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Motivational Interviewing, Behavior & Change:

An Introduction to Magic!

Kathlynn Northrup-Snyder, PhD, CNS, RN

Kathlynn@CommunityHealthConcepts.com

April, 2017

Copyrighted by Kathlynn Northrup-Snyder. No part of the presentation may be copied/used without permission from the author.

Northwest Addiction Technology Transfer Center

The ATTC Network

Ten Regional Centers

Four National Focus Centers

• SBIRT

• Hispanic and Latino

• Native American-Alaska Native

• Rural and Frontier

Two Centers of Excellence

• YMSM + LGBT

• PPW

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Workshop Plan

• A brief overview & application of behavioral theories

• An overview of Motivational Interviewing

• Application of OARS

• Introduction to Discord, change talk & sustain talk

Sign in sheet

Folders

Breaks & Lunch

Restrooms

Freedom of movement

Mobile phones

ATTC Forms

Name

Agency & Position

What favorite spring tradition or activity do you

enjoy?

Share a personal strength you bring to your work.

What hopes do your have for this training?

Traditional Client Education

Watch: http://www.youtube.com/watch?v=80XyNE89eCs

Debrief steps in traditional provider approaches: Find out what the issue is Explain/persuade why the client should be doing the

behavior Give 3 benefits for change Give advice about how

to do it Emphasize any negative

consequences Gain consensus about

a plan

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Dimensions of Health

Created by Northrup-Snyder, K., 2006

Domain Definitions• Physical wellness - a healthy body maintained by eating right,

exercising regularly, avoiding harmful habits, making informed and responsible decisions about health, seeking medical care when needed, and participating in activities that help prevent illness. Not just a fully “well” body- definition for physical wellness is based on individual perception!

• Emotional wellness – understanding & expressing a range of emotions and coping with problems that arise in everyday life.

• Mental/Intellectual wellness (information gathering)- involves having a mind open to new ideas and concepts. Such as gathering information on a new diagnosis or seeking a second opinion. Appreciating your role in learning compared to faculty role.

Domain Definitions• Spiritual wellness - the state of harmony between you

and others. Or an understanding of your place in the greater universe.

• Environmental wellness - Refers to an appreciation of the external environment and the role individuals play in preserving, protecting, and improving environmental conditions. AND understanding the effects of your living and working environment on your health.

• Social wellness - refers to the ability to perform social roles effectively, comfortably, and without harming others. Includes introversion vs extroversion preferences.– Occupational wellness an ability to enjoy what you are

doing to earn a living or to contribute to society

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Dimensions - Ignored

Real Play Choose 3-4 behaviors you have been told you

should change or you believe you should change

Realize they can come from any of the 6 health domains

Keep the choices comfortable for general discussion

Choose 1 behavior you are especially resistant to change

Choose 1-2 behaviors you feel 2 ways about

Choose 1 behavior you are feeling confident about taking on in the very near future.

(Miller & Rollnick, 2012)

What is a Behavior?• the way in which a person, organism, or group

responds to a specific set of conditions….

• Break down a goal into smaller sets of action-Obesity has 3 full goals:

– 1.

– 2.

– 3.

– +?

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What is a Behavior?

• Break down a goal into smaller sets of action- Obesity has 3 full goals (nutrition, activity, and mental health/image)– Recognize the multiple factors that influence a single

behavioral choice • nutrition can break down to:

– Recognize the time or other dimensions for movement toward a behavior.• Increasing fruit & vegies can mean:

• What are behaviors you deal with in your life or practice?

Theories Sort Things Out

Understand Health Issues Levels of Prevention (primary, secondary, tertiary)

• Determines which program level to use

Old models used in new ways Erickson’s Developmental Model

• Determines age appropriate programming/education

Theories Provide an Overview

Identification of client readiness for change Stages of Change Model (SOC)

Working with the less-motivated client Stages of Change Model (SOC)

Integrated Behavioral Model (IBM)

Working with the motivated client Implementation Intention Model (IIM)

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Change is a Process

1. Establish knowledge• understand the concept• value the new action

Paths of Behavioral Change (Adapted from Donatelle & Davis, 2000)

2. Value the behavior• believe the new action is

possible

3. Feel the change• confidence for change• need proof of change

4. New Skills• possess new skills• practice new skills regularly

5. Attain new behavior-• real-life skill practice• new habit

To be compliant or not to be?

13.5% 68% 13.5%2.5% 2.5%

Innovators

Early Adopters

Early Majority Adopters Majority Adopters

Late

Majority Adopters

Laggards

Diffusion of Innovations (Rogers, 1983)

Stages of Change (Prochaska & DiClemente, 1983)

Precontemplation

Contemplation

PreparationAction

Maintenance

Increase Pro’s

Decrease con’s

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Application of SOC

Find a partner or you can do this yourself Assign one as coach and one as client The coach works the client through the

Readiness for Change worksheet. Debrief about what the client discovered Switch places if enough time 4-5 min each

Integrated Behavioral Model (Fishbein, 2000, Montano & Kasprzyk, 2008)

Breaking Down IBM

• Background Influence- any factors that might influence the thinking on decision making:

Seeking counseling- perhaps prior experience with a counselor was good or bad

Exercising- perhaps exercise in their youth is filled with successful athleticism or a sense of being uncoordinated.

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Breaking Down IBM

AttitudeAffect- positive or negative feelings

associated with the thought of the behaviorCognitive Construct- positive and negative

beliefs/understanding about a behavior. Seeking counseling- “I’m not crazy” or “I feel

peaceful when talking to someone” Exercising- “I’m scared I’ll hurt myself” or “I

feel so euphoric when I exercise”

Breaking Down IBM

Perceived NormsSocial Support- any perceived or real social

situations that might support or detract from the behavioral action Seeking counseling- “my family will think I’m crazy” or “my

family routinely uses counseling” Exercise- “my friends think exercise is

just for health nuts” or “I have a friend who jogs with me every morning”

Breaking Down IBM

Personal AgencySelf-efficacy- personal belief in ability that

might support or detract from the behavioral action

Perceived control-over the behavioral action. Seeking counseling- “my family will think

I’m crazy” or “my family routinely uses counseling”

Exercise- “my friends think exercise is just for health nuts” or “I have a friend who jogs with me every morning”

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Additional Effects on Intention or Behavior

Knowledge/Skills- what you have already to perform the behavior Have made other appointments for health care or have

already used the exercise equipment

Past Behavior/Habit- experiences that may “color” the current behavioral focus Previous history of counseling or exercise Another’s history/experience of counseling or exercise

Environmental Conditions- any facilitating or constraining issue that influence behavior choice even with positive intention. access, cost, safety, policy support

Application of IBM

• Find a partner or do on your own

• Assign one as coach and one as client

• The coach works the client through Integrating Factors for Change

• Debrief about what the client discovered

• Switch places if enough time

• 4-5 min each

The Mismatch Between Intention & Action

• Getting Started: Pulling a Rabbit out of the Hat

Remembering to act on behavior

Seizing the opportunity to act

Moving past reluctance to act

• Unwanted influences

Getting sidetracked!

Conflicting desires- to do it or not?

Poor planning for any obstacles

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Deliberation orMotivational Phase

Successful GoalPursuit and Goal

Achievement

Improved HealthOutcomes

Self-regulatory problems

Implemental orVolitional Phase

Linden A, Butterworth S, & Roberts N.(2006)

Implementation Intentions Model

When, where, how; If-Then planning; Support

Application of IIM

Find a partner or do on your own

Assign one as coach and one as client

The coach works the client through Planned Change worksheet

Debrief about what the client discovered

Switch places if enough time

4-5 min each

ReferencesDonatelle R. J. & Davis, L. (2000). Access to health (6th ed.). Needham

Heights, MA: Allyn & Bacon.

Fishbein, M. (2000). The role of theory in HIV prevention. AIDS Care, 12,273-278.

Gollwitzer, P. M. & Sheeran, P. (1993). Goal achievement: the role of intentions. European Review of Social Psychology, 4, 141-185.

Golwitzer, P. M. (1996). The volitional benefits of planning In: Golwitzer P. M. & Bargh, J. A. (Eds.), The psychology of action: Linking cognition and motivation to behavior (pp. 287-312). New York: Guilford Press.

Gollwitzer, P. M. (1999). Implementation intentions: Strong effects of simple plans. American Psychologist, 54, 493-503

.

Janis, I. L., & Mann, L. (1977). Decision making: A psychological analysis of conflict, choice and commitment. New York: Academic Press.

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ReferencesLinden A, Butterworth S, & Roberts N.(2006). Disease management Interventions II:

What else is in the black box? Disease Management. 9, 73-85.

Montano, D & Kaspyrsk, D. (2008). “Theory of Reasoned Action, Theory of Planned Behavior, and the Integrated Behavioral Model. “ In K. Glanz, B. K. Rimer, & K. Viswanth (eds.) Health Behavior and Health Education: Theory, Research, and practice (4th ed). Jossey-Bass: San Francisco, CA.

Prochaska, J. O. & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrative model of change. Journal Consulting and Clinical Psychology, 51, 390-395.

Rogers, E. M., (1983). Diffusion of innovations. New York: Free Press

Triandis, H. C. (1977), Interpersonal Behavior. Monterey, CA: Brooks &Cole.

Whitehead, D. (2004). Health Promotion and health education: advancing the concepts. Journal of Advanced Nursing, 47, 311-320.