Ambivalence: Prerequisite for success in motivational interviewing with adolescents?

Ewing, Sarah W. Feldstein; Apodaca, Timothy R.; Gaume, Jacques

doi:10.1111/add.13286

Cited by 34 publications

(30 citation statements)

References 72 publications

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“…Better measures are needed for capturing more nuanced perceptions within the interim period as decisions are being made about whether to change [68]. …”

Section: Discussionmentioning

confidence: 99%

The impact of therapists’ words on the adolescent brain: In the context of addiction treatment

Ewing

Yezhuvath²,

Shokri‐Kojori³

et al. 2016

Behavioural Brain Research

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Despite foundational work, we still do not know how therapist behaviors influence brain response and related treatment outcomes for alcohol-using adolescents. Therefore, we examined this question with 17 binge drinking youth (mean age = 16.62 years; 64.3% female; 42.9% Hispanic; 28.6% bi-/multi-racial). In this within-subjects design, all youth completed a baseline assessment, two therapy sessions, an fMRI scan, and were re-evaluated for behavior change at one-month post-treatment. During the fMRI session, youth were presented with two types of therapist responses from their treating therapist: higher-skill therapeutic statements prescribed in an empirically-supported addiction treatment (complex reflections) versus language standard within addiction treatment more broadly (closed questions). In terms of behavior change, at the one-month follow-up, youth showed significant reductions in their number of drinking days and binge drinking days post-treatment. Further, we found main effects for complex reflections and closed questions across the superior middle temporal gyrus and middle temporal gyrus (FWE-corrected, p<.05). Complex questions showed a relatively stronger response than closed questions within the bilateral anterior cingulate gyrus. Additionally, greater BOLD response in the parietal lobe during closed questions was significantly associated with less post-treatment drinking. Finally, lower BOLD responses during both complex reflections and closed questions in the precuneus were associated with greater post-treatment ratings of importance of changing drinking. This study represents a first step in understanding how certain therapist behaviors influence the developing adolescent brain and how that neural response may be associated with youth treatment outcomes in the context of addiction treatment.

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“…Better measures are needed for capturing more nuanced perceptions within the interim period as decisions are being made about whether to change [68]. …”

Section: Discussionmentioning

confidence: 99%

The impact of therapists’ words on the adolescent brain: In the context of addiction treatment

Ewing

Yezhuvath²,

Shokri‐Kojori³

et al. 2016

Behavioural Brain Research

Self Cite

View full text Add to dashboard Cite

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“…Contrasting with other types of adolescent addiction treatment 14 , ambivalence is one of the central tenets of the clinical framework of MI 15 . Ambivalence represents a client’s experience of simultaneously wanting to make a change while also being reticent to do so.…”

Section: Introductionmentioning

confidence: 99%

Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change

et al. 2017

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An increasing number of studies have implicated network functional connectivity with addiction. Yet, none have examined functional connectivity as a potential mechanism of adolescent behavior change. We examined the underlying neural mechanisms of a promising treatment for adolescents, motivational interviewing (MI). We began by employing psychophysiological interaction (PPI) to evaluate network response in a sample of adolescent cannabis users (N = 30). Next, we examined correlations between network connectivity and clinical metrics of treatment outcome. PPI analyses seeded on the orbitofrontal cortex (OFC) showed significant increases in functional connectivity across the inferior frontal gyrus (IFG), precentral gyrus, anterior and posterior cingulate gyrus, supplementary motor area (SMA), superior frontal gyrus, pallidus, caudate, and parahippocampal gyrus. Further, greater functional connectivity between the OFC and anterior cingulate/medial frontal gyrus was associated with less behavior change (e.g., greater post-treatment cannabis problems). These data support the role of the OFC network as a mechanism of adolescent addiction treatment response.

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“…While the amygdala has been less prominent throughout the adult addiction literature, the developmental adolescent and young adult health risk literature increasingly supports the amygdala in cannabis and other illicit substance use (Filbey and Dunlop 2014; Schacht et al 2012; Yip et al 2016). In other words, there may be something about the nature of appetitive rewards or cues during adolescence, that particularly activates limbic processing relative to adulthood (Feldstein Ewing et al 2016a, b, c). …”

Section: Discussionmentioning

confidence: 99%

“…These steps are fundamental to guiding appropriate and developmentally-responsive methods in prevention and intervention efforts. For example, while the integration of neuroimaging into treatment devleopment is an emerging area (Feldstein Ewing et al 2016a, b; c; Feldstein Ewing et al 2016a, b; c), the significant involvement of brain behavioral control areas (e.g., OFC, IFG) and emotion regulation areas (e.g., amygdala) suggest that effective prevention and intervention efforts for adolescent overweight/obesity may need to include content articulated to improving control over urges and emotionally-driven decision-making around food consumption, presented in a manner that is sensitive and responsive to this age group. However, while individual-level efforts for adolescent overweight/obesity exist (Kong et al 2013), successful treatment efforts for adolescent overweight/obesity are complicated by the nature in which food is purchased and offered in adolescent living situations, which are inherently family-based (Rhee et al 2016).…”

Section: Discussionmentioning

confidence: 99%

Overweight adolescents’ brain response to sweetened beverages mirrors addiction pathways

Ewing

Claus

Hudson

et al. 2016

Brain Imaging and Behavior

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Many adolescents struggle with overweight/obesity, which exponentially increases in the transition to adulthood. Overweight/obesity places youth at risk for serious health conditions, including type 2 diabetes. In adults, neural substrates implicated in addiction (e.g., orbitofrontal cortex (OFC), striatum, amygdala, and ventral tegmental area) have been found to be relevant to risk for overweight/obesity. In this study, we examined three hypotheses to disentangle the potential overlap between addiction and overweight/obesity processing by examining (1) brain response to high vs. low calorie beverages, (2) the strength of correspondence between biometrics, including body mass index (BMI) and insulin resistance, and brain response and (3) the relationship between a measure of food addiction and brain response using an established fMRI gustatory cue exposure task with a sample of overweight/obese youth (M age = 16.46; M BMI = 33.1). Greater BOLD response was observed across the OFC, inferior frontal gyrus (IFG), nucleus accumbens, right amygdala, and additional frontoparietal and temporal regions in neural processing of high vs. low calorie beverages. Further, BMI scores positively correlated with BOLD activation in the high calorie > low calorie contrast in the right postcentral gyrus and central operculum. Insulin resistance positively correlated with BOLD activation across the bilateral middle/superior temporal gyrus, left OFC, and superior parietal lobe. No relationships were observed between measures of food addiction and brain response. These findings support the activation of parallel addiction-related neural pathways in adolescents’ high calorie processing, while also suggesting the importance of refining conceptual and neurocognitive models to fit this developmental period.

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Ambivalence: Prerequisite for success in motivational interviewing with adolescents?

Abstract: Background and Aims The exploration and resolution of ambivalence play an essential role in motivational

Cited by 34 publications

References 72 publications

The impact of therapists’ words on the adolescent brain: In the context of addiction treatment

The impact of therapists’ words on the adolescent brain: In the context of addiction treatment

Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change

Overweight adolescents’ brain response to sweetened beverages mirrors addiction pathways

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