Component Analysis of Motivational Interviewing

描述(由申请者提供)：对于有效的心理社会治疗的调解人和调解人，我们知之甚少。在最近完成的R21研究的基础上，这项建议的R01研究的主要目的是严格测试动机访谈(MI)的行为改变(MOBC)假设机制。与我们之前的研究一样，MI将被分解为三个不同的组成部分：1)完全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)，包括移情和非指令咨询；以及3)自我改变控制(SCC)。这项研究的一个主要目标将是通过实验来操纵承诺强度，这是MI的假设中介，并证明它与减少饮酒的关系。被诊断为AUD的问题饮酒者(N=300)将在基线时进行评估，并随机分配到FMI、SOMI或SCC，并在治疗期间以及治疗后1、3和6个月进行密集跟踪。作为评估程序的一部分，将通过交互式语音录音(IVR)和在治疗期间对客户谈话进行编码来收集MI调解人的日常流程评估(例如，承诺强度)。参与者还将在1个月和6个月提供血液样本，以评估是否酗酒并证实自己的报告。我们假设，与其他条件相比，FMI将在治疗结束时和治疗后随访期产生显著减少的饮酒结果；相对于其他条件，FMI将显著增加承诺强度；并且增加的承诺强度将中介条件影响对饮酒结果的关系。此外，作为次要目标，我们假设基线客户动机(使用IVR评估)将显著缓和治疗条件和结果之间的关系。对于缺乏动力的人，治疗效果(FMI相对于SOMI/SCC)将更强。描述了一些额外的次要目标和探索性分析，以阐明MI的MOBC超越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.