Successful Behavior Change through Motivational Interviewing

1. Successful Behavior Change through Motivational Interviewing Brevard Health Alliance

2. Presentation Overview • Clients and Change • Motivational Interviewing: Principles • Clinical Applications • Overcoming Obstacles • Stages of Change

3. Your Experience with Patients & Behavior Change • What have been your experiences with patients and their expectations of treatment related to behavior changes? • How do you typically approach this topic? • Do you think that our patients that don’t change are just unmotivated?

4. Why DON’T People Change? • (INSERT EXCUSES) – Comfort, defense, habit, it has worked in the past • How do you respond to these excuses? -Normalize excuses and explain we all do things that are bad for us

5. Why Do People Change? Individuals change voluntarily when they… • Become interested in/concerned about need for change • Become convinced that change is best option in cost-benefit analysis • Organize a plan of action that they are committed to implementing • Take necessary actions to make and sustain change

6. Stages of Change

7. What is Motivational Interviewing? • “…a method of communication rather than a set of techniques. It is not a bag of tricks for getting people to do what they don’t want to do; rather, it is a fundamental way of being with & for people – a facilitative approach to communication that evokes change”(Miller & Rollnick 2002)

8. More on Motivational Interviewing… • Clinical style that elicits patient’s own motivations for behavior change into action. • Collaborative: working with the patient to decide importance of behavior change. • Evocative: activate skills, motivation, and resources for change. • Honoring patient autonomy: acceptance of choices made by our patients. • Goal-oriented: moves toward a particular goal and develops discrepancy between person’s current behavior and what their goals/values are.

9. Four General Principles of MI • Express Empathy • Develop discrepancy • Support self-efficacy • Roll with resistance

10. Principle 1: Express Empathy • Listen actively with the goal of understanding patient’s motives. • Use open-ended questions, reflections, and brief summaries of what patient says. • Resist the righting reflex! Acceptance facilitates change. • Ambivalence is normal.

11. Ambivalence • “I want to, and I don’t want to” • Passing through ambivalence is a natural phase in the process of change. • Ambivalence is a reasonable place to visit but you wouldn’t want to live there. • As the provider, we can empathize with & reflect back this ambivalence! COMPONENTS of CHANGE RESISTANCE AMBIVALENCE MOTIVATION

12. Principle 2: Develop Discrepancy • Motivation for change occurs when people perceive a discrepancy between where they are and where they want to be. • Values and beliefs are key factors. • The patient rather than the practitioner should make the arguments for change.

13. Questions to Assess Motivation and Develop Discrepancy D A R N

14. Principle 3: Support Self-Efficacy • A person's belief in the possibility of change is an important motivator. • The patient, not the practitioner, is responsible for choosing and carrying out change. • The practitioner's own belief in the person’s ability to change becomes a self-fulfilling prophecy. • Practitioner plays the role of “Guide” instead of “Director” • Utilize positive affirmations, crediting person for action, values, or traits!

15. Informing Within MI while preserving Self-Efficacy Ask permission to discuss necessary behavior change “May I talk to you about the health risks associated with your diabetes?” Talk about what others do “Some patients in your situations reduce their intake of fatty foods, others tackle their smoking. I wonder what makes more sense to you” Offer choices “…these strategies could all benefit your health. What makes most sense to you right now?”

16. Listening for Commitment • Listen to patient’s words to determine what the patient is… READY WILLING & ABLE to do regarding health behavior change! • Give the patient ample opportunity to arrive at the point of commitment • Reinforce language about making healthy changes

17. Principle 4: Roll with Resistance • Avoid arguing for change (Resist the righting reflex!) • The patient is the primary resource in finding answers and solutions. New perspectives from the patient are invited and not directly opposed. Find out more information from them instead of providing them information. • Resistance is a signal to respond differently. • Reluctance and ambivalence are to be acknowledged (and even respected) and not confronted directly.

18. Overcoming Patient Obstacles “ I can’t see why I need to change” (DENIAL) • Use listening to unlock underlying issues can lay path to behavior change “I can see what you mean but…” • Use patience and acceptance of this seemingly irrational process “Just tell me what you think I should do” • Offer 1+ suggestions and use a guiding question to check if it makes sense to patient, i.e., “How will this work for you” “I really can’t cope at all” • Convey your understanding through reflective listening

19. Overcoming Practitioner Obstacles • Strive for awareness of your feelings and moods • Keep both your aspirations and the patient’s aspirations in mind

20. Common Practitioner Traps… • Directing patient behavior • Persuading too hard • Rescuing the patient • Overloading the patient with information

21. In Summary… • Listen to the patient • Communicate understanding • Guide more than direct • Respect autonomy • Align your aspirations with that of the patient • Listen for, encourage, and reinforce language about change

22. Questions? • Any questions, comments or concerns you would like addressed?