BEHAVIOUR CHANGE QUESTIONNAIRE

We all have a behaviour that we would like to change, such as smoking, drinking, drugs, binge eating, and much more. We also have many reasons to change these behaviours, the risks associated with them being one. Yet there is often something that prevents us from acting on our attention to change and this questionnaire may help you determine what that barrier may be so that you can then tackle it.

Rate each of the following as explanations or reasons for your behaviour, using the following rating scheme:

3 = Definately; 2 = Probably; 1 = Not Very Likely; 0 = Definately Not

- Patterns of behaviour in your family
- Pattern of behaviour in your country
- Your age
- Low value assigned to health
- Own health
- Low perceived vulnerability to harm
- High perceived barriers to behaviour change
- Lack of cues to action
- Low intention to change behaviour
- Negative attitudes towards behaviour change
- Low belief that others think behaviour change is important
- Low motivation to comply with behaviour change
- Low perceived control over behaviour change
- Low belief in own ability to perform behaviour change
- Belief that others can control behaviour change
- High belief that behaviour change can be controlled by chance
- Belief that own circumstances would make it difficult to change behaviour
- Belief that now is not the right time to change
- Belief that I cannot control this type of behaviour
- Belief that I am a weak willed person
- Belief that to change this behaviour would interfere with my emotional coping
- Belief that if I change behaviour it would be distressing


After rating each of these explanations for your risky or unhealthy behaviour, focus on all of the ones that you have rated as 3 as these are the most important factors in maintaining a behaviour that may be causing you harm and therefore also the most important factors to work on in your recovery journey. You may also benefit from answering the following questions:

1. Where does the behaviour take place, when do you engage in the behaviour, and who with? (*This will help you determine what situations or people may be a trigger to these behaviours you are trying to escape.)

2. Which of the above rated explanations provides the most important reason/explanation for the behaviour in questions? (*This will break the problem down, providing you with an idea of what your main focus should be when trying to stop a behaviour.)

3. What else explains the behaviour and/or the resistance to change? (*This will give you further insight in to the function of the behaviour as well as enable you to prepare for other factors that may try to interfere with your attempts to change.)

Good luck everyone!