Module 1, Motivational interviewing

Question 1

What is ambivalencE?

Answer 1

• person experiences competing/ mixed feelings/ motivations

Question 2

What is motivation?

Answer 2

• Determination to change a behaviour
• Become actively involved in the treatment process
• Make sacrifices for the process
• Assessed by systematically exploring the costs and benefits of a particular behaviour
• “Motivation is not about admitting being an alcoholic; it means believing that the good things about drinking are now outweighed by the adverse consequences and deciding to do something about it”

Question 3

What are the stages of change?

Answer 3

• pre contemplation
• contemplation
• preparation
• action
• maintenance
• relapse

Question 4

What triggers change?

Answer 4

• Firstly, change is a process NOT an event
• Behaviour change research shows that the process of change can be triggered
  
  • When patient connects with something of intrinsic value, something important to them
  • When intrinsic motivation arises from patients exploring how their present reality differs from what they really want and value (discrepancy)
  • When patients explore their ambivalence to change (I want to, and I don’t want to)
  • When they feel confident that they can change
• “What concerns fo you have about your asthma control?””
• “What might you do to improve control?”

Question 5

How do people change?

Answer 5

• they recognise that current behaviour is a concern or a problem
• they believe they will be better off if they change
• they believe that they are able to change

Question 6

What are the 4 principles of MI?

Answer 6

1. Express empathy
2. Develop discrepancy
3. Roll with client resistance rather than opposing it directly. Avoid argument & direct confrontation
4. Support self efficacy & optimism

Question 7

Principles of MI in practcie…

Answer 7

Question 8

What are the central tools in MI?

Answer 8

R- resist the righting reflex Resist the urge to actively fix patients problems U- understand patients motivation Help them recognise it Listen for and actively seek out goals, beliefs, aspirations
L- listen to patient
E- empower patient

O- open ended questions “Tell me about the good things and the not so good things” “how important is it to you to manage your…” “whats your understanding of the purpose of taking this medication”
A- affirming
R- reflecting
S- summarising

Question 9

What is RULE?

Answer 9

• Resist the righting reflex
  
  • Resist tendency to actively fix patient’s problems
  • Explore ambivalence
• Understand your patient’ s motivation
  
  • Help them recognise it
  • Listen for and actively seek out goals, beliefs, aspirations
  • Explore discrepancy
• Listen to your patient (OARS)
• Empower your patient  Raising awareness of self-efficacy

Question 10

What is the O in OARS?

Answer 10

Open-Ended Questions (Can’t be answered with “yes” or “no”)

• Establishes atmosphere of acceptance and trust & explores problem area(s)
• Examples: “tell me about the good things and the not so good things about…”
  
  • “tell me about a typical day in relation to…”
  • “how important is it to you to manage your…?”
  • “what’s your understanding of the purpose of this medication?”
• Avoid rhetorical questions: “wouldn’t it be better for you to take your medications?”
• Tends to stop momentum – try to use reflection statements 2:1 to questions
• Use key questions nearing end of consultation, resistant lowered, patient using change talk – “what do you think you will do now?”; “so how will you proceed?”; “what do you plan on doing tonight”

Question 11

What is the A in OARS?

Answer 11

• AFFIRMING
• Build patient’s feelings of empowerment and self-efficacy
• Recognizes and reinforces success
• Key: needs to be expressed with genuineness
• Expresses optimism
• Sees any progress as progress
  
  • “It takes a lot of strength to go through all you have been through.”

Question 12

What is the R in OARS?

Answer 12

• REFLECTING
• Sustains momentum of discussion
• What you think the person means may not be what he or she really means
• Involves making statements, not asking questions e.g.
  
  • so you feel….’
  • “it sounds like you …”
  • “you’re wondering if…”
• Double-sided statements – “on the one hand you feel…and on the other hand…” – avoid ‘but’
• Fear: am I putting words in their mouths?
• Reality: taking guesses at what patient means in order to understand them better

Question 13

What is the S in OARS?

Answer 13

• SUMMARISING
• Lets patient know you’re listening and understanding
• Pulls together and links relevant information
• Allows patients to hear their own motivations and ambivalence
• Helps to bridge and transition between topics
• Focuses on priority content and feelings