Test 2 Motivational Interviewing Flashcards
What is motivational interviewing used for?
- to treat patients with substance dependence, addiction to gambling, mental disorders, and diseases requiring behavioral change
- can also be for personnel management, sales, or marketing
define motivational interviewing
- collaborative, patient-centered form of guiding to elicit and strengthen motivation for change
- “a therapeutic style intended to help clinicians work with patients to address the patient’s fluctuation between opposing and behaviors and thoughts”
What does motivational interviewing focus on?
- empathetic understanding
- movement towards belief in self-efficacy
What are the components of a patient’s motivation to change?
- willingness
- self-efficacy
- readiness
define self-efficacy
a patient’s perception of their ability or their self-confidence in their ability to initiate and maintain behavioral change
How is readiness assessed?
related to the priority a patient gives to needed behavioral changes to improve health
How is willingness assessed?
by the amount of discrepancy patients perceive between their current health status and goal they have for themselves
What are the results of empathetic understanding?
- your patients are free from fear of being judged
- creates a safe and trustful environment
- sets the stage for patients to make decisions needed to change
- allow pharmacists ability to resolve patient’s feelings of ambivalence
What is the key to successful behavior change?
persistence
What are the stages of the Transtheoretical Model of Change?
- Stage 1: Pre-contemplation
- Stage 2: Contemplation
- Stage 3: Preparation
- Stage 4: Action
- Stage 5: Maintenance
Pre-contemplation
- not yet ready to change
- lack of recognition of the problem
- denies serious risks
Pre-contemplation communication approaches
- raise awareness
- provide information
- convey empathy
- encourage pt to think about it
- express willingness to help
- avoid arguing
Contemplation
- thinking about change
- aware of consequences
- express willingness to change within 6 months
Contemplation communication approaches
- ask pt to list pros and cons
- provide information benefits of change
- reinforce positive statements
- acknowledge ambivalence
- show empathy
- identify discrepancy between goals and behaviors
- encourage small steps
Preparation
- commitment to change in < a month
- understand that benefits outweigh the changes
Preparations communication approaches
- helps ptsformulate plans
- tailor to meet pt’s needs
- ask about barriers to change & how to overcome them
- provider information and referrals as needed
Action
- initiation of change
- experience challenges
- efforts to maintain resolve
- considered to last for six months
Action communication approaches
- provide positive reinforcement
- focus on benefits of change
- discuss strategies to prevent relapse
- define slips vs. relapse
Maintenance
- incorporate change into life-style
- this phase is > 6 months
- avoid relapse
Maintenance communication approaches
- continue reinforcement for success
- assist in problem solving in case of a lapse
Spirit of Motivational Interviewing key elements
- collaboration (vs confrontation)
- evocation
- autonomy (vs. authority)
What does collaboration do?
build rapport and facilitates trust
What are the principles of motivational interviewing?
- express empathy
- support self-efficacy
- rolling with resistance
- developing discrepancy
- eliciting and reinforcing change-talk
When does resistance occur?
- when pts feel conflicted
- when pts feel that their freedom / autonomy is being impinged upon
How is a discrepancy developed?
when pts perceive a mismatch between where they are and where they want to be
Preparatory change talk
- DARN
- Desire (I want to change)
- Ability (I can change)
- Reason (It’s important to change)
- Need (I should change)
Implementing change talk
- CAT
- Commitment (I will make changes)
- Activation (I am ready, prepared, willing to change)
- Taking Steps (I am taking specific actions to change)
OARS
- Open-ended questions
- Affirmations
- Reflections / Reflective Listening
- Summaries
