Practical measuresPractical measures Practical measuresPractical measures
changes, this triggers fears. The bigger these steps
towards change, the more likely it is that fear will be
aroused. Thus any change is hampered. As Maurer
(2004, p. 21) notes, “fear of change is rooted in the
brain’s psychology, and when fear takes hold it can
prevent creativity and change. The brain is designed
that any new challenge triggers some degree of fear.”
As a result, it is best to suggest that patients take
small, individually appropriate steps, to help them
reach their goal. These steps should be so small that
they avoid triggering the fight or flight response.
Of course, everyone’s reaction will be different.
The therapist and patient should work together to
define the patient’s goals, the steps needed to reach
these goals, and an appropriate exercise program.
In the process, the therapist asks about previous
changes that the patient has achieved. From the
starting point of these personal experiences, the
exercise program is planned.
Bear in mind that excessive demands lead to frus-
tration and fear while not enough challenge incites
boredom. Although the exercises must be con-
structed in small steps, they can be adapted to each
patient’s capacities by increasing the speed of an
exercise and progressing to more difficult ones. In
this way boredom is avoided. Ultimately, the speed
of progress is determined by patients, in line with
their ability and aspirations.
Every exercise should be a small challenge that
leads to a personal sense of achievement once it has
been performed for a set number of repetitions.
Avoid strain and failure. You can adapt each step
by varying the difficulty of the exercise, the num-
ber of repetitions, and the speed of execution. The
patient’s individual needs govern the program.Asking questions
You may find it helpful to guide patients towards
accessing their own resources by asking questions.
Even if patients cannot immediately answer, if you
repeat the question, it will have an ongoing effect,
and take root in the patient’s memory. At some
later point patients will find a solution because they
are mentally prepared. Through repeated question-
ing the patients’ attention is focused selectively on
essential information that will help them achieve
their exercise aims. Patients are able to find a solutionfor themselves, and their motivation to act is greater
than if you yourself give them the solution. In this
way their self-reliance is improved.
The first step is the decision to change some-
thing, and before they choose a therapist patients
will already have taken this decision. They really
want to change their state of health. In other words,
they already have some risk awareness, even if this
does not effectively predict future health behav-
ior change by itself (Weinstein 2003). In addition
patients need appropriate strategies. You can rein-
force patients’ decision to change by asking what
resources they used to solve other problems and
talking about role models in similar situations.
Even if when patients have decided to change,
they may not be prepared to carry out exercise pro-
grams on their own. First you should help patients
accept the need for exercise and then point the way
to self-help. Patients’ decisions depend on their out-
come expectancies – their beliefs about the positive
and negative results of different forms of behavior.
Every patient knows: “If I exercise I will gain mobil-
ity and be able to control my weight, but exercising
is demanding and exhausting.” Only if the positive
outcome expectancies (the “pros”) outweigh the
negative ones (the “cons”) is there the chance to
change behavior. Here you could recount how other
patients have acted in similar situations and direct
patients’ attention to the pros by asking appropriate
questions.
Once patients have made a conscious decision to
exercise, the time is right to inquire about their per-
sonal experiences. It is vital to bolster their confi-
dence in their own efficacy since they must believe
that they are able to practice regularly in spite of
everyday obstacles. For instance, their resolve could
be strengthened by the sentence: “In spite of my
heavy workload, I am certain that I can exercise
daily.”
The next step is to identify the setting and the
specific exercises. Ask questions about realistic
times and place for practice as well as how long and
how to measure success; now the path and exer-
cises become feasible. Talking like this, the patient
makes the decision to exercise, and states the inten-
tion to carry it out (Gollwitzer 1999). Through the
questioning process, patients visualize a context for
exercise and become familiar with it.