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Prevention 2014: Motivational Interviewing: Basic Concepts and Methods

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Paul D. Nagy, MS …

Paul D. Nagy, MS

1st Annual Duke Preventive Cardiology Symposium
Saturday, April 26, 2014
The overall goal of this activity is to review the latest advancements in the management of lipids in clinical practice, including the new American Heart Association and American College of Cardiology guidelines on lipids announced in November 2013. Topics include learning about evaluation and treatment options in lipids and lipoprotein disorders, as well as focusing on new prevention guidelines, physical activity, nutrition, drug therapies, advanced lipoprotein testing, special patient populations, and new technologies for lifestyle management.

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  • Nonetheless, many providers remain convinced: achieving health should be sufficiently motivating for patients, and if they simply inform patients about the dangers associated with unhealthy behaviors, the patients will change their behavior.
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    • 1. Paul Nagy, LPC, LCAS,CCS paul.nagy@duke.edu Assistant Professor Duke School of Medicine Department of Psychiatry and Behavioral Sciences
    • 2.  Runaway health costs  Unhealthy lifestyle and behaviors contribute to cardiovascular and most other major diseases  Current standard of care is minimally effective  Motivation and efficacy are significant predictors of change  Provider’s conversational style and approach influences adherence and outcomes  Patients express greater satisfaction with their providers and providers feel more effective and less stressed
    • 3.  Over half of patients in the US do not comply with provider recommendations  40% of patients take medications incorrectly or not at all  80% do not comply with lifestyle change modifications, esp. nutrition & exercise  A 2002 review of patients followed after myocardial infarction, only ½ had quit smoking Grace-Cleveland, Journal of Pediatric Health Care, 2007; Rea, Annals of Intern Med, 2002
    • 4. “Motivational Interviewing is NOT a way of tricking others people into changing; it is a way of activating their own motivation and resources for change.” Miller & Rollnick, 2013
    • 5.  Started in addictions treatment in 1980’s  Has shown to be effective in >300 controlled trials targeted to a wide spectrum of behavior changes  Outperforms information giving and advising  A specifiable, verifiable and generalizable set of skills and practices  Works well in combination with feedback, health coaching, self monitoring and planning approaches  Fidelity best assured with coaching and feedback
    • 6. “….motivation should not be thought of as a personality problem, or as a trait that a person carries through the counselor’s doorway. Rather motivation is a state of readiness or eagerness to change, which may fluctuate from one time or situation to another. This state is one that can be influenced.” - William Miller, 1991
    • 7. “Motivational interviewing is a person-centered, goal-oriented method of communication for eliciting and strengthening intrinsic motivation for positive change.” Miller & Rollnick, 2009
    • 8.  Empathy and unconditional regard helps patient to recognize, explore and resolve ambivalence  Builds motivation by eliciting and reflecting “change talk” and focusing on self efficacy  Mobilizes commitment to action by evoking reasons and strategies
    • 9. “People are usually better persuaded by the reasons which they have themselves discovered than by those which have come into the minds of others.” - Blaise Pascal
    • 10.  Patient as expert  Avoid “righting reflex” and “expert trap”  Stages of change model  There is no “wrong motivation”  Discover what matters to the patient and exploring discrepancy between desires and behaviors  Information sharing and advice can be helpful  With permission  When communicated clearly (teachback)  When relevant to what the patient wants  Evoking hope and confidence
    • 11. Partnership Evocation Acceptance Autonomy Absolute worth Affirmation Compassion
    • 12. MI is MI when:  The communication style and spirit incorporates person centered, empathic listening (OARS)  There is a particular target for change and topic of conversation (focus)  The interviewer evokes the person’s own reasons and ideas for change (evoke)  The interviewer guides and assists the person in making a change (planning) (Miller and Rollnick, 2013)
    • 13. Open ended questions Affirmations Reflective listening Summaries “
    • 14. 1) Engaging – empathic listening 2) Focusing – targeting change 3) Evoking – motivation and ideas 4) Planning – getting to change
    • 15.  Agenda setting  Scaling (importance, confidence, commitment)  Pros and Cons  Elicit-provide-elicit  Use of hypotheticals  Scaling  SMART (specific, measurable, realistic and timely) planning
    • 16.  Miller, William and Rollnick, Stephen, Motvational Interviewing: Helping People Change. Third Edition., New York: Guilford Press, 2012.  Prochaska, J., Norcross, J. and DiClemente, C. Changing for Good. New York: Harper and Collins, 1994  Rollnick, S. and Miller, W.R., What is Motivational Interviewing? Behavioural and Cognitive Psychotherapy, 23, 325-334, 1995.  Rollnick, Stephen, Miller, William, and Butler, Christopher, Motivational Interviewing in Health Care, New York, Guilford Press, 2008.  Rosengren, David, Building Motivational Skills: A Practitioner Workbook, Guilford Press, 2009. - www.motivationalinterview.org