Introduction to the special series on motivational interviewing and psychotherapy

Neural Conversational Agent for Weight Loss Counseling: Protocol for an Implementation and Feasibility Study

BACKGROUND

Obesity is a common, serious and costly chronic disease. Current clinical practice guidelines recommend that providers augment the longitudinal care of people living with obesity with consistent support for the development of self-efficacy and motivation to modify their lifestyle behaviors. Lifestyle behavior change aligns with the goals of motivational interviewing (MI), a client-centered yet directive counseling modality. However, training health care providers to be proficient in MI is expensive and time-consuming, resulting in a lack of trained counselors and limiting the widespread adoption of MI in clinical practice. Artificial intelligence (AI) counselors accessible via the internet can help circumvent these barriers.

OBJECTIVE

The primary objective is to explore the feasibility of conducting unscripted MI-consistent counseling using Neural Agent for Obesity Motivational Interviewing (NAOMI), a large language model (LLM)-based web app for weight loss counseling. The secondary objectives are to test the acceptability and usability of NAOMI's counseling and examine its ability to shift motivational precursors in a sample of patients with overweight and obesity recruited from primary care clinics.

METHODS

NAOMI will be developed based on recent advances in deep learning in four stages. In stages 1 and 2, NAOMI will be implemented using an open-source foundation LLM and (1) few-shot learning based on a prompt with task-specific instructions and (2) domain adaptation strategy based on fine-tuning LLM using a large corpus of general psychotherapy and MI treatment transcripts. In stages 3 and 4, we will refine the best of these 2 approaches. Each NAOMI version will be evaluated using a mixed methods approach in which 10 adults (18-65 years) meeting the criteria for overweight or obesity (25.0≥BMI≤39.9) interact with NAOMI and provide feedback. NAOMI's fidelity to the MI framework will be assessed using the Motivational Interviewing Treatment Integrity scale. Participants' general perceptions of AI conversational agents and NAOMI specifically will be assessed via Pre- and Post-Interaction Questionnaires. Motivational precursors, such as participants' confidence, importance, and readiness for changing lifestyle behaviors (eg, diet and activity), will be measured before and after the interaction, and 1 week later. A qualitative analysis of changes in the measures of perceptions of AI agents and counselors and motivational precursors will be performed. Participants will rate NAOMI's usability and empathic skills post interaction via questionnaire-based assessments along with providing feedback about their experience with NAOMI via a qualitative interview.

RESULTS

NAOMI (version 1.0) has been developed. Participant recruitment will commence in September 2024. Data collection activities are expected to conclude in May 2025.

CONCLUSIONS

If proven effective, LLM-based counseling agents can become a cost-effective approach for addressing the obesity epidemic at a public health level. They can also have a broad, transformative impact on the delivery of MI and other psychotherapeutic treatment modalities extending their reach and broadening access.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/60361.

Engaging Law Enforcement Employees in Mental Health Help-Seeking: Examining the Utilization of Interactive Screening Program and Motivational Interviewing Techniques

AIM

The Interactive Screening Program (ISP) is an anonymous screening and dialogue platform used in workplaces to encourage mental health help-seeking. This study examined utilization of ISP among law enforcement workplaces and assessed how motivational interviewing techniques were associated with various help-seeking outcomes.

METHOD

This retrospective study used secondary ISP screening and dialogue data collected from 2013 to 2019 at four law enforcement workplaces or unions (N = 691). Independent variables include counselors' use of motivational interviewing techniques in their dialogue such as asking questions and showing empathy in their response. Help-seeking outcomes include requesting a referral, making a commitment to counseling services, decreased ambivalence about mental health services, and increased willingness to seek future services.

RESULTS

Two-thirds of participants screened within the high distress level of ISP. Among them, 53% responded to the counselor's initial email and 50% of those who responded requested a referral for future services. Binary logistic regression models showed that counselors' use of confrontation in the dialogue was associated with improved willingness to seek services among ISP users (OR = 2.88, 95% CI = 1.24, 6.64). Further, ISP users who accessed ISP through their workplace peer support program, as compared to their employee assistance program (EAP), are more likely to show decreased ambivalence about seeking future services over time (OR = 0.28, 95% CI = 0.09, 0.80).

CONCLUSION

This study demonstrates that the anonymous ISP program can successfully engage employees with high distress levels, including employees with suicidal ideation. Results highlight the importance of customizing ISP counselors' responses to be responsive for law enforcement employees.

A pilot study on the efficacy of motivational interviewing groups in alcohol use disorders

OBJECTIVES

The present pilot study was designed to measure the feasibility and efficacy of motivational interviewing (MI) in groups in France, using the Wagner and Ingersoll's method.

METHOD

Participants (N = 85) were people with an alcohol use disorder (AUD) recruited from addiction consultation centers: 37 received five sessions of 2-h MI groups and 48 were assigned to treatment-as-usual condition (TAU). The sample was middle-aged (M = 43.95, SD = 12.96).

RESULTS

MI in groups seems to lead to a significant decrease in alcohol use and anxiety and depressive symptoms of participants in the MI condition. Moreover, there seems to be an increase in subjective happiness scores after the MI groups. In addition, participants' reactions were very positive.

CONCLUSIONS

This study provides encouraging results in favor of the feasibility and efficacy of MI in groups. The use of MI in groups has many advantages in clinical settings.

Designing a Chatbot for a Brief Motivational Interview on Stress Management: Qualitative Case Study

Background

In addition to addiction and substance abuse, motivational interviewing (MI) is increasingly being integrated in treating other clinical issues such as mental health problems. Most of the many technological adaptations of MI, however, have focused on delivering the action-oriented treatment, leaving its relational component unexplored or vaguely described. This study intended to design a conversational sequence that considers both technical and relational components of MI for a mental health concern.

Objective

This case study aimed to design a conversational sequence for a brief motivational interview to be delivered by a Web-based text messaging application (chatbot) and to investigate its conversational experience with graduate students in their coping with stress.

Methods

A brief conversational sequence was designed with varied combinations of MI skills to follow the 4 processes of MI. A Web-based text messaging application, Bonobot, was built as a research prototype to deliver the sequence in a conversation. A total of 30 full-time graduate students who self-reported stress with regard to their school life were recruited for a survey of demographic information and perceived stress and a semistructured interview. Interviews were transcribed verbatim and analyzed by Braun and Clarke’s thematic method. The themes that reflect the process of, impact of, and needs for the conversational experience are reported.

Results

Participants had a high level of perceived stress (mean 22.5 [SD 5.0]). Our findings included the following themes: Evocative Questions and Clichéd Feedback; Self-Reflection and Potential Consolation; and Need for Information and Contextualized Feedback. Participants particularly favored the relay of evocative questions but were less satisfied with the agent-generated reflective and affirming feedback that filled in-between. Discussing the idea of change was a good means of reflecting on themselves, and some of Bonobot’s encouragements related to graduate school life were appreciated. Participants suggested the conversation provide informational support, as well as more contextualized feedback.

Conclusions

A conversational sequence for a brief motivational interview was presented in this case study. Participant feedback suggests sequencing questions and MI-adherent statements can facilitate a conversation for stress management, which may encourage a chance of self-reflection. More diversified sequences, along with more contextualized feedback, should follow to offer a better conversational experience and to confirm any empirical effect.

Integrating Motivational Interviewing and Brief Behavioral Activation Therapy: Theoretical and Practical Considerations

Behavioral Activation and specifically the Brief Behavioral Activation Therapy for Depression (BATD) has a strong record of empirical support but its focus on practical out of session activation-based assignments can lead to poor levels of adherence if efforts to enhance motivation are not prioritized. Towards this end, this manuscript describes the assimilative integration of Motivational Interviewing (MI) and BATD to improve clinical outcomes by integrating MI's focus on building and maintaining motivation to change into BATD. The manuscript provides an overview of MI and BATD, theoretical issue raised in integrating the two approaches, and examples of how this integration results in a nondirective and motivation-focused approach to conducting BATD.

An augmented cognitive behavioural therapy for treating post-stroke depression: description of a treatment protocol

Aim:

Currently, no evidence-based treatment is available for mood problems after stroke. We present a new psychological intervention designed to reduce depressive complaints after stroke.

Method of protocol development:

This intervention was based on cognitive behavioural therapy principles and was shown feasible in a pilot study. In order to meet the specific needs of stroke patients (concerning both sensori-motor, cognitive, and behavioural problems), we incorporated motivational interviewing, grief resolution, and psycho-education. We emphasised for each session to take into account the cognitive deficits of the patients (i.e. be concrete, accessible, structured, specific, and repeat information). Moreover, we augmented the psychologist-administered therapy with the contribution of an occupational or movement therapist aimed at facilitating patients’ goal-setting and attainment. The intervention consisted of 12 one-hour sessions with a psychologist and three or four one-hour sessions with an occupational or movement therapist. Currently, the effectiveness of the intervention is evaluated in a randomised controlled trial.

Discussion:

The proposed psychological treatment protocol is innovative, as it applies cognitive behavioural therapy in a stroke-specific manner; moreover, it supports goal attainment by incorporating occupational or movement therapy sessions.

The impact of bone mineral density testing, fracture assessment, and osteoporosis education in men treated by androgen deprivation for prostate cancer: a pilot study

PURPOSE

Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and engage in few healthy bone behaviors (HBBs). A multicomponent intervention was piloted in this population. Changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated.

METHODS

A pre-post pilot study was performed in a convenience sample of men recruited from the Princess Margaret Cancer Centre. Men were sent personalized letters explaining their dual x-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t tests and McNemar's test were used to assess changes in outcomes.

RESULTS

A total of 148 men completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < 0.0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = 0.015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = 0.007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ 0.001), and there was uptake of vitamin D supplementation from 44 % (n = 65) to 68 % (n = 99) (p < 0.0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. -0.22 ± 4.2, p = 0.005) compared to men with normal bone density.

CONCLUSIONS

Our results provide preliminary evidence that a multicomponent intervention such as the one described can lead to increased knowledge and feelings of susceptibility regarding OP and can enhance uptake of some HBBs.

Brief motivational feedback for college students and adolescents: a harm reduction approach

Alcohol consumption and its attendant problems are prevalent among adolescents and young adult college students. Harm reduction has been found efficacious with heavy drinking adolescents and college students. These harm reduction approaches do not demand abstinence and are designed to meet the individual where he or she is in the change process. The authors present a case illustration of a harm reduction intervention, the Brief Alcohol Screening and Intervention for College Students (BASICS), with a heavy-drinking female college student experiencing significant problems as a result of her drinking. BASICS is conducted in a motivational interviewing style and includes cognitive-behavioral skills training and personalized feedback.