Motivational Interviewing

& HEALSHow to Get Students Off

the CouchA Brief Taste of MI

Helena Mackenzie, PhDRegion 5 Mental Health Specialist

Objectives

Identify why more traditional health care approaches often don’t result in behavior change

List a word that reflects the spirit of Motivational Interviewing (“ACE”)

List a key skill used in MI (“OARS”)

Identify one change tool

Feel motivated to learn more about MI and applying it to HEALS

Identify a behavior you currently want to change…

Common Choices

Exercise more

Drink less

Eat more fruit/veggies

Stop smoking

Stop being late

Stick to a budget

Stages of Change(Prochaska & DiClemente)

Precontemplation: What problem?

Contemplation: Aware of the problem, but not quite ready…

Preparation: Plan to take action in the next month; beginning to take small steps

Action: Modifying behavior to overcome problem

Maintenance: work to prevent relapse and consolidate gains

How Do You Increase Someone’s Motivation?

The “Righting Reflex”A Practitioner/Helper Problem

Stems from a natural desire to help…

Helper/Practitioner’s “goal”: “diagnose the problem” “fix the problem” “control the problem” “get good results”

Practitioner tries to create change by… Providing reasons for

change (education) Provide

solution/treatment/skill building

Demonstration:Trying to Force Change

Provider/Helper Argues for Change

Demonstration of an “Ineffective Provider”

http://www.youtube.com/watch?v=80XyNE89eCs&feature=relmfu

Lisa Marlo, PhD, Professor of Psychiatry at the University of Florida

Student/Patient Argues Against

Change/Shuts Down

Resistance or Ambivalence?

Ambivalence: The True Dilemma of

Change Ambivalence is a state of

mind in which a person has co-existing but conflicting feelings about something

Fundamental and NORMAL part of the change process

“I want to, but I don’t want to…”

“You tell me a reason to change, I’ll tell you a reason not to…”

“People are usually more convinced by reasons they discovered themselves than by those found by others.”

--Blaise Pascal

Motivational Interviewing

Allows the individual to identify and verbalize their own reasons for change… We serve as the guide…

MI Defined: Motivational interviewing is a form of

collaborative conversation for strengthening a person's own motivation and commitment to change. It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change.

-MINT (2012)

Spirit of MI (“ACE”)

Autonomy NOT confrontation

CollaborationNOT authoritative

EvocationNOT education

Is this MI Spirit? (place your vote)

Student: I know my RA told you I’m depressed, but I’m not. Helper: You don’t believe you’re depressed.

What do you think she’s seeing that is making her worry this way?

Student: I had no idea I weighed that much. I guess that’s why everyone tells me I shouldn’t eat so much.

Helper: Right. You need to cut down on your eating and I know some good ways to get you started.

Student: I think your BMI thing is wrong because I am not “obese.” Helper: You don’t think of yourself as

someone who has a weight problem.

Strategies to Develop a Motivational ConversationOARS

Open-ended questions Avoid Yes/No “What types of exercise have you

previously tried?”

Affirmations Provide support & encouragement “Taking care of yourself is really important

to you”

Reflective Listening Making a statement that guesses at the

speaker’s meaning

Summarizing Organizes and links information

Open-Ended Questions

Encourage the person to give you more than a “yes/no” response Do you drink alcohol daily? (closed) What are your drinking habits like?

(open)

Typically can’t be answered with one word or brief responses How many fruits and vegetables do

you eat daily? (closed) Tell me about your daily eating

habits (open)

Open-Ended Questions?Place Your Vote

Are you doing okay today?

How much do you exercise?

What types of healthy foods do you like?

Do you eat fruit and vegetables daily?

What activities in the recreation department sound interesting to you?

Affirmations

Statements of appreciation of student/patient’s strengths, successes, efforts to change

Purpose is to empower and support self-efficacy

Avoid using word “I”

Different than compliments

Affirmation Practice

Student Says…

Student with diabetes tells you they are checking their glucose levels regularly

Overweight student tells you she has stopped drinking pop

Student tells you that he felt discouraged after failing recent TABE, but now has plan and feels confident he will pass next time

Possible Affirmation…

You are determined to keep your diabetes under control

Your health is really important to you

When you set your mind to something you feel confident you’ll accomplish your goal

Reflections…

Reflections are guesses at what you believe a person is saying. Show the person that you hear and understand them and invite them to continue talking

You can reflect many things… Speech Facial Expression Behavior Or guess at the deeper

meaning of words

Example Reflections…

Student

You don’t have a clue what it’s like living on this center

There is no way I can lose weight

I don’t eat vegetables and that’s a done deal

Student cries after STD result

I look gross when I work out. No way I’m doing that here

Reflection from Helper

You don’t think I can understand how hard it is

Losing weight doesn’t feel possible right now

There is no way you are going to eat vegetables

This news feels overwhelming

Looking good is important to you

Applying MI to HEALS

A Brief MI-Consistent Conversation

① Agree on the Focus

Elevated BMI

Explore and agree on a behavior to discuss or ask permission to discuss a particular

behavior

Exercise

???Social

Activities

Alcohol

Stress

Eating

_________________________________________________________________

Explore Ambivalence and Strengthen Motivation for Change

Change

Willing = importance

Able= Confidence

In order to be READY to change, person must be WILLING and ABLE

Follow up questions to elicit change talk: Why did you pick ____ instead of

_____(slightly lower number)? What would have to happen to make you

move up to a ____ (slightly higher number)?

Ask about importance and confidence around specific change…

Use OARS to clarify pros and cons…Use Reflections and Open-Ended Questions when hear change talk or are met with resistance…

Decisional Balance Worksheet: Explore the Ambivalence of Change…

Summarize Progress and Identify Next Step

Provide summary of information discussed then…

Ask: What do you make of all

this? Or...What, if anything, would be

a first step? Or…What do you intend to do

next?

Guiding Principles to Remember (RULE)

Resist the Righting Reflect Don’t argue with the student!

Understand the student’s motivation What is important to this person?

Listen to the student Ask open-ended questions and use

reflections to check your understanding

Empower the student (create self-efficacy) Affirm the student’s strengths

Demonstration of an Effective Provider: MI in Action

http://www.youtube.com/watch?v=URiKA7CKtfc&feature=relmfu

Lisa Merlo, PhD, Department of Psychiatry at the University of Florida

Further Reading...

Helpful Articles…

Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change. American Psychologist, 47 (9), 1102-1114.

Berg-Smith, M., Stevens, V., et al. (1999). A brief motivational intervention to improve dietary adherence in adolescents. Health Education Research, 14 (3), 399-410.

Butterworth, S., Linden, A., et al. (2006). Effect of motivational interviewing-based health coaching on employees’ physical and mental health status. Journal of Occupational Health Psychology, 11 (4), 358-365.

Hillsdon, M., Thorogood, M., et al. (2002). Advising people to take more exercise is ineffective. International Journal of Epidemiology, 31, 808-815.

Resnicow, K., Baskin, M, & McCarty, F. (2005). Results of Go Girls: A weight control program for overweight African-American adolescent females. Obesity Research, 13 (10),1739-1748.

Resnicow, K., Campbell, M., et al. (2004). Body and Soul: A dietary intervention conducted through African-American churches. American Journal of Preventative Medicine, 27 (2), 97-105.

Richards, A., Kattelmann, K., et al. (2006). Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption. American Dietetic Association, 106, 1405-1411.