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Ingesson Hammarberg S, Sundbye J, Tingvall R, Hammarberg A, Nehlin C. A qualitative interview study of patient experiences of receiving motivational enhancement therapy in a Swedish addiction specialist treatment setting. Addict Sci Clin Pract 2023; 18:44. [PMID: 37475039 PMCID: PMC10357895 DOI: 10.1186/s13722-023-00398-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Motivational enhancement therapy (MET) has shown to be efficacious as treatment of alcohol use disorder (AUD), in reducing alcohol consumption and related consequences. However, qualitative research on how patients perceive this treatment is lacking. The aim of this study was to explore how patients experience MET as a treatment for AUD. METHODS Fifteen patients (8/7 female/male) participated in semi-structured interviews after receiving MET at a specialized addiction outpatient clinic in Sweden. Data were analyzed by thematic analysis. RESULTS Five themes were identified: the therapist conveyed the MI-spirit, the therapist did not guide on how to reach the goal, participants were committed to change before starting treatment, participants were uncertain if treatment was enough to maintain change, and significant others were not wanted in sessions. Participants appreciated the supportive relationship with their therapist, but some experienced therapy as overly positive, with no room to talk about failure. Further, they experienced a low level of guidance in goal-setting. For some, this was empowering, while others requested more direction and advice. Participants perceived their motivational process to have started before treatment. MET was considered to be too brief. None of the participants brought a significant other to a session. CONCLUSIONS Therapist behaviors in line with MI spirit were emphasized as key to the development of a positive therapeutic relationship. More specific advice on goal-setting may be effective for supporting change in some patients. Longer treatment is requested among patients to support the patient's self-efficacy for change. Significant others can support change without necessarily being present in sessions. TRIAL REGISTRATION The current trial was retrospectively registered at isrtcn.com (14539251).
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Affiliation(s)
- Stina Ingesson Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden.
| | - Jennie Sundbye
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden
| | - Rebecca Tingvall
- Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Norra Stationsgatan 69, 113 64, Region Stockholm, Sweden
| | - Christina Nehlin
- Department of Medical Sciences, Psychiatry, Uppsala University, Uppsala, Sweden
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Hilton CE. Behaviour change, the itchy spot of healthcare quality improvement: How can psychology theory and skills help to scratch the itch? Health Psychol Open 2023; 10:20551029231198938. [PMID: 37746584 PMCID: PMC10517624 DOI: 10.1177/20551029231198938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Despite the clear utility and transferability, National Health Service (NHS) quality improvement initiatives have yet to benefit fully from what is already known within health psychology. Thus far, evidence from established, seminal behaviour change theory and practice have been ignored in favour of newly developed models and frameworks. Further, whilst there is a growing interest in what is commonly referred to as 'human factors' of change and improvement, there is scant transferability of known psychologically informed implementation skills into routine NHS Improvement practice. The science and practice of healthcare improvement is growing, and the behaviour change aspect is critical to sustainable outcomes. Therefore, this paper offers practical guidance on how seminal psychological behaviour change theory and motivational interviewing (a person-centred skills-based approach specifically developed to support people through change) can be combined to better address individual and organisational change within a healthcare improvement context.
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Wang SY, Dimoff JD, Wang L. Beyond Change Talk and Sustain Talk: Identity Construction and Therapeutic Change in Motivational Interviewing. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2022. [DOI: 10.1080/10720537.2022.2148794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Shu-Yi Wang
- Counseling and Wellness Center, University of Florida, Gainesville, Florida, USA
| | - John D. Dimoff
- Department of Graduate Psychology, Chatham University, Pittsburgh, Pennsylvania, USA
| | - Lei Wang
- Department of Graduate Psychology, Chatham University, Pittsburgh, Pennsylvania, USA
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Dobber J, Latour C, van Meijel B, Ter Riet G, Barkhof E, Peters R, Scholte Op Reimer W, de Haan L. Active Ingredients and Mechanisms of Change in Motivational Interviewing for Medication Adherence. A Mixed Methods Study of Patient-Therapist Interaction in Patients With Schizophrenia. Front Psychiatry 2020; 11:78. [PMID: 32265746 PMCID: PMC7105777 DOI: 10.3389/fpsyt.2020.00078] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms. METHODS First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk. RESULTS We found the therapist factor "a trusting relationship and empathy" important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by "patient change talk". Surprisingly, sequential MI-consistent therapist behavior like "affirmation" and "emphasizing control" was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change. CONCLUSIONS Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see "MI at work" in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
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Affiliation(s)
- Jos Dobber
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Corine Latour
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Berno van Meijel
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam UMC (VUmc), Amsterdam Public Health Research Institute, Amsterdam, Netherlands.,Parnassia Academy, Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Gerben Ter Riet
- Department of General Practice, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | | | - Ron Peters
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Department of Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
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Magill M, Hallgren KA. Mechanisms of behavior change in motivational interviewing: do we understand how MI works? Curr Opin Psychol 2018; 30:1-5. [PMID: 30677627 DOI: 10.1016/j.copsyc.2018.12.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022]
Abstract
This work provides an overview of Motivational Interviewing (MI) theory, the nature of the evidence for its mechanisms of action, and considers future directions. There are three hypotheses purported to explain how MI works: The Technical Hypothesis, the Relational Hypothesis, and the Conflict Resolution Hypothesis. In contrast to the latter two hypotheses, the Technical Hypothesis has received the most empirical attention in the MI process literature. Research shows that clinician technical skills in MI are well-defined, they relate to the intended client mechanisms (i.e. change talk and sustain talk), but the evidence supporting client mechanisms as predictors of subsequent changes to behavior is less conclusive. Future research and clinical implications are briefly considered.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI 02912, United States.
| | - Kevin A Hallgren
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA 98195, United States
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Emma Hilton C. "It's the Symptom of the Problem, Not the Problem itself": A Qualitative Exploration of the Role of Pro-anorexia Websites in Users' Disordered Eating. Issues Ment Health Nurs 2018; 39:865-875. [PMID: 30307783 DOI: 10.1080/01612840.2018.1493625] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The growing trend in the use of the Internet and social media as a method of self-managing illness presents a critical opportunity to better understand the role of pro-anorexia (pro-ana) websites for eating disorders. Therefore, 155 pro-ana website messages regarding criticism that the site was responsible for developing anorexia were inductively thematically analysed. The analysis revealed five main themes: eating disorders are mental illnesses and websites do not cause mental illness, pro-ana websites and eating disorders are more than wanting to be thin (with sub-theme residents and visitors), eating disorders develop regardless of pro-ana websites, pro-ana sites do not cause eating disorders but they may trigger or encourage them (with sub-theme the problem is the user, not the site) and pro-ana sites provide support. Pro-ana websites and online communities present clinicians with complex treatment challenges. Collaborative, therapeutic consultations about pro-ana website use may help to establish how and when accessing them may hinder the treatment process.
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Affiliation(s)
- Charlotte Emma Hilton
- a Department of Health and Life Sciences, School of Psychological, Social and Behavioural Sciences , Coventry University , Coventry , UK
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Dobber J, Latour C, de Haan L, Scholte op Reimer W, Peters R, Barkhof E, van Meijel B. Medication adherence in patients with schizophrenia: a qualitative study of the patient process in motivational interviewing. BMC Psychiatry 2018; 18:135. [PMID: 29776393 PMCID: PMC5960122 DOI: 10.1186/s12888-018-1724-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 05/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) may be an effective intervention to improve medication adherence in patients with schizophrenia. However, for this patient group, mixed results have been found in randomized controlled trials. Furthermore, the process of becoming (more) motivated for long-term medication adherence in patients with schizophrenia is largely unexplored. METHOD We performed a qualitative multiple case study of MI-sessions to analyse the interaction process affecting motivation in patients with schizophrenia. Fourteen cases of patients with schizophrenia, who recently experienced a psychotic relapse after medication-nonadherence, were studied, comprising 66 audio-recorded MI-sessions. In the MI-sessions, the patients expressed their cognitions on medication. We used these cognitions to detect the different courses (or patterns) of the patients' ambivalence during the MI-intervention. We distinguished successful and unsuccessful cases, and used the cross-case-analysis to identify success factors to reach positive effects of MI. RESULTS Based on the expressed cognitions on medication, we found four different patterns of the patient process. We also found three success factors for the intervention, which were a trusting relationship between patient and therapist, the therapist's ability to adapt his MI-strategy to the patient's process, and relating patient values to long-term medication adherence. CONCLUSIONS The success of an MI-intervention for medication adherence in patients with schizophrenia can be explained by well-defined success factors. Adherence may improve if therapists consider these factors during MI-sessions.
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Affiliation(s)
- Jos Dobber
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD, Amsterdam, The Netherlands.
| | - Corine Latour
- grid.431204.0ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands
| | - Lieuwe de Haan
- 0000000084992262grid.7177.6Department of Psychiatry, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Wilma Scholte op Reimer
- grid.431204.0ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Tafelbergweg 51, 1105 BD Amsterdam, The Netherlands ,0000000084992262grid.7177.6Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ron Peters
- 0000000084992262grid.7177.6Department of Cardiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Emile Barkhof
- 0000 0004 0501 8787grid.468622.cGGZ Rivierduinen, Sandifortdreef 19, 2333 ZZ Leiden, The Netherlands
| | - Berno van Meijel
- grid.448984.dInholland University of Applied Sciences, De Boelelaan 1109, 1081 HV Amsterdam, The Netherlands ,0000 0004 0435 165Xgrid.16872.3aDepartment of Psychiatry, VU University Medical Center, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands ,Parnassia Psychiatric Institute, Monterseweg 93, 2553 RJ The Hague, The Netherlands
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Hilton CE, Johnston LH. Health psychology: It's not what you do, it's the way that you do it. Health Psychol Open 2017; 4:2055102917714910. [PMID: 29379610 PMCID: PMC5779922 DOI: 10.1177/2055102917714910] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the growth in theoretical understandings of health behaviour and standardised approaches to health interventions (e.g. behaviour change taxonomies), health psychology has paid comparatively less attention to the importance of the implementation processes - 'how to' rather than 'what to' of such interventions. The clinical and interpersonal skills that often reflect these implementation processes are poorly defined within the health psychology literature. The level of proficiency in such skills expected of Health and Care Professions Council registered practitioner health psychologists is unclear and poorly documented within the UK training requirements. This article explores the potential impact of this and offers some pragmatic solutions.
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