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Introduction to behavioral medicine:
Lifestyle and health
The stages of change:
The Prochaska-DiClemente model
Eszter Tisljár-Szabó
Department of Behavioral Sciences
[email protected]
• Course organizer: Mónika Andrejkovics
[email protected]
• Homepage: mti.deoec.com
• Log-in name: NKstudent
• password: magatartas
Biomedical model (19th
century)
Bio-psycho-social model (20th
century) 
Health psychology, behavioral
medicine
What causes illness?
Illnesses come from outside
the body
Illness is caused by multitude factors:
biological, psychological, and social
factors
Who is responsible
for illness?
Individual is not responsible,
they are victims
Individual may be held responsible
for their health and illness
How should illness
be treated?
With vaccination, sugery,
chemotherapy etc., to change
the physical state of the body
The whole person should be treated
(bio-psycho-social)
Who is responsible
for treatment?
The medical profession
The patient is in part responsible
What is the
relationship
between the mind
and the body?
The funcion independently of
each other
There is an interaction between the
two
What is the role of
psychology in health
and illness?
Illness may have psychological
consequences but no
psychological causes
Illness can not only have
psychological consequences but
psychological causes as well.
Ogden, 2007, p 4
The role of behavior
75% of all death due to cancer are
related to behaviour
(Doll&Peto, 1981)
other factors
25%
tobacco
tobacco
30%
sexual
behaviour
alcohol
7%
3%
poor diet
35%
alcohol
poor diet
sexual behaviour
other factors
• McKeown: 50% of mortality from the ten leading causes of death is due to
behavior
 Health behavior seem to be important in predicting mortality and the
longevity of individuals
 research and models to understand and predict health-related behaviors.
 One of these is the stages of change model (Prochaska&DiClemente,
Nocross)
Nonadherence is present
• around 40% of patients don’t follow the treatment plans
• this number doubles when plans are complicated and/or
require lifestyle changes
What’s wrong?
– Repeated education is often not successful +
frustrated
– Promising an improved outcome is not enough
– Confrontational = critical
– Relapse = failure  giving up + avoid contact with
physician
A typical interview
http://www.youtube.com/watch?v=80XyNE89eCs
The ‚Stages of Change’
Approach
(Prochaska, DiClemente, Norcross)
Motivational interviewing
(Rollnick, Miller)
http://www.womentowomen.com/womenshealth/howtomakelifechanges.aspx
Contemplation
Preparation
Action
Maintenance
Not thinking about change
May be resigned
Feeling of no control
Denial: does not belive it applies to self
Belives consequences are not serious
I am happy being a smoker and intend to continue
smoking.
•Considering a change
•Weighing benefits and cost of behavior
•I have been coughing a lot recently, perhaps I should think
about stopping smoking.
• Experimenting with small changes
• I will stop going to the pub and will buy lower tar
cigarettes.
• Taking a definitive action to change
• I have stopped smoking.
• Maintaining new behavior over time
• I have stopped smoking for four month now.
RELAPSE
Precontemplation
•
•
•
•
•
•
Interventions based on the Stages of Change
model  motivational inteview
• First step: identifying the patients position in the change
process
• Focus of the visit: help the patient move along the stages
= Identify the stage of change and engage patient in a
process to move to the next step
• As a start:
– brief and simple advice = opening assessment of where the
patient is in the behavior change process
• developing and maintaining
positive relationship,
• personalizing risk factors,
• posing questions that provoke
thoughts about risk factors
• Reflect with empaty
• Gently point out discrepancies
between goals and statements
Considering benefits and disadvantages
Decisional balance sheet
Benefits of the present
behavior
Disadvantages of the present
behavior
Reduces anxiety
Feels good
Together with the others
Costs a lot
Takes time
Not anymore fancy
Stinky fingers
Disadvantages of change
Benefits of change
Temporary mood change
Irritability
Gaining weigth
Drop out of the gang
Saving money
Healthier life, less illnesses
Better physical fittness
My children like me better
Relapse is common!!!
Explain that even though a relapse, „it is best to avoid smokethey have learned something new filled environments”
about themselves and about the
process of changing behavior
Focus on the successful part of the „you did it for six days; what
plan
made that work?”
Support patients and re-engage their efforts in the change process!
The effective interview
http://www.youtube.com/watch?v=URiKA7CKtfc
Used literature
Ogden, J. (2007) Health Psychology: A Textbook. Maidenhead, Open
University Press.
Zimmermann et al. (2000) A Stages of Change Approach to Helping
Patients Change Behavior. American Family Physician, 61, 5.