1. How We Change: Behavior Change and Personal Training
CHAPTER 8

2. Understand the distinct, predictable stages of behavior change.
OBJECTIVES
Understand the distinct, predictable stages of behavior change.
Determine the stage your client is in for a particular behavior.
Match training approach to different stages of change.

3. INTRODUCTION
While you can’t force a client to show up for an appointment, you can take a step toward improving the current abysmal dropout rate during the first year of personal training by learning to assist clients in making positive changes, not just in their exercise habits, but in other areas of their life as well.
Understanding the process of change is the first step toward improving the noncompliance rate.

4. THE CONTEXT FOR LASTING CHANGE
Relationship
Accountability

5. RELATIONSHIP
Change occurs best in the context of a supportive and encouraging relationship.
The Personal Trainer–client relationship can provide this context when a client wishes to develop a healthier lifestyle.
A skilled Personal Trainer allows the process of change to unfold with ease by offering a profound level of encouragement and willingness to accept and meet the client “where they are.”

6. ACCOUNTABILITY
The Personal Trainer–client relationship provides a structure of accountability for both parties.
The Personal Trainer must be accountable to his or her client.
Conversely, when a client shares a commitment to achieve goals with a Personal Trainer they respect and who believes in them, they are likely to stay motivated and keep their commitments.

7. BEHAVIOR MODIFICATION THEORY
Behaviorism argues that human behavior is dictated by the environment, primarily the antecedents and consequences of the behavior.
In a meta-analysis of over 100 physical activity interventions, behavior modification strategies had greater effects on increasing exercise adherence than all other approaches.

8. CLASSICAL AND OPERANT CONDITIONING
Classical conditioning (Pavlov) states that a response (behavior) can be modified by changing the stimulus (antecedent).
Operant conditioning (Skinner) is the philosophy that behavior is shaped by consequences or rewards.

9. BEHAVIORAL CHANGE AS A STAGED PROCESS
Transtheoretical model to describe behavior change
Precontemplation (I won’t, I can’t)
Contemplation (I might)
Preparation (I will)
Action (I am)
Maintenance (I still am)

10. PRECONTEMPLATION
Individuals who are “precontemplators” are in one of two categories: “I won’t” or “I can’t.”
Generally speaking, the “I won’ts” are disinterested in change, whereas the “I can’ts” are dispirited and cannot imagine being able to make a change.
The “I won’t” precontemplators have no interest in changing a behavior because they do not believe they have a problem.
The “I can’t” precontemplators do not believe they are capable of changing.

11. CONTEMPLATION
During this stage, clients are “thinking about” changing an unhealthy behavior and are considering taking action within the next 6 months.
Individuals are well aware that a particular behavioral change would benefit them, and they are becoming more dissatisfied with the results of not changing.
Yet, they need to resolve their ambivalence before their actions will be successful and sustainable.

12. PREPARATION
The “I will” stage is defined as the stage where the client has consciously decided to take action within the next month, and is actively planning to do so.
The motivators are defined and strong, and feelings of ambivalence have largely been handled.
A characteristic behavior at this stage is “experimenting” with the change of concern.

13. ACTION (I am)
A client is committed to a new behavior, and he or she is doing it consistently, building up to the target level.
This is the busiest stage because people are concentrating and working very hard practicing a new behavior, refining it, and incorporating it consistently into their lives.
This stage begins when a client is consistently acting on changing a behavior and ends when they have been doing it consistently for 6 months.

14. MAINTENANCE
The “maintenance” stage is achieved when someone has adopted a new behavior and done it consistently for 6 months.
It is referred to as “I still am!” This is when the new behavior is a firmly established habit and the client is absolutely confident in their ability to maintain the behavior.

15. Strategies For Different Stages
Precontemplation
Not yet discovered “pros” to outweigh discomfort and difficulty of change
Need information
Need to understand all the benefits of change
Client must be receptive to info
Need to know right time to provide info
Need to be non-judgmental
Info alone will not change behavior

16. Strategies For Different Stages
Contemplative
May last a while
Highlight is ambivalance
Must listen and be empathetic
Must understand the clients need to work through issues on own timetable

17. Strategies For Different Stages
Preparation
Recognizable by client’s commitment to change
Time when all cognitive and behavior processes could be appropriate
“Written Contract”
Set rewards for goals met
May be good to use processes of substitution and use of cues

18. Strategies For Different Stages
Action
Typically 6 months long
Hard work for client
Don’t think they are coasting along easily
Still need support and encouragement
Still use cues, substitution and rewards
Also need social support
Remind them how far they have come
Use assessments for proof

19. Strategies For Different Stages
Maintenance
Always at risk of slip back to unhealthy behaviors
Recognize beginning of a lapse
When handled chances are good they won’t go too far
Avoid boredom
Keep workouts fresh and fun
New equipment
Change environment
New classes – cross training

21. COGNITIVE CHANGE PROCESSES
Consciousness Raising: Includes information gathering, either by learning new facts about a subject, or discovering previously unknown feelings, values, etc. Health education is an important consciousness raising technique for Personal Trainers to utilize. For example, when doing fitness assessments, a client can discover exactly what their fitness level is in relation to healthy norms.

22. Self-image (Self Re-evaluation): A positive self-image should be aligned with the new behavior. A client is excited when considering how he or she will look, feel, and act, and how life will be better as the changed self, so the client is drawn to the target behavior.

23. Dramatic release: Dramatic release is similar to consciousness-raising, but works at a deeper, emotional level. For example, when a client’s close friend has a sudden heart attack, this may motivate the client to start running again.

24. Social norms: Social norms reflect the relationships between individuals and provide support and reinforce new behavior. Groups such as Weight Watchers are very helpful in early stages of change. In these settings, group expectations reinforce the new healthy behavior. There is a palpable collective empathy for the “changer,” and at the same time, numerous role models are present to provide tips and encouragement.

25. Role Modeling: The process of role modeling involves considering how our behaviors affect those that we love. For example, parents who begin to question what they are teaching their children about health and wellness may take up exercise or quit smoking. This process is helpful in the early stages of change when finding the pros of a behavior change is occurring.

26. BEHAVIORAL CHANGE PROCESSES
Commitment: Making a formal commitment connotes a full acceptance of responsibility for changing. An example of this change strategy is called a contingency contract, an agreement between the Personal Trainer and client that details goals, time frames, measures of success, and rewards. The more specific a commitment, the more effective it is.

27. Environmental Control: In environmental control, the client identifies and eliminates the cues that produce the problem behavior from the environment. They then develop new cues that signal the healthy behavior. For example, they can be reminded to exercise by strategically placed notes to themselves, by getting s from the Personal Trainer, or by putting exercise clothes in their car to encourage going to the gym after work.

28. Substitutions (counter-conditioning): Countering, or substituting healthy behaviors in the place of unhealthy ones, can be called the “instead of” process. When exercising is the target behavior, the Personal Trainer can encourage stairs “instead of” elevators, or biking to work “instead of” driving, or substituting a short walk for zoning out in front of the television.

29. Social support (helping relationships): This process is important in all stages of change. The Personal Trainer can provide a very important element of social support for clients as they traverse the stages of change. Other sources of support can come from family close friends and should be encouraged. For example, suggest a client walk with a friend, because it is much more likely that they will keep their promise to walk if they are meeting someone.

30. Rewards (reinforcement): In this process, the target behavior is rewarded to help increase its frequency. The reinforcement could come from the Personal Trainer, by rewarding a client for completed exercise sessions and/or for accomplishing specific goals. The client can come up with their own reward system, and make it part of their formal commitment.