Behaviour Change

Question 1

introduction

Answer 1

Behaviour in LICBT -maintain illness

• Engagement is vital to help break behaviour cycle
• (Michie et al 2011) framework for understanding influences of behavioural change models
• motivation - capability - opportunity all influence behaviour
• Lack of these result in limited probability of behaviour occurring
• Usually used to see how likely engagement of the patient is, and why and how we can increase this.
• Michie et al 2011- Interactions between capability, opportunity and motivation. Thus, by increasing one, can enhance another, leading to higher engagement with behavioural change.

Question 2

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Answer 2

Different techniques to engage behaviour change.

• Engagement can be affected by reflective motivation (linked to conscious psychological concepts e.g. goals Michie et al 2011)
• Miller and Rodnick (2012) –importance of goal or change or how confident they can achieve goal or change. Lower levels of self-efficacy impact engagement. Lower importance = less engaged.

Persuasion -Michie et al 2011- when an individual change another’s perspective and increases motivation

• Benefits may outweighed by costs of change or benefits associated with current behaviour
• Few things that can persuade behaviour change…
  - Paradoxical reaction if pressured into change. Thus support using empathy and relatively neutral approach.
  - Give change talk/confidence talk
  - Strategies e.g. pros and cons via decision balance sheet or less structured discussion
  - conversations around concern that others have about the client (new perspectives).
  - Looking back to life before difficulties and looking forward, how difficulties could affect future.
  - Uncovering goals and values and contrasting current behaviour.
  - By going over rationale builds Confidence = new route to recovery.

Question 3

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Answer 3

• past attempts, chronicity of difficulties or low self-efficacy can have an impact.
• take in terms of facilitation not blocking of change. -rephrase statements or re-frame past or present attempts at change.
• hypothetical thinking -frees up thinking and allows creative thinking.
• clinician factors can encourage engagement; positive feedback; enthusiasm.

Question 4

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Answer 4

Incentivisation -increases motivation learning that one event follows another; or behaviour is followed by a consequence.
-Adachi (2005) principles of learning theory can be applied in interview to understand and enhance engagement. look out for circumstance; behaviour; consequence.

• determine focus for intervention through predicting what change in behaviour will have greatest benefit and how likely the behaviour will be changed.
• Conceptualized through transactional analysis as strokes (Stewart and Joines 2012). Interaction perceived as pleasant e.g. nod. May be more likely to engage if more positive strokes

Question 5

Paragraph 2 (e)

Answer 5

• should be aware that clinician needs to adopt neutral stance in that happy expressions may inhibit talk about neg experiences or express difficult emotions.
• Clinical strokes –reinforce disclosure / effort / progress.
• Nonverbal- nods /noises encourage elaboration.
  o E-too many stokes = patronizing/false.
• Thus, incentivisation processes operate over different levels –
  o Contribute to problem development
  o Used directly to treat psychological difficulties
  o Reinforce client’s efforts
  o Reward certain forms of communication
  o Maximise engagement

Question 6

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Answer 6

Modelling Increases perceived capability and opportunity.

• Bandura -conditioning observation followed by imitation.
• Michie et al 2011 – modelling influences behaviour by increasing confidence e.g. graded exposure holding snake, creates opportunity to imitate behaviour.
• Allows coping in situations more effective through repetition = less distress increase in functioning, new actions reinforced.

-Examples of others in treatment or in self-help worksheets. Contain details of persons progress and examples of completed sheets.
o Reassures clients of applicability; normalize difficulties; hope for recovery; new coping methods; examples of behaviour and materials to imitate.
o Greater the similarity more helpful find info (Papworth et al 2015)

-Practitioner – materials and demonstrating strategies. Show how to approach. Provide forms of questioning helpful when outside of session show opportunity to attempt exercises – opportunity for coaching and reinforcement.

Question 7

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Answer 7

• heightened capability and confidence leave session prepared and motivated
• provides rationale for why some poor outcomes -linked to forms of medium-intensity drift e.g. overview or little detail in self-help materials within session will reduce learning opp.
• signals capability issues too – should consider other modelling intervention especially when confidence or capability are flagged

Question 8

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Answer 8

Environmental restructuring
- Rearranging physical and social environment to increase opportunity for change. (only when indicated insufficient for engagement with treatment)

• Opportunities may be limited due to little personal power
  o Hagan and small (1997a) -power map to consider areas that may be inhibiting opportunity and guide
  intervention.
  o can be used as formulation tool to understand circumstance

-Social and physical elements of Michie et al (2011) opportunity category.
o pinpoint limiting factor (can be material matters; personal factors; home and family; social life) and seek to help client work through problem-solving process to increase power

• practitioner can help the client through…
   Providing information
   Exploring the issue to facilitate problem-solving
   Contact resources on client’s behalf
   Contact other services due to risk.
   Maslow (1943)-hierarchy of needs basic needs often prioritised over psychological needs; practitioners can work to change this.

Question 9

Conclusion

Answer 9

• COM B important to assess engagement of client which lead to poorer response and dropout.
• Can be used to guide intervention’s and increase inclusivity and treatment outcomes by allowing influence of clinician on clients’ engagement.