Motivate Change with Motivational Interviewing. Outline. Quick Poll 3/15/17. Dawn Clifford, PhD, RD. Which best describes your current use of MI?

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Motivate Change with Motivational Interviewing Dawn Clifford, PhD, RD Outline MI Basics Change Talk Evoking change talk Listening for change talk Reflecting change talk Quick Poll Which best

1 Motivate Change with Motivational Interviewing Dawn Clifford, PhD, RD Outline MI Basics Change Talk Evoking change talk Listening for change talk Reflecting change talk Quick Poll Which best describes your current use of MI? a. MI? What s MI? b. I know a little about MI, but I haven t used it much. c. I ve dabbled in MI, with room to grow. d. I would consider myself fairly experienced in MI. 1

2 Part 1 A collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person s own reasons for change within an atmosphere of acceptance and compassion 2

Evidence for MI Researchers have assessed the use of MI in counseling for: Cardiovascular disease Diabetes Weight concerns With pediatrics and adults 2 of the studies were meta-analyses In most

3 Evidence for MI Researchers have assessed the use of MI in counseling for: Cardiovascular disease Diabetes Weight concerns With pediatrics and adults 2 of the studies were meta-analyses In most cases, MI was found to be effective in supporting the behavior change process. Bean et al. Pediatr Obes.2014;10(2): ; Miller et al. J Obes.2014;2014:345941; Armstrong et al. Obes Rev. 2011;12(9) ; Thompson et al. J Clin Nurs.2011;20(9-10): ; Channon et al. Diabetes Care.2007;30(6): ; Wang et al. Daibetes Res Clin Pract. doi: /j.diabres Ambivalence Having mixed feelings or contradictory ideas about something or someone Fence-sitting is normal Change Talk: speech that favors change I want to eat better. I would probably have more energy. I really need to do this. Sustain Talk: reasons not to change I just love sweets. I hate sweating. I didn t make any of the changes you suggested. Discord: disconnect arguing, interrupting, discounting, ignoring I don t know why I m here. This is a waste of time. A key goal in MI is to elicit and highlight (reflect) change talk!! 3

4 Activity 1: Ambivalence Sounds Like Write down something you have heard that expresses ambivalence in behavior change. Example: I ve been trying to get up early in the morning to walk, but I keep pressing snooze. My problem is that I go to bed too late. Partnership Acceptance Absolute Worth Accurate Empathy Autonomy Support Affirmation Compassion Evocation Partnership Compassion Acceptance Evocation The Spirit of M.I. Activity 2: Spirit of MI Worksheet For each counselor response, indicate whether it is consistent with the spirit of MI. Write either MI or Not MI on the line. After each counselor response that is MI consistent, explain why in the space below. 1. Yes, you really should start some sort of regular walking routine. 2. Well, I have some ideas about what might help, but first let me hear what you ve already considered. 3. If you want to eat out less often, you ll really need to start going to the grocery store and planning out your meals. 4. Your blood sugars are really high. You really need to start watching your diet. Why don t you start going to our diabetes class? 5. Have you tried eating more slowly? That really works for me. I tend to not overeat when I slow it down. 6. Some people like to add structured physical activity into their days, while others prefer to just walk more and take the stairs, squeezing in little bouts of activity throughout the day. What do you prefer. 7. You re quite committed to making this change. 8. It sounds like you re really adamant about starting the low carb diet your friend is on. I really don t think you should. 9. It sounds like you aren t completely convinced that you d like to start making changes. Whether you decide to try making some changes to your eating habits is completely up to you. What do you think you will do? 4

5 The Four Processes of MI Build on one another. Not always a linear process Depends largely on client s readiness to change Each process lays the foundation for the next. Planning Evoking Focusing Engaging Miller & Rollnick, 2013 Eating more regularly throughout the day Adding structured exercise to the week Adding small bouts of activity throughout the day Planning satisfying, balanced meals at home Other: Tuning into hunger and fullness Choosing satisfying, balanced meals when eating out Beverages Being more mindful while eating The Four Processes of MI Build on one another. Not always a linear process Depends largely on client s readiness to change Each process lays the foundation for the next. Planning Evoking Focusing Engaging Miller & Rollnick,

6 The Four Processes of MI Build on one another. Not always a linear process Depends largely on client s readiness to change Each process lays the foundation for the next. Planning Evoking Focusing Engaging Miller & Rollnick, 2013 O A R S Open-ended questions Affirmations Reflections Summaries 6

Reflect change talk Strategy1: Evoke Change Talk Open ended questions Ask for the change

7 Change Talk Part 2 3 Strategies to Promote Change Talk 1. Evoke change talk 2. Listen for change talk 3. Reflect change talk Strategy1: Evoke Change Talk Open ended questions Ask for the change talk Why do you want to make this change? In what ways would being more active make you feel better? What do you NOT like about the way things are now? The power of What else? 7

8 Strategy 2: Listen for Change Talk Sometimes it s obvious I ve got to start eating better. My blood sugars were up last year and it freaked me out. Sometimes it s not I eat out way too much. It s just so much easier and I hate doing dishes. Strategy 2: Listen for Change Talk Often, clients speak change talk and sustain talk in the same breath. Sounds like: I know I d save money if I cooked more meals at home, but I hate doing dishes and cleaning the kitchen. When all is said and done, it s easier just to get takeout. I went for a walk the other day, but it was hot and humid. I felt better after I went, but man I hate this time of year. green = change talk red = sustain talk Activity 3: Listening for Change Talk Go through the client statements on your handout and underline the change talk draw a wavy line under the sustain talk. 8

9 Activity 3: Listening for Change Talk I feel sick after I eat fried chicken. I don t know why I eat it. I guess just because it tastes so good. 1. I know I need to start eating breakfast, but I don t feel that hungry in the morning and I m always rushing out the door. 2. I do enjoy fruits and vegetables. It s not that I don t like them. What I don t like is cleaning the dishes afterwards. 3. I know I need to cut back on soda. My doctor told me my blood sugars have been a little high. But I need that caffeine fix in the afternoon. 2. I get home at night and I m exhausted. The last thing I feel like doing is exercise. I just want to relax and hang out. Strategy 3: Reflect Change Talk Now that you ve found it, shine a light on it. With reflective listening Strategy 3: Reflect Change Talk I know I d save money if I cooked more meals at home, but I hate doing dishes and cleaning the kitchen. When all is said and done, it s easier just to get takeout. You would like to save money by finding some simple dishes that don t make too big of a mess. I went for a walk the other day, but it was hot and humid. I felt better after I went, but man I hate this time of year. You feel more energized on the days you exercise 9

10 Activity 4: Responding to Change Talk On your handout write out a response that emphasizes the change talk. Start each reflection with You Use as few words as possible. Activity 4: Responding to Change Talk I feel sick after I eat at fried chicken. I don t know why I eat it. I guess just because it tastes so good. Response: You don t like the way you feel when you eat there. 1. I know I need to start eating breakfast, but I don t feel that hungry in the morning and I m always rushing out the door. Response: 2. I do enjoy fruits and vegetables. It s not that I don t like them. What I don t like is cleaning the dishes afterwards. Response: 3. I know I need to cut back on soda. My doctor told me my blood sugars have been a little high. But I need that caffeine fix in the afternoon. Response: 4. I get home at night and I m exhausted. The last thing I feel like doing is exercise. I just want to relax and hang out. Response: Activity 1, Revisited Write a reflective listening response that highlights the change talk from Activity 1. 10

Take Home Messages Build motivation for change before talking about the how to change Tune your ears for change talk Ask questions to elicit more change talk Reflect the change talk you hear

11 Take Home Messages Build motivation for change before talking about the how to change Tune your ears for change talk Ask questions to elicit more change talk Reflect the change talk you hear Resources Motivational Interviewing in Nutrition and Fitness Guilford Press, References 1. Miller WR, Rollnick S. Motivational Interviewing: Helping People Change. 3rd ed. New York, NY: Guilford Press; Bean MK, Powell P, Quinoy A, Ingersoll K, Wickham EP, Mazzeo SE. Motivational interviewing targeting diet and physical activity improves adherence to paediatric obesity treatment: results from the MI values randomized controlled trial. Pediatr Obes. 2014;10(2): Miller ST, Oates VJ, Brooks MA, Shintani A, Gebretsadik T, Jenkins DM. Preliminary efficacy of group medical nutrition therapy and motivational interviewing among obese African American women with type 2 diabetes: a pilot study. J Obes. 2014;2014: Armstrong MJ, Mottershead TA, Ronksley PE, Sigal RJ, Campbell TS, Hemmelgarn BR. Motivational interviewing to improve weight loss in overweight and/or obese patients: a systematic review and meta-analysis of randomized controlled trials. Obes Rev. 2011;12(9): Thompson DR, Chair SY, Chan SW, Astin F, Davidson PM, Ski CF. Motivational interviewing: a useful approach to improving cardiovascular health? J Clin Nurs. 2011;20(9-10): Channon SJ, Huws-Thomas MV, Rollnick S, et al. A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care. 2007;30(6): Wang D, Li XY, Zhang LN, Zhou L, Zhang KJ. Effects of motivational interviewing on lifestyle modification and diabetes prevention in adults with pre-diabetes [published online February 23, 2015]. Diabetes Res Clin Pract. doi: /j.diabres

The Road to Health ACT I. MRS. JACKSON: Well, I think we better have the doctor, although I don t know how I can pay him.

The Road to Health ACT I. MRS. JACKSON: Well, I think we better have the doctor, although I don t know how I can pay him. The Road to Health CHARACTERS: Mrs. Jackson (A widow) Mrs. King (A friend) Frances (Mrs. King s daughter) Frank (Mrs. Jackson s son) Mollie (Mrs. Jackson s daughter) Miss Brooks (Frank s teacher) Katie