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  <head>
    <title>099-03 Stress, motivation, habits, and behaviour change</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Stress, motivation, and behaviour change">
      <outline text="Stress and its physiology">
        <outline text="Stressor is the event, stress the response"/>
        <outline text="Threat, challenge, loss, or irrelevance"/>
        <outline text="Acute stress prioritises attention and energy"/>
        <outline text="Harm: extreme, prolonged, poor recovery"/>
        <outline text="Rapid sympathetic and adrenal-medullary response">
          <outline text="Noradrenaline: alertness, vascular tone"/>
          <outline text="Adrenaline: cardiac output, ventilation, glucose"/>
        </outline>
        <outline text="Slower hypothalamic-pituitary-adrenal axis">
          <outline text="Cortisol mobilises substrates, alters immunity"/>
          <outline text="Feeds back to brain and pituitary"/>
        </outline>
        <outline text="One cortisol value needs timing and context"/>
      </outline>
      <outline text="Allostasis and appraisal">
        <outline text="Allostasis: stability through change"/>
        <outline text="Allostatic load: cumulative physiological cost">
          <outline text="A framework, not a standard clinical test"/>
        </outline>
        <outline text="Poverty, discrimination, caregiving sustain demand">
          <outline text="Not reducible to individual attitude"/>
        </outline>
        <outline text="Primary appraisal: what is at stake"/>
        <outline text="Secondary appraisal: options and coping resources"/>
      </outline>
      <outline text="Coping, control, and support">
        <outline text="Problem-, emotion-, meaning-focused coping"/>
        <outline text="Direct action if controllable, acceptance if not"/>
        <outline text="Avoidance relieves briefly, maintains fear"/>
        <outline text="Perceived control helps unless illusory or blaming"/>
        <outline text="Predictability permits preparation"/>
        <outline text="Support quality matters more than contact"/>
        <outline text="Advice ignoring autonomy becomes a demand"/>
      </outline>
      <outline text="Motivation and expectancy">
        <outline text="Drives, incentives, and goals"/>
        <outline text="Dopamine: learning reward predictors, not pleasure"/>
        <outline text="Wanting, liking, effort, learning dissociate">
          <outline text="Cue pull without pleasure in addiction"/>
        </outline>
        <outline text="Expectancy-value: success, value, cost"/>
        <outline text="Risk information changes one component"/>
        <outline text="Ask which immediate costs dominate"/>
      </outline>
      <outline text="Self-efficacy and autonomy">
        <outline text="Self-efficacy: confidence for a specific behaviour">
          <outline text="Practice, modelling, encouragement, physiology"/>
        </outline>
        <outline text="Not generic self-esteem"/>
        <outline text="Specific attainable goals with feedback"/>
        <outline text="Break broad goals into observable steps"/>
        <outline text="Autonomous versus controlled motivation"/>
        <outline text="Competence, autonomy, relatedness"/>
        <outline text="Controlling rewards undermine interest"/>
        <outline text="Informed choice is not abandonment"/>
      </outline>
      <outline text="Habits and planning">
        <outline text="Cue-linked responses from stable repetition"/>
        <outline text="Persist after the outcome loses value"/>
        <outline text="Knowledge change alone has limited effect"/>
        <outline text="Redesign cues, friction, sequence, reinforcement"/>
        <outline text="Implementation intention links cue to action"/>
        <outline text="Action planning: where, when, how"/>
        <outline text="Coping planning: response to barriers"/>
        <outline text="Plans must stay flexible"/>
      </outline>
      <outline text="Behaviour models and conversation">
        <outline text="Capability, opportunity, motivation"/>
        <outline text="Keeps structural barriers in view"/>
        <outline text="Training, reminders, redesign match gaps"/>
        <outline text="Stage models match support to readiness">
          <outline text="Progress is not always in order"/>
        </outline>
        <outline text="Motivational interviewing explores ambivalence">
          <outline text="Elicits own reasons, avoids argument"/>
        </outline>
      </outline>
      <outline text="Risk and behavioural economics">
        <outline text="Immediacy, vividness, dread, trust shape risk"/>
        <outline text="Relative risk without baseline misleads"/>
        <outline text="Absolute frequencies with the same denominator"/>
        <outline text="Check understanding in the person&#x27;s own words"/>
        <outline text="Defaults, present bias, loss aversion, norms"/>
        <outline text="Ethical defaults: transparent, easy refusal"/>
        <outline text="Incentives can coerce when resources are scarce"/>
      </outline>
      <outline text="Relapse, evaluation, and synthesis">
        <outline text="Relapse is information, not moral failure"/>
        <outline text="Lapse: review, self-compassion, restart"/>
        <outline text="Stress narrows attention, strengthens habits"/>
        <outline text="Lifestyle cannot remove structural adversity"/>
        <outline text="Specify mechanism and outcome"/>
        <outline text="Engagement is not benefit"/>
        <outline text="Monitor stigma and widening disparities"/>
        <outline text="Smallest mechanism-matched intervention, then revise"/>
      </outline>
    </outline>
  </body>
</opml>
