Intervention Ingredients and Mechanisms of an Efficacious Motivational Interview

描述(由申请者提供)：NIAAA已将未上大学的年轻人确定为有针对性的干预措施的关键人群，以减少酗酒和相关的负面后果。基于动机访谈(MI)原则的简短干预已经在大学生中证明了有效性，但对MI的有效性、积极治疗成分以及将大量饮酒的年轻人归类为非大学学生的行为改变机制知之甚少。目前的研究将检验一系列理论驱动的假设，这些假设是关于在有效的MI中对结果的会话内预测因子与这一未被研究的人群有关的。为此，这项研究将从最近完成的临床试验(AA016000；PI：Colby)的音频记录会话文件中收集观察评级的过程数据(动机面试技能代码2.5；客户语言评估-近端/远端)。这项临床试验在过去一个月大量饮酒的未成年人(17-20岁)样本(N=167)中，将单次会议MI与时间匹配的冥想和放松训练(REL)进行了对照。与REL相比，MI在3个月的随访中显著减少了饮酒和与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；感知的饮酒规范；改变饮酒的自我效能；限制饮酒的行为策略)。这些结果提供了一个独特的机会，可以用一个研究不足但需求很高的年轻人群体来研究治疗过程中的过程。具体地说，这项研究将结合新的概念和统计考虑来检查：MI功效的技术假设，MI过程的动机构建和改变计划元素的客户语言机制(MI唤起、聚焦和规划)，特定的会议期间MI成分(探索酒精使用的利弊，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)，它们预测客户语言机制和特定条件(治疗师MI同理心和精神，客户改变的基线动机)，在这些条件下，因果模型被最佳地指定。此外，时间匹配对照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过程文献中很少达到的对比水平。从这项研究中获得的信息可以立即以心肌梗死传播指南的形式传达给服务机构，或者直接以经验支持的心肌梗死治疗提供原则的形式传达给提供者。这项研究还可以通过检查其关键因果模型在人群中的一致性，同时额外扩展模型以确定因果链中的进一步联系，从而为MI文献提供信息。最后，MI作为一种行为改变干预的成功可能是因为它有能力利用以患者为中心的治疗的核心原则，这表明这一系列研究可能对更广泛的治疗促进行为研究具有影响。

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.