Motivational Interviewing Flashcards
Basic principles of motivational interviewing
collaborate -> don’t confront
evoke –> don’t lecture
encourage autonomy -> not authority
elicit values, fears, hopes, expectations
Fostering autonomy
Honor autonomy
Ask, Inform, Listen
Activate patient’s own motivation
Barriers to change
Social -> norms
Spiritual -> suffering/deserved
Psychological -> depressed/anxious
Biology -> exercise hurts
Stages of change
Pre-contemplation Contemplation Preparation Action Maintenance - need to know what stage patient is at -> may not be ready for a different stage yet
Closed questions
Yes/No –> patients expect you to have answer after they ask the question
Open questions
more productive and engaging with the patient
Direct, guide, follow questions
ASK questions
- good way to gather info
- develops rapport
- unhealthy behaviors tend to cluster
- chance to ask other questiosn
?s to elicit change talk
Desire?
Ability?
Reasons?
3 productive questions to ask
How important is change to you?
How confident are you that you can do this?
How has this behavior kept you from moving forward?
LISTEN!!!!
eye contact, reflect, silence is ok, be honest, listen to tone
Change talk
Desire Ability Reasons Need Commitment Taking steps
Informing
don't overwhelm patient consider priorities offer choices talk about what others do ask permission
Why does patient hear you?
Bewildered Overwhelmed High emotion Mood Distractions White coat syndrome Wants to look good
Motivators for change
Make it personal to patient –> relevant to something important to them
Identities that motivate
Good parent Spiritual Good christian Good spouse/partner Responsible
Values that motivate
considerate independent disciplined strong successful good community member
Why people DON’T change
ambivalence
resistance
personal struggles
Ambivalence
more people WANT to be healthier but feel UNCOMFORTABLE with change
Resistance
natural human tendency to resist coercion
- pushing for adherence can decrease adherence
Sources of resistance
rigid see no benefit undesired change or consequences think its not possible no support cost not ready
Medication adherence
helpful –> patient accepts condition
hinders –> unpredictable condition, negative S.E., fears, stigma
