Functional Imagery David Kavanagh Training Jackie Andrade - - PowerPoint PPT Presentation

Functional Imagery Training

David Kavanagh Jackie Andrade

Functional Imagery Training

What would you like to achieve?

• Think about a goal you would like to achieve this week
• Write one sentence. Think carefully about your choice of

words

• Imagine it happening

Functional Imagery Training

Motivational interviewing

• This is not MI [0:58 – 2mins]

https://www.youtube.com/watch?v=80XyNE89eCs

• This is MI [0:11 – 4mins]
• https://www.youtube.com/watch?v=URiKA7CKtfc

Functional Imagery Training

Ob Observations leading to MI

• Many people can change with minimal assistance
• Therapists vary in impact
• Empathy appears to be a key variable

Functional Imagery Training

Mo Moti tivati tional inte terviewing

Creates a safe environment to consider change

• Emphasizes autonomy, collaboration
• Avoids judgement, confrontation

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 Training

MI MI Str trate tegies

• OARS—
• Open-ended questions
• Affirmations
• Reflections
• Summaries

Functional Imagery Training

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) √

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 Training

MI MI effects in meta-an anal alyses

• Physical activity in chronic disease

8 trials

• 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 Training

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 (√)

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 Training

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
• 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 Training

The lemon exercise to introduce multisensory imagery

Functional Imagery Training

Functional Imagery Training (FIT)

• FIT is a new way of supporting behaviour change by

strengthening motivation.

• Based on motivational interviewing
• Elicits and trains mental imagery to motivate change

Functional Imagery Training

Mental imagery supports behaviour and decision making

• Imagining the future reduces impulsivity Daniel, Stanton & Epstein

(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)

Functional Imagery Training

Elaborated Intrusion Theory

Kavanagh, Andrade & May (2005) Imaginary relish and exquisite torture: The Elaborated Intrusion theory of

• desire. Psychological Review, 112, 446-

467

external cues anticipatory responses associated thoughts negative affect physiological deficit sense of associated deficit

desire thoughts

implications imagery propositions automatic influences attentional / working memory allocation

subjective state of desire

pleasure / relief

• Cravings and desires

work in same way

• Imagery is key

Functional Imagery Training

20 40 60 80 100 1+ sensory elements Taste Picture Swallow Smell Sound M 2.3 senses (SD 2.5)

% > 0 (‘at least some of the time')

Imagery in alcohol craving

Kavanagh, May & Andrade (2009) Br J Clinical Psy

Functional Imagery Training

Functional desires

visual imagery predicts desire to play hockey: r = .61*** May et al (2008) 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 Training

Blocking imagery reduces desire

May, Andrade, Kavanagh, & Panabokke (2010). Visual imagery tasks suppress craving for cigarettes, Behaviour Research and Therapy, 48, 476-485

4 5 6 7 8 before after before after

experiment 3 experiment 4 neutral imagery clay modelling

Cigarette craving

auditory visual

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 & Rosenberg, 2007 1 7

auditory visual

Functional Imagery Training

Goal conflict: the EI approach

• Goal conflict is common Hofmann et al (2011)
• All goals are desired
• Same cognitive cycle creates unwanted cravings and

desirable desires

• It is easier to imagine succumbing to immediate temptation

than achieving good intentions

Functional Imagery Training

Imagining pleasure of healthy goal

• Weakens desire for competing goals by blocking desire

imagery

• Strengthens desire for healthy goal

Healthy goal becomes more

• immediate
• salient
• achievable
• wanted

Functional Imagery Training

• Motivational interviewing

with imagery

• Positive imagery of

proximal goals

• Makes goal concrete,

close and achievable

• Trains goal imagery as a

skill, refining goals and incorporating successes into imagery

20

Motivation for change Elicits affectively charged mental imagery Trains everyday use of imagery to support self-management Cues fresh imagery based on experiences, new goals

Functional Imagery Training

Functional Imagery Training

Functional Imagery Training

Imagery at key points during MI:

• Benefits of hypothetical change
• Past successes, strategies
• Potential/proposed plan
• Solutions to any barriers

training and support

Functional Imagery Training

Focus on positive proximal outcomes

Functional Imagery Training

Alcohol—2 uncontrolled pilot trials

• Study 1 (n = 12)
• 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

Functional Imagery Training

Gym attendance

(N = 48; Brief Advice vs FIT over 2 weeks; 1x 30-45min session + SMS/ email at 5, 10 days)

This slide showed results from study that is not yet published

Functional Imagery Training

FIT to reduce high energy snacking

FIT FIT 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 Training

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

• 1 face to face session (1hr) activity focus
• 1 phone session (45min) diet
• Fortnightly booster calls

Linda Solbrig

Functional Imagery Training

FIT weight loss pilot results

This slide showed results from study that is not yet published

Functional Imagery Training

So Some interesting anecdotal remarks …. ….

‘I will use this for other areas of my life where I am struggling; to get me out

• f this black hole I have been in recently…’

‘And because it is all positive imagery my depressed mood has really improved over the past months.’ ‘I could not leave the house for four days because I though the people In Aldi would make fun of how fat I was…but I focused on the imagery to help me get over my panic attack…to help me leave the house again…’ ‘It is all about changing one’s mind set – isn’t it? I feel so positive and motivated because I never looked at it like this before….’ ‘I don’t know if you hypnotised me or what you have done, but the positive reinforcement of the imagery, it really makes me feel good about being in this for the long-haul. I enjoy the path and I am not deprived like when I was on all these diets before…’

Functional Imagery Training

Current trials comparing FIT with MI

• NHMRC Project Grant 1099400, Kavanagh DJ, Graves N,

Connor J, Hides L, Gullo M, Connolly J, Andrade J, May J. A new, low-cost e-health treatment for Alcohol Use Disorder using mental imagery. 2016-2019

• NIHR PenCLAHRC2, Solbrig L, Andrade J, Parkin T, Jones R.

Functional Imagery Training as a personalized e-health intervention for weight loss. 2015-2017

Functional Imagery Training

FIT part 1 Imagery-based MI on incentives

Functional Imagery Training

FIT part 2 Imagery-based MI on self-efficacy and planning

Functional Imagery Training

FIT part 3 Training imagery for self regulation

Functional Imagery Training

Potential homework: Take photos

Reminding them of the images

• (Requires creation of an image)
• (Can be a transitional commitment)

Help them identify 1 or 2 to start

Functional Imagery Training

So Some photos are about ob

• bjects,
• t
• thers ab

about the emotion

Why How Wins

Functional Imagery Training

Encourage this as an ongoing activity

• Makes the imagery less hypothetical
• Actual benefits
• Effective strategies
• Successes that have occurred
• Encourages new images

Functional Imagery Training

Reinforce commitment, by encouraging

• Creation of an audio/video on the plan
• I am going to…
• …because (benefit ranked top/ with most emotion)
• I know I can do it, because…
• Sharing the recording with a trusted supporter
• To start a conversation on how the person wants them to help
• Replaying the recording at home

Functional Imagery Training

Training: making imagery routine

We cue home practice with SMSs, phone calls They cue home practice using

• Routine behavior
• Phone notifications

Functional Imagery Training

Goal in Mind app

• Guides imagery with

audios, photos

• Records daily,

cumulative

• imagery practice
• goal achievement
• https://apps.ihbi.qut.edu.a

u/gim/

Functional Imagery Training

Managing cravings

• Cognitive blocking
• Mindfulness
• Image modification (cognitive therapy)
• Cravings buster video

Functional Imagery Training

Ways of using FIT

• Typical treatment: two session plus booster calls
• We have used it for increasing and for reducing behaviours
• FIT to motivate engagement with treatment
• As brief intervention to motivate specific behaviour e.g.

CBT homework, address avoidance

Functional Imagery Training

Contexts

• Depression
• Limited awareness of imagery
• Working memory deficits
• Psychotic symptoms

Functional Imagery Training

De Depression

+ive future is hard to envisage successes are hard to remember both will be discounted…so

• Help retrieval of episodes using content
• Focus on
• positive aspects
• strategies can use
• One small initial step
• Potential assistance, scaffolding

Functional Imagery Training

Li Limited awareness of imagery

• Draw attention to any imagery e.g., when planning a

route, reading a book, remembering a past event

• If can generate in session, does it matter?
• Encourage to take & use photos to cue it
• Elicit awareness of physical sensations

Functional Imagery Training

Wo Working memory deficits

Problem—holding, manipulating information

• Use whiteboard or paper
• If possible, get them to write
• Include simple pictures
• Encourage them to use app, audios
• e.g. what, when, how reminder
• Imagery audios
• Phone reminders
• Phone or send SMSs to remind them about their plan

Functional Imagery Training

Ps Psychotic symptoms

Hallucinations

• Avoid explicitly eliciting imagery?
• e.g. instead talk in detail about specific events in past or

future

Lack of energy/sedation

• Small, easy steps
• Ask for assistance to get started?

Functional Imagery Training

Summary

• We argue that imagery increases affective power of

discussions about behaviour change

• Through FIT, people can learn to use imagery themselves

for maintaining motivation

• Work to date suggests FIT has wide application