Counseling, Behaviour Change and Goal Setting

1. Counseling, Behaviour Change and Goal Setting CPAFLA Ch 2 and 3 ACSM Ch 62 and 65

2. Counseling • Your goal is to effect change and help an individual adopt an active and healthy lifestyle or to motivate an individual to maintain an active lifestyle. • You need to consider a broad range of factors for each individual: • current health status • background (exercise history, health, etc.) • desired goals • mind-set and motivation • accessibility and availability (facilities, costs, time commitment) • individual interests and abilities • values and beliefs • support systems (individual, group, and social)

3. Counseling • You need knowledge and skills in a wide variety of areas: sociology, psychology, interpersonal communication, marketing, public relations, kinesiology, etc. Two common problems in the health and fitness field are: • A lack scientific background combined with well-developed marketing and promotional abilities (flash but no substance). • Well-educated individuals who lack the skills to communicate information to potential clients/customers.

4. Functions of Health Counselor • 1. Develop rapport and convey a sense of empathy for challenges they may face in making changes • 2. Assess health related behaviours and state of readiness for change • Understanding how participant perceives the impact of behaviours on health and quality of life • 3. Facilitate change • Discuss potential benefits and problems associated with implementing a lifestyle change

5. 1. Developing Rapport • Acceptance - setting tone of openness and acceptance during initial conversation • Refrain from appearing to make judgments • Unconditional acceptance - Accepting oneself without any preset conditions for acceptance • Important in developing positive self esteem • Conditional acceptance - Conditions or “standards” have to met to be judged worthy. • I have to look like that, or play as well as so-and-so. • Behaviours, actions, performance Both Verbal and Non-verbal objectives and empathic responses from counselor are important

7. Expressing Empathy • Empathy - ability to understand people from their frame of reference rather than your own • Helps create perception of unconditional acceptance • Facilitates disclosure of information important in developing effective programs • Active listening techniques can convey empathy • Rephrasing - reflects emotional content, develops rapport, ensures accurate interpretation and that you are listening and understanding • Questions to clarify or gain more information • Non verbal Communication • Eye contact, body movements, voice inflection, proximity and interpersonal distance

9. Self Esteem • Refers to how one feels about oneself and ones characteristics • Self esteem is critical for behaviour change and adopting more healthy lifestyles. • High self esteem is positively associated with acceptance by (and of) others, greater social effectiveness, less deviant behaviour, participation in physical activity, and good dietary practices. • It is negatively associated with alcohol, tobacco and drug abuse.

10. Levels of Self-Esteem (Figure 2-1, page 2-3) Superordinate Superordinate Dimension/Domain Dimension/Domain Subdomaine Subdomaine Facet Facet Subfacet Subfacet State (feelings of self-efficacy) State (feelings of self-efficacy)

12. Distorted Perceptions • Distorted perceptions can affect self-esteem and motivation, (e.g. “I’m fat and overweight”). • Others have problems in the other direction, (“I’m in good shape”). • In may cases a poor self-image is due to unrealistic expectations of an ideal self-image (e.g. models in society). • CPAFLA - objective testing and feedback creates • realistic view of self • Realistic outlook • Realistic aspiration and goals

13. 2. Assessing Health-Related Behaviours • Behavioural assessment - history, self report, self monitoring - family may also provide valuable information • Many tools in CPAFLA • Motivational Assessment - though we cannot motivate individuals directly, we can appeal to what motivates them • Assist them in finding aspect of their history that can bring them awareness of the value of fitness • Then help them develop clear goals and a program to achieve them

14. 3. Facilitate Change • Role of counselor is to facilitate change not prescribe it - work with client to discuss, develop and agree on a plan for change • Ultimate goal - participant to accept and maintain responsibility for personal behaviour • Assist participant in identifying all of the benefits as well as costs of behaviour change - all aspects of health - counselor can help broaden scope

15. Factors affecting participation • Three main reasons for approaching counselor • Gain health benefit • Strength, weight loss, reduce stress or disease risk • Enjoyment or pleasure • Self image • All reasons require the following to be in place • Beliefs • That physical activity will produce desired benefits • Their own ability to stay with program • Attitudes • Value attached to a belief • Intentions • Realistic planned approach - SMART goal setting • Reinforcement - chosen by client

16. Styles for Helping People Change (CPAFLA) • Each style is effective in certain situations and ineffective in others. • An appraiser should be able to use the most appropriate style for particular participants and particular needs. • Appropriate style may shift during interview

18. The Preacher "Thou Shalt Jog" Advantages/Disadvantages • some people need to be told (Ad) • some people respond negatively to commands (Disad) • very little discussion or client input (Disad) • no alternative action plan (Disad) • Client not a full participant in creating change (Disad) • unfounded assumptions about participant's activity preferences (Disad)

19. The Expert “Research shows that jogging at a heart rate of 70 to 85% of your maximum, 3-5 times per week for 20 to 30 minutes continuously will increase your aerobic capacity.” Advantages/Disadvantages • some people want the facts (Ad) • this style provides a credible rationale for assessment and recommendations (Ad) • it prevents dialogue about lifestyle preferences (Disad) • people not willing to change because scientific information suggests they should (Disad) • some people feel intimidated by information and will not express their opinions or ask questions for fear of appearing to lack knowledge (Disad)

20. The Counselor "I have knowledge about fitness, you know what activities you want to do, and now we have your test results, so let's talk." Advantages Disadvantages • focuses on the individual (Ad) • it sets the stage for dialogue (Ad) • goals are set by participants with guidance from the appraiser rather than the reverse (Ad) • the chances for permanent, beneficial changes are increased (Ad) • the style appeals to nearly all participants (Ad) • some people just want to be told what to do (Disad)

22. Strategies for Effective Leadership/Counseling • 1. Know your clients: • 2. Make your clients feel important: • 3. Help client design a program to meet their individual needs : • 4. Provide information (fitness, health, nutrition, etc.): • 5. Help clients understand their own fitness goals: • 6. Decrease the "hassle factor": • 7. Help clients use one another for support and encouragement: • 8. Provide opportunities for regular assessment: • 9. Make fitness fun: • 10. Provide a good model of safe and effective practices: • 11. Work on your own development as a leader: • 12. Market the "product":

23. Behaviour Change • Transtheoretical Model - Prochaska and DiClimente - derived from social learning theory • CPAFLA Fig 2-3, 2-4 • Progression of behaviour change through a series of stages • 1. Pre-contemplation - no intent, no exercise • 2. Contemplation - intent, no exercise • 3. Preparation - intent, occasional exercise • 4. Action - regular exercise • 5. Maintenance - exercise for 6 months or more • Rate of progression relates to use of strategies, expected outcomes and self confidence

26. Health Behaviour Change Model • Conceptualized in three stages • 1. Antecedent - includes pre-contemplation, contemplation and preparation phases of transtheoretical model • 2. Adoption - (Action) - early phases of change • 3. Maintenance - later phases of change • Antecedents - refers to all conditions that can assist, initiate, hinder or support change • Ask client to rate intention 0-10 • Fig 65.1 - intentions can change and may be influenced by many factors

28. Antecedents • Information -often a stimulus for beginning • Needs to be clear and simple - most effective when combined with instructions about how to make change • Emphasize benefits rather than risks • Test knowledge critical to behaviour change prior to program - correct myths and misperceptions • Instructions should be kind but firm - remove ambiguity • Ask participant to repeat information important to behaviour change

29. Antecedents (cont) • Models - family, friends… • Allows participant to see how others make changes • Ask them to think about people they know or admire who have made changes • Experience - people are more likely to repeat a behaviour if it was helpful in the past • Client should be made to answer question: • “How can I make sure that I benefit from this program?”

30. Adoption • When to intervene or encourage adoption of a new behaviour should be guided by experience • Ask “ are you ready to….” • Goal setting is an important part of adoption phase • Flexible, individually tailored, achievable • Include needs and preferences • Rate confidence 0-100% - 70%+ more likely to succeed • Early phase most difficult • praise (immediate and specific), clients active ongoing social support 2-3 times as likely ot succeed

31. SMART GOAL SETTING Specific Is the goal specific? • Do you know how, where, when, with whom, and how long you will do this? Action-oriented Measurable Is it measurable? • Will you know when it is done? Acceptable Will you feel good about doing this? • Meaningful -- is this a personal goal or for someone else? Realistic Are you able to do this? • Genetic characteristics, personal preferences, time, money Timely Is there a deadline attached? • Set short and long term goals • Create new goals once they are achieved • * Maslow's Theory: once a need (or goal) is satisfied, it no longer motivates.*

32. Goal Setting for Athletes Review periodically to stay “psyched” or make adjustments: 1. What is your long-term dream/goal? 2. What is your dream/goal for this year? 3. What do you feel is a realistic performance goal that you can achieve this year? 4. Can you make a commitment to accept yourself? 5. If you don't meet your desired performance goal, to what extent will you still be able to accept yourself (0-10)? 6. Whenever you work out, can you set an on-site goal of best effort and be satisfied to get to just that goal? 7. What do you feel is your most important psychological goal this year, to achieve better preparation or mental control? 8. Describe your personal goal for your next session.

33. Maintenance • Behaviour that satisfies or reduces discomfort is likely to be maintained • Four Strategies • Monitoring and Feedback • Diary, physiological monitoring • Making the activity as satisfying as possible Reinforcement - very individualistic • Relapse prevention - and anticipation - decide what to do in event of relapse now • Making a formal commitment - Contract • Realistic and achievable, revised as necessary • Problem solving for goals not achieved

34. Developing a Program • Ask client to consider change • Requires good self esteem, confidence, belief, attitude, and intention as well as good client counselor rapport • Provide information, instructions and models for change • Building confidence, reducing disincentives, increasing incentives - providing agreeable options from large knowledge base • Request commitment • SMART goals, relapse prevention, contracts and rewards - decide on monitoring and reevaluation criteria

36. CPAFLA - Seven step approach • Describes step by step process of working with a client to develop an effective program • Step 1 - Build rapport and structure • Step 2 - Gather information • Step 3 - conduct fitness appraisal • Step 4 - Interpret fitness appraisal results • Step 5 - Generate alternatives for change • Step 6 - Develop an action plan • Step 7 - Follow up • Our focus today is on steps 1,2, 5 and 6 • Utilize CPAFLA forms to gather information, and to generate a plan with the client.