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Behavioral Block 1 Lecture 4
Introduction to Motivational Interviewing
20
Medical
Graduate
05/07/2010

Additional Medical Flashcards

 


 

Cards

Term

­self-management focus

Definition

­
-All in the hands of the patient.
-All of you will try to help patients
  But the patients have to do all the work!

Term
motivating our patients
Definition

Helping them to become more self-motivated 

Term
Transtheoretical Model
Definition

1. Individuals progress through stages of change

2. Movement may be forward or backward

3. Movement may be cyclical

-No failure in Modivational Modeling.

Term

Benefits of learning about this Transtheoretical Model theory

Definition

1. More realistic expectations

2. Greater recognition of small accomplishments

3. Greater success over time

4. Less frustration and burn-out

Term

Transtheoretical Model Stages

Definition

1. Precontemplation

2. Contemplation

3. Determination (Preparation)

4. Action

5. Maintenance

6. Relapse

7. Termination

Term

Precontemplation

Definition

-Smoking

-Just get them thinking about quiting.

-Make them think they can actually quit.

Not considering change

uGoal: Move to contemplation
uBarriers to moving forward:

1. Knowledge of risks/consequences

2. Self-efficacy

3. Contentment

Term

Contemplation

Definition

-Considering the change, but not sure. Their are a lot of questions.

 

Considering change - ambivalent

uGoal: Move to determination
uBarriers to moving forward:
Knowledge of risks/consequences
Self-efficacy
Contentment
Indecisiveness

Term

Determination/Preparation

Definition

Committed to change within 1 month

uGoal: Move to action, design plan
uBarriers to moving forward:
Loss of commitment
Knowledge of options
Making decisions about plans for change

Term

Action

Definition

-Help them maintain the change.

 

Has begun changing behavior

-Goal: Optimize plans, maintain changes
-Barriers to moving forward:
Failure and disillusionment
Overconfidence

Term

Maintenance

Definition

-Change maintained for 6 months


Behavior change is well-learned typically for 6 months

uGoal: Stable, new lifestyle; attainment of original goals
uBarriers to maintaining maintenance:
Major losses and stresses
Failure to attain original goals

Term

Relapse

Definition

-Normal part of the process, they haven’t failed. Learn what went wrong, restage them. All up to the patient.

uResumption of undesired behavior
uRelapse is a normal, expected stage of behavior change

  Goals:

Identify relapse
Reframe as opportunity to learn
Restage

Term

Termination/Exit

Definition

-Not even thinking about going back to previous behavior.

uRelapse is highly unlikely
uNew lifestyle is stable
uPrecontemplation about returning to behavior

Term

Motivational Interviewing

(people are ambivalent about change)

Definition

May not be aware what change is needed
May misinterpret seriousness of condition
May understand regimen required, but do not see a way to do it without great difficulty

Term
1.  Develop Rapport--Techniques
Definition

 

A.  Lifestyle probe

B.  Typical Day

GOAL is to understand. A conversation, not an interrogation!

C.  The good, the bad, and the ugly (Get some specifics on how they're dealing with the problem).


 

Term
2.  Set Agenda-Techniques
Definition

-Goal is to have patient direct agenda.

 

If you could change one thing about your plan for coping with ________ (illness), what would it be?

Consider use of agenda setting chart.

Here are some things that most affect health of people with ________ (diabetes).  You are the best judge of what to consider changing.  Are you ready to think about changing any one of these?  Or do you have other concerns?  What would you like to focus on first?

Term

3.  Assess importance and confidence

Definition

Readiness to change is influenced by perceptions of importance and confidence

Important = I believe I need to change

Confidence = I believe that I will be able to change


1. Introduce the assessment

I am not really sure exactly how you feel about changing X.  Can you help me by answering 2 simple questions, and then we can see where to go from there?

2. If resistance, back down, do not do assessment

Sometimes it can be a mistake to move too quickly. I don’t want you to feel pressured.  Maybe we can talk about this again in the future?

3. Assess Importance

How do you feel at the moment about [change?] How  important is it to you to change on a scale of 0 to 10?

4. Assess Confidence

If you decided right now  to [change], how confident do you feel about succeeding with this?  On a scale of 0-10?

Term

4. Increase motivation for change (increase importance and confidence)

Definition

-Watch for resistance—a sign you are going too fast.

-If perceived importance is very low, probably best to leave the topic and move onto another area of consultation.

A.  Why so high?

You stated it was fairly important to you to personally change [behavior].  Why did you rate it a 6 and not a 1?

B.  How can you go higher?

What would it take for you to go from a 6 to a 8 or 9?

What stops you moving up from 6 or 7?

-We’re looking for positive things here. Looking for what’s stopping them.

Term

Dealing with Resistance—3 Traps

Definition

1.  Take control away

Solution:  emphasize personal choice

2.  Misjudge importance, confidence, or readiness (An 8 may not be the same for them. You need to Reassess).

Solution:  reassess readiness, importance and confidence

3.  Meet force with force

Solution:  back off and come alongside the patient

Term

­Henry is a 45 year old married male with a 25 year history of smoking.  He comes to your office and tells you that he is seriously considering quitting.  He says that he wants to quit for his birthday which is about a month away.  What stage of change is Henry experiencing?

Definition

C. Determination

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