1. Introduction to Change and Motivation

2. What is Behaviour Behaviour is the result of the interaction between what we believe and how we feel. If we want to assist our clients in changing we need to help them change their underlying beliefs and feelings related to the behaviour. Behaviour change can be difficult to achieve and even more challenging to maintain.

3. Influencing Factors on Behaviour Change Motivation Beliefs underlying the Behaviour The value of the behaviour e.g. How does the behaviour serve me? Perceived costs and benefits of changing Barriers to changing Self-belief in our ability to change the behaviour Support and reinforcement from others

4. Behaviour Change & Chronic Illness Many assume that with a diagnosis of a health problem this would motivate people to change- this is not always the case. Only 50% of heart attack patients quit smoking and only 40% of patients take medication appropriately (Ley et al 1974) The level of psychological issues with chronic illness is approximately 30% The combination of psychological factors and managing a medical condition does not make the ideal conditions for sustaining behaviour change.

5. What is Motivational Interviewing (MI)? Motivation is a state of readiness or eagerness to change (Miller& al. 1991) Motivational Interviewing (MI) is a cognitive behaviour technique that helps patients to identify and change behaviours to improve the quality of their lives. Evidence-based talk therapy based on four principles to help patients.

6. Principles 1. To help understand your thought process in regards to your problem behaviour. 2. To identify and measure the emotional reactions of the problem behaviour. 3. To identify how thoughts and feelings interact to produce the patterns in behaviour. 4. To challenge your thought patterns and implement alternative behaviours.

7. Stages of Change (Prochanska and DiClemente) 1.) Precontemplation: Not thinking of changing 2.) Contemplation: Start thinking about changing in the next 6 months 3.) Preparation: Get ready to change in the next month; 4.) Action: Change occurs 5.) Maintenance: Continuing change after the first goals have been reached. 6.) Relapse: May occur during this process at any stage and this is where your support network including your Employment Consultant can assist you

8. Creating the Conditions for Change Express Empathy: Active listening, and reflection Avoid Argument: If we actively challenge the client they will defend their position even more. Supporting Self-Efficacy: Belief in one’s ability to change is fundamental to success. Rolling With Resistance: Gently challenge your thought processes that underlie the problem behaviour. Developing Discrepancy: You need to be aware that your current situation has consequences and you need to set obtainable goals.

9. How To Do It Establish Rapport: Support, encouragement, be genuine. Setting the Agenda: Let the client set the agenda for change and assist by giving feedback. What would you like to change? Assessing Readiness for Change: “On a scale of 1 to 10, how committed are you to change?” Sharpening The Focus: Breaking down goal into small goals-more achievable. Make self-contract. “I am willing to change my behaviours as necessary to reach my goal I have chosen.....” Identifying Ambivalence: The behaviour is occurring because there are positive and negatives for this behaviour. Assist the client with writing pros and cons list for changing the behaviour. Eliciting Self-Motivating Statements: Encourage the client to use positive statements about themselves ad their progress. Handling Resistance: Use reflection Shifting focus: Assisting clients around barriers to behaviour change.

10. Other Strategies Anticipating Obstacles: Avoid tempting situations Ask your friends not to tempt you Minimize the tempting quality If in the situation, distract yourself. When tempted, remind yourself of your goal Ask other people to remind you of your goal

11. Strategies Continued Self Monitoring; Keep a diary Identify triggers to unwanted behaviours Who? What Situation? Where? Consequences?

12. Improving Self-Efficacy Beliefs Pick a target you feel there is some chance of reaching. Focus on the process of change, not on the final goal. Distinguish between past performance and the present situation Pay close attention to small successes. Don't let old emotions hold you back Be aware that a depressed mood can hold you back from achieving your goals Begin with the easiest situation and work your way to the most difficult situation.