HCP and patient

Schizophrenia - Disease Management

5 MIN

Implementing motivational interviewing techniques in schizophrenia

Motivational interviewing is a conversational technique that can be used for effective communication between healthcare professionals and patients, helping to encourage patient empowerment, shared decision-making, and behavior change. It involves four key interactive elements-engagement, goal-setting, motivating, and planning-each of which must be revisited and adapted as circumstances evolve along the patient journey.1 In this article, you can find guidance on how to implement motivational interviewing with your patients.

What is motivational interviewing?  

Motivational interviewing has been defined as "a collaborative conversation style for strengthening a person’s own motivation and commitment to change."1 It has been implemented effectively in psychiatry, as well as in medical specialties, such as cardiology, as demonstrated by improved patient outcomes.2,3 For example, a lower frequency of relapse has been observed among people with psychosis receiving motivational interviewing in combination with psychoeducation, compared with a control group receiving no such intervention.2

Key elements of motivational interviewing

Motivational interviewing is a collaboration with patients, family, caregivers, and the care team that should continue and evolve throughout the patient journey. The four key interactive elements of motivational interviewing are engagement, goal-setting, motivating, and planning.1 

1. How to engage your patient

It is key to establish rapport by demonstrating your personal interest in the patient.4,5 This may include asking open-ended, rather than yes/no, questions,5 giving your patient the opportunity and time to tell their story without rushing,5 while clearly expressing your interest,4 and referring to previous conversations to demonstrate effective listening.5

2. How to set goals with your patient

Collaborate with your patient to identify attainable goals that are meaningful to them, as well as any discrepancies between these goals and their current behavior.5 This can involve: identifying how your patient makes sense of their own symptoms and treatment;4 empowering your patient to participate in decision-making around their own treatment;6 encouraging them to reflect on their own goals, values, and willingness to change;5 and helping them to relate their goals and values to the target behavior, such as long-term medication adherence.5

3. How to motivate your patient

It is crucial to elicit the patient’s motives for change. By understanding their motive, you can continue the conversation in a way that strengthens their motivation to achieve a goal or target behavior.5 You may approach this, for example, by exploring the challenges or barriers articulated by your patient5 or by discussing the advantages and disadvantages of a treatment approach in the context of a patient's goals.1

4. How to make plans with your patient

Finally, to ensure behavior change, it is key to develop short- and longer-term plans that initiate and maintain change.1 You may find it useful to break down longer-term goals into shorter-term subgoals,1 as small, specific steps help your patient commit to the behavior. The most fundamental aspect is working with the patient to create a concrete plan that aligns with the patient’s own actions and strategies for reaching their goals.4

Engagement remains important throughout the patient journey

Engaging with patients is a clinical skill that remains important throughout goal-setting, motivating, and planning. As circumstances evolve and obstacles are met along the way, it will be necessary to re-engage and potentially revisit and adapt other steps of the process.1

Psychiatry motivational interviewing - infographics thumbnail
References
  1. Miller WR, Rollnick S. Motivational Interviewing, Third Edition. 2013.

  2. Bröms G, Cahling L, Berntsson A, Öhrmalm L. Psychoeducation and motivational interviewing to reduce relapses and increase patients' involvement in antipsychotic treatment: interventional study. Br J Psych Bull 2020;44:265–268.

  3. Hardcastle SJ, Taylor AH, Bailey MP, et al. Effectiveness of a motivational interviewing intervention on weight loss, physical activity and cardiovascular disease risk factors: a randomised controlled trial with a 12-month post-intervention follow-up. Int J Behav Nutr Phys Act 2013;10:40

  4. Dobber J, Latour C, van Meijel B, et al. Active ingredients and mechanisms of change in motivational interviewing for medication adherence. A mixed methods study of patient–interaction in patients with schizophrenia. Front Psychiatry 2020;11:78. 

  5. Dobber J, Latour C, de Haan L, et al. Medication adherence in patients with schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry 2018;18:135.

  6. Citrome L. Long-acting Injectable antipsychotics: what, when, and how. CNS Spectr 2021;26:118–129.