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Motivational Interviewing
& HEALSHow to Get Students Off
the CouchA Brief Taste of MI
Helena Mackenzie, PhDRegion 5 Mental Health Specialist
Objectives
Identify why more traditional health care approaches often don’t result in behavior change
List a word that reflects the spirit of Motivational Interviewing (“ACE”)
List a key skill used in MI (“OARS”)
Identify one change tool
Feel motivated to learn more about MI and applying it to HEALS
Identify a behavior you currently want to change…
Common Choices
Exercise more
Drink less
Eat more fruit/veggies
Stop smoking
Stop being late
Stick to a budget
Stages of Change(Prochaska & DiClemente)
Precontemplation: What problem?
Contemplation: Aware of the problem, but not quite ready…
Preparation: Plan to take action in the next month; beginning to take small steps
Action: Modifying behavior to overcome problem
Maintenance: work to prevent relapse and consolidate gains
The “Righting Reflex”A Practitioner/Helper Problem
Stems from a natural desire to help…
Helper/Practitioner’s “goal”: “diagnose the problem” “fix the problem” “control the problem” “get good results”
Practitioner tries to create change by… Providing reasons for
change (education) Provide
solution/treatment/skill building
Demonstration:Trying to Force Change
Provider/Helper Argues for Change
Demonstration of an “Ineffective Provider”
http://www.youtube.com/watch?v=80XyNE89eCs&feature=relmfu
Lisa Marlo, PhD, Professor of Psychiatry at the University of Florida
Student/Patient Argues Against
Change/Shuts Down
Resistance or Ambivalence?
Ambivalence: The True Dilemma of
Change Ambivalence is a state of
mind in which a person has co-existing but conflicting feelings about something
Fundamental and NORMAL part of the change process
“I want to, but I don’t want to…”
“You tell me a reason to change, I’ll tell you a reason not to…”
“People are usually more convinced by reasons they discovered themselves than by those found by others.”
--Blaise Pascal
Motivational Interviewing
Allows the individual to identify and verbalize their own reasons for change… We serve as the guide…
MI Defined: Motivational interviewing is a form of
collaborative conversation for strengthening a person's own motivation and commitment to change. It is a person-centered counseling style for addressing the common problem of ambivalence about change by paying particular attention to the language of change.
-MINT (2012)
Spirit of MI (“ACE”)
Autonomy NOT confrontation
CollaborationNOT authoritative
EvocationNOT education
Is this MI Spirit? (place your vote)
Student: I know my RA told you I’m depressed, but I’m not. Helper: You don’t believe you’re depressed.
What do you think she’s seeing that is making her worry this way?
Student: I had no idea I weighed that much. I guess that’s why everyone tells me I shouldn’t eat so much.
Helper: Right. You need to cut down on your eating and I know some good ways to get you started.
Student: I think your BMI thing is wrong because I am not “obese.” Helper: You don’t think of yourself as
someone who has a weight problem.
Strategies to Develop a Motivational ConversationOARS
Open-ended questions Avoid Yes/No “What types of exercise have you
previously tried?”
Affirmations Provide support & encouragement “Taking care of yourself is really important
to you”
Reflective Listening Making a statement that guesses at the
speaker’s meaning
Summarizing Organizes and links information
Open-Ended Questions
Encourage the person to give you more than a “yes/no” response Do you drink alcohol daily? (closed) What are your drinking habits like?
(open)
Typically can’t be answered with one word or brief responses How many fruits and vegetables do
you eat daily? (closed) Tell me about your daily eating
habits (open)
Open-Ended Questions?Place Your Vote
Are you doing okay today?
How much do you exercise?
What types of healthy foods do you like?
Do you eat fruit and vegetables daily?
What activities in the recreation department sound interesting to you?
Affirmations
Statements of appreciation of student/patient’s strengths, successes, efforts to change
Purpose is to empower and support self-efficacy
Avoid using word “I”
Different than compliments
Affirmation Practice
Student Says…
Student with diabetes tells you they are checking their glucose levels regularly
Overweight student tells you she has stopped drinking pop
Student tells you that he felt discouraged after failing recent TABE, but now has plan and feels confident he will pass next time
Possible Affirmation…
You are determined to keep your diabetes under control
Your health is really important to you
When you set your mind to something you feel confident you’ll accomplish your goal
Reflections…
Reflections are guesses at what you believe a person is saying. Show the person that you hear and understand them and invite them to continue talking
You can reflect many things… Speech Facial Expression Behavior Or guess at the deeper
meaning of words
Example Reflections…
Student
You don’t have a clue what it’s like living on this center
There is no way I can lose weight
I don’t eat vegetables and that’s a done deal
Student cries after STD result
I look gross when I work out. No way I’m doing that here
Reflection from Helper
You don’t think I can understand how hard it is
Losing weight doesn’t feel possible right now
There is no way you are going to eat vegetables
This news feels overwhelming
Looking good is important to you
① Agree on the Focus
Elevated BMI
Explore and agree on a behavior to discuss or ask permission to discuss a particular
behavior
Exercise
???Social
Activities
Alcohol
Stress
Eating
_________________________________________________________________
Explore Ambivalence and Strengthen Motivation for Change
Change
Willing = importance
Able= Confidence
In order to be READY to change, person must be WILLING and ABLE
Follow up questions to elicit change talk: Why did you pick ____ instead of
_____(slightly lower number)? What would have to happen to make you
move up to a ____ (slightly higher number)?
Ask about importance and confidence around specific change…
Use OARS to clarify pros and cons…Use Reflections and Open-Ended Questions when hear change talk or are met with resistance…
Decisional Balance Worksheet: Explore the Ambivalence of Change…
Summarize Progress and Identify Next Step
Provide summary of information discussed then…
Ask: What do you make of all
this? Or...What, if anything, would be
a first step? Or…What do you intend to do
next?
Guiding Principles to Remember (RULE)
Resist the Righting Reflect Don’t argue with the student!
Understand the student’s motivation What is important to this person?
Listen to the student Ask open-ended questions and use
reflections to check your understanding
Empower the student (create self-efficacy) Affirm the student’s strengths
Demonstration of an Effective Provider: MI in Action
http://www.youtube.com/watch?v=URiKA7CKtfc&feature=relmfu
Lisa Merlo, PhD, Department of Psychiatry at the University of Florida
Helpful Articles…
Prochaska, J., DiClemente, C., & Norcross, J. (1992). In search of how people change. American Psychologist, 47 (9), 1102-1114.
Berg-Smith, M., Stevens, V., et al. (1999). A brief motivational intervention to improve dietary adherence in adolescents. Health Education Research, 14 (3), 399-410.
Butterworth, S., Linden, A., et al. (2006). Effect of motivational interviewing-based health coaching on employees’ physical and mental health status. Journal of Occupational Health Psychology, 11 (4), 358-365.
Hillsdon, M., Thorogood, M., et al. (2002). Advising people to take more exercise is ineffective. International Journal of Epidemiology, 31, 808-815.
Resnicow, K., Baskin, M, & McCarty, F. (2005). Results of Go Girls: A weight control program for overweight African-American adolescent females. Obesity Research, 13 (10),1739-1748.
Resnicow, K., Campbell, M., et al. (2004). Body and Soul: A dietary intervention conducted through African-American churches. American Journal of Preventative Medicine, 27 (2), 97-105.
Richards, A., Kattelmann, K., et al. (2006). Motivating 18- to 24-year-olds to increase their fruit and vegetable consumption. American Dietetic Association, 106, 1405-1411.