1
|
Bhuptani PH, Block A, Jiménez Muñoz P, Bello MS, Ramsey S, Ranney M, Carey K, Rich J, Langdon K. Enhancing distress tolerance to uplift motivation in recovery: Results from an open development trial. Digit Health 2023; 9:20552076231158575. [PMID: 36845079 PMCID: PMC9950608 DOI: 10.1177/20552076231158575] [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] [Received: 06/03/2022] [Accepted: 02/02/2023] [Indexed: 02/25/2023] Open
Abstract
Objective This open pilot study examines the feasibility, acceptability, and qualitative outcomes of an interactive web- and text message-delivered personalized feedback intervention aimed at cultivating motivation and tolerance of distress for adults initiating outpatient buprenorphine treatment. Methods Patients (n = 10) initiating buprenorphine within the past 8 weeks first completed a web-based intervention focused on enhancing motivation and providing psychoeducation on distress tolerance skills. Participants then received 8 weeks of daily personalized text messages that provided reminders of salient motivational factors and recommended distress tolerance-oriented coping skills. Participants completed self-report measures to assess intervention satisfaction, perceived usability, and preliminary efficacy. Additional perspectives were captured via qualitative exit interviews. Results In total, 100% of retained participants (n = 9) engaged with the text messages throughout the entire 8-week period. Mean scores of 27 (SD = 5.05) on the Client Satisfaction Questionnaire at the end of 8-week period indicated a high degree of satisfaction with the text-based intervention. The average rating on the System Usability Scale was 65.3 at the end of the 8-week program, suggesting that the intervention was relatively easy to use. Participants also endorsed positive experiences with the intervention during qualitative interviews. Clinical improvements were observed across the intervention period. Conclusions Preliminary findings from this pilot suggest that the content and delivery method of this combined web- and text message-based personalized feedback intervention is perceived by patients as feasible and acceptable. Leveraging digital health platforms to augment buprenorphine has potential for high scalability and impact to reduce opioid use, increase adherence/retention to treatment, and prevent future incidence of overdose. Future work will evaluate the efficacy of the intervention in a randomized clinical trial design.
Collapse
Affiliation(s)
- Prachi H. Bhuptani
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA
| | - Amanda Block
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Paola Jiménez Muñoz
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA
| | - Mariel S. Bello
- Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA
| | - Susan Ramsey
- Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA,Department of Medicine, Alpert Medical School of Brown University,
Providence, RI, USA,Division of General Internal Medicine, Department of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Megan Ranney
- Brown-Lifespan Center for Digital Health, Providence, RI, USA,School of Public Health, Brown University, Providence, RI, USA
| | - Kate Carey
- Department of Behavioral and Social Sciences, Brown University School of Public
Health, Providence, RI, USA,Center for Alcohol and Addiction Studies, Brown University School of Public
Health, Providence, RI, USA
| | - Josiah Rich
- Department of Medicine and Epidemiology, Brown University,
Providence, RI, USA,Center for Prisoner Health and Human Rights, The Miriam Hospital,
Providence, RI, USA
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA,Department of Psychiatry and Human Behavior, Alpert Medical School
of Brown University, Providence, RI, USA,Brown-Lifespan Center for Digital Health, Providence, RI, USA,Kirsten Langdon, Department of Psychiatry,
Rhode Island Hospital, 146 West River, Street, Suite 11A, Providence, RI 02904,
USA.
| |
Collapse
|
2
|
Jagroep W, Cramm JM, Denktaș S, Nieboer AP. Behaviour change interventions to promote health and well-being among older migrants: A systematic review. PLoS One 2022; 17:e0269778. [PMID: 35709205 PMCID: PMC9202883 DOI: 10.1371/journal.pone.0269778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Whether behaviour change interventions are effective for the maintenance of older migrants’ health and well-being is uncertain. A systematic review was conducted to assess evidence for the capacity of behaviour change techniques (BCTs) to promote the health and well-being of older migrants. Methods Electronic databases (Cochrane CENTRAL, Embase, Ovid MEDLINE and Web of Science) were searched systematically to identify relevant randomised controlled trials, pre–post studies and quasi-experimental studies published before March 2021. Additional articles were identified through citation tracking. Studies examining BCTs used to promote the health and/or well-being of older migrants were eligible. Two independent reviewers used the Behaviour Change Technique Taxonomy version 1 to extract data on BCTs. Data on intervention functions (IFs) and cultural adaption strategies were also extracted. Intervention contents (BCTs, IFs, culture adaption strategies) were compared across effective and ineffective interventions according to health and well-being outcome clusters (anthropometrics, health behaviour, physical functioning, mental health and cognitive functioning, social functioning and generic health and well-being). Results Forty-three studies (23 randomised controlled trials, 13 pre–post studies and 7 quasi-experimental studies) reporting on 39 interventions met the inclusion criteria. Thirteen BCTs were identified as promising for at least one outcome cluster: goal-setting (behaviour), problem-solving, behavioural contract, self-monitoring of behaviour, social support (unspecified), instruction on how to perform the behaviour, information about health consequences, information about social and environmental consequences, demonstration of the behaviour, social comparison, behavioural practice/rehearsal, generalisation of a target behaviour and addition of objects to the environment. Three BCTs (instruction on how to perform the behaviour, demonstration of the behaviour, and social comparison) and two IFs (modelling and training) were identified as promising for all outcome clusters. Conclusions Thirteen distinct BCTs are promising for use in future interventions to optimise health and well-being among older migrants. Future research should focus on the effectiveness of these BCTs (combinations) in various contexts and among different subgroups of older migrants, as well as the mechanisms through which they act. Given the scarcity of interventions in which cultural adaption has been taken into account, future behavioural change interventions should consider cultural appropriateness for various older migrant (sub)groups. Trial registration PROSPERO CRD42018112859.
Collapse
Affiliation(s)
- Warsha Jagroep
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- * E-mail:
| | - Jane M. Cramm
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Semiha Denktaș
- Department of Psychology, Education and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anna P. Nieboer
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Teggart K, Ganann R, Sihota D, Moore C, Keller H, Senson C, Phillips SM, Neil-Sztramko SE. Group-based nutrition interventions to promote healthy eating and mobility in community-dwelling older adults: a systematic review. Public Health Nutr 2022; 25:1-32. [PMID: 35570675 PMCID: PMC9991860 DOI: 10.1017/s136898002200115x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 02/28/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To identify the efficacy of group-based nutrition interventions to increase healthy eating, reduce nutrition risk, improve nutritional status and improve physical mobility among community-dwelling older adults. DESIGN Systematic review. Electronic databases MEDLINE, CINAHL, EMBASE, PsycINFO and Sociological Abstracts were searched on July 15, 2020 for studies published in English since January 2010. Study selection, critical appraisal (using the Joanna Briggs Institute's tools) and data extraction were performed in duplicate by two independent reviewers. SETTING Nutrition interventions delivered to groups in community-based settings were eligible. Studies delivered in acute or long-term care settings were excluded. PARTICIPANTS Community-dwelling older adults aged 55+ years. Studies targeting specific disease populations or promoting weight loss were excluded. RESULTS Thirty-one experimental and quasi-experimental studies with generally unclear to high risk of bias were included. Interventions included nutrition education with behaviour change techniques (BCT) (e.g. goal setting, interactive cooking demonstrations) (n 21), didactic nutrition education (n 4), interactive nutrition education (n 2), food access (n 2) and nutrition education with BCT and food access (n 2). Group-based nutrition education with BCT demonstrated the most promise in improving food and fluid intake, nutritional status and healthy eating knowledge compared with baseline or control. The impact on mobility outcomes was unclear. CONCLUSIONS Group-based nutrition education with BCT demonstrated the most promise for improving healthy eating among community-dwelling older adults. Our findings should be interpreted with caution related to generally low certainty, unclear to high risk of bias and high heterogeneity across interventions and outcomes. Higher quality research in group-based nutrition education for older adults is needed.
Collapse
Affiliation(s)
- Kylie Teggart
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Rebecca Ganann
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Davneet Sihota
- Global Health Graduate Program, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Caroline Moore
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, Waterloo, ON, Canada
- Department of Kinesiology and Health Sciences, Faculty of Health, University of Waterloo, Waterloo, ON, Canada
| | - Christine Senson
- Healthy and Safe Communities Department, City of Hamilton Public Health Services, Hamilton, ON, Canada
| | - Stuart M Phillips
- Department of Kinesiology, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Sarah E Neil-Sztramko
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ONL8S 4L8, Canada
| |
Collapse
|
4
|
Gültzow T, Zijlstra DN, Bolman C, de Vries H, Dirksen CD, Muris JWM, Smit ES, Hoving C. Decision aids to facilitate decision making around behavior change in the field of health promotion: A scoping review. PATIENT EDUCATION AND COUNSELING 2021; 104:1266-1285. [PMID: 33531158 DOI: 10.1016/j.pec.2021.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To broadly synthesize literature regarding decision aids (DAs) supporting decision making about diet, physical activity, sleeping and substance use a scoping review was performed. METHODS Multiple sources were used: (1) Scientific literature searches, (2) excluded references from a Cochrane review regarding DAs for treatments and screenings, and (3) results from additional searches. Interventions had to (1) support informed decision making and (2) provide information and help to choose between at least two options. Two researchers screened titles and abstracts. Relevant information was extracted descriptively. RESULTS Thirty-five scientific articles and four DAs (grey literature) were included. Results were heterogeneous. Twenty-nine (94%) studies described substance use DAs. All DAs offered information and value and/or preference clarification. Many other elements were included (e.g., goal-setting). DA's effects were mixed. Few studies used standardized measures, e.g., decisional conflict (n = 4, 13%). Some positive behavioral effects were reported: e.g., smoking abstinence (n = 1). CONCLUSIONS This research shows only some positive behavioral effects of DAs. However, studies reported heterogeneous results/outcomes, impeding knowledge synthesis. Areas of improvement were identified, e.g., establishing which intervention elements are effective regarding health behavior decision making. PRACTICE IMPLICATIONS DAs can potentially be beneficial in supporting people to change health behaviors - especially regarding smoking.
Collapse
Affiliation(s)
- Thomas Gültzow
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands.
| | - Daniëlle N Zijlstra
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Catherine Bolman
- Faculty of Psychology, Open University of the Netherlands, the Netherlands
| | - Hein de Vries
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| | - Carmen D Dirksen
- CAPHRI Care and Public Health Research Institute, Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Jean W M Muris
- CAPHRI Care and Public Health Research Institute, Department of General Practice, Maastricht University, Maastricht, the Netherlands
| | - Eline S Smit
- University of Amsterdam, Amsterdam School of Communication Research/ASCoR, Department of Communication Science, Amsterdam, the Netherlands
| | - Ciska Hoving
- CAPHRI Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
5
|
Javadivala Z, Allahverdipour H, Asghari Jafarabadi M, Emami A. An Interventional strategy of physical activity promotion for reduction of menopause symptoms. Health Promot Perspect 2020; 10:383-392. [PMID: 33312934 PMCID: PMC7722991 DOI: 10.34172/hpp.2020.57] [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] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/10/2020] [Indexed: 01/17/2023] Open
Abstract
Background: Physical activity (PA) programs are inexpensive, non-pharmaceutical and universally accessible options with demonstrated efficacy in reducing menopausal symptoms. The purpose of this study was to determine the effectiveness of a behavioral strategy for initiating and sustaining PA with the hope to reduce or eliminate menopausal symptoms. Methods : Menopausal and perimenopausal women (n=190) were randomly assigned to intervention (n=95) and non-intervention (n=95) groups using a random-numbers table. The intervention group consisted of 18 neighborhood network subgroups, each consisting of five to six women known to one another. They participated in a 12-week regular PA program, augmented by eight interactive group education and discussion sessions. The Menopause Rating Scale (MRS) self-report instrument was used to determine perceived severity of menopausal symptoms. Results: The intervention group showed a significant reduction in the frequency and severity of menopausal symptoms (P < 0.001). Those whose symptoms rated severe/very severe for hot flushes were reduced from 30.1% to 11.8%. Also, participants whose sleep problems and joint discomfort rated severe/very severe declined from 28% to 6.5% and joint discomfort rated severe or very severe was reduced from 52.7% to 4.4%, respectively. Conversely in the nonintervention group, hot flushes, sleep problems and joint problems got significantly worse(P < 0.05). Conclusion: Implementing educational program that increases awareness of PA benefits in combination with existing neighborhood networks that facilitate communication and cooperation may increase PA levels and decrease menopausal symptoms. Such networks offer alow-cost means of improving quality of life (QOL) for perimenopausal and menopausal women.
Collapse
Affiliation(s)
- Zeinab Javadivala
- Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hamid Allahverdipour
- Research Center for Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.,Department of Health Education & Promotion, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Azita Emami
- Dean, University of Washington School of Nursing, Seattle, Washington, USA
| |
Collapse
|
6
|
Sawyer A, Lewthwaite H, Gucciardi DF, Hill K, Jenkins S, Cavalheri V. Behaviour change techniques to optimise participation in physical activity or exercise in adolescents and young adults with chronic cardiorespiratory conditions: a systematic review. Intern Med J 2019; 49:1209-1220. [DOI: 10.1111/imj.14141] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Affiliation(s)
- Abbey Sawyer
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Physiotherapy DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Hayley Lewthwaite
- Alliance for Research in Exercise, Nutrition and Activity, School of Health ScienceUniversity of South Australia Adelaide South Australia Australia
| | - Daniel F. Gucciardi
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
| | - Kylie Hill
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Sue Jenkins
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Physiotherapy DepartmentSir Charles Gairdner Hospital Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| | - Vinicius Cavalheri
- School of Physiotherapy and Exercise Science, Faculty of Health ScienceCurtin University Perth Western Australia Australia
- Institute for Respiratory Health Perth Western Australia Australia
| |
Collapse
|
7
|
Abstract
BACKGROUND Limited data exist on the benefits of, barriers to, and potential strategies to break up time spent sitting in cancer survivors. Such data will be meaningful given the consequences of prolonged sitting. OBJECTIVES The aim of this study was to conduct a mixed-method research study consisting of semistructured telephone interviews to identify recurrent themes associated with prolonged sitting in cancer survivors. METHODS African American breast cancer survivors (N = 31) were recruited from a local tumor registry. Telephone interviews were conducted and group consensus processes were used to identify recurrent themes. The a priori categories were benefits, barriers, and potential strategies to breaking up prolonged periods of sitting. RESULTS Recurrent themes contributing most to prolonged sitting were leisure time interest (45%: eg, watching television and reading) and health challenges (27%: eg, pain and fatigue). Most (66%) women perceived improved health as benefits to breaking up time spent sitting. Nonetheless, many (41%) survivors reported health (eg, pain and fatigue) as the biggest challenge to interrupt time spent sitting. Engaging in light intensity activities (eg, staying active, keep moving) was the most commonly reported strategy for breaking up prolonged sitting. CONCLUSIONS African American breast cancer survivors identified the benefits and barriers to breaking up time spent sitting as well as potential strategies to interrupt time-spent sitting. IMPLICATIONS FOR PRACTICE Clinicians are integral in promoting breaks from prolonged sitting throughout the initial phases of the cancer continuum. Successful studies will begin with early intervention in the clinical setting, with increasing intensity as survivors transition to the recovery phase.
Collapse
|
8
|
Motivational interviewing and the decisional balance procedure for cessation induction in smokers not intending to quit. Addict Behav 2017; 64:171-178. [PMID: 27619008 DOI: 10.1016/j.addbeh.2016.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/11/2016] [Accepted: 08/30/2016] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE). Assessments were obtained at baseline, immediately post-treatment, 1week, and 4weeks. RESULTS Compared to HE, the MIDB sessions scored significantly higher on the Motivational Interviewing Treatment Integrity (MITI) scale (all standardized differences d>1, p<0.001). Unexpectedly, self-report Pros of smoking scores increased for MIDB but decreased for HE (MIDB vs HE standardized difference d=0.5; 95%CI 0.1 to 1.0, p=0.021). Both groups showed significant reductions in smoking rates and increases in motivation to quit, quit attempts, and self-reported abstinence, with no significant group differences. Changes in the Pros of smoking were correlated with MITI scores, but not with cessation outcomes. In contrast, increases in the Cons of smoking and therapeutic alliance were predictive of better cessation outcomes. CONCLUSIONS The decisional balance exercise as formulated by earlier versions of MI may be counter-productive and cautions around its use are warranted. Instead, improved cessation outcomes appear associated with increasing perceived benefits of quitting and positive therapeutic alliance.
Collapse
|
9
|
Nathan AG, Marshall IM, Cooper JM, Huang ES. Use of Decision Aids with Minority Patients: a Systematic Review. J Gen Intern Med 2016; 31:663-76. [PMID: 26988981 PMCID: PMC4870418 DOI: 10.1007/s11606-016-3609-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities. METHODS We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05. RESULTS We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs. DISCUSSION DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.
Collapse
Affiliation(s)
- Aviva G Nathan
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA.
| | - Imani M Marshall
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Jennifer M Cooper
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| | - Elbert S Huang
- Section of General Internal Medicine, , University of Chicago, 5841 S. Maryland Avenue, MC 2007, Chicago, IL, 60637, USA
| |
Collapse
|
10
|
Motivational interviewing and decisional balance: contrasting responses to client ambivalence. Behav Cogn Psychother 2013; 43:129-41. [PMID: 24229732 DOI: 10.1017/s1352465813000878] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND A recommendation in original descriptions of motivational interviewing (MI) was to "explore ambivalence". Contrasting procedures for doing so have been clarified through the evolution of MI. AIMS This article describes two conceptually distinct methods for responding to ambivalence: decisional balance (DB) and MI's evocation of change talk, and reviews empirical evidence to recommend when each procedure is appropriate (and inappropriate) in clinical practice. METHOD The authors summarize findings of clinical outcome research to examine how these two interventions impact the resolution of client ambivalence. RESULTS With ambivalent people, a DB intervention tends to decrease commitment to change, whereas evocation (a key element of MI) promotes change. When a person has already made the decision to change, evocation is unnecessary and may deter change, whereas DB may further strengthen commitment. CONCLUSIONS DB is an appropriate procedure when the clinician wishes to maintain neutrality and not favor the resolution of ambivalence in any particular direction. Evocation is appropriate when the clinician intends to help clients resolve ambivalence in the direction of change.
Collapse
|