Module 4

1. Module 4 Motivational Interviewing (MI)

2. How Does Behavior Change? Behavior ABehavior B

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. Nn Transtheoretical Model Pre-contemplation Relapse Contemplation Maintenance Determination Action SynonymsDetermination = PreparationTermination = Exit Termination 4-4

5. Prochaska & DiClemente: Stages of Readiness to Change StageDescriptionObjectives Pre-contemplationNot considering change ContemplationAmbivalent about change • Identify patient’s goals • Provide information • Bolster self-efficacy • Develop discrepancy between goal & behavior • Elicit self-motivational statements

6. Prochaska & DiClemente: Stages of Readiness to Change (continued) StageDescriptionObjectives DeterminationCommitted to change ActionInvolved in change • Strengthen commitment to change • Plan strategies for change • Identify and manage new barriers • Recognize relapse or impending relapse

7. Prochaska & DiClemente: Stages of Readiness to Change (continued) StageDescriptionObjectives 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

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

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

10. Principles of MI (continued) • 3. Provide Choices • It’s the individual’s choice: • Whetherto change • Howto change

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

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

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

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

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?”

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”

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.”

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.”

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

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.”

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 ...”

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

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)?”

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)?”

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?”

26. For Ambivalence - DEARS Develop discrepancy • Compare positives and negatives of behavior • Positives and negatives of changing in light of goals • Elicit self-motivational statements Empathize • Ambivalence and pain of engaging in behavior that hinders goals

27. For Ambivalence - DEARS(continued) Avoid Arguments • Don’t push for change, avoid labeling Roll 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

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