Motivational Interviewing and Behavior Change PDF

Motivational Interviewing and Behavior Change or ‘How many times do I have to tell you -------?’ Peggy Landrum, PhD, RN, CS  Precontemplation NOT READY TO CHANGE – no intention to change – feels coerced – responds defensively SO: – don’t rus...

Motivational Interviewing and Behavior Change or ‘How many times do I have to tell you -------?’ Peggy Landrum, PhD, RN, CS  Precontemplation NOT READY TO CHANGE – no intention to change – feels coerced – responds defensively SO: – don’t rush – raise doubt – raise awareness  Contemplation THINKING ABOUT CHANGE – acknowledges problem – weighing pros and cons – ‘chronic contemplators’ = depression? SO: – elicit reasons for change, risks not changing – strengthen confidence – encourage commitment to attempt change – discrepancy  Preparation GETTING READY TO CHANGE – planning change for near future – slight changes already to ‘test’ – solidifying plans to change SO: – don’t ignore – help develop plan for change – identify range of options – strengthen commitment  Action READY TO MAKE CHANGE – what we usually think of as ‘change’ – actually do what’s been planned – engagement in behavior / reward for change SO: – don’t stall – support self-efficacy / confidence in ability – help identify necessary steps / resources – support problem solving  Maintenance CONTINUING TO SUPPORT BEHAVIOR CHANGE – maintains behavioral change – integrates / establishes behavior into lifestyle SO: – don’t misjudge – affirm client commitment / efforts to change – ask about pos benefits of change – strategies to prevent relapse  The Major Goal of MI: to elicit client’s own motivation for changing As indicated by Change Talk!  Techniques for working with clients with no intention to change or who are thinking about change but not ready Motivational Interviewing Decisional Balance Exercise Scaling Rulers  Motivational Interviewing: What is it? A particular way to be with another person -Brief intervention -Directive -Client centered  The ‘PACE’ of the MI SPIRIT (foundation for everything MI) bea -client talks more Damission for Partnership/collaborationask Acceptance: respect autonomy, absolute worth, affirmation, accurate empathy Compassion – acting in the interest of another Evocation – of client’s Change Talk, values, goals, strengths, wisdom ----------------------------------------------------------- (following 6 slides elabprate on these principles)  in addition…… MI considers empathy an essential element. MI avoids arguing, persuading, directing, labeling. MI discourages trying to fix somebody, or trying to get them to do it your way MI promotes and strengthens self-efficacy.  Processes of Motivational Interviewing interactions Four Processes communication non verbal Engaging insing basicminutes of session ; critical Hirst fell behavior Focusing Agenda setting target , Evoking jexploring client Planning setting goals, commitment  Assumptions of M.I. Motivation: state of readiness to change that fluctuates and can be changed Relationship: motivation not only within client but also within relationship Nurse style: impact on client resistance and motivational responses  OARS Skills Four skills are important from start to finish – they form the acronym OARS Asking#Open Questions* ( whatI how Affirming observation not praise Reflective Listening -high pitch voice closed question - tone-reflection Summarizing regular ------------------------------------- Informing and Advising – how to Goal of Motivational Interviewing To create cognitive dissonance b/t where one IS and where one WANTS TO BE ----- Or ----- To create / amplify discrepancy b/t present behavior and broader goals  Long-term compliance: what contributes? Client feels behavior change is personal choice Client – nurse encounter is positive Client has adequate self-confidence in own ability to make recommended behavior changes – self efficacy  M.I. Skills (What to do???) patient do most of talking ~ Ask open-ended questions Listen reflectively ; stating back hearing , I most important making a what guess they meas Affirm grespectnotice clients strengths befforts Summarize Elicit ‘change talk’  Listen reflectively Requires continuous alert tracking Reflection = hypothesis Means suspending advice, suggestions, judgments, teaching, warnings, questioning Pursue exploration of client's thoughts and processes A means of checking, rather than assuming you know what is meant · undershoot · Don't use reflection as a way to teach  Listen reflectively examples It sounds like you….. You’re feeling….. It seems to you that….. You’re wondering if you…. So you mean...  Listen reflectively examples “You’re not quite sure that you’re ready to make a change, but you understand that your sugars might improve if you start exercising a bit.” “You’re not ready to try quitting smoking right now, but it sounds like your kids are worried about your health.”  Elicit change talk Ultimate goal of M.I. How to recognize ‘change talk’ – Advantages of changing – Disadvantages of not changing – Optimism for change – Intent to change Strategies – Evocative questions – Decisional balance – Readiness / importance / confidence rulers  Four categories of Change Talk Problem recognition Expression of concern Intention to change Optimism about change  Questions to evoke change talk statements Group 1: Problem recognition (‘what difficulties have you had in relation to your drinking?’) Group 2: Concern (‘what worries you about your drinking?’) Group 3: Intention to change (‘how did you decide it’s time to change your drinking?’) Group 4: Optimism (‘what’s helped you to feel encouraged about changing how you drink?’)  Decisional Balance - Summary in precontemplation is contemplation) juseful Ambivalence: acknowleging presence of ambivalence as normal Pros and Cons: weighing good and not-so-good reasons to change (or not) Discrepancy: highlights differences b/t status quo (now) and change (then)  Decisional Balance Good things about my Not so good things behavior: about my behavior: Not so good things Good things about about changing my changing my behavior: behavior:  Change Rulers Measuring where a Ruler Dimensions person is at this – Importance of moment in the changing change process – Confidence in odds along 3 related but of success at different changing dimensions – Readiness to begin to change now explore importance ex How did you decide on X instead Y ? Importance Ruler How important is it to you to stop behavior X? 0 |----|----|----|----|----|----|----|----|----| 10 If 0 is “not important at all” and 10 is “ very important,” what # would you give yourself?  make more confident Build confidencejex- what would you about making these changes? exiconat have Confidence Ruler youfound helpful? If you decided right now to stop behavior x, how confident do you feel about succeeding with this? 0 |----|----|----|----|----|----|----|----|----| 10 If 0 is “not confident at all” and 10 is “ very confident,” what # would you give yourself? Summary of approaches for clients not quite ready for change Motivational interviewing Decisional balance Rulers – Importance – Confidence – Readiness