Primary author: __Laura Kester

Motivational Interviewing

Motivational interviewing (MI) is a means of behavioral intervention that utilizes a directive, individual-focused approach to explore and resolve conflicting feelings that inhibit behavior change (Apodaca & Longabaugh, 2009, p.705). Traditional techniques of inducing behavior change have been based on the concept that educating individuals would result in behavior changes. With this in mind, numerous efforts of behavioral intervention have been created that focus on the dispersal of information. However, in contrast, we now recognize that behavior is a complex product that evolves through the interaction of underlying beliefs/values, cost-benefit ratio, barriers, perception of self-efficacy, internal motivation and external reinforcement (Bundy, 2004, p. 43). Preceding the expansion of the focus on motivation, there were several theories that were created to illicit behavior change. Each of these theories, including “Social learning theory, the Health Belief Model, the Theory of Reasoned Action, the Trantheoretical Model, and the Precaution Adoption Model” (Emmons & Rollnick, 2001 p. 68) recognized the significance of motivation within their constructs. Recognizing the fundamental necessity in both achieving and maintaining behavior change, motivational interviewing was created in the 1983 by William Miller and Stephen Rollnick as a means of creating changes that begin from within the individual. It arose out of the foundation of Carl Rogers’ work on non-directive counseling and was initially developed for the counseling of alcoholism (Rubak, Sandbaek, Lauritzen, &Christensen, 2005, p. 305). It later became diversified and utilized to address a variety of public health concerns. In an article by Rubak et al, MI was found to “outperform traditional advice giving in approximately 80% of the studies (2005, p. 309)”. Since its creation it has been applied to many healthcare settings including, the public heath setting.

The success of MI lies in the understanding of the Transtheoretical model, which recognizes that changes in behavior occur through a progression of a stage model that can result in success, relapse, or somewhere in between. It is a cycle that allows for self-renewal. The transtheoretical model looks at behavior change as a 6-stage progression that begins with an individual in pre-contemplation and evolves through contemplation, preparation, action maintenance, and termination (Suarez & Mullins, 2008, p. 418). Recognition of these stages is pivotal to MI, where the provider must recognize which stage an individual is in and evolve through the stages with them, respecting the individual’s autonomy, regardless of whether or not the provider agrees with their decisions (Suarez & Mullins, 2008, p. 419).

The concept of MI is carried out through several steps: (1) educing the individual’s motivation to change by allowing them to evaluate their personal value system/aspirations in a manner that produces a desire for behavior change, and (2) allowing the individual to communicate their ambivalence and subsequently assisting them in creating a suitable conclusion of their conflict (Rollnick & Miller, 1995, p. 325). In order to produce this environment it is necessary that the individual providing the motivational interview conveys compassion, avoids conflict, supports the individual’s sense of ability to change, responds flexibly to resistance while gently challenging the individual by questioning and seeking clarification/elaboration, and ultimately helps draw attention to discrepancies via recognition of where the individual is and where they would like to be (Bundy, 2004 p. 44).

The difficulty with implementing MI into a public health setting is that it is an individualized method that would need to be utilized for a larger population. In order to do such, it requires that the public health community generalize their interventions enough to reach larger populations, but not so large that it loses the benefit of the individualized concept. This was discussed in a paper by Emmons & Rollnick where they emphasize the importance of pilot work with target groups (2001, p. 73) in order to be successful. This has also been addressed in a variety of attempts to create briefer models of the intervention that can more easily to utilized in short-lived interactions varying from 5-10 minutes for behaviors such as smoking and drinking with varied interactions approaches, including in person or over-the-phone (Emmons & Rollnick, 2001 p. 70). This briefer model allows for many opportunities in public health where an individualized approach can be used and there is still the opportunity to reach several individuals.

There are various other areas that have utilized MI, including “alcohol abuse, drug addiction, [psychiatric diagnosis], smoking cessation, weight loss, adherence to treatment and follow-up, increasing physical activity, and in the treatment of asthma and diabetes” (Ruba et al., 2005, p. 306). The benefit that MI has when compared to other interventions is its non-confrontational nature, that allows intervention without making individuals feel threatened or looked down upon. In a study done in 2010 looking at MI in relation to safe sex for individuals with HIV it was found that the participants appreciated the non-judgmental approach of MI and felt that it provided them with an opportunity they normally did not find in counseling sessions making them more interested and willing to participate (Golin, David, Przybyla, Fowler, Parker, Earp, Quinlivan, Kalichman, Patel, Grodensky, 2010, p. 242). It is this aspect of MI that allows interventions to meet participants where they are and allows them to progress at their own pace that makes MI such a powerful tool that has great potential in. future public health interventions.

References:

1. Apodaca TR & Longabaugh R. (2009). Mechanisms of change in motivational interviewing: a review and preliminary evaluation of the evidence. Addiction, 104, 705-715.
2. Bundy C. (2004). Changing behavior: using motivational interviewing techniques. Journal of Royal Society of Medicine, 44, 43-47
3. Rubak S, Sandbaek A, Lauritzen T, & Christensen B. (2005). Motivational Interviewing: a systematic review and meta-analysis. British Journal of General Practice, 55, 305-312
4. Emmons KM & Rollnick S. (2001). Motivational Interviewing in the Health Care Settings: Opportunities and Limitations. American Journal of Preventative Medicine, 20 (1), 68-74
5. Suarez M & Mullins S. (2008). Motivational Interviewing and Pediatric Health Behavior Interventions. Journal of Developmental & Behavioral Pediatrics, 29, 417-428.
6. Rollnick S. & Miller W.R. What is Motivational Interviewing? Behavioral and Cognitive Psychotherapy, 23, 325-334.
7. Golin CE, Davis RA, Przybyla SM, Fowler B, Parker S, Earp JA, Quinlivan EB, Kalichman SC, Patel SN, Grodensky CA. (2010). SafeTalk, a Multicomponent, Motivational Interviewing-Based, Safer Sex Counseling Program for People Living with HIV/AIDS: A Qualitative Assessment of Patient Views AIDS Patients Care and STDs, 24, 237-245