|Year : 2016 | Volume
| Issue : 2 | Page : 76-81
The effectiveness of motivational interviewing on the psychological symptoms (depression, anxiety, and stress) of 2nd year high school boy adolescences of Isfahan city
Gholam Hossein Pooyan, Elham Frouzande
Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
|Date of Web Publication||17-Mar-2016|
Dr. Elham Frouzande
Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan
Source of Support: None, Conflict of Interest: None
Aim: The aim of this study was to determine the effectiveness of motivational interviewing on the psychological symptoms of 2nd year high school boy students of Isfahan city during the year 2014–2015. Methodology: This study was conducted with the semi-experimental method, pretest and posttest with the control group. The statistical population of this study was all the 2nd year high school boy students of Isfahan city who were randomly selected and put in the experimental group (15 individuals) and control group (15 individuals). First, the questionnaire of psychological symptoms (DASS, 1995) was performed and posttest was taken from experimental and control groups after conducting eight sessions in the experimental group. Result: Data analysis showed that motivational interviewing had a significant effect on the psychological symptoms of boy adolescents and would lead to the decrease in depression and anxiety (F = 11.18, P < 0.05). Conclusions: As a result, conducting motivational interviewing sessions was an effective method in decreasing the psychological symptoms of boy adolescents.
Keywords: Adolescents, motivational interviewing, psychological symptoms
|How to cite this article:|
Pooyan GH, Frouzande E. The effectiveness of motivational interviewing on the psychological symptoms (depression, anxiety, and stress) of 2nd year high school boy adolescences of Isfahan city. Int J Educ Psychol Res 2016;2:76-81
|How to cite this URL:|
Pooyan GH, Frouzande E. The effectiveness of motivational interviewing on the psychological symptoms (depression, anxiety, and stress) of 2nd year high school boy adolescences of Isfahan city. Int J Educ Psychol Res [serial online] 2016 [cited 2019 Nov 12];2:76-81. Available from: http://www.ijeprjournal.org/text.asp?2016/2/2/76/168505
| Introduction|| |
Growth in adolescents is influenced by genetic, biological, environmental, and social factors. Adolescence is a transition period between childhood and adulthood and adolescent is experiencing physical maturity, society wants him behave as a developed, independent, creative and productive person, change relations with peers and adults, and has sexual compatibility and job tendency, in addition, he or she seeks an identity for himself or herself. Some psychologists believe that if teens have no problem in this course they will become a healthy adult and play their role well. However, if the mental health of adolescent goes out of the mainstream, he or she will be a misguided teenager. Depression in adolescents is posed as a mental health problem in different societies. Approximately 15–20 percent of adolescents have one or more periods of major depression. This amount is equal to the amount of depression in adults. 2–8 percent of adolescents are chronically depressed and for a few months or a few years, they are melancholy and they blame themselves. Depressive symptoms increased once between 13 and 15-year-old. Prominent symptoms of depression in adolescents may identified by frown and sulk or negativism, isolation, complained of not being understood and not appreciated, poor school performance, drug abuse, anti-social behavior, sexual recklessness, school avoidance, evasion home, drug abuse, and suicide. Depression often is not found in pure form and in 50 percent of patients with depression have an anxiety disorder.
Relative to adults, adolescents appear to show a strong preference for psychotherapy over antidepressants. Change is necessary for any treatment. Making motivations in students is an important duty of educational staff. Motivational interviewing is one of the coping methods with nonmotivated students for the purpose of behavioral changes. Miller and Rollnick believe that a change is included many parts like a puzzle. One of the methods that we can put aside these parts is that we should imagine motivation as a basic process of change. There are many reasons for the attractiveness of motivational interviewing and tends more to it than the traditional and common methods.
Motivational interviewing, first, raised directly the major problem common in all treatments, that is, resistance to change and fix it up, second, it is flexible and can be used as stand-alone approach in combination with other therapies. Third, there is a considerable amount of research evidence that support the efficiency and effectiveness of motivational interviewing in drug abuse and problems related to health and physical and mental health. Fourth, research has shown that motivational interviewing is learnable, and in a few meetings we can achieve to significant therapeutic effects.
The important thing is that motivational interviewing is an approach to interview and evaluate any problems with teenagers. Studies using motivational interviewing techniques have reported that the increase in behavior is related to change among different populations. In a Mtalyz, motivational interviewing and cognitive behavioral therapy for adolescents found that motivational interviewing techniques systems have been implemented in different systems such as orbit, social systems, and primary care. Motivational interviewing techniques can be an effective intervention to enhance adherence in adolescents  and increase healthy behaviors such as diet and exercise.
Flynn suggests that concurrent use of other approaches such as motivational interviewing, cognitive behavioral can develop therapist-client relationship, more involved bodies in the treatment, the more active and do homework by the authorities to have greater therapeutic results. Short form of motivational interviewing is effective in raising awareness of their partners in solving the conflict, but to overcome and overcome conflict, the implementation of additional meetings are more effective.
The studies showed that the individuals who were more anxious were more under the effect of teachers' behaviors and interactions. On the other hand, these people had more tension in competitive situations and the intervention of motivational interviewing is effective to some extent on the decrease of these kinds of tensions. Most researchers found out that the role of cognitive factors was very effective in making anxiety in people. For instance, Wien in his studies in the field of the role of cognitive factors in making anxiety in people reached to this conclusion that children who were more anxious spoke more with themselves and did irrelevant assignments more than less anxious children. Reviewing the process of therapy sessions of motivational interviewing and paying attention to the extension of discrepancies between the advantages and the disadvantages can help to the decrease of anxiety in children.
Westen and Morrison studied a meta-analysis of depression treatments and anxiety disorders and understood that 37–48 percent of adolescents in a sample who were under the therapy and spent the period of therapy and 46–56 percent of them who were willing to be treated did not show any recovery from themselves after the surveys of intervention. Lack of clients' participation in therapy sessions and their nonreadiness to the adolescent changes, the return of problems or disorders in adolescent patients, their lack of regular attendance in therapy sessions, their low motivation and commitment for continuing their changes, their high level of ambivalence and resistance, their fear from therapy techniques, their nonconducting therapy tasks, and their low level of success expectation in usual treatment programs  are often high. Therefore, motivational interviewing is a good method for treating adolescents who suffer from psychological illnesses based on conducted studies.
Many studies were done on the efficacy of motivational interviewing on the adolescents such as homeless adolescents, addicted adolescents, and the decrease of consuming addiction drugs and its related dangers in adolescents. With regard to treatment costs, a combined model of motivational interviewing and cognitive therapy is economical.
There are some methods and techniques in the world such as role induction, preparation sessions, the increase in motivation, and motivational interviewing for increasing the efficacy of traditional nonmedical treatments as a pretreatment. In Iran, primary treatments are not usual motivational interviewing as a hopeful clinical style for working with adolescents due to adolescents' acceptance, respect, doubt, and nonincreased resistance. This approach can be helpful for more involvement of patients during their treatment and the identification of useful therapy aims. With regard to the diversity in the extension of conducted studies and the new use of motivational interviewing in Iran, the present study attempts to answer to this question that whether motivational interviewing is effective on the psychological symptoms of boy adolescents or not?
| Methodology|| |
This study was done with the semi-experimental method and pretest and posttest of the control group. The statistical population of this study was all 2nd year high school boy students of Isfahan city during the year 2014–2015. In this study, sampling method was random-cluster sampling. First, one district was selected from six districts. Then, two schools of this district were chosen in a random and cluster way. Next, 30 students were chosen randomly from the students of these two schools and were put randomly in the experimental and control groups. First, the researcher run psychological symptoms tests and after eight sessions of 90 min intervention in the form of a group and on a weekly basis of the experimental group, posttest was taken from experimental and control groups. The structure and the content of motivational interviewing sessions are as follows:
- In the first session, students became familiar with introduction, norms, group process, philosophy facilitator, the practice of freedom the practice of dimensions of behavioral effects, the practice of cycle changes, and the survey of commitment and assurance
- In the second session, cycle changes and the survey of commitment and assurance are explained to the students and practical by them
- In the third session, emotions are identified, and the dimensions of behavioral effects are surveyed with emotional dimensions and household duties
- In the fourth session, the positive and negative dimensions of behaviors and their changes are surveyed. Therefore, brainstorming is practices in this session by students, and its advantages and disadvantages are surveyed. Furthermore, the tables of negative and positive dimensions of behaviors will be completed by students
- In the fifth session, coping with doubt and hesitancy are trained to the students. Furthermore, reforming and substituting options are described to the students and practiced by them
- In the sixth session, prominent values are prioritized. Furthermore, values are defined and matched with behaviors
- In the seventh and eighth sessions, the summary of previous sessions is given in the framework of practicing the viewpoint of motivational interviewing and starting the program of behavioral changes.
Based on the topic of the study, data were collected with the DASS questionnaire (depression, anxiety, and stress). DASS questionnaire was designed and made in 1995 by Luvi Band. Luvi Band identified the psychometric features of this questionnaire on the student samples and nonclinical samples. In this questionnaire, three mental statuses which were depression, anxiety, and stress were investigated.
Furthermore, this questionnaire has options related to the symptoms of depression (14 questions), anxiety (14 questions), and stress (14 questions), and are completed by people.
Scores are given based on the options like not at all (0), to some extent (1), greatly (2), and so much (3). Furthermore, the total score shows the amount of depression, anxiety, and stress in an estimate way between atleast zero and atmost 42. DASS questionnaire was surveyed by Sepehri and Samani in 1385 and its alpha coefficient was reported respectively 0.89, 0.84, and 0.68 for depression, anxiety, and stress. Therefore, this questionnaire has an appropriate validity and reliability. It should be noted that scores were converted to the numbers between zero and 100 in order to be more apprehensible to people. Therefore, zero shows the worst state and 100 shows the best state. In the present study, Cronbach' alpha of this questionnaire was reported, respectively 0.91, 0.84, and 0.83 for sub-criteria like depression, anxiety, and stress.
Unfortunately, despite efforts to conduct follow-up research, because the early closure of schools and lack of cooperation by the authorities, do not allow follow-up session.
The obtained data were analyzed with covariance method for the purpose of surveying the assumptions of research. Furthermore, Cax-Bax conversions were used in this study for the purpose of minimizing the standard deviations of this study due to the high dispersion of variances.
The mean and standard deviation of psychological symptoms in the test and control groups in the pretest and posttest have been reported in [Table 1].
Results of [Table 1] shows the mean and standard deviation in the experimental group (0.23, 4.42), there was a significant difference (05.0 > P), in the pretest and mean and standard deviation (0.19, 4.26).
With regard to the frequency of the statistical data of [Table 2] related to depression, we could conclude that motivational interviewing had a significant effect on the depression of adolescents (P < 0.05). And it significantly has been reduced in depression (F = 6.59).
With regard to the frequency of the statistical data of [Table 3] related to anxiety, we could conclude that motivational interviewing had a significant effect on the anxiety of adolescents (P < 0.05) and it significantly has been reduced anxiety (F = 12.14).
With regard to the frequency of the statistical data of [Table 4] related to stress, we could conclude that motivational interviewing did not have a significant effect on the stress of adolescents (P < 0.05) and it has not significantly reduced stress (F = 4.54).
| Discussion and Conclusion|| |
The purpose of this study was to investigate the effectiveness of motivational interviewing approach on psychological symptoms (anxiety, stress, depression) in adolescent boys. In recent decades add short-term treatments to conventional treatments, in order to increase their effectiveness has increased. Motivational interviewing and behavioral activation support treatment in a wide range of the population.
The results of the present study showed that the approach of motivational interviewing had a significant effect on the decrease of students' depression and anxiety (P < 0.05). On the other hand, the approach of motivational interviewing will lead to the decrease in the students' depression and anxiety. The results of the present study are in line with the findings of Mohseni and Moghaddam, Baradi, Duleh, and Barera.,,,
The results of this study support a therapeutic approach to reduce symptoms of depression and anxiety in adolescents. This approach allows the therapist achieve better health outcomes without serious resistance and motivation to change their bodies. The main goal of motivational interviewing is increasing the intrinsic motivation for change. This approach instead of providing information, advice, persuasion and coercion, facilitate behavioral changes through the process of interaction and during the two-stage internal motivation and strengthen commitment to change.
We can say that the approach of motivational interviewing is an approach of short-term and leading treatment seeking which its aim is to provoke the changes of behavior with the help of treatment seekers for the purpose of seeking and removing the discrepancies. Therefore, this approach combines the person-centered method (such as intimacy and empathy) and its technique (such as key questions and reflective listening). In this method, adolescents are trained to follow a model of problem solving in dealing with the problem. For instance, adolescents ask themselves in difficult situations how they should face problems? Then, they themselves answer to their questions and talk to themselves about their problems step by step.
Mohseni and Moghaddam studied the efficacy of motivational interviewing on the test anxiety of 1st year high school girl students. Intervention was performed during the five sessions of 2 h as a group. Results showed that the intervention of motivational interviewing had a significant effect on the decrease of test anxiety of students. Baradi surveyed the efficacy of motivational interviewing on a depressed adolescent in a case study. This adolescent was ambivalent about seeking his life changes and could identify his own conflicts at the end of the sessions and find suitable solutions. Douleh used motivational interviewing and behavior therapy as a step by step approach for treating depressed adolescents. Results showed that the activities of the groups that were under the therapy were increased and their depression levels were decreased. Barrera studied motivational interviewing as a treatment along the cognitive behavioral treatment and found out that motivational interviewing could have a positive effect on involving a patient during treatment as a pretreatment session. Motivational interviewing is a therapeutic method in the third wave approaches that discuss about the motivation for treatment and the need for treatment and the need for homework ion and challenge the patient's motivation for and against that patient finally decides who will have to follow the treatment. This approach considers the capabilities, strengths, and has individual and environmental opportunities that he builds and set up a new way of life and the new meaningful relationships with others. Counselor gives information to the individual, to describe something, or give feedback or opens the way for personal information. However, consultation is not happen, so this is the concept of providing information. Trust of advisor to the capacity of the authorities is essential for change.
The sessions of motivational interviewing help clients to move from their external needs toward their inner desires in order to change their behaviors. Also, clients need to express their own feelings about the changes under the pressure and force in any form with the use of empathetic techniques, reflective listening, accurate understanding, acceptance, respect, and the tolerance of clients' resistance. In fact, the main purpose of these sessions is to increase clients' inner motivation when their changes are occurred by themselves and not with the imposition of external factors. Therefore, we can say that the sessions of motivational interviewing are practical in its exact meaning and lead to the change in the viewpoint of students and the decrease in the situational anxieties and depression.
According to the researcher, prolong meetings or concurrent use of other approaches such as cognitive behavioral approach, will increase the efficiency of motivational interviewing sessions. Although this study shows the effectiveness of motivational interviewing on depression and anxiety in adolescents, but due to small sample size (n = 15) requires that additional studies be conducted with this population in the efficacy of motivational interviewing. One of the limitations of this study was that the students' psychological symptoms were only surveyed with the questionnaire and because the study sample comprised only of boys, we should precaution from generalizing these results to girls.
I appreciate the efforts and support of Dr. Elham Foroozande in this study.
Financial support and sponsorship
A thesis research project.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Leila P. The Effect of Life Skills Training on Self-esteem, Self-efficacy and Anxiety of High School Students in Isfahan. MS Thesis, Islamic Azad University, Isfahan (Khorasgan) Branch, Faculty of Education and Psychology; 2010.
Jaafar A, Hussein SS. Mahmoud MS, Fatemeh R, Mojgan N. Behavioural problems in adolescents. J Behav Sci 2007;1:163-70
Asghar A, Marzyeh RE, Hamidreza N, Iran M. Comparison of three methods of medication, cognitive therapy and behavioral therapy in reducing depression in adolescents. Sci Res Psychol 2006;29:65-80.
Bradley KL, McGrath PJ, Brannen CL, Bagnell AL. Adolescents' attitudes and opinions about depression treatment. J Community Ment Health 2010;46:242-51.
Miller WR, Rollnick S. Motivational Interviewing: preparing People for Change. 2nd
ed. New York: Guilford Press; 2002. p. 20-5.
Arkowitz H, Westra HA, Miller WR. Motivational Interviewing in the Treatment of Psychological Problems. New York: Guilford Press; 2007. p. 7-9.
Macgowan MJ, Engle B. Evidence for optimism: Behavior therapies and motivational interviewing in adolescent substance abuse treatment. Child Adolesc Psychiatr Clin N
Riekert KA, Borrelli B, Bilderback A, Rand CS. The development of a motivational interviewing intervention to promote medication adherence among inner city, African American adolescents with asthma. Patient Educ Couns 2011;82:117-22.
Olson AL, Gaffney CA, Lee PL, Starr P. Changing adolescent health behaviors: The Healthy Teens counselling approach. Am J Prev Med 2008;35:359-64.
Tanya ND. Motivational Interviewing Assessment and Behavior Therapy as a Stepped-care Approach to the Treatment of Adolescent Depression. Western Michigan University Libraries: Western Michigan University, Dissertations; 2013. p. 162.
Barrera TL. Motivational Interviewing as Adjunct to Cognitive Behavior Therapy for Anxiety. Houston: University of Houston; 2013.
Mohseni M, Moghaddam AK. The Efficiency of Motivational Interviewing on the Test Anxiety of the First-year High School Girl Students. The Conference of Pathology, Etymology, and the Recovery in Psychology; 2014.
Westen D, Morrison K. A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: an empirical examination of the status of empirically supported therapies. J Consult Clin Psychol 2001;69:875-99.
Rollnick S, Miller WR, Butler CH. Motivational Interviewing in Health Care: helping Patients Change Behavior. New York: Guilford Press; 2007. p. 37-40.
Vogel PA, Hansen B, Stiles TC, Götestam KG. Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD. J Behav Ther Exp Psychiatry 2006;37:247-55.
Turner SL, Thomas AM, Wagner PJ, Moseley GC. A collaborative approach to wellness: diet, exercise, and education to impact behavior change. J Am Acad Nurse Pract 2008;20:339-44.
Jones N, Furlanetto DL, Jackson JA, Kinn S. An investigation of obese adults' views of the outcomes of dietary treatment. J Hum Nutr Diet 2007;20:486-94.
Slagle DM, Gray MJ. The utility of motivational interviewing as an adjunct to exposure therapy in the treatment of anxiety disorders. Prof Psychol Res Pract 2007;38:329-37.
Baer J, Peterson P, Wells E. Rationale and design for a brief intervention for homeless adolescents. Addict Res Theory 2004;12:317-34.
Thush C, Wiers RW, Theunissen N, Van den Bosch J, Opdenacker J, van Empelen P, et al.
A randomized clinical trial of a targeted intervention to moderate alcohol use and alcohol-related problems in at-risk adolescents. Pharmacol Biochem Behav 2007;86:368-76.
Ci D, Kameri M. The analysis of experiments. Translated by Shahkar GH. Tehran: The Publication Center of Tehran University; 2006.
[Table 1], [Table 2], [Table 3], [Table 4]