4
Chapter
Motivation and cognitive-behavioral intervention strategiesPractical measures Practical measures
Practical measures Practical measuresUseful strategies for motivational counseling were
originally developed to treat addiction (Prochaska &
DiClemente 1983, Rollnick et al 2008). These tactics
can be applied to change other forms of behavior.
As shown by everyday experience as well as empir-
ical research, it is difficult to develop the ability to
suppress strong habitual or situational impulses in
favor of new needs that have been rationally rec-
ognized. For instance, your intention to diet stalls
when you are faced with your favorite food. By the
same token, patients may accept rationally their
therapist’s advice for daily practice of certain exer-
cises but be unable to carry it out. One reason for
this is because we prefer small short-term gains over
greater long-term rewards (Ainsli 2005).
This impulsive, unwholesome behavior can be
explained by the existence of multiple competing
evaluation and control systems (McClure et al 200 4 ).
Because of their attitudes and subjective norms,
people do not always do what they intend to do. In
social psychology this is called the intention–behavior
gap (Bandura 1986, 2000; Sniehotta et al 200 5 ).
Therefore, we need special self-control strategies
in order to achieve long-term objectives in the face
of passing emotions or proven habitual reactions.
One self-control strategy recommends you to
arrange your environment so that it is less likely
that you will yield to temptation. As an example,
a woman who wishes to change her activity pattern
may arrange to meet a friend so that they can per-
form the new activity together. This gives her an
additional motivation because of her social commit-
ment. In the same way, if there is a good team spirit
within a exercising group, the individual participants
are more motivated to participate regularly.
Self-control techniques recommend learning to
influence your individual motivation level. This
means selectively focusing your attention on infor-
mation that will help you achieve your goal while
ignoring stimuli that distract you from that goal
(Kuhl 1985). For example, if an eagerly awaited
vacation starts with a dawn flight, a traveler will
motivate himself to get up in time by imagining the
expected pleasures of the trip. Rising early then
becomes the lesser evil compared with missing the
plane.
A factor that is important in achieving a desired
behavior is the difference between goal intentions(i.e., “I want to go on vacation”) and implementation
intentions (“Tomorrow at 5 a.m. I will take a taxi
to the airport”) (Gollwitzer 1999). Studies have
shown that participants who try to smoke less,
achieve healthier eating habits, or follow an exer-
cise program are more successful if they have set
out their specific intentions (Abraham & Sheeran
2000 ).
It has been repeatedly demonstrated that patients’
physical activity pattern can improve through short,
one-off cognitive-behavioral interventions. In a
review of studies published between 1966 and 2006,
Smitherman et al (2007) give the following general
recommendations:
• Give patients time to make their decisions.
• Present several options instead of a single
course of action.
• Describe how other patients have acted in a
similar situation.
• Tell patients that they can judge best what is
good for them.
• Provide information in a neutral, impersonal
way.
These ideas are similar to a technique called motiva-
tional interviewing, presented by Rollnick & Miller
(1995). According to the authors, this method is
determined by its “spirit” and its “interpersonal
style.” Here, different cognitive and personality
variables are taken into account, and there is a con-
scious attempt to avoid reactance (the strengthen-
ing of a contrary attitude).Practical measures
Let us now explore a number of attitudes, measures,
and techniques that can be used to minimize pos-
sible resistance against intended behavioral changes
while allowing for patients’ cognitive and personal
differences.Small steps
Changing your lifestyle is always difficult because
an old, tried and tested position has to be given up.
Depending on our own personal experience with