Neural Mechanisms of Motivational Interviewing

描述（由申请人提供）：关于AUD有效心理社会治疗的介导者和调节者知之甚少。在最近完成的R21研究的基础上，本研究的主要目的是严格检验动机性面试（MI）的行为改变（MOBC）的假设机制。在我们以前的研究中，MI将被分解为三个不同的组成部分：1）完整的MI（FMI），包括其关系（例如，精神）和技术（指导）策略，2）仅精神MI（SOMI），包括移情和非指导性咨询，以及3）自我改变控制（SCC）。这项研究的主要目标是实验性地操纵承诺强度，MI的假设中介，并证明其与减少饮酒的关系。将在基线时对诊断为AUD的问题饮酒者（N=300）进行评估，并随机分配至FMI、SOMI或SCC组，并在治疗期间和治疗后1、3和6个月进行集中随访。MI调解人的日常过程评估（例如，承诺强度）将作为评估程序的一部分，通过交互式语音记录（IVR）和治疗期间的客户谈话编码收集。参与者还将在第1个月和第6个月提供血液样本，以评估重度饮酒和证实自我报告。我们假设，FMI将产生显着减少饮酒的结果在治疗结束时，并在治疗后的随访期间相对于其他条件; FMI将显着增加承诺强度相对于其他条件;和增加承诺强度将介导的关系条件对饮酒结果的影响。此外，作为次要目的，我们假设基线客户动机（使用IVR评估）将显着缓和治疗条件和结果之间的关系。治疗效果（FMI相对于SOMI/SCC）对那些动机低的人来说会更强。描述了一些额外的次要目的和探索性分析，以阐明MI的MOBC超出假设的主要目的。

DESCRIPTION (provided by applicant): Relatively little is known about the mediators and moderators of effective psychosocial treatment for AUD. Building on the work of a recently completed R21 study, the primary aim of this proposed R01 study is to rigorously test the hypothesized mechanisms of behavior change (MOBC) of motivational interviewing (MI). As in our previous study, MI will be dismantled into three distinct components: 1) full MI (FMI) consisting of its relational (e.g., spirit) and technical (directive) strategies, 2) spirit-only MI (SOMI) consisting of empathic and non-directive counseling, and 3) a self-change control (SCC). A primary goal of the study will be to experimentally manipulate commitment strength, the hypothesized mediator of MI, and demonstrate its relationship to reduced drinking. Problem drinkers diagnosed with AUD (N=300) will be assessed at baseline and randomly assigned to FMI, SOMI, or SCC and followed intensively during treatment and at 1, 3, and 6 months post treatment. Daily process assessment of MI mediators (e.g., commitment strength) will be collected via Interactive Voice Recordings (IVR) and coding of client talk during therapy sessions as part of the assessment procedures. Participants will also provide blood samples at month 1 and 6 to assess for heavy drinking and corroborate self report. We hypothesize that FMI will yield significantly reduced drinking outcomes at end treatment and during the post treatment follow-up period relative to the other conditions; that FMI will significantly increase commitment strength relative to the other conditions; and that increased commitment strength will mediate the relationship of condition effects on drinking outcomes. In addition, as a secondary aim we hypothesize that baseline client motivation (assessed using IVR) will significantly moderate the relationship between treatment condition and outcome. Treatment effects (FMI relative to SOMI/SCC) will be stronger for those with low motivation. A number of additional secondary aims and exploratory analyses are described to elucidate the MOBC of MI beyond those hypothesized as primary aims.