Motivational interviewing Flashcards
motivational interviewing is a method of causing __
motivational interviewing is a method of causing behavior change
6 stages of behavior change
- precontemplation
- contemplation
- preparation
- action
- maintenance
- relapse
precontemplation is __ about change
precontemplation is NOT yet THINKING about change
contemplation is __ about change
contemplation is THINKING about change
at what stage can you temporarily exit the stages of change circle
preparation
relapse is __ and __
relapse is normal and common
5 steps of contemplating change
- Identifying the behavior: this is how I eat
- Identifying a problem: eating this way is a problem
- Desiring a change: I want to eat better
- Feeling confident about a change: eating better will help me be healthier and feel better
- Doing it!
3 values of stages of change models
- Sending a patient home even thinking about change is a huge step
- Knowing where patients are stuck may help you narrow down the likely barriers
- Framework that can be used to facilitate empathy
the 4 spirits of MI
- acceptance (autonomy and empathy)
- collaboration
- compassion
- evocation
MI: acceptance
if given a choice, more likely to __
MI: acceptance
if given a choice, more likely to make a change
__ acceptance facilitates change
nonjudgmental acceptance facilitates change
MI: acceptance
__ is normal
MI: acceptance
ambivalence (not knowing where you are) is normal
MI: collaboration
being an equal partner
MI: compassion
MI is not a magic bullet or trick
MI: evocation
eliciting patient’s perspective as well as “change talk”
change talk consists of the patient’s expression of their own __, __, __, and __ for behavior change
change talk consists of the patient’s expression of their own desires, ability, reasons, and need for behavior change
sustain talk consists of the patient’s expression of their own __, __, and __ for behavior change
sustain talk consists of the patient’s expression of their own desires, reasons and need to stay the same, and inability for behavior change
MI: where is the patient? what is their perspective?
empathy, use stages of change
collect info
MI: what are the micro-skills needed?
Person centered guiding skills (OARS)
Giving information (includes suggestions, voicing your concerns, etc.)
“Rolling with resistance”
MI: what is the overarching goal as a physician
Paying attention to, reflecting, eliciting, and reinforcing change talk: the reasons, desire, ability, need, etc. for behavior change
The more change-talk you hear from the patient, the more likely they are to want to change
O in OARS
These are questions that invite the patient to say more than a yes, no, number or one word answer.
A in OARS
These are statements that reinforce and convey recognition of the patient’s strengths, abilities, efforts, as well as past and current successes
R in OARS
These are statements in which the provider repeats (exact words), rephrases (slight re-wording), or paraphrases (e.g., amplifying the thought or feeling, use of analogy, making inferences).
S in OARS
These are statements in which the provider reviews patient’s stance on the behavior at the current moment and can be a useful tool to then elicit the “next steps” with a key question.
“Eating healthier was very important to you back then and you made sure that nothing stopped you from doing so.”
which letter of OARS
Affirmations
“How would you like for things to be different with your ____?”, “What concerns you about your____?”
which letter of OARS
Open-ended questions
“You’ve done the hard work of eating healthier and losing some weight. You’ve felt really good about those changes, and recently you feel like you had a little setback. Getting to a healthy weight and feeling good about yourself is a priority for you and right now you’re not sure what to do. What would be most helpful for you right now?”
which letter of OARS
Reflections
“You’ve done the hard work of eating healthier and losing some weight. You’ve felt really good about those changes, and recently you feel like you had a little setback. Getting to a healthy weight and feeling good about yourself is a priority for you and right now you’re not sure what to do. What would be most helpful for you right now?”
Summaries
how to effectively give information
Provide information when asked
Ask for permission before giving (if the patient does not ask)
Provide small “chunks” of information while frequently getting feedback to assess the patient’s perspective on that information: the elicit-provide-elicit (EPE) model
elicit-provide-elicit (EPE) model
elicit consent
provide small chunk of information
elicit confirmation of understanding
when should you give information in a visit?
NOT first
importance scale
how important is it for you right now to change?
if patient is at a 6, ask (2 questions)
- why is it a 6 and not a 3?
- What would make you go from 6 to 9?
confidence scale
if you decide to change, how confident are you that you will be able to?
key questions for demonstrating the advantages of change
- “How would you like for things to be different in the way you are feeling?”
- “What would be the advantage of making this (or a) change?”
- “I know that it is difficult to start making these kinds of changes. Let’s say you were able to, and your son got to a healthier weight. What would be the positive things you might see in his life? In your family?”
- “How were you able to overcome this in the past?”
key questions for demonstrating the disadvantages of the status quo
“What worries you about your current situation?”
“What makes you think that you need to do something about ______ (e.g., your smoking)?”
“In what ways does this concern you?”
“What do you think will happen if you donʼt change anything?”
“Putting aside what others are telling you to do, what are you saying to yourself, about what you think is best for you?”
to elicit change talk you should use questions to point out the advantages of __ and the disadvantages of __
to elicit change talk you should use questions to point out the advantages of change and the disadvantages of the status quo
MI can blend well with __
MI can blend well with CBT
Cognitive Behavioral Therapy (CBT) =
thoughts + feelings + behaviors
