IPL Symposia: Working with resistive behaviour Chidi Onwuasoanya

Problems Solutions

Helping patients change behaviour What strategies have you observed/used in practice to influence behaviour change? What are your observations in the following video clip? https://www.youtube.com/watch?v=Ow0lr63y4Mw

MOTIVATIONAL INTERVIEWING (MI) What is MI?

Talking with patients about change in an effective way. Definition of MI Talking with patients about change in an effective way. I wish I can stop smoking, it’s really affecting my health Can I give you information about services that can support you?

MI supports and enables behaviour change

Definition of MI MI is a person centered, semi-directive approach that was originally developed within medical settings to help people with addiction problems (Miller & Rollnick, 2008) Acknowledges that people are not always ready or willing to change their behaviour to improve their health, and it takes a non-judgmental approach. MI is a collaborative conversation style that strengthens a person’s own commitment to change. Persuasive and supportive rather than confrontational

We can make changes about.. Smoking Social Health Medication Adherence Relationships Keeping Appointments Drugs Physical Health Alcohol Mental Health Addictions Exercise

Observe the professional’s approach and the patient’s response in the following video clip: http://www.youtube.com/watch?v=80XyNE89eCs

Observe the different approach, compared to the previous video clip https://www.youtube.com/watch?v=URiKA7CKtfc

MI MAY HELP WITH… AMBIVALENCE PROCRASTINATION RESISTANCE

Observe how MI is used to work on resistance to change in the video clip: https://www.youtube.com/watch?v=KwDx3nKVQ0k

Using MI to support behaviour change Successful in influencing attitudes & behaviour Acknowledges that people are at different stages of readiness to change, which may fluctuate at times. This may also cause a feeling of ambivalence. Attempts to move the individual away from ambivalence and support them to achieve the next stage of behaviour.

Cycle of change

MI Strategies Open question Affirmation Reflection Summarise OARS

Processes of MI Engaging Focusing Evoking Planning By applying the OARS MI strategies at each stage.

Observe the OARS strategies of MI, engagement and communication skills used in this video clip: https://www.youtube.com/watch?v=bTRRNWrwRCo

Approaches used in MI MI offers information and advice only when it is allowed and desired by the patient. It is a patient-centered approach that values patient’s feelings and shows empathy It avoids argument It supports self-efficacy, giving positive affirmation for any change to increase and encourage patient’s belief that they are able to make the required changes It encourages patient’s consideration of alternative views whilst allowing the need to ‘roll with resistance’ and avoids challenging directly.

Encourages patients to appreciate change by considering the difference between how clients are at present and how they want their lives to be. MI strategies encourage ‘change talk’ and opens up discussions on any barriers to their achieving their goals, and what support they need to achieve them.

Thank you

Reading List Miller, W.R., and Rollnick, S. (2012) Motivational Interviewing – what it is, how it works, how to learn it. Course Materials. Cardiff. Rollnick, S., Miller, W.R., and Butler, C. (2008) Motivational Interviewing in Health Care – helping patients change behaviour. New York Guilford Press Rollnick, S., and Miller, W. R. (1995). What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334. Rubak, S., Sandback, A., Lauritzen, T., and Christensen, B. (2005). Motivational Interviewing: a systematic review and meta-analysis. British Journal of General Practice, 22, 305-312. Prochaska, J.O., and DiClemente, C.C. (1984). The transtheoretical approach: Crossing the traditional boundaries of therapy. Melbourne, Florida: Krieger Publishing Company. Tober, G., and Raistrick, D. (eds) (2007) Motivational Dialogue; preparing addiction professionals for motivational interviewing practice. Routledge. London.

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