Fond, Guillaume; Ducasse, Déborah
The motivational interview aims to help patients to resolve their ambivalence regarding problematic behaviors and to guide them into change. It differs from other therapeutic approaches mainly through the attitude of the therapist. In motivational interviewing, the therapist defends the statu quo. By reactance, the patient defends the change and enhance her/his motivation. This article provides a summary of the other concepts of motivational interviewing and its applications in the psychiatric daily practice. PMID:26143220
Dilallo, John J.; Weiss, Gony
The use of motivational interviewing strategies in the practice of adolescent psychopharmacology is described. Motivational interviewing is an efficient and collaborative style of clinical interaction and this helps adolescent patients to integrate their psychiatric difficulties into a more resilient identity.
Miller, William R.; Rose, Gary S.
Responds to M. Stanton's comments on the current author's original article. One of the puzzles of motivational interviewing is why it works at all. How can it be that an individual interview or two yields change in a long-standing problem behavior even without any effort to alter social context? The time involved is such a tiny part of the…
Lev-Ran, Shaul; Nitzan, Uri
Harmful behaviors and low adherence to medical treatment significantly contribute to an increased rate of hospitalizations, mortality and morbidity. Leading health organizations worldwide are making great efforts to find and develop efficient strategies in order to recruit patients to adhere to medical treatment and adopt a healthier lifestyle. Motivational interviewing is an evidence-based approach that the physician can apply in numerous health care situations in order to increase patients' adherence to treatment. It is a patient-centered approach, based on principles of collaboration, autonomy and evocation. Research indicates that the patient's verbal commitment towards change is directly correlated to future behavioral change. Therefore, the approach includes learnable techniques which assist in allowing the patient to speak about the advantages of behavioral change and treatment. Thus, motivational interviewing helps patients adopt a healthier lifestyle while contributing to the professionalism of physicians and their sense of satisfaction from work. PMID:22026060
Westra, Henny A.; Arkowitz, Hal; Dozois, David J.A.
Seventy six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research. PMID:19665347
This paper briefly reviews the research literature on motivational interviewing (MI) and behaviour change in adolescents and then discusses the implications of adolescent cognitive and social-emotional developmental processes for the relational and technical components of MI. Research suggests that MI is efficacious in improving substance use in adolescents. Research has been slower to emerge in other behaviours, but available randomized controlled trials suggest that MI has great promise for improving mental and physical health outcomes in this developmental period. The relational and technical components of MI are highly relevant for the adolescent developmental period, and studies have shown that these components are related to outcomes in this population. There are several ways to include MI in clinical interventions for adolescents, ranging from MI in brief settings to using MI as a platform from which all other treatments are offered. Future research is necessary to test the effects of MI in adolescent group settings and the full integration of MI into other adolescent treatment approaches. PMID:22114919
Reich, Catherine M.; Howard Sharp, Katianne M.; Berman, Jeffrey S.
Despite attempts to engage students, undergraduate instructors are often challenged by low motivation among students to study outside of the classroom. The current study adapted motivational interviewing, which is often used with therapy clients ambivalent to change, to target college student motivation to study for exams. Findings indicated…
Villaume, William A.; Berger, Bruce A.; Barker, Bradford N.
Objectives This article describes a written assignment for a first-year professional communication course to facilitate the understanding and mastery of motivational interviewing in dealing with patient ambivalence and resistance. The goal was to immerse students in how motivational interviewing differs from traditional biomedical counseling with regard to phrasing individual responses to the patient and managing the flow of interaction. Methods Students were required to write a script for a working prototype of the Auburn University Virtual Patient. The script had to specify the text for the virtual patient's comments, 2-5 possible responses for the student pharmacist to choose from, and multiple interactional paths representing motivational interviewing, biomedical counseling, and a mix of the 2. Results Student feedback and test results are reported. Qualitative analysis of written student feedback indicated that (1) the project took too much time because of the complexities of the computer procedures resulting from the Virtual Patient being a prototype, and (2) the computer procedures deflected attention from the critical thinking involved in writing the script. Quantitative item analysis of final examination results indicated that students scored an average one full-letter grade better on the questions about motivational interviewing than on the questions covering other topics. Conclusion The scriptwriting assignment is a challenging exercise in assimilating the verbal skills necessary for using motivational interviewing in patient counseling. Many students exhibited greater interest in motivational interviewing, greater knowledge of why motivational interviewing is successful, greater facility with wording responses, and greater confidence in their ability to use motivational interviewing in the future. Because almost all students had negative reactions to the difficulty and time involved in making their scripts actually work with the virtual patient
Sheldon, Lisa A.
Motivational interviewing, which began as a counseling technique in addiction recovery, is a client-centered tool for making changes, increasing helpful behaviors and decreasing unhelpful behaviors. It relies on an individual's intrinsic motivation and interest in change, using a non-confrontational approach to frame goals in a practical,…
Hawes, Starlyn M.; Duval, Elizabeth R.; Spresser, Carrie D.; Martínez, David A.; Lynam, Ian; Barnes, Amy; Hinton-Dampf, Amber M.; Murphy, Meghan E.; Marken, Patricia A.; Catley, Delwyn
Objective To create, implement, and evaluate a pharmacy course on motivational interviewing. Design A 3-hour elective course was created to train doctor of pharmacy (PharmD) students in brief patient-centered motivational interviewing counseling strategies that have proven effective with the types of health issues most commonly addressed in pharmacy settings. Students were assisted in developing their skills through required readings, interactive lectures, in-class demonstrations and practice sessions, out of class skills practice, one-on-one supervision provided by doctoral level clinical health psychology students, and written reflections on each class session. Assessment Students demonstrated significant improvement in motivational interviewing skills and a high level of motivation for and confidence in using these skills in their future practice. Students overall assessment of the course and supervision process was highly positive. Conclusion This patient-centered counseling skills course was feasible and produced improvements in PharmD students' counseling skills and increased their motivation and confidence to use motivational interviewing skills in their future communications with patients. PMID:20585431
Miller, William R.; Rose, Gary S.
The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward "looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant…
Dickinson, Daniel M.; Edmundson, Eldon; Tomlin, Kathyleen
Addiction treatment agencies face challenges in adopting and sustaining Motivational Interviewing (MI) use. Addiction Educators can assist agencies in changing practices by preparing new practitioners to have some beginning skills in adoption and sustaining strategies. Investigators assessed three types of agency training and six administrative…
Miller, William R.; Hendrickson, Stacey M. L.; Venner, Kamilla; Bisono, Ani; Daugherty, Mikyta; Yahne, Carolina E.
This study evaluated the cross-cultural transportability of motivational interviewing (MI), an evidence-based addiction treatment method. Free clinical training in MI was offered in separate targeted workshops for 86 African American, Native American, and Spanish-speaking addiction treatment providers. Audiotaped pre- and posttraining clinical…
Comments on the article by Miller and Rose (September 2009). As Miller and Rose opened "the black box of treatment to examine linkages between processes of delivery and client outcomes" (p. 529) in motivational interviewing (MI), it is important that their model include factors from the social context that may explain conditions that enhance or…
Alcohol use disorders are related to many negative health, emotional, societal, and economic consequences. These disorders are often difficult to treat because individuals suffering from them tend to be ambivalent about and resistant to change. Motivational interviewing (MI) provides healthcare prov...
Burke, Brian L.
Motivational Interviewing (MI) is a promising 25-year-old therapeutic approach that integrates relationship-building principles and more directive strategies to move clients toward behavioral change. A large and expanding number of controlled research studies of MI have demonstrated its efficacy for addictive behaviors ranging from use of alcohol,…
Madson, Michael B.; Mohn, Richard S.; Schumacher, Julie A.; Landry, Alicia S.
The Client Evaluation of Motivational Interviewing was used to assess motivational interviewing experiences in a predominantly female, African American sample from the Southeastern United States who received motivational interviewing-based feedback during a multicomponent lifestyle intervention. Motivational interviewing was experienced…
Borrello, Maria; Pietrabissa, Giada; Ceccarini, Martina; Manzoni, Gian M.; Castelnuovo, Gianluca
Obesity is one of today’s most diffused and severe public health problems worldwide. It affects both adults and children with critical physical, social, and psychological consequences. The aim of this review is to appraise the studies that investigated the effects of motivational interviewing techniques in treating overweight and obese children. The electronic databases PubMed and PsychINFO were searched for articles meeting inclusion criteria. The review included studies based on the application of motivational interviewing (MI) components and having the objective of changing body mass index (BMI) in overweight or obese children from age 2 to age 11. Six articles have been selected and included in this review. Three studies reported that MI had a statistically significant positive effect on BMI and on secondary obesity-related behavior outcomes. MI can be applicable in the treatment of overweight and obese children, but its efficacy cannot be proved given the lack of studies carried out on this specific sample. PMID:26617555
Moyers, Theresa B.; Miller, William R.; Hendrickson, Stacey M. L.
Although many studies have shown that motivational interviewing (MI) is effective in reducing problem behaviors, few have investigated purported causal mechanisms. Therapist interpersonal skills have been proposed as an influence on client involvement during MI sessions and as a necessary precursor to client commitment language. Using the…
Opheim, Arild; Andreasson, Sven; Eklund, Astri Brandell; Prescott, Peter
Objective: To explore the effects of brief training in Motivational interviewing (MI) for medical students. Design: Video recordings of consultations between 113 final-year medical students and simulated patients were scored blind by two independent raters with the Motivational Interviewing Skill Code (MISC). Half of the students participated in a…
Motivational interviewing is presented as an approach to address resistant behaviors in clinical supervision. A case example is used to illustrate the process in which the relational and technical elements of motivational interviewing can be applied to supervisee resistance. Implications for supervisors and researchers are discussed.
Madson, Michael B; Mohn, Richard S; Zuckoff, Allan; Schumacher, Julie A; Kogan, Jane; Hutchison, Shari; Magee, Emily; Stein, Bradley
Motivational interviewing (MI) is an intervention approach that has solid evidence of efficacy with substance use disorders. Research and training have benefitted from the development of observational measures to assess MI fidelity and competence. However, one untapped area of assessment is the client perception of the clinician use of MI. Client perceptions of MI have been found through qualitative interviews to relate to motivation to change, view of the therapist and safety of therapy. The Client Evaluation of MI (CEMI) scale was developed to assess client perception of clinician MI use. This study further evaluated the CEMI through exploratory and confirmatory factor analysis with a sample of 500 individuals with dual diagnosis pre-discharge from an inpatient unit. Participants completed an MI based session prior to completing CEMIs. A two factor (relational and technical) model explained 51.1% of the cumulative variance and was supported through confirmatory factor analysis. Suggestions for revisions are provided as well as potential uses of the CEMI and future directions for research. PMID:22999814
Iarussi, Melanie M.
Professional counselors practicing in higher education settings aspire to meet the developmental needs of college students in addition to addressing their mental health and substance use concerns. Motivational interviewing (MI) is an evidence-based counseling approach that focuses on enhancing motivation and commitment to change. This article…
Hanich, Laurie B.
This article describes the construction and development of a course assignment that uses student interviews as an instructional tool to bridge the gap between theory and practice in a graduate educational psychology course. The first part of the article describes the student interview assignment used to examine theories of motivation. The second…
Santa Ana, Elizabeth J.; Wulfert, Edelgard; Nietert, Paul J.
Dually diagnosed patients with chemical dependency and a comorbid psychiatric disorder typically show poor compliance with aftercare treatment, which may result in costly and pervasive individual and societal problems. In this study, the authors investigated the effect of adding motivational interviewing in a group format to standard treatment for…
Lindhe Soderlund, Lena; Nordqvist, Cecilia; Angbratt, Marianne; Nilsen, Per
The aim of this study was to identify barriers and facilitators to nurses' application of motivational interviewing (MI) to counselling overweight and obese children aged 5 and 7 years, accompanied by their parents. Ten welfare centre and school health service nurses trained and practiced MI for 6 months, then participated in focus group…
Christopher, Paulette J.; Dougher, Michael J.
Several published reports have now documented the clinical effectiveness of motivational interviewing (MI). Despite its effectiveness, there are no generally accepted or empirically supported theoretical accounts of its effects. The theoretical accounts that do exist are mentalistic, descriptive, and not based on empirically derived behavioral…
Cummings, Sherry M.; Cooper, R. Lyle; Cassie, Kim McClure
This article reviews and assesses the existing research literature on the efficacy of motivational interviewing (MI) to promote lifestyle changes and improve functioning among older adults confronting serious health challenges. A comprehensive literature review was conducted of intervention studies that tested the use of MI to achieve behavioral…
Scholl, Mark B.; Schmitt, Dorothy M.
Motivational Interviewing (MI; W. R. Miller & S. Rollnick, 2002) is presented as a potentially effective counseling strategy for assisting traditionally aged college students in reducing their problematic, heavy alcohol use. MI's congruence with two developmental theories--Self-Determination Theory (R. M. Ryan & E. L. Deci, 2000) and…
Young, Tabitha L.
This article presents developmentally appropriate applications of Motivational Interviewing (MI; Miller & Rollnick, 2002) for use in preparing group members for the working stages of group. Practical strategies are offered for using MI to facilitate an atmosphere of trust, recognize member readiness for change, identify and resolve members'…
Madson, Michael B.; Schumacher, Julie A.; Noble, Jeremy J.; Bonnell, Melissa A.
Many undergraduate psychology students assume positions as mental health paraprofessionals during or after college. The present study was a quasi-experimental evaluation of the effectiveness of teaching motivational interviewing (MI), a counseling approach that applies to many paraprofessional occupations. Results from 83 undergraduates indicated…
Hettema, Jennifer E.; Hendricks, Peter S.
Objective: Motivational interviewing (MI) is a treatment approach that has been widely examined as an intervention for tobacco dependence and is recommended in clinical practice guidelines. Previous reviews evaluating the efficacy of MI for smoking cessation noted effects that were modest in magnitude but included few studies. The current study is…
Stotts, A L; Schmitz, J M; Rhoades, H M; Grabowski, J
A brief motivational interviewing (MI) intervention was evaluated within the context of an outpatient, cocaine-detoxification program. MI was hypothesized to assist patients in completing the detoxification program and to improve outcomes during subsequent treatment. Participants (N = 105) were randomly assigned to MI or to detox-only conditions. Results indicated that although participants completed the detoxification program at equal rates, completers who received MI increased use of behavioral coping strategies and had fewer cocaine-positive urine samples on beginning the primary treatment. MI patients with lower initial motivation were more likely to complete detoxification. PMID:11680565
Polcin, Douglas L.; Bond, Jason; Korcha, Rachael; Nayak, Madhabika B.; Galloway, Gantt P.; Evans, Kristy
An intensive, 9-session Motivational Interviewing (IMI) intervention was assessed using a randomized clinical trial of 217 methamphetamine (MA) dependent persons. Intensive motivational interviewing (IMI) was compared with a standard single standard session of MI (SMI) combined with eight nutrition education sessions. Interventions were delivered weekly over two months. All study participants also received standard outpatient group treatment three times per week. Both study conditions showed significant decreases in MA use and ASI drug scores, but there were no significant differences between the two conditions. However, reductions in ASI psychiatric severity scores and days of psychiatric problems during the past 30 days were found for clients in the IMI condition but not SMI. SMI may be equally beneficial to IMI in reducing MA use and problem severity, but IMI may help alleviate co-occurring psychiatric problems that are unaffected by shorter MI interventions. Additional studies are needed to assess the problems, populations, and contexts for which IMI is effective. PMID:25115166
Moyers, Theresa B; Martin, Tim; Manuel, Jennifer K; Hendrickson, Stacey M L; Miller, William R
This report presents reliability, validity and sensitivity indices for the Motivational Interviewing Treatment Integrity (MITI) scale. Factor analysis of MI treatment sessions coded with the Motivational Interviewing Skills Code (MISC) was used to derive 10 elements of MI practice, forming the MITI. Canonical correlation revealed that the MITI captured 59% of the variability in the MISC. Reliability estimates for the MITI were derived using three masked, independent coders. Intra-class coefficients ranged from .5 to .9 and were generally in the good to excellent range. Comparison of MITI scores before and after MI workshops indicate good sensitivity for detecting improvement in clinical practice as result of training. Implications for the use of this instrument in research and supervision are discussed. PMID:15723728
To enhance compliance and achieve better outcomes, providers must actively engage their patients and caregivers in different ways than in the past. One strategy that has gained national attention is motivational interviewing through evidence-based health coaching. A closer look at this exciting new clinical skill reveals what it is, how it works, why it is so successful, and why our traditional patient approach has fallen short. PMID:25268529
Fiszdon, Joanna M; Kurtz, Matthew M; Choi, Jimmy; Bell, Morris D; Martino, Steve
Adherence to treatment in psychiatric populations is notoriously low. In this randomized, controlled, proof-of-concept study, we sought to examine whether motivational interviewing (MI) could be used to enhance motivation for, adherence to, and benefit obtained from cognitive rehabilitation. Dual diagnosis MI, developed specifically for individuals with psychotic symptoms and disorganization, was further adapted to focus on cognitive impairments and their impact. Sixty-four outpatients diagnosed with schizophrenia spectrum disorders completed baseline assessments and were randomized to receive either the 2-session MI focused on cognitive functioning or a 2-session sham control interview focused on assessment and feedback about preferred learning styles. Next, all participants were given 4 weeks during which they could attend up to 10 sessions of a computer-based math training program, which served as a brief analog for a full course of cognitive rehabilitation. As hypothesized, MI condition was associated with greater increases in task-specific motivation along with greater training program session attendance. Moreover, postinterview motivation level predicted session attendance. There were no significant differences in improvement on a measure of cognitive training content, which may have been due to the abbreviated nature of the training. While the literature on the efficacy of MI for individuals with psychosis has been mixed, we speculate that our positive findings may have been influenced by the adaptations made to MI as well as the focus on a nonpharmacological intervention. PMID:26420905
Lord, Sarah Peregrine; Can, Doğan; Yi, Michael; Marin, Rebeca; Dunn, Christopher W.; Imel, Zac E.; Georgiou, Panayiotis; Narayanan, Shrikanth; Steyvers, Mark; Atkins, David C.
The current paper presents novel methods for collecting MISC data and accurately assessing reliability of behavior codes at the level of the utterance. The MISC 2.1 was used to rate MI interviews from five randomized trials targeting alcohol and drug use. Sessions were coded at the utterance-level. Utterance-based coding reliability was estimated using three methods and compared to traditional reliability estimates of session tallies. Session-level reliability was generally higher compared to reliability using utterance-based codes, suggesting that typical methods for MISC reliability may be biased. These novel methods in MI fidelity data collection and reliability assessment provided rich data for therapist feedback and further analyses. Beyond implications for fidelity coding, utterance-level coding schemes may elucidate important elements in the counselor-client interaction that could inform theories of change and the practice of MI. PMID:25242192
Lord, Sarah Peregrine; Can, Doğan; Yi, Michael; Marin, Rebeca; Dunn, Christopher W; Imel, Zac E; Georgiou, Panayiotis; Narayanan, Shrikanth; Steyvers, Mark; Atkins, David C
The current paper presents novel methods for collecting MISC data and accurately assessing reliability of behavior codes at the level of the utterance. The MISC 2.1 was used to rate MI interviews from five randomized trials targeting alcohol and drug use. Sessions were coded at the utterance-level. Utterance-based coding reliability was estimated using three methods and compared to traditional reliability estimates of session tallies. Session-level reliability was generally higher compared to reliability using utterance-based codes, suggesting that typical methods for MISC reliability may be biased. These novel methods in MI fidelity data collection and reliability assessment provided rich data for therapist feedback and further analyses. Beyond implications for fidelity coding, utterance-level coding schemes may elucidate important elements in the counselor-client interaction that could inform theories of change and the practice of MI. PMID:25242192
Resnicow, Ken; McMaster, Fiona
Motivational Interviewing (MI), a counseling style initially used to treat addictions, increasingly has been used in health care and public health settings. This manuscript provides an overview of MI, including its theoretical origins and core clinical strategies. We also address similarities and differences with Self-Determination Theory. MI has been defined as person-centered method of guiding to elicit and strengthen personal motivation for change. Core clinical strategies include, e.g., reflective listening and eliciting change talk. MI encourages individuals to work through their ambivalence about behavior change and to explore discrepancy between their current behavior and broader life goals and values. A key challenge for MI practitioners is deciding when and how to transition from building motivation to the goal setting and planning phases of counseling. To address this, we present a new three-phase model that provides a framework for moving from WHY to HOW; from building motivation to more action oriented counseling, within a patient centered framework. PMID:22385702
Motivational Interviewing (MI), a counseling style initially used to treat addictions, increasingly has been used in health care and public health settings. This manuscript provides an overview of MI, including its theoretical origins and core clinical strategies. We also address similarities and differences with Self-Determination Theory. MI has been defined as person-centered method of guiding to elicit and strengthen personal motivation for change. Core clinical strategies include, e.g., reflective listening and eliciting change talk. MI encourages individuals to work through their ambivalence about behavior change and to explore discrepancy between their current behavior and broader life goals and values. A key challenge for MI practitioners is deciding when and how to transition from building motivation to the goal setting and planning phases of counseling. To address this, we present a new three-phase model that provides a framework for moving from WHY to HOW; from building motivation to more action oriented counseling, within a patient centered framework. PMID:22385702
Tuccero, Donna; Railey, Kenyon; Briggs, Melvania; Hull, Sharon K
This article reviews the history, methodology, and evidence related to the effective use of motivational interviewing (MI) in the primary care setting. MI has been shown to have a positive effect in promotion and modification of health habits and to increase treatment engagement. MI is also effective when used in conjunction with other treatment modalities, such as educational programs and cognitive behavioral therapy. Practical application of MI can be accomplished in a variety of primary care settings by a wide range of practitioners, incorporates nicely into new health care delivery models, and may improve the patient-provider relationship. PMID:27262001
Balán, Iván C.; Moyers, Theresa B.; Lewis-Fernández, Roberto
Treatment non-adherence in psycho-pharmacotherapy remains a significant challenge to the effective clinical management of psychiatric disorders, especially among underserved racial/ethnic groups. This article introduces Motivational Pharmacotherapy, an approach that integrates Motivational Interviewing into psycho-pharmacotherapy sessions in order to increase treatment adherence. We describe what aspects of Motivational Interviewing were incorporated into Motivational Pharmacotherapy and how we tailored the intervention to the clinical and cultural characteristics of monolingual Spanish-speaking immigrants with Major Depressive Disorder. Transcriptions of the interactions between psychiatrists and patients help illustrate this approach. In our experience, Motivational Pharmacotherapy differs substantially from standard pharmacotherapy in how it recasts clinicians and patients as equal experts, prioritizes patients' motivation to engage in treatment rather than clinicians' multiple inquiries about symptoms, encourages patients' self-efficacy to overcome barriers, and attends to the momentum of patients' language about commitment to change. We also found that Motivational Pharmacotherapy can be feasibly incorporated into medication treatment, can be tailored to patients' culture and disorder, and may help increase adherence to psycho-pharmacotherapy. PMID:23965260
Wallace, Lloyd; Turner, Fiona
The Motivational Interviewing Skills Code (MISC) has been developed to measure motivational interviewing skill, but a need has been identified for more economical instruments. This study expands on a previous systematic review by Madson and Campbell (2006) and examines the extent to which motivational interviewing integrity measures other than the…
Robinson, Cendrine; Rogers, Charles R.; Okuyemi, Kola
Background Tobacco use is higher among homeless individuals than the general population. Homeless individuals are also more likely to have symptoms of depression. Depression symptoms may add to the burden of homelessness by increasing psychological distress and serve as a barrier to quitting smoking. Objectives The primary goal of this study was to assess the impact of depression symptoms on psychological distress in homeless smokers. The effect of depression symptoms on abstinence and the effect of Motivational Interviewing (MI) on cessation among smokers was also explored. Methods Homeless smokers (N=430) enrolled in a smoking cessation study were randomized to Motivational Interviewing (MI) or standard care (SC). Participants received nicotine replacement therapy and were followed for 26 weeks. Participants were categorized into a depression symptoms (DS) group or control group using the Patient Health Questionnaire-9. Between group differences of perceived stress, hopelessness, confidence, craving and abstinence were assessed at weeks 8 and 26. The interaction between depression symptoms (levels: DS and control) and the intervention (levels: MI and SC) was also assessed. Results Homeless smokers in the DS group reported higher levels of hopelessness, perceived stress, and craving. There was no effect of DS status on abstinence at week 8 or week 26. There was no significant interaction between depression symptoms (DS vs. Control) and the intervention (MI vs. SC). Conclusion Despite reporting greater psychological distress, homeless smokers with depression symptoms in this sample had abstinence levels similar to the control group. Future research should explore protective factors among depressed smokers. PMID:27267588
Woodin, Erica M.; Sotskova, Alina; O’Leary, K. Daniel
Motivational interviewing is a directive, non-confrontational intervention to promote behavior change. The current study examined therapist behaviors during a successful brief motivational interviewing intervention for physically aggressive college dating couples (Woodin & O’Leary, 2010). Forty-five minute motivational interviews with each partner were videotaped and coded using the Motivational Interviewing Treatment Integrity scale (MITI; Moyers, Martin, Manuel, & Miller, 2003). Hierarchical modeling analyses demonstrated that therapist behaviors consistent with motivational interviewing competency predicted significantly greater reductions in physical aggression perpetration following the intervention. Specifically, greater reflection to question ratios by the therapists predicted reductions in aggression for both men and women, greater percentages of open versus closed questions predicted aggression reductions for women, and there was a trend for greater levels of global therapist empathy to predict aggression reductions for women. These findings provide evidence that motivational interviewing seems to have an effect on behavior change through therapist behaviors consistent with the theoretical underpinnings of motivational interviewing. PMID:22119133
Minkin, Alison; Snider-Meyer, Jill; Olson, Debra; Gresser, Susan; Smith, Heather; Kier, Frederick J
This study investigated the effectiveness of training geriatric home-based primary care (HBPC) nursing staff in motivational interviewing (MI) techniques, with the goal of increasing patient medication adherence. Nursing staff received 4 hours of training in MI techniques from a licensed psychologist. Results indicated that the MI training increased medication adherence in the HBPC veteran sample by a small, but statistically significant, margin both 1 month and 6 months after the intervention. Although the effect size may be considered small, the clinical and cost ramifications of even a small gain in adherence are extremely important for the patient, clinician, and the medical facility. MI techniques may provide a cost-effective and impactful means of enhancing patient adherence to medications. PMID:25171241
Christopher, Paulette J; Dougher, Michael J
Several published reports have now documented the clinical effectiveness of motivational interviewing (MI). Despite its effectiveness, there are no generally accepted or empirically supported theoretical accounts of its effects. The theoretical accounts that do exist are mentalistic, descriptive, and not based on empirically derived behavioral principles. Empirical research is being generated regarding the role of client and therapist verbal behavior in MI. Client and therapist speech in MI sessions has been correlated with subsequent client behavior change (Amrhein, Miller, Yahne, & Fulcher, 2003; Gaume, Gmel, & Daeppen, 2008; Moyers et al., 2007). Although provocative, these findings are correlational and no theory has yet been provided to explain them. The purposes of the present paper are (a) to bring MI to the attention of clinical behavior analysts; (b) to provide a conceptual account of MI that relies on recent developments in the behavior analysis of motivation and verbal behavior, especially stimulus equivalence and transformation of functions; (c) to provide a possible answer to two critical questions: “How does MI evoke client in-session talk abut behavior change?” and “Why is this change talk related to outcomes?”; and (d) to use this account to identify important research questions and perhaps enhance MI's effectiveness. PMID:22478518
Christopher, Paulette J; Dougher, Michael J
Several published reports have now documented the clinical effectiveness of motivational interviewing (MI). Despite its effectiveness, there are no generally accepted or empirically supported theoretical accounts of its effects. The theoretical accounts that do exist are mentalistic, descriptive, and not based on empirically derived behavioral principles. Empirical research is being generated regarding the role of client and therapist verbal behavior in MI. Client and therapist speech in MI sessions has been correlated with subsequent client behavior change (Amrhein, Miller, Yahne, & Fulcher, 2003; Gaume, Gmel, & Daeppen, 2008; Moyers et al., 2007). Although provocative, these findings are correlational and no theory has yet been provided to explain them. The purposes of the present paper are (a) to bring MI to the attention of clinical behavior analysts; (b) to provide a conceptual account of MI that relies on recent developments in the behavior analysis of motivation and verbal behavior, especially stimulus equivalence and transformation of functions; (c) to provide a possible answer to two critical questions: "How does MI evoke client in-session talk abut behavior change?" and "Why is this change talk related to outcomes?"; and (d) to use this account to identify important research questions and perhaps enhance MI's effectiveness. PMID:22478518
Bonde, Ane Høstgaard; Bentsen, Peter; Hindhede, Anette Lykke
Motivational interviewing is a counseling method used to bring about behavior change; its application by school nurses for preventing obesity in children is still new. This study, based on in-depth interviews with 12 school nurses, shows how school nurses adapted motivational interviewing and integrated it into their daily practice along with…
Steinberg, Marc L.; Ziedonis, Douglas M.; Krejci, Jonathan A.; Brandon,Thomas H.
Individuals with schizophrenia have a much higher prevalence of tobacco smoking, a lower cessation rate, and a higher incidence of tobacco-related diseases than the general population. The initial challenge has been to motivate these individuals to quit smoking. This study tested whether motivational interviewing is effective in motivating smokers…
Pyle, Joni J
The ability of registered nurses to communicate well with their patients is foundational to patient-centered care, the management of chronic illness, and general healthcare. It is also vital to the nurse-patient relationship. Nurses, however, tend to identify with their patients' physical needs and rely heavily on the technical skills with which they feel more comfortable. This lack of ability to communicate well with their patients can result in poor nurse-patient understanding, can lead to poor patient outcomes, and a lack of patient engagement and involvement in their care. Motivational interviewing (MI), a patient-centered manner of communication, is a means to direct the nurse-patient interaction in a way that is patient centered. Brief education of MI has shown to be effective in increasing the self-efficacy of nurses in their ability to communicate well with their patients. In 2 geographically diverse Pennsylvania home care settings, MI education was provided to 20 nurses. The educational intervention was designed to increase the self-efficacy of nurses regarding their ability to affect the negative behaviors of chronically ill patients. A pretest and posttest was administered to the nurse participants to determine the effectiveness of the educational intervention. This evidence-based education increased the nurses' overall communication self-efficacy by 25%. PMID:25654455
Lusilla-Palacios, Pilar; Castellano-Tejedor, Carmina
Background. An acute spinal cord injury (ASCI) is a severe condition that requires extensive and very specialized management of both physical and psychological dimensions of injured patients. Objective. The aim of the part of the study reported here was twofold: (1) to describe burnout, empathy, and satisfaction at work of these professionals and (2) to explore whether a tailored program based on motivational interviewing (MI) techniques modifies and improves such features. Methods. This paper presents findings from an intervention study into a tailored training for professionals (N = 45) working in a spinal cord injury (SCI) unit from a general hospital. Rehabilitation professionals' empathy skills were measured with the Jefferson Scale of Physician Empathy (JSPE), burnout was measured with the Maslach Burnout Inventory (MBI), and additional numeric scales were used to assess the perceived job-related stress and perceived satisfaction with job. Results. Findings suggest that professionals are performing quite well and they refer to satisfactory empathy, satisfaction at work, and no signs of burnout or significant stress both before and after the training. Conclusions. No training effect was observed in the variables considered in the study. Some possible explanations for these results and future research directions are discussed in depth in this paper. The full protocol of this study is registered in ClinicalTrials.gov (identifier: NCT01889940). PMID:26770827
Polcin, Douglas L.; Sterling, Jennifer; Brown, Thomas; Brown, Michelle; Buscemi, Raymond; Korcha, Rachael
Although motivational interviewing (MI) is a widely used intervention for alcohol and drug problems, little is known about client and therapist experiences. Client and therapist views could help better understand how MI works and what factors are important. This paper investigates experiences of clients and therapists who participated in a study that examined a standard single session of MI (MI 1) and a more intensive 9-session model (MI 9) for methamphetamine dependence. Qualitative methods included open ended questions presented to 184 clients at 2-month follow-up and 189 clients at 6-month follow-up. In addition, a focus group consisting of two therapists who delivered the interventions and two adherence monitors who listened to audiotape recordings of sessions was conducted. Clients in both conditions felt supportive, nonjudgmental therapist attitudes were helpful. Most clients in the MI 9 condition but few receiving MI 1 volunteered that feedback and advice were helpful. A strong majority in both conditions desired more sessions. Expert panel members emphasized: 1) multiple benefits of a nonjudgmental stance, 2) finding the right balance among different MI interventions, and 3) understanding the interaction of supportive and directive interventions. Panel members also emphasized that one advantages of MI 9 over MI 1 was that it enabled client change plans to be implemented over time. PMID:26185335
Murphy, James G; Dennhardt, Ashley A; Skidmore, Jessica R; Martens, Matthew P; McDevitt-Murphy, Meghan E
The authors conducted two randomized clinical trials with ethnically diverse samples of college student drinkers in order to determine (a) the relative efficacy of two popular computerized interventions versus a more comprehensive motivational interview approach (BASICS) and (b) the mechanisms of change associated with these interventions. In Study 1, heavy drinking participants recruited from a student health center (N = 74, 59% women, 23% African American) were randomly assigned to receive BASICS or the Alcohol 101 CD-ROM program. BASICS was associated with greater post-session motivation to change and self-ideal and normative discrepancy relative to Alcohol 101, but there were no group differences in the primary drinking outcomes at 1-month follow-up. Pre to post session increases in motivation predicted lower follow-up drinking across both conditions. In Study 2, heavy drinking freshman recruited from a core university course (N = 133, 50% women, 30% African American) were randomly assigned to BASICS, a web-based feedback program (e-CHUG), or assessment-only. BASICS was associated with greater post-session self-ideal discrepancy than e-CHUG, but there were no differences in motivation or normative discrepancy. There was a significant treatment effect on typical weekly and heavy drinking, with participants in BASICS reporting significantly lower follow-up drinking relative to assessment only participants. In Study 2, change in the motivation or discrepancy did not predict drinking outcomes. Across both studies, African American students assigned to BASICS reported medium effect size reductions in drinking whereas African American students assigned to Alcohol 101, e-CHUG, or assessment did not reduce their drinking. PMID:21198224
Guydish, Joseph; Jessup, Martha; Tajima, Barbara; Manser, Sarah Turcotte
The National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) is designed to test drug abuse treatment interventions in multisite clinical trials and to support the translation of effective interventions into practice. In this study, qualitative methods were applied to examine adoption of motivational interviewing and motivational enhancement therapy (MI/MET) in five clinics where these interventions were tested. Participants were clinic staff (n = 17) who were interviewed about the MI/MET study, and about whether MI/MET was adopted after the study ended. Although clinics’ participation in a clinical trial includes many elements thought to be necessary for later adoption of the intervention, we found that there was “adoption” in one clinic, “partial adoption” in one clinic, “counselor adoption” in one clinic, and “no adoption” in two clinics. These findings highlight a distinction between adoption at the organizational and counselor levels, and suggest that a range of adoption outcomes may be observed in the field. Findings are relevant to clinical staff, program directors, administrators and policy makers concerned with improvement of drug abuse treatment systems through adoption of evidence-based practices. PMID:21138198
Olsen, Sara; Smith, Simon S.; Oei, Tian P. S.; Douglas, James
Objective: Adherence to continuous positive airway pressure (CPAP) therapy for obstructive sleep apnoea (OSA) is poor. We assessed the effectiveness of a motivational interviewing intervention (motivational interview nurse therapy [MINT]) in addition to best practice standard care to improve acceptance and adherence to CPAP therapy in people with…
Robbins, Lorraine B.; Pfeiffer, Karin A.; Maier, Kimberly S.; LaDrig, Stacey M.; Berg-Smith, Steven Malcolm
Motivational interviewing, which involves the use of person-centered, directive counseling techniques, shows promise for changing adolescent behaviors. The purpose of this article was to describe the methodology and findings related to the treatment fidelity of three face-to-face motivational interviewing sessions involving middle school girls and…
Resnicow, Ken; Harris, Donna; Wasserman, Richard; Schwartz, Robert P; Perez-Rosas, Veronica; Mihalcea, Rada; Snetselaar, Linda
Rates of childhood obesity in the United States remain at historic highs. The pediatric primary care office represents an important yet underused setting to intervene with families. One factor contributing to underuse of the primary care setting is lack of effective available interventions. One evidence-based method to help engage and motivate patients is motivational interviewing, a client-centered and goal-oriented style of counseling used extensively to increase autonomous motivation and modify health behaviors. This article summarizes the methods and results from a large trial implemented in primary care pediatric office and concludes with recommendations for improving the intervention and increasing its dissemination. PMID:27261549
Roman, Brenda; Borges, Nicole; Morrison, Ann K.
Background: Despite a large percentage of health care costs being related to smoking, obesity, and substance abuse, most physicians are not confident in motivating patients to change health behaviors. Motivational interviewing (MI) is a directive, patient-centered approach for eliciting behavior change. The purpose of this study was to teach…
Iarussi, Melanie H.; Tyler, Jessica M.; Littlebear, Sarah; Hinkle, Michelle S.
Motivational interviewing (MI), a humanistic counseling style used to help activate clients' motivation to change, was integrated into a basic counseling skills course. Nineteen graduate-level counseling students completed the Counselor Estimate of Self-Efficacy at the start and conclusion of the course. Significant differences were found between…
Financing a company is more complex than ever-and more important to its economic success. The demands on a CFO are tremendous. Optimizing capital costs requires an unprecedented level of technical sophistication. Yet the best CFOs today are not mere technicians. They are also strategists and innovators. Gary Wilson exemplifies the new CFO. In his 5 years as executive vice president and CFO of the Walt Disney Company and his 12 years at Marriott Corporation, he has shown how the finance function can add value-not just account for it. How does a CFO create value for shareholders? "Just like all the great marketing and operating executives," Wilson says, "by being creative." To Wilson, being creative means rethinking assumptions and finding clever ways to achieve financial and strategic goals. Some of Wilson's innovative deal making-like the off-balance-sheet financing he used at Marriott-is well known. At Marriott, he discovered the power of separating the ownership of an asset from its control. Marriott's strength was in operations, yet the company had a great deal of money tied up in real estate. Growth would require even more investment in real estate. Wilson's solution was to sell the hotels-in effect, removing them and the debt used to finance them from the balance sheet-and contract to operate them. In this interview, Wilson gives his view of the role of finance in today's corporation and explains the thinking behind some of the successful deals he has engineered-including Disney's Silver Screen movie-making partnerships and Euro Disneyland. PMID:10106405
Frey, Andy J.; Lee, Jon; Small, Jason W.; Seeley, John R.; Walker, Hill M.; Feil, Edward G.
There is a critical need to engage theory-driven research related to the deployment of mental health promotion initiatives and student outcomes. A growing body of research supporting the use of motivational interviewing and engagement strategies in education suggests that this approach may be promising to better understand mechanisms through which…
Wolever, Ruth Q.
As rates of preventable chronic diseases and associated costs continue to rise, there has been increasing focus on strategies to support behavior change in healthcare. Health coaching and motivational interviewing are synergistic but distinct approaches that can be effectively employed to achieve this end. However, there is some confusion in the literature about the relationship between these two approaches. The purpose of this review is to describe a specific style of health coaching—integrative health coaching—and motivational interviewing, including their origins, the processes and strategies employed, and the ways in which they are similar and different. We also provide a case example of how integrative health coaching and motivational interviewing might be employed to demonstrate how these approaches are synergistic but distinct from each other in practice. This information may be useful for both researchers and clinicians interested in investigating or using behavior change interventions to improve health and cost outcomes in chronic disease. PMID:24416683
Jelsma, Judith G M; Mertens, Vera-Christina; Forsberg, Lisa; Forsberg, Lars
Many randomized controlled trials in which motivational interviewing (MI) is a key intervention make no provision for the assessment of treatment fidelity. This methodological shortcoming makes it impossible to distinguish between high- and low-quality MI interventions, and, consequently, to know whether MI provision has contributed to any intervention effects. This article makes some practical recommendations for the collection, selection, coding and reporting of MI fidelity data, as measured using the Motivational Interviewing Treatment Integrity Code. We hope that researchers will consider these recommendations and include MI fidelity measures in future studies. PMID:25962891
Lee, Christina S.; López, Steven R.; Colby, Suzanne M.; Rohsenow, Damaris; Hernández, Lynn; Borrelli, Belinda; Caetano, Raul
A randomized clinical trial of culturally adapted (CAMI) and un-adapted motivational interviewing (MI) to reduce drinking and related problems among heavy drinking Latinos randomized and assessed 58 participants at baseline, at 2 (86% retention) and 6 months (84% retention). Significant declines across both were found in heavy drinking days/month and drinking consequences (p < .001), with greater reductions for drinking consequences for CAMI at 2 months (p = .009) and continuing reductions in CAMI at 6 months. Findings provide preliminary support for the value of culturally adaptation to enhance the efficacy of motivational interviewing with Latino heavy drinkers. PMID:24215227
Flattum, Colleen; Friend, Sarah; Neumark-Sztainer, Dianne; Story, Mary
Over the past decade, motivational interviewing has been used by health professionals to promote health behavior changes and help individuals increase their motivation or "readiness" to change. This paper describes a preliminary study that evaluated the feasibility of motivational interviewing as a component of New Moves, a school-based obesity prevention program. New Moves is a program for inactive adolescent high school girls who are overweight or at risk of becoming overweight due to low levels of physical activity. Throughout the 18-week pilot study, 41 girls, age 16 to 18 years, participated in an all-girls physical education class that focused on increasing physical activity, healthful eating, and social support. Individual sessions, using motivational interviewing techniques, were also conducted with 20 of the girls to develop goals and actions related to eating and physical activity. Among the 20 girls, 81% completed all seven of the individual sessions, and girls set a goal 100% of the time. Motivational interviewing offers a promising component of school-based obesity-prevention programs and was found to be feasible to implement in school settings and acceptable to the adolescents. PMID:19103327
Snape, Laura; Atkinson, Cathy
The current systematic literature review sought to determine the effectiveness of Motivational Interviewing (MI) in educational settings. Student-focused school-based MI (SBMI) studies were assessed using qualitative and quantitative assessment frameworks and data were reported using PRISMA guidelines. Eleven studies met the inclusion criteria,…
Smith, Douglas C.; Lanesskog, Deirdre; Cleeland, Leah; Motl, Robert; Weikert, Madeline; Dlugonski, Deirdre
People with multiple sclerosis (MS) are likely to benefit from regular exercise, but physical inactivity is more common among people with MS than among the general population. This small randomized study evaluated whether motivational interviewing (MI) affects adherence to and personal experience in an exercise program. Inactive people with MS…
Kertes, Angela; Westra, Henny A.; Angus, Lynne; Marcus, Madalyn
Motivational Interviewing (MI) has recently been applied to the treatment of anxiety disorders in an effort to bolster engagement with and response rates to cognitive behavioral therapy (CBT). In a recent randomized control trial, the addition of MI as a pretreatment compared to no pretreatment was found to significantly improve response to CBT…
Rash, Elizabeth M.
Brief interventions based on motivational interviewing (MI) are emerging as effective strategies for behavior change in college students. However, implementation of MI-based brief interventions may be challenging in the college health environment, and their practicality is controversial. The author explored college health clinicians' perspectives…
Marley, Scott C.; Carbonneau, Kira; Lockner, Donna; Kibbe, Debra; Trowbridge, Frederick
Objective: To examine the relationships between physical and social self-concepts, motivational interviewing (MI), and nutrition assessment skills with dimensions of counseling self-efficacy. Design: Cross-sectional survey. Setting: Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics. Participants: Sixty-five WIC…
Soderlund, Lena L.; Malmsten, Janna; Bendtsen, Preben; Nilsen, Per
Objective: To evaluate how a motivational interviewing (MI) training course for child healthcare nurses in Sweden affected their work with children's weight issues and their attitudes to MI. Design: Cross-sectional survey, descriptive design. Setting: Nurses were recruited from 33 different child healthcare centres in Ostergotland, Sweden. Method:…
Walters, Scott T.; Vader, Amanda M.; Nguyen, Norma; Harris, T. Robert; Eells, Jennifer
Motivational interviewing (MI) has been recommended as a supervision style in probation. This project examined the effectiveness of an MI training curriculum on probation officer MI skill and subsequent probationer outcome. Twenty probation officers were randomized to receive MI training, or to a waiting list control, while an additional group of…
Patterson, Gregory A.
Blended learning holds the potential of improving the way we educate students and of making them more motivated. Blended education--the melding of information technology based distance learning with school attendance--is perhaps the best way to educate students for 21st century skills, says Michael Horn in a "Kappan" interview. Horn points out…
Soderlund, Lena Lindhe; Nilsen, Per; Kristensson, Margareta
Objective: This article explores the training and counselling experiences of 20 nurses, aiming to identify key elements in the process of learning and applying motivational interviewing (MI) counselling skills with adherence to protocols. Setting/method: The nurses were recruited from 10 primary health care units in Ostergotland, Sweden. The study…
Hohman, Melinda; Doran, Neal; Koutsenok, Igor
This study reports initial results of a program designed to train California corrections staff (n = 576) in motivational interviewing (MI), a method of communication that is based on a client-centered, collaborative style. After three days of training, participants made significant gains in terms of knowledge of MI principles and reflective…
Jensen, Chad D.; Cushing, Christopher C.; Aylward, Brandon S.; Craig, James T.; Sorell, Danielle M.; Steele, Ric G.
Objective: This study was designed to quantitatively evaluate the effectiveness of motivational interviewing (MI) interventions for adolescent substance use behavior change. Method: Literature searches of electronic databases were undertaken in addition to manual reference searches of identified review articles. Databases searched include…
Young, Tabitha L.; Hagedorn, W. Bryce
Motivational interviewing (MI) is an empirically based practice that provides counselors with methods for working with resistant and ambivalent clients. Whereas previous research has demonstrated the effectiveness of training current clinicians in this evidenced-based practice, no research has investigated the efficacy of teaching MI to…
Mason, Michael J.
Very little work regarding C. Rogers's (1961) client-centered counseling has been published in the counseling discipline's journals over the last 20 years. However, during this time there has been an impressive output of empirical research using motivational interviewing (MI) in which C. Rogers's theory and approach are foundational. A review of…
Strait, Gerald Gill; Smith, Bradley H.; McQuillin, Sam; Terry, John; Swan, Suzanne; Malone, Patrick S.
Motivational interviewing (MI) is an effective method of promoting change in adults, but research on adolescents is limited. This study tests the efficacy of MI for promoting academic achievement in middle school students. Participants were 103 6th-, 7th-, and 8th-grade students randomly assigned to either a MI (n = 50) or a waitlist control…
Apodaca, Timothy R.; Magill, Molly; Longabaugh, Richard; Jackson, Kristina M.; Monti, Peter M.
Objective:To examine significant-other (SO) and therapist behaviors as predictors of client change language within motivational interviewing (MI) sessions. Method: Participants from an emergency department received a single session of MI that included SO participation (N = 157). Sessions were coded using therapy process coding systems. Sessions…
Clarke, Philip B.; Giordano, Amanda L.; Cashwell, Craig S.; Lewis, Todd F.
Spiritual bypass is the avoidance of underlying emotional issues by focusing solely on spiritual beliefs, practices, and experiences. Motivational interviewing (MI) is a client-centered, compassionate approach to effectively addressing resistance among those who present with spiritual bypass. In this article, the authors provide background…
Moyers, Theresa B.; Martin, Tim; Houck, Jon M.; Christopher, Paulette J.; Tonigan, J. Scott
Client speech in favor of change within motivational interviewing sessions has been linked to treatment outcomes, but a causal chain has not yet been demonstrated. Using a sequential behavioral coding system for client speech, the authors found that, at both the session and utterance levels, specific therapist behaviors predict client change talk.…
Juarez, Patricia; Walters, Scott T.; Daugherty, Mikyta; Radi, Christopher
Motivational interviewing (MI) is a brief intervention that has been shown to reduce heavy drinking among college students. Because all college studies of MI to date have included a personalized feedback report, it remains unclear which of the components is necessary to produce behavior change. This study evaluated the separate and collective…
Britton, Peter C.; Patrick, Heather; Wenzel, Amy; Williams, Geoffrey C.
Cognitive behavioral therapy (CBT) has been found to be effective in preventing suicide-related behavior. However, it is often difficult to engage patients who are at-risk in treatment. Motivational Interviewing (MI) has been shown to increase treatment engagement and improve treatment outcomes when it is used to complement other treatments. As a…
Hohman, Melinda; Pierce, Paloma; Barnett, Elizabeth
Motivational interviewing (MI) is an evidence-based communication method to assist clients in resolving their ambivalence regarding change. With a school emphasis on evidence-based practice and learning outcomes, a social work department implemented a semester-long course on MI. The purpose of this study was to determine baseline skills and…
Kaplan, Sebastian; Elliott, Harold
Objective: The authors propose that motivational interviewing (MI), a brief intervention designed to manage ambivalence regarding complex behavior change, is well suited for integration into psychiatric residency training programs. Methods: The authors provide a brief description of MI. In addition, based on a review of the literature the authors…
Smith, Jennifer L.; Carpenter, Kenneth M.; Amrhein, Paul C.; Brooks, Adam C.; Levin, Deborah; Schreiber, Elizabeth A.; Travaglini, Laura A.; Hu, Mei-Chen; Nunes, Edward V.
Objective: Training through traditional workshops is relatively ineffective for changing counseling practices. Teleconferencing supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). Method: Ninety-seven drug treatment counselors completed a 2-day MI workshop and were randomized to live…
Lundahl, Brad W.; Kunz, Chelsea; Brownell, Cynthia; Tollefson, Derrik; Burke, Brian L.
Objective: The authors investigated the unique contribution motivational interviewing (MI) has on counseling outcomes and how MI compares with other interventions. Method: A total of 119 studies were subjected to a meta-analysis. Targeted outcomes included substance use (tobacco, alcohol, drugs, marijuana), health-related behaviors (diet,…
Small, Jason W.; Lee, Jon; Frey, Andy J.; Seeley, John R.; Walker, Hill M.
As specialized instructional support personnel begin learning and using motivational interviewing (MI) techniques in school-based settings, there is growing need for context-specific measures to assess initial MI skill development. In this article, we describe the iterative development and preliminary evaluation of two measures of MI skill adapted…
Purpose: The purpose of this article is to present an exploration of some of the issues surrounding adherence to vocal behavioral change in voice therapy within the context of Motivational Interviewing (MI) and to explore MI's potential for integration into voice therapy (MI-adapted voice therapy). MI is a style of interpersonal communication in…
Cryer, Sarah; Atkinson, Cathy
Research suggests motivational interviewing (MI) techniques are both widely-used by educational psychologists (EPs) and effective in supporting young people of secondary age. To date, there has been no published research investigating the use of MI with primary-aged children. This study details the use of a short MI-based intervention with a…
Walters, Scott T.; Vader, Amanda M.; Harris, T. Robert; Field, Craig A.; Jouriles, Ernest N.
Motivational interviewing (MI) is a counseling style that has been shown to reduce heavy drinking among college students. To date, all studies of MI among college students have used a format that includes a feedback profile delivered in an MI style. This study was a dismantling trial of MI and feedback among heavy-drinking college students. After…
Lewis, Todd F.; Osborn, Cynthia J.
Solution-focused counseling (SFC) and motivational interviewing (MI) have gained recognition over the past 2 decades. A review of the features of these counseling approaches is provided, as well as an examination of the similarities and differences on several dimensions of counseling. Attention is given to empirical research, and it is proposed…
This article presents an interview with Allan Wigfield, professor and chair of the Department of Human Development and distinguished scholar-teacher at the University of Maryland. He has authored more than 100 peer-reviewed journal articles and book chapters on children's motivation and other topics. He is a fellow of Division 15 (Educational…
Bachiller, Diana; Grau-López, Lara; Barral, Carmen; Daigre, Constanza; Alberich, Cristina; Rodríguez-Cintas, Laia; Valero, Sergi; Casas, Miquel; Roncero, Carlos
The relapse rate after discharge from inpatient detoxification is high. The objective of this pilot study is to assess the sociodemographic, clinical and therapeutic factors associated with maintaining abstinence in patients who participated in a brief motivational interviewing group during admission for detoxification. A total of 46 patients, diagnosed substance dependent according to DSM -IV, and admitted to the Hospital Detoxification Unit, participated in a brief motivational interviewing group. Sociodemographic, clinical, motivation to change (University of Rhode Island Change Assessment, URICA) and satisfaction with the treatment group (Treatment Perceptions Questionnaire, CPT) data were collected. Abstinence and treatment retention two months after discharge were assessed by weekly telephone calls. A survival analysis was performed. Being male, having more cognitions of the maintenance stage of change at discharge, being satisfied with group therapy and therapist during hospitalization are associated with longer abstinence after discharge. The brief motivational interviewing group approach with patients admitted for detoxification is related to greater likelihood of maintaining abstinence and subsequent treatment retention. PMID:26132300
Flinn, Sharon; Jones, Christine
Individuals vary in the degree in which they are willing to make significant changes in areas of their daily life, especially after an illness or injury. Motivational interviewing (MI) has been used to predict a persons’ readiness to change and to build the necessary intrinsic motivation that is needed to make difficult changes. The article describes the stages of change model and strategies that can be applied to patients in different stages of change. Vignettes are provided to apply the various principles of MI and to assist hand therapists with an approach that supports the recovery efforts of their patients. PMID:21144704
Wahab, Stéphanie; Trimble, Jammie; Mejia, Angie; Mitchell, S Renee; Thomas, Mary Jo; Timmons, Vanessa; Waters, A Star; Raymaker, Dora; Nicolaidis, Christina
This article focuses on design, training, and delivery of a culturally tailored, multi-faceted intervention that used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a community-based participatory research approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program. PMID:24857557
van den Berk-Clark, Carissa; Patterson Silver Wolf (Adelv unegv Waya), David A.; Ramsey, Alex
This study evaluated motivational interviewing (MI) in a permanent supportive housing agency. The agency’s contradictory social service and business missions resulted in an incompatible organizational culture theorized to diminish MI’s effectiveness. A combination of observational, interview, and archival data collected over 3 years were used to examine MI implementation within an incompatible supportive housing agency. Two major themes arose: how MI is used to categorize and change clients in permanent supportive housing and how worker–worker relationships affect MI implementation. The results suggest that within incompatible organizational environments, key elements of effective MI implementation are greatly weakened. PMID:25129815
van den Berk-Clark, Carissa; Patterson Silver Wolf, David A; Ramsey, Alex
This study evaluated motivational interviewing (MI) in a permanent supportive housing agency. The agency's contradictory social service and business missions resulted in an incompatible organizational culture theorized to diminish MI's effectiveness. A combination of observational, interview, and archival data collected over 3 years were used to examine MI implementation within an incompatible supportive housing agency. Two major themes arose: how MI is used to categorize and change clients in permanent supportive housing and how worker-worker relationships affect MI implementation. The results suggest that within incompatible organizational environments, key elements of effective MI implementation are greatly weakened. PMID:25129815
Wahab, Stéphanie; Trimble, Jammie; Mejia, Angie; Mitchell, S. Renee; Thomas, Mary Jo; Timmons, Vanessa; Waters, A. Star; Raymaker, Dora; Nicolaidis, Christina
This article focuses on design, training, and delivery of a culturally-tailored, multi-faceted intervention which used motivational interviewing (MI) and case management to reduce depression severity among African American survivors of intimate partner violence (IPV). We present the details of the intervention and discuss its implementation as a means of creating and providing culturally appropriate depression and violence services to African American women. We used a CBPR approach to develop and evaluate the multi-faceted intervention. As part of the evaluation, we collected process measures about the use of MI, assessed MI fidelity, and interviewed participants about their experiences with the program. PMID:24857557
Moyers, Theresa B; Martin, Tim; Houck, Jon M; Christopher, Paulette J; Tonigan, J Scott
Client speech in favor of change within motivational interviewing sessions has been linked to treatment outcomes, but a causal chain has not yet been demonstrated. Using a sequential behavioral coding system for client speech, the authors found that, at both the session and utterance levels, specific therapist behaviors predict client change talk. Further, a direct link from change talk to drinking outcomes was observed, and support was found for a mediational role for change talk between therapist behavior and client drinking outcomes. These data provide preliminary support for the proposed causal chain indicating that client speech within treatment sessions can be influenced by therapists, who can employ this influence to improve outcomes. Selective eliciting and reinforcement of change talk is proposed as a specific active ingredient of motivational interviewing. PMID:19968387
Rapp, Richard C.; Otto, Amy L.; Lane, D. Timothy; Redko, Cristina; McGatha, Sue; Carlson, Robert G.
Background Poor linkage with substance abuse treatment remains a problem, negating the benefits that can accrue to both substance abusers and the larger society. Numerous behavioral interventions have been tested to determine their potential role in improving linkage. Methods A randomized clinical trial of 678 substance abusers compared the linkage effect of two brief interventions with the referral standard of care (SOC) at a centralized intake unit (CIU). Interventions included five sessions of strengths-based case management (SBCM) or one session of motivational interviewing (MI). A priori hypotheses predicted that both interventions would be better than the standard of care in predicting linkage and that SBCM would be more effective than MI. We analyzed the effect of the two interventions on overall treatment linkage rates and by treatment modality. Logistic regression analysis examined predictors of treatment linkage for the sample and each group. Results Two hypotheses were confirmed in that SBCM (n = 222) was effective in improving linkage compared to the SOC (n = 230), 55.0% vs. 38.7% (p < .01). SBCM improved linkage more than MI (55.0% vs. 44.7%, p < .05). Motivational interviewing (n = 226) was not significantly more effective in improving linkage than the standard of care (44.7% vs. 38.7%; p > .05). The three trial groups differed only slightly on the client characteristics that predicted linkage with treatment. Conclusions The results of this study confirm a body of literature that supports the effectiveness of case management in improving linkage with treatment. The role of motivational interviewing in improving linkage was not supported. Results are discussed in the context of other case management and motivational interviewing linkage studies. PMID:18242883
This article provides an overview of motivational interviewing (MI) as an effective intervention for trauma informed care. It offers a description of trauma and its most commonly associated negative side effects in the school setting. Within this context, basic theoretical concepts of MI are discussed. The article closes by examining the need for future research regarding MI as an effective, school-based intervention for adolescents. PMID:26739933
Background According to World Health Organization about 75% of cardiovascular diseases and type 2 diabetes and 40% of all cases of cancer could be prevented if the risk factors tobacco use, unhealthy diets, physical inactivity and harmful use of alcohol could be eliminated. Patients often need help in monitoring themselves to make the proper lifestyle changes and it is important that adequate support is provided to enable the patients to take control over their health. Motivational interviewing is a framework that can help to facilitate this movement. The aim of this study was to describe how patients in primary health care settings experience lifestyle discussions based on motivational interviewing. Methods This study has a descriptive design and qualitative content analysis was used as the method. Sixteen patients who had each visited a registered nurse for lifestyle discussions were interviewed. Results The results show that the lifestyle discussions could enable self-determination in the process of lifestyle change but that certain conditions were required. Mutual interaction between the patient and the nurse that contributes to a sense of well-being in the patients was a necessary condition for the lifestyle discussion to be helpful. When the discussion resulted in a new way of thinking about lifestyle and when patient initiative was encouraged, the discussion could contribute to change. The patient’s free will to make a lifestyle change and the nurse’s sensitivity in the discussions created fertile soil for change. Conclusions This study focuses on MI-based discussions, and the result shows that a subset of patients, who self-reported that they are motivated and aware of their role in making lifestyle changes, appreciate these strategies. However, it is not known whether discussions would be experienced in the same way if RNs used another method or if patients who were less motivated, engaged, or aware of their role in making lifestyle changes were
González-Del-Castillo-McGrath, Mauricio; Madrigal-Orozco, Catalina; Anguiano-Flores, Laura; Amador-Licona, Norma
Objectives: To determine the effectiveness of a motivational interviewing-based educational program in reducing the number and intensity of new caries and bacterial dental plaque levels at 6 months post randomization. Study Design: A randomized and single blind clinical trial in 100 schoolchildren between 6-10 years of age presenting the highest risk score of caries according to the Caries Management by Risk Assessment (CAMBRA) criteria was performed. These patients were randomized to two groups: control (in which the mothers initially received an oral prevention informative session) and experimental (in which the mothers received the initial informative session, followed by individual motivational interviewing sessions during a period of 6 months). The International Caries Detection and Assessment System (ICDAS) scores and bacterial plaque were evaluated at baseline, at 6 and 12 months. Results: After 12 months, children in the experimental group had 2.12 ± 0.8 new caries versus 3.5 ± 0.9 in the control group (t=7.39; p<0.001). Caries in the experimental group was seen to be limited to the enamel, with a median intensity of 2 (range 0-3) versus 3 (0-6) in the control group (U=1594; p<0.0001). Bacterial plaque determined by the O’Leary index decreased in both groups; however, it decreased more in the experimental than in the control group (34.3 vs. 20.6; t=-3.12, p= 0.002) respectively. Conclusions: Motivational interviewing is better than traditional educational programs in preventing caries and decreasing bacterial plaque. Key words:Health educational, motivational interviewing, caries risk. PMID:25674320
Snape, Laura; Atkinson, Cathy
Research suggests motivational interviewing (MI) techniques can be useful in educational settings for improving motivation in disaffected pupils. This exploratory mixed methods study sought to investigate whether implementing an MI-based programme through school-based paraprofessionals would be effective in improving pupil motivation. Five pupils…
Benzo, Roberto; Vickers, Kristin; Ernst, Denise; Tucker, Sharon; McEvoy, Charlene; Lorig, Kate
BACKGROUND Self-management (SM) is proposed as the standard of care in chronic obstructive pulmonary disease (COPD) but details of the process and training required to deliver effective SM are not widely available. In addition, recent data suggest that patient engagement and motivation are critical ingredients for effective self-management. This manuscript carefully describes a self-management intervention using Motivational Interviewing skills, aimed to increase engagement and commitment in severe COPD patients. METHODS The intervention was developed and pilot tested for fidelity to protocol, for patient and interventionist feedback (qualitative) and effect on quality of life. Engagement between patient and interventionists was measured by the Working Alliance Inventory. The intervention was refined based in the results of the pilot study and delivered in the active arm of a prospective randomized study. RESULTS The pilot study suggested improvements in quality of life, fidelity to theory and patient acceptability. The refined self-management intervention was delivered 540 times in the active arm of a randomized study. We observed a retention rate of 86% (patients missing or not available for only 14% the scheduled encounters). CONCLUSIONS A self-management intervention, that includes motivational interviewing as the way if guiding patient into behavior change, is feasible in severe COPD and may increase patient engagement and commitment to self-management. This provides a very detailed description of the SM process for (the specifics of training and delivering the intervention) that facilitates replicability in other settings and could be translated to cardiac rehabilitation. PMID:23434613
Ingersoll, Karen S.; Ceperich, Sherry D.; Hettema, Jennifer E.; Farrell-Carnahan, Leah; Penberthy, J. Kim
Alcohol exposed pregnancy (AEP) is a leading cause of preventable birth defects. While randomized controlled trials (RCTs) have shown that multi-session motivational interviewing-based interventions reduce AEP risk, a one-session intervention could facilitate broader implementation. The purposes of this study were to: (1) test a one-session motivational AEP prevention intervention for community women and (2) compare outcomes to previous RCTs. Participants at risk for AEP (N=217) were randomized to motivational interviewing+assessment feedback (EARLY), informational video, or informational brochure conditions. Outcomes were drinks per drinking day (DDD), ineffective contraception rate, and AEP risk at 3 and 6 months. All interventions were associated with decreased DDD, ineffective contraception rate, and AEP risk. Participants who received EARLY had larger absolute risk reductions in ineffective contraception and AEP risk, but not DDD. Effect sizes were compared to previous RCTs. The one-session EARLY intervention had less powerful effects than multi-session AEP prevention interventions among community women, but may provide a new option in a continuum of preventive care. PMID:23192220
Dellasega, Cheryl; Añel-Tiangco, Raquel M.; Gabbay, Robert A.
Aim To determine how patients with Type 2 DM feel about a Motivational Interviewing (MI) intervention designed to promote positive behavior change. Method Qualitative study using focus groups conducted by the same facilitator. Setting Family or general internal medicine practice clinics affiliated with an academic medical center and a community general hospital. One site consisted of primarily low income Hispanic patients. Participants Four focus groups consisting of nineteen adult patients with Type 2 Diabetes Mellitus solicited from a large NIH-funded randomized controlled trial on MI and Diabetes. Results Across and within group analysis was performed on transcripts of the taped interviews. Patient perceptions of standard care were largely negative, with several individuals describing paternalistic and demeaning attitudes. Five themes related to MI emerged: Nonjudgmental Accountability, Being Heard and Responded to as a Person, Encouragement and Empowerment, Collaborative Action Planning & Goal Setting, and Coaching Rather than Critiquing. Conclusions Some patients with Type 2 Diabetes are receptive to motivational interviewing which is a provider approach that is more patient-centered and empowering than traditional care. PMID:21899911
Background Behavioral interventions such as psychotherapy are leading, evidence-based practices for a variety of problems (e.g., substance abuse), but the evaluation of provider fidelity to behavioral interventions is limited by the need for human judgment. The current study evaluated the accuracy of statistical text classification in replicating human-based judgments of provider fidelity in one specific psychotherapy—motivational interviewing (MI). Method Participants (n = 148) came from five previously conducted randomized trials and were either primary care patients at a safety-net hospital or university students. To be eligible for the original studies, participants met criteria for either problematic drug or alcohol use. All participants received a type of brief motivational interview, an evidence-based intervention for alcohol and substance use disorders. The Motivational Interviewing Skills Code is a standard measure of MI provider fidelity based on human ratings that was used to evaluate all therapy sessions. A text classification approach called a labeled topic model was used to learn associations between human-based fidelity ratings and MI session transcripts. It was then used to generate codes for new sessions. The primary comparison was the accuracy of model-based codes with human-based codes. Results Receiver operating characteristic (ROC) analyses of model-based codes showed reasonably strong sensitivity and specificity with those from human raters (range of area under ROC curve (AUC) scores: 0.62 – 0.81; average AUC: 0.72). Agreement with human raters was evaluated based on talk turns as well as code tallies for an entire session. Generated codes had higher reliability with human codes for session tallies and also varied strongly by individual code. Conclusion To scale up the evaluation of behavioral interventions, technological solutions will be required. The current study demonstrated preliminary, encouraging findings regarding the utility
Hoy, Janet; Natarajan, Aravindhan; Petra, Megan M
Motivational interviewing (MI) is a robust evidence-based intervention that has been used to evoke intrinsic motivation to change behaviors. MI as an intervention focuses on facilitating movement through the stages of the transtheoretical model of change. A study by Coombs et al. (Substance abuse treatment and the stages of change: Selecting and planning interventions, Guilford Press, New York, 2001) demonstrated that suicidal individuals move through such stages toward suicidal behavior, yet research and applications of MI for suicide have been minimal. In hopes of generating increased exploration of MI for suicidality, this article reviews the theoretical rationale and existing empirical research on applications of MI with suicidal individuals. Potential uses of MI in suicide risk assessment/crisis intervention, as well as an adjunct to longer-term treatment, are discussed. PMID:26886871
Vansteenkiste, Maarten; Sheldon, Kennon M
In this article we compare and integrate two well-established approaches to motivating therapeutic change, namely self-determination theory (SDT; Deci & Ryan, 1985, ) and motivational interviewing (MI; Miller & Rollnick, 1991, ). We show that SDT's theoretical focus on the internalization of therapeutic change and on the issue of need-satisfaction is fully compatible with key principles and clinical strategies within MI. We further suggest that basic need-satisfaction might be an important mechanism accounting for the positive effects of MI. Conversely, MI principles may provide SDT researchers with new insight into the application of SDT's theoretical concept of autonomy-support, and suggest new ways of testing and developing SDT. In short, the applied approach of MI and the theoretical approach of SDT might be fruitfully married, to the benefit of both. PMID:16480567
Hilliard, Marisa E.; Anderson, Barbara J.
Suboptimal regimen adherence among youth with type 1 diabetes (T1D) is a common challenge for patients, families, and providers. Motivational interviewing (MI) is a brief communication style designed to elicit intrinsic motivation and strengthen commitment to behavior change goals. As pediatric MI research expands, a critical review of its evidence base and applicability to promote adherence behaviors for youth with T1D is needed. This review introduces the core tenets of MI and clinical applications in T1D, synthesizes the existing MI research in T1D, and discusses the next steps in MI research. Overall, mixed results for MI interventions in T1D reflect variations in research study design and clinical implementation. Targeting adherence rather than glycemic outcomes typically demonstrates greater results, highlighting the promise of MI to facilitate meaningful and enduring improvements in youths’ T1D adherence behaviors. PMID:25142716
Friederichs, Stijn A H; Oenema, Anke; Bolman, Catherine; Guyaux, Janneke; Van Keulen, Hilde M; Lechner, Lilian
The purpose of this study was to identify which question/reflection format leads to the most favorable results in terms of effect on autonomous motivation and appreciation for the intervention in a web-based computer-tailored physical activity (PA) intervention, based on principles from self-determination theory (SDT) and motivational interviewing (MI). For this purpose, a randomized trial was conducted among 465 Dutch adults, comparing three web-based computer-tailored MI/SDT PA interventions, including (i) exclusively open-ended questions (without skillful reflections), (ii) exclusively multiple choice questions (with skillful reflections) and (iii) including both question types (with skillful reflections). Measurements included motivation-related determinants of PA and process variables, measured at baseline, directly following the intervention and 1-month post-intervention. Results suggest that open-ended questions represent an important element in web-based MI in terms of effect on autonomous motivation. In order to optimize appreciation of the intervention, a combination of both open-ended and multiple choice question types seems to hold most promise. The findings of this study suggest that both open-ended and multiple choice questions should be included in web-based computer-tailored SDT/MI PA interventions. More research is needed to reveal the optimal configuration of this novel intervention type. PMID:24101160
Stanhope, Victoria; Tennille, Julie; Bohrman, Casey; Hamovitch, Emily
To better address the needs of individuals with a range of complex health conditions, the Affordable Care Act has shifted the focus from acute care to prevention through behavior change and promoted the integration of physical and behavioral healthcare systems. Central to healthcare reform is delivering person-centered care, which means actively engaging people in their treatment decisions and managing their wellness. Motivational Interviewing (MI) is perhaps the most widely used intervention to promote behavior change. Although MI is utilized across most health disciplines, social workers are uniquely positioned to lead dissemination and on-going training efforts in this area. PMID:27191828
Letourneau, Katherine; Goodman, Janice H
Regular physical activity reduces the burden of chronic diseases in older adults, but the majority of this population is relatively sedentary. Individuals considering a change in behavior, such as increasing exercise, often experience a mental state of ambivalence, which can lead to inaction. Ambivalence is resistant to traditional counseling methods used in medical settings, such as patient education. Motivational interviewing (MI) is a conversational style that has been shown to help overcome ambivalence by guiding patients to voice their personal reasons for change. Nurse practitioners are uniquely positioned to use MI with older adults to address ambivalence toward increasing physical activity. PMID:25199152
Background Wikipedia is one of the most accessed sources of health information online. The current English-language Wikipedia contains more than 28,000 articles pertaining to health. Objective The aim was to characterize individuals’ motivations for contributing to health content on the English-language Wikipedia. Methods A set of health-related articles were randomly selected and recent contributors invited to complete an online questionnaire and follow-up interview (by Skype, by email, or face-to-face). Interviews were transcribed and analyzed using thematic analysis and a realist grounded theory approach. Results A total of 32 Wikipedians (31 men) completed the questionnaire and 17 were interviewed. Those completing the questionnaire had a mean age of 39 (range 12-59) years; 16 had a postgraduate qualification, 10 had or were currently studying for an undergraduate qualification, 3 had no more than secondary education, and 3 were still in secondary education. In all, 15 were currently working in a health-related field (primarily clinicians). The median period for which they have been an active editing Wikipedia was 3-5 years. Of this group, 12 were in the United States, 6 were in the United Kingdom, 4 were in Canada, and the remainder from another 8 countries. Two-thirds spoke more than 1 language and 90% (29/32) were also active contributors in domains other than health. Wikipedians in this study were identified as health professionals, professionals with specific health interests, students, and individuals with health problems. Based on the interviews, their motivations for editing health-related content were summarized in 5 strongly interrelated categories: education (learning about subjects by editing articles), help (wanting to improve and maintain Wikipedia), responsibility (responsibility, often a professional responsibility, to provide good quality health information to readers), fulfillment (editing Wikipedia as a fun, relaxing, engaging, and
D’Amico, Elizabeth J.; Houck, Jon M.; Hunter, Sarah B.; Miles, Jeremy N.V.; Osilla, Karen Chan; Ewing, Brett A.
Objective Little is known about what may distinguish effective and ineffective group interventions. Group motivational interviewing (MI) is a promising intervention for adolescent alcohol and other drug (AOD) use; however, the mechanisms of change for group MI are unknown. One potential mechanism is change talk, which is client speech arguing for change. The present study describes the group process in adolescent group MI and effects of group-level change talk on individual alcohol and marijuana outcomes. Method We analyzed 129 group session audio recordings from a randomized clinical trial of adolescent group MI. Sequential coding was performed using the Motivational Interviewing Skill Code (MISC) and the CASAA Application for Coding Treatment Interactions (CACTI) software application. Outcomes included past-month intentions, frequency, and consequences of alcohol and marijuana use, motivation to change, and positive expectancies. Results Sequential analysis indicated that facilitator open-ended questions and reflections of change talk (CT) increased group CT. Group CT was then followed by more CT. Multilevel models accounting for rolling group enrollment revealed group CT was associated with decreased alcohol intentions, alcohol use and heavy drinking three months later; group sustain talk was associated with decreased motivation to change, increased intentions to use marijuana, and increased positive alcohol and marijuana expectancies. Conclusions Facilitator speech and peer responses each had effects on change and sustain talk in the group setting, which was then associated with individual changes. Selective reflection of CT in adolescent group MI is suggested as a strategy to manage group dynamics and increase behavioral change. PMID:25365779
Turner, Rick; And Others
In a series of interviews, Rick Turner, Dean Smith, Jack and Barbara Nicklaus, and Orel Hershiser discuss their experiences in school athletics, the relationship between athletics and academic education, and the role of athletics in the process of learning about life. (BC)
Klonek, Florian E; Güntner, Amelie V; Lehmann-Willenbrock, Nale; Kauffeld, Simone
Human behavior contributes to a waste of environmental resources and our society is looking for ways to reduce this problem. However, humans may perceive feedback about their environmental behavior as threatening. According to self-determination theory (SDT), threats decrease intrinsic motivation for behavior change. According to self-affirmation theory (SAT), threats can harm individuals' self-integrity. Therefore, individuals should show self-defensive biases, e.g., in terms of presenting counter-arguments when presented with environmental behavior change. The current study examines how change recipients respond to threats from change agents in interactions about environmental behavior change. Moreover, we investigate how Motivational Interviewing (MI) - an intervention aimed at increasing intrinsic motivation - can reduce threats at both the social and cognitive level. We videotaped 68 dyadic interactions with change agents who either did or did not use MI (control group). We coded agents verbal threats and recipients' verbal expressions of motivation. Recipients also rated agents' level of confrontation and empathy (i.e., cognitive reactions). As hypothesized, threats were significantly lower when change agents used MI. Perceived confrontations converged with observable social behavior of change agents in both groups. Moreover, behavioral threats showed a negative association with change recipients' expressed motivation (i.e., reasons to change). Contrary to our expectations, we found no relation between change agents' verbal threats and change recipients' verbally expressed self-defenses (i.e., sustain talk). Our results imply that MI reduces the adverse impact of threats in conversations about environmental behavior change on both the social and cognitive level. We discuss theoretical implications of our study in the context of SAT and SDT and suggest practical implications for environmental change agents in organizations. PMID:26257676
Klonek, Florian E.; Güntner, Amelie V.; Lehmann-Willenbrock, Nale; Kauffeld, Simone
Human behavior contributes to a waste of environmental resources and our society is looking for ways to reduce this problem. However, humans may perceive feedback about their environmental behavior as threatening. According to self-determination theory (SDT), threats decrease intrinsic motivation for behavior change. According to self-affirmation theory (SAT), threats can harm individuals’ self-integrity. Therefore, individuals should show self-defensive biases, e.g., in terms of presenting counter-arguments when presented with environmental behavior change. The current study examines how change recipients respond to threats from change agents in interactions about environmental behavior change. Moreover, we investigate how Motivational Interviewing (MI) — an intervention aimed at increasing intrinsic motivation — can reduce threats at both the social and cognitive level. We videotaped 68 dyadic interactions with change agents who either did or did not use MI (control group). We coded agents verbal threats and recipients’ verbal expressions of motivation. Recipients also rated agents’ level of confrontation and empathy (i.e., cognitive reactions). As hypothesized, threats were significantly lower when change agents used MI. Perceived confrontations converged with observable social behavior of change agents in both groups. Moreover, behavioral threats showed a negative association with change recipients’ expressed motivation (i.e., reasons to change). Contrary to our expectations, we found no relation between change agents’ verbal threats and change recipients’ verbally expressed self-defenses (i.e., sustain talk). Our results imply that MI reduces the adverse impact of threats in conversations about environmental behavior change on both the social and cognitive level. We discuss theoretical implications of our study in the context of SAT and SDT and suggest practical implications for environmental change agents in organizations. PMID:26257676
Martino, Steve; Paris, Manuel; Añez, Luis; Nich, Charla; Canning-Ball, Monica; Hunkele, Karen; Olmstead, Todd A; Carroll, Kathleen M
The effectiveness of a competency-based supervision approach called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA: STEP) was compared to supervision-as-usual (SAU) for increasing clinicians' motivational interviewing (MI) adherence and competence and client retention and primary substance abstinence in a multisite hybrid type 2 effectiveness-implementation randomized controlled trial. Participants were 66 clinicians and 450 clients within one of eleven outpatient substance abuse programs. An independent evaluation of audio recorded supervision sessions indicated that MIA: STEP and SAU were highly and comparably discriminable across sites. While clinicians in both supervision conditions improved their MI performance, clinician supervised with MIA: STEP, compared to those in SAU, showed significantly greater increases in the competency in which they used fundamental and advanced MI strategies when using MI across seven intakes through a 16-week follow-up. There were no retention or substance use differences among the clients seen by clinicians in MIA: STEP or SAU. MIA: STEP was substantially more expensive to deliver than SAU. Innovative alternatives to resource-intensive competency-based supervision approaches such as MIA: STEP are needed to promote the implementation of evidence-based practices. PMID:27431042
Harris, Kari Jo; Catley, Delwyn; Good, Glenn E.; Cronk, Nikole J.; Harrar, Solomon; Williams, Karen B.
Objective To examine the efficacy of four individually-delivered Motivational Interviewing counseling sessions for smoking cessation versus a matched intensity comparison condition. Method From 2006–2009, students attending college in the Midwest smoking at least 1 of 30 days were recruited regardless of their interest in quitting. 30 fraternities and sororities were randomized, resulting in 452 participants. Results No significant differences were found for 30-day cessation between treatment and comparison at end of treatment (31.4% vs 28%, OR=1.20, 95% CI .72,1.99) or at follow-up (20.4% vs 24.6%, OR=.78, 95% CI .50,1.22). Predictors of cessation at follow-up, regardless of condition, included more sessions attended (OR 1.2, 95% CI 1.1,1.8) and more cigarettes smoked in 30 days at baseline (OR 4.7, 95% CI 2.5,8.9). The odds of making at least one quit attempt were significantly greater for those in the smoking group at end of treatment (OR 1.75, 95% CI 1.11,2.74) and follow-up (OR 1.66, 95% CI 1.11,2.47). Modeling showed reduction in days smoked for both groups. At end of treatment, more frequent smokers in the treatment condition had greater reductions in days smoked. Conclusion Motivational Interviewing for smoking cessation is effective for increasing cessation attempts and reducing days smoked in the short run. PMID:20828584
Cryer, Sarah; Atkinson, Cathy
Research suggests motivational interviewing (MI) techniques are both widely-used by educational psychologists (EPs) and effective in supporting young people of secondary age. To date, there has been no published research investigating the use of MI with primary-aged children. This study details the use of a short MI-based intervention with a primary-aged pupil identified as disengaged. A case-based approach was employed, using pupil and teacher interviews and observational fieldnotes to assess the usefulness of the intervention. Data were analysed using thematic analysis and the intervention checked for adherence to the MI spirit and principles. Here the process, structure and outcomes of the intervention are exemplified through an illustrative case study with a nine-year-old boy. Results indicate that the adapted intervention had a significant impact on learning motivation and classroom behaviour. The implications of the findings are discussed in relation to the use of school-based therapeutic interventions by EPs. PMID:26339113
Laws, M. Barton; Rose, Gary S.; Beach, Mary Catherine; Lee, Yoojin; Rogers, William S.; Velasco, Alyssa Bianca; Wilson, Ira B.
Objective Motivational Interviewing (MI) consistent talk by a counselor is thought to produce “change talk” in clients. However, it is possible that client resistance to behavior change can produce MI inconsistent counselor behavior. Methods We applied a coding scheme which identifies all of the behavioral counseling about a given issue during a visit (“episodes”), assesses patient concordance with the behavioral goal, and labels providers’ counseling style as facilitative or directive, to a corpus of routine outpatient visits by people with HIV. Using a different data set of comparable encounters, we applied the concepts of episode and concordance, and coded using the Motivational Interviewing Treatment Integrity system. Results Patient concordance/discordance was not observed to change during any episode. Provider directiveness was strongly associated with patient discordance in the first study, and MI inconsistency was strongly associated with discordance in the second. Conclusion Observations that MI-consistent behavior by medical providers is associated with patient change talk or outcomes should be evaluated cautiously, as patient resistance may provoke MI-inconsistency. Practice Implications Counseling episodes in routine medical visits are typically too brief for client talk to evolve toward change. Providers with limited training may have particular difficulty maintaining MI consistency with resistant clients. PMID:25791372
Simon, Patricia; Ward, Nadia L.
This study examined training outcomes for lay service providers who participated in a motivational interviewing (MI) training program designed to help increase intrinsic motivation and academic achievement among urban, low-income minority youth. Seventeen lay academic advisors received 16 hours of workshop training in MI. Additionally, two 2-hour…
Terry, John; Strait, Gill; McQuillin, Sam; Smith, Bradley H.
Motivational interviewing (MI) is a brief client-centred intervention that increases intrinsic motivation for change. Little research has been conducted on MI to promote academic behaviours, but two studies found that one session of MI did improve middle-school students' math grades [Strait, G., Smith, B., McQuillin, S., Terry, J., Swan, S., &…
Polcin, Douglas L.; Evans, Kristy; Bond, Jason C.; Galloway, Gantt P.
Motivational interviewing (MI) for the treatment of alcohol and drug problems is typically conducted over 1 to 3 sessions. The current work evaluates an intensive 9-session version of MI (Intensive MI) compared to a standard single MI session (Standard MI) using 163 methamphetamine (MA) dependent individuals. The primary purpose of this paper is to report the unexpected finding that women with co-occurring alcohol problems in the Intensive MI condition reduced the severity of their alcohol problems significantly more than women in the Standard MI condition at the 6-month follow-up. Stronger perceived alliance with the therapist was inversely associated with alcohol problem severity scores. Findings indicate that Intensive MI is a beneficial treatment for alcohol problems among women with MA dependence. PMID:24074649
Moyers, Theresa B.; Martin, Tim; Houck, Jon M.; Christopher, Paulette J.; Tonigan, J. Scott
Client speech in favor of change within motivational interviewing (MI) sessions has been linked to treatment outcomes, but a causal chain has not yet been demonstrated. Using a sequential behavioral coding system for client speech (SCOPE) this study found that, at both the session level and utterance level, specific therapist behaviors predict client change talk. Further, a direct link from change talk to drinking outcomes was observed, and support was found for a mediational role for change talk between therapist behavior and client drinking outcomes. These data provide preliminary support for the proposed causal chain indicating that client speech within treatment sessions can be influenced by therapists, who can employ this influence to improve outcomes. Selective eliciting and reinforcement of change talk is proposed as a specific active ingredient of MI. PMID:19968387
Ertem, Melike; Duman, Zekiye Çetinkaya
Medication nonadherence decreases the success of clinical treatment and the efficient use of resources, thereby creating a barrier to effective health care. In this report, we describe the achievement of treatment collaboration through motivational interviews (MI) in a patient with treatment-resistant schizophrenia. In this case study, we conducted six MIs during which we asked open-ended and reflective questions, established empathy with the patient, and developed discrepancies, leading to ambivalent feelings being revealed. We used the importance, confidence and self-efficacy ruler. The MI method can be used to ensure continued treatment effectiveness, to increase patient awareness about the disease and benefits of treatment, and to increase patients' self-efficacy. PMID:26992863
Davis, Jordan P; Houck, Jon M; Rowell, Lauren N; Benson, Jennifer G; Smith, Douglas C
Few studies have investigated the impact of adolescent change language on substance use treatment outcomes and even fewer have examined how adolescents respond to normative feedback. The purpose of this study was to understand the influence normative feedback has on adolescent change language and subsequent alcohol and cannabis use 3months later. We examined how percent change talk (PCT) was associated with subsequent alcohol and drug use outcomes. Adolescents (N=48) were randomly assigned to receive brief motivational interviewing (MI) or MI plus normative feedback (NF). Audio recordings were coded with high interrater reliability. Adolescents with high PCT who received MI+NF had significantly fewer days of alcohol and binge drinking at follow up. There were no differences between groups on cannabis use or treatment engagement. Findings indicate that NF may be useful for adolescents with higher amount of change talk during sessions and may be detrimental for individuals with higher sustain talk. PMID:26710670
Brown, Richard A; Abrantes, Ana M; Minami, Haruka; Prince, Mark A; Bloom, Erika Litvin; Apodaca, Timothy R; Strong, David R; Picotte, Dawn M; Monti, Peter M; MacPherson, Laura; Matsko, Stephen V; Hunt, Jeffrey I
Substance use among adolescents with one or more psychiatric disorders is a significant public health concern. In this study, 151 psychiatrically hospitalized adolescents, ages 13-17 with comorbid psychiatric and substance use disorders, were randomized to a two-session Motivational Interviewing intervention to reduce substance use plus treatment as usual (MI) vs. treatment as usual only (TAU). Results indicated that the MI group had a longer latency to first use of any substance following hospital discharge relative to TAU (36 days versus 11 days). Adolescents who received MI also reported less total use of substances and less use of marijuana during the first 6 months post-discharge, although this effect was not significant across 12 months. Finally, MI was associated with a significant reduction in rule-breaking behaviors at 6-month follow-up. Future directions are discussed, including means of extending effects beyond 6 months and dissemination of the intervention to community-based settings. PMID:26362000
Smith, Jennifer L.; Carpenter, Kenneth M.; Amrhein, Paul C.; Brooks, Adam C.; Levin, Deborah; Schreiber, Elizabeth A.; Travaglini, Laura A.; Hu, Mei-Chen; Nunes, Edward V.
Background Training through traditional workshops is relatively ineffective for changing counseling practices. Tele-conferencing Supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). Method 97 community drug treatment counselors completed a 2-day MI workshop and were randomized to: live supervision via tele-conferencing (TCS; n=32), standard tape-based supervision (Tape; n=32), or workshop alone (Workshop; n=33). Supervision conditions received 5 weekly supervision sessions at their sites using actors as standard patients. Sessions with clients were rated for MI skill with the Motivational Interviewing Treatment Integrity (MITI) coding system pre-workshop and 1, 8, and 20 weeks post-workshop. Mixed effects linear models were used to test training condition on MI skill at 8 and 20 weeks. Results TCS scored better than Workshop on the MITI for Spirit (mean difference = 0.76; p < .0001; d = 1.01) and Empathy (mean difference = 0.68; p < .001; d = 0.74). Tape supervision fell between TCS and Workshop, with Tape superior to Workshop for Spirit (mean difference = 0.40; p < .05). TCS was superior to Workshop in reducing MI non-adherence and increasing MI adherence, and was superior to Workshp and Tape in increasing the reflection to question ratio. Tape was superior to TCS in increasing complex reflections. Percentage of counselors meeting proficiency differed significantly between training conditions for the most stringent threshold (Spirit and Empathy scores ≥ 6), and were modest, ranging from 13% to 67%, for TCS and Tape. Conclusion TCS shows promise for promoting new counseling behaviors following participation in workshop training. However, further work is needed to improve supervision methods in order to bring more clinicians to high levels of proficiency and facilitate the dissemination of evidence-based practices. PMID:22506795
Lord, Sarah Peregrine; Sheng, Elisa; Imel, Zac E; Baer, John; Atkins, David C
Empathy is a basic psychological process that involves the development of synchrony in dyads. It is also a foundational ingredient in specific, evidence-based behavioral treatments like motivational interviewing (MI). Ratings of therapist empathy typically rely on a gestalt, "felt sense" of therapist understanding and the presence of specific verbal behaviors like reflective listening. These ratings do not provide a direct test of psychological processes like behavioral synchrony that are theorized to be an important component of empathy in psychotherapy. To explore a new objective indicator of empathy, we hypothesized that synchrony in language style (i.e., matching how statements are phrased) between client and therapists would predict gestalt ratings of empathy over and above the contribution of reflections. We analyzed 122 MI transcripts with high and low empathy ratings based on the Motivational Interviewing Treatment Integrity global rating scale. Linguistic inquiry and word count was used to estimate language style synchrony (LSS) of adjacent client and therapist talk turns. High-empathy sessions showed greater LSS across 11 language style categories compared with low-empathy sessions (p<.01), and overall, average LSS was notably higher in high-empathy versus low-empathy sessions (d=0.62). Regression analyses showed that LSS was predictive of empathy ratings over and above reflection counts; a 1 SD increase in LSS is associated with a 2.4 times increase in the odds of a high-empathy rating, controlling for therapist reflections (odds ratio=2.4; 95% CI: 1.36; 4.24, p<.01). These findings suggest empathy ratings are related to synchrony in language style, over and above synchrony of content as measured by therapist reflections. Novel indicators of therapist empathy may have implications for the study of MI process as well as the training of therapists. PMID:25892166
Stein, L. A. R.; Lebeau, Rebecca; Colby, Suzanne M.; Barnett, Nancy P.; Golembeske, Charles; Monti, Peter M.
Objective: Motivational interviewing to reduce alcohol and marijuana use among incarcerated adolescents was evaluated. Method: Adolescents (N = 162, 84% male; M = 17.10 years old) were randomly assigned to receive motivational interviewing or relaxation training, with follow-up assessment 3 months after release. Results: Compared with those who received relaxation training, adolescents who received motivational interviewing had lower rates of alcohol and marijuana use at follow-up, with some evidence for moderating effects of depression. At low levels of depression, adolescents who received motivational interviewing had lower rates of use. Adolescents who received relaxation training and who had high levels of depressive symptoms early in incarceration showed less use at follow-up than those low in depressive symptoms who received relaxation training. Conclusions: This brief motivational interviewing intervention during incarceration reduces alcohol and marijuana use after release. In addition, depressive symptoms early in incarceration should be considered in treating these adolescents, but more work is needed to extend follow-up period and account for the impact of depression on outcomes. PMID:21513687
Gibbons, Carly J.; Carroll, Kathleen M.; Ball, Samuel A.; Nich, Charla; Frankforter, Tami L.; Martino, Steve
Background Teaching community program therapists to use motivational interviewing (MI) strategies for addictions treatment with sufficient frequency (i.e., adherence) and skill (i.e., competence) is a priority and challenge for the field. The development of psychometrically valid MI integrity measures that can be used for supervision and evaluation and be both sensitive and robust across clinical situations is needed. Objective This article examines the performance of the Independent Tape Rating Scale (ITRS) (1) when used to evaluate the delivery of MI within a one-session assessment intake (2). Methods Audiotapes of 315 sessions of therapists in MI and counseling-as-usual conditions were rated according to the ITRS by raters blind to treatment condition. Results Results indicate that community therapists were successfully trained and supervised to use MI within an assessment intake session, with MI adherence and competence that was discriminable from counseling-as-usual practices. Increased therapist MI adherence and competence was associated with increases in an index of client motivation for change, though unrelated to treatment outcome. Conclusions and Scientific Significance The ITRS appears to be a valid instrument for measuring therapist MI adherence and competence within an assessment intake. PMID:20942726
Clair-Michaud, Mary; Martin, Rosemarie A; Stein, Linda A R; Bassett, Shayna; Lebeau, Rebecca; Golembeske, Charles
The impact of Motivational Interviewing (MI) on risky behaviors of incarcerated adolescents and adults has been investigated with promising results. Findings suggest that MI reduces substance use, improves motivation and confidence to reduce use, and decreases risky behaviors. The current study investigated the impact of MI on general, alcohol-related, and marijuana-related delinquent behaviors in incarcerated adolescents. Participants in the study were incarcerated adolescents in a state correctional facility in the Northeast region and were assessed as part of a larger randomized clinical trial. Adolescents were randomly assigned to receive MI or relaxation therapy (RT) (N=189) treatment. Delinquent behaviors and depressive symptomatology were measured using the Delinquent Activities Scale (DAS; Reavy, Stein, Paiva, Quina, & Rossi, 2012) and the Center for Epidemiological Studies-Depression scale (CES-D; Radloff, 1991) respectively. Findings indicate that depression moderated treatment effects. Compared to RT, MI was better at reducing predatory aggression and alcohol-related predatory aggression 3 months post-release when depressive symptoms were low. Identifying an efficacious treatment for these adolescents may benefit society in that it may decrease crimes against persons (i.e., predatory aggression) post release. PMID:26517954
Decker, Suzanne E.; Carroll, Kathleen M.; Nich, Charla; Canning-Ball, Monica; Martino, Steve
Treatment integrity ratings (adherence and competence) are frequently used as outcome measures in clinician training studies, drawn from recorded real client or role-played client sessions. However, it is unknown whether clinician adherence and competence are similar in real client and role-played sessions or whether real and role-play clients provide similar opportunities for skill demonstration. This study examined the correspondence of treatment adherence and competence ratings obtained in real client and role-played sessions for 91 clinicians trained in Motivational Interviewing (MI), using data from a multi-site trial examining three methods of clinician training (Martino et al., 2011). Results indicated overall poor integrity rating correspondence across the two session types, as indicated by weak correlations (r = .05–.27). Clinicians were rated significantly more MI adherent overall and specifically used more advanced MI strategies in role-played than real client sessions at several assessment time points (d = 0.36, 0.42). Real clients, in comparison to the role-play actor, demonstrated greater motivation at the beginning of the session (d = 1.09), discussion of unrelated topics (d = 0.70), and alliance with the clinician (d = 0.72). These findings suggest that MI integrity rating data obtained from real client and role-played sessions may not be interchangeable. More research is needed to improve the procedures and psychometric strength of treatment integrity assessment based on role-played sessions. PMID:23205626
Bricker, J.B.; Tollison, S.J.
Background Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) are two emerging therapies that focus on commitment to behavior change. Aim Provide the first systematic comparison of MI with ACT. Methods A systematic comparison of MI and ACT at the conceptual level, with a focus on their philosophical and theoretical bases, and at the clinical level, with a focus on the therapeutic relationship, use of language in therapy, and use of values in therapy. Results Conceptually, MI & ACT have distinct philosophical bases. MI’s theoretical basis focuses on language content, whereas ACT’s theoretical basis focuses on language process. Clinically, ACT and MI have distinct approaches to the therapeutic relationship, fundamentally different foci on client language, and different uses of client values to motivate behavior change. ACT, but not MI, directly targets the willingness to experience thoughts, feelings, and sensations. Conclusions Despite their conceptual and clinical differences, MI and ACT are complementary interventions. Collaborations between MI and ACT researchers may yield fruitful cross-fertilization research on core processes and clinical outcomes. PMID:21338532
Interian, Alejandro; Martinez, Igda; Rios, Lisbeth Iglesias; Krejci, Jonathan; Guarnaccia, Peter J.
Poor antidepressant adherence is a significant issue in depression treatment that adversely affects treatment outcomes. While being a common problem, it tends to be more common among Latinos. To address this problem, the current study adapted a Motivational Interviewing (MI) intervention to improve adherence among Latinos with depression. The adaptation process included six focus groups that elicited participants’ perspectives (N = 30), applying the intervention with test cases (N = 7) to fine tune the intervention, and eliciting feedback on the intervention (N = 5). The findings generated from these adaptation phases are described, along with a case example. Examples of adaptations to the MI included reframing antidepressant adherence as a way to luchar (struggle) against problems, focusing on motivation for improving depression and not just medication, refining methods for imparting antidepressant information, and inclusion of personalized visual feedback on dose-taking. The findings provide a description of the antidepressant issues experienced by a group of Latinos, as well as considerations for applying MI with this population. The intervention remained grounded in MI principles, but was contextualized for this Latino group. PMID:20438160
Ruzek, Erik A.; Domina, Thurston; Conley, AnneMarie M.; Duncan, Greg J.; Karabenick, Stuart A.
Value-added (VA) models measure teacher contributions to student learning and are increasingly employed in educational reform efforts. Using data from 35 seventh-grade teachers and 2,026 students across seven schools, we employ VA methods to measure teacher contributions to students' motivational orientations (mastery and performance achievement…
Benzo, Roberto P
There is no conclusive evidence about the way to a promote behavior change in self-management programs for patients with chronic obstructive pulmonary disease (COPD). The latter is a significant knowledge gap as there is a need to promote a sustained effect in interventions like Pulmonary Rehabilitation or Supporting Programs. Embracing patient's values seems to be a key ingredient to ignite genuine motivation for behavior change. This manuscript describes two pilot qualitative studies carried out in patients with severe COPD aimed to engage the patient inner experience and promote self-management: a trial testing motivational interviewing (MI) as one style of helping patients with severe COPD make changes in their behavior and second a trial testing a mindfulness-based intervention. The MI study consisted of a 3-month program of weekly coaching phone calls after one face-to-face visit. The following themes were outstanding: patients value the supportive communication with coach and believe the MI-based coaching created increased level of awareness and accountability. They perceived an increase in physical activity and reported "feeling better" or other benefits not directly related to exercise. The Mindfulness for Health Program was a mandatory 8-week program that consisted on 2-hour classes aimed to cultivate nonjudgmental attention in the moment (through different meditative practices and sharing) plus monthly face-to-face encounters aimed to sustain practice and sharing of life experiences for 1 year. The following themes (at 1 year) were outstanding: appreciating life by seeing hardships as opportunities, valuing the self through compassion and awareness, cultivating connectedness with others, acquiring joy, and adopting healthy behaviors. In the search for the "holy grail" for self-management programs that can promote a behavior change, mindfulness and MI seem promising for cultivating a way to live a life in which people are fully present and consciously
Teeter, Benjamin S; Kavookjian, Jan
Adherence to prescribed medications continues to be a problem in the treatment of chronic disease. Motivational interviewing (MI) has been shown to be successful for eliciting patients' motivations to change their medication-taking behaviors. Due to the constraints of the US healthcare system, patients do not always have in-person access to providers. Because of this, there is increasing use of non-traditional healthcare delivery methods such as telephonic counseling. A systematic review was conducted among published studies of telephone-based MI interventions aimed at improving the health behavior change target of medication adherence. The goals of this review were to (1) examine and describe evidence and gaps in the literature for telephonically delivered MI interventions for medication adherence and (2) discuss the implications of the findings for research and practice. The MEDLINE, CINAHL, psycINFO, psycARTICLES, Academic Search Premier, Alt HealthWatch, Health Source: Consumer Edition, and Health Source: Nursing/Academic Edition databases were searched for peer-reviewed research publications between 1991 and October 2012. A total of nine articles were retained for review. The quality of the studies and the interventions varied significantly, which precluded making definitive conclusions but findings among a majority of retained studies suggest that telephone-based MI may help improve medication adherence. The included studies provided promising results and justification for continued exploration in the provision of MI via telephone encounters. Future research is needed to address gaps in the current literature but the results suggest that MI may be an efficient option for healthcare professionals seeking an evidence-based method to reach remote or inaccessible patients to help them improve their medication adherence. PMID:25584086
DiLillo, Vicki; Ingle, Krista; Harvey, Jean Ruth; West, Delia Smith
Background While Internet-based weight management programs can facilitate access to and engagement in evidence-based lifestyle weight loss programs, the results have generally not been as effective as in-person programs. Furthermore, motivational interviewing (MI) has shown promise as a technique for enhancing weight loss outcomes within face-to-face programs. Objective This paper describes the design, intervention development, and analysis of a therapist-delivered online MI intervention for weight loss in the context of an online weight loss program. Methods The MI intervention is delivered within the context of a randomized controlled trial examining the efficacy of an 18-month, group-based, online behavioral weight control program plus individually administered, synchronous online MI sessions relative to the group-based program alone. Six individual 30-minute MI sessions are conducted in private chat rooms over 18 months by doctoral-level psychologists. Sessions use a semistructured interview format for content and session flow and incorporate core MI components (eg, collaborative agenda setting, open-ended questions, reflective listening and summary statements, objective data, and a focus on evoking and amplifying change talk). Results The project was funded in 2010 and enrollment was completed in 2012. Data analysis is currently under way and the first results are expected in 2016. Conclusions This is the first trial to test the efficacy of a synchronous online, one-on-one MI intervention designed to augment an online group behavioral weight loss program. If the addition of MI sessions proves to be successful, this intervention could be disseminated to enhance other distance-based weight loss interventions. Trial Registration Clinicaltrials.gov NCT01232699; https://clinicaltrials.gov/ct2/show/NCT01232699 PMID:27095604
Krummenacher, Isabelle; Cavassini, Matthias; Bugnon, Olivier; Schneider, Marie P
To ensure successful treatment, HIV patients must maintain a high degree of medication adherence over time. Since August 2004, patients who are (or are at risk of) experiencing problems with their HIV antiretroviral therapy (ART) have been referred by their physicians to an interdisciplinary HIV-adherence program. The program consists of a multifactorial intervention along with electronic drug monitoring (MEMS(TM)). The pharmacists organize individualized semi-structured motivational interviews based on cognitive, emotional, behavioral, and social issues. At the end of each session, the patient brings an adherence report to the physician. This enables the physician to use the adherence results to evaluate the treatment plan. The aim of this study was to retrospectively analyze this on-going interdisciplinary HIV-adherence program. All patients who were included between August 2004 and the end of April 2008 were analyzed. One hundred and four patients were included (59% women, median age 39 (31.0, 46.0) years, 42% black ethnicity). Eighty (77%) patients were ART-experienced patients and 59% had a protease inhibitor-based treatment. The retention rate was high (92%) in the program. Patient inclusion in this HIV-adherence program was determined by patient issues for naive patients and by nonadherence or suboptimal clinical outcomes for ART-experienced patients. The median time spent by a subject at the pharmacy was 35 (25.0, 48.0) minutes, half for the medication handling and half for the interview. The adherence results showed a persistence of 87% and an execution of 88%. Proportion of undetectable subjects increased during study. In conclusion, retention and persistence rates were high in this highly selected problematic population. PMID:21271406
Background Lifestyle is one of the main determinants of people’s health. It is essential to find the most effective prevention strategies to be used to encourage behavioral changes in their patients. Many theories are available that explain change or adherence to specific health behaviors in subjects. In this sense the named Motivational Interviewing has increasingly gained relevance. Few well-validated instruments are available for measuring doctors’ communication skills, and more specifically the Motivational Interviewing. Methods/Design The hypothesis of this study is that the Scale for Measuring Motivational Interviewing Skills (EVEM questionnaire) is a valid and reliable instrument for measuring the primary care professionals skills to get behavior change in patients. To test the hypothesis we have designed a prospective, observational, multi-center study to validate a measuring instrument. –Scope: Thirty-two primary care centers in Spain. -Sampling and Size: a) face and consensual validity: A group composed of 15 experts in Motivational Interviewing. b) Assessment of the psychometric properties of the scale; 50 physician- patient encounters will be videoed; a total of 162 interviews will be conducted with six standardized patients, and another 200 interviews will be conducted with 50 real patients (n=362). Four physicians will be specially trained to assess 30 interviews randomly selected to test the scale reproducibility. -Measurements for to test the hypothesis: a) Face validity: development of a draft questionnaire based on a theoretical model, by using Delphi-type methodology with experts. b) Scale psychometric properties: intraobservers will evaluate video recorded interviews: content-scalability validity (Exploratory Factor Analysis), internal consistency (Cronbach alpha), intra-/inter-observer reliability (Kappa index, intraclass correlation coefficient, Bland & Altman methodology), generalizability, construct validity and sensitivity to change
Dray, J; Gilchrist, P; Singh, D; Cheesman, G; Wade, T D
This study examined whether: (1) brief training in motivational interviewing (MI) can prepare mental health nurses (MHNs) to provide MI to patients; and (2) this MI impacts on patients with respect to premature discharge. Six MHNs on an inpatient eating disorder unit were trained in MI, and their treatment adherence and competence were evaluated at post-training and 2-month follow-up. Premature discharge was examined by comparing a 3-month period in 2009 before MI administration with 2010 when MI was being administered. MHNs significantly improved their MI adherence and competence. Satisfaction with the training was high as was patient satisfaction with MI. Premature discharge rates significantly decreased. Brief training in MI is sufficient to significantly increase competency and adherence in the practice of MI by MHNs, which may in turn be effective in improving patients' treatment adherence by reducing premature discharge rates. Future research will need to utilize a randomized controlled design in order to further investigate these findings. PMID:24842409
Klonek, Florian E; Kauffeld, Simone
Reduction of energy costs has become a concern for many organizations. First, we review energy-saving studies in organizations in which consumers showed resistance to change their behavior. Second, we relate resistance to change to the psycholinguistic construct "sustain talk" that describes verbal arguments against behavior change (e.g., "Work processes have priority here"). Third, we argue how Motivational Interviewing (MI)-an interaction-approach to facilitate behavior change-might be helpful in dealing with this behavior. We transfer MI to interactions about energy-savings in organizations and demonstrate how qualification in MI for energy managers may affect these interactions. Therefore, we present three short case scenarios (i.e., video vignettes) that demonstrate socio-interactional mechanisms underlying energy-relevant decisions and behaviors. Consumer' verbal responses are graphed as one single time-variant index of readiness versus resistance (R-index) in order to illustrate interactional dynamics. In sum, we combine theoretical and empirical perspectives from multiple disciplines and discuss an innovative socio-interaction approach that may facilitate energy-efficient behavior in organizations. PMID:25821440
Dellasega, Cheryl; Gabbay, Robert; Durdock, Kendra; Martinez-King, Nancy
Aims This paper evaluates a novel nursing intervention designed to improve physical and psychological outcomes for adult patients with Type 2 DM. Background Self care behaviors are an important component of diabetes treatment, yet for many reasons, patients do not adhere to suggested plans. Motivational Interviewing (MI) is a patient centered strategy that helps overcome ambivalence to change. Nurses, who frequently educate patients with diabetes about self care, can use MI as a way to improve health behaviors. Methods As a component of a large RCT, focus groups were used to evaluate the impact of an MI nursing intervention. Nineteen patients (8% of treatment group) participated in four different groups. IPA was used to explore patient response to the intervention. Results/Findings Patients were able to reflect on and identify responses to sessions with the study nurses that differed from “typical” health care provider visits. Many of their descriptions captured the essence of MI practice. Conclusion MI is a viable and useful technique for nurses to use in educating and caring for persons with Type 2 DM. PMID:24817822
Klonek, Florian E.; Kauffeld, Simone
Reduction of energy costs has become a concern for many organizations. First, we review energy-saving studies in organizations in which consumers showed resistance to change their behavior. Second, we relate resistance to change to the psycholinguistic construct “sustain talk” that describes verbal arguments against behavior change (e.g., “Work processes have priority here”). Third, we argue how Motivational Interviewing (MI)—an interaction-approach to facilitate behavior change—might be helpful in dealing with this behavior. We transfer MI to interactions about energy-savings in organizations and demonstrate how qualification in MI for energy managers may affect these interactions. Therefore, we present three short case scenarios (i.e., video vignettes) that demonstrate socio-interactional mechanisms underlying energy-relevant decisions and behaviors. Consumer' verbal responses are graphed as one single time-variant index of readiness versus resistance (R-index) in order to illustrate interactional dynamics. In sum, we combine theoretical and empirical perspectives from multiple disciplines and discuss an innovative socio-interaction approach that may facilitate energy-efficient behavior in organizations. PMID:25821440
Cascaes, Andreia Morales; Bielemann, Renata Moraes; Clark, Valerie Lyn; Barros, Aluísio J D
OBJECTIVE To analyze the effectiveness of motivational interviewing (MI) at improving oral health behaviors (oral hygiene habits, sugar consumption, dental services utilization or use of fluoride) and dental clinical outcomes (dental plaque, dental caries and periodontal status). METHODS A systematic search of PubMed, LILACS, SciELO, PsyINFO, Cochrane and Google Scholar bibliographic databases was conducted looking for intervention studies that investigated MI as the main approach to improving the oral health outcomes investigated. RESULTS Of the 78 articles found, ten met the inclusion criteria, all based on randomized controlled trials. Most studies (n = 8) assessed multiple outcomes. Five interventions assessed the impact of MI on oral health behaviors and nine on clinical outcomes (three on dental caries, six on dental plaque, four on gingivitis and three on periodontal pockets). Better quality of evidence was provided by studies that investigated dental caries, which also had the largest population samples. The evidence of the effect of MI on improving oral health outcomes is conflicting. Four studies reported positive effects of MI on oral health outcomes whereas another four showed null effect. In two interventions, the actual difference between groups was not reported or able to be recalculated. CONCLUSIONS We found inconclusive effectiveness for most oral health outcomes. We need more and better designed and reported interventions to fully assess the impact of MI on oral health and understand the appropriate dosage for the counseling interventions. PMID:24789647
Can, Doğan; Marín, Rebeca A; Georgiou, Panayiotis G; Imel, Zac E; Atkins, David C; Narayanan, Shrikanth S
The dissemination and evaluation of evidence-based behavioral treatments for substance abuse problems rely on the evaluation of counselor interventions. In Motivational Interviewing (MI), a treatment that directs the therapist to utilize a particular linguistic style, proficiency is assessed via behavioral coding-a time consuming, nontechnological approach. Natural language processing techniques have the potential to scale up the evaluation of behavioral treatments such as MI. We present a novel computational approach to assessing components of MI, focusing on 1 specific counselor behavior-reflections, which are believed to be a critical MI ingredient. Using 57 sessions from 3 MI clinical trials, we automatically detected counselor reflections in a maximum entropy Markov modeling framework using the raw linguistic data derived from session transcripts. We achieved 93% recall, 90% specificity, and 73% precision. Results provide insight into the linguistic information used by coders to make ratings and demonstrate the feasibility of new computational approaches to scaling up the evaluation of behavioral treatments. (PsycINFO Database Record PMID:26784286
Cassin, Stephanie E; von Ranson, Kristin M; Heng, Kenneth; Brar, Joti; Wojtowicz, Amy E
In this randomized controlled trial, 108 women with binge-eating disorder (BED) recruited from the community were assigned to either an adapted motivational interviewing (AMI) group (1 individual AMI session + self-help handbook) or control group (handbook only). They were phoned 4, 8, and 16 weeks following the initial session to assess binge eating and associated symptoms (depression, self-esteem, quality of life). Postintervention, the AMI group participants were more confident than those in the control group in their ability to change binge eating. Although both groups reported improved binge eating, mood, self-esteem, and general quality of life 16 weeks following the intervention, the AMI group improved to a greater extent. A greater proportion of women in the AMI group abstained from binge eating (27.8% vs. 11.1%) and no longer met the binge frequency criterion of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) for BED (87.0% vs. 57.4%). AMI may constitute a brief, effective intervention for BED and associated symptoms. PMID:18778135
Smith, Douglas C.; Ureche, Daniel J.; Davis, Jordan P.; Walters, Scott T.
Background Many adolescents in need of substance use disorder treatments never engage in treatment. Further, the most promising interventions that could be adapted to target treatment engagement often use normative feedback (NF) despite concerns about its appropriateness for adolescents. This preliminary study will inform a larger trial designed to isolate whether NF is an inert, helpful, or harmful active ingredient within pre-treatment Motivational Interviewing (MI) interventions designed to increase treatment engagement. Methods Adolescents (n=48) presenting for treatment intake assessments were randomized to receive MI (n=22) or MI +NF (n=26) immediately following their assessments. Three-month outcomes included the percentage of youth engaged in treatment, the percentage of youth reporting past month binge drinking, and the percentage of days of abstinence. Results Treatments were delivered with high fidelity, and a high proportion of eligible participants were recruited and retained in this study. Participants significantly increased their percentage of days of abstinence by approximately 10% at follow up (d=.32, p =.03), with no significant differences between groups. Fifty-five percent of youth in MI and 41.7% of youth in MI+NF engaged in treatment (OR=.60, ns, 95% CI [.136 – 2.68]). Conclusions Larger trials should test whether NF is an active ingredient in adolescent MI interventions, and also determine the mechanisms through which MI+NF may produce effects. PMID:25551562
Clancy, Richard; Taylor, Andrew
Motivational interviewing (MI) is an evidence-based intervention that has been widely recommended in clinical settings where consumer behaviour change is a goal of treatment. Training clinicians in MI, as with other translational endeavours, does not always result in changes to clinical practice. The present study compares two post-training approaches to consolidate MI skills following a training workshop. We randomly assigned 63 clinicians working in mental health or drug and alcohol services to receive either face-to-face group consolidation sessions or to access a series of online consolidation resources. We compared clinician engagement and devised a new instrument to measure clinician outcomes. Participants who completed follow-up consolidation retained knowledge, attitudes, and practices, regardless of consolidation method. Face-to-face consolidation sessions were superior to online materials in engaging participants (mean sessions attended was 2.1 (maximum possible = 3) compared to a mean of 1.38 sessions, respectively (t(61) = -2.73, P = 0.008, d = 0.72, 95% confidence interval: 0.19-1.25). Engagement to the completion of consolidation sessions was also influenced by previous training in MI. For every additional hour of previous MI training, there was a 10% increase in the odds that the participant would complete the final consolidation session. PMID:26767548
Imel, Zac E.; Baldwin, Scott A.; Baer, John; Hartzler, Bryan; Dunn, Christopher; Rosengren, David; Atkins, David C.
Objective The goal of measuring therapist adherence is to determine if a therapist can perform a given treatment. Yet the evaluation of therapist behaviors in most clinical trials is limited. Typically, randomized trials have few therapists and minimize therapist variability through training and supervision. Furthermore, therapist adherence is confounded with uncontrolled differences in patients across therapists. Consequently, the extent to which adherence measures capture differences in actual therapist adherence versus other sources of variance is unclear. Method We estimated intra-class correlations (ICCs) for therapist adherence in sessions with real and standardized patients (RPs and SPs), using ratings from a motivational interviewing (MI) dissemination trial (Baer et al., 2009) in which 189 therapists recorded 826 sessions with both patient types. We also examined the correlations of therapist adherence between SP and RP sessions, and the reliability of therapist level adherence scores with generalizability coefficients (GCs). Results ICC’s for therapist adherence were generally large (average ICC for SPs = 0.44, RPs = 0.40), meaning that a given therapist’s adherence scores were quite similar across their sessions. Both ICCs and GCs were larger for SP sessions as compared to RPs on global measures of MI adherence, such as Empathy and MI Spirit. Correlations between therapist adherence with real and standardized patients were moderate to large on three of five adherence measures. Conclusion Differences in therapist-level adherence ratings were substantial, and standardized patients have promise as tools to evaluate therapist behavior. PMID:24588405
Osilla, Karen Chan; Ortiz, J. Alexis; Miles, Jeremy N.V.; Pedersen, Eric R.; Houck, Jon M.; D'Amico, Elizabeth J.
Clients who verbalize statements arguing for change (change talk, CT) in psychotherapy are more likely to decrease alcohol and other drug use (AOD) compared to clients who voice statements in opposition of change (sustain talk, ST). Little is known about how CT and ST are expressed in groups where adolescents may vary in their AOD use severity and readiness to change. First, we examined how session content was associated with CT/ST, and then we looked at whether different subtypes of CT/ST were associated with subsequent AOD outcomes three months later. Audio recordings (N=129 sessions) of a 6-session group motivational interviewing (MI) intervention, Free Talk, were coded. Session content was not associated with CT; however, some session content was associated with higher percentages of ST (e.g., normative feedback). Subtypes of CT (Commitment and Reason) were associated with improved AOD outcomes, whereas Ability subtype remarks were related to increased marijuana use, intentions, and consequences. Findings offer helpful guidance for clinical training and narrow in on the type of CT to try to elicit in group MI sessions. Regardless of session content, adolescents can benefit from hearing CT during the group. PMID:25602608
Riegel, Barbara; Masterson Creber, Ruth; Hill, Julia; Chittams, Jesse; Hoke, Linda
Hospitalizations are common in heart failure (HF). Multimorbidity, defined as ≥2 comorbid conditions, drives many readmissions. The purpose of this pilot study was to test the effectiveness of motivational interviewing (MI) in decreasing these hospital readmissions. We enrolled 100 hospitalized HF patients into a randomized controlled trial, randomizing in a 2:1 ratio: intervention (n = 70) and control (n = 30). The intervention group received MI tailored to reports of self-care during one home visit and three to four follow-up phone calls. After 3 months, 34 participants had at least one hospital readmission. The proportion of patients readmitted for a condition unrelated to HF was lower in the intervention (7.1%) compared with the control group (30%, p = .003). Significant predictors of a non-HF readmission were intervention group, age, diabetes, and hemoglobin. Together, these variables explained 35% of the variance in multimorbidity readmissions. These preliminary results are promising in suggesting that MI may be an effective method of decreasing multimorbidity hospital readmissions in HF patients. PMID:26743119
Asteris, Mark M., Jr.
This study was designed to investigate the differences in Motivational Interviewing (MI) skill acquisition and retention among probation officers. This study had a randomized, experimental, pretest-posttest control group design using the MITI 3.1.1 and the VASE-R to measure MI skill acquisition and retention. A random sample (n = 24) of probation…
Geller, Josie; Dunn, Erin C.
This paper focuses on the integration of Motivational Interviewing (MI) and cognitive behavioral therapy (CBT) in the treatment of eating disorders. Although CBT is regarded as the treatment of choice in this population, it nevertheless has limitations: some patients fail to engage, drop out from treatment prematurely, or simply do not improve.…
Carpenter, Kenneth M.; Cheng, Wendy Y.; Smith, Jennifer L.; Brooks, Adam C.; Amrhein, Paul C.; Wain, R. Morgan; Nunes, Edward V.
Objective: The relationships between the occupational, educational, and verbal-cognitive characteristics of health care professionals and their motivational interviewing (MI) skills before, during, and after training were investigated. Method: Fifty-eight community-based addiction clinicians (M = 42.1 years, SD = 10.0; 66% Female) were assessed…
Cole, Bonnie; Clark, Denice Crowe; Seale, J. Paul; Shellenberger, Sylvia; Lyme, Alan; Johnson, J. Aaron; Chhabria, Aruna
To enhance the skills of primary care residents in addressing substance misuse, residency screening, brief intervention, and referral to treatment (SBIRT) programs increasingly offer motivational interviewing (MI) training, but seldom include feedback and coaching. This innovative 2-round "Virginia Reel" approach, supplementing 3 hours of basic MI…
Moyers, Theresa B.; Houck, Jon
Motivational Interviewing began as a treatment for substance misuse and has strong empirical support as an intervention for these disorders. It is very common for MI to be combined with other types of treatment when it is used for substance abuse, and this article focuses on one example of this: the COMBINE Research Project. We examine the…
Juhnke, Brenna A.; Juhnke, Gerald A.; Curtis, Russell C.; Thompson, E. Heather; Coll, Kenneth M.; Yu, Fangzhou; Moyer, Michael S.; Mullett, Alison
Motivational interviewing is a proven, evidence-based intervention. It has been successfully utilized as a potent intervention with students presenting a broad range of concerns from substance abuse to obesity. To date, however, no articles exist within the general counseling literature or the "Journal of School Counseling" specifically…
Koken, Juline A.; Naar-King, Sylvie; Umasa, Sanya; Parsons, Jeffrey T.; Saengcharnchai, Pichai; Phanuphak, Praphan; Rongkavilit, Chokechai
The provision of culturally relevant yet evidence-based interventions has become crucial to global HIV prevention and treatment efforts. In Thailand, where treatment for HIV has become widely available, medication adherence and risk behaviors remain an issue for Thai youth living with HIV. Previous research on motivational interviewing (MI) has…
Newbery, Natasha; McCambridge, Jim; Strang, John
Purpose: The feasibility of a community-level drug prevention intervention based upon the principles of motivational interviewing within a further education college was investigated in a pilot study. Design/methodology/approach: The implementation over the course of a single term of "Let's Talk about Drugs" was studied with both action research…
Tollison, Sean J.; Lee, Christine M.; Neighbors, Clayton; Neil, Teryl A.; Olson, Nichole D.; Larimer, Mary E.
The purpose of this study was to examine the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. First year students (N=67) took part in a Brief Alcohol Screening and Intervention for College Students (BASICS) led by peer facilitators trained in MI and BASICS.…
van Etten, Shawn; Pressley, Michael; Freebern, Geoffrey; Echevarria, Marissa
Hypothesizes that students are conscious of their decision making regarding academics, and thus, are able to report factors affecting their academic motivation. Finds that they reported more factors than have been considered in previous theoretical analyses of academic motivation, with students perceiving interactions between motivational factors…
Mun, Eun-Young; Atkins, David C.; Walters, Scott T.
Foxcroft, Coombes, Wood, Allen, and Almeida Santimano (2014) recently conducted a meta-analysis evaluating the effectiveness of motivational interviewing (MI) in reducing alcohol misuse for youth up to age 25. They concluded that the overall effect sizes of MI in this population were too small to be clinically meaningful. The present paper critically reviews the Foxcroft et al. meta-analysis, highlighting weaknesses, such as problems with search strategies, flawed screening and reviews of full-text articles, incorrect data abstraction and coding, and, accordingly, improper effect size estimation. In addition, between-study heterogeneity and complex data structures were not thoughtfully considered or handled using best practices for meta-analysis. These limitations undermine the reported estimates and broad conclusion made by Foxcroft et al. about the lack of MI effectiveness for youth. We call for new evidence on this question from better-executed studies by independent researchers. Meta-analysis has many important utilities for translational research. When implemented well, the overall effectiveness as well as different effectiveness for different populations can be examined via meta-analysis. Emerging methods utilizing individual participant-level data, such as integrative data analysis, may be particularly helpful for identifying the sources of clinical and methodological heterogeneity that matter. The need to better understand the mechanisms of alcohol interventions has never been louder in the addiction field. Through more concerted efforts throughout all phases of generating evidence, we may achieve large-scale evidence that is efficient and robust and provides critical answers for the field. PMID:26237287
Tanana, Michael; Hallgren, Kevin A; Imel, Zac E; Atkins, David C; Srikumar, Vivek
Motivational interviewing (MI) is an efficacious treatment for substance use disorders and other problem behaviors. Studies on MI fidelity and mechanisms of change typically use human raters to code therapy sessions, which requires considerable time, training, and financial costs. Natural language processing techniques have recently been utilized for coding MI sessions using machine learning techniques, rather than human coders, and preliminary results have suggested these methods hold promise. The current study extends this previous work by introducing two natural language processing models for automatically coding MI sessions via computer. The two models differ in the way they semantically represent session content, utilizing either 1) simple discrete sentence features (DSF model) and 2) more complex recursive neural networks (RNN model). Utterance- and session-level predictions from these models were compared to ratings provided by human coders using a large sample of MI sessions (N=341 sessions; 78,977 clinician and client talk turns) from 6 MI studies. Results show that the DSF model generally had slightly better performance compared to the RNN model. The DSF model had "good" or higher utterance-level agreement with human coders (Cohen's kappa>0.60) for open and closed questions, affirm, giving information, and follow/neutral (all therapist codes); considerably higher agreement was obtained for session-level indices, and many estimates were competitive with human-to-human agreement. However, there was poor agreement for client change talk, client sustain talk, and therapist MI-inconsistent behaviors. Natural language processing methods provide accurate representations of human derived behavioral codes and could offer substantial improvements to the efficiency and scale in which MI mechanisms of change research and fidelity monitoring are conducted. PMID:26944234
Mohammadi, Tayebeh Malek; Hajizamani, Abolghasem; Bozorgmehr, Elham
Background: Oral diseases are common chronic diseases that are affected by human health behavior. One-way to promote health behaviors can be achieved through education. The present study aims to assess the effect of an oral health education program using motivational interviewing (MI) method on oral health status of preschool children. Materials and Methods: This study recruited 222 volunteer children and their parents from 10 elementary schools into a community trial. At baseline, plaque, gingival and decayed, missing, and filled teeth indexes were measured in the children. They were randomly allocated into test groups where they and their parents received oral health education using MI and the control group received traditional oral health education. The test group had recall and postal reminder during 6 months of the study, but there was no reminder for the control group. After 6 months, the same oral health indexes were measured. Data were analyzed using SPSS version 20 (SPSS Inc., Chicago, IL, USA) by t-test, Mann-Whitney and Wilcoxon signed ranks test. P < 0.05 was considered as significant. Results: The results showed that after both oral health education programs, differences of plaque index (PI) (P = 0.000) and gingival index (P = 0.000) were significant between the two groups. The number of children with healthy gingiva and low PI were more frequent in the test group after intervention. Conclusion: Considering the limitations of this study, oral health status of children after education of parents using MI was observed, and it should be considered in oral health education programs. PMID:26604963
Salamati, Payman; Poursharifi, Hamid; Rahbarimanesh, Ali akbar; koochak, Hamid Emadi; Najafi, Zahra
Background: Motivational interviewing (M.I.) is an option for modifying an individual's behavior. It is used as an educational method in recent years. The aim of our study was to indicate whether or not education, using lecture alone and lecture with M.I., would affect the performance of nursing personnel regarding their hand hygiene. If so, which of these two methods were most effective for this purpose? Methods: This was an interventional study conducted in Bahrami Pediatric Hospital in Tehran. The study population consisted of all nursing personnel in the hospital. Considering the responsibilities of different nurses and their educational status, we divided them into three classes. The participants of each class were randomly assigned to either the control or experiment groups training lecture alone or lecture with M.I., respectively. We used Independent-t, Paired-t, Mann-Whitney U and Wilcoxon signed ranks tests for analysis. Results: Education using lecture alone improved the hand hygiene performance of nursing personnel only in the first and third classes (P = 0.002 and P = 0.001, respectively). Similarly, lecture combined with M.I. improved the hand hygiene performance of personnel in the first and third classes (P < 0.001 and P = 0.004, respectively). The latter method was more effective compared to lecture alone in the first and third classes (P < 0.001 and P = 0.013, respectively). Conclusions: Education based on lecturing improves hand hygiene performance among nursing personnel. It will be more effective if combined with M.I. PMID:23671777
Houck, Jon M.; Hunter, Sarah B.; Benson, Jennifer G.; Cochrum, Linda L.; Rowell, Lauren N.; D’Amico, Elizabeth J.
There is considerable evidence for Motivational interviewing (MI) in changing problematic behaviors. Research on the causal chain for MI suggests influence of facilitator speech on client speech. This association has been examined using macro (session-level) and micro (utterance-level) measures; however, effects across sessions have largely been unexplored, particularly with groups. We evaluated a sample of 129 adolescent group MI sessions, using a behavioral coding system and timing information to generate information on facilitator and client speech (CT: change talk) within 5 successive segments (quintiles) of each group session. We hypothesized that facilitator speech (open-ended questions and reflections of CT) would be related to subsequent CT. Repeated measures analysis indicated significant quadratic and cubic trends for facilitator and client speech across quintiles. Across quintiles, cross-lagged panel analysis using a zero-inflated negative binomial model showed minimal evidence of facilitator speech on client CT, but did indicate several effects of client CT on facilitator speech, and of client CT on subsequent client CT. Results suggest that session-level effects of facilitator speech on client speech do not arise from long-duration effects of facilitator speech; instead, we detected effects of facilitator speech on client speech only at the beginning and end of sessions, when open questions respectively suppressed and enhanced client expressions of CT. Findings suggest that clinicians must remain vigilant to client CT throughout the group session, reinforcing it when it arises spontaneously and selectively employing open-ended questions to elicit it when it does not, particularly towards the end of the session. PMID:26415055
Viau, Krista S.; Jones, Jessica L.; Murtaugh, Maureen A.; Gren, Lisa H.; Stanford, Joseph B.; Bilder, Deborah A.
Objective To measure change in patient activation and self-efficacy in individuals with phenylketonuria (PKU) before and after a 6-month phone-based motivational interviewing (MI) intervention and determine the feasibility of implementing dietary counseling for PKU using an MI approach. Methods Participants (n = 31) included preadolescents (7–12 years), adolescents (13–17 years), and adults (18–35 years) with early-treated PKU. Participants completed online questionnaires assessing self-reported stage of change (SOC), patient activation, and self-efficacy for PKU self-management behaviors. The intervention included monthly phone-based dietary counseling using MI during which participants set monthly goals. Results Patient activation and self-efficacy were significantly different by age group (both p < 0.01) with higher scores in older participants. Self-efficacy significantly increased from baseline to month 6 among adolescents and adults (7.4 ± 1.9 and 8.6 ± 1.3, respectively, p = 0.002). Preadolescents did not have a significant change in self-efficacy (p = 0.79). There was no increase in patient activation for preadolescents or adolescents/adults (p = 0.19 and p = 0.24, respectively). Indicators of learning problems were not significantly associated with self-efficacy (p = 0.33) or patient activation (p = 0.83). Conclusion These results demonstrate the feasibility of implementing phone-based dietary counseling for PKU using MI. This study also supports further investigation of MI as an intervention approach to improving self-efficacy and self-management behaviors in adolescents and adults with PKU. PMID:27014576
McMaster, Fiona; Bocian, Alison; Harris, Donna; Zhou, Yan; Snetselaar, Linda; Schwartz, Robert; Myers, Esther; Gotlieb, Jaquelin; Foster, Jan; Hollinger, Donna; Smith, Karen; Woolford, Susan; Mueller, Dru; Wasserman, Richard C.
BACKGROUND AND OBJECTIVE: Few studies have tested the impact of motivational interviewing (MI) delivered by primary care providers on pediatric obesity. This study tested the efficacy of MI delivered by providers and registered dietitians (RDs) to parents of overweight children aged 2 through 8. METHODS: Forty-two practices from the Pediatric Research in Office Settings Network of the American Academy of Pediatrics were randomly assigned to 1 of 3 groups. Group 1 (usual care) measured BMI percentile at baseline and 1- and 2-year follow-up. Group 2 (provider only) delivered 4 MI counseling sessions to parents of the index child over 2 years. Group 3 (provider + RD) delivered 4 provider MI sessions plus 6 MI sessions from a RD. The primary outcome was child BMI percentile at 2-year follow up. RESULTS: At 2-year follow-up, the adjusted BMI percentile was 90.3, 88.1, and 87.1 for groups 1, 2, and 3, respectively. The group 3 mean was significantly (P = .02) lower than group 1. Mean changes from baseline in BMI percentile were 1.8, 3.8, and 4.9 across groups 1, 2, and 3. CONCLUSIONS: MI delivered by providers and RDs (group 3) resulted in statistically significant reductions in BMI percentile. Research is needed to determine the clinical significance and persistence of the BMI effects observed. How the intervention can be brought to scale (in particular, how to train physicians to use MI effectively and how best to train RDs and integrate them into primary care settings) also merits future research. PMID:25825539
Dunhill, David; Schmidt, Stacie; Klein, Robin
Background Motivational interviewing (MI) is a patient-centered method of behavior change counseling. It has shown promise in enabling patients to identify and improve problem health behaviors. Incorporating MI education into residency training may be beneficial. Objective To review the current evidence regarding the impact of MI education in graduate medical education. Results Of the 9 studies of MI education in graduate medical education training, most noted favorable outcomes after MI education. Outcomes included improvements in residents' view of MI, MI skill use and competency, and resident satisfaction with MI interventions. Of the 5 studies that looked at residents' views of MI, 3 found improvements in resident assessments of the importance of and confidence in using MI. Of the 4 studies of MI skills, 3 reported improvements in residents' use of and competency in the MI skill. The quality of MI education in the graduate medical education literature is limited by overreliance on preintervention and postintervention analysis as a study design, the variable intensity of educational interventions, and limited use of validated assessment tools and quantitative outcome measures. Conclusions Review of the literature shows that MI education can be successfully implemented within the residency education environment. The intensity of MI interventions, coupled with experiential learning and feedback, correlated with favorable outcomes in terms of resident use of MI skills and resident satisfaction. Further study is needed to determine which MI skills are most effectively taught to residents, the impact of MI training on resident behavior in clinical settings, and the impact on clinical outcomes. PMID:24949125
Mesters, Ilse; Ausems, Marlein; van Breukelen, Gerard; Campbell, Marci; Resnicow, Ken; Brug, Johannes; de Vries, Hein
Background Computer tailoring and motivational interviewing show promise in promoting lifestyle change, despite few head-to-head comparative studies. Purpose Vitalum is a randomized controlled trial in which the efficacy of these methods was compared in changing physical activity and fruit and vegetable consumption in middle-aged Dutch adults. Methods Participants (n = 1,629) were recruited via 23 general practices and randomly received either four tailored print letters, four motivational telephone calls, two of each type of intervention, or no information. The primary outcomes were absolute change in self-reported physical activity and fruit and vegetable consumption. Results All three intervention groups (i.e., the tailored letters, the motivational calls, and the combined version) were equally and significantly more effective than the control group in increasing physical activity (hours/day), intake of fruit (servings/day), and consumption of vegetables (grams/day) from baseline to the intermediate measurement (week 25), follow-up 1 (week 47) and 2 (week 73). Effect sizes (Cohen’s d) ranged from 0.15 to 0.18. Participants rated the interventions positively; interviews were more positively evaluated than letters. Conclusions Tailored print communication and telephone motivational interviewing or their combination are equally successful in changing multiple behaviors. Electronic supplementary material The online version of this article (doi:10.1007/s12160-010-9231-3) contains supplementary material, which is available to authorized users. PMID:20878293
Bean, Melanie K.; Jeffers, Amy J.; Tully, Carrie B.; Thornton, Laura M.; Mazzeo, Suzanne E.
There is an urgent need for innovative approaches to pediatric obesity treatment. There is also a demand for targeted strategies that reduce attrition and improve treatment adherence. Intervening exclusively with parents of overweight children is a novel approach with demonstrated efficacy in reducing child body mass index (BMI) percentile. Motivational interviewing (MI), a brief communication style for exploring and resolving ambivalence about behavior change, might enhance treatment engagement when implemented as part of obesity interventions. The aim of this report is to provide the rationale and methods for a novel study of MI with parents in the treatment of their children’s overweight. We designed and are currently implementing NOURISH+MI, a randomized controlled trial examining the feasibility and efficacy of an adjunct values-based MI intervention, implemented within a culturally-tailored parent intervention for overweight children ages 5-11 years, NOURISH+ (Nourishing Our Understanding of Role modeling to Improve Support and Health). Specifically, we are randomly assigning 60 parents to this adjunctive treatment, and investigating if adding two MI sessions prior to the NOURISH+ group intervention will enhance treatment effects. We will be able to compare NOURISH+MI participants with those from the two NOURISH+ treatment conditions (NOURISH+ and control). We hypothesize that children whose parents participate in NOURISH+MI will demonstrate lower attrition and greater adherence with NOURISH+, ultimately leading to greater treatment effects, compared with children whose parents are randomized to NOURISH+ or a control group. Findings will contribute to the emerging literature examining the efficacy of MI within pediatric obesity interventions. PMID:24530488
Background: Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. Purpose: To compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle int...
Landry, Alicia; Madson, Michael; Thomson, Jessica; Zoellner, Jamie; Connell, Carol; Yadrick, Kathleen
Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. The purpose of this study was to compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with…
Mertens, Vera-Christina; Forsberg, Lars; Verbunt, Jeanine A; Smeets, Rob E J M; Goossens, Mariëlle E J B
Treatment fidelity and proficiency of a nurse-led motivational interviewing (MI)-based pre-treatment and control condition was evaluated. A random sample was scored by means of the Motivational Interviewing Treatment Integrity (MITI) scale, and a second rater was in charge. MI fidelity was satisfactory for three out of five ratings. Most mean ratings were higher in the MI-based intervention, but differences were not statistically significant. The threshold for beginning MI proficiency was only exceeded for one score and one additional measure. In general, higher levels of fidelity in the intervention condition confirmed that MI was partially applied there. Although the quality of MI delivery as well as mixed inter-rater reliabilities of the fidelity scores leaves room for improvement, robust findings between the two raters were found. These results suggest the need for rigor selection of MI counselors on beforehand, and continuous supervision. Furthermore, fidelity check in studies using MI is needed. PMID:26695644
D’Amico, Elizabeth J.; Osilla, Karen Chan; Hunter, Sarah B.
This study examined how teens who had committed a first-time alcohol or other drug (AOD) offense responded to a motivational interviewing (MI) group intervention. Participants were 101 first-time AOD adolescent offenders (M=15.88; 63% male, 54% Hispanic). We developed and tested a six-session curriculum called Free Talk and solicited feedback from different teens after each session. Groups were recorded and transcribed. Feedback was categorized using the Motivational Interviewing Treatment Integrity scale (MITI 3.0). Feedback indicated high levels of evocation, collaboration, autonomy/support, and empathy. The current study highlights that utilizing group MI can be an acceptable approach for at-risk youth. PMID:21113392
Wilhelm, Susan L; Aguirre, Trina M; Koehler, Ann E; Rodehorst, T Kim
Although most Hispanic/Latino-American mothers initiate breastfeeding, duration and exclusivity of breastfeeding remain low. We explored whether a motivational interviewing (MI) intervention could help rural Mexican-American mothers continue breastfeeding. We used a two-group (MI intervention n = 26, attention control [AC] n = 27) repeated measures experimental design. Assessments and interventions occurred at 3 days, 2 weeks, and 6 weeks postpartum (time points when mothers are particularly vulnerable to discontinuing breastfeeding), with a final phone assessment at 6 months postpartum. We collected demographic data and measured intent to breastfeed for 6 months (intent question), self-efficacy (Breastfeeding Self-Efficacy Scale-Short Form), and collected breastfeeding information (breastfeeding assessment questionnaire). Independent t-tests and Mann Whitney U non-parametric tests were used to evaluate group differences (α = 0.05). High levels of attrition by week 6 impaired our ability to evaluate the potential of our MI intervention. No significant differences were found between groups for any of the outcome variables (intent to breastfeed for 6 months, breastfeeding self-efficacy, and duration of breastfeeding). Though the mothers intended to breastfeed for 6 months and were confident in their ability to do so, most did not breastfeed for 6 months. At 6 months, mothers receiving the MI intervention had breastfed an average of 90 days compared to 82 days for those receiving the AC sessions and 22% of the mothers in each group were still breastfeeding at some level. Because of the impact of attrition during this study, we discuss factors that contributed to attrition and approaches to lessen this problem in future studies. Such efforts may require a greater investment of time and resources and should be budgeted accordingly. Culturally appropriate interventions are needed to help rural Mexican-American mothers meet their breastfeeding goals, thus
Gabbay, Robert A.; Añel-Tiangco, Raquel M.; Dellasega, Cheryl; Mauger, David T.; Adelman, Alan; Van Horn, Deborah H.A.
Objective To determine if the addition of nurse case managers (NCMs) trained in motivational interviewing (MI) to usual care would result in improved outcomes in high risk type 2 diabetes patients. Methods A 2-year randomized controlled pragmatic trial randomized 545 patients to usual care control (n=313) or those who received the intervention (n= 232) with additional practice embedded NCM care, including MI-guided behavior change counseling. NCMs received intensive MI training with ongoing fidelity assessment. Results Systolic BP was better in the intervention group (131±15.9 vs. 135±18.2, p < 0.05). HbA1c, LDL, and diastolic BP improved in both groups: HbA1c (control group 9.1% to 8.0%, intervention group 8.8% to 7.8%), LDL (control group 127 to 100 mg/dL, intervention group 128 to 102 mg/dL), diastolic BP (control group 78 to 74 mm Hg, intervention group 80 to 74 mm Hg). Depression symptom scores were better in the intervention group. The reduction in diabetes-related distress approached statistical significance. Conclusions NCMs and MI improved systolic BP and complications screening. The large decrease in HbA1C and LDL in the control group may have obscured any further intervention effect. Although nurses prompted providers for medication titration, strategies to reduce provider clinical inertia might also be needed. Significant findings of the study In patients with type 2 diabetes, an intervention with nurse case management and motivational interviewing improves systolic blood pressure, depression, and screening for complications. What this study adds First study to look at the benefit of the addition of motivational interviewing to nurse case management in the care of the high-risk adult with type 2 diabetes. Particular attention was given to ensuring fidelity to the motivational interviewing approach. PMID:23368423
Frey, Andy J.; Lee, Jon; Small, Jason W.; Seeley, John R.; Walker, Hill M.; Feil, Edward G.
The majority of Tier 2 interventions are facilitated by specialized instructional support personnel, such as a school psychologists, school social workers, school counselors, or behavior consultants. Many professionals struggle to involve parents and teachers in Tier 2 behavior interventions. However, attention to the motivational issues for…
LaBrie, Joseph W.; Lamb, Toby F.; Pedersen, Eric R.; Quinlan, Thomas
This study examines the effectiveness of a single-session group motivational enhancement intervention with college students adjudicated for violation of alcohol policy. The intervention consisted of a timeline Followback assessment of drinking, social norms re-education, decisional balance for behavior change, relapse prevention, expectancy…
Gabbay, Robert A; Kaul, Shailja; Ulbrecht, Jan; Scheffler, Neil M; Armstrong, David G
Foot ulceration and lower-extremity amputation are devastating end-stage complications of diabetes. Despite agreement that diabetic foot self-care is a key factor in prevention of ulcers and amputation, there has only been limited success in influencing these behaviors among patients with diabetes. While most efforts have focused on increasing patient knowledge, knowledge and behavior are poorly correlated. Knowledge is necessary but rarely sufficient for behavior change. A key determinant to adherence to self-care behavior is clinician counseling style. Podiatrists are the ideal providers to engage in a brief behavioral intervention with a patient. Motivational interviewing is a well-accepted, evidence-based teachable approach that enhances self-efficacy and increases intrinsic motivation for change and adherence to treatment. This article summarizes some key strategies that can be employed by podiatrists to improve foot self-care. PMID:21242475
Landry, Alicia; Madson, Michael; Thomson, Jessica; Zoellner, Jamie; Connell, Carol; Yadrick, Kathleen
Little is known about the effective dose of motivational interviewing for maintaining intervention-induced health outcome improvements. The purpose of this study was to compare effects of two doses of motivational interviewing for maintaining blood pressure improvements in a community-engaged lifestyle intervention conducted with African-Americans. Participants were tracked through a 12-month maintenance phase following a 6-month intervention targeting physical activity and diet. For the maintenance phase, participants were randomized to receive a low (4) or high (10) dose of motivational interviewing delivered via telephone by trained research staff. Generalized linear models were used to test for group differences in blood pressure. Blood pressure significantly increased during the maintenance phase. No differences were apparent between randomized groups. Results suggest that 10 or fewer motivational interviewing calls over a 12-month period may be insufficient to maintain post-intervention improvements in blood pressure. Further research is needed to determine optimal strategies for maintaining changes. PMID:26590242
Cook, Gabriel I.; Rummel, Jan; Dummel, Sebastian
This study examined value-added intentions by manipulating the cognitive frame associated with monetary contingencies for detecting prospective memory (PM) cues. We associated a loss-frame with a monetary punishment for failing to respond to cues and a gain-frame with a monetary reward for remembering to respond to cues and compared those frames to a no-frame control condition with no contingency linked to performance. Across two experiments, we find increased PM performance for participants in the loss-frame (Experiments 1 and 2) and in the gain-frame (Experiment 2) conditions relative to the no-frame condition. This value-related improvement in PM was not accompanied by a significant increase in cue monitoring as measured by intention-induced interference to an ongoing task and recognition memory for ongoing-task items. The few previous studies investigating motivational PM showed mixed results regarding whether PM improves due to incentives or not. Our results provide further evidence that, under some experimental conditions, PM improves with rewards and that the benefit generalizes to penalizing performance. The results have both practical implications and theoretical implications for motivation models of PM. PMID:26042017
van Hooft, Edwin A J
Because unemployment negatively affects people's well-being, it is of crucial importance that unemployed individuals move back to work. The process of getting reemployed, however, is difficult and complex. Therefore, many unemployed job seekers are assisted by employment counselors. The present study focuses on motivating and hindering factors in the reemployment process, examining the added value of the counselors' assessment of job seekers' attitudes, perceptions, and behaviors. The results of a 3-wave study with job seeker self-ratings and counselor-ratings indicated that perceived health problems is the most consistent predictor of job search and reemployment status. The findings further provide some convergent validity evidence for self- and counselor-rated situational-level motivators (i.e., attitude, social pressure, self-efficacy) and job search intensity. Although method effects did not seem to threaten the validity of the prediction of job search intensity and procrastination, employment counselors' assessments of job seekers' job search intensity and procrastination were significantly more strongly related to reemployment success than job seekers' self-ratings. Future research should therefore include other-reports, in addition to job seeker self-reports, to get a more complete view of people's job search behavior. Also reemployment counseling firms may want to use the expert knowledge of their employment counselors more systematically. PMID:24447217
Carlbring, Per; Jonsson, Jakob; Josephson, Henrik; Forsberg, Lars
Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance. PMID:19967577
Simon, Patricia; Ward, Nadia L.
This study examined training outcomes for lay service providers who participated in a Motivational Interviewing (MI) training program designed to help increase intrinsic motivation and academic achievement among urban low-income and minority youth. Seventeen lay academic advisors received 16 hours of training in MI. Two, two-hour booster sessions plus five, two- hour weekly group supervision sessions were conducted with lay advisors over a period of seven months. One-hundred percent of lay advisors (n =17) participated in all training, booster sessions and assessments. Seventy-one percent of lay advisors (n=12) completed all group supervision sessions and submitted tapes for review. MI training was associated with increased knowledge of MI principles among lay service providers; increased proficiency in responding to simulated clients in an MI consistent style; increased use of MI adherent behaviors in sessions with real clients and maintenance of high motivation to use MI from pretest to posttest. Although lay advisors increased their knowledge of MI, further training is required for advisors to increase competence in delivering MI. Overall, Implications for using MI in the context of school-based settings is discussed. PMID:26356248
Draxten, Michelle; Flattum, Colleen; Fulkerson, Jayne
The purpose of this study was to describe the components and use of motivational interviewing (MI) within a behavior change intervention to promote healthful eating and family meals and prevent childhood obesity. The Healthy Home Offerings via the Mealtime Environment (HOME) Plus intervention was part of a two-arm randomized-controlled trial and included 81 families (children 8-12 years old and their parents) in the intervention condition. The intervention included 10 monthly, 2-hour group sessions and 5 bimonthly motivational/goal-setting phone calls. Data were collected for intervention families only at each of the goal-setting calls and a behavior change assessment was administered at the 10th/final group session. Descriptive statistics were used to analyze the MI call data and behavior assessment. Overall group attendance was high (68% attending ≥7 sessions). Motivational/goal-setting phone calls were well accepted by parents, with an 87% average completion rate. More than 85% of the time, families reported meeting their chosen goal between calls. Families completing the behavioral assessment reported the most change in having family meals more often and improving home food healthfulness. Researchers should use a combination of delivery methods using MI when implementing behavior change programs for families to promote goal setting and healthful eating within pediatric obesity interventions. PMID:26940585
D’Amico, Elizabeth J.; Hunter, Sarah B.; Miles, Jeremy N.V.; Ewing, Brett A.; Osilla, Karen Chan
Group Motivational Interviewing (MI) interventions that target youth at-risk for alcohol and other drug (AOD) use may prevent future negative consequences. Youth in a teen court setting (n=193; 67% male, 45% Hispanic; mean age 16.6 (SD = 1.05) were randomized to receive either a group MI intervention, Free Talk, or usual care (UC). We examined client acceptance, intervention feasibility and conducted a preliminary outcome evaluation. Free Talk teens reported higher quality and satisfaction ratings, and MI integrity scores were higher for Free Talk groups. AOD use and delinquency decreased for both groups at three months, and 12-month recidivism rates were lower but not significantly different for the Free Talk group compared to UC. Results contribute to emerging literature on MI in a group setting. A longer term follow-up is warranted. PMID:23891459
Dickerson, Daniel L; Brown, Ryan A; Johnson, Carrie L; Schweigman, Kurt; D'Amico, Elizabeth J
American Indians/Alaska Natives (AI/AN) exhibit high levels of alcohol and drug (AOD) use and problems. Although approximately 70% of AI/ANs reside in urban areas, few culturally relevant AOD use programs targeting urban AI/AN youth exist. Furthermore, federally-funded studies focused on the integration of evidence-based treatments with AI/AN traditional practices are limited. The current study addresses a critical gap in the delivery of culturally appropriate AOD use programs for urban AI/AN youth, and outlines the development of a culturally tailored AOD program for urban AI/AN youth called Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY). We conducted focus groups among urban AI/AN youth, providers, parents, and elders in two urban communities in northern and southern California aimed at 1) identifying challenges confronting urban AI/AN youth and 2) obtaining feedback on MICUNAY program content. Qualitative data were analyzed using Dedoose, a team-based qualitative and mixed methods analysis software platform. Findings highlight various challenges, including community stressors (e.g., gangs, violence), shortage of resources, cultural identity issues, and a high prevalence of AOD use within these urban communities. Regarding MICUNAY, urban AI/AN youth liked the collaborative nature of the motivational interviewing (MI) approach, especially with regard to eliciting their opinions and expressing their thoughts. Based on feedback from the youth, three AI/AN traditional practices (beading, AI/AN cooking, and prayer/sage ceremony) were chosen for the workshops. To our knowledge, MICUNAY is the first AOD use prevention intervention program for urban AI/AN youth that integrates evidence-based treatment with traditional practices. This program addresses an important gap in services for this underserved population. PMID:26306776
Abad, Neetu; Carry, Monique; Herbst, Jeffrey H.; Fogel, Catherine I.
Prison is an environment in which programs can be implemented to change harmful behaviors among high-risk populations. Incarcerated women experience high rates of HIV and other sexually transmitted diseases (STDs), yet little research has examined women’s motivation to reduce risky behaviors during incarceration. In-depth individual interviews were conducted with former and current women prisoners in two North Carolina correctional facilities and analyzed to identify barriers and facilitators of behavior change while in prison. Analyses revealed key motivators of behavior change: Viewing prison as a place to recover from past trauma, removing oneself from negative social networks, gaining access to needed mental and physical health services, and engaging in self-care and self-reflection. Barriers to behavior change include fear of recidivism, stigma of being in prison, and return to undesirable social networks post-release. Moreover, women noted that the provision of mental health services, educational enhancement and housing assistance could help them reduce engagement in high-risk behaviors after their incarceration. These findings can be incorporated into HIV/STD risk reduction interventions to facilitate positive behavior change among incarcerated women prisoners. Prison itself is a tremendous education in the need for patience and perseverance. It is above all a test of one’s commitment.—Nelson Mandela, 1995 PMID:26693183
Woelber, Johan P.; Spann-Aloge, Narin; Hanna, Gilgamesh; Fabry, Goetz; Frick, Katrin; Brueck, Rigo; Jähne, Andreas; Vach, Kirstin; Ratka-Krüger, Petra
Background: The success of periodontal therapy depends on the adherence of patients to professional recommendations. The aim of this study was to investigate the influence of a workshop in motivational interviewing (MI) on non-surgical periodontal treatment performed by dental students. Materials and Methods: In the experimental group patients with periodontitis were treated by students trained in MI, while in the control group patients were treated by students who had not been trained in MI. Clinical oral parameters were assessed by a blinded periodontist in addition to the evaluation of psychological questionnaires given before and after the non-surgical periodontal treatment (6 months). Conversations between patients and students were recorded and rated with the Motivational Treatment Integrity Code (MITI-d) by a blinded psychologist. Results: There were 73 patients in the MI group and 99 patients in the control group. The MI group showed significantly higher scores in the MITI-d analysis. Regression analysis showed that there were no significant differences between groups with regard to plaque level, gingival bleeding, pocket depth reduction or bleeding upon probing. However, patients in the MI-group showed significantly higher interdental cleaning self-efficacy than patients in the control group (MI = 19.57 ± 4.7; control = 17.38 ± 6.01; p = 0.016). Conclusion: Teaching MI to dental students resulted in a significant improvement in the self-efficacy of interdental cleaning in patients compared to a control group of non-trained students, but no improvement in other aspects of non-surgical periodontal therapy. The study also showed that an 8-h workshop with supervision significantly improved the MI-compliant conversations of dental students without requiring more conversation time. PMID:26941698
Background Childhood obesity is associated with serious physiological and psychological consequences including type 2 diabetes, higher rates of depression and low self-esteem. With the population of overweight and obese youth increasing, appropriate interventions are needed that speak to the issue of readiness to change and motivation to maintain adherence to healthy behavior changes. Motivational Interviewing (MI) is a method of therapy found to resolve ambivalence, enhance intrinsic motivation and promote confidence in a person's ability to make behavior changes. While MI has shown promise in the adult obesity literature as effecting positive lifestyle change, little is known about the effectiveness of MI with overweight and obese youth. This study aims to: 1) demonstrate that MI is an effective intervention for increasing a person's self-efficacy; 2) demonstrate that exposure to MI will facilitate healthy behavior changes; 3) explore psychological changes related to participation in MI and 4) compare physiological and anthropometric outcomes before and after intervention. Methods/Design The current investigation is a prospective study conducted with ongoing participants who regularly attend an outpatient pediatric care center for weight-loss. Overweight youth (BMI > 85th %ile) between the ages of 10 and 18 who meet eligibility criteria will be recruited. Participants will be randomly assigned to a control group (social skills training) or a treatment group (MI). Participants will meet with the therapist for approximately 30 minutes prior to seeing the dietician, over the course of 6 months. Participants will also undergo a full day assessment at the beginning and end of psychology intervention to evaluate body fat, and metabolic risk (screening for diabetes, high cholesterol, high blood pressure and fitness level). The paper and pencil portions of the assessments as well as the clinical testing will occur at baseline and at the conclusion of the intervention (6
Zagarins, Sofija E.; Feinberg, Rebecca G.; Garb, Jane L.
Aims To determine whether glycemic control is improved when Motivational Interviewing (MI), a patient-centered behavior change strategy, is used with Diabetes Self Management Education (DSME) as compared to DSME alone. Methods Poorly controlled type 2 diabetes (T2DM) patients (n=234) were randomized into 4 groups: MI+DSME or DSME alone, with or without use of a computerized summary of patient self management barriers. We compared HbA1c changes between groups at 6 months and investigated mediators of HbA1c change. Results Study patients attended the majority of intervention visits (mean 3.4/4), but drop-out rate was high at follow-up research visits (35%). Multiple regression showed that groups receiving MI had a mean change in HbA1c that was significantly lower (less improved) than those not receiving MI (t=2.10; p=0.037). Mediators of HbA1c change for the total group were diabetes self-care behaviors and diabetes distress; no between-group differences were found. Conclusions DSME improved blood glucose control, underlining its benefit for T2DM management. However, MI+DSME was less effective than DSME alone. Overall, weak support was found for the clinical utility of MI in the management of T2DM delivered by diabetes educators. PMID:21074887
Rongkavilit, Chokechai; Wang, Bo; Naar-King, Sylvie; Bunupuradah, Torsak; Parsons, Jeffrey T.; Panthong, Apirudee; Koken, Juline A.; Saengcharnchai, Pichai; Phanuphak, Praphan
Motivational interviewing (MI) has been shown to reduce sexual risks among HIV-positive men who have sex with men (HMSM) in the U.S. We conducted a randomized trial of Healthy Choices, a 4-session MI intervention, targeting sexual risks among 110 HIV-positive youth ages 16–25 years in Thailand. Risk assessments were conducted at baseline, 1 month, and 6 months post-intervention. This report presents the analysis of 74 HMSM in the study. There were 37 HMSM in the Intervention group and 37 in the control group. The proportions of participants having anal sex and having sex with either HIV-uninfected or unknown partners in past 30 days were significantly lower in Intervention group than in control group at 6 months post-intervention (38% vs. 65%, p = .04; and 27% vs. 62%, p < .01, respectively). There were no significant differences in general mental health scores and HIV stigma scores between the two groups at any study visit. Thirty-five (95%) HMSM in the Intervention group vs. 31 (84%) in control group attended ≥3 sessions. Loss to follow-up was 8% and 30%, respectively (p = .04). Healthy Choices for young Thai HMSM was associated with sexual risk reduction. Improvements in mental health and HIV stigma were noted in Intervention group. Healthy Choices is a promising behavioral intervention and should be further developed to serve the needs of young HMSM in resource-limited countries. PMID:24668304
Coyne, Noreen; Correnti, Deborah
Motivational interviewing (MI) as a strategy to promote behavior change has its roots in the addiction field. In recent years there is growing use of MI as an intervention to help patients with diet, physical activity, and other lifestyle changes. This counseling approach initially developed by clinical psychologists is a goal-oriented, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence (). MI is appealing because it is seen as a practical front-line intervention that is concordant with patient-centered care that is being called for in the health service environment.This column profiles four published research/synthesis articles describing experiences by different groups in implementing MI strategies. As you will read, results from trials evaluating MI on patient outcomes are mixed and there continues to be gaps in the evidence on how to best implement MI and on which patients will most likely benefit. Even with outstanding questions, MI shows promise in the very challenging area of promoting behavior change and warrants continued investigation. Interested readers are encouraged to read the original articles for more details. PMID:24326477
Rothman, Emily F.; Wang, Na
Objective To describe the intervention development process and feasibility testing of a hospital-based brief intervention to reduce the perpetration of adolescent dating abuse (ADA). To our knowledge, this intervention is the first to focus exclusively on ADA perpetration reduction via a motivational interview-type intervention in this setting. Method The rationale for and the six Intervention Mapping steps used to generate the intervention are described. Feasibility is conceptualized as intervention acceptability, demand, implementation, practicality, integration, and limited-efficacy. Results The Real Talk intervention was integrated smoothly into the emergency department setting. Participants did not experience any negative impact, and the vast majority (86%) reported that they felt helped. Quantitative assessments suggest that the intervention reduced the number of participants in the pre-contemplation stage of change regarding their use of relationship violence, and may have moved them forward into the action stage. Real Talk participants were more likely than those in the control group to tell friends to help them stay calm around their partner after drinking alcohol, and to talk with their doctor to get help for their problems. Conclusions Real Talk was developed to meet an unmet need for tertiary ADA interventions in non-school settings. It was developed in accordance with a recommended framework, informed by theory, and subsequently tested for feasibility. Feasibility assessment results suggest that Real Talk can be implemented in health care settings and may influence attitudinal and behavioral outcomes in the desired directions. PMID:27525169
Holstad, Marcia McDonnell; DiIorio, Colleen; Kelley, Mary E.; Resnicow, Kenneth; Sharma, Sanjay
We present the results of a clinical trial that tested the efficacy of using motivational interviewing (MI) in a group format to promote adherence to antiretroviral medications and risk reduction behaviors (RRB) in 203 predominately African American HIV infected women. It was compared to a group health promotion program. Participants were followed for 9 months. Adherence was measured by MEMS®; and RRB by self-report. Controlling for recruitment site and years on ART, no significant group by time effects were observed. Attendance (≥7/8 sessions) modified the effects. Higher MI attendees had better adherence at all follow-ups, a borderline significant group by time effect (p = 0.1) for % Doses Taken on Schedule, a significantly larger proportion who reported abstinence at 2 weeks, 6, and 9 months, and always used protection during sex at 6 and 9 months. Though not conclusive, the findings offer some support for using MI in a group format to promote adherence and some risk reduction behaviors when adequate attendance is maintained. PMID:21165692
Dunn, Chris; Darnell, Doyanne; Carmel, Adam; Atkins, David C.; Bumgardner, Kristin; Roy-Byrne, Peter
This quasi experimental study compared the Motivational Interviewing (MI) integrity in two prevalent brief intervention (BI) service delivery models for drug abuse. Routine primary care providers (RCPs) and non-routine care providers (NRCPs) performed BIs using an MI style within the same medical setting, patient population, and Screening, Brief Intervention, and Referral for Treatment (SBIRT) protocol. Interventionists (9 RCPs and 6 NRCPs) underwent similar MI training and performed a total of 423 BIs. We compared the MI integrity scores for all audio recorded sessions from these two SBIRT models for up to 40 months post MI training. Both groups met beginning proficiency in MI on 4 of 5 MI integrity scores, but NRCPs met more of the higher competency criteria than RCPs. There may be limitations with regards to MI fidelity when using RCPs to conduct BIs in some primary care settings. Further experimental investigation is warranted to replicate this finding and identify casual factors of observed differences in MI fidelity. PMID:25515624
Larsen, Marie H; Wahl, Astrid K; Krogstad, Anne-Lene; Aas, Eline
There are few studies evaluating the cost-effectiveness of self-management interventions for patients with psoriasis. Motivational interviewing (MI) as a telephone follow-up after climate-heliotherapy was effective on several clinical parameters, but its cost-effectiveness is unknown. A cost-utility analysis was conducted alongside a randomized controlled trial (RCT) comparing MI with usual care. A total of 169 Norwegian patients were included. A within-trial analysis compared the costs and quality-adjusted life years (QALYs). Utilities were measured with the 15D instrument, supplemented with Dermatological Life Quality Index (DLQI). A time-integrated summary score defined the clinical effects. QALYs were adjusted for baseline differences. MI provided equivalent quality of life and utility (15D: -0.0022 QALYs (95% Cl -0.02, 0.01), p = 0.77, and DLQI: -0.62 QALYs (95%CI -0.65, 0.41), p = 0.24, at lower costs €-1103 (-2293, 87), p = 0.058, compared with treatment-as-usual. The MI intervention was thus cost-effective. This result was more evident when using the DLQI as outcome measure compared with 15D. PMID:26714522
Saffari, Mohsen; Pakpour, Amir H; Mohammadi-Zeidi, Isa; Samadi, Mohammad; Chen, Hui
Background: This study aimed to determine whether motivational interviewing (MI) could change dietary habit and body mass index (BMI) in obese/overweight women. Methods: A cluster-randomized controlled study was performed in four health centers in Qazvin, central Iran. In total, 327 obese/overweight women were selected by a multi-stage sampling method and randomly assigned into control and experimental groups. Food frequency (using questionnaire; FFQ), BMI, and metabolic markers including blood pressure, total serum cholesterol and fasting blood glucose levels were measured in all participants. Data were collected twice (before and one year after the MI interventions). Data were analyzed using student t-test, and Stepwise Linear Regression. Results: There was a significant increase in daily consumption of dietary fiber, whole grain products, fruits and vegetables in the MI group (P<0.05). The consumption of meat product, total fat, saturated fat, carbohydrate and total energy intake were also significantly reduced after MI intervention (P<0.05). As a result, body weight and BMI were significantly reduced in the intervention group compared to the control group (P<0.05). Conclusion: MI is suggested to be an effective strategy to change life style and reduce BMI in overweight/obese women in the long term. This effect needs to be further investigated in different gender and age populations. PMID:25648690
Tollison, Sean J.; Mastroleo, Nadine R.; Mallett, Kimberly A.; Witkiewitz, Katie; Lee, Christine M.; Ray, Anne E.; Larimer, Mary E.
The purpose of this study was to replicate and extend previous findings (Tollison et al., 2008) on the association between peer facilitator adherence to motivational interviewing (MI) microskills and college student drinking behavior. This study used a larger sample size, multiple follow-up time-points, and latent variable analyses allowing for…
Goldman, Ron; Baker, Alison; Lindros, Jeanne; Boucher, Jenelle
Abstract The results of a feasibility study funded by a National Institutes of Health Small Business Innovation Research Phase 1 grant to assess the potential of using online, avatar-based simulation technology to increase pediatricians' use of motivational interviewing techniques to reduce childhood obesity are promising, with potentially positive implications for individual and public health outcomes. PMID:24761323
Young, Tabitha L.; Gutierrez, Daniel; Hagedorn, W. Bryce
This study investigated the relationships between motivational interviewing (MI) and client symptoms, attendance, and satisfaction. Seventy-nine clients attending a university-based counseling center were purposefully assigned to treatment or control conditions. Statistical analyses revealed client symptoms in both groups improved. However,…
Okuyemi, Kolawole S.; James, Aimee S.; Mayo, Matthew S.; Nollen, Nicole; Catley, Delwyn; Choi, Won S.; Ahluwalia, Jasjit S.
Despite high smoking rates among those living in poverty, few cessation studies are conducted in these populations. This cluster-randomized trial tested nicotine gum plus motivational interviewing (MI) for smoking cessation in 20 low-income housing developments (HDs). Intervention participants (10 HDs, n = 66) received educational materials, 8…
Weiss, William H.
A systematic approach to the motivation of employees involves two-way communication, involvement, commitment, training, participation, and job enrichment. Demotivation is a pitfall which may occur when motivation is lacking. (BP)
Walitzer, Kimberly S; Dermen, Kurt H; Barrick, Christopher; Shyhalla, Kathleen
Widespread adoption of empirically-supported treatment innovations has the potential to improve effectiveness of treatment received by individuals with substance use disorders. However, the process of disseminating such innovations has been complex, slow, and difficult. We empirically describe the dissemination and adoption of a treatment innovation--an alcohol-treatment preparatory therapeutic procedure based on motivational interviewing (MI)--in the context of Rogers' (2003) five stages of innovation-decision process (knowledge, persuasion, decision, implementation and confirmation). To this end, 145 randomly-chosen outpatient addiction treatment clinics in New York State received an onsite visit from a project trainer delivering one of three randomly-assigned dissemination intensities: a 15-minute, a half-day or a full-day presentation. Across these clinics, 141 primary administrators and 837 clinicians completed questionnaires assessing aspects of five innovation-decision stages. At each clinic, questionnaire administration occurred immediately pre- and post-dissemination, as well as 1 and 6 months after dissemination. Consistent with Rogers' theory, earlier stages of the innovation-decision process predicted later stages. As hypothesized, dissemination intensity predicted clinicians' post-dissemination knowledge. Clinician baseline characteristics (including gender, pre-dissemination knowledge regarding the MI preparatory technique, education, case load, beliefs regarding the nature of alcohol problems, and beliefs and behavior with regard to therapeutic style) predicted knowledge and persuasion stage variables. One baseline clinic characteristic (i.e., clinic mean beliefs and behavior regarding an MI-consistent therapeutic style) predicted implementation stage variables. Findings suggest that dissemination strategies should accommodate clinician and clinic characteristics. PMID:25934460
Rongkavilit, Chokechai; Wang, Bo; Naar-King, Sylvie; Bunupuradah, Torsak; Parsons, Jeffrey T; Panthong, Apirudee; Koken, Juline A; Saengcharnchai, Pichai; Phanuphak, Praphan
Motivational interviewing (MI) has been shown to reduce sexual risks among HIV-positive men who have sex with men (HMSM) in the US. We conducted a randomized trial of Healthy Choices, a 4-session MI intervention, targeting sexual risks among 110 HIV-positive youth ages 16-25 years in Thailand. Risk assessments were conducted at baseline, 1 month, and 6 months post-intervention. This report presents the analysis of 74 HMSM in the study. There were 37 HMSM in the Intervention group and 37 in the control group. The proportions of participants having anal sex and having sex with either HIV-uninfected or unknown partners in past 30 days were significantly lower in Intervention group than in Control group at 6 months post-intervention (38 vs. 65 %, p = .04; and 27 vs. 62 %, p < .01, respectively). There were no significant differences in general mental health scores and HIV stigma scores between the two groups at any study visit. Thirty-five (95 %) HMSM in the Intervention group vs. 31 (84 %) in control group attended ≥ 3 sessions. Loss to follow-up was 8 and 30 %, respectively (p = .04). Healthy Choices for young Thai HMSM was associated with sexual risk reduction. Improvements in mental health were noted in Intervention group. Healthy Choices is a promising behavioral intervention and should be further developed to serve the needs of young HMSM in resource-limited countries. PMID:24668304
Farrell-Carnahan, Leah; Hettema, Jennifer; Jackson, Justin; Kamalanathan, Shivi; Ritterband, Lee M.
Abstract Background: Alcohol-exposed pregnancy (AEP) is a leading cause of birth defects. Effective face-to-face preconception interventions based on motivational interviewing (MI) exist and should be translated into remote formats for maximum public health impact. This study investigated the feasibility and promise of a one-session, remote-delivered, preconception, MI-based AEP intervention (EARLY Remote) for non–treatment-seeking community women. Subjects and Methods: This was a single-arm, prospective pilot intervention study. All participants received the intervention via telephone and mail. Feasibility of remote-delivery methods, treatment engagement, treatment credibility, MI treatment integrity, and therapeutic alliance were examined. Outcomes were 3- and 6-month drinks per drinking day (DDD), rate of unreliable contraception, and proportion of women at risk for AEP due to continued risk drinking and no or unreliable contraception use. Results: Feasibility of remote delivery was established; participants were engaged by the intervention and rated it as credible. Integrity to MI and therapeutic alliance were good. Both DDD and rate of unreliable contraception decreased significantly over time. Proportions of women who drank at risk levels, used unreliable or no contraception, and/or were at risk for AEP in the past 90 days decreased significantly from baseline to 6 months. Conclusions: Remote delivery was feasible, and the translated remote intervention may reduce AEP risk. Refinement of EARLY Remote may facilitate its placement within a spectrum of effective MI-based preconception AEP interventions as part of a stepped-care approach. EARLY Remote may have an important role within a stepped-care model for dissemination to geographically disperse women at risk for AEP. This could result in substantial public health impact through reduction of AEP on a larger scale. PMID:23763608
Rand, Cynthia S.; Borrelli, Belinda; Bilderback, Andrew; Hovell, Mel; Riekert, Kristin A.
Rationale: Secondhand smoke exposure (SHSe) is a significant modifiable risk for respiratory health in children. Although SHSe is declining overall, it has increased for low-income and minority populations. Implementation of effective SHSe interventions within community organizations has the potential for significant public health impact. Objectives: To evaluate the effectiveness of motivational interviewing (MI) delivered in the context of a SHS education reduction initiative within Head Start to reduce preschool children’s SHSe. Methods: A total of 350 children enrolled in Baltimore City Head Start whose caregivers reported a smoker living in the home were recruited. Caregivers were randomized to MI + education or education alone. Assessments were conducted at baseline, 3, 6, and 12 months. Measurements and Main Results: The primary outcome measure was household air nicotine levels measured by passive dosimeters. Secondary outcomes included child salivary cotinine, self-report of home smoking ban (HSB), and smoking status. Participants in the MI + education group had significantly lower air nicotine levels (0.29 vs. 0.40 mg), 17% increase in prevalence of caregiver-reported HSBs, and a 13% decrease in caregiver smokers compared with education-alone group (all P values < 0.05). Although group differences in salivary cotinine were not significant, among all families who reported having an HSB, salivary cotinine and air nicotine levels declined in both groups (P < 0.05). Conclusions: MI may be effective in community settings to reduce child SHSe. More research is needed to identify ways to tailor interventions to directly impact child SHSe and to engage more families to make behavioral change. Clinical trial registered with www.clinicaltrials.gov (NCT 00927264). PMID:24821270
Magill, Molly; Gaume, Jacques; Apodaca, Timothy R.; Walthers, Justin; Mastroleo, Nadine R.; Borsari, Brian; Longabaugh, Richard
Objective The technical hypothesis of motivational interviewing (MI) posits that therapist implemented MI skills will be related to client speech regarding behavior change and that client speech will predict client outcome. The current meta-analysis is the first aggregate test of this proposed causal model. Method A systematic literature review, using stringent inclusion criteria, identified k = 16 reports describing 12 primary studies. Review methods calculated the inverse-variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple targeted behaviors (i.e., alcohol or illicit drug use, other addictive behaviors). Results Therapist MI-consistent skills were correlated with more client language in favor of behavior change (i.e., change talk; r = .26, p < .0001), but not less client language against behavior change (i.e., sustain talk; r = .10, p = .09). MI-inconsistent skills were associated with less change talk (r = −.17, p = .001) as well as more sustain talk (r = .07, p = .009). Among these studies, client change talk was not associated with follow-up outcome (r = .06, p = .41), but sustain talk was associated with worse outcome (r = −.24, p = .001). In addition, studies that examined composite client language (e.g., an average of negative and positive statements) showed an overall positive relationship with client behavior change (r = .12, p = .006; k = 6). Conclusions This meta-analysis provides an initial test and partial support for a key causal model of MI efficacy. Recommendations for MI practitioners, clinical supervisors, and process researchers are provided. PMID:24841862
Carlbring, Per; Forsberg, Lars; Rosendahl, Ingvar
Background. Effective psychological treatment, including cognitive behavioral therapy and motivational interviewing (MI), is available for people with problematic gambling behaviors. To advance the development of treatment for gambling disorder, it is critical to further investigate how comorbidity impacts different types of treatments. The purpose of this study was to investigate whether screening for risky alcohol habits can provide guidance on whether people with gambling disorder should be recommended cognitive behavioral group therapy (CBGT) or MI. Methods. The present study is a secondary analysis of a previous randomized controlled trial that compared the effects of CBGT, MI and a waitlist control group in the treatment of disordered gambling. Assessment and treatment was conducted at an outpatient dependency clinic in Stockholm, Sweden, where 53 trial participants with gambling disorder began treatment. A modified version of the National Opinion Research Centre DSM-IV Screen for gambling problems was used to assess gambling disorder. The Alcohol Use Disorders Identification Test (AUDIT) was used to screen for risky alcohol habits. Results. The interaction between treatment and alcohol habits was significant and suggests that patients with gambling disorder and risky alcohol habits were better helped by MI, while those without risky alcohol habits were better helped by CBGT. Conclusions. The results support a screening procedure including the AUDIT prior to starting treatment for gambling disorder because the result of the screening can provide guidance in the choice of treatment. Patients with gambling disorder and risky alcohol habits are likely to be best helped if they are referred to MI, while those without risky alcohol habits are likely to be best helped if they are referred to CBGT. PMID:27069823
Heilemann, MarySue V; Pieters, Huibrie C; Kehoe, Priscilla; Yang, Qing
US-born Latinos report significantly more depression than foreign-born Latinos in the US, and Latinas have twice the rate of depression than Latino men. The purpose of this pilot study was to test the feasibility of an innovative, short-term program of Schema Therapy (ST) combined with Motivational Interviewing (MI) techniques to reduce depression and increase resilience among second generation Latinas of low income in the US. In addition to blending ST and MI strategies with a focus on resilience, a novel technique called collaborative-mapping was a crucial strategy within treatment. Scheduling for sessions was flexible and patients had unlimited cell phone access to the therapist outside of sessions, although few used it. A mixed linear regression model for BDI-II scores of 8 women who completed all eight 2-h sessions demonstrated that the treatment significantly decreased BDI-II scores during the course of treatment (p = .0003); the average decreasing rate in BDI-II scores was 2.8 points per visit. Depression scores remained sub-threshold for 12 months after treatment completion. Resilience scores significantly increased after treatment completion and remained high at all follow-up visits through 1 year (p < .01). Thus, this short term, customized intervention was both feasible and effective in significantly decreasing depression and enhancing resilience for this sample with effects enduring one year after treatment. This study is the first to combine ST and MI in therapy, which resulted in an appealing, desirable, and accessible depression treatment for this severely understudied, underserved sample of low income, second generation Latinas in the US. PMID:21619859
Chariyeva, Zulfiya; Golin, Carol E; Earp, Jo Anne; Maman, Suzanne; Suchindran, Chirayath; Zimmer, Catherine
Little is known about the amount of Motivational Interviewing (MI) needed to reduce risky sexual behavior among People Living with HIV/AIDS (PLWHA) or the roles self-efficacy and motivation to practice safer sex play. Among 183 PLWHA who received safer sex MI and were surveyed every 4 months over a 12 month period, we used hierarchical negative binomial regression models to examine the association between amount of counseling time and sexual risk behavior. We performed mediation analysis to evaluate whether changes in self-efficacy and motivation explained this association. This study found that as MI time and number of provided sessions increased, participants' sexual risk behavior decreased. The effect of MI time and number of sessions on sexual behavior was mediated by self-efficacy but not by motivation to practice safer sex. PMID:22228069
Solomon, Daniel H.; Gleeson, Timothy; Iversen, Maura; Avorn, Jerome; Brookhart, M. Alan; Lii, Joyce; Losina, Elena; May, Frank; Patrick, Amanda; Shrank, William H.; Katz, Jeffrey N.
Purpose While many effective treatments exist for osteoporosis, most people do not adhere to such treatments long-term. No proven interventions exist to improve osteoporosis medication adherence. We report here on the design and initial enrollment in an innovative randomized controlled trial aimed at improving adherence to osteoporosis treatments. Methods The trial represents a collaboration between academic researchers and a state-run pharmacy benefits program for low-income older adults. Beneficiaries beginning treatment with a medication for osteoporosis are targeted for recruitment. We randomize consenting individuals to receive 12-months of mailed education (control arm) or an intervention consisting of one-on-one telephone-based counseling and the mailed education. Motivational Interviewing forms the basis for the counseling program which is delivered by seven trained and supervised health counselors over ten telephone calls. The counseling sessions include scripted dialogue, open-ended questions about medication adherence and its barriers, as well as structured questions. The primary endpoint of the trial is medication adherence measured over the 12-month intervention period. Secondary endpoints include fractures, nursing home admissions, health care resource utilization, and mortality. Results During the first 7 months of recruitment, we have screened 3,638 potentially eligible subjects. After an initial mailing, 1,115 (30.6%) opted out of telephone recruitment and 1,019 (28.0%) could not be successfully contacted. Of the remaining, 879 (24.2%) consented to participate and were randomized. Women comprise over 90% of all groups, mean ages range from 77–80 years old, and the majority in all groups was white. The distribution of osteoporosis medications was comparable across groups and the median number of different prescription drugs used in the prior year was 8–10. Conclusions We have developed a novel intervention for improving osteoporosis medication
Scholars who study volunteer activities are attaching ever greater importance to the motivations of volunteers who participate in volunteer activities. However, deficiencies are, on the whole, to be found in the empirical studies by scholars in China on the participating volunteers' motivations. To make up for the deficiencies in the research on…
Background The non-pharmacological approach to cholesterol control in patients with hyperlipidemia is based on the promotion of a healthy diet and physical activity. Thus, to help patients change their habits, it is essential to identify the most effective approach. Many efforts have been devoted to explain changes in or adherence to specific health behaviors. Such efforts have resulted in the development of theories that have been applied in prevention campaigns, and that include brief advice and counseling services. Within this context, Motivational Interviewing has proven to be effective in changing health behaviors in specific cases. However, more robust evidence is needed on the effectiveness of Motivational Interviewing in treating chronic pathologies -such as dyslipidemia- in patients assisted by general practitioners. This article describes a protocol to assess the effectiveness of MI as compared with general practice (brief advice), with the aim of improving lipid level control in patients with dyslipidemia assisted by a general practitioner. Methods/Design An open, two-arm parallel, multicentre, cluster, controlled, randomized, clinical trial will be performed. A total of 48-50 general practitioners from 35 public primary care centers in Spain will be randomized and will recruit 436 patients with dyslipidemia. They will perform an intervention based either on Motivational Interviewing or on the usual brief advice. After an initial assessment, follow-ups will be performed at 2, 4, 8 and 12 months. Primary outcomes are lipid levels (total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides) and cardiovascular risk. The study will assess the degree of dietary and physical activity improvement, weight loss in overweight patients, and adherence to treatment guidelines. Discussion Motivational interview skills constitute the primary strategies GPs use to treat their patients. Having economical, simple, effective and applicable techniques is essential
Finney, Sara J.; Sundre, Donna L.; Swain, Matthew S.; Williams, Laura M.
Accountability mandates often prompt assessment of student learning gains (e.g., value-added estimates) via achievement tests. The validity of these estimates have been questioned when performance on tests is low stakes for students. To assess the effects of motivation on value-added estimates, we assigned students to one of three test consequence…
Wei, Fang-Yi Flora
This unit activity is integrated into the chapters on radio of the appropriate course--Survey of Mass Media, Broadcast Journalism, News Writing, Media Programing, or Communication Technology. Employing the concept of a "hot-clock radio format," the purpose of this unit activity is to motivate students' collaborative learning in news…
This narrative interview study of a Spanish learner documents and explains apparent contradictions in a student's story when reporting on why she continues to take Spanish even when she does not like it or perform well in foreign language courses. A dialectical approach to human activity based on sociocultural theory is used to make sense of her…
Carr, Carol; Johnson, La-Shell; Smith, Rosie; Lawrence, Mary; Kaye, Leanne; Gellin, Mindy; Manning, Michelle
Peer Connect matches cancer survivors and caregivers (guides) with those currently experiencing cancer-related issues seeking support (partners). Motivational interviewing (MI)-based communication skills are taught to provide patient-centered support. There is little guidance about MI-based applications with cancer survivors who may have multiple coping needs. This paper addresses the results and lessons learned from implementing Peer Connect. Thirteen cancer survivors and two caregivers received a 2-dayMI, DVD-based training along with six supplemental sessions. Nineteen partners were matched with guides and received telephone support. Evaluation included guide skill assessment (Motivational Interviewing Treatment Integrity Code) and 6-month follow-up surveys with guides and partners. Guides demonstrated MI proficiency and perceived their training as effective. Guides provided on average of five calls to each partner. Conversation topics included cancer fears, family support needs, coping and care issues, and cancer-related decisions. Partners reported that guides provided a listening ear, were supportive, and nonjudgmental. Limited time availability of some guides was a challenge. MI can provide support for cancer survivors and caregivers without specific behavioral concerns (e.g., weight and smoking). An MI support model was both feasible and effective and can provide additional support outside of the medical system. PMID:24078346
Allicock, Marlyn; Carr, Carol; Johnson, La-Shell; Smith, Rosie; Lawrence, Mary; Kaye, Leanne; Gellin, Mindy; Manning, Michelle
Peer Connect matches cancer survivors and caregivers (guides) with those currently experiencing cancer-related issues seeking support (partners). Motivational interviewing (MI)-based communication skills are taught to provide patient-centered support. There is little guidance about MI-based applications with cancer survivors who may have multiple coping needs. This paper addresses the results and lessons learned from implementing Peer Connect. Thirteen cancer survivors and two caregivers received a 2-day MI, DVD-based training along with six supplemental sessions. Nineteen partners were matched with guides and received telephone support. Evaluation included guide skill assessment (Motivational Interviewing Treatment Integrity Code) and 6-month follow-up surveys with guides and partners. Guides demonstrated MI proficiency and perceived their training as effective. Guides provided on average of five calls to each partner. Conversation topics included cancer fears, family support needs, coping and care issues, and cancer-related decisions. Partners reported that guides provided a listening ear, were supportive, and nonjudgmental. Limited time availability of some guides was a challenge. MI can provide support for cancer survivors and caregivers without specific behavioral concerns (e.g., weight and smoking). An MI support model was both feasible and effective and can provide additional support outside of the medical system. PMID:24078346
Kiene, Susan M; Bateganya, Moses H; Lule, Haruna; Wanyenze, Rhoda K
Provider-initiated HIV testing and counseling (PITC) has rapidly expanded in many countries including Uganda. However, because it provides HIV prevention information without individualized risk assessment and risk reduction counseling it may create missed opportunities for effective HIV prevention counseling. Our objective was to assess the effect of a brief motivational interviewing-based intervention during outpatient PITC in rural Uganda compared to Uganda's standard-of-care PITC at reducing HIV transmission-relevant sexual risk behavior. We enrolled 333 (160 control, 173 intervention) participants in a historical control trial to test the intervention vs. standard-of-care. Participants received PITC and standard-of-care or the intervention counseling and we assessed sexual risk behavior at baseline and 3 and 6 months follow-up. The intervention condition showed 1.5-2.4 times greater decreases in high risk sexual behavior over time compared to standard-of-care (p = 0.015 and p = 0.004). These data suggest that motivational interviewing based counseling during PITC may be a promising intervention to reduce high-risk sexual behavior and potentially reduce risk of HIV infection. PMID:27037546
Van Voorhees, Benjamin W.; Fogel, Joshua; Pomper, Benjamin E.; Marko, Monika; Reid, Nicholas; Watson, Natalie; Larson, John; Bradford, Nathan; Fagan, Blake; Zuckerman, Steve; Wiedmann, Peggy; Domanico, Rocco
Background Internet-based interventions for education and behavior change have proliferated, but most adolescents may not be sufficiently motivated to engage in Internet-based behavior change interventions. We sought to determine how two different forms of primary care physician engagement, brief advice (BA) versus motivational interview (MI), could enhance participation outcomes in an Internet-based depression prevention intervention. Methods Eighty-three adolescents at risk for developing major depression were recruited by screening in primary care and randomized to two groups: BA (1–2 minutes) + Internet program versus MI (10–15 minutes) + Internet program. We compared measures of participation and satisfaction for the two groups for a minimum of 12 months after enrollment. Results Both groups engaged the site actively (MI: 90% versus BA: 78%, p=0.12). MI had significantly higher levels of engagement than BA for measures including total time on site (143.7 minutes versus 100.2 minutes, p=0.03), number of sessions (8.16 versus 6.00, p=0.04), longer duration of session activity on Internet site (46.2 days versus 29.34 days, p=0.04), and with more characters typed into exercises (3532 versus 2004, p=0.01). Adolescents in the MI group reported higher trust in their physician (4.18 versus 3.74, p=0.05) and greater satisfaction with the Internet-based component (7.92 versus 6.66, p=0.01). Conclusions Primary care engagement, particularly using motivational interviewing, may increase Internet use dose, and some elements enhance and intensify adolescent use of an Internet-based intervention over a one to two month period. Primary care engagement may be a useful method to facilitate adolescent involvement in preventive mental health interventions. PMID:20694059
Background Unplanned pregnancies and sexually transmitted infections (STIs) are important and costly public health problems in the United States resulting from unprotected sexual intercourse. Risk factors for unplanned pregnancies and STIs (poverty, low educational attainment, homelessness, substance abuse, lack of health insurance, history of an abusive environment, and practice of commercial sex work) are especially high among women with a history of incarceration. Project CARE (Contraceptive Awareness and Reproductive Education) is designed to evaluate an innovative intervention, Motivational Interviewing with Computer Assistance (MICA), aimed at enhancing contraceptive initiation and maintenance among incarcerated women who do not want a pregnancy within the next year and who are anticipated to be released back to the community. This study aims to: (1) increase the initiation of highly effective contraceptives while incarcerated; (2) increase the continuation of highly effective contraceptive use at 3, 6, 9, and 12 months after release; and (3) decrease unsafe sexual activity. Methods/Design This randomized controlled trial will recruit 400 women from the Rhode Island Department of Corrections (RI DOC) women’s jail at risk for an unplanned pregnancy (that is, sexually active with men and not planning/wanting to become pregnant in the next year). They will be randomized to two interventions: a control group who receive two educational videos (on contraception, STIs, and pre-conception counseling) or a treatment group who receive two sessions of personalized MICA. MICA is based on the principles of the Transtheoretical Model (TTM) and on Motivational Interviewing (MI), an empirically supported counseling technique designed to enhance readiness to change targeted behaviors. Women will be followed at 3, 6, 9, and 12 months post release and assessed for STIs, pregnancy, and reported condom use. Discussion Results from this study are expected to enhance our
Riekert, Kristin A.; Borrelli, Belinda; Bilderback, Andrew; Rand, Cynthia S.
Objectives To develop and assess the feasibility of a motivational interviewing (MI) based asthma self-management program for inner-city, African-American, adolescents with asthma. Methods 37 African-American adolescents (age 10-15 years) recently seen in an inner-city emergency department for asthma and prescribed an asthma controller medication participated in the newly developed program consisting of 5 home visits. Adolescents and their caregivers completed phone-based surveys before and after the intervention. Results 95% of the adolescents completed all 5 sessions; 89% of caregivers and 76% of adolescents believed other families would benefit from the intervention. Caregivers were more likely to report 100% adherence post-intervention compared to pre-intervention and reported a trend for adolescents taking greater responsibility for their asthma. There were no pre-post differences in adolescent-reported medication adherence, but adolescents did reported increased motivation and readiness to adhere to treatment. Caregivers and adolescents each reported statistically significant increases in their asthma quality of life. Conclusions The findings from this pilot study suggest that MI is a feasible and promising approach for increasing medication adherence among inner-city adolescents with asthma and is worthy of further evaluation in a randomized trial. PMID:20371158
Development of a Fully Automated, Web-Based, Tailored Intervention Promoting Regular Physical Activity Among Insufficiently Active Adults With Type 2 Diabetes: Integrating the I-Change Model, Self-Determination Theory, and Motivational Interviewing Components
Moreau, Michel; Gagnon, Marie-Pierre
Background Type 2 diabetes is a major challenge for Canadian public health authorities, and regular physical activity is a key factor in the management of this disease. Given that fewer than half of people with type 2 diabetes in Canada are sufficiently active to meet the recommendations, effective programs targeting the adoption of regular physical activity (PA) are in demand for this population. Many researchers argue that Web-based, tailored interventions targeting PA are a promising and effective avenue for sedentary populations like Canadians with type 2 diabetes, but few have described the detailed development of this kind of intervention. Objective This paper aims to describe the systematic development of the Web-based, tailored intervention, Diabète en Forme, promoting regular aerobic PA among adult Canadian francophones with type 2 diabetes. This paper can be used as a reference for health professionals interested in developing similar interventions. We also explored the integration of theoretical components derived from the I-Change Model, Self-Determination Theory, and Motivational Interviewing, which is a potential path for enhancing the effectiveness of tailored interventions on PA adoption and maintenance. Methods The intervention development was based on the program-planning model for tailored interventions of Kreuter et al. An additional step was added to the model to evaluate the intervention’s usability prior to the implementation phase. An 8-week intervention was developed. The key components of the intervention include a self-monitoring tool for PA behavior, a weekly action planning tool, and eight tailored motivational sessions based on attitude, self-efficacy, intention, type of motivation, PA behavior, and other constructs and techniques. Usability evaluation, a step added to the program-planning model, helped to make several improvements to the intervention prior to the implementation phase. Results The intervention development cost was
Jalali, Farzad; Afshari, Reza; Babaei, Ali; Abasspour, Hassan; Vahedian-Shahroodi, Mohammad
Background The prevalence of smoking is much higher in prisoners than it is in the general population. Prisoners who smoke cause many health problems for themselves and other prisoners. Therefore, we should help them stop smoking. Objective To compare the effects of motivational interviewing-based (MI-based) treatment and its combination with nicotine replacement therapy (NRT) on smoking cessation in prisoners at Mashhad Central Prison. Methods The study was designed as a double-blind, randomized, controlled clinical trial, and it began in February 2013 and ended in February 2014. Two hundred and thirteen prisoners met the inclusion criteria and were enrolled in the study. They were divided randomly into three groups, i.e., MI-based treatment, MI with NRT, and the control group, which didn’t receive any therapy. The outcome measures were reported after intervention and at a 90-day follow-up, and changes in the CO levels in expired air and nicotine dependency were measured. Results The average age of the subjects was 37.59 ± 8.76, and their mean duration of imprisonment was 3.3 ± 1.90 years. They smoked an average of 21.84 ± 8.72 cigarettes per day. Analysis of the concentration of CO in expired air in the pre-test, post-test, and at the follow-up for the three groups showed that the variations in the mean CO concentrations in the MI group and the MI with NRT group at the pre-test and at the post-test were statistically significant (p < 0.001), but no significant changes occurred between the post-test and the follow-up (p > 0.050). In addition, the results indicated that CO concentration in expired air in the MI with NRT group was statistically significant, with better efficacy of smoking cessation, compared with control group and the MI group after the follow-up (p = 0.02). Conclusions Motivational interviewing combined with NRT for smoking cessation is more effective than MI alone, and it resulted in a significant decrease in the CO concentration in expired
Pettifor, Audrey; Corneli, Amy; Kamanga, Gift; McKenna, Kevin; Rosenberg, Nora E.; Yu, Xuesong; Ou, San-San; Massa, Cecilia; Wiyo, Patricia; Lynn, Diana; Tharaldson, Jenae; Golin, Carol; Hoffman, Irving
Objective We pilot tested a Motivational Interviewing (MI) –based counseling intervention for individuals with Acute HIV Infection (AHI) to reduce risky sexual behavior in Lilongwe, Malawi. Methods Twenty-eight individuals diagnosed with AHI were randomized to receive either brief education alone, or the brief education plus the MI-based intervention, called Uphungu Wanga. Participants in Uphungu Wanga received four sessions delivered on the day of diagnosis, three days later and at weeks 1 and 2 with a booster session at week 8; participants were followed for 24 weeks from diagnosis. An interviewer administered quantitative questionnaire was conducted at baseline and at weeks 2, 4, 8, 12, 16, 20 and 24. Semi-structured qualitative interviews (SSI) were conducted at weeks 2, 8, 12, and 24. Results The majority of participants in both arms reported rapid and sustained behavior change following diagnosis with AHI. Very few participants reported having sex without a condom after diagnosis. Participants reported a trend towards fewer sex partners and abstaining from sex during study follow-up. Participants in the MI-based arm provided concrete examples of risk reduction strategies in the SSIs while those in the brief education arm primarily described reducing risk behavior, suggesting that the MI-based group may have acquired more risk reduction skills. Conclusions Individuals in both study arms reduced risky sexual behaviors after diagnosis with AHI. We found few major differences between study arms during the 6-month follow up period in self-reported sexual behaviors therefore a MI-based intervention may not be needed to trigger behavior change following AHI. However, comparing the MI-based intervention to repeated brief education sessions made it difficult to assess the potential benefit of an MI-based intervention in a setting where standard counseling often consists of one post-test session. Nevertheless, provision of counseling immediately following diagnosis
Rosengren, David B; Baer, John S; Hartzler, Bryan; Dunn, Christopher W; Wells, Elizabeth A
The authors developed and evaluated a group-administered method for measuring motivational interviewing (MI) skills. The video assessment of simulated encounters (VASE) consists of three videotaped vignettes of actors playing substance abusers. Each vignette is followed by eight questions asking examinees to generate written responses consistent with MI principles. Twenty-two clinicians completed the VASE questionnaire and two other measures of MI skill: a paper-and-pencil measure that elicited responses to written scenarios and an audiotaped interaction with a standardized patient (SP), subsequently scored for MI skill by independent tape raters. Psychometric analyses of this original VASE scale evaluated: (1) scoring reliability of the 24 VASE items; (2) internal reliability of the VASE full-scale score, seven subscale scores and the three vignettes; and (3) concurrent validity with aforementioned indices of MI skill. Analyses informed the removal of two subscales, redesign of a third and revisions to a fourth. The resulting 18-item VASE-R scale retains its three-vignette format, and assesses overall MI skill as well as the following five MI "microskills": reflective listening, responding to resistance, summarizing, eliciting change talk and developing discrepancy. The VASE-R requires further analysis to evaluate these revisions, but shows promise as a cost-effective alternative for use in MI skill assessment in a variety of training and research contexts. PMID:16102376
Dunn, Chris; Darnell, Doyanne; Yi, Sheng Kung Michael; Steyvers, Mark; Bumgardner, Kristin; Lord, Sarah Peregrine; Imel, Zac; Atkins, David C.
Standardized rating systems are often used to evaluate the proficiency of Motivational Interviewing (MI) counselors. The published inter-rater reliability (degree of coder agreement) in many studies using these instruments has varied a great deal; some studies report MI proficiency scores that have only fair inter-rater reliability, and others report scores with excellent reliability. How much can we to trust the scores with fair versus excellent reliability? Using a Monte Carlo statistical simulation, we compared the impact of fair (0.50) versus excellent (0.90) reliability on the error rates of falsely judging a given counselor as MI proficient or not proficient. We found that improving the inter-rater reliability of any given score from 0.5 to 0.9 would cause a marked reduction in proficiency judgment errors, a reduction that in some MI evaluation situations would be critical. We discuss some practical tradeoffs inherent in various MI evaluation situations, and offer suggestions for applying findings from formal MI research to problems faced by real-world MI evaluators, to help them minimize the MI proficiency judgment errors bearing the greatest cost.
Foster, Caroline; McDonald, Susan; Frize, Graham; Ayers, Sarah; Fidler, Sarah
Emerging evidence suggests financial incentives (FIs) improve medication adherence in select populations. A small proportion of adolescents with perinatal HIV (PaHIV) transfer to adult services with established poor adherence and advanced disease. We describe a single center adherence intervention combining FIs with motivational interviewing (MI). Eligible patients (PaHIV,16-25 years, CD4 count ≤ 200, off ART despite multiple attempts) received MI, and FI dependent on viral load (VL) reduction for 1 year. Outcome measures compared CD4 gain from baseline at 1 year and 12 months post cessation of FI/MI. Eleven young people enrolled; median age 19 years, 8 female. Baseline median CD4 count 30 cells/μL (IQR 10-160), VL 12,870 c/mL. Outcomes at 12 months: 9/11 ever achieved VL < 50, 5 sustained undetectable VL, median CD4 140, mean CD4 gain 90 cells/μL at 1 year. Twelve months post cessation of MI/FI; six VL < 50, median CD4 75, mean CD4 gain 122 cells/μL. Total FI expenditure £1,350: £68 per 50 CD4 cells at 1 year, £55 at 24 months. To prevent death, adolescents with PaHIV require novel interventions to reverse poor patterns of adherence established since childhood. FI/MI improved virological and immunological outcomes with minimal expenditure. Extension of this pilot work for vulnerable individuals is now indicated. PMID:24428797
Combining Motivational Interviewing With Compliance Enhancement Therapy (MI-CET): Development and Preliminary Evaluation of a New, Manual-Guided Psychosocial Adjunct to Alcohol-Dependence Pharmacotherapy*
Heffner, Jaimee L.; Tran, Giao Q.; Johnson, Candace S.; Barrett, Suzan Winders; Blom, Thomas J.; Thompson, Rachel D.; Anthenelli, Robert M.
Objective: Psychosocial interventions that are practical, transportable, and effective in promoting treatment adherence and efficacy are greatly needed in both research and clinical settings involving alcohol-dependence pharmacotherapy. In this article, we describe the development and preliminary evaluation of an integrative treatment blending motivational interviewing and compliance enhancement therapy (MI-CET) as a means of enhancing adherence and retention in an ongoing clinical trial. Method: Medication adherence, session attendance, and study completion rates were examined for 121 treatment-seeking, alcohol-dependent adults participating in a randomized clinical trial of citalopram (n = 81) versus placebo (n = 40). All participants received the manual-guided MI-CET intervention as an adjunct to pharmacotherapy. Preliminary adherence and retention data for this trial were compared with data from prior studies involving treatment for alcohol dependence with a selective serotonin reuptake inhibitor. Results: High rates of medication adherence (79% of citalopram and 91% of placebo completers took ≥80% of doses), session attendance (average of 90% for citalopram and 93% for placebo groups), and study completion (81% for citalopram and 88% for placebo groups) were obtained in the present study using MI-CET. These rates were at least comparable to or were, in some cases, 20%–30% higher than rates obtained in the comparison trials. Conclusions: These results suggest that MI-CET is feasible as a psychosocial adjunct to alcohol-dependence pharmacotherapy. Given its strengths as a clinical and research intervention (e.g., practicality, transportability), further evaluation of its efficacy is warranted. PMID:20105415
Ouimet, Marie Claude; Dongier, Maurice; Di Leo, Ivana; Legault, Lucie; Tremblay, Jacques; Chanut, Florence; Brown, Thomas G
Background In a previously published randomized controlled trial (Brown et al. Alcohol Clin Exp Res 2010; 34, 292–301), our research team showed that a 30-minute brief motivational interviewing (BMI) session was more effective in reducing percentages of risky drinking days in drunk driving recidivists than a control information–advice intervention at 12-month follow-up. In this sequel to the initial study, 2 main hypotheses were tested: (i) exposure to BMI increases the time to further arrests and crashes compared with exposure to the control intervention (CTL) and (ii) characteristics, such as age, moderate the benefit of BMI. Methods A sample of 180 community-recruited recidivists who had drinking problems participated in the study. Participants gave access to their provincial driving records at baseline and were followed up for a mean of 1,684.5 days (SD = 155.7) after randomization to a 30-minute BMI or CTL session. Measured outcomes were driving arrests followed by convictions including driving while impaired (DWI), speeding, or other moving violations as well as crashes. Age, readiness to change alcohol consumption, alcohol misuse severity, and number of previous DWI convictions were included as potential moderators of the effect of the interventions. Results For arrests, Cox proportional hazards modeling revealed no significant differences between the BMI and the CTL group. When analyses were adjusted to age tertile categories, a significant effect of BMI in the youngest age tertile (<43 years old) emerged. For crashes, no between-group differences were detected. Conclusions BMI was better at delaying DWI and other dangerous traffic violations in at-risk younger drivers compared with a CTL similar to that provided in many remedial programs. BMI may be useful as an opportunistic intervention for DWI recidivism prevention in settings such as DWI courts. Treatment effectiveness studies are needed to ascertain how the present findings generalize to the
Stuckey, Heather L.; Dellasega, Cheryl; Graber, Nora J.; Mauger, David T.; Lendel, Irina; Gabbay, Robert A.
Background Despite evidence that diabetes is costly and devastating, the health care system is poorly equipped to meet the challenges of chronic disease care. The Penn State Institute of Diabetes & Obesity is evaluating a model of managing Type 2 DM which includes nurse case management (NCM) and motivational interviewing (MI) to foster behavior change. The primary care intervention is designed to improve patients' self care and to reduce clinical inertia through provider use of standardized clinical guidelines to achieve better diabetes outcomes. Methods This RCT tests the efficacy of an enhanced NCM intervention on Type 2 DM (n=549) patient outcomes mediated by changes in self-care behavior and diabetes management. Outcome measures include: (a) effect on clinical parameters such as HbA1c (<7), BP (<130/80), and LDL (<100), depression scores and weight; (b) process measures such as complication screening; (c) patient psychological and behavioral outcomes as measured by emotional distress (PAID), diabetes-specific quality of life (ADDQoL), patient satisfaction (DTSQ), self-care activities (SDSCA); and (d) physician satisfaction and cost-effectiveness of the intervention. Conclusions Baseline includes (mean) age = 58; BMI = 34.4; 57% females; 47% Caucasian, and 39% Hispanic. Patients had elevated HbA1c (8.4), BP (137/77) and LDL (114). Overall, patients were depressed (CES-D = 21.6) and had an extremely negative quality of life (ADDQoL = -1.58). We believe that enhanced NCM will both improve self-care and reduce emotional distress for patients with diabetes. If proven effective, enhanced NCM may be translated to other chronic illnesses. PMID:19328244
Sanci, Lena; Chondros, Patty; Sawyer, Susan; Pirkis, Jane; Ozer, Elizabeth; Hegarty, Kelsey; Yang, Fan; Grabsch, Brenda; Shiell, Alan; Cahill, Helen; Ambresin, Anne-Emmanuelle; Patterson, Elizabeth; Patton, George
Objective To evaluate the effectiveness of a complex intervention implementing best practice guidelines recommending clinicians screen and counsel young people across multiple psychosocial risk factors, on clinicians’ detection of health risks and patients’ risk taking behaviour, compared to a didactic seminar on young people’s health. Design Pragmatic cluster randomised trial where volunteer general practices were stratified by postcode advantage or disadvantage score and billing type (private, free national health, community health centre), then randomised into either intervention or comparison arms using a computer generated random sequence. Three months post-intervention, patients were recruited from all practices post-consultation for a Computer Assisted Telephone Interview and followed up three and 12 months later. Researchers recruiting, consenting and interviewing patients and patients themselves were masked to allocation status; clinicians were not. Setting General practices in metropolitan and rural Victoria, Australia Participants General practices with at least one interested clinician (general practitioner or nurse) and their 14–24 year old patients. Intervention This complex intervention was designed using evidence based practice in learning and change in clinician behaviour and general practice systems, and included best practice approaches to motivating change in adolescent risk taking behaviours. The intervention involved training clinicians (nine hours) in health risk screening, use of a screening tool and motivational interviewing; training all practice staff (receptionists and clinicians) in engaging youth; provision of feedback to clinicians of patients’ risk data; and two practice visits to support new screening and referral resources. Comparison clinicians received one didactic educational seminar (three hours) on engaging youth and health risk screening. Outcome Measures Primary outcomes were patient report of (1) clinician
Background Especially children at risk for asthma are sensitive to the detrimental health effects of passive smoke (PS) exposure, like respiratory complaints and allergic sensitisation. Therefore, effective prevention of PS exposure in this group of vulnerable children is important. Based on previous studies, we hypothesized that an effective intervention program to prevent PS exposure in children is possible by means of a motivational interviewing tailored program with repeated contacts focussing on awareness, knowledge, beliefs (pros/cons), perceived barriers and needs of parents, in combination with feedback about urine cotinine levels of the children. The aim of the PREPASE study is to test the effectiveness of such an intervention program towards eliminating or reducing of PS exposure in children at risk for asthma. This article describes the protocol of the PREPASE study. Methods The study is a one-year follow-up randomized controlled trial. Families with children (0–13 years of age) having an asthma predisposition who experience PS exposure at home are randomized into an intervention group receiving an intervention or a control group receiving care as usual. The intervention is given by trained research assistants. The intervention starts one month after a baseline measurement and takes place once per month for an hour during six home based counselling sessions. The primary outcome measure is the percentage of families curtailing PS exposure in children (parental report verified with the urine cotinine concentrations of the children) after 6 months. The secondary outcome measures include: household nicotine level, the child’s lung function, airway inflammation and oxidative stress, presence of wheezing and questionnaires on respiratory symptoms, and quality of life. A process evaluation is included. Most of the measurements take place every 3 months (baseline and after 3, 6, 9 and 12 months of study). Conclusion The PREPASE study incorporates
Cost-effectiveness of tailored print communication, telephone motivational interviewing, and a combination of the two: results of an economic evaluation alongside the Vitalum randomized controlled trial
Background The aim of the present study was to evaluate the cost-effectiveness of tailored print communication (TPC), telephone motivational interviewing (TMI), a combination of the two, and no intervention on two outcomes in adults aged 45 to 70, half of them having hypertension: increasing the number of public health guidelines met for three behaviors (physical activity and fruit and vegetable consumption), and impact on quality adjusted life years (QALYs). Methods Participants (n = 1,629) from 23 Dutch general practices were randomized into one of four groups, which received 4 TPCs, 4 TMIs, 2 of each (combined), or no intervention (control), respectively. The self-reported outcomes, measured at baseline and 73 weeks follow-up (7 months after the last intervention component), were difference in total number of guidelines met at follow-up compared to baseline, and number of QALYs experienced over 73 weeks. The costs of implementing the intervention were estimated using a bottom-up approach. Results At 73 weeks follow-up participants showed increased adherence with 0.62 (TPC), 0.40 (TMI), 0.50 (combined), and 0.26 (control) guidelines compared to baseline, and experienced 1.09, 1.08, 1.08, and 1.07 QALYs, respectively. The costs for the control group were considered to be zero. TMI was more expensive (€107 per person) than both the combined intervention (€80) and TPC (€57). The control condition was most cost-effective for lower ceiling ratios, while TPC had the highest probability of being most cost-effective for higher ceiling ratios (more than €160 per additional guideline met, and €2,851 for each individual QALY). Conclusions For low society's willingness to pay, the control group was most cost-effective for the number of QALYs experienced over 73 weeks. This also applied to the increase in the number of guidelines met at lower ceiling ratios, whereas at higher ceiling ratios, TPC had a higher probability of being more cost-effective than the TMI
Choosing or designing training that ensures that your engineers are meeting standards and gaining competencies to operate safely and effectively means that a lot rests on the skills and expertise of the training provider. John Thatcher, CEO at Eastwood Park, explains how the right training has the potential to improve service and organisational-level performance. PMID:27132305
Effects of nurse-led motivational interviewing of patients with chronic musculoskeletal pain in preparation of rehabilitation treatment (PREPARE) on societal participation, attendance level, and cost-effectiveness: study protocol for a randomized controlled trial
Background Non-adherence and drop-out are major problems in pain rehabilitation. For patients with various health problems, motivational interviewing (MI) has shown promising effects to tackle these problems. In chronic pain patients, the effectiveness of MI is however unknown. Therefore, a MI-based pre-pain rehabilitation intervention (MIP) addressing motivation, expectations, and beliefs has been developed to prepare eligible patients for rehabilitation treatment. Methods/design Study design: A parallel randomized controlled trial including two interventions: a motivational interviewing pre-pain rehabilitation intervention (MIP) and a usual care (UC) control arm. Follow-up will be 6 months after completion of rehabilitation treatment. Study population: One hundred and sixty (n = 80 per arm) patients with chronic non-specific musculoskeletal pain visiting an outpatient rehabilitation department, who are eligible to participate in an outpatient cognitive behavioral pain rehabilitation program. Intervention: MIP consists of two sessions to prepare and motivate the patient for pain rehabilitation treatment and its bio psychosocial approach. UC consists of information and education about the etiology and the general rehabilitation approach of chronic pain. Both the MIP and UC contain two sessions of 45 to 60 minutes each. Objective: The aim of the current study is to evaluate the effectiveness of MIP compared to UC in terms of an increase in the long-term level of societal participation and decrease of drop-out during rehabilitation treatment. Main study endpoints: Primary outcome is the change in level of participation (according to the ICF-definition: ‘involvement in a life situation’) 6 months after completion of rehabilitation treatment. Secondary outcomes are adherence and treatment drop-out, disability, pain intensity, self-reported main complaints, (pain-specific) self-efficacy, motivation, and quality of life. Costs are calculated including the costs
Anderson, Claire; Kirkpatrick, Susan
Introduction Narrative interviews place the people being interviewed at the heart of a research study. They are a means of collecting people's own stories about their experiences of health and illness. Narrative interviews can help researchers to better understand people's experiences and behaviours. Narratives may come closer to representing the context and integrity of people's lives than more quantitative means of research. Methodology Researchers using narrative interview techniques do not set out with a fixed agenda, rather they tend to let the interviewee control the direction, content and pace of the interview. The paper describes the interview process and the suggested approach to analysis of narrative interviews, We draw on the example from a study that used series of narrative interviews about people's experiences of taking antidepressants. Limitations Some people may find it particularly challenging to tell their story to a researcher in this way rather than be asked a series of questions like in a television or radio interview. Narrative research like all qualitative research does not set out to be generalisable and may only involve a small set of interviews. PMID:26613739
Toward systematic integration between self-determination theory and motivational interviewing as examples of top-down and bottom-up intervention development: autonomy or volition as a fundamental theoretical principle
Clinical interventions can be developed through two distinct pathways. In the first, which we call top-down, a well-articulated theory drives the development of the intervention, whereas in the case of a bottom-up approach, clinical experience, more so than a dedicated theoretical perspective, drives the intervention. Using this dialectic, this paper discusses Self-Determination Theory (SDT) [1,2] and Motivational Interviewing (MI)  as prototypical examples of a top-down and bottom-up approaches, respectively. We sketch the different starting points, foci and developmental processes of SDT and MI, but equally note the complementary character and the potential for systematic integration between both approaches. Nevertheless, for a deeper integration to take place, we contend that MI researchers might want to embrace autonomy as a fundamental basic process underlying therapeutic change and we discuss the advantages of doing so. PMID:22385828
Swindall, Vickie; Cantrell, R. Jeffrey
Describes "Character Interviews," a class activity that guides children, especially reluctant readers, to the meaning of a story through a thoughtful understanding of character as they consider a character's emotions and motives, to respond to a question as that character would. Describes the interview process. Offers sample interviews and…