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Motivational Interviewing

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Aim of Motivational Interviewing ... Recognizing danger signs. Developing coping skills. Action Stage ... express concern ... – PowerPoint PPT presentation

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Title: Motivational Interviewing


1
Motivational Interviewing
  • Anne Mounsey

2
Helping people to change behavior is a journey
not an event.
3
Impact of Behavior on Health
  • Half of U. S. deaths each year are attributable
    to behavior
  • Substance abuse ( tobacco, alcohol, drugs)
    responsible for 550,000 deaths/yr.
  • Unsafe sex responsible for 30,000 deaths/yr.

4
Motivational Interviewing
  • Information alone does not change behavior
  • Attempts to persuade patients will increase
    resistance.

5
Introduction
  • Some patients may never have discussed exactly
    how they feel about smoking etc.
  • Simply talking about the behavior can help
    clarify their thoughts
  • Try not to get hooked on outcomes.

6

7
Determine Stage of Change
  • Are you thinking about quitting in the next six
    months?
  • If no, precontemplator
  • If yes, ask next question
  • Are you thinking about quitting in the next 30
    days?
  • If no, contemplator
  • If yes, preparation

8
Integrating the Behavioral Theories
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange

Not Stage-dependent
Use Motivational Interviewing
Stages of Change Motivational Interviewing
Stage-based interventions Motivational
Interviewing
Local and national resources
9
Aim of Motivational Interviewing
  • The focus of the office visit is not to convince
    the patient to change but..
  • To encourage the patient to come up with self
    motivational statements that help them move from
    one stage of change to the next.

10
Interviewing Principles of MI (DARES).
  • D Develop discrepancy
  • A Avoid argumentation
  • R Roll with resistance
  • E Express empathy
  • S Support self-efficacy

11
Precontemplation
  • Goal is to raise doubt, increase perception/
    consciousness of problem
  • Personalize risks and rewards
  • Explore decisional balance
  • express concern
  • state the problem non-judgmentally
  • agree to disagree
  • advise a trial of limited behavior change
  • importance of follow-up (even if no change)

12
Contemplation
  • Goal is to tip the balance
  • elicit and - aspects current behavior
  • elicit and - aspects of new behavior
  • summarize (patient could write these down)
  • demonstrate discrepancies between
  • values (what they say) and actions (what they
    do)
  • advise a trial of new behavior
  • Support self-efficacy

13
Assessment of a patients readiness to change
  • Overall goal is for the patient to think about
    change.
  • This involves assessing
  • importance
  • confidence

14
Strategy for Assessing Importance
  • Scaling Questions How important is it to you to
    stop smoking? How would you rate it on a scale of
    0 to 10, 0 being unimportant and 10 being very
    important.

15
Strategies for Exploring Importance
  • 1. Do little more
  • 2. Scaling questions
  • 3. Examine the pros and cons
  • 4. Explore their health concerns about the
    behavior
  • 5. Advantages of changing their behavior.

16
Assessment of Confidence.
  • If you decided right now to stop smoking how
    confident do you feel about succeeding?
  • Numerical Scale.

17
Building Confidence
  • Scaling questions
  • Brainstorming
  • Previous Successes

18
The goal is to get the patient to think about
change
19
High importance
Low importance
20
Readiness
  • However confident and important they feel the
    change is, now may not be the right time.
  • Is now a good time for you to be thinking about
    making the change?

21
Preparation (also called Determination)
  • Goal is to help patient determine the best course
    of action
  • working on motivation is not helpful
  • supporting self-efficacy (review strengths,
    coming to doctor)
  • help decide on achievable goals
  • caution re difficult road ahead
  • relapse wont disrupt relationship
  • Recognizing danger signs
  • Developing coping skills

22
Action Stage
  • Provide continued follow up and support.
  • Studies show patients are more likely to succeed
    if given regular (weekly) follow up initially.
  • Continue positive reinforcement of healthy choice.

23
Maintenance
  • Goal is to help prevent relapse
  • anticipate difficult situations (triggers)
  • recognize the ongoing struggle
  • support the patients resolve
  • reiterate that relapse wont disrupt your
    relationship

24
Relapse
  • Goal is to renew the process of contemplation
  • explore what can be learned from the relapse
  • express concern
  • emphasize the positive aspects of what they
    accomplished temporariy and of current efforts to
    seek care
  • support self-efficacy

25
Assessment of nicotine replacement
  • If the patient smokes more than 30 cigarettes a
    day he will need nicotine replacement.
  • Or if he smokes within a few minutes of waking up

26
Signs and Symptoms of Nicotine Withdrawal
  • Irritability and anxiety
  • Decreased heart rate
  • Increased appetite
  • Decreased concentration

27
Nicotine Replacement
  • Doubles the smoking cessation rate.
  • Methods
  • patch
  • gum
  • inhaler
  • nasal spray
  • lozenges

28
Commit Lozenges
  • 2 mg and 4 mg. Use the 4 mg if smoke within 30
    mins of getting up.
  • Max of 20 lozenges a day.
  • Let lozenge dissolve slowly usually takes about
    30 mins.
  • Stop after 12 weeks.

29
Nicotine Patch
  • Regime
  • 21mg/24hrs for 4weeks
  • 14mg/24hrs for 2 weeks
  • 7mg/24hrs for 2 weeks
  • If patient smokes patch.

30
Nicotine Patch
  • 50 of people have local irritation from the
    patch.
  • Apply above waistline and rotate site
  • Remove at bed time.
  • Studies of smokers with CAD using the patch have
    shown no increase in morbidity and mortality.

31
Nicotine Gum
  • Comes in 2mg and 4mg.
  • If smoke 10 a day use 4mg strength a max of
    20/day.
  • Chew gum slowly and when peppery taste emerges
    park between teeth and buccal mucosa.

32
Adverse Effects of Gum
  • Nausea and dyspepsia.
  • Caused by swallowing nicotine.

33
Nicotine Nasal Spray.
  • Use 4 sprays per hour.
  • Side effects of nasal and throat irritation,
    rhinorrhea and nausea.

34
Nicotine Inhaler
  • Primarily absorbed through oral cavity,
    oesophagus and stomach
  • Need to use 4 inhalers a day to achieve adequate
    nicotine levels. Each inhaler contains 500 puffs.
  • Works well for people who need to do something
    with their hands.

35
Nicotine Replacement
  • No data available comparing delivery systems.
  • Be guided by patient preference.
  • Gum costs least (80/month)
  • Nasal spray costs most (200/month)

36
Bupropion
  • Has been shown to have similar effects on quit
    rates as nicotine replacement.
  • Used with nicotine replacement has higher quit
    rate than either alone.
  • Contraindicated in seizure disorders.
  • Start with 150mg qd for 3 days then bid.
  • Set quit date 2 weeks after therapy initiated.

37
What happens
  • Patient sees you as an ally and not a boss
  • Patient works with you to consider an issue
  • Patient feels comfortable and listened to
  • Physicians self esteem is not dependant on
    patients change.

38
To promote behavior change...
  • Listening is far more important and effective
    than giving advice
  • Asking questions is far more important and
    effective than giving advice.
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