Behavior Change is Hard
We are all creatures of habit. Behavior change is both difficult to achieve and even more difficult to maintain.
Motivational interviewing is a person-centered counselling method that involves enhancing a patient’s intrinsic motivation to change by means of five guiding principles, represented by the acronym READS:
Roll with resistance
Express empathy
Avoid argumentation
Develop discrepancy
Support self-efficacy
Roll with resistance: At one point or another we’ve all made an excuse like, “Just one more – we’re celebrating tonight,” or negotiated with ourselves, “I’ll stop smoking tomorrow.” These are just a couple examples of resistance. Confronting these resistances will create additional barriers, thus in motivational interviewing, roll with the resistance. Resistance is a legitimate concern because it is predicative of poor treatment outcomes and lacks involvement from the patient. This behavior may signal that the patient views the situation differently and may not believe or accept information that has been presented and needs more time exploring the reason behind the resistance.
Express empathy and avoid argumentation: They say you catch more flies with honey than vinegar. Understanding and expressing empathy is crucial to establishing and maintaining a rapport in the patient-physician relationship. The basis of motivational interviewing is reflective listening and an attitude of acceptance of the patient’s feelings and perspectives. Try to understand the patient’s perception, although this does not mean that you have to agree with it.
Develop discrepancy: The patient needs two things: (1) to set obtainable goals to work towards and (2) to be aware their current situation has consequences. The physician can help the patient understand the difference between their behavior and their personal goals. Discrepancy is amplified between where The patient is currently and where they want to be.
Support self-efficacy: It’s as simple as believing, I can do this. Self-efficacy is believing in the possibility of change and is an important motivator. It gives the patient belief or confidence in their ability to take responsibility to carry out personal change. Understanding the patient’s strength and setting small reasonable, obtainable goals that the patient can accomplish is crucial and will help build confidence.
Applying the principles of motivational interviewing to everyday patient interactions has been proven effective in eliciting “behavior change.
Specifically, we look at beliefs that drive behavior, determine where shifts need to occur, and develop an experience that will disrupt those beliefs and cause these needed shifts.
Source: Facilitating Behavior Change. Adult Meducation, pgs: 58-64.
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