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Model of motivational interviewing that emerged from

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Unformatted text preview: E Handout: Motivational Interviewing 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, and cynical. Patient examines benefits and barriers to change. Ambivalence, emotional arousal, defensiveness, resistance, self-evaluation, values-behavior gap. ID patient's goals Give information 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 behavior Elicit self-motivational statements Avoid argument 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 of success. 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 sustain change. 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 indicate? 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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