motivational interviewing:

of 39 /39
Motivational Interviewing: Helping People Change Problem Behaviors Using Smoking Cessation as the Model

Upload: azura

Post on 22-Feb-2016




2 download

Embed Size (px)


Motivational Interviewing: Helping People Change Problem Behaviors Using Smoking Cessation as the Model . Andrée Aubrey , MSW, LCSW, CTTS Director, Area Health Education Center FSU College of Medicine Department of Family Medicine and Health Affairs [email protected] 850-645-6439. - PowerPoint PPT Presentation


Page 1: Motivational Interviewing:

Motivational Interviewing:Helping People Change Problem Behaviors

Using Smoking Cessation as the Model

Page 2: Motivational Interviewing:

Andrée Aubrey, MSW, LCSW, CTTS

Director, Area Health Education CenterFSU College of Medicine

Department of Family Medicine and Health Affairs

[email protected]

Page 3: Motivational Interviewing:

At the end of this training, learners will be able to:

• Articulate the key components of MI interventions; • Demonstrate competence in an evidence based and

practical approach to behavior change counseling;• Focus the assessment interview on identifying and/or

enhancing the client’s own reasons for wanting to quit tobacco or make other health related changes;

• Use reflective listening skills to more fully understand clients’ perspectives about “the problem” and potential strategies to address those problems;

• Enhance client self-efficacy for making a change.

Page 4: Motivational Interviewing:

What would you say to this patient?

• Video slide here

Page 5: Motivational Interviewing:

Typical Tobacco Cessation Counseling

• Video slide here

Page 6: Motivational Interviewing:

Problems with Traditional Approach

• Focuses on “fixing” the problem • Assumes knowledge and information are keys

to motivating behavior change • “Teaches” patients how to make the desired


• Often leads to a “Yes, but…” tug of war

Page 7: Motivational Interviewing:

Motivational Interviewing is NOT a treatment for tobacco dependency. It is an evidence-

based intervention for tobacco users WHO ARE NOT YET READY TO QUIT.

You can lead a horse to water but you cannot make

him drink….

Page 8: Motivational Interviewing:

The most effective treatment for tobacco dependency is a combination of ….

1. Practical Counseling2. Pharmacotherapy3. Systems level interventions

MI “salts the oats”

Page 9: Motivational Interviewing:

TX for Tobacco Dependency• Problem Solving: compulsions to use, triggers to smoke,

changes in lifestyle• Coping Skills: developing or enhancing other coping mechanisms

• ASKING every client at every visit about tobacco use – paper screening like a vital sign OR electronic health record (EHR) prompt

• ADVISING about the benefits of quitting• REFERRING for treatment if not able to provide on-site

• Reminder systems which prompt clinicians to do the 2A/R intervention

• Nicotine Replacement Therapy: Patch, gum, lozenge, nasal spray, inhaler

• Bupropion: Wellbutrin SR• Verenicline: Chantix

Practical Counseling


Systems Interventions

Page 10: Motivational Interviewing:

What is Motivational Interviewing?

• A collaborative, person-centered form of guiding to elicit and strengthen motivation for change

• Empirically validated approach for helping people change addictive or other problematic behaviors


Page 11: Motivational Interviewing:

MI• A consumer-centered, yet guiding style of

counseling that is shaped by a guiding philosophy and understanding of what triggers change.

• Involves the conscious and disciplined use of specific communication strategies to evoke the person’s own motivations for change.

Page 12: Motivational Interviewing:

Three Essential Elements of MI

• MI is a particular conversation about change

• MI is collaborative (person-centered, not expert-recipient; partnership; honors autonomy and self-determination)

• MI is evocative – seeks to call forth the person’s own motivation and commitment

Page 13: Motivational Interviewing:

Persuasion Exercise: Part 1• SPEAKER: Talk about something you’d like to

change. May be a behavior, attitude, or habit but something it would be good to change.

• COUNSELOR #1: – Explain why he/she should make this change– Give at least 3 benefits of making the change– Tell him/her how to do it– Emphasize how important it is to make the change

Page 14: Motivational Interviewing:

Persuasion Exercise: Part 2COUNSELOR #1• Why would you want to make this change?• If you do decide to make this change, how

might you go about it in order to succeed?• What are your three best reasons to do it?• On a scale of 0 to 10, how important is it for

you to make the change? *Why are you at___ and not 0?

Page 15: Motivational Interviewing:

Persuasion Exercise: Part 3

COUNSELOR #2• Give a short summary of the speaker’s

motivation for change:– Summarize desire, ability, reasons, need for

change– Then, ask “So what do you think you will do?”– Affirm strengths of the speaker

Page 16: Motivational Interviewing:

TO BE DOING MI THERE MUST BE…• a Target such as a health related behavioral

change; attitude; decision (forgiveness); habit

• Change Talk

• Without these, there may be great rapport building and patient-centered listening, but not MI

Page 17: Motivational Interviewing:

Underlying Theory of MI

• People are ambivalent about making changes• When the clinician advocates for change, it

will evoke resistance from the person• Resistance predicts lack of change• Getting the person to talk about making the

change makes it more likely that he/she will do it

Page 18: Motivational Interviewing:

Change Talk

Page 19: Motivational Interviewing:

Resistant Non-compliant

Refuses to take care of herself

Unwilling to change

Non-adherentDifficult person

Doesn’t understand Waste of

my time

Lost Cause!

Page 20: Motivational Interviewing:

Where do we start?• Understanding basic principles of MI• MI skills:

– Open ended questions– Affirmations – Reflective listening– Summaries and

• Informing/ Advising

Page 21: Motivational Interviewing:

Open Ended Questions • Open questions

– Encourages patient speech– More efficient for gathering information– Builds relationship – patients perceive clinician as caring

and showing personal interest• Closed questions

– Effective for gathering information, if you ask the right questions!

• Question-answer trap– A series of questions (lends itself to quantification focus)

Page 22: Motivational Interviewing:

Open-ended Questions

Video Example of MI in action!

Page 23: Motivational Interviewing:

Video slide here

Page 24: Motivational Interviewing:


• Statement of appreciation and understanding – Builds rapport and conveys respect for their

struggles, feelings, achievements, humanity – Reinforces open exploration– Promotes self-efficacy for change

• The point is to notice and appropriately affirm the person’s strengths and efforts

Page 25: Motivational Interviewing:

Affirmations• “I am sure that when you do decide to quit,

you will figure out a way that works for you.”

• “You are clearly a resourceful person, to cope with so many difficulties for so long.”

• “If I were in your position, I would have a hard time dealing with so much stress.”

• “I know this is not easy to hear.”

Page 26: Motivational Interviewing:

Reflective Statements

Clinician • Keep the person

talking and thinking

• Avoid a premature focus on solutions

• Improve “adherence”

• Enjoy your interactions more

Person• Listen to one’s

own reasons • Hear how the

behavior fits into one’s life

• Freedom to explore the desire or reasons for change in a safe environment

Page 27: Motivational Interviewing:

Reflective Listening

• Use a down-turn in inflection• Make statements, rather than asking


• Focus on change talk


Page 28: Motivational Interviewing:

Practice Simple Reflections• Tobacco user: “All my friends smoke, and I feel like I

wouldn’t belong anymore if I quit.”– Instead of: “Would you rather die from lung cancer?”– Try: “Smoking helps you fit in.”

• Tobacco user: “I know I need to quit, but I don’t know how I would deal w/ my depression without smoking.” – Instead of: “We’ve got a great medication that will help you

quit and help w/ your depression at the same time. Let’s get you a prescription and I’ll sign you up for one of our Quit Smoking now classes.”

– Try: “You have had some thoughts about quitting.”– Try: “You’ve been using smoking as a coping mechanism for

a long time.”– Try: “It’s kind of scary to think about quitting.”

Page 29: Motivational Interviewing:

Janine has been at the detox program for three days and has an appointment with you this morning, before being discharged.

“Well, I’ve ben wearing the patch since I got

admitted and haven’t really been craving

cigarettes. But I am just not sure what is going to happen once I get

home. “

Page 30: Motivational Interviewing:

• You were not expecting to give up smoking when you got admitted for alcohol detox.

• It’s surprising to you that the cravings have been pretty manageable.

• Your experience with the NRT patch has been positive.

• Not smoking or drinking while at detox has been a positive experience and you are wondering how your home environment is going to influence your sobriety.

Page 31: Motivational Interviewing:

Double-sided Reflections • May be used to highlight ambivalence

• “On one hand, there are some things about smoking that you really enjoy like socializing with your friends, and yet you are worried about the health effects of continuing to smoke and the impact it has on your children.”

Page 32: Motivational Interviewing:

Yes….but • People usually are ambivalent about change • Comfortable w/ status quo and disadvantages

to change • Arguments on either side of the ….but… cancel

each other out.

“You would like to cut down on your drinking and you are concerned about fitting in with your friends.”

Page 33: Motivational Interviewing:

Reflective Listening Skills

TALKER: • Discuss something you’ve been

thinking about changing

LISTENER: • Respond with reflective

listening STATEMENTS

Remember, you don’t have to hit a home run, just put a little wood on it!

Page 34: Motivational Interviewing:

Summaries: Putting it all together

• Effective transitions when moving from the “building motivation” phase to the “goal-setting” stage

• Useful if the person starts to get off track

• Focus on the person’s own motivations for change

Page 35: Motivational Interviewing:

Help Get Person Back On-track

• "So far you've listed three reasons to keep smoking; and three reasons to quit. And you found that quitting for your daughter's sake was the most important of all these reasons."

Page 36: Motivational Interviewing:

Possible Responses?

• Video slide here

Page 37: Motivational Interviewing:

Possible Responses?

Video slide here

• Video slide here

Page 38: Motivational Interviewing:

Is it change talk?

• I want to quit smoking so I’ll be here for my grandchildren.

• My boss told me I had to join this QSN class or my insurance costs will double.

• No one can tell me what to do!• I wish my life was different. • It took me 12 years to get off cocaine. I am

not using any drug, not even NRT!

Page 39: Motivational Interviewing: