Term
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Definition
• Motivation is the driving force of action
• Motivation can be intrinsic or extrinsic
• Motivation is closely linked with emotions, change, and learning
• Provider-patient relationship has evolved from paternalistic to one that promotes patient autonomy and active participation |
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Term
| Motivational Interviewing |
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Definition
• A clinical approach to help patients facing mental health and substance abuse disorders as well as chronic conditions approach change
• Based on the following assumptions:
– Ambivalence about substance use (and change) is normal and constitutes an important motivational obstacle in recovery
– Ambivalence can be resolved by working with your client’s intrinsic motivations and values
– The alliance between you and your client is a collaborative partnership to which you each bring important expertise
– An empathic, supportive, yet directive, counseling style provides conditions under which change can occur (Direct argument and aggressive confrontation may tend to increase client defensiveness and reduce the likelihood of behavioral change)
• Important to recognize ambivalence as a central problem that can manifest as lack of motivation
– Ambivalence should not be viewed as denial or resistance->Provider to patient friction |
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Term
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Definition
precontemplation- I don’t see how my cocaine use warrants concern, but I hope that by agreeing to talk about it, my wife will feel reassured.
contemplation- I can’t picture how quitting heroin would improve my self-esteem, but I can’t imagine never shooting up again.
preparation- I’m feeling good about setting a quit date, but I’m wondering if I have the courage to follow through.
action- Staying clean for the past 3 weeks really makes me feel good, but part of me wants to celebrate by getting loaded.
maintenance- These recent months of abstinence have made me feel that I’m progressing toward recovery, but I’m still wondering whether abstinence is really necessary. |
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Term
| The motivational interviewer must proceed with |
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Definition
a strong sense of purpose, clear strategies and skills for pursuing that purpose, and a sense of timing to intervene in particular ways at incisive moments.”
—Miller and Rollnick |
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Term
| 5 general principles of motivational interviewing |
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Definition
1. Express empathy through reflective listening
2. Developdiscrepancybetweenclients’goals or values and their current behavior
3. Avoidargumentanddirectconfrontation
4. Adjust to client resistance rather than opposing it directly
5. Support self-efficacy and optimism |
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Term
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Definition
– A learnable skill for understanding another’s meaning through the application of reflective listening
– Leaves conversation open, nonjudgmental and encouraging
– Examples:
• Could you tell me a little more about that?
• Let me make sure I have this correct. If I go astray, please correct me.
• I can see how anyone in your situation may feel this way. |
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Term
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Definition
– Help the patient discern how current behavior
may differ from ideal future behavior
– Separate the person from the behavior to show how behavior may impact ideal actions
– Help the patient discover possible consequences to their behavior and present arguments
for change |
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Term
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Definition
– Resistance frequently stems from trying to convince patients about possible consequences or force change
– Understand that arguments are counterproductive; if you begin arguing or become defensive, stop and reassess your approach
• It seems that we are not on the same page here; let’s stop for a second. Can you tell me more about what brought you here today? I want to make sure I’m understanding.
– Walk with patients—don’t drag them |
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Term
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Definition
– Resistance is predictive of poor
treatment outcomes
– Resistance also shows us that we have varying viewpoints on the situation
– Can manifest as arguing, interrupting, denying, ignoring |
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Term
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Definition
– I don’t plan on quitting smoking right now.
– So you don’t think that complete tobacco cessation would work for where you are at right now? |
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Term
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Definition
– My girlfriend is nagging me all of the time about my alcohol
use; she says I’m an alcoholic and it’s really annoying.
– It sounds like your girlfriend cares a lot about you but is showing this in a way that is upsetting to you. Maybe we could speak with her about finding a way to express her concern in a way that is more positive. |
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Term
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Definition
– Recognize the strengths in your patient and help
bring these to the forefront of conversation
– Use modeling of other individuals in similar situations who were able to make
positive changes
– Educating your patient can help them feel more confident
• Explaining the biology of addiction and the need for medical treatment shows this is a real disease |
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Term
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Definition
– Open questions
• Invites additional information
– Affirming
• Builds a stronger connection, shows respect
– Reflecting
• Further explore their personal experience
– Summarizing
• Conveys understanding
– Plus
• Additional information or advice with permission |
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Term
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Definition
• Openquestions:
– What is most concerning to you? – What changes have you noticed?
• Affirmations:
– I’m very impressed with the changes I’ve seen.
– It’s great how quickly you have been able to cut back on your alcohol consumption.
• Reflections:
– RepeatàRephraseàParaphrase
• Summarization
– This is what I’ve learned so far, what information am I still missing? |
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Term
| The Brief Negotiated Interview |
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Definition
• Foundation in motivational interviewing, developed for substance abuse intervention
• Provider is able to help the patient present reasons for change and determine necessary actions
for change
• Part of the SBIRT framework
– Screening (determines severity of actions/behaviors) – Brief intervention (brief negotiated interview)
– Referral to treatment (directly links patient to necessary services) |
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Term
| Brief negotiated interview (BNI) algorithm |
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Definition
1 build rapport- tell me about typical day in your life. where does your current use fit in?
2. pros and cons- help me understand, through your eyes, the good things about using (x), what are some of the not-so-good things aobut using (x)?
summarize- so on the one hand (pros) and on the other hand (cons)
3. information and feedback- I have some information on low-risk guidelines for drinking and drug use, would you mind if I shared them with you?
elicit- we know that drinking- 4 or more (F)/5 or moe (M) drinks in 2 hrs, or more than 7 (F)/14 (M) drinks in a week, having a BAC of __ and/or use of illicit drugs such as ___. provide-... can put you at risk for social or legal problems as well as illness and injury. it can also cause health problems like (insert medical information). elicit- what are your thoughts on that?
4. readiness ruler- on a scale from 1-10 w 1being not ready at all and 10 being completely ready, how ready are you to change your x use? reinforce positives- you marked __ that's great. that means you are __% ready to make a change. ask about lower #- why did you choose that number and not a lower one like a 1 or 2?
5. action plan- what are some steps/options that will work for you to stay healthy and safe? what will help you to reduce the things you don't like about using (x)?
identify strengths and supports- what supports do you have for making this change? tell me about a challenge you overcame in the past. how can you use those supports/resources to help you now?
write down steps- those are great ideas! is it okay for me to write down your plan, your own perscription for change to keep with you as a reminder? will you summarize the steps you'll take to change your 9x) use?
offer appropriate resources
thank pt- thank you for talking with me today |
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Term
| motivating interviewing principles |
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Definition
| build rapport- provide feedback -build readiness to change -> negotiate plan for change |
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Term
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Definition
– Start with a more general conversation; get to know your patient
– Ask about proceeding with conversation
– Remember, resistance is normal • Simple reflection, reframing |
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Term
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Definition
– Ask for permission to share what you have found or learned through conversation
– If you performed screenings, present your findings
– Discuss links to other possible health concerns |
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Term
| Are they ready for change? |
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Definition
| – On a scale of 1–10, how ready are you to make changes in your tobacco use? |
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Term
| On a scale of 1–10, how important is it for you to cut back on tobacco? |
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Definition
– Why a 2 and not a 1?
• Try to bring out change talk
– What are the benefits of tobacco?
– What are some of the not great things that
have resulted from tobacco?
• Start the internal dialogue
– If you were able to cut back on tobacco, how do you see your life changing? |
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Term
| On a scale of 1–10, how important is it for you to cut back on tobacco? |
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Definition
– Great! Why is it an 8 rather than a 4?
After addressing and understanding the importance, move to the patient’s confidence |
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Term
| On a scale of 1–10, how confident are you that you could cut back on tobacco if you decided to? |
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Definition
– Why a 3 rather than a 1?
• Have you been successful quitting or cutting back
in the past? Tell me about it.
– What would need to happen to move your confidence to a 5?
• Discuss self-awareness and possible barriers |
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Term
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Definition
– Actively engage the patient
– Listen to concerns
– Reframe resistance
– Create an ally in change |
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Term
| Self-motivational statements to look for |
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Definition
– I guess my alcohol use is more serious than I thought.
– I am really worried about what may happen to me if I don’t quit.
– I should do something about this.
– I know that if I tried, I could make a change.
• These show that the patient’s ambivalence and resistance are starting to subside |
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