Motivational
interviewing- A method of producing behavioural change by helping patients to explore and resolve ambivalence, increasing motivation to change
- Persuasion and coercion are not appropriate
- Key elements:
- Feedback—after assessment of patient's current condition
- Responsibility—emphasis on patient's personal responsibility for change
- Advice—clear advice that things need to change
- Menu—providing alternative strategies to help the patient change his or her behaviour
- Empathy—active understanding of patient's experience
- Supporting self efficacy—encouraging patient to believe he or she can change using examples from their past
- Explore view of problems
- "What do you see the problem as?"
- "What about other people?"
- Feed back what doesn't fit together (the Columbo scam)
- Identify pros and cons - a balance sheet
NOT doctors orders - must be non-judgemental - Then discuss motivation
"What do you enjoy about eating/drinking/smoking?"
Acknowledge negative, while reinforcing positive -
"I hear what you are saying, but..."
Explore in detail reasons for changing behaviour -
"Why do you want to stop?" - Tackle denial - the Columbo scam
Tackle poor motivation - "It's your choice"
Tackle self-esteem - "Let's look at what you've acheived"
- Avoid confrontation
- Stay neutral
- Formulate agenda - make it explicit
- Avoid conflict of agendas - "I can't talk to anybody (= I can't talk to you)"
- Negotiate
- Summarise
Motivational interviewing and smoking
- Define behavioural cycle of change
- Define strategies for change
- What makes people stop smoking?
- What makes them carry on?
- Needs:
- Motivation
- Encouragement
- Support
- How can we help?
- Thinking about stopping
- Raise the issue
- Build up a picture of smoking habit
- Deciding to stop
- Reinforce the interest in stopping
- Help the patient decide to stop
- Stopping
- Give practical advice on stopping
- PLAN A DAY
- STICK TO IT
- PREPARE FOR DANGER TIMES
- CHANGE ROUTINE
- PLAN LOTS TO DO
- SPEND TIME WITH NON-SMOKERS
- Work out coping strategies
- Give practical advice on stopping
- Staying stopped
- Maintain interest
- Give positive encouragement
- Thinking about stopping