Cognitivist Perspectives n Behaviour is determined by thought n Behaviour is governed by goals n Few (if any) instincts n Emotions, feelings, motives trace back to thoughts n Human beings start out as “flawed” thinkers…but we can be salvaged!

Attribution Errors n Fundamental Error n Self-serving Bias n Halo Effect n Labeling (the self-fulfilling prophecy) n The “Catastrophizing” Effect n Thought-Feeling Distinction

Cognitivist Strategies n “Foot in the door” n “Door in the face” n Low-balling n Ingratiation n Guilt/Fear

Health Care Providers’ Roles: n Patient centered n Information exchange, not information download n Patients must “save themselves” n Negotiate, don’t dictate, behaviour n Understand and accept, don’t coerce and manipulate

Health Care Providers’ Roles n Patients’ resistance is nothing more than a source of information that must be dealt with n Assess the patient’s motivation and level of readiness rather than presume it

Model for Describing Change Prochaska et. al. n Precontemplation n Contemplation n Preparation n Action n Maintenance

Precontemplation n Individual is not seriously considering change and isn’t interested in discussing it Characteristics: - unawareness - unwillingness - too discouraged

Contemplation n Individual begins to seriously consider making a change (within six months) Characteristics: - open to information, education - perceived temptation risk is high - often motivated by self-esteem issues

Preparation n Individual begins experimenting, making small changes and a resolution to change Characteristics: - actually taking baby-steps - bargaining with self for rewards - highly reliant on external support

Action n Individual is actively involved in making change and experiments with techniques Characteristics: - bigger steps but most stressful stage - actively fighting against coercive forces - developing sense of autonomy and esteem

Maintenance n Individual must learn to successfully cope with temptations n Characteristics: - has been adherent for at least six months - able to identify self-defeating behaviours - higher level of self-worth

Health Care Providers’ Behaviours Precontemplation: n patient not ready for argument n open to knowing information is available, not necessarily open to information itself n “cheerleader” tactic not useful n understanding and acceptance most important

Health Care Providers’ Behaviours Contemplation: n Information and education best accepted n emotional support n help enlist significant others for support n planning important n environmental re-organization

Health Care Providers’ Behaviours Preparation: n need praise, encouragement, support n need external monitoring n need to ‘test-drive’ behavioural changes in a safe, non-threatening environment n need assistance with environmental control

Health Care Providers’ Behaviours Action: n continued emotional support necessary n need close monitoring and someone to “call out” relapses n constant counter-conditioning required n external stimulus control gradually replaced by internal stimulus control

Health Care Providers’ Behaviours Maintenance: n less encouragement, more criticism (but supportive!) n internal, not external, motivation

Key Features of Adherence Patients are: n interested n believe their health care providers n understand and accept interventions n have made an internal cost-benefit analysis n in control of decisions n recognize their own responsibility

Stages of Change n Recognize patient’s readiness for change n Provide continuous support, but modify based on stage n Education isn’t enough n Identify personal triggers to motivate behavioural change n Time, time, time

12-Step Method (AA) 1) Admit our lives are unmanageable 2) Believe in Power greater than self 3) Decide to turn over life to greater Power 4) Searching and fearless moral inventory of self 5) Admit to self and to one other exact nature of wrongs committed

12-Step Method (AA) 6 & 7) Able to want to have character defects removed 8) List all persons harmed by actions 9) Make amends to all who are harmed 10) Continue to take personal inventory 11) Prayer, Meditation 12) Carry the message to others - teach

The Culture Shock Model 1) Euphoria, expectation 2) Irritation 3) Rejection of host culture 4) Idealization of home culture 5) Projection onto host culture 6) Adjustment 7) Adaptation

Model for Stages of Death and Dying Kubler-Ross: n Denial n Anger n Bargaining n Depression n Acceptance

Maslow (Hierarchy of Needs)

Strengths/Limitations of Cognitivist Perspectives Strengths: - useful, practical, goal-oriented - clear, reasonable, concrete Limitations: - incomplete view of human nature - does not explain more complex issues - no theory for more complex cases