Motivational Interviewing Flashcards
(89 cards)
1
Q
Motivational interviewing definition
A
Patient centered counseling style for eliciting behavior change in order to improve a patient’s health
2
Q
What is the most effective way to motivate people to change?
A
Motivational interviewing
3
Q
Eliciting or drawing out reasons for ______ from change is more effective than trying to convince them to change
A
change
4
Q
Key elements to motivational interviewing
A
developing rapport and collaborative alliance
5
Q
_______ for the patient
A
compassion
6
Q
How can we show compassion
A
Non-judgmental, tolerating their distress, expressing your desire to help
7
Q
Acceptance and respect for the _____________ ____________
A
Patient’s autonomy
8
Q
What question can we ask to show we support patient autonomy during motivational interviewing
A
what steps are you ready to take at this time?
9
Q
Three pieces to motivational interviewing approach?
A
- compassion for the patient
- Acceptance and respect for patient autonomy
- Collaborative partnership with the patient
10
Q
Key component of empathy
A
listening
11
Q
What should you avoid in motivational interviewing?
A
Avoid labeling the behavior as a problem
12
Q
What questions can you ask to help understand the patient’s perspective?
A
What do you see as your challenge making this change?
What do you look forward to the most in overcoming this concern?
13
Q
DARN CAT
A
Desire to change
Ability co change
Reasons to change
Need to change
Commitment to change
Action, intention to act
Taking the steps to change
14
Q
DARN out of DARN CAT is what port of change
A
preparing for change
15
Q
CAT out of DARN CAT is what part of change
A
mobilizing for change
16
Q
“I could cut back a little”
A
Need to change
17
Q
“I have to quit for my children”
A
Reasons to change
18
Q
“I’m going to do it. I’m going to change”
A
Action, intention to act
19
Q
I want my life back
A
Commitment to change
20
Q
Motivational interviewing approach: directive
A
don’t tell the patient what to do and avoid giving advice, guide towards being introspective
21
Q
Motivational interviewing approach: non-directive
A
patient produces their own motivations, goals and ambivalence. Develop a plan collaboratively.
22
Q
Non-directive motivational interviewing approach is _______
A
patient centered
23
Q
Directive and non-directive combined
A
guide them to act on motivations, participate in collaboration
24
Q
Authoritative
A
unsolicited, direct advice
The provider is the expert
25
Patient centered
The patient is involved for their motivations and behaviors, even if they need help uncovering
26
What would you like to see in your life a year from now, regarding your drug use?
Patient centered
27
Research shows that people do better at quitting smoking when they use a smoking cessation medication
Authoritative
28
We are going to get you on a plan that I think will work for you
authoritative
29
what do you think contributed to your relapse
patient centered
30
OARS
Open ended questions
Affirmations
Reflective listening
Summaries
31
Ask, tell, ask approach is also the _______
OARS
32
What are open ended questions important?
Build momentum vs. closed ended which can be conversation stoppers
33
What is the intent of purposeful pauses?
Pausing can work like a question after a reflective statement, pause: many patients will fill the pause
34
What are affirmations important?
Recognize, highlight and respond to a patient's strengths and healthy behavior in a positive light. Develops patient's feeling of hope and confidence, acknowledge strength
35
What are some examples of affirmations?
I am encouraged to hear that you have thought about quitting
What changes have you been successful in making in your life?
You have courage to seek treatment at this time
36
Why is reflective listening important?
listen and reply with summarized version of what they said, demonstrates that you understand the patient's view and are non-judgemental
37
Reflections are not _______- they are ______ that mirror the content or emotional tone of the patient's own words
questions, statements
38
Reflective listening ex:
I drank though my divorce, losing my job....
It sounds like you drank during some pretty hard times
39
Reflective listening ex:
I want to live to se my granddaughter graduate high school, college, get married and have a child
Being there for your granddaughter is important for you
40
It would be more than I can take to try and get sober and fail again
1. I don't see you as a failure
2. Do you worry about failing
3. From your perspective, failing again would be very distressing
4. It would be more than you can take to fail again
3. From your perspective, failing again would be very distressing
41
Provide attention to ______ _______ and less to "non-change" or "sustain" talk
change talk
42
Example of change talk
I am interested in hearing more about how you want to start treatment
43
Example of reflecting emotion
It looks like you feel sad about that
44
Reflective listening tips
1. Provide attention to change talk
2. Occasionally reflect emotions, especially non-verbal
3. Offer more reflections than questions
4. Sometimes, you can exaggerate what they say
45
Summarizing
Summarizing key points during the discussion helps reinforce them
46
"So far, you've listed three reasons to keep smoking, and three reasons to quit. And you said quitting for daughter's sake was the most important of all these reasons"
Example of summarizing
47
Engaging
Gain trust and invite patient to collaborate on making a change
48
Focusing
helping patient focus on a specific aspect of the health problem
49
Evoking
using questions to guide patient about stating their feelings and thoughts and their motivation to change
50
Planning
facilitating the patient in establishing a plan for achieving their goal
51
Engaging helps to support the ________ alliance with the patient
therapeutic
52
How should you introduce a topic of health concern
openness, concern and lack of judgement
53
Establishing rapport increases the patients ______ to change and building a therapeutic alliance
openness
54
Steps in establishing rapport
1. ask permission
2. be reassuring
3. normalize- left them know they are not alone
55
There were signs of drug use in your physical today. Can we talk about that?
Example of asking permission
56
I hope we can just talk and explore what's going on, to see if I can be of any help
Example of being reassuring
57
Other people have bottomed out too and have recovered. You are not alone
Example of normalizing- let them know they are not alone
58
Mrs.Adams is a 28yo female presenting for her annual CPE and you notice her BMI is not in the obese range.
1. I am sure that you have had some bad experiences due to your obesity. Let's work together to help you lose weight.
2. Do you feel comfortable discussing your weight as it relates to your health?
3. How can I help you lose weight?
4. I think we need to set a plan for you to lose weight
2. Do you feel comfortable discussing your weight as it relates to your health?
59
To achieve a focus you may need to:
suggest a menu of options, negotiate the focus, narrow the focus as needed, ensure focus is clear and strong enough to support change
60
Focusing
Collaboratively selecting a target behavior based on the patient's concerns
61
You may need to re-focus at ______ office visit
each
62
"because you are just starting to consider to stop smoking, we could clarify what you might get out of quitting, what might get in the way, or what you will need to succeed? What would you like to focus on?"
Example of focusing a patient
63
Basic steps for evoking
invite the patient to state their insights and ideas rather than imposing provider's own ideas
64
Motivation to change
Readiness for change
Feelings of ambivalence
Evoking statements
65
Motivation to change
individual's sense of importance in changing, confidence in being able to change, willingness to change
66
How is it for you living with this?
So, what do you think about what we've discussed so far?
Evoking questions
67
Ambivalence
wanting both pleasure of indulgence and benefits of restraint
68
What is a principal obstacle in ambivalence
lack of resolve
69
Strategies for ambivalence
Articulation, decisional balance, resolution & change guide
70
Articulation
get patient to explain and clarify why they are not concerned
71
Decisional balance
examining the pluses and minuses to help clarify
72
Resolution & change-guide
more likely to produce change
73
When asked about quitting drinking on a scale of 1-10, Mrs.Adams says "Oh, I'd say about a 3"
1. with my help that will soon be a 10
2. Why not higher?
3. Why not lower?
4. That's sad, truly sad
2. Why not higher?
74
In motivational interviewing the _______ should produce their own _____ ______ _____
patient, plan for change
75
"Tell me what you would like to accomplish regarding quitting smoking in the next 90 days"
example of planning
76
Avoid building ______ in the first place
resistance
77
What can you do to help with resistance?
1. avoid building it in the first place
2. De-escalate
3. Work their resistance
78
Resistance is considered a product of the interaction between the provider and the patient, rather than a _____ of the patient
trait
79
Why does resistance occur?
Stems from the provider assuming patient is more ready than they really are
80
Strategies to help with resistance
invite patient to consider a different perspective
monitor their readiness for change
affirm the patient that they have freedom of choice and self direction
81
How to de-escalate resistance
1. refocus on building rapport with the patient
2. Ask if they would be willing to review a past, successful health behavior or change
3. Ask about a less threatening health behavior like getting enough sleep or increasing daily walking
4. Be prepared to discuss at a later visit
82
The only way to have sustained change over a long period of time is by being an
advocate
83
How to work resistance
1. Do not confront it
2. Agree with the patient
3. Reframing- glass half empty vs. glass half full
84
Mr.Arnolds, a musician, tells you "If I quit doing drugs, I won't be able to perform anymore"
1. That could be true. You might find that the only reason you can play the guitar well is because you use drugs
2. You're worried you won't be able to play guitar well without drugs
3. That's a pretty ridiculous attitude, isn't it?
4. How did you play before drugs?
1. That could be true. You might find that the only reason you can play the guitar well is because you use drugs
85
Motivational interviewing in the office has
time constraints
86
When is motivational interviewing the most effective?
after the initial screening (SBIRT)
87
How should motivational interviewing be use?
briefly and repeatedly
88
What are basic steps for motivational interviewing
Engaging, focusing, evoking, planning
89
What is Winnie's favorite question
"Help me to understand"
