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addictions final > MI & model of change > Flashcards

MI & model of change Flashcards

1
Q

what is the transtheoretical model of change

A

six specific steps necessary for any type of radical change to occur:

  • precontemplation
  • contemplation
  • preparation
  • action
  • adaptation/maintenance
    -evaluation
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2
Q

explain the pre contemplation stage

A
  • no insight into SUD
  • Individual will resist change and typically has no intention of altering behaviour
  • Unaware of the impact of behaviour on those around them
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3
Q

role of RPN in pre-contemplation stage

A

use MI - keep pt engaged
- Build rapport and trust; increase problem awareness; raise the sense of the importance of the change.

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4
Q

explain the contemplation stage

A
  • pts get ready for change
  • they become aware that they are stuck in a situation and must decide whether they wish to change or remain where they are
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5
Q

role of RPN in contemplation stage

A
  • the focus is on pros and cons
  • Acknowledge ambivalence regarding the difficulties associated with change
  • explore the discrepancy between present behaviour and the service user’s personal values and goals
  • assist in weighing pros and cons of change, while working to tip the scales towards change
  • Discussing reasons for change and risks of not changing important, as is increasing confidence in ability to change
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6
Q

explain preparation stage

A
  • pt considers changing drug-using behaviour and anticipates what this future action will entail
  • pt adherent to OATs
  • pts more involved, show up for apts
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7
Q

role of RPN in preparation stage

A
  • build pt confidence
  • talk about timing of change
  • provide information, options
  • help pt identify and resolve barriers to success, including friends and family who may still benefit from user’s drug-using behaviour, along with activities associated with drug use
  • help pt develop realistic plans that can be easily implemented with minimal risk of failure
    • dont rush; work at pt’s pace
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8
Q

describe the action phase

A
  • the work and behavioural change begins; heavy emphasis on problem solving and problem-solving skills
  • Entails changing awareness, emotions, self-image, and thinking
  • pt is actively involved in the change process
  • pt will be abstinent or on OAT
  • they may still be using drugs but are involved with tx with harm reduction awareness
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9
Q

role of RPN in action phase

A
  • Support of positive decisions and positive reinforcement
  • help develop attainable goals
  • monitor progress and assist pt in self-monitoring
  • relapse prevention teaching
  • helping pt identify and explore times that may lead to use (emotions, urges, cravings, social situations, etc.)
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10
Q

describe maintenance/adaption phase

A
  • pt has made changes and is sticking with it
  • e.g., pt on OAT, only seen once every 3 months, taking antidepressants
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11
Q

role of RPN in maintenance phase

A
  • focus on skills training
  • focus on supporting and encouraging new behaviour
  • provide different counselling approaches to support pt in adapting to not using drugs
  • help develop plans to address triggers that can lead to lapse or relapse
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12
Q

describe the evaluation/termination phase

A
  • Sees service user move beyond problem solving, with a focus on preventing reoccurrence and dealing with the reality of sobriety
  • Service users assess their strengths and areas that may be problematic in the future as they develop a reoccurrence-prevention plan
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13
Q

role of RPN in evaluation/termination phase

A
  • Reinforce new skills, new knowledge, and the positive changes produced
  • review triggers that can lead to lapse
  • develop strategies on how to return to the new behaviour if a lapse occurs rather than returning to previous behaviours that led to drug use
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14
Q

consciousness raising

A

increasing information to service users about themselves and their problem

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15
Q

dramatic relief

A

experiencing and expressing feelings about one’s problems and solutions grieving losses, partaking in role play to appreciate impact of changed behaviour

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16
Q

Environmental Re-evaluation

A

assesses habits that affect one’s social and physical environment; increase awareness that one can be a positive or negative role model for others

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17
Q

Self Re-evaluation

A

users assess how they think and feel about themselves with respect to their substance use; value clarification, healthy role models, imagery used

18
Q

Self-liberation

A

choose and commit to change beliefs and actions

19
Q

Reinforcement Management

A

providing consequences: punishments or rewards

20
Q

helping relationships

A

combining caring, trust, openness, and acceptance and support for healthy behaviour

21
Q

counter-conditioning

A

substituting healthier alternatives for problem drug-using behaviours; focus on substituting alternatives for problem behaviours with an emphasis on self-care

22
Q

stimulus control

A

removing cues for drug use and replacing them with prompts for healthier alternatives

23
Q

SOCIAL LIBERATION

A

increasing engagement in non-drug-related behaviours, considering the needs of others, becoming involved in broader issues; increase is social opportunities or alternatives

24
Q

what is MI as defined by William miller

A

An interpersonal and interactional process wherein which there exists the probability of behaviours occurring that are intended to lead to positive outcomes

25
Q

reasons people resist change

A
  • Nature of necessary change is misunderstood
  • Change is forced or mandated
  • Hard work required to change what you have been doing for a long time
  • New skills and knowledge often required
  • Changing threatens one’s competence
  • Too many changes are asked for all at once
  • Goal is not seen as achievable
26
Q

Change talk vs Sustain Talk

A

Change talk is talking about the possibility of changing and sustain talk is talking about remaining in the same situation.

27
Q

MI tactics

A
  • Encourage the change talk, and acknowledge sustain talk but do not dwell on it.
  • Acknowledge difficulties in the process, do not dwell on them.
  • Summarize progress and encourage their growth through observations.
  • COGNITVE DISSONANCE
28
Q

what is MI

A
  • Influenced by Carl Rogers; developed by William Miller in 1983
  • Brief, person-centred method; uses intrinsic motivation to change
  • Explores and resolves client ambivalence
  • Uses the ideas of attribution, cognitive dissonance, self-efficacy and empathy
  • Interpersonal process that de-emphasizes labelling
  • Emphasizes internal attribution for change and individual responsibility
  • Strength-based counselling style; counsellor works with user, rather than doing things for or to them
  • Focus on locating natural motivating issues within a person’s life
  • Non-confrontational in nature; acknowledges that creating conflict is counterproductive
  • Seeks to increase user’s awareness of their behaviour as well as unrecognized strengths and opportunities for change
29
Q

Cognitive Dissonance

A
  • Cognitions include our thoughts and beliefs; our opinions about the environment, ourselves, our actions and behaviours
  • Consistency occurs when these cognitions align
  • If balance not obtained, individual will experience state of tension or inconsistency between their opinions, attitudes, beliefs, and actions
  • Dissonance occurs when this tension motivates individuals to alter their thoughts, bringing their beliefs and perceptions closer
30
Q

Principles of MI: RULE

A
  • Resist providing suggestions
  • Understand the person’s motivation to change
  • Listen intently, provide feedback
  • Empowerment through encouragement and support
31
Q

Components of MI: PACE

A
  • Partnership: MI is collaborative work
  • Acceptance: Absolute worth; Autonomy and support; Affirmation; Accurate empathy
  • Compassion: non-judgemental, non-blaming, non-shaming
  • Evocation: draw knowledge and options from service users rather than imparting information or opinions
32
Q

Attributes of MI

A
  • Express Empathy: sets the stage for acceptance of efforts to facilitate change
  • Develop Discrepancies: perceived values versus actual behaviours and outcomes. User must be able to perceive discrepancy between present behaviour and personal goals and values
  • Roll with Resistance: resist arguing against resistance; have service user voice arguments for change
  • Support Self-Efficacy: service users (and counsellors) must believe change can happen
33
Q

OARS

A
  • Open-Ended Questions: allow service user to guide conversation
  • Affirmations – compliment user on behaviours, strengths, and efforts
  • Reflections – 2- 3 reflections after open ended questions
  • Summarizing – ensure mutual understanding of discussion
34
Q

change talk

A
  • Verbalizing arguments for change
  • Allows service users to openly discuss new idea
  • Think in ways different from when misusing drugs
  • Contrasted with “sustain talk”: conversations that favour the status quo and resisting change and “disengagement traps”: approaches that negate value of MI
  • Proficient use of MI techniques will increase change talk and decrease sustain talk
35
Q

disengagement trap: assessment trap

A

When you begin and focus only on information gathering rather than exploring the service user’s motivation for change.

36
Q

disengagement trap: question and answer trap

A

Asking too many questions and not letting the service user lead the discussion.

37
Q

disengagement trap: expert trap

A

Assuming and communicating that you have the best answers to resolve the service user’s challenges.

38
Q

disengagement trap: premature focus trap

A

Focusing the discussion before fully engaging with the service user.

39
Q

disengagement trap: labelling trap

A

Defining the service user through a label.

40
Q

disengagement trap: blaming trap

A

When the discussion shifts to blaming or finding faults with others rather than on the change process.

41
Q

disengagement trap: chat trap

A

Engaging in access small talk that is not action orientated.

42
Q

MI PROCESSES

A
  • Engaging: establish a mutually trusting and respectful helping relationship
  • Focusing: “what” stage; entails clarifying particular goal or direction for change and exploring ambivalence to change
  • Evoking: “why” stage; counsellor assists service users to find, nurture, and implement their own reasons to change
  • Planning: “how” stage; counsellor helps the service user develop specific change plan that service user is willing to implement

addictions final (13 decks)

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