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Behavioral Med Motivational Interviewing Month 4 Week 4
Behavioral Med Motivational Interviewing Month 4 Week 4
25
Medical
Graduate
08/18/2018

Additional Medical Flashcards

 


 

Cards

Term
Motivation
Definition
• Motivation is the driving force of action
• Motivation can be intrinsic or extrinsic
• Motivation is closely linked with emotions, change, and learning
• Provider-patient relationship has evolved from paternalistic to one that promotes patient autonomy and active participation
Term
Motivational Interviewing
Definition
• A clinical approach to help patients facing mental health and substance abuse disorders as well as chronic conditions approach change
• Based on the following assumptions:
– Ambivalence about substance use (and change) is normal and constitutes an important motivational obstacle in recovery
– Ambivalence can be resolved by working with your client’s intrinsic motivations and values
– The alliance between you and your client is a collaborative partnership to which you each bring important expertise
– An empathic, supportive, yet directive, counseling style provides conditions under which change can occur (Direct argument and aggressive confrontation may tend to increase client defensiveness and reduce the likelihood of behavioral change)
• Important to recognize ambivalence as a central problem that can manifest as lack of motivation
– Ambivalence should not be viewed as denial or resistance->Provider to patient friction
Term
5 stages of change
Definition
precontemplation- I don’t see how my cocaine use warrants concern, but I hope that by agreeing to talk about it, my wife will feel reassured.
contemplation- I can’t picture how quitting heroin would improve my self-esteem, but I can’t imagine never shooting up again.
preparation- I’m feeling good about setting a quit date, but I’m wondering if I have the courage to follow through.
action- Staying clean for the past 3 weeks really makes me feel good, but part of me wants to celebrate by getting loaded.
maintenance- These recent months of abstinence have made me feel that I’m progressing toward recovery, but I’m still wondering whether abstinence is really necessary.
Term
The motivational interviewer must proceed with
Definition
a strong sense of purpose, clear strategies and skills for pursuing that purpose, and a sense of timing to intervene in particular ways at incisive moments.”
—Miller and Rollnick
Term
5 general principles of motivational interviewing
Definition
1. Express empathy through reflective listening
2. Developdiscrepancybetweenclients’goals or values and their current behavior
3. Avoidargumentanddirectconfrontation
4. Adjust to client resistance rather than opposing it directly
5. Support self-efficacy and optimism
Term
Empathy:
Definition
– A learnable skill for understanding another’s meaning through the application of reflective listening
– Leaves conversation open, nonjudgmental and encouraging
– Examples:
• Could you tell me a little more about that?
• Let me make sure I have this correct. If I go astray, please correct me.
• I can see how anyone in your situation may feel this way.
Term
Discrepancy:
Definition
– Help the patient discern how current behavior
may differ from ideal future behavior
– Separate the person from the behavior to show how behavior may impact ideal actions
– Help the patient discover possible consequences to their behavior and present arguments
for change
Term
Avoiding arguments:
Definition
– Resistance frequently stems from trying to convince patients about possible consequences or force change
– Understand that arguments are counterproductive; if you begin arguing or become defensive, stop and reassess your approach
• It seems that we are not on the same page here; let’s stop for a second. Can you tell me more about what brought you here today? I want to make sure I’m understanding.
– Walk with patients—don’t drag them
Term
Adjusting resistance:
Definition
– Resistance is predictive of poor
treatment outcomes
– Resistance also shows us that we have varying viewpoints on the situation
– Can manifest as arguing, interrupting, denying, ignoring
Term
Simple reflection:
Definition
– I don’t plan on quitting smoking right now.
– So you don’t think that complete tobacco cessation would work for where you are at right now?
Term
Reframing:
Definition
– My girlfriend is nagging me all of the time about my alcohol
use; she says I’m an alcoholic and it’s really annoying.
– It sounds like your girlfriend cares a lot about you but is showing this in a way that is upsetting to you. Maybe we could speak with her about finding a way to express her concern in a way that is more positive.
Term
Self-efficacy:
Definition
– Recognize the strengths in your patient and help
bring these to the forefront of conversation
– Use modeling of other individuals in similar situations who were able to make
positive changes
– Educating your patient can help them feel more confident
• Explaining the biology of addiction and the need for medical treatment shows this is a real disease
Term
OARS:
Definition
– Open questions
• Invites additional information
– Affirming
• Builds a stronger connection, shows respect
– Reflecting
• Further explore their personal experience
– Summarizing
• Conveys understanding
– Plus
• Additional information or advice with permission
Term
OARS examples
Definition
• Openquestions:
– What is most concerning to you? – What changes have you noticed?
• Affirmations:
– I’m very impressed with the changes I’ve seen.
– It’s great how quickly you have been able to cut back on your alcohol consumption.
• Reflections:
– RepeatàRephraseàParaphrase
• Summarization
– This is what I’ve learned so far, what information am I still missing?
Term
The Brief Negotiated Interview
Definition
• Foundation in motivational interviewing, developed for substance abuse intervention
• Provider is able to help the patient present reasons for change and determine necessary actions
for change
• Part of the SBIRT framework
– Screening (determines severity of actions/behaviors) – Brief intervention (brief negotiated interview)
– Referral to treatment (directly links patient to necessary services)
Term
Brief negotiated interview (BNI) algorithm
Definition
1 build rapport- tell me about typical day in your life. where does your current use fit in?
2. pros and cons- help me understand, through your eyes, the good things about using (x), what are some of the not-so-good things aobut using (x)?
summarize- so on the one hand (pros) and on the other hand (cons)
3. information and feedback- I have some information on low-risk guidelines for drinking and drug use, would you mind if I shared them with you?
elicit- we know that drinking- 4 or more (F)/5 or moe (M) drinks in 2 hrs, or more than 7 (F)/14 (M) drinks in a week, having a BAC of __ and/or use of illicit drugs such as ___. provide-... can put you at risk for social or legal problems as well as illness and injury. it can also cause health problems like (insert medical information). elicit- what are your thoughts on that?
4. readiness ruler- on a scale from 1-10 w 1being not ready at all and 10 being completely ready, how ready are you to change your x use? reinforce positives- you marked __ that's great. that means you are __% ready to make a change. ask about lower #- why did you choose that number and not a lower one like a 1 or 2?
5. action plan- what are some steps/options that will work for you to stay healthy and safe? what will help you to reduce the things you don't like about using (x)?
identify strengths and supports- what supports do you have for making this change? tell me about a challenge you overcame in the past. how can you use those supports/resources to help you now?
write down steps- those are great ideas! is it okay for me to write down your plan, your own perscription for change to keep with you as a reminder? will you summarize the steps you'll take to change your 9x) use?
offer appropriate resources
thank pt- thank you for talking with me today
Term
motivating interviewing principles
Definition
build rapport- provide feedback -build readiness to change -> negotiate plan for change
Term
Building rapport:
Definition
– Start with a more general conversation; get to know your patient
– Ask about proceeding with conversation
– Remember, resistance is normal • Simple reflection, reframing
Term
Presenting feedback:
Definition
– Ask for permission to share what you have found or learned through conversation
– If you performed screenings, present your findings
– Discuss links to other possible health concerns
Term
Are they ready for change?
Definition
– On a scale of 1–10, how ready are you to make changes in your tobacco use?
Term
On a scale of 1–10, how important is it for you to cut back on tobacco?
Definition
– Why a 2 and not a 1?
• Try to bring out change talk
– What are the benefits of tobacco?
– What are some of the not great things that
have resulted from tobacco?
• Start the internal dialogue
– If you were able to cut back on tobacco, how do you see your life changing?
Term
On a scale of 1–10, how important is it for you to cut back on tobacco?
Definition
– Great! Why is it an 8 rather than a 4?
After addressing and understanding the importance, move to the patient’s confidence
Term
On a scale of 1–10, how confident are you that you could cut back on tobacco if you decided to?
Definition
– Why a 3 rather than a 1?
• Have you been successful quitting or cutting back
in the past? Tell me about it.
– What would need to happen to move your confidence to a 5?
• Discuss self-awareness and possible barriers
Term
Creating a plan:
Definition
– Actively engage the patient
– Listen to concerns
– Reframe resistance
– Create an ally in change
Term
Self-motivational statements to look for
Definition
– I guess my alcohol use is more serious than I thought.
– I am really worried about what may happen to me if I don’t quit.
– I should do something about this.
– I know that if I tried, I could make a change.
• These show that the patient’s ambivalence and resistance are starting to subside
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