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Behavioral Wellness
Coaching Your Client to Making Behavioral Changes that Last
Certified Obesity Management
Specialist, COMS
Behavioral Management – The Basics
Phases of change Coaching/Guidance Goal Setting Making changes that last
Approaches to Behavioral Management or Modification
Success Breeds Success Begin with changing one pattern or
behavior at a time with your clients Manageable/Achievable Reinforcement Build confidence small goals =
increased success Gain control
Side Effect – Improve Health & Weight Loss
How is the Approach Different? An individualized, client driven
program Listen to your client – what is causing
his or her disease? Treat the cause(s). NO Cookie-Cutter programming Focus on lifestyle behaviors and
patterns Baby steps approach to change Treat the behaviors one by one
Identifying Your Client
Procrastinator Low-self esteem Pessimist Negative Self Talker People Pleaser
What Approaches in the Past
Have your client record his or her past programs
Was the program successful for any period of time?
What did he or she learn from it? What did they like about it? Dislike?
Was it qualitative or quantitative? (Calorie count or food portion control?)
Why did he or she stop the program?
Using Cognitive Change
A man is literally what he thinks, his character being the complete sum of all his thoughts. James Allen [1864 -1912]
Thoughts -- lead to -- Behaviors
Changing Thoughts -- lead to -- Altered Behaviors
Cognitive Change
Motivation Dealing with “ Mistakes” Goal Setting Mental Outlook Beliefs
If we treat people as they are, we make them worse. If we treat people as they ought to be, we help them become what they are capable of becoming.
Johann Wolfgang von Goethe [1749 - 1832]
Antecedents/Triggers to Behavior
People Family Work-Coworkers
Events/Situations Time of day TV/Gaming Movie Theatre Ballgame Card Games Parties
Feelings Job Performance
Anxiety Stress Tension Skipping Meals Loneliness and
Boredom
Behaviors/Consequences
BEHAVIORS Bingeing Eating Too Rapidly Eating Alone Eating Off
Schedule Holiday Traditions
CONSEQUENCES
Immediate Enjoyment Delayed Consequences
ShameGuiltHopelessnessDepression/AngerNegative Self-
perceptionWeight Gain
Making Changes that Last
Only 20% of people who need to make a change are prepared to take action
Long lasting change passes through FIVE stages: Pre-Contemplation Contemplation Preparation Action Maintenance
Stage 1: Pre-Contemplation
40% of people are in this stage
May be unaware there’s a problem
May know it’s unhealthy but not ready to change
Typically don’t discuss the problem
Challenge is to help them WAKE UP
Usually takes an outside force - illness or birthday or event
Stage 2: Contemplation
“I should change, but…” Your client can become stalled in this
stage To move forward, the client must be
convinced that it is worth it! The benefits of making a change
exceed the sacrifices Many people procrastinate for years Only the client can make it happen!
Negative Self-Talk
There is no use in trying I can’t do it with my family If it weren’t for my job, spouse,
parents It is not a priority for me at this time I am too tired to add one more thing Losing weight is not going to change
______
Moving Forward in Stage 2
Weigh the pros and cons
Write a list of gain your client can expect, especially immediate gains, not just long term gains
Make a list of personal, specific reasons to change
Have your client consider the negative of continuing with the current situation (20 years from now)!
Journal/Log
Have generic forms for clients to complete and report back to you weekly.
Return to grade school with calendars and sticker system for rewards and visual cues.
More likely to complete activity if they “see” what is expected.
Date Resting HR Activity Peak HR Duration Distance Exit HR Comments
Stage 3: Preparation
Change requires foresight! Drop-outs don’t plan well for
obstacles Help your client anticipate common
problems During this stage, your client may
make it to the edge of change and refuse to take the leapAssist in Developing an Early Warning System
Your client knows it is healthy
BUT putting it into action is
a challenge
Here are a few statistics that might motivate your client to exercise and stick
with it
Exercise Statistics
Only 20% of the American population exercise regularly enough to gain or maintain cardiovascular benefits
40% are active but less frequently and less intensely to gain health benefits
40% are completely sedentary Of those persons who begin a formal exercise program,
40-50% drop out within 6 months The people least likely to exercise in a formal program
and most likely to drop out if they do begin an exercise program are blue collar workers, smokers and overweight persons!
Ask your client if he or she wants to be just another statistic?
Top Ten Exercise Excuses
1. It makes me sore 2. It’s inconvenient 3. I’m too busy 4. I don’t have the energy 5. I’m too old 6. I’m too fat 7. I’m under a lot of stress as it is 8. I get enough exercise at work 9. It’s boring10. I keep meaning to start
SMART GOALS
Specific Measurable Accountable Realistic Time Frame
Use written goals to evaluate and address barriers
Behavior Changes Occur if:
People believe they can make the change The change will help achieve their goal
Thinking Positive:Develop a problem solving approach
Can Make You Feel:Better
More MotivatedHappier
Strategies for Maintaining Motivation
Make a specific plan for your exercise - what, when, where how often, how long, etc.
Schedule exercise around other daily activities such as before meals and after sleep.
Alternate activities daily, especially if you are over 40.
Include both aerobic and anaerobic activities. Periodically change your exercise program. Self-monitor and maintain progress records. Exercise with a friend.
Moving Forward in Stage 3
It may require a nudge “You can do it” “You’re ready”
Set a date for change Go public with it Try a half-way measure Take charge of the situation Set Realistic goals Plan Get support
Stage 4: ACTION!
If your client has done the homework, he/she is ready for ACTION
Cognitive Methods Positive Thoughts -- New Thoughts Positive Beliefs -- New Behaviors Behavioral Techniques to alter your environment
Strengthen your client’s commitment to change Help him/her develop the Refuse-To-Lose
Mentality! Commitment involves personal responsibility Your client must take charge of his/her situation No one else can do it for your client YOUR CLIENT IS IN CHARGE
BEHAVIOR CHAINING
The procedure for building chains is called chaining RULES FOR CHAINING:
1. Define the target behavior 2. Reinforce successive elements of the chain 3. Monitor the results
Behavior chain is a sequence of related behaviors, each of which provides the cue for the next, and the last of which produces a reinforcer
A chain is really a series of signals and behaviors Almost everything your client does can be
considered part of a behavior chain Getting dressed, eating, using the computer, etc
Functional (Task) Analysis
What is a functional analysis? Breaking the behavioral chain into small
manageable steps
Functional Analysis Behavior Chain Trigger Thoughts Behavior
Feelings Consequences (Positive/Negative)
How Analyzing a Behavior Can Help Your Client
Generally, when a situation arises, your client reacts
Your client skips from the trigger to the behavior Your client doesn’t think about what’s “in
between” Thoughts & Feelings
Helping your client identify the “in between stuff,” he/she is able to break the chain!
The chain can be broken at any point! But, your client has to break it
Behavior Modification
What the National Institute of Health (NIH) has to say about behavior modification: “Unless a person acquires a new set of eating
and physical activity habits, long-term weight reduction is unlikely to succeed.”
“The acquisition of new habits is particularly important for long-term weight maintenance at a lower weight. Most people return to baseline weights in the absence of continued interventions.”
Primary Assumptions of Behavior Modification
1. Changing eating and physical activity habits makes it possible to change body weight.
2. Patterns of eating and physical activity are learned behaviors and can be modified.
3. To change these patterns over the long-term, the environment must be changed.
Breaking the Chains
Breaking the chains takes time and commitmentInstruct your client to do the following: Anything that is incompatible with eating (exercising,
talking) Stay out of the kitchen Anticipate the situation (Rehearsal/Practice) Pre-plan the approach (Be ready) Don’t wallow in guilt (Stinkin’ Thinkin’) Stay educated DO SOMETHING DIFFERENT! Keep a food and feelings log to ID your chains
Examine it for patterns and make adjustments
What is “STRESS?”
Stress can be defined as the “wear & tear” on your client’s body as he/she adjusts to the continually changing environment
Stress is actually the body’s reaction to triggers Stress is a fight-or-flight response in the body mediated by
adrenaline and other hormones Stress is comprised of physiological changes such as
increased heart rate, blood pressure, breathing, muscle tension, and blood sugar, as well as dilated pupils, dry mouth
Stress is the state of increased arousal necessary for an organism to defend itself at a time of danger!
Effects can be positive or negative, depending on how your client reacts: Positive influence - compels us into action Negative influence - negative feelings, health problems
What Causes Stress?
Causes are multiple and varied Classified into 2 groups:
External (25% of your clients stress) Internal (Self-Generated – 75% of your clients stress)
Unfortunately, most of the stress your client will experience is self-generated!
Your client will tend to create a majority of his/her upsets and stress
Because your client creates a majority of his/her stress, your client can do something about it!
This gives your client a measure of choice and control This leads to the basic premise of stress reduction and stress
management To master stress, your client must change 4 Categories of Change:
Behavior, Thinking, Choices, Situation
10 Practical Strategies Management
1. Decrease or Discontinue Caffeine Your client may not realize caffeine is a drug, a strong stimulant
that actually generates a stress reaction in the body 2. Regular Exercise
At the very least, exercise 3-4 times per week for a minimum of 30 minutes each time
3. Sleep Chronically stressed clients suffer from fatigue People who are tired don’t cope well with stress Encourage your client to go to bed 30 minutes earlier and monitor the
results after a few days or a week Sleeping in is fine but if you sleep too long, it throws off your body
rhythms during the following day. Most people require 5-10 hours per night
Naps are valuable if they are short and timed properly (5-20 minutes) Sleep Hygiene – Sleep where you sleep! No phone, computer, tv, etc.
10 Practical Strategies for Management
4. Time Outs and Leisure - Decompress Pacing
Have your client monitor his/her stress and energy level and pace him/herself Work-Leisure Balance
Average person works 3 hours more per week than 20 years ago That translates to an extra month of work each year! The less leisure the more stress
5. Realistic Expectations People become upset about things, not because they are stressful, but
because it doesn’t occur with what they expected When expectations are realistic life feels more predictable and manageable Expectations for others: Expect less from people who can’t give you what
you want. It makes it easier - not great, just less upsetting Avoid using “Should” to avoid putting expectations on those that can
disappoint you “Thou shall not should on yourself and thou shall not should on
anyone else”
10 Practical Strategies for Management
6. Reframing Technique used to change the way your client looks at things in
order to feel better about them The key to reframing is to realize there are many ways to
interpret the same situation! -- Is the glass half empty or half full?
Reframing does not change the external reality but simply helps clients view things differently and less stressfully
7. Belief Systems Your client literally has thousands of premises and assumptions
about all kinds of things that he/she holds to be the truth Most of these beliefs are held unconsciously; often your client
is unaware of them Beliefs create stress in two ways
The first is the behavior that results from them When beliefs are in conflict with those of others –
COMPROMISE! “What am I really doing and what is behind this?”
10 Practical Strategies for Management
8. Support System/Ventilation Encourage your client to talk to a friend, family member, or co-
worker -- A problem shared is a problem halved – Therapy works due to the relationship of sharing and trusting
People who keep things to themselves carry a considerable and unnecessary burden
Writing is a good ventilation tool 9. Humor
The antidote for upsets! -- Humor is an individual thing 10. Relaxation/Meditation
Just as your client has the capability of mounting and sustaining a stress reaction, he/she also has the ability to put his/her body into a state of deep relaxation
Relaxation neutralizes stress and produces a claming effect As little as 20 minutes once a day can create significant benefits! Breathing
Stage 4: ACTION
Set Goals What does your client want to accomplish? Encourage him/her to DREAM A LITTLE! Set some achievable short term goals that
are day-to-day Set long-term goals for the future WRITE A CONTRACT!
How to Coach Towards Achieving Goals Specific goals Divide your client’s goals into smaller parts Develop a plan that is progressive Review your client’s progress regularly
Goals
What are goals? The Ends Toward Which Effort Is Directed
Why have goals? “A goal is a target tomorrow which sharpens your aim today.”
Are goals necessary? A goal is a dream with a timeline
The Payoff of Goals
Your client will be taking control of his/her life
Gives direction to his/her energy Clears accountability of success Defines and helps prevent failure Can be used to create reward system
All you need to know is that today you’re going to work out. You don’t need to know that you’re going to keep it up for 6 months, 2 weeks, or even 2 days. You just need to know that you’ll do it today. Those days will add up on their own.
Elizabeth Streb
There was a woodsman who had a new ax. The first day he was able to chop down 20 trees. With each passing day, he worked longer and harder, while chopping down fewer trees. A friend wandered by and suggested, “Why don’t you sharpen your ax?” The woodsman replied, “I’m too busy. I’ve got to chop down more trees!”
“SHOULD” leads to DECISION,
which leads toSACRIFICE
“WANT” leads to CHOICE,which leads to
COMMITMENT
ACTION
Establish Rewards Your client should
reinforce good efforts with rewards for reaching goals
Replace Old Behaviors with Healthier Ones Your client should
fill the need with new healthier alternatives
Change the Environment Your client should
avoid cues that trigger old habits
It’s the simple things! Make significant
adjustments Prepare for
Troublesome Situations It’s rehearsal time!
YOU ARE A PART OF YOUR CLIENT’S SUPPORT SYSTEM!
Help comes in many different forms, you are one part of your client’s support system.
What does your client want? Your client should tell people to increase his/her accountability to the changes.
Your client should be clear on the kind of support he/she wants and needs!
Some clients need more support than others; as the health professional, you must help him/her decide how to structure an effective support system.
Action Stage
Weight loss takes longer than most people expect or are willing to accept
Your client should expect to focus on the situation for AT LEAST SIX MONTHS!
If your client is not prepared for LONG TERM goals and behavior changes, he/she risks resuming old habits
Remember: CHANGE IS A MARATHON, NOT A SPRINT!
Stage 5: Maintenance
Determine what is DIFFERENT
What Worked? What DIDN’T Work Realize that people slip-
up How your client
explains the slip-up to him/herself matters!
Keep PERSPECTIVE!
Use CHARTS/LOGS to track progress
Change takes root for your clients when he/she develops a new identity
Who does your client want to be and what does she want the change to say about her?
Programming For Success
Your client should: Attend regular sessions - Compliance
Accountability and social support Keep written records
Change his/her environment
Change his/her mindset
