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

描述(申请人提供)：激励性面试(ML)是如何运作的？尽管研究一直表明ML的积极作用，但研究发现，客户特征和结果之间几乎没有关系。可能的作用机制(MOA)包括ML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ML改编的疗效的随机对照试验，项目选择。项目选择测试了四个疗程的手动干预措施，目标是酒精暴露怀孕(AEP)的风险。从3个城市各抽取2个高危样本，对415名危险饮酒妇女进行干预，对危险饮酒和避孕措施不充分的干预效果为轻到中度，对AEP风险的干预效果为中等。拟议的研究将使用Project Choose的治疗过程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，我们将测试多个假设的m1的MOA。具体地说，我们将检查治疗师行为、客户行为和人际互动，评估它们之间的关系，以及它们与结果的关系。我们将使用动机访谈治疗诚信(MITI)代码来测试SELECTIONS干预治疗师的ML行为。我们将使用激励性面试技能代码和客户抵制代码来测试客户行为(改变和抵制谈话)。我们将使用有效的测量方法，在逐个行动和全球的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。使用人际关系理论来考察ML是一种创新，它将允许我们在人际关系的复杂空间中描绘ML治疗师的行为和客户的行为。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性中介和调节模型来开发ML的MOA的解释模型。该项目对公共卫生的影响将是明确ML的必要和足够的成分，以允许以科学为基础改进临床实践。一旦确定了这些组成部分，就可以针对包括成瘾障碍在内的慢性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.