Intervention Ingredients and Mechanisms of an Efficacious Motivational Interview

NIAAA已确定非大学约束的年轻人作为有针对性的干预，以减少重度酒精使用和相关的负面后果的关键人群。简短的干预措施，动机访谈（MI）的原则为基础，已在大学生中表现出疗效，但很少有人知道MI的疗效，积极的治疗成分，行为改变的机制与大量饮酒的年轻人被归类为非大学。本研究将测试一系列理论驱动的假设，这些假设是关于有效MI结局的治疗期内预测因素的。为此，本研究将从最近完成的临床试验（AA 016000; PI：科尔比）的音频记录会话文件中收集观察评级的过程数据（动机性访谈技能代码2.5;客户语言评估-近端/远端）。临床试验比较了一个单一的会议MI的时间匹配的对照冥想和放松训练（REL）的样本（N=167），过去一个月的大量饮酒者（17-20岁）。与REL相比，MI在3个月随访时显著减少了酒精使用和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，以调查负责治疗改善与研究不足，但高需求的年轻成人人群的会话内过程。具体而言，这项研究将纳入新的概念和统计考虑，以检查：多元智能效能的技术假设、多元智能过程中动机建立的客户语言机制和变革计划要素（MI诱发、聚焦和计划），特定的会话内MI成分（探索酒精使用的利弊，提供酒精使用的个性化反馈，并规划限制饮酒的行为策略），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），在这些条件下最佳指定因果模型。此外，时间匹配的控制条件的存在允许会话内成分和机制的条件间测试，这是迄今为止在MI过程文献中很少实现的对比度水平。从本研究中获得的信息可以立即以MI传播指南的形式传达给服务机构，或者以医学支持的MI治疗提供原则的形式直接传达给提供者。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来为MI文献提供信息，同时还可以扩展该模型以确定因果链中的进一步联系。最后，MI作为一种行为改变干预的成功可能是由于它能够利用以客户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产生影响。

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.