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ACE-CPT · Chapter 3

Basics of Behavior Change

Psychology, Motivation & Adherence — Health Belief Model, SDT, Stages of Change, Self-Efficacy, Operant Conditioning, and Real-World Case Studies.

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35Case Studies
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HBM · SDT · TTM · Self-Efficacy · Operant Conditioning · Adherence

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Five Stages of Change (TTM)

StageDefinitionTrainer Strategy
PrecontemplationNot active, not planning to start in next 6 monthsRaise consciousness; discuss risks; don't push — build rapport
ContemplationInactive but thinking about change in next 6 monthsExplore pros/cons; serve as cue to action; keep plan simple
PreparationTaking small steps; may exercise but inconsistentlyCollaboratively design a starter program; set SMART goals
ActionConsistently active for fewer than 6 monthsReinforce habits; address lapses proactively; build social support
MaintenanceActive 6+ months; habit establishedPrevent relapse; diversify program; strengthen community ties

Ten Processes of Change

ProcessTypeDescription
Consciousness RaisingCognitiveFinding and learning new facts about healthy behavior change
Dramatic ReliefCognitiveExperiencing negative emotions about unhealthy behavior, then relief from deciding to change
Self-ReevaluationCognitiveRecognizing behavior change as part of one's identity
Environmental ReevaluationCognitiveRealizing how behavior affects the social environment
Self-LiberationCognitiveDeciding to change and believing in the ability to do so
Helping RelationshipsBehavioralSeeking and using social support for behavior change
Counter-ConditioningBehavioralSubstituting healthy behaviors for unhealthy ones
Reinforcement ManagementBehavioralIncreasing rewards for healthy behavior; reducing rewards for unhealthy
Stimulus ControlBehavioralRemoving cues for unhealthy behavior; adding cues for healthy behavior
Social LiberationBehavioralTaking advantage of social environments that reinforce new behavior norms

Operant Conditioning Outcomes

TypeWhat HappensEffect
Positive ReinforcementPositive stimulus added↑ Behavior
Negative ReinforcementNegative stimulus removed↑ Behavior
ExtinctionPositive stimulus removed↓ Behavior
PunishmentAversive stimulus added↓ Behavior

Health Belief Model Variables

Perceived SusceptibilityHow likely does the person think they are to develop a health problem?
Perceived SeriousnessHow severe do they believe the consequences of illness would be?
Perceived BenefitsDoes the person believe action will reduce the threat? Benefits must outweigh barriers.
Perceived BarriersObstacles (time, cost, embarrassment) the person believes stand in the way.
Cues to ActionAny trigger that prompts the decision to change — labs, advice, family illness.

6 Sources of Self-Efficacy

1. Past Performance ExperienceMost powerful source. Previous success directly raises self-efficacy.
2. Vicarious ExperienceObserving someone similar succeed ("If they can, so can I").
3. Verbal PersuasionEncouragement and positive feedback from a credible source.
4. Physiological State AppraisalsHow clients interpret bodily sensations — teach normal vs. warning signs.
5. Emotional State AppraisalsPositive emotions raise SE; negative emotions lower it.
6. Imaginal ExperiencesMental image of what exercise will feel like — cultivate positively.

6 Cognitive Distortions

All-or-Nothing Thinking"I missed one session — my whole week is ruined." No middle ground.
Overgeneralizing"I always quit everything." One setback = permanent pattern of failure.
Catastrophizing / MagnificationBlowing things out of proportion. "Even if I lose weight, I'll gain it all back."
Jumping to ConclusionsMind reading or fortune telling without evidence.
Labeling"I'm just not a fitness person." Rigid negative labels on self.
Personalization & BlameTaking full blame for things outside control, or blaming others for own choices.

SDT — Three Core Needs

CompetenceBelief in ability to perform tasks. Built by achievable challenges and positive feedback.
AutonomyFeeling behavior is self-chosen. Involve clients in goal-setting and program decisions.
RelatednessBelonging and connectedness. Introduce clients; encourage accountability partnerships.
Task vs Ego ClimateTask climate (effort-focused) → commitment. Ego climate (rivalry-focused) → dropout.

Adherence Determinants

Personal — Strongest PredictorPA history. Internal locus of control. Low negative affect. Enjoyment of activity.
Environmental — SocialSpousal support = most reliable social predictor of exercise adherence.
Environmental — AccessProximity to facility is a consistent predictor. Time = most cited barrier.
PA Factors — DesignEnjoyment is paramount. Avoid excessive early intensity (injury = dropout). Customize everything.