By Denise Williams | News & Views

If you work in cardiopulmonary rehabilitation, chances are you have a patient who needs to stop smoking, start exercising, eat healthier, lose weight or adhere to their medication plan – or all of the above. Chances also are that simply telling them to make these changes probably isn’t going to yield the desired results. That’s because, well, change is hard.

That’s true for the general public – not for the CR/PR population exclusively – but for these individuals, behavior change is so very critical to their recovery. How, then, can you help them make the differences that will improve their health and their lives?

One technique that’s piquing interest is motivational interviewing. Arpi Minassian, PhD, a clinical professor of psychiatry at the University of California, San Diego, describes the term as “a communication style that clinicians use to help people explore their willingness and challenges around making difficult changes in their behavior.” Instead of lecturing to or talking at people, which often puts them on the defensive, she explains that the goal is to work collaboratively with patients to talk through the reasons holding them back from change. Importantly, the approach is nonjudgmental, encourages interaction and views patients in a positive light. “You recognize that they’re trying their best,” Minassian says. “You pay attention to what’s important to them, then tie in their motivation for change to those values and what they want in their life.”

While Minassian notes that motivational interviewing was first enlisted by psychologists in an effort to help patients with substance abuse problems, she says the mindset is now applied across the spectrum of behavior changes and in numerous populations. The technique hasn’t been widely used in CR/PR yet, but the medical literature suggests it holds great promise for this subset of patients.

Joel W. Hughes, PhD, FAACVPR, a professor and director of clinical training at Kent State’s Department of Psychological Sciences, buys into that idea. Motivational interviewing is well-suited for the CR/PR discipline, he suggests, in part because rehab is an accessible setting for so-called micro-interventions. “We don’t have time to conduct six weeks of behavior-change therapy, necessarily, but we do have time to talk to people while they’re exercising or as they’re cooling down or as they’re taking their blood pressure,” he says. “You note their behaviors and inquire from time to time, taking the long view that if [the patient] doesn’t make the change on Day 1, maybe they’ll do it on Day 34.”

Learning Opportunity

Hughes and Minassian team up for an engaging and interactive AACVPR webinar to introduce some of the basic principles of motivational interviewing, which are fairly simple to learn, and tips for incorporating the strategy into practice.

Instead of just a simple voiceover Power Point presentation, the audience is treated to a simulated demonstration of the technique in action. This lively role-play segment of the program casts Hughes as a PR participant who is floundering with his exercise routine. Minassian, posing as his therapist, uses motivational interviewing tactics to help him explore his struggle. 

The co-presenters deliver a webinar that is as fun and engaging as it is informative. Attendees leave armed with an understanding of a tool they can use right away and in any setting. “There’s no license, no certification,” Hughes points out. “It’s something you can simply go practice in your life.” But he and Minassian both emphasize that the key to success is consistent application of motivational interviewing. For that reason, they recommend the webinar for any and all CR/PR professionals – from new faces who have no previous exposure to the technique to practitioners who have some level of familiarity with it but could use a refresher.

At a bare minimum, Minassian says webinar participants will benefit from learning the basic principles underlying motivational interviewing. Those ideas are important to learn in order to be a good listener, she explains, which is essential for clinicians to maintain a good professional relationship with patients. “It’s about how do you communicate with your patients so that they feel heard and understood,” she asserts.

The recording of the March 23 presentation is available to AACVPR members, at no charge, here. Non-members can access the webinar for a fee.