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Understanding behaviour change: The role of Motivational Interviewing Dr Jeff Breckon CPsychol. Motivational Interviewing Network of Trainers (MINT)

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Page 1: Understanding behaviour change: The role of …€¦ · Understanding behaviour change: The role of Motivational Interviewing ... The role of Motivational Interviewing . ... Developing

Understanding behaviour change: The role of Motivational Interviewing

Dr Jeff Breckon CPsychol.

Motivational Interviewing Network of Trainers (MINT)

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Dr Jeff Breckon

Presenter Disclosure Information:

This speaker has no conflicts of interest

Understanding behaviour change: The role of Motivational Interviewing

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Themes

• Issues and myths of [PA] behaviour change

• Behaviour change counselling interventions

• Motivational interviewing

– Relational

– Technical

– Four processes

– Psycholinguistics of change (CT/ST)

• Where next?

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ISSUES OF [PA] BEHAVIOUR CHANGE

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We have some challenges!

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2011

1961

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ITS COMPLICATED!

7 www.employeewellnessnetwork.com

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“Over 75% of individuals do not maintain behavior

changes in multiple areas of behavior including

substance use, smoking, physical activity, nutrition, and management of chronic physical and mental health

conditions”

(Naar-King, Earnshaw & Breckon, 2013)

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PHYSICAL ACTIVITY (PA) specifically

• Multiple conditions (e.g. smoking, alcohol, diet)

• Requires significant effort

• It is a 'complex intervention'

• Success is dependant on environmental and social factors as well as personal 'engagement‘

• ‘Positive contamination’

• Seasonality

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Some nations build PA into their commute (or day-to-day life)

Norrkoping, April 2013

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INFORMATION IS NOT ENOUGH: ITS HOW YOU PRESENT INFORMATION THAT MATTERS…

60% 20%

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BEHAVIOUR CHANGE COUNSELLING INTERVENTIONS

The role of the health professional:

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Client outcomes before and after random reassignment to a new counsellor

0

5

10

15

20

25

30

35

40

45

50

1 2 3 4

% Positive Urines

35

37

39

41

43

45

47

49

1 2 3 4

Methadone Use

30

35

40

45

50

55

60

1 2 3 4

% Employed

0

1

2

3

4

5

6

1 2 3 4

% Arrested

McLellan et al (1988) Journal of Nervous and Mental Disease, 176, 423-430.

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Clinician effects

• Substantial empirical evidence indicates that clinicians account for a significant portion of outcome in behavioural and psychosocial treatments

• In fact, one of the best predictors for how well clients will do after behavioural interventions is which clinician they have

Moyers (2013)

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"We need to move beyond just a brand name" (Terri Moyers)

MI

BAT

CBT

ACTIVE INGREDIENTS?

SFT

550 named behavioral therapies… knowing the identification of core

components (that are part of many successful interventions) is critical

(Fixsen, 2005)

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MOTIVATIONAL INTERVIEWING

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A technical definition of MI

“Motivational interviewing is a collaborative, goal orientated 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.” (Miller & Rollnick, 2012)

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A technical definition of MI

“Motivational interviewing is a collaborative, goal orientated 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.” (Miller & Rollnick, 2012)

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OR…

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"MI with someone is like entering their home. One should enter with respect, interest and kindness, affirm what is good, and refrain from providing

unsolicited advice and rearranging their furniture. “

(An Alaskan elder reflecting on an MI workshop by Steve Berg-Smith)

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MI

MI Spirit

Change (and

Sustain) Talk

MI Processes

MI Micro skills

(OARS)

The Elements of Motivational Interviewing

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Collaboration Acceptance

Compassion Evocation

MI Spirit

Adapted from Miller & Rollnick (2013)

MI Spirit

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MI Micro skills

(OARS)

– Open ended questions

– Affirmations

– Reflective listening

– Summarising

OQs • Disadvantages of the Status

Quo • Advantages of Change • Optimism for Change • Intention to Change

1. What the client means

2. Words the client

says

3. Words the practitioner hears

4. What the practitioner

thinks the client means

Reflective listening

1. Repeating (repeat an element).

2. Rephrasing (repeat with synonyms).

3. Paraphrase (repeat best guess at meaning; saying the next sentence).

4. Reflection of feeling (paraphrase that emphasizes the emotional dimension).

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Four ‘+’ processes

MI Processes

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BENEFITS OF STAYING THE SAME & COSTS OF

CHANGE

BENEFITS OF CHANGE & COSTS OF STAYING THE

SAME

Sustain Talk & (Discord)

Change Talk Change (and Sustain) Talk

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PREDICTOR PRECURSOR

Sustain vs Change talk

• Desire

• Ability

• Reasons

• Need

• Commitment

• Activation

• Taking steps

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WHERE NEXT?

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WHERE NEXT: VALUES MATCHING VS STAGE MATCHING INTERVENTIONS (HUTCHISON, JOHNSTON & BRECKON, 2011)

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WHERE NEXT: IMPLEMENTATION SCIENCE

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SCIENCE TO SERVICE GAP

A key part of 'Implementation Science' (Fixsen, 2010)

science service

SERVICE GAP

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The Challenge

• What is known is not what is adopted in the health sector

• What is adopted is not used with fidelity and good outcomes

for consumer

• What is used with fidelity is not sustained for a useful period

of time

• What is used with fidelity is not used on a scale sufficient to

impact on societal health problems

(Adapted from Fixsen, 2010)

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WHERE NEXT: MI-CBT FOR MAINTAINING BEHAVIOUR CHANGE

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CBT Maintenance Strategies and MI Integration (Naar-King, Earnshaw & Breckon, 2013)

Maintenance Strategy MI Integration

Managing the Goal Violation Effect

• Avoid the term relapse • Empathise with slips • Elicit change talk about maintenance • Consider an importance ruler • Explore discrepancy between values/goals and slips Emphasise adoption of new

behaviors

Flexible Goal Setting • Offer menu of options of short-term goals • Develop a change plan’ for maintenance • Consider a commitment ruler

Identifying Triggers and Developing Coping Skills

• Ask for permission before engaging in treatment tasks • Use Elicit-Provide-Elicit strategy when discussing rationales or providing

information/advice • Consider rulers for treatment tasks.

Supporting Self-Efficacy • Use affirmations instead of praise • Ask open-ended questions to elicit confidence statements • Consider an Affirmations Card Sort or a confidence ruler • Avoid the ‘false-hope syndrome.’

Increasing Social Support • Use MI skills to increase motivation for social skills training or to address ambivalence about engaging significant others

• Include specific plans for social support in the change plan for maintenance • Consider addressing social support in each session in relation to specific treatment

tasks.

Using Extrinsic Reinforcers • Use of MI skills to elicit the identification of internal reasons for maintenance • Use Elicit-Provide-Elicit when discussing rationale • Present reinforcers as a menu of options to support autonomy.

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Information Sources Breckon, J.D. (2014) Motivational Interviewing to promote physical activity and nutrition behaviour change. In, Doing Exercise Psychology (M. Anderson & S. Hanrahan, Eds.). Human Kinetics, Champaign, Ill. Breckon, J. D., Johnston, L. H. & Hutchison, A. (2008) Physical activity counseling content and competency: A systematic review. Journal of Physical Activity and Health, 5, 398-417. Crust, L., Swann, C., Allen-Collinson, J., Breckon, J. & Weinberg, R. (in press) A phenomenological exploration of exercise mental toughness: Perceptions of exercise leaders and regular exercisers. Qualitative Research in Sport, Exercise and Health. Hutchison, A., Breckon, J. D., & Johnston, L. H. (2009). Physical activity behaviour change interventions based on the transtheoretical model: A systematic review. Health Education & Behavior, 36, 829-845. Johnston, L. H., Breckon, J. D. & Hutchison, A. (2008) Influencing Health Behaviour: Applying Theory to Practice. In, L. Dugdill, D. Crone and R. Murphy (Eds) Physical Activity and Health Promotion: Evidence-based Approaches to Practice. London: Blackwell Miller, W.R & Rollnick, S. (2013) Motivational Interviewing: preparing people for change. London: Guilford Press. Naar-King, S., Earnshaw, P. & Breckon, J. (2013) Towards a Universal Maintenance Intervention: Integrating Motivational Interviewing with Cognitive-Behavioural Strategies for Maintenance of Behaviour Change. Cognitive and Behavioral Practice, 27(2), pp.126- 137. Rollnick, S., Miller, W.R. & Butler, C. (2008) Motivational Interviewing in Health Care: Helping patients change behaviour. London: Guildford. Rosengren, D. (2009) Building Motivational Interviewing Skills: A practitioner workbook. London: Guilford. Scott, S., Breckon, J. & Copeland, R. (in press) Determinants and Strategies for Physical Activity Maintenance in Chronic Health Conditions: A Qualitative Study. Journal of Physical Activity and Health.

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Dr. Jeff Breckon [email protected]

THANKS FOR LISTENING

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