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Introduction

Motivational interviewing is a talk therapy that can be used by health care professionals to help people change their behavior by resolving their ambivalence (Rollnick, Miller, & Butler, 2008). There are many behaviors college students may need or want to change (Werch. et al., 2010; Werch et al., 2007). These behaviors include:

• Studying more
• Exercising more
• Eating more healthfully
• Maintaining more healthy relationships with others
• Increasing sleep
• Alcohol use and abuse

Occupational therapy practitioners can use motivation interviewing to help college students engage in these behaviors and have a health productive college experience.

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 therapy practitioners must first 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.

Evidence

A Cochrane review found that 75% of randomized controlled students found motivational interviewing to be a significantly effective intervention  (Rubak, Sandbæk, Lauritzen, & Christensen, 2005). They reviewed several studies with outcomes important to college students like physical activity levels, body mass index, and use of substances (like alcohol and cigarettes). Borsari & Carey (2000) found that motivational interviewing was effective for college students.

Case Study

Jessie is a 21-year old first year physical therapy student. Jessie reported that school has always come easily to her, and she never really had to study in high school or in her undergraduate studies to become a recreational therapist. Unfortunately, Jessie did not study for her exams, and subsequently failed the first set of exams in her DPT program. Jessie met with her academic advisor who referred her to the occupational therapist at the University to develop adaptive study skills and routines.

Intervention Plan

Problem Statement

Jessie demonstrates a lack of knowledge about effective study strategies and a lack of adaptive studying routines. These deficits are limiting Jessie’s success in school.

Long Term Goals

1. Jessie will independently implement 5/5 adaptive study skills by the end of the Spring 2018 Semester
2. Jessie will move from pre-contemplation to maintenance related to studying behaviors by the end of the semester.

Short Term Goals

1. Jessie will verbalize 3 new adaptive studying techniques within 2 weeks.
2. Jessie will implement 1 new adaptive studying techniques into her routine within 2 weeks.
3. Jessie will move from pre-contemplation to action related to her studying behaviors within 2 weeks.

Intervention Format

Individual

Setting

Jessie will meet with the occupational therapist individually at the student health clinic for 30 minutes 4x per semester.

Supplies

None

Agenda

• Meet Jessie & develop rapport (5 min)
• Assess Jessie’s readiness for change (2 min)
• Engaging in motivational interviewing of study habits (18 minutes)
  • o Potential open-ended questions
    • “Why do you want to become a physical therapist?”
    • “Tell me about how you study?”
    • “What is preventing you from being more successful in PT school”
  • o Provide affirmations
    • “It sounds like you are really motivated to become a physical therapist”
    • “You are willing to work hard to improve your grades”
    • “You are a smart person”
  • o Provide reflections
    • “Your past performance in your class doesn’t reflect your skills and ability”
    • “You think that you should study more frequently”
  • Provide a summary of the discussion (5 min)

Documentation

S: “I want to do better in school, but I don’t know how”

O: Client presented for 30-minute session focusing on study skills using a motivational interviewing approach. Client reported that she failed 4/4 midterm exams in her DPT program this past week. Client demonstrated depressed affect ad tearfulness when discussing performance. Client reported that she does not study and subsequently does not have any study habits, roles, and routines established.  Client reported that she is receptive to trying something new. Client identified two new adaptive study behaviors. With permission, the therapist educated the client on active vs passive learning strategies.

A: Client presents with maladaptive study strategies resulting in decreased academic performance in graduate school. Client presented in pre-contemplation stage of change, however advanced to preparation during the discussion. Client would continue to benefit from skilled OT services to help client to continue advancing her readiness to alter study habits and be a more successful graduate student.

P: Continue with motivational interviewing approach to develop adaptive study habits and routines. Evaluate success new study habits and continue to refine and develop as needed.  Client to see OT 2x/ month for 30 minutes each.

References

Borsari, B., & Carey, K. B. (2000). Effects of a brief motivational intervention with college student drinkers. Journal of Consulting and Clinical Psychology, 68(4), 728-733. http://dx.doi.org/10.1037/0022-006X.68.4.728

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

Rubak, S., Sandbæk, A., Lauritzen, T., & Christensen, B. (2005). Motivational interviewing: a systematic review and meta-analysis. Br J Gen Pract, 55(513), 305–312.

Werch, C. E., Chad., Bian, H., Moore, M. J., Ames, S., DiClemente, C. C., & Weiler, R. M. (2007). Brief Multiple Behavior Interventions in a College Student Health Care Clinic. Journal of Adolescent Health, 41(6), 577–585. http://doi.org/10.1016/J.JADOHEALTH.2007.06.003

Werch, C. E., Moore, M. M., Bian, H., Diclemente, C. C., Huang, I. C., Ames, S. C., … & Pokorny, S. B. (2010). Are Effects From A Brief Multiple Behavior Intervention For College Students Maintained At 12-months?. Alcoholism: Clinical & Experimental Research, 34(6), 60A.