A simple model to find patient hope for positive lifestyle changes: GRIN

Jen Unwin, clinical psychologist
Dr David Unwin, GP

We work together in a GP practice to bring psychology into the GP realm.We realised that psychological theory can seem complex and time consuming to translate into general practice. However, a large proportion of consultations are for physical and mental health conditions exacerbated by behavioural/lifestyle factors such as smoking, alcohol consumption, inactivity and poor nutrition. Doctors often lack the confidence and competence to address these issues in clinic, assuming a lack of patient motivation or fearing opening a can of worms in an all-too-short consultation.The result can be worsening wellbeing, repeat consulting and poly-pharmacy. We have devised a simple four-step plan that we have been using in 10-minute GP appointments for more than 15 years. It enhances the hope that people have for achieving their personal goals and hence their ability to make significant and lasting positive changes in their wellbeing and health. Specifically it is part of an approach that has helped us achieve drug-free remission for 57 people with type 2 diabetes, along with significant practice drug budget savings (Unwin and Unwin, 2014).


A simple model is presented as a template for conversations with patients that inspire hope and facilitate positive lifestyle changes. The model derives from positive psychology and solution-focused therapy.
The approach focuses on four steps: patients’ goals, resources, self-chosen next steps and shared noticing of success. Ideas are described for trying out the model in practice. These simple concepts can also be applied more widely, resulting in more hopeful and successful team meetings, family discussions and personal development plans.

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