Intervention Protocol Based on Transtheoretical Model of Behavior Change for Metabolic Syndrome

Ludwig, Martha Wallig Brusius; Dutra, Nathália Susin; Boff, Raquel de Melo; Feoli, Ana Maria Pandolfo; Gustavo, Andréia da Silva; Macagnan, Fabrício Edler; Oliveira, Margareth da Silva

doi:10.1590/0102.3772e37401

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Clinical Psychology and Culture • Psic.: Teor. e Pesq. 37 • 2021 • https://doi.org/10.1590/0102.3772e37401 copy

Intervention Protocol Based on Transtheoretical Model of Behavior Change for Metabolic Syndrome

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The present study is the translation and adaptation of an intervention based on the Transtheoretical Model of Change directed to patients at cardiovascular risk. The original 29-session manual was translated into Portuguese, extended to 36 sessions, and applied in a pilot study. The protocol was reduced to 12 sessions through the grouping based on the processes of change. The products of the present study were the processes in each behavior, the versatility of the protocol, the interdisciplinary work, the great cost-benefit, and the potential of effectiveness. Finally, the importance of consistent training in Motivational Interview, Transtheoretical Model and group management for proper use are highlighted, and the costs and benefits of protocols versus more flexible treatments are discussed.

Keyword
Treatment adherence; Transtheoretical model of change; Motivation; Metabolic syndrome; weight loss

Sessions	Session Name	Original sessions	Change processes evoked
Session 1	The Stages of Change and a typical day	PCP 1 + PCP 2	Consciousness raising
Session 2	Expressions of concern and values	PCP6 + PCP7	Self-reevaluation and dramatic relief.
Session 3	Relationships and roles	PCP9 + PCP10	Environmental Reevaluation
Session 4	Pros and Cons	PCP 8	Decisional Balance
Session 5	Temptation and Confidence	PCP11 + PCP12	Self-Efficacy
Session 6	Determining a goal, preparing for change, and reviewing	PCP13+ PCP 14	Self-liberation
Session 7	Identifying triggers, managing desires and impulses, and rewarding successes	AM2 + AM9+ AM4	Stimulus Control, Counterconditioning, Reinforcement Management
Session 8	Managing thoughts	AM 8	Stimulus Control, Counterconditioning, Reinforcement Management
Session 9	Effective communication, effective refusals, and critical management	AM5+ AM6+ AM7	Counterconditioning and Reinforcement Management
Session 10	New ways to enjoy life, social support, needs and resources	AM10	Stimulus Control, Counterconditioning, Reinforcement Management, Help Relations and Social Liberation.
Session 11	Developing an Action Plan and committing to it after a lapse	AM11 + AM12	Self-liberation
Session 12	Review and closure	AM15	Self-Efficacy and Reinforcement Management

Title and process of change of the original session (withdrawal)	Purpose of the session	Justification of withdrawal
PCP 3: Physiological effects of alcohol (consciousness raising)	To verify the extent of alcohol use (AUDIT).	The intervention forecasted that each patient would receive printed blood test results, which were discussed, allowing them to know the extent of their problem and share with the group if they wanted to. A printed version of feedback from the psychology assessment was also delivered to each patient and discussed.
	To learn how alcohol can harm their bodies from a physiological point of view.
PCP 4: Physiological effects of drugs (Consciousness raising)	That clients answer a questionnaire evaluating the extent of the use of the drug(s).	The workshops and lectures throughout the intervention offered information about MS and its repercussions for health as well as on the consequences of sedentary lifestyle and of unhealthy diet.
	For clients to learn how the drug(s) can physiologically harm their bodies.
AM 1: The stages of change (Consciousness raising)	That clients learn the stages of change and determine in which one they were.	Clients had already learned this in the first session, and stages were resumed in discussions whenever necessary.
AM 3: Handling stress (counterconditioning)	That clients recognize how much it can affect the body and behavior to be in stressful situations.	The protocol already provided the work on avoiding and/or managing stressful situations through effective communication, and through problem solving. In this way, the counterconditioning was already worked on.
AM 3: Handling stress (counterconditioning)	To learn techniques to act against stress, as it can be a trigger for use. To practice relaxation techniques.

Session	Change Process	Session Objectives	Materials to Work With (Records)
1	Increased consciousness	- Clients learn the Stages of the Change Model.	The Stages of Change.
		- Clients complete the exercise to determine their own stage of change for problem behaviors.	Where am I?
		- Clients reflect on how their days have been, how they have been eating and how they have been related to the activity and/or physical exercise.
2	Self-reassessment and Emotional Relief.	- Clients discuss ways in which other people have expressed concerns about their lifestyle.	Expressions of concern and values.
		- Clients wonder if they themselves have personal concerns about their lifestyle.
		- To help clients identify their personal values.
		- To help clients determine if their personal values are discrepant or in accordance with their lifestyle.
3	Surrounding Revaluation	- Clients recognize that the behavior can affect several areas of their life (personal, professional, leisure, etc.).	Relationships and roles
		-Clients identify current and potential relationships, and think about whether the unhealthy lifestyle can harm relationships with others.
		- Clients discuss whether their relationships have changed due to unhealthy lifestyle.
		- Clients identify the roles they play in life.
		- Clients recognize how the unhealthy lifestyle has affected such roles.
4	Pros and cons	- Clients learn how to identify the pros and cons of behavior.	- My pros and cons of poor diet.
4	Pros and cons	- Clients learn how to attach importance to the pros and cons.	- My pros and cons of not exercising.
5	Efficacy	- Clients identify situations in which they are more tempted to get out of the diet and not exercise.	- Temptation and confidence in food.
		- Clients seek to increase their confidence about their ability to stay on the diet and exercise even in tempting situations.	- Temptation and confidence for Physical Exercise.
		- Clients discuss the implications of various levels of temptation and trust.	- Examples of problem solving.
		- Clients learn to think about problems and review an example of how to solve problems.	- Description of your problem.
6	Self-deliberation	- Clients learn about how to set appropriate goals.	- Determination of objectives and change plan
		- Clients create declared aims and a plan to change to achieve those aims.	- My goals and my plan of change
		- Clients review the topics seen during the course of the group.	- Review
		- Clients discuss changes and the progress they have made.	- Cards with several achievements or successes of each of the group members during the course, to be delivered to them.
7	Conditioning, Stimulus Control, Counterconditioning, Reinforcement Management	- Clients create "clues" to start new health behaviors	- My "clues" to start new behaviors
		- Clients identify situations or emotions that are a trigger to get out of the diet or not exercise.	- When am I more tempted to get out of the diet?
		- Customers create appropriate ways to avoid or to change these "triggers". situations	- When am I more tempted not to exercise?
		- Clients discuss desires and impulses, identify the differences among them.	- Handling Impulses and Desires
		- Clients learn how to replace desires and impulses with positive/functional thoughts and behaviors.	- Rewarding My Success
		- Clients understand the importance of gratifying positive behaviors.	- When am I more tempted to get out of the diet?
		- Clients identify recent achievements.
		- Clients have ideas on how to reward their positive behaviors.
8	Stimulus Control, Counterconditioning, Reinforcement Management.	- Clients identify how thoughts can generate temptation to get out of the diet and to not exercise.	- Identifying and challenging maladaptive thoughts.
8			- Clients learn techniques on how to manage their thoughts.
9	Counterconditioning and Reinforcement Management	- Clients learn three communication styles (passive, aggressive, and assertive).	- Effective Communication
		- Clients determine their typical ways of communicating with others.	- Practicing Refusals
		- Clients learn tools to communicate effectively.	- Handling Reviews
		- Clients think of people who often eat poorly and/or are sedentary, and who can offer you foods out of diet or who can encourage them not to exercise.
		- Clients practice skills to refuse offers to get out of the diet or to not exercise.
		- Clients learn how to receive, appropriately, criticism from others.
		- Clients learn techniques to criticize others constructively and effectively.
10	Stimulus Control, Counterconditioning, Reward Management, Help Relations and Social Deliberation.	- Clients identify healthy activities that can be pleasurable	- New ways to enjoy life
		- Clients identify potential problems in performing these activities and solutions to these potential problems.	Who and what can help me?
		- Clients identify potential sources of social support, understand its importance and learn how to develop it.	- Needs and resources
		- Clients identify areas of life that have not been fully developed or that have been harmed due to an unhealthy lifestyle.
		- Clients identify locations for information and assistance to develop these areas.
11	Self-Deliberation	- Clients review strategies to maintain the behaviors they started.	- Review
		- Clients plan management strategies if they resume their old lifestyle.	- My action plan
		- Clients choose the best strategies according to their personality.	- "What can I do after a lapse?"
		- Clients understand that relapses and lapses are a part of any behavior change.
		- Clients create ideas/strategies on how to resume lifestyle change (diet and exercise adhering) after a lapse.
12	Self-Efficacy and Reinforcement Management	- Clients review the topics worked on during the course of the group.	- Cards with messages prepared by you, in advance for each client, that list several achievements or successes achieved by them during the course of the group.
		- Clients discuss the changes and progress they have made.	- "Review" Leaflet
		- Clients engage in closure activities.

Instituto de Psicologia, Universidade de Brasília Instituto de Psicologia, Universidade de Brasília, 70910-900 - Brasília - DF - Brazil, Tel./Fax: (061) 274-6455 - Brasília - DF - Brazil
E-mail: revistaptp@gmail.com

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