Motivational Interviewing

Question 1

What are 5 Behaviors/habits that negatively health outcomes?

Answer 1

Drug/alcohol use
Sexual risk taking
Diet/obesity
Smoking
Sedentary Lifestyle

Question 2

Describe the 5 stages of change.

Answer 2

Precontemplation=not ready for change

Contemplation=thinking about change

preparation=getting ready to make change

action=making the change

maintenance=sustaining the behavior change until integrated into lifestyle

Question 3

Define motivational interviewing.

Answer 3

Motivational interviewing is a

style of counselling implemented to

encourage change in

health-related behaviors

Question 4

What are 3 important points for the patient/physician relationship in motivational interviewing?

Answer 4

Collaboration vs Confrontation



Evocation vs Imposing Ideas



Autonomy vs Authority



Question 5

Describe 4 motivational interviewing skills?

Answer 5

Interviewing Skills:

Open ended questions
=Cannot be answered yes/no
=Instead open-ended questions invite elaboration, specifically information regarding the patient’s view of his/her health behavior

Affirmations
Recognize strengths, positive behaviors, successes
Must be congruent and genuine
Often reframing something that the patient has said or done
Specific examples usually more powerful than a generality

Reflections
Reflection involves repeating/paraphrasing the
patient’s views regarding their health behavior
Expresses empathy, assures the patient that you
understand things from their perspective
Reflections are also used to reframe the patient’s
responses to encourage change
Examples of reflective responses:
“It sounds like . . .
“What I hear you saying . . .”
“Help me to understand. On the one hand you
. . . and on the other hand . ..”

Summaries
A special type of reflection which summarizes
important elements of the discussion
Often the summary is used to highlight the
patient’s ambivalence regarding changing the behavior
Used as a bridge to help the patient move on to
a stronger commitment or a concrete plan

Question 6

What are 3 roadblocks in motivational interviewing?

Answer 6

Resistance

Ambivalence

Lack of Confidence

Question 7

What are 3 examples of resistance and how should it be addressed?

Answer 7

=Arguing-The patient contests the accuracy, expertise,
or integrity of the clinician
=Interrupting-The patient breaks in and interrupts the
clinician in a defensive manner
=Denying-The patient expresses unwillingness to
recognize problems

Rolling with Resistance Reflection
Avoid Arguing !!!
The simplest approach to responding to resistance is with nonresistance, by repeating the patient’s statement in a neutral form.This acknowledges and validates what the patient has said and can elicit an opposite response.
Change focus

Question 8

What is ambivalence? How does it affect change? How can it be resolved?

Answer 8

Patients contemplating change are often have ambivalent views and feelings about their health behaviors and need to change
Conflicting attitudes can immobilize the patient and encourage them to maintain the status quo

Helping patient clarify ambivalent feelings can move them toward change (cost/benefits list)
Reflecting and reframing ambivalent feelings
can help lead the patient to a resolution
Identifying a discrepancy between the patient
values/future goals and their behavior

Question 9

How does a lack of confidence affect change? How can it be resolved?

Answer 9

Despite reaching a decision to change a behavior, patients may still lack of confidence that they can succeed
Past failures and perceived roadblocks can lead to immobilization

Affirmations recognizing strengths, past success
Identifying specific solutions to perceived roadblocks
Using a scale sometimes helpful
=“On a scale of 1 to 10, how important do you think
it is for you to quit smoking?” (Patient says 7 out of 10)