الفهرس 
Techniques of motivational interviewingOnly 14 pages are availabe for public view
 |  | from | 121 |  |  |
| | | from | 121 | | |
Abstract
M
otivation is generally defined as the driving force behind our actions, fueled by our desire for something. It is that internal strength that gets us to move, and take action, to whatever goal or end we desire or plan to achieve.
Motivational interviewing (MI) is a relatively new cognitive -behavioral technique that aims to help patients identify and change behaviors that may be placing them at risk of developing health problems. These principles are: to help the patient to understand his or her thought processes related to the problem, to identify and measure the emotional reactions to the problem, to identify how thoughts and feelings interact to produce the patterns in behavior, to challenge his or her thought patterns and implement alternative behaviors, to provide feedback, to clarifying goals &finally to active helping.
We have discussed the four central principles of motivational interviewing which are: a) to express empathy by using reflective listening to convey understanding of the patient’s Point of view and underlying drives, b) Develop the discrepancy between the patient’s most deeply held values and their current behavior, c) Sidestep resistances by responding with Empathy and understanding rather than Confrontation and d) finally to Support self-efficacies by building the patient’s Confidence that change is possible.
There are also five early methods discussed which are designed to help clients explore and resolve their ambivalence about making changes as open questions, reflective listening, affirming &summarizing.
It was found that motivational interviewing was highly used in the treatment of different psychiatric disorders, as eating disorders where there is a specific and evidence-based model of how AN is maintained which is “Maudsley model of anorexia treatment” and that the principles and techniques of MI used during the assessment were 1st opening moves, giving medical feedback, ongoing risk monitoring, developing a plan for improving nutritional health, case formulation and working for change and finally relapse prevention and ending.
Since the method that had been suggested as a potentially effective adjunct to a comprehensive behavioral weight loss program is Motivational interviewing so there were specific strategies utilized in MI with individuals in a behavioral weight control program which include: eliciting self-motivational statements, reflective summary statements, the use of objective data and negotiating a plan for change.
As regard anxiety disorders, the combination of MI with CBT may be particularly promising for the treatment of anxiety, with MI directed at increasing motivation and resolving ambivalence about change and CBT directed at helping the client achieve the desired changes, Application of treatment for anxiety embodies all of the core strategies and principles of MI and focuses on ambivalence about changing the overall problem and applying coping meth-ods for managing anxiety Consequently in the application of MI, we explore change state¬ments only after there has been significant validation and understand¬ing of the side of the ambivalence.
Regarding obsessive compulsive disorder (OCD), which is a chronic anxiety disorder motivational interviewing (MI) principles appear promising to address some potential obstacles to OCD treatment as MI can be conceived of as increasing motivation to do something difficult or unpleasant in the short-term for long-term gain.
where It had been developed a brief (four-session) readiness intervention (RI) of MI for patients with OCD who after an initial assess¬ment, declined to enter ERP for reasons other than practical obstacles to care in order to address the following issues, 1st psychoeducation, 2nd deal with the patient’s ambivalence about change, 3rd viewing a videotape of ERP, 4th constructing a sample exposure hierarchy, 5th doing a telephone conversation with a patient who had completed ERP.
As regard adherence to treatment in schizophrenia, there are specific elements of MI to address adherence in individuals with SSD as five basic principles underlie MI, engaging the client in the hospital through ex¬pressing empathy and reflective listening to help, identifying goals through developing discrepancy, roll with resistance , support self-efficacy, conducting a cost benefit discussions of how medication taking might facilitate or interfere with attaining a goal.
As regard depression and sucidality, it had been found that Motivational interviewing (MI) may be one way to enhance the effectiveness of psychotherapy and drug therapy for depression, because it emphasizes two issues that are highly relevant to depression, increasing intrinsic motivation and resolving ambivalence about change.
Therapists who work with depression need to address not only the pre-symptoms of depression and other associated distress but also causal issues and ways of dealing with them. Unless there is some way to guide the therapist in developing the foci of therapy for depression, it had been developed a simple and useful method of thinking about foci of treatment for depression in MI that could potentially be applied to other disorders as well which were (three levels of foci) reducing the overall symptoms of depression and other distress, discussing the problems that contribute to the depression and distress; and what the client needs to do to change these problems, working to increase motivation and resolve ambivalence at change are addressed at each level.
Moreover caring for suicidal clients, the use of MI promotes greater autonomy in the context of what may likely be limited choices for further treatment. Moreover, the benefits of using MI in this population may also be seen in the development of an enhanced therapeutic alliance. With the posi¬tive alignment of autonomy and alliance, clients may further benefit from actively identifying and adopting alternatives to passive compli-ance or to noncompliance, both of which are common problems in the usual clinical management and treatment of suicidality.
As regard post-traumatic stress disorder, Development of a useful MI-based approach for enhancing motivation to change post-traumatic stress disorder symptoms and related problems raised a number of is¬sues that had to be addressed. One important consideration related to the structure of the most common PTSD programs, These programs typically offer long-term outpatient services including sequential group interventions with varying foci, the motivation enhancement intervention had to be brief (four to eight sessions) and in a group therapy format. Therefore, the intervention was designed to be flexible in the specific problems that were targeted regarding motivation to change.
The resulting intervention is called the PTS motivation enhance¬ment (PME) group, currently a four-session structured group treatment. The PME Group protocol currently consists of four 90-minute modules (with each module conducted in one session) where 1st module focus on group review and possible problem identification, 2nd module focus on decisional balance methods, 3rd module performing a comparison to an average guy,4thmodule identifying the concepts of roadblocks.
Also one foundation of this intervention is the trans-theoretical model, particularly the stages of change the clinical methods are direct applications or modifications of MI approaches.
Regarding couple therapy, Most couple therapies place significant therapeutic accent on such clinical practices as direct confrontation with a client problematic behavior, use of skills training and analysis of cognitive distortions, ideas that parallel those espoused in motivational interviewing are also being applied to couple therapies beyond systems approaches. Client-centered therapy, one of the foundational elements of motivational interviewing, has been widely used with couples for several decade%.
There are many ways to apply the principles of motivational interviewing in working with couples as, one approach is to continue practicing individual motivational interviewing with the client while the significant other observes or participates, using motivational interviewing with both partners present can help each one listen to and better understand the other’s perspective and point of view.
Another way to use motivational interviewing in working with couple is to do motivational interviewing with both partners during the course of the treatment.
A third approach to motivational interviewing with a couple is to focus on the dyadic interaction sequences that maintain the problem behavior. One way to target problematic patterns of communication within the couple is to explore alternate ways of interacting, which can be accomplished by teaching the couple how to practice motivation interviewing with each other.
As regard addiction and smoking, No matter what the potential improvement in outcomes, substance abusers cannot benefit if they do not enter, or link with, treatment in the first place. Linkage with substance abuse treatment is impeded by numerous influences that serve as obstacles, or barriers, to obtaining treatment.
Andersen’s model of health care utilization suggests three categories of barriers: predisposing characteristics such as gender and age; situational illness factors such as motivation and perceived extent of substance abuse problem; and inhibiting factors such as homelessness and lack of social support for change
So Motivational interviewing (MI), was a treatment strategy developed to enhance motivation for change.
Although early MI studies focused on alcohol abusers, it now has been evaluated and used with other addictions (e. g., drugs, gambling, and smoking) and health problems.
Brief motivational approaches are increasingly being utilized to improve both treatment readiness and motivation to decrease substance abuse, each of which may impact entry into treatment and treatment retention. Based upon a number of theoretical principles, including decisional balance, self-perception theory, and the trans-theoretical model of change, MI combines Rogerian and strategic techniques into a directive but predominantly client-centered and collaborative format.
Through an empathic, accepting, and non-judgmental approach, asking open ended questions, using reflective listening, developing discrepancy, roll with resistance clients, asking non threatening questions all helped to explore the negative impact of substance use on their lives, the benefits of changing, and the relationship between substance use and core values. Goals for behavior change are also elicited, an act that is itself correlated with actual behavior change.
Yet regarding smoking: It was hypothesized that MI intervention addressed to motivating behavior change in adolescent smokers will enhance readiness to change, increase smokers’ perceptions of cons of smoking (negative consequences), decrease perceptions of pros of smoking (positive benefits) and temptations regarding further change, and also decrease the smoking rate among adolescents.
Yet before the intervention, it had been reviewed issues related to ambivalence, how to monitor the students’ reactions to dealing with resistance and how to help the students set goals. Then it was prepared the protocol following semi structured counseling scripts. The written manual included six sections: establishing rapport, exploring pros and cons of smoking, personalized feedback, imagining the future, setting goals, and increasing pros of smoking. A therapeutic environment was created in which the interview was guided by the philosophy of motivational interviewing.
The intervention protocol followed the MI therapeutic style. Five sessions were delivered for each participant lasting approximately 45 min each. Clients were guided in imagining their lives in the future if they continued smoking versus if they quit. During MI, it had been explored the pros and cons of smoking and quitting, highlighting ambivalence and identifying salient aspects of smoking for the clients. Then helped clients formulate a detailed action plan, anticipate barriers to accomplishing the plan, and strategize ways to overcome barriers. It was enhanced self-efficacy for change by asking students about past personal successes and personal characteristics that contribute to an ability to change.
Then reviewed a personalized feedback sheet that summarized information from the baseline assessment. Feedback included corrective normative feedback and personalized information about the client’s health effects and dependence level. The length of the sessions and interview data were recorded. The participants were also given the feedback sheet, goal sheet, and information about strategies for quitting and coping with withdrawal.