Does Motivational Therapy work?

Ferrara et al. (2018) compared desmopressin, motivational therapy, and desmopressin with motivational therapy.  They studied 137 patients with a mean age of 8.8 years. They evaluated the child’s response at 3 months.  Motivational therapy included: avoiding punishment, having a supportive environment, remembering that bedwetting is not the child’s fault, management of constipation, tracking wet and dry nights, tracking fluid intake, encouraging regular voiding during the day, increasing fluid intake in the morning and early afternoon, avoiding pull-ups, and rewarding dryness AND rewarding the above behaviors.  They also discouraged certain foods in the evening. Of the three groups, they found that desmopressin alone achieved a positive response in 58%, motivational therapy alone achieved a positive response in 3%, and in children with desmopressin and motivational therapy they had a positive response of 66%.  A positive response was 50% or more decrease in wet nights per week.  The difference between desmopressin and desmopressin with motivational therapy is not statistically significant.

My opinion: We know that desmopressin can decrease wet nights on the night that it’s taken.  Typically, the child will start wetting again on the nights they don’t take it. I would be more interested in a positive response once they’ve weaned off of desmopressin with motivational therapy.  Would they have a lower chance of relapse? The motivational therapy included is not harmful to the child and it could improve their self-esteem.  The interventions improve overall bladder health which is important. I also find that these interventions take longer than 3 months to improve overall bowel and bladder health.  Three months might not have been a long enough time frame for an improvement in their wet nights.    

Ferrara, P., Amodeo, M., Sbordone, A., Ianniello, F., Verrotti, A., Petitti, T., & Ruggiero, A. (2018). The impact of motivational therapy in the management of enuretic children. Turkish Journal of Urology, 44(4): 346-50. evaluated: 10.5152/tud.2018.50329

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