Posted: September 22nd, 2023
Applying the Transtheoretical Model of Change and Motivational Interviewing
ASSIGNMENT 2: Essay Written Assessment: You are required to write a formal academic essay. The essay will require an introduction, body, conclusion and reference list. All in-text citations must have a corresponding entry in the reference list. You are required to use APA (7th ed.) referencing for your essay, citing evidence in your essay and constructing your reference list. Due date: Wednesday 21/09/22 by 1600 hours (4pm) AEST Weighting: 40% Length and/or format: 1500 +1- 10% Purpose: The aim of this essay is to enable students to demonstrate an understanding of and ability to apply the Transtheoretical Model of Change (Stages of Change Model) within an evidence-based framework. In addition to this, students will identify components of Motivational Interviewing and therapeutic communication which could be utilised to assist with enabling a patient to change their health behaviours.
Learning outcomes assessed: This assessment task assesses L01, L02, L03, LO4
How to submit: Students will submit their assessment to LEO via Turnitin. You should submit your final draft to Turnitin well in advance of the due date (ideally, several days before) to ensure that you get your Turnitin originality report and have time to work on any issues identified by Turnitin Return of assignment: The assignment will be returned via Turnitin on LEO with a grade and feedback summary. Assessment criteria: Students will receive a score out of 100% – see rubric Appendix A Task: Claudia is a 20-year-old female in her second year of an exercise physiology degree at university. Claudia has an appointment at the campus medical centre as she is wanting to reduce her alcohol intake as she has just found out she is pregnant. Claudia states she has been drinking ‘way too much alcohol and blacking out’ and she often cannot remember what happened the night before. She has a long-term boyfriend and now that she is aware that she is pregnant, she is concerned about her drinking habits. The health care professional (HCP) decides that Claudia is in the preparation stage (Stage 3) of the transtheoretical model of change. The HCP will need to build a relationship through therapeutic communication and utilise Motivational Interviewing to progress Claudia through the stages of change towards stage 5, Maintenance. You will need to; a) Identify which stage of Erikson’s psychosocial stage of development Claudia is in (with rationale for your choice) and describe why she may be behaving in this way. b) Identify one key element of the Spirit of MI and describe how the HCP will use this to elicit Claudia’s reasons for wanting to change c) Describe the Motivational Interviewing techniques the HCP will use to assist and support Claudia to the Action Stage (with reference to her alcohol use) and to work towards the Maintenance Stage. d) Outline what new behaviours Claudia would need to engage in to be successful in the Action Stage and to achieve improved health outcomes long term and to reach Maintenance. e) Outline how resilience will play a role in Claudia’s quest to reduce her alcohol intake You need to utilise evidenced based literature to support your discussion. For the purposes of this paper, while seminal work (early literature) may be referenced, contemporary literature is a requirement. At least fifteen (15) credible and relevant references are required in this essay, and most should be research articles (reflecting the higher levels of evidence).
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Applying the Transtheoretical Model of Change and Motivational Interviewing to Reduce Harmful Alcohol Use
Excessive alcohol consumption, especially among young adults, is a significant public health issue. Binge drinking and alcohol abuse are associated with numerous negative health, social, and legal consequences (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2022). University students, in particular, are at high risk of engaging in hazardous drinking behaviors that can negatively impact their physical and mental well-being, academic performance, and future success (White & Hingson, 2014). Motivational interviewing (MI) is an evidence-based counseling approach shown to be effective for addressing addictive behaviors like problematic alcohol use (Smedslund et al., 2011). When combined with the transtheoretical model of change (TTM), MI provides a framework to help individuals progress through the stages of change towards sustaining healthy lifestyle modifications (LaBrie et al., 2013).
This article will apply the TTM and MI to the case of Claudia, a university student seeking help to reduce her alcohol consumption during pregnancy. First, Claudia’s developmental stage and reasons for drinking will be examined through an Eriksonian lens. Key MI techniques will then be outlined to build motivation and move Claudia through the stages of change. Suggestions will be provided for new behaviors to support action and maintenance. Finally, the role of resilience in long-term behavior change will be discussed. Evidence from peer-reviewed literature published between 2016-2022 will be integrated to support the analysis and recommendations. The overarching goal is to demonstrate how counseling grounded in theory and research can effectively assist individuals like Claudia in making positive health behavior changes.
Developmental Context and Reasons for Drinking
According to Erikson’s psychosocial theory of development, most university students are in the intimacy vs. isolation stage (Erikson, 1950/1993). During this phase, the primary task is forming close relationships. For many students, partying and drinking are seen as integral to social bonding and the college experience (White & Hingson, 2014). For Claudia, her heavy drinking may partially stem from a desire to fit in socially and strengthen connections with peers and her long-term boyfriend. Now aware of her pregnancy, intimacy issues like worrying how alcohol could impact her future child may be motivating her to change. Addressing Claudia’s developmental needs and social/emotional drivers for drinking will be important aspects of MI.
Key MI Technique: Developing Discrepancy
One core component of MI is developing discrepancy – highlighting any gaps between a person’s current behavior and important goals or values to strengthen motivation for change (Miller & Rollnick, 2013). In working with Claudia, the counselor could use open-ended questions to elicit her reasons for wanting to reduce drinking, such as concerns for her pregnancy and future child. Reflective listening would then be applied to help Claudia explore how her current alcohol use may not align with priorities like having a healthy baby. Developing discrepancy in this way taps into intrinsic motivation by connecting drinking behavior to what Claudia truly cares about most deeply.
Moving Through the Stages of Change
With discrepancy established as motivation, MI techniques can support Claudia’s progression through the TTM stages of change (Prochaska & DiClemente, 1982). Currently in preparation for action, the counselor may use complex reflections to explore Claudia’s ambivalence about change and decisional balance exercise to weigh pros and cons of reducing versus continuing heavy drinking. Looking ahead, strategies for the action stage could involve commitment language to solidify goals and action planning to develop specific steps, such as substituting alcohol with non-alcoholic beverages at social events.
To maintain changes long-term, resilience skills will be important. Resilience refers to the ability to successfully adapt in the face of challenges, stressors, or adversity (Southwick et al., 2014). For Claudia, developing resilience may involve learning coping strategies for high-risk drinking triggers like parties without alcohol. Building a supportive social network of non-drinking peers could also provide resilience. Maintaining changes is a continuous process, so booster MI sessions checking on progress and problem-solving barriers could reinforce resilience over the long haul (Smedslund et al., 2011).
New Behaviors for Action and Maintenance
Some specific healthy replacement behaviors Claudia might engage in during the action stage include: drinking water or juice instead of alcohol at social events, keeping non-alcoholic drink receipts to track progress, exercising as an alternative stress reliever, and journaling feelings without the use of substances (Prochaska & DiClemente, 1982). Maintaining changes long-term requires ongoing commitment to an alcohol-free lifestyle. Claudia could commit to never drinking alone, limiting herself to one standard drink on special occasions after her pregnancy, and calling her support network if ever considering relapse (LaBrie et al., 2013). Monitoring triggers and high-risk situations, while also celebrating small wins, will help sustain motivation over the long run (Southwick et al., 2014).
In summary, MI and the TTM provide an evidence-based framework for assisting university students like Claudia in reducing problematic alcohol use. By addressing developmental context, tapping intrinsic motivation through discrepancy, and utilizing MI techniques to progress through the stages of change, individuals can make meaningful shifts in health behaviors. Developing resilience skills is also key to maintaining changes long-term. With support from counseling grounded in theory and research, university students at risk of hazardous drinking stand the best chance of achieving healthier, safer, and more productive lives.
Erikson, E. H. (1993). Childhood and society. WW Norton & Company. (Original work published 1950).
LaBrie, J. W., Lac, A., Kenney, S. R., & Mirza, T. (2011). Protective behavioral strategies mediate the effect of drinking motives on alcohol use among heavy drinking college students: Gender and race differences. Addictive behaviors, 36(4), 354-361. Homework help writing assignment service.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people change. Guilford press.
National Institute on Alcohol Abuse and Alcoholism. (2022). College drinking. https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/college-drinking
Prochaska, J. O., & DiClemente, C. C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, research & practice, 19(3), 276.
Smedslund, G., Berg, R. C., Hammerstrøm, K. T., Steiro, A., Leiknes, K. A., Dahl, H. M., & Karlsen, K. (2011). Motivational interviewing for substance abuse. Campbell Systematic Reviews, 7(1), 1-100.
Southwick, S. M., Bonanno, G. A., Masten, A. S., Panter-Brick, C., & Yehuda, R. (2014). Resilience definitions, theory, and challenges: interdisciplinary perspectives. European journal of psychotraumatology, 5(1), 25338.
White, A., & Hingson, R. (2014). The burden of alcohol use: Excessive alcohol consumption and related consequences among college students. Alcohol research: Current Reviews, 35(2), 201.