Which of the following statements is most characteristic of Intensive Therapeutic Lifestyle Change (ITLC)?
a. Gradual changes are encouraged in one's daily routine, including habits around sleep, diet, physical activity and stress management.
b. There is a singular focus on one health-related d...
Which of the following statements is most characteristic of Intensive Therapeutic Lifestyle
Change (ITLC)?
a. Gradual changes are encouraged in one's daily routine, including habits around sleep, diet,
physical activity and stress management.
b. There is a singular focus on one health-related domain to ensure that patients make
substantial change in this area
c. Programs need to be delivered in-person to be effective
d. These utilize multiple modalities and a multidisciplinary team - ANS D. These utilize
multiple modalities and a multidisciplinary team
ITLCs encourage drastic changes in one's daily routine, not gradual changes. ITLCs produce
the essential induction phase that is needed for people to make the dramatic lifestyle changes
necessary for treating severe disease and precedes the maintenance and support phases in
lifestyle change. ITLC treatment programs are usually administered in a group setting and
typically focus on multiple modalities and generally utilized a multidisciplinary team. They can be
delivered in-person or virtually.
Overall annual medical expenditures among people diagnosed with diabetes in the United
States are how much higher compared with people without diabetes?
a. 1.5 times higher
b. 2.3 times higher
c. 3.5 times higher
d. 6.2 times higher - ANS B. 2.3 times higher
What percentage of US adults with diabetes are unaware that they have it?
a. 27%
b. 16%
c. 23%
d. 34% - ANS C. 23%
According to the CDC, 23% of US adults who met laboratory criteria for diabetes were not
aware of or did not report having diabetes (undiagnosed diabetes). Approximately 11% of the
US population (adults and children) have diabetes and nearly 15% of US adults have diabetes.
Which of the following is true about positive psychology?
,a. It acknowledges the value of negative emotions, alone time, and reflecting on previous
failures
b. It reinforces autonomy and self-efficacy
c. Avoidance of negative thoughts and emotions is preferable as these can serve as detractors
to growth
d. It emphasizes self-improvement by focusing on strengthening areas of weakness - ANS
B. It reinforces autonomy and self-efficacy
Positive psychology reinforces autonomy and self-efficacy (b), and emphasizes current skills
abilities, strengths, and positive actions (d). It acknowledges the value of positive emotions,
engagement, relationships, meaning, and accomplishment (a). Positive psychology improves
attention, open-mindedness, and creativity. It also recognizes that a healthy ratio of positive to
negative emotions (not the avoidance of) builds resilience that foster adaptation and changes
(c).
A 45-year-old man wants to make lifestyle changes to reduce his body weight and increase
regular moderate intensity exercise. He wants to address weight loss first but is frustrated
because he feels like his past efforts have failed. His health care provider decides that
supporting his self-efficacy would be useful. Which of the following is the most appropriate
inquiry to make at this point?
a. "Who in your life is most likely to support you to achieve your weight loss goal right now?"
b. "Tell me about a time when you overcame a challenge to accomplish something you really
wanted to achieve."
c. "What factor in your life would most motivate you to work towards weight loss right now?"
d. "Deciding to improve your health is a great decision - how will you feel when you achieve
this?" - ANS B. "Tell me about a time when you overcame a challenge to accomplish
something you really wanted to achieve."
The primary foundation of self-efficacy is mastery experiences. The inquiry inviting the man to
describe a previous experience of overcoming a challenge is a strong invitation to report a
mastery experience. Other options invite him to describe other supportive people or factors
rather than self-efficacy experiences or are likely to negatively impact self-efficacy due to the
practitioner's "cheerleading".
When asked a scaling question to assess his confidence to make a lifestyle change, a
48-year-old man responds that he is "4 out of 10 confident." His health care provider responds
with a follow-up inquiry: "What stops you from being 8 or 9 out of 10?" This response is an
example of which of the following?
a. An invitational challenge
b. Setting a stretch goal
c. The righting reflex
d. Rolling with resistance - ANS C. The righting reflex
, Miller and Rollnick define the righting reflex as attempts to use an expert stance to urge patients
into change. Such challenges are likely to evoke a self-defensive reaction rather than further
discussion about the possibility of change.
A 43-year-old man with type 2 diabetes has had unstable and high hemoglobin A1c (HbA1c)
over a number of years. He has recently moved to another city and is seeing a new primary
care provider. Over the past 12 weeks, his HbA1c has decreased from 7.9% to 6.7%. Which of
the following physician attributes would most likely explain this?
a. Insightful reflections of adaptive patient behaviors
b. Highly developed capacity for empathy
c. Autonomy-supportive informational approach
d. Curious open inquiry about the reasons behind fluctuations - ANS B. Highly developed
capacity for empathy
Patient-rated physician empathy has been shown to result in patients being more likely to
achieve good HbA1c control. It is also a factor in good outcomes for hypertension and blood
glucose levels.
A 22-year-old woman has been working with a health coach to make changes to her sleep
practices, which she has been intermittently implementing. During the current consultation, she
appears agitated as the coach uses the decisional balance tool to address ambivalence with
her. The coach reminds her clearly that her health is at stake. She suddenly states quite
forcefully: "You don't understand how hard this all is." Which of the following is the most
appropriate response and what is it demonstrating?
a. "I can see you're really angry with me right now." (Accurate Deep Empathy)
b. "You want some changes even though you're angry." (Double Reflection)
c. "I'd like to understand more of your experience - can you help me?" (Reflective Inquiry)
d. "You're not sure I really understand the challenge you're facing." (Shifted Focus Reflection) -
ANS D. "You're not sure I really understand the challenge you're facing." (Shifted Focus
Reflection)
Recognizing that you have erred by arguing for change (rather than seeking to understand your
patient's experience) likely leads to discord. This can be effectively managed through a shifted
focus reflection.
Last month, a 38-year-old woman with elevated blood pressure developed an action plan of
walking for 15 minutes a day, four days a week after dinner. At a subsequent appointment, she
reports that she has not been walking regularly as she feels tired after work, and her husband is
constantly nagging her to exercise, which she finds irritating. Which of the following is the most
appropriate response to help reframe the woman's perspective?
a. "How do you and your husband usually get along?"
b. "It sounds like your husband really cares about you."
c. "You feel your husband's approach is not very encouraging."
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