Motivational interviewing with a depressed adolescent

Perceptions of motivational interviewing in genetic counseling practice and training

Motivational interviewing (MI) is a counseling approach that allows a provider to engage in a dialog with patients to evoke motivation for health behavior change or decision-making. MI is a relatively recent addition to the curricula of genetic counseling programs, and recent research has demonstrated its utility in genetic counseling practice. However, the perspectives of genetic counselors trained in MI have yet to be studied with the intent of illuminating how it is applied in practice or what should be emphasized in training. This qualitative study interviewed fifteen genetic counselors from various practice areas who have had training in MI. The interviews focused on how MI is being used in practice, and the strengths and weaknesses of their MI training. Five themes were identified through inductive qualitative analysis: (a) utility of MI in genetic counseling practice, (b) value of MI in genetic counseling training, (c) barriers to implementing MI in genetic counseling practice, (d) barriers to training genetic counselors in MI, and (e) timing of MI training. The perspectives discovered from this study can help inform genetic counseling educators who wish to include MI in their curriculum. In addition for those programs that already include MI, these results serve as a guide for the development of training role-plays and/or standardized patient encounter scenarios.

Study protocol for comparing Screening, Brief Intervention, and Referral to Treatment (SBIRT) to referral as usual for depression in African American churches

Background

Depression is a leading cause of disability worldwide. African American adults, compared to White adults, are half as likely to be screened for depression in primary care settings. Disparities in depression screening contribute to poor clinical outcomes, as African Americans with depression are more disabled and sicker longer compared to Whites. African American churches are trusted settings that provide access to supports for depression. Indeed, in the first study of its kind, the investigators found that 20% of adults in African American churches screened positive for depression using the Patient Health Questionnaire-9 (PHQ-9). However, no subjects with a positive screen (PHQ-9 ≥ 10) accepted a treatment referral when offered by research personnel. Community Health Workers, who are trusted paraprofessionals from the target community, may bridge the gap between depression screening and treatment. The investigators have trained and certified 112 Community Health Workers from 45 African American churches in New York City to deliver an evidence-based intervention called Screening, Brief Intervention, and Referral to Treatment (SBIRT). Thus, the aim of the current study is to test the impact of Community Health Worker-delivered depression screening in Black churches on engagement with clinical services.

Methods

Using a hybrid type 1 effectiveness-implementation design, we propose a 2-arm, mixed-methods cluster randomized controlled trial. Church study sites will be randomized to either SBIRT (intervention arm) or referral as usual (usual care arm). This trial will be conducted with 600 church members across 30 churches (300 intervention; 300 usual care). Our primary outcome is treatment engagement, defined as attending a depression-related clinical visit. Secondary outcomes will be changes in Mental Health-Related Quality of Life and depressive symptoms at 3 and 6 months post-screening. Lastly, we will conduct a concurrent, mixed-methods (qualitative-quantitative) process evaluation to assess contextual facilitators and barriers of screening and referral.

Discussion

This is the first randomized trial of a church-placed, community health worker-delivered intervention for depression in African American populations. This study may provide a novel and effective approach to increasing depression identification and treatment linkage in economically disadvantaged populations with high depression rates.

Trial registration

ClinicalTrials.govNCT04524767. Registered on 21 August 2020.

Academic Motivation: Concepts, Strategies, and Counseling Approaches

Motivation is an important foundation of academic development in students. This article discusses academic motivation; its various component concepts in areas such as beliefs, goals, and values; and intrinsic and extrinsic motivation. It also presents major, widely studied theoretical perspectives of academic motivation and briefly illustrates strategies for increasing academic motivation. The article addresses the importance of the school counselor's role in student academic development and describes preventive (classroom guidance) and remedial (small-group counseling intervention and individual counseling intervention) approaches that school counselors can utilize for promoting academic motivation.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight

The aim of this study was to compare the effect of motivational interview (MI) with conventional care on the depression scale scores of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design, including two groups: intervention group [Motivational Interview Group (MIG)], control group [Conventional Intervention Group (CIG)].

INTERVENTION

three face-to-face 30min' interviews three months apart (only MIG interviews were based on MI principles).

OUTCOMES

change in Children Depression Inventory (CDI) scores. We used a mixed repeated-measures ANOVAs analysis to assess the group vs time interaction. Effect size was calculated for ANOVA with difference of means of the total score (DOMTS). CDI scores were compared by a paired t-test. Eighty-three (84%) adolescents finished the intervention. There was a significant time vs group interaction both groups. While in the CIG scores significantly increased, in the MIG the scores significantly decreased. The DOMTS was significantly different between the two groups. We concluded that MI showed a positive effect on depression scale scores over time relatively to conventional intervention.

Healthcare professionals experience with motivational interviewing in their encounter with obese pregnant women

OBJECTIVE

to explore and describe how healthcare professionals in the Southern Region of Denmark experienced motivational interviewing as a communication method when working with pregnant women with obesity.

DESIGN

a qualitative, descriptive study based on face-to-face interviews with 11 obstetric healthcare professionals working in a perinatal setting.

METHODS

a thematic descriptive method was applied to semi-structured interviews. The healthcare professional's experiences were recorded verbatim during individual semi-structured qualitative interviews, transcribed, and analysed using a descriptive analysis methodology.

FINDINGS

motivational interviewing was found to be a useful method when communicating with obese pregnant women. The method made the healthcare professionals more aware of their own communication style both when encountering pregnant women and in their interaction with colleagues. However, most of the healthcare professionals emphasised that time was crucial and they had to be dedicated to the motivational interviewing method. The healthcare professionals further stated that it enabled them to become more professional in their daily work and made some of them feel less 'burned out', 'powerless' and 'stressed' as they felt they had a communication method in handling difficult workloads.

CONCLUSION

healthcare professionals experienced motivational interviewing to be a useful method when working perinatally. The motivational interviewing method permitted heightened awareness of the healthcare professionals communication method with the patients and increased their ability to handle a difficult workload. Overall, lack of time restricted the use of the motivational interviewing method on a daily basis.

Exploring the use of Motivational Interviewing with a disengaged primary-aged child

Research suggests motivational interviewing (MI) techniques are both widely-used by educational psychologists (EPs) and effective in supporting young people of secondary age. To date, there has been no published research investigating the use of MI with primary-aged children. This study details the use of a short MI-based intervention with a primary-aged pupil identified as disengaged. A case-based approach was employed, using pupil and teacher interviews and observational fieldnotes to assess the usefulness of the intervention. Data were analysed using thematic analysis and the intervention checked for adherence to the MI spirit and principles. Here the process, structure and outcomes of the intervention are exemplified through an illustrative case study with a nine-year-old boy. Results indicate that the adapted intervention had a significant impact on learning motivation and classroom behaviour. The implications of the findings are discussed in relation to the use of school-based therapeutic interventions by EPs.

Motivational interviewing at the intersections of depression and intimate partner violence among African American women

This article focuses on design, training, and delivery of a culturally tailored, multi-faceted intervention that used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a community-based participatory research approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program.

Treatment of the depressed alcoholic patient

Alcohol use disorders (AUDs) and depressive illnesses are highly prevalent, frequently co-occur, and are associated with worse outcomes when paired. The assessment and treatment of patients with co-occurring alcohol use disorders and depressive illnesses is wrought with many significant challenges. When it comes to advocating treatment guidelines for this dually-diagnosed population, the data are limited, but, nonetheless, do suggest that an integrated approach to patients presenting with co-occurring AUD and depressive symptoms can be efficacious. In this approach, ongoing evaluation and treatment are provided under one roof according to the evolving needs of each patient. Utilizing antidepressant medications in conjunction with psychosocial therapies may augment overall treatment efficacy; data also suggest that combining and tailoring psychosocial therapies, such as motivational enhancement therapies, cognitive therapies, and twelve-step facilitation may further improve treatment outcomes for patients with co-occurring depressive and alcohol use disorders.

Extending motivational interviewing to the treatment of major mental health problems: current directions and evidence

Motivational interviewing (MI) was originally developed for the treatment of substance abuse but is rapidly expanding to other major mental health populations beyond addictions. This brief review considers the use of MI and related motivational enhancement therapies (METs) in the treatment of anxiety, depression, and eating disorders, and concurrent psychosis and substance use disorders. MI-MET has been added and (or) integrated into treatment for these problems in a wide variety of ways, most commonly as a pretreatment to other therapies (psychosocial treatments and pharmacotherapy) or integrated into standard assessment procedures. In each problem domain, the bulk of the current evidence supports the value of adding MI to existing therapies in increasing engagement with treatment and in improving clinical outcomes. This is particularly encouraging in that many of the populations included in these investigations represent severe and treatment-recalcitrant populations. However, research on the application of MI to other major mental health problems beyond addictions is in the early stages, with existing studies having numerous limitations (for example, small uncontrolled studies or lack of adequate control groups, and failure to establish both MI treatment integrity and the unique contribution of MI in integrated treatments). In short, the substantial body of promising preliminary findings strongly support the continued investigation of MI and related methods for these populations in well-designed clinical trials that examine not only the additive value of MI but also mechanisms underlying these effects and individual differences (moderators) indicating the need for MI.

Introduction to the special series on motivational interviewing and psychotherapy

Clinical and research applications of motivational interviewing (MI) have grown at a remarkable pace over the past 25 years. Most of this work has targeted the addictions and health-related behaviors. The series of articles in this issue highlight a rapidly accelerating recent trend: the application of MI to other problems typically seen in clinical practice. This introductory article describes MI, its core principles, treatment methods, and the variety of ways in which it has been employed. The 6 case reports in this issue are then described. They illustrate how MI can be employed with generalized anxiety, adolescent depression, lifestyle changes, social anxiety disorder, suicidality, and intimate partner violence. The series of articles in this issue concludes with a commentary on the cases and a practice-friendly review of outcome research on MI.