Rapid Reference to Lifestyle and Behavior Change

CHAPTER 1: It's a serious problem* Brief epidemiology and the disease states caused or exacerbated by patient inaction/non compliance leading to a likelihood of diminishing quality of life and life expectancy (with evidence); drug and other therapies available to help behavior change.CHAPTER 2: Why bother?*Behaviour change does happen (example of COPD & smoking where the woman stopped years ago after advice). Also, the man who attributes his efforts to quit drinking to when his general practitioner raised the subject of his drinking in a non-judgmental way and merely showed respectful concern. This man quit drinking 10 years later. *Examples of behaviour change special patient groups and the comorbidity they need to counter (e.g. hypertensive, obese diabetic), the hypertensive antisocial drinker, the COPD afflicted smoker, the promiscuous drug abuser etc: alcohol, drugs, diet/obesity, smoking, limited exercise, stress, promiscuity diabetes and hypertension and COPD.*Generic skills can be used in all kinds of consultations - examples *It can make a difference - general comments on evidence for effectiveness of interventionCHAPTER 3: Making advice work* Some guidelines on making the best of brief advice-giving.CHAPTER 4: The skilful consultation* Analogy of breaking bad news and examples* Example of script (diabetes script analysis exercise): consider shifts from skilful consultation to breakdown* Concordant and discordant consultingCHAPTER 5: Raising the subject & assessing motivation* Includes assessment of importance and confidence at the heart of this chapter, with some examples.* Raising the subject: Why take such care in raising the subject? Four ways to raise the subject; ways to structure the session;* Assessing motivation: Assessing importance & confidence; Assessing desire or readiness to change; Tip for assessing motivation to change; * Potholes: getting in and out of them: Raising the subject too abruptly; The question-answer-trap; Investigating bad behaviour; quantity is all that matters; * Chapter summary and referencesCHAPTER 6: Exploring the importance of change* Why? (nobody attempts change unless they will avoid bad or gain good )* How? (menu of ways to explore importance)* Potholes to avoid (lecturing with biomedical information to convince patient that it is more important than he/she thinks)* Troubleshooting * Dialogue examples CHAPTER 7: Enhancing confidence to change* Why? (healthy people don't set themselves up to fail, so must first feel capable.)* How? (menu of ways to explore and enhance confidence, offer information about successful cases, teach that multiple relapses predicts success, return to scaling questions, e.g "what would it take for you to...")* Potholes to avoid (seeming glib or condescending about the difficulty of change, cheer-leading)* Troubleshooting (hopelessness, "I can't change because the entire world has turned against me...")* Dialogue examples CHAPTER 8: Relapse & recovering commitment to change* Why? (almost everybody relapses, relapse is part of change)* How? (info about relapse being normal, get agreement to try again with slightly different plan.)CHAPTER 9: Singing from the same sheet: the value of teamwork* The importance of nurses and doctors taking the same approach to behaviour change, and how to achieve this great idea!CHAPTER 10: The world of theory & evidence* A brief summary of models of behaviour change and a brief summary of evidence * Menu of several session diagrams * Quick literature reviewCHAPTER 11 * Agreement, patient totally hopeless, uncomfortable with being non-directive, given the weight of these issues, patient blames everything else, patient has psych symptoms you don't feel you can handle?APPENDICES: * Some "fine print" elaborating the major points found in the chapters. Some dialogue examples for specific behaviors.Useful reading* Websites and other reading material