Why is Motivational The efficacy of MI meta analyses Interviewing - - PDF document

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Denise Ernst PhD

Motivational interviewing is a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by drawing out and exploring a person’s own reasons for change within an atmosphere of acceptance and compassion.

Why is Motivational Interviewing (MI) a method to consider?

MI has substantial evidence base supporting it’s effectiveness in facilitating change in behaviors that are hard to change MI is effective with both psychological (behavior change) and physical outcomes (BMI, BP, BAC) MI focuses the responsibility for change on the patient; encourages self-management and self- determination

The efficacy of MI –meta analyses

MI out performs traditional advice giving in 80% of studies Effective in 10-20 minutes More encounters over longer time period increase likelihood of an effect Physicians and other health providers can be as effective as psychologists or clinicians

Compassion: active promotion of the client’s welfare and needs. Acceptance, including accurate empathy, affirmation, absolute worth of the person, and support of the person’s autonomy. Partnership with the client; MI is done “for” and “with” a person and not “to” a person Evocation of clients motivation, hopes, dreams, desires, values, goals, and abilities.

What else to watch for in conversations about change?

Righting reflex; avoid convincing, arguing, trying to fix, prescribing, directing Ambivalence; normal part of the change process, not pathological or a sign of denial but a place where people get stuck

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Engaging with OARS: The MI micro skills

Open-ended questions to keep the conversation moving forward and encourage self-exploration Affirming the patient’s strengths, efforts, character and worth Reflective listening to stay focused on the patient and convey understanding and empathy Summarizing to provide the big picture and to transition

Putting on the CAPE!

Informing in the MI way

Asking permission Finding out what the patient already knows Tailoring your information to meet the needs of the patient Providing time and space for the patient to think about and respond to the information Acknowledging that the patient is the expert on his/her

• wn life

Encouraging the patient to use the information in the way that suits them best

Sustain Neutral Change Talk Talk Talk Moves away Moves from change towards change

Growing evidence that increased change talk as well as decreased sustain talk given by the client in an interaction leads to better outcomes. The clinician can influence the client’s language with their responses. The technical components of MI involve strategically and intentionally shaping the client’s language toward change.

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Some potential targets

Health behaviors; smoking, drinking, eating habits, physical activity, sleeping habits Self-monitoring; blood sugar, blood pressure, diaries, symptoms Medication or treatment adherence

What did you notice?

Compassion Acceptance, empathy, autonomy support, and affirming Partnership Evocation

Examples of questions and evoking the patient’s perspective

I wanted to welcome you and offer you the

• pportunity just to tell me what you’ve been

through, and how you’re feeling about coming up here this morning. What do you notice about the effect of smoking

• n your sport?

Is there anything else about it that you’re concerned about that you haven’t mentioned?

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Examples of reflections

• f change talk

So there’s something about your body feeling a bit challenged by this. And so there’s a bit of a worry you have about what the condition of your heart might be. You might even give it a try.

Examples of reflecting ambivalence

So there’s stuff you get out of this, but on the other hand you notice the effect on your chest in the morning

Information exchange

Clinician: I was going to ask you about that. How much do you know about those kind of stop smoking aids? Patient: Not much. Not much. I’ve never really tried to approach quitting. I didn’t see the need, but Clinician: Right. I mean that would be a decision that you take for yourself, and I’m not suggesting you make that, but what is it you’d most like to know about stop smoking aids? I mean, is there any piece of that puzzle that I can help you with?

Information exchange

Clinician: Perhaps I can just let you know that there is quite a range of these aids. Some of them you’re quite right, like bupropion, that is a drug that can have side effects, and it doesn’t contain any nicotine. OK. So that’s one kind of aid. OK, but then there are others that contain nicotine like a patch or gum that really are devices for helping you tail off the withdrawal symptoms gently. So there’s broadly those two kinds of aids, and the success rates of them are reasonably good, but it sounds like you’re particularly concerned about a drug that might have side effects.

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The takeaways

How you communicate with your patients makes a difference in the outcomes Putting your cape on will help (compassion, acceptance, partnership, and evocation) Attending to and shaping the language of the patient will also help Even with difficult, challenging cases, empathy can take you a long ways

References

Rollnick, Miller, & Butler, (2007). Motivational Interviewing in Health Care: Helping Patients Change

• Behavior. The Guilford Press, New York, NY.

Miller, W.R. & Rollnick, S. (2013). Motivational Interviewing; Helping People Change. The Guilford Press, New York, NY. Rubak, et. al. (2005) MI: A systematic review and meta

• analysis. British Journal of General Practice 2005; 55: 305–

312. Hettema, et. al. (2005) Motivational Interviewing. Annual Review of Clinical Psychology, 1:91–111.

Additional Resources

Motivational Interviewing Network of Trainers (MINT) website has a list of trainings coming up, trainers around the world, and an extensive bibliography of MI research and publications. motivationalinterviewing.org Denise’s email (feel free to contact me) denise@deniseernst.com