How to make exercise changes stick using behavioural change theory with Dr Tim Anstiss. EP#550
Apr 16, 2024
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Dr. Tim Anstiss, a medical doctor specializing in behavior change, explains key behavior change theory and motivational interviewing concepts in this podcast. Topics include improving healthcare professionals' communication on physical activity, exploring motivational interviewing and behavior change, empowering patients through conversation, empathetic listening in clinical practice, and tips for improving motivational interviewing skills in physical activity.
Adopt person-centered style for discussing physical activity with patients to avoid common traps like over-assessment and rushing into planning.
Motivational interviewing focuses on exploring individual motivations for change, originating in drug and alcohol fields to guide individuals through stages of change.
Motivation and confidence play crucial roles in behavior change, with MI emphasizing intrinsic motivation and self-efficacy through techniques like scaling questions.
Enhance consultations by employing micro skills like open questions, affirmations, reflections, and behavior change techniques such as decisional balance and scaling questions for sustained motivation.
Deep dives
Approaching Healthcare Professionals on Physical Activity
Healthcare professionals often lack practical skills for discussing physical activity with patients, falling into traps like over-assessing, using the 'yes but' approach, and rushing into planning. It's crucial to adopt a person-centered conversational style, focusing on drawing out the patient's reasons for change rather than imposing advice. Avoiding the 'expert trap' and understanding the stages of change model help tailor conversations to the patient's readiness.
Motivational Interviewing and Behavior Change
Motivational interviewing (MI) emphasizes a person-centered approach, helping individuals explore their own motivations for change. Unlike cognitive-behavioral therapy (CBT), MI focuses on resolving ambivalence and guiding individuals through the stages of change. MI originated in drug and alcohol fields, encouraging self-motivating statements to drive behavior change.
Enhancing Motivation and Confidence
Motivation and confidence are crucial in behavior change. MI addresses ambivalence and aids individuals in exploring their mixed feelings about change. By using scaling questions to assess importance and confidence levels, clinicians can tailor support to individuals at different stages of change. MI emphasizes building intrinsic motivation and self-efficacy for sustained change.
Practical Skills and Techniques for Clinicians
Clinicians can enhance consultations by employing micro skills like asking open questions, offering affirmations, providing reflections, and summarizing key points. Behavior change techniques like decisional balance, exploring two possible futures, and employing scaling questions aid in enhancing motivation and commitment. Self-monitoring, goal setting, and follow-up discussions further support sustained behavior change.
Facilitating Personalized Planning and Overcoming Barriers
Encouraging patients to engage in self-monitoring, goal-setting, and considering follow-up conversations can enhance commitment and maintenance of behavior change. Clinicians should address barriers and concerns empathetically, sharing corrective information when needed. Recognizing and strengthening 'change talk' signals in conversations can reinforce motivation and build self-efficacy for sustained activity.
Approaching Patients with Personalized Planning Cases
When engaging with patients such as James and Sarah, a conversational approach emphasizing autonomy and evoking patient thoughts is vital. Using importance and confidence scaling questions, clinicians can explore readiness for change and support tailored planning. Engaging in empathic reflections and solution-focused strategies helps build commitment and encourage sustained physical activity changes.
Challenges in Learning Motivational Interviewing
Clinicians may face challenges in transitioning from a diagnosing mindset to a coaching approach in motivational interviewing. Resisting the urge to immediately provide solutions and mastering empathic listening are key hurdles. Deliberate practice with feedback is crucial in overcoming these challenges and enhancing motivational interviewing skills.
Top Tips and Resources for Improving Motivational Interviewing
Recommended resources for improving motivational interviewing skills include the book 'Motivational Interviewing in Healthcare' and the 'Active Conversations' course available on the 'Moving Medicine' website. Engaging in deliberate practice, accessing demonstrations, worksheets, and moderation in courses are advised for clinicians seeking to enhance their motivational interviewing proficiency.
Behaviour change theory and Motivational Interviewing (MI) principles are often an area cited by healthcare professionals as something they would like more training on. The BJSM has collaborated with the PACC programme to develop this podcast and has invited Dr Tim Anstiss, an expert in this area, to explain some key behaviour change theory and motivational interviewing concepts in this conversation. Tim is a medical doctor specialising in behaviour change and wellbeing improvement. He trained as a trainer in motivational interviewing in the mid 90’s and has trained thousands of health and care professionals, managers and coaches in Motivational Interviewing, health coaching, brief interventions and shared decision making.
“The Physical Activity Clinical Champions or PACC programme is a national project delivering physical activity education to professionals working in healthcare to help get patients more physically active. It was previously being led by public health England as part of the moving healthcare professionals programme and funded by the national lottery & Sport England and is now being led by a consortium of The Faculty of Sport and Exercise Medicine, The Advance Wellbeing Research Centre at Sheffield Hallam University and Intelligent Health and is being re-designed with new resources. This podcast forms part of a series to support physical activity education for professionals working in healthcare. For anyone you would like to get involved with PACC project then please do email us at pacc@shu.ac.uk
For further information on behaviour change and MI please go to the moving medicine website:
A great course run by Moving Medicine that you can sign up to improve understanding in behaviour change and up skill on principles of motivational interviewing is Active Conversations.
Books mentioned:
Motivational Interviewing in Health Care, Second Edition. Helping Patients Change Behaviour
