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Behaviour change: How to help yourself and your clients do more
Beth Langley, Physiotherapist BSc(Hons), CSCS, MCSP,
MHCPC, MBACPAR
STRIVE FOR
BETTER.
Agenda• What is behaviour change?
• Why should we change behaviour?
• The Transtheoretical model
• Motivational interviewing
• Models of behaviour
• Principle of behaviour change
• Methods of behaviour change
Residential Rehab Modules
Strength training
Proprioception CardioProsthetic
InputGait Re-
education
Pain Management
Electrical Stimulation
Objective Testing
Wellness Monitoring
Pilates
Home exerciseHome
SchedulingBehaviour Change
HydrotherapyOutdoor Rehab
MassageEffusion
managementManual Therapy
What is behaviour change?
• Health: Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or infirmity
(World Health Organisation, 1948)
• Health Behaviour: An action taken by a person to maintain,
attain, or regain good health and to prevent illness. Health
behaviour reflects a person's health beliefs (Online Medical
Dictionary, 2017)
• Behaviour: The way in which an animal or person behaves in
response to a particular situation or stimulus
What is behaviour change?
• Behaviour change is commonly defined as a research-based
consultative process for addressing knowledge, attitudes and
practices that are intrinsically linked to the goals of a programme
• The vision of behaviour change includes providing participants
with relevant information and motivation through well-defined
strategies
• Behaviour change strategies tend to focus on the individual as a
locus of change
What influences our behaviour?
• Messenger
• Incentives
• Norms
• Defaults
• Salience
• Priming
• Affect
• Commitment
• Ego
MINDSPACE, Behavioural Economics, Cabinet Office and Institute for Government (2010)
Why change behaviour?
Health Benefits : Physiological, Psychological
Increased quality of life
Improved objective measures
Compliance with rehabilitation
Independence
Support friends and family
Increase Productivity
Improve longevity Increase self-esteem
Motivational interviewing
1. Open ended questions
2. Affirmations
3. Reflective listening
4. Summarise
5. Implement
Motivational interviewing
1. Open ended questions: ‘’ What makes you think changing might be hard?’’
2. Affirmations: ‘’ You managed your home exercises for a whole week, well
done. What enabled you to do that?’’
3. Reflections: ‘’So you said that exercising was easier when you had more
time and when the kids were at school. Could you plan you exercises into
your day during school time? Maybe include the kids during the school
holidays?’’
4. Summarise: ‘’You seem to really want to get the benefits of doing your
exercise programme but find it difficult to make time and fit it around the
children, is that fair to say?’’
5. Implement: ‘’Shall we see if putting aside time during the school day makes it
easier for your to complete a whole week of exercise?’’
Resistance behaviour
• Arguing
• Interrupting
• Ignoring
• Looking away
• Disagreeing
• Denying
• Change of Subject
• Discounting
• Excusing
• Sidetracking
• Blaming
BACK OFF FROM RESISTANCE AND DISENGAGE FROM NEGATIVE CONVERSATION:
THEY ARE NOT READY
Principles of behaviour change
Principles Acknowledge
Barriers
Ambivalence Confidence
Readiness Self-efficacy Decisional
Balance
Importance
Reflective
listening
Resistance Motivation Information Giving
Behaviour change techniques
• Benefit : Cost
• Problem Solve
• Contingency planning
• Cognitive re-structuring
• Feedback
• Stress Management
• Rewards
• Explore multiple solutions
• Social support
• Stimulus control
• Modelling
• Goal Setting
• Information giving
• Barrier Identification
• Time management
• The list goes onBBB.40 well
established techniques
Behaviour Change Checklist…
�What is the behaviour we want to change?
�Are they ready? What stage of change are they in?
�Can you link their actions, beliefs and health to one or more of the models?
�What are the benefits and barriers to change?
�Can you apply Motivational Interviewing to help you understand them and
them to understand themselves?
�Which Behaviour Change principles and techniques will you need to deploy?
�How will you know if you have successfully changed and maintained
behaviour?
�Are you prepared for the ups and downs?
When to apply a technique…
Early Stages of Change:
• Increase importance
• Evaluate the environment
• Evaluate the individual
• Social liberation
• Dramatic relief
Later Stages of Change:
• Counter conditioning
• Social Support
• Reinforce
• Self liberate
• Stimulus control