Module 4 Motivational Interviewing MI How Does Behavior

Module 4 Motivational Interviewing (MI)

How Does Behavior Change? Behavior A Behavior B 4 -2

ASSUMPTIONS n n n Behavioral issues are common Change often takes a long time The pace of change is variable Knowledge is usually not sufficient to motivate change Relapse is the norm 4 -3

Transtheoretical Model Pre-contemplation Relapse Contemplation Maintenance Determination Action Termination Synonyms Determination = Preparation Termination = Exit 4 -4

Prochaska & Di. Clemente: Stages of Readiness to Change Stage Description Objectives Pre-contemplation Not considering change § Identify patient’s goals § Provide information § Bolster self-efficacy Contemplation Ambivalent about change § Develop discrepancy between goal & behavior § Elicit self-motivational statements 4 -5

Prochaska & Di. Clemente: Stages of Readiness to Change (continued) Stage Description Objectives Determination Committed to change § Strengthen commitment to change § Plan strategies for change Action Involved in change § Identify and manage new barriers § Recognize relapse or impending relapse 4 -6

Prochaska & Di. Clemente: Stages of Readiness to Change (continued) Stage Description Maintenance Relapse Behavior change Undesired behaviors Termination Objectives § Assure stability of change § Foster personal development § Identify relapse when it occurs § Reestablish self-efficacy and commitment § Behavioral strategies Change is very stable§ Assure stability of change 4 -7

Principles of MI 1. Advice n n Give advice only when individuals will be receptive Target advice to stage of change 4 -8

Principles of MI (continued) 2. Reduce Barriers § § Bolster self-efficacy Address logistical barriers 4 -9

Principles of MI (continued) 3. Provide Choices It’s the individual’s choice: § Whether to change § How to change 4 -10

Principles of MI (continued) 4. Decrease Desirability Help individuals: § Decrease their perceptions of the desirability of the behavior § Identify other behaviors to replace the positive aspects of alcohol use 4 -11

Principles of MI (continued) 5. Empathy § Develop and communicate an understanding of the individual’s situation and feelings around the behavior § Explore pain around the behavior 4 -12

Principles of MI (continued) 6. Feedback Help the individual identify and understand relevant: § Risks of the behavior § Negative consequences of the behavior 4 -13

Interview Techniques n n n Open-ended questions Reflective listening Affirmation Summarization Elicit self-motivational statements 4 -14

Open-ended Questions Avoid closed and leading questions like: n n “Would you like to quit? ” “Do you know that alcohol is bad for you? ” Instead ask: n n “What do you think about your alcohol use? ” “What do you know about the risks of drinking? ” 4 -15

Reflective Listening n n n Mirrors what the patient says Creates a sense of safety for the patient Deepens the conversation Helps patients understand themselves Says: n n “I hear you” “This is important” “Please tell me more” “I’m not judging you” 4 -16

Reflective Listening n n n Patient: Response: Patient: (continued) “To tell you the truth, I really enjoy drinking. ” “You like drinking alcohol? ” “Yes. I like the taste, and it really relaxes me. ” 4 -17

Reflective Listening (continued) Example 1: “My girlfriend gets really angry when I get drunk and pass out. ” “She gets mad when you do that. ” 4 -18

Affirmation n n Conveys support, respect, and encouragement Helps patients reveal less positive aspects about themselves “You’ve tried very hard to quit. ” 4 -19

Affirmation n (continued) “You are very courageous to be so revealing about this. ” “You’ve accomplished a lot in a short time. ” “I can understand why drinking feels so good to you. ” 4 -20

Summarization n n “What you’ve said is important. ” “I value what you say. ” “Here are the salient points. ” “Did I hear you correctly? ” “We covered that well. Now let's talk about. . . ” 4 -21

Elicit Self-Motivational Statements Problem recognition n “Has alcohol caused you any problems? ” Concern n “Do you ever worry about your alcohol use? ” 4 -22

Elicit Self-Motivational Statements (continued) Intention to change n n “What might be some advantages of quitting or cutting down? ” “On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say (1 or 2 points lower)? ” 4 -23

Elicit Self-Motivational Statements (continued) Intention to Change § “On a scale of 0 to 10, how important is it for you to change your (behavior)? ” § “Why didn't you say (1 or 2 points lower)? ” 4 -24

Elicit Self-Motivational Statements (continued) Optimism § “What difficult goals have you achieved in the past? ” § “What might work for you if you did decide to change? ” 4 -25

For Ambivalence - DEARS Develop discrepancy § Compare positives and negatives of behavior § Positives and negatives of changing in light of goals § Elicit self-motivational statements Empathize § Ambivalence and pain of engaging in behavior that hinders goals 4 -26

For Ambivalence - DEARS (continued) Avoid Arguments § Don’t push for change, avoid labeling Roll with resistance § Change strategies in response to resistance § Acknowledge reluctance and ambivalence as understandable § Reframe statements to create new momentum § Engage patient/client in problem-solving 4 -27

For Ambivalence - DEARS (continued) Support self-efficacy n n Bolster responsibility and ability to succeed Foster hope with menus of options 4 -28