Download Motivating Behavior Change

MOTIVATING BEHAVIORAL
CHANGE: CANCER PREVENTION
AND INTERVENTION
DR. MARICA TIPTON
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TRAINING OBJECTIVES
• Understand Motivation
• Recognize Individuals willingness and
readiness to change
• Describe what makes change sustainable
• Application of motivational principles to
cancer prevention and/or screening
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MOTIVATION
Urge to Move Toward One’s Goals to Accomplish Tasks
– Needs
Inherently biological state of deficiency
(cellular or bodily) that compel drives
– Drives
Perceived state of tension (urge) that occurs
when our bodies are deficient in some need
– Incentives
Any external object or event that motivates
behavior
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MODELS OF MOTIVATION
Optimal Arousal Model
– Yerkes and Dodson Law
(1908)
Moderate levels of
arousal lead to
optimal performance.
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MODELS OF MOTIVATION
Hierarchical Model
– Maslow’s hierarchy of needs
Needs range from most
basic physiological
necessities to highest
psychological needs for
growth and fulfillment.
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HUNGER: SURVIVAL OF THE INDIVIDUAL
Why Dieting Does not Work—and What Does
Weight loss usually temporary;
net weight gain on rebound
– Eat slowly; stop when you’re full.
– Log your eating and monitor your weight regularly.
– Low glycemic diet: 40% fat, 40% carb, 20% protein
– Drink lots of water.
– At least moderate physical activity, daily
– Get support from friends and family.
– Get good sleep.
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NEEDS TO BELONG AND EXCEL
Need to Belong: Affiliation
– Humans are inherently social creatures.
– Rejection can lead to problems.
• health problems
• depression, suicide
• anger, violence, and aggression
–Columbine, Virginia Tech
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NEEDS TO BELONG AND EXCEL
Need to Excel: Achievement
• Achievement motivation:
Desire to do things well and overcome
obstacles
– Atkinson (1964)
Tendency to achieve success is a
function of:
• motivation to succeed
• expectation of success
• incentive value of the success
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MOTIVATION MODELS
Three Models of Motivation
1. Extrinsic motivation
Motivation that comes from
outside a person and usually
involves rewards and praises
• Can have drawbacks
– If the reward is removed,
the motivation can disappear.
– If the reward stays the same
(does not increase)
motivation can drop.
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MOTIVATION MODELS
Three Models of Motivation
2. Intrinsic motivation
Motivation that comes from
within a person and includes
four different elements:
– challenge
– enjoyment
– mastery
– autonomy and selfdetermination
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MOTIVATION MODELS
Three Models of Motivation
3. Perceived organizational support
Individuals’ beliefs about how
much the organization
appreciates and supports their
contributions and well-being
• Related to individuals
happiness, less stress, fewer
missed workdays, less work
tardiness, and fewer “long”
lunch breaks
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BASIC PROCESSES OF LEARNING
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LEARNING
An enduring change in behavior that
occurs with experience
• There are many different forms of
learning.
• Learning and memory work together;
without one, the other cannot happen.
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CONDITIONING MODELS OF LEARNING
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CLASSICAL CONDITIONING
A neutral stimulus
becomes associated
with a stimulus to
which the learner has
an automatic, inborn
response.
• Ivan Pavlov
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HOW CLASSICAL CONDITIONING WORKS
• Unconditioned Response (UCR)
•
– Automatic, inborn reaction to a
stimulus
• Unconditioned Stimulus (UCS)
•
– Environmental input that produces the
unconditioned response
• Conditioned Stimulus (CS)
•
– Previously neutral input that an
organism learns to associate with the
UCS
• Conditioned Response (CR)
•
– Behavior that an organism learns to
perform when presented with the CS
alone
Salivation
Food
Ringing Bell
Salivation
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FORWARD CONDITIONING
UCS
Illness
NS
UCR
New Taste
CS
Application
Taste Aversion
Nausea
Learned Association
CR
Neutral stimulus is presented just
before the UCS
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CLASSICAL CONDITIONING
Two Fundamental Criteria for Conditioning to Occur:
1. Multiple pairings
of UCS and neutral stimulus (CS) are
necessary for an association to be learned.
2. Close in time:
The UCS and CS must be paired or presented
very close together in time in order for an
association to form.
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OPERANT CONDITIONING
Reinforcer
• Internal or external event
• Increases the frequency of a behavior
– Primary reinforcers
• not learned
• innate and satisfy biological needs
• food, water, or sex
– Secondary (or conditioned) reinforcers
• learned by association (classical conditioning)
• money, grades, or approval
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REINFORCEMENT
Reinforcement increases behavior.
Positive Reinforcement
Fun with Drinking Buddies
Behavior
Drinking Alcohol
Negative Reinforcement
Anxiety Reduced
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OBSERVATIONAL LEARNING
Albert Bandura (1986)
• Enactive Learning
– Learning by doing
• Observational Learning
– Learning by watching the
behavior of others
– Modeling
– imitation of behaviors
performed by others
– Bobo doll study (1960s)
– consequences to model
matter
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Images; ourtesy of Albert Bandura
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BRINGING IT ALL TOGETHER
MAKING CONNECTIONS IN LEARNING:
WHY DO PEOPLE SMOKE?
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WHY DO PEOPLE SMOKE?
• Social Learning Theory
– A form of peer acceptance
• Operant Conditioning
– Helps maintain smoking behavior
– Negative reinforcers
• Some use behavior modification to end the
habit
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WHY DO
PEOPLE
SMOKE?
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MOTIVATIONAL INTERVIEWING
MILLER & ROLLNICK (2002)
• A client-centered, directive method for enhancing
intrinsic motivation to change by exploring and resolving
ambivalence.
• Process to help Prepare People for Change
• Help People Make Choices
– Cognitive Domain – processing information, knowledge
and mental skills
– Affective Domain – Attitudes and feelings
– Psychomotor Domain – manipulative, manual or physical
skills which prompts action.
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STAGES OF CHANGE
1.
2.
3.
4.
5.
6.
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
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PRE-CONTEMPLATION
• The Client is not planning to change within the next six
months.
• Role of the Community Health Worker: To encourage the
client to begin thinking about their risks and possible
behavior change.
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CONTEMPLATION
• The individual is planning to change within the next six
months
• Role of the Community Health Worker: To support the client
to begin actively planning steps for changing their behavior.
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PREPARATION
• The individual is actively preparing to make changes within
the next month
• Role of the Community Health Worker: To support the client
to develop an individualized and realistic plan for behavior
change.
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ACTION
• The individual has made the change for more than one day
and less than six months.
• Role of the Community Health Worker: To encourage and
support the client to take actions and change behaviors in
accordance with their plan.
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MAINTENANCE
• The individual has maintained this change for more than six
months.
• Role of the Community Health Worker: To acknowledge and
congratulate the client for their success, to support them in
maintaining new behaviors, and to prevent relapse to
previous risk behaviors.
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RELAPSE
• The individual found it hard to maintain new behaviors or
faced challenges that made it hard to be consistent with
the new behavior. May have relapsed due to
relationships, trauma, loss, doubt, or any number of
factors.
• Role of the Community Health Worker: Not to judge the
client and to assist them in accepting that relapse is often
a normal part of the change process. Assist them in
identifying what influenced their relapse, what they have
learned, what they want to do now. Revisit the client’s
behavior change plan.
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Group Activity
Tina is a single 29 year old female with a
5 year old daughter. She has just loss
her mother to a 6 year colon cancer
battle. Cancer runs on the maternal and
paternal side of Tina’s family. Tina’s
maternal grandfather died of colon
cancer, her maternal grandmother died of
lung cancer, her paternal grandfather
died of prostate cancer. Tina should
have a colonoscopy done every 3-5 years
starting at the age of 30.
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Group Activity
1.
2.
3.
4.
5.
6.
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Relapse
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