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Motivational Interviewing: Changing the Conversation Joseph A. Banken, PhD, Clinical Psychologist; MINT Member Sandra R. Brown, MNSc, APRN.

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Presentation on theme: "Motivational Interviewing: Changing the Conversation Joseph A. Banken, PhD, Clinical Psychologist; MINT Member Sandra R. Brown, MNSc, APRN."— Presentation transcript:

1 Motivational Interviewing: Changing the Conversation Joseph A. Banken, PhD, Clinical Psychologist; MINT Member Sandra R. Brown, MNSc, APRN

2 Workshop Goals O State two elements of the Spirit of MI O Discuss one core skill O Distinguish one clinician behavior that is MI- adherent

3 I use motivational interviewing in my practice A. All the time B. Maybe once a month C. Only when working with a non-compliant patient D. Never use it – I don’t know what it is

4 Wall Street Journal Headline – April 29, 2013 To Motivate Patients to Change, Doctors Stop Scolding

5 Background O Motivational Interviewing begin in 1983 when William R. Miller, PhD was working in alcohol treatment O 30 years later: O Bill Miller & Steve Rollnick – published 3rd ed (2012),1 st ed (1991) O MI has found its place in inpatient/outpatient, leadership, justice system, schools, O Among many disciplines – social work, pharmacy, physicians, nursing, dieticians, dentists O >25,000 articles in the literature O 456 RCTs published in past 5 years (MeSH Search)

6 Definition O MI is a collaborative conversation style used to strengthen a person’s own motivation and commitment to change. O MI is helpful in working with anyone who is ambivalent about or reluctant to change behavior in the best interest of his/her own health and well-being. ‘Being motivated is incomplete without commitment.’ (Miller & Rollnick, 2012)

7 Significance O 25% have at least one daily activity limiting condition O 50% at least one chronic disease O 63% overweight or obese O 80% older adults have at least one chronic disease O Dental caries are the most common chronic disease of 6 to 11 year olds ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ O 97% of all healthcare spending is used to treat a current condition CDC: Chronic Disease and Health Promotion (2012)

8 Significance O Behavior is the #1 Killer of Americans O Tobacco use O Poor nutrition/eating habits O Inactivity O Excessive alcohol consumption O Medication non-adherence O Unsafe/risky health or lifestyle habits (sex, dental) O Only 3% of every healthcare dollar is spent on prevention CDC: Chronic Disease and Health Promotion (2012)

9 Can Motivational Interviewing Be Effective With Them? Source: Children’s Healthcare of Atlanta (Strong4Life)

10 Which of the following is a hallmark of MI? A. Motivating another person to change nutritional habits B. Giving specific advice and facts about health risks of obesity that will cause behavior change C. Using the expert clinical role to direct healthy behavior change D. Listening for and guiding a person’s change talk in a direction of health that is meaningful to him

11 Spirit of MI PartnershipAcceptance CompassionEvocation

12 Partnership O Myth - You can motivate others O MI is done “with” another O Collaborative O Avoiding ‘advice-giving’ O Avoiding ‘expert’ trap O “MI outperforms traditional advice-giving” and has significant effects on behavior whether related to medication adherence or personal habits (Rubak et al, 2005)

13 Acceptance Autonomy Accurate Empathy Absolute Value Affirmation

14 Compassion O A deliberate commitment to pursue the welfare and benefits of another person O Not just nice and friendly attitude/behavior toward them O Work with your heart in the right place so that the trust you engender will be deserved

15 Evocation O Desire O Ability O Reason O Need O Commitment O Taking Action O Listening for ambivalence O Develop discrepancy O Elicit change talk O Enhance intrinsic motivation “It is the truth we ourselves speak, rather than the treatment we receive, that heals us.” ~O. Hobart Mowrer (1966)

16 A cornerstone of MI that can help with unhealthy eating behavior A. Redirect the patient toward a healthier lifestyle B. Use reflective listening to guide and evoke change talk, while respecting autonomy C. Reframing incorrect information and providing evidence-based education D. All of the above

17 OARS Open-Ended Questions Affirming Reflective Listening Summary

18 Reflective Listening O Cornerstone of MI O Listening for the many layers O Making no assumptions O Your statements mirror what the patient has shared – explicitly or implicitly

19 Open Ended Questions O Specific and targeted questions to evoke from the her – desire, reason, ability, need, commitment to change (if any) O How important the change is to her O How confident she is to take the necessary action

20 Behavior Counts O MI Non-Adherent Behavior O Examples: Disagreeing, Confronting, Arguing, Giving advice without permission, Warning O Discord O Breakdown in provider-client relationship O Causes resistance or push-back

21 Demonstration MI non- adherent MI adherent

22 MI Wrap-up O Change is fundamentally self-change O Each is his own expert O People have their own strengths, motivations and resources for change O Change thrives in a collaborative partnership O Change is not a power struggle O Motive for change cannot be installed O Cannot change someone’s choice about his own behavior Miller & Rollnick (2012)

23 Resources O Bean, M., Biskobing, D., Francis, G., Wickham E. (2012). Motivational interviewing in health care: results of a brief training in endocrinology. Journal of Graduate Medical Education. Sep, O Bishop, C. J., & Jackson, J. (2013). Motivational interviewing: How advanced practice nurses can impact the rise of chronic disease. The Journal for Nurse Practitioners, 9(2), O Dart, M. (2010). Motivational interviewing in nursing practice: empowering the patient. Jones & Bartlett Publishers. O Gorin, A., Wiley, J., McCauley, O., Hernandez, D., Grant, A., & Cloutier, M. (2014). Steps to growing up healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health, 14:72 O Miller, W.R., Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioral and Cognitive Psychotherapy, 37, O Miller W.R., Rollnick, S. (2012). Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press. O Van NM, Sawatzky JA. Improving cardiovascular health with motivational interviewing: A nurse practitioner perspective. J Am Acad Nurse Pract Dec;22(12): O Xiaoli Gao, X., Lo, E., Ching, S., & Chan, K. (2014). Motivational interviewing in improving oral health: a systematic review of randomized controlled trials. Journal of Periodontology (85)3. p

24 Contact Information O Joseph A. Banken O Central Arkansas Veterans Healthcare System O O O Sandra R. Brown O Central Arkansas Veterans Healthcare System O O


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