FEATURE STORY/ BEHAVIOUR CHANGE WITH BRIEF ACTION PLANNING
language is the strongest predictor of success”7. If you invited
a friend to dinner and they said, “I will try to come”, you could
infer that they are less likely to show up than the friend who
said, “I will be there”. Likewise, when patients describe their
action plans to you, listen to the way they talk about their plan.
If you hear uncertainty, the next steps will help you resolve it
with them.
With a commitment statement in hand, you can proceed
directly to Question Two.
On a Scale of Zero to 10, How
Confident or Sure Do You Feel
About Carrying Out Your Plan?
Your patient’s confidence level is very important to their
success. Asking patients to estimate their confidence level
on a scale of zero to 10 helps you to assess their likelihood of
success. A confidence level of seven or higher indicates likely
success.
This is where problem solving comes in. To help your patients
have the best chance at success, you can work with your
patient to modify their plan, address barriers or choose a
completely different plan that they feel more confident in.
Some patients will struggle with a numerical scale. Another
option is to ask them to choose whether they are “very sure”,
“kind of sure” or “not sure at all”. In this case, you are looking
for a response of “very sure”.
It is important to verbally recognize that a low level of
confidence is better than no confidence at all. By affirming
this, you can reinforce your patient’s strengths and internal
motivation to change.
Skill: Problem Solving for Low Confidence
Research has found that when people respond with a
confidence level below seven, they are less likely to succeed.
Dr. Smith: That sounds great. How often
would you like to go?
Ms. Ng: Well, my friend goes on Tuesdays
and Fridays. It could be fun to join her.
Dr. Smith: And when would you like to
start?
Ms. Ng: I could start this Tuesday.
Dr. Smith: Just so that we are both clear on
your plan, can you repeat the whole thing
back to me?
Ms. Ng: Okay. Starting on Tuesday, I’m
going to try to go to a yoga class at lunch
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SPRING 2016
Work together with your patient on changing the plan to
increase their confidence. If the patient is struggling to come
up with ideas, you may wish to offer another behavioural
menu. Use SMART planning to help them get specific.
on Tuesdays and Fridays.
Dr. Smith: Excellent. And how confident
or sure do you feel on a scale of zero to
10 that you will be able to complete this
plan?
Ms. Ng: Maybe around a five.
Dr. Smith: A five is a lot higher than a zero,
so it sounds like you’re pretty confident. We
usually find that people who are a seven
or higher are more likely to complete their
plan. Is there anything you can think of
that could move your confidence from a
five to a seven?