Psychiatry. 2010;67:1044–1051. 29. Bush G. Attention-deficit/hyperactivity disorder and attention networks. Neuropsychopharmacology. 2010;35:278–300. 30. Carver CS, Johnson SL, Joormann J. Serotonergic function, twomode models of self-regulation, and vulnerability to depression: what depression has in common with impulsive aggression. Psychol Bull. 2008;134:912–943. 31. Bylund DB, Reed AL. Childhood and adolescent depression: why do children and adults respond differently to antidepressant drugs? Neurochem Int. 2007;51:246–253. 32. Paus T, Keshavan M, Giedd JN. Why do many psychiatric disorders emerge during adolescence? Nat Rev Neurosci. 2008;9:947–957. 33. Stringaris A, Baroni A, Haimm C, et al. Pediatric bipolar disorder versus severe mood dysregulation: risk for manic episodes on follow-up. J Am Acad Child Adolesc Psychiatry. 2010;49:397–405. 34. Hobfoll SE, Palmieri PA, Johnson RJ, et al. Trajectories of resilience, resistance, and distress during ongoing terrorism: the case of Jews and Arabs in Israel. J Consult Clin Psychol. 2009;77:138–148. 35. Farbstein I, Dycian A, Gothelf D, et al. A follow-up study of adolescent attempted suicide in Israel. J Am Acad Child Adolesc Psychiatry. 2002;4l:1342–1349. 36. Gould M, Adler A, Zamorski M, et al. Do stigma and other perceived barriers to mental health care differ across Armed Forces? J Soc Med. 2010;103:148–156. 37. Melamed Y, Solomon Z, Mark M. [Mentally ill soldiers in the reserves-professional secrecy and therapist judgment regarding reporting incapacity to carry weapons]. Harefuah. 2002;141:17– 19,127. 38. Lee J, Korczak D. Emergency physician referrals to the pediatric crisis clinic: reasons for referral, diagnosis and disposition. J Can Acad Child Adolesc Psychiatry. 2010;19:297–302.

Motivational Interviewing with Adolescents and Young Adults

Cigarette smoking poses a major threat to public health. While cessation support provided by healthcare professionals is effective, its use remains low. Chatbots have the potential to serve as a useful addition. The objective of this study is to explore the possibility of using a motivational interviewing style chatbot to enhance engagement, therapeutic alliance, and perceived empathy in the context of smoking cessation.A preregistered web-based experiment was conducted in which smokers (n = 153) were randomly assigned to either the motivational interviewing (MI)-style chatbot condition (n = 78) or the neutral chatbot condition (n = 75) and interacted with the chatbot in two sessions. In the assessment session, typical intake questions in smoking cessation interventions were administered by the chatbot, such as smoking history, nicotine dependence level, and intention to quit. In the feedback session, the chatbot provided personalized normative feedback and discussed with participants potential reasons to quit. Engagement with the chatbot, therapeutic alliance, and perceived empathy were the primary outcomes and were assessed after both sessions. Secondary outcomes were motivation to quit and perceived communication competence and were assessed after the two sessions.No significant effects of the experimental manipulation (MI-style or neutral chatbot) were found on engagement, therapeutic alliance, or perceived empathy. A significant increase in therapeutic alliance over two sessions emerged in both conditions, with participants reporting significantly increased motivation to quit. The chatbot was perceived as highly competent, and communication competence was positively associated with engagement, therapeutic alliance, and perceived empathy.The results of this preregistered study suggest that talking with a chatbot about smoking cessation can help to motivate smokers to quit and that the effect of conversation has the potential to build up over time. We did not find support for an extra motivating effect of the MI-style chatbot, for which we discuss possible reasons. These findings highlight the promise of using chatbots to motivate smoking cessation. Implications for future research are discussed. 

/pdf/can-chatbots-help-to-motivate-smoking-cessation-a-study-on-1b1v8s60.pdf

Can chatbots help to motivate smoking cessation? A study on the effectiveness of motivational interviewing on engagement and therapeutic alliance

Initial conversations about weight with patients are important to set the tone for future dialogue and management of obesity. There is often reluctance in raising the topic of overweight or obesity in consultations. We aimed to evaluate literature to discover the perceived barriers to optimal discussion about weight status and preferred weight-based terminology for adults, adolescents and parents of younger children. Fear of offending patients, insufficient training and lack of knowledge of referral pathways were identified as factors hindering healthcare professionals’ ability to discuss weight with patients. Neutral terms, such as ‘weight’, were preferred by patients, with ‘fat’ and ‘obese’ viewed as undesirable and stigmatising words. There is a need for greater support and provision of specific training, including education on communicating weight status, for those involved in the management of obesity. More research is necessary to assess the impact of interventions to improve initial discussions with patients about weight.

/pdf/the-use-of-effective-language-and-communication-in-the-10jw6emchs.pdf

The Use of Effective Language and Communication in the Management of Obesity: the Challenge for Healthcare Professionals.

Objective: Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. Design:
 Eight databases were searched from inception till 30 May 2020. A revised Cochrane risk-of-bias tool and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to evaluate the risk of bias and overall evidence. Meta-analysis and meta-regression were performed on Stata software using the random effects model. Overall effect was evaluated using Hedges’ g, and heterogeneity was assessed using Cochran’s Q and I2. Setting:
 Cluster randomised controlled trials (cluster-RCT) delivered in school. Participants:
 Children and adolescents (6–18 years of age) with overweight and obesity. Results:
 Twelve cluster-RCT from seven countries with 1755 participants were included in the meta-analysis. School-based interventions for the treatment of childhood obesity reduced BMI and BMI z-scores with a medium effect (g = 0·52). Subgroup analyses showed greater effectiveness of brief school-based interventions and the interventions conducted in lower-middle to upper-middle economies. Meta-regression assessed the heterogeneity and the final model, with covariates of the type of economies and trial duration, accounted for 41·2 % of the variability. The overall quality of evidence was rated low because of the high risk of bias and inconsistency. Conclusions:
 School-based interventions are a possible approach to provide universal healthcare for the treatment of childhood obesity, and further well-designed cluster-RCT with longer follow-up are needed. This study is registered with PROSPERO (CRD42020160735).

School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials.

Enhancing motivation is a crucial issue in pediatric obesity interventions, as behavioral changes related to food intake and physical exercise are difficult to carry out with an insufficient level of motivation. In the treatment setting, low motivation towards change may lead to early termination or inadequate treatment outcomes. This paper reviews widely-used models of motivation, including the transtheoretical model of change, self-determination theory, and motivational interviewing (MI). We introduce useful strategies based on each theoretical model to enhance motivation, such as an importance and confidence scale and a decisional balance technique. A review of recent MI interventions in children and adolescents is presented to discuss the efficacy of MI-based interventions and considerations for applying MI in pediatric obesity.

Motivating Children and Adolescents in Obesity Treatment.

Motivational interviewing (MI) is an effective method to promote weight loss that can be delivered by non-mental health providers. The aim of this study was to evaluate whether MI was superior to conventional counseling to improve the anthropometric outcomes of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design in a school setting. The study included two groups: Motivational Interviewing Group (MIG) and control group (Conventional Intervention Group, CIG). Students participated in three face-to-face 30-min interviews, 3 months apart. Outcomes were BMI z-score, abdominal circumference, percentages of fat mass and muscle mass, and blood pressure. Sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) manual. Mixed repeated-measures ANOVAs were used to assess the group versus time interaction. Effect sizes were calculated for each ANOVA with eta-squared measures (η2). Eighty-three adolescents finished the protocol. While MIG participants showed a significant improvement in all anthropometric scores at 6 months, CIG participants showed an unfavorable change in those variables. Conclusion: Our results provide additional evidence of the short-term usefulness of a school-based MI intervention on anthropometric outcomes of adolescents with obesity/overweight, demonstrating that pediatricians can play an important role in the prevention and management of pediatric obesity. Trial registration: The study is called IMAGINE and is registered in Clinicaltrials.gov
 with the number NCT02745795.

Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight.

The aim of this study was to compare the effect of motivational interview (MI) with conventional care on the depression scale scores of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design, including two groups: intervention group [Motivational Interview Group (MIG)], control group [Conventional Intervention Group (CIG)]. Intervention: three face-to-face 30min' interviews three months apart (only MIG interviews were based on MI principles). Outcomes: change in Children Depression Inventory (CDI) scores. We used a mixed repeated-measures ANOVAs analysis to assess the group vs time interaction. Effect size was calculated for ANOVA with difference of means of the total score (DOMTS). CDI scores were compared by a paired t -test. Eighty-three (84%) adolescents finished the intervention. There was a significant time vs group interaction on both groups. While in the CIG scores significantly increased, in the MIG the scores significantly decreased. The DOMTS was significantly different between the two groups. We concluded that MI showed a positive effect on depression scale scores over time relatively to conventional intervention.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight.

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing

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Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight.

Effect of Motivational Interviewing on depression scale scores of adolescents with obesity and overweight.

Quality-of-life outcomes of a weight management program for adolescents based on motivational interviewing