Chapter 6 158 rehearsal, mainly role-playing (6). Application of cognitive-behavioral techniques includes one of the three core teaching principles that should be used by the IMR trainers every session to enable skills training for promoting illness selfmanagement (3, 6). In the current study, motivational and educational strategies were sufficiently implemented; however, cognitive-behavioral strategies were not. IMR participants, by practicing a skill both inside and outside of a session, will feel more confident in using that skill in everyday life. Role-playing provides the trainer with a structure for practicing a skill using interactive teaching methods. Teaching a skill using role-play can often be combined with modeling, which can be executed by the IMR trainer (6). Home assignments are also a cognitive-behavioral technique (6). In the implementation guide, these cognitive-behavioral techniques were consistently named as critical ingredients for the successful implementation of the poorly implemented elements in this study (6). Therefore, we suggest that the poor implementation of these critical cognitive-behavioral techniques may have greatly impeded the implementation of the other seven insufficiently implemented elements. Role-playing was completely unused in the IMR groups of this study. However, roleplay appears to be a crucial component of IMR implementation (6). IMR trainers should be familiar with it because it has been used in their education. However, in the interviews with both trainers and clients, it appeared that before IMR, both groups had experienced anxiety and stage fright with role-playing. Therefore, in implementing IMR, the trainers felt uncomfortable about doing role-play, partly due to anticipated reluctance from clients. This resulted in avoidance. In addition, they appeared to avoid giving homework assignments for fear that this would lead to dropout. The lack of readiness to use role-plays, modeling, and home assignments would appear to be explained as a shortcoming in the training process of IMR trainers. The IMR trainers’ discomfort could be overcome by practicing these skills regularly during training and supervision sessions. Therefore, improvements in the training of IMR clinicians could address these common concerns of practitioners and better equip them with the cognitive-behavioral skills they require to effectively implement the IMR program. Some relevant suggestions from the implementation guide mentioned above were not applied (6), for example, using experiential learning exercises in the initial twoday training for IMR trainers and specialized follow-up training in motivational and cognitive-behavioral strategies. In addition, IMR implementation was not initiated with a very small group of participants to practice, and supervision was provided only once every two weeks instead of once a week. One might suggest that more
RkJQdWJsaXNoZXIy MjY0ODMw