47% of Australians have had at least one chronic disease. We know very well that many of these diseases, including substance use disorders, are attributed to modifiable lifestyle factors. These factors include the 3Fs and 3Ss:
However, promoting health behaviour change is not an easy feat. One of the commonly used techniques apart from Cognitive Behaviour Therapy (CBT) is Motivational Interviewing (MI)
This week Julie Schulz and I discuss Motivational Interviewing (MI).
MI is essentially a client-centred counselling process that results in change through resolving 'ambivalence'.
But firstly, what is 'ambivalence'?
Before we explore the concept of ambivalence, one must understand the Stages of Change / the Transtheoretical Model that was described by Prochaska and DiClemente in the 1980s. When we are faced with the idea of change, this sets off a dynamic process within an individual as illustrated below
'Ambivalence', therefore, is a state of conflict that occurs in an individual when in the 'contemplative' stage. For example, Mrs.P wants to give up drinking for its detrimental effects on health however when she works through the pros and cons of quitting, she realises the restriction that it may have on her social outings thus resulting in a state of 'ambivalence '. This is not uncommon and working through this state of ambivalence is where MI is extremely useful.
A health coach, psychologist and/or doctors who specialise in Lifestyle Medicine can assist with this.
The key factor here is to also recognise that relapse is not a sign of 'failure'. It is an expected stage of change as depicted above. Reflection is then utilised to work through the causes of relapse and the potential barriers that may prevent an individual to continue making the necessary changes in their life. As with many psychological therapies, the client is the driving force in these sessions hence there is no loss of control.
We also acknowledge that there are several other ways to promote behaviour change but MI is certainly one that has been supported by good evidence.
Author: Dr Saveena Nithiananthan MBBS, FRACGP, IBLM
Savena is a General Practitioner, Medical Educator and member of the International Board of Lifestyle Medicine