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Motivational Interviewing (MI)

How Does Behavior Change?

From Behavior A to Behavior B (image of person thinking)

Assumptions

Behavioral issues are common
Change often takes a long time
The pace of change is variable
Knowledge is usually not sufficient to motivate change
Relapse is the norm

Transtheoretical Model

This diagram shows the Transtheoretical Model as an iterative process beginning with Pre-contemplation, then Contemplation, Determination, Action, Maintenance, Relapse, back to Pre-contemplation. There is also connection from Maintenance to Termination (Exit), as well as a connection between Action and Relapse. In the process, movement can also occur from Relapse to Contemplation or Determination.

Prochaska & DiClemente: Stages of Readiness to Change

Stage	Description	Objectives
Pre-contemplation	Not considering change	Identify patient’s goals Provide information Bolster self-efficacy
Contemplation	Ambivalent about change	Develop discrepancy between goal & behavior Elicit self-motivational statements
Determination	Committed to change	Strengthen commitment to change Plan strategies for change
Action	Involved in change	Identify and manage new barriers Recognize relapse or impending relapse
Maintenance	Behavior change	Assure stability of change is stable Foster personal development
Relapse	Undesired behaviors	Identify relapse when it occurs Reestablish self-efficacy and commitment Behavioral strategies
Termination	Change is very stable	Assure stability of change

Principles of MI

1. Advice

Give advice only when individuals will be receptive
Target advice to stage of change

2. Reduce Barriers

Bolster self-efficacy
Address logistical barriers

3. Provide Choices
It’s the individual’s choice:

Whether to change
How to change

4. Decrease Desirability
Help individuals:

Decrease their perceptions of the desirability of the behavior
Identify other behaviors to replace the positive aspects of alcohol use

Reflective Listening

Mirrors what the patient says
Creates a sense of safety for the patient
Deepens the conversation
Helps patients understand themselves
Says:

I hear you
This is important
Please tell me more
I’m not judging you

Reflective Listening (continued)

Patient:  To tell you the truth, I really enjoy drinking.
Response:    You like drinking alcohol?
Patient:  Yes. I like the taste, and it really relaxes me.

Example 1:

“My girlfriend gets really angry when I get drunk and pass out.”
“She gets mad when you do that.”

Affirmation

Conveys support, respect, and encouragement
Helps patients reveal less positive aspects about themselves

“You’ve tried very hard to quit.”
“You are very courageous to be so revealing about this.”
“You’ve accomplished a lot in a short time.”
“I can understand why drinking feels so good to you.”

Summarization

“What you’ve said is important.”
“I value what you say.”
“Here are the salient points.”
“Did I hear you correctly?”
“We covered that well. Now let's talk about ...”

Elicit Self-Motivational Statements

Problem recognition

“Has alcohol caused you any problems?”

Concern

“Do you ever worry about your alcohol use?”

Intention to change

“What might be some advantages of quitting or cutting down?”
“On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say (1 or 2 points lower)?”
“On a scale of 0 to 10, how important is it for you to change your (behavior)? ”
“Why didn't you say (1 or 2 points lower)?”

Optimism