Motivational Interview

Motivational Interviewing - Is not

Being excited and over the top, that bringing a lot of energy

Motivational Interviewing - Is

Coming alongside the patient and helping them take control of their health; hearing the patient, allowing them to feel understood and validated; bringing MI around your own style; patient needs a sense of ownership of their healthcare so that behavioural change is instigated by them

What is the "Righting Reflex"?

Seeing a problem then immediately trying to rectify that problem; it inhibits the learning of the patient to fix it themselves; Motivational Interviewing avoids positioning yourself to be a problem solver for all patients all the time

How might Motivational Interviewing (MI) help with practitioner longevity?

It may help by channeling the helpful drive into skillful advice giving

How does MI approach behavioral change when patients come in wanting a certain method of treatment?

It involves giving them the option of changing methods to more effective methods, not forcing them

What are discussion points related to behavioral change in MI?

Setting the expectation, education, and Motivational Interviewing itself

What are the 4 Processes of Motivational Interviewing (MI)?

Engagement, Focusing, Evoking, and Planning

What is "Engagement" in MI?

It involves using open questions, not being superficially warm and friendly or undertaking idle chit chat, letting them start the conversation ("Are you able to tell me about your condition"), inviting the patient to tell their story without leading them in a specific direction, and both parties deciding very quickly whether this is going to be a worthwhile experience; it also helps the patient say what they want to

What is "Focusing" in MI?

It involves assessing behaviors the patient wants to work on, helping the patient find focus on their direction, clarifying with the patient what is most relevant to them ("what is the main thing you would like to take away from our session today?"), and for the "all over patient," developing a refocusing statement; it also involves finding out what is important to the patient, including what they can do, what they want to do, and what they don't want to do

What is "Evoking" in MI, and what is it considered?

It involves helping patients say why and how they might change; it is considered the heart of MI

What are the 3 stages of change in "Evoking"?

Sustain talk (resistance and reasons against change), Ambivalence, and Change talk (patient wants and has reasons for change)

What strategies are used in "Evoking" to assess importance and confidence?

The Importance and Confidence Strategy, which asks "How important is it to you, to do something about you" and "How confident do you feel about succeeding"

What is "Planning" in MI?

The plan has to be the patient’s goal; it involves asking "How ready are you to consider planning some small steps toward change," "Why is this plan important to you," "What change have you chosen," and "How are you going to make this change"; the patient is taking responsibility actively in the consultation to help themselves move forward

What are the 4 Skills of Motivational Interviewing (MI)?

Asking, Listening, Affirming, and Summarizing

What is "Reflective Listening" in MI?

It is a statement, in your own words, using key words from the patient

What is "Affirming" in MI?

Statements and gestures that recognize client strength and acknowledge behaviors that lead in the direction of positive change; it involves praising behaviors

What is "Summarizing" in MI and when is it particularly helpful?

It is an application of Reflective Listening; it is used throughout a conversation but is particularly helpful at transition points, such as the end of a topic, recounting a personal experience, or nearing the end of a focus conversation

How can you effectively summarize in MI?

By stating "I'm going to summarise everything; let me know if I got anything wrong"; end the summary with an invitation; an effective summary is a time to pause and reconnect with the patient to show you are actively listening, and it allows for the ability to retake or redirect the conversation

What happens in an Acute Pain Episode?

Injury leads to an Inflammatory Response, which leads to Repair/Remodeling

How does acute injury transition to chronic/persistent pain?

It results in a hypersensitive nervous system

What belief characteristics can change pain from acute to chronic/persistent?

Unhelpful or incorrect beliefs, Catastrophizing (worst case scenario), Rumination (excessively and repetitively thinking about negative feelings, experiences, or situations), Certainty (hard to give exact diagnoses especially with chronic cases), Hypervigilance/behavioral changes (avoidance, increase anxiety), Psychological influences, and Biological changes

What biological changes are associated with chronic pain due to a sympathetic stress response?

Adrenaline and cortisol leading to impairment on the immune system and digestive system; also Emotions (feelings, physical sensations, urges) like anxiety, despair, and depression

Explain the "Ball vs. Leaf + Car Analogy" for acute to chronic pain.

If a ball is thrown at a car, the alarm goes off (representing an acute injury triggering a response). If a leaf falls onto the car, the alarm does not go off. However, in chronic pain, the system becomes hypersensitive, similar to the car alarm being so sensitive that even a leaf causes it to go off, meaning everything causes the alarm (pain) to go off