Imagine walking into your first-ever yoga class. The instructor takes the time to welcome everyone and describes the history of yoga, the key principles, and the potential benefits for those who practice it. You look around at the class, and there are yoga practitioners of all levels, from beginners, like yourself, to advanced learners with years of experience.
The instructor shows you images of the poses you are going to master and explains how they will be beneficial. But, before the first class ends, you don’t actually practice anything.
In the next class, the instructor names the yoga poses and watches as the beginners in the class are frozen with fear and confusion. The intermediate learners try to remember the poses and then try to follow the advanced learners instead.
This is a strange and confusing yoga class, no?
You were told all about yoga and how it would be beneficial, but you weren’t actually taught how to practice yoga! You were expected, from one class to the next, to show progress in yoga with minimal guidance from the instructor.
This scenario is surely strange (and highly unlikely in the yoga world). However, something similar happens all of the time for patients and clients during visits to their healthcare professionals.
In the first appointment, the health professional explains the client’s current health status and how certain lifestyle changes could benefit them. But they are not supported with the tools and strategies that can help them make those changes. Then, at the following appointment, they are expected to have made progress by whatever means they could on their own.
Health coaches help to ensure their clients do not feel alone, afraid, or confused on their journey to improved health and wellness, as you might have felt during those imaginary yoga classes.
But, for your clients to truly feel supported and guided, it is of vital importance that health professionals like yourself engage clients with proven health behavior change strategies.
This article describes five proven behavior change strategies you can implement with your coaching clients to help them feel more confident in making health behavior changes.
The strategies described in this article are a summary of the strategies utilized in Nutrition Counseling & Education Skill Development by Kathleen D. Bauer and Doreen Liou, one of the central textbooks used in AFPA’s Certified Holistic Nutritionist Program.
An Introduction to the ABCs of Behavior
There are several behavior change theories that are useful in guiding coaches in developing their own coaching program and style. One of the most popular is the Social Cognitive Theory of behavior change, which sets a framework for discussing behavior change strategies by focusing on points in behavior sequences. The ABCs of behavior (Antecedent, Behavior, and Consequence) are useful for understanding which strategies might be most helpful for your client based on their specific circumstances. ABC stands for:
- Antecedent (stimulus, cue, trigger): Feeling hunger stimulates the desire to eat, just like triggers such as having a bowl of fruit out on the table can trigger munching on fruit as a snack. Antecedents could include the physical availability of foods, social triggers (like parties), emotional triggers (like stress), and psychological behaviors (like motivation).
- Behavior (response, eating): The behavior is the response to the antecedent. In nutrition, it could address the speed at which your client eats, the physical environment in which they eat, and their awareness of what and how much they are eating, among others.
- Consequence (punishment, reward): These include positive and negative reinforcements. Behaviors can be rewarded or punished with something immediate, such as giving or taking away a privilege, or with something more long-term, such as feeling more or less energetic, staying out of the hospital, and others.
As a coach, you can determine which of the following strategies are appropriate for your client after evaluating the ABCs of the particular behavior you and your client want to address.
A behavior chain is a way to allow clients to reflect on behaviors by analyzing the sequence of events from the antecedent to the consequence. Behavioral strategies can focus on one aspect of the antecedents, behaviors, or consequences, or they can focus on the behavior chain as a whole. For example, you and your client may want to address stress before diving into eating behaviors that respond to stress. Research shows that clients with fewer stressors are more likely to be receptive to behavior change interventions and stick to them long-term.
Bauer and Lui suggest the following way to implement behavior chains with your client:
Ask your client to write down a frequent behavior by first specifying the behavior, then identifying the cue, and then describing the consequence. Ask them if it is a behavior they would like to continue. If so, follow up by asking them how to encourage the occurrence of the cue, and if not, ask them how to reduce the incidence of the trigger.
Cue Management (Stimulus Control)
Cue management focuses on the antecedent of the ABCs of behavior. It is a way that coaches and clients can work together to identify and modify social or environmental cues that trigger a behavior. This strategy can be developed as follows:
- Identify a specific behavior that the client wants to maintain or modify.
- Identify several cues. These could be in the physical environment (location, activities, restaurant eating, shopping, reminders, and food storage), the social environment (social events, negative social influence, and social support), or eating behaviors (time food stays in the mouth and which and how much food remains on the plate).
- Identify strategies for increasing positive behaviors and reducing negative behaviors via cue management. For example, if reading while eating stimulates mindless eating, you and your client can discuss the possibility of eating without distractions.
- Explore implementing reminders to carry out the new activity.
Countering is a technique in which clients exchange problem behaviors (B in the chain) with healthy behaviors. Here, the cue or trigger isn’t addressed but rather the behavior itself. Countering is helpful when the objective is to find an activity that could substitute a problem behavior.
For example, if the problem behavior is waking up too late to eat breakfast, this behavior could be exchanged with one that motivates the client to wake up early enough to eat breakfast. This could include listening to their favorite True Crime podcast in the shower or setting their favorite song as an alarm.
Some other examples of substitutions include:
- Foods that are healthier alternatives
- Active diversions
- Physical activities
- Relaxation activities
Behaviors are often learned, and observing others accomplish a goal or modify a behavior can improve a person’s belief that they, too, can modify a health behavior. The process of observing others and implementing changes in a similar way is called modeling.
Some ways you can use modeling in your coaching practice include videos of clients, documentaries, testimonials, success stories, coaching buddies, group coaching, and mentors.
Problem-solving is a process where the coach and client work together to identify the behavior chain, identify barriers to change, and identify possible options for overcoming the barriers.
There are several types of perceived barriers, also known as obstacles or roadblocks, to change:
- A lack of knowledge (does not know what behaviors are harmful or positive for health)
- A lack of skill (does not know how to cook or do yoga)
- A lack of risk-taking (fear or worry)
- A lack of social support
- The complexity of the diet
- Cultural barriers (cultural foods not available in the region)
- Financial limitations
One technique developed by Glasgow and his team for problem-solving is called STOP, which stands for:
- Specify the problem
- Think of options
- Opt for the best solution
- Put the solution into action
Behavior change strategies are essential for coaches to successfully support clients in gaining the confidence to want to change behaviors, the skills for how to change behaviors, and the tools for actually changing behaviors in a sustainable fashion. This article described five behavior change strategies: problem-solving, modeling, countering, cue management, and behavior chains.
Note that these behavior change strategies can be powerful, and they should not be misused to trigger disordered eating habits or a fear of food. Ideally, your client has a concrete health goal in mind and is aware of how their current behaviors influence their health problems. Always check in with your client regularly, and ensure they are eating enough nutritious food, not overexercising, and practicing self-care.