Motivating Behaviour Change

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Motivating Behaviour Change

• Liz Cornwallis (Associates)
• Health Improvement Training and Consultancy
• cornwallis_at_scottishhealth.org

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Aims of the workshopEveryone will walk away
from this workshop with

• An initial understanding (or refresher) of
  Motivational Interviewing
• A desire to learn more
• Some tools and strategies that you can start
  using immediately

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Behaviour Change a complex issue!

• He must know its a problem. I mean he cant
  walk too far, he is so short of breath. Yet will
  he admit it? Will he talk about doing something
  about it? (Nurse)
• I try to advise them about diet. Every day I do
  this. Information leaflets, diaries to fill in
  and lengthy discussions here in the clinic.
  Its not an easy job. Nice people, most of them,
  but hopeless at making changes.
• (Dietician in community health centre)

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Behaviour changePeople and issues we meet

• Small groups exercise-
• Identify common scenarios in your day to day work
  in which you would discuss/ promote physical
  activity with individuals
• Identify any issues or difficulties you find in
  raising these issues and helping people make
  changes.

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The Righting Reflex

• Human beings seem to have a built-in desire to
  set things right it is common when we see
  something awry, to want to fix it.
• See someone going astray and the reflex kicks in
  to set them back on the right path.
• Miller Rollnick 2002

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Common practitioner beliefs and responses

• They dont see the problem.
• They dont understand the problem.
• They dont know how to change.
• They just dont care.

• I must give them insight.
• I must give them knowledge
• I must give them skills
• I must make them feel bad or afraid enough, then
  they will change

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Is there something missing?

• What currently sustains someones way of being
  may not merely be an insufficiency of insight,
  knowledge, skills or concern.
• Do we know what makes people behave as they do?
• Do we know what beliefs and values influence
  their current behaviour?

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The Cycle of Change Prochaska and
Diclemente (1982)
Stable safer lifestyle (termination)
Making change (action)
Preparing to Change (preparation)
Maintaining change (maintenance)
Thinking about change (contemplation)
Relapsing (relapse)
Not interested in changing (pre-contemplation)
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Personal Experience of Change

• Work in pairs and apply the cycle of change model
  to your own life.
• Take a few minutes to think about something you
  have tried to change. Identify which stages of
  change you have been through and what moved you
  on to the next stage or hindered your progress.
• Share this information with your partner

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Ready, Willing and Able

• Readiness, Importance and Confidence
• Readiness Am I ready to change?
• Importance Is change worthwhile?
• Confidence Can I succeed?

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Key concepts in negotiating behaviour change

• Firm Stand
• Person with bigger feet
• Talk to your partner for a few minutes about
  something you have been thinking about changing.
• Person with smaller feet
• Quickly decide what your partner should do about
  this and tell your partner what you think he/she
  should do, taking a firm stand.
• Take a couple of minutes to discuss how it felt
• for you both

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Firm Stand- Points to Consider

• Were all individuals and so we often respond
  differently to different approaches.
• Our response to a practitioners style often
  depends on what stage of change we are currently
  at.
• Resistance often occurs if the practitioner and
  the client are not focused on the same stage of
  change - the clients agenda is not being met.
• Resistance is not useful and is often a sign to
  change tack.
• If the practitioner stresses one side of the
  clients ambivalence, the client will often
  promote the other - this is the nature of
  ambivalence.

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Four Key Concepts

• Readiness to Change
• Two Agendas
• Ambivalence about Change
• Resistance to Change

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The Scales of Ambivalence
The role of the practitioner is to help tilt the
balance of the scales in the direction of change.

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The challenge

• How can we best use our knowledge, skills and
  experience to guide the client to a helpful
  conclusion but without merely trying to
  persuade them to change?

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• People are generally better persuaded by the
  reasons which they have themselves discovered,
  than by those which have come into the mind of
  others.
• Blaise Pascal 1670
• French mathematician, physicist and philosopher.

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Definition of Motivational Interviewing

• We define motivational interviewing as a
  client-centred, directive method for enhancing
  intrinsic motivation to change and resolving
  ambivalence.
• Miller and Rollnick 2002

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Motivational Interviewing

• What is it?
• A counselling technique which helps you to
  explore a clients motivation for behaviour
  change, and support the client in making that
  change.
• A collection of approaches and skills that have
  been shown to be successful in helping people
  change (not new).
• Originally used in addictions field and has been
  applied across a wide range of topics.
• See reference list for evidence of effectiveness
  in promoting physical activity
• Adapted for use in health care settings - Brief
  motivational interviewing or brief negotiation.
• Where did it come from?
• Jointly developed by William R Miller and Steven
  Rollnick since the early 1980s.

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Which aspects can be translated in to your work?

• The Spirit
• Understanding Ambivalence
• Modification of your role

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The spirit of motivational interviewing

• In motivational interviewing the most important
  thing by far is the spirit of the method.
• Put simply, this is a collaborative conversation
  about behaviour change.
• The client is encouraged to be an active
  decision-maker.
• The practitioner provides structure to the
  discussion, expert information, where
  appropriate, and elicits the patient views and
  aspirations about behaviour change.
• The patient/client is treated with great respect
  and as an ally rather than an opponent.

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Practising the Art

• Key tasks
• Establishing rapport
• Agenda setting
• Assessing importance confidence and readiness
• Exploring importance
• Building confidence
• Exchanging information
• Reducing resistance

• Key skills
• Asking open questions
• Reflective listening
• Eliciting self motivating statements
• Affirming
• Summarising

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Assessing importance, confidence (and readiness)

• Exercise in pairs
• One listener, one talker.
• Purpose To try out the readiness ruler in
  simulated practice.
• Talker
• speak about something youd like to change, or
  role play a patient/client.
• Listener
• Ask how important this change is to the talker
  using the 1-10 scale.
• Ask how confident the talker feels about making
  the change using the 1-10 scale.
• Discuss how the numbers given might relate to the
  clients level of readiness to change.

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Benefits of using a motivational interviewing
approach

• Increases clients confidence and self esteem
• Reduces pressure to change immediately
• Helps create trust
• Improves communication
• Pace is determined by client
• Door is kept open
• Can increase confidence of practitioner in
  raising behaviour change issues with clients
• Can be adopted into practice to ensure client is
  receiving similar message from all practitioners.