Stage Model in Group Counseling Programs

1. 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 progress • Biggest 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.

3. 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

4. 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

5. 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

6. 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

7. 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.

8. 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.

9. 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

13. 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

14. 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.

17. Conceptual Model of Group Cohesion

18. 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.

19. 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

20. 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

21. 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.

22. 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.

24. 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

25. 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

26. 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. Leadership style • 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

29. 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. 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 Key Exercise Leader Skills

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

36. Your Viewpoint • How large should an exercise class be to produce the greatest adherence, and retention? • Medium classes (50 to 80 participants) • Large classes (150 to 200 participants) • Small classes (20 to 30 participants)

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

38. 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)expectsa leader who addresses attention and reinforcement to the whole group not individually

41. 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 care • Similarity 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.

43. 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.

45. Group Composition • Mixed gender makeup • May cause discomfort • May cause feelings of being an oddity • Similarity of members • Affects comfort level and motivation • Group enthusiasm • Results in greater enjoyment and future intentions to join an exercise group • May increase feelings of self-consciousness and worries about embarrassment and social evaluation if you are beginner exercisers or new to the class

46. 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