social entertainment, and encouraging reliance on family undermine the patient’s self‐efficacy and are not a usual part of the physician’s professional input (Bandura 2010; Ha et al. 2018).43 A Excessive focus on areas of weakness and negative introspection where patients turn against themselves can be a hindrance to behaviour change (Trifu et al. 2019; Beck 2020).
44 A Cognitive Behavioural Therapy (CBT) is best used in preparation, action, and maintenance stages. She is already prepared to use the gym but is worried her knee will limit her ability. CBT techniques can help her reframe this limiting thought by realizing she can start gently and do more as time goes on (Fredrickson and Joiner 2018; Soderlund 2018).
45 D Positive psychology to affirm what she is already doing with her meals is the best course of action at this stage (Fredrickson and Joiner 2018; Crespo et al. 2019).
46 A Addressing a patient’s ideas, concerns, and expectations (ICE) is a good practice. Summarizing shows good listening and understanding abilities (Miller 2018; Ng and Luk 2019).
47 D Goal setting is not appropriate in the precontemplation stage. General advice on benefits of leading a healthy lifestyle should be given (Miller and Rollnick 2012; Kelly and Shull 2019, p. 45).
48 A Action plans are based on the patient’s ability, readiness, and confidence (Kelly and Shull 2019, p. 45).
49 D Lifestyle prescriptions are based on scientific evidence (Kelly and Shull 2019, p. 45).
50 C It is a good practice to have a relapse prevention plan constructed for each behaviour change and the plan reviewed as the patient’s life circumstances change (Larimer et al. 1999; Kelly and Shull 2019, p. 50).
51 C CBT assists with problem solving and deeper understanding of underlying challenges (Trifu et al. 2019; Beck 2020).
52 A A relapse is a sustained period when an action plan is not followed (Larimer et al. 1999; Witkiewitz and Marlatt 2004).
53 A A lapse is a short period when an action plan was not followed (Larimer et al. 1999; Witkiewitz and Marlatt 2004).
54 B A relapse prevention plan should explore triggers for lapses such as when, under what circumstances, with whom, and who to turn to during a relapse (Kelly and Shull 2019, p. 50).
55 D Support with digital self‐help apps (Kelly and Shull 2019, p. 46).
56 B Encouraging a significant other to help remind you of your action plan when they notice a lapse is the most appropriate advice (Kelly and Shull 2019, p. 50).
57 B Ensure action plans are completed based on readiness for appropriate behaviour change. Action plans should be written and reviewed at each visit (Kelly and Shull 2019, p. 48).
58 A The confronting patient should be avoided and positive psychology applied instead (Wong 2011; Fredrickson and Joiner 2018).
59 A Successes, not failures, should be discussed first (Wong 2011; Fredrickson and Joiner 2018).
60 A Lifestyle prescriptions are based on scientific evidence and the patient’s medical condition (Lianov and Johnson 2010; Kelly and Shull 2019, p. 45).
61 B The interviewer should develop a discrepancy between where the patient is and what he wants (Yakovenko et al. 2015; Soderlund 2018; Tolchin et al. 2019).
62 A CBT assists with a deeper understanding of the underlying challenges. The other options describe motivational interviewing techniques (Trifu et al. 2019; Beck 2020).
References
1 Alexandrova, A. (2017). A Philosophy for the Science of Well‐being. Oxford University Press.
2 Bandura, A. (2010). Self‐efficacy. In: The Corsini Encyclopaedia of Psychology, 1–3. Wiley Online Library.
3 Beauchamp, M.R., Crawford, K.L., and Jackson, B. (2019). Social cognitive theory and physical activity: Mechanisms of behaviour change, critique, and legacy. Psychology of Sport and Exercise 42: 110–117.
4 Beck, J.S. (2020). Cognitive Behaviour Therapy: Basics and Beyond. Guilford Publications.
5 Boissy, A., Windover, A.K., Bokar, D. et al. (2016). Communication skills training for physicians improves patient satisfaction. Journal of General Internal Medicine 31 (7): 755–761.
6 Chen, M.F., Wang, R.H., and Hung, S.L. (2015). Predicting health‐promoting self‐care behaviours in people with pre‐diabetes by applying Bandura social learning theory. Applied Nursing Research 28 (4): 299–304.
7 Crespo, F.S., Jaén‐Moreno, M.J., Gutiérrez‐Rojas, L. et al. (2019). “Readiness to change” predicts efficacy of reduction among smokers with severe mental illness. European Addiction Research 25 (5): 256–262.
8 DiClemente, C.C., Prochaska, J.O., Fairhurst, S.K. et al. (1991). The process of smoking cessation: an analysis of precontemplation, contemplation, and preparation stages of change. Journal of Consulting and Clinical Psychology 59 (2): 295.
9 Dwamena, F., Holmes‐Rovner, M., Gaulden, C.M. et al. (2012). Interventions for providers to promote a patient‐centred approach in clinical consultations. Cochrane Database of Systematic Review 12: CD003267. https://doi.org/10.1002/14651858.CD003267.pub2. PMID: 23235595.
10 Frates, E.P. and Bonnet, J. (2016). Collaboration and negotiation: the key to therapeutic lifestyle change. American Journal of Lifestyle Medicine 10 (5): L302–L312.
11 Fredrickson, B.L. and Joiner, T. (2018). Reflections on positive emotions and upward spirals. Perspectives on Psychological Science 13 (2): 194–199.
12 Ha, F.J., Hare, D.L., Cameron, J.D., and Toukhsati, S.R. (2018). Heart failure and exercise: a narrative review of the role of self‐efficacy. Heart, Lung and Circulation 27 (1): 22–27.
13 Hashemzadeh, M., Rahimi, A., Zare‐Farashbandi, F. et al. (2019). Transtheoretical model of health behavioural change: a systematic review. Iranian Journal of Nursing and Midwifery Research 24 (2): 83.
14 Hicks, R. and McCracken, J. (2009). Mentoring vs. coaching‐do you know the difference? Physician Executive 35 (4): 71–73.
15 Hojat, M., Louis, D.Z., Markham, F.W. et al. (2011). Physicians' empathy and clinical outcomes for diabetic patients. Academic Medicine 86 (3): 359–364.
16 Jay, M., Gillespie, C., Schlair, S. et al. (2010). Physicians' use of the 5As in counseling obese patients: is the quality of counseling associated with patients' motivation and intention to lose weight? BMC Health Services Research 10 (1): 159.
17 Keles, S. and Idsoe, T. (2018). A meta‐analysis of group cognitive behavioural therapy (CBT) interventions for adolescents with depression. Journal of Adolescence 67: 129–139.
18 Kelly, J. and Shull, J. (2019). Foundations of Lifestyle Medicine: Lifestyle Medicine Board Review Manual, 2ee, 39–61. American College of Lifestyle Medicine.
19 LaMorte, W.W. (2018). Behavioural Change Models: The Health Belief Model. Boston University, School of Public Health.
20 Larimer, M.E., Palmer, R.S., and Marlatt, G.A. (1999). Relapse prevention: an overview of Marlatt’s cognitive‐behavioural model. Alcohol Research & Health 23 (2): 151.
