L22 - Motivational Interviewing and Behaviour Change Among Adolescents (with a Focus on Anorexia) Flashcards
What is motivational interviewing?
it’s generally a short-term therapy that helps individuals find their own internal motivation to make difficult life changes
Information about anorexia
1 of 4 forms of eating disorder
1% prevalence
primarily occurs in adolescence
highly resistant to change
- ego-syntonic
What are the key features of anorexia?
Dramatic weight loss
Intense fear of gaining weight
Body image distortion
Additional Features
- Anxiety concerns
- Obsessive-compulsive style
What are some motivational issues to consider with anorexia?
ambivalence and resistance
autonomy and control
introjection and compulsions
- externalizing the disorder
– Ed or Edie
– the anorexic voice
- structure and autonomy support
scaffolding: structures to promote growth and stability
What are the 3 stages of FBT change?
Return to previous weight
Gradual return to adolescent control of eating
Gradual exploration of Autonomy and Identity issues
Change mechanism?
- exposure
- decreasing ambivalence
- increasing autonomy
What is the problem with FBT?
FBT is very successful at stage 1
- account for empirically validated success
Many patients (and families) have difficulty with the transition to independent eating
- Maintenance of cognitive symptoms
- Maintenance of safety behaviours
Possible Solution:
- add treatment elements that promote motivation to change
Motivational Interviewing applied to family-based therapy of Anorexia
integrated with family-based treatment
thought to facilitate the motivation to change
Who are the founders of motivational interviewing?
dr. william miller and dr. stephen rollnick (1991)
“Patient-centered, directive counseling style that builds on intrinsic motivation to facilitate change in health-related behaviours”
What are the pros of motivational interviewing?
compatible with individual differences in ambivalence
suitable for mandated treatments
brief
trainable
non-confrontational
Some examples of motivational components
the readiness ruler
- measuring readiness to change
- on a scale from 0-10, how eager are you to put change into place?
- can be adapted to various symptoms of the eating disorder
“i have given myself a 5 because one of my goals is to be able ot go away to tennis camp this summer”
“you’re anxious about whether your eating disorder may prevent you from going to the camp”
Importance and confidence are the drivers of change
What is the lingo in motivational interviewing?
4 Principles
- expressing empathy
- developing discrepancy
- rolling with resistance
- supporting self-efficacy
What are the four techniques for motivational interviewing?
OARS
- Open-ended questions
- Affirmations
- Reflective listening
- Summaries
What are the goals of Motivational Interviewing?
Develop discrepancy between current behaviour and values
Decrease ambivalence
let clients decide on their own to change
enhance readiness to change
A method of communication rather than a set of techniques
Does motivational interviewing work?
Meta-analyses of 72 studies:
- works in small doses; has relatively large effects
- efficacy is enhanced by negativity; works better with angry, resistant people; works by reducing negativity
- therapists differ in their efficacy in using motivational interviewing; empathy is the best predictor of therapist success
Why would motivational interviewing work with adolescents?
- supports role development
- non-confrontational
- promotes autonomy
- deals with ambivalence
