Motivational Interviewing for Health Behavior Change

Lecture given 10/29/2025

what are some problems with standard practice?

giving advice makes people argue back, knowledge weakly correlated with behavior change, controlling and directive approaches are appropriate for acute care but not behavior change

motivational interviewing (MI)

a set of communication techniques and strategie to build motivation for change (particularly among those who are ambivalent about change) and to sustain that change over time

what are ineffective approaches to motivational interviewing?

confronting, taking side of change, acting as expert, labeling behavior as problem, warning, persuading, lecturing, providing solutions

ambivalence

pulled between wanting to change and not wanting to change

natural part of the changing process

what happens when you confront patients about change?

resistance, reversal, and reactance

medical communication style

focused on problem and solution, parental relationship, I am the expert, assumes patient is motivated, advise/warn/persuade, goals are prescribed, argumentation and correction of patient’s perspective

motivational communication style

focused on patients concerns and perspectives, equal partnership, match intervention to patient’s level of motivation, emphasize personal choice

O in OARS

open ended questions

A in OARS

affirmations

statements of understanding, helps to build rapport, reinforce their strengths and successes, focus on parts of goal that were accomplished, reframe failure as a partial success or something from which they can learn

R in OARS

reflective listening

statement, not a question, hypothesis testing, take a guess at what the person means

S in OARS

self-motivational statements or summaries

longer than reflections, use mid-visit to transition to another topic or to highlight both sides of the patients ambivalence, use at the end of the consultation to re-cap major discussion points

reflecting

simplest level of reflective listening, merely repeats what the patient has said

rephrasing

type of reflective listening, provides patient with a different point of view and helps to move patient forward

reflections of feeling

deepest form of reflection, not a repetition of overt content but rather implied content that is not clear to the patient

complex reflections of meaning

a reflection that adds some kind of new meaning to what the patient has said, it is not a reflection of only the content of what the patient has said but adds additional meaning/content/or directs the discussion in a new direction

how do you know someone is resistant?

negating, ignoring, interrupting, arguing, silent treatment, no eye contact, body language

how can you roll with resistance?

confrontation and persuasion are ineffective

examine your own behavior and reactions- resistance may be due to your pressuring the patient to change

communication style can directly affect the level of patient resistance, driving it upward or downward

how can you enhance motivation for change?

motivation exercises, confidence exercises, exploring ambivalence, decisional balance, providing health feedback

how should you provide health feedback?

elicit permission, provide feedback in a non-threatening/neutral manner, elicit the person’s interpretation

what are hints from your patient that you are practicing motivational interviewing?

patient discusses emotions, cooperates, engages, and discloses information

is motivational interviewing actually effective?

according to RCTs, yes, it is effective at promoting healthy behaviors and reducing maladaptive/risky behaviors