REGISTER  |  SIGN IN
United States Patent5722418
BroMarch 3, 1998
Title
Method for mediating social and behavioral processes in medicine and business through an interactive telecommunications guidance system
Abstract
A method for mediating social and behavioral influence processes through an interactive telecommunications guidance system for use in medicine and business (10) that utilizes an expert (200) such as a physician, counselor, manager, supervisor, trainer, or peer in association with a computer (16) that produces and sends a series of motivational messages and/or questions to a client, patient or employee (50) for changing or reinforcing a specific behavioral problem and goal management. The system (10) consists of a client database (12) and a client program (14) that includes for each client unique motivational messages and/or questions based on a model such as the transtheoretical model of change comprising the six stages of behavioral change (100) and the 14 processes of change (114), as interwining, interacting variables in the modification of health, mental health, and work site behaviors of the client or employee (50). The client program (14) in association with the expert (200) utilizes the associated 14 processes of change (114) to move the client (50) through one of the six stages of behavioral change (100) when appropriate by using a plurality of transmission and receiving means. The database and program are operated by a computer (16) that at preselected time periods sends the messages and/or questions to the client (50) through use of a variety of transmission means and furthermore selects a platform of behavioral issues that is to be addressed based on a given behavioral stage or goal (100) at a given time of day.
Inventors:Bro; L. William (Los Angeles, CA)
Appl. No.:315630
Filed:September 30, 1994
Current U.S. Class:600/545 128/905 128/920 434/118 482/9 600/300 600/544 
Field of Search:128/630,637,638,670,671,731-733,739-741,904,905,920,923 434/236,118,365 395/761 370/449 482/900,901,902,8,9
U.S. Patent Documents
3742938July 1973Stern
3808694May 1974Hutchinson et al.
4112425September 1978Zobrist et al.
4237344December 1980Moore
4328494May 1982Goodall
4377214March 1983Hansen et al.
4396976August 1983Hyatt
4602127July 1986Neely et al.
4773492September 1988Ruzumma
4831242May 1989Englehardt et al.
4835372May 1989Gombrich et al.
4912552March 1990Allison, III et al.
4916435April 1990Fuller
4922514May 1990Bergeron et al.
4933873June 1990Kaufman et al.
4952928August 1990Carroll et al.
5008835April 1991Jachmann et al.
5014298May 1991Katz
5018736May 1991Pearson et al.
5023901June 1991Sloan et al.
5036462July 1991Kaufman et al.
5038800August 1991Oba
5068080November 1991Impink, Jr. et al.
5085527February 1992Gilbert
5126957June 1992Kaufman et al.
5127003June 1992Doll, Jr. et al.
5142484August 1992Kaufmann et al.
5170426December 1992D'Alession et al.
5189395February 1993Mitchell
5206897April 1993Goudreau et al.
5218344June 1993Ricketts
5219322June 1993Weathers
5224173June 1993Kuhns et al.
5245656September 1993Loeb et al.
5462051October 1995Oka et al.
Other References
Mori, DeAnna L., "The Vulnerable Body Image of Females with Feelings of Depression," Jrnl. Research and Personality 25, 343-354 (1991). .
Nelson, R. Eric and Craighead, W. Edward, "Selective Recall of Positive and Negative Feedback, Self-control Behaviors and Depression," Jrnl. Abnormal Psych. 1977, vol. 86 No. 4, 379-388. .
Freeman, Walter J., "The Physiology of Perception," Scientific American, Feb., 1991, pp. 78-85. .
Cann, Arnie and Ross, Debra A., "Olfactory Stimuli as Context Cues in Human Memory," American Jrnl. of Psychology, Spring 1989, vol. 102, No. 1, pp. 91-102. .
Schab, Frank R., "Odors and Remembrance of Things Past," Jrnl. Expmtl. Psych:Learning, Memory and Cognition 1990, vol. 16, No. 4, 648-655. .
Tulving, Endel & Thomson, Donald M., "Encoding Specificity and Retrieval PRocesses in Episodic Memory," Psych. Rev. 1973, vol. 80, No. 5, 352-373. .
O'Hair, Dan and Cody, Michael J., "Gender and Vocal Stress Differences During Truthful and Deceptive Information Sequences," Human Relations, vol. 40, No. 1, 1987, pp. 1-14. .
Ulett, George A.; Akpinar, Sevket and Itil, Turan M. "Quantitative EEG Analysis During Hypnosis," Electroenceph. Clin. Neurophysiol., 1972, 33:361-368. .
Blair, Alan J.; Lewis, Vivien J. and Booth, David A., "Responses to Leaflets About Eating and Shape by Women Concerned About Their Weight", Behavioral Psychotherapy, 1992, 20, 279-286. .
Kearsley, Greg P. and Frost, Jana, "Design Factors for Successful Videodisc-Based Instruction," Educational Technology, Mar. 1985, pp. 7-13. .
Jones, Loretta L. and Smith, Stanley C., "Lights, Camera, Reaction! The Interactive Videodisc:A Tool For Teaching Chemistry," T.H.E. Journal, 78 Mar. 1989. .
McConnaughy, Eileen A., et al., "Stages of Change in Psychotherapy:A Folow-Up Report," Psychotherapy, vol., 26, Winter 1989 No. 4..~
Primary Examiner: Nasser; Robert
Assistant Examiner: Huang; Stephen
Attorney, Agent or Firm:Cislo & Thomas
Parent Case Text


CROSS-REFERENCED RELATED APPLICATION

This application is a continuation of application Ser. No. 08/112,955 filed Aug. 30, 1993 (now U.S. Pat. No. 5,377,258 issued Dec. 27, 1994.
Claims

I claim:
1. A system for interactive preventative medical guidance and commercial goal management comprising:
a) polling means for creating a database of personalized input data indicative of an individual's particular behavioral issue;
b) evaluation means for determining an individual's temporal behavioral stage from said database selected from one of a plurality of behavioral stages;
(c) mediation means for determining from said evaluation means and said database a behavioral routine for changing said selected temporal behavioral stage;
(d) program means including transmission means for delivering to said individual specific content based communication based on said behavioral routine determined by said mediation means for changing said selected temporal behavioral stage; and
(e) feedback means for receiving an individual's response to said content based communication wherein said mediation means provides periodic reevaluation of said response for determining readjustment of said behavioral routine and said content based communication.

2. The system as specified in claim 1 wherein said polling means for creating said database comprising a compact disc and a compact disc player interfacing with a computer.

3. The system as specified in claim 2 wherein said evaluation means for determining an individual's temporal behavioral stage comprising a compact disc and a compact disc player that interfaces with a computer.

4. The system as specified in claim 1 wherein said mediation means for determining a behavioral routine is a physician.

5. The system as specified in claim 1 wherein said mediation means for determining a behavioral routine is a counselor.

6. The system as specified in claim 5 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes guided imagery through prompts and ques delivered by said counselor.

7. The system as specified in claim 5 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes systematic desensitization.

8. The system as specified in claim 1 wherein said plurality of behavioral stages comprises a precontemplation stage; contemplation stage; preparation stage; action stage; maintenance stage; and relapse stage.

9. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage comprises an overlearning technique.

10. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage comprises application of a generation effect.

11. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes refresher practice.

12. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes contextual variety.

13. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes delivery of an increased plurality of descriptive examples.

14. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes double-bind quizzes and questions to crystallize positive compliance.

15. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes an interactive quiz.

16. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage utilizes time and place shifting in delivering said individual specific content based communication.

17. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage integrates context-dependent memory for said individual's particular behavioral issue into said behavioral routine.

18. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage uses state-dependent memory for said individual's particular behavioral issue into said behavioral routine.

19. The system as specified in claim 1 wherein said behavioral routine for changing said selected temporal behavioral stage comprises means of awarding and crediting rewards from a predetermined deposit.

20. The system as specified in claim 1 wherein said feedback means for receiving said individual's response comprising an electronic weight scale that does not allow the individual to view his weight.

21. The system specified in claim 1 wherein said feedback means for receiving said individual's response comprising an olfactory unit to provide smells in association with said database.

22. The system specified in claim 1 wherein said feedback means for receiving said individual's response comprising a voice stress analyzer.

23. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprising using an interactive television system.

24. The system specified in claim 1 wherein said feedback means for receiving said individual's response comprising an EEG measuring and recording device.

25. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprising an interactive video system.

26. The system specified in claim 1 wherein said program means for delivering said individual specific content based communication addresses stored information from an optical disc.

27. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a cellular phone system.

28. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a dual tone multifrequency set having voice recognition.

29. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a Local Area Network (LAN).

30. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises text and sound message software.

31. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises asynchronized transfer mode (ATM).

32. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a software agent program having remote programming.

33. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a cellular digital packet data (CDPD) network.

34. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises an interactive video system.

35. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a personal digital assistance.

36. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a wireless interactive personal communicator having the shape of a woman's compact.

37. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a wireless personal communicator.

38. The system specified in claim 1 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises a wireless interactive personal communicator having the configuration of a wristband containing a two-way communication unit.

39. The system specified in claim 1 wherein said feedback means for receiving said individual's response comprises a timing device for measuring said individual response latency.

40. The system specified in claim 1 wherein said feedback means for receiving said program means including transmission means comprises a personalized monograph delivering said individual's specific content based communication.

41. The system specified in claim 1 wherein said program means including transmission means comprises a behavioral contract for delivering to said individual specific content based communication received from an earlier response.

42. An interactive preventative medical guidance system for use by a client comprising:
a) means for recording and accessing a client's database that includes a client program which incorporates for each client, a calling schedule and personal identification number;
b) means for reinforcing predetermined client behavior based upon said means for recording and accessing said clients database by use of an expert who determines for each client one of either specific motivational messages, stimuli or questions which are to be responded to by the client;
(c) a computer having means for accessing said client database and said client program, said computer producing in sequence, a digital telephone signal that corresponds to a client's telephone number, a digital client validation request signal and one of either said motivational messages, stimuli or questions determined by said expert as said means for reinforcing said predetermined client behavior that are only sent if said client's validation request signal is responded to by the client with a valid personal identification number,
(d) means for converting digital signals produced by said computer to telephone tone signals that are sent to a client's dual tone multifrequency telephone set via a telephone network where said telephone set is queued to respond to the client's validation request, hear said motivational message(s) and to respond to said questions;
(e) means for converting telephone tone signals originating at said client's telephone set to digital signals for application to and processing by said computer; and
(f) means for permanently recording and evaluating all outgoing and incoming client communications for periodic reevaluation by said expert for updating said motivational messages, stimuli or questions determined by said expert as said means for reinforcing said predetermined client behavior.

43. The system as specified in claim 42 wherein said means for recording and accessing a client's database comprising a compact disc and a compact disc player interfacing with said computer.

44. The system as specified in claim 42 wherein said means for recording and accessing a client's program comprising a compact disc and a compact disc player that interfaces with said computer.

45. The system as specified in claim 42 wherein said computer comprising an IBM-AT compatible computer having an 80386 micro processor or equivalent including a Dialogic D41 4-line speech card.

46. The system as specified in claim 42 wherein said means for converting said digital signals from said computer to telephone tone signals comprising a digital/telephone tone signal converter having circuit means for performing the conversion in either direction.

47. The system as specified in claim 42 wherein said means for reinforcing a client's program comprising an electronic weight scale that does not allow the client to view his/her weight.

48. The system specified in claim 42 wherein said means for reinforcing a client's program comprising an olfactory unit to provide smells in association with said client database.

49. The system specified in claim 42 wherein said means for reinforcing a client's program comprising a voice stress analyzer.

50. The system specified in claim 42 wherein said means for reinforcing a client's program comprising using an interactive television system.

51. The system specified in claim 42 wherein said means for reinforcing a client's program comprising an EEG measuring and recording device.

52. The system specified in claim 42 wherein said means for reinforcing a client's program comprising an interactive video system.

53. The system specified in claim 42 wherein said means for reinforcing a client's program addresses stored information from an optical disc.

54. The system as specified in claim 42 wherein said mediation means for determining a behavioral goal routine is a peer.

55. The system as specified in claim 42 wherein said mediation means for determining a behavioral goal routine is a manager.

56. The system as specified in claim 42 wherein said mediation means for determining a behavioral goal routine is a supervisor of a manager.

57. The system specified in claim 42 wherein said transmission means for delivering said individual content based communication and said feedback means for receiving said individual's response comprises ISDN.

58. A method for an automated and interactive positive motivation system comprising the steps of:
(a) recording a client calling schedule and personal identification number for a client;
(b) storing said recording of said client calling schedule and said personal identification number in a client database;
(c) producing a digital telephone signal that corresponds to said recording and said storing of said personal identification number in accordance with said client calling schedule in said client database;
(d) converting said produced digital telephone signal to telephone tone signals in correspondence to said recording and said storing of said personal identification number in accordance with said client calling schedule in said client database;
(e) sending said telephone tone signals from said converting of said digital telephone signal in accordance to said recording and said storing of said client calling schedule in said client database to a client's dual tone multifrequency telephone set;
(f) comparing said telephone tone signals from said converting of said digital telephone signal corresponding to said personal identification number in said client database to a client's telephone tone signal input wherein if a match is found, a program means delivers one of either motivational messages, stimuli or questions to said client; and
(g) processing said client's response to said motivational messages, stimuli or questions by said program means and permanently recording said client's response in said client database, whereby said client calling schedule in said client database is updated by said program means for producing and converting said digital telephone signal in accordance with said client calling schedule to deliver another set of said motivational messages, stimuli or questions to said client.
Description
TECHNICAL FIELD

The invention pertains to the general field of information exchange services, in business, education and personal health care and more particularly to a computerized telecommunication system that conveys health awareness and goal management messages which maintain surveillance over patents, clients or employees by periodically sending behavioral motivation reinforcement messages and/or questions that require a patient's or employees interaction. In addition, the system uniquely utilizes social power through the avenue of telecommunications for modifying human behavior. It draws upon or is utilized by various authority figures or peers alternatively for modifying or reinforcing individual behavior. The invention can be supplemented by the addition of an additional expert or authority figure such as a physician or administrator to the system for providing interactive behavioral and motivational guidance to increase healthy behavioral changes to the patient or employee's prescribed medical regimens or work goals based upon his interaction over a period of time. Alternatively, peers or other persons of social influence may be added through its system to enhance each individual's performance.

BACKGROUND ART

One of the major advances of present-day society is in the field of computerized telecommunications. Today, in the growing fields of social psychology, behavioral medicine, and human motivation, formal verbal interchange is essential to provide modification of behavior and reinforcement. By using computerized telecommunications coupled with voice recognition technology, a client's or employees behavior can be modified and reinforced at the site where behavior occurs and wherever the client or employee goes. It has been found that as the frequency of reinforcing feedback increases, the client shows more rapid progress towards a particular goal. Similarly, the establishment of goals requires feedback and feedback requires goals, thus feedback is one of the key mechanisms in which goals are attained.

However, numerous studies have shown that feedback in itself does not have the power to motivate performance without the establishment of goals. By utilizing a system of continuous computerized reinforcement, a client or employee can be provided with more opportunity and greater frequency of therapeutic contact or feedback than through treatment or supervision in person. Additionally, the use of an interactive system vastly increases the therapeutic effect of this method of behavioral modification and reinforcement. As such, the subject invention uniquely mediates positive or beneficial expectancies of the physician, counselor, manager, administrator or other authority figure to the patient, client or employee.

Learning is enhanced through interactive feedback, and feedback in some form heightens the learning experience. The number of times in school a teacher asks any one child for an answer is fairly limited. Most of the time, children raise their hands and respond, and get back a "right" or "wrong." If they are wrong, they have lost their chance, and someone else is called upon for the answer. In traditional adult education, motivation and behavioral modification, the amount of continuing feedback is limited to the time actually spent with a counselor or supervisor, or in a class or seminar. Here, too, the feedback is limited to the actual time the physician, counselor, supervisor or trainer spends providing interaction with any one client or employee. By contrast, the addition of a computer and telecommunications or broadcast transmission allows "narrowcast" interaction and feedback on a continuous 24-hour basis to the client or employee wherever he goes, allowing for far greater frequency of interaction. Most importantly, in the case of adult behavior modification, this feedback, reinforcement and resulting motivation becomes available for the first time at the site where the behavior occurs.

Learning by playing and doing is fundamental to all mammals. While audio broadcast or telecommunications are media based upon hearing, and video broadcast is a medium based upon seeing, interactive feedback utilizing these architectures is a medium based upon doing or responding to the stimulus of feedback. Recent studies have revealed that the single best way to increase mammalian intelligence is through interactive stimulation. The frequency of feedback that we receive in relation to goals generally is the single greatest factor affecting learning, motivation and modifying behavior. Further, learning by receiving immediate feedback is preferable to receiving a delayed response. Children prefer interactive television games to merely watching a television program. They become impatient with long strings of dialogue, and the focus of their attention is diverted by devices providing rapid feedback. Adults display the same behavior throughout their lives. For example, when purchasing an appliance, they rarely read the instructions before trying to use it. The need to receive continuing feedback, at all levels of life, is a human characteristic, thus providing a basic survival mechanism which fosters learning and continuing growth. When feedback is combined with goals it becomes a powerful motivating force.

Research indicates that learning is enhanced by interactive feedback. Where the quantity of interactive feedback is increased, focus is sustained or increased, thereby stimulating keen responsiveness, as is the case with video games. The active involvement required to respond by answering provocative questions stimulates conscious awareness of and focus on the issue at hand. Learning, motivation and behavioral modification systems that incorporate rapid feedback foster problem-solving abilities, pattern recognition, management and allocation of resources, logical thinking patterns, memory, quick thinking, and reasoned judgment. Most importantly, when these skills are practiced at the site where the desired behavior is to occur, learning is more vivid and is quickly integrated into real life.

A sense of control is perceived with the provision of feedback. By engaging the client or employee to direct his focus and asking provoking questions, involvement is increased and stimulation results. When the individual learner achieves success and immediately receives positive feedback, self-esteem is rapidly built. When success is rewarded, confidence and resilience are enhanced and knowledge is created.

Historically, individuals have sought self-improvement, guidance and learning through self-help books, manuals, seminar workshops, personal counseling and programs of a periodic or short duration. With the best of intentions relapse usually occurs within several days after reading a book or attending a seminar, or several months after the conclusion of a behavioral modification program.

In contrast, computer-derived, self-adjusting motivational guidance, which interactively cues and polls the client and comments on his performance as he goes about his daily life throughout the year, has a more lasting effect. It differs importantly from seminars and visits to counselors or with a supervisor in that it modifies behavior at the site where the behavior occurs, with personal or customized intervention. The more frequent interactive dialogue between the counselor or supervisor-controlled computer and the client or employee enhances the feedback and therapeutic simulation in much the same way as has been experienced in other interactive communication structures, such as education and entertainment. For instance, consumers accord a higher value to interactive entertainment software than to passive software, due to the greater stimulation afforded by this mode. In entertainment software, an example would be some of the new video games that present a mode which runs like an animated cartoon until one elects to interact. As an animated cartoon, the video usually becomes boring within minutes. But as an interactive video game, the software stimulates the user with hours of entertainment.

In our culture, it is usually assumed that, given adequate information, people will use it rationally. Numerous studies have indicated that compliance with medical recommendations alone is less than perfect and generally only approaches 50 to 60
percent in many instances. Many physicians assume that if an individual is exposed to verbal information pertaining to his or her health issue, that behavioral change will take place. Given this viewpoint, the physician's responsibility is often seen as ending when the proper words are spoken. In fact, many problem behaviors and compliance with various medical requirements require constant feedback and adjustment over an extended period of time. Likewise, in other forms of education, personal management, sales and advertising, continuing reinforcement is often necessary to achieve the desired results.

Before a patient or employee can be expected to follow the intended recommendation of a physician, supervisor or counselor, he must have a thorough understanding of what is expected of him/her. One major criticism of contemporary medical care is that patients do not receive as much information as they would like. The resultant dissatisfaction precipitates a tendency to (1) ignore the physician's or counselor's recommendations, (2) forego follow-up appointments and (3) "shop" physicians rather than continue with one whom he feels is too vague.

In medical practice, initially, the physician must establish a baseline of the patient's knowledge to determine the extent of the patient's understanding, his grasp of the rationale behind the recommended behavioral changes, and his perception of the actions such changes will entail. It is important that the physician confirm the patient's understanding by having the patient repeat the explanations and instructions he has received, or by asking the patient to rephrase them in his own words. Too frequently, a physician will disregard this procedure because of time constraints or because he is uncomfortable doing so--circumstances that need to be addressed by the physician.

Of valuable assistance in successful behavioral modification is social or referent power, which is defined as the "primary basis of the social action becoming a significant other, a person whose approval and acceptance is highly regarded." Incorporating the use of social or referent power into a behavioral modification program entails three phases: (1) building, (2) using, and (3) retaining referent power.

Phase I is typically established during the physician/patient information-provision stage, during which the patient database is determined. Once established, referent power can be applied during Phase 2, with the physician offering both directives and encouragement to the patient.

Behavior modification necessitated by a medical condition requires that the patient subscribe to a particular medical regimen. Tailoring a regimen comprises (1) consideration of the various facets of the patient's existing routine and (2) modification of the regimen to minimize changes in the patient's lifestyle. The patient's cooperation is often proportionate to the degree of change demanded of him. If fewer behavior modifications are expected, the patient is more likely to adhere to the regimen.

The quality of the physician-patient relationship is critical to the success of a prescribed medical regimen, with the physician's interpersonal skills and manner central to the patient's perception of the physician. A patient responds to the forthcoming changes in his lifestyle emotionally; a physician responds professionally. The result is frequently a dissatisfied patient, one who sees his physician as unfriendly and uncaring. Equipped with this opinion, a patient is much less likely to heed the parameters of his regimen. The evolution of a therapeutic physician-patient alliance can only occur if the physician conveys--both verbally and nonverbally--his interest in the patient, vis a vis giving a patient the cathartic opportunity to tell his own story, expressions of respect, and empathetic concern.

In research literature on social power and influence, the degree to which patients comply with the recommendations of health care practitioners has often been seen as directly related to the physicians' use of referent, reward and coercive powers. Generally, medical recommendations are mentally internalized by patients based upon the regard in which they hold the caregiver and the continuation of some form of positive reward or reinforcer. However, in modern medical practice, physicians have shown that they generally lack the time, inclination or financial incentives for the continuing monitoring of a patient's behavior and compliance with the prescribed regime.

Therefore, a need exists for a computer driven interactive two-way communication link that increases the opportunity to create realistic and engaging behavioral reinforcement and guidance in the home or office and at remote locations, with both stationary and portable wired and wireless communication devices to assist the physician in the practice of medicine by facilitating compliance with medical requirements in regard to their patients. Similarly, a parallel situation exists in business organizations for the motivation of employees on a continuing basis in their natural environment.

Although in medicine, a physician is crucial to achieving permanent behavior change, other components of the primary health care organization are also important. Optimally, the physician-patient contact provokes a commitment from the patient and the initiation of a behavior modification program. Maintenance of such change necessitates methodical instruction, coaching, and protracted follow-up. For example, a patient diagnosed with chronic heart disease will require more than just prescribed medication. He will need to institute or revise his exercise regimen, relearn cooking habits, and appraise stress-inducing activities. Such extreme behavior modification will involve not just physician and patient, but nurses, clinic aids, conferences, and possibly educators, dieticians, social workers and psychologists.

Furthermore, psychotherapy outcome studies have been aimed at how people change their behavior, with and without the use of psychotherapy counseling. The results of these outcome studies have produced a number of definitive structures or models of the process of change that underlies both self-initiated and therapy-assisted modification of human behavior.

In the past, these processes have been administered ad hoc or randomly by various counselors and supervisors within verbal exchange processes, in person or through various methods including but not limited to bibliotherapy, direct telephone contact and counseling, group therapy sessions and seminars. Furthermore, it must be remembered that outpatients, on the average, spend about 99 percent of their waking week outside of a therapy situation. Therefore, in medicine there are advantages to having a medical regimen and behavioral guidance parallel those self change efforts or techniques that patients utilize outside of the physician's office into their daily lives. The disadvantages of the prior art are overcome by the present invention which provides a more comprehensive approach while affording greater convenience and increased interactive contact for physicians, psychotherapists and various counselors as well as supervisors, managers and administrators in a commercial setting.

Years ago, family physicians developed their social power to such a high degree that patients would strive to get well by compliance with his medical recommendations. Due to trends toward greater specialization, medical economics, and use of evolving technology, the physician house call has generally become no longer possible. The subject invention, by utilizing various telecommunication devices and computers, uniquely permits the greater personalization of medical treatment on a continuing basis. Today, physicians are not able to spend the time to make effective use of the variety of behavioral techniques available for motivating patient compliance. However, by the use of the present subject invention which extends the physician's recommendations and monitors their implementation uniquely through a counselor and computer, former patient rapport and affiliation can be reestablished. In the commercial marketplace, various supervisors can orchestrate and monitor employee goals by providing continuing feedback and guidance regardless of where they are located.

Therefore, a need exists to apply and distribute behavioral change processes, individually and collectively, through the medium of computerized telecommunication in association with a physician, manager or person of authority or influence. More particularly, this need is magnified due to the large number of variables and combinations in timing the administration of processes and behavioral changes throughout a given, prescribed medical regimen. The computerized administration and transmission of these social, behavioral and motivational processes, both separately and collectively, is a novel and unique advancement not known in the art.

In summary, a computerized interactive system increases the patient's or employees ability to resolve his medical or work problems at the site where his behavior occurs, and adjusts him within the framework of a preset goal. By including, within the context of the personalized message, challenges in the form of questions, an entertaining and stimulating process can be added due to the increased feedback or interactive nature of new telecommunication technology.

With regard to the prior art, many types of systems have endeavored to provide an effective means for providing surveillance over the behavioral modification of a patient or client by using a telecommunication link. However, these prior art systems have not disclosed an adequate and cost-effective telecommunication network that uses a computer in combination with a telephone or other platforms to provide positive behavioral based motivational messages and/or questions that are answered by a patient or client by means of a dual tone multifrequency telephone set or other platforms.

Further, the prior art systems have not disclosed utilization with such hardware as voice stress analyzers, on line services, olfactory units, CD-ROM platforms, interactive television in connection with a telecommunication link as a further behavioral modification means in use with the client or employee.

A search of the prior art discloses patents that show different types of feedback mechanisms:

______________________________________ PATENT NO. INVENTOR ISSUED ______________________________________ 3,742,938 T. J. Stern 03 July 1973 3,808,694 W. Y. Hutchinson et al. 07 May 1974 4,112,425 G. J. Zobrist et al. 05 Sep. 1978 4,237,344
Moore 02 Dec. 1980 4,328,494 R. Goodall 04 May 1982 4,377,214 G. G. Hansen et al. 22 Mar. 1983 4,396,976 G. P. Hyatt 02 Aug. 1983 4,602,127 J. F. Neely et al. 22 July 1986 4,773,492 E. Ruzumna 27 Sep. 1988 4,831,242 W. H. Englehardt et al. 16
May 1989 4,835,372 Gombrich et al. 30 May 1989 4,916,435 Fuller 10 Apr. 1990 4,922,514 Bergeron et al. 01 May 1990 4,912,552 Allison III et al. 27 Mar. 1990 4,933,873 Kaufman et al. 12 June 1990 4,952,928 G. T. Carroll et al. 28 Aug. 1990
5,008,835 Jackmann et al. 16 Apr. 1991 5,014,298 Katz 07 May 1991 5,018,736 Person et al. 28 May 1991 5,023,901 Sloan et al. 11 June 1991 5,036,462 Kaufman et al. 30 July 1991 5,038,800 K. Oba 13 Aug. 1991 5,068,080 Impink Jr. et al. 26 Nov. 1991
5,085,527 P. A. Gilbert 04 Feb. 1992 5,126,957 S. B. Kaufman, et al. 30 June 1992 5,127,003 W. J. Doll, Jr. et al. 30 June 1992 5,142,484 S. B. Kaufman, et al. 25 Aug. 1992 5,170,426 F. D. D'Alessio, et al. 08 Dec. 1992 5,189,395 M. S. Mitchell
23 Feb. 1993 5,206,897 N. Goudreau, et al. 27 Apr. 1993 5,218,344 J. G. Ricketts 08 June 1993 5,219,322 L. R. Weathers 15 June 1993 5,224,173 R. J. Kuhns, et al. 29 June 1993 5,245,656 S. K. Loeb, et al. 14 Sep. 1993 ______________________________________

The Sloan et al., patent discloses a surveillance system which integrates voice identification with passive monitoring mechanisms. The system comprises a central station located at a supervisory authority and a plurality of remote voice verification units. Each unit is located at a designated locality for an individual under surveillance and is connected to the central station via telephone lines. The central station consists of a control computer system and a violation computer system. The central station maintains and analyzes all relevant data for each individual, and initializes and retrieves information from each voice verification unit. Each voice verification unit conducts a voice verification test of a respective individual according to test schedules outlined by the central station. Test and monitoring results obtained during a defined surveillance period are transmitted to the central station on a periodic or exigent basis. Each remote station has a modem input, test means input connected to a microphone, and a third input to receive passive monitoring signals. The active and passive signals are analyzed according to an algorithm and command signals received from the central station. The test means also has an output to prod the individual to speak a preselected series of words. The test schedule in each remote is randomly created for each period and individual.

The Fuller patent discloses a remote confinement monitoring station and system with a central office that provides means for automatic selection of a specific confinee. The central office selects scheduled or semi-random monitoring calls, to avoid a high degree of predictability by the confinee, auto dialing means for transmission of a prerecorded or synthesized audio instruction message to the confinee, and recording of information received in response to the acts of the selected confinee preformed in response to the communicated message. The central office has a computer with a telephone line modem, a voice synthesizer, and other accessories and displays for automatic recording of data received including a visual camera image and breath analyzer results, and can include automatic image comparison and violation signal alarming.

The Moore patent discloses a rapid response hospital health care communications system. The system includes an auto dialer telephone system to allow patients to communicate from outside the hospital to receive advice and health care as indicated by the patient's medical profile. The communications system includes a health care console with an information storing computer connected through various communication paths to in-hospital patients, and by telephone means to out-of-hospital patient locations. Each out-of-hospital location includes a communication interface with a telephone, a console, and a hand-held remote control comprising a plurality of sensors, indicators and features. The interface includes an auto dialer and auto identifier that dials the health care console and identifies the patient by a computer recognizable code.

The Kaufman et al., patent discloses an interactive patient assisting device that has both preselected doses of medicine and a physical testing device that can communicate with a remote medical center over the telephone system. The system includes a clock/calendar unit that can be programmed to establish a schedule of a variety of activities, a pharmaceutical dispenser, a voice synthesizer and recognition unit, a computer, displays, and monitor means for blood pressure, oxygen and temperature. For communicating to a remote location, an automatic dialer, modem and telephone are included.

The Bergeron et al., patent discloses a method and system for the dispatch of resources to remote sites in response to alarm signals. A processor accesses the database of, for instance, a field service engineer designated to provide services to particular remote sites in response to the alarm signals received from those sites. The processor then attempts to establish a telephone connection with the field service engineer and provide the engineer with information by means of synthesized voice messages. The system may execute remote diagnostic programs and determine the results and attempt to communicate with selected resources. The system has a conventional processor with a database, voice synthesizer, voice system and auto dialer. When the system dials and the telephone is answered, the system requests an identification code by means of the touchtone buttons before it communicates.

The Hutchinson patent discloses a weighing and height measuring device. It is especially adapted for use with a remote digital read-out system. The device comprises a weight responsive moving platform connected by cable to a remote digital read-out unit. One of the objects of the invention is to provide a weight measuring device adapted for use with a remote read-out and/or computer input device.

The Stern patent discloses a cardiac pacer and heart pulse monitor for remote diagnosis wherein information from a pair of sensors is transmitted by means of a telephone handset and transmitter, over a commercial telephone system to a remote receiver. Information received at the receiver may then be processed by means of an appropriate computer and program system.

The Carroll patent discloses an adaptable electronic monitoring system. The system is configured to fit the needs of a particular monitoring or identification application by selecting appropriate modules. The system provides for monitoring at a central location and communication between the location of the sensed information to the processing site by means of a normal telephone communications system.

The Doll patent discloses a digital/audio interactive communications network. The digital network may be a wide area, metropolitan or local area network, and may communicate with other networks. The digital network ties a digital LAN server and an audio server together. The system works with software directed to a client/server architecture in an application that requires recording and playback of audio information.

The D'Alessio patent discloses a method and system for home incarceration using a telephone network and voice verification. The system has a control center with a process server connected to controllers through a LAN such as an ethernet or wide area network. New inmates are added by voice training so that the system can create voice templates of selected words. A data base of the voice templates and phone numbers, work schedules, etc. is created. Calls received are screened by using caller ID. Calls to and from the inmate are performed on a predetermined or random frequency, the frequency being a function of the patient's behavior. All activities are maintained in a log file.

The Ricketts patent discloses a method and system for monitoring personnel using computers and transceivers and a network. The interactive system monitors the identity and location of the inmates of a correctional facility, hospital, school or the like, and can alert the inmate that the inmate is entering a restricted area, or being approached by another inmate within a predetermined threshold distance. The inmate's transceiver can include a bar code for use of vending machines, telephone and the like, with the transactions being allowed or denied by the computer.

The Weathers patent discloses a psychotherapy apparatus and method for treating undesirable emotional arousal of a patient. The system presents visual and audio stimuli in each ear and eye separately and synchronously and alternately, the presentation being controlled in response to the patient's physiological responses to the stimuli. In addition to the behavior modification stimuli supplied to the patient by the computer, an operator, using a microphone, can direct the patient's attention.

The other cited patents are for background purposes and are indicative of the art to which the invention relates.

It will be noted that the above mechanisms and systems do not allow the utilization of various well known elements used in a unique random calling manner with a client, employee or patient database and client, employee or patient program of prescribed messages and/or questions for particular persons. More particularly, the instant apparatus and method provides a uniquely reinforcing approach of allowing the physician, person in authority, peer, or expert to use prescribed messages and/or questions for particular persons. More particularly, the instant apparatus and method provides a uniquely reinforcing approach of allowing the use of random calls at random locations from a list of possible locations where a client, employee or patient may be located. Furthermore, this system utilizes existing telecommunication technology including pagers, online services, etc., unlike many of the devices described in the above referenced patents.

SUMMARY OF THE INVENTION

The automated and interactive positive motivational system is designed to be used by doctors, psychologists, counselors, managers, administrators, peers or other trainers to provide motivational messages and/or questions to clients, employees and patients having behavioral and various addiction, volitional or motivation problems. Its basic configuration comprises:

(a) means for recording and accessing a patient's database that includes for each patient the name, schedule of telephone numbers where the patient may be reached during each 24-hour period, personal identification number, and previous history of messages and the patient's responses;

(b) means for measuring and recording a patient's weight without revealing their weight to them and transmitting said weight information telephonically for use in a weight reduction program;

(c) first means for recording and accessing a patient's or employees program that includes for each patient or employee specific motivational messages, personal and unique metaphoric references, goals, and/or questions that are to be responded to by the patient or employee through either the telephone, one- or two-way interactive beeper, personal communicator, modem, personal computer, or interactive television;

(d) a computer having means for accessing the patient database and said patient or employee program. If a match is found between a patient's or employee's database and patient or employee's program, the computer produces a sequence, a digital telephone signal which corresponds to his telephone number or beeper or personal communicator number, a digital patient or employee validation request signal and a digital motivational message(s) and/or questions. The messages and/or questions are only then sent if the patient's or employee's validation request signal is responded to by the patient with a valid personal identification number (PIN) in the telephone mode, or broadcast without a PIN with a beeper or personal communicator;

(e) means for converting the digital signals produced by the computer to telephone tone signals that are sent to a patient's dual tone multifrequency telephone set or computer and modem via a telephone network. The telephone set or a computer is used to respond to the computer's validation request, hear the motivational message(s) and/or to respond to the questions;

(f) means for converting the telephone tone signals originating at the patient's telephone set, personal computer, or hand-held wireless device, to digital signals for application to and processing by the host computer; and

(g) second means for permanently recording all the outgoing and incoming patient or employee communications.

An important object of the invention is that the system manipulates speech messages that are stored, not in an analog format common to audio tape storage systems, but in digital format that is stored on a read-only compact disc, a computer hard drive or the like. The use of compact discs allows the system to access files quickly and accurately. Therefore, it is possible for the computer to access more than one speech file at a time. Each telephone line that the system is servicing is actually a small "slice" of computer time during which speech files are being played from or recorded. The more lines that are active, the more slices of time that must be managed. The system provides the functions to operate with more than one telephone line simultaneously, thereby allowing a physician, manager or other counselor, at all times over a 24-hour period, to process and supervise many more patients or employees than otherwise. In addition, the system allows for a patient or employee to receive more doses of behavioral intervention over any time period than in any other manner.

Another object of the invention is directed to accomplishing most tasks in a voice response application by accepting, recognizing and making decisions based on a keypad input from the caller's dual tone multifrequency telephone or computer. The telephone keypad generally sends dual tone multifrequency (DTMF) tone signals but occasionally multifrequency (MF) tones are used by certain types of telephone switching equipment. While these two signalling methods are not compatible, the system will work with either one equally well.

Still another object of the invention is the use of digitized voice signals for the transmission of messages to the patient or employee. Digitized voice signals are typically made by sampling the voice wave form 6000 to 8000 times per second in order to accurately reconstruct good speech quality. Each sample takes 8 to 12 bits, this results in 48,000 to 96,000 bits of information per second that must be stored. It is common in telephonic applications for a digitized voice to be compressed by storing only the differences between samples. Therefore, the speech card that the system supports uses a compression technique known as Adaptive Differential Pulse Code Modulation (ADPCM) which recognizes that there is only a small difference between the speech samples and stores a logarithmic function of the difference between speech samples. The result is good speech quality at only 3000 bytes per second of data throughput.

Yet still another object of the invention is the utilization of an expert, such as a physician or authority figure, to a system of behavioral motivation and guidance which adds an additional dimension of support and, most importantly, increases the impact of the intervention. Often, individuals regard certain "experts" with elevated respect and regard their advice with increased attention. Various categories of experts, such as doctors, educators, scientists, and public personalities, are attributed elevated or enhanced knowledge by the public at large and their recommendations and advice are accorded greater recognition and enhanced value. Today in modern commerce, recommendations and endorsements by experts and public personalities are traded for monetary value in recognition of their value in facilitating the sale of goods and services to consumers. Likewise, in the practice of medicine, the recommendation of a physician is generally accorded higher import to a patient than that of a layman. In the field of commerce, a parallel example would be that of a person of influence who sits higher in hierarchy of his employer than that of his immediate superior. Alternatively, peers mediate social influence through their equalitarian or reciprocal relationships.

Therefore, the present invention involves a method to increase the impact of various behavioral modification formats, delivered by telecommunications, and administered by one or more computers. uniquely extends the prior art of physician counseling and sales, marketing and personal management techniques by the addition of an "expert" who is regarded by the patient, consumer or employee with a degree of respect or regard at appropriate or strategic times during the behavioral process or intervention. In addition, it provides for the addition of peer influence for additional reinforcement and support.

Yet, another object of the invention is that the patient or employee program may be directed to any subject matter such as motivational training, teaching, psychological behavior modification, and reinforcement of a medical regimen, wherever motivations would be facilitated by daily or periodic intervention. The following is a partial list of some of the component areas that the patient or employee program may be directed to:

1. nutrition

2. exercise

3. weight loss (diet/weight management)

4. optimism (and hope)

5. life-long learning

6. time management

7. stress management

8. optimal health management

9. immune system enhancement

10. midlife transformation/emergence

11. women and men in aging and transition (heart disease, menopause, etc.)

12. control or self-discipline

13. compliance with medical requirements

14. pain control

15. anger management

16. acceptance of mortality

17. reforming the concept of aging

18. memory management

19. reformation of self-destructive behavior

20. transformation of regret

21. anxiety management

22. mental and physical resilience

23. early cancer screening and detection

24. an interactive journal

25. wake up and sleep meditations

26. control of performance anxiety and mental rehearsal

27. enhanced self-esteem

28. Short and long term goal management

Accordingly it is an object of the present invention to record the daily or periodic activity schedule of each patient or employee enabling contact with the patient or employee on a scheduled or random basis by telephone, personal computer or other means such as a wireless alpha-numeric pager, laptop computer, personal communicator, cellular phone, or modem that is used to contact patients or employees wherever they may be during the day or night. If the patient or employee misses a call, they may call in to the computer and get their message by using a specific password.

Yet a further object of the invention is that the patient or employee program in association with the use of an expert or authority figure will utilize one of several types of behavioral modification techniques. By way of example, but not of limitation, one such behavioral modification technique used may be the transtheoretical model of change comprising the six stages of behavioral change and the 14 processes of change, as interwining and interacting variables in the modification of health and mental health behaviors of the patient. These six invariant stages of behavioral change, which have been identified and to which the patient program may be directed, are:

1. Precontemplation

2. Contemplation

3. Preparation

4. Action

5. Maintenance

6. Relapse

The patient program further includes the associated 14 processes of change utilized to move the patient through the six stages of behavioral change. The following is a list of these 14 process areas that the patient program may be directed to:

A. Consciousness raising

B. Self Liberation

C. Social Liberation

D. Self re-evaluation

E. Environmental re-evaluation

F. Counter conditioning

G. Stimulus control

H. Reinforcement management

I. Dramatic relief

J. Helping relationships

K. Self efficacy

L. Temptations to relapse

M. Decisional pros

N. Decisional cons

The object of the present invention is to utilize these 14 processes within the previously cited six behavioral stages of individual growth, through computerized management and administration, by initiating prompts and cues and related educational material for guidance and reinforcement by the patient or employee program in association with the use of an expert or authority figure in addition to that of his supervisor, counselor or trainer.

Another object of the invention is that the use of an expert and the patient program may be directed to the field of chronic disease detection. More particularly, the patient program will provide periodic behavioral cues to aid the expert in the early diagnosis and cure of such chronic diseases as glaucoma, dental and periodontal disease, cancer, heart disease, and diabetes.

Still yet another object of the present invention is the use of the patient program to address issues for the management of such chronic diseases as diabetes, hypertension, and others where compliance with the expert's suggested medical regimen can be critical. By applying the aforementioned transtheoretical model, the patient program will provide the gradual courage to overcome individual resistance and to reinforce periodic self and physician examinations while extending the relationship with the expert in a manner heretofore not known.

Yet another object of the present invention shall be the formulation and publication of individually customized information in the form of reports, or graphs, indicating performance and response profiles, educational monographs, and tutorials and other materials necessary for providing motivation and education for use by both the counselor, expert and the patient or employee. By storing in a data base memory device a group of prerecorded informational data of a generalized nature and accumulating personal response profiles in said memory device, it is possible to mix or formulate a customized set of unique and individual printed educational and medical record documents.

Another object of the present invention would be that for each individual patient or employee, based upon his education, gender, age, demographic profile, psychological profile and prior response profiles, an educational document and text would be formulated according to the individual's present behavioral stage.

A further object of the present invention is to provide a large central mainframe computer or interconnected series of personal computers containing a multiplicity of microprocessors which could be used by local or regional clinics and hospitals for interactive, telecommunication and/or multivideo transmission for enabling thousands of individual patients to be provided interactive medical guidance and feedback in real time or delayed service, whereby a hospital may currently serve a greater outpatient population in its locality and place increasing emphasis on home health care.

Another object of the present invention is to use higher capacity transfer modes of transmission such as asynchronous transfer mode (ATM) and Integrated Services Digital Network (ISDN) as an alternative method of transmission for behavioral guidance and motivational reinforcement. Since the present invention relies upon telecommunications which are transmitted or delivered synchronously, this alternative embodiment relates to the asynchronous transmission of information by both wire and wireless means in private and public networks. Therefore, an additional object of the present invention is to use such higher capacity transfer modes as asynchronous transfer mode and ISDN for both data and real time and delayed transmissions; as an example, voice and video wherein it is equally adaptable to both local and wide area networks.

The rationale of the system is that man is in a continuous state of growth and development. The system provides the motivation and reinforcement through continuous daily monitoring of each patient as he works towards his basic goals for optimal health by maintaining prescribed regimens or goals. By this daily or periodic reinforcement and guidance utilizing interactive feedback, the system is able to maintain the organization and intervention between the physician, counselor, manager, the patient, or employee and his or her goals.

By mobilizing patients to accept responsibility for their own health through behavioral guidance in preventive health programs and to comply with medical prescriptions in the dispensing and taking of medicines, large savings can thereby be realized, contributing to national goals of medical cost containment. The aging of the population necessitates greater health care expenditures which in turn are aggravated by the possibility of older individuals having one or more chronic diseases wherein non-compliance with medical regimens can become financially costly, dangerous and even life-threatening. Likewise, large savings can accrue by keeping employees motivated and focused on assigned goals.

These and other objects and advantages of the present invention will become apparent from the subsequent detailed description of the preferred embodiment and the appended claims taken in conjunction with the accompanying drawings.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a block diagram showing the interactive activity between the system and a patient, client or employee;

FIG. 2A is an application flowchart of the computer software program. FIG. 2B is a continuation of the application flowchart of FIG. 2A; and

FIG. 3 is a diagram of the spiral model of the stages of change utilized by the expert in association with the client program.

DESCRIPTION OF THE PREFERRED EMBODIMENT

An optimal best mode for carrying out the invention is presented in terms of a preferred embodiment that is designed to allow doctors, psychologists, counselors, managers, peers and other trainers to maintain surveillance over their patients or employees by utilizing a wired or wireless telecommunication link to perform automated information exchange. The preferred embodiment of the interactive social process guidance system 10, as shown in FIG. 1, comprises a means for recording and accessing a patient's or employee's database 12 and a patient's or employee's program 14, by using a computer 16, having a digital signal/telephone tone converter 18 and a printer 22, wherein access means comprise a telephone or other wired or wireless telecommunications network 24 and a patient or employee dual tone multifrequency telephone set 26. A patient or employee 50 uses the system 10 which can also be enhanced by the incorporation of the following elements that are operated by the aforesaid network 26: a modem 30 that operates a computer printer or facsimile machine 32, an alpha-numeric one-way or two-way pager 34, a two-way interactive message device 36, an electronics scale 38, an olfactory unit 40, a voice stress analyzer 42, an interactive television system or personal computer 44, an EEG or blood sugar or blood pressure or heart monitor or cholesterol measuring and recording device 46, general or personalized monographs, interactive video, optical discs, i.e., CD-ROMs, cellular phones, and a timing device 47 for measuring response latency.

The patient or employee database 12 in the preferred embodiment consists of a compact disc (CD) recording that is played back on a CD player that interfaces with the computer 16 as shown in FIG. 1. However, other database recording and playback units can also be used. By way of example but not of limitation, these units include but are not limited to hard disks or other random access memory devices or a tape cartridge that is played back to the computer by means of a tape cartridge player or an optical disc and optical disc playback unit. The patient, client or employee database includes for each patient or employee 50, the patient's, client's or employee's name, their calling schedule by week, day and time, each patient's or employee's personal identification number (PIN), and previous history of messages received and response profiles.

The patient, client or employee program 14 in the preferred embodiment, is also recorded and played back by a CD player or other recording and/or playback units, as described above for the patient, client or employee database 12, and is connected to the computer 16 and to the telecommunications network 24 as shown in FIG. 1. The patient or employee program 14 is especially designed to serve a plurality of specific patients or employees. The program 14 can include as many motivational and reinforcement messages as are necessary to help with a specific behavioral problem. The motivational and reinforcement messages are designed to provide therapeutic or behavioral intervention at specific or random times and more particularly to provide therapeutic intervention at the site and appropriate time where the behavior to be corrected occurs. In the field of behavioral guidance and reinforcement it has been found that even with the best of intentions, relapses usually occur within several days following the reading of a book or attending a seminar to several months after the conclusion of a behavioral modification program. Thus, by transmitting feedback or progress towards goals plus behavioral motivation and reinforcement messages on a periodic or random basis, the behavioral modification program can continue on course to a curable or successful conclusion.

In addition to or in combination with the messages, the system 10 is also designed to send a patient or employee behavioral modification queries or polling questions. These questions may be answered by the patient or employee by pressing on a specific key on the keypad of the dual tone multifrequency telephone set, computer keyboard, touchscreen 26 or by use of a speech recognition device. The answers to the questions are analyzed by the patient's or employees doctor or trainer to find root problems and to determine the next series of messages and/or questions that are to be transmitted to him or her 50 at the next transmittal period. All messages, questions and the patient's or employee's response to the questions as well as the time, date, duration of each call and touch tones entered by the patient or employee 50 are retained in a permanent log or record by means of the printer or other type of storage device 22 which is directly connected to the computer 16 as shown in FIG. 1.

The telephone by its very nature, has always been interactive on a two-way basis and because of its wide usage it lies within the comfort zone of nearly all patients. The telephone is also cost effective and is convenient for both the caller and the patient. Additionally, social learning theories suggest that education carried out in the setting in which the behavior is taking place will have the greatest impact. Thus, telephone counseling at home or in the work place may have greater behavioral impact and relevance than that within the clinic. For patients who cannot come to a clinic because of their physical condition, distance or the presence of a psychiatric disorder that makes the intimacy of face-to-face contact intolerable, the telephone or other remote communications device is the sole available means for counseling. By calling patients on their transportable cellular telephones or other portable communication devices 58, behavioral reinforcement can also be provided for busy patients on the go and increase the instances wherein motivation can be provided in the place where the behavior occurs. In a similar manner, employees can benefit by the usage of such a system for motivation in the workplace.

The patient or employee database 12 and patient program 14 interface with the computer 16 that in the preferred embodiment consists of a personal computer. The patient or employee database 12 and patient or employee program 14 as described above, are externally stored as shown in FIG. 1. However, these elements may also be stored on a hard disc located within the computer 16 or on other mass media storage devices such as CD-ROM, writable optical media, or removable mass media cartridges. The computer 16 is configured in part to include a speech card such as a Dialogic D41 4-line or larger 16A, having a real-time clock 16B and a logic network 16C, operated by the system software 16D.

The Dialogic type card or other similar device 16A allows a speech compression technique to be used that samples a small difference between speech samples and stores a logarithmic function of the difference between the speech samples. This technique results in good speech quality at only 3000 bytes per second. The real-time clock 16B sets and selects the appropriate time for a particular patient to be accessed from the patient database 12 and the patient program 14. The logic network 16C provides the logic necessary to determine if a match between the patient or employee stored in the database 12 and in the patient or employee program 14 is available. The system software 16D provides the algorithms to operate the system 10 in combination with the logic network 16C. The operating steps of the software program are shown in the software flowchart included as FIGS. 2A and 2B.

As shown in FIGS. 2A and 2B, the computer program builds a patient or employee database and sets the database to a computer clock time. In a typical operating sequence, the computer 16 at a preselected week and time, accesses the patient or employee database 12 and the patient or employee program 14. If a match is found between the patient's or employee's database entry 12 and program 14, the computer 16 via the logic network 16C, produces in sequence, a digital telephone number and a digital patient or employee validation request signal.

Both of these signals are applied to the digital signal/telephone tone signal converter 18. The converter 18 includes circuit means to accept and convert the digital signals from the computer 16 to telephone tone signals that correspond to the patient's or employee's telephone number and a personal identification number. The converter 18 can also be designed to include a telephone number redial circuit and a random telephone number dialer circuit. The redial circuit allows a patient's or employee's busy telephone number to be automatically re-dialed at selectable time intervals. The random number dialer allows patient or employee telephone numbers stored in the patient or employee database 12 to be randomly selected and called.

From the digital signal/telephone tone signal converter 18, the telephone tone signals are applied as shown in FIG. 1 to a telephone network 24. The network 24 relays the tone signals to the patient's or employee's dual tone multifrequency telephone set 26 from where the patient or employee 50 can answer the telephone 26 and respond to the request to provide a personal identification number. The patient or employee 50 responds by pressing on specific keys on the keypad of the telephone set 26. If the patient or employee 50 responds with a valid number it is routed via the telephone network 24, back through the converter 18 to the logic network 16C in the computer 16. Upon the receipt of a valid number, the logic network 16C enables the patient or employee program 14 to allow the audio signals carrying the messages and/or questions to be transmitted via the telephone network 24 to the patient's or employee's telephone or computer 26 from where the patient or employee 50 can receive the message and respond to the questions.

The telephone network 24 used in the preferred embodiment is serviced by the local telephone public utility company, or cable company supplying telephone. However, if a closed circuit operation is desired, such as within the confines of a network, an enclosed area or building, a private telephone network or Local Area Network (LAN) may be employed. In either of the above scenarios the patient's or employee's dual tone multifrequency telephone set 26 may be hardwired to the telephone network 24 or, a transportable cellular 58 or a two-way pager 34 that uses RF or satellite communication links may be used. By calling a patient or employee 50 on their transportable cellular telephone or other device 58, the motivation message can in many instances be sent to the place where the behavior is occurring when the message carries its greatest effect. As also shown in FIG. 1 by dotted lines, in lieu of making the initial patient or employee contact by using the telephone set 26, the contact can be made by means of a modem 30, an alpha-numeric pager 34, a two-way, interactive, computer activated message display 37 or other such devices. If a modem 30 is used, it can be connected directly to a computer printer or facsimile machine (FAX), text screen telephone or on-line system 32. In this patient or employee alerting medium, after the patient or employee 50 receives a motivational message or a question, the patient 50 response can be made by calling the computer 16 on the dual tone multifrequency telephone 26 by use of a special computer access telephone number. Likewise, if an alpha-numeric pager 34 is used the patient or employee response would be made as previously described.

The use of a two-way interactive message display 36 further provides an enhanced patient or employee interface in that text and graphics can be included with the messages and questions. The display 36 is connected directly to the computer 16 via the telephone network 24 and digital/telephone tone signal converter 18. Additionally, screen and textual media position the software developed hereunder for future interactive television and multimedia applications when they commercially appear and may be added to the system.

Although not shown, it may be envisioned in one embodiment that a one-way or two-way, interactive message display 36 be in the form and design of a ladies' compact containing a mirror. The compact 36 comprises a small screen for the reception of alpha/numeric data which it receives over existing paging networks, and in addition, as an option, it may receive wireless voice transmission over a built-in speaker. For transmission purposes, in one embodiment, the compact 36 comprises four (4) response buttons which allow the patient 50 to respond to the messages and questions received either as data on the alpha/numeric screen or as audio transmission from the built-in speaker. In use, the compact 36 would utilize the before described cellular wireless, PCS or PCS modes and would operate on either analog or digital transmission.

Another embodiment would be a wrist communicator which would be used for providing behavioral modification through a one-way or two-way interactive message display 36 and designed to be attached to the wrist with a flexible band. The aforesaid device would receive data from paging networks or via wireless transmission and display the data on an alpha-numeric screen. For transmission purposes, the wrist unit 36 would contain response buttons, allowing the patient or employee 50 to respond to messages and polling questions transmitted from the personal communication device or via cellular transmission. Both the aforesaid ladies' compact 36 and the wrist unit 36 could operate through a variety of transmission modes in either analog or digital format.

Additionally, a unique software program which is commercially available instructs the computer to send text messages which are encoded to activate special software algorithms contained within the computer 16 receiving the messages via the modem
30. This special software contained in the receiving computer will activate either internal or external speakers or telephone handset in order that the text messages may be heard as the text scrolls across the screen. The sound emphasizes and enhances the text presentation, or the patient or employee 50 may choose to listen and not read the text while performing other tasks.

Likewise, an interactive television system 44 can be used wherein customized broadcasts can be responded to by individual patients or whole classes of subscribers, providing a low cost alternative to individual customized instruction. In addition to or in lieu of an interactive television system 44, an interactive videodisc system 54 comprising a videodisc player or similar means such as a CD-ROM or the like and monitor interfaced with a microcomputer may be used.

Additionally, the aforementioned speaking screen embodiment is equally applicable to all screen media, such as the aforementioned interactive television, screen telephones, personal digital assistants, communicators and computer terminals.

Alternatively, the aforementioned interactive data communications may be performed by asynchronous transfer mode or other high capacity transfer modes in addition to the currently available transfer mode commonly used to transmit digitized voice. The asynchronous transfer mode is one of a general class of digital packet switching technologies that relay and route traffic by means of an address contained within a very short, fixed-length packet referred to in the industry as a cell. Therefore, it is envisioned that the system 10 may utilize a packet switching technology as the aforementioned asynchronous transfer mode to route traffic by means of addresses contained within packets, in contrast to the transfer modes or technologies that route data over dedicated physical paths that are established during call set-up and remain fixed for the duration of a call. With the system 10 using asynchronous transfer mode, the creation of local area networks or LANs can be used for the mounting volume of traffic generated by the current patient or employee behavioral program. Moreover, unlike other transfer modes, an asynchronous transfer mode provides two further benefits: (1) it positions local area networks for future multimedia applications if they appear when more patients or employees are added to the system, and (2) it seamlessly integrates local traffic into the future wide area asynchronous transfer mode network.

With the use of optical discs or CD-ROMs 56, CDI and similar devices a computer-based information metering system is envisioned wherein a patient 50 may be billed through the use of an encryption-metering device only for amount of therapy the patient 50 wishes to access.

The motivation and behavioral messages and patient questions can also be used in combination with auxiliary devices to fortify the patient's messages or questions and provide feedback to the physician or counselor. For example, in the field of weight loss, an electronics scale 38 can be utilized to supply the timely weight of the patient to determine if a weight loss or gain has occurred during the reporting period. As shown in FIG. 1, the electronic weight scale is connected to an ordinary telephone line which automatically dials the telephone number associated with the operating system and transmits the weight of a patient 50 standing on the scale 38 digitally to the patient's program 14 and database 12 for later feedback and analysis in accordance with a weight reduction program.

The scale 38 prevents the patient 50 from becoming aware of their day-to-day weight fluctuations. This is consistent with new insights in behavior theory with respect to human motivation which allow an observer or instructor using the computer to review the patient's weight periodically through the use of the computer 16 which is at a remote location and can guide the patient 50 from time to time based upon the trend or average of their weight, and other devices such as glucose monitoring, blood pressure, heart rate, and cholesterol monitoring.

Yet another preferred embodiment shown in FIG. 1 incorporates the use of a voice stress analyzer 42, which offers a digital numerical evaluation of the speaker's voice stress level to monitor a patient's or employee's response during a behavioral motivation reinforcement question. Research by D. O'Hair and M. J. Cody entitled "Gender and vocal stress differences during truthful and deception information sequences," in Human Relations, Vol. 40, 1-14 (1987), indicates that voice stress analyzers can be objectively and unobtrusively used to detect vocal stress indicative of deception. If a patient or employee 50 knows that his veracity is being tested and that his responses are being analyzed for deception, then there is greater motivation on his part to adhere to the program 14 and hence more rapidly progress towards a particular goal. In addition, commonly encountered self-deception is reduced using this mode.

Yet another preferred embodiment would be a timing means which would be started at the end of a polling question. The timing meahs would be stopped upon commencement of the patient's or employee's response and the interval between the end of the question and the commencement of the response would be recorded. While polling is often useful as a means of determining a patient's or employee's progress, or lack thereof, it is extremely difficult to determine on the basis of traditional methods whether the response is based on an actual occurrence or feeling of the patient or employee 50 or whether it is fabricated on the spot for the purpose of providing an answer. In the former case, it is common to think of the attitude as being pre-integrated and crystallized and thus quite stable, whereas in the latter case the response represents an improvisation or may be lacking veracity. By first observing the patient's or employee's base line or time to respond to questions of known behavior or fact a typical observable pattern emerges. Later his pattern can be compared to the latency in response time to questions of unknown veracity. By measuring and observing the patient's or employee's latency response interval over a period of time, useful clues and insights emerge which can be used to assess and predict more accurately the degree of crystallization of a person's attitudes and resulting behavior. Such a latency response measuring tool could also be utilized in conjunction while a live counselor or manager is working in real time with the patient or employee 50.

This embodiment could be utilized in conjunction with any of the cited means herein of communicating polling questions. It is a unique application of determining latency of response to computerized behavioral reinforcement in order to determine the relative degree of crystallization of gradually learned behavior. A further advantage is that such method and apparatus would be transparent from the perspective of the respondent.

Another preferred embodiment incorporates the use of an EEG measuring and recording device 46 which can be used to assess hypnotic susceptibility either in the presence of the patient 50 or at some distance by use of a modem for transmitting signals which indicate various brainwave states. Behavior research indicates that there is an increase in alpha activity in the EEG when subjects are exposed to behavioral intervention techniques such as hypnosis, relaxation and meditation. In addition, studies with psychotropic drugs have demonstrated that increased and synchronized alpha activity is a characteristic of all the major tranquilizers. A 1972 study by G. A. Ulett, S. Akpinar and T. M. Itil ("Quantative EEG analysis during hypnosis," Electroencephalography and Clinical Neurophysiology, Vol. 33, 361-368) reported significant EEG differences between the hypnotic and awake states, with all subjects experiencing increased alpha activity in the hypnotic state. The computer 16
in this mode, receiving and analyzing the signals, can then adjust the intervention to correspond to the patient's 50 brainwave state.

Another preferred embodiment shown in FIG. 1, is a computer-driven system for behavioral and motivational reinforcement and guidance which can be applied to various modes of interactive television 44. Its feature of providing customized instruction, learning, and motivational prompts and cues, often where the behavior occurs, provides a unique approach toward directed interactive learning and behavior modification. Using interactive television 44, the computer-driven system converts the traditional broadcast format to a customized "narrowcast," where either classes of learners or individual subscribers are addressed according to their individual issues without specific categories, and each in turn returns individual specific responses to questions or polling, which are then recorded in the patient or employee database 12. This application becomes possible because of the larger number of channels available with fiber optic cable, wireless transmission or a combination of both facilitating two-way interaction.

It is envisioned that three separate modes of transmission from a computer with interactive television can be utilized:

(1) fiber optic cable for two-way communication--the computer transmission would appear on the subscriber's screen and he would in turn reply either through a remote control unit or telephone back over the fiber optic cable. The computer would receive his return transmission or reply and note it accordingly in its memory. Periodic and finer tuned follow-up reinforcement could occur via wired or wireless telephone based upon the patient's or employee's responses over specific time periods.

(2) coaxial cable--inasmuch as existing coaxial cable systems can transmit hundreds of times more data than a conventional telephone line, the subject computer driven system can transmit learning, motivational guidance and reinforcement to classes of subscribers over existing coaxial cable systems and the subscribers can reply using a remote unit containing computer hardware for reply back over the cable. Alternatively, the remote unit can contain a modem for reply back over wired or wireless telephone line.

(3) wireless transmission--subscribers without cable would receive the signal via antenna in the case of localized transmission or dish in the case of satellite transmission. The transmission would contain the computer driven learning, motivation and reinforcement. The subscriber would reply via wired or wireless telephone.

In each mode of transmission, subscribers can be reminded of an upcoming transmission via telephone 26 or wireless radio pager 34 as described herein. Additionally, explanatory brochures can be used with any of the above described interactions as a method of further reinforcing a patient or employee 50 toward a particular goal. With today's technology and regulatory infrastructure, programming for interactive television would remain in its current analog form and a special unit, usually a controller box plus remote positioned atop the TV set, would allow the viewer to dip into the data stream and manipulate what appears on the TV screen. With digital and compression technology (compression of up to six or more digital channels into the same bandwidth as one analog channel), a settop box would be used to decode and decompress video and audio signals in real time.

Another preferred embodiment is the use of a computer-based information metering system that uses optical discs 56 as transport and storage media, encrypting to protect data and is metered or by other payment means to permit usage by patients on a pay-per-view or pay per bit of information basis. The encryption-metering device would use digital technology and would be made available through cellular phones, wireless cable transmission, modem, interactive television and CD-ROM. Information would be distributed in encrypted form to users. After the user browses through the menu or index at no charge and selects the item needed, the encryption-metering device will decrypt the information required, record which data was used, by whom and for what issues or subjects, and will permit the user to be billed only for the data used. This information would be unreadable or unlistenable until decrypted and users would be charged based on the number of bits of information selected. A metering chip or computer board would be used to gauge data use just as an electric meter tracks power demand. Information may be retrieved in either full-text audio or image form. A decryption program keeps track of how much data is decoded and can subtract its costs from a prepaid credit stored on a chip as a form of payment. The encryption-metering technology may use a Microsoft Windows.RTM. based application or other commercially available software, with familiar graphical interfaces and menuing systems to which users are accustomed, and would be available on a variety of computer platforms.

Another preferred embodiment is the use of CD-ROM or CDI 56 (Compact Disc with Read Only Memory), a high-density storage and delivery medium similar to digital audio compact discs, which stores vast amounts of data in a digital form. Each CD-ROM
56 will hold about 600 megabytes of data, equivalent to a shelf of books almost 100 feet long, with a full text index. CD-ROMs 56 offer the fastest and most convenient way to access material from large data bases. However, most present CD-ROM systems require the user to purchase an entire data base on CD-ROMs. By contrast, the use of encryption technology and metering allows the applicant to distribute each CD-ROM for little or no cost and then charge the user only for the information actually used. The CD-ROMs 56 would be used with standard as well as portable CD-ROM players, allowing users instant access to the material virtually anywhere.

Additionally, the system of computerized telecommunications as previously described and enumerated will include the adjunct of a system for collecting expert comment, feedback and advice to greater facilitate the behavioral intervention.

Inasmuch as the relevant expert or authority figure 200 would be located some distance from the primary counselor or manager, a system has been devised for providing expert feedback at regular or periodic intervals, as follows:

A. The expert or authority figure 200 would receive summary reports of the patient's, employee's or client's 50 progress at discrete intervals. These reports would either be in the form of text, graphs, charts or verbal communications.

B. The expert or authority figure 200 would, in addition, receive recommendations of the appropriate behavioral technique, relevant goals and progress thereto, and prompts and cues in accordance with a behavioral model, such as the transtheoretical model 100, which will be more fully described below. These recommendations could additionally be in the form of prefabricated scripts which would provide greater time-saving and convenience for the health care professional or authority figure.

C. All of the above would be provided either in writing, via modem, the mail, telephone, cable network, wirelessly, CD-Rom, or other compatible means.

D. The expert or authority figure 200, upon receiving the data on each patient, employee, or client 50, would then record his advice and recommendations by means of audio tape, video tape, or download in real time his recommendations by dialing the counselor's or manager's computer for replay at a later time.

E. The counselor's or manager's computer would, through its software program, mix and blend the expert's or authority figure's 200 feedback and advice into the patient's or employee's program at appropriate intervals, all in accordance with the behavioral model or the expert's or counselor's decision.

In a system of sales, advertising, or commercial business, expert or authority messages would provide recommendations and advice at appropriate branches in the behavioral model, depending upon the employee's behavior and his stage of progress towards his sales or commercial goals.

Numerous studies have demonstrated that practitioners can use the esteem, trust and motivation provided by the physician-patient relationship to build up self-control and personal responsibility on the part of patients, resulting in heightened adherence and greater compliance with medical regimens. The subject invention facilitates the application of specific, proven behavioral strategies by extending the intervention into the patient's daily life by allowing the addition of an expert's or appropriate authority figure 200 comments to be used as an adjunct to the counselor or manager interaction. Specifically, while the counselor or manager and patient or employee proceed through their ongoing relationship process, the expert 200 or physician or other authority figure elicits a commitment from the patient, client or employee to investigate behavioral change or focus on predetermined goals. The counselor or manager in turn reinforces the commitment. The expert 200, physician, authority figure or manager receives written reports as to the patient, client or employee's progress and in turn comments upon them to the patient, client or employee in subsequent messages using the subject invention as a means of communication.

The power of an expert or authority figure 200 allows figures such as physicians or administrator's to exert social power over their patients or employees. One behavioral strategy to harness a form of this social power is to facilitate behavioral compliance with medical regimens. Research has shown that greater feelings of self-control increase behavioral commitment and play an important role in facilitating adherence. Generally, individuals may be more likely to adhere to preventive health measures if they are actively involved in making choices and in implementing their own decisions.

The subject invention facilitates individual choice, self-monitoring and self-reinforcement, all under the supervision of both expert 200, physician, or other authority figure and counselor or manager jointly, thereby increasing personal responsibility. Personal or individual responsibility has been variously cited in a medical context as the key to a policy of national health promotion and disease prevention, with the result of reduced overall medical costs. By facilitating greater compliance with medical regimens and resulting lower medical costs, the subject invention extends the state of the art accordingly.

In utilizing the subject invention, the expert 200 or physician utilizes a proven behavioral Strategy consisting of three phases. This procedure can be used effectively in conjunction with the transtheoretical model 100, described more fully below, or with other behavioral, motivational or goal setting procedures.

In the first phase, the practitioner or expert 200 attempts to build his or her motivating power. This is done by assessing the patient's 50 expectancies and responding to them with sufficient interest and concern. This phase is synchronized to the precontemplation 102 and contemplation stages 104 of the transtheoretical model 100 as will be more fully explained below.

Phase two consists of providing continuing motivation and encouragement to embark on the needed course of action. This phase is synchronized to the preparation 106 and action stages 108 of the transtheoretical model 100, described more fully below. In addition, during this phase two, the physician or expert 200 can utilize the rapport developed during phase one to prepare the patient or client 50 to realistically expect difficulties and problems that may lie ahead. This procedure is called behavioral rehearsal or stress inoculation. The principle underlying stress inoculation is that it enable individuals to cope more adequately with short-term loss before long-term gains are attained. This behavioral rehearsal is used in conjunction with providing preparatory information. Preplanning, role playing and imagery are variously used in behavioral rehearsal.

In the third phase, the expert 200 or physician provides support for the patient's preparation and anticipation of ongoing self-sufficiency. This phase is synchronized with the action and maintenance stages of the transtheoretical model. This procedure lessens potential adverse reactions to separation from treatment upon attainment of the patient's or patient's goals, by giving assurances of positive regard and arranging for gradual rather than abrupt termination of contact. By continuing to build the patient's or client's 50 sense of self-esteem and self-sufficiency during this period, a sense of personal responsibility is thus fostered. These dispositioned attributions for success thereby increase the likelihood of long-term maintenance.

In instances where relapse 112 occurs, as in the transtheoretical model 100, the expert 200 or physician may immediately intervene by allowing the patient or client 50 to attribute the relapse to normal factors outside of his control and encourage him to quickly re-enter the process by providing the recontemplation of another attempt.

During each of these phases, the physician or expert 200 may schedule additional appointments for face-to-face patient evaluation.

A singular advantage of the subject invention is that the physician or expert 200 can custom tailor reinforcement for compliance to the patient's or client's 50 response profile. Adherence drops off sharply, according to a number of studies, as the complexity of treatment regimens increases. Acute, serious illness with painful symptoms elicit the highest degrees of compliance. Chronic illness, especially those of a longer duration, elicit the lowest. In the elderly, the risk of non-compliance increases where several chronic illnesses are present requiring multiple medications at various intervals during the day. The subject invention can be uniquely adjusted to suit such situations by increasing the timing of interactive reinforcement and balancing the ratio of reinforcement prompts and cues between the counselor and physician in a manner prescribed by the physician or other expert 200.

As shown in FIG. 3 and as reported by Prochaska and DiClemente (1984), the preferred behavioral model embodiment is the application of the spiral or staged model of change incorporated within the patient program 14 and utilized by the expert 200
which comprises a multifaceted behavioral modification program.

Researchers James Prochaska, Carlo DiClemente and John Norcross have created a spiral model of behavioral change 100 which conceptualizes the process of behavioral change in a patient 50 in the context of a non-linear framework. Their research revealed that relapse is the rule rather than the exception among individuals with addictive behavior patterns. Therefore, by reframing relapse as a normal stage in the process, their model suggests that relapse is merely a temporary setback and that most relapsers do not regress all the way back to where they began. Instead, they use relapse as a learning experience from which to attain newer heights and move forward, in a spiral process change.

The spiral model of change 100, as shown in FIG. 3, depicts the cycle of change as consisting of six (6) distinct behavioral stages. Therefore, the patient program 14 will be directed to moving the patient 50 from one of the following six and variant stages of behavioral change 100, which are: precontemplation stage 102; contemplation stage 104; preparation stage 106 (not shown); action stage 108; maintenance stage 110; and relapse stage 112.

Prochaska, et al., have found that each of these six (6) behavioral stages is characterized by a set of specific behavior patterns. Precontemplation 102 is the behavioral stage 100 in which people are not intending to change their behavior. Many individuals or patients in this stage are unaware or underaware that they have a problem. Typically, their families, friends, neighbors or employers are well aware that there are problems. Usually the patient 50 in this behavioral stage 100 feels coerced into changing. He may feel pressured by a spouse who threatens to leave; an employer who threatens to fire him; parents who threaten to disown him; or courts who threaten to punish him. He may even demonstrate change as long as the pressure is on. Once the pressure is off, however, research has shown that he quickly returns to his old ways.

The contemplation stage 104 is the behavioral stage 100 in which one becomes aware that a problem exists. In this behavioral stage 100, the patient 50 seriously thinks about overcoming his problems. Although contemplators think about change, they have not made commitments to take action. Research has typically shown that patients in this behavioral stage 100 remain stuck in the contemplation stage 104 for long periods of time.

The preparation stage 106 is that behavioral stage 100 in which the patient 50 begins to start the modification of his behavior, which is directly followed by the action stage 108, wherein he is modifying his behavior, experiences, and/or environment in order to overcome his behavioral problem. The action stage 108 is the busiest stage and requires considerable commitment of time and energy. Behavioral changes made in the action stage 108 tend to be most visible and receive the greatest recognition from others.

The maintenance stage 110 is the time in which one works to prevent relapse and continue the gains made during the action stage 108. Traditionally, the maintenance stage 110 was viewed as a static stage. However, research has shown that the maintenance stage 110 is not an absence of change, but a continuation of behavioral change. Unfortunately, with some of the most common behavior problems, the patient 50 will not successfully maintain his gains the first time through the stages of change 100. By way of example but not of limitation, smokers who are successful self changers make an average of three to four action attempts before they become long-term maintainers. Since the relapse stage 112 is the rule rather than the exception, in solving such common problems as alcohol abuse, smoking, and weight control, the patient 50 will demonstrate a behavior along the spiral model of change 100.

In the spiral pattern, the patient 50 will process from contemplation 104 to preparation 106 (not shown), to action 108, to maintenance 110, but most individuals will go back to the relapse stage 112. During the relapse stage 112, the patient 50
will regress to an earlier stage. Some relapsers feel like failures: embarrassed, ashamed, and/or guilty. These individuals become demoralized and do not want to think about change. As a result, they return to the precontemplation stage 102.

Therefore, it is an object of the patient program 14 in this embodiment to utilize the patient's data base 12 and computer 16 to determine where the patient is on the stage model of change 100, and from there--through interactive telecommunications and in association with the expert 200--move the patient 50 from one stage to the next stage, until the maintenance stage 110 is achieved and maintained, and the targeted problem behavior is eliminated. The likelihood of successful change appears to be directly linked to an individual's position on the spiral (i.e., the particular stage within the model). Indeed, the progress made by patients as a result of professional interventions tends to be a function of the stage 100 they are in at the start of treatment.

By way of example but not of limitation, the patient program 14 and patient data base 12 will ask the patient 50 if he currently has a problem or has engaged in a desired positive behavior. If he reports an undesired status and does not intend to change in the foreseeable future such as the next six months, he will be categorized as being in the precontemplation stage 102. If the patient 50, however, intends to change within the next six months, then he is categorized as being in the contemplation stage 104. For the preparation stage 106, the patient 50 indicates that he is planning to change in the next month or have made some changes, but was not at a particular criterion. By way of example but not of limitation, an exercise program wherein the patient 50 was performing a minimum of 20 minutes three times a week would be considered in the action stage 108. Similarly, a patient 50 in the action stage 108 would have reached a particular criterion, such as quitting smoking or cocaine, within the past six months. A patient 50 in the maintenance stage 110 has reached the criterion more than six months before the patient data base 12 was instituted. The timing criteria varies, but most often is the same for all behavioral problems, wherein a 12-month criterion is typically appropriate for assessing action and intentions to be taken.

Once the behavioral stage 100 has been categorized from the patient data base 12, the stages of change