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Introduction

Motivational interviewing is a talk therapy that can be used by healthcare professionals to help people change their behavior by resolving their ambivalence (Rollnick, Miller, & Butler, 2008). The symptoms of a person with an anxiety disorder can interfere with daily activities such as job performance and relationships. These behaviors may include:

• • • Restlessness or feeling on edge
    • Difficulty concentrating
    • Muscle tension
    • Sleep problems
    • Sudden and repeated attacks of intense fear
    • Fear or avoidance of places that have caused anxiety in the past

Theory

The transtheoretical model suggests that in order to make a health behavior, individuals must progress through the stages of change (Prochaska, Redding, & Evers, 2008). Individuals progress in a linear fashion, so occupational therapists must understand the individual’s readiness for change and develop the intervention to “meet them where they are at.” The goal of the intervention is to then help them progress to the next level, until the client has made and sustained the desired health behavior. The stages of change include pre-contemplation, contemplation, preparation, action, and maintenance.

Evidence

An RCT by Kristina J. Korte and  Norman B. Schmidt in 2013 found that motivational interviewing is effective in reducing anxiety. Eighty participants were randomly assigned into motivational interviewing or health-focused psychoeducation control group. The motivation group showed a significant reduction in anxiety than the control group (Korte & Schmidt, 2013).

Case Study

Clint, is a 25 year old male that was a goaltender for the Florida Panthers hockey team. About a month ago, his neck was slashed with another player’s skate blade during a game, almost killing him. Following this incident, he is plagued by PTSD, alcoholism, and OCD and has made a suicide attempt. The fear from the near death experience and his acquired PTSD has kept him from returning back to work. Playing hockey gives Clint a feeling of purpose; without it he feels depressed and has no interest in doing anything throughout the day. This is also affecting his roles at home as a father and a husband. He used to be the main financial provider of the household and the anxiety is negatively impacting many aspects of his life.

Intervention Plan

Problem Statement

• Clint demonstrates a lack of knowledge about effective coping strategies. Clint is unable to return to work due to his fears and anxiety.

Outcomes

2 long term goals

• Clint will implement 3 positive coping strategies for dealing with his anxiety so that he can return to work in 1 month.
• Clint will move from contemplation to action related to better coping strategies so that he may return to work within 1 month.

3 short term goals

• Clint will identify 5 positive coping strategies for dealing with his anxiety so that he can return to work in 2 weeks.
• Clint will move from contemplation to preparation related to his better coping strategies so that he may return to work within 2 weeks.
• Clint will implement 1 positive coping strategy for dealing with his anxiety so that he can return to work in 2 weeks.

Description of the setting

• Clint will meet with the occupational therapist individually at the outpatient health clinic at the Florida Panthers arena for 30 minutes twice a week for 1 month.

Supplies

• None

Agenda & description

• Meet Clint & develop rapport (5 mins)
• Assess Clint’s readiness for change (2 mins)
• Engage in motivational interviewing to develop coping strategies to return back to work (18 mins)
  • Potential open-ended questions:
    • “Can you describe to me what happened to you during your accident?”
    • “What do you think is keeping you from returning back to work?”
    • “Tell me what you are doing to achieve returning back to work.”
    • “Tell me how your drinking habits make you feel.”
    • “What do you think are some ways that you can cope better with your anxiety and fears?”
  • Provide affirmations:
    • “It sounds like you’re very motivated to return back to playing hockey”
    • “You will do whatever it takes to return back to your career”
    • “You are very courageous for talking about this and wanting to seek help”
  • Provide reflections:
    • “It sounds like you would like to find other ways to cope with this anxiety besides drinking”
    • “What I’m hearing is that you believe that if you stop drinking you will not be brave enough to return to work”
  • Provide a summary of the discussion (5 mins)

Documentation

S: Clint states that after his accident any time he feels anxiety coming on he resorts with drinking or drug use to calm the nerves. He states he wants to get back to work more than anything but any time he gets on the ice he has flashbacks to the accident.

O: Client presented to 30 minute session using a motivational interviewing approach. Client reported that he missed 5/5 practices this past week. Client demonstrated anxiety and fearfulness when discussing having to get back on the ice. Client reported that during his month of recovery he has turned to drinking and drug use to cope with his resulting feelings but that he wants to find more positive ways of coping. Client identified 3 alternative positive coping strategies.

A: Client presents with anxiety and maladaptive coping strategies resulting in the inability to return to work and provide for the family. Client presented in the contemplation stage of change evidenced by his ability to weigh the pros and the cons of his maladaptive behavior, however advanced to preparation during the discussion evidenced by his identification of 3 healthy coping strategies. Client would continue to benefit from skilled OT services to help client to continue advancing his readiness to alter coping strategies in order to successfully deal with anxiety and return to work.

P: Continue with motivational interviewing approach to move to the action stage of change. Work on strengthening commitment to use adaptive coping strategies during times of anxiety.  Evaluate the adaptive behaviors that he has chosen to replace the maladaptive. Client will see OT twice a week for the next month.

References

Korte, K. J., & Schmidt, N. B. (2013). Motivational enhancement therapy reduces anxiety sensitivity. Cognitive Therapy and Research, 37(6), 1140-1150. doi:http://dx.doi.org.ezproxy.fiu.edu/10.1007/s10608-013-9550-3

National Institute of Mental Health (2016). Anxiety Disorders. Retrieved January 19, 2018, from https://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml

Prochaska, J. O., Redding, C. A., & Evers, K. E. (2008). The Transtheoretical Model and Stages of Change. In K. Glanz, B. K. Rimer, & K. Viswanath (Eds.), Health Behavior and Health Education: Theory, Research, and Practice. San Francisco, CA: Jossey-Bass

Rollnick, S., Miller, W. R., & Butler, C. (2008). Motivationals Interviewing in Healthcare: Helping Patients Change Behavior. American Journal of Pharmaceutical Education (Vol. 73). http://doi.org/10.1111/j.1465-3362.2009.00073.x