From Behavior A to Behavior B (image of person thinking)
Assumptions
Behavioral issues are common
Change often takes a long time
The pace of change is variable
Knowledge is usually not sufficient to motivate change
Relapse is the norm
Transtheoretical Model
This diagram shows the Transtheoretical Model as an iterative process beginning with Pre-contemplation, then Contemplation, Determination, Action, Maintenance,
Relapse, back to Pre-contemplation. There is also connection from Maintenance to Termination (Exit), as well as a connection between Action and Relapse. In the process, movement can also
occur from Relapse to Contemplation or Determination.
Prochaska & DiClemente: Stages of Readiness to Change
Stage
Description
Objectives
Pre-contemplation
Not considering change
Identify patient’s goals Provide information Bolster self-efficacy
Contemplation
Ambivalent about change
Develop discrepancy between goal & behavior Elicit self-motivational statements
Determination
Committed to change
Strengthen commitment to change Plan strategies for change
Action
Involved in change
Identify and manage new barriers Recognize relapse or impending relapse
Maintenance
Behavior change
Assure stability of change is stable Foster personal development
Relapse
Undesired behaviors
Identify relapse when it occurs Reestablish self-efficacy and commitment Behavioral strategies
Termination
Change is very stable
Assure stability of change
Principles of MI
1. Advice
Give advice only when individuals will be receptive
Target advice to stage of change
2. Reduce Barriers
Bolster self-efficacy
Address logistical barriers
3. Provide Choices It’s the individual’s choice:
Whether to change
How to change
4. Decrease Desirability Help individuals:
Decrease their perceptions of the desirability of the behavior
Identify other behaviors to replace the positive aspects of alcohol use
Reflective Listening
Mirrors what the patient says
Creates a sense of safety for the patient
Deepens the conversation
Helps patients understand themselves
Says:
I hear you
This is important
Please tell me more
I’m not judging you
Reflective Listening (continued)
Patient: To tell you the truth, I really enjoy drinking.
Response: You like drinking alcohol?
Patient: Yes. I like the taste, and it really relaxes me.
Example 1:
“My girlfriend gets really angry when I get drunk and pass out.”
“She gets mad when you do that.”
Affirmation
Conveys support, respect, and encouragement
Helps patients reveal less positive aspects about themselves
“You’ve tried very hard to quit.”
“You are very courageous to be so revealing about this.”
“You’ve accomplished a lot in a short time.”
“I can understand why drinking feels so good to you.”
Summarization
“What you’ve said is important.”
“I value what you say.”
“Here are the salient points.”
“Did I hear you correctly?”
“We covered that well. Now let's talk about ...”
Elicit Self-Motivational Statements
Problem recognition
“Has alcohol caused you any problems?”
Concern
“Do you ever worry about your alcohol use?”
Intention to change
“What might be some advantages of quitting or cutting down?”
“On a scale of 0 to 10, how important do you think it is for you to quit? Why didn’t you say (1 or 2 points lower)?”
“On a scale of 0 to 10, how important is it for you to change your (behavior)? ”
“Why didn't you say (1 or 2 points lower)?”
Optimism
“What difficult goals have you achieved in the past?”
“What might work for you if you did decide to change?”
For Ambivalence - DEARS
Develop discrepancy
Compare positives and negatives of behavior
Positives and negatives of changing in light of goals
Elicit self-motivational statements
Empathize
Ambivalence and pain of engaging in behavior that hinders goals
Avoid Arguments
Don’t push for change, avoid labeling
Roll with resistance
Change strategies in response to resistance
Acknowledge reluctance and ambivalence as understandable
Identify patient’s goals
