Transcript Motivational Interviewing: Strategies to Support

Brief Overview of
Motivational Interviewing
August 17, 2012
SBIRT Training
Peg Dublin, RN, MPH
ACCESS Community Health Network
Member of Motivational Interviewing Network
of Trainers
TWO TRIALS
Motivational Interviewing
MI is a collaborative, personcentered form of guiding to elicit
and strengthen motivation for
change by allowing them to
articulate reasons for and against
change…
Adapted from: William Miller & Stephen Rollnick, 2002,
Motivational Interviewing.
OARS
OARS
MI
principles
MI Spirit
MI
Principles
Change
Talk
MI
MI spirit
Change
Talk
Spirit of MI
 Positive or Success Priority—belief that
humans develop in the direction of what is best for
them (health and adaptive behavior) if given
support.
 Empathic—able to put oneself in their shoes,
listening so well to be able to enter their world
 Safe Environment—creates trust & rapport
 Collaborative/Egalitarian—treats client as an
equal and as their ally.
Spirit . . .
 Non-Judgmental—accept person as they are,
does not give opinion
 Honors Autonomy—makes clear that control
and choice is clearly theirs regarding change
 Builds on Theoretical Underpinnings— selfperception, self-determination and self-efficacy
Dancing
instead of
Wrestling
Underlying Concepts of MI
 People are ambivalent about change
 Providers who push for change elicits
“resistance” from the client/student.
 Resistance predicts lack of change
 Evoking the client’s own change talk will
enhance behavior change
Is MI Evidence-Based?
 Literature search found 230 randomized controlled
trials
 Studies addressed wide range of behavioral problems
and diseases, such as obesity, alcohol use, smoking,
HIV risk behavior, pain management
 Meta-analysis showed significant effect for MI
 Using MI in brief encounters of 15 min., 64% of
studies showed effect
Rubak, Sandboek et al., 2005
Evidence …
 Other Studies:
 Martins and McNeil (2009) reviewed 39 studies, 24
focused on diet and exercise, 9 on diabetes, 4 on oral
health: MI effective in bringing about change in all areas
 Floyd (2007) studied MI with non-pregnant women to
reduce risk of fetal alcohol exposure through use of
contraception and reduced alcohol consumption: women
in intervention twice as likely to have reduced risk
Theoretical Underpinnings
 Bem’s Self-Perception Theory (psychologist
Daryl Bem)
 Self-Determination Theory
 Bandura’s Self-Efficacy Theory (Albert
Bandura, 1986)
How to Start?
 Got the Spirit?
 Behavioral Focus
 Establish Rapport
Establishing Rapport
 Body language
 Collaborative language
 Time (be patient, let brain work)
 When in doubt – Ask permission!
FIVE BASIC PRINCIPLES OF MI
 Express Empathy – “Fence-sitting is pretty
normal!”
 Develop Discrepancy – “Who do you want to
be?”
 Avoid Argumentation/Roll with Resistance – “Go
with the flow”
 Support Self-Efficacy – Honor their ability
 Tread Tactfully – Ask permission & apologize if
wrong.
Emphasizing
Personal Choice & Control
 Perceived
threats to one’s freedom
can lead to natural resistance.
 Assure person of truth – that they
are ultimately in charge of
whatever they decide to do - or not
to do.
Skill #1: OARS
O= open-ended questions
A= affirmations
R=reflections
S=summaries
Open-Ended Questions
me how what a typical day looks
like for you with regards to drinking
alcohol.”
 “What are your goals regarding your
health.”
 “Tell
Affirmations
Acknowledge effort, values, skills,
strengths…
 Examples
really care about your future.”
 “Look at how well you’ve cut back on
drinking.”
 “You
Reflections
 Simple Reflection
 Paraphrase,
short
 Examples
frustrated.”
 Complex Reflection
 Picking out the change talk or unstated
emotion
“You’re
Simple & Complex:
 Client: I barely drink at all anymore. I find it helps
settle my nerves. I don’t think it’s really a problem.
 Simple Reflection: You’re not concerned about
your drinking at this time because you only drink to
settle your nerves..
 Complex Reflection: On the one hand you don’t
think there is a problem with your drinking, and on
the other hand you do care if there is an effect on your
health.
Summaries
 Metaphoric bouquet of flowers
 Review of what’s been said
 Targeting “change talk”
 Transition to next steps
Practice Reflections in Pairs
Person 1: Talks for 1 minute about the first time they
did something challenging, fun or memorable.
Person 2: Using reflections, respond to either what
has been said or how they must have
felt…emotionally at the time.
MI in a Nutshell




Talk less than the client
Offer 2-3 times more reflections than
questions
Ask 2 times more open than closed questions
Listen empathically through complex
reflections
Skill #2:
Eliciting Change Talk
DARN-CAT
 Desire
 Ability
 Reasons
 Need
 Commitment
 Activation
 Taking Steps
Skill #3: EPE for Giving Information
 Elicit-Provide-Elicit
 Ask what they know (Elicit)
 Ask or get permission to Provide
Information/Options (Provide)
 If advice, offer several options rather than
one (for some people…)
 Ask what they think now (Elicit)
DVD demonstration
HTTP://WWW.YOUTUBE.COM/WATCH?V=0Z6
5EPPMFHK&FEATURE=EMSHARE_VIDEO_USER
The MI Path to Change
M
I
Change Talk (Desire, Ability,
Reasons, Need)
Commitment
Change
Eight Stages of Learning MI
1. Overall Spirit of MI
2. OARS
3. Recognizing Change Talk and
Resistance
4. Eliciting and Strengthening
Change Talk
5. Rolling with Resistance
6. Developing a Change Plan
7. Consolidating Commitment
8. Transition and Blending
Next Steps
 Sign up training opportunities as they come available
 Building Motivational Interviewing Skills: a Practitioners
Workbook by David Rosengren (2009).
 Motivational Interviewing: Preparing People for Change (2nd Ed.)
by William Miller & Stephen Rollnick (2001)
 www.motivationalinterview.org
 www.casaa.unm.edu (Center on Alcoholism, Substance Abuse,
and Addictions)
Contact Information
Peg Dublin
[email protected]
312-526-2216