FunctionalImagery

TrainingDavidKavanagh

JackieAndrade

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

TrainingThelemonexercisetointroducemultisensoryimagery

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

Training

Focusonpositiveproximaloutcomes

FunctionalImagery

TrainingAlcohol—2uncontrolledpilottrials

• Study1(n=12)• 4hrcontact• 2x90minface-to-facesessionsinWeek1• +5x10-15minphonecallsto6months

• Usedourfirstapp

• Study2(n=24)• 3.5hrcontact• Retained7sessionsover6months,butonlybyphone• Added24SMSreminders

• Usedstandardphonecalendar,photolibrary

Effectsonweeklydrinks

This slideshowedresults fromstudythatisnotyetpublished

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

TrainingFITpart1

Imagery-basedMIonincentives

FunctionalImagery

TrainingFITpart2

Imagery-basedMIonself-efficacyandplanning

FunctionalImagery

TrainingFITpart3

Trainingimageryforselfregulation

FunctionalImagery

TrainingPotentialhomework:Takephotos

Remindingthemoftheimages

• (Requirescreationofanimage)

• (Canbeatransitionalcommitment)

Helpthemidentify1or2tostart

FunctionalImagery

TrainingSomephotosareaboutobjects,

othersabouttheemotion

WhyHow

Wins

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?

FunctionalImagery

TrainingSummary

• Wearguethatimageryincreasesaffectivepowerofdiscussionsaboutbehaviour change• ThroughFIT,peoplecanlearntouseimagerythemselvesformaintainingmotivation• WorktodatesuggestsFIThaswideapplication