Understanding behaviour change: The role of Motivational Interviewing. Dr Jeff Breckon CPsychol. Motivational Interviewing Network of Trainers (MINT)

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1 Understanding behaviour change: The role of Motivational Interviewing Dr Jeff Breckon CPsychol. Motivational Interviewing Network of Trainers (MINT)

2 Dr Jeff Breckon Understanding behaviour change: The role of Motivational Interviewing Presenter Disclosure Information: This speaker has no conflicts of interest

3 Themes Issues and myths of [PA] behaviour change Behaviour change counselling interventions Motivational interviewing Relational Technical Four processes Psycholinguistics of change (CT/ST) Where next?

4 ISSUES OF [PA] BEHAVIOUR CHANGE

5 We have some challenges!

6

7 ITS COMPLICATED! 7

8 Over 75% of individuals do not maintain behavior changes in multiple areas of behavior including substance use, smoking, physical activity, nutrition, and management of chronic physical and mental health conditions (Naar-King, Earnshaw & Breckon, 2013)

9 PHYSICAL ACTIVITY (PA) specifically Multiple conditions (e.g. smoking, alcohol, diet) Requires significant effort It is a 'complex intervention' Success is dependant on environmental and social factors as well as personal 'engagement Positive contamination Seasonality

10 Some nations build PA into their commute (or day-to-day life) Norrkoping, April 2013

11 INFORMATION IS NOT ENOUGH: ITS HOW YOU PRESENT INFORMATION THAT MATTERS 20% 60%

12 The role of the health professional: BEHAVIOUR CHANGE COUNSELLING INTERVENTIONS

13 Client outcomes before and after random reassignment to a new counsellor % Positive Urines % Employed Methadone Use % Arrested McLellan et al (1988) Journal of Nervous and Mental Disease, 176,

14 Clinician effects Substantial empirical evidence indicates that clinicians account for a significant portion of outcome in behavioural and psychosocial treatments In fact, one of the best predictors for how well clients will do after behavioural interventions is which clinician they have Moyers (2013)

15 MI CBT BAT 550 named behavioral therapies knowing the identification of core components (that are part of many successful interventions) is critical (Fixsen, 2005) ACTIVE INGREDIENTS? SFT "We need to move beyond just a brand name" (Terri Moyers)

16 MOTIVATIONAL INTERVIEWING

17 A technical definition of MI Motivational interviewing is a collaborative, goal orientated style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change within an atmosphere of acceptance and compassion. (Miller & Rollnick, 2012)

18 A technical definition of MI Motivational interviewing is a collaborative, goal orientated style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change within an atmosphere of acceptance and compassion. (Miller & Rollnick, 2012)

19 OR

20 "MI with someone is like entering their home. One should enter with respect, interest and kindness, affirm what is good, and refrain from providing unsolicited advice and rearranging their furniture. (An Alaskan elder reflecting on an MI workshop by Steve Berg-Smith)

21 The Elements of Motivational Interviewing MI Spirit MI Micro skills (OARS) MI Change (and Sustain) Talk MI Processes

22 MI Spirit Collaboration Acceptance MI Spirit Compassion Evocation Adapted from Miller & Rollnick (2013)

23 MI Micro skills (OARS) Reflective OQs listening 1. Repeating (repeat an element). Disadvantages of the Status 2. Rephrasing (repeat with synonyms). Quo next Advantages sentence). of Change Optimism for Change the Intention emotional dimension). to Change 3. Paraphrase (repeat best guess at meaning; saying the 4. Reflection of feeling (paraphrase that emphasizes Open ended questions Affirmations Reflective listening Summarising 4. What the practitioner thinks the client means 1. What the client means 3. Words the practitioner hears 2. Words the client says

24 MI Processes Four + processes

25 Change Talk BENEFITS OF CHANGE & COSTS OF STAYING THE SAME Change (and Sustain) Talk BENEFITS OF STAYING THE SAME & COSTS OF CHANGE Sustain Talk & (Discord)

26 Sustain vs Change talk Desire Ability Reasons Need Commitment Activation Taking steps PREDICTOR PRECURSOR

27 WHERE NEXT?

28 WHERE NEXT: VALUES MATCHING VS STAGE MATCHING INTERVENTIONS (HUTCHISON, JOHNSTON & BRECKON, 2011)

29 Values card sort

30 WHERE NEXT: IMPLEMENTATION SCIENCE

31 A key part of 'Implementation Science' (Fixsen, 2010) SCIENCE TO SERVICE GAP science service SERVICE GAP

32 The Challenge What is known is not what is adopted in the health sector What is adopted is not used with fidelity and good outcomes for consumer What is used with fidelity is not sustained for a useful period of time What is used with fidelity is not used on a scale sufficient to impact on societal health problems (Adapted from Fixsen, 2010)

33 WHERE NEXT: MI-CBT FOR MAINTAINING BEHAVIOUR CHANGE

34 Maintenance Strategy CBT Maintenance Strategies and MI Integration (Naar-King, Earnshaw & Breckon, 2013) MI Integration Managing the Goal Violation Effect Flexible Goal Setting Identifying Triggers and Developing Coping Skills Supporting Self-Efficacy Increasing Social Support Using Extrinsic Reinforcers Avoid the term relapse Empathise with slips Elicit change talk about maintenance Consider an importance ruler Explore discrepancy between values/goals and slips Emphasise adoption of new behaviors Offer menu of options of short-term goals Develop a change plan for maintenance Consider a commitment ruler Ask for permission before engaging in treatment tasks Use Elicit-Provide-Elicit strategy when discussing rationales or providing information/advice Consider rulers for treatment tasks. Use affirmations instead of praise Ask open-ended questions to elicit confidence statements Consider an Affirmations Card Sort or a confidence ruler Avoid the false-hope syndrome. Use MI skills to increase motivation for social skills training or to address ambivalence about engaging significant others Include specific plans for social support in the change plan for maintenance Consider addressing social support in each session in relation to specific treatment tasks. Use of MI skills to elicit the identification of internal reasons for maintenance Use Elicit-Provide-Elicit when discussing rationale Present reinforcers as a menu of options to support autonomy.

35 Information Sources Breckon, J.D. (2014) Motivational Interviewing to promote physical activity and nutrition behaviour change. In, Doing Exercise Psychology (M. Anderson & S. Hanrahan, Eds.). Human Kinetics, Champaign, Ill. Breckon, J. D., Johnston, L. H. & Hutchison, A. (2008) Physical activity counseling content and competency: A systematic review. Journal of Physical Activity and Health, 5, Crust, L., Swann, C., Allen-Collinson, J., Breckon, J. & Weinberg, R. (in press) A phenomenological exploration of exercise mental toughness: Perceptions of exercise leaders and regular exercisers. Qualitative Research in Sport, Exercise and Health. Hutchison, A., Breckon, J. D., & Johnston, L. H. (2009). Physical activity behaviour change interventions based on the transtheoretical model: A systematic review. Health Education & Behavior, 36, Johnston, L. H., Breckon, J. D. & Hutchison, A. (2008) Influencing Health Behaviour: Applying Theory to Practice. In, L. Dugdill, D. Crone and R. Murphy (Eds) Physical Activity and Health Promotion: Evidence-based Approaches to Practice. London: Blackwell Miller, W.R & Rollnick, S. (2013) Motivational Interviewing: preparing people for change. London: Guilford Press. Naar-King, S., Earnshaw, P. & Breckon, J. (2013) Towards a Universal Maintenance Intervention: Integrating Motivational Interviewing with Cognitive-Behavioural Strategies for Maintenance of Behaviour Change. Cognitive and Behavioral Practice, 27(2), pp Rollnick, S., Miller, W.R. & Butler, C. (2008) Motivational Interviewing in Health Care: Helping patients change behaviour. London: Guildford. Rosengren, D. (2009) Building Motivational Interviewing Skills: A practitioner workbook. London: Guilford. Scott, S., Breckon, J. & Copeland, R. (in press) Determinants and Strategies for Physical Activity Maintenance in Chronic Health Conditions: A Qualitative Study. Journal of Physical Activity and Health.

36 THANKS FOR LISTENING Dr. Jeff Breckon

37

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