helping patients change behavior: why does … patients change behavior: why does motivational...

Helping Patients Change Behavior: Why Does Motivational Interviewing Work? Friday, October 28th, 2011; 12:00-2:00pm

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Workshop: Helping Patients Change Behavior: Why Does Motivational Interviewing Work? - 10/28/11 - 12:15pm - 2:15pm

Practitioner Role:

Your task is to try as hard as you can to convince and persuade the speaker to make the change that he or she is considering. (This is not a motivational interviewing exercise!) Fit in as many of the following persuasion tactics and you can in the short time allotted.

� Become the EXPERT – you know what’s best for the person and how they can do it!

� Advise. Directly advise the speaker to make the change, and discourage him or her from

delaying or not changing.

� Explain why it is important for him/her to make the change.

� Warn the speaker what may happen if the change is not made.

� Make suggestions as to how the speaker could go about making the change.

� Direct or tell the speaker what to do, preferably in “should”, “must” or “need to” language.

� Refute and minimize their excuses – offer logical counter-argument if the speaker resists or

gives excuses.

� Analyze what the REAL issues may be.

An Early Intervention – TAKE 1: PERSUADE ME!”

Speaker Role – be yourself:

Talk to the listener regarding something about yourself that you – want to change – need to change – should change – have been thinking about changing

but you haven’t changed yet

i.e. – something you’re ambivalent about!

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Early Intervention – Take 2:

“A TASTE OF MI!”

Speaker Role – be yourself: Talk to the listener regarding something about yourself that you

– want to change – need to change – should change – have been thinking about changing

but you haven’t changed yet i.e. – something you’re ambivalent about! Practitioner Role: Ask the open questions listed below. Listen carefully to the speaker with a goal of understanding the dilemma. Feel free to respond a little bit & affirm, but GIVE NO ADVICE!

1) “What is the change you are considering?” 2) “What, if anything, concerns you about making the change?” 3) “What makes the change important to you?” 4) “What else makes it important?” 5) “What kinds of steps do you think you’ll need to take to move in the right

direction?” 6) “What’s one thing you could do fairly soon to start the process, if you

choose to?”

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Observation Guide: Spirit and Guiding Principles of MI

SPIRIT: ACE Comments or Examples

A: Autonomy Honor the patient’s choice about change. Often, acknowledging a persons’ right and freedom to choose NOT to change, frees them up to consider the change.

C: Collaboration Create a safe, collaborative environment and encourage/facilitate joint-decision making and problem solving.

E: Evocation Evoke or draw out patient’s own ideas and motivation for change. Understand their own perspectives; uncover values and goals that support health behavior change.

GUIDING PRINCIPLES: RULE Comments or Examples

R: Resist the Righting Reflex

People generally believe what they hear themselves say they should do & react in opposition to what others tell them to do. The patient is his/her own expert.

U: Understand your Patient’s Motivations

It is the patient’s own reasons for change, and not ours, which are most likely to trigger behavior change.

L: Listen to your Patient

When it comes to behavior change, the answers most likely lie within the patient and finding them requires listening and discovery (like panning for gold).

E: Empower your Patient

The patient who is active in the consultation, thinking aloud about the why and how of change, is more likely to follow through.

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Importance�Ruler��

1��2��3��4��5��6��7��8��9��10�Not� � � � Unsure� � � Somewhat� � � � � Very�Important� � � � � � Important� � � � � Important��

Confidence�Ruler��

� � � � � � � � � � � � � �1��2��3��4��5��6��7��8��9��10�Not�at�all�� Unsure� � Somewhat� � � Very�� Totally�Confident� � � � � � � � � � � � � Confident��

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Agenda Setting Sample: Weight LossAgenda Setting Sample: Weight Loss

“These are some lifestyle areas that people can choose from when working on their weight. I’ve put them in these circles. There may also be some other things that you wish to add, that we may not have thought about. Which one of these areas stands out to you… which do you think you might like to work on or talk about with me today?”

“These are some lifestyle areas that people can choose from when working on their weight. I’ve put them in these circles. There may also be some other things that you wish to add, that we may not have thought about. Which one of these areas stands out to you… which do you think you might like to work on or talk about with me today?”

Eliminating or reducing sweets

Eating out less; preparing meals at home

Reducing Alcohol

Exercise

Weighing regularly

Eating more fruits and veg

Portion Control

??

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Sample Agenda Setting Worksheet for Diabetes Sample Introduction/Dialogue: These are some things that people with diabetes may decide to change or work on to help improve their health. [Explain the pictures.] There are some blank circles because there may be something that’s not pictured that you would like to focus on in terms of your diabetes. Let’s add those. Which area would you like to focus on today? Work on? Which of these seems the most important to you to change right now? [Another option is to use a sheet of paper with blank circles and write in them.] Source: Bob Mash, PhD ‐ CME, October 2003, Vol. 21, no. 10.

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Giving Information and Advice in MI

FIRST, ask yourself…

“Have I elicited the client’s own ideas and knowledge on the subject?” “Is what I’m going to convey likely to be helpful and/or relevant to him or her?”

Three kinds of “permission” to give advice in MI:

1. The client asks for advice directly.

2. You ask the client’s permission to give advice:

“Can I make a suggestion?” “Would you be interested in some resources?” “Would you like to know what has worked for some of my other clients?”

3. You qualify the advice to emphasize autonomy:

“A lot of people fine that ______ works well, but I don’t know if that’s something that interests you.” “This may not fit for you, but some people find that…”

Elicit-Provide-Elicit (E-P-E) 1) ELICIT the client’s ideas/knowledge about the subject: “What have you heard about how people get support to stop using?” “What ideas do you have for transportation?” 2) If you feel advice or information would still be helpful, PROVIDE advice or

information with permission (either by asking directly or by implying their autonomy):

“May I make a suggestion?” “Would you be interested in knowing about some resources?”

“I don’t know if this would interest you, but some people find…” * Be sure to GIVE MORE THAN ONE OPTION!

3) ELICIT their response to the suggestion or information: “What do you think of that?” “How does that sound to you?” “How does that strike you?”,

Source: EckMaahs & Associates, LLC. www.eckmaahs.com; 651-489-1122. Adapted from W.R. Miller, Motivational interviewing; Preparing People to Change, 2002.

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Motivational Interviewing

Directions: Carefully observe the interactions between the Patient and the Practitioner in each vignette. Record your observations below: VIDEO or AUDIO I: VIDEO or AUDIO II:

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