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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 go right back to the old habits we have. 

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

    Ambivalence is the state of having feelings that are mixed regarding 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 comes 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 is going to drive a desire for behaving a particular way.

    The planning phase is where 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 an action. Motivation directly relates to planning and the execution of those plans. 

    Motivational Foundations

    Motivational interviewing is set to enhance the clients’ intrinsic motivation for changing by exploring and resolving ambivalence. 

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

    Amotivation is a state where someone is not motivated to behave.

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

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

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

    Autonomous motive 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 in order to achieve external reward or avoid a punishment of some kind. It reflects complying with the demands of other people.

    Introjected Regulation is the behavior done to avoid any negative feelings for the enhancement of positive feelings. 

    Identified regulation is a behavior done due to it being valued and personally important.

    Integrated regulation is a behavior done to be fully congruent with someone’s values and needs. 

    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 the 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 of change and disadvantages of staying the same.

    Value and Goal Exploration 

    Value exploration is when clients find why the goal is actually important for 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 their discrepancies that are in their values or goals.

    Support self-efficacy for the clients.

    Avoid any kind of argument with a client.

    Adjust to the forms of client resistance that you encounter. 

    Express Empathy

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    Accurate use of empathy sees reflective listening being used 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 for 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 to 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 the confidence a person has that they are able to complete a behavior needed for some specific outcome. 

    We usually use four things in order to enhance self-efficacy:

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

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

    Avoid Arguments and Adjust to Client Resistance

    Nutrition coaches are better off not entering into arguments 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 to summarize, 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 separate. 

    It is not necessary to accept the stage of change as part of motivational interviewing, but they can be effective together. 

    NASM CNC Chapter 16: Motivational Interviewing 1
    NASM CNC Chapter 16: Motivational Interviewing 2
    NASM CNC Chapter 16: Motivational Interviewing 3

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