Cognitivist Cognitivist Perspectives Perspectives Behaviour is determined by thought Behaviour is determined by thought Behaviour is governed by goals Behaviour is governed by goals Few (if any) instincts Few (if any) instincts Emotions, feelings, motives trace Emotions, feelings, motives trace back to thoughts back to thoughts Human beings start out as “flawed” Human beings start out as “flawed” thinkers…but we can be salvaged! thinkers…but we can be salvaged!
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Cognitivist PerspectivesCognitivist Perspectives
Behaviour is determined by thoughtBehaviour is determined by thought Behaviour is governed by goalsBehaviour is governed by goals Few (if any) instinctsFew (if any) instincts Emotions, feelings, motives trace Emotions, feelings, motives trace
back to thoughtsback to thoughts Human beings start out as “flawed” Human beings start out as “flawed”
thinkers…but we can be salvaged!thinkers…but we can be salvaged!
Attribution ErrorsAttribution Errors
Fundamental ErrorFundamental Error Self-serving BiasSelf-serving Bias Halo EffectHalo Effect Labeling (the self-fulfilling Labeling (the self-fulfilling
prophecy)prophecy) The “Catastrophizing” EffectThe “Catastrophizing” Effect Thought-Feeling DistinctionThought-Feeling Distinction
Cognitivist StrategiesCognitivist Strategies
““Foot in the door”Foot in the door” ““Door in the face”Door in the face” Low-ballingLow-balling IngratiationIngratiation Guilt/FearGuilt/Fear
Health Care Providers’ Health Care Providers’ Roles:Roles:
Patient centeredPatient centered Information exchange, not Information exchange, not
information downloadinformation download Patients must “save themselves”Patients must “save themselves” Negotiate, don’t dictate, behaviourNegotiate, don’t dictate, behaviour Understand and accept, don’t Understand and accept, don’t
coerce and manipulatecoerce and manipulate
Health Care Providers’ Health Care Providers’ RolesRoles
Patients’ resistance is nothing Patients’ resistance is nothing more than a source of information more than a source of information that must be dealt withthat must be dealt with
Assess the patient’s motivation Assess the patient’s motivation and level of readiness rather than and level of readiness rather than presume itpresume it
Model for Describing Model for Describing ChangeChange
Individual is not seriously considering Individual is not seriously considering change and isn’t interested in change and isn’t interested in discussing itdiscussing it
Characteristics:Characteristics:
- unawareness- unawareness
- unwillingness- unwillingness
- too discouraged- too discouraged
ContemplationContemplation
Individual begins to seriously consider Individual begins to seriously consider making a change (within six months)making a change (within six months)
Characteristics:Characteristics:
- open to information, education- open to information, education
- perceived temptation risk is high- perceived temptation risk is high
- often motivated by self-esteem issues- often motivated by self-esteem issues
PreparationPreparation
Individual begins experimenting, Individual begins experimenting, making small changes and a making small changes and a resolution to changeresolution to change
- bargaining with self for rewards- bargaining with self for rewards
- highly reliant on external support- highly reliant on external support
ActionAction
Individual is actively involved in Individual is actively involved in making change and experiments with making change and experiments with techniquestechniques
Characteristics:Characteristics:
- bigger steps but most stressful stage- bigger steps but most stressful stage
- actively fighting against coercive forces- actively fighting against coercive forces
- developing sense of autonomy and - developing sense of autonomy and esteemesteem
MaintenanceMaintenance
Individual must learn to successfully Individual must learn to successfully cope with temptationscope with temptations
Characteristics:Characteristics:
- has been adherent for at least six - has been adherent for at least six monthsmonths
- able to identify self-defeating - able to identify self-defeating behavioursbehaviours
- higher level of self-worth- higher level of self-worth
Health Care Providers’ Health Care Providers’ BehavioursBehaviours
Precontemplation:Precontemplation: patient not ready for argument patient not ready for argument open to knowing information is open to knowing information is
available, not necessarily open to available, not necessarily open to information itselfinformation itself
““cheerleader” tactic not usefulcheerleader” tactic not useful understanding and acceptance most understanding and acceptance most
importantimportant
Health Care Providers’ Health Care Providers’ BehavioursBehaviours
Contemplation:Contemplation: Information and education best Information and education best
acceptedaccepted emotional supportemotional support help enlist significant others for help enlist significant others for
supportsupport planning importantplanning important environmental re-organizationenvironmental re-organization
Health Care Providers’ Health Care Providers’ BehavioursBehaviours
Preparation:Preparation: need praise, encouragement, supportneed praise, encouragement, support need external monitoringneed external monitoring need to ‘test-drive’ behavioural need to ‘test-drive’ behavioural
changes in a safe, non-threatening changes in a safe, non-threatening environmentenvironment
need assistance with environmental need assistance with environmental controlcontrol
Health Care Providers’ Health Care Providers’ BehavioursBehaviours
Action:Action: continued emotional support necessarycontinued emotional support necessary need close monitoring and someone to need close monitoring and someone to
“call out” relapses“call out” relapses constant counter-conditioning requiredconstant counter-conditioning required external stimulus control gradually external stimulus control gradually
replaced by internal stimulus controlreplaced by internal stimulus control
Health Care Providers’ Health Care Providers’ BehavioursBehaviours
Maintenance:Maintenance: less encouragement, more less encouragement, more
criticism (but supportive!)criticism (but supportive!) internal, not external, motivationinternal, not external, motivation
Key Features of AdherenceKey Features of Adherence
Patients are:Patients are: interestedinterested believe their health care providersbelieve their health care providers understand and accept interventionsunderstand and accept interventions have made an internal cost-benefit have made an internal cost-benefit
analysisanalysis in control of decisionsin control of decisions recognize their own responsibilityrecognize their own responsibility
Stages of ChangeStages of Change
Recognize patient’s readiness for Recognize patient’s readiness for changechange
Provide continuous support, but Provide continuous support, but modify based on stagemodify based on stage
Education isn’t enoughEducation isn’t enough Identify personal triggers to Identify personal triggers to
motivate behavioural changemotivate behavioural change Time, time, timeTime, time, time
12-Step Method (AA)12-Step Method (AA)
1) Admit our lives are unmanageable1) Admit our lives are unmanageable
2) Believe in Power greater than self2) Believe in Power greater than self
3) Decide to turn over life to greater 3) Decide to turn over life to greater PowerPower
4) Searching and fearless moral 4) Searching and fearless moral inventory of selfinventory of self
5) Admit to self and to one other exact 5) Admit to self and to one other exact nature of wrongs committednature of wrongs committed
12-Step Method (AA) 12-Step Method (AA)
6 & 7) Able to want to have character 6 & 7) Able to want to have character defects removeddefects removed
8) List all persons harmed by actions8) List all persons harmed by actions
9) Make amends to all who are harmed9) Make amends to all who are harmed
10) Continue to take personal inventory10) Continue to take personal inventory
11) Prayer, Meditation11) Prayer, Meditation
12) Carry the message to others - 12) Carry the message to others - teachteach
The Culture Shock ModelThe Culture Shock Model
1) Euphoria, expectation1) Euphoria, expectation
2) Irritation2) Irritation
3) Rejection of host culture3) Rejection of host culture
4) Idealization of home culture4) Idealization of home culture
