motivational interviewing: enhancing motivation to change strategies

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Motivational Interviewing: Enhancing Motivation To Change Strategies. Learning Objectives. At the end of this session, you will be able to Describe the stages of change. Demonstrate at least two methods to elicit change talk. Use a decisional balance and readiness ruler. - PowerPoint PPT Presentation


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Motivational Interviewing:Enhancing Motivation To Change Strategies1Learning ObjectivesAt the end of this session, you will be able toDescribe the stages of change.Demonstrate at least two methods to elicit change talk.Use a decisional balance and readiness ruler.Describe an overarching motivational interviewing (MI) strategy effective in brief intervention.

2Stages of Change3Theoretical FrameworkInforming MIProchaska and DiClemente identified five stages of change your patient can experience:Precontemplation Contemplation PreparationActionMaintenanceProchaska & DiClemente (1984)

4Precontemplation The patient is not yet recognizing problem or considering change.Clinicians goal is to build rapport and raise awareness.Clinicians task is to inform and encourage.

MI Informed by Stages of Change(continued)5MI Informed by Stages of Change(continued)Contemplation The patient is evaluating reasons for and against change.Clinicians goal is to build motivation.Clinicians task is to explore and resolve ambivalence.

6MI Informed by Stages of Change(continued)PreparationThe patient is planning for change.Clinicians goal is to negotiate a plan.Clinicians task is to facilitate decisionmaking.

7MI Informed by Stages of Change(continued)ActionThe patient is making the identified change(s).Clinicians goal is to support implementation of the plan.Clinicians task is to support self-efficacy.

8MI Informed by Stages of Change(continued)MaintenanceThe patient is working to sustain change(s).Clinicians goal is to help maintain change.Clinicians task is to prevent relapse.

9MI Informed by Stages of Change(continued)RelapseEvent(s) trigger the individual to return to previous behaviors.Reengage.Review goals and strategies.Recurrence does not equal failure.

10Learning ExerciseAt what stage does a patient consider the possibility of change?PrecontemplationContemplationPreparationAction11RememberReadiness to changeStateTrait

12Change Talk13Increasing Change TalkChange talk is at the heart of MI. Through our conversations, we elicit Desire I wish/want toAbility I can/couldReasons Its important becauseNeed I have to14What Is Change Talk?Change talkPatient expresses motivation to change.Example

I wish I could stop drinking so much because I dont want that to be an example for my children.

15Learning ExerciseIdentify the change talk statements:I have to cut down on my drinking so I can make it to work on time.My spouse wants me to give up cigarettes.The doctor thinks it is important for me to decrease my alcohol intake.I want to stop taking my pain meds, but the pain wont go away.

16MI Strategies17MI Strategies Most Commonly Used in Brief InterventionDecisional balanceReadiness rulerPersonalized reflective discussion

18Decisional Balance: An Explanatory Model of Behavior ChangeHighlights the individuals ambivalence(maintaining versus changing a behavior)Leverages the costs versus the benefits

19Conducting a Decisional Balance DiscussionAccept all answers.Explore answers.Note both the benefits and costs of current behavior and change.Explore costs/benefits with patients goals and values.

Answers2020Exercise 3The Decisional BalanceCamilla or Marcus, 24Accident Pain Loss of income Buys illegal drugs Drinks excessivelyAggressive tendencies

21Readiness Rulers: I-C-RReadiness rulers can addressImportanceConfidenceReadiness

ConfidenceReadinessImportance2222Readiness Ruler On a scale of 1 to 10, how ready are you to make a change?

23Linking Screening and Brief InterventionMI strategies facilitateFinding personal and compelling reasons to changeBuilding readiness to changeMaking commitment to change

24The Personalized ReflectiveDiscussionUses screening/assessment results to generate a specific type of reflective discussion aimed at gently increasing readiness and the desire to change

Sampl & Kadden, 2001

25Negotiate commitment Initiate reflective discussionProvide feedbackbased on screening/assessment dataEvoke personal meaningEnhance motivationPersonalized Reflective Discussion Enhancing motivation and commitment

26Initiating Reflective DiscussionStart the reflective discussion asking permission of our patients to have the conversation. Example: Would it be all right with you to spend a few minutes discussing the results of the wellness survey you just completed?

27Providing FeedbackReviewScoreLevel of riskRisk behaviorsNormative behavior Substance use riskBased on your AUDIT screeningScore: 27 You are hereLow ModerateHigh Very High 0 4028Evoking Personal MeaningReflective questions: From your perspective..What relationship might there be between your drinking and ____?What are your concerns regarding use?What are the important reasons for you to choose to stop or decrease your use?What are the benefits you can see from stopping or cutting down?29SummarizingAcknowledges the patients perceived benefits of useElicits the personal and important problems or concerns caused by useElicits, affirms, and reinforces motivation to changeHelps resolve ambivalence and reinforces motivation30Enhancing MotivationReadiness Ruler

31Negotiating CommitmentSimpleRealisticSpecificAttainableFollowup time line

Negotiating aPLAN32Personalized Reflective Discussion DemonstratedPersonalized Reflective Discussion Exercise33Summary: Benefits of Using MI

E vidence basedP atient centeredP rovides structureR eadily adaptable34Summarizing Motivation for ChangeMotivation is an intrinsic process.Ambivalence is normal.Motivation arises out of resolving discrepancy.Change talk facilitates change.

35Whats NextIn the next session, well cover the brief negotiation interview, a semistructured brief intervention process based on MI that is a proven evidence-based practice.