Meta-Analysis of Randomized Controlled Trials of Motivational Enhancement Therapy for Reducing Substance Use

Evaluating Two Brief Motivational Interventions for Excessive-Drinking University Students

OBJECTIVE

Two brief computerized motivational interventions for excessive-drinking university students were evaluated.

METHOD

Participants (N = 88, females = 61.5%, mean age = 21.05 years) were randomly assigned to a control group or one of two experimental groups: Computerized Brief Intervention (CBI) or Computerized Brief Intervention-Enhanced (CBI-E). CBI followed the principles of Motivational Interviewing to motivate participants to change their drinking behavior. CBI-E additionally used the principles of Systematic Motivational Counseling to identify and discuss with participants their dysfunctional motivational patterns that were interfering with their attainment of emotional satisfaction. At baseline and a three-month follow-up, the participants completed a battery of measures of alcohol consumption and related problems.

RESULTS

At baseline, the participants were confirmed to be heavy drinkers with many drink-related negative consequences. Males and females responded differently to the interventions. During follow-up, males' alcohol use was ordered: CBI-E < CBI < Controls. The females in all three groups reduced their alcohol use, but there were no significant group differences.

CONCLUSIONS

Males responded to the interventions as expected. For females, the assessment itself seemed to serve as an effective intervention, and there were no post-intervention differences among the three groups. Suggestions for future research using CBI and CBI-E are discussed.

The effectiveness of mobile-based ecological momentary motivational enhancement therapy in reducing craving and severity of cannabis use disorder: Study protocol for a randomized controlled trial

Objective

This study aims to investigate the effectiveness of Ecological Momentary Motivational Enhancement Therapy (EM-MET) in reducing craving and severity of Cannabis Use Disorder (CUD) among young adults.

Methods

This multicenter, single-blinded randomized controlled trial (RCT) will be conducted over a period of 11 weeks. Eighty patients with CUD will be randomly assigned to two equal-sized parallel groups, either the Motivational Enhancement Therapy (MET) group or the EM-MET group. All participants will receive four individual face-to-face sessions of MET (twice a week). The MET group will not receive any other treatments after these sessions; however, in the EM-MET group, the top triggers of patients will be assessed using mobile-based Ecological Momentary Assessment (EMA) five times a day within three weeks (after face-to-face sessions) and they will receive a call from the therapist who provides them with EM-MET (in the form of an emergency telephone helpline) as soon as they report experiencing triggers of cannabis use that are assessed using EMA in their everyday lives. Primary outcomes including CUD severity and the severity of craving will be evaluated using the Leeds Dependence Questionnaire and the Self-efficacy and Temptation Scale, respectively. These assessments will be conducted at pre-treatment, post-treatment, and a six-week follow-up.

Discussion

If proven feasible and effective, the results of this study will offer clinicians an evidence-based treatment approach to address craving and dependency in patients with CUD. Moreover, these patients will receive effective treatment in real time and in real life, when and where it is most needed. However, it is important to consider the limitations of this study, such as the specific population studied in Tehran, Iran, which may affect the generalizability of the results. Nevertheless, the implementation of Ecological Momentary Interventions (EMIs) in real-life settings holds promise for timely and effective treatment.Trial registration: This trial was registered in the Iranian Registry of Clinical Trials on 21 February 2023. Registry No. IRCT20221224056908N1.

"Ordinary days would be extraordinary": The lived experiences of severe and enduring anorexia nervosa

OBJECTIVE

Approximately 25% of individuals with anorexia nervosa (AN) experience a chronic form of the disorder, referred to as severe and enduring anorexia nervosa (SE-AN). Although the classification of SE-AN remains preliminary, there have been increasing calls for a harm reduction-based, collaborative treatment model for these patients. To provide such care for patients with SE-AN, it is critical to listen to and learn from their lived experiences.

METHOD

Patients (N = 17) admitted to an inpatient eating disorders program who met initial criteria for SE-AN completed semi-structured interviews about the course of their illness and prior treatment episodes. Interviews were audio recorded and transcribed. Data were analyzed using an inductive, reflexive approach to thematic analysis that examined common themes within and across interviews.

RESULTS

Three themes were identified focused on (1) the all-encompassing nature of SE-AN, (2) treatment experiences, and (3) living with chronic illness. Within these themes, there were subthemes. Overall, individuals noted clear insight about their condition, both negative and positive experiences with previous treatment, and hope for better quality of life despite their illness.

DISCUSSION

Individuals with SE-AN describe their illness as a chronic condition and hope for a harm reduction-based treatment. Future work, including the lived experiences of individuals with SE-AN, is important to build our understanding of the classification and clinical characteristics of SE-AN and to develop treatment approaches that may best serve these individuals.

PUBLIC SIGNIFICANCE

Many people with anorexia nervosa do not achieve a full recovery despite repeated treatment episodes throughout their lifespan. Understanding the lived experiences of individuals with SE-AN may help to inform future treatment development efforts that could improve eating disorder and quality of life outcomes for these patients.

Culturally adapted motivational interviewing with cognitive behavior therapy and mindfulness-based relapse prevention for substance use disorder in Pakistan (CAMAIB): protocol for a feasibility factorial randomised controlled trial

BACKGROUND

The use of psychoactive substances significantly impacts the health, social and economic aspects of families, communities and nations. There is a need to develop and test psychological interventions aimed for individuals with substance use disorder (SUD) in lower- and middle-income countries (LMICs), such as in Pakistan. The aim of this exploratory trial is to test the feasibility and acceptability of two culturally adapted psychological interventions in a factorial randomised controlled trial (RCT).

METHODS

The proposed project will be conducted in three phases. The first phase of the study will focus on cultural adaptation of the interventions through qualitative interviews with key stakeholders. The second phase will be to refine and produce manually assisted interventions. Third and last stage would be to assess the feasibility of the culturally adapted interventions through a factorial RCT. The study will be carried out in Karachi, Hyderabad, Peshawar, Lahore and Rawalpindi, Pakistan. Recruitment of participants will take place from primary care and volunteer organisations/drug rehabilitation centres. A total of 260 individuals diagnosed with SUD (n = 65) in each of the four arms will be recruited. The intervention will be delivered weekly over a period of 12 weeks in both individual and group settings. Assessments will be carried out at baseline, at 12th week (after completion of intervention) and 24th week post-randomisation. The analysis will determine the feasibility of recruitment, randomisation, retention and intervention delivery. Acceptability of intervention will be determined in terms of adherence to intervention, i.e. the mean number of sessions attended, number of home assignments completed, attrition rates, as well as through process evaluation to understand the implementation process, context, participants' satisfaction, and impact of the study intervention. The health resource use and impact on the quality of life will be established through health economic data.

DISCUSSION

This study will provide evidence for feasibility and acceptability of culturally adapted manually assisted psychological interventions for individuals with SUD in the context of Pakistan. The study will have clinical implications if intervention is proven feasible and acceptable.

TRIAL REGISTRATION

Name of the registry: ClinicalTrials.gov, Trial registration number: NCT04885569 , Date of registration: 25th April 2021.

What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah

BACKGROUND

Pornography has become mainstream in society, including in the state of Utah, which is a highly religious, conservative state.

AIM

The purpose of this study is to gather basic descriptive norms for pornography use in the state of Utah (given its unique religious profile), establish clinical cutoffs based on frequency and duration of pornography consumption, and begin to establish a clinical picture of problematic pornography use in a regionally representative sample.

METHODS

We recruited a representative sample of 892 Utahns via CloudResearch.com. Participants completed the following measures: Consumption of Pornography - General (COPS); Problematic Pornography Use Scale; Clear Lake Addiction to Pornography Scale; The Inventory of Depression and Anxiety Symptoms (Second Version).

OUTCOME

Documentation of pornography use norms among Utahns.

RESULTS

In our sample, 79% reported viewing pornography in their lifetime (85% of men, 75% of women). The most common frequency of pornography viewing was weekly or monthly among men, and monthly or every 6 months among women, which is comparable to national averages. Men and women showed significantly different pornography use frequencies. We demonstrate a relationship between higher levels of pornography use and higher perceived levels of pornography use as a problem or "addiction" and depression scores and explore the typical demographics of our highest pornography users.

CLINICAL TRANSLATION

This study will aid clinicians in using the COPS to derive normal pornography use compared to above average pornography use among pornography users from a religious background, especially for clinicians who seek to provide normative data to clients presenting with problematic pornography use like in motivational interviewing interventions.

STRENGTHS AND LIMITATIONS

Strengths include our measures generally demonstrated strong validity, we provide the beginnings of sound clinical implementation of the COPS for benchmarking pornography use in a clinical setting in Utah, and that our sample was representative of the state of Utah according to current census data. Limitations include those commonly seen in survey-based data collection methods, and that findings from our unique Utah sample may not be as relevant among other religious or cultural samples.

CONCLUSION

Our findings provide an updated picture of pornography use in the state of Utah and suggest that even those high in religiosity continue to use pornography. Our results can provide a spectrum of pornography use, aiding a pornography user in treatment to be able to compare his or her use to this norm. Esplin CR, Hatch SG, Ogles BM, et al. What is Normal Pornography Use in a Highly Religious Area? Exploring Patterns of Pornography Use in Utah. J Sex Med 2022;19:823-833.

How to increase the role of social workers in suicide preventive interventions

OBJECTIVE

Suicide is a serious public health issue that affects individuals, families and societies all over the world. International studies provide consistent evidence that the presence of psychiatrists in a region is associated with lesser suicide rates. However, many psychiatric patients including suicidal patients do not have access to psychiatrists. This indicates that mental health and non-mental health social workers need to be involved in suicide prevention efforts. This paper is the first comprehensive work that discusses how to increase the role of social workers in the area of suicide prevention.

METHODS

A review of the relevant literature.

RESULTS

Increasing the role of social workers in suicide prevention efforts may reduce suicide risk in groups and people at elevated risk for suicide, as well as the general population.

CONCLUSION

Recommendations are provided for how the social work profession can improve upon suicide prevention while incorporating universal, selective and indicated suicide preventive interventions. Social work research efforts should focus on how to increase the role of social workers in suicide prevention and the management of suicidal patients. Social work education programmes should modify their curricula and increase their attention on suicide prevention. Mental health social workers need to educate the patient and their family on suicide risk factors. Furthermore, mental health and non-mental health social workers need to educate the general public on suicide risk factors.

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.

Enhanced self-monitoring blood glucose in non-insulin-requiring Type 2 diabetes: A qualitative study in primary care

AIMS AND OBJECTIVES

To contribute to both theoretical and practical understanding of the role of self-monitoring blood glucose for self-management by describing the experience of people with non-insulin-requiring Type 2 diabetes in an enhanced structured self-monitoring blood glucose intervention.

BACKGROUND

The complex context of self-monitoring blood glucose in Type 2 diabetes requires a deeper understanding of the clients' illness experience with structured self-monitoring of blood glucose. Clients' numeracy skills contribute to their response to blood glucose readings. Nurses' use of motivational interviewing to increase clients' regulatory self-efficacy is important to the theoretical perspective of the study.

DESIGN

A qualitative descriptive study.

METHODS

A purposive sample of eleven adults recently (<2 years) diagnosed with non-insulin-requiring Type 2 diabetes who had experienced a structured self-monitoring blood glucose intervention participated in this study. Audio recordings of semi-structured interviews and photographs of logbooks were analysed for themes using constant comparison and member checking.

RESULTS

The illness experience states of Type 2 diabetes include 'Diagnosis,' 'Behavior change,' and 'Routine checking.' People check blood glucose to confirm their Type 2 diabetes diagnosis, to console their diabetes-related fears, to create personal explanations of health behaviour's impact on blood glucose, to activate behaviour change and to congratulate their diabetes self-management efforts.

CONCLUSIONS

These findings support the Transtheoretical model's stages of change and change processes. Blood glucose checking strengthens the relationships between theoretical concepts found in Diabetes Self-management Education-Support including the following: engagement, information sharing and behavioural support.

RELEVANCE TO CLINICAL PRACTICE

Tailoring diabetes care specifically to clients' stage of their illness experience with use of self-monitoring blood glucose contributes to engagement in self-management. Motivational interviewing and collaborative decision-making using blood glucose checking increase regulatory self-efficacy for people living with non-insulin-requiring Type 2 diabetes.

Impact of Brief Intervention Workshops on Addiction Provider Knowledge, Skills, Negative Attitudes, and Interest in Implementing Evidence-Based Practices

This study evaluated the impact of Motivational Interviewing (MI) and Screening, Brief Intervention, and Referral to Treatment (SBIRT) workshops on posttraining knowledge, skills, negative attitudes, and interest in implementing evidence-based practices (EBPs). Participants ( N = 70) were primarily mental health counselor (41.4%), social workers (20.0%), substance abuse counselors (15.7%), school counselors (5.7%), and nursing professionals (4.3%) who selected the 1- or 2-day workshop for continuing education credit. Participants attended either a Basic MI training workshop (1 day) or a Basic MI training plus an advanced MI/SBIRT training workshop (2 days) to assess if exposure to two EBPs would improve training outcomes. Participants in both the 1-day and 2-day workshops reported posttraining increased perceived knowledge and skills, decreased negative attitudes toward EBPs, and increased interest in implementing EBPs from pretraining to posttraining. There were no differences between participants in the Basic MI or MI plus advanced MI/SBIRT training conditions. Implications for reducing the research-practice gap in EBPs are discussed.