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PSYC 471 > Lecture 22: Motivational Interviewing with Adolescents > Flashcards

Lecture 22: Motivational Interviewing with Adolescents Flashcards

1
Q

motivational interviewing

A

Patient-centred, directive counselling style that builds on intrinsic motivation to facilitate change in health-related behaviours

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1
Q

challenge of motivational interviewing

A
  • A lot of motivational interviewing patients are resistant or ambivalent to treatment
  • You have to address the motivational questions leading to the resistance first
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2
Q

key of motivational interviewing

A

find some personally relevant reasons that a person would want to change

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3
Q

treatment challenges for anorexia

A
  • Denial
  • Minimization
  • Secrecy
  • Lack of motivation to recover
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4
Q

Family-based treatment (the Maudsley Approach) to anorexia

A

views families as a resource for recovery

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5
Q

key elements of family-based treatment for anorexia

A
  • Parents take charge of refeeding
  • Siblings offer support
  • No blame for ill teen
  • Separation of disorder and adolescent (externalizing the illness)
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6
Q

information about anorexia

A
  • 1 of 4 forms of eating disorders
  • 1% prevalence
  • Primarily occurs in adolescence
  • Highly resistant to change
  • Ego-syntonic
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7
Q

ego-syntonic

A

they feel good about themselves as they lose weight

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8
Q

mean age of anorexia over time

A

The mean age for anorexia used to be 16-17 but now it is 11-12

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9
Q

recovery of younger vs. older anorexic patients

A

Younger girls seem to recover better because the intervention that works best is family-based therapy. They’re also less good at hiding things

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10
Q

how long does it take to recover fully from anorexia?

A

5-6 years

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11
Q

anorexia is a type of ____

A

food/fat phobia

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12
Q

key features of anorexia

A
  • Dramatic weight loss
  • Intense fear of gaining weight
  • Body image distortion
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13
Q

comorbid features of anorexia

A
  • Anxiety concerns
  • Obsessive-compulsive disorder
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14
Q

motivational issues to consider in anorexia

A
  • Ambivalence and resistance
  • Autonomy and control: the person is being controlled by their eating disorder
  • Introjection and compulsions: Externalizing the disorder (anorexic voice)
  • Structure and autonomy support
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15
Q

3 stages of FBT for anorexia

A
  1. Return to previous weight (usually happens within 2-4 months)
  2. Gradual return to adolescent control of eating
  3. Gradual exploration of autonomy and identity issues
16
Q

change mechanisms of FBT

A
  • Exposure
  • Decreasing ambivalence
  • Increasing autonomy
17
Q

problem with FBT for anorexia

A
  • FBT is very successful at stage 1 (accounts for empirically validated success)
  • Many patients (and families) have difficulty with the transition to independent eating: Maintenance of cognitive symptoms & safety behaviour
18
Q

possible solution to improve FBT

A

add treatment elements that promote motivation to change

19
Q

motivational interviewing application to anorexia

A
  • Integrated with family-based treatment
  • Thought to facilitate the motivation to change
20
Q

founders of motivational interviewing

A

Dr. William Miller & Dr. Stephen Rollnick, 1991

21
Q

stages of change model

A
  1. precontemplation: increase awareness of need to change
  2. contemplation: motivate and increase confidence in one’s ability to change
  3. preparation: negotiate a plan
  4. action: reaffirm commitment and follow-up
  5. maintenance: encourage active problem-solving
  6. relapse: assist in coping
22
Q

the readiness rule

A
  • Measures a patient’s readiness to change on a scale of 1-10
  • Can be adapted to various symptoms of the eating disorder
23
Q

importance of confidence

A

confidence is a key driver of change

24
Q

advantage of motivational interviewing

A
  • Compatible with individual differences in ambivalence
  • Suitable for mandated treatments
  • Brief
  • Trainable
  • Non-confrontational
25
Q

4 principles of motivational interviewing

A
  • Expressing empathy
  • Developing discrepancy
  • Rolling with resistance
  • Supporting self-efficacy
26
Q

OARS technique

A
  • Open-ended questions
  • Affirmations
  • Reflective listening
  • Summaries
27
Q

goals of motivational interviewing

A
  • Develop discrepancy between current behaviour and values
  • Decrease ambivalence
  • Let clients decide on their want to change
  • Enhance readiness to change
  • “A method of communication rather than a set of techniques”
28
Q

meta-analysis of motivational interviewing

A
  • A meta-analysis of 72 studies found that:
    1) It works in small doses and has relatively large effects
    2) Efficacy is enhanced by negativity; works better with angry resistant people by reducing negativity
    3) Therapists differ in their efficacy in using motivational interviewing; empathy is the best predictor of therapist success
29
Q

why does motivational interviewing work with adolescents

A
  • Supports role development
  • Non-confrontational
  • Promotes autonomy
  • Deals with ambivalence
30
Q

Koestner’s vaccine story

A
  • Koestner and his team conducted presentations and open houses in Black communities to create trust in vaccines because these communities have a history of medical distrust
  • Many people came to the presentation, but almost all of them already believed in the importance of vaccines
  • Open houses with one-on-one conversations that utilized motivational interviewing were much more effective
31
Q

motivational interviewing in adolescents

A
  • The use of MI is increasing among adolescents
  • It’s primarily evaluated for adolescent substance use
  • It’s expanding to other health behaviours
32
Q

25 substance abuse motivational interviewing studies in teens

A
  • 14 marijuana use
  • 12 alcohol use
  • 11 tobacco use
  • 5 street drugs
  • D= .20
33
Q

10 non-substance use motivational interviewing studies in teens

A
  • 4 diet and physical activity
  • 3 diabetes management
  • 3 sexual risk behaviour
  • D= .35
34
Q

longitudinal motivational interviewing in adolescents findings

A

Long-term follow-ups show that gains are maintained

35
Q

motivational interviewing conclusions

A
  • Motivational interviewing acknowledges the resistance and ambivalence most people have about changing their behaviour
  • Motivational interviewing may help anorexic teens in family-based treatment move toward change

PSYC 471 (61 decks)

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