Motivational Interviewing April Wiechmann, PhD Assistant Professor Associate Director of the Memory Disorders Clinic Department of Geriatrics Adapted with permission from Dr. Susan Franks and Dr. James Hall
Learning Objectives Define Motivational Interviewing Define the technical components of MI Define the steps for Prochaska s change theory. Describe the key communication skills used throughout MI: Tools of the Trade
Define Motivational Interviewing Motivational Interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change
Prochaskaʹs change theory In order to promote changes in health behaviors, you must first know if your patient is ready to make change There are 5 stages of change known as Prochaska s change theory: 1. Pre contemplation (Not ready) Not yet acknowledging that there is a problem behavior that needs to be changed 2. Contemplation (Getting ready) Acknowledging that there is a problem but not yet ready or sure of wanting to make a change 3. Preparation (Ready) 4. Action Getting ready to change Changing behavior 5. Maintenance Maintaining the behavior change
The Spirit of MI Collaboration!!! Evocation!! Respect!! One must assume the role of a partner or collaborator, rather than an expert. Must respect the patient s personal reasons for change and ideas for how change might occur. Difficult because we assume the role of being an expert.
Creating Change Talk Open ended questions Affirmations Reflections Summaries
Good MI Skills Ask permission Affirmations skilled clinicians can almost always find something they appreciate in their pts and can convey this appreciation. Empathy can enhance a pt s sense of autonomy by emphasizing the pt s control or freedom to make decisions.
Things to avoid!! Confrontation Advise without permission Direct or demand
Eliciting Change Talk Stage 1: Motivation and Confidence MOTIVATION On a scale of 1 to 10, with 10 being very motivated, how MOTIVATED are you to... (quit smoking, eat more F & V, exercise more, take your meds)? 1 2 3 4 5 6 7 8 9 10 Not at all Somewhat Very CONFIDENCE On a scale of 1 to 10, with 10 being very confident, assuming you decided to... (quit smoking, begin exercising) how CONFIDENT are you that you could succeed? 1 2 3 4 5 6 7 8 9 10 Not at all Somewhat Very
Eliciting Change Talk: Stage 2 Strategy 1) Could have been Lower**** (Elicits a sense that they have the ability to change, creates optimism) You said your level of interest was a 5. Why did you say 5 instead of 0 or 1? You said your confidence to change was a 7. Why did you say 7 instead of 0 or 1? When asking about LOWER ratings, you are to ask why their score is NOT lower. This helps develop a sense of confidence (self efficacy) that they have the capability to change their behavior because they have done it before. Strategy 2) Could have been Higher (Elicits negative outcome expectations/barriers) You said your level of interest was a 5. What would it take to get you to a 9 or 10? You said your confidence to change was a 7. What would it take to get you to a 9 or 10? By asking what it would take to get them closer to a 10, you are finding out what the barriers are, and thus, determining your treatment plan
Treatment Planning Once you have figured out what the barriers are, you are in a position to suggest several options for treatment Here are some things that have worked for other people, that I think would be helpful for you 1) Amazing Strategy 1 2) Amazing Strategy 2 3) Amazing Strategy 3 Now you can partner with the patient in developing a plan of action Which of these do you think might work best for you? Which of these might you be willing to try?
Motivational Interviewing: Evoking commitment to change In this video clip, the Physician works together with the patient to develop a specific focus. The provider does this by asking open ended questions, providing affirmation, using reflective listening and summarizing for the patients (OARS). He also helps the patient to scale the importance of the issue and the patients confidence level for change behavior. https://www.youtube.com/watch?v=dm rjjpcute Video demonstration produced by Health Team Works Video, standard you tube license
How MI fits into Health Care MI is a refined form of guiding Informing, Asking, Listening We become more committed to that which we voice for ourselves Your role is to allow the patient to hear back their own words and values Patient takes the positive side of the argument Your role is to guide the patient in voicing their own reasons for change Patient discovers discrepancy of current behavior with core values and goals Patient states their pros/reasons for change Patient solves their own barriers Your role is to provide information about the options for treatment, based on the patient s personal barriers
Nationally, 72.0% of adults report having one or more unhealthy behaviors. 40 35 30 25 20 15 Percent of Adult Population United Health Foundation Percent of Adult Population 10 5 0 0 1 2 3 4 5 Prevalence of Zero through 5 Unhealthy Behaviors* Among US Adults (BRFSS 2014) *unhealthy behaviors: smoking, obesity, physical inactivity, excessive drinking, and insufficient sleep
Summary Ask permission Ask about pros and cons of a specific behavior Link behavior to core values Obtain ratings of motivation and confidence Probe for higher and lower ratings Partner with patient to develop a plan of actions
Thank You!