Motivation & Commitment

©Carrie Cadwell PsyD HSPP Cadwell Psychological Services, LLC www.cadwellpsychologicalservices.com

Behavior Change

• What we will address today: – Stages of Change (Prochaska et al) • • • Understanding readiness (ie motivation & commitment) Behavior change unfolds in stages---what is your stage?

What needs to happen to move to the next stage – Relapse Prevention (Marlatt, et al) • I’ve lost the weight---SUCCESS---now what?

Stages of Change

• • • Precontemplation – Individual may see but does not own the problem – Low motivation/low commitment Contemplation – Individual owns problem and considering change – Increasing motivation/low commitment Preparation – Intention to take action in the immediate future – Increasing motivation and commitment

Stages of Change

• • • Action – Actively engaged in changing lifestyle – High Motivation and Commitment Maintenance – Sustaining and prevention of relapse – Variable motivation and commitment Termination – Mastery---problem is 100% gone – Realistic? Goal= lifetime of maintenance

Timelines for Change

• • • • • Precontemplation—no intention to take action in next 6 months Contemplation---people can get stuck in this stage (chronic contemplation/behavioral procrastination)**** Preparation—action within the next month Action---implementing changes over 6 months – Benchmarks---30 days, 90 days, 6 months Maintenance---6 months-5 years…to lifetime

Stages of Change

• Ask yourself: – Where am I in these stages---behaviorally AND cognitively/emotionally • Ex: Enrolled in weight loss program but doing it for someone else---who owns the problem? (vulnerable) – How do I move to the next stage? How do we help people move to the next stage?

• Next we will look at processes of change……

Processes of Change

• Precontemplation  Contemplation – Consciousness Raising • • Raising awareness of causes, consequences, cures Education, feedback, confrontation, interpretation, bibliotherapy, media exposure – Dramatic Relief • • • Increasing the emotional experience of behavior change Personal testimonies, role-playing, grief sharing- what does the problem mean to you—what would happen if it was gone

Processes of Change

• Environmental Re-evaluation – Examining how the problem/behavior impacts others • So thinking about others can help move us from precontemplation to contemplation but at that point we have to begin to think about how it impacts us to implement and sustain change

Processes of Change

• Contemplation  Preparation – Self-Re-evaluation • • • • Evaluating self-image with and without the behavior/problem Value clarification Who are my role-models? Establishing healthy role models Using imagery to “see” the self you want – Real Self; Ideal Self, Ought Self—what’s realistic

Processes of Change

• Preparation  Action – Self Liberation • • Enhancing the belief that one can change and committing/recommitting to that BIG ISSUE here is choices – 2 choice= greater commitment than one choice for action – 3 choices= greater commitment than 2 choices – No greater benefit to 4 plus choices—overload

Processes of Change

• Preparation  Action – Social Liberation • • • • Increasing social opportunities or alternatives Reconstructing environment Enlisting of supportive others as agents or advocates Working on increasing social choices----advocating for healthier choices in cafeterias/vending machines etc

Processes of Change

• Action and Maintenance – Contingency Management • • • What will be or are the consequences of moving toward or away from my goal? CLEARLY ESTABLISH Self-change should emphasize incentive/rewards more than punishment---fear change= vulnerability Extrinsic and intrinsic – Helping Relationships • • Social support, buddy systems, coaching calls Building relationships and bonds with people who help not hinder

Process of Change

• Action and Maintenance – Counterconditioning • • Learning healthy behaviors that can substitute/replace Ex: not just learning the weight program but relaxation skills, assertiveness skills, problem-solving skills – Stimulus Control • • Remove cues for unhealthy behavior – What do I see, hear, smell that triggers me Add cues that prompt healthy choices – Ex: lay your work-out clothes where you would normally put robe; change your route to work; “its your choice” cards

Decisional Balance

• Across stages and processes a common thread is the issue of pros & cons to change – Heavy emphasis on increasing pros of change moving from precontemplation to contemplation – Heavy emphasis on decreasing the cons of change moving from contemplation to action – Pros must increase twice as much as cons decrease

Self-Efficacy

• • • Belief or confidence in yourself to you can change Situation-specific Several types: – Self-efficacy for starting – Self-efficacy for sustaining – Self-efficacy for coping with high-risk situations to prevent relapse

Temptations

• • • 3 common tempting situations: – Negative Affect/Emotional Distress – Positive Social Situations – Carvings What is your plan when these happen…because they will This raises the issue of relapse prevention….

Relapse Prevention

• • • • Using principles of self-control to anticipate and cope with high risk situations to prevent relapse Initial programs are externally administered….RP is self-administered Long-term maintenance and initial behavior change require difference approaches It is not enough to say that we have “front loaded” during an initial program….we have to lay out an “afterwards” program

Relapse Prevention

• Lapse vs Relapse – Lapse= singular occurrence of behavior and/or return to unhelpful thinking patterns – Relapse= return to regular engagement in the unhealthy behavior – Most of us associate “total failure” with relapse-- instead drop that term…talk about lapses

Relapse Prevention

• Beware “Abstinence Violation Effect”: – We commit to indefinite change, 100% abstinence from our unhealthy behavior forever – Then we experience “natural lapses” – “if we are not 100% successful then we are a total failure and the situation is hopeless” • • Either-or thinking is not helpful to sustaining motivation and commitment over time Lapses are a natural part of the journey • Success is noticing the lapse and rejoining your healthy journey

Relapse Prevention

• • 1 st lapse  often occurs when individual unexpectedly encounters a high-risk situation 2 nd + lapses lapse  not “taken by surprise”….instead there is a series of forks in the road for which the choices made by the individual put them closer and closer to the high-risk situation and – Look at what was happening prior to finding yourself in your high-risk situation

Relapse Prevention

• Importance of balance – “should” versus “wants” – When we “should” ourselves to death life is out of balance • We view ourselves as self-deprived and the rationalize excessive unhealthy indulgence as justified due to that – Build in small daily “healthy” pleasures to balance the necessary daily “shoulds”

Relapse Prevention

• Relapse Prevention emphasizes: – Skill training to manage high risk situations – Cognitive Reframing – Lifestyle Rebalancing

Relapse Prevention

• Several Steps: – What are my high-risk situations?

– For each situation, rate how successfully you imagine you would cope – If not well, what is missing? Skill Deficits – How adequate are my coping tools? What do I need to add/learn? (skills training) – When I find myself in high-risk situations, what are my alternatives (generate more than 1)

Relapse Prevention

• Reframe: high-risk situations are “junctures where choices are made” not “uncontrollable challenges that must be endured” – A thought and urge is just that-----you are not the thought, you are not the urge – That which we resist, persists…..notice the thought/urge as it is and implement coping tools as needed

Relapse Prevention

• • Expect to be triggered and uncomfortable – Urges= rise in intensity, peak, and then decline (ride out the wave) – What are your early warning signals (different than high-risk situations)==“mini-decisions” Expect the lapse and prepare – “post-slip” plan – Ex: wallet card that states what to do once your lapse occurs

Relapse Prevention

• Address your positive expectancies from unhealthy behavior – Behavior is functional---it communicates something and has meaning – What are you getting out of the behavior or in avoiding a healthy behavior?

In Summary….

• When planning for change… – Where is your readiness?

– How do you move to the next stage?

– Evaluate self-efficacy – Once you achieve success…..

• • Plan for relapse prevention How will you sustain and ride the wave once your initial 12-16 week program is over?

References

• The material presented in this presentation is a reflection of the following resources: – Prochaska, J.O., Johnson, S., & Lee, P. (1998) The Transtheoretical Model of Change. In The Handbook of Health

Behavior Change, 2 nd

ed (Eds. Shumaker, S.A., Schron, E.B., Ockene, J.K., McBee, W.L.): Springer Publishing Company – Marlatt G.A. & George, W.H. (1998) Relapse Prevention and the Maintenance of Optimal Health. In The Handbook of

Health Behavior Change, 2

Company

nd

ed (Eds. Shumaker, S.A., Schron, E.B., Ockene, J.K., McBee, W.L.): Springer Publishing