Behaviour change: How to help yourself and your clients do more

Beth Langley, Physiotherapist BSc(Hons), CSCS, MCSP,

MHCPC, MBACPAR

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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

BehaviourChange

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)

Benefits vs Barriers

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

Readiness

Decisional balance

How Important is changing?

How confident are you that you can change?

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

Self-efficacy…

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

Health belief model

Theory of planned behaviour…

Fear Avoidance Model…

Vicious Cycle of Symptoms…

How do we change behaviour?

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

OPPORTUNITYCAPABILITYMOTIVATION

Discussion

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Thanks for listening!Any Questions?