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Bard A, Forsberg L, Wickström H, Emanuelson U, Reyher K, Svensson C. Clinician motivational interviewing skills in 'simulated' and 'real-life' consultations differ and show predictive validity for 'real life' client change talk under differing integrity thresholds. PeerJ 2023; 11:e14634. [PMID: 37810783 PMCID: PMC10552748 DOI: 10.7717/peerj.14634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 12/04/2022] [Indexed: 10/10/2023] Open
Abstract
Background Accurate and reliable assessment of clinician integrity in the delivery of empirically supported treatments is critical to effective research and training interventions. Assessment of clinician integrity can be performed through recording simulated (SI) or real-life (RL) consultations, yet research examining the equivalence of these data is in its infancy. To explore the strength of integrity assessment between SI and RL samples in Motivational Interviewing (MI) consultations, this article examines whether Motivational Interviewing Treatment Integrity (MITI) assessments differ between SI and RL consultations and reviews the predictive validity of SI and RL MI skills categorisations for RL client response language. Methods This study first compared MITI coding obtained in SI and RL consultations for 36 veterinary clinicians. Multilevel models of 10 MITI behaviour counts and four MITI global scores were run using MLwiN 3.02 to assess if a significant difference existed between SI and RL MITI data, with consultation within clinician within cohort (A and B) as nested random effects. Second, we investigated the effect of SI and RL MI skills groupings on rate of RL client response talk using three multivariable regression models. Two Poisson regression models, with random intercepts for farm and veterinarian and offset for number of minutes of the recordings, were estimated in the statistical software R using the package glmmTMB for the two response variables Change Talk and Sustain Talk. A logistic regression model, with the same random intercepts, with the response variable Proportion Change Talk was also estimated using the same package. Results Veterinary clinicians were less MI consistent in RL consultations, evidenced through significantly lower global MITI Cultivating Change Talk (p < 0.001), Partnership (p < 0.001) and Empathy (p = 0.003) measures. Despite lower objective MI skills groupings in RL consultations, ranking order of veterinary clinicians by MI skills was similar between contexts. The predictive validity of SI and RL MI skills groupings for RL client Change Talk was therefore similar, with significantly more RL client Change Talk associated with veterinarians categorised in the highest grouping ('moderate') in both SI (p = 0.01) and RL (p = 0.02) compared to untrained veterinarians in each respective context. Conclusions Findings suggest SI and RL data may not be interchangeable. Whilst both data offer useful insights for specific research and training purposes, differing contextual MI skills thresholds may offer a more equitable assessment of clinician RL client-facing MI integrity. Further research is needed to explore the applicability of these findings across health contexts.
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Affiliation(s)
- Alison Bard
- Bristol Veterinary School, The University of Bristol, Bristol, United Kingdom
| | | | | | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
| | - Kristen Reyher
- Bristol Veterinary School, The University of Bristol, Bristol, United Kingdom
| | - Catarina Svensson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden
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Cinciripini PM, Minnix JA, Robinson JD, Kypriotakis G, Cui Y, Blalock JA, Lam CY, Wetter DW. The Effects of Scheduled Smoking Reduction and Precessation Nicotine Replacement Therapy on Smoking Cessation: Randomized Controlled Trial With Compliance. JMIR Form Res 2023; 7:e39487. [PMID: 37338956 DOI: 10.2196/39487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 04/04/2023] [Accepted: 04/30/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Smoking remains a major public health problem, and it is important to provide a variety of efficacious and appealing options to encourage smokers to quit smoking. Scheduled smoking is a method of gradual reduction, preparing smokers to quit by systematically reducing cigarette consumption according to a predetermined schedule that increases the time between cigarette consumption. Gradual reduction may be preferred to abrupt quitting, but the efficacy of this cessation approach is unclear. OBJECTIVE This study aims, first, to evaluate the overall effectiveness of scheduled smoking alone, or in combination with precessation nicotine replacement therapy (NRT), versus standard NRT starting on the quit date with no prior smoking reduction and, second, to evaluate the impact of schedule compliance on the effectiveness of the intervention. METHODS A total of 916 participants recruited from the Houston metropolitan area were randomly assigned to 1 of the following 3 groups: scheduled smoking plus a precessation nicotine patch (n=306, 33.4%), scheduled smoking only with no precessation patch (n=309, 33.7%), and enhanced usual care (n=301, 32.9%) control. The primary abstinence outcomes were carbon monoxide-verified, self-reported, 7-day point prevalence abstinence at 2 and 4 weeks after the quit date. Unadjusted and adjusted logistic regression analyses were performed to evaluate the intervention effect. Scheduled smoking was implemented using a handheld device for 3 weeks before quitting. This trial was not registered because data collection began before July 1, 2005. RESULTS Results for the first aim showed no overall differences in abstinence among the 3 groups in both the unadjusted and adjusted models. However, the results for the second aim showed a clear effect on abstinence by schedule compliance at 2 and 4 weeks and 6 months after quitting (odds ratio [OR] 2.01, 95% CI 1.31-3.07), 4 weeks (OR 1.58, 95% CI 1.05-2.38), and 6 months (OR 1.68, 95% CI 1.04-2.64), with the differences at 2 and 4 weeks after quitting being the most robust. We also found that scheduled smoking was related to a reduction in nicotine withdrawal, negative affect, and craving when compared with the controls. CONCLUSIONS Scheduled smoking, when combined with precessation use of NRT, can result in significantly higher abstinence rates than usual care (abrupt quitting with NRT), particularly in the early postquit phase (2 and 4 weeks after cessation) when smokers are compliant with the procedure. Scheduled smoking also produced a better overall quitting experience by reducing symptoms of nicotine withdrawal and craving, in comparison with usual care, which could encourage future quit attempts. Studies in this area should focus on the use of counseling or other methods to improve adherence.
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Affiliation(s)
- Paul M Cinciripini
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jennifer A Minnix
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jason D Robinson
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - George Kypriotakis
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Yong Cui
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Janice A Blalock
- Department of Behavioral Science, University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cho Y Lam
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
| | - David W Wetter
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, United States
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Herzing M, Wickström H, Jacobsson A, Källmén H, Forsberg L. Enhancing compliance with waste sorting regulations through inspections and motivational interviewing. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023:734242X231154145. [PMID: 36843382 DOI: 10.1177/0734242x231154145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
This field experiment investigates the effect of first-time inspections of restaurants' waste sorting and explores whether motivational interviewing (MI) training of inspectors in this specific setting enhances the propensity of restaurants to be compliant with regulations. Our results show strong positive effects of first inspections with an average improvement of 55%. Also, the MI training of inspectors seems to affect compliance. However, this may also be a combined effect of the first inspection, MI training and more days between inspections. Further research is needed.
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Affiliation(s)
- Mathias Herzing
- Department of Economics, Stockholm University, Stockholm, Sweden
| | | | - Adam Jacobsson
- Department of Economics, Stockholm University, Stockholm, Sweden
| | - Håkan Källmén
- Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Magill M, Walthers J, Figuereo V, Torres L, Montanez Z, Jackson K, Colby SM, Lee CS. The role of the relational context and therapists' technical behaviors in brief motivational interviewing sessions for heavy alcohol consumption: Findings from a sample of Latinx adults. J Subst Abuse Treat 2023; 144:108898. [PMID: 36270197 DOI: 10.1016/j.jsat.2022.108898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 08/07/2022] [Accepted: 10/10/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Motivational interviewing (MI) theory and process research highlights the role of therapist technical and relational behaviors in predicting client in-session statements for or against behavior change (i.e., change and sustain talk, respectively). These client statements, in turn, have been shown to predict intervention outcomes. The current study examines sequential associations between therapist behaviors and client change and sustain talk in a sample of Latinx individuals who engage in heavy alcohol consumption. DATA Data are from a completed randomized clinical trial of a culturally adapted (CAMI) versus unadapted MI targeting alcohol use and consequences among Latinx individuals. METHOD The study collected observational coding data with the Motivational Interviewing Skill Code (MISC 2.5, i.e., therapist behaviors and global ratings) and the Client Language Assessment - Proximal/Distal (CLA-PD, i.e., client language). Frequentist and Bayesian sequential analyses examined the relationship among nine different categories of therapist behaviors and three different categories of client language (i.e., change talk, sustain talk, neutral). We examined odds ratios and conditional probabilities for the direction, magnitude, and significance of the association between the use of MI technical behaviors and subsequent client statements about change. The study compared these same transitional associations between low/average (i.e., <4) and high (i.e., ≥4) MI Spirit sessions. RESULTS The pattern of results was replicated across both analytic frameworks. Questions and reflections about change talk versus sustain talk versus neutral statements showed greater odds of predicting the intended client response (i.e., change talk, sustain talk, neutral, respectively) compared to other possible client responses. Conditional probabilities for these transitions were high, ranging from 0.55 to.88. The magnitude of certain technical transitions significantly differed between low/average and high MI Spirit sessions. CONCLUSIONS Analyses supported the hypothesized associations between therapist use of technical MI behaviors and client change language within this Latinx sample. Analyses of MI Spirit as a moderator of these transitions showed partial support.
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Affiliation(s)
- Molly Magill
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America.
| | - Justin Walthers
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
| | - Victor Figuereo
- University of Pittsburgh School of Social Work, United States of America
| | | | | | - Kristina Jackson
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
| | - Suzanne M Colby
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, United States of America
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Svensson C, Wickström H, Forsberg L, Betnér S, von Brömssen C, Reyher KK, Bard AM, Emanuelson U. Dairy herd health management activities in relation to training of veterinarians in motivational interviewing. Prev Vet Med 2022; 204:105679. [PMID: 35636232 DOI: 10.1016/j.prevetmed.2022.105679] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/09/2022] [Accepted: 05/13/2022] [Indexed: 11/30/2022]
Abstract
Communication has been identified as one constraint for cattle veterinarians to act as proactive health consultants. Motivational Interviewing (MI), an evidence-based client-centered communication methodology, may therefore be a useful tool in veterinary herd health management (VHHM). The aim of this exploratory study was to investigate associations between training in MI and different measures of performance in VHHM. MI skills of 36 Swedish cattle veterinarians randomly assigned to two groups - MI veterinarians (n = 18) who had received six-months training in MI and control veterinarians (n = 18) who were not trained - were assessed using the MI Treatment Integrity coding system. Skills were categorized as untrained, trained_poor, trained_near moderate and trained_moderate. Veterinarians each visited two to six cattle farms for VHHM consultations and revisited the same farms three to six months later to document implementation of recommendations. A gamma model and logistic or ordered logistic regression models were used to evaluate associations between MI training and performance measured as: a) proportion of consultations resulting in written herd health plans, b) proportion of recommended measures fully or partially implemented, c) Likert scores of different estimates of client satisfaction and d) total time during 6 months allocated to VHHM visits on cattle farms. We found no evidence of any significant effects of MI training on the eight performance variables analyzed. However, a pattern of numerically higher values (better performance) in trained veterinarians with poor or moderate MI skills than in untrained veterinarians was observed in most variables. Clients were highly satisfied with veterinarians' attitude, competence and time efficiency. Farms implemented a median of 66.7% (interquartile range: 50-100) of the measures partially or fully. Veterinarians allocated little time to VHHM visits (median: 2.2; interquartile range: 0.65-4.1 h per week of full-time work within cattle). Veterinarians with moderate skills spent 2.14 times more time on VHHM visits than untrained veterinarians, but the confidence interval was wide (0.88-5.21). The pattern of numerically higher values in trained veterinarians supported findings from other studies in the same project indicating a positive effect of MI training on VHHM. Our observations suggest a considerable potential to increase veterinarians' engagement in VHHM.
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Affiliation(s)
- Catarina Svensson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07 Uppsala, Sweden.
| | - Hans Wickström
- MeetMe Psykologkonsult AB, Åvägen 16, SE-443 31 Lerum, Sweden.
| | - Lars Forsberg
- MIC Lab AB, Drottninggatan 55, SE-111 21 Stockholm, Sweden.
| | - Staffan Betnér
- Department of Energy and Technology, Unit of Applied Statistics and Mathematics, Swedish University of Agricultural Sciences, P.O. Box 7032, SE-750 07 Uppsala, Sweden.
| | - Claudia von Brömssen
- Department of Energy and Technology, Unit of Applied Statistics and Mathematics, Swedish University of Agricultural Sciences, P.O. Box 7032, SE-750 07 Uppsala, Sweden.
| | - Kristen Klara Reyher
- The Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom.
| | - Alison Margaret Bard
- The Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom.
| | - Ulf Emanuelson
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, P.O. Box 7054, SE-750 07 Uppsala, Sweden.
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Abstract
Veterinarians often give advice in a persuasive form, a style that has been shown to evoke resistance to change in clients experiencing psychological ambivalence (i.e. those who see both advantages and disadvantages to changing). With this style of communication, veterinarians run the risk of counteracting their purpose to encourage clients to follow recommendations. Motivational interviewing (MI) is a client-centered communication methodology that aims to facilitate clients’ internal motivation to change. In MI, Change Talk represents clients’ own statements expressing consideration of, motivation for or commitment to behavior change and has been shown to be strongly correlated with behavior change. Sustain Talk is corresponding statements related to maintaining the status quo. The aim of this exploratory study was to evaluate the potential of MI to facilitate behavior change in veterinary herd health management (VHHM) by investigating the effect of dairy cattle veterinarians’ MI skills on client Change and Sustain Talk. We recorded VHHM consultancies on 170 Swedish cattle farms performed by 36 veterinarians, randomly distributed into 2 groups: MI veterinarians (n = 18) had received 6-month training in MI and control veterinarians (n = 18) had not received any training. Veterinarians’ MI skills were assessed using the Motivational Interviewing Treatment Integrity coding system 4.2.1 and categorized as poor_untrained, poor_trained, near moderate and moderate. Client communication was coded using the Client Language Easy Rating coding system. The effect of MI skills on Change Talk, Sustain Talk and Proportion of Change Talk(Change Talk divided by the sum of Sustain Talk plus Change Talk) was investigated using cross-classified regression models with random intercepts for veterinarian and client (farm). The models also included additional explanatory variables (e.g. type of veterinarian and client’s satisfaction with the consultation). The veterinarian’s MI skills were associated with the client’s Change Talk, but results regarding Sustain Talk or Proportion of Change Talk were inconclusive. Clients of veterinarians reaching the highest (i.e. moderate) MI skills expressed 1.5 times more Change Talk than clients of untrained veterinarians. Clients of general large animal practitioners expressed less Sustain Talk than clients of animal health veterinarians and had higher Proportion of Change Talk. Results indicate that learning to practice MI may be one means to improve adherence to veterinary recommendations and to improve efficiency in VHHM services.
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Walthers J, Janssen T, Mastroleo NR, Hoadley A, Barnett NP, Colby SM, Magill M. A Sequential Analysis of Clinician Skills and Client Change Statements in a Brief Motivational Intervention for Young Adult Heavy Drinking. Behav Ther 2019; 50:732-742. [PMID: 31208683 PMCID: PMC6582982 DOI: 10.1016/j.beth.2018.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022]
Abstract
This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians' use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians' use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.
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Affiliation(s)
| | - Tim Janssen
- Brown University, Center for Alcohol and Addiction Studies
| | | | - Ariel Hoadley
- Brown University, Center for Alcohol and Addiction Studies
| | | | | | - Molly Magill
- Brown University, Center for Alcohol and Addiction Studies.
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Kitzmann J, Ratka‐Krueger P, Vach K, Woelber JP. The impact of motivational interviewing on communication of patients undergoing periodontal therapy. J Clin Periodontol 2019; 46:740-750. [DOI: 10.1111/jcpe.13132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 04/02/2019] [Accepted: 05/05/2019] [Indexed: 12/30/2022]
Affiliation(s)
- Julia Kitzmann
- Private Practice Hamburg Germany
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Petra Ratka‐Krueger
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
| | - Kirstin Vach
- Faculty of Medicine, Institute for Medical Biometry and Statistics Medical Center – University of Freiburg Freiburg Germany
| | - Johan P. Woelber
- Department of Operative Dentistry and Periodontology, Faculty of Medicine University of Freiburg Freiburg Germany
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Mache S, Vitzthum K, Groneberg DA, Harth V. Effects of a multi-behavioral health promotion program at worksite on smoking patterns and quit behavior. Work 2019; 62:543-551. [PMID: 31104040 DOI: 10.3233/wor-192889] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Tobacco use is associated with various severe health risks. Therefore, the need to decrease smoking rates is a great public health concern. The workplace has capability as a setting through which large groups of smokers can be reached to encourage smoking cessation. OBJECTIVE The aim of the present study was to evaluate effects of a multi behavioral worksite health promotion intervention. The primary outcome was the change of smoking rate. Secondary outcomes were changes in smoking attitudes and readiness to stop smoking among employees over an intervention period of 12 months. METHOD 112 and 110 employees were enrolled in the intervention and control arm respectively. The intervention group received a 12-month multicomponent health promotion intervention. One of the main elements of the multicomponent intervention was a smoking cessation and counseling program. During the pilot year, participants completed a self-evaluation questionnaire at baseline and again after 12 months to related outcomes and changes. RESULTS Results showed that participants' quit behavior and smoking behavior changed over time in the intervention group (IG). Readiness to quit smoking also increased in the IG compared to the comparison group (CG). Some positive intervention effects were observed for cognitive factors (e.g., changes attitudes towards smoking). Baseline willingness to change smoking behavior was significantly improved over time. CONCLUSIONS This study showed initial results of a long-term multicomponent worksite health promotion program with regard to changes in smoking behavior, attitudes towards smoking and readiness to quit smoking. The evaluation suggests that a worksite health promotion program may lead to improvements in smoking behavior for a number of workers.
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Affiliation(s)
- Stefanie Mache
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-University, Frankfurt am Main, Germany
| | - V Harth
- Institute for Occupational and Maritime Medicine (ZfAM), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Laws MB, Magill M, Mastroleo NR, Gamarel KE, Howe CJ, Walthers J, Monti PM, Souza T, Wilson IB, Rose GS, Kahler CW. A sequential analysis of motivational interviewing technical skills and client responses. J Subst Abuse Treat 2018; 92:27-34. [PMID: 30032941 PMCID: PMC6250061 DOI: 10.1016/j.jsat.2018.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 06/12/2018] [Accepted: 06/14/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND The technical hypothesis of Motivational Interviewing (MI) proposes that: (a) client talk favoring behavior change, or Change Talk (CT) is associated with better behavior change outcomes, whereas client talk against change, or Sustain Talk (ST) is associated with less favorable outcomes, and (b) specific therapist verbal behaviors influence whether client CT or ST occurs. MI consistent (MICO) therapist behaviors are hypothesized to be positively associated with more client CT and MI inconsistent (MIIN) behaviors with more ST. Previous studies typically examine session-level frequency counts or immediate lag sequential associations between these variables. However, research has found that the strongest determinant of CT or ST is the client's previous CT or ST statement. Therefore, the objective of this paper was to examine the association between therapist MI skills and subsequent client talk, while accounting for prior client talk. METHODS We analyzed data from a manualized MI intervention targeting both alcohol misuse and sexual risk behavior in 132 adults seen in two hospital emergency departments. Transcripts of encounters were coded using the Motivational Interviewing Skills Code (MISC 2.5) and an additional measure, the Generalized Behavioral Intervention Analysis System (GBIAS). Using these measures, we analyzed the association between client talk following specific classifications of MICO skills, with the client's prior statement as a potential confounder or effect modifier. RESULTS With closed questions as the reference category, therapist simple reflections and paraphrasing reflections were associated with significantly greater odds of maintaining client talk as CT or ST. Open questions and complex reflections were associated with significantly greater odds of CT following ST, were not associated significantly with more ST following ST, and were associated with more ST following CT (i.e., through an association with less Follow Neutral). CONCLUSIONS Simple and paraphrasing reflections appear to maintain client CT but are not associated with transitioning client ST to CT. By contrast, complex reflections and open questions appeared to be more strongly associated with clients moving from ST to CT than other techniques. These results suggest that counselors may differentially employ certain MICO technical skills to elicit continued CT and move participants toward ST within the MI dialogue.
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Affiliation(s)
- M Barton Laws
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States.
| | - Molly Magill
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Nadine R Mastroleo
- College of Community and Public Affairs, Binghamton University, Binghamton, NY, United States
| | - Kristi E Gamarel
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - Chanelle J Howe
- Department of Epidemiology, Centers for Epidemiology and Environmental Health, Brown University School of Public Health, Providence, RI, United States
| | - Justin Walthers
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Peter M Monti
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Timothy Souza
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Ira B Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI, United States
| | - Gary S Rose
- William James College, Newton, MA, United States
| | - Christopher W Kahler
- Department of Behavioral and Social Sciences and the Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
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Conway LG, Harris KJ, Catley D, Gornick LJ, Conway KR, Repke MA, Houck SC. Cognitive complexity of clients and counsellors during motivation-based treatment for smoking cessation: an observational study on occasional smokers in a US college sample. BMJ Open 2017; 7:e015849. [PMID: 29074509 PMCID: PMC5665329 DOI: 10.1136/bmjopen-2017-015849] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Motivational interviewing (MI) is a widely used and promising treatment approach for aiding in smoking cessation. The present observational study adds to other recent research on why and when MI works by investigating a new potential mechanism: integrative complexity. SETTING The study took place in college fraternity and sorority chapters at one large midwestern university. PARTICIPANTS Researchers transcribed MI counselling sessions from a previous randomised controlled trial focused on tobacco cessation among college students and subsequently scored clients' and counsellors' discussions across four counselling sessions for integrative complexity. INTERVENTIONS This is an observational secondary analysis of a randomised controlled trial that tested the effectiveness of MI. We analysed the relationship between integrative complexity and success at quitting smoking in the trial. PRIMARY AND SECONDARY OUTCOME MEASURES Success in quitting smoking:Participants were categorised into two outcome groups (successful quitters vs failed attempters), created based on dichotomous outcomes on two standard variables: (1) self-reported attempts to quit and (2) number of days smoked via timeline follow-back assessment procedures that use key events in participants' lives to prompt their recall of smoking. RESULTS We found (1) significantly higher complexity overall for participants who tried to quit but failed compared with successful quitters (standardised β=0.36, p<0.001, (Lower Confidence Interval.)LCI=0.16, (Upper Confidence Interval) UCI=0.47) and (2) the predictive effect of complexity on outcome remains when controlling for standard motivational and demographic variables (partial r(102)=-0.23, p=0.022). CONCLUSIONS Taken together, these results suggest that cognitive complexity is uniquely associated with successful quitting in MI controlled trials, and thus may be an important variable to more fully explore during treatment.
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Affiliation(s)
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Delwyn Catley
- Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Kansas City & Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Missouri, USA
| | | | - Kathrene Renee Conway
- School of Public and Community Health Sciences, University of Montana, Missoula, Montana, USA
| | - Meredith A Repke
- Department of Psychology, University of Montana, Missoula, Montana, USA
| | - Shannon C Houck
- Department of Psychology, Syracuse University, Syracuse, New York, USA
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