Motivational Interviewing; Overcoming Barriers NYA MAUGHN PSYCHIATRIST 78 TH UWI /BAMP CME CONFERENCE SAT NOVEMBER 14 TH 2015
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1 Motivational Interviewing; Overcoming Barriers NYA MAUGHN PSYCHIATRIST 78 TH UWI /BAMP CME CONFERENCE SAT NOVEMBER 14 TH 2015
2 Objectives 1. Define and describe Motivational Interviewing (MI) 2. Share basic strategies which can be utilised in day-to-day practice 3. Summarise evidence base
3 Self management in Diabetes
4 Behavioural Change is key
5 Multiple Barriers to change
6 Barriers social psycho logical biological
7 No change
8 Given these multiple factors More flexible in our approaches Adjust to the individual s needs Adjust to their inclination to change
9 Our approach as clinicians can also impede the process of change
10 Modern approach
11 WRESTLING Versus DANCING
12 Alternative
13 Origins of Motivational Interviewing (MI) William Miller 1983 Stephen Rollnick 1991 Experience with problem drinkers Research and theories developed over time
14 Origins of Motivational Interviewing (MI) Non directive counselling (Carl Rogers 1953) Cognitive Dissonance (Thesiger 1957) Reformulation as self-perception theory (Bem 1972) Transtheoretical model of change (Prochaska and DiClemente)
15 Origins of Motivational Interviewing (MI) Readiness to change
16 MI useful in early stages of change cycle Precontemplation Contemplation Action
17 Origins of Motivational Interviewing (MI) Components of change Confidence Importance Commitment
18 What is MI? A collaborative, goal-oriented 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 Motivational Interviewing: Helping People Change. William R Miller, PhD, Stephen Rollnick, PhD. Guilford Press, Sep 2012
19 What is MI? A way of TALKING with people that promotes change To help them to TALK themselves into doing things differently drawing out rather than putting into
20 What is MI? Resolve ambivale nce Strengthen motivation Encourage change talk Move in direction of positive change
21 What is MI? A psychotherapeutic approach Does not have to be formal MI moments versus therapy sessions It is Subtle and Strategic
22 The spirit of MI Partnership Acceptance Compassion Evocation
23 The Principles of MI Express Empathy Develop Discrepancy Roll with Resistance Support Self-efficacy
24 Express Empathy Seeing the world through the eyes of another Conveys understanding Exploring the problem
25 Develop Discrepancy Mismatch between where they are and where they want to be Explore current behaviour, person s values and future goals Explore costs identified, pros and cons (decisional balance)
26 Roll with Resistance Misalliance in the relationship Accepting statements of resistance rather than confronting them directly Avoiding argument Avoid righting reflex
27 Support Selfefficacy The expectation that one can succeed The belief that change is possible instills hope Increase a person s perception that they have within themselves abilities to achieve their desired goal Focus on past successes, skills, strengths Optimism
28 Core skills OARS Open questions Affirmations Reflections Summaries
29 Core skills Open questions Invites elaboration and deeper thoughts about an issue
30 Core skills Affirmations Statements about strengths Something positive about the person and gives credit or acknowledgement Might be a trait, behaviour, feeling or past or present accomplishment Must be genuine Can be used to reframe position
31 Core skills Affirmations I really like the way you are approaching this problem, I can see that you are very organised and logical and I am sure this will help you to succeed in changing.
32 Core skills Reflections Active listening Restating in your own words content, feeling and meaning A statement rather than a question You have been trying to keep your blood sugar down and you are upset by this set-back.
33 Core skills Summaries Recap Let s take a look at what we have talked about so far. You are not at all sure that you have a problem with your blood sugar but you do feel badly about the effect on your family. You said that your family is the most important thing to you and you would consider taking medication if you believed it was hurting them.
34 Change talk (components of change) DARN-CATS Desire I want to do this Ability I can do this Reasons - Specific reasons for change Need It is important for me to do this Commitment I will do it Activating-By doing this Taking Steps-I got started on
35 Change talk (start to shift) DARN-C Desire - Want, wish, like Ability - Can, could, able Reasons - Specific reason for change Need - Need to, have to, must, important Commitment - Will, intend to, going to
36 Other techniques for eliciting change talk Good things/not so good things Looking backward Looking forward Consider importance Importance/Confidence Ruler
37 The processes of MI Engaging Focussing Evoking Planning
38 Evidence for MI Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review of randomized controlled trials Obesity Reviews 2011:12;709-23
39 Evidence for MI Systematic review and meta-analysis of RCTs using MI CVD risk factors Pooled sample size Pooled effect size P value Body mass index HbA1c Cholesterol Systolic blood pressure No of cigarettes/day Standard ethanol content Rubak et al. Br J Gen Pract 2005:55;305-12
40 Evidence for MI MI out performs traditional advice giving in the treatment of a broad range of behavioural problems and diseases Applicable in the management of lifestyle problems and diseases Mental and Physical health Rubak et al. Br J Gen Pract 2005:55;305-12
41 Evidence for MI Eating disorders Psychosis Alcohol abuse Drug addiction Smoking cessation Weight loss Adherence to treatment and follow-up Increasing physical activity Asthma Diabetes HIV
42 Evidence for MI Used by various healthcare providers Psychiatrists Psychologists Doctors Nurses Midwives Dieticians Other
43 Evidence for MI MI can be effective even in brief encounters of only 15 minutes More than one encounter increases the likelihood of effect Rubak et al. Br J Gen Pract 2005:55;305-12
44 Evidence for MI Project MATCH Research Group, 1997 Concluded that MI is a cost-effective technique to facilitate change in patients who might be resistant to treatment
45 Summary A way of relating which promotes change A way of TALKING WITH To help them to TALK themselves into doing things differently It is Subtle and Strategic drawing out rather than putting into
46 Summary
47 Summary Janet Treasure 2004
48 Summary MI is effective for a broad range of conditions Can be used by all health professionals Repeated brief moments improves effectiveness
49 Summary A psychotherapeutic approach We have the skills to DANCE with our patients Consider different styles
50 MI in action Video clip BMJ e-learning
51 References Aloha A, Groop P. (2013) Barriers to self-management of diabetes. Diabetic Medicine, 30 (4), Archer N, Ismail K, Bridgen O, Morgan Jones R, Price L, Gayle C. Three Dimensions of Care for Diabetes: a pilot service. J Diabetes Nurs 2012; 16:3. Rollnick S, Miller W. R. (1995) What is motivational interviewing? Behavioural and Cognitive Psychotherapy, 23, Treasure J. (2004) Motivational interviewing. Advances in Psychiatric Treatment, 10 (5), Rubak S. et al (2005) Motivational interviewing: a systematic review and meta-analysis. British Journal of General Practice,55:
52 Thank You! Happy Dancing!!
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