During the process of engaging patients who struggle with adherence in relation to behaviour change, I suggested in my last newsletter that clinicians should take the following factors into account:
- Styles of consulting
- Psychological reactance
- The influence of habit
My last newsletter discussed the three styles of consulting and how they relate to patient care. Today I will discuss the concept of ‘psychological reactance’ in physiotherapy and how it influences resistance.
A. Definition and explanation of reactance theory
Reactance theory suggests that when individuals perceive a threat to their freedom or autonomy, they experience negative emotions that motivate them to restore their sense of control. This can lead to resistance or defiance towards the source of the threat. In physiotherapy, reactance can manifest as resistance to treatment recommendations, non-compliance, or engaging in behaviours that undermine progress.
B. Importance of understanding reactance in physiotherapy
Understanding reactance is crucial in physiotherapy because it can significantly impact patients’ motivation and adherence to treatment. Patients may resist treatment recommendations or engage in behaviours that undermine their progress, which can ultimately lead to poorer outcomes. Recognising and managing reactance can improve patient-therapist communication, build trust, and increase patients’ motivation to participate in treatment.
C. The impact of reactance on patient’s motivation and adherence to treatment
Reactance can significantly impact patient’s motivation and adherence to treatment. Patients who perceive their autonomy as threatened are more likely to resist treatment recommendations or engage in behaviours that undermine their progress. This can lead to poorer outcomes, decreased patient satisfaction, and increased healthcare costs.
Recognising Reactance in Patients
A. Signs and symptoms of reactance in physiotherapy
Recognising reactance in patients can be challenging because it can manifest in various ways. Some common signs and symptoms of reactance in physiotherapy include resistance to treatment recommendations, non-compliance and engaging in behaviours that undermine progress. Patients may express their reactance verbally by questioning treatment recommendations, expressing their dissatisfaction, or outright refusing to comply. Alternatively, patients may engage in non-compliant behaviours, such as skipping exercises or not following through with self-care recommendations.
B. How to differentiate reactance from other forms of resistance
It’s essential to differentiate reactance from other forms of resistance, such as fear, lack of understanding or mistrust. Reactance is unique in that it’s driven by the perceived threat to one’s freedom or autonomy. In contrast, other forms of resistance may be due to a lack of knowledge or understanding, fear of pain or injury, or mistrust of healthcare providers.
C. The role of communication and patient-therapist relationship in recognising reactance
Effective communication and a positive patient-therapist relationship are crucial in recognising reactance in patients. Physiotherapists need to be attentive to patients’ verbal and non-verbal cues and take the time to understand their concerns and needs. Building trust, providing clear explanations and involving patients in treatment.
Managing Reactance in Physiotherapy
A. Strategies for managing reactance in physiotherapy
Providing choice: Giving patients options and involving them in treatment decisions can help reduce reactance by empowering patients and increasing their sense of control over their treatment.
Explanation and education: Providing clear explanations of the rationale behind treatment recommendations and educating patients about the benefits of treatment can help reduce reactance by increasing their understanding and trust in the process.
Collaboration: Collaborating with patients to develop treatment plans that align with their goals and preferences can help reduce reactance by increasing their sense of ownership and involvement in the process.
Acknowledgment and validation: Acknowledging and validating patients’ concerns, fears and preferences can help reduce reactance by showing empathy and understanding.
Positive reinforcement: Providing positive feedback and reinforcement for compliant behaviour can help increase
B. The importance of ongoing communication and monitoring in managing reactance
Effective management of reactance requires ongoing communication and monitoring of patients’ progress and concerns. Physiotherapists need to be attentive to patients’ verbal and non-verbal cues and adjust treatment plans accordingly. Regular check-ins and feedback can help identify any issues and address them before they escalate.
Why Physiotherapists Need to Know About Reactance
A. Improved patient outcomes and satisfaction
Understanding and managing reactance can improve patient outcomes and satisfaction by increasing motivation and adherence to treatment recommendations.
B. Increased patient trust and rapport
Recognising and addressing reactance can help build trust and rapport between patients and physiotherapists, which can lead to improved communication, collaboration, and patient-centred care.
C. More effective treatment planning and delivery
Understanding reactance can help physiotherapists develop more effective treatment plans and delivery strategies that align with patients’ goals, needs and preferences.
Where to from here for Thinking.Physio?
Skills practice and reflection will be the cornerstone of my training. I am available for both in person and Zoom PD for your group.
If you have a staff member who is struggles communicating with patients, you might be interested in one-on-one coaching for him/her. I take on a limited number of clients each year.
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