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

描述（由申请人提供）：动机性访谈（Ml）是如何工作的？尽管研究一致显示Ml的积极作用，但研究发现客户特征与结果之间的关系很少。可能的作用机制包括治疗师行为、来访者行为和人际互动。研究人员完成了一项随机对照试验，研究Ml的适应性，项目选择的有效性。“选择项目”测试了一项针对酒精暴露妊娠（AEP）风险的四期手工指导干预。从3个城市的2个高风险样本中抽取的415名风险饮酒妇女中，干预对风险饮酒和不充分避孕有小到中等的影响，对AEP风险有中等的影响。拟议的研究将使用“选择项目”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，并将这些过程数据与现有数据集合并。然后，我们将测试Ml的一些假设MOAs。具体来说，我们将检查治疗师行为、客户行为和人际互动，评估它们之间的相互关系，以及它们与结果的关系。我们将使用动机性访谈治疗完整性（MITI）代码测试CHOICES干预治疗师的Ml行为。我们将使用动机性访谈技巧代码和客户抗拒代码测试客户行为（改变和抗拒谈话）。我们将使用有效的测量方法，在逐个行为和全局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研究机器学习是一种创新，它将使我们能够在人际关系空间中描述机器学习治疗师行为和客户行为。最后，我们将通过评估治疗师学习行为、来访者行为和人际互动相互影响以及对最终结果的影响的相互竞争的中介和调节模型，建立一个关于学习学习的MOAs的解释模型。该项目的公共卫生影响将是明确Ml的必要和充分组成部分，使临床实践能够以科学为基础进行改进。一旦确定了这些因素，就可以针对包括成瘾性疾病在内的慢性疾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.