motivational interviewing: changing the conversation joseph a. banken, phd, clinical psychologist;...
TRANSCRIPT
Motivational Interviewing: Changing
the Conversation
Joseph A. Banken, PhD, Clinical Psychologist; MINT MemberSandra R. Brown, MNSc, APRN
Workshop GoalsO State two elements of the Spirit of MIO Discuss one core skillO Distinguish one clinician behavior
that is MI-adherent
I use motivational interviewing in my practice
A. All the timeB. Maybe once a monthC. Only when working with a
non-compliant patientD. Never use it – I don’t know
what it is
Wall Street Journal Headline – April 29, 2013
To Motivate Patients to Change,
Doctors Stop Scolding
BackgroundO Motivational Interviewing begin in 1983 when
William R. Miller, PhD was working in alcohol treatment
O 30 years later:O Bill Miller & Steve Rollnick – published 3rd ed
(2012),1st ed (1991)O MI has found its place in inpatient/outpatient,
leadership, justice system, schools,O Among many disciplines – social work, pharmacy,
physicians, nursing, dieticians, dentistsO >25,000 articles in the literatureO 456 RCTs published in past 5 years (MeSH
Search)
DefinitionO MI is a
collaborative conversation style used to strengthen a person’s own motivation and commitment to change.
O MI is helpful in working with anyone who is ambivalent about or reluctant to change behavior in the best interest of his/her own health and well-being.
‘Being motivated is incomplete without commitment.’(Miller & Rollnick, 2012)
SignificanceO 25% have at least one daily activity limiting
conditionO 50% at least one chronic diseaseO 63% overweight or obeseO 80% older adults have at least one chronic
diseaseO Dental caries are the most common chronic
disease of 6 to 11 year olds ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
O 97% of all healthcare spending is used to treat a current condition
CDC: Chronic Disease and Health Promotion (2012)
SignificanceO Behavior is the #1 Killer of Americans
O Tobacco useO Poor nutrition/eating habitsO InactivityO Excessive alcohol consumptionO Medication non-adherenceO Unsafe/risky health or lifestyle habits (sex,
dental)
O Only 3% of every healthcare dollar is spent on preventionCDC: Chronic Disease and Health Promotion (2012)
Can Motivational Interviewing Be Effective With Them?
Source: Children’s Healthcare of Atlanta (Strong4Life)
Which of the following is a hallmark of MI?
A. Motivating another person to change nutritional habits
B. Giving specific advice and facts about health risks of obesity that will cause behavior change
C. Using the expert clinical role to direct healthy behavior change
D. Listening for and guiding a person’s change talk in a direction of health that is meaningful to him
Spirit of MI
Partnership
Acceptance
Compassion Evocation
PartnershipO Myth - You can motivate othersOMI is done “with” anotherO CollaborativeO Avoiding ‘advice-giving’O Avoiding ‘expert’ trap
O “MI outperforms traditional advice-giving” and has significant effects on behavior whether related to medication adherence or personal habits (Rubak et al, 2005)
Acceptance
Acceptance
Autonomy
Accurate
Empathy
Absolute Value
Affirmation
CompassionO A deliberate commitment to
pursue the welfare and benefits of another person
O Not just nice and friendly attitude/behavior toward them
O Work with your heart in the right place so that the trust you engender will be deserved
Evocation
ODesireOAbilityOReasonONeedOCommitmentOTaking Action
OListening for ambivalence
ODevelop discrepancy
OElicit change talk
OEnhance intrinsic motivation
“It is the truth we ourselves speak, rather than the treatment we receive, that heals us.” ~O. Hobart Mowrer (1966)
A cornerstone of MI that can help with unhealthy eating behavior
A. Redirect the patient toward a healthier lifestyle
B. Use reflective listening to guide and evoke change talk, while respecting autonomy
C. Reframing incorrect information and providing evidence-based education
D. All of the above
OARSOpen-Ended
Questions
Affirming
Reflective Listening
Summary
Reflective ListeningO Cornerstone of MIO Listening for the many layersO Making no assumptionsO Your statements mirror what the
patient has shared – explicitly or implicitly
Open Ended QuestionsO Specific and targeted questions to
evoke from the her – desire, reason, ability, need, commitment to change (if any)
O How important the change is to her O How confident she is to take the
necessary action
Behavior CountsO MI Non-Adherent Behavior
O Examples: Disagreeing, Confronting, Arguing, Giving advice without permission, Warning
O DiscordO Breakdown in provider-client
relationshipO Causes resistance or push-back
Demonstration
MI non-adherent
MI adherent
MI Wrap-upO Change is fundamentally self-change
O Each is his own expert
O People have their own strengths, motivations and resources for change
O Change thrives in a collaborative partnership
O Change is not a power struggle
O Motive for change cannot be installed
O Cannot change someone’s choice about his own behavior
Miller & Rollnick (2012)
ResourcesO Bean, M., Biskobing, D., Francis, G., Wickham E. (2012). Motivational interviewing in
health care: results of a brief training in endocrinology. Journal of Graduate Medical Education. Sep, 357-361.
O Bishop, C. J., & Jackson, J. (2013). Motivational interviewing: How advanced practice nurses can impact the rise of chronic disease. The Journal for Nurse Practitioners, 9(2), 105-109.
O Dart, M. (2010). Motivational interviewing in nursing practice: empowering the patient. Jones & Bartlett Publishers.
O Gorin, A., Wiley, J., McCauley, O., Hernandez, D., Grant, A., & Cloutier, M. (2014). Steps to growing up healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health, 14:72
O Miller, W.R., Rollnick, S. (2009). Ten things that motivational interviewing is not. Behavioral and Cognitive Psychotherapy, 37, 129-140.
O Miller W.R., Rollnick, S. (2012). Motivational interviewing: helping people change. 3rd ed. New York: Guilford Press.
O Van NM, Sawatzky JA. Improving cardiovascular health with motivational interviewing: A nurse practitioner perspective. J Am Acad Nurse Pract. 2010 Dec;22(12):654-60
O Xiaoli Gao, X., Lo, E., Ching, S., & Chan, K. (2014). Motivational interviewing in improving oral health: a systematic review of randomized controlled trials. Journal of Periodontology (85)3. p 426-437.
Contact InformationO Joseph A. Banken
O Central Arkansas Veterans Healthcare System
O [email protected] 501-257-6607
O Sandra R. BrownO Central Arkansas Veterans Healthcare
SystemO [email protected] 501-257-2635