Ata Ghaderi

An evaluation of training in motivational interviewing for nurses in child health services.

BACKGROUND Acquiring proficiency in motivational interviewing (MI) may be more difficult than generally believed, and training research suggests that the standard one-time workshop format may be insufficient. Although nurses represent one of the professions that have received most training in MI, training in this group has rarely been systematically evaluated using objective behavioral measures. AIMS To evaluate an enhanced MI training program, comprising a 3.5-day workshop, systematic feedback on MI performance, and four sessions of supervision on practice samples. METHODS Nurses (n = 36) in Swedish child health services were trained in MI. Skillfulness in MI was assessed using the Motivational Interviewing Treatment Integrity (MITI) Code. Effects of training were compared to beginning proficiency thresholds. RESULTS Participants did not reach beginning proficiency thresholds on any of the indicators of proficiency and effect sizes were small. CONCLUSIONS The present study adds to a growing body of literature suggesting that the current standard MI training format may not provide practitioners with enough skillfulness. Moreover, the results indicate that even enhanced training, including systematic feedback and supervision, may not be sufficient. Suggestions for improved MI training are made.

The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science

Background: Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is great; even the best treatments do not work for everyone, treatments have not been developed for many mental disorders, and the implementation of treatments needs to address worldwide scalability. Psychological treatments have yet to benefit from numerous innovations that have occurred in science, particularly those that have emerged in the past 20 years, and arguably vice versa. This Commission comprises ten parts that each outline an area in which we see substantial opportunity and scope for advancements that will move psychological treatments research forward. / Part 1: How do existing treatments work? Making the case for the mechanisms of psychological treatments Beyond knowing that an intervention is efficacious, research initiatives are needed that clarify the key mechanisms through which interventions work. An experimental psychopathological approach enables the identification of mechanisms. Research on these mechanisms has considerable scope to facilitate treatment innovation. / Part 2: Where can psychological treatments be deployed? Research to improve mental health worldwide We outline a number of factors to facilitate worldwide access to psychological treatments. Future research initiatives need to continue to develop and assess the efficacy of brief and flexible interventions that can be adapted to meet the needs of individuals across cultural contexts, and delivered and disseminated in a sustainable way. / Part 3: With what? The potential for synergistic treatment effects—using and developing cross-modal treatment approaches The combination of psychological and pharmacological treatments needs to be better understood, both in terms of the clinical effect and the underlying shared and different mechanisms. Efforts to develop and investigate the efficacy of novel cross-modal treatments could contribute to treatment innovation. / Part 4: When in life? Psychological science, prevention, and early intervention—getting the approach right from the start The social and economic tolls of mental health problems early in life make the development of effective prevention and early intervention approaches a priority. A preventive focus and a developmental approach are needed to identify risk factors for psychopathology, and identification of the optimal time at which to offer prevention approaches is needed to increase the likelihood of vulnerable young people growing up with positive mental health. / Part 5: Technology—can we transform the availability and efficacy of psychological treatment through new technologies? New technologies provide exciting and timely means by which to disseminate and extend the efficacy and global reach of evidence-based interventions. eHealth and mHealth approaches that use information technology (eg, the internet, virtual reality, serious gaming) and mobile and wireless applications (eg, text messaging, apps) are examples of how technology has been harnessed to innovate psychological treatments and their availability and evaluation. / Part 6: Trials to assess psychological treatments The findings of randomised controlled trials that assess psychological therapies inform policy and practice. Accordingly, the design and conduct of these trials warrants scrutiny and ongoing efforts for quality improvement (eg, reporting standards, specification of protocols, inclusion and exclusion criteria, choice of outcome measures, measurement of adverse effects, and prevention of bias in design and analysis). We outline several opportunities for further improvement that should enhance the credibility and quality of future trials. / Part 7: Training—can we cultivate a vision for interdisciplinary training across mental health sciences to improve psychological treatments? Early examples of collaboration between basic scientists and clinicians translated into historical steps in the innovation of psychological treatment. Such synergy has become less apparent in the past few years. The improvement in links between clinical psychology, psychiatry, and basic research has the potential to deliver more advances in psychological treatments. We propose opportunities to improve training in interdisciplinary mental health sciences. This training approach would be the first step toward forging links between scientists and clinicians in the next generation and bridging the gap between clinical practice and the basic research programmes that underpin psychological treatments. / Part 8: Whom should we treat, for what, and with what? Embracing the complexity of mental disorders from personalised models to universal approaches Mental disorders are inherently complex (eg, hetero-geneity in symptoms across disorders, high rates of comorbidity) and evidence-based treatments must address this complexity. Potential solutions include considering both highly individualised (ie, personalised) approaches and so-called universal or transdiagnostic approaches that target common mechanisms. A goal of future research will be to examine whether these approaches improve treatment effectiveness. / Part 9: Target: suicidal behaviour—protecting lives Suicidal behaviour is one of many areas in which advances are needed. Despite developments in the understanding of risk factors that predict the likelihood of suicide attempts, and the treatment and prevention of suicidal behaviour, many questions remain. We specify areas for future research—eg, use of new technologies, the role of culture, input from individuals with lived experience of suicidal behaviour, and using a team-based approach in the development, assessment, and dissem-ination of prevention efforts. / Part 10: Active innovation and scrutiny of future psychological treatments research The task of improving psychological treatments is an exciting prospect for scientists and clinicians with an interest in the so-called science of mental life. Clinicians, researchers, service users, carers, funders, commissioners, managers, policy planners, and change experts all have a part to play in improving psychological treatment. Some long-held ideas need examination, from the branding of psychological treatment types, to considering what people actually want treatment for. Scrutiny of new ideas should be rigorous and yet encourage innovation.

Using Early Change to Predict Outcome in Cognitive Behaviour Therapy: Exploring Timeframe, Calculation Method, and Differences of Disorder-Specific versus General Measures

Early change can predict outcome of psychological treatment, especially in cognitive behavior therapy. However, the optimal operationalization of “early change” for maximizing its predictive ability, and differences in predictive ability of disorder-specific versus general mental health measures has yet to be clarified. This study aimed to investigate how well early change predicted outcome depending on the week it was measured, the calculation method (regression slope or simple subtraction), the type of measures used, and the target disorder. During 10–15 weeks of internet-based cognitive behavior therapy for depression, social anxiety disorder, or panic disorder, weekly ratings were collected through both disorder-specific measures and general measures (Outcome Questionnaire-45 (OQ-45) and Clinical Outcomes in Routine Evaluation-10 (CORE-10)). With outcome defined as the disorder-specific measure, change at week four was the optimal predictor. Slope and subtraction methods performed equally well. The OQ-45 explained 18% of outcome for depression, 14% for social anxiety disorder, and 0% for panic disorder. Corresponding values for CORE-10 were 23%, 29%, and 25%. Specific measures explained 41%, 43%, and 34% respectively: this exceeded the ability of general measures also when they predicted themselves. We conclude that a simple calculation method with a disorder-specific measure at week four seems to provide a good choice for predicting outcome in time-limited cognitive behavior therapy.

Motivational Interviewing to Prevent Childhood Obesity : A Cluster RCT

OBJECTIVE: The objective was to evaluate a manualized theory-driven primary preventive intervention aimed at early childhood obesity. The intervention was embedded in Swedish child health services, starting when eligible children were 9 to 10 months of age and continuing until the children reached age 4. METHODS: Child health care centers in 8 Swedish counties were randomized into intervention and control units and included 1355 families with 1369 infants. Over ∼39 months, families in the intervention group participated in 1 group session and 8 individual sessions with a nurse trained in motivational interviewing, focusing on healthy food habits and physical activity. Families in the control group received care as usual. Primary outcomes were children’s BMI, overweight prevalence, and waist circumference at age 4. Secondary outcomes were children’s and mothers’ food and physical activity habits and mothers’ anthropometrics. Effects were assessed in linear and log-binominal regression models using generalized estimating equations. RESULTS: There were no statistically significant differences in children’s BMI (β = –0.11, 95% confidence interval [CI]: –0.31 to 0.08), waist circumference (β = –0.48, 95% CI: –0.99 to 0.04), and prevalence of overweight (relative risk = 0.95, 95% CI: 0.69 to 1.32). No significant intervention effects were observed in mothers’ anthropometric data or regarding mothers’ and children’s physical activity habits. There was a small intervention effect in terms of healthier food habits among children and mothers. CONCLUSIONS: There were no significant group differences in children’s and mothers’ anthropometric data and physical activity habits. There was, however, some evidence suggesting healthier food habits, but this should be interpreted with caution.

A comparison of clinical characteristics between adolescent males and females with eating disorders.

BackgroundEating disorders (ED) are serious disorders that have a negative impact on both the psychological and the physiological well-being of the afflicted. Despite the fact that ED affect both genders, males are often underrepresented in research and when included the sample sizes are often too small for separate analyses. Consequently we have an unclear and sometimes contradictory picture of the clinical characteristics of males with ED. The aim of the present study was to improve our understanding of the clinical features of adolescent males with eating disorders.MethodsWe compared age at presentation, weight at presentation, history of significantly different premorbid weight and psychiatric (Attention Deficit Hyperactivity Disorder (ADHD)) and somatic comorbidity (celiac disease and diabetes) of 58 males to 606 females seeking medical care for eating disorders at the Children’s Hospital in Uppsala, Sweden during the years 1999–2012. As all boys were diagnosed with either AN or Other Specified Feeding or Eating Disorder (OSFED) atypical AN, the age and weight comparisons were limited to those girls fulfilling the diagnostic criteria for AN or OSFED atypical AN.ResultsThere was no significant difference in age at presentation. Differences in weight at presentation and premorbid weight history were mixed. A significantly higher percentage of males had a history of a BMI greater than two standard deviations above the mean for their corresponding age group. As well, there was a higher prevalence of ADHD among the males whereas celiac disease and diabetes only was found among the females.ConclusionsA better understanding of the clinical characteristics of males with ED at presentation should improve our ability to identify males with ED and thereby aid in tailoring the best treatment alternatives.

Group behavioral activation for patients with severe obesity and binge eating disorder: a randomized controlled trial.

The aim of the present study was to assess whether behavioral activation (BA) is an efficacious treatment for decreasing eating disorder symptoms in patients with obesity and binge eating disorder (BED). Ninety-six patients with severe obesity and BED were randomized to either 10 sessions of group BA or wait-list control. The study was conducted at an obesity clinic in a regular hospital setting. The treatment improved some aspects of disordered eating and had a positive effect on depressive symptoms but there was no significant difference between the groups regarding binge eating and most other symptoms. Improved mood but lack of effect on binge eating suggests that dysfunctional eating (including BED) is maintained by other mechanisms than low activation and negative mood. However, future studies need to investigate whether effects of BA on binge eating might emerge later than at post-assessment, as in interpersonal psychotherapy for bulimia nervosa.

Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption?

INTRODUCTION Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass. METHODS Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed. RESULTS After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery. DISCUSSION These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.

Training in Methods of Preventing Childhood Obesity Increases Self-Efficacy in Nurses in Child Health Services: A Randomized, Controlled Trial

OBJECTIVE To evaluate the effects of training in methods of preventing childhood obesity on self-efficacy (SE) in nurses. METHODS In a randomized, controlled trial conducted in child health services in Sweden, nurses in the intervention and control groups of the PRIMROSE prevention trial of childhood obesity were offered a 5-day workshop on dietary and physical activity interventions, and motivational interviewing. Self-efficacy for influencing parents to promote healthy dietary and physical activity behaviors in their children was measured using an 18-item instrument. Difference in SE between groups at post-assessment was analyzed using multiple linear regression analysis. RESULTS Compared to control nurses (n = 38), intervention nurses (n = 22) demonstrated higher SE (β = 14.70, P < .001). CONCLUSIONS AND IMPLICATIONS Training in methods of preventing childhood obesity increased SE in nurses. Self-efficacy should be included as a construct in evaluations of clinical training.

Self‐reported symptoms of adult attention deficit hyperactivity disorder among obese patients seeking bariatric surgery and its relation to alcohol consumption, disordered eating and gender

Symptoms of adult attention deficit hyperactivity disorder (ADHD) are common among people with obesity. Symptoms of ADHD are associated with other impulsive behaviours. Impulsivity can manifest differently in women and men.

Infrequent attention to dietary and physical activity behaviours in conversations in Swedish child health services

To investigate conversations between nurses and parents in Swedish child health services and to assess to what extent attention is directed towards dietary and physical activity behaviours in children.