Motivational Interviewing: Strategies for Enhancing Motivation To Change

Transcription

1 SECSAT-APRN Southeastern Consortium for Substance Abuse Training - Advanced Practice Registered Nurses Motivational Interviewing: Strategies for Enhancing Motivation To Change Alan Lyme, LCSW Dr. Sylvia Shellenberger, PhD Southeastern Consortium for Substance Abuse Training Advanced Practice Registered Nurses Funded by Grant 1U79T Substance Abuse and Mental Health Services Administration (SAMHSA) Last revised: April 5, 2014 Funded by: Funded by:

2 Key Contributors & SECSAT APRN Site Coordinators Mercer University, School of Medicine J. Paul Seale, MD Principal Investigator Annie Biers, LPC, Project Coordinator Sylvia Shellenberger, PhD Mercer University, Georgia Baptist College of Nursing Dr. Frieda Fuller Dr. Laura K. Baraona Armstrong Atlantic University Dr. Anita Nivens Dr. Linda Tuck Emory University, Nell Hodgson Woodson School of Nursing Dr. Carolyn Clevenger Dr. Ursula Kelly Dr. Phyllis Wright University of North Georgia Dr. Sharon Chalmers South University Dr. Doris Parrish Johns Hopkins University Dr. Christine Savage Dr. Deborah Finnell Georgia College & State University Dr. Deborah MacMillan Dr. Sallie Coke University of Alabama, Birmingham Dr. Susanne Fogger

3 Learning Objectives At the end of this session, you will be able to 1. Describe the importance of change talk 2. Identify change talk segments that can be mined to highlight ambivalence 3. Describe the steps in a brief intervention 3

4 Change Talk 4

5 What Is Change Talk? Change talk Patient expresses motivation to change. Example 5

6 Change talk is like gold! As patients speak about change, they begin to see the possibilities No pressure or persuasion is needed 6

7 Two types of Change Talk Preparatory change talk Still working through ambivalence Mobilizing change talk Reflects resolution of ambivalence Most predictive of a positive outcome The different types of change talk can be described using the mnemonic DARN - CAT 7

8 Desire I would like to... I wish... I really want to drink less Ability Reason I think I could cut back to 2 drinks a day. I can skip that nightcap before bedtime. I am able to buy the smaller cans. I know I would feel better if I lost 50 pounds. I would have more energy if I started exercising. I would worry less about my liver if I drank less. Need I need to cut down for sure. I should do this for my grandchildren. I have to get a handle on this or I ll lose my job.

9 Commitment I will make changes Activation I am ready, prepared, willing to change Taking steps I am taking specific actions to change

10 I d be healthier if I quit. I wish I could quit. I ll think about quitting. I ve got to quit smoking. I think I can quit. Ability Activation Need Desire Reason 10

11 I want to lose weight. I could probably lose 20 pounds. I d have more energy. I m going to lose 20 pounds. I ve got to lose some weight. Reason Need Commitment Ability Desire 11

12 Change Talk vs. Sustain Talk Change Talk and Sustain Talk Opposite sides of a coin Sustain Talk The other side of ambivalence 12

13 Stuck in the Middle with You: Ambivalence Change talk often comes intertwined with sustain talk. That s the nature of ambivalence. 13

14 Match Sustain Talk Examples I really like marijuana I don t see how I could give up pot I have to smoke to be creative I don t think I need to quit I m not willing to quit I intend to keep smoking and nobody can stop me Reason Need Desire Inability Commitment 14

15 Snatching Change Talk from the Jaws of Ambivalence 15

16 Identify the Change Talk Within the Sustain Talk I really don t want to stop smoking, but I know that I should. I ve tried before and it s really hard. 1. You really don t want to change 2. It s pretty clear to you that you ought to quit. 3. You don t think you can quit. 16

17 Identify the Change Talk Within the Sustain Talk See, the thing is, all my friends drink. Some of them probably drink way too much too, but if I quit drinking, I don t have any friends. I just stay home. 1. That would be pretty lonely 2. Quitting would cause a new problem for you. 3. And at the same time you recognize that you and probably some of your friends are drinking way too much. 17

18 Identify the Change Talk Within the Sustain Talk I know you re worried that I m getting addicted, and I guess I can see what you mean, but I really need more pain medicine. I don t know how I would get through the day without it. If you won t prescribe it, then I ll find someone else who will. 1. You understand my worry about dependence. 2. It s hard to imagine how you would get along without more medicine. 3.One way or another, you re going to get more medicine. 18

19 Using MI to Link Screening and Brief Intervention MI strategies facilitate Finding personal and compelling reasons to change Building readiness to change Making commitment to change MI BI 19

20 Introducing the Brief Intervention Uses screening/assessment results to generate a reflective discussion aimed at gently increasing readiness and the desire to change Sampl & Kadden,

21 Brief Intervention Enhancing motivation and commitment Negotiate commitment (Plan) Engage in reflective discussion Enhance motivation Provide feedback based on screening/ assessment data (Focus) Evoke personal meaning 21

22 Summary: Benefits of Using MI Evidence based Patient centered Provides structure Readily adaptable 22

23 Summarizing Motivation for Change Motivation is an intrinsic process. Ambivalence is normal. Motivation arises out of exploring, amplifying and resolving discrepancy. Change talk facilitates change. 23

24 What s Next In the next session, we ll cover the brief negotiated interview, a semi-structured evidence-based brief intervention based on MI QUESTIONS? 24