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motivational interviewing techniques afp

Bendigo CHS Men’s Health ClinicImproving access to primary care, January/February - Teaching in general practice, Australian Family Physician (incorporating Annals of General Practice) 23 The research and proposition behind motivational interviewing is that this method promotes change talk, and strengthens self-efficacy and behavioural intention. RULE is a useful mnemonic to draw upon when implementing the spirit of MI in general practice. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change. Opening Statement • I’m not here to preach to you or tell you what you “should” do; how would I know, it’s your life and not mine! Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking – or not. Employ motivational interviewing techniques for a patient who smokes and discuss non-pharmacological and pharmacological methods of quitting. Motivational interviewing is practiced by licensed therapists and substance-abuse counselors. To learn more about MI see the Motivational interviewing is a set of patient-centered communication techniques—focused on being empathetic, nonjudgmental, and supportive—which helps individuals express their own reasons for change and take responsibility for their own behavior. Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. A truly collaborative therapeutic relationship is a powerful motivator. Engagement: using a person-centered empathic listening. ‘I want to manage my diabetes better’, the importance of change for the patient (willingness). In subsequent consultations, when these strategies don't work, it is easy to give up hope that he will change his drinking, characterise him as 'unmotivated' and drop the subject altogether. A meta-analysis of motivational interviewing: twenty-five years of empirical studies. Successful progression through these stages leads to action, where the necessary steps to achieve change are undertaken. If a practitioner feels that the patient needs health advice at this point in order to set appropriate goals, it is customary to ask permission before giving advice as this honours the patient's autonomy. Naar-King S, Wright K, Parsons J, et al. Diane Jankowski RN BSN CCM . This involves goal setting and negotiating a 'change plan of action'. Every care is inaccuracies contained therein or for the consequences of any action taken by any person as a result of For example, the patient who presents with serious health problems as a result of heavy drinking, who shows genuine concern about the impact of alcohol on his health, and in spite of advice from his practitioner to cut back his drinking, continues to drink at harmful levels, embodies this phenomenon. 0000005892 00000 n afp@racgp.org.au, © The Royal Australian College of General Practitioners 2016 0000002156 00000 n 0000032159 00000 n One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. J Consult Clin Psychol 2003;71:843–61. Focusing: identifying a target for change that is to be the primary subject of discussion in therapy. Techniques to Avoid. If you don't have anything you can download the MS Word Viewer free of charge. substance abuse, weight management). To save the file right click or option-click the link and choose "Save As...". Jensen CD, Cushing CC, Aylward BS, Craig JT, Sorell DM, Steele RG. In general practice, the particular difficulties associated with quick consultation times can present unique challenges in implementing MI. Forget how you would get there for a moment. New York: The Guilford Press, 2002. Motivational Interviewing and Oral Health Communication: Case-based Studies Maureen George, PhD RN AE-C FAAN . 0000037295 00000 n This can often have a paradoxical effect in practice, inadvertently reinforcing the argument to maintain the status quo. 2. Rollnick S, Miller WR, Butler CC. Evocation: the evocation of the patient’s own motivation. Thinking and talking about change pave the way for change. Evoking: eliciting ‘change talk’ to support patient motivation. Participants learn 14 different Motivational Interviewing techniques that can be used to help clients identify and overcome reluctance to discuss to achieve their goals. MI uses many techniques to help the person change. Motivation to change is elicited from the client, and is not imposed from outside forces. Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. A brief guide to motivational interviewing: Year 3 motivational interviewing workshop. This change process is modelled in five parts as a progression from an initial precontemplative stage, where the individual is not considering change; to a contemplative stage, where the individual is actively ambivalent about change; to preparation, where the individual begins to plan and commit to change. Helping patients change behavior. MP3 Most web browsers will play the MP3 audio within the browser, Your comment is being submitted, please wait, Mental health nurses in general practiceA personal perspective, Psychological encounters in general practice, Motivational interviewing techniquesFacilitating behaviour change in the general practice setting, Cognitive behaviour therapyIncorporating therapy into general practice, Acceptance and commitment therapyPathways for general practitioners, Problem solving therapyUse and effectiveness in general practice, Early and tight glycaemic controlThe key to managing type 2 diabetes, Cutaneous plaque in a diabetic patientA case study, Managing undernutrition in the elderlyPrevention is better than cure, Using a mobile phone application in youth mental healthAn evaluation study, Changes in the demography of Australia and therefore general practice patient populations, Assessing pathology training needsResults from a survey of general practice registrars, Problem gamblingAetiology, identification and management. A male patient, 52 years of age, who drinks heavily and has expressed the desire to reduce drinking, but continues to drink heavily. Patients benefit from this relationship the most when the practitioner also embodies hope that change is possible. If successful, action leads to the final stage, maintenance, where the person works to maintain and sustain long term change.3 Relapse is considered an important stage in the change process and is used as an opportunity to learn about sustaining maintenance in the future. In what ways do you want your life to be different in 5 years? I'm going to explain the basics of motivational interviewing for personal trainers. Ambivalence is a conflicted state where opposing attitudes or feelings coexist in an individual; they are stuck between simultaneously wanting to change and not wanting to change. These were:1, Using MI techniques, the practitioner can tailor motivational strategies to the individual's stage of change according to the Prochaska and DiClemente model (Table 1).1,2. whether change is an immediate priority (readiness). It has been shown to be effective in the primary care setting with smoking cessation, hazardous drinking, physical activity, nutrition and chronic disease. You may not remember all of the processes and techniques of MI, but if you incorporate the Spirit of MI in all of your interactions with youth, you would have gone a long way in making a difference. 0000005251 00000 n The Substance Use Motivation Ruler is an excellent tool derived from motivational interviewing. The seminal text on motivational interviewing (Motivational Interviewing: Preparing People for Change) by Miller & Rollnick defines the theory as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (1). I want to go back to being healthy and strong, with enough energy to enjoy my friends and family’. To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting. Miller WR, Rollnick S. Motivational Interviewing. 0000012820 00000 n Motivational Interviewing has been used successfully in primary care for the brief intervention phase of addiction treatment (D’amico, 2018, VanBuskirk & Wetherell, 2014) and provides an effective means for motivating patients to use other substance use therapies (Frost, 2018; Luty, 2018). 5 Principles of Motivational Interviewing. Motivational Interviewing tools and techniques provide structured and efficient ways to help patients develop internal motivation to change. Recent meta-analyses show that MI is equivalent to or better than other treatments such as cognitive behavioural therapy (CBT) or pharmacotherapy, and superior to placebo and nontreatment controls for decreasing alcohol and drug use in adults4–6 and adolescents.7 Motivational interviewing has also been shown to be efficacious in a number of other health conditions, such as smoking cessation,8 reducing sexual risk behaviours,9–11 improving adherence to treatment and medication,12 as well as diabetes management.13 In addition, studies support the applicability of MI to HIV care, such as improving adherence to antiretroviral therapy14,15 and the reduction of substance use among HIV positive men and women.15 As such, MI is an important therapeutic technique that has wide applicability within healthcare settings in motivating people to change. This article provides an overview of motivational interviewing. To open a PDF file you will need compatible software such as Adobe Reader. The Royal Australian College of General Practitioners. Requests for permission to reprint articles must be sent to permissions@racgp.org.au. Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. C ompassionate Service. SPIRIT Of MOTIVATIONAL INTERVIEWING While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points: 1. Kuyper L, de Wit J, Heijman T, Fennema H, van Bergen J, Vanwesenbeeck I. %PDF-1.4 %âãÏÓ Motivational interviewing improves weight loss in women with type 2 diabetes. Outline emergency management of an acute asthma attack. The core principle of the approach is negotiation rather than conflict. 0000004800 00000 n New York: The Guilford Press, 2008. Why are you at ____ and not zero? The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi-experimental pilot study. Although paradoxical, the MI approach is effective at engaging apparently 'unmotivated' individuals and when considered in the context of standard practice can be a powerful engagement strategy (Case study, Table 2). It is the patient's own reasons for change, rather than the practitioner's, that will ultimately result in behaviour change. J Consult Clin Psychol 2011;79:433–40. Australian Family Physician, Vol. Motivational Interviewing (MI) is a style of counseling that mental health professionals use to encourage productive verbal sessions with patients who are afflicted with multiple, or co-occurring, disorders. Diabetes Care 2007;30:1081–7. Motivational Interviewing can be a great technique for personal trainers to use to understand and encourage clients to stick with fitness. 0000006990 00000 n ADefinition"of"Motivational"Interviewing" The!definition!of!Motivational!Interviewing!(MI)!has!evolved!and!been!refined!since!the!original! Motivational interviewing ( MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. This technique identifies the discrepancy for a patient between their current situation and where they would like to be. is published by The Royal Australian College of General Practitioners, 0000034451 00000 n Importantly, an authoritative or paternalistic therapeutic style may in fact deter change by increasing resistance.1. 41(9), Sept., 2012, pp 660-667. • Motivational Interviewing Techniques: Facilitating change in the general practice setting • Talking Points – Discussing OUD with your patient (Appendix C) • Stages of Change and Associated Interventions (Appendix D) • SMART Recovery Change Plan Worksheet (Appendix E) • Addiction and Mental Health Resource List (Appendix F) The practical application of MI occurs in two phases: building motivation to change, and strengthening commitment to change. In Phase I, four early methods represented by the acronym OARS (Table 3) constitute the basic skills of MI. For further information and online motivational interviewing training opportunities visit www.motivationalinterviewing.org. 0000023860 00000 n Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. In: Miller WR, Rollnick S, editors. What strengths do you have that would help you make a change? What would be different in your life if you lost weight? If a practitioner has more time, four additional principles (Table 5) can be applied within a longer therapeutic intervention. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. Their transtheoretical model of behaviour change (the 'Stages of Change') describes readiness to change as a dynamic process, in which the pros and cons of changing generates ambivalence. Motivational interviewing Janet Treasure Abstract Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. Patient outcomes improve when they are an active collaborator in their treatment.17 Empowering patients involves exploring their own ideas about how they can make changes to improve their health and drawing on the patient's personal knowledge about what has succeeded in the past. Example: 'If you can think of a scale from zero to 10 of how confident you are that you can cut back the amount you are drinking. their values and goals), Can take the form of compliments or statements of appreciation and understanding, Helps build rapport and validate and support the patient during the process of change, Most effective when the patient’s strengths and efforts for change are noticed and affirmed, Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement, Encourages continual personal exploration and helps people understand their motivations more fully, Can be used to amplify or reinforce desire for change, Links discussions and ‘checks in’ with the patient, Ensure mutual understanding of the discussion so far, Point out discrepancies between the person’s current situation and future goals, Demonstrates listening and understand the patient’s perspective. Provide harm reduction strategies. The views expressed by the authors of articles in Australian Family Physician are their own and not Again, a 'confidence ruler' could be employed if a practitioner is time poor. Recommendations PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). When these strategies don’t succeed, the practitioner may characterise the patient as ‘unmotivated’ or ‘lacking insight’. Motivational interviewing, second edition: Preparing people for change. To open click on the link, your computer or device will try and open the file using compatible software. Burke BL, Arkowitz H, Menchola M. The efficacy of motivational interviewing: a meta-analysis of controlled trials. Motivational interviewing includes a range of techniques to help people make changes in their behaviour. All rights reserved. The Prochaska and DiClemente Stages of Change model2 offers a conceptual framework for understanding the incremental processes that people pass through as they change a particular behaviour. On this scale, zero is not confident at all and 10 is extremely confident. A general rule-of-thumb in MI is that equal amounts of time in a consultation should be spent listening and talking. download the MS Word Viewer free of charge, Wikipedia: Comparison of reference management software, Raise doubt and increase the patient’s perception of the risks and problems with their current behaviour. Motivational interviewing in health care. DOC Some documents on this site are in Microsoft Word format. What difficulties have resulted from your drinking? Healthy choices: Motivational enhancement therapy for health risk behaviours in HIV-positive youth. Where would you be on this scale? Gray E, McCambridge J, Strang J. In keeping with the spirit of MI, a simple phrase reminding the patient of their autonomy is useful, 'You are the expert on you, so I'm not sure I am the best person to judge what will work for you. While we are not advocating MI for all patient interactions in general practice, we invite practitioners to explore their own ambivalence toward adopting MI within their practice, and consider whether they are 'willing, ready and able'. The Techniques Of MI. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. What are the advantages of reducing your drinking? AIDS Educ Prev 2006;18:1–11. taken to reproduce articles accurately, but the publisher accepts no responsibility for errors, omissions or within, or mailed with, Australian Family Physician is not necessarily endorsed by the publisher. Family members, friends and peers of those with co-occurring mental disorders can use the motivational interviewing technique outside of How did you do it? A discussion of how continuing to drink (maintaining the status quo) will impact his future goals to travel in retirement or have a good relationship with his children may be the focus. New York: Pergamon, 1986. Parsons J, Rosof E, Punzalan JC, Di Maria L. Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project. 0000004364 00000 n Motivational interviewing moves the practitioner to develop a paradigm shift, a new mindset, a new way of seeing change. These will have "DOC" in brackets along with the filesize of the download. 0000007561 00000 n The heart or spirit of MI can be denoted by the acronym CARE. Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice. completion of recommended screening or diagnostic tests or specialist/allied health/psychologist referral. Finally, decide on a 'change plan' together. The practitioner connects health behaviour change to the things the patient cares about, Education: the patient is presumed to lack the insight, knowledge or skills required to change. Privacy | Terms of use, Facilitating behaviour change in the general practice setting, Incorporating therapy into general practice, Use and effectiveness in general practice, Results from a survey of general practice registrars. Miller and Rollnick17have attempted to simplify the practice of MI for health care settings by developing four guiding principles, represented by the acronym RULE: The righting reflex describes the tendency of health professionals to advise patients about the right path for good health. It is easy to conclude that this patient lacks motivation, his judgment is impaired or he simply does not understand the effects of alcohol on his health. If you do not have it you can download Adobe Reader free of charge. Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. 0000002726 00000 n The practitioner would emphasise that the decision to change is 'up to him', however they would work with the patient to increase his confidence that he can change (self efficacy). 0000002258 00000 n Curr HIV/AIDS Rep 2005;2:159–64. Follow the prompts to chose a location. Example: 'If you can think of a scale from zero to 10 of how important it is for you to lose weight. Prochaska J, DiClemente C. Towards a comprehensive model of change. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. What would it take for you to go from ___ to (a higher number)?'. Ask your client to pinpoint, on a scale of 1 to 10, how motivated they are to end their drug use. Motivational interviewing (MI) is an effective counselling method that enhances motivation through the resolution of ambivalence. Within MI, the therapist is viewed as a facilitator rather than expert, who adopts a nonconfrontational approach to guide the patient toward change. In MI, the opposite approach is taken, where the patient's motivation is targeted by the practitioner. Volume 41, No.9, September 2012 Pages 660-667. A natural response for a practitioner who encounters such opposition (termed ‘resistance’ in the psychological literature) is to reiterate health advice with greater authority or to adopt a more coercive style in order to educate the patient about the imminent health risks if they don’t change. Barriers to implementing MI in general practice include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients' overwhelming desire for 'quick fix' options to health issues and the brevity of consultation times. This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient. This trap can be avoided by employing strategies to elicit 'change talk'.1 There are many strategies to elicit 'change talk', but the simplest and most direct way is to elicit a patient's intention to change by asking a series of targeted questions from the following four categories: Alternatively, if a practitioner is time poor, a quick method of drawing out 'change talk' is to use an 'importance ruler'. Motivational interviewing is good for people who are too emotional to be motivated. 0000008212 00000 n 0000009790 00000 n Motivational interviewing. Complete a GP management plan with a patient with asthma Complete/review Asthma Cycle of The practitioner would therefore work on understanding this ambivalence, by exploring the pros and cons of continuing to drink alcohol. . smoking, overeating, heavy drinking) or adopting healthy or safe behaviours (eg. To view these documents you will need software that can read Microsoft Word format. The first part of this manual provides an overview of Motivational Interviewing concepts and skills which can be used as a framework for offering case management. Fisher J, Fisher W, Cornman D, Amico R, Bryan A, Friedland G. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behaviour among HIV-infected patients.

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