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Forgács‐Kristóf K, Ádám S, Vargay A, Major J. Novel motivational interviewing-based intervention improves engagement in physical activity and readiness to change among adolescents with chronic pain. Health Expect 2024; 27:e14031. [PMID: 38556853 PMCID: PMC10982597 DOI: 10.1111/hex.14031] [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: 10/20/2023] [Revised: 01/22/2024] [Accepted: 03/17/2024] [Indexed: 04/02/2024] Open
Abstract
INTRODUCTION Engaging adolescents with chronic pain in physical activities is challenging. Motivational interviewing (MI) combined with activity promotion may encourage teens to make behavioural changes. This research aimed to assess the feasibility and acceptability of our MI-based physical activity promotion programme, the M3 training. METHODS In our exploratory study with 35 adolescent-parent dyads, we evaluated the feasibility by enrolment, drop-out and retention rates. Acceptability of the M3 training was examined by adherence rates and participation experiences through open-ended questions. We also assessed changes in pain self-efficacy and readiness to change after the M3 training intervention. RESULTS The M3 training was feasible with an adequate enrolment (77.8%) and retention (85.7%) rate. Both teens and parents found the M3 training acceptable and considered exercise and physical activity the most helpful elements of the programme (36% and 37%, respectively). While self-efficacy remained unchanged, we identified a significant increase in the readiness to change for adolescents and parents. CONCLUSION M3 training improved physical activity engagement while prioritising adolescents' autonomy. Furthermore, it appears to be a clinically relevant approach and could result in a positive shift in readiness to change within a shorter timeframe. PATIENT OR PUBLIC CONTRIBUTION The preliminary version of the M3 training was reviewed and commented upon by the public (adolescents and adults). Adolescents who participated in this study were designing their own movement programme, considering their lived experiences. Participants' feedback was used to create the online version of the M3 training (which will be published elsewhere).
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Affiliation(s)
| | - Szilvia Ádám
- Health Services Management Training Centre, Faculty of Health and Public ServicesSemmelweis UniversityBudapestHungary
| | - Adrienn Vargay
- Institute of PsychologyELTE Eötvös Loránd UniversityBudapestHungary
- HRC Bethesda Children's HospitalPaediatric Pain CentreBudapestHungary
| | - János Major
- HRC Bethesda Children's HospitalPaediatric Pain CentreBudapestHungary
- Institute of Behavioural SciencesSemmelweis UniversityBudapestHungary
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2
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Orchowski LM, Zinzow H, Thompson M, Wood S. Open pilot trial of an interactive digital application for campus sexual violence prevention. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1977-2000. [PMID: 36623242 PMCID: PMC10272022 DOI: 10.1002/jcop.22985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 11/16/2022] [Accepted: 12/15/2022] [Indexed: 06/14/2023]
Abstract
Digital applications, or "serious games" for health address learning goals in a cognitively active, interactive manner, with the potential for widespread dissemination. This study used a mixed methods approach to develop and conduct a formative evaluation of a digital application for sexual assault prevention. Make a change is a digital application that uses the principles of games for health to foster learning, engagement, and skill-building around risk and protective factors for sexual victimization, sexual aggression, and bystander intervention. The digital application includes four narrative chapters, six embedded activities, as well as a user-derived change plan in which individuals establish goals for behavior change following program completion. This multisite study at a 2- and a 4-year college utilized student interviews (n = 14), stakeholder interviews (n = 10), and focus groups with students (n = 40) to inform intervention development. A total of 41 college students then participated in an open trial and completed self-report surveys (pre, post, and 1-month follow-up) to evaluate the feasibility, acceptability, utility, and preliminary outcomes. Most of the sample reported enjoyment, usefulness, and perceived competence after completing the application. Data evidenced a trend to reduce the frequency of heavy drinking, and perceptions of social norms evidenced change over time. Findings support the feasibility and effectiveness of this novel format for the delivery of sexual assault prevention programming.
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Affiliation(s)
- Lindsay M Orchowski
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Rhode Island, Providence, USA
| | - Heidi Zinzow
- Department of Psychology, Clemson University, South Carolina, Clemson, USA
| | - Martie Thompson
- Department of Public Health and Exercise Science, Appalachian State University, North Carolina, Boone, USA
| | - Sharon Wood
- Happy People Games, Newtown, Connecticut, USA
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3
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Kozhumam AS, Lovvorn C, O’Leary P, Minja L, Boshe J, Nickenig Vissoci JR, Mmbaga BT, Staton CA. Utility of Family Reports in Predicting Emergency Department Patient Alcohol Use in Tanzania. J Stud Alcohol Drugs 2022; 83:760-767. [PMID: 36136447 PMCID: PMC9523754 DOI: 10.15288/jsad.21-00141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 02/15/2022] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Myriad reasons, including stigma, may prevent patients from self-reporting harmful use of alcohol in Tanzania. Family members may be more forthright but might not know the extent of the patient's alcohol use or suffer alcohol-related stigma as well. Our study aims to compare the reporting of patient alcohol use by emergency department patients themselves and their family members in Tanzania in order to describe the potential use of family reports as a proxy for patient self-reports. METHOD We conducted a secondary descriptive analysis of a prospective cohort of adult patients seeking treatment for injury and their family members. We evaluated alcohol use behavior, alcohol-related consequences, and alcohol-related stigma reported by 231 patients and 231 family members (both majority male, ages 25-45 years), measured by the Alcohol Use Disorders Identification Test (AUDIT), Perceived Alcohol Stigma (PAS) scale, and the Drinker Inventory of Consequences (DrInC). Alcohol use behavior concordance/discordance between patients and families was established, and alcohol use and perceived stigma were analyzed. RESULTS More than 72% of patient-family pairs showed alcohol use (AUDIT) concordance. Receiver operating characteristic curve and regression analysis suggests family reports to be clinically relevant, significant, and potentially accurate markers of patient alcohol use (sensitivity: 95.10%, specificity: 69.77%). Findings support the existence of stigma toward alcohol in this context, with similar stigma levels of patients and family members. CONCLUSIONS Family-reported patient alcohol use may be an accurate proxy for patient self-reporting. Further research is needed into stigma toward alcohol that is culturally appropriate and adopted.
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Affiliation(s)
- Arthi S. Kozhumam
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Carter Lovvorn
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Paige O’Leary
- Duke Global Health Institute, Duke University, Durham, North Carolina
| | - Linda Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Judith Boshe
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - João Ricardo Nickenig Vissoci
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
| | - Blandina T. Mmbaga
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania
- Kilimanjaro Christian Medical Center, Moshi, Tanzania
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Catherine A. Staton
- Duke Global Health Institute, Duke University, Durham, North Carolina
- Duke Department of Emergency Medicine, Duke University Medical Center, Durham, North Carolina
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4
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Meredith LR, Grodin EN, Karno MP, Montoya AK, MacKillop J, Lim AC, Ray LA. Preliminary study of alcohol problem severity and response to brief intervention. Addict Sci Clin Pract 2021; 16:54. [PMID: 34429151 PMCID: PMC8386030 DOI: 10.1186/s13722-021-00262-6] [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: 04/30/2021] [Accepted: 08/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Findings have been mixed as to whether brief intervention (BI) is appropriate and effective for individuals with more severe alcohol use problems. Motivation to change drinking has been supported as a mechanism of behavior change for BI. This exploratory study examined aspects of motivation as mechanisms of clinical response to BI and alcohol problem severity as a moderator of treatment effects. Methods Non-treatment-seeking heavy drinkers (average age = 35 years; 57% male) were randomized to receive BI (n = 27) or attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and post-intervention: importance, confidence, and readiness. Moderated mediation analyses were implemented with treatment condition as the focal predictor, changes in motivation as mediator, 1-month follow-up drinks per day as the outcome, and an alcohol severity factor as second-stage moderator. Results Analysis of importance displayed a significant effect of intervention condition on importance (p < 0.003) and yielded a significant index of moderated mediation (CI − 0.79, − 0.02), indicating that the conditional indirect effect of treatment condition on drinking through importance was stronger for those with higher alcohol severity. For all motivation indices, alcohol severity moderated the effect of post-intervention motivation levels on drinking (p’s < 0.05). The direct effect of treatment condition on drinking was not significant in any model. Conclusions Findings highlight the relevance of considering one’s degree of alcohol problem severity in BI and alcohol screening efforts among non-treatment seeking heavy drinkers. These nuanced effects elucidate both potential mechanisms and moderators of BI response. Trial registration Clinicaltrials.gov: NCT04710095. Registered January 14, 2021—retrospectively registered, https://clinicaltrials.gov/ct2/show/study/NCT04710095.
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Affiliation(s)
- Lindsay R Meredith
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Erica N Grodin
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Mitchell P Karno
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amanda K Montoya
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - James MacKillop
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Aaron C Lim
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA
| | - Lara A Ray
- Department of Psychology, University of California Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095-1563, USA. .,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA.
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Dobber J, Snaterse M, Latour C, Peters R, Ter Riet G, Scholte Op Reimer W, de Haan L, van Meijel B. Active Ingredients and Mechanisms of Change in Motivational Interviewing for Smoking Cessation in Patients With Coronary Artery Disease: A Mixed Methods Study. Front Psychol 2021; 12:599203. [PMID: 34239470 PMCID: PMC8258345 DOI: 10.3389/fpsyg.2021.599203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 05/18/2021] [Indexed: 11/16/2022] Open
Abstract
Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event. Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation. Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.” Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.
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Affiliation(s)
- Jos Dobber
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Marjolein Snaterse
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Corine Latour
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Ron Peters
- Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Gerben Ter Riet
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Wilma Scholte Op Reimer
- Faculty of Health, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam University Medical Centers, Department of Cardiology, University of Amsterdam, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Amsterdam University Medical Centers, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Berno van Meijel
- Inholland University of Applied Sciences, Amsterdam, Netherlands.,Amsterdam University Medical Centers, Department of Psychiatry, VU Medical Center, Public Health Research Institute (APH), Amsterdam, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
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6
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Lee CS, Magill M, Figuereo VJ, Jackson K, Colby SM. Examining client self-exploration in motivational interviewing: Preliminary psychometrics of an observational rating measure. J Subst Abuse Treat 2021; 129:108345. [PMID: 34080540 DOI: 10.1016/j.jsat.2021.108345] [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: 07/16/2020] [Revised: 01/08/2021] [Accepted: 02/15/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE We examine in-session self-exploration among Latinx heavy drinkers who received a motivational interview (MI) to reduce heavy drinking. The goals of this study are to report the validity and reliability of an adaptation of the Global Client Rating for Self-Exploration from the Motivational Interviewing Skill Code (MISC SE). METHOD The study measured the MISC SE as three subscales (Emotional, Cognitive, New Learning/Developing Discrepancy SE) to assess underlying processes that might allow for higher predictive validity in relation to behavioral change (drinking) outcomes. The study created a dichotomous variable, Personally Relevant Vulnerable Making (PR-VM), to distinguish the disclosure of particularly sensitive material related to drinking behavior. The study used the measure of Everyday Discrimination as a criterion variable for the PR-VM measure. The study collected observationally rated data for n = 158 participants. RESULTS Subscales showed moderate correlations with the MISC SE (r = 0.421 to 0.574, p < .001). The MISC SE was not associated with number of drinking days or percent heavy drinking days at 3-month follow-up. Cognitive and New Learning/Developing Discrepancy SE were associated with fewer drinking days (r = -0.247 to -0.266, p < .005), and Cognitive SE was associated with percent heavy drinking days (r = -0.169, p < .05), Subscale interrater reliability was comparable to the MISC SE (ICC = 0.72 to 0.86). The study observed higher mean scores on the Everyday Discrimination scale when session PR-VM was present than when not present (t (df = 118) = -3.02, p < .005). CONCLUSIONS The subscale adaptation of the SE measure may provide a sensitive approach to understanding how self-exploration relates to behavior change in the context of MI.
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Affiliation(s)
- Christina S Lee
- Boston University School of Social Work, 264 Bay State Road, Boston, MA 02215, United States of America.
| | - Molly Magill
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
| | - Victor J Figuereo
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, United States of America.
| | - Kristina Jackson
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
| | - Suzanne M Colby
- Department of Psychiatry & Human Behavior, Center for Alcohol and Addiction Studies, Alpert Medical School of Brown University, Providence, RI 02903, United States of America.
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Gaume J, Grazioli VS, Paroz S, Fortini C, Bertholet N, Daeppen JB. Developing a brief motivational intervention for young adults admitted with alcohol intoxication in the emergency department - Results from an iterative qualitative design. PLoS One 2021; 16:e0246652. [PMID: 33556153 PMCID: PMC7869998 DOI: 10.1371/journal.pone.0246652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 01/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Unhealthy alcohol use among young adults is a major public health concern. Brief motivational interventions for young adults in the Emergency Department (ED) have shown promising but inconsistent results. METHODS Based on the literature on brief intervention and motivational interviewing efficacy and active ingredients, we developed a new motivational intervention model for young adults admitted in the ED with alcohol intoxication. Using an iterative qualitative design, we first pre-tested this model by conducting 4 experimental sessions and 8 related semi-structured interviews to evaluate clinicians' and patients' perceptions of the intervention's acceptability and feasibility. We then conducted a consultation meeting with 9 international experts using a nominal group technique. The intervention model was adjusted and finally re-tested by conducting 6 new experimental sessions and 12 related semi-structured interviews. At each round, data collected were analyzed and discussed, and the intervention model updated accordingly. RESULTS Based on the literature, we found 6 axes for developing a new model: High level of relational factors (e.g. empathy, alliance, avoidance of confrontation); Personalized feedback; Enhance discrepancy; Evoke change talk while softening sustain talk, strengthen ability and commitment to change; Completion of a change plan; Devote more time: longer sessions and follow-up options (face-to-face, telephone, or electronic boosters; referral to treatment). A qualitative analysis of the semi-structured interviews gave important insights regarding acceptability and feasibility of the model. Adjustments were made around which information to provide and how, as well as on how to deepen discussion about change with patients having low levels of self-exploration. The experts' consultation addressed numerous points, such as information and advice giving, and booster interventions. DISCUSSION This iterative, multi-component design resulted in the development of an intervention model embedded in recent research findings and theory advances, as well as feasible in a complex environment. The next step is a randomized controlled trial testing the efficacy of this model.
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Affiliation(s)
- Jacques Gaume
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Véronique S. Grazioli
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
- Department of Vulnerabilities and Social Medicine, University Center for General Medicine and Public Health, Lausanne, Switzerland
| | - Sophie Paroz
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Cristiana Fortini
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Nicolas Bertholet
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Bernard Daeppen
- Department of Psychiatry, Addiction Medicine, Lausanne University Hospital, Lausanne, Switzerland
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8
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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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Lee CS, Colby SM, Rohsenow DJ, Martin R, Rosales R, McCallum TT, Falcon L, Almeida J, Cortés DE. A randomized controlled trial of motivational interviewing tailored for heavy drinking latinxs. J Consult Clin Psychol 2019; 87:815-830. [PMID: 31403817 PMCID: PMC7137580 DOI: 10.1037/ccp0000428] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This randomized controlled trial (Clinicaltrials.gov NCT [01996280]) compared the efficacy of a brief motivational interview (MI) adapted to address social stressors and cultural influences (culturally adapted MI [CAMI]) to a standard MI for heavy-drinking Latinxs. CAMI was hypothesized to reduce heavy drinking days and frequency of alcohol-related consequences more than MI. Moderators of treatment effect were explored. METHOD Latinxs (N = 296; 63% male, M age = 41 years) who reported 2+ past month heavy drinking episodes received a single-session (MI/CAMI), with assessments at baseline and 3, 6, and 12 months. RESULTS Both conditions showed significant reductions in percent heavy drinking days and frequency of alcohol-related consequences through 12-month follow-up when compared with baseline; reductions were not significantly different by condition. Acculturation moderated treatment condition effect on alcohol-related problems at 3 months (d = .22, 95% CI [.02, .41]); less acculturated individuals experienced less frequent consequences of drinking after CAMI than MI (d = .34, 95% CI [-.60, -.08]). Discrimination moderated condition effect on frequency of alcohol-related consequences at 3 months (d = .17, 95% CI [-.33, -.01]); individuals with higher levels of baseline discrimination had less frequent consequences after CAMI than MI (d = .20, 95% CI [-.39, -.01]). CONCLUSIONS Participants in both groups improved with no significant differences between groups. Moderation effects suggest that cultural adaptation has particular benefit for more vulnerable individuals and support the theory of change in this adaptation model. MI is efficacious with Latinx heavy drinkers and should be used to mitigate health disparities related to alcohol misuse. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Christina S. Lee
- Department of Applied Psychology, Bouvé College of Health Sciences, Northeastern University, 360 Huntington Avenue, Boston, MA, 02115, USA
| | - Suzanne M. Colby
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main St., Providence, RI, 02912, USA
| | - Damaris J. Rohsenow
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main St., Providence, RI, 02912, USA
- Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA (when the work was done)
| | - Rosemarie Martin
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main St., Providence, RI, 02912, USA
| | - Robert Rosales
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, USA
| | - Tonya Tavares McCallum
- Center for Alcohol and Addiction Studies, Brown University, 121 South Main St., Providence, RI, 02912, USA
| | - Luis Falcon
- College of Fine Arts, Humanities, and Social Sciences, University of Massachusetts at Lowell, 820 Broadway Street, Lowell, MA
| | | | - Dharma E. Cortés
- Health Equity Research Lab, Cambridge Health Alliance/Harvard Medical School, 1035 Cambridge Street, Cambridge, MA 02141
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10
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Grodin EN, Lim AC, MacKillop J, Karno MP, Ray LA. An Examination of Motivation to Change and Neural Alcohol Cue Reactivity Following a Brief Intervention. Front Psychiatry 2019; 10:408. [PMID: 31244697 PMCID: PMC6580427 DOI: 10.3389/fpsyt.2019.00408] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background: Brief interventions represent a promising psychological intervention targeting individuals with heavy alcohol use. Motivation to change represents an individual's openness to engage in a behavior change strategy and is thought to be a crucial component of brief interventions. Neuroimaging techniques provide a translational tool to investigate the neurobiological mechanisms underlying potential mediators of treatment response, including motivation to change. Therefore, this study aimed to examine the effect of a brief intervention on motivation to change drinking behavior and neural alcohol taste cue reactivity. Methods: Non-treatment-seeking heavy drinkers were randomized to receive a brief drinking intervention (n = 22) or an attention-matched control (n = 24). Three indices of motivation to change were assessed at baseline and after the intervention or control session: importance, confidence, and readiness. Immediately following the intervention or control session, participants also underwent an functional magnetic resonance imaging (fMRI) during which they completed an alcohol taste cues paradigm. Results: There was a significant effect of the brief intervention on increasing ratings of importance of changing drinking behavior, but not on ratings of confidence or readiness to change. Ratings of importance after the intervention or control session were associated with neural alcohol taste cue reactivity, but notably, this effect was only significant for participants who received the intervention. Individuals in the intervention condition showed a positive association between ratings of importance and activation in the precuneus, posterior cingulate, and insula. Conclusions: The brief drinking intervention was successful at improving one dimension of motivation to change among non-treatment-seeking heavy drinkers. The brief intervention moderated the relationship between ratings of importance and brain activation in circuitry associated with interoceptive awareness and self-reflection. Together, findings represent an initial step toward understanding the neurobiological mechanisms through which a brief intervention may improve motivation to change.
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Affiliation(s)
- Erica N. Grodin
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - James MacKillop
- Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Mitchell P. Karno
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Psychiatry and Biobehavioral Sciences, UCLA School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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11
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McQueen JM, Ballinger C, Howe TE. Factors associated with alcohol reduction in harmful and hazardous drinkers following alcohol brief intervention in Scotland: a qualitative enquiry. BMC Health Serv Res 2017; 17:181. [PMID: 28270194 PMCID: PMC5341443 DOI: 10.1186/s12913-017-2093-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/11/2017] [Indexed: 11/11/2022] Open
Abstract
Background Alcohol Brief Intervention (ABI) uses a motivational counselling approach to support individuals to reduce excessive alcohol consumption. There is growing evidence on ABI’s use within various health care settings, although how they work and which components enhance success is largely unknown. This paper reports on the qualitative part of a mixed methods study. It explores enablers and barriers associated with alcohol reduction following an ABI. It focuses on alcohol’s place within participants’ lives and their personal perspectives on reducing consumption. There are a number of randomised controlled trials in this field though few ABI studies have addressed the experiences of hazardous/harmful drinkers. This study examines factors associated with alcohol reduction in harmful/hazardous drinkers following ABI. Methods This qualitative study was underpinned by a realist evaluation approach and involved semi-structured interviews with ten harmful or hazardous alcohol drinkers. Participants (n = 10) were from the intervention arm of a randomised controlled trial (n = 124). All had received ABI, a 20 min motivational counselling interview, six months previously, and had reduced their alcohol consumption. Interviews were recorded, transcribed verbatim and thematically analysed. Results Participants described their views on alcohol, its’ place in their lives, their personal perspectives on reducing their consumption and future aspirations. Conclusions The findings provide an insight into participants’ views on alcohol, ABI, and the barriers and enablers to change. Participants described a cost benefit analysis, with some conscious consideration of the advantages and disadvantages of reducing intake or abstaining from alcohol. Findings suggest that, whilst hospital admission can act as a catalyst, encouraging individuals to reflect on their alcohol consumption through ABI may consolidate this, turning this reflective moment into action. Sustainability may be enhanced by the presence of a ‘significant other’ who encourages and experiences benefit. In addition having a purpose or structure with activities linked to employment and/or social and leisure pursuits offers the potential to enhance and sustain reduced alcohol consumption. Trial registration Trial registration number TRN NCT00982306 September 22nd 2009.
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Affiliation(s)
- Jean M McQueen
- Institute of Health and Wellbeing, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK.
| | - Claire Ballinger
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Tracey E Howe
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
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12
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[Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use]. Prax Kinderpsychol Kinderpsychiatr 2016; 65:534-49. [PMID: 27595811 DOI: 10.13109/prkk.2016.65.7.534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Influence of Counsellor- and Intervention Variables on Motivation to Change Following a Brief Motivational Intervention to Reduce Risky Alcohol Use Brief interventions are recommended for prevention and early intervention of risky alcohol use. However, evidence of their effectiveness, in particular for children and adolescents, is heterogeneous. Analysis of counsellor and intervention variables may provide insights into mechanisms of action in brief interventions and thereby contribute to an enhanced effectiveness. We analyzed data of N = 141 children and adolescents who were treated for acute alcohol intoxication in the emergency department. Study participants received a brief motivational intervention to reduce risky alcohol use during hospitalization. We applied multiple regression analysis to examine counsellor variables (empathy, affirmation, competence, congruence) and intervention variables (readiness and confidence ruler, decisional balance, goal agreement) as predictors of motivation to change. Higher scores on the basic therapeutic skill "positive affirmation" (R2 = 7.1 %; p < .01), finishing the intervention with a written goal agreement (R2 = 2.9 %; p < .05) and younger age were associated with greater readiness to change (R2 = 10.2 %; p < .01). Therefore, a special focus should be put on the counsellor skill "positive affirmation" when training new counsellors. Results also indicate that younger patients respond stronger to a brief intervention in this context.
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13
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Linowski SA, DiFulvio GT, Fedorchak D, Puleo E. Effectiveness of an Electronic Booster Session Delivered to Mandated Students. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2016; 36:123-9. [PMID: 26857563 DOI: 10.1177/0272684x16628726] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
College student drinking continues to be a problem in the United States. Students who have violated campus alcohol policy are at particularly high risk for dangerous drinking. While Brief Alcohol Screening and Intervention for College Students (BASICS) has been found to be an effective strategy in reducing high-risk drinking and associated consequences, questions remain about ways to further reduce risk or sustain changes associated with a face-to face intervention. The purpose of this study was to assess the effectiveness of a computer-delivered personalized feedback (electronic booster) delivered to policy violators who completed a mandated BASICS program. At 3-month post-intervention, 346 participants (60.4% male and 39.6% female) were randomized to one of two conditions: assessment only (n = 171) or electronic booster feedback (n = 175). Follow-up assessments were given to all participants at 3, 6, and 12-month post-initial intervention. Both groups showed reductions in drinking after the in-person BASICS intervention, but no additional reductions were seen with the addition of an electronic booster session. Findings suggest that although brief motivational interventions delivered in person to mandated students have been shown to be effective with mandated students, there is no additional benefit from an electronic booster session delivered 3-month post-intervention for this population.
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Affiliation(s)
| | - Gloria T DiFulvio
- Department of Health Promotion and Policy, University of Massachusetts Amherst, MA, USA
| | - Diane Fedorchak
- Center for Health Promotion, University of Massachusetts Amherst, MA, USA
| | - Elaine Puleo
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, MA, USA
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14
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Donovan DM, Hatch-Maillette MA, Phares MM, McGarry E, Peavy KM, Taborsky J. Lessons learned for follow-up phone booster counseling calls with substance abusing emergency department patients. J Subst Abuse Treat 2015; 50:67-75. [PMID: 25534151 PMCID: PMC4305001 DOI: 10.1016/j.jsat.2014.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 10/15/2014] [Accepted: 10/27/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Post-visit "booster" sessions have been recommended to augment the impact of brief interventions delivered in the emergency department (ED). This paper, which focuses on implementation issues, presents descriptive information and interventionists' qualitative perspectives on providing brief interventions over the phone, challenges, "lessons learned", and recommendations for others attempting to implement adjunctive booster calls. METHOD Attempts were made to complete two 20-minute telephone "booster" calls within a week following a patient's ED discharge with 425 patients who screened positive for and had recent problematic substance use other than alcohol or nicotine. RESULTS Over half (56.2%) of participants completed the initial call; 66.9% of those who received the initial call also completed the second call. Median number of attempts to successfully contact participants for the first and second calls were 4 and 3, respectively. Each completed call lasted an average of about 22 minutes. Common challenges/barriers identified by booster callers included unstable housing, limited phone access, unavailability due to additional treatment, lack of compensation for booster calls, and booster calls coming from an area code different than the participants' locale and from someone other than ED staff. CONCLUSIONS Specific recommendations are presented with respect to implementing a successful centralized adjunctive booster call system. Future use of booster calls might be informed by research on contingency management (e.g., incentivizing call completions), smoking cessation quitlines, and phone-based continuing care for substance abuse patients. Future research needs to evaluate the incremental benefit of adjunctive booster calls on outcomes over and above that of brief motivational interventions delivered in the ED setting.
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Affiliation(s)
- Dennis M Donovan
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA.
| | - Mary A Hatch-Maillette
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA; Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, 98195, USA
| | - Melissa M Phares
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA
| | - Ernest McGarry
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA
| | - K Michelle Peavy
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA
| | - Julie Taborsky
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, 98105, USA
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15
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Lee CS, Longabaugh R, Baird J, Streszak V, Nirenberg T, Mello M. Participant report of therapist-delivered active ingredients in a telephone-delivered brief motivational intervention predicts taking steps towards change. ADDICTION RESEARCH & THEORY 2015; 23:421-428. [PMID: 26441490 PMCID: PMC4592139 DOI: 10.3109/16066359.2015.1025062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE Given the widespread potential for disseminating Motivational Interviewing (MI) through technology, the question of whether MI active ingredients are present when not delivered in person is critical to assure high treatment quality. The Participant Rating Form (PRF) was developed and used to evaluate therapist-delivered active ingredients in phone-delivered MI with hazardous drinking Emergency Department patients. METHOD A factor analysis of all PRFs completed after receiving one call (n=256) was conducted. Multiple regression analysis was used to examine whether PRF factors predicted a measure of motivation to change -- taking steps-at the second call (n=214). RESULTS The majority of participants were male (65%), with a mean age of 32 years and with an average alcohol ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test) score of 20.5 (SD = 7.1). Results of the factor analysis for the PRF revealed Relational (working collaboration) and Technical (MI behaviors) factors. After controlling for demographics, alcohol severity, and baseline readiness, the technical factor predicted self-report of increased taking steps towards change while the relational factor did not explain any additional variance. CONCLUSIONS Our study adds to the growing literature investigating patient perspectives of therapist skill as a source of information to better understand MI active ingredients. The PRF is a feasible instrument for measuring the patient's experience of phone-based MI. Results indicate that MI active ingredients of change (relational and technical components) were present in the telephone intervention as hypothesized. Clinical Trial Registration # 01326169.
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Affiliation(s)
- Christina S Lee
- Department of Applied Psychology, Northeastern University, Boston, MA, USA
| | - Richard Longabaugh
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
| | - Janette Baird
- Emergency Medicine, Injury Prevention Center, Brown University, Providence, RI, USA
| | - Val Streszak
- Emergency Medicine, Injury Prevention Center, Brown University, Providence, RI, USA
| | - Ted Nirenberg
- Emergency Medicine, Injury Prevention Center, Brown University, Providence, RI, USA
| | - Michael Mello
- Emergency Medicine, Injury Prevention Center, Brown University, Providence, RI, USA
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16
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Gaume J, McCambridge J, Bertholet N, Daeppen JB. Mechanisms of action of brief alcohol interventions remain largely unknown - a narrative review. Front Psychiatry 2014; 5:108. [PMID: 25206342 PMCID: PMC4143721 DOI: 10.3389/fpsyt.2014.00108] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 08/06/2014] [Indexed: 11/13/2022] Open
Abstract
A growing body of evidence has shown the efficacy of brief intervention (BI) for hazardous and harmful alcohol use in primary health care settings. Evidence for efficacy in other settings and effectiveness when implemented at larger scale are disappointing. Indeed, BI comprises varying content; exploring BI content and mechanisms of action may be a promising way to enhance efficacy and effectiveness. Medline and PsychInfo, as well as references of retrieved publications were searched for original research or review on active ingredients (components or mechanisms) of face-to-face BIs [and its subtypes, including brief advice and brief motivational interviewing (BMI)] for alcohol. Overall, BI active ingredients have been scarcely investigated, almost only within BMI, and mostly among patients in the emergency room, young adults, and US college students. This body of research has shown that personalized feedback may be an effective component; specific MI techniques showed mixed findings; decisional balance findings tended to suggest a potential detrimental effect; while change plan exercises, advice to reduce or stop drinking, presenting alternative change options, and moderation strategies are promising but need further study. Client change talk is a potential mediator of BMI effects; change in norm perceptions and enhanced discrepancy between current behavior and broader life goals and values have received preliminary support; readiness to change was only partially supported as a mediator; while enhanced awareness of drinking, perceived risks/benefits of alcohol use, alcohol treatment seeking, and self-efficacy were seldom studied and have as yet found no significant support as such. Research is obviously limited and has provided no clear and consistent evidence on the mechanisms of alcohol BI. How BI achieves the effects seen in randomized trials remains mostly unknown and should be investigated to inform the development of more effective interventions.
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Affiliation(s)
- Jacques Gaume
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jim McCambridge
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine , London , UK
| | - Nicolas Bertholet
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
| | - Jean-Bernard Daeppen
- Alcohol Treatment Center, Department of Community Health and Medicine, Lausanne University Hospital , Lausanne , Switzerland
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17
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Dewing S, Mathews C, Cloete A, Schaay N, Shah M, Simbayi L, Louw J. From research to practice: lay adherence counsellors' fidelity to an evidence-based intervention for promoting adherence to antiretroviral treatment in the Western cape, South Africa. AIDS Behav 2013; 17:2935-45. [PMID: 23666183 DOI: 10.1007/s10461-013-0509-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In the Western Cape, lay counsellors are tasked with supporting antiretroviral (ARV) adherence in public healthcare clinics. Thirty-nine counsellors in 21 Cape Town clinics were trained in Options for Health (Options), an evidence-based intervention based on motivational interviewing (MI). We evaluated counsellors' ability to deliver Options for addressing poor adherence following 5 days training. Audio-recordings of counselling sessions collected following training were transcribed and translated into English. Thirty-five transcripts of sessions conducted by 35 counsellors were analysed for fidelity to the Options protocol, and using the Motivational Interviewing Treatment and Integrity (MITI) code. Counsellors struggled with some of the strategies associated with MI, such as assessing readiness-to-change and facilitating change talk. Overall, counsellors failed to achieve proficiency in the approach of MI according to the MITI. Counsellors were able to negotiate realistic plans for addressing patients' barriers to adherence. Further efforts aimed at strengthening the ARV adherence counselling programme are needed.
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Affiliation(s)
- Sarah Dewing
- Health Systems Research Unit, Medical Research Council of South Africa, PO Box 19070, Tygerberg, 7505, South Africa,
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18
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Kulesza M, McVay MA, Larimer ME, Copeland AL. A randomized clinical trial comparing the efficacy of two active conditions of a brief intervention for heavy college drinkers. Addict Behav 2013; 38:2094-101. [PMID: 23410849 DOI: 10.1016/j.addbeh.2013.01.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
Abstract
Brief interventions for college heavy drinkers have shown promise in reducing drinking and alcohol-related negative consequences. However, intervention duration, content, method of delivery, and follow-up length vary across studies. It therefore remains unclear whether intervention length significantly influences the interventions' efficacy. The present study is a randomized clinical trial systematically evaluating the efficacy of two brief interventions aimed at reducing alcohol use and alcohol-related negative consequences among college student drinkers. Treatment mediators were also evaluated. Participants (N=278) were, on average, 20.1 years old (SD=2.4), mostly Caucasian (87%) and female (71%). They were randomly assigned to a 10-minute brief intervention, a 50-minute brief intervention, or an attention-control group. Both active interventions were provided by clinical graduate students trained in Brief Alcohol Screening and Intervention for College Students (BASICS). As hypothesized, participants in both active conditions significantly reduced their alcohol consumption, as compared to the control group participants F(2,264)=9.84, p=.00, η(2)=.07. There were no significant differences in alcohol-related negative consequences F(2,264)=3.08, p=.06, η(2)=.02. The hypothesized mediators, alcohol drinking norms and coping behavioral strategies, explained significant variance in intervention efficacy, but neither self-efficacy nor alcohol expectancies were significant mediators. Given the preliminary nature of our investigation, more research is warranted to determine parameters of the critical mechanisms of change within brief alcohol interventions with college student drinkers.
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Affiliation(s)
- Magdalena Kulesza
- Department of Psychology, Louisiana State University, Baton Rouge, LA 70803, United States.
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19
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Warren JA, Hof KR, McGriff D, Morris LNB. Five Experiential Learning Activities in Addictions Education. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2012. [DOI: 10.1080/15401383.2012.710172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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20
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Wilson GB, Heather N, Kaner EFS. New developments in brief interventions to treat problem drinking in nonspecialty health care settings. Curr Psychiatry Rep 2011; 13:422-9. [PMID: 21744155 PMCID: PMC3166704 DOI: 10.1007/s11920-011-0219-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The delivery of brief interventions (BIs) in health care settings to reduce problematic alcohol consumption is a key preventive strategy for public health. However, evidence of effectiveness beyond primary care is inconsistent. Patient populations and intervention components are heterogeneous. Also, evidence for successful implementation strategies is limited. In this article, recent literature is reviewed covering BI effectiveness for patient populations and subgroups, and design and implementation of BIs. Support is evident for short-term effectiveness in hospital settings, but long-term effects may be confounded by changes in control groups. Limited evidence suggests effectiveness with young patients not admitted as a consequence of alcohol, dependent patients, and binge drinkers. Influential BI components include high-quality change plans and provider characteristics. Health professionals endorse BI and feel confident in delivering it, but training and support initiatives continue to show no significant effects on uptake, prompting calls for systematic approaches to implementing BI in health care.
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Affiliation(s)
- Graeme B. Wilson
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
| | - Nick Heather
- Department of Psychology, School of Life Sciences, Northumbria University, Northumberland Building, Newcastle Upon Tyne, NE1 8ST UK
| | - Eileen F. S. Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne, NE2 4AX UK
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21
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Hallgren KA, Moyers TB. Does readiness to change predict in-session motivational language? Correspondence between two conceptualizations of client motivation. Addiction 2011; 106:1261-9. [PMID: 21375643 PMCID: PMC3107890 DOI: 10.1111/j.1360-0443.2011.03421.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS Client language reflecting motivation for changing substance use (i.e. change talk) has been shown to predict outcomes in motivational interviewing. While previous work has shown that change talk may be elicited by clinician behaviors, little is known about intrapersonal factors that may elicit change talk, including clients' baseline motivation for change. The present study tested whether in-session change talk differs between clients based on their readiness for change. DESIGN AND SETTING First-session audio recordings from Project MATCH, a large multi-site clinical trial of alcohol treatments. PARTICIPANTS Project MATCH out-patients (n = 69) and aftercare patients (n = 48) receiving motivational enhancement therapy (MET). MEASUREMENTS Client language from first-session MET was coded using the Sequential Code for Observing Process Exchanges. Readiness and stages of change were assessed using both categorical and dimensional variables derived from the University of Rhode Island Change Assessment and the Stages of Change Readiness and Treatment Eagerness Scale, administered prior to first treatment sessions. FINDINGS Stage of change scales followed some of the expected correspondence with change talk, although the associations were generally small in magnitude and inconsistent across measures and treatment arms. Higher overall readiness did not predict more overall change talk, contemplation had mixed associations with preparatory change talk, and preparation/action did not predict commitment language. CONCLUSIONS Motivational language used in initial sessions by people receiving counselling for excessive alcohol consumption does not appear to be associated with readiness to change as construed by the Transtheoretical Model.
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Affiliation(s)
- Kevin A Hallgren
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, NM, USA.
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22
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Magill M, Apodaca TR, Barnett NP, Monti PM. The route to change: within-session predictors of change plan completion in a motivational interview. J Subst Abuse Treat 2010; 38:299-305. [PMID: 20149571 DOI: 10.1016/j.jsat.2009.12.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 11/24/2009] [Accepted: 12/31/2009] [Indexed: 10/19/2022]
Abstract
This study is the first to examine within-session therapist and client language/process predictors of a client's decision to complete a written Change Plan in an alcohol-focused motivational interview (MI). Data were from an ongoing hospital-based clinical trial (N = 291). Trained raters coded audiorecorded MI sessions using the Motivational Interviewing Skill Code. Logistic regression analyses found that therapist MI-consistent behaviors (b = .023, p < .001) and client change talk (b = .063, p < .001) were positive predictors, and client counter change talk (b = -.093, p < .001) was a negative predictor of the decision to complete a Change Plan regarding alcohol use. Mean comparisons showed that compared to noncompletion, Change Plan completion did not result in significantly greater changes in client motivational readiness. Completion of a Change Plan is a proximal outcome in MI that is associated with client intention to change (change talk) and may predict follow-up alcohol outcomes. Analyses of such theory-driven proximal client mechanisms provide a more complete model of MI process and may inform MI providers of necessary treatment ingredients.
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Affiliation(s)
- Molly Magill
- Brown University, Center for Alcohol and Addiction Studies, Providence, RI 02912, USA.
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23
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Stein LAR, Minugh PA, Longabaugh R, Wirtz P, Baird J, Nirenberg TD, Woolard RF, Carty K, Lee C, Mello M, Becker B, Gogineni A. Readiness to change as a mediator of the effect of a brief motivational intervention on posttreatment alcohol-related consequences of injured emergency department hazardous drinkers. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2009; 23:185-95. [PMID: 19586135 DOI: 10.1037/a0015648] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Brief motivational interventions (BMIs) are usually effective for reducing alcohol use and consequences in primary care settings. We examined readiness to change drinking as a mediator of the effects of BMI on alcohol-related consequences. Participants were randomized into three conditions: (a) standard care plus assessment (SC), (b) SC plus BMI (BI), and (c) BI plus a booster session (BIB). At 12-month follow-up BIB patients had significantly reduced alcohol consequences more than had SC patients. Patients receiving BI or BIB maintained higher readiness scores 3 months after treatment than did patients receiving SC. However, readiness mediated treatment effects only for those highly motivated to change prior to the intervention but not for those with low pre-intervention motivation. BI and BIB for these patients decreased alcohol consequences in part because they enhanced and maintained readiness for those highly motivated prior to the intervention, but not for those with low motivation. Results are opposite of what would be expected from MI theory. An alternative explanation is offered as to why this finding occurred with this opportunistically recruited Emergency Department patient population.
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Affiliation(s)
- L A R Stein
- Department of Psychology, Social Sciences Research Center, University of Rhode Island Training School, Kingston, RI 02881, USA.
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