Where Do We Go from Here?Supporting Change in Those

Who Aren’t Motivated to Change

Heather Patrick, PhDVP, Behavioral Science

What do we do with these folks?

BY IGNORING…

• We’ve developed an evidence base that doesn’t include them

• And that tells us nothing about how to work with them

BY ATTEMPTING TO EDUCATE…

• We have assumed ignorance where it likely doesn’t exist

BY ATTEMPTING TO NUDGE… BY CHEERING ON… BY FINDING OTHER WAYS TO “MOTIVATE”…

• We have missed an opportunity to understand

• And have assumed that we know what’s best

TTM / STAGES OF CHANGE

• Precontemplation — A client has no intention of changing

• “I can’t” or “I won’t”

Miller & Rollnick, 2013MOTIVATIONAL INTERVIEWING

• Acknowledges ambivalence as a normal part of the change process

• Supports clinicians in developing skills to work with — rather than against — a client and his/her ambivalence

LaGuardia, 2016SELF-DETERMINATION THEORY

• Amotivation as part of the motivational continuum

• A clinical approach that includes supporting client choice, providing unconditional positive regard, and training practitioners to “check their agenda”

Prochaska, et al., 2002

•The “I Won’t”

•The “I Can’t”

•Ambivalence

•The role of relatedness

Look Deeper

20 Usage ExamplesPoster

WHAT IF…We developed a smoking cessation program that didn’t start with quit?

THE

JOURNEY

WHERE DO YOU START — IF NOT WITH QUIT?

EXPLORE

• 9 days

• Make information relevant

• Allow users to explore how smoking fits in with their lives—reasons to smoke, reasons to quit, and time & financial costs of smoking

Mobile breath sensor

The Bluetooth-enabled Pivot Breath Sensor is an educational and motivational tool that measures carbon monoxide (a chemical in cigarette smoke) in the breath, helping users see how smoking affects their carbon monoxide levels.

Personal dashboard

As users log their cigarettes and take breath samples, the Pivot app displays these and other metrics to help users raise their awareness of their smoking behaviors and track changes in real time.

WHERE DO YOU START — IF NOT WITH QUIT?

Hi! I’m your Coach, Jenn. I’m looking forward to working with you as you go through Pivot. What’s one thing you want me to know about you and smoking?

I was wondering if you ever smoked or someone like a parent smoked?

Hi Jenn. Thanks for reaching out.

It sounds like you’re wondering if I could relate to what you’re going through.

AP

AP

Hi! I’m your Coach, Jenn. I’m looking forward to working with you as you go through Pivot. What’s one thing you think people don’t get about you and smoking?

If you knew me, as my friends do, it’s totally incongruous with my character. It doesn’t match who I am…

Most people consider smoking obnoxious and a deal-killer for dating

DB

DB

WHERE DO YOU START — IF NOT WITH QUIT?

BA

Happy Friday! You’re making great progress with Pivot! I see that you recently completed the Reasons activity.

How does smoking make you feel during your “me” time?

Shameful. Powerless. Unclean. Willing to accept the thought of illness and disease… Embarrassed.

Thank you for feeling comfortable to share this with me. It sounds like you’re feeling bad about yourself for smoking.

What makes you feel strong and in control?

I feel strong when I’m not basing my to do list on time to go buy a pack of cigarettes and when I decide not to light up a cigarette.

Such a powerful declaration. What would your life be like if you didn’t have to work around cigs?

Ah! Fresh. Clean. Healthy. And I would exercise more because my breathing would be better.

What are some small ways you can remind yourself of this vision you have for your future?

BA

BA