Behaviour walking as I could Change: I definitely feel more - PowerPoint PPT Presentation

I’ve become aware that maybe I’m not doing as much Behaviour walking as I could Change: I definitely feel more confident, Conversations I have more energy and I’m & Techniques more driven That Work! I’m more motivated and DR AMANDA PITKETHLY happier

Module content u What gets in the way for our clients when they try to change their behaviour? u What gets in the way for you as practitioners when working with clients? u Important theories of behaviour u How do we actually support our clients behaviour change?

What gets in the way for our clients? Influences on PA are complex and PA is a complex behaviour ...

Why don’t people exercise? Reasons for Not Exercising (Willis and Campbell, 1992) Lack of time. • Fatigue. • Lack of facilities. • Lack of knowledge about health • and fitness. Lack of reason/ability to adhere • Lack of perception of value in • exercise Demographics •

Foresight obesity systems map demonstrating at its centre ('core') the imbalance between appetite regulation and sedentary existence. , Media; , social; , psychological; , economic; , food; , activity; , infrastructure; , developmental; , biological; , medical;-c, positive influence;-&, negative influence. https://www.researchgate.net/fi gure/Foresight-obesity-systems- map-demonstrating-at-its- centre-core-the-imbalance- between_fig1_40441706

W hy are some people physically active and others not? ( The Lancet ; Bauman et al. 2012).

What gets in the way for you as practitioners when working with clients?

Benefits of PA ‘Physical activity u is a cornerstone in the primary prevention of at least 35 chronic conditions (Booth et al., 2012). Exercise or PA as u a first-line treatment of 26 chronic diseases (Pederson & Saltin, 2015), including:

What about exercise and the brain? The hippocampus Show pics … hippos (horse) kampus u (sea monster) is involved in the formation of new memories and is associated with important aspects of learning, and also emotions as it seems to be involved in severe mental illnesses. Exercise also upregulates growth factors in the brain like u brain derived neurotrophic factor (BDNF) which stimulate the growth of neurons (brain cells) and also repairs them … it’s like miracle growth for your brain which can be stimulated by lifestyle choices … MOVING…THINKING …EATING Exercise up also regulates various neurotransmitters like u serotonin and dopamine This understanding helps to explain why we see exercise u improving mood, self-esteem and performance of different types… including academic performance for example …It helps our children develop physically and also has been shown to improve cognitive control and academic achievement (Hillman et al 2009) …but the benefits are not just for the young …also its u contribution to improved skill learning and neuroplasticity which enhances cognitive and emotional function even in older adults (Erickson & Framer, 2009) And so there is a lot of evidence to show that if you u exercise regularly you are smarter, happier, less anxious, less depressed, get better sleep, and so on

More benefits for older adults …

It’s never too late …

http://www.independent.co.uk/news/uk/home-news/a- http://farm1.staticflickr.com/34/166360343_0c7338e9b8_z.j https://religionnews.com/2019/04/22/w centenarian-marathon-runner-thats-nothing- pg?zz=1 2372037.html?action=gallery orlds-oldest-marathoner-at-108-is-a- Fauja Singh, born 1911 model-of-more-than-simply-stamina/

Important theories of behaviour

Self-determination theory

Stages of Change 1: Not thinking about doing more physical activity 2: Starting to think about doing more physical activity 3: Being physically active occasionally, but not regularly 4: Being regularly physically active for less than 6 months 5: Being regularly physically active for longer than 6 months

The ten processes of change Consciousness-raising (Get the facts) — Self-liberation (Make a commitment) — u u increasing awareness via information, believing in one's ability to change and education, and personal feedback about the making commitments and re-commitments to healthy behaviour. act on that belief. Dramatic relief (Pay attention to feelings) — Helping relationships (Get support) — finding u u feeling fear, anxiety, or worry because of the people who are supportive of their change. unhealthy behaviour, or feeling inspiration Counter-conditioning (Use substitutes) — u and hope when they hear about how people substituting healthy ways of acting and are able to change to healthy behaviours. thinking for unhealthy ways. Self-re-evaluation (Create a new self-image) u Reinforcement management (Use rewards) — u — realizing that the healthy behaviour is an increasing the rewards that come from important part of who they are and want to positive behaviour and reducing those that be. come from negative behaviour. Environmental re-evaluation (Notice your u Stimulus control (Manage your environment) u effect on others) — realizing how their — using reminders and cues that encourage unhealthy behaviour affects others and how healthy behaviour as substitutes for those that they could have more positive effects by encourage the unhealthy behaviour. changing. Social liberation (Notice public support) — u realizing that society is more supportive of the healthy behaviour.

Basically .... Your task at different stages Stage Task Precontemplation Raise doubt, increase the perception of risks and problems with current patterns of behaviour. Contemplation Decisional Balance – evoke reasons for change, risk of not changing, developing self-efficacy. Preparation Planning – determining the best course of action. Consider and anticipate road blocks. Action Implement plan – support the newly formed behaviours so they can turn into habits – develop self-efficacy. Maintenance Identify and use strategies to prevent lapse and relapse.

Self-regulated learning Self-regulated learning is a systematic method that can help people take ownership of their own behaviour i.e. through planning, self- monitoring, effort, self-efficacy, self- evaluation and reflection.

Self-efficacy theory u Self-efficacy (confidence) sources u Self - efficacy refers to an individual's belief in his or her capacity to execute behaviors necessary to produce specific performance attainments (Bandura, 1977, 1986, 1997). u Self - efficacy reflects confidence in the ability to exert control over one's own motivation, behavior, and social environment. u When you know your clients are struggling with confidence, ask them: ‘think about something that you do/have done well, tell me about that …’ then use reflective listening which a) shows you respect and hear them, and b) help them clarify their thinking

Self-efficacy sources? (Bandura, 1977, 1986, 1997) Influences Possible Outcomes Performance Accomplishments Persistence Vicarious Learning Perceived Improved Self- behaviours efficacy Social Persuasion Approach Versus Avoidance Emotional Arousal

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How do we actually support our clients behaviour change?

‘ People are generally better persuaded by the reasons they themselves discover than by those that enter the minds of others’ Blaise Pascal (1623-1662) There are predictable outcomes when we try to change the behaviour of others by confrontation or offering unsolicited advice, i.e. the harder we push – the harder they push back .

The righting reflex u We are here because we care about helping others change for the better, that is a good thing. u With the best intentions, we want to share what we know and when we see someone going in the ‘wrong’ direction, who can benefit from what we know we want to tell them u Ironically, this selfless motive can be overly directive and often an ineffective or counterproductive way of helping people change u The righting reflex, is the desire to fix what seems wrong with people .... u What could be wrong with that? .... Ambivalence gets in the way ... More on that soon ...

The ‘ambivalence see- saw’: … ah, but I know I feel so much better ... If I could just get out for a 15 Hmm ... I’ve had such minute a busy day, I’m tired walk/jog/cycle ... and it’s raining outside, I really want to chill out on the couch … Sustain talk…………Ambivalence………..….Change Talk

But what do I actually do …?

People often say…. I’m not motivated to become more physically active ... The question isn’t ‘why aren’t you motivated?’ It is “What motivates you?”

Motivational Interviewing? A lot of research across a broad range of behaviour change contexts shows that this is very powerful technique to help empower people to make their own changes successfully. MI is a directive, client centred counselling style that enhances motivation for change by helping the client clarify and resolve ambivalence about the behaviour change. “… a collaborative conversation style for strengthening a person’s own motivation and commitment to change ” (Rollnick & Miller 2012)