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Brief intervention in A&E fails to show impact. BMJ, 2015; 351:h4205
Dear Madam,
Researchers at the University of Pennsylvania concluded that a brief motivational intervention, designed to improve motivation, had no significant impact in reducing heavy drinking and the risk of violence in a sample of 600 women. I wonder if the researches have misinterpreted some cardinal principles of the current approach to health behaviour change and motivational interviewing (Miller and Rose, 2015)?
Motivational interviewing aims to help the patient explore and resolve ambivalence about behaviour change by increasing the importance of change within the context of their values and bolstering their confidence that change can happen (Miller and Rollnick, 2013). This is not something that can be achieved within the setting of a brief intervention: achieving successful health behaviour change can takes months and often years. The process of change begins with engagement with the patient and then collaboratively exploring their values. Developing discrepancy can begin at this early stage where the patient is supported, in a non-judgemental way, to consider if their current behaviour moves them towards, or drives them away from, their values? Motivational interviewing places importance in understanding the purpose or function of the patient’s behaviour. Once these motives have been brought into the patient’s awareness, more positive self-regulated behaviour can be shaped. Throughout this process the pace will be dictated by the patient and their readiness to change. One has also to bear in mind that the cognitive mastery needed to contemplate and manage a significant change is beyond the scope of a brief intervention. Perhaps it is time for some patient centred outcome research in this area (Concannon, 2015)?
References
Concannon, T. W. (2015) Can patient centred outcomes research improve healthcare. BMJ. 351:h3859
Miller, W.R. and Rollnick, S. (2013) Motivational interviewing: Helping people change. (Third Edition) New Guildford Press: New York.
Miller, W.R. and Rose, G.S. (2015) Motivational Interviewing and Decisional Balance: Contrasting Responses to Client Ambivalence. Behavioural and Cognitive Psychotherapy. 43:129-141.
Competing interests:
No competing interests
10 August 2015
Fiona M Martin
Lecturer-Mental Health Nursing
Queen's University Belfast
Medical Biology Centre. QUB, 97 Lisburn Road. Belfast BT( 7BL
Re: Brief intervention in emergency department does not reduce partner violence in women, US study shows
Brief intervention in A&E fails to show impact. BMJ, 2015; 351:h4205
Dear Madam,
Researchers at the University of Pennsylvania concluded that a brief motivational intervention, designed to improve motivation, had no significant impact in reducing heavy drinking and the risk of violence in a sample of 600 women. I wonder if the researches have misinterpreted some cardinal principles of the current approach to health behaviour change and motivational interviewing (Miller and Rose, 2015)?
Motivational interviewing aims to help the patient explore and resolve ambivalence about behaviour change by increasing the importance of change within the context of their values and bolstering their confidence that change can happen (Miller and Rollnick, 2013). This is not something that can be achieved within the setting of a brief intervention: achieving successful health behaviour change can takes months and often years. The process of change begins with engagement with the patient and then collaboratively exploring their values. Developing discrepancy can begin at this early stage where the patient is supported, in a non-judgemental way, to consider if their current behaviour moves them towards, or drives them away from, their values? Motivational interviewing places importance in understanding the purpose or function of the patient’s behaviour. Once these motives have been brought into the patient’s awareness, more positive self-regulated behaviour can be shaped. Throughout this process the pace will be dictated by the patient and their readiness to change. One has also to bear in mind that the cognitive mastery needed to contemplate and manage a significant change is beyond the scope of a brief intervention. Perhaps it is time for some patient centred outcome research in this area (Concannon, 2015)?
References
Concannon, T. W. (2015) Can patient centred outcomes research improve healthcare. BMJ. 351:h3859
Miller, W.R. and Rollnick, S. (2013) Motivational interviewing: Helping people change. (Third Edition) New Guildford Press: New York.
Miller, W.R. and Rose, G.S. (2015) Motivational Interviewing and Decisional Balance: Contrasting Responses to Client Ambivalence. Behavioural and Cognitive Psychotherapy. 43:129-141.
Competing interests: No competing interests