9/28/18 Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal Denise Ernst PhD motivation for and commitment to a specific goal by drawing out and exploring a person ’ s own reasons for change within an atmosphere of acceptance and compassion. Why is Motivational The efficacy of MI –meta analyses Interviewing (MI) a method to consider? � MI out performs traditional advice giving in 80% of � MI has substantial evidence base supporting it’s studies effectiveness in facilitating change in behaviors � Effective in 10-20 minutes that are hard to change � More encounters over longer time period increase � MI is effective with both psychological (behavior likelihood of an effect change) and physical outcomes (BMI, BP, BAC) � Physicians and other health providers can be as effective as psychologists or clinicians � MI focuses the responsibility for change on the patient; encourages self-management and self- determination What else to watch for in conversations about change? � Compassion: active promotion of the client ’ s welfare and needs. � Righting reflex; avoid convincing, arguing, trying to � Acceptance, including accurate empathy, fix, prescribing, directing affirmation, absolute worth of the person, and support of the person ’ s autonomy. � Ambivalence; normal part of the change process, not pathological or a sign of denial but a place where � Partnership with the client; MI is done “ for ” people get stuck and “ with ” a person and not “ to ” a person � Evocation of clients motivation , hopes, dreams, desires, values, goals, and abilities. 1
9/28/18 Engaging with OARS: The MI micro skills Putting on the CAPE! � Open-ended questions to keep the conversation moving forward and encourage self-exploration � Affirming the patient’s strengths, efforts, character and worth � Reflective listening to stay focused on the patient and convey understanding and empathy � Summarizing to provide the big picture and to transition Informing in the MI way � Asking permission � Finding out what the patient already knows � Tailoring your information to meet the needs of the patient � Providing time and space for the patient to think about and respond to the information � Acknowledging that the patient is the expert on his/her own life � Encouraging the patient to use the information in the way that suits them best � Growing evidence that increased change talk as well as decreased sustain talk given by the client in an Sustain Neutral Change interaction leads to better outcomes. Talk Talk Talk � The clinician can influence the client ’ s language with their responses. � The technical components of MI involve strategically Moves away Moves and intentionally shaping the client ’ s language from change towards change toward change. 2
9/28/18 Some potential targets � Health behaviors; smoking, drinking, eating habits, physical activity, sleeping habits � Self-monitoring; blood sugar, blood pressure, diaries, symptoms � Medication or treatment adherence Examples of questions and evoking What did you notice? the patient’s perspective � Compassion � I wanted to welcome you and offer you the opportunity just to tell me what you’ve been � Acceptance, empathy, autonomy support, and through, and how you’re feeling about coming affirming up here this morning. � Partnership � What do you notice about the effect of smoking on your sport? � Evocation � Is there anything else about it that you’re concerned about that you haven’t mentioned? 3
9/28/18 Examples of reflections of change talk Examples of reflecting ambivalence � So there’s something about your body feeling a bit challenged by this. � So there’s stuff you get out of this, but on the other hand you notice the effect on your � And so there’s a bit of a worry you have about what the chest in the morning condition of your heart might be. � You might even give it a try. Information exchange Information exchange Clinician: I was going to ask you about that. How much Clinician: Perhaps I can just let you know that there is do you know about those kind of stop smoking aids? quite a range of these aids. Some of them you’re quite right, like bupropion, that is a drug that can have side effects, and it doesn’t contain any nicotine. OK. So Patient: Not much. Not much. I’ve never really tried to that’s one kind of aid. OK, but then there are others approach quitting. I didn’t see the need, but that contain nicotine like a patch or gum that really are devices for helping you tail off the withdrawal Clinician: Right. I mean that would be a decision that symptoms gently. So there’s broadly those two kinds of you take for yourself, and I’m not suggesting you make aids, and the success rates of them are reasonably that, but what is it you’d most like to know about stop good, but it sounds like you’re particularly concerned smoking aids? I mean, is there any piece of that puzzle about a drug that might have side effects. that I can help you with? 4
9/28/18 The takeaways � How you communicate with your patients makes a difference in the outcomes � Putting your cape on will help (compassion, acceptance, partnership, and evocation) � Attending to and shaping the language of the patient will also help � Even with difficult, challenging cases, empathy can take you a long ways References Additional Resources � Rollnick, Miller, & Butler, (2007). Motivational Interviewing in Health Care: Helping Patients Change Behavior. The Guilford Press, New York, NY. � Motivational Interviewing Network of Trainers (MINT) website has a list of trainings coming up, � Miller, W.R. & Rollnick, S. (2013). Motivational trainers around the world, and an extensive Interviewing; Helping People Change. The Guilford Press, bibliography of MI research and publications. New York, NY. motivationalinterviewing.org � Rubak, et. al. (2005) MI: A systematic review and meta analysis. British Journal of General Practice 2005; 55: 305– � Denise’s email (feel free to contact me) 312. denise@deniseernst.com � Hettema, et. al. (2005) Motivational Interviewing. Annual Review of Clinical Psychology, 1:91–111. 5
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