Functional Imagery David Kavanagh Training Jackie Andrade - PowerPoint PPT Presentation

Functional Imagery David Kavanagh Training Jackie Andrade

Functional Imagery What would you like to achieve? • Think about a goal you would like to achieve this week Training • Write one sentence. Think carefully about your choice of words • Imagine it happening

Functional Imagery Motivational interviewing • This is not MI [0:58 – 2mins] Training https://www.youtube.com/watch?v=80XyNE89eCs • This is MI [0:11 – 4mins] • https://www.youtube.com/watch?v=URiKA7CKtfc

Functional Imagery Ob Observations leading to MI • Many people can change with minimal assistance Training • Therapists vary in impact • Empathy appears to be a key variable

Functional Imagery Mo Moti tivati tional inte terviewing Creates a safe environment to consider change • Emphasizes autonomy, collaboration • Avoids judgement, confrontation Training Elicits & draws the person’s attention to their own • incentives and related desires/needs for change, & • experiences supporting their confidence in changing (i.e. they argue for change--‘change talk’, rather than ‘sustain talk’) and through empathic reflections, magnifies the emotional impact of these If they decide to change, supports their development of • specific plans, and • commitment to action.

Functional Imagery MI MI Str trate tegies • OARS— • Open-ended questions Training • Affirmations • Reflections • Summaries

Functional Imagery MI MI effects in meta-an anal alyses • Medication adherence 17 trials (11 in each) • Continuous 3-12m SMD = .70 (0.15, 1.25) √ • Categorical RR = 1.17 (1.05, 1.31) √ Training Palacio et al (2016) • Contraceptive use 8 trials • to 4m RR = 1.32 (1.11, 1.56) √ • to 8-12m RR = 1.18 (0.96, 1.46) X • Births to 12-24m RR = 0.80 (0.51, 1.26) X Wilson et al (2015) • Pain 7 trials • Pain intensity to post g = .27 (.04, .50) (√) • …to 6m g = .10 (-.06, .26) X • Physical functioning (3 trials) g = .12 (-.02, .27) X Alperstein & Sharpe(2016)

̴ Functional Imagery MI MI effects in meta-an anal alyses • Physical activity in chronic disease 8 trials Training • Activity SMD = .19 (.06, .32) (if fidelity test, .30) (√) O’Halloran et al (2014) • Weight 11 trials • Mass (weight or BMI) SMD = -0.51 (-1.04, +.01) ̴ • Weight WMD = -1.47 kg (-2.05, -0.88 ) √ • BMI WMD = -0.25 (-.50, .01) Armstrong (2011)

Functional Imagery MI MI effects in meta-an anal alyses • Alcohol use in young people 84 trials ≥ 4 mths • Drinks/week SMD = -.11 (-.15, -.06) ≈ 1.2 drinks (√) • Frequency SMD = -.14 (-.21, -.07) ≈ 0.2 days (√) Training Foxcroftet al (2016) • Illicit drug use in adolescents 10 trials (3-12mths) • Attitudes (3 trials) d = .44 ( .20, .67) √ • Use (8 trials) d = .05 (-.06, .17) X Li et al (2015) • Gambling 5 trials • Frequency to post WMD = -1.30 days/mth (-2.39, -.21) ( √ ) • Expenditure WMD = -.23 log $ (-.42, -.05) ( √ ) Yavolenkoet al (2015)

Functional Imagery Im Implications • MI is usually significantly better than a control, • but relative effects are often small, decay over time • Some interpret this as a lack of clinical significance Training • Can also see as a reasonable effect of a short intervention • Are there opportunities to increase effects? • MI is heavily verbal • What if it systematically used imagery? • MI is in the clinic, not in the decision situation • What if people were shown how to use it by themselves?

Functional Imagery The lemon exercise to introduce multisensory imagery Training

Functional Imagery Functional Imagery Training (FIT) • FIT is a new way of supporting behaviour change by Training strengthening motivation. • Based on motivational interviewing • Elicits and trains mental imagery to motivate change

Mental imagery supports behaviour Functional Imagery and decision making • Imagining the future reduces impulsivity Daniel, Stanton & Epstein Training (2013) • Imagery turns plans into behaviour Knäuper et al., (2009) • Imaginal rehearsal improves performance and motivation in sport e.g., Paivio (1985) • Imagery increases confidence that something happened/can happen e.g., Garry et al (1996) Imagination inflation. • Imagery is emotive Holmes & Matthews (2005)

Elaborated Functional Imagery Intrusion external anticipatory associated cues responses thoughts Theory desire thoughts implications imagery propositions Training • Cravings and desires work in same way pleasure / relief • Imagery is key subjective sense of state of desire associated deficit Kavanagh, Andrade & May (2005) physiological negative Imaginary relish and exquisite torture: deficit affect The Elaborated Intrusion theory of desire. Psychological Review, 112, 446- 467 automatic influences attentional / working memory allocation

Functional Imagery Imagery in alcohol craving Sound Training Smell Swallow Picture Taste 1+ sensory elements M 2.3 senses (SD 2.5) 0 20 40 60 80 100 % > 0 (‘at least some of the time') Kavanagh, May & Andrade (2009) Br J Clinical Psy

Functional Imagery Functional desires visual imagery predicts desire to play hockey: r = .61*** May et al (2008) Training imagery about environment predicts behaviour change r = .27* – .52*** Boomsma (2013) change in imagery frequency predicts change in physical activity frequency, r= .45*** Andrade et al. (unpublished)

Functional Imagery Blocking imagery reduces desire auditory visual auditory visual 8 Training 7 Cigarette craving 6 5 4 before after before after experiment 3 experiment 4 neutral imagery clay modelling May, Andrade, Kavanagh, & Panabokke (2010). Visual imagery tasks suppress craving for cigarettes, Behaviour Research and Therapy, 48, 476-485 See also: Andrade, Pears, May & Kavanagh, 2012; Harvey, Kemps & Tiggemann, 2005; Kemps, Tiggemann & Hart, 2005; Kemps & Tiggemann, 2007; 2009; Kemps, Tiggemann, Woods & Soekov, 2004; McClelland, Kemps and Tiggemann, 2006; Steel, Kemps & Tiggemann, 2006; Versland & 1 Rosenberg, 2007 7

Functional Imagery Goal conflict: the EI approach • Goal conflict is common Hofmann et al (2011) • All goals are desired Training • Same cognitive cycle creates unwanted cravings and desirable desires • It is easier to imagine succumbing to immediate temptation than achieving good intentions

Imagining pleasure of healthy goal Functional Imagery • Weakens desire for competing goals by blocking desire imagery • Strengthens desire for healthy goal Training Healthy goal becomes more immediate • salient • achievable • wanted •

Functional Imagery Functional Imagery Training • Motivational interviewing with imagery Training • Positive imagery of proximal goals Motivation for change • Makes goal concrete, close and achievable • Trains goal imagery as a Cues fresh imagery Elicits affectively skill, refining goals and based on experiences, charged mental incorporating successes new goals imagery into imagery Trains everyday use of imagery to support self-management 20

Functional Imagery Functional Imagery Training Training Imagery at key points during MI: • Benefits of hypothetical change • Past successes, strategies training and • Potential/proposed plan support • Solutions to any barriers

Functional Imagery Training Focus on positive proximal outcomes

Functional Imagery Alcohol—2 uncontrolled pilot trials • Study 1 (n = 12) Training • 4hr contact • 2 x 90 min face-to-face sessions in Week 1 • + 5 x 10-15 min phone calls to 6 months • Used our first app • Study 2 (n = 24) • 3.5 hr contact • Retained 7 sessions over 6 months, but only by phone • Added 24 SMS reminders • Used standard phone calendar, photo library

Ef Effects on weekly drinks This slide showed results from study that is not yet published

Gym attendance Functional Imagery (N = 48; Brief Advice vs FIT over 2 weeks; 1x 30-45min session + SMS/ email at 5, 10 days) Training This slide showed results from study that is not yet published

Functional Imagery FIT to reduce high energy snacking FIT FIT Training FIT FIT Andrade, J., Khalil, M., Dickson, J., May, J. & Kavanagh, D.J. (2016). Functional Imagery Training to reduce snacking: Testing a novel motivational intervention based on Elaborated Intrusion theory. Appetite .

Functional Imagery On One-ar armed 3 month pilot of FIT for weight loss an and increas asing physical al ac activity 22 participants, BMI > 25 (mean BMI=29.9, age=39), 17 completed Training • 1 face to face session (1hr) activity focus • 1 phone session (45min) diet • Fortnightly booster calls Linda Solbrig

Functional Imagery FIT weight loss pilot results Training This slide showed results from study that is not yet published