Motivational Interviewing to Help People Quit Tobacco
The principles of motivational interviewing can be used to increase the likelihood that a patient who does not want to quit tobacco use will decide to quit. Motivational interviewing is a directive, patient-centered counseling style for eliciting behavior change by helping patients to explore and resolve ambivalence.
Motivational interviewing can be characterized in a few key points:
- The motivational interviewing counseling style is generally quiet and eliciting.
- Motivation to change is elicited from within the patient and not imposed from without.
- It is the patient's task, not the provider’s, to articulate and resolve ambivalence.
The basic approach to interactions in motivational interviewing is captured by the acronym OARS.
The OARS Method
Open-ended questions are questions that patients cannot answer with “yes" or "no." Examples of open-ended questions are: "What brings you here today?" or "Tell me about what's been happening since we last met?"
Use open-ended questions to explore patient perceptions about quitting:
"How important do you think it is for you to quit smoking?"
"What might happen if you quit?"
Normalize feelings and concerns:
Many people worry about managing without cigarettes.
Support the right to choose or reject change:
"I hear you saying you're not ready to quit right now. I'm here to help when you are ready."
Receiving affirmations can be rare to those suffering from addictions. Examples of affirmations are:
"You are doing a really great job in finding other ways to manage your stress."
"I know your positive outlook on life will help you through your cravings."
Use reflective listening techniques to seek shared understanding. Your patients will tell you what has worked and what hasn't.
Highlight discrepancies between the patient's present behavior and expressed priorities, values and goals:
"So, you think smoking helps you to maintain your weight."
"It sounds like you are very devoted to your family. How do you think your smoking is affecting your children?"
Reinforce and support "change talk" and "commitment" language:
"It's great that you are going to quit when you get through this busy time at work."
Build and deepen commitment to change:
"There are effective treatments that will ease the pain of quitting, including counseling and many medication options."
Use this technique to reflect back to the client what he or she has been telling you. Summaries are an effective way to communicate your interest in a client, build rapport and call attention to important elements of the discussion and to shift attention or direction.
"What I have heard so far is that you enjoy smoking. On the other hand, your boyfriend hates your smoking, and you're worried you might develop a serious disease."