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Chapter
Motivation and cognitive-behavioral intervention strategiesPractical measures Practical measures
Practical measures Practical measuresBy repeating such questions, the patient is guided
towards the conditions of practicing regularly in the
future. Patients can decide on their individual exer-
cise options because they now have a realistic idea
of what is involved. Their outcome expectancies
boost their belief in their own effectiveness, and
this belief helps them to complete a realistic plan.
Behavior change begins.
If patients want to keep up their changed behav-
ior, they must be able to see the success of their
exercise practice. Here again, asking questions
guides them towards noticing perceptible changes.
You should help them to accept even small changes
as positive steps. Physical activity must be joy if it is
to be sustained, so success should be assessed appro-
priately. It is the patients’ evaluation system that is
crucial, not the therapist’s.
Appropriate questions could be:
• Can you think of small things that will tell you
something has changed?
• What would you like to achieve? What would
show you that there is hope that you will reach
that aim?
• When would you be proud of yourself?
If you ask open questions (such as what, how, when,
where), patients have the freedom to weigh their
options and decide for themselves. Give information
in the form of different options rather than ordering
patients to follow a single course of action: avoid
closed questions that only allow a “yes” or “no”
response. When patients feel they can decide freely,
they are able to develop the self-motivation to
change their behavior.Immediate or delayed reward
If there is a choice between a proven immediate
reward and a not yet proven and therefore theoreti-
cal delayed reward, we usually decide in favor of the
short-term gain. As a result familiar behavior pat-
terns often persist and change does not take place.
In order to adopt a good new habit it is necessary to
minimize the influence of the “now” and to remind
ourselves of the “later.” In this way patients’ atten-
tion is directed towards future success.
During an exercise session we need to put in
an immediate extra effort while at the same timeabstaining from momentary relaxation or other
pleasurable activities. In the long term the profit is
clear: improved circulation, reduced risk of disease,
weight loss, increased energy and mobility, greater
self-esteem. Through questions the therapist again
points to this delayed reward. Additionally, ques-
tions about the choice of the exercise context (time,
length, place) help patients to focus on their prac-
tice instead of succumbing to their habits and to
fleeting emotions.
In a skillfully constructed exercise sequence, the
last exercises are chosen so that patients see some
success. Then, at the end of a sequence it is easy to
point out an immediate improvement (for instance
of mobility) or to demonstrate it during the coor-
dination phase. The patient’s attention is directed
by questions like: What has changed? How does ...
feel now?
At the end of a sequence, most patients experi-
ence relaxation as a form of reward. This is because
relaxation is perceived more clearly compared to
the time before and during an exercise. It is even
more important that this relaxation lasts for some
time after the sequence so that it can be experi-
enced positively in everyday life.The known and the unknown
The main problem in relearning movements is that a
well-known movement that has become unhealthy
must be replaced by a similar movement that meets
current demands. In this way a new movement pat-
tern is created that is not a health hazard or is more
beneficial. While learning this pattern there is the
risk that patients try only to modify something they
already know instead of giving up their old pattern
and developing the desired movement from scratch
(Hotz 1988, p. 46).
It is sensible to start with simple but usually
unknown movements, referred to in this book as
“basic exercises.” Here patients’ perception is guided
by questions about different types of sensory infor-
mation (verbal, visual, kinesthetic). With the help of
sensory perception, patients are able to repeat and
hone the exercise on their own and to form a cor-
rect pattern of movement. From these simple new
movements the more complex forms of the āsanas
are later developed. If those more complex forms