Motivational Interviewing - Overview

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Transcript - Motivational Interviewing - Overview

(Opening montage of various images of people exercising, eating well, meeting with their doctor, with music playing in the background.)

Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle
Motivational Interviewing Overview

(Narration by DR. Vallis over images of a man jogging on a path surrounded by green fields, mouth-watering red and green apples falling, a mountain biker cycling through a forest, alcohol being poured into a glass, a fast burning cigarette with the prohibition symbol in red, the exterior of a hospital building, a lady in a hospital chair receiving treatment, a nurse hanging an IV bag with patients in the background, various medications falling out of several bottles, a young couple holding each other while walking outside, an older gentleman golfing, a hand and computer mouse superimposed over fast moving traffic, a lit cigarette being tapped against an overflowing ashtray, two hands each holding a glass of red wine making a toast.)

DR. VALLIS: What does it take to lead a healthy lifestyle? It’s about eating right, being physically active, not drinking to excess and not smoking at all. From a physician’s perspective, the challenge is that these behaviours depend less on the latest medical science and more on the personal choices made each day by the individual patient. But in our increasingly fast-paced culture, it can often be difficult for people to make the healthy choice.

(Background music fades, then stops. DR. VALLIS is standing next to an empty reception area. We see the empty waiting room in the background. He is alone. He addresses the camera directly.)

Text on screen:
DR. Michael Vallis
Queen Elizabeth II Health Sciences Centre
Dalhousie University

DR. VALLIS: Despite these challenges, primary care physicians and other healthcare providers can play an important role in helping their patients lead healthier lifestyles. But to do so, we have to rethink the traditional physician-patient relationship.

(Narration by DR. Vallis over images of a female doctor and male patient, interacting in an examining room, with low background music.)

DR. VALLIS: We need to go from focusing on the message we send - the recommending and telling we do so well - to how that message is actually received by the patient.

(Narration by DR. VALLIS over text on screen.)

Text on screen:
Changing the relationship:
Listen to the patient
Understand their perspective
Establish goals that combine patient’s perspective with physician’s recommendations
Help them move past barriers

DR. VALLIS: This means listening to the patient and understanding their perspective. We must work with them to establish evidence-based goals - and then support them as they address their personal barriers to change.

(DR. VALLIS is standing next to an empty reception area. We see the empty waiting room in the background. He is alone. He addresses the camera directly. Background music fades, then stops.)

Text on screen:
Self-management support

DR. VALLIS: We need to provide what’s called self-management support. And through this video and other tools in the ''Prevention in Hand'' initiative, we’ll touch on some of the ways you can support your patients in making sustainable behaviour change.

(DR. SELBY walks up to the camera. He then stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly.)

Text on screen:
DR. Peter Selby
Centre for Addiction and Mental Health
University of Toronto

DR. SELBY: Behavioural science studies the factors that influence individual choice. It has become an increasingly valuable part of medical practice. Helping patients adopt healthy behaviour requires understanding the basics of behaviour change counselling: in particular, the communications skills that increase a patient’s motivation to change.

(Background music. Narration by DR. SELBY over text on screen.)

Text on screen:
The spirit of motivational interviewing:
Autonomy rather than authority
Collaboration rather than coercion
Evoking change rather than instilling it

DR. SELBY: The most efficient of these is called motivational interviewing: a method that asks physicians to work alongside their patients rather than talk at them. It’s about respecting a patient’s autonomy rather than being authoritarian. There’s no I-V infusion that instils change. It requires collaborative relationships to be developed - ones that evoke change from the patient, rather than coercing or forcing the change to happen.

(Narration by DR. SELBY over still image of female doctor and male patient in examining room.)

Text on screen:
Express empathy and take a nonjudgmental stance
If you want to be heard, first listen.

DR. SELBY: Motivational interviewing is guided by several key principles: the most important of which is to express empathy.

(DR. SELBY stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)

DR. SELBY: Listening to someone’s explanation of their behaviour, and then actively communicating your understanding back to them, is a time-tested way to engage in meaningful dialogue about behaviour change. In doing so, remember to always demonstrate a nonjudgmental attitude and encourage the patient to be curious about their own behaviour. This goes a long way towards developing motivation.

(Background music. Narration by DR. SELBY over still image of male doctor in examining room.)

Text on screen:
Recognize ambivalence
Sometimes we can want two conflicting things at once.

DR. SELBY: Recognize ambivalence. Ambivalence is having simultaneous, conflicting feelings.

(DR. SELBY stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly.)

DR. SELBY: For example, we want to be healthy, but at the same time enjoy eating unhealthy foods. Recognizing and normalizing this ambivalence helps patients find reasons to continue when barriers get in the way of change.

(Narration by DR. SELBY over still image of female doctor and male patient in examining room.)

Text on screen:
Roll with resistance
If you get pushback from the patient, don’t push harder—work alongside him or her instead.

DR. SELBY: Roll with resistance. Motivational arguments aren’t based on emotion, but rather on beliefs.

(DR. SELBY stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)

DR. SELBY: When you hear a patient say “yes, but…”, you’re in a motivational argument. There are also times when a patient won’t argue, but will go silent instead. It’s important to recognize this resistance, but instead of pushing back, seek to understand their perspective first.

(Background music. Narration by DR. SELBY over still image of female doctor and male patient in examining room.)

Text on screen:
Develop discrepancy
Explore the disconnect between the patient’s values/goals and current behaviour

DR. SELBY: Develop discrepancy. Helping patients recognize the discrepancy between their stated goals and their current behaviour can be very motivating.

(Background music stops. DR. SELBY stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly.)

DR. SELBY: This can be as simple as asking a question. For example, “I understand it is important to you to be there for your children. How does your drinking fit with that?”

(Background music. Narration by DR. SELBY over still image of female doctor and male patient in examining room.)

Text on screen:
Support self-efficacy
Encourage patients to take steps to increase their level of confidence in specific behaviours.

DR. SELBY: Support self-efficacy. Finally, the idea that the best predictor of future behaviour is past behaviour isn’t particularly helpful when promoting change.

(Background music fades, then stops. DR. SELBY stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly.)

DR. SELBY: In this case, a strong predictor of behaviour is self-efficacy, that is, a person’s confidence in their ability to accomplish a specific goal in a specific situation. This is especially important if expressed during the latter part of an interview. For example, if a patient makes a statement such as “I will start walking for 30 minutes every day“, it’s a clear indication that they are displaying a sense of commitment.

(DR. VALLIS is standing next to an empty reception area. We see the empty waiting room in the background. He is alone. He addresses the camera directly.)

DR. VALLIS: Now that you know the principles behind motivational interviewing, the following techniques will help you operationalize them in your work.