end to recurrent, self-destructive thoughts and self-dialogue • Involves mentally saying the word “STOP”, pushing away destructive automatic thoughts, andthensubstituting constructive thoughts • Imagine a big red stop sign

  42. 5. Prepare constructive responses to substitute automatic dysfunctional cognitions • Intervention techniques: • Identify and develop constructive thoughts to substitute for dysfunctional ones • Use challenging self-evaluation questions • Use imagery • An intense mental rehearsal is used to set new patterns of thinking • Can imagine worst-case scenario and allow negative thoughts to emerge, then make a plan for a better response

  43. 6. Substitute constructive thoughts for destructive ones • Replace destructive thoughts with previously prepared constructive thoughts • Ex/ “I learned that I shouldn’t buy potato chips”

  44. Cognitive Distortions • Cognitive distortions are negative thinking patterns that have little in common with reality and hamper behavior change • They are exaggerated or irrational thought patterns • “should”, “must”, “have to” • “always”, “never”, “every” • May involve “all-or-nothing attitude”

  45. Education During Counseling • Education is the primary step to changing dietary behavior and maintaining dietary objectives • Education helps clients to understand why the dietary change is important and be informed to make their own decisions • In the Nutrition Care Process (NCP), nutrition education is divided into 2 categories: • Content • Application

  46. Education During Counseling • Per AND Nutrition Care Process: • Content is defined as “instruction or training intended to lead to nutrition-related knowledge” • Application addresses assistance in skill development and interpreting medical results related to a nutrition prescription • Education component of nutrition counseling must include intervention that facilitates behavior change

  47. Effective Ways to Enhance Education • Effective Education Strategies • Effective Education Language • Positive or Negative Approaches

  48. Education During Counseling:Effective Education Strategies • Educational targets have been linked to specific educational interventions (see below):

More Related