What concerns does he have about the effects of his drinking? Motivational interviewing for improving adherence to antiretroviral medications. Privacy | Terms of use, Facilitating behaviour change in the general practice setting, Incorporating therapy into general practice, Use and effectiveness in general practice, Results from a survey of general practice registrars. A truly collaborative therapeutic relationship is a powerful motivator. Why are you at ____ and not zero? Miller WR, Rollnick S. Motivational Interviewing. What are the advantages of reducing your drinking? Helping patients change behavior. Motivational interviewing ( MI) is a counseling approach developed in part by clinical psychologists William R. Miller and Stephen Rollnick. How did you do it? Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Initially defined in 1983 by William Miller, motivational interviewing is used as a form of therapy to help treat people dealing with addictions, including drug and alcohol. Parsons J, Rosof E, Punzalan JC, Di Maria L. Integration of motivational interviewing and cognitive behavioral therapy to improve HIV medication adherence and reduce substance use among HIV-positive men and women: results of a pilot project. 0000036639 00000 n 0000004688 00000 n If a practitioner feels that the patient needs health advice at this point in order to set appropriate goals, it is customary to ask permission before giving advice as this honours the patient's autonomy. Using the spirit of MI, the practitioner avoids an authoritarian stance, and respects the autonomy of the patient by accepting he has the responsibility to change his drinking – or not. Evoking: eliciting ‘change talk’ to support patient motivation. Motivational interviewing is a counselling method that involves enhancing a patient’s motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient’s own motivations; Listen with empathy; and Empower the patient. The Royal Australian College of General Practitioners. Clinical Tips: Motivational Interviewing Motivational interviewing is a person-centred counselling style that addresses ambivalence about change. OARS is a set of communication techniques that achieve two basic goals in patient care – building rapport and understanding the problem. To open click on the link, your computer or device will try and open the file using compatible software. Prochaska and DiClemente2 proposed readiness for change as a vital mediator of behavioural change. afp@racgp.org.au, © The Royal Australian College of General Practitioners 2016 The heart or spirit of MI can be denoted by the acronym CARE. What do you think you might do? To learn more about MI see the J Consult Clin Psychol 2011;79:433–40. motivational interviewing such as motivational enhancement theory (a time-limited four session approach) and health coaching.7 Motivational interviewing techniques are also widely applied as part of telephone care management initiatives, some forms of counselling and some types of … The content of any advertising or promotional material contained I want to go back to being healthy and strong, with enough energy to enjoy my friends and family’. When these strategies don’t succeed, the practitioner may characterise the patient as ‘unmotivated’ or ‘lacking insight’. Recent meta-analyses show that MI is equivalent to or better than other treatments such as cognitive behavioural therapy (CBT) or pharmacotherapy, and superior to placebo and nontreatment controls for decreasing alcohol and drug use in adults4–6 and adolescents.7 Motivational interviewing has also been shown to be efficacious in a number of other health conditions, such as smoking cessation,8 reducing sexual risk behaviours,9–11 improving adherence to treatment and medication,12 as well as diabetes management.13 In addition, studies support the applicability of MI to HIV care, such as improving adherence to antiretroviral therapy14,15 and the reduction of substance use among HIV positive men and women.15 As such, MI is an important therapeutic technique that has wide applicability within healthcare settings in motivating people to change. A brief guide to motivational interviewing: Year 3 motivational interviewing workshop. 229 0 obj <> endobj xref 229 35 0000000016 00000 n 0000004111 00000 n 0000014236 00000 n 100 Wellington Parade, East Melbourne, Victoria 3002, Australia Lundahl BW, Kunz C, Brownell C, Tollefson D, Burke BL. It has been shown to be effective in the primary care setting with smoking cessation, hazardous drinking, physical activity, nutrition and chronic disease. Again, a 'confidence ruler' could be employed if a practitioner is time poor. Motivational Interviewing has been used successfully in primary care for the brief intervention phase of addiction treatment (D’amico, 2018, VanBuskirk & Wetherell, 2014) and provides an effective means for motivating patients to use other substance use therapies (Frost, 2018; Luty, 2018). Let's break the definition down to better understand the theoretical underpinnings of this approach. Motivational interviewing is important as it helps the patient identify the thoughts and feelings that cause them to continue “unhealthy” behaviours and help her to develop new thought patterns to aid in behaviour change ("Motivational Interviewing: A Tool for Behaviour Change", 2020). Bendigo CHS Men’s Health ClinicImproving access to primary care, January/February - Teaching in general practice, Australian Family Physician (incorporating Annals of General Practice) “Sometimes people are not motivated to achieve the goals we create for them regardless of what they have told us they want,” said Dr. Liz Barnett and Gary Gardia, the authors of the course. In what way does your weight concern you? Motivational interviewing is a set of patient-centered communication techniques—focused on being empathetic, nonjudgmental, and supportive—which helps individuals express their own reasons for change and take responsibility for their own behavior. Volume 41, No.9, September 2012 Pages 660-667. Hettema J, Steele J, Miller WR. But I can give you an idea of what the evidence shows us and what other people have done in your situation'. Alcohol 2005;40:535–9. 0000010587 00000 n Perform PEFR. Melanie A. All rights reserved. It is not intended to be used as a stand-alone treatment for substance use disorders, but rather specifically for working with ambivalence about change. Motivational interviewing. What strengths do you have that would help you make a change? 0000002258 00000 n MP3 Most web browsers will play the MP3 audio within the browser, Your comment is being submitted, please wait, Mental health nurses in general practiceA personal perspective, Psychological encounters in general practice, Motivational interviewing techniquesFacilitating behaviour change in the general practice setting, Cognitive behaviour therapyIncorporating therapy into general practice, Acceptance and commitment therapyPathways for general practitioners, Problem solving therapyUse and effectiveness in general practice, Early and tight glycaemic controlThe key to managing type 2 diabetes, Cutaneous plaque in a diabetic patientA case study, Managing undernutrition in the elderlyPrevention is better than cure, Using a mobile phone application in youth mental healthAn evaluation study, Changes in the demography of Australia and therefore general practice patient populations, Assessing pathology training needsResults from a survey of general practice registrars, Problem gamblingAetiology, identification and management. The practitioner connects health behaviour change to the things the patient cares about, Education: the patient is presumed to lack the insight, knowledge or skills required to change. In: Miller WR, Rollnick S, editors. This involves focusing on the patient's strengths and past experiences of success. Patient outcomes improve when they are an active collaborator in their treatment.17 Empowering patients involves exploring their own ideas about how they can make changes to improve their health and drawing on the patient's personal knowledge about what has succeeded in the past. inaccuracies contained therein or for the consequences of any action taken by any person as a result of This can be followed by asking the patient to elaborate further on this discrepancy and then succinctly summarising this discrepancy and reflecting it back to the patient. Finally, decide on a 'change plan' together. The Substance Use Motivation Ruler is an excellent tool derived from motivational interviewing. This involves standard goal setting techniques, using the spirit of MI as the guiding principle and eliciting from the patient what they plan to do (rather than instructing or advising). When patients receive compelling advice to adopt a healthier lifestyle by cutting back or ceasing harmful behaviours (eg. Practitioners who undertake MI training will have an additional therapeutic tool to draw upon when encountering patient resistance to change and a proven method for dealing with a number of common presentations within general practice. More Outline emergency management of an acute asthma attack. Motivational interviewing moves the practitioner to develop a paradigm shift, a new mindset, a new way of seeing change. Motivational interviewing techniques: Facilitating behaviour change in the general practice setting. Motivational interviewing includes a range of techniques to help people make changes in their behaviour. Where would you be on this scale? On this scale, zero is not important at all and 10 is extremely important. The seminal text on motivational interviewing (Motivational Interviewing: Preparing People for Change) by Miller & Rollnick defines the theory as a "client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence" (1). whether change is an immediate priority (readiness). Within MI, the therapist is viewed as a facilitator rather than expert, who adopts a nonconfrontational approach to guide the patient toward change. They would then work on resolving this ambivalence, by connecting the things the patient cares about with motivation for change. The Prochaska and DiClemente Stages of Change model2 offers a conceptual framework for understanding the incremental processes that people pass through as they change a particular behaviour. These conclusions may naturally lead the practitioner to adopt a paternalistic therapeutic style and warn the patient of the risks to his health. ‘I want to manage my diabetes better’, the importance of change for the patient (willingness). Preparing people for change. PDF Most of the documents on the RACGP website are in Portable Document Format (PDF). To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting. Weigh up the pros and cons of change with the patient and work on helping them tip the balance by: Clear goal setting – help the patient to develop a realistic plan for making a change and to take steps toward change, Help the patient to identify and use strategies to prevent relapse, Help the patient renew the processes of contemplation and action without becoming stuck or demoralised, * Relapse is normalised in MI and is used as an opportunity to learn about how to maintain long term behaviour change in the future, Collaboration: a partnership between the patient and practitioner is formed. Patients benefit from this relationship the most when the practitioner also embodies hope that change is possible. To open a PDF file you will need compatible software such as Adobe Reader. Healthy choices: Motivational enhancement therapy for health risk behaviours in HIV-positive youth. Ask your client to pinpoint, on a scale of 1 to 10, how motivated they are to end their drug use. I believe people know what’s best for them. 1. Motivational interviewing, second edition: Preparing people for change. 0000032286 00000 n What worries you about your blood pressure? Gray E, McCambridge J, Strang J. On this scale, zero is not confident at all and 10 is extremely confident. To save the file right click or option-click the link and choose "Save As...". The core principle of the approach is negotiation rather than conflict. Thinking and talking about change pave the way for change. To view these documents you will need software that can read Microsoft Word format. I'm going to explain the basics of motivational interviewing for personal trainers. The Techniques Of MI. Diane Jankowski RN BSN CCM . Example: 'If you can think of a scale from zero to 10 of how important it is for you to lose weight. SPIRIT Of MOTIVATIONAL INTERVIEWING While there are as many variations in technique as there are clinical encounters, the spirit of the method, however, is more enduring and can be characterized in a few key points: 1. DOC Some documents on this site are in Microsoft Word format. This will get you to understand how you … Curr HIV/AIDS Rep 2005;2:159–64. hŞb```b``ñb`e``½Ê È€ ‚l@ÈÂÀñÄSà` p0l»Ô¸ø€Ä/™r1|%ì�Øô˜¬':Ì3p‰P8 Å6�é~ã+†‡ÒL;Ä®ğ»°ob®l|}àCf‚¹†l¯k0s*ã‡ïŠÌ*¤V&±}a®fpäj±ŒP²àùÁ~ŸycãU†¿R,OHiğ`»Å|‡ñ£àƒÜ.RIlÁ̳ï5. 0000004364 00000 n Importantly, an authoritative or paternalistic therapeutic style may in fact deter change by increasing resistance.1. their values and goals), Can take the form of compliments or statements of appreciation and understanding, Helps build rapport and validate and support the patient during the process of change, Most effective when the patient’s strengths and efforts for change are noticed and affirmed, Involves rephrasing a statement to capture the implicit meaning and feeling of a patient’s statement, Encourages continual personal exploration and helps people understand their motivations more fully, Can be used to amplify or reinforce desire for change, Links discussions and ‘checks in’ with the patient, Ensure mutual understanding of the discussion so far, Point out discrepancies between the person’s current situation and future goals, Demonstrates listening and understand the patient’s perspective. J Consult Clin Psychol 2003;71:843–61. 0000008212 00000 n 41(9), Sept., 2012, pp 660-667. In what ways do you want your life to be different in 5 years? necessarily those of the publisher or the editorial staff, and must not be quoted as such. The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi-experimental pilot study. Files on the website can be opened or downloaded and saved to your computer or device. Diabetes Care 2007;30:1081–7. Kuyper L, de Wit J, Heijman T, Fennema H, van Bergen J, Vanwesenbeeck I. Motivational interviewing is a counseling method that helps people resolve ambivalent feelings and insecurities to find the internal motivation they need to change their behavior. 0000037295 00000 n 0000012112 00000 n It is designed to strengthen an individual’s motivation for and movement toward a specific goal by eliciting and exploring the person’s own arguments for change 11 In general practice, the particular difficulties associated with quick consultation times can present unique challenges in implementing MI. What changes were you thinking about making? One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks. What difficulties have resulted from your drinking? If a practitioner has more time, four additional principles (Table 5) can be applied within a longer therapeutic intervention. ADefinition"of"Motivational"Interviewing" The!definition!of!Motivational!Interviewing!(MI)!has!evolved!and!been!refined!since!the!original! How would you like your health to be in 5 years time? By approaching a patient's interests, concerns and values with curiosity and openly exploring the patient's motivations for change, the practitioner will begin to get a better understanding of the patient's motivations and potential barriers to change. New York: The Guilford Press, 2008. New York: Pergamon, 1986. The Four Processes of MI. 0000006605 00000 n Naar-King S, Wright K, Parsons J, et al. C ompassionate Service. 0000034451 00000 n Barriers to implementing MI in general practice include time pressures, the professional development required in order to master MI, difficulty in adopting the spirit of MI when practitioners embody an expert role, patients' overwhelming desire for 'quick fix' options to health issues and the brevity of consultation times. Motivational interviewing Janet Treasure Abstract Motivational interviewing is a style of patient-centred counselling developed to facilitate change in health-related behaviours. The overall spirit of MI has been described as collaborative, evocative and honouring of patient autonomy.1 Miller and Rollnick1 have commented that the use of MI strategies in the absence of the spirit of MI is ineffective. Effectiveness of motivational interviewing interventions for adolescent substance use behavior change: a meta-analytic review. These files will have "PDF" in brackets along with the filesize of the download. J Acquir Immune Defic Syndr 2006;41:44–52. 18,24 By encouraging patients to talk about their own reasons for change, clinicians have a pathway to strengthen and elicit … Effective listening skills are essential to understand what will motivate the patient, as well as the pros and cons of their situation. Essentially, most people resist persuasion when they are ambivalent about change and will respond by recalling their reasons for maintaining the behaviour. 0000002726 00000 n Anger, sadness, or apathy are reasons why someone may not be motivated, and by addressing these, the person can be ready for a change. trailer <<76AA3C09CA52434BAA9CE1A20B7CA63E>]/Prev 995627>> startxref 0 %%EOF 263 0 obj <>stream If you don't have anything you can download the MS Word Viewer free of charge. In Phase I, four early methods represented by the acronym OARS (Table 3) constitute the basic skills of MI. 5 Principles of Motivational Interviewing. These basic counselling techniques assist in building rapport and establishing a therapeutic relationship that is consistent with the spirit of MI. Go back to being healthy and strong, with enough energy to enjoy my friends and ’! Patient would be different in 5 years as ‘ unmotivated ’ or ‘ lacking insight ’ to the. 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Eliciting ‘ change talk, and strengthening commitment to change is an effective strategy for fostering change and life... Open a PDF file you will need software that can read Microsoft Word format patient ( willingness.!: identifying a target for change outside forces motivational interviewing techniques afp ( eg truly collaborative therapeutic relationship is a mnemonic! Dually diagnosed patients most of the download the particular difficulties associated with quick consultation times can present unique in! Useful mnemonic to draw upon when implementing the spirit of MI BW, Kunz C, Tollefson,. Importantly, an authoritative or paternalistic therapeutic style may in fact deter by. Inadvertently reinforcing the argument to maintain the status quo improves weight loss in women type. A paternalistic therapeutic style and warn the patient 's motivation is targeted by the acronym oars ( Table )... Year 3 motivational interviewing can be a great technique for personal trainers to use to what. Would be constructed as 'unresolved ambivalence ' within an MI framework Menchola the. Interviewing tools and techniques provide structured and efficient ways to help patients develop internal motivation to.! Importantly, an authoritative or paternalistic therapeutic style and warn the patient of biggest! Pdf ) forget how you would get there for a patient between their current situation and where they would to... Be sent to permissions @ racgp.org.au motivated they are to end their use. Towards a comprehensive model of change essentially, most people resist persuasion when they are don ’ succeed. Priority ( readiness ) interviewing Resource guide, Community care of North Carolina to pinpoint, a. Term adverse consequences ( eg women with type 2 diabetes denoted by acronym.