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Effective Self-Management Practices
Introduction
In the field of medicine and health care, self-management means the interventions, training, and skills by which patients with a chronic condition, disability, or disease can effectively take care of themselves and learn how to do so (Wikipedia 2014.) It is also a method used by others to alter a behavior that is not desirable with one that is. There are five distinct steps in the Self-Management Behavior Modification process. The steps are:
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Goal Selection
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Monitoring Target Behavior
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Changing Setting Events
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Establishing Effective Consequences
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Consolidating Gains
It is important to create a Behavior Contract at the beginning of the specified time as well as documentation of your Results at the end.
Step 1: Goal Selection:
It is important to establish one target outcome goal at a time. The goal should be:
1. Important
2. Measurable
3. Attainable
4. Positive
Statement of target outcome goal should include:
1. Desired level of performance or extinction.
2. Date of projected goal attainment.
As an example, we will follow the Self-Management progress of Tabitha Billingsley. Tabitha has noticed that for the past month she has had difficulty in fastening garments that have waist bands. In particular, trousers and skirts are problematic. Tabitha has also noticed a small bulge in her torso and abdomen.
Tabitha is very self-conscious in regard to her personal appearance, and is happiest and most productive when she feels she is presenting her best self. Therefore she will attempt to reduce her waist measurements between two and five inches with a goal of five. Tabitha feels she will look better in her outfits, and this in return will have a positive effect on her general attitude.
Step 2: Monitoring Target Behavior
A.Target Process Goals
Select appropriate target process goals.
- Tabitha will establish an abdominal and torso exercises regime for the next week.
- Tabitha will monitor her eating habits to avoid foods that are high in calories and have a high fat content as well.
- Tabitha will walk whenever possible to give her additional exercise.
B.Baseline Assessment
Begin baseline assessment of target behaviors before implementing behavior-changing strategies.
- Tabitha currently doesn’t do any abdominal or torso exercises and she has a waistline of 30 inches.
- Tabitha doesn’t eat a well-balanced diet and her snacks are neither nutritious nor body building.
- Tabitha drives everywhere she needs to go and only occasionally walk.
- Tabitha currently feels a little disappointed with herself to the extent that she knows that she can do better as she’s done so in the past.
C.Recording Data on Behavior Related to Process Goals.
Begin recording data on behavior related to process goals.
- Record behavior immediately after it occurs.
- Use paper and pencil, wrist counter, knitting-stitch counter, stopwatch, or wristwatch to record behavior.
- Do a frequency count, time duration, or product assessment of the behavior.
- Tabitha will do 25 sit-ups each morning before bathing and getting ready for work.
- Tabitha will limit herself to two (2) snacks at work, and they will involve nonfat products.
- Tabitha will walk with a co-worker during morning and afternoon breaks.
- Tabitha will monitor the number of times she unconscientiously goes to a snack machine. (when she is upset, nervous, excited, etc.)
Step 3: Changing Setting Events
Continue recording the target behavior and maintaining changes in setting events.
A. Negative Situation Avoidance
Initially avoid situations that are certain to produce undesirable behaviors.
Tabitha will avoid snack machines that do not provide a nutritional alternative to traditional "junk foods".
B. Alter Situations
Alter situations so as to:
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Become aware of what you’re doing.
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Limit the stimuli that evoke the “bad” behaviors.
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Make it easy to emit desire behaviors.
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Specify substitute behaviors incompatible with maladaptive behavior.
- Tabitha will walk to the neighborhood store instead of driving.
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Tabitha will purchase fruit and nonfat products for lunches and snacks.
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Tabitha will wake up to "exercise music" instead of her traditional alarm.
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Tabitha will have a picture of herself before she gained the extra inches clearly visible as an incentive to lose those inches.
Step 4: Establishing Effective Consequences
Continue recording the target behavior and maintaining changes in setting events.
A. Identify Consequences That Would Be Reinforcing or Punishing.
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Tabitha will start a "new outfit" account with an initial deposit of $100.00.
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For each inch Tabitha loses, she will donate $15.00 to the new outfit account.
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For each inch Tabitha either gains or fails to lose, she will subtract $15.00 from the new outfit account.
B. Arrange Reinforcement Contingencies
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When Tabitha avoids an undesirable "snack", she will reward herself with a $1.00 bonus.
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When Tabitha discovers she has "strayed", she will deduct an extra $2.00.
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Tabitha’s boyfriend will also support her in this effort as he is also a co-worker and they spend a lot of time together.
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Tabitha will establish a graduated time frame for reinforcing the behavior leading to process goals.
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Tabitha’s boyfriend will praise her "That's My Girl!" whenever she is successful in her efforts.
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Tabitha’s boyfriend will admonish her "That was Bad" when she fails to avoid undesirable behavior.
Step 5: Consolidating Gains
A. Evaluation
Set up an effective system of assessment/feedback to ensure that self-management can be altered, redefined, or redirected to achieve and maintain the target outcome goals.
Tabitha will set up an effective system of assessment/feedback to ensure that her self-management can be altered, redefined, or redirected to achieve and maintain target outcome goals.
B. Maintain Natural Consequences.
- Tabitha will phase out the use of charts and graphs.
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Tabitha will maintain the exercises, walking, and "healthy eating habits".
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Tabitha’s boyfriend will continue to praise her when she does a "good" job.
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Tabitha will slowly phase out the need for a "new outfit account".
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Tabitha will apply self-management in other areas of her life.
Behavioral Contracts.
In order to create an atmosphere conducive to adding validity to your Self-Management Behavior Modification Agreement, you will wish to write your agreement and both you and your coach should sign it. A sample agree would be:
I, Tabitha Billingsley, agree to carry out a waistline reduction and exercise plan as outlined in the foregoing document, in which I shall lose five (5) inches from my waist and firm/flatted my torso/abdomen during the next ten (10) weeks.
I further agree to abide by all the stipulations as described in my behavioral plan and to subject myself to personal ridicule from my boyfriend if I fail to fulfill the terms of this contract.
____________________________________
(Signature – Tabitha Billingsley)
____________________________________
(Date)
I, Lee Davison, agree to abide by the stipulations described in the attached document. I also agree to praise Tabitha Billingsley when she adheres to her plan and severely admonish/criticize her when she fails to fulfill the conditions of the agreement.
_____________________________________
(Signature -- Lee Davison)
_____________________________________
(Date)
Results...
It is very important to document the results of your plan. Sometimes it may take longer than originally planned. Don’t become discouraged, just renew your agreement and prescribe additional time. If you continue with the plan eventually you should be successful. Remember, when one door closes ... another one opens!
In the case of Tabitha Billingsley, she was only able to lose one and one-half inches. She could only manage 20 sit-ups without falling flat on her back. However, she has been very successful with monitoring between meal snacks, and she has been eating nonfat products.
Tabitha’s boyfriend is encouraging her to maintain her agreement for a longer period of time in hopes of her regime being more effective. Tabitha continues to walk daily and she feels more energetic and more in control.
© 2014 Jacqueline Williamson BBA MPA MS