Motivational Interviewing

1. Motivational Interviewing Peter Cochrane: General Practice Education and Training Alcohol and Drug Training and Resource Unit Alcohol and Drug Service Primary and Community Health Services Metro North Health Service District Queensland Health

3. Motivational Interviewing in health care Meta-analysis reports Hettema et al (2005) � 72 clinical trials; increased exercise, diet, & eating disorder program adherence Rubak et al (2005) � 72 RCTs (1991-2004); statistically & clinically significant effect in 75% of studies; emphasized successful application of BMI Burke et al (2003) � 30 studies; similar to other active treatments and better than placebo/no treatment for exercise, dietary, ETOH, and smoking cessation problems

4. Video clip Awareness

5. One size does not fit all

6. Why might sensible advice not work? Sensible advice is fine when it works � sometimes all people need is a little additional information If it doesn�t work, repeating it builds resistance: people either develop contrary positions or avoid the advisor People who are unable to follow sensible advice feel like failures � I can�t do anything about it so why bother trying

7. The difficulty of change Think of a time or a situation when someone wanted you to change some aspect of your behaviour or lifestyle work habits use of recreational time spending habits domestic routines eating, drinking or smoking

9. The difficulty of change Think about a behaviour you have wanted to change in the past or present, for example: not spending enough time with the family not exercising poor diet Was it hard to change? If so, why�.?

11. Changing behaviour If we want to change behaviour it is necessary to change the underlying beliefs and feelings related to that behaviour (Christine Bundy 2004)

12. Stages of Change

13. Assessing readiness to change Ask: On a scale of 1-5, how ready are you right now to change your behaviour? ______________________________________ 1 2 3 4 5 Not ready Thinking of change Undecided Somewhat ready Very ready

14. Motivational Interviewing Motivational Interviewing is a client centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence Miller & Rollnick (2002)

15. Client centred & directive Asking Listening Informing Goal oriented

16. Enhancing intrinsic motivation Motivation - Readiness Readiness - Importance Why should I change? (personal values and expectations of the importance of change) - Confidence How will I do it? (self-efficacy) (Rollnick, Mason, & Butler 1999)

18. Exploring & resolving ambivalence People have valid reasons to both change and to maintain their �target behaviour� good vs. less good ; likes vs. dislikes Exploration of ambivalence aims to elicit change and commitment talk develop discrepancy

19. Four Column Diagram

20. Change talk Preparatory talk DARN statements Desire: tell you something the person wants Ability: what the person perceives they can do Reasons: specific arguments for change Need: language that indicates a necessity to change or feeling obliged to change Preparatory talk leads to commitment talk Amrhein et al. (2003)

21. Change talk Commitment talk Commitment talk: statements about the likelihood of change Increasing intensity of commitment talk leads to action Taking steps: statements stating what action has been taken

22. Recognising change talk I�ve got to get back some energy. I will take my medication regularly. I�m sure I�d feel better if I exercised regularly. I might be able to cut down a bit. I really should cut out junk food but I can�t. I could probably take a walk before dinner.

23. Recognising change talk I wish I could lose some weight. This pain keeps me from playing the piano. I�d like to cut down my cholesterol, but I do love cheeses. I plan to quit at the start of next month. I want to go to the gym but it hurts. I will think about seeing the specialist. I need to do something about getting fit so I bought some walking shoes.

24. Eliciting change talk Why would you want to quit smoking? How would you do it, if you decided to? What for you, are the three best reasons for quitting? How important is it for you to quit? Where does that leave you?

25. Key principles A. Express empathy B. Raise ambivalence & develop discrepancy C. Roll with resistance D. Support self efficacy

26. OARS Open-ended questions Offers client freedom to respond Invites client�s perspective and encourages self-exploration Affirmation Expresses appreciation of who the client is Build self-efficacy Reflection Makes a statement that checks understanding Says what the client meant Summarising Collects or links what the client has said Prepares for transitions

27. Agenda setting Can help focus session with patient Allows patient to identify what behaviour they would like to address Can be useful when you need to take more of a directive approach

28. Video clip Targeting behaviour Geoff, recently diagnosed with diabetes

29. Differing styles In pairs Each person think of something you would like to change (e.g. read more) Person with orange paper is first counsellor �Client� tell the counsellor what you want to change In response, counsellor follows the instructions provided Swap roles so that person with blue paper is counsellor Repeat process

30. Video clip Demonstration of combining the skills rehearsed

32. Conclusion Motivational Interviewing is an evidence based counseling style to assist people to make lifestyle / behaviour changes works on assisting people to become ready to change and to take the steps needed to make a change is non-judgmental but does not require the clinician to endorse unhealthy behaviour

33. References Amrhein, P., Miller, W., Yahne, C., Palmer, M & Fulcher, L. (2003). Client commitment language during motivational interviewing predicts drug use outcomes. Journal of Consulting and Clinical Psychology, 71(5), 862-78. Birmingham, M (1986). An Outpatient treatment programme for adolescent substance abusers. Journal of Adolescence,9,123-133. Bundy, C (2004). Changing behaviour: using motivational interviewing techniques. Journal of the Royal Society of Medicine, 97 (Suppl. 44):43-47. Ernst, D. (2006). Advanced motivational interviewing workshop. Adelaide Mueser, K., Noorsby, D., Drake, R & Fox, L. (2003). Integrated treatment for dual disorders: A guide for effective practice. London: Guilford Press. Miller & Rollnick. (2002). Motivational Interviewing: Preparing People for Change. New York: Guilford Press. Rollnick, Mason & Butler (1999). Health Behaviour Change: A guide for practitioners. Churchill Livingstone. Tomlin, K., & Richardson, H. (2004). Motivational Interviewing and Stages of Change. Minnesota: Hazelden Van Dorsten, B (2007). The Use of Motivational Interviewing in Weight Loss. Current Diabetes Reports, 7:386-390. Zuckoff, A. (2006). A motivational approach to working with co-existing disorders. Workshop presentation. Adelaide www.motivationalinterview.org

34. References Assay, T.P., & Lambert, M.J. (1999). The empirical case for the common factors in therapy: Quantitative findings. In M.A. Hubble, B.l. Duncan, & S.D. Miller (Eds.), The heart and soul of change: What works in therapy (pp. 33-56). Washington, DC: American Psychological Association. Egan, G. (2001). Exercises in Helping Skills: A Training Manual to Accompany �The Skilled Helper� (7th edn). Pacific Grove, CA: Brookes/Cole. Egan, G. (2002). The Skilled Helper: A Problem-Management and Opportunity-Development Approach to Helping (7th edn). Pacific Grove, CA: Brookes/Cole. Ivey, E., & Ivey, M. (1999). Intentional Interviewing and Counselling (4th edn). Pacific Grove, CA: Brookes/Cole. Jarvis,T., Tebbutt,J., Mattick, R., & Shand F. (2005). Treatment Approaches for Alcohol and Drug Dependence. Australia: John Wiley & Sons, LTD. Rogers, C. (1980). A Way of Being. Boston: Houghton Mifflin Company. Rollnick, S., Miller, W., & Butler, C. (2008). Motivational Interviewing in Health Care: Helping patients change behaviour. New York: Guilford Press

35. References http://promotehealth.info/wp-content/uploads/exercise-busy-schedule.bmp http://images.google.com.au/images?hl=en&q=fat+people+eating&gbv=2&aq=0&oq=fat+people&safe=active http://images.google.com.au/images?gbv=2&hl=en&safe=active&sa=1&q=measuring+waist+circumference&aq=0&oq=measuring+waist http://images.google.com.au/images?gbv=2&hl=en&safe=active&q=calendars&sa=N&start=0&ndsp=18 http://images.google.com.au/images?gbv=2&hl=en&safe=active&sa=1&q=nutritious+food&aq=0&oq=nutritious http://images.google.com.au/images?gbv=2&hl=en&safe=active&sa=1&q=donuts&aq=f&oq=