The biopsychosocial approach requires healthcare professionals to recognize the role of social, psychological, and cultural factors that affect patients’ experiences and wellbeing. As a therapist, my role is to identify and address these psychosocial issues holistically and comprehensively to deliver quality care to patients. Physical therapists can offer evidence-based techniques that promote, rehabilitate, and prevent any factors that may influence patients during therapy. Negative social and psychological issues can lead to negative patient outcomes. The paper provides suggestions on the use of self-efficacy and imagery concepts to improve outcomes among patients experiencing demotivation and stress.
Self-efficacy
Self-efficacy is a social cognitive theory (SCT) posited to influence a patient’s behavior significantly. It refers to an individual’s capability to execute target behaviors (Williams and Rhodes 114). The theory postulates that individuals can be influenced to grasp and consolidate healthy deportments if motivated to learn. Furthermore, it indicates that these factors, although independent, will impact a person’s capability to perform desired behaviors (Al Ubaidi 2). There are three major mechanisms through which self-efficacy affects human behavior; they include affective processes such as cognition and emotion, expected outcomes, and perceived capability.
Affective processes relate to an individual’s inspiration to execute appropriate actions. According to the self-efficacy theory, a component of SCT, an individual’s self-efficacy, reflects their drive to perform the desired behavior. According to Williams and Rhodes, a person’s potency is not about their capacity to perform a behavior (115). Rather, they can regularly commit to the desired deportment even during dissuading conditions (Williams and Rhodes 115). Through this conception, healthcare professionals can understand why individuals are prompted to perform the desired behavior.
The theory also postulates that a person’s probability of executing a desired action or behavior will depend on their perceived capacity. This conceptualization relates to the belief that one can perform the required activity. Unless the patient acknowledges that he or she can produce appropriate behaviors, they will have minimal motivation to change or persevere during adverse circumstances (Al Ubaidi 3). Therefore, providers must promote an individual’s capability perception to improve health outcomes. The outcome expectation of an individual will also influence their probability of undertaking a behavior. For example, suppose one expects to lose weight after adopting a specific deportment; they will be motivated to take the actions to achieve the desired goals or outcomes (Al Ubaidi 3). A behavioral scientist should always strive to identify an individual’s outcome expectation for their habits.
Example: Case
The clients attending my exercise class typically complain of feeling demotivated to commit to my proposed routines. By targeting the core determinants of self-efficacy, I will attempt to improve their drive to commit to my exercise routine, thereby influencing their behavior. Al Ubaidi and Williams and Rhodes support this perspective by underscoring their efficacy in enhancing one’s behavior (4; 115). Therefore, I will focus my interventions on their capability perception, inspiration, and outcome expectations to achieve optimal outcomes.
Treatment Intervention
I will use individual-based assessments to identify the motivational barriers that are negatively affecting my clients. These impediments may include low confidence, work or family-related stress, time constraints, or self-imposed restrictions. During the evaluation procedure, I will use motivational interviewing strategies to help them recognize individual hindrances that influence their behaviors. Motivational interviewing is an evidence-based approach that integrates the use of a collaborative and goal-oriented communication style to enhance an individual’s drive to commit to a specific goal. During this communication phase, my role as a physical therapist is two-fold: evoke a positive change talk in the patient to eliminate unconscious resistance and increase their self-awareness on specific obstacles.
For example, during the assessment, the patient may report the deficiency of inspiration to participate in the exercise. I will use the motivational interviewing strategies to engage the patient by asking open-ended questions to distinguish their demotivation’s root cause. I will encourage the client to reflect on any issues in their personal or professional life that has affected how they feel during the past months. After the assessment, I will summarize the findings and establish a two-way communication system to encourage the client’s feedback.
I will then develop interventions/treatment goals in conjunction with the client. The patient will be encouraged to use diaries or other tools to self-reflect on their desired objectives. Collaborating with the individual to develop therapy-related aims will help me identify their outcome expectation. For example, if the patient identifies weight loss as a goal, it means that they anticipate that by engaging in the exercise, a behavioral component, they will lose weight, thereby attaining the expected outcome. According to Al Ubaidi, outcome expectations can be both destructive and beneficial to the patient (2). Therefore, it is essential that I help the patients to establish realistic plans.
I can also educate them on what to anticipate during and after the exercise and the period required. According to Al Ubaidi, patient education and clear exercise demonstration will improve patients’ self-efficacy and outcome expectations (3). With the previously identified barriers in mind, I will develop a patient-centered intervention. For instance, if, after reflection, we distinguished work-related pressure as the primary cause of the demotivation, I will focus on develop interventions that promote work-life balance. The patient’s capacity perception will influence their drive to stick to the proposed therapy. I will develop interventions that are achievable and realistic to attain this goal.
Imagery
Mental imagery plays a critical role in promoting the mental health of people. It is one of the primary mechanisms that help us to make decisions and remember important events. Imagery relates to the technique used to create vivid images, smells, emotions, or events in the absence of an external stimulus (Pearson et al. 591). Through memory recreation, mental imagery can lead an individual to re-experience an original or past stimulus. It can either be voluntary or aided, for instance, triggering a mental image.
The primary role is to guide the patient into an altered state of consciousness to achieve positive meaning in mental imagery. Empirical evidence has demonstrated that the brain structures involved during mental imagery are similar to those producing actual real-life perceptions (Pearson et al. 593). Because mental imagery emulates real-life experiences, its techniques can help patients pre-experience future events and influence them to perceive those activities as pleasant and rewarding. Various techniques are employed in mental imagery, including visual presentation, imagery rescripting, imaginal exposure, and music therapy. Overall, this approach leads to awareness of the cognitive and neural mechanisms that underlie psychopathology.
Example: Case
One of my clients has been dealing with stress for the last four weeks. Since I prefer maintaining professional boundaries with patients, I only have access to the patient’s clinical profile information. She is 45 years old, married, a housewife with three adult children, two of whom have a drug addiction problem. During a previous session, she did not have any positive associations with the images shown to her, including those she was fond of in the past. The client reports feeling distressed, and it is hard for her to concentrate or find the motivation to come to the treatment sessions.
Treatment Intervention
My primary role as a therapist is to remove, reduce, or help the patient adjust to the stress. I can use various mental imagery techniques, including relaxation, to help the patient. Relaxation techniques can help patients reduce uncomfortable thoughts and feelings that will distract them from attentive to imagery presentations. To do this, I will give an induction that focuses on relaxation, such as setting a piece of music that the client will listen to during the session. There will be no interactive dialogue during the session to keep distractions to a minimum. However, the clients can paint, write, or draw anything that resonates with her experience during the session. While listening to music, the patient will kinaesthetically sense the mood set by the chosen music. From the ambient atmosphere, she will become aware of her bodily reactions and memories that are activated during the session through emotional resonance.
I will conduct a post-session evaluation to establish what the patient felt, remembered, or associated with the music. In collaboration with the patient, I will work through the images, associations, memories, images, and emotions that came up while listening to music. The patient can induce a domestic situation affecting her, for instance, the drug addiction issues affecting her children. Emotional resonance activated during the music session is assumed to be the most relevant issue affecting the patient.
However, it is important to note that different individuals experience music differently depending on their satisfied or unsatisfied needs and motivations. The music experience may reveal and trigger a wide range of psychodynamic experiences that may be mentalized. Therefore, the information shared by the patient may be misinterpreted. A further evaluation of the patient’s socio-cultural and economic factors is needed. This evaluation further self-reflection, discussion, and brainstorming of possible techniques and interventions that the patient may feel are important. Depending on the outcome of the assessment, I can offer two prescriptions: music that allows for grief and mourning to invoke feelings of compassion instead of pity or music that gives an induction of hope in the future. According to Frohne-Hagemann, using the music therapy technique can improve a patient’s self-care and enhance emotional support (254). Guided imagery and music techniques can also be used in group therapy. The same guided imagery process is applied, although in this case, it is done in a group format. The assessment can also be a one-on-one approach or group-based.
Conclusion
Issues such as stress and demotivation influence a patient’s capability to engage and stick to healthy behaviors during dissuading moments. Self-efficacy postulates that a healthcare provider can achieve positive outcomes by designing interventions that target motivational barriers, outcome expectations, and individuals’ capability. Due to its ability to invoke salient experiences, guided mental imagery and music therapy can reveal the cognitive factors affecting an individual’s wellbeing.
References
Frohne-Hagemann, Isabelle. “Guided Imagery and Music (GIM): Reflections on Supervision in Training and Therapy Isabelle Frohne-Hagemann.” An Interdisciplinary Journal of Music, vol. 9, no. 2, 2017, pp. 252–266.
Al-Ubaidi, Basem, Abbas. “Motivational Interviewing Skills: A Tool for Healthy Behavioral Changes.” Journal of Family Medicine and Disease Prevention, vol. 3, no. 4, 2017, pp. 1–5.
Pearson, Joel, Naselaris, Thomas, Holmes, Emily, and Kosslyn, Stephen. “Mental Imagery: Functional Mechanisms and Clinical Applications.” Trends in Cognitive Sciences, vol. 19, no. 10, 2015, pp. 590–602.
Williams, David, and Ryan E. Rhodes. “The Confounded Self-Efficacy Construct: Review, Conceptual Analysis, and Recommendations for Future Research.” Health Psychology Review, vol. 10, no. 2, 2016, pp. 113–128.