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Using the Transtheoretical Model and Motivational Interviewing in the Development and Implementation of Health Behavior Interventions Buffalo Center for Social Research Mary Marden Velasquez, PhD University of Texas-Austin School of Social


  1. Using the Transtheoretical Model and Motivational Interviewing in the Development and Implementation of Health Behavior Interventions Buffalo Center for Social Research Mary Marden Velasquez, PhD University of Texas-Austin School of Social Work velasquez@mail.utexas.edu Stages of Change Stages of Change Stages of Change Stages of Change Transtheoretical Model Transtheoretical Model Transtheoretical Model Transtheoretical Model STAGES OF CHANGE Precontemplation - Contemplation - Preparation - Action - Maintenance - Termination PROCESSES OF CHANGE Experiential Processes Behavioral Processes Consciousness Raising Self-Liberation Self-Reevaluation Counterconditioning Dramatic Relief Stimulus Control Department of Family and Department of Family and Department of Family and Department of Family and Environmental Reinforcement Reevaluation Management Community Medicine Community Medicine Community Medicine Community Medicine Social Liberation Helping Relationships University of Texas University of Texas University of Texas University of Texas Medical School at Houston Medical School at Houston Medical School at Houston Medical School at Houston DECISIONAL BALANCE SELF-EFFICACY 1

  2. Motivational Interviewing Transtheoretical Model Motivational Interviewing is an empathic, client centered, yet directive counseling style. Its goal is to explore and resolve • Offers an integrative framework for ambivalence about changing behaviors understanding, measuring, and intervening with problem behaviors • Clinicians assess clients’ readiness to change and enhance motivation through a series of techniques, depending on patients’ stage of readiness 2

  3. Why Motivational Interviewing? Motivational Interviewing Assumptions – I • Evidence-based >130 clinical trials � Motivation is a state of readiness to change, which may fluctuate from one time or situation • Relatively brief to another. This state can be influenced • Specifiable • Grounded in testable theory � Motivation for change does not reside • With specifiable mechanisms of action solely within the client • Generalizable across problem areas � The counselor’s style is a powerful determinant • Complementary to other treatment methods of client resistance and change. An empathic • Verifiable – Is it being delivered properly? style is more likely to bring out self-motivational responses and less resistance from the client �������������� ����������������������������������� Motivational Interviewing Assumptions – II ��� � ������������� � In motivational interviewing, the � People struggling with behavioral problems counselor does not assume an authoritarian role. often have fluctuating and conflicting motivations The counselor seeks to create a positive atmosphere that is conducive to change. for change, also known as ambivalence. Ambivalence is a normal part of considering and � ����������� Consistent with a collaborative role, making change and is NOT pathological the counselor’s tone is not one of imparting things, such as wisdom or insight, but rather eliciting – finding these things within and drawing them out � Each person has powerful potential for change. from the person. The task of the counselor is to release that potential and facilitate the natural change process that is already inherent in the individual. Basic Interaction Strategies � ������ � ! Responsibility for change is left with the client, hence there is respect for the � � �������������������� individual’s autonomy. The clients are always free to take our advice or not. When motivational interviewing is done properly, it is the client � �������������� rather than the counselor who presents the arguments for change. � ������������� � ����������� 3

  4. The Flow of Change Talk Using OARS Micro-skills MI Desire ��������������������� Ability "������������������������������������ ������������ ����������������������� Reasons �#�����������$���������������������%�����#� Need ������������������������%���&����������������� ����������#$��"��������������������������� Commitment ��������� �#���'������������ ������ ������������������������������%������$� Change Project CHOICES Efficacy Study: A Recent Studies Fetal Alcohol Syndrome (FASD) Project CHOICES Efficacy Study: A Fetal Alcohol Spectrum Disorder Trial (FASD) Trial (CDC) Preventing Alcohol Exposed Pregnancy After a Jail Term (NIAAA) Project CHOICES is a multisite clinical trial funded by the STI Screening in Young Women: A Stage-Based Intervention (NIAID) CDC, aimed at reducing alcohol consumption and HIV Risk Reduction in Alcohol-Abusing MSM (NIAAA) increasing birth control use among women at high- risk for having an alcohol-exposed pregnancy. A Transtheoretical Model Group Therapy for Cocaine (NIDA) Preventing Alcohol Exposed Pregnancy Screening and Brief Intervention in Primary Care (NIAAA) After a Jail Term Alcohol Screening, Brief Intervention and Referral to Treatment (SBIRT; CSAT) Project SUCCESS is a demonstration and efficacy study Efficacy of Motivational Enhancement and Physiologic Feedback for funded by NIAAA, in collaboration with the UT-H School of Prenatal Smoking (RWJ) Public Health. SUCCESS is aimed at reducing alcohol consumption and increasing the use of contraception in How Does Motivational Interviewing Work? Mechanisms of Action in Project CHOICES (NIAAA) high-risk women in a county jail. A Transtheoretical Model Group Therapy for Cocaine (��)����*+�� This study, funded by the National Institute on Drug This study, funded by the National Institute on Drug This study, funded by the National Institute on Drug This study, funded by the National Institute on Drug Abuse, will test the efficacy of a group treatment Abuse, will test the efficacy of a group treatment Abuse, will test the efficacy of a group treatment Abuse, will test the efficacy of a group treatment for substance abusers based on the stages and for substance abusers based on the stages and for substance abusers based on the stages and for substance abusers based on the stages and processes of change. Each group session is based processes of change. Each group session is based processes of change. Each group session is based processes of change. Each group session is based ������������������������������ on a specific TTM process of change. Motivational on a specific TTM process of change. Motivational on a specific TTM process of change. Motivational on a specific TTM process of change. Motivational �������������������������� Interviewing counseling strategies are used Interviewing counseling strategies are used Interviewing counseling strategies are used Interviewing counseling strategies are used throughout the sessions. throughout the sessions. throughout the sessions. throughout the sessions. �������� �����!�������������������"������� ����� ��"��������#��������$!���#%&������'��(���)���� ��������������*������� �������������"�+�������)������� ��������������������������"��������������������� ���� ����� ���� ��"������������������������������� ����� ������*�������������'����������"��������������&� 4

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