Motivational Interviewing in Primary Care: The Basics
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1 Motivational Interviewing in Primary Care: The Basics Nick Weiss, MD Assistant Professor of Psychiatry, U of Washington Consultant, Partnership Access Line and 2nd Opinion Consults Seattle Children s Hospital
2 Disclosures In the past 12 months, I have had not had any financial relationships with the manufacturer(s) of any commercial product(s) and/or provider(s) of commercial service(s) discussed in this activity. I will not discuss unapproved/investigative uses of medications in my presentation.
3 Objectives To understand the fundamental spirit and principles of MI To understand the MI approach to assessing readiness for change To understand the MI approach to building motivation and confidence for change
4 Why Motivational Interviewing?
5 What is MI? Motivational Interviewing is a collaborative conversation style for strengthening a person s own motivation and commitment to change.
6
7 Areas of Use Substance use Going to counseling Sleep hygiene Using coping skills Risky sex Diet Medication adherence Exercise
8 The Spirit of MI Partnership Acceptance Compassion Evocation
9 Principles of MI Express empathy Avoid the righting reflex Normalize ambivalence Roll with resistance Assess readiness Support motivation and build confidence
10 Avoid the Righting Reflex Patient: Well, I overdo it sometimes, but I don t have a problem with drinking. Coming Alongside You feel mostly in control of your drinking and don t see it as an issue. Amplified Reflection Drinking has never really caused any problems at all for you. Double-sided Reflection You think you ve gone too far sometimes, but you don t think you have any kind of alcohol problem.
11 Normalize Ambivalence
12 Rolling with Resistance Patient: I don t smoke that much. It totally helps with my anxiety. And helps me sleep. It works a lot better than those pills Dr. Nick gave me. They didn t do $%! Clinician: Are there any downsides to smoking? Patient: Not for me. Clinician: Ok. Maybe your parents think it s a problem, but you don t. Patient: Yeah. They think it s affecting my grades.
13 Assessing Readiness
14 Why Use Readiness Rulers?
15 Building Motivation
16 Building Motivation with Decisional Balance
17
18 No Change: Keep drinking the same amount Change: drink less
19 No Change: Keep drinking the same amount Change: drink less
20 Motivation Confidence
21 Ways to Build Confidence Use the confidence ruler Affirm strengths Review past successes Share success stories
22 Take Home Nuggets MI has support and is a great way to avoid fruitless power struggles Own the spirit of MI first, then use techniques Roll with resistance Distinguish between low motivation and low confidence with readiness rulers Raise discrepancy with decisional balance sheets Build true confidence Have empathy for your patient...and yourself
23 Some Resources Short Online Guide to MI: otivational_interviewing_definition_principles_approach Decisional Balance Sheet: %20CBT/pages/2%20Engagement/Decisional%20Balance%20Scale.pdf Live Training Opportunities: Web-Based Training for Primary Care:
24 Evidence-Base for MI Jensen, et al. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: A meta-analytic review. Journal of Consulting and Clinical Psychology, 79, Miller, M and Leffingwell T. Meta-Analysis of Motivational Interviewing for Adolescent Health Behavior: Efficacy Beyond Substance Use. Journal of Consulting and Clinical Psychology, 82, Gayes L and Steele R. A meta-analysis of motivational interviewing interventions for pediatric health behavior change. Journal of Consult and Clinical Psychology, Borrelli et al. Motivational Interviewing for Parent-child Health Interventions: A Systematic Review and Meta-Analysis. Pediatric Dentistry, 37,
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