Motivational Interviewing: Enhancing Motivation To Change Strategies

Motivational Interviewing:Enhancing Motivation ToChange Strategies

Learning ObjectivesAt the end of this session, you will be able to—1. Describe the stages of change.2. Demonstrate at least two methods to elicit change talk.3. Use a decisional balance and readiness ruler.4. Describe an overarching motivational interviewing (MI)strategy effective in brief intervention.

Stages of Change

Theoretical FrameworkInforming MIProchaska and DiClemente identified five stages of changeyour patient can aration4.Action5.MaintenanceProchaska & DiClemente (1984)

MI Informed by Stages of Change(continued)1. Precontemplation The patient is not yetrecognizing problem orconsidering change. Clinician’s goal is to buildrapport and raiseawareness. Clinician’s task is to informand encourage.

MI Informed by Stages of Change(continued)2. Contemplation The patient is evaluatingreasons for and againstchange. Clinician’s goal is to buildmotivation. Clinician’s task is to exploreand resolve ambivalence.

MI Informed by Stages of Change(continued)3. Preparation The patient is planning forchange. Clinician’s goal is to negotiatea plan. Clinician’s task is to facilitatedecisionmaking.

MI Informed by Stages of Change(continued)4. Action The patient is making theidentified change(s). Clinician’s goal is to supportimplementation of theplan. Clinician’s task is to supportself-efficacy.

MI Informed by Stages of Change(continued)5. Maintenance The patient is working tosustain change(s). Clinician’s goal is to helpmaintain change. Clinician’s task is to preventrelapse.

MI Informed by Stages of Change(continued) Relapse– Event(s) trigger theindividual to return toprevious behaviors.– Reengage.– Review goals and strategies.– Recurrence does not equalfailure.

Learning ExerciseAt what stage does a patient consider thepossibility of change?a. Precontemplationb. Contemplationc. Preparationd. Action

Remember“Readiness to change”StateTrait

Change Talk

Increasing Change TalkChange talk is at the heart of MI. Through ourconversations, we elicit— Desire – I wish/want to Ability – I can/could Reasons – It’s important because Need – I have to

What Is Change Talk?Change talk Patient expresses motivationto change. Example“I wish I could stopdrinking so muchbecause I don’t wantthat to be an examplefor my children.”

Learning ExerciseIdentify the change talk statements:a. I have to cut down on my drinking so I can make it to work ontime.b. My spouse wants me to give up cigarettes.c.The doctor thinks it is important for me to decrease myalcohol intake.d. I want to stop taking my pain meds, but the pain won’t goaway.

MI Strategies

MI Strategies Most CommonlyUsed in Brief Intervention Decisional balance Readiness ruler Personalizedreflective discussion

Decisional Balance: An ExplanatoryModel of Behavior Change Highlights the individual’sambivalence(maintaining versuschanging a behavior) Leverages the costsversus the benefits

Conducting aDecisional Balance Discussion Accept all answers. Explore answers. Note both the benefits andcosts of current behavior andchange. Explore costs/benefits withpatient’s goals and values.Answers

Exercise 3The Decisional BalanceCamilla or Marcus, 24 Accident Pain Loss of income Buys illegal drugs Drinks excessively Aggressive tendencies

Readiness Rulers: I-C-RConfidenceReadiness rulers canaddress— Importance Confidence Readiness

Readiness RulerOn a scale of 1 to 10, how ready are you to makea change?

Linking Screening and BriefInterventionMI strategies facilitate— Finding personal andcompelling reasons tochange Building readiness to change Making commitment tochange

The Personalized ReflectiveDiscussionUses screening/assessment results to generate aspecific type of reflective discussion aimed at gentlyincreasing readiness and the desire to changeSampl & Kadden, 2001

Personalized Reflective DiscussionEnhancing motivation and mitmentProvide feedbackbased on screening/assessment dataEnhancemotivationEvokepersonalmeaning

Initiating Reflective Discussion Start the reflective discussion askingpermission of our patients to have theconversation. Example: “Would it be all right with you tospend a few minutes discussing the results ofthe wellness survey you just completed?”

Providing FeedbackSubstance use riskBased on your AUDIT screening—Score: 27Low0ModerateReview Score Level of risk Risk behaviors Normative behaviorYou are hereHighVery High40

Evoking Personal MeaningReflective questions: From your perspective . What relationship might there be between your drinking and? What are your concerns regarding use? What are the important reasons for you to choose to stop ordecrease your use? What are the benefits you can see from stopping or cuttingdown?

Summarizing Acknowledges the patient’s perceived benefits ofuse Elicits the “personal and important” problems orconcerns caused by use Elicits, affirms, and reinforces motivation tochange Helps resolve ambivalence and reinforcesmotivation

Enhancing MotivationReadiness Ruler

Negotiating Commitment Simple Realistic Specific Attainable Followup time lineNegotiatingaPLAN

Personalized ReflectiveDiscussion DemonstratedPersonalized Reflective Discussion Exercise

Summary: Benefits of Using MIE vidence basedP atient centeredP rovides structureR eadily adaptable

SummarizingMotivation for Change Motivation is an intrinsicprocess. Ambivalence is normal. Motivation arises out ofresolving discrepancy. “Change talk” facilitateschange.

What’s NextIn the next session, we’ll cover the brief negotiationinterview, a semistructured brief intervention processbased on MI that is a proven evidence-based practice.

Motivational Interviewing: Enhancing Motivation to Change Strategies Author: Carol Dawson-Rose Subject: Motivational Interviewing: Enhancing Motivation to Change Strategies Keywords: Motivational Interviewing: Enhancing Motivation to Change Strategies Created Date: 5/14/2015 11:06:55 AM