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Working with Obese Children
    and Adolescents


                                Psychological Background
                                            and
                                Therapeutic Interventions



                                                   Vincent O’Brien

Lorenzo Gios and Sara Carbone                                    1
2
Lifestyle choices, perceptions, and ways of thinking are
   strong influences on health and health behaviours.

                Many of these develop
        during childhood and adolescence and
       have a long term influence on our health.




                                                           2
In this presentation I want to look at how
      an understanding of social cognition
 and other theories can help us to understand
and work with obese children and adolescents.



                                                2
Social Behaviour, Cognition and Health




                                         3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.
   We can divide this into:




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.
   We can divide this into:

 Person Perception




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.
   We can divide this into:

 Person Perception
      making sense of others




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.
   We can divide this into:

 Person Perception
      making sense of others

 Self Regulation




                                                               3
Social Behaviour, Cognition and Health
Social Behaviour is a consequence of perceptions of reality.

Social Cognition is how we make sense of social situations.
   We can divide this into:

 Person Perception
      making sense of others

 Self Regulation
      making sense of ourselves



                                                               3
Health Behaviour

Why do people adopt positive health
          behaviours?




                                      4
5
A number of theoretical models have been
 suggested to explain how we make decisions
          about health behaviours.

The health belief model focuses on three aspects
               of decision making.

   Threat perception (What is the risk to me?)
 Behavioural Evaluation (What do I need to do?)
     Cues to action (Why should I do this?)



                                                   5
Health Belief Model   6
Health Belief Model   6
Threat        Behavioural
                                Cues to Action
  Perceptions     Evaluation



                   Benefits         Internal
 Susceptibility
                   Efficacy         External



                    Costs         Health
   Severity
                   Barriers      Motivation



Health Belief Model                              6
Threat        Behavioural
                                Cues to Action
  Perceptions     Evaluation



                   Benefits         Internal
 Susceptibility
                   Efficacy         External



                    Costs         Health
   Severity
                   Barriers      Motivation



Health Belief Model                              6
Threat        Behavioural
                                Cues to Action
  Perceptions     Evaluation



                   Benefits         Internal
 Susceptibility
                   Efficacy         External



                    Costs         Health
   Severity
                   Barriers      Motivation



Health Belief Model                              6
7
Planned Behaviour Theory suggests that factors
 such as attitudes, social conformity and drivers
and opportunities for behavioural change are a at
   the centre of of personal decision making




                                                    7
Planned Behaviour Theory   8
Attitudes




Planned Behaviour Theory   8
Attitudes   =   Consequences




Planned Behaviour Theory          8
Value


   Attitudes   =   Consequences




Planned Behaviour Theory                  8
Value


   Attitudes   =   Consequences

                                  Efficacy




Planned Behaviour Theory                    8
Value


   Attitudes       =   Consequences

                                      Efficacy




Subjective Norms




Planned Behaviour Theory                        8
Value


   Attitudes       =   Consequences

                                      Efficacy




                         Views of
Subjective Norms   =      Others




Planned Behaviour Theory                        8
Value


   Attitudes       =   Consequences

                                           Efficacy




                         Views of
Subjective Norms   =      Others      +   Compliance




Planned Behaviour Theory                               8
Value


     Attitudes        =   Consequences

                                              Efficacy




                            Views of
 Subjective Norms     =      Others      +   Compliance




Behavioural Control


Planned Behaviour Theory                                  8
Value


    Attitudes       =   Consequences

                                            Efficacy




                          Views of
 Subjective Norms   =      Others      +   Compliance




Behavioural Control =    Resources




Planned Behaviour Theory                                8
Value


    Attitudes       =   Consequences

                                             Efficacy




                          Views of
 Subjective Norms   =      Others      +   Compliance




Behavioural Control =    Resources     +   Opportunity




Planned Behaviour Theory                                 8
9
Antonovsky has argued that when things make
sense to us we are more able to manage our lives
   and are more likely to take positive actions
           To enhance our well being.

     He calls this our ‘sense of coherence’.




                                                   9
Sense of Coherence




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.   10
Sense of Coherence
Comprehensible
Life is structured,
 predictable and
    explainable




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.   10
Sense of Coherence
Comprehensible                     Manageable
Life is structured,               Personal and
 predictable and                external resources
    explainable                    are available




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.   10
Sense of Coherence
Comprehensible                     Manageable
                                                                     Meaningful
Life is structured,               Personal and
                                                                  Fits with sense of
 predictable and                external resources
                                                                          self
    explainable                    are available




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.     10
Sense of Coherence
Comprehensible                     Manageable
                                                                     Meaningful
Life is structured,               Personal and
                                                                  Fits with sense of
 predictable and                external resources
                                                                          self
    explainable                    are available




  It makes
sense to me




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.     10
Sense of Coherence
Comprehensible                     Manageable
                                                                     Meaningful
Life is structured,               Personal and
                                                                  Fits with sense of
 predictable and                external resources
                                                                          self
    explainable                    are available



                                  I have
  It makes
                               what it takes
sense to me
                                to do this




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.     10
Sense of Coherence
Comprehensible                     Manageable
                                                                     Meaningful
Life is structured,               Personal and
                                                                  Fits with sense of
 predictable and                external resources
                                                                          self
    explainable                    are available



                                  I have
  It makes
                               what it takes                     It’s worth it!
sense to me
                                to do this




 Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass.     10
Sense of Coherence
           It makes sense

              Resources



         It makesworth it! me
              It’s sense to
               Meaningful


              Manageable


             Comprehensible




                                11
12
According to Personal Construct Theory, we
  divide the world and our lived experiences of it,
into similar and dissimilar constructs. We form our
impressions, make our decisions based on these,
   largely pre constructed, general impressions.




                                                      12
According to Personal Construct Theory, we
  divide the world and our lived experiences of it,
into similar and dissimilar constructs. We form our
impressions, make our decisions based on these,
   largely pre constructed, general impressions.

George Kelly (1955) developed the Repertory Grid
interview technique to help therapists understand
                    how their




                                                      12
According to Personal Construct Theory, we
  divide the world and our lived experiences of it,
into similar and dissimilar constructs. We form our
impressions, make our decisions based on these,
   largely pre constructed, general impressions.

George Kelly (1955) developed the Repertory Grid
interview technique to help therapists understand
                    how their
   Clients understand and make sense of their
                      world.



                                                      12
Personal Constructs




                                                                          Me as
                                        Ideal
      Me                                 me
                                                                         others
                                                                         see me




 Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   13
Personal Constructs


     Open                                                              Reserved




                                                                          Me as
                                        Ideal
      Me                                 me
                                                                         others
                                                                         see me




 Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   13
Personal Constructs

                                  Me


     Open                                                              Reserved




                                                                          Me as
                                        Ideal                            others
                                         me                              see me




 Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   13
Personal Constructs

                                                           Me as
                                  Me                      others
                                                          see me




     Open                                                              Reserved




                                        Ideal
                                         me


 Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   13
Personal Constructs

                             Ideal                         Me as
                              me     Me                   others
                                                          see me




     Open                                                              Reserved




 Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   13
Personal Constructs
    Make our Lives Predictable

    Grow and Change

    Influence Perceptions and Expectations

    Represents ‘Personal Truths’

    Not always internally consistent

    Understanding another person’s construct is a measure of
    empathy




Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton   14
15
Our recent work with 9 and 10 year old
 children gave us an interesting insight
        into how children think.




                                           15
Our recent work with 9 and 10 year old
 children gave us an interesting insight
        into how children think.

We found they were strongly influenced
       by parents and peers.




                                           15
Our recent work with 9 and 10 year old
 children gave us an interesting insight
        into how children think.

We found they were strongly influenced
       by parents and peers.

Even if they new some of the ‘technical’
 information about healthy living, they
didn’t always understand how to fit it in
            to their own lives.


                                           15
16
Young children are often very concerned that they fit




                                                       16
Young children are often very concerned that they fit
                   in with others.




                                                       16
Young children are often very concerned that they fit
                   in with others.

    Family and friends, are important influences.




                                                       16
Young children are often very concerned that they fit
                     in with others.

      Family and friends, are important influences.
But children are constantly looking to see what is normal




                                                         16
Young children are often very concerned that they fit
                     in with others.

      Family and friends, are important influences.
But children are constantly looking to see what is normal
                      how to fit in.




                                                         16
Young children are often very concerned that they fit
                     in with others.

      Family and friends, are important influences.
But children are constantly looking to see what is normal
                      how to fit in.

   And this can distort and disrupt ‘rational’ thinking.




                                                           16
How children think




                     17
How children think
   What kinds of food are least healthy?


   “Pasta isn’t very
healthy because it’s got
      calories.....




                                           17
How children think
   What kinds of food are least healthy?

                                    But we need
   “Pasta isn’t very            calories don’t we?
healthy because it’s got       So it must be healthy.”
      calories.....




                                                         17
How children think
What kinds of foods are least healthy?




                                         18
How children think
What kinds of foods are least healthy?


 “My mum says...”




                                         18
How children think
What kinds of foods are least healthy?

                                   “Chinese
 “My mum says...”                food isn’t very
                            healthy.... because you
                             always get too much
                                   to eat.”




                                                      18
What’s important?




                    19
What’s important?
 Listening to children- (Understanding how they think)




                                                         19
What’s important?
 Listening to children- (Understanding how they think)

 Working with them not on them




                                                         19
What’s important?
 Listening to children- (Understanding how they think)

 Working with them not on them

 Working with families, groups, communities.




                                                         19
What’s important?
 Listening to children- (Understanding how they think)

 Working with them not on them

 Working with families, groups, communities.

 Take into account social and environmental factors that inform and
 support health behaviours.




                                                                      19

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Working With Children

  • 1. Working with Obese Children and Adolescents Psychological Background and Therapeutic Interventions Vincent O’Brien Lorenzo Gios and Sara Carbone 1
  • 2. 2
  • 3. Lifestyle choices, perceptions, and ways of thinking are strong influences on health and health behaviours. Many of these develop during childhood and adolescence and have a long term influence on our health. 2
  • 4. In this presentation I want to look at how an understanding of social cognition and other theories can help us to understand and work with obese children and adolescents. 2
  • 6. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. 3
  • 7. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. 3
  • 8. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. We can divide this into: 3
  • 9. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. We can divide this into: Person Perception 3
  • 10. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. We can divide this into: Person Perception making sense of others 3
  • 11. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. We can divide this into: Person Perception making sense of others Self Regulation 3
  • 12. Social Behaviour, Cognition and Health Social Behaviour is a consequence of perceptions of reality. Social Cognition is how we make sense of social situations. We can divide this into: Person Perception making sense of others Self Regulation making sense of ourselves 3
  • 13. Health Behaviour Why do people adopt positive health behaviours? 4
  • 14. 5
  • 15. A number of theoretical models have been suggested to explain how we make decisions about health behaviours. The health belief model focuses on three aspects of decision making. Threat perception (What is the risk to me?) Behavioural Evaluation (What do I need to do?) Cues to action (Why should I do this?) 5
  • 18. Threat Behavioural Cues to Action Perceptions Evaluation Benefits Internal Susceptibility Efficacy External Costs Health Severity Barriers Motivation Health Belief Model 6
  • 19. Threat Behavioural Cues to Action Perceptions Evaluation Benefits Internal Susceptibility Efficacy External Costs Health Severity Barriers Motivation Health Belief Model 6
  • 20. Threat Behavioural Cues to Action Perceptions Evaluation Benefits Internal Susceptibility Efficacy External Costs Health Severity Barriers Motivation Health Belief Model 6
  • 21. 7
  • 22. Planned Behaviour Theory suggests that factors such as attitudes, social conformity and drivers and opportunities for behavioural change are a at the centre of of personal decision making 7
  • 25. Attitudes = Consequences Planned Behaviour Theory 8
  • 26. Value Attitudes = Consequences Planned Behaviour Theory 8
  • 27. Value Attitudes = Consequences Efficacy Planned Behaviour Theory 8
  • 28. Value Attitudes = Consequences Efficacy Subjective Norms Planned Behaviour Theory 8
  • 29. Value Attitudes = Consequences Efficacy Views of Subjective Norms = Others Planned Behaviour Theory 8
  • 30. Value Attitudes = Consequences Efficacy Views of Subjective Norms = Others + Compliance Planned Behaviour Theory 8
  • 31. Value Attitudes = Consequences Efficacy Views of Subjective Norms = Others + Compliance Behavioural Control Planned Behaviour Theory 8
  • 32. Value Attitudes = Consequences Efficacy Views of Subjective Norms = Others + Compliance Behavioural Control = Resources Planned Behaviour Theory 8
  • 33. Value Attitudes = Consequences Efficacy Views of Subjective Norms = Others + Compliance Behavioural Control = Resources + Opportunity Planned Behaviour Theory 8
  • 34. 9
  • 35. Antonovsky has argued that when things make sense to us we are more able to manage our lives and are more likely to take positive actions To enhance our well being. He calls this our ‘sense of coherence’. 9
  • 36. Sense of Coherence Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 37. Sense of Coherence Comprehensible Life is structured, predictable and explainable Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 38. Sense of Coherence Comprehensible Manageable Life is structured, Personal and predictable and external resources explainable are available Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 39. Sense of Coherence Comprehensible Manageable Meaningful Life is structured, Personal and Fits with sense of predictable and external resources self explainable are available Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 40. Sense of Coherence Comprehensible Manageable Meaningful Life is structured, Personal and Fits with sense of predictable and external resources self explainable are available It makes sense to me Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 41. Sense of Coherence Comprehensible Manageable Meaningful Life is structured, Personal and Fits with sense of predictable and external resources self explainable are available I have It makes what it takes sense to me to do this Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 42. Sense of Coherence Comprehensible Manageable Meaningful Life is structured, Personal and Fits with sense of predictable and external resources self explainable are available I have It makes what it takes It’s worth it! sense to me to do this Antonovsky, A. (1979) Health, stress, and coping. San Francisco, CA: Jossey-Bass. 10
  • 43. Sense of Coherence It makes sense Resources It makesworth it! me It’s sense to Meaningful Manageable Comprehensible 11
  • 44. 12
  • 45. According to Personal Construct Theory, we divide the world and our lived experiences of it, into similar and dissimilar constructs. We form our impressions, make our decisions based on these, largely pre constructed, general impressions. 12
  • 46. According to Personal Construct Theory, we divide the world and our lived experiences of it, into similar and dissimilar constructs. We form our impressions, make our decisions based on these, largely pre constructed, general impressions. George Kelly (1955) developed the Repertory Grid interview technique to help therapists understand how their 12
  • 47. According to Personal Construct Theory, we divide the world and our lived experiences of it, into similar and dissimilar constructs. We form our impressions, make our decisions based on these, largely pre constructed, general impressions. George Kelly (1955) developed the Repertory Grid interview technique to help therapists understand how their Clients understand and make sense of their world. 12
  • 48. Personal Constructs Me as Ideal Me me others see me Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 13
  • 49. Personal Constructs Open Reserved Me as Ideal Me me others see me Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 13
  • 50. Personal Constructs Me Open Reserved Me as Ideal others me see me Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 13
  • 51. Personal Constructs Me as Me others see me Open Reserved Ideal me Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 13
  • 52. Personal Constructs Ideal Me as me Me others see me Open Reserved Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 13
  • 53. Personal Constructs Make our Lives Predictable Grow and Change Influence Perceptions and Expectations Represents ‘Personal Truths’ Not always internally consistent Understanding another person’s construct is a measure of empathy Kelly, G (1955) The psychology of personal constructs (vols. 1 and 2). N.Y.: Norton 14
  • 54. 15
  • 55. Our recent work with 9 and 10 year old children gave us an interesting insight into how children think. 15
  • 56. Our recent work with 9 and 10 year old children gave us an interesting insight into how children think. We found they were strongly influenced by parents and peers. 15
  • 57. Our recent work with 9 and 10 year old children gave us an interesting insight into how children think. We found they were strongly influenced by parents and peers. Even if they new some of the ‘technical’ information about healthy living, they didn’t always understand how to fit it in to their own lives. 15
  • 58. 16
  • 59. Young children are often very concerned that they fit 16
  • 60. Young children are often very concerned that they fit in with others. 16
  • 61. Young children are often very concerned that they fit in with others. Family and friends, are important influences. 16
  • 62. Young children are often very concerned that they fit in with others. Family and friends, are important influences. But children are constantly looking to see what is normal 16
  • 63. Young children are often very concerned that they fit in with others. Family and friends, are important influences. But children are constantly looking to see what is normal how to fit in. 16
  • 64. Young children are often very concerned that they fit in with others. Family and friends, are important influences. But children are constantly looking to see what is normal how to fit in. And this can distort and disrupt ‘rational’ thinking. 16
  • 66. How children think What kinds of food are least healthy? “Pasta isn’t very healthy because it’s got calories..... 17
  • 67. How children think What kinds of food are least healthy? But we need “Pasta isn’t very calories don’t we? healthy because it’s got So it must be healthy.” calories..... 17
  • 68. How children think What kinds of foods are least healthy? 18
  • 69. How children think What kinds of foods are least healthy? “My mum says...” 18
  • 70. How children think What kinds of foods are least healthy? “Chinese “My mum says...” food isn’t very healthy.... because you always get too much to eat.” 18
  • 72. What’s important? Listening to children- (Understanding how they think) 19
  • 73. What’s important? Listening to children- (Understanding how they think) Working with them not on them 19
  • 74. What’s important? Listening to children- (Understanding how they think) Working with them not on them Working with families, groups, communities. 19
  • 75. What’s important? Listening to children- (Understanding how they think) Working with them not on them Working with families, groups, communities. Take into account social and environmental factors that inform and support health behaviours. 19

Editor's Notes

  • #20: HBM uses two aspects of representations of health: perception of illness threat and evaluation of counter measures. Internal cues: physical symptoms external: campaigns, advice from others
  • #21: HBM uses two aspects of representations of health: perception of illness threat and evaluation of counter measures. Internal cues: physical symptoms external: campaigns, advice from others
  • #22: HBM uses two aspects of representations of health: perception of illness threat and evaluation of counter measures. Internal cues: physical symptoms external: campaigns, advice from others
  • #23: HBM uses two aspects of representations of health: perception of illness threat and evaluation of counter measures. Internal cues: physical symptoms external: campaigns, advice from others
  • #25: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #26: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #27: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #28: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #29: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #30: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #31: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #32: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #33: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources
  • #34: Connor and Sparks 1991 Attitudes to health behaviour Will follow a health behaviour if It leads to valued outcomes supported by people who’s views they value access to necessary resources