Motivational Interviewing (MI) Module 4 Motivational Interviewing (MI)

How Does Behavior Change? Behavior A Behavior B

ASSUMPTIONS 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

Transtheoretical Model Nn Transtheoretical Model Pre-contemplation Relapse Contemplation Maintenance Determination Action Synonyms Determination = Preparation Termination = Exit Termination 4-4 18

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

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

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

Principles of MI 1. Advice Give advice only when individuals will be receptive Target advice to stage of change 40

Principles of MI (continued) 2. Reduce Barriers Bolster self-efficacy Address logistical barriers 41

Principles of MI (continued) 3. Provide Choices It’s the individual’s choice: Whether to change How to change 42

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 43

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 44

Principles of MI (continued) 6. Feedback Help the individual identify and understand relevant: Risks of the behavior Negative consequences of the behavior 45

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

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

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

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

Reflective Listening (continued) Example 1: “My girlfriend gets really angry when I get drunk and pass out.” “She gets mad when you do that.” 63

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

Affirmation (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.” 70

Summarization “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 ...” 71

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

Elicit Self-Motivational Statements (continued) Intention to change “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)?”

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)?”

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?” 80

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

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

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