BANCO DE QUESTÕES ACLM

SECTION 2 – Fundamentals of health behavior change

Question 1 (1 point)
For the last three months a 14-year-old girl with prediabetes has
successfully adhered to her plan of swimming for 20 minutes per day, five
days a week after school, and she is excited to see the health
improvements she has made. According to the Transtheoretical Model of
behavior change (TTM), which of the following best describes the girl's
current stage of change?
Question 1 options:
a. Contemplation
b. Preparation
c. Action
d. Maintenance

Question 2 (1 point)
During an initial consultation, a woman shares that she would like to focus
on improving her sleep by increasing the amount of sleep she is getting
each night. Her health care provider decides to take a "coach approach" to
helping the woman with this goal. Which of the following responses best
exemplifies a "coach" role in helping the woman with her desired behavior
change?
Question 2 options:
a. "How helpful do you think it would be to set an alarm to go to bed so
that you get enough sleep?"
b. "For many of my patients I find that regular exercise is helpful in
improving sleep quality and duration."
c. "Did you know that exposure to electronic devices before bed can
interfere with melatonin production?"
d. "In the next week, what could you think about or do that would move
you forward toward this goal?"
Question 3 (1 point)
According to Social Cognitive Theory, self-efficacy, which is a powerful
predictor of health behavior change, is most effectively increased through
mastery experiences. For a patient who is focused on improving his eating
habits, which of the following is the best example of a mastery experience
in the context of a culinary medicine group visit?
Question 3 options:
a. The patient listens to practical tips and strategies to make grocery
shopping easier.
b. The patient observes someone similar to himself preparing a plant-
based meal.
c. The patient receives words of encouragement regarding their intention
to eat healthier.
d. The patient practices proper knife skills while chopping fruits and
vegetables.

Question 4 (1 point)
A 48-year-old man has started a new exercise program. According to the
Transtheoretical Model, how long would he need to continue the new
regimen before he would be considered to have moved from the Action
stage, in which relapse is more likely, to the Maintenance stage?
Question 4 options:
a. 3 months
b. 6 months
c. 12 months
d. 24 months
Question 5 (1 point)
Which of the following is true about positive psychology?
Question 5 options:
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

Question 6 (1 point)
A 74-year-old man with type 2 diabetes shares that for the past week he
has been struggling to maintain his healthy eating plan. He states that this
is mostly because he has been eating the leftover chips and cookies from
the birthday party he hosted for his granddaughter last weekend. Which of
the following strategies is most beneficial in addressing this lapse?
Question 6 options:
a. Advise the patient going forward to forego situations that may trigger
maladaptive dietary habits.
b. Ask about the specific triggers for the lapse and create a plan to
navigate high-risk situations in the future.
c. Invite the patient to reflect on his previously unhealthy diet and how his
choices impacted his health.
d. Educate the patient as to the negative health consequences associated
with consuming processed foods.
Question 7 (1 point)
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?
Question 7 options:
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?"

Question 8 (1 point)
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?
Question 8 options:
a. An invitational challenge
b. Setting a stretch goal
c. The righting reflex
d. Rolling with resistance
Question 9 (1 point)
A 39-year-old man wants to make several behavioral lifestyle changes
including those involving diet, sleep hygiene, exercise and alcohol
reduction. His health coach applies an approach based on Social Cognitive
Theory by asking him to take account of social and environmental factors
and his thinking styles to assist him. Which of the following characteristics
of Social Cognitive Theory (SCT) is central to behavior change?
Question 9 options:
a. Autonomy and connectedness as primary drivers of SCT
b. Effect of mastery experiences on self-efficacy beliefs
c. Vicarious social learning supporting sustained behavior change
d. Motivational readiness potentiated by environmental social support

Question 10 (1 point)
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?
Question 10 options:
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

Question 11 (1 point)
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?
Question 11 options:
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)

Question 12 (1 point)
A 37-year-old woman wants to change her eating habits and reduce her
body weight, although she is not certain she wants to engage in regular,
moderately vigorous exercise. In conversation with a Coach, she decides to
keep a log of her food and activity. Why is this strategy so important?
Question 12 options:
a. If the woman does not document her exercise program, she will not
likely do it.
b. Close monitoring of one's behavior is the basis of self-regulation and
therefore can enhance confidence to change.
c. Gathering actual data about food and activity will help her see her poor
choices.
d. It is important that the Coach have data so the patient is accountable to
them.
Question 13 (1 point)
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?
Question 13 options:
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."
d. "Who else could help to keep you accountable?"

Question 14 (1 point)
During a follow-up appointment, a 52-year-old man with type 2 diabetes
expresses his frustration with not being able to commit to his plan of
walking for 20 minutes during his lunch breaks at work. He shares that due
to a time-sensitive project he was assigned on Monday, he wasn't able to
take a break that day. Now that he hasn't exercised for several days in a
row, he feels he might as well not even bother, because he's "blown it for
the week." Using the ABCD method of behavioral change, his health care
provider asks, "How would having a different belief lead to a different
outcome?" Which of the following responses from the man would be most
effective in prompting his behavior change efforts of exercising regularly?
Question 14 options:
a. "I can recognize that life happens one day at a time and today is a new
day to take action to improve my health."
b. "I can recognize that there are things I can't control and I don't have to
be so hard on myself."
c. "I can accept that making time to exercise isn't easy and that it's okay to
struggle and not succeed."
d. "I can acknowledge that being frustrated doesn't support my health nor
does it motivate me."

Question 15 (1 point)
A 24-year-old woman meets with her health care provider to review her
action plan from the previous visit, which focused on having fruit as a
snack after work. The woman shares that on most days she has been able
to make this change. However, she states she is frustrated as last week she
had a cookie and thought to herself "Well, I've already ruined my diet by
having one cookie so I might as well just eat the whole package." Which of
the following is the best response to support the woman in reframing this
non-productive thinking?
Question 15 options:
a. "How does this kind of thinking align with your action plan?"
b. "What might you do to help reduce this temptation?"
c. "What might be a more neutral way to see this situation?"
d. "How does eating cookies align with your personal goals?"

Question 16 (1 point)
A 55-year-old man who is overweight presents for a wellness visit. After
being weighed, the man states that he recognizes he needs to lose weight
and that exercise will help, but he is concerned he doesn't have time to
exercise given his busy work schedule. Which of the following questions
would best evoke further change talk?
Question 16 options:
a. "What challenges have you faced in the past with your weight?"
b. "What is your biggest struggle when it comes to exercising?"
c. "What are your top three reasons for wanting to lose weight?"
d. "What barriers do you foresee to exercising regularly?
Question 17 (1 point)
Together with her health care provider, a 48-year-old woman created an
action plan to attend a one-hour chair yoga class two times a week at the
local community center. On her next visit, the woman appears frustrated
and shares, "I've only been able to make it to class once this week—I
seriously can never do anything right." According to cognitive behavioral
techniques, this statement is an example of which of the following types of
non-productive thinking?
Question 17 options:
a. Overgeneralizing
b. All or nothing
c. Fortune telling
d. Mind Reading

Question 18 (1 point)
During an initial consultation, a 66-year-old woman with rheumatoid
arthritis and generalized anxiety disorder states that she is struggling with
severe pain. She reports that she has become increasingly stressed and
anxious about it over the last few months, particularly since none of the
medications she is taking are helping her symptoms. As a result, she would
like to learn more about how to better manage her stress. She mentions
that a friend recommended meditation, which she tried and found made
her feel calmer and more at ease. She states, however, that it would be
hard to find time to meditate between working a full-time job and
watching her grandchildren in the evenings. Which of the following is the
best example of a double-sided reflection based on what the woman has
shared?
Question 18 options:
a. "You have many responsibilities right now which make it challenging to
find time to meditate."
b. "You often don't have time to meditate and when you meditate you feel
calmer and less stressed."
c. "You would like to better manage your stress and think meditation could
be one possible option."
d. "You are experiencing severe pain and it is causing you to feel more
stressed and anxious."

Question 19 (1 point)
A 36-year-old woman presents for a wellness visit. Her vital signs and labs
are within normal limits. She quit smoking last year. She has a body mass
index (BMI) of 32 kg/m2 and is now thinking about making an effort to
lose weight in a few weeks when the school holidays end. What should the
provider discuss with her at this visit regarding weight loss?
Question 19 options:
a. A weight loss plan start date
b. Health risks associated with obesity
c. Personal health benefits of weight loss
d. Strategies for weight loss maintenance

Question 20 (1 point)
A 35-year-old woman reports that for the past 4 months she has followed
through on her commitment not to smoke cigarettes. However, she has
several friends who quit smoking for a similar period of time and then
'relapsed.' She is seeking advice on how to prevent this from happening to
her. Which of the following is the best advice for this woman?
Question 20 options:
a. Allow yourself to smoke one cigarette if the temptation to smoke
becomes overwhelming
b. Keep reminding yourself of the harms of smoking and the benefits you
are gaining by quitting
c. Plan regular meetings with your health care provider to keep yourself
accountable
d. Be aware of your 'lapse triggers' which may be certain times, places or
people

RESPOSTAS SECTION 2

Question 1 0 / 1 point
For the last three months a 14-year-old girl with prediabetes has
successfully adhered to her plan of swimming for 20 minutes per day, five
days a week after school, and she is excited to see the health
improvements she has made. According to the Transtheoretical Model of
behavior change (TTM), which of the following best describes the girl's
current stage of change?
a. Contemplation
b. Preparation
c. Action
d. Maintenance

Hide question 1 feedback

Feedback: According to the Transtheoretical Model of behavior change
developed by Prochaska and DiClemente, an individual is in the action
stage of change when they have made specific, intentional lifestyle
changes, but have not yet maintained their target behavior for six months
or more.
Citation(s):Brehm B A. Behavior change models and theories. In The
Professional's Guide to Health and Wellness Coaching. San Diego, CA:
American Council on Exercise;2019:52-55.
Prochaska JO, Prochaska JM. Transtheoretical model. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:220.
Prochaska, J.O. &Prochaska, J.M. (2016). Changing to thrive: overcome the
top risks to lasting health and happiness. Hazelden Publishing, Center City,
MN.

Question 2 0 / 1 point
During an initial consultation, a woman shares that she would like to focus
on improving her sleep by increasing the amount of sleep she is getting
each night. Her health care provider decides to take a "coach approach" to
helping the woman with this goal. Which of the following responses best
exemplifies a "coach" role in helping the woman with her desired behavior
change?

a. "How helpful do you think it would be to set an alarm to go to bed so

that you get enough sleep?"
b. "For many of my patients I find that regular exercise is helpful in
improving sleep quality and duration."

c. "Did you know that exposure to electronic devices before bed can
interfere with melatonin production?"
d. "In the next week, what could you think about or do that would move
you forward toward this goal?"

Hide question 2 feedback

Feedback: It is important to note that providers have distinct roles as
"experts" and as "coaches" when it comes to helping patients initiate and
sustain health behavior changes. While the "expert approach" positions
the provider as an authority figure and educator who solves the problems
and has all the answers, the "coach approach" positions the provider as a
partner and facilitator of change who fosters possibilities and co-discovers
answers with the patient. The coach approach empowers patients and sets
the stage for effective, collaborative relationships.
Citation(s):
Moore M, Jackson E, Tschannen-Moran, B. Coaching Psychology Manual.
2nd ed. Philadelphia, PA: Wolters Kluwer;2016:5-6.
The Person-Centered Approach to Coaching." Editors Cox, E., Bachkirova,
T., & Clutterbuck, D. (2018). The complete handbook of coaching. SAGE; 54
Frates, E. P., & Moore, M. (2012). Health and wellness coaching skills for
lasting change. In J. M. Rippe (Ed.), Lifestyle medicine (2nd ed., pp. 343-
362). CRC Press, Taylor & Francis Group. doi:10.1201/b13781-33

Question 3 0 / 1 point
According to Social Cognitive Theory, self-efficacy, which is a powerful
predictor of health behavior change, is most effectively increased through
mastery experiences. For a patient who is focused on improving his eating
habits, which of the following is the best example of a mastery experience
in the context of a culinary medicine group visit?
a. The patient listens to practical tips and strategies to make grocery
shopping easier.
b. The patient observes someone similar to himself preparing a plant-
based meal.
c. The patient receives words of encouragement regarding their intention
to eat healthier.
d. The patient practices proper knife skills while chopping fruits and
vegetables.

Hide question 3 feedback

Feedback: According to Albert Bandura, self-efficacy is influenced by four
factors—mastery experience, vicarious experience, verbal persuasion and
somatic and emotional states. Mastery experiences—which have the
strongest influence on self-efficacy beliefs—occur when a patient attempts
and is successful in completing a task or skill related to his or her health
behavior change goal. Practice opportunities—such as applying proper
knife skills when chopping fruits and vegetables as part of a culinary
medicine group visit—is the best example of a mastery experience.
Citation(s):
Gholami M, Herman C, Ainsworth MC, Pekmezi D, Linke S. Applying
psychological theories to promote healthy lifestyles. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:219-220.
Hayden J. Introduction to Health Behavior Theory. 2nd ed. Burlington, MA:
Jones & Bartlett Learning; 2014:16-21.

Question 4 0 / 1 point
A 48-year-old man has started a new exercise program. According to the
Transtheoretical Model, how long would he need to continue the new
regimen before he would be considered to have moved from the Action
stage, in which relapse is more likely, to the Maintenance stage?
a. 3 months
b. 6 months
c. 12 months
d. 24 months

Hide question 4 feedback

Feedback: According to the Transtheoretical Model (TTM), a behavior must
be sustained for at least six months for a person to be considered in the
Maintenance stage.
Citation(s):
Prochaska JO, Prochaska JM. Transtheoretical model. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:215.
Associated learning objective: Differentiate at least three health behavior
change theories and their potential application to practice
Question 5 0 / 1 point
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
Hide question 5 feedback
Feedback: 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).
Citation(s):
Seligman MEP. Flourish: A Visionary New Understanding of Happiness and
Well-Being. Atria Books; 2011
Frederickson B. Positivity: Discover the Upward Spiral that will Change
Your Life. Harmony Random House; 2009.

Question 6 0 / 1 point
A 74-year-old man with type 2 diabetes shares that for the past week he
has been struggling to maintain his healthy eating plan. He states that this
is mostly because he has been eating the leftover chips and cookies from
the birthday party he hosted for his granddaughter last weekend. Which of
the following strategies is most beneficial in addressing this lapse?
a. Advise the patient going forward to forego situations that may trigger
maladaptive dietary habits.
b. Ask about the specific triggers for the lapse and create a plan to
navigate high-risk situations in the future.
c. Invite the patient to reflect on his previously unhealthy diet and how his
choices impacted his health.
d. Educate the patient as to the negative health consequences associated
with consuming processed foods.
Hide question 6 feedback
Feedback: Following a lapse—which is a short-term period when an action
plan is not followed—it is most helpful to discuss the triggers that led to
the lapse in order to help the patient reframe and learn from the
experience. In terms of relapse prevention planning, assessing triggers for
lapses and creating a plan for navigating high-risk situations in the future is
key for helping patients maintain positive changes given that lifestyle
change is an ongoing process marked by ebb and flow of intentionality and
adherence.
Citation(s):
Prochaska, J.O. & Prochaska, J.M. (2016). Changing to thrive: overcome the
top risks to lasting health and happiness. Hazelden Publishing, Center City,
MN.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of
how people change: Applications to addictive behaviors. American
Psychologist, 47(9), 1102-1114. doi: 10.1037/0003-066X.47.9.1102

Question 7 0 / 1 point
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?"
Hide question 7 feedback
Feedback: 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".
Citation(s):
Gholami M, Herman C, Ainsworth MC, Pekmezi D, Linke S. Applying
psychological theories to promote healthy lifestyles. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:197, 200.
Wallace, A. "Bringing the Positive Psychology Approach to the Exam Room"
Editor Liana, L. Roots of Positive Change. American College of Lifestyle
Medicine; 2019: 56-60.

Question 8 0 / 1 point
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
Hide question 8 feedback
Feedback: 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.
Citation(s):
Moore M, Jackson E, Tschannen-Moran B. Coaching Psychology Manual.
2nd ed. Philadelphia, PA: Wolters Kluwer;2016:81.
Miller W, Rollnick S. Motivational Interviewing. 3rd ed. New York, NY:
Guilford Press;2013:174.

Question 9 0 / 1 point
A 39-year-old man wants to make several behavioral lifestyle changes
including those involving diet, sleep hygiene, exercise and alcohol
reduction. His health coach applies an approach based on Social Cognitive
Theory by asking him to take account of social and environmental factors
and his thinking styles to assist him. Which of the following characteristics
of Social Cognitive Theory (SCT) is central to behavior change?
a. Autonomy and connectedness as primary drivers of SCT
b. Effect of mastery experiences on self-efficacy beliefs
c. Vicarious social learning supporting sustained behavior change
d. Motivational readiness potentiated by environmental social support
Hide question 9 feedback
Feedback: Mastery experiences are a central tenet of Social Cognitive
Theory (SCT). They are also the most important driver of self-efficacy
development. It is this aspect that makes SCT a valuable behavior change
theory and one of the most robust behavior change theories.
Citation(s):
Gholami M, Herman C, Ainsworth MC, Pekmezi D, Linke S. Applying
psychological theories to promote healthy lifestyles. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:200.

Question 10 0 / 1 point
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
Hide question 10 feedback
Feedback: 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.
Citation(s):
Riess, H. Neporent, L. The Empathy Effect: Seven Neuroscience-Based Keys
for Transforming the Way We Live, Love, Work and Connect Across
Differences. Sounds True; 2018.

Question 11 0 / 1 point
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)
Hide question 11 feedback
Feedback: 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.
Citation(s):
Fifield P, Suzuki J, Minski S, Carty J. Motivational interviewing and lifestyle
change. In: Rippe JM, ed. Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC
Press; 2019: 211.

Question 12 0 / 1 point
A 37-year-old woman wants to change her eating habits and reduce her
body weight, although she is not certain she wants to engage in regular,
moderately vigorous exercise. In conversation with a Coach, she decides to
keep a log of her food and activity. Why is this strategy so important?
a. If the woman does not document her exercise program, she will not
likely do it.
b. Close monitoring of one's behavior is the basis of self-regulation and
therefore can enhance confidence to change.
c. Gathering actual data about food and activity will help her see her poor
choices.
d. It is important that the Coach have data so the patient is accountable to
them.
Hide question 12 feedback
Feedback: Self-regulation strategies begin with self-monitoring and are
used to enhance confidence for change. "If the woman does not document
her exercise program..." is incorrect because the woman is interested in
changing her diet, not necessarily her exercise program. "Gathering actual
data…" places the practitioner in an unhelpful "expert" role, which will
likely undermine autonomy. There is no suggestion that the patient does
not already understand the links between the three factors.
Citation(s):
Gholami M, Herman C, Ainsworth MC, Pekmezi D, Linke S. Applying
psychological theories to promote healthy lifestyles. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:201.

Question 13 0 / 1 point
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."
d. "Who else could help to keep you accountable?"
Hide question 13 feedback
Feedback: In response to sustain talk, the concept of reframing invites the
patient to consider a different perspective of the situation being described.
By offering a different meaning to the information being shared about her
husband—such as that nagging bespeaks love—the patient is invited to
consider a different angle of view and more positive interpretation.
Citation(s):
Miller W, Rollnick S. Motivational Interviewing. 3rd ed. New York, NY:
Guilford Press;2013:201- 202.

Question 14 0 / 1 point
During a follow-up appointment, a 52-year-old man with type 2 diabetes
expresses his frustration with not being able to commit to his plan of
walking for 20 minutes during his lunch breaks at work. He shares that due
to a time-sensitive project he was assigned on Monday, he wasn't able to
take a break that day. Now that he hasn't exercised for several days in a
row, he feels he might as well not even bother, because he's "blown it for
the week." Using the ABCD method of behavioral change, his health care
provider asks, "How would having a different belief lead to a different
outcome?" Which of the following responses from the man would be most
effective in prompting his behavior change efforts of exercising regularly?

a. "I can recognize that life happens one day at a time and today is a new
day to take action to improve my health."
b. "I can recognize that there are things I can't control and I don't have to
be so hard on myself."
c. "I can accept that making time to exercise isn't easy and that it's okay to
struggle and not succeed."
d. "I can acknowledge that being frustrated doesn't support my health nor
does it motivate me."
Hide question 14 feedback
Feedback: The ABCD method of behavior change is a cognitive behavioral
technique to support patients in identifying non-productive thinking
associated with a health behavior. The framework—which is a mnemonic
developed by Dr. Albert Ellis—focuses first on identifying the activating
event or situation associated with non-productive thinking (A- activating
event; missing his exercise session) and the belief associated with the
event (B-belief; since he missed a few days he's blown the whole week).
From there the consequence of the event—both emotional and behavioral
—are explored (C-consequences; not exercising all week and feeling
frustrated and disappointed in himself), from which there is an
opportunity to support the patient in disputing the negative thinking (D-
disputing the negative thinking; recognizing that while he has missed walks
earlier in the week exercising is important for his health and today is a new
day to recommit to his action plan).
Citation(s):
Brehm B A, Matthews JA. Skills and methods for supporting lifestyle
change. In: The Professional's Guide to Health and Wellness Coaching. San
Diego, CA: American Council on Exercise;2019:83-84.
Learned Optimism. New York, A.A. Knopf, 1991; 210-234

Question 15 0 / 1 point
A 24-year-old woman meets with her health care provider to review her
action plan from the previous visit, which focused on having fruit as a
snack after work. The woman shares that on most days she has been able
to make this change. However, she states she is frustrated as last week she
had a cookie and thought to herself "Well, I've already ruined my diet by
having one cookie so I might as well just eat the whole package." Which of
the following is the best response to support the woman in reframing this
non-productive thinking?
a. "How does this kind of thinking align with your action plan?"
b. "What might you do to help reduce this temptation?"
c. "What might be a more neutral way to see this situation?"
d. "How does eating cookies align with your personal goals?"
Hide question 15 feedback
Feedback: This type of non-productive thinking—known as all-or-nothing
—occurs when patients think about themselves and their behaviors in
"black-or-white" categories with an inability or unwillingness to see shades
of gray. This type of extreme and polarized thinking leads patients to often
see their engagement in a behavior (such as dietary habits) with no middle
ground or partial solution, which causes individuals to engage in extreme
and often inconsistent behaviors. To help frame non-productive thinking,
providers can ask the patient how he might see the situation differently in
order to help the patient replace non-productive thinking with more
realistic interpretations to support behavior change.
Citation(s):
Seligman, Martin E. P. Learned Optimism. New York, A.A. Knopf, 1991; 210-
234
Clifford, D. Curtis, L. Motivational Interviewing in Nutrition and Fitness.
New York, NY: Guilford Press;2016:124-125.

Question 16 0 / 1 point
A 55-year-old man who is overweight presents for a wellness visit. After
being weighed, the man states that he recognizes he needs to lose weight
and that exercise will help, but he is concerned he doesn't have time to
exercise given his busy work schedule. Which of the following questions
would best evoke further change talk?
a. "What challenges have you faced in the past with your weight?"
b. "What is your biggest struggle when it comes to exercising?"
c. "What are your top three reasons for wanting to lose weight?"
d. "What barriers do you foresee to exercising regularly?
Hide question 16 feedback
Feedback: As outlined in motivational interviewing, one of the simplest
and most effective ways to evoke change talk—a patient's own statements
that favor change—is to ask open-ended questions for which the answer
highlights the patient's desire, ability, reasons and/or need for change.
Citation(s):
Miller W, Rollnick S. Motivational Interviewing. 3rd ed. New York, NY:
Guilford Press;2013:171-174.

Question 17 0 / 1 point
Together with her health care provider, a 48-year-old woman created an
action plan to attend a one-hour chair yoga class two times a week at the
local community center. On her next visit, the woman appears frustrated
and shares, "I've only been able to make it to class once this week—I
seriously can never do anything right." According to cognitive behavioral
techniques, this statement is an example of which of the following types of
non-productive thinking?
a. Overgeneralizing
b. All or nothing
c. Fortune telling
d. Mind reading

Hide question 17 feedback

Feedback: As originally outlined by Dr. David Burns in the 1980's,
overgeneralizing is a type of non-productive thinking—or cognitive
distortion—that occurs when a patient sees a single event as a never-
ending pattern of defeat and disappointment. By recognizing patient's
non-productive thinking, providers can help to best support patients in
addressing and reframing thoughts in a more positive way which support
behavior change efforts.
Citation(s):
Brehm B A, Matthews JA. Skills and methods for supporting lifestyle
change. In The Professional's Guide to Health and Wellness Coaching. San
Diego, CA: American Council on Exercise; 2019: 81-82.
Ackerman C. Cognitive Distortions: When your Brain Lies to You. Accessed
August 2, 2023. Positivepscyhology.com/cognitive-distortions
Question 18 0 / 1 point
During an initial consultation, a 66-year-old woman with rheumatoid
arthritis and generalized anxiety disorder states that she is struggling with
severe pain. She reports that she has become increasingly stressed and
anxious about it over the last few months, particularly since none of the
medications she is taking are helping her symptoms. As a result, she would
like to learn more about how to better manage her stress. She mentions
that a friend recommended meditation, which she tried and found made
her feel calmer and more at ease. She states, however, that it would be
hard to find time to meditate between working a full-time job and
watching her grandchildren in the evenings. Which of the following is the
best example of a double-sided reflection based on what the woman has
shared?
a. "You have many responsibilities right now which make it challenging to
find time to meditate."
b. "You often don't have time to meditate and when you meditate you
feel calmer and less stressed."
c. "You would like to better manage your stress and think meditation could
be one possible option."
d. "You are experiencing severe pain and it is causing you to feel more
stressed and anxious."
Hide question 18 feedback
Feedback: As outlined in motivational interviewing, a double-sided
reflection acknowledges sustain talk ("it would be hard to find time to
meditate") and pairs it with previously expressed change talk ("when I
meditate, I feel calm and less stressed"), exploring the client's ambivalence
by highlighting reasons she has given both for and against change.
Citation(s):
Fifield, P, Suzuki J, Minski S, Carty J. Motivational interviewing and lifestyle
change. In: Rippe JM, ed. Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC
Press; 2019:211.
Miller W, Rollnick S. Motivational Interviewing. 3rd ed. New York, NY:
Guilford Press; 2013: 199- 200.
Matthews JA, Muth, ND. The art of coaching. In: The Professional's Guide
to Health and Wellness Coaching. San Diego, CA: American Council on
Exercise;2019:126.

Question 19 0 / 1 point
A 36-year-old woman presents for a wellness visit. Her vital signs and labs
are within normal limits. She quit smoking last year. She has a body mass
index (BMI) of 32 kg/m2 and is now thinking about making an effort to
lose weight in a few weeks when the school holidays end. What should the
provider discuss with her at this visit regarding weight loss?
a. A weight loss plan start date
b. Health risks associated with obesity
c. Personal health benefits of weight loss
d. Strategies for weight loss maintenance
Hide question 19 feedback
Feedback: The woman is thinking about making a behavior change in the
next few weeks, placing her in the Contemplation stage of change.
Interventions appropriate for patients at this stage of change include
personalizing the benefits of the anticipated change. A more generic
discussion of health risks would be appropriate for the Precontemplation
stage, while more specific plans, such as setting a start date are more
appropriate for the Preparation stage. Discussions regarding strategies for
maintenance of the behavior are appropriate during the Action stage.
Citation(s):
Prochaska JO, Prochaska JM. Transtheoretical model. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:215.

Question 20 0 / 1 point
A 35-year-old woman reports that for the past 4 months she has followed
through on her commitment not to smoke cigarettes. However, she has
several friends who quit smoking for a similar period of time and then
'relapsed.' She is seeking advice on how to prevent this from happening to
her. Which of the following is the best advice for this woman?

a. Allow yourself to smoke one cigarette if the temptation to smoke

becomes overwhelming
b. Keep reminding yourself of the harms of smoking and the benefits you
are gaining by quitting
c. Plan regular meetings with your health care provider to keep yourself
accountable
d. Be aware of your 'lapse triggers' which may be certain times, places or
people
Hide question 20 feedback
Feedback: Smokers who successfully quit smoking for more than 6 weeks
usually relapse due to triggers--situations that make them want a
cigarette--, rather than due to nicotine withdrawal. Common triggers
include: being around others who smoke, drinking alcohol, attending a
party, being under stress or feeling angry, and having easy access to
cigarettes. Smokers who have quit and want to avoid relapse should know
their triggers and avoid them to the extent possible.
Citation(s):
Fiore MC, Baker TB, et al. Treating Tobacco Use and Dependence: 2008
Update. Rockville, MD: U.S. Department of Health and Human Services.
Public Health Service; 2008.
Prochaska JO, Prochaska JM. Transtheoretical model. In: Rippe JM, ed.
Lifestyle Medicine. 3rd ed. Boca Raton, FL: CRC Press; 2019:220.
Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of
how people change: Applications to addictive behaviors. American
Psychologist, 47(9), 1102-1114. doi: 10.1037/0003-066X.47.9.1102