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Introduction

Motivational interviewing is an intervention approach with the primary purpose of strengthening an individual’s motivation toward positive change (Miller, 2013). To help individuals move away from ambivalence and resistance to change, motivational interviewing cultivates intrinsic motivation and a sense of autonomy in the client (Resnicow & McMaster, 2012). The key characteristic of motivational interviewing includes offering full acceptance of the client through compassion and empathy (Miller, 2013). Furthermore, through reflective listening and affirmation, the therapist encourages the client to explore and become empowered to motivate change (Miller, 2013).

Research currently supports motivational interviewing as an effective intervention to decrease weight through positive, weight-related behavior change in clients who are experiencing ambivalence (Barnes & Barber, 2017). In the United States, obesity has risen to approximately 69.2%. The consequences of obesity can be fatal, as it is linked to increased risk of cardiovascular disease, hypertension, type II diabetes, metabolic syndrome, and stroke. Hence, it is paramount that change occurs in individuals with obesity who are experiencing ambivalence and resistance to change. Therefore, by cultivating empowerment and self-efficacy in individuals with diabetes through Motivational Interviewing, occupational therapists can promote positive weight-related change (Barnes & Barber, 2017).

Theory

In this instance, the transtheoretical model (TTM)  will be used to track the client’s stage of change. This model claims that prevention is possible at early stages of a client’s journey even if they have not taken an interest in therapy or counselling. Change is viewed as non-linear and can be interrupted at any time leading to the regression into a previous stage. An individual moves from one stage to the another as a result of the decisional balance and feelings of self- efficacy. According to TTM, decisional balance is when a person can identify the pros and cons of changing a behavior (Jones- Smith, 2012).

Evidence

Occupational health professionals have used motivational interviewing techniques as key drivers in developing maintainable lifestyle change programs, with weight loss as an objective (Botes, 2007). Motivational interviewing, when used as a tool in behavior-based weight loss programs, has demonstrated greater loss of weight, increased exercise time, and improved nutritional diets in those individuals in comparison to those who participated in a weight loss program that did not use motivational interviewing techniques (Carels, 2007; Mirkarimi, et al. 2017). Motivational interviewing has also demonstrated applicability in sustaining obesity management for women with type 2 diabetes for up to 18 months, although African-American women tend to sustain only up to 6 months (Delia, DiLillo, Bursac, Gore, & Greene, 2007). Motivational interviewing can also work even if the individual providing motivational interviewing isn’t in the same physical location. According to one study, personalized text messages using motivational interviewing techniques were shown to be helpful in maintaining healthy behaviors within an adolescent population (Woolford, Clark, Strecher, & Resnicow, 2010).

Case Study

Rosa is a 52-year-old woman who weights 265 lbs and has type 2 diabetes (Cypress, 1999). She has difficulty losing weight, and does not know what to do  to about it.  The client reports feeling fatigued for the most part of the day, especially in the afternoons. Rosa also reports that she has gained a lot of weight in the last 5 years and that she has never been this overweight before. Rosa and her primary doctor are concerned about her health decline and encourage her to to lose some weight to improve her health. However, she complains that the pain in her knees and ankles makes it difficult to do any exercise (Cypress, 1999).

Intervention Plan

Problem Statement

Client is unable to lose weight secondary to poor awareness of exercise strategies.

Outcomes

Long Term Goal

Client will engage in exercise 3 times a week in order to demonstrate an  exercise routine for weight loss, in six month.

Short Term Goals

Client will identify a time and place for new exercise routine to facilitate weight loss in two weeks.

Client will identify alternative exercise strategies to maintain a healthy exercise routine for weight loss in two weeks.

Intervention format

Individual

Setting

Client will meet at the occupational therapist at the outpatient Hospital at 9:00am twice a week for one 30 minute session.

Supplies

None

Agenda

• Meet Tina and develop rapport (5min)
• Assess readiness for change (2 min)
• Engage in motivational interviewing on exercise habits (16 min)
  • Potential open-ended questions
    • “Why do you want to lose weight?”
    • “Tell me about your exercise routine”
    • “What is your diet like?”
  • Provide affirmations
    • “ It sounds like to me that you are motivated to exercise more.”
    • “ You are willing to try new things to improve your exercise routine”
    • “You are a determined”
  • Provide reflections
    • “It sounds like you are upset that you cannot stick with an exercise routine.
    • “ You want to start exercising on a more frequent basis”
  • Provide Summary of discussion (7 min)

Documentation:

• S: “I am desperate for help. I really need to lose weight. Lately, I have been feeling down.”
• O: Client engaged in a thirty minute OT session. The therapist used motivational interviewing was as the intervention. The client was asked open ended questions and about her reason for wanting OT services. She was asked about the weight loss methods she has tried in the past to which she responded, “I have I tried a walking program, but the pain in my knees does not allow me to walk for long.” Client was asked to discuss other types of exercise that mitigate stress on her knees. She responded, “Maybe I can do some sitting exercises…but I am not sure how though.” She was then asked to identify possible locations and times that would work well for her. She identified her bedroom and early mornings to be appropriate for her lifestyle. The client asked the therapist for pictures or videos of appropriate sitting exercises for her routine. The client was given a printed guide with images of exercises and was educated on them with verbal explanations and physical demonstrations, followed by actual performance of the exercises she learned.
• A:  Based on her answers during the motivational interview, the client is aware that she is overweight and demonstrates motivation to engage in an exercise program to lose the extra weight. Her past efforts to engage in exercise indicates her motivation but she needs an individualized exercise program that will not cause pain in the knees. The client’s ability to identify a time and place to engage in a possible exercise routine shows that she is taking steps to move from the contemplation to the preparation phase to lose weight. The client reported that she felt empowered with new knowledge of exercises she could do and a renewed commitment to adopt a healthier lifestyle.
• P:  Client will benefit from a thirty minute OT sessions to evaluate her progress regarding her commitment to exercise and to identify strategies to maintain her exercise routine and prevent relapsing into a sedentary lifestyle. Client will perform exercise regimen three times a week to lose weight.

References

Barnes, R. D., & Barber, J. A. (2017). Preliminary examination of metabolic syndrome response to motivational interviewing for weight loss as compared to an attentional control and usual care in primary care for individuals with and without binge-eating disorder. Eating Behaviors, 26, 108-113. doi:10.1016/j.eatbeh.2017.02.007

Botes, D. (2007). Taking steps to weight loss. Occupational Health, 59(7), 27-29. Retrieved from http://ezproxy.fiu.edu/login?url=https://search-proquest-com.ezproxy.fiu.edu/docview/207320104?accountid=10901

Carels, Robert A R A. (2007). Using motivational interviewing as a supplement to obesity treatment: A stepped-care approach. Health Psychology, 26(3), 374; 374.

Cypress, M. (1999). Case study: A 52-year-old woman with obesity, poorly controlled type 2 diabetes, and symptoms of depression. Clinical Diabetes, 17(3), 143.

Delia Smith West, DiLillo, V., Bursac, Z., Gore, S. A., & Greene, P. G. (2007). Motivational interviewing improves weight loss in women with type 2 diabetes. Diabetes Care, 30(5), 1081-7. Retrieved from http://ezproxy.fiu.edu/login?url=https://search-proquest -com.ezproxy.fiu.edu/docview/223033525?accountid=10901

Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing, Third Edition : Helping People Change. New York, NY: The Guilford Press. ISBN 978-1-60918-227-4

Mirkarimi, K., Kabir, M. J., Honarvar, M. R., Ozouni-Davaji, R. B., & Eri, M. (2017). Effect of  motivational interviewing on weight efficacy lifestyle among women with overweight and obesity: A randomized controlled trial. Iranian Journal Of Medical Sciences, (2), 187.

Mirkarimi, K., Eri, M., Ghanbari, M. R., Kabir, M. J., Raeisi, M., Ozouni- Davaji, R. B., . . .  Charkazi, A. (2017). Modifying attitude and intention toward regular physical activityusing protection motivation theory: A randomized controlled trial. Eastern Mediterranean Health Journal, 23(8), 543-550. doi://dx.doi.org.ezproxy.fiu.edu/10.26719/201723.8.543

Resnicow, K., & McMaster, F. (2012). Motivational interviewing: Moving from why to how with  autonomy support. The International Journal of Behavioral Nutrition and Physical   Activity, 9(1), 19. doi:10.1186/1479-5868-9-19

Woolford, S. J., Clark, S. J., Strecher, V. J., & Resnicow, K. (2010). Tailored mobile phone text messages as an adjunct to obesity treatment for adolescents. Journal of Telemedicine and Telecare, 16(8), 458-461. doi:10.1258/jtt.2010.100207