| Author(s): | Croghan, Emma |
|---|---|
| Issue: | Volume 19(32), 20 April 2005, pp 50-51 |
| Publication Type: | [Art & Science: Health Promotion Series: 3] |
| Publisher: | © Copyright 2005 RCN Publishing Company Ltd. |
| Institution(s): | Emma Croghan is an independent nurse consultant, public health, Barton Turns, Staffordshire. Email: ecconsultnow@aol.com Date of acceptance: February 7 2005. These keywords are based on the subject headings irom the British Nursing Index. This article has been subject to double-blind review. For related articles and author guidelines visit the online archive at www.nursing-standard.co.uk and search using the keywords |
This article, the third of eight in the health promotion series, aims to offer nurses strategies to help clients avoid relapsing into previous behaviour patterns following a lifestyle change.
IN THE CONTEXT of behaviour change success is generally defined as occurring when the client reaches and maintains the new 'healthy' behaviour. However, most people make three to seven attempts before a new behaviour is securely adopted (Prochaska and DiClemente 1983). Clients who are undergoing a change in behaviour pattern, or who have reached and are maintaining a new behaviour, need help to avoid relapsing into the previous behaviour and require support and encouragement if they do relapse.
By assessing the client's readiness and motivation to change his or her behaviour, tailoring responses accordingly and supporting him or her in his or her choice of life activities, the nurse will avoid alienating the client. In this context success could be defined in terms of the client's attempt at behaviour change and his or her willingness to return to the nurse or other supportive practitioner to try again.
When clients make a behavioural change there is a possibility that they will return to their previous behaviour at any point during the change process or after the change has been made. In the stages of change outlined in the Transtheoretical Model, this phase is known as relapse (Prochaska and DiClemente 1983). Relapse is not inevitable, but it can be a usual part of the process of change, particularly with addictive behaviours. It is common for people to temporarily lapse into previous behaviour patterns. Relapse is often associated with high-risk or stressful situations involving emotional states (highs or lows), personal conflict, or social situations or pressures.
To avoid relapse, clients need to be encouraged to anticipate their behaviour in these situations (which happen to everyone) and to think about how they will avoid a temporary or more permanent relapse. Clients should also be encouraged to seek support from family and friends by talking to them about the potential for relapse in high-risk situations.
Changing the client's perception of relapse is also a key strategy in avoiding relapse. Clients often believe that a temporary lapse means an inevitable relapse, the behaviour change attempt is completed and they revert to their old behaviour. This is known as 'the abstinence violation syndrome', as exemplified by clients who give a reason why they should not change (for example, 'If I stop smoking I will put on weight') and then fulfil that prophecy by altering their behaviour (eating chocolate every time they would have had a cigarette) and therefore revert to their previous behaviour (Health Education Authority (HEA) 1996).
However, temporary lapses do not mean the behaviour change attempt is sabotaged-they are learning opportunities that allow clients to identify situations that might prompt a lapse and/or relapse. A temporary lapse can also be viewed as a point of choice: 'Will I be a smoker or a non-smoker?' The nurse should raise this as a possibility early in the change process.
People often use avoidance strategies when making a change to prevent potential relapse in stressful or high-risk situations, for example: 'When I am with Jane I always drink too much, so I will avoid her company for a month or two.' In the short term this can be a useful strategy, but in the longer term might cause feelings of isolation or anger towards the behaviour change, prompting a relapse. As a general rule, avoidance is useful in the short term, perhaps a week or two, but in the longer term clients should be encouraged to examine their fears and deal with them. In the example above, where the client plans to avoid Jane, she could instead speak to Jane and discuss her fears with her over the telephone before meeting her.
When clients have a temporary lapse they should be encouraged to consider why it happened and what they can learn from the situation. They could ask themselves:
[black right pointing small triangle] What they could have done instead of relapsing into the previous behaviour pattern.
[black right pointing small triangle] How they felt before and after the relapse.
[black right pointing small triangle] What they could do to avoid this happening in the future.
Clients could do this using a lapse evaluation form (Table 1). They could also be encouraged, in partnership with the nurse, to consider a formal plan like the SMART plan, which involves specific objectives and measurable outcomes (Box 1). This is suitable for those who have previously relapsed or to reinforce learning from a temporary lapse. For further explanation visit: www.time-management-guide.com/goal-setting-guidelines.html
| [Help with image viewing] [Email Jumpstart To Image] | TABLE 1 Lapse evaluation |
| [Help with image viewing] [Email Jumpstart To Image] | BOX 1 SMART plan for increasing fruit and vegetable intake |
Making a SMART plan can have several positive outcomes:
[black right pointing small triangle] It allows potential difficulties to be identified in advance.
[black right pointing small triangle] It can increase self-belief and motivation by formalising thought processes for analysis.
[black right pointing small triangle] It enhances the evaluation of the change by providing a framework for the evaluation to happen.
Overall good preparation, assessment, planning and evaluation of the situation are needed to ensure the client has a positive experience and achieves the desired outcome.
Relapse can be prevented, but some clients will experience temporary lapses which should be seen as points of choice and learning opportunities rather than devastating moments when all is lost. If the client has completely relapsed, perhaps during a long holiday, and does not feel like continuing the nurse should be supportive and reassess the patient's motivation and readiness to make the change.
If the client is no longer internally motivated, or is content to continue with his or her previous behaviour, then the nurse should reassure him or her that this is a normal part of the change process and that at some point he or she is likely to want to try again. Clients should understand that they can return to the nurse and receive a complete package of support whenever they are ready to try again. Clients who have been through a process of change will have learnt new information about themselves and their behaviour in both stressful and comfortable situations, and they will be more likely to make and maintain that behaviour change in the future
Health Education Authority (1996) Helping People Change: A Trainer's Manual. HEA, London. [Context Link]
Prochaska JO, DiClemente CC (1983) Stages and processes of self-change of smoking: toward an integrative model of change. Journal of Consulting and Clinical Psychology. 51, 3, 390-395. [Context Link]
Keywords: Behaviour change; Health education; Health promotion
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