Module 4 Motivational Interviewing (MI)

4-2 How Does Behavior Change? Behavior ABehavior B

4-3 ASSUMPTIONS Behavioral issues are common Change often takes a long time The pace of change is variable Knowledge is usually not sufficient to motivate change Relapse is the norm

4-4 Nn Transtheoretical Model Determination Relapse Pre-contemplation Contemplation Maintenance Action Termination Synonyms Determination = Preparation Termination = Exit 4-4

4-5 Prochaska & DiClemente: Stages of Readiness to Change Stage Description Objectives Pre-contemplation Not considering change Contemplation Ambivalent about change  Identify patient’s goals  Provide information  Bolster self-efficacy  Develop discrepancy between goal & behavior  Elicit self-motivational statements

4-6 Prochaska & DiClemente: Stages of Readiness to Change (continued) Stage Description Objectives Determination Committed to change Action Involved in change  Strengthen commitment to change  Plan strategies for change  Identify and manage new barriers  Recognize relapse or impending relapse

4-7 Prochaska & DiClemente: Stages of Readiness to Change (continued) Stage Description Objectives Maintenance Behavior change Relapse Undesired behaviors Termination Change is very stable  Assure stability of change  Foster personal development  Identify relapse when it occurs  Reestablish self-efficacy and commitment  Behavioral strategies  Assure stability of change

4-8 Principles of MI 1. Advice Give advice only when individuals will be receptive Target advice to stage of change

4-9 Principles of MI (continued) 2. Reduce Barriers  Bolster self-efficacy  Address logistical barriers

4-10 Principles of MI (continued) 3. Provide Choices It’s the individual’s choice:  Whether to change  How to change

4-11 Principles of MI (continued) 4. Decrease Desirability Help individuals:  Decrease their perceptions of the desirability of the behavior  Identify other behaviors to replace the positive aspects of alcohol use

4-12 Principles of MI (continued) 5. Empathy  Develop and communicate an understanding of the individual’s situation and feelings around the behavior  Explore pain around the behavior

4-13 Principles of MI (continued) 6. Feedback Help the individual identify and understand relevant:  Risks of the behavior  Negative consequences of the behavior

4-14 Interview Techniques Open-ended questions Reflective listening Affirmation Summarization Elicit self-motivational statements

4-15 Open-ended Questions Avoid closed and leading questions like: “Would you like to quit?” “Do you know that alcohol is bad for you?” Instead ask: “What do you think about your alcohol use?” “What do you know about the risks of drinking?”

4-16 Reflective Listening Mirrors what the patient says Creates a sense of safety for the patient Deepens the conversation Helps patients understand themselves Says: “I hear you” “This is important” “Please tell me more” “I’m not judging you”

4-17 Reflective Listening (continued) Patient: “To tell you the truth, I really enjoy drinking.” Response: “You like drinking alcohol?” Patient: “Yes. I like the taste, and it really relaxes me.”

4-18 Reflective Listening (continued) Example 1: “My girlfriend gets really angry when I get drunk and pass out.” “She gets mad when you do that.”

4-19 Affirmation Conveys support, respect, and encouragement Helps patients reveal less positive aspects about themselves “You’ve tried very hard to quit.”

4-20 Affirmation (continued) “You are very courageous to be so revealing about this.” “You’ve accomplished a lot in a short time.” “I can understand why drinking feels so good to you.”

4-21 Summarization “What you’ve said is important.” “I value what you say.” “Here are the salient points.” “Did I hear you correctly?” “We covered that well. Now let's talk about...”

4-22 Elicit Self-Motivational Statements Problem recognition “Has alcohol caused you any problems?” Concern “Do you ever worry about your alcohol use?”

4-23 Elicit Self-Motivational Statements (continued) Intention to change “What might be some advantages of quitting or cutting down?” “On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say (1 or 2 points lower)?”

4-24 Elicit Self-Motivational Statements (continued) Intention to Change  “On a scale of 0 to 10, how important is it for you to change your (behavior)? ”  “Why didn't you say (1 or 2 points lower)?”

4-25 Elicit Self-Motivational Statements (continued) Optimism  “What difficult goals have you achieved in the past?”  “What might work for you if you did decide to change?”

4-26 For Ambivalence - DEARS D evelop discrepancy  Compare positives and negatives of behavior  Positives and negatives of changing in light of goals  Elicit self-motivational statements E mpathize  Ambivalence and pain of engaging in behavior that hinders goals

4-27 For Ambivalence - DEARS (continued) A void Arguments  Don’t push for change, avoid labeling R oll with resistance  Change strategies in response to resistance  Acknowledge reluctance and ambivalence as understandable  Reframe statements to create new momentum  Engage patient/client in problem-solving

4-28 For Ambivalence - DEARS (continued) Support self-efficacy Bolster responsibility and ability to succeed Foster hope with menus of options