Ch 16: Motivational Interviewing Flashcards
A client-centered coaching style that helps clients resolve ambivalence and elicit behavior change.
Motivational Interviewing (MI)
The state of having mixed feelings about change
Ambivalence
- A client with ambivalence wants to change and at the same time does not want to change.
Motivational interviewing helps:
Helps clients define their current and ideal selves and form a plan that moves the current self toward an ideal self. When an individual wants to change dietary behaviors to improve body composition, overall health, or athletic performance, motivational interviewing is a coaching approach that can be used to help clients change specific health behaviors
At its core, Motivational interviewing is:
Non-confrontational, collaborative, empathetic, and goal-oriented style of communication
In US, Percentage of Obese or Overweight Americans
70%
Rewards that are immediate – for example, the pleasure of eating high-sugar, high-fat foods.
Proximal Rewards
Rewards that are far away, such as a loss of 30 pounds.
Distal Rewards
The build-up of mental energy that drives the desire to behave in certain ways – behavior often needs plans.
Motivational Phase
Point where individuals decide how they will turn their motivation into behavior.
Planning Phase
Initial deliberative stages
Clients create a motivational foundation for implementing change
Implemental Stage
Clients plan when, where, and how to act. Plans will fail to drive action if a person questions the desirability or feasibility of the chosen goal
The collective reasons that drive a person to take action.
Motivation
- Brain processes that energize and direct behavior
- Motivation, as energy, is subject to change
- Has a direct relationship with planning as well as the execution of plans
if a client can strongly link their nutrition choices to valuable life outcomes:
Motivation should direct planning, prioritization, and action
Motivation Aspects
Goal
Vision
Admire
Support
Teamwork
Mentor
Performance
Success
A motivational theory that describes individuals psychological needs for growth – self-determination theory also describes different types of motivational regulation and considers these regulations anywhere on a continuum of motivation.
Self-Determination Theory (SDT)
A state in which a person is not motivated to behave.
Amotivation
Types of Motivation: Self-Determination Theory
Controlled: Amotivated-> External ->Introjected
Autonomous: Identified -> Integrated -> Intrinsic
Types of Motivation: Self-Determination Theory: Identified
The behavior is consistent with my goals
Types of Motivation: Self-Determination Theory: Integrated
The behavior is part of my Identity
Types of Motivation: Self-Determination Theory: Intrinsic
The behavior feels good
Those with motives who feel outside or internal pressure to do certain behaviors.
Controlled Motives
Behaviors that are enacted with a sense of volition and choice – autonomously motivated people want to do the behavior.
Autonomous Motives
Losing weight because there is a weight-loss challenge at work and the winning team gets a prize
Controlled Motives (External)
Losing weight because of the guilt of being overweight
Controlled Motives (Introjected)
The client believes that achieving and maintaining a healthy weight is personally important.
Autonomous Motives (Identified)
Losing weight because being healthy and fit is consistent with the client’s other health goals (e.g., running a half marathon)
Autonomous Motives (Integrated)
Behavior performed to achieve some external reward or to avoid punishment – it is reflective of complying with other people’s demands.
External Regulation
Behavior performed to avoid negative feelings (i.e., shame or guilt) or to enhance positive feelings (i.e., ego).
Introjected Regulation
Behavior performed because it is valued and personally important.
Identified Regulation
Behavior performed because it is fully congruent with a person’s values and needs.
Integrated Regulation
Less-depleting.
Autonomous Control
The support of a client regardless of what they say or do – it is the belief that the client is trying their best despite perceived destructive behaviors.
Unconditional Positive Regard (UPR)
The feeling of freedom from external influences or control – the individual is perceived to be the source of their own behavior.
Autonomy
Motivational Interviewing COmponents
Compassion, Collaboration, Acceptance, Evocation
Individuals that are met with negative regard
Less likely to communicate true feelings, have the desire to change, and lack awareness of true internal feelings.
When the client voices the benefits of change and disadvantages of staying the same.
Change Talk
Ambivalence
A person experiences ambivalence when there are competing demands between desirable behaviors
An individual’s ability to modify their behavior.
Self-Regulation
Self-regulation skills help clients resist negative external influences and are necessary for goal-directed behavior
Clients discover why the goal is important to them. They then create specific behavior-oriented goals based on what their values are.
Value Exploration
- Systematic examination of the relationship between life values and behavior change or maintenance
When values are prioritized, behaviors are linked with the client’s personal sense of a desired identity.
Value Prioritization
Personal goals that come from a value system enhance motivation by providing self-incentive and guidance for health habits
Focusing on a Client’s Values
Can increase the importance of change and provide the direction for behavioral priorities
Personal Goals that come from a client’s value system
Can enhance motivation by providing self-incentive and guidance for health habits
Value Exploration
Examination of the relationship b/w life values and behavior change or maintenance
Values
The root of the behavioral decision-making process
End states that express values
Goals
Three different relationships between problematic behaviors and values
Self-oriented: The behavior is good for the individual but bad for others.
Short-sighted: The behavior is good for the individual now but bad for the individual later.
Inefficient: The behavior satisfies some needs or values but prevents others.
Three basic psychological needs of Self-Determination Theory
Competence, relatedness, and autonomy (empathetic listening)
Behavior represents the individuals core self, values, and interest
Five general principles to practice MI
- Express empathy through reflective listening.
- Help clients identify discrepancies between their values or goals and their behavior.
- Support self-efficacy.
- Avoid arguments.
- Adjust to client resistance.
Listening that clarifies and expresses an understanding of a person’s own experiences and goals.
Reflective Listening
When a person’s behavior is attributed to “the way they are” rather than to external factors.
Fundamental Attribution Error
The support of a client regardless of what they say or do – it is the belief that the client is trying their best despite perceived destructive behaviors.
Unconditional Positive Regard
Accurate Empathy occurs:
When the coach uses reflective listening that clarifies and expresses an understanding of a person’s own experiences and goals and personal meaning for those goals.
Nutrition Coaches will benefit from two concepts that relate to coaching with accurate empathy
The first concept is called the fundamental attribution error
Unconditional positive regard is the opposite of the fundamental attribution error
Empathetic listening can be accomplished when the coach does the following:
Respects and accepts the client
Is nonjudgmental
Provides sincere compliments
Provides unconditional support
Reflective listening involves:
- Suspending the self and self-interest and being thoroughly immersed in what the client is saying.
- Coaches should think about their body language, too.
- -Coaches are giving their client complete and undivided attention.
—After the client has expressed themselves, the coach may respond.
A well-placed reflective statement:
Encourages a client to divulge more information that may be helpful in the change process. Reflective listening may have a certain format that includes (but is not limited to) starting with the following phrases:
“It sounds like…”
“You feel like…”
“You want to do this but at the same time…”
“Tell me more…”
A person’s ideal version of themselves
Ideal comparator
Strategies for Identity Discrepancies
Values exploration, may help a client see the differences in how they are behaving now with how they would like to perceive themselves.
Discrepancies can also be created by having clients imagine possible futures that weigh the cost and benefits of changing.
Four Methods for building Self-Efficacy
- Performance accomplishments
- Vicarious experience
- Verbal persuasion
- Physiological states
Provide a client with a chance to make an attainable change. For example, if the client typically eats out 4 nights per week, celebrate their success when they drop down to 1 night per week.
Performance Accomplishments
Provide examples of other clients who have been in the current client’s shoes. Give examples of what they did to achieve their goals.
Vicarious Experience
If a client is not sure that they have the ability to do a certain task, remind them of times in the past where they have successfully made changes. Maybe the client is not sure that they have time to do food preparation but they also said the same thing about fitting in exercise. Remind them that when they scheduled effectively they were able to exercise more.
Verbal Persuasion
Create a positive coaching relationship that mitigates nervousness and anxiety. If a client feels unsure about a certain behavior, either provide empathetic listening to help the client see a solution or suggest a different behavior that does not elicit negative emotions.
Physiological States
A positive statement about a client’s character that acknowledges their efforts.
Affirmation
Affirmations are not just about giving praise for a job done well; the articulation of why the coach believes the client is successful (prioritized) is impactful.
Affirmations can:
Empower clients to believe in their abilities, improve self-confidence, support change, and decrease defensiveness while encouraging persistence
Process Mindset
Different way of reframing failure
Opposite of Resistence
Change Talk
Describes movement toward change, whereas resistance describes movement away
Change Talk
What can diffuse resistance talk
Reflections and/or open-ended questions
One strategy with reflective listening is to sparingly amplify a client’s sustain talk
Motivational Interviewing Strategies
- Express Empathy
- Discrepancy Identification
- Support Self-Efficacy
- Avoid Arguments
- Client Resistance Adjustments
Behavioral change model that demonstrates progression through stages until the change becomes part of the everyday lifestyle.
Transtheoretical Model (TTM)
The six stages of change in the Transtheoretical Model (TTM)
- Precontemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Termination
_____________ explains how and why people change and _________________ is a coaching style that helps people improve their motivation for change.
TTM; MI
Types of Precontemplators and Resistance to Change
Reluctant precontemplators
Rebellious precontemplators
Resigned precontemplator
Rationalizing precontemplator
These clients may feel overwhelmed by the change process. Changing seems hopeless to them
Resigned precontemplator
Action: Instill hope and explore barriers to changing.
These clients do not feel as if they are in personal risk from their behavior.
Rationalizing precontemplator
Action: Empathy and reflective listening – Let the client talk about the pros of their behavior.
These clients lack proper knowledge or think the goal is too far away. They may not recognize the consequences of their current behaviors. They may not want to risk the discomfort or challenge of changing.
Reluctant precontemplator
Action: Empathetic listening and providing sensitive feedback
These clients have the information to know that their behaviors are problematic. They are, in fact, adamant about not changing.
Rebellious precontemplators
Action: Ensure the client that no one can force them to make any changes and that you have no intention of making them do anything they do not want to do. Provide them with a variety of options to see if one is appealing.
Goal during the Contemplation Stage
-Coach’s goal is to help the client get out of ambivalence by helping them see more pros of changing.
-They may provide personally relevant health information to the client.
During the Planning Stage
- Clients in the preparation phase need to create a plan that they feel will work for them.
- Once they make a plan, commitment toward following the plan needs to be enhanced.
- The coach may present a menu of common barriers that clients may encounter. The client can pick the barriers that are personally relevant to them. The coach may then ask the client what they think they might do to overcome these barriers.
During the Action Stage
Coaches can help clients by teaching them how to make effective plans
Specific plans that can enhance a client’s intentions to act
Implementation Intentions
- if–then plans that link situations with desired behaviors. This works by assigning control of a behavior onto the environment
Imperative during the Maintenance Phase
Imperative to identify relapses early
Encourage client that a Slipup is just a Slipup
Minimize Slipups
The client can also restructure their environment
- If they know that certain foods trigger them to overeat, they should avoid having them in the house.
- Alternatively, they can create planned cheat meals with a predetermined quantity of food
Stages of Change and Actions to Take With Your Client: Precontemplation
Provide empathetic and reflective listening.
Do a value exploration to see how the client’s behaviors fit in with their values.
Build rapport.
Avoid arguments.
Begin with a small change and provide affirmation for each success.
Enhance self-efficacy.
Stages of Change and Actions to Take With Your Client: Contemplation
Help clients resolve ambivalence and encourage change.
Have clients get bloodwork done to examine biomarkers of health. Relevant health information may encourage change.
Use decisional balance sheets.
Provide affirmations.
Continue to enhance self-efficacy.
Stages of Change and Actions to Take With Your Client: Preparation
Assess strength of commitment to change.
Help clients develop feasible plans.
Help clients make specific action plans that dictate when, where, how, and with whom a behavior will occur.
Stages of Change and Actions to Take With Your Client: Action
Revise plans as needed.
Foster strong self-efficacy.
Harness social support.
Create and follow through on plans.
Stages of Change and Actions to Take With Your Client: Maintenance
Encourage clients to organize their environment so that temptations to relapse are minimal.
Strengthen commitment to the goal.
Identify relapses early.
Encourage clients to forgive relapses and return to their routine.
Harness social support.
Collaboration:
Support, Teamwork, Communication, Trust, Motivation, Inspiration and Success
Change happens when:
People connect behaviors with values
Overcome Behaviors in the Contemplative Stage
- Have clients get bloodwork done to examine biomarkers of health. Relevant health information may tip the scales toward change.
- Help clients resolve ambivalence and “tip the balance” in favor of change.
- Decisional balance sheets.
- Affirmations
Overcome behaviors that reside in the Preparation Stage
- Assess strength of commitment to change.
- Help clients make specific action plans that dictate when, where, how, and with who a behavior will occur.
- Help clients develop feasible plans.
Helping a client overcome behaviors that reside in the Action Stage
- Harness social support
- Foster strong self-efficacy
- Create and follow through on plans
- Revise plans as needed
Helping a client overcome behaviors that reside in the Maintenance Stage
- Identify relapses early
- Encourage clients to forgive relapses and return to their routine
- Strengthen commitment to the goal
- Encourage clients to organize their environment so that temptations to relapse are minimal
Ambivalence is seen as:
A normal part of the change process
Lack of harmony in the client-coach relationship
Dissonance
Changing because an individual wants to change is ?
Autonomous motive
How many basic psychological needs are there in self-determination theory?
3
Which of the following reframes the idea of failures as ineffective solutions?
A process mindset
