Page 105 - Nutrition Counseling and Education Skills: A Guide for Professionals

Chapter 8. People can learn from their mistakes with the help of the counselor and continue trying.

Processes of Change

A second dimension of the model examines 10 processes of change or the activities people use to progress
through the SOC when there are shifts in behaviors, thoughts, and intentions. The 10 processes are cognitive
and behavioral activities that clients use at different stages to promote changes in behaviors.3,4 At each stage,
there are specific, appropriate tasks and goals to be accomplished in moving on to the next stage.3

The 10 processes should be integrated into the SOC so that the treatment intervention matches the client’s
current stage. These are the ways that people adopt or modify new health promoting behaviors, eliminate
risky behaviors, or change individual environments, either by themselves or with counseling.3,7

1. Consciousness raising increases the client’s awareness of the health risks and insight into the consequences of the problem health behavior. It is
the change process with the greatest focus and agreement.3 It is most effective in helping people process information outside of their
consciousness.
Because people notice the positive information about themselves and ignore the negative, an outside party can provide feedback and
education about the health behavior. Possible interventions are feedback from the counselor or others, confrontations, providing educational
reading materials, media, and motivational interviewing approaches discussed in Chapter 6. Precontemplaters and contemplaters in stages 1
and 2 become more aware of the negative consequences of their behaviors, such as overeating and weight gain.

2. Dramatic relief or catharsis increases emotional awareness and feelings about the unhealthy behavior that may be relieved if appropriate action
is taken. Techniques to use include role playing, personal testimonies, feedback, media, and motivational interviewing approaches.

3. Self-reevaluation includes both cognitive (thoughts) and affective (feelings) reassessments of the client’s self-image either with or without the
unhealthy eating, such as one’s image as an obese person or a thinner person. Healthy role models, clarifying personal core values about
health, and imagery may be useful. Changes are needed in how a person thinks and feels in the contemplation stage.3

4. Environmental reevaluation includes both cognitive (thoughts) and affective (feelings) assessment of how the personal behavior or health
problem affects the client’s social environment, especially family members. The client becomes aware that he or she may be a positive or
negative role model for others. Reassessment may come from empathy training, testimonials, documentaries, or family interventions.

5. Self-liberation is the belief that one can change and the commitment to act on that belief. Public testimonies, New Year’s resolutions, and
having multiple choices and alternatives may enhance willpower and belief in oneself.

6. Social liberation increases social alternatives and opportunities that support healthy behaviors for those who lack them. Empowerment and
advocacy may be helpful.7

7. Counterconditioning entails changing the behavior in response to activities, such as substituting healthier coping strategies for unhealthy ones.
Positive self-statements (“I can do it.”), relaxation, and assertion are other strategies in the action stage.

8. Stimulus control removes environmental cues for unhealthy eating behavior and adds healthy ones instead; this is discussed further in Chapter
7. Avoidance of unhealthy foods, removing these cues to eating, choosing healthier food choices, and self-help groups can support change in
eating practices in the action stage.

9. Reinforcement management includes positive reinforcement and rewards for healthy behaviors, as discussed in Chapter 7, and is helpful in the
action stage. Behaviors are controlled by their consequences. When reinforcement is contingent on a certain response, that behavior may
increase. Incentives, written contracts, reinforcement from others, and group recognition are strategies.4

10. Helping relationships provide caring, openness, acceptance, and support for healthy food choices and behavior change. Counselor phone calls
or emails, having a buddy, attending a support group, and rapport with others can give social support.3,4

CASE ANALYSIS 3

What processes of change are appropriate for Mr. Howard’s SOC?

Matching Processes to Stages of Change

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