An introduction to Motivational Interviewing Dr Tim Anstiss M.B., M.Ed., D.Occ.Med.,M.F.S.E.M. Visiting Research Fellow Human Development and Health Academic Department University of Southampton Medical School
Aims Provide a brief taste of motivational interviewing Explore the core processes and principles associated with this empirically supported approach to behaviour change
Structure of the workshop 50 minute interactive presentation Opportunity to ask questions during the course of the workshop Reflections and close
About your presenter Medical Doctor Further training in Sports and Exercise Medicine, Occupational Medicine Trained in CBT, IPT, ACT, CFT, Set up an NHS Exercise Medicine Unit in 90 s Helped design/develop the 12m Peckham Pulse Used behaviour change methods in range of settings: cardiac rehabilitation, chronic pain, psychiatry, rehabilitation, drug and alcohol, occupational health, leisure, weight loss, etc Running skills development workshops for over 20 years
www.academyforhealthcoaching.co.uk Helped DH create the Lets Get Moving materials Trained over 100 health/fitness professionals for NERS in Wales Working with National Cancer Survivorship Initiative: Training clinicians in MI with cancer survivors Working with UK Active: using MI in primary care settings to people become more active
Resistance behaviours Arguing Interrupting Ignoring Looking away Disagreeing Blaming Denying Changing the subject Discounting Excusing Sidetracking Question: How often do you see these behaviours? Why do patients show these behaviours?
Resistance Goes up and down Influenced by your behaviour You confront - it increases
Want to increase resistance? Take away control away Overestimate readiness to change Confront force with force
Ambivalence Unsure In two minds Undecided Change or not change Very natural state Very common state People get stuck Can be stuck for years Help the person explore their ambivalence Help them think it through for themselves Help them decide
Ambivalence Change (stop smoking) No Change (continue to smoke) + + + Advantages of stopping _ Disadvantages of stopping Advantages of smoking + + + _ Disadvantages of smoking You tell them how great its going to be They voice difficulties and disadvantages They start telling you about advantages You start lecturing them on bad things about smoking
Blaise Pascal C17th French Mathematician / Philosopher People are generally better persuaded by the reasons which they themselves discovered, than by those which have been discovered by others Let people talk themselves into changing
What is motivational interviewing Layperson s definition: a collaborative conversation style for strengthening a person s own motivation and commitment to change. Technical definition: a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change within an atmosphere of acceptance and compassion. Motivational Interviewing 3 rd edition.
Motivation varies in both amount and quality Autonomous Intrinsic Freely choose to do it Enjoy the behaviour Controlled Feel forced to do it Extrinsic Do it for some later benefit Question Which quality of motivation is most likely to lead to lasting change?
The four processes Agreement about next steps? planning evoking focussing engaging A plan may emerge when to ask what s next Don t rush into planning One option is to think about it some more Draw out their ideas, hopes, concerns, reasons, etc Before you share yours (If you need to) Decide on the topic This may change over time New things issues may come into focus Get respectful, collaborative conversation started Keep it going Empathise Roll with any resistance
3 communication styles Direct Guide Follow And ability to move from one style to another as the situation demands
MI is not a specific BCT (behaviour change technique) but rather a vehicle for the delivery of multiple bct s Setting the scene Agreeing the agenda Typical day Good things / less good things Assessing and building importance Assessing and building confidence Looking back Looking forwards Information sharing Two possible futures The key question Exploring options Agreeing a plan Goal setting Shared decision making Implementation plans Graded tasks Reframing Anticipatory coping Contracting Self-monitoring Cue control Follow ups Scheduling Prompts and reminders
People change When it is important enough to them When they think they can do it Importance Important to them, but not confident Ready to change This may be enough Might need some skills Might need some ongoing support Confident they can change, but see no reason to change Confidence
Spirit partnership evocation
Spirit empathy Explains 30% outcomes in psychotherapy and counselling Clinicians can increase by training in accurate empathic listening It involves an ability and willingness to understand the others persons thoughts feelings and struggles from their perspective, to adopt their frame of reference, to see the world thought their eyes It needs to be communicated autonomy They are the active decision maker
Core skills O pen questions 2:1 Closed questions 2:1 A ffirming R eflecting (accurate empathy) S ummarising I nformation sharing and advice
Self Behaviour change, persistence, success Efficacy Mastery experiences Vicarious experience Verbal persuasion Physiological feedback Albert Bandura
How confident are you that if you did decide to change, that you would be able to keep up this change 0 For each scale ask: Why X and not a lower number such as 0? (use your OARS) For confidence scale ask: 5 What would have to happen for your confidence to be 8 or 9 Is there anything we can do to help you become more confident? (maybe share information about what other people find helpful) 10 summarise Ask them what they think they will do Rollnick et al (1999)
Motivational Interviewing After 30 years of research Evidence-based >1000 clinical trials > 20 systematic reviews, meta-analyses Relatively brief Grounded in testable theory With specifiable mechanisms of action Generalisable across problem areas Complementary to other treatment methods Learnable by a broad range of providers
Thank you Tim Anstiss drtim@appliedwellbeing.com 07973255946