Motivational Interviewing Techniques
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Questions and Answers

Which of the following best describes the 'Guiding' process in motivational interviewing?

  • Uncovering the patient's inherent reasons and desires for change.
  • Pinpointing specific areas where behavioral modifications would be advantageous. (correct)
  • Establishing a strong rapport and trust with the patient.
  • Formulating a concrete action plan to enact behavioral changes.

Which of the following reflects the purpose of affirmations in motivational interviewing?

  • Providing specific feedback on areas where the patient needs to improve.
  • Directly advising patients on the best course of action for their health.
  • Establishing a collaborative and respectful environment by acknowledging the patient's strengths and commitments. (correct)
  • Challenging the patient's negative beliefs to promote a more positive outlook.

A health coach asks a patient, 'What are some things that are most important to you in your daily life?' This is an example of what kind of question?

  • An open question, encouraging the patient to elaborate. (correct)
  • A leading question, guiding the patient towards a particular answer.
  • A closed question, as it seeks specific information.
  • A rhetorical question, not requiring a direct response.

Why are open questions preferred over closed questions in motivational interviewing?

<p>They encourage the patient to reflect and share more information. (C)</p> Signup and view all the answers

Which of the following is a characteristic of closed questions?

<p>They typically elicit 'yes' or 'no' answers. (A)</p> Signup and view all the answers

During a motivational interviewing session, a practitioner says, 'So, it sounds like you're feeling unsure about making these changes, but you're also hopeful that it could improve your health. Is that right?' This is an example of which MI skill?

<p>Reflection (A)</p> Signup and view all the answers

What is the primary goal of 'evoking' in the context of motivational interviewing?

<p>To elicit the patient's own motivations and reasons for change. (C)</p> Signup and view all the answers

A patient states, 'I don't think I can ever stick to a diet.' How might a practitioner using motivational interviewing respond, incorporating an affirmation?

<p>'It sounds like you're dedicated to making a change, and that takes real commitment.' (C)</p> Signup and view all the answers

Which of the following statements best describes the core principle of motivational interviewing in diabetes management?

<p>Collaboratively working with patients to explore their ambivalence and strengthen their own motivation for behavior change. (B)</p> Signup and view all the answers

A diabetes patient expresses frustration with checking their blood sugar multiple times a day, stating, "It's just so time-consuming and I don't always see the point." Which response demonstrates a reflective listening technique?

<p>&quot;So, it sounds like you're finding it difficult to fit blood sugar checks into your daily routine and are questioning its value.&quot; (D)</p> Signup and view all the answers

A patient with diabetes has made a small improvement in their diet but hasn't yet achieved their target A1c level. Which response would be an example of using affirmation in motivational interviewing?

<p>&quot;I notice you've started including more vegetables in your meals. That's a great step towards improving your health overall.&quot; (D)</p> Signup and view all the answers

A patient who has recently been diagnosed with diabetes says, "I know I need to make changes, but it all feels so overwhelming. I don't even know where to start." How could you use an open-ended question to explore this further?

<p>&quot;What feels most overwhelming to you about managing your diabetes right now?&quot; (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of motivational interviewing?

<p>It relies on the clinician lecturing the patient on the importance of the patient improving their lifestyle. (A)</p> Signup and view all the answers

A patient with poorly controlled diabetes attends their appointment. They state 'I know my numbers are bad. I don't know why I even bother coming in here. Nothing changes.' Which of the following is the most appropriate response?

<p>&quot;Let's focus on finding small, manageable steps you feel confident you can take. What changes, even small ones, do you think you'd be willing to try this week?&quot; (D)</p> Signup and view all the answers

You have been working with a patient utilizing motivational interviewing techniques. At the end of the session, what would be the MOST effective way to ensure the patient feels heard an understood?

<p>Summarize the key points of the conversation and ask the patient if the summary accurately reflects their perspective. (D)</p> Signup and view all the answers

A patient says, "I hate exercising. It's boring and I never have time." Which of the following options is the BEST reponse?

<p>&quot;Would you be open to exploring different types of physical activity to find something you enjoy?&quot; (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of reflective listening?

<p>Offering advice to solve the speaker's problem. (B)</p> Signup and view all the answers

When using reflective listening with a patient, what type of talk should you primarily reflect back to them?

<p>Change talk, to encourage consideration of new behaviors. (B)</p> Signup and view all the answers

Which of the following best describes the primary purpose of reflective listening?

<p>To demonstrate understanding and encourage further exploration by the speaker. (A)</p> Signup and view all the answers

A patient says, "I know I should exercise more, but it's so hard to find the time." According to the principles of 'Change Talk', which element does this statement primarily represent?

<p>Need (B)</p> Signup and view all the answers

Which of the following is the most appropriate way to start a summary during a conversation with a patient?

<p>&quot;Let me see if I understand what you've told me so far.&quot; (C)</p> Signup and view all the answers

How can strategically summarizing points of discussion with a patient elicit 'change talk'?

<p>By connecting key points to reveal the patient's willingness to consider change. (D)</p> Signup and view all the answers

What is the main purpose of using summaries in a conversation?

<p>To provide a concise recap and encourage further thought and planning. (C)</p> Signup and view all the answers

During a reflective listening session, a patient states, "I want to quit smoking, but I don't think I'm strong enough." Which two elements of 'Change Talk' are represented in this statement?

<p>Desire and Ability (D)</p> Signup and view all the answers

A client expresses uncertainty about initiating a healthy lifestyle change. Which question would be MOST effective in understanding their perspective, according to the principles described?

<p>&quot;On a scale of 0 to 10, how ready are you to make this change, and why did you choose that number?&quot; (B)</p> Signup and view all the answers

A patient rates the importance of attending physical therapy as a '2' out of 10. Following the principles outlined, what is the MOST appropriate next step for the healthcare provider?

<p>Explore the reasons why the patient chose '2' instead of a lower number. (A)</p> Signup and view all the answers

A client is hesitant to seek therapy. Using the principles of motivational interviewing, which approach would be LEAST effective?

<p>Immediately prescribing a specific therapy program. (B)</p> Signup and view all the answers

A patient states they are very confident they could start exercising, but they don't see the point. Which element of motivation is MOST lacking?

<p>Importance (D)</p> Signup and view all the answers

A patient expresses low confidence in their ability to adhere to a new medication schedule. What strategy would be MOST effective in boosting their confidence, according to the information?

<p>Breaking down the schedule into smaller, manageable steps. (B)</p> Signup and view all the answers

According to the principles, what is the relationship between importance, confidence, and readiness?

<p>Importance plus confidence equals readiness. (D)</p> Signup and view all the answers

What question is designed to understand the benefits that the patient envisions in seeking a therapist?

<p>&quot;Why did you choose _____, and not a lower number like 1 or 2?&quot; (D)</p> Signup and view all the answers

After a patient provides a number on the importance ruler, which follow-up question is designed to uncover potential motivators?

<p>&quot;What would it take to move your number a little higher?&quot; (B)</p> Signup and view all the answers

A clinician is trying to understand a patient's perspective on their alcohol consumption. Which question would be MOST effective in eliciting a detailed response about their motivations, fears, and past experiences?

<p>How has your drinking affected your relationships with family and friends? (D)</p> Signup and view all the answers

A doctor is working with Mr. Jones, a diabetic patient with an A1c of 9.8 and blood pressure of 150/94. The doctor wants to use open-ended questions to understand Mr. Jones's perspective. Which of the following is the MOST appropriate initial question?

<p>It must be uncomfortable for you now, seeing all this...what's the next step? (B)</p> Signup and view all the answers

Which of the following affirmations would be MOST effective in supporting a patient who has made a recent positive change, such as adhering to a diet?

<p>You were able to make healthful decisions for yourself, despite serious temptation. (A)</p> Signup and view all the answers

A patient states, "I keep trying to exercise, but I always end up quitting after a week." Which of the following responses demonstrates reflective listening?

<p>It sounds like you get frustrated when you're not seeing immediate results. (C)</p> Signup and view all the answers

A patient is hesitant to discuss their struggles with substance abuse. How could you use affirmations to build rapport?

<p>By focusing on the patient's past successes in other areas of their life. (A)</p> Signup and view all the answers

A patient says, "I feel overwhelmed by all the changes I need to make to manage my diabetes." As a healthcare provider, what is the MOST appropriate reflective listening response?

<p>You feel overwhelmed by the number of changes needed to manage your diabetes? (A)</p> Signup and view all the answers

After discovering that Mr. Jones hasn't been monitoring his blood sugar consistently, which of the following questions is MOST likely to reveal his reasons?

<p>How do you feel about checking your blood sugar? (A)</p> Signup and view all the answers

Which affirmation best acknowledges the challenges that a patient faces when dealing with a chronic condition?

<p>You're handling this chronic condition with incredible strength, even during difficult moments. (B)</p> Signup and view all the answers

When using a confidence ruler (0-10 scale) and a client rates themselves at a 0 or 1, what is the most appropriate next step?

<p>Reassess the importance they place on the behavior change or reflect on their priorities. (B)</p> Signup and view all the answers

Following the confidence questioning, what is the purpose of asking 'What would it take to move your number a little higher?'

<p>To understand what actions could increase the client's confidence. (A)</p> Signup and view all the answers

A client rates their confidence in starting a new exercise routine as a '3'. Which follow-up question is MOST likely to elicit information about what contributes to their current level of confidence, rather than focusing on barriers?

<p>&quot;Why did you choose a 3, and not a lower number like 1 or 2?&quot; (A)</p> Signup and view all the answers

In the context of motivational interviewing, reflecting on the reasons a client gives for their confidence level primarily helps the practitioner to:

<p>Understand what factors contribute to the client's sense of self-efficacy. (B)</p> Signup and view all the answers

A patient is working to change a behavior. Using a scale of 0 to 10, they rate their confidence as an 8. According to the principles of eliciting confidence, what would be the BEST question to ask next?

<p>&quot;Why did you choose 8 instead of a lower number?&quot; (D)</p> Signup and view all the answers

What is the MOST important reason for asking about a client's confidence level in achieving a specific health-related goal?

<p>To understand the client's perceived ability and readiness to take action. (A)</p> Signup and view all the answers

A new client tells you that they are not confident that they can cut back on sugars in their diet. Using the confidence ruler technique, once they state their number, what is the MOST appropriate interview technique to use next?

<p>Ask what would need to happen to raise their confidence in reducing sugar intake. (C)</p> Signup and view all the answers

Why is it important to reflect on the reasons given by a patient for their confidence score (on a scale of 0-10), regarding a health behavior change?

<p>Reflecting helps reinforce positive beliefs. (D)</p> Signup and view all the answers

Flashcards

Diabetes Goal Attainment

Many diabetic patients are not at their A1c, lipid, BP, or weight goals.

Diabetes Management Complexity

Significant lifestyle changes, including diet adjustments and increased activity, are needed.

Challenges in Diabetes Management

Diet, activity, costs, depression, burnout, anger, denial and poor understanding.

Ineffectiveness of Fear Tactics

Describing potential complications rarely results in behavior change.

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Stages of Change

Patients are often at different stages of readiness for change.

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Motivational Interviewing

A collaborative counseling strategy to elicit and strengthen motivation for behavior change.

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Patient-Centered Approach

A patient-centered approach where the patient does most of the talking and decision-making.

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Safe Setting Importance

Creating a safe setting for people to consider change.

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MI's Goal in Diabetes Care

Helping patients build motivation and confidence to improve their diabetes control.

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Engaging (MI Process)

Establishing a relationship before discussing change.

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Guiding (MI Process)

Identifying specific areas where change would be beneficial for the patient.

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Evoking (MI Process)

Eliciting the patient's own reasons and motivation for change.

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Planning (MI Process)

Collaboratively developing a specific plan or strategy for behavior change.

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Open Questions (MI)

Questions that invite more than a 'yes' or 'no' response.

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Affirmations (MI)

Statements acknowledging the patient's strengths or efforts.

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Closed Questions

Questions that can be answered with a simple 'yes' or 'no'.

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Patient Disclosures

Activities, relationships, fears, and past attempts relating to a specific behavior.

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Open Questions

Questions that encourage detailed, narrative responses.

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Key Open-Ended Questions

Explore the patient's perspective and motivations.

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Affirmations

Statements of empathy and support for a patient's strengths and past achievements.

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Components of Affirmations

Acknowledge struggles, skills, goals and values, and positive actions.

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Reflective Listening

A statement that mirrors content and feelings of the speaker.

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What are Affirmations?

Statements of empathy and support for past accomplishments and strengths

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What is Reflection?

Mirroring what someone said, or how they are feeling.

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Sustain Talk

Statements defending the current behavior, indicating a pre-contemplation stage.

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Change Talk

Statements indicating consideration or planning for behavior change, reflecting contemplation.

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DARN-CAT

Desire, Ability, Reason, Need, Commitment, Activation, Taking steps.

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Summary

Restating key parts of a conversation to recall, promote new ideas and build confidence.

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Strategic Summarization

Reiterating and linking key points to create connections and evoke change talk.

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Desire (Change Talk)

Expressing a wish for something different.

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Ability (Change Talk)

Believing in the potential to achieve a goal or change a current situation.

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Motivation for Change

A person's drive to change, influenced by importance and confidence.

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Importance (in motivation)

How vital it is for someone to make a health change, based on personal benefits.

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Confidence (in motivation)

How sure a person is about their ability to make a change.

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Readiness Equation

Motivation equals the product of Importance and Confidence.

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Importance & Confidence Discussion

Talking about importance and confidence can be a turning point in the conversation.

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Importance Ruler

An instrument to gauge a person's interest in a specific behavior (e.g. daily exercise).

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Initial Question (Importance Ruler)

Ask on a scale of 0-10 how important it is to you to do X.

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Follow-up Question (Importance)

Explore their reasoning for not selecting a lower number to uncover perceived benefits

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Confidence Ruler

Assesses a person's confidence level regarding a specific behavior on a scale of 0-10.

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Eliciting Confidence

Explore reasons for the chosen confidence rating, focusing on existing strengths.

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Enhancing Confidence

Identify actionable steps needed to increase confidence in behavior change.

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Reassessing Values

Examine underlying values before pursuing behavior modification.

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Reflecting Priorities

Considering priorities before moving forward.

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Study Notes

  • Motivational interviewing aims to help patients with diabetes self-management using open questions, reflections, affirmations and summaries.

Prevalence of Uncontrolled Diabetes

  • Many diabetic patients are not at the goal for A1c , Lipids, BP, and weight showing that over 90% are still struggling

Barriers to Diabetes Management

  • Diabetes management is not a matter of simply taking a pill
  • Managing diabetes often needs a significant lifestyle change
  • Significant life style changes include changing diet, activity, costs, depression, burnout, anger, denial, and poor understanding

Drawbacks of Physician Approach

  • Describing potential complications of their condition doesn't result in behavior change
  • Fear tactics emphasizing future suffering are not effective, especially when people are burdened with pain or other challenges
  • Lectures on statistics and facts can cause patients to disengage

Patient Readiness for Change

  • Change is a process, not an event including pre-contemplation, contemplation, preparation, action, maintenance and relapse

Motivational Interviewing

  • It is a collaborative counselling technique designed to strengthen motivations for behavior change
  • It can be incorporated into routine patient care as a patient centered approach where they do most of the talking
  • It involves creating a safe setting for people to consider change
  • It has been successfully applied to substance abuse management and diabetes
  • Goal is to encourage discussion about behaviors associated with diabetes self-management, and improve motivation and confidence for change

Motivational Interviewing Principles

  • Resist the righting reflex
  • Understand the patient's motivation
  • Listen to your patient
  • Empower your patient

Motivational Interviewing Spirit

  • Collaboration with the patient and avoid taking the expert role
  • Evocation of the patient's desires and reasons for change, giving advice only with permission
  • Autonomy, respecting the patient's autonomy and allowing control over their decisions
  • Compassion: promote the patient's welfare

Four Processes of Motivational Interviewing

  • Engaging including taking time to build a relationship
  • Guiding in order to identify areas of beneficial change and evoke internal motivation
  • Planning a behavior strategy

The Four Basic Motivational Interviewing Skills (OARS)

Open questions
  • Questions that cannot be answered with one word
Affirmations
  • Statements to form a respectful, collaborative relationship by acknowledging talent, quality, or commitment
Reflections
  • Conversational statements for discussion
Summarization
  • A summary of the questions to promote shared decisions made during a discussion

  • Motivational interviewing assesses a patient’s confidence, ability, and commitment for them to achieve the goals and provide successful behavior change

Closed Questions:
  • Answered with a yes or no, where the person asking does most of the talking
  • They can be judgmental, and force the patient into a certain answer
Open Questions:
  • Cannot be answered with yes or no and allow a fuller discussion
  • They are non-judgmental, and allow the patient to think out loud and use their own words

Examples of starter questions for closed ended and open ended

  • Closed Ended: "Do you...?" and "Are you...?"
  • Open Ended: ‘Tell me about...?" and "Help me understand...?"

Examples of questions:

  • Closed Ended: "Are you here for your annual check-up?" vs. Open Ended: "What would you like to talk about today?"
  • Closed Ended: "Are you having any problems with your child's behavior?" vs. Open Ended: "Tell me about successes you've had with managing your child's behavior..."

Open-Ended Key Questions to encourage patients to have conversation

  • What does it mean to you about your health?
  • What do you think has to change?
  • What are the most important reasons to you for a change?

Affirmations

  • Statements of empathy and support of past accomplishments and strengths
  • They anchor patients to their strengths to address behaviours
  • Use ‘you’ to emphasize the patient showing you are a real survivor for example

Acknowledgement of

  • Struggles or difficulties and Successes,
  • Identifying skills, strengths, goals and values
  • Notice and appreciate good actions, encouraging positive reinforcements

Be specific about the affirmations

Reflective Listening Considerations

  • Reflections are statement, and not a question and it captures what has been said and/or what the patient is feeling

Reflective Listening

  • Allows people to hear things they may have only been thinking while understanding what they said
  • Active listening to words and emotions, requires attention
  • Reflections are not giving advice and are not a question

Tips when interacting with the patients

  • Listen and acknowledge; remain supportive and non-judgemental.
  • Reflect change talk vs sustain talk.
  • Help clients discover solutions and don't offer advice.
Change talk includes:
  • Desire- "I want to..."
  • Ability- ‘'I can..."
  • Reason- "Important..."
  • Need- ‘I should..."
  • Commitment- "I will..."
  • Activation- "I am ready..."
  • Taking steps- "I am doing it now.."

Example stems when reflecting

  • "It sounds like...", ""It has been hard for you..."" or "You're feeling..."

Reflection Types

  • Restating content is saying what was said in the conversation directly; making a guess about their feelings or the exact meaning behind their statement
  • Siding with the patient to what they are stating and identify the ambivalence

Reflective Listening Considerations

  • Reflect about the statements or emotions; helps to understand key issues; shows that thoughts matter
  • Encourages conversation flow/rapport; never has to be perfected; allow the person to talk, feel understood

Summarizing is restating the key points which makes it useful in the conversation

  • It can include thoughts and concerns while thinking of new ideas
  • It creates a plan for their steps and feel confident about moving forward

Consider the following phrase:

-“Let me what you’ve said so far.." or "Here's what I've heard you tell me…"

-Summaries can connect discussions strategically to make connections -This can elicit change talk or statements the patient can signal they are willing to change

  • You can also include; " I am wondering what you thinking in the plans."

Motivation to take care of themselves and their family can factor in

-Confidence to their ability to change, however small steps leads to larger goals increases confidence

  • Importance+ Confidence = Readiness

Health care provides discuss issues because

-People may feel important but lack confidence

  • Health care are a major part of making a realistic change of action
  • These include; "How to make a realistic with you?"
  • To help increase the amount and values to create benefits to behavior changes, boosting actions and connecting personal values to behavior
  • It is best to stay judgement free and let the patients make a tie to connect for themselves
  • Help them think about how they make changes and can use open-ended questions

To best move towards action

  • Ask if there is a realistic action plan for behavior change- " You can see yourself from drinking 4 to 1or 2."
  • First share the patients thought about what they are going for and agree with it with " Elicit-Provide-Elicit" .

It is important to note if some will be ready for an action plan such as

  • "You are achieveing a heathly weight but are ready to start yet".
  • If there are any values, confidence to depend to make a change they can respond with small changes or simply about making about the change
  • Do not push, the way for building motivation.

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Explore motivational interviewing techniques. Questions cover guiding principles, affirmations, open vs. closed questions, and evoking change talk. Learn how to effectively apply these skills in health coaching and patient interactions.

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