Assess priorities, confidence to change behavior.
Behavioral change is unlikely if patients view the change as unimportant and are not confident that they can make the change, noted Dr. Rosengren, a clinical psychologist at the University of Washington, Seattle.
He focused on health behaviors related to diabetes, such as controlling weight or hemoglobin [A.sub.1c] levels, but he described a technique that is applicable to any health-related behavior.
The technique first involves asking the patient to rate the importance of the change on a scale of 0-10. No matter what the patient's answer, ask him or her, "Why did you pick that number and not a lower number?" and "What would it take to give it a higher number?"
In answering, the patient is forced to articulate in his or her own words the importance of change. Studies of motivational interviewing have shown that patients are much more likely to make a change when they articulate those reasons.
The case isn't hopeless even if a patient says the importance of change is zero. The physician should then ask, "Why is this something that you don't want to spend time on now?" or "If it's a zero now, has it ever been higher than this for you?" If the patient says that it was higher a few months back, one can explore what was going on at that time. A third response is to have the patient project into the future. "If it's a zero now, what would need to happen for it to look like a three or a four?"
After exploring the patient's perceived importance of change, ask, "If you decided to make the change, how confident are you (on a 0-10 scale) that you would succeed?" It's important to use that conditional language, because you don't want the patient fighting against the idea that the change must occur right now. Once again, ask why the patient chose a certain number and not a lower number and what it would take to have a higher confidence rating.
If the physician is fortunate enough to have a patient who rates both importance and confidence highly, the time has come to make a specific plan for the change. But making specific plans can be futile if the patient rates low in importance, confidence, or both.
A key concept in any motivational interview is that patients are unlikely to change their behavior unless they are ready to change. If physicians do things to create resistance, patients become even less likely to change their behavior.
More information and other techniques can be found at www.motivationalinterview.org.
BY ROBERT FINN
San Francisco Bureau
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|Title Annotation:||Adult Psychiatry|
|Publication:||Clinical Psychiatry News|
|Date:||Apr 1, 2004|
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