Intervention Ingredients and Mechanisms of an Efficacious Motivational Interview

有效动机访谈的干预成分和机制

• 批准号: 9087106
• 负责人: Molly Magill
• 金额: $ 27.63万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2018-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9087106
• 关键词: 20 year old; Accounting; Adult; Alcohol abuse; Alcohol consumption; Alcoholic beverage heavy drinker; Alcohols; Area; Behavior Therapy; Behavioral; Behavioral Research; Binding; Client; Clinical; Clinical Trials; Code; Cognitive; Complex; Data; Distal; Elements; Empathy; Feedback; Goals; Guidelines; Health; Heavy Drinking; Individual; Intervention; Knowledge; Language; Lead; Link; Literature; Mediating; Mediation; Meditation; Modeling; Motivation; National Institute on Alcohol Abuse and Alcoholism; Nondirective Therapy; Outcome; Parents; Pathway interactions; Patient Self-Report; Patients; Performance; Population; Process; Provider; Public Health; Relaxation Therapy; Research; Rosa; Sampling; Self Efficacy; Series; Services; Specific qualifier value; Strategic Planning; Study models; Target Populations; Testing; Therapeutic; Time; Training; Treatment Efficacy; Validation; active method; alcohol use disorder; base; behavior change; behavioral outcome; brief intervention; causal model; college; computerized data processing; coping; cost efficient; drinking; follow-up; improved; interest; intervention effect; motivational enhancement therapy; motivational intervention; novel; outcome prediction; personalized care; randomized trial; reduced alcohol use; skills; success; theories; trial comparing; university student; young adult

DESCRIPTION (provided by applicant): NIAAA has identified non-college bound young adults as a key population for targeted intervention to reduce heavy alcohol use and related negative consequences. Brief interventions, based in the principles of Motivational Interviewing (MI), have demonstrated efficacy among college students, but very little is known about MI efficacy, active treatment ingredients, and mechanisms of behavior change with heavy drinking young adults categorized as non-college. The current study will test a series of theory-driven hypotheses regarding the within-session predictors of outcome in an efficacious MI with this understudied population. To do so, this study will collect observationally-rated process data (Motivational Interviewing Skill Code 2.5; Client Language Assessment - Proximal/Distal) from audio-recorded session files derived from a recently completed clinical trial (AA016000; PI: Colby). The clinical trial compared a single session MI to a time-matched control of meditation and relaxation training (REL) in a sample (N=167) of underage, past-month heavy drinkers (17-20 years old). Compared to REL, MI significantly reduced alcohol use and alcohol-related negative consequences at 3-month follow-up while additionally impacting a series of theory-driven cognitive and behavioral intermediate outcomes (motivation to change drinking; perceived drinking norms; self-efficacy to change drinking; behavioral strategies to limit drinking). These results present a unique opportunity to investigate the within-session processes responsible for therapeutic improvement with an understudied, yet high need young adult population. Specifically, this research will incorporate novel conceptual and statistical considerations to examine: the Technical Hypothesis of MI efficacy, the client language mechanisms of the motivation building and change planning elements of MI process (MI Evoking, Focusing, and Planning), the specific within-session MI ingredients (exploring the Pros and Cons of Alcohol Use, providing Personalized Feedback on Alcohol Use, and planning for Behavioral Strategies to Limit Drinking) that predict client language mechanisms and the specific conditions (therapist MI Empathy and Spirit, client baseline motivation to change) under which causal models are optimally specified. Moreover, the presence of the time-matched control condition allows for between-condition tests of within-session ingredients and mechanisms, which is a level of contrast rarely achieved in the MI process literature to date. Information derived from this study can be immediately communicated to service settings in the form of MI dissemination guidelines or directly to providers in the form of empirically-supported principles of MI treatment delivery. This research can also inform the MI literature by examining the consistency of its key causal model across populations while additionally extending the model to identify further links in the causal chain. Finally, the success of MI as a behavior change intervention may be due to its capacity to harness core principles of client-centered therapy, which suggest this line of research may have implications for treatment-facilitated behavioral research more broadly.

描述（由申请人提供）：NIAAA已经确定非上大学的年轻人作为有针对性干预的关键人群，以减少大量饮酒和相关的负面后果。基于动机性访谈（MI）原则的简短干预已经在大学生中证明了有效性，但对于非大学生重度饮酒青年的MI有效性、有效治疗成分和行为改变机制知之甚少。目前的研究将测试一系列理论驱动的假设，这些假设是关于有效的心肌梗死在未充分研究的人群中的预后预测因素。为此，本研究将从最近完成的临床试验（AA016000; PI: Colby）的录音会议文件中收集观察评定的过程数据（动机性访谈技能代码2.5；客户语言评估-近端/远端）。该临床试验将单次MI与时间匹配的冥想和放松训练（REL）对照进行了比较，样本（N=167）为未成年人，过去一个月的重度饮酒者（17-20岁）。与REL相比，MI在3个月的随访中显著减少了酒精使用和酒精相关的负面后果，同时还影响了一系列理论驱动的认知和行为中间结果（改变饮酒的动机；感知饮酒规范；改变饮酒的自我效能感；限制饮酒的行为策略）。这些结果提供了一个独特的机会来研究对治疗改善负有责任的会话过程，对研究不足，但高需求的年轻成人人群。具体来说，这项研究将结合新的概念和统计考虑来检查：MI疗效的技术假设，MI过程中动机建立和改变计划要素的来访者语言机制（MI唤起，聚焦和计划），特定的会话内MI成分（探索酒精使用的优缺点，提供酒精使用的个性化反馈，以及规划限制饮酒的行为策略）预测来访者语言机制和特定条件(治疗师MI共情和精神，客户基线变更动机)，在此基础上因果模型得到最佳指定。此外，时间匹配控制条件的存在允许对会话内成分和机制进行条件间测试，这是迄今为止MI过程文献中很少实现的对比水平。从本研究中获得的信息可以以心肌梗死传播指南的形式立即传达给服务机构，或以经验支持的心肌梗死治疗提供原则的形式直接传达给提供者。本研究还可以通过检查其关键因果模型在人群中的一致性来为MI文献提供信息，同时进一步扩展模型以确定因果链中的进一步联系。最后，MI作为一种行为改变干预的成功可能是由于它能够利用以客户为中心的治疗的核心原则，这表明这条研究路线可能会对更广泛的治疗促进行为研究产生影响。