How to Change Behavior for Occupational Therapy

How do you change someone’s behavior? There is no easy answer, and I wish I knew definitively as an occupational therapist. But I might be on the right track here.

We’ve all been there: Maybe you and your team thought you did the best job in the world and are very proud of yourself – only to find that the patient was re-admitted to the hospital, or is back on the caseload. Other therapists may encounter patients on a day to day bases who refuse therapy, or aren’t engaged, or say they will do one thing, but end up doing the opposite. Or perhaps you are working with a frustrated parent who cannot motivate or get their child to change for “the better”.

Several theories have been proposed on how to change behaviors. Some align well with occupational therapy, some not so much:

  • Social Cognitive Theory – suggests that people learn new behaviors by observing and imitating others.
  • Self-Determination Theory – proposes that people are more likely to change their behavior when they have autonomy, competence, and relatedness.
  • Motivational Interviewing (MI) is a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. Occupational therapy practitioners can use MI to help clients who may be ambivalent or resistant to change, to become more engaged and motivated to participate in their therapy.
  • Theory of Planned Behavior – explains that people’s behavior is determined by their attitudes, subjective norms, and perceived behavioral control.
  • The Transtheoretical Model of Change – suggests that individuals move through stages of change (precontemplation, contemplation, preparation, action, and maintenance) when making behavior changes.
  • Behavioural economics – People’s behavior is influenced by cognitive biases and heuristics.
  • Behavioural psychology – Based on the principles of classical and operant conditioning to explain how behavior is shaped by reinforcement and punishment.

As occupational therapists know, one major component or factor for change is motivation.

According to Self-Determination Theory, people are more likely to change their behavior when they have intrinsic motivation, which means that the behavior is self-endorsed and aligns with their values and interests. In contrast, extrinsic motivation, which comes from external factors such as rewards or punishment, is less effective in promoting long-term behavior change.

Another key aspect to change behavior is using strategies to help individuals overcome barriers to change such as lack of knowledge, skills, or resources. Additionally, providing people with social support, such as the support of friends, family, or a group of peers, can also be helpful in promoting behavior change. This can be seen as education and peer support for clients.

Another consideration is opportunity for change. The more opportunities that a client has to practice change, the more they are likely to change. Some ways to promote this include:

  1. Setting Goals: Setting specific, measurable, and achievable goals can help individuals focus on the behavior they want to change and provide a sense of direction. SMART goals, for example.
  2. Create a plan: Create a plan with the client that outlines the steps that need to be taken to achieve the goal and strategies to overcome any obstacles or barriers. Clients should then be able to develop their own plans on their own to generalize in their own situations in the future.
  3. Monitor Progress: Monitoring progress can help individuals stay on track and make adjustments to their plan if necessary. Apps can help with this.
  4. Self-reflection: Reflecting on one’s own behavior and identifying the underlying thoughts, emotions, and beliefs that drive it, can help individuals gain insight into their behavior and make changes. CBT may be helpful to integrate.
  5. Use of assistive technology: Technology can help individuals track their behavior and progress, provide reminders, and even offer virtual coaching or support.
  6. Environmental changes: Changing or modifying the environment can also make it easier to change behavior. This is totally in OT’s wheelhouse!
  7. Social support: Surrounding oneself with supportive people who encourage and motivate behavior change can be very effective. Kind of like the going to the gym with friends thing.

To sum up, one way to potentially bring about change for our clients is the 4 major factors in order of:

  1. Motivations for change
  2. Education for change
  3. Social support for change
  4. Opportunities for change

This means that OTs can and should address all four where possible, according to this proposed model. In the evaluation stage, motivational interviewing may be used to find out more about potential motivations.

With MI, the occupational therapist would use open-ended questions and reflective listening to help clients explore their thoughts and feelings about the behavior in question, and then work with the clients to identify their own reasons for change. The therapist would help the client to focus on the positive aspects of change and help them to resolve any ambivalence they may have about making the changes.

Overall, therapy may take a lot of repetition, re-addressing certain components, and lots of practice. Some specific interventions that may be helpful include:

  • Roleplay
  • Rehearsal
  • Mock situations
  • Real-world practice
  • Planning ahead for situations

One last thing to not overlook is the cognition and psychology piece. Our thoughts, feelings, emotions, thinking of the past, present, and future. Think food or drug cravings. Or the negative things we tell ourselves. So CBT or ACT may be helpful as an adjective approach along with other OT strategies and interventions.

So what do you think? Will addressing these 4 components be the key to promoting health change in our clients?