Motivational interviewing and cognitive behaviour therapy in the treatment of adolescent overweight and obesity : study design and methodology

Background

Despite the high prevalence and negative physical and psychosocial consequences of overweight and obesity in adolescents, very little research has evaluated treatment in this population. Consequently, clinicians working with overweight and obese adolescents have little empirical research on which to base their practise. Cognitive behavioural therapy has demonstrated efficacy in promoting behaviour change in many treatment resistant disorders. Motivational interviewing has been used to increase motivation for change and improve treatment outcomes. In this paper we describe the rationale and design of a randomised controlled trial testing the efficacy of motivational interviewing and cognitive behaviour therapy in the treatment of overweight and obese adolescents.
Methods

Participants took part in a motivational interview or a standard semi-structured assessment interview and were then randomly allocated to a cognitive behavioural intervention or a wait-list control condition. The cognitive behavioural intervention, the CHOOSE HEALTH Program, consisted of 13 individual treatment sessions (12 face-to-face, 1 phone call) followed by 9 maintenance sessions (7 phone calls, 2 face-to-face). Assessments were conducted prior to participation, after the treatment phase and after the maintenance phase of intervention. Improvement in body composition was the primary outcome; secondary outcomes included improved cardiovascular fitness, eating and physical activity habits, family and psychosocial functioning.
Conclusion

Despite the demonstrated effectiveness of motivational interviewing and cognitive behavioural therapy in the long-term management of many treatment resistant disorders, these approaches have been under-utilised in adolescent overweight and obesity treatment. This study provides baseline data and a thorough review of the study design and treatment approach to allow for the assessment of the efficacy of motivational interviewing and cognitive behavioural therapy in the treatment of adolescent overweight and obesity. Data obtained in this study will also provide much needed information about the behavioural and psychosocial factors associated with adolescent overweight and obesity.

Television journalism : the cultural politics of contemporary current affairs interviewing

This thesis examined television current affairs interviewing to determine the influence of the cultural politics of Australian commercial and non-commercial networks. Marketplace pressures to rate highly was the major influence on commercial programs resulting in the use of shorter dramatic interviews, more celebrities, fewer politicians, hidden cameras and ambush interviews.

Investigative interviewing of children : barriers to adopting 'best-practice' guidelines

This research examined the global difficulties of investigative interviewers in adhering to best-practice guidelines (i.e. open-ended questions) when interviewing children about abuse. It demonstrated that the importance of, and rationale for, using open-ended questions is not well understood by investigative interviewers, nor are they adequately reinforced with police organisations.

Interviewing techniques, genres and contexts

A study of the ways in which the media interview has been described and theorised in academic literature, and in particular the genres of interviewing that this literature has produced. Identifies interviewing techniques used on radio in regional Queensland. Evaluates the ways in which interviewing techniques and practices are mediated by questions of gender and work culture.

Improving the legal aspects of police interviewing of suspects

The purpose of this paper is to provide some guidance to police interviewers and trainers in relation to improving the legal aspects of police questioning of suspects. The paper is written with reference to Victorian legislation. Sixteen professionals (defence barristers, academics, prosecutors, and detectives), all with extensive knowledge of the law and experience evaluating police interviews with suspects, took part in individual indepth interviews (M ¼ 100 minutes). The aim of the interviews was to discuss the limitations of police interviews with suspects and to provide exemplars of concerns from a set of de-identified transcripts that had been provided to the professionals prior to their interviews with us. Overall, four key limitations were raised: (a) inadequate particularisation of offences, (b) inappropriate phrasing of questions, (c) poor introduction of allegations, and (d) questions that unfairly ask the suspect to comment on the victim’s perspective. These concerns and their practical implications are discussed.

The relationship between investigative interviewing experience and open-ended question usage

We present three studies examining the role of prior job experience in interviewing and interviewers’ ability to learn open-ended questions during a training program. We predicted a negative relationship such that more experienced interviewers would perform worse after training than less experienced interviewers, and that (irrespective of baseline performance) the more experienced interviewers would improve the least during training. These predictions were made for two reasons. First, specific questions are commonly used in the workplace (i.e. open-ended questioning constitutes new learning). Second, experience in the use of specific questions potentially interferes with newly learned open-ended questions. Overall, our predictions were supported across different participant samples (including police officers specialized in child abuse investigation and social workers from the child protection area), time delays, and modes of training. The results highlight the need for investment in ongoing investigative interviewing training commencing early during professionals’ careers, prior to the establishment of long-term habits in the use of specific questions.

Motivational interviewing techniques : facilitating behaviour change in the general practice setting

Background: One of the biggest challenges that primary care practitioners face is helping people change longstanding behaviours that pose significant health risks.

Objective: To explore current understanding regarding how and why people change, and the potential role of motivational interviewing in facilitating behaviour change in the general practice setting.

Discussion: Research into health related behaviour change highlights the importance of motivation, ambivalence and resistance. Motivational interviewing is a counselling method that involves enhancing a patient's motivation to change by means of four guiding principles, represented by the acronym RULE: Resist the righting reflex; Understand the patient's own motivations; Listen with empathy; and Empower the patient. Recent meta-analyses show that motivational interviewing is effective for decreasing alcohol and drug use in adults and adolescents and evidence is accumulating in others areas of health including smoking cessation, reducing sexual risk behaviours, improving adherence to treatment and medication and diabetes management.

The association between investigative interviewers' knowledge of question type and adherence to best-practice interviewing

It is well established that not all investigative interviewers adhere to ‘best-practice’ interview guidelines (i.e., the use of open-ended questions) when interviewing child witnesses about abuse. However, little research has examined the sub skills associated with open question usage. In this article, we examined the association between investigative interviewers' ability to identify various types of questions and adherence to open-ended questions in a standardized mock interview. Study 1, incorporating 27 trainee police interviewers, revealed positive associations between open-ended question usage and two tasks; a recognition task where trainees used a structured protocol to guide their response and a recall task where they generated examples of open-ended questions from memory. In Study 2, incorporating a more heterogeneous sample of 40 professionals and a different training format and range of tests, positive relationships between interviewers' identification of questions and adherence to best-practice interviewing was consistently revealed. A measure of interviewer knowledge about what constitutes best-practice investigative (as opposed to knowledge of question types) showed no association with interviewer performance. The implications of these findings for interviewer training programs are discussed.