1. Chapter 9 The Role of Counseling in Prevention Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill

2. After reading this chapter, you should be able to: 9.1 Explain counseling and how it evolves from communication skills, and list careers which rely on counseling skills. 9.2 Differentiate between genetic programming, environmental conditions, and lifestyle factors, and the role of counseling in each. 9.3 Synthesize genetic programming, environmental conditions, and lifestyle factors while examining the health issues of obesity and metabolic syndrome. Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill The Role of Counseling in Prevention 9-1

3. The Role of Counseling in Prevention (cont.) After reading this chapter, you should be able to: 9.4 Describe the impact of genetic, environmental, and lifestyle factors on mental health. 9.5 Demonstrate an understanding of the motivation strategy called AIM. 9.6 Understand the Trans-theoretical Model of Change and its technique called Motivational Interviewing. Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-2

4. Factors Influencing Physical Health Genetic Environmental Lifestyle Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-3

5. Lifestyle Factors Influencing Health Risk Sleep Use of leisure time Marital status Family size Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-4 Occupation Living environment Exercise Attitude toward health care

6. Lifestyle Factors Influencing Health Risk (cont.) Smoking Job stress Number of sexual partners Eating habits, use of caffeine Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-5 Drinking habits and drug use Religious beliefs and practices Hours on the road

7. BMI < 18.5 Underweight 18.5 to 25 Normal Weight 25 to 30 Overweight 30 to 40 Obese 40 to 50 Morbid Obesity >50 Super-Obese Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-6

8. Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved 9-7

9. Prevalence of Obesity in Adults Ages 20-74 Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved 9-8

10. Age-adjusted Death Rates for CHD, Stroke, Lung and Breast Cancer for White and Black Females (US: 2004). Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved 9-9

11. Associations of Obesity Heart disease especially coronary artery disease, heart failure, and stroke Cancer of the breast, colon, uterus, prostate, kidney, esophagus,and gallbladder Metabolic syndrome – the biggest preventable cause of death after smoking Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-10

12. Associations of Obesity (cont.) High blood pressure, high cholesterol, and diabetes Osteoarthritis especially of knees and back Pulmonary embolism and deep vein thrombosis Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-11

13. Associations of Obesity (cont.) Poor physical functioning e.g., reduced ADLs, immobility, reduced sexual function, falls, work absenteeism Increased healthcare costs Gallstones, reflux, fatty liver Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-12

14. Associations of Obesity (cont.) Kidney stones Gout Psychological issues including depression, social functioning, and quality of life Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-13

15. Metabolic Syndrome Definition High density lipoprotein over –40 mg% for men –50 mg% for women Triglycerides –Fasting over 150 mg% –Random over 400 mg% Fasting blood sugar over 100 mg% Hypertension over 135/85 Maximum girth over –35” for women –40” for men BMI over 30 Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-14

16. Steps to Control Obesity Diet rich in fruits, vegetables, and whole grains Limiting high fat, and high simple sugar foods Portion control (e.g., half portions at restaurants) Weighing yourself daily Keeping a food diary Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-15

17. Steps to Control Obesity (cont.) Realization that this is a life long process not a quick fix diet 30 minutes every day of cardiovascular exercise Joining a group (e.g., Weight Watchers) Avoiding fast food establishments, which often use too much fat, sugar, and salt Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-16

18. Counseling and Mental Health Genetic programming Environment and mental health Lifestyle factors in mental health - stress Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-17

19. Counseling Strategies for Prevention: AIM Awareness - Previous history - Family history - Personal, social, and psychiatric Hx Information Motivation Contingency management procedures Token economy Cognitive dissonance Antagonists to motivation Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-18

20. Trans-Theoretical Model (TTM) of Change Pre-contemplation: “I don’t have a problem,” “I drink, but I’m not an alcoholic.” The client feels it is a non-issue. The appropriate management is informational only as the patient is in denial; e.g., “You have cirrhosis; if you continue to drink you will halve your life expectancy; if you ever decide you need any help please call me or see me, I am available at any time.” Contemplation: “Maybe I’ll change someday.” The client thinks about it but is ambivalent. “I can do it by myself.” The appropriate management is to tell the client pros and cons as above; “How do you feel about giving up drinking? When will you see me again?” This stage may last months or years. Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-19

21. Trans-Theoretical Model (TTM) of Change (cont.) Recognition/Preparation: “I’ve got to do something.” The client is ready for change. The appropriate management is heavily supportive. “I absolutely agree; have you thought about attending an AA meeting?” You might arrange an appointment with an alcohol counselor, show client a list of local AA meetings, or call them at home or see them again. Goal setting, preparation, and motivation are key. Action: “I’m doing it!” The client has stopped drinking and is attending AA. AA is now their primary support. Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-20

22. Trans-Theoretical Model (TTM) of Change (cont.) Maintenance: “I did it!” The client has abstained for a year. The habit has changed, hopefully permanently. Relapse: “I fell off the wagon.” At any time a person on maintenance may relapse into contemplation or recognition/preparation. Ask: “How did you feel when you were sober? What do you want to do to stop again?” Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-21

23. Motivation Empathy: Be certain you understand what the client is feeling and reflect this back to them (see Chapter 2) Develop Discrepancies: “If this is how you want your life to be why do you spend your evenings drinking when you want to do other things?” Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-22

24. Motivation (cont.) Roll with Resistance: “I’m not going to AA.” To answer this the counselor will not even ask why not, but explore other avenues. The counselor will accept this response is human nature. Support Self-Efficacy: “O.K. I understand you don’t want to see the doctor now. If you want a referral later let me know.” Therapeutic Communication for Health Professionals, 3rd ed. ©2011 by The McGraw-Hill Companies, Inc. All Rights Reserved McGraw-Hill 9-23