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1 © Eliane Duvekot Eliane Duvekot

2 Family Motivational Intervention
Training motivational interviewing for family members of patients with schizophrenia and cannabis use

3 Contents presentation
Background Intervention Research design

4 Why aiming an intervention at cannabis use and compliance?
Early independent predictors of a poor outcome: 1. Cannabis 2. Poor compliance 3. Lack of insight Linszen 2006

5 © Eliane Duvekot Eliane Duvekot

6 Control intervention: supportive counseling
Randomised controlled trials Motivational Interviewing in schizophrenia: compliance Compliance therapy 4-6 sessions, n=74 Control intervention: supportive counseling 23% more improvement with MI 4 other RCT’s, 2/4 MI significantly better Kemp BMJ 1996, BJP 1998

7 RCT MI in schizophrenia: drug use
MI+CBT+family-intervention, n=36 Intensive treatment: 5x MI, 24x CBT, x family-intervention Significantly more abstinence, better level of functioning, symptom reduction and less relapse 7 other RCT’s, 6/7 MI effective Barrowclough AJP 2001;158:

8 © Eliane Duvekot Eliane Duvekot

9 Family interventions in dual diagnosis patients
25-50% dual diagnosis patients live with their parents, even more have frequent contact Family stress  unfavorable course schizophrenia and increase of drug use Need of information in family members Mueser, Guilford Press 2003

10 Contents presentation
Background Intervention Research design

11 Basic considerations FMI
Need of information Improvement of contact Promote desired change Parents are neither care workers nor do they need a therapy, therefore we provide a training

12 Family motivational intervention
Psychoeducation Schizophrenia: 2 sessions Schizophrenia and cannabis: 1 session Interaction skills: 6 sessions Motivational Interviewing: 6 sessions Workshop MI care workers Individual supervision care workers

13 Stadia van verandering bij gewoonteproblemen
definitieve uitgang terugval volhouden uitvoeren voorstadium start beslissen en voorbereiden overwegen Naar Prochaska, DiClemente, & Norcross, 1992

14 Interaction skills Interaction problems Own needs
Communication: transmitting and listening Ownership of problems Constructive confrontation Conflicts: unwilling or unable Collaboration

15 Stages of change Permanent exit start Relapse Maintenance Action
Precontemplation start Preparation Contem-plation Prochaska, DiClemente, & Norcross, 1992

16 Stages and actions Precontemplation Contemplation Preparation Action
Maintenance Relapse Raising doubt Influence balance Choose moment, plan Advise, support Relapse prevention Reassure, renew plans

17 Motivational Interviewing
Wheel of change Listening, summarizing, open ended questions Change talk, selective reflection Resistance

18 Contents presentation
Background Intervention Research design

19 Study design Randomisation: Intervention or psychoeducation only, n=80
Outcome: cannabis use patient, wellbeing parents, communication skills parents Individual supervision care worker of patients in the Intervention arm Workshop MI for care workers

20 Contact with parents/ family members
Inclusion criteria Schizophrenia schizophreniform/schizoaffective disorder Cannabis use At least 2 days/week per week. Age < 41 years Contact with parents/ family members At least 10 hours per week

21 Flow chart patients

22 Flow chart parents

23 FMI team: who is who Maarten Smeerdijk, psycholoog
Marijke Krikke, trainer Anouschka de Jager, trainer Bas van Raay, interactievaardigheden Lieuwe de Haan, lid werkgroep Don Linszen, principal investigator Gerard Schippers, AIAR René Keet, projectleider

24 Thanks for your attention!
© Eliane Duvekot Eliane Duvekot


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