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FunctionalImagery
TrainingWhatwouldyouliketoachieve?
• Thinkaboutagoalyouwouldliketoachievethisweek• Writeonesentence.Thinkcarefullyaboutyourchoiceofwords• Imagineithappening
FunctionalImagery
TrainingMotivationalinterviewing
• ThisisnotMI[0:58– 2mins]
https://www.youtube.com/watch?v=80XyNE89eCs• ThisisMI [0:11– 4mins]
• https://www.youtube.com/watch?v=URiKA7CKtfc
FunctionalImagery
TrainingObservationsleadingtoMI
• Manypeoplecanchangewithminimalassistance
• Therapistsvaryinimpact• Empathyappearstobeakeyvariable
FunctionalImagery
TrainingMotivationalinterviewing
Createsasafeenvironmenttoconsiderchange• Emphasizesautonomy,collaboration• Avoidsjudgement,confrontation
Elicits&drawstheperson’sattentiontotheirown• incentivesandrelateddesires/needsforchange,&• experiencessupportingtheirconfidenceinchanging
(i.e.theyargueforchange--‘changetalk’,ratherthan‘sustaintalk’)
andthroughempathicreflections,magnifiestheemotionalimpactofthese
Iftheydecidetochange,supportstheirdevelopmentof• specificplans,and• commitmenttoaction.
FunctionalImagery
TrainingMIStrategies
• OARS—• Open-endedquestions• Affirmations• Reflections• Summaries
FunctionalImagery
TrainingMIeffectsinmeta-analyses
• Medicationadherence 17trials(11ineach)• Continuous3-12m SMD=.70(0.15,1.25)√• Categorical RR=1.17(1.05,1.31)√
Palacio etal (2016)
• Contraceptiveuse 8trials• to4m RR= 1.32(1.11,1.56)√• to8-12m RR= 1.18(0.96,1.46) X• Birthsto12-24m RR= 0.80(0.51,1.26) X
Wilson etal (2015)
• Pain 7trials• Painintensitytopost g=.27(.04,.50) (√)• …to6m g=.10(-.06,.26) X• Physicalfunctioning(3trials) g=.12(-.02,.27)X
Alperstein &Sharpe(2016)
FunctionalImagery
TrainingMIeffectsinmeta-analyses
• Physicalactivityinchronicdisease 8trials• ActivitySMD=.19(.06,.32)(iffidelitytest,.30)(√)
O’Halloran etal (2014)
• Weight 11trials• Mass(weightorBMI)SMD=-0.51(-1.04,+.01) ̴• WeightWMD=-1.47kg(-2.05,-0.88 ) √• BMIWMD=-0.25(-.50,.01) ̴
Armstrong (2011)
FunctionalImagery
TrainingMIeffectsinmeta-analyses
• Alcoholuseinyoungpeople 84trials≥4mths• Drinks/week SMD=-.11(-.15,-.06)≈1.2drinks (√)• Frequency SMD=-.14(-.21,-.07) ≈0.2days(√)
Foxcroft etal(2016)
• Illicitdruguseinadolescents 10trials(3-12mths)• Attitudes (3trials) d=.44(.20,.67)√• Use (8trials) d=.05(-.06,.17)X
Lietal(2015)
• Gambling 5trials• Frequencytopost WMD=-1.30days/mth (-2.39,-.21)(√)• Expenditure WMD=-.23log$(-.42,-.05) (√)
Yavolenkoetal(2015)
FunctionalImagery
TrainingImplications
• MIisusuallysignificantlybetterthanacontrol,• butrelativeeffectsareoftensmall,decayovertime
• Someinterpretthisasalackofclinicalsignificance• Canalsoseeasareasonable effectofashortintervention
• Arethereopportunitiestoincreaseeffects?• MIisheavilyverbal
• Whatifitsystematicallyusedimagery?• MIisintheclinic,notinthedecisionsituation
• Whatifpeoplewere shownhowtouseitbythemselves?
FunctionalImagery
TrainingFunctionalImageryTraining(FIT)
• FITisanewwayofsupportingbehaviour changebystrengtheningmotivation.• Basedonmotivationalinterviewing• Elicits andtrains mentalimagerytomotivatechange
FunctionalImagery
TrainingMentalimagerysupportsbehaviouranddecisionmaking• ImaginingthefuturereducesimpulsivityDaniel, Stanton&Epstein
(2013)
• Imageryturnsplans intobehaviour Knäuper etal., (2009)• Imaginalrehearsalimprovesperformanceandmotivationinsporte.g.,Paivio (1985)
• Imageryincreasesconfidencethatsomethinghappened/canhappene.g.,Garryetal(1996)Imagination inflation.
• ImageryisemotiveHolmes &Matthews (2005)
FunctionalImagery
TrainingElaboratedIntrusionTheory
Kavanagh,Andrade&May(2005)Imaginary relish andexquisite torture:TheElaborated Intrusiontheoryofdesire.Psychological Review,112,446-467
external cues
anticipatory responses
associated thoughts
negative affect
physiological deficit
sense of associated deficit
desire thoughtsimplications imagery propositions
automatic influencesattentional / working memory allocation
subjective state of desire
pleasure / relief
• Cravingsanddesiresworkinsameway
• Imageryiskey
FunctionalImagery
Training
0 20 40 60 80 100
1+ sensory elements
Taste
Picture
Swallow
Smell
Sound
M2.3senses(SD2.5)
%>0(‘atleast someofthetime')
Imageryinalcoholcraving
Kavanagh,May&Andrade(2009)BrJClinicalPsy
FunctionalImagery
TrainingFunctionaldesires
visualimagerypredictsdesiretoplayhockey:r=.61***Mayetal (2008)
imageryaboutenvironmentpredictsbehaviourchanger=.27*– .52***Boomsma (2013)
changeinimageryfrequencypredictschangeinphysicalactivityfrequency,r=.45***Andrade etal.(unpublished)
FunctionalImagery
TrainingBlockingimageryreducesdesire
May,Andrade,Kavanagh,&Panabokke (2010).Visualimagerytaskssuppresscravingforcigarettes,Behaviour ResearchandTherapy,48,476-485
4
5
6
7
8
before after before after
experiment3 experiment4neutralimagery claymodelling
Cigarettecraving
auditory visual
Seealso:Andrade, Pears,May&Kavanagh,2012; Harvey, Kemps&Tiggemann,2005;Kemps, Tiggemann &Hart, 2005;Kemps&Tiggemann,2007;2009;Kemps, Tiggemann,Woods&Soekov, 2004;McClelland, KempsandTiggemann,2006;Steel, Kemps&Tiggemann,2006;Versland &Rosenberg, 2007
17
auditory visual
FunctionalImagery
TrainingGoalconflict:theEIapproach• GoalconflictiscommonHofmannetal(2011)
• Allgoalsaredesired• Samecognitivecyclecreatesunwantedcravingsanddesirabledesires• Itiseasiertoimaginesuccumbingtoimmediatetemptationthanachievinggoodintentions
FunctionalImagery
TrainingImaginingpleasureofhealthygoal• Weakensdesireforcompetinggoalsbyblockingdesireimagery• Strengthensdesireforhealthygoal
Healthygoalbecomesmore• immediate• salient• achievable• wanted
FunctionalImagery
Training• Motivationalinterviewingwithimagery
• Positiveimageryofproximalgoals
• Makesgoalconcrete,closeandachievable
• Trainsgoalimageryasaskill,refininggoalsandincorporatingsuccessesintoimagery
20
Motivationforchange
Elicitsaffectivelychargedmental
imagery
Trainseverydayuseofimagerytosupportself-management
Cuesfreshimagerybasedonexperiences,
newgoals
FunctionalImageryTraining
FunctionalImagery
TrainingFunctionalImageryTraining
ImageryatkeypointsduringMI:• Benefits ofhypotheticalchange• Pastsuccesses, strategies• Potential/proposedplan• Solutions toanybarriers
trainingandsupport
FunctionalImagery
TrainingAlcohol—2uncontrolledpilottrials
• Study1(n=12)• 4hrcontact• 2x90minface-to-facesessionsinWeek1• +5x10-15minphonecallsto6months
• Usedourfirstapp
• Study2(n=24)• 3.5hrcontact• Retained7sessionsover6months,butonlybyphone• Added24SMSreminders
• Usedstandardphonecalendar,photolibrary
FunctionalImagery
TrainingGymattendance
(N=48;BriefAdvicevsFITover2weeks;1x30-45minsession+SMS/emailat5,10days)
This slideshowedresults fromstudythatisnotyetpublished
FunctionalImagery
TrainingFITtoreducehighenergysnacking
FIT
FIT
FIT
FIT
Andrade,J.,Khalil,M.,Dickson, J.,May,J.&Kavanagh,D.J.(2016).FunctionalImageryTrainingtoreducesnacking:TestinganovelmotivationalinterventionbasedonElaboratedIntrusiontheory.Appetite.
FunctionalImagery
TrainingOne-armed3monthpilotofFITforweightlossandincreasingphysicalactivity
22participants,BMI>25(meanBMI=29.9,age=39),17completed• 1facetofacesession(1hr)activity focus• 1phonesession(45min)diet• Fortnightlyboostercalls LindaSolbrig
FunctionalImagery
TrainingFITweightlosspilotresults
This slideshowedresults fromstudythatisnotyetpublished
FunctionalImagery
TrainingSomeinterestinganecdotalremarks….‘IwillusethisforotherareasofmylifewhereIamstruggling;togetmeoutofthisblackholeIhavebeeninrecently…’
‘Andbecause itisallpositiveimagerymydepressedmoodhasreallyimprovedoverthepastmonths.’
‘IcouldnotleavethehouseforfourdaysbecauseIthoughthepeople InAldiwouldmakefunofhowfatIwas…butIfocusedontheimagerytohelpmegetovermypanicattack…tohelpmeleavethehouseagain…’
‘Itisallaboutchangingone’smindset– isn’tit?IfeelsopositiveandmotivatedbecauseIneverlookedatitlikethisbefore….’
‘Idon’tknowifyouhypnotisedmeorwhatyouhavedone,butthepositivereinforcementoftheimagery,itreallymakesmefeelgoodaboutbeinginthisforthelong-haul.IenjoythepathandIamnotdeprivedlikewhenIwasonallthesedietsbefore…’
FunctionalImagery
TrainingCurrenttrialscomparingFITwithMI
• NHMRCProjectGrant1099400,KavanaghDJ,GravesN,ConnorJ,HidesL,GulloM,ConnollyJ,AndradeJ,MayJ.Anew,low-coste-healthtreatmentforAlcoholUseDisorderusingmentalimagery.2016-2019• NIHRPenCLAHRC2,Solbrig L,AndradeJ,ParkinT,JonesR.FunctionalImageryTrainingasapersonalizede-healthinterventionforweightloss.2015-2017
FunctionalImagery
TrainingPotentialhomework:Takephotos
Remindingthemoftheimages
• (Requirescreationofanimage)
• (Canbeatransitionalcommitment)
Helpthemidentify1or2tostart
FunctionalImagery
TrainingEncouragethisasanongoingactivity
• Makestheimagerylesshypothetical• Actualbenefits• Effective strategies• Successesthathaveoccurred
• Encouragesnewimages
FunctionalImagery
TrainingReinforcecommitment,byencouraging
• Creationofanaudio/videoontheplan• Iamgoingto…• …because(benefitrankedtop/withmostemotion)• IknowIcandoit,because…
• Sharingtherecordingwithatrustedsupporter• Tostartaconversationonhowthepersonwantsthemtohelp
• Replayingtherecording athome
FunctionalImagery
TrainingTraining:makingimageryroutine
WecuehomepracticewithSMSs,phonecalls
They cuehomepracticeusing• Routinebehavior• Phonenotifications
FunctionalImagery
TrainingGoalinMindapp
• Guidesimagerywithaudios,photos
• Recordsdaily,cumulative• imagerypractice• goalachievement
• https://apps.ihbi.qut.edu.au/gim/
FunctionalImagery
TrainingManagingcravings
• Cognitiveblocking• Mindfulness• Imagemodification(cognitivetherapy)
• Cravingsbustervideo
FunctionalImagery
TrainingWaysofusingFIT
• Typicaltreatment:twosessionplusboostercalls• Wehaveuseditforincreasingandforreducingbehaviours
• FITtomotivateengagementwithtreatment• Asbriefinterventiontomotivatespecificbehaviour e.g.CBThomework,addressavoidance
FunctionalImagery
TrainingContexts
• Depression• Limitedawarenessofimagery• Workingmemorydeficits• Psychoticsymptoms
FunctionalImagery
TrainingDepression
+ive future ishardtoenvisagesuccessesarehardtorememberbothwillbediscounted…so
• Helpretrievalofepisodesusingcontent• Focuson
• positiveaspects• strategiescanuse
• Onesmallinitialstep• Potentialassistance,scaffolding
FunctionalImagery
TrainingLimitedawarenessofimagery
• Drawattentiontoanyimagerye.g.,whenplanningaroute,readingabook,rememberingapastevent
• Ifcangenerate insession,doesitmatter?
• Encourage totake&usephotostocueit
• Elicitawareness ofphysicalsensations
FunctionalImagery
TrainingWorkingmemorydeficits
Problem—holding,manipulatinginformation
• Usewhiteboardorpaper• Ifpossible,getthemtowrite• Includesimplepictures
• Encourage themtouseapp,audios• e.g.what,when,howreminder• Imageryaudios• Phonereminders
• PhoneorsendSMSstoremindthemabouttheirplan
FunctionalImagery
TrainingPsychoticsymptoms
Hallucinations• Avoidexplicitlyelicitingimagery?• e.g.insteadtalkindetailaboutspecificeventsinpastorfuture
Lackofenergy/sedation• Small,easysteps• Askforassistancetogetstarted?