Motivational interviewing and adolescents: creating behaviour change
Motivational Interviewing (MI) is a patient-centred method for enhancing motivation to change by exploring and resolving ambivalence. Originally developed by William R. Miller and Stephen Rollnick in the early 1980s to treat substance abuse, MI has since been adapted for various behavioural issues, including those affecting adolescents. Adolescence is a critical period for behaviour formation, and MI's non-confrontational approach can be particularly effective in promoting positive behaviour changes during this stage of life.
What is motivational interviewing?
MI is built on several core principles: expressing empathy, developing discrepancy, rolling with resistance, and supporting self-efficacy. These principles help create a supportive environment where adolescents feel understood and are more open to discussing their behaviours and considering change.
Expressing empathy: Through reflective listening, practitioners create a safe space where adolescents feel heard and respected. This empathetic approach reduces defensiveness and fosters trust.
Developing discrepancy: By helping adolescents recognize the gap between their current behaviours and their broader goals or values, MI encourages them to consider the benefits of change.
Rolling with resistance: Instead of confronting resistance directly, MI practitioners accept it as a natural part of the change process. This approach prevents power struggles and keeps the conversation productive.
Supporting self-efficacy: MI emphasizes the adolescent’s ability to make positive changes, bolstering their confidence in their capacity to change.
Application of motivational interviewing in adolescents
Adolescents face unique challenges, including peer pressure, identity formation, and a natural inclination towards risk-taking behaviours. On a biological level they also make decisions in different ways to adults.(1) MI's respectful and non-judgmental approach makes it particularly suitable for this age group.
Substance abuse: MI has proven effective in addressing substance use among adolescents. A study by Colby et al. (2012) demonstrated that MI could significantly reduce alcohol use in adolescents by enhancing their motivation to change and their commitment to quit or reduce drinking.(2) Baer et al. (2001) conducted brief motivational interventions aimed at reducing alcohol use with high-risk adolescents.(3) The results indicated a significant reduction in alcohol consumption and alcohol-related problems, highlighting MI's effectiveness in addressing substance abuse in this demographic.
Diet and exercise: Adolescents living with obesity or unhealthy eating habits can benefit from MI. In a recent meta-analysis, Kao et al. (2023) summarise that MI can help adolescents improve healthy eating and physical activity in the short term.(4) Another systematic review and meta-analysis showed that MI is a useful tool when delivered regularly by highly trained professionals.(5) Whether parents attend sessions needs to be decided on a case by case basis and individual sessions with adolescents can be particularly beneficial.
Mental health: Two studies show that MI can promote and improve attendance in mental health services and MI can help with family engagement. (6-8) MI also has a positive effect of depression scores in children living with overweight or obesity.(9)
Mechanisms of behaviour change in adolescents
Understanding how MI facilitates behaviour change in adolescents involves examining the psychological and developmental factors at play.
Autonomy and self-determination: Adolescents are developing a sense of independence and self-identity. MI’s emphasis on personal choice and self-efficacy aligns with adolescents' need for autonomy, making them more receptive to change.
Cognitive development: During adolescence, cognitive abilities such as abstract thinking and problem-solving are still maturing. MI helps adolescents articulate their thoughts and feelings, enhancing their ability to weigh the pros and cons of their behaviours and consider long-term consequences.
Emotional regulation: Adolescents often experience heightened emotions and may struggle with impulse control. MI’s empathetic approach can help them manage their emotions and reduce impulsive behaviours by fostering a supportive and non-judgmental environment.
Motivational interviewing strategies for adolescents
Building rapport: Establishing a trusting relationship is crucial. Practitioners should demonstrate genuine interest, patience, and respect for the adolescent’s perspective.
Engaging in reflective listening: Reflective listening helps adolescents feel understood and valued. It involves mirroring their thoughts and feelings, which can help clarify their motivations and ambivalence.
Eliciting change talk: MI focuses on encouraging adolescents to verbalize their desire, ability, reasons, and need for change. This "change talk" is predictive of actual behaviour change.
Developing a change plan: Once an adolescent expresses readiness to change, the practitioner helps them develop a concrete plan. This includes setting specific, achievable goals and identifying potential obstacles and strategies to overcome them.
Challenges and considerations
While MI is a powerful tool for promoting behaviour change, practitioners must be mindful of certain challenges when working with adolescents.
Resistance to authority: Adolescents may resist change due to a natural aversion to authority figures. MI’s non-confrontational approach can help mitigate this resistance by emphasizing collaboration and autonomy.
Varied developmental Stages: Adolescents develop at different rates, and practitioners must tailor their approach to the individual’s cognitive and emotional maturity.
Cultural sensitivity: Practitioners should be aware of cultural differences that may impact an adolescent’s attitudes and behaviours. MI’s emphasis on empathy and respect for the individual’s perspective can help navigate these differences effectively.
Future directions and research
While existing research supports the effectiveness of MI in promoting behaviour change among adolescents, further studies are needed to explore its long-term impact and potential applications in diverse settings.
Longitudinal studies: Long-term studies could provide insights into the sustained impact of MI on adolescent behaviour and health outcomes.
Diverse populations: Research on MI’s effectiveness across different cultural, socioeconomic, and demographic groups would help tailor interventions to meet the needs of diverse adolescent populations.
Integration with technology: Exploring the integration of MI with digital tools, such as mobile apps and online platforms, could enhance accessibility and engagement for adolescents.
CONCLUSION
Motivational Interviewing offers a promising approach to fostering behaviour change in adolescents. It’s empathetic, non-confrontational style aligns well with the developmental needs of this age group, making it an effective tool for addressing a range of behavioural issues. By focusing on the individual’s motivations and supporting their autonomy, MI can help adolescents make positive changes that improve their health and well-being.
Kate is a Senior Specialist Dietitian. She is a Lead Childhood Weight Management Dietitian with South Tyneside and Sunderland NHS Foundation Trust and Chair of the North East Branch of the BDA.
Kate Roberts, RD
References:
- Hartley CA, Somerville LH. The neuroscience of adolescent decision-making. Curr Opin Behav Sci. 2015 Oct 1;5:108-115. doi: 10.1016/j.cobeha.2015.09.004. PMID: 26665151; PMCID: PMC4671080
- Colby SM, Barnett NP, Monti PM, Rohsenow DJ, Weissman K and Spirito A (2012). Brief motivational intervention for adolescent smokers in medical settings. Addictive Behaviours, 37(6), 739-742
- Baer JS, Kivlahan DR, Blume AW, McKnight P and Marlatt GA (2001). Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. American Journal of Public Health, 91(8), 1310-1316
- Kao TA, Ling J, Vu C, Hawn R, Christodoulos H. Motivational Interviewing in Pediatric Obesity: A Meta-analysis of the Effects on Behavioural Outcomes. Ann Behav Med. 2023 Jul 19;57(8):605-619. doi: 10.1093/abm/kaad006. PMID: 37195909; PMCID: PMC10354860
- Lutaud R, Mitilian E, Forte J, Gentile G, Reynaud R, Truffet C, Bellanger T. Motivational interviewing for the management of child and adolescent obesity: a systematic literature review. BJGP Open. 2023 Dec 19;7(4):BJGPO.2022.0145. doi: 10.3399/BJGPO.2022.0145. PMID: 37402547; PMCID: PMC11176675
- Dean S, Britt E, Bell E, Stanley J, Collings S. Motivational interviewing to enhance adolescent mental health treatment engagement: a randomized clinical trial. Psychol Med. 2016 Jul;46(9):1961-9. doi: 10.1017/S0033291716000568. PMID: 27045520.
- Grupp-Phelan J, Stevens J, Boyd S, Cohen DM, Ammerman RT, Liddy-Hicks S, Heck K, Marcus SC, Stone L, Campo JV, Bridge JA. Effect of a Motivational Interviewing-Based Intervention on Initiation of Mental Health Treatment and Mental Health After an Emergency Department Visit Among Suicidal Adolescents: A Randomised Clinical Trial. JAMA Netw Open. 2019 Dec 2;2(12):e1917941. doi: 10.1001/jamanetworkopen.2019.17941. PMID: 31860104; PMCID: PMC6991223
- Williams AA, Wright KS. Engaging families through motivational interviewing. Pediatr Clin North Am. 2014 Oct;61(5):907-21. doi: 10.1016/j.pcl.2014.06.014. Epub 2014 Aug 3. PMID: 25242705
- Freira S, Lemos MS, Williams G, Ribeiro M, Pena F, Machado MDC. Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight. Psychiatry Res. 2017 Jun;252:340-345. doi: 10.1016/j.psychres.2017.03.020. Epub 2017 Mar 12. PMID: 28327447
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