Lecture 22: Motivational Interviewing with Adolescents Flashcards
motivational interviewing
Patient-centred, directive counselling style that builds on intrinsic motivation to facilitate change in health-related behaviours
challenge of motivational interviewing
- A lot of motivational interviewing patients are resistant or ambivalent to treatment
- You have to address the motivational questions leading to the resistance first
key of motivational interviewing
find some personally relevant reasons that a person would want to change
treatment challenges for anorexia
- Denial
- Minimization
- Secrecy
- Lack of motivation to recover
Family-based treatment (the Maudsley Approach) to anorexia
views families as a resource for recovery
key elements of family-based treatment for anorexia
- Parents take charge of refeeding
- Siblings offer support
- No blame for ill teen
- Separation of disorder and adolescent (externalizing the illness)
information about anorexia
- 1 of 4 forms of eating disorders
- 1% prevalence
- Primarily occurs in adolescence
- Highly resistant to change
- Ego-syntonic
ego-syntonic
they feel good about themselves as they lose weight
mean age of anorexia over time
The mean age for anorexia used to be 16-17 but now it is 11-12
recovery of younger vs. older anorexic patients
Younger girls seem to recover better because the intervention that works best is family-based therapy. They’re also less good at hiding things
how long does it take to recover fully from anorexia?
5-6 years
anorexia is a type of ____
food/fat phobia
key features of anorexia
- Dramatic weight loss
- Intense fear of gaining weight
- Body image distortion
comorbid features of anorexia
- Anxiety concerns
- Obsessive-compulsive disorder
motivational issues to consider in anorexia
- 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
3 stages of FBT for anorexia
- Return to previous weight (usually happens within 2-4 months)
- Gradual return to adolescent control of eating
- Gradual exploration of autonomy and identity issues
change mechanisms of FBT
- Exposure
- Decreasing ambivalence
- Increasing autonomy
problem with FBT for anorexia
- 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
possible solution to improve FBT
add treatment elements that promote motivation to change
motivational interviewing application to anorexia
- Integrated with family-based treatment
- Thought to facilitate the motivation to change
founders of motivational interviewing
Dr. William Miller & Dr. Stephen Rollnick, 1991
stages of change model
- precontemplation: increase awareness of need to change
- contemplation: motivate and increase confidence in one’s ability to change
- preparation: negotiate a plan
- action: reaffirm commitment and follow-up
- maintenance: encourage active problem-solving
- relapse: assist in coping
the readiness rule
- Measures a patient’s readiness to change on a scale of 1-10
- Can be adapted to various symptoms of the eating disorder
importance of confidence
confidence is a key driver of change
advantage of motivational interviewing
- Compatible with individual differences in ambivalence
- Suitable for mandated treatments
- Brief
- Trainable
- Non-confrontational
4 principles of motivational interviewing
- Expressing empathy
- Developing discrepancy
- Rolling with resistance
- Supporting self-efficacy
OARS technique
- Open-ended questions
- Affirmations
- Reflective listening
- Summaries
goals of motivational interviewing
- 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”
meta-analysis of motivational interviewing
- 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
why does motivational interviewing work with adolescents
- Supports role development
- Non-confrontational
- Promotes autonomy
- Deals with ambivalence
Koestner’s vaccine story
- 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
motivational interviewing in adolescents
- The use of MI is increasing among adolescents
- It’s primarily evaluated for adolescent substance use
- It’s expanding to other health behaviours
25 substance abuse motivational interviewing studies in teens
- 14 marijuana use
- 12 alcohol use
- 11 tobacco use
- 5 street drugs
- D= .20
10 non-substance use motivational interviewing studies in teens
- 4 diet and physical activity
- 3 diabetes management
- 3 sexual risk behaviour
- D= .35
longitudinal motivational interviewing in adolescents findings
Long-term follow-ups show that gains are maintained
motivational interviewing conclusions
- 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
