Motivational Interviewing Paper

Motivational Interviewing Paper

Motivational Interviewing Paper

Abstract
Healthcare providers face challenges in promoting people’s health behaviors and addressing risky lifestyle choices due to patients’ indecisiveness, unwillingness to change, and limited awareness of the potential consequences of risky behaviors, including sedentary lifestyles and substance use. In psychology, unhealthy behaviors like cigarette smoking and substance use are primary predictors and risk factors for multiple behavioral disorders like addiction and borderline personality disorder (BPD). William Miller conceptualized motivational interviewing (MI) in 1983 as an ideal approach for exploring and addressing ambivalence in patients with substance use disorders. MI is consistent with the five steps of change proposed by the transtheoretical model (TTM): pre-contemplation, contemplation, preparation, action, and substance/maintenance. As a behavioral change model, motivational interviewing (MI) emphasizes four processes of improving an individual’s intrinsic motivation to change: engaging, focusing, evoking, and planning. Amidst the success of this care modality in facilitating behavioral change in people with behavioral disorders, Miller and Stephen Rollnick updated MI in 2013 to promote healthy behaviors and lifestyle choices to address other healthcare concerns, including obesity, diabetes mellitus, cardiovascular diseases (CVDs), cancer, and respiratory complications associated with behavioral risk factors.
Keywords: ambivalence, motivational interviewing, transtheoretical model, behavioral disorders, pre-contemplation, contemplation, evoking, healthy behaviors and lifestyle choices, intrinsic motivation.

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Motivational Interviewing
Healthcare professionals have a responsibility to improve patient outcomes by involving them in care delivery processes, and decision-making, and cultivating intrinsic motivation to change. In patients with behavioral and mental disorders like substance abuse disorder and addiction, ambivalence is a profound aspect that affects adherence to medical and non-pharmacologic interventions, as well as compromises individual preparedness to change. Consequently, psychologists should implement care modalities that promote intrinsic motivation to comply with goal-related behavior and actions.
Motivational interviewing (MI) is an evidence-based care model which focuses on strengthening the patient’s involvement in care processes and the promotion of healthy behaviors by resolving ambivalence and improving intrinsic motivation to change. According to Dobber et al. (2019), motivational interviewing is “a collaborative conversation style for strengthening a person’s motivation and commitment to change” (p. 2). It emphasizes various personalized approaches for deliberately igniting and sustaining patients’ commitment to achieving the desired outcomes, including relationship building, understanding patients’ change goals, eliciting change talks, and supporting patients to develop flexible plans for change implementation and sustenance. Amidst the need to promote patient autonomy and involvement in care delivery, this paper provides an overview of motivational interviewing as a care modality, its theory and practice techniques, and research that evaluates its effectiveness with various major disorders, including schizophrenia and substance use disorders.
An Overview of Motivational Interviewing as a Care Delivery Modality
Risky behaviors, such as smoking, physical inactivity, unhealthy eating patterns, and substance abuse are the primary causes of increased mortality and morbidity across populations. Healthcare professionals face challenges in addressing risky behaviors and activities because they are inseparable from individual motivations and willingness to change. According to Frost et al. (2018), healthcare professionals should implement sustained behavioral change strategies to motivate individuals to accommodate and practice healthy behaviors and actions, as well as address the ambivalence problem. In this sense, ambivalence is the presence of simultaneous, positive, and negative attitudes toward a process or an outcome (Chilton et al., 2018). For example, people struggling with substance use disorders may have positive perceptions regarding cessation programs and interventions. However, their commitment may be hampered by the perceptions of the imminent side effects of medications and the potential consequences of substance use cessation. As a result, healthcare professionals should emphasize a care delivery modality that analyzes and resolves ambivalence.
William Miller conceptualized motivational interviewing (MI) in 1983 as a profound care delivery modality for helping people grappling with substance use disorders, such as addiction change their behavior. In 2013, Miller and Rollnick updated motivational interviewing to ensure its consistency with the overarching need to promote healthy behaviors, including physical activity, healthy diets, and medication adherence. According to Arbuckle et al. (2021), motivational interviewing is a personalized counseling approach that promotes behavioral change by resolving ambivalence, capitalizing and strengthening intrinsic motivation, and improving individual preparedness for changes. The primary tenet of this care modality is the perception that an empathic counseling style is highly likely to facilitate change and positive outcomes than confrontational approaches (Arbuckle et al., 2021). Also, motivational interviewing focuses on the plausibility of promoting positive health outcomes and healthy behaviors by complying with the bioethical principle of individual autonomy and self-determinism, where care recipients participate in decision-making processes and influence care delivery trajectories.
Motivational interviewing (MI) focuses on promoting behavioral change by prompting healthcare providers to blend fundamental patient-centered skills, including active listening, emotional intelligence, and empathy with evidence-based motivational methods, such as improved patient involvement, change talks, and supporting patient change goals (Martino et al., 2019). Another profound element of motivational interviewing (MI) that facilitates individual change is patient education. When partnering with patients grappling with behavioral and mental disorders and health concerns, it is essential to consider health illiteracy and limited access to information as essential health determinants. As a result, continuing patient education can improve individual awareness of the potential consequences of risky behaviors and the importance of healthy behaviors, including medication adherence, substance use cessation, and physical activity in improving health and wellness.
Theory and Practice Techniques for Motivational Interviewing
Theoretical Underpinnings of Motivational Interviewing
In 1983, William Miller developed motivational interviewing as a model for facilitating behavioral change, especially in people struggling with substance use disorders like addiction. However, this theoretical model has significantly evolved to accommodate other healthcare issues, including the prevention of chronic diseases associated with unhealthy diets and sedentary lifestyles. As a model for promoting behavioral change, motivational interviewing (MI) is a profound component of the broader transtheoretical model (TTM). Hashemzadeh et al. (2019) argue that the transtheoretical model of behavioral change states that the process of transforming people’s behavior entails planned steps rather than a coincidence. In this sense, people demonstrate varied levels of readiness for change and are in different stages of change. Hashemzadeh et al. (2019) provide the five stages of change consistent with the transtheoretical model (TTM): pre-contemplation, contemplation, preparation, action, and substance/maintenance.
During the pre-contemplation stage, people have no or limited knowledge of the underlying risky behaviors and are unwilling, and unprepared to change. Also, they are resistant, unmotivated, and unwilling to change the status quo. Raihan & Cogburn (2023) recommend healthcare professionals implement consciousness-raising therapy at the pre-contemplation stage to improve people’s awareness of the actual and potential consequences of risky behaviors as well as prepare them to change.
In the second stage (contemplation), people are aware of the imminent threats associated with risky behaviors and are seriously considering change as an ideal strategy for alleviating adverse ramifications and promoting their health and wellness. However, ambivalence and indecisiveness pose significant challenges to people who are contemplating behavioral change (Raihan & Cogburn, 2023). At this point, chronic contemplation and behavioral procrastination are possible outcomes if effective preparation, actions, and sustenance mechanisms are lacking or insufficient. Total abstinence from risky behaviors, development of short-term goals accompanied by reward-based positive reinforcement, ongoing patient education, and the improvement of patient’s self-efficacy are the recommended interventions for preventing behavioral procrastination and ensuring change sustenance (Raihan & Cogburn, 2023). Motivational interviewing aligns and supports these stages of behavioral change proposed by the transtheoretical model (TTM).
Practice Techniques for Motivational Interviewing
As a profound component of the transtheoretical model (TTM), motivational interviewing (MI) encourages interpersonal collaboration between healthcare providers and clients with multiple behavioral and mental disorders. According to Frost et al. (2018), this care modality explores and solves ambivalence and indecisiveness through four overlapping steps: engaging in meaningful working relationships, focusing on the problem, evoking the individual desire to change, and planning for change. Firstly, engaging in meaningful working relationships is a multifactorial process that requires effective communication skills and mechanisms for establishing rapport with clients and obtaining buy-in from care recipients. Arbuckle et al. (2020) contend that healthcare professionals should assess patients’ readiness and address barriers to change, including ambivalence, indecisiveness, and behavioral procrastination. Also, they should focus on building coalitions, establishing consensus discussions, and supporting interactive problem-solving and decision-making processes.
Secondly, healthcare professionals should evoke and sustain people’s desire to change by educating them about the actual and potential consequences of risky behaviors and providing information on the recommended strategies for abstinence. When educating clients about the detrimental health effects of risky behaviors and lifestyle choices, personalized communication models and skills are fundamental. Dobber et al. (2020) recommend multifactorial interventions for evoking and maintaining the individual desire to change: supporting self-esteem, demonstrating empathy, ensuring the patient’s autonomy, developing a safe environment for in-depth self-exploration, influencing the patient’s sense-making, and effectively establishing and communicating desired goals. Further, utilizing the decisional balance strategy can evoke patients’ desire to change by enabling them to establish trade-offs between the pros and cons of adopting healthy behaviors.
Finally, the change planning phase requires in-depth discussion and collaboration between care providers and patients. It is crucial to note that the primary focus of motivational interviewing is to explore and address ambivalence and indecisiveness that compromise behavioral change. Consequently, proper planning is essential to prevent behavioral procrastination and chronic contemplation. According to Dobber et al. (2020), the planning phase entails an in-depth discussion about potential barriers to behavioral change, identifying an effective plan of action, and supporting the patient during the change process. Proper affirmation, ongoing education, and coordination are requisites for proper change planning and implementation.
Research Evaluating Motivational Interviewing’s Effectiveness in Major Disorders
The current scholarly literature supports the application of motivational interviewing (MI) as an effective care modality for addressing behavioral disorders and improving outcomes of patients with various degenerative disorders, including schizophrenia. In a mixed-methods study, Dobber et al. (2020) explore the clinical factors employed by motivational interviewing (MI) therapists in promoting outcomes of schizophrenia patients. According to the researchers, non-adherence to antipsychotic drug treatment affects about 42% to 74% of schizophrenia patients. Often, patients feel ambivalent about medication adherence and face indecisiveness due to the perceptions of imminent side effects associated with antipsychotic drugs for schizophrenia (Dobber et al., 2020). For example, burdensome side effects of these drugs include sedation and weight gain. To explore and address ambivalence, healthcare professionals rely massively upon motivational interviewing to elicit change, develop partnerships with schizophrenia patients, support patients’ change goals, and help them in implementing change plans.
Another aspect that contributes to the effectiveness of motivational interviewing (MI) in improving adherence to antipsychotic drugs is the significant role of patient education. According to Harmanci et al. (2021), psychoeducation based on motivational interviewing contribute to medication adherence, the promotion of self-efficacy, hope, and psychological well-being. The effectiveness of psychoeducation relies massively upon communication skills, engagement levels, and effective planning. Examples of appropriate communication skills that promote psychoeducation are empathy, active listening, and emotional intelligence.
Similarly, motivational interviewing can significantly facilitate behavioral change among people with behavioral disorders, including substance use disorder. In a randomized clinical trial (RCT), Oveisi et al. (2020) investigate the effectiveness of motivational interviewing (MI) for women in treatment for drug use in Iran. According to the researchers, motivational interviewing supports the implementation of the transtheoretical model (TTM) that emphasizes individual readiness to change. The primary tenets of MI include eliciting self-motivational statements, personalized feedback, reflective and active listening, and establishing partnerships with patients (Oveisi et al.,2020). Further, this care modality discourages confrontational approaches to interpersonal communication and focuses on promoting patient self-efficacy. The study revealed consistent findings on the effectiveness of motivational interviewing in decreasing the desire to engage in substance abuse and the subsequent improvement of self-efficacy (Oveisi et al., 2020). These findings support the rationale and plausibility of improving patient outcomes by igniting their intrinsic motivation, addressing ambivalence, and strengthening their responsibility for behavioral change.
Conclusion
Patients have a significant role in spearheading behavioral change and promoting healthy behaviors and acts. However, they may lack adequate information, awareness, and motivation to facilitate change. Equally, they may grapple with ambivalence and indecisiveness that affect their willingness to change. Healthcare professionals have a professional and ethical obligation to evoke intrinsic motivation and support patients’ change goals. Motivational interviewing (MI) is a profound care delivery modality that requires care providers to engage patients in care delivery processes, focus on the issues compromising change, evoke intrinsic motivation, and plan effectively before implementing change interventions. By applying motivational interviewing, healthcare professionals can demonstrate effective communication skills, educate patients, and assess their self-efficacy. Based on the success of motivational interviewing in promoting behavioral change, Miller and Rollnick updated it in 2013 to promote patient outcomes and address behavioral risk factors for other healthcare issues, such as chronic conditions.

References
Arbuckle, M. R., Foster, F. P., Talley, R. M., Covell, N. H., & Essock, S. M. (2020). Applying motivational interviewing strategies to enhance organizational readiness and facilitate implementation efforts. Quality Management in Health Care, 29(1), 1–6. https://doi.org/10.1097/qmh.0000000000000234
Chilton, J. A., Rasmus, M. L., Lytton, J., Kaplan, C. D., Jones, L. A., & Hurd, T. C. (2018). Ambivalence: A key to clinical trial participation? Frontiers in Oncology, 8. https://doi.org/10.3389/fonc.2018.00300
Dobber, J., Latour, C., van Meijel, B., ter Riet, G., Barkhof, E., Peters, R., Scholte op Reimer, W., & de Haan, L. (2020). Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient-therapist interaction in patients with schizophrenia. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.00078
Frey, A. J., Lee, J., Small, J. W., Sibley, M., Owens, J. S., Skidmore, B., Johnson, L., Bradshaw, C. P., & Moyers, T. B. (2020). Mechanisms of motivational interviewing: A conceptual framework to guide practice and research. Prevention Science, 22. https://doi.org/10.1007/s11121-020-01139-x
Frost, H., Campbell, P., Maxwell, M., O’Carroll, R. E., Dombrowski, S. U., Williams, B., Cheyne, H., Coles, E., & Pollock, A. (2018). Effectiveness of motivational interviewing on adult behaviour change in health and social care settings: A systematic review of reviews. PLOS ONE, 13(10), 1–39. https://doi.org/10.1371/journal.pone.0204890
Harmanci, P., & Budak, F. K. (2021). The effect of psychoeducation based on motivational interview techniques on medication adherence, hope, and psychological well-being in schizophrenia patients. Clinical Nursing Research, 31(2), 105477382110464. https://doi.org/10.1177/10547738211046438
Martino, S., Zimbrean, P., Forray, A., Kaufman, J. S., Desan, P. H., Olmstead, T. A., Gilstad-Hayden, K., Gueorguieva, R., & Yonkers, K. A. (2019). Implementing motivational interviewing for substance misuse on medical inpatient units: A randomized controlled trial. Journal of General Internal Medicine, 34(11), 2520–2529. https://doi.org/10.1007/s11606-019-05257-3
Oveisi, S., Stein, L. A. R., Babaeepour, E., & Araban, M. (2020). The impact of motivational interviewing on relapse to substance use among women in Iran: A randomized clinical trial. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02561-9
Rahimi, A., Hashemzadeh, M., Zare-Farashbandi, F., Alavi-Naeini, A., & Daei, A. (2019). Transtheoretical model of health behavioral change: A systematic review. Iranian Journal of Nursing and Midwifery Research, 24(2), 83–90. https://doi.org/10.4103/ijnmr.ijnmr_94_17
Raihan, N., & Cogburn, M. (2023). Stages of change theory. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK556005/

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Each student will be required to write a 7–10-page (excluding Title page, Abstract, and Reference page) APA style paper on a clinical  modality of their choosing.  The paper will include an
overview of the modality, its theory and practice technique, and a section on research evaluating its effectiveness with at least one major disorder. You cannot use the research articles assigned in
the weekly readings. This assignment will be graded using the Grading Rubric for Graduate Written Assignments.
Topic: Motivational interviewing