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motivational interviewing

Acceptance of the patient, their perspectives and feelings
Reflective listening – without judging, blaming or criticising

Ambivalence toward change is normal

Developing a discrepancy – between current pt behaviour and the broader goals and values of the patient. The pt should argue toward change (not the dr).

Avoid arguing or trying to force a change
Use resistance as a sign to respond differently and try a different approach

Support self-efficacy – the pt is responsible for selecting the behaviour to change and to carry out that change. The dr must reflect belief that the pt has the ability to successfully make and maintain the change

Provide pt with objective feedback (e.g. lab results) to enhance pt motivation to change. ‘what does this mean for you?’

Assess motivation and confidence to change
Assess pt’s perception of pros and cons of smoking
Dr shares non-judgemental information with pt about tobacco use
Dr brainstorms with pt about possible solutions
Pt sets a pt-centred and achievable goal
Arrange for follow-up
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Experience propels people along their developmental journeys

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Learning theory – operant condition = the consequences of a behaviour determine whether the behaviour is repeated in future
e.g. taking pills delays progression (negative reinforcement)
going for jobs unsuccessful so stopped trying and moved to new workplace (punishment – withholding a promotion)
cycling relieves symptoms, so she does that whenever she cant sleep (negative reinforcement)

social learning theory – learn by watching those around them ‘observational learning’ – looking to others for information about appropriate behaviour
having a positive attitude about the MS gains respect and admiration from others (better than pity)

Bandura argues that experience gives people a sense of self-efficacy – self-efficacy beliefs help to determine when people will imitate others. Whether an individual imitates others depends on who the other person is, on whether that person’s behaviour is rewarded and on the individual’s beliefs about her own abilities