Lecture 5: Motivational interviewing

Question 1

obstacles for change

Answer 1

• Demoralisation
• Effort and Time
• Resistance
• Automatic cognitive processes
• Environmental factors

Question 2

resistance often arises out of…

Answer 2

fear

Question 3

what is motivation?

Answer 3

• degree of willingness/readiness for change
• can vary over time
• can be influenced
• underlies the actual change of behaviour

Question 4

3 components of motivation

Answer 4

• will to change
• confidence in own ability to change
• readiness to change

Question 5

ambivalence =

Answer 5

conflicting motivations (i would like to change but i still find it too difficult)

-> ambivalence evokes discomfort and is often the start of change (cognitive dissonance)

Question 6

motivational interviewing=

Answer 6

a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

Question 7

principles of motivational interviewing

Answer 7

1. show empathy
2. unconditional acceptance (of the person, not necessarily the behaviour)
3. avoid discord/discussion
4. roll with the resistance (judo)
5. affirmation
6. develop disbalance (cognitive dissonance)

Question 8

the ‘spirit’ of motivational interviewing

Answer 8

collaboration
compassion
evocation
acceptance

Question 9

so, what does not work?

Answer 9

• Convincing
• Direct Confrontation
• Discussion
• Tips & Tricks
• Stressing negative consequences usually doesn’t work
• Unsolicited advice

Question 10

giving advice is fine if…

Answer 10

• a decision is already made
• someone asks for it
• the other does not have the right information

Question 11

what does work?

Answer 11

• moving along (judo)
• exploring the other’s point of view

Question 12

righting reflex=

Answer 12

repair reflex/for your own good reflex (mensen echt gaan proberen te overtuigen)

Question 13

4 processes of MI

Answer 13

1. engaging
2. focusing
3. evocation
4. planning

Question 14

stages of change model

Answer 14

pre-contemplation (engaging)
contemplation (focusing/evoking)
preparation (focusing/evoking/planning)
action
maintenance
relapse/fixed

Question 15

engaging =

Answer 15

shall we get to work together?

• therapeutic alliance
• can take long or be immediately
• provide feeling of safety
• techniques: comforting, asking for permission, giving options, talking about their values

Question 16

focusing =

Answer 16

which change are we talking about?

clarifying and prioritizing

Question 17

evocation =

Answer 17

why change?

1. explore and increase ambivalence
2. evoke change talk

Question 18

• The balance between change and sustain talk predicts change
• Influenced by the clinician
• Increase of intrinsic motivation by evocation of change language

Answer 18

oke

Question 19

change talk =

Answer 19

Disdvantages of status quo
Advantages of Change
Confidence about changing
Determination to change

Question 20

DARN-Cat =

Answer 20

desire
ability
reason
need
commitment

Question 21

how to use OARS to evoke change talk

Answer 21

Open questions
- More directed than in engagement-phase

Affirmations
- compliment, reframe, validate

Reflections
- Content, emotion, ambivalence etc.
- More provoking, more complex. (‘smart guessing’)
- Simple reflections : Complex reflections = 1:2

Summaries
- Like picking a bouquet of flowers (not everything!

Question 22

other techniques of MI

Answer 22

• Discuss values and goals (“What do you hope will be different in your life in a few years?” What role does ….have in that process?)
• Looking back and ahead (How was your life before…What will your life look like when…?)
• “Third-person” view
• Two futures (How will your life look in 5 years if…)
• Normalize ambivalence
• “If you could give yourself advice, what would it be?
• Scaling questions (next slide)
• Optional: decisional balance

Question 23

scaling questions

Answer 23

• op een schaal van een tot tien, hoe graag wil je veranderen?
• op een schaal van een tot tien, hoe veel vertrouwen heb je er in dat dit gaat lukken?

Question 24

planning=

Answer 24

how to change?

• hoe zou je vanaf hier verder willen gaan?
• kleine, haalbare stappen (SMART)
• terug naar vorige fase als dat nodig is
• hier start het behandelingsprotocol

Question 25

wanneer is iemand klaar om te veranderen?

Answer 25

• meer change talk/commitment talk
• minder sustain talk
• praten over oplossingen
• visualiseren