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ALL IN THE TIMING:
CREATIVE STRATEGIES FOR
ENGAGING AND WORKING
WITH THE
PRECONTEMPLATIVE PERSON

   Association for Medical Education and Research
       in Substance Abuse Annual Conference
                                                    Lifestage, Inc.
                                                     www,lifestage.org
“TIMING HAS A LOT TO DO WITH THE
           OUTCOME OF A RAIN DANCE”
                                    OLD WEST WISDOM




The “action” paradigm of behavior change is a model that
enrolled clients in relatively brief programs designed to
conquer smoking, weight, alcohol, spending or other
problematic behavior and expected them to take action within
weeks. Failure to maintain the action is attributed to the
clients‟ lack of will power or motivation.

90% of behavior change programs are designed for people
who are ready to take action and change their behavior.
20% of people who present for help are ready to take action or
change their behavior.
Prochaska, Norcross & Clemente, Changing For Good, HarperCollins Books, 2006.
“REALIT Y IS THAT WHICH,
       WHEN YOU STOP BELIEVING IN IT,
        DOESN‟T GO AWAY.” P H I L L I P K . D I C K


 “The popular concept among behavioral therapists is that no
  time is better than the present to take action against an
  addictive habit. In theory, it sounds right. But the cold light of
  reality presents a dif ferent picture. I am convinced that there
  is a tremendous advantage in a well -prepared, pre-emptive
  attack against the smoking habit.” D r. B a l a s a P r a s a d S to p S m o k i n g Fo r
  Good
“THERE IS A TIDE IN THE AFFAIRS OF MEN
                  WHICH, TAKEN AT THE FLOOD,
                        LEADS ON TO FORTUNE;
        OMITTED, ALL THE VOYAGE OF THEIR LIFE
      IS BOUND IN SHALLOWS AND IN MISERIES.
      ON SUCH A FULL SEA ARE WE NOW AFLOAT,
      AND WE MUST TAKE THE CURRENT WHEN IT
                                      SERVES,
                      OR LOSE OUR VENTURES.”
W M S H A K E S P E A RE , J U L I U S C E S E AR , AC T 4 , S C E N E 3 , 21 8 - 2 24   .
CHANGE IS A PROCESS THAT PROCEEDS
        IN STAGES OR STEPS

But change is not a lateral process.
All in the timing: How To Understand & Connect With the Precontemplative Person
ADDICTION AND
CHANGE:
Understanding
and Intervening
in the Process

Carlo
C.DiClemente,
Ph.D. ABPP
UMBC
Psychology
www.umbc.edu/
psych/habits
THE PREPARED MIND

 “At certain moments in history, there are individuals whose
  minds are prepared to recognize the importance of things that
  unprepared minds ignore or throw away.” P r o c h a s k a , N o r c r o s s & C l e m e n t e ,
  Changing For Good, HarperCollins Books, 2006: 17




 With pre-contemplative people, information about addictive
  behavior – or any other health-threatening behavior pattern –
  has to transcend the psychological barriers that allow the
  behavior to continue despite its negative consequences.
INTERVENTIONS THAT DO NOT
MATCH THE PERSON'S
READINESS ARE LIKELY TO:

DAMAGE RAPPORT

BLOCK RECEPTIVITY TO THE
MESSAGE

IMPEDE CHANGE
“ M O T I VAT I O N A L I N T E R V I E W I N G A N D T H E S TA G E S O F C H A N G E ”
S U B S TA N C E A B U S E A N D M E N TA L H E A LT H S E R V I C E S A D M I N I S T R AT I O N ,
W W W. S A M H S A . G O V / C O - O C C U R R I N G / T O P I C S / T R A I N I N G / C H A N G E . A S P X
THE PRECONTEMPLATIVE PERSON

 The precontemplative
  mind set is operating
  from a protective
  network of defenses.
  These defenses
  inhibit cognitive
  awareness of
  consequences to
  behavior and block
  the capacity to absorb
  information about it.
tread
                      lightly
                      or
 SELF-PROTECTION IS   they
HEIGHTENED FOR THE    will
 PRE-CONTEMPLATIVE    run
                      the
           PERSON.    other
                      way
TO AN ACTIVE SMOKER, E.G., SMOKING IS
        A FORM OF SELF-CARE


All effective             “There must be
strategies must really    pragmatic acceptance
start where people        that people are where
are, with their unique,   they are, as well as
complex, subjective       compassion for any
experience.               struggles and
                          suffering linked to the
                          problem behavior.”
                          The Smoke -Free Smoke Brea k: Stop Smoking
                          Now With Mindfulness & Acceptance , Pavel
                          Somov, PhD & Marla Somova , PhD
CHANGE CAN BE PERCEIVED AS A
THREAT AND TRIGGER THE “STRESS
         RESPONSE” --
FEAR-BASED INTERVENTIONS REINFORCE THE
  SUBCONSCIOUS PERCEPTION OF THREAT
PSYCHOLOGICAL BARRIERS TO
COMMUNICATION IN PRE-CONTEMPLATION


  All information about the addictive behavior and its
   consequences is communicated over some kind of barrier, like
   speaking to someone through a closed door.
 These defenses include:
  Denial: “I don‟t see anything wrong here.”
  Rationalization: “I know that what I‟m doing might be bad for
   me but I couldn‟t handle my stress without it.”
  Projection: “You‟re not so perfect. You are judgmental. You have
   no right to criticize me.”
  Blame: “Ever y time I try to quit my spouse sabotages me.”
  Internalization: I feel guilty and shameful about doing this, so
   that‟s something….”
THE
NEUROSCIENCE
 OF BONDING
REWIRING ONE‟S BRAIN
  IS UNCOMFORTABLE,
ANXIETY-INDUCING AND
  REQUIRES TIME AND
         PERSISTENCE,
SUCCESSFUL SUSTAINED BEHAVIOR
       CHANGE: ALL IN THE TIMING

The will to change and the skills/tools to navigate change must
occur at the same time.


Desire: “I want ” – necessary for change to occur; but
 without the tools and skills needed to achieve some degree of
 success leads to repeated, frustrating attempts that do not
 succeed and produce more shame, anxiety and
 demoralization.
Competence: “I can”-        tools, skills and knowledge are
 key to making a behavior change; but desire ignites the
 energy to use them.
DESIRE AND COMPETENCE

When a person has
 the desire to change
 and at the same
 time the tools, skills
 and knowledge to
 get through the
 tensions of change
 action is possible.
PROCESSES OF CHANGE


Experiential Processes
              Concern the person‟s thought processes
              Generally seen in the early Stages of Change

Behavioral Processes
              Action oriented
              Usually seen in the later Stages of Change

A D D I CT I ON A N D C H A N G E : U n d e r s t a n d i n g a n d I n te r ve n i n g i n t h e P r o c e s s
C a r l o C . D i C le m e n te , P h . D . A B P P U M B C P s yc h o lo g y
w w w. umb c . e d u/ p s yc h / h a b i t s
PRECONTEMPLATION AND THE
        PROCESSES OF CHANGE

 Consciousness-raising     Counter-conditioning -
 – reframe problems to       provide alternatives for
 integrate new             the behavior that provide
 information with the      something that
 person‟s stated           approaches it‟s perceived
 perspective, e.g. “when   benefits, e.g. medication,
 I take a smoke break I    relaxation, emotional
 am breathing deeply       intelligence skills,
 and taking care of        mindfulness,
 myself – what happens
 if I take the break and
 breathe without the          Cancer Prevention Research Center
                               Transtheoretical Model,
 smoke?”                       http://www.uri.edu/research/cprc/TTM/Processe
                               sOfChange.htm
MORE PROCESSES OF CHANGE

Environmental re-           Helping
 evaluation – “My kids        relationships –
  are upset that I smoke     Encourage social
  and are always on me
  to quit”                    and interpersonal
 “It is very inconvenient
                              relationships with
  to take a smoke break       people who do not
  now that we have to go      smoke – educate
  so far from the             about the role of
  building”                   social networks in
                              health behavior
                              change;
SOCIAL NETWORKS INFLUENCE
            BEHAVIOR CHANGE


Every facet of health examined so far
appears to “spread” from person to person.

The strength of a network effect
depends on the strength of a friendship.

“Friendship as a health factor” Science, Volume 323 23 January
2009, www.sciencemag.org
EMOTIONAL INTELLIGENCE IS THE
               FOUNDATION FOR EFFECTIVE
                   COMMUNICATION

 Self- Awareness and Self-Control – an accurate understanding of
  how one‟s behavior and words affect others
 Emotional and inner awareness – an accurate understanding of
  how one‟s emotions and thoughts affect behaviors
 Accurate self-assessment of skills and abilities – an honest
  assessment of strengths and weaknesses
 Conscious planning of communication – the ability to plan the
  tone of a conversation to achieve the best results
 Respectful listening – listen deeply and seek to understand what
  others are saying
 Creativity and sense of play – the ability to take one self lightly
  and engage with serious situations in a creative way

D a n G o l e m a n , E m o t i o n a l I n te l l i g e n c e , B a n t a m D e l l , 2 0 0 6
EMOTIONAL INTELLIGENCE:         AN EXPRESSION
  OF THE RICH INTERPLAY OF CONSCIOUS FEELINGS,
   THOUGHT- ACTION REPERTOIRES, AND ATTITUDES

“Emotional Intelligence
(EI): Our ability to
engage our emotionality
in effective ways in
order to facilitate
positive outcomes in our
relationships.”
D r. M i c h a el E . Ro c k . o n e o f a few
s pe c i alist s i n t h e wo rl d c urre n t l y
l i c ensed to c e r t i fy pro fe s s ion als i n t h e
un de r s t a nding o f, t h e s t a t i st ic al
re s e arc h ba c k g ro un d i n , a n d t h e
i n te rpret a t ion a n d us e o f t h e B a rOn
E Q- i
EMBRACE THE “WOBBLE”

The first rule of intervention in a behavior change process is the
same as the first rule in improvisation:
 Accept what is;
 Accept people as they are;
 Listen;
 Take in what is being expressed and build on it;
 Notice the facts – both spoken and unspoken;

“Improvising has much in common with riding a bicycle, surfing or
skiing. Things are not stable, linear, or predictable. The situation is
always in flux. Our footing keeps changing. This approach may be
uncomfortable or unsettling at first, and it is natural to seek out
security. ..We can stop trying to flee from the wobble.”
Patricia Ryan Madson, Improv Wisdom, Crown Publishing Books, 2005: 82 .
EMBRACING THE “WOBBLE” IN A
   WORKPLACE SMOKING CESSATION
            PROGRAM
What is:                Employees who smoke
A workplace wellness    must take all the
program in which        classes other
employees earn points   employees take plus a
that reduce their       series of 6 90-minute
medical deductible by   smoking cessation
increasing amounts      classes.
based on their
completion of           All classes and
requirements.           exercises hours must
                        take place on
                        employees‟ own time.
WHO WANTS WHAT

The employer‟s          The employees‟
 objectives :             objectives:
 Reduce the number of
  employees who smoke;
                          Reduce insurance co-
 Reduce health care       pays;
  costs related to
                          In most cases, continue
  smoking;
                           to smoke while
 Provide tools and        fulfilling the employer‟s
  knowledge to help        mandate to attend
  employees who smoke      smoking cessation
  achieve cessation.       classes;
EMPLOYEES ACHIEVE THEIR OBJECTIVE BY
ATTENDING SMOKING CESSATION CLASSES.
    CHANGES IN SMOKING BEHAVIOR
        CANNOT BE MANDATED.
PRE-CONTEMPLATIVE
PEOPLE IN A WORKPLACE
SETTING SPENDING THEIR
OWN TIME TO TALK ABOUT   What
SOMETHING THEY DO NOT    is
   WANT TO TALK ABOUT
IF WHAT IS: LITTLE OR NO DESIRE TO
      CHANGE SMOKING BEHAVIOR
                         Talk around the closed
What works:              doors by connecting
 Acceptance that the     through open
  defenses associated     pathways:
  with pre-
                         Emotional connection
  contemplation will
  disrupt and distort    Empathy
  messages that          Respect for a person‟s
  directly challenge      humanity, individuality
  smoking behavior.       and freedom to think
                          for him/herself
ASSERTIVE ENGAGEMENT:
                      IT‟S ALL IN THE TIMING

“This is not for the faint -hearted but nor is it for the indelicate
and insensitive. We are seeking to unbalance someone, to pull
the defensive carpet from under their feet. This is a role that in
any ideal scenario would sit with a skilled therapist in a
perfectly crafted environment. But as we‟ll say a thousand
times, assertive engagement is about working in an imperfect
environment and still seeking change. It is okay to challenge
defenses but be mindful that the client rarely is in a safe space
and even more rarely will return to a safe space after having
met with you. So we proceed with care but we proceed
nonetheless.”
“Precontemplation and Assertive Social Intervention” Assertive Engagement Resource
HOW TO “EMBRACE THE WOBBLE” BET WEEN
  EMPLOYER AND EMPLOYEES‟ OBJECTIVES:



Focus on developing competence in other
areas that can impact health:
 Identify stressors at work and home;
 Teach about the stress response and its ef fects on health and
  ability to cope with change;
 Identify and build on individual strengths, e.g. perseverance,
  resourcefulness, humor, social skills;
 Cultivate competence in getting through stressful situations
  and states of mind through the processes of change;
CHANGE CAN MAKE A PERSON FEEL LIKE A FISH OUT
OF WATER – IT HELPS TO UNDERSTAND THE TENSIONS
  OF CHANGE AND OUR OWN APPROACH TO CHANGE
Reduce the
                          reactive,
   INCREASE EMOTIONAL     fear-based
                          “threat”
                          response to
            RECEPTIVITY   change.
                          Give only

   THROUGH EMOTIONAL      small bits of
                          information
                          that are
          CONNECTIONS;    easily
                          digested
                          and applied
FOCUS ON: WORKING THE
 SOIL & PLANTING SEEDS
EXPLAIN THAT NICOTINE CHANGES THE BRAIN AND
        IMPACTS THE FREEDOM TO THINK FOR OURSELVES



 3 Brain Regions are involved with nicotine dependence and cravings



 BLUE: the thalamus,
 the brain region critical to
 one's ability to calm down
  when stressed.

 RED : the striatum, a region
  implic ate d in the pleasure system of the brain.

 GREEN : the anterior cingulate cor tex,
  a region vital to self -control and concentr ation.


                                   Credit: Image courtesy of Duke University Medical Center
EXPERIENCES CHANGE THE BRAIN
YOGA BREATHING
MINDFULNESS
CHAIR YOGA
BREATH WORK      Teach
                 Breath
                 Work and
                 Why It
                 Matters
SELF-KNOWLEDGE PROMOTES
 EMOTIONAL INTELLIGENCE

            Emotional
             intelligence grows
             through increasing
             connections
             between emotions
             and higher cognitive
             functions.
“Through increased self-
awareness, individuals are more
able to detach themselves from
events and regulate their
emotions in order to prevent
them from becoming „immersed
in‟ and „carried away‟ by
emotional reactiveness.”
Mark Slaski and Susan Cartwright, “Emotional intelligence
training and its implications for stress, health and
p e r f o r m a n c e ” S t r e s s a n d H e a l t h Vo l u m e 1 9 2 0 0 3
PROVIDER RELATIONSHIP SKILLS:
EMPATHY COMMUNICATION BOUNDARIES
• Everyone has blind spots – if we are open to seeing our own
   ambivalence toward change we will be more open to
   acceptance of others‟ ambivalence;

• Compassion and understanding toward self is the doorway to
   empathy toward others;

• Recognize and respond to the ef fect that role hierarchies have
   on perception and communication;
G o l e m a n , D a n i e l ( 1 9 9 8 ) Wo r k i n g w i t h E m o t i o n a l I n te l l i g e n c e , B a n t a m B o o k s
Training in effective approaches to working
with precontemplative clients is available for
your staff, organization or conference.
                                                 Jude
                                                 Treder-
                                                 Wolff,
                                                 LCSW,
                                                 RMT, CGP

                                                 Nicholas
                                                 Wolff,
              496 SMITHTOWN BYPASS SUITE 202     LCSW,
                         SMITHTOWN, NY11787      BCD, TEP
                                631-366-4265
                          WWW.LIFESTAGE.ORG

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All in the timing: How To Understand & Connect With the Precontemplative Person

  • 1. ALL IN THE TIMING: CREATIVE STRATEGIES FOR ENGAGING AND WORKING WITH THE PRECONTEMPLATIVE PERSON Association for Medical Education and Research in Substance Abuse Annual Conference Lifestage, Inc. www,lifestage.org
  • 2. “TIMING HAS A LOT TO DO WITH THE OUTCOME OF A RAIN DANCE” OLD WEST WISDOM The “action” paradigm of behavior change is a model that enrolled clients in relatively brief programs designed to conquer smoking, weight, alcohol, spending or other problematic behavior and expected them to take action within weeks. Failure to maintain the action is attributed to the clients‟ lack of will power or motivation. 90% of behavior change programs are designed for people who are ready to take action and change their behavior. 20% of people who present for help are ready to take action or change their behavior. Prochaska, Norcross & Clemente, Changing For Good, HarperCollins Books, 2006.
  • 3. “REALIT Y IS THAT WHICH, WHEN YOU STOP BELIEVING IN IT, DOESN‟T GO AWAY.” P H I L L I P K . D I C K  “The popular concept among behavioral therapists is that no time is better than the present to take action against an addictive habit. In theory, it sounds right. But the cold light of reality presents a dif ferent picture. I am convinced that there is a tremendous advantage in a well -prepared, pre-emptive attack against the smoking habit.” D r. B a l a s a P r a s a d S to p S m o k i n g Fo r Good
  • 4. “THERE IS A TIDE IN THE AFFAIRS OF MEN WHICH, TAKEN AT THE FLOOD, LEADS ON TO FORTUNE; OMITTED, ALL THE VOYAGE OF THEIR LIFE IS BOUND IN SHALLOWS AND IN MISERIES. ON SUCH A FULL SEA ARE WE NOW AFLOAT, AND WE MUST TAKE THE CURRENT WHEN IT SERVES, OR LOSE OUR VENTURES.” W M S H A K E S P E A RE , J U L I U S C E S E AR , AC T 4 , S C E N E 3 , 21 8 - 2 24 .
  • 5. CHANGE IS A PROCESS THAT PROCEEDS IN STAGES OR STEPS But change is not a lateral process.
  • 7. ADDICTION AND CHANGE: Understanding and Intervening in the Process Carlo C.DiClemente, Ph.D. ABPP UMBC Psychology www.umbc.edu/ psych/habits
  • 8. THE PREPARED MIND  “At certain moments in history, there are individuals whose minds are prepared to recognize the importance of things that unprepared minds ignore or throw away.” P r o c h a s k a , N o r c r o s s & C l e m e n t e , Changing For Good, HarperCollins Books, 2006: 17  With pre-contemplative people, information about addictive behavior – or any other health-threatening behavior pattern – has to transcend the psychological barriers that allow the behavior to continue despite its negative consequences.
  • 9. INTERVENTIONS THAT DO NOT MATCH THE PERSON'S READINESS ARE LIKELY TO: DAMAGE RAPPORT BLOCK RECEPTIVITY TO THE MESSAGE IMPEDE CHANGE “ M O T I VAT I O N A L I N T E R V I E W I N G A N D T H E S TA G E S O F C H A N G E ” S U B S TA N C E A B U S E A N D M E N TA L H E A LT H S E R V I C E S A D M I N I S T R AT I O N , W W W. S A M H S A . G O V / C O - O C C U R R I N G / T O P I C S / T R A I N I N G / C H A N G E . A S P X
  • 10. THE PRECONTEMPLATIVE PERSON  The precontemplative mind set is operating from a protective network of defenses. These defenses inhibit cognitive awareness of consequences to behavior and block the capacity to absorb information about it.
  • 11. tread lightly or SELF-PROTECTION IS they HEIGHTENED FOR THE will PRE-CONTEMPLATIVE run the PERSON. other way
  • 12. TO AN ACTIVE SMOKER, E.G., SMOKING IS A FORM OF SELF-CARE All effective “There must be strategies must really pragmatic acceptance start where people that people are where are, with their unique, they are, as well as complex, subjective compassion for any experience. struggles and suffering linked to the problem behavior.” The Smoke -Free Smoke Brea k: Stop Smoking Now With Mindfulness & Acceptance , Pavel Somov, PhD & Marla Somova , PhD
  • 13. CHANGE CAN BE PERCEIVED AS A THREAT AND TRIGGER THE “STRESS RESPONSE” --
  • 14. FEAR-BASED INTERVENTIONS REINFORCE THE SUBCONSCIOUS PERCEPTION OF THREAT
  • 15. PSYCHOLOGICAL BARRIERS TO COMMUNICATION IN PRE-CONTEMPLATION  All information about the addictive behavior and its consequences is communicated over some kind of barrier, like speaking to someone through a closed door. These defenses include:  Denial: “I don‟t see anything wrong here.”  Rationalization: “I know that what I‟m doing might be bad for me but I couldn‟t handle my stress without it.”  Projection: “You‟re not so perfect. You are judgmental. You have no right to criticize me.”  Blame: “Ever y time I try to quit my spouse sabotages me.”  Internalization: I feel guilty and shameful about doing this, so that‟s something….”
  • 17. REWIRING ONE‟S BRAIN IS UNCOMFORTABLE, ANXIETY-INDUCING AND REQUIRES TIME AND PERSISTENCE,
  • 18. SUCCESSFUL SUSTAINED BEHAVIOR CHANGE: ALL IN THE TIMING The will to change and the skills/tools to navigate change must occur at the same time. Desire: “I want ” – necessary for change to occur; but without the tools and skills needed to achieve some degree of success leads to repeated, frustrating attempts that do not succeed and produce more shame, anxiety and demoralization. Competence: “I can”- tools, skills and knowledge are key to making a behavior change; but desire ignites the energy to use them.
  • 19. DESIRE AND COMPETENCE When a person has the desire to change and at the same time the tools, skills and knowledge to get through the tensions of change action is possible.
  • 20. PROCESSES OF CHANGE Experiential Processes  Concern the person‟s thought processes  Generally seen in the early Stages of Change Behavioral Processes  Action oriented  Usually seen in the later Stages of Change A D D I CT I ON A N D C H A N G E : U n d e r s t a n d i n g a n d I n te r ve n i n g i n t h e P r o c e s s C a r l o C . D i C le m e n te , P h . D . A B P P U M B C P s yc h o lo g y w w w. umb c . e d u/ p s yc h / h a b i t s
  • 21. PRECONTEMPLATION AND THE PROCESSES OF CHANGE  Consciousness-raising  Counter-conditioning - – reframe problems to provide alternatives for integrate new the behavior that provide information with the something that person‟s stated approaches it‟s perceived perspective, e.g. “when benefits, e.g. medication, I take a smoke break I relaxation, emotional am breathing deeply intelligence skills, and taking care of mindfulness, myself – what happens if I take the break and breathe without the  Cancer Prevention Research Center Transtheoretical Model, smoke?” http://www.uri.edu/research/cprc/TTM/Processe sOfChange.htm
  • 22. MORE PROCESSES OF CHANGE Environmental re- Helping evaluation – “My kids relationships – are upset that I smoke Encourage social and are always on me to quit” and interpersonal  “It is very inconvenient relationships with to take a smoke break people who do not now that we have to go smoke – educate so far from the about the role of building” social networks in health behavior change;
  • 23. SOCIAL NETWORKS INFLUENCE BEHAVIOR CHANGE Every facet of health examined so far appears to “spread” from person to person. The strength of a network effect depends on the strength of a friendship. “Friendship as a health factor” Science, Volume 323 23 January 2009, www.sciencemag.org
  • 24. EMOTIONAL INTELLIGENCE IS THE FOUNDATION FOR EFFECTIVE COMMUNICATION  Self- Awareness and Self-Control – an accurate understanding of how one‟s behavior and words affect others  Emotional and inner awareness – an accurate understanding of how one‟s emotions and thoughts affect behaviors  Accurate self-assessment of skills and abilities – an honest assessment of strengths and weaknesses  Conscious planning of communication – the ability to plan the tone of a conversation to achieve the best results  Respectful listening – listen deeply and seek to understand what others are saying  Creativity and sense of play – the ability to take one self lightly and engage with serious situations in a creative way D a n G o l e m a n , E m o t i o n a l I n te l l i g e n c e , B a n t a m D e l l , 2 0 0 6
  • 25. EMOTIONAL INTELLIGENCE: AN EXPRESSION OF THE RICH INTERPLAY OF CONSCIOUS FEELINGS, THOUGHT- ACTION REPERTOIRES, AND ATTITUDES “Emotional Intelligence (EI): Our ability to engage our emotionality in effective ways in order to facilitate positive outcomes in our relationships.” D r. M i c h a el E . Ro c k . o n e o f a few s pe c i alist s i n t h e wo rl d c urre n t l y l i c ensed to c e r t i fy pro fe s s ion als i n t h e un de r s t a nding o f, t h e s t a t i st ic al re s e arc h ba c k g ro un d i n , a n d t h e i n te rpret a t ion a n d us e o f t h e B a rOn E Q- i
  • 26. EMBRACE THE “WOBBLE” The first rule of intervention in a behavior change process is the same as the first rule in improvisation:  Accept what is;  Accept people as they are;  Listen;  Take in what is being expressed and build on it;  Notice the facts – both spoken and unspoken; “Improvising has much in common with riding a bicycle, surfing or skiing. Things are not stable, linear, or predictable. The situation is always in flux. Our footing keeps changing. This approach may be uncomfortable or unsettling at first, and it is natural to seek out security. ..We can stop trying to flee from the wobble.” Patricia Ryan Madson, Improv Wisdom, Crown Publishing Books, 2005: 82 .
  • 27. EMBRACING THE “WOBBLE” IN A WORKPLACE SMOKING CESSATION PROGRAM What is: Employees who smoke A workplace wellness must take all the program in which classes other employees earn points employees take plus a that reduce their series of 6 90-minute medical deductible by smoking cessation increasing amounts classes. based on their completion of All classes and requirements. exercises hours must take place on employees‟ own time.
  • 28. WHO WANTS WHAT The employer‟s The employees‟ objectives : objectives:  Reduce the number of employees who smoke;  Reduce insurance co-  Reduce health care pays; costs related to  In most cases, continue smoking; to smoke while  Provide tools and fulfilling the employer‟s knowledge to help mandate to attend employees who smoke smoking cessation achieve cessation. classes;
  • 29. EMPLOYEES ACHIEVE THEIR OBJECTIVE BY ATTENDING SMOKING CESSATION CLASSES. CHANGES IN SMOKING BEHAVIOR CANNOT BE MANDATED.
  • 30. PRE-CONTEMPLATIVE PEOPLE IN A WORKPLACE SETTING SPENDING THEIR OWN TIME TO TALK ABOUT What SOMETHING THEY DO NOT is WANT TO TALK ABOUT
  • 31. IF WHAT IS: LITTLE OR NO DESIRE TO CHANGE SMOKING BEHAVIOR  Talk around the closed What works: doors by connecting  Acceptance that the through open defenses associated pathways: with pre-  Emotional connection contemplation will disrupt and distort  Empathy messages that  Respect for a person‟s directly challenge humanity, individuality smoking behavior. and freedom to think for him/herself
  • 32. ASSERTIVE ENGAGEMENT: IT‟S ALL IN THE TIMING “This is not for the faint -hearted but nor is it for the indelicate and insensitive. We are seeking to unbalance someone, to pull the defensive carpet from under their feet. This is a role that in any ideal scenario would sit with a skilled therapist in a perfectly crafted environment. But as we‟ll say a thousand times, assertive engagement is about working in an imperfect environment and still seeking change. It is okay to challenge defenses but be mindful that the client rarely is in a safe space and even more rarely will return to a safe space after having met with you. So we proceed with care but we proceed nonetheless.” “Precontemplation and Assertive Social Intervention” Assertive Engagement Resource
  • 33. HOW TO “EMBRACE THE WOBBLE” BET WEEN EMPLOYER AND EMPLOYEES‟ OBJECTIVES: Focus on developing competence in other areas that can impact health:  Identify stressors at work and home;  Teach about the stress response and its ef fects on health and ability to cope with change;  Identify and build on individual strengths, e.g. perseverance, resourcefulness, humor, social skills;  Cultivate competence in getting through stressful situations and states of mind through the processes of change;
  • 34. CHANGE CAN MAKE A PERSON FEEL LIKE A FISH OUT OF WATER – IT HELPS TO UNDERSTAND THE TENSIONS OF CHANGE AND OUR OWN APPROACH TO CHANGE
  • 35. Reduce the reactive, INCREASE EMOTIONAL fear-based “threat” response to RECEPTIVITY change. Give only THROUGH EMOTIONAL small bits of information that are CONNECTIONS; easily digested and applied FOCUS ON: WORKING THE SOIL & PLANTING SEEDS
  • 36. EXPLAIN THAT NICOTINE CHANGES THE BRAIN AND IMPACTS THE FREEDOM TO THINK FOR OURSELVES  3 Brain Regions are involved with nicotine dependence and cravings  BLUE: the thalamus, the brain region critical to one's ability to calm down when stressed.  RED : the striatum, a region implic ate d in the pleasure system of the brain.  GREEN : the anterior cingulate cor tex, a region vital to self -control and concentr ation. Credit: Image courtesy of Duke University Medical Center
  • 38. YOGA BREATHING MINDFULNESS CHAIR YOGA BREATH WORK Teach Breath Work and Why It Matters
  • 39. SELF-KNOWLEDGE PROMOTES EMOTIONAL INTELLIGENCE Emotional intelligence grows through increasing connections between emotions and higher cognitive functions.
  • 40. “Through increased self- awareness, individuals are more able to detach themselves from events and regulate their emotions in order to prevent them from becoming „immersed in‟ and „carried away‟ by emotional reactiveness.” Mark Slaski and Susan Cartwright, “Emotional intelligence training and its implications for stress, health and p e r f o r m a n c e ” S t r e s s a n d H e a l t h Vo l u m e 1 9 2 0 0 3
  • 41. PROVIDER RELATIONSHIP SKILLS: EMPATHY COMMUNICATION BOUNDARIES • Everyone has blind spots – if we are open to seeing our own ambivalence toward change we will be more open to acceptance of others‟ ambivalence; • Compassion and understanding toward self is the doorway to empathy toward others; • Recognize and respond to the ef fect that role hierarchies have on perception and communication; G o l e m a n , D a n i e l ( 1 9 9 8 ) Wo r k i n g w i t h E m o t i o n a l I n te l l i g e n c e , B a n t a m B o o k s
  • 42. Training in effective approaches to working with precontemplative clients is available for your staff, organization or conference. Jude Treder- Wolff, LCSW, RMT, CGP Nicholas Wolff, 496 SMITHTOWN BYPASS SUITE 202 LCSW, SMITHTOWN, NY11787 BCD, TEP 631-366-4265 WWW.LIFESTAGE.ORG