How does Motivational Interviewing Work? Mechanisms of Action in Project CHOICES

描述（由申请人提供）：动机面试（MI）是如何工作的？尽管研究一致显示MI的积极影响，但研究发现客户特征与结果之间的关系很少。可能的作用机制（MOA）包括MI治疗师行为、客户行为和人际互动。研究人员完成了一项关于MI适应性疗效的随机对照试验，即项目选择。项目选择测试了一个四个会议，手动指导干预针对酒精暴露的怀孕（AEP）的风险。有一个小到中度的影响，风险饮酒和避孕措施不足和AEP风险的干预措施中的415个风险饮酒的妇女从2个高风险样本在3个城市。拟议的研究将使用Project CHOICES的治疗会话录音带及其结果数据集。我们将对录音带进行评级，以捕捉治疗师和客户的行为以及人际互动，并将此过程数据与现有数据集合并。然后，我们将测试MI的多个假设的MOA。具体来说，我们将研究治疗师的行为，客户的行为，和人际交往，评估他们的相互关系，以及他们的关系的结果。我们将使用动机访谈治疗完整性（MITI）代码测试CHOICES干预治疗师的MI行为。我们将使用动机性访谈技巧代码和客户阻力代码测试客户行为（改变和阻力谈话）。我们将使用经过验证的测量方法，在逐个行为和全球基础上检查人际互动，以确定人际互动变量与治疗师行为，客户行为和结果的关系。运用人际关系理论来考察心理咨询师的心理咨询行为，将使我们能够在人际关系的复杂空间中描述心理咨询师和来访者的心理咨询行为。最后，我们将通过评估治疗师Ml行为、客户行为和人际互动对彼此和最终结果的影响的竞争中介和调节模型，开发Ml的MOAs的解释模型。该项目的公共卫生影响将是指定MI的必要和充分的组成部分，这将允许基于科学的临床实践改进。一旦确定了这些成分，就可以为包括成瘾性疾病在内的慢性疾病患者的一系列威胁健康的行为开发新的、基于科学的干预措施。

DESCRIPTION (provided by applicant): How does Motivational Interviewing (Ml) work? Although studies consistently show positive effects of Ml, research has found few relationships between client characteristics and outcomes. Possible mechanisms of action (MOA) include Ml therapist behaviors, client behaviors, and interpersonal interactions. The investigators completed a randomized controlled trial of the efficacy of an adaptation of Ml, Project CHOICES. Project CHOICES tested a four session, manual-guided intervention targeting risk for alcohol- exposed pregnancy (AEP). There was a small to moderate effect of the intervention on risk drinking and inadequate contraception and a moderate effect on AEP risk among 415 risk-drinking women drawn from 2 high risk samples in each of 3 cities. The proposed study will use Project CHOICES' audiotapes of therapy sessions and its outcomes dataset. We will rate audiotapes to capture therapist and client behaviors and interpersonal interactions, and merge this process data with the existing dataset. We will then test a number of hypothesized MOAs of Ml. Specifically, we will examine therapist behaviors, client behaviors, and nterpersonal interactions, evaluate their inter-relationships, and their relationships to outcomes. We will test the Ml behaviors of CHOICES intervention therapists using the Motivational Interviewing Treatment Integrity (MITI) code. We will test client behaviors (change and resistance talk) using the Motivational Interviewing Skill Code and the Client Resistance Code. We will examine interpersonal interactions on an act-by-act and global basis using validated measures to determine the relationship of interpersonal interaction variables to therapist behaviors, client behaviors, and outcomes. Using interpersonal theory to examine Ml is an nnovation that will allow us to depict Ml therapist behaviors and client behaviors in interpersonal circumplex space. Lastly, we will develop an explanatory model of the MOAs of Ml by evaluating competing mediator and moderator models of the impact of therapist Ml behaviors, client behaviors, and interpersonal nteractions on each other and on final outcomes. The public health impact of this project will be to specify the necessary and sufficient components of Ml that will allow science-based improvements to clinical practice. Once these components are identified, new, science-based interventions could be developed for a range of health-threatening behaviors for people with chronic illnesses including addictive disorders.