Component Analysis of Motivational Interviewing

描述（由申请人提供）：关于AUD的有效心理社会治疗的中介和调节因子，我们所知相对较少。基于最近完成的一项R21研究的工作，本R01研究的主要目的是严格检验动机访谈（MI）的行为改变（MOBC）假设机制。在我们之前的研究中，MI将被分解为三个不同的组成部分：1)完整的MI （FMI）由其关系（例如，精神）和技术（指令）策略组成，2)纯精神MI （SOMI）由共情和非指令咨询组成，3)自我改变控制（SCC）。本研究的主要目标是通过实验操纵承诺强度，即假定的MI的中介，并证明其与减少饮酒的关系。诊断为AUD的问题饮酒者（N=300）将在基线进行评估，并随机分配到FMI， SOMI或SCC，并在治疗期间和治疗后1,3和6个月进行强化随访。MI调解员的日常过程评估（例如，承诺强度）将通过交互式语音录音（IVR）收集，并在治疗期间对客户谈话进行编码，作为评估程序的一部分。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，相对于其他情况，FMI将在治疗结束时和治疗后随访期间显著降低饮酒结果；相对于其他条件，FMI会显著提高承诺强度；增加的承诺强度会调节条件对饮酒结果的影响。此外，作为次要目标，我们假设基线客户动机（使用IVR评估）将显著调节治疗状况和结果之间的关系。治疗效果（FMI相对于SOMI/SCC）对动机低的患者更强。一些额外的次要目标和探索性分析被描述来阐明心肌梗死的MOBC超出那些假设的主要目标。

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. PUBLIC HEALTH RELEVANCE: Motivational Interviewing (MI) is an effective intervention with tremendous implications for a variety of populations suffering from conditions and disorders related to public health, including smoking, gambling, exercise adherence, nutrition, illicit drug use, and alcohol abuse. This R01 builds on a previously implemented pilot study to investigate the mechanisms of change of MI. If its aims are achieved, it will strengthen the efficacy of MI, as well as AUD treatments in general, which can be utilized and implemented in a variety of health settings.