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INTRODUCTION

Many of the common contemporary health problems such as diabetes, heart disease, and cancer, are related to patients’ lifestyles and specific behaviors. To treat patient’s health issues, clinicians must encourage reduction or elimination of destructive behaviors (e.g., smoking and alcohol dependence), promotion of healthier behaviors (e.g., weight control, regular exercise, stress management, safer sex), and adherence to medical regimens intended to treat acute or chronic illness (e.g., taking medications, dietary restrictions, checking blood glucose). Clinicians are hardly alone in their influence on patients’ behavior. Patients’ social networks, their personal histories, genetics and life circumstances, as well as the media and broader societal forces also shape behavior. Not everyone’s vision of the good life involves careful attention to healthy behavior. Many patients prefer a medication or procedure over behavior change to ameliorate a problem. All this can leave clinicians unclear about how much they are supposed to be pressing for behavior change and what are the limits of their influence in the brief context of the patient encounter.

Fortunately, work done in the field of behavioral medicine in the past 30 years has great practical application for clinicians and patients alike. In this chapter, we will incorporate the contributions from the most researched approaches to behavior change: the Stages of Change Model, Motivational Interviewing, Self-Efficacy, Social Influence, Willpower, Goal Setting, Mindfulness, Self-Monitoring, and Contingency Management. The objective is to use this research as the basis for a practical approach to influencing patients that respects both the complexity of human behavior and the resources and limitations of the medical encounter.

BEHAVIOR CHANGE MODELS

The Stages of Change Model introduced the idea that people move through a succession of five relatively distinguishable stages in making changes in behavior (in addition to Relapse if they revert to old behaviors after an initial period of success). Quickly determining the patient’s stage of change with regard to specific behaviors allows the clinician to focus where further discussion or assistance would be most valuable. Many of the other behavior change models and strategies work well when integrated into this framework. The stages are outlined in Table 19-1.

Table 19-1.Stages of change and patient characteristics.

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