NASM CNC Chapter 16: Motivational Interviewing

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Chapter Goals:

  • Discuss motivational interviewing.
  • Know the role that ambivalence plays in behaviors.
  • Discuss the five strategies that there are usually for motivational interviewing.
  • Do the techniques for motivational interviewing with your clients.

Introduction to Motivational Interviewing

Changing someone’s habits is not easy to do. Even when we do not see change, it is easy to return to our old habits. 

Motivational Interviewing is an approach that focuses on the client and helps resolve any ambivalence; its goal is to elicit some change. 

Ambivalence is the state of having feelings that are mixed regarding the change. Clients that have ambivalence want the change, but at the same time, they do not want it. 

Why Change at All?

Many people know the dangers to their health that come from being overweight or obese. 

Proximal rewards are the rewards that are very close, like eating foods high in sugar or high in fat. 

Distal rewards are the rewards that are further away, like maybe losing 40 pounds.

The motivational phase is the build-up of mental energy that will drive a desire to behave a particular way.

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In the planning phase, people will decide how they turn their motivation into behaviors.

It usually goes from the motivation stage to the planning stage and then lastly to the action stage. 

What is Motivation?

Motivation is best defined as the collective reason for which someone is driven to action. Motivation directly relates to planning and the execution of those plans. 

Motivational Foundations

Motivational interviewing is set to enhance the client’s intrinsic motivation for change by exploring and resolving ambivalence. 

Self-determination theory is a theory of motivation that describes people’s needs for growth. It also describes many types of motivation regulation, which are considered anywhere on the motivation continuum to intrinsic motivation. It can lie on the continuum anywhere from motivation, to extrinsic, to intrinsic motivation. 

Motivation is a state in which someone is not motivated to behave.

Extrinsic motivation is when a behavior is done for some reason outside of the person’s inherent pleasure.

Intrinsic motivation is the opposite of extrinsic motivation, where behavior is directed by personal satisfaction like enjoyment and striving for self-determination and competence. 

Controlled motives are those that are outside of internal pressure to do particular behaviors.

Autonomous motives are the behaviors that are brought up with a sense of volition and choice. People that are autonomously motivated will want to do the behavior. 

External regulation says that behavior is done to achieve external rewards or avoid the punishment of some kind. It reflects complying with the demands of other people.

Introjected Regulation is the behavior done to avoid negative feelings and enhance positive ones. 

Identified regulation is a behavior done because it is valued and personally important.

Integrated regulation is a behavior that is fully congruent with someone’s values and needs. 

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Motivational Interviewing

This is less about specific techniques and more about the mindset it is based on. You need to have a partnership with your clients. 

Unconditional positive regard is what coaches need to provide for their clients. This is giving support to clients regardless of what someone says or does. The belief that your client is doing their absolute best even if you see some destructive behaviors. 

Autonomy is feeling freedom from outside controls. The person is seen to be the source of their own behavior.  

Ambivalence is what someone experiences when they are competing demands between desirable behaviors. Change talk is when the client voices the benefits and disadvantages of staying the same.

Value and Goal Exploration 

Value exploration is when clients discover why the goal is important to them. They make specific behavior-oriented goals that are based on their own values.

Value prioritization is when values are behaviors that are prioritized and linked with their own sense of some desired identity.

Motivational Interviewing Strategies

First, you must express empathy through the use of reflective listening.

Next, we see helping clients find discrepancies in their values or goals.

Support self-efficacy for the clients.

Avoid any argument with a client.

Adjust to the forms of client resistance that you encounter. 

Express Empathy

Accurate use of empathy sees reflective listening as that clarifies and expresses the knowledge of someone’s own experience, goals, and personal meanings of the goals. The last chapter covered reflective listening, but to summarize, this is the ability of the coach to interpret a client’s thoughts and feelings. 

The first concept of using actual empathy is known as fundamental attribution error. This is when a person’s behavior is attributed to how they are instead of external factors. The opposite of this concept is called unconditional positive regard, which is more self-explanatory.

Empathetic listening is accomplished when a coach respects and accepts their client, does not judge the client, gives sincere and real compliments, and gives unconditional support.

Identify Discrepancies

Identifying discrepancies is part of a feedback loop. People have this ideal version of themselves that is their ideal comparator. People take information regarding the current person they are and if a discrepancy is seen between the current version and the ideal version, then they do behaviors to reduce this discrepancy that exists.

When a client’s situation is known from the right empathetic listening, then they are freer to change. Just understanding a client alone does not drive action. 

Supporting Self-Efficacy

Self-efficacy is a person’s confidence to complete a behavior needed for some specific outcome. 

We usually use four things to enhance self-efficacy:

  • Performance accomplishments
  • Vicarious experience
  • Verbal persuasion
  • Physiological states

Affirmation is a positive statement about a client’s character acknowledging their efforts.

Avoid Arguments and Adjust to Client Resistance

Nutrition coaches are better off not arguing with clients as this can cause someone to get defensive. Change talk is better implemented and is the opposite of resistance. 

Stages of Change and Motivational Interviewing

This was discussed in a previous chapter, but this is called the stages of change model. This includes pre-contemplation, contemplation, preparation, action, maintenance, and relapse. This is a behavioral change model that shows the progression of someone through stages as something becomes a part of their everyday lifestyle. 

Tailoring Interventions to a Client’s Readiness

Motivational interviewing and the stages of change were developed separately. 

Accepting the stage of change as part of motivational interviewing is unnecessary, but they can be effective together. 

NASM CNC Chapter 16: Motivational Interviewing 4
NASM CNC Chapter 16: Motivational Interviewing 5
NASM CNC Chapter 16: Motivational Interviewing 6
Tyler Read - Certified Personal Trainer with PTPioneer

Tyler Read


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