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Stage Model in Group Counseling Programs

Chapter 8

2+Group Effect (example)

450 participants lost a combined 7,500 pounds Each week, entire team stepped onto a giant truck

scale to monitor their progressBiggest Loser TV Show

Contests in Season 5 have lost over 1000 lbs.Training for Twin’s Cities Marathon sponsored

by Lifetime Fitness? 400 participants throughout the various clubs joined

and over 350 finished the marathon.

+Social Influence

Real or imagined pressure to change one’s behavior, attitudes, or beliefs Can come from doctors, fitness leaders, family

members, and so on

An understanding of this pressure may lead to the development of interventions that use social influence to increase physical activity participation

+Social Support Research

Most important type of social influence in exercise and physical activity settings is the perceived comfort, caring, assistance, and information that a person receives from others

Two approaches

Measure size of one’s social network

Measure amount and type of support that an exerciser receives

+Size of Social Network

Measured by the number of groups or individuals an exerciser can turn to for support

Does not take into account quality or type of support provided

+ Types of Support Instrumental support

Practical, tangible assistance Emotional support

Encouragement, praise, empathy, concern Informational support

Directions, suggestions, advice, feedback Companionship support

Friends, family members, exercise groups Validation

Comparison with others to gauge progress

+Does social support change my attitude about physical activity?Carron et al, meta-analysis summarized this research to

find:

-social support from the family (es = .59) and important others (es = .63) have a positive effect effect on one’s attitude about physical activity.

+Does social support improve one’s ability to overcome one’s perceived barriers to exercising or physical activity?

One’s perceived level of social support was not related to barrier efficacy, that is, the belief you can overcome the barrier to exercise in males and female exercisers 45 years to 64 years of age.

+What affect does social support have on one’s adherence to PA?

Carron et al., meta-analysis that examined this relations found to have a moderate effect size (positive) effect on adherence.

10+Long-term consequences

Group based interventions are effective in the short term but what happens when the class or program ends? Do the clients stop exercising? Do the clients PA behavior regress?

11+Group programs

Group programs maintain a high rate of PA after the program.

Studies have shown that the retention rate is higher than one-on-one personal training.

12+What are keys to a successful group intervention?

Developing a high level of cohesion in the class or exercise group

Developing a high level of perceived and social support

Being a socially enriching leader

The size of the class is related to greater adherence

The composition of the class

+Group Cohesion

A cohesive exercise group is one in which group members are drawn to a common goal and are integrated around the pursuit of that goal and satisfying social interactions and communication

More cohesive exercise groups foster greater exercise adherence

Team building results in improved adherence and fewer dropouts

+How Does Group Cohesion Foster Adherence?

Cohesive groups may foster more positive attitudes toward class attendance.

People feel more positively about exercising in cohesive groups because these groups provide greater social support and interaction.

More cohesive groups may generate greater exercise self-efficacy in group members than less cohesive groups.

15+Group Cohesion Effect

Alan (2003) demonstrated that connection is what brings older adults to a group exercise experience.

Group classes that are taught from a student-center perspective with an emphasis on cohesion enhances adherence (Carron, et. al., 1998).

Heinzelmann & Bagley (1970) reported 90% of adult participants in an exercise program preferred to exercise in a group setting.

Group exercise produces higher rates of exercise maintenance ( Massie & Sheppard, 1971).

Seniors believe they have a better exercise experiences in groups (Carron, 1999)

Developing a highly cohesive group focused on the exercise task and the outcomes produces high exercise compliance (Carron et. al., 1996)

16+Major reasons for joining a group class.One reason is they are attracted to the

task which accounts for the greatest difference between those who attended and did not attend (Spink & Carron, 1992)

Second reason is certain target groups prefer to exercise with people.

+Conceptual Model of Group Cohesion

+Group Cohesion

Attraction to the task accounts for the greatest difference between those who attended and did not attend (Spink & Carron, 1992)

High cohesive exercise groups is positively associated with older adults exercise levels and key to programming exercise for the older adult.

+ How to Increase Feelings of Group Cohesion

Develop feelings of distinctiveness among members Give them members the right to chose Assign group roles and/or positions Establish group norms (expectation of the members and

leader) Provide opportunities to make sacrifices for group Provide opportunities for interaction Buddy system Environmental Conditions

Type of music Proper exercise temperature

+ Influence of Family &Parental Support

Social support from parents and family has been identified as one of the most important determinants of participation in physical activity.

Parents provide many different types of social support: Instrumental: provide transportation, pay fees Emotional: provide encouragement Informational: teach a new activity Companionship: play with their children

+Parental Models & Exercise

Children that come from parent who exercise usually exercise.

Early modeling is important to exercise compliance. As early as pre-school.

Activity level of the day care provider has a great effect on the child PA level.

+ Spousal or Partner Support

Individuals have better attendance and fewer drop out rates when exercising with a spouse Emotional support Companionship support

Spouses/partners provide much-needed support to mothers with young children, because mothers may have difficulty finding time to exercise Women who are single parents have the lowest physical activity

rates. Instrumental support

23+Perceived social support

Higher one’s level of perceived and actual social support the greater the adherence level!

Family, spouse, and parental support Provide opportunities for the spouse to participate Free child day care centers Pestering a love one to exercise may result in behavioral

reactance, that is, doing the opposite.

+Downside to Family Support

Behavioral reactance: When family members pressure a loved one to exercise, that person may respond in the opposite manner and actually exercise less.

Social control Overprotectiveness Parental pressure

+Influence of Physician

Many people look to health professionals for advice on how to become physically active

Physicians who exercise regularly are important role models

Not all physicians prescribe exercise: Don’t perceive exercise as an immediate treatment Don’t feel qualified to perform exercise counseling

+Interesting Fact: Dogs as Social Influence People who own dogs are more likely to meet

recommended physical activity levels than those who do not.

Many dog owners report feeling guilty if they do not walk their dogs; guilt avoidance becomes a powerful incentive.

Dogs provide companionship support.

27+ Influence of Exercise Class Leader Single most important determinant of an exerciser’s

continued participation in an exercise program Exercise leaders provide many different types of

social support: Informational: show what exercises to do Emotional: provide encouragement/praise Instrumental: organize fitness classes Companionship: distract from feelings of pain,

fatigue, boredom

28+

Socially supportive: Encouragement Verbal reinforcement Praise Showing interest in participants Engaging in casual conversation before/after

class Bland:

Verbal criticism of exercisers who made mistakes

No encouragement or praise No interaction before/after class

Leadership style

+Effects of Socially Supportive Leadership Style

Clients report:

Greater exercise self-efficacy More energy and enthusiasm Less post-exercise fatigue Less concern about embarrassing oneself and trying new

things More enjoyment Stronger intentions to join another class in future

30+What is the number one most important characteristic of exercise class leader?

Westcott (1991) indicated that participants rated knowledge as the most important characteristic of a fitness instructor.

+ 31

Key Exercise Leader Skills Understanding of muscle balance Proper warm-up and stretching Provide movement options and verbal

cues Beginning intensity within the exercise

session Demonstrate methods of monitoring

intensity during cardio segment Use different choreographic techniques Know step training, kickboxing,

stationary indoor cycling, and water exercise.

Have alternative expertise; such as yoga or pilates; weight training; etc.

Building self-confidence Develop coping skill in the client

Provide multiple muscle group modifications,

Type of positive music Demonstrate exercise with proper form

and alignment Know a variety of flexibility exercises

appropriate for the target group Understand relaxation and deep breathing

techniques (relaxation training) Be able to teach low and high impact

classes Create smooth transitions in the session How to motivate the client. Using a Stage-matching motivation

techniques & Approach How to set goals

32+Leading a Stage-based group

Your role for people in stages 1 & 2 is to provide information related to: What you have learned in your major about exercise. Adopt the role of teacher.

Your role for people in stage 3 is to be motivator

Your role for people in stages 4 & 5 is to provide less information but serve as analyzer and consultant. Analyzer = help clients overcome barriers to exercise &

prevent relapses Consultant = provide clients alternatives and suggestions

33+Helping clients move through the stages of change Stage 1 – “I am not thinking about it.”

Express empathy Listen and not judge Leave them with a way to get a hold of you when they are ready.

Stage 2 – “I am thinking about it but quite ready.” Identify the compelling reasons to change (pros/cons)

Stage 3 – “I will exercise” Examine any barriers or challenges Find possible solutions (coping strategies) Goal setting Enlist the support of family, friends, or others

34+Helping clients move through the stages of change Stage 4 –”I am exercising”

Relapse prevention Goal setting Rewards Enlist the support of others Encourage the joining of groups

Stage5 -”I still am exercising” Variety Address boredom Enlist the support of others

35+Leadership skills that Have a Positive Effect Introduce yourself to the class and have them introduce

each other. Cite the purpose of the workout and what will happen

during the workout Wear attire and footwear that fits the population or activity.

E.g., seniors do not wear spandex E.g., spin class participant wearing cycling shorts & shoes

Explain the class format and what is expected. Give positive cues, that is, smile, be energetic, etc. Demonstrate frequently Provide feedback frequently throughout the workout and

program

+Your Viewpoint

How large should an exercise class be to produce the greatest adherence, and retention?

A. Medium classes (50 to 80 participants)

B. Large classes (150 to 200 participants)

C. Small classes (20 to 30 participants)

37+Answer

Small (20-30 participants) and large (100-150 participants produces the greatest adherence and retention.

+Your Viewpoint

As the group exercise class size increase, what happens to the members view of the leader effectiveness?

39+Group Size Effect

As number of people increases, member’s perceptions of group cohesiveness decrease because of the following: Crowding Fewer interactions Less enjoyment

As group size increases, client’s perceived satisfaction of having a good workout session increases.

As class size increased perceived leadership qualities by the participant about the exercise leader decreases.

40+Class Size

Participants in small classes (20-30 members) expect more individual attention and reinforcement.

Participants in large classes (100-150 members)expects a leader who addresses attention and reinforcement to the whole group not individually

+Group Composition

Obese people like to exercise in classes with other obese people?

Do women prefer to attend exercise classes where men are also members?

42+Group composition

Gender makeup Women often report that they feel uncomfortable

in exercise groups where male exercisers are in the majority (Benson, Arthure,& Rideout, 1997)

Men seem not to careSimilarity of oneself to other group

members Obese people prefer exercising with other obese

people (Bain, Wilson, & Chailkind, 1989) People generally want to exercise with others of

similar abilities.

+Group Composition

First-time exercisers that receive encouragement and attention from other group members elicit feelings of self-confidence and low anxiety in classes?

Answer is: False

44+Group composition

Socially enriching versus bland groups

Groups that involved participants that were enthusiastic, encouraged each other, and socially interacted experience have greater adherence.

But Novice participants may not like the socially enriching environment and prefer first to master the exercise skills. Martins & Fox (2001) found that first time exercisers need

to master exercise skills not attention from others which produces high anxiety.

+ Group Composition Mixed gender makeup

May cause discomfort May cause feelings of being an oddity

Similarity of membersAffects comfort level and motivation

Group enthusiasmResults in greater enjoyment and future

intentions to join an exercise groupMay increase feelings of self-consciousness

and worries about embarrassment and social evaluation if you are beginner exercisers or new to the class

+Summary

The type of social support is different from person to person.

Social influence can affect one exercise behavior. (e.g., parents and spouses)

The task and social aspects are factors that influence group exercise behavior.

Team building activities have positive adherence affects.

Socially supportive exercise leader has a positive effect on one’s exercise adherence and enjoyment.

The exercise groups makeup and size of the class effects the level of exercise adherence, clients satisfaction, and one’s perception of having a good workout.

47+The End