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MOTIVATING BEHAVIORAL CHANGE: CANCER PREVENTION AND INTERVENTION DR. MARICA TIPTON Photo credit: © Gage/Getty Images © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display MODELS OF MOTIVATION Optimal Arousal Model – Yerkes and Dodson Law (1908) Moderate levels of arousal lead to optimal performance. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display 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. Photo credit: ©Brand X Pictures/PunchStock RF; ©BananaStock/PunchStock RF; ©Jacobs Stock Photography/Jupiterimages RF © McGraw-Hill Education Permission required for reproduction or display 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 Photo credit: ©Brand X Pictures/PunchStock RF; ©BananaStock/PunchStock RF; ©Jacobs Stock Photography/Jupiterimages RF © McGraw-Hill Education Permission required for reproduction or display 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 Photo credit: ©Brand X Pictures/PunchStock RF; ©BananaStock/PunchStock RF; ©Jacobs Stock Photography/Jupiterimages RF © McGraw-Hill Education Permission required for reproduction or display BASIC PROCESSES OF LEARNING © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display CONDITIONING MODELS OF LEARNING © McGraw-Hill Education Permission required for reproduction or display CLASSICAL CONDITIONING A neutral stimulus becomes associated with a stimulus to which the learner has an automatic, inborn response. • Ivan Pavlov Photo credit: Time & Life Pictures/Getty Images © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display FORWARD CONDITIONING UCS Illness NS UCR New Taste CS Application Taste Aversion Nausea Learned Association CR Neutral stimulus is presented just before the UCS © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display REINFORCEMENT Reinforcement increases behavior. Positive Reinforcement Fun with Drinking Buddies Behavior Drinking Alcohol Negative Reinforcement Anxiety Reduced © McGraw-Hill Education Permission required for reproduction or display 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 Photo credits: Joe Brenneis/Life Magazine/Time & Life Pictures/Getty Images; ourtesy of Albert Bandura © McGraw-Hill Education Permission required for reproduction or display BRINGING IT ALL TOGETHER MAKING CONNECTIONS IN LEARNING: WHY DO PEOPLE SMOKE? © McGraw-Hill Education Permission required for reproduction or display 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 © McGraw-Hill Education Permission required for reproduction or display WHY DO PEOPLE SMOKE? © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display STAGES OF CHANGE 1. 2. 3. 4. 5. 6. Pre-contemplation Contemplation Preparation Action Maintenance Relapse © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display 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. © McGraw-Hill Education Permission required for reproduction or display Group Activity 1. 2. 3. 4. 5. 6. Pre-contemplation Contemplation Preparation Action Maintenance Relapse © McGraw-Hill Education Permission required for reproduction or display