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Unformatted text preview: E Handout: Motivational
T ranst heoret ical model The model of motivational interviewing that emerged from examination of 18 psychological
and behavioral theories about how change occurs.
What are the barriers that reduce 1. Knowledge deficit
physicians' willingness or
2. Skills deficit
effectiveness in motivating health 3. Beliefs and attitudes
behaviors? St age Goal/Clues St age-appropriat e int ervent ions Precontemplation Patient begins thinking about change.
Surprise, ignorance, not thinking about change,
tried before & failed - now hopeless, helpless,
Patient examines benefits and barriers to
Ambivalence, emotional arousal,
defensiveness, resistance, self-evaluation,
values-behavior gap. ID patient's goals
Support self-efficacy Contemplation Handout: Motivational
Interviewing: The Basics
Discuss the 7 Stages of Change,
clues to the stage, and stageappropriate interventions. Preparation See table to the right. Determination Explore ambivalence
Develop discrepancies between goals and
Elicit self-motivational statements
Roll with resistance
Strengthen commitment to change by providing
a menu of options.
Address barriers to full-fledged action
Shift form motivational to behavior skills
Patient builds conviction to act and confidence Build self-efficacy
Develop plan for action (realistic goals, trial
period, plan for problems & lapses)
Patient expresses own reasons for change.
Taking steps toward change, experimenting
with small changes. Action Patient anticipates barriers to avoid.
Taking action, meeting criteria for < 6 mos,
makes changes alone, withdrawal symptoms,
new coping behaviors. Handout: A Stage of Change
Approach to Helping Patients
Change Behavior Maintenance Patient consistently employs strategies to
Meeting criteria for > 6 mos; still actively
monitoring. What does patient resistance to MI Physician has moved too far ahead of the patient in the change process, and a shift back to
empathy and thought-provoking questions is required. Relapse See relapse as an event, rather than return to
earlier stage. Readiness t o Change Ruler Agenda-Set t ing Chart CHAPTER 8: SEXUAL HISTORY
AND RISK REDUCTION
Lecture: Sexuality and the
Physician-Patient Relationship Straight line drawn on a paper that represents a continuum from the left "not prepared to
c hange" to the right "ready to change." Patients are asked to mark on the line their current
position in the change process. Physicians question patients about why they did not place
t he mark further to the left (elicit motivational statements) and what it would take to move the
line further to the right (elicits perceived barriers).
Useful when multiple lifestyle changes are recommended for long-term disease
management. Physician draws multiple circles on a paper, filling in behavior changes that
h ave been shown to affect the disease in question and ad...
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This note was uploaded on 09/19/2013 for the course MEDICINE All taught by Professor Johnsmith during the Fall '12 term at Eastern Virginia Medical School.
- Fall '12