Motivational Interviewing

Question 1

What are the 5 stages in Prochaska & DiClemente’s model of behavior change? Briefly describe each stage.

Answer 1

Precontemplation (i.e., person does not recognize problem, or denies it)
Contemplation (i.e., person is thinking about change, but is ambivalent and not yet ready; weighs pros/ cons)
Preparation (i.e., person is ready and/ or planning to take small steps to change)
Action (i.e., person is actively engaging in new behavior)
Maintenance (i.e., person has achieved change and is trying to sustain it)

Question 2

Which stages benefit most from MI to resolve ambivalence?

Answer 2

Precontemplation and Contemplation

Question 3

The “Spirit” of MI is described as what four qualities?

Answer 3

Collaborative, Evocative (i.e., drawing out a person’s motivations, not imposing them), Autonomy (i.e., change is a person’s choice), Compassion/ Acceptance

Question 4

Why is MI called “client-centered and semi-directive”?

Answer 4

Because it helps resolve ambivalence by drawing out the patient’s own motivations while still guiding toward change

Question 5

According to the spirit of MI, who should do most of the talking?

Answer 5

The patient

Question 6

What is the “righting reflex”?

Answer 6

The clinician’s instinct to fix or correct the patient’s behavior by directing them to a “better” choice

Question 7

Why is the righting reflex considered “anti-MI”? What does the righting reflex make more difficult to resolve in the patient?

Answer 7

Because it provokes defensiveness, produces “sustain talk,” and results in “Yes, but…” responses; Ambivalence

Question 8

What three things should clinicians do instead of giving in to the righting reflex?

Answer 8

Evoke the patient’s own reasons for change, reflect, and respect their autonomy

Question 9

What are the four stages of Motivational Interviewing? (EFEP) Briefly describe each stage.

Answer 9

Engaging (i.e., build rapport by agenda setting, asking permission)
Focusing (i.e., identify primary patient concern; use “elicit-provide-elicit” technique to acquire information)
Evoking (i.e., draw out patient’s motivation for change; use OARS to elicit DARN CT)
Planning (i.e., co create specific, measurable goals; discuss concrete steps to reach goals)

Question 10

What is “change talk”?

Answer 10

Language arguing for change (e.g., includes desire, ability, reasons, need, and/ or the commitment and steps a person has to taken to make a change – DARN CT)
Q: What is “sustain talk”?

Question 11

What is “sustain talk”?

Answer 11

Language supporting the status quo (i.e., includes desire, reasons, and/ or commitment to stay the same)

Question 12

Give one example of change talk and one of sustain talk.

Answer 12

Change talk: “I want to quit smoking”; Sustain talk: “I like how smoking relaxes me”

Question 13

What does DARN CT stand for? What does OARS stand for? What is each one used for?

Answer 13

Desire, Ability, Reasons, Need, Commitment, Steps Taken
Open Ended Questions, Affirmations, Reflective Listening, Summarizing
DARN CT describes the features of “change talk”; OARS describes a set of skills to be used by the physician during motivational interview to evoke “change talk”