Motivational interviewing and self-determination theory in a web-based computer tailored physical activity intervention: A randomized controlled trial

Objective: This study explores whether a web-based physical activity (PA) intervention grounded in self-determination theory (SDT) and motivational interviewing (MI) is more effective and better appreciated than a traditional web-based PA intervention.

Design: A randomized controlled trial was conducted, comparing (1) I Move; a web-based PA intervention based on SDT and MI, (2) Active Plus; a traditional web-based PA intervention and (3) a waiting list control condition.

Main outcome measures: Weekly minutes of moderate to vigorous PA and weekly days with ≥30 min PA were measured through self-report at baseline and at 3 and 6 months from baseline.

Results: I Move achieved a small, but significant increase in weekly minutes of moderate to vigorous PA, while Active Plus did not have a significant impact on this outcome. Both interventions were effective in increasing weekly days with ≥30 min PA, whereas Active Plus yielded a greater effect on this outcome.

Conclusion: Overall, the web-based PA intervention grounded in SDT and MI did not outperform the traditional web-based PA intervention. Further research should reveal whether this type of intervention is profitable for long-term maintenance of PA levels.     

Motivational interviewing or reminders for glaucoma medication adherence: Results of a multi-site randomised controlled trial

Objective: Nonadherence reduces glaucoma treatment efficacy. Motivational interviewing (MI) is a well-studied adherence intervention, but has not been tested in glaucoma. Reminder interventions also may improve adherence.

Design: 201 patients with glaucoma or ocular hypertension were urn-randomised to receive MI delivered by an ophthalmic technician (OT), usual care or a minimal behavioural intervention (reminder calls).

Main Outcome Measures: Outcomes included electronic monitoring with Medication Event Monitoring System (MEMS) bottles, two self-report adherence measures, patient satisfaction and clinical outcomes. Multilevel modelling was used to test differences in MEMS results by group over time; ANCOVA was used to compare groups on other measures.

Results: Reminder calls increased adherence compared to usual care based on MEMS, p = .005, and self-report, p = .04. MI had a nonsignificant effect but produced higher satisfaction than reminder calls, p = .007. Treatment fidelity was high on most measures, with observable differences in behaviour between groups. All groups had high baseline adherence that limited opportunities for change.

Conclusion: Reminder calls, but not MI, led to better adherence than usual care. Although a large literature supports MI, reminder calls might be a cost-effective intervention for patients with high baseline adherence. Replication is needed with less adherent participants.     

Barriers to Learning Motivational Interviewing: A Survey of Motivational Interviewing Trainers' Perceptions

Trainers reported that motivational interviewing (MI)–inconsistent behaviors were frequently perceived during training and believed to create barriers to learning. More barriers were perceived in corrections than in mental health training audiences. Strategies to facilitate unlearning MI‐inconsistent behaviors may accelerate acquisition of MI.     

Continuing Education in Motivational Interviewing for Addiction Counselors: Reducing the Research‐to‐Practice Gap

The authors evaluated the effectiveness of continuing education training in motivational interviewing (MI) for addiction counselors. Participants reported a significant increase in counseling self‐efficacy, and 87.5% reported increasing MI use in their practice. Only 3.8%, however, participated in posttraining consultation.     

动机性访谈：一种以咨客为中心的行为改变咨询技术

动机性访谈是目前在西方国家比较流行的一种以咨客为中心的行为改变咨询技术,但在我国关于这一技术的研究和应用都还比较少。本文概述了动机性访谈技术的理论基础、应用原则(表达神入;发展差异;接受阻抗;维持自我效能)和基本技能,并介绍了这一咨询技术的应用现状与研究方向。     

Motivational interviewing as a way to promote physical activity in obese adolescents: A randomised-controlled trial using self-determination theory as an explanatory framework

Using self-determination theory (SDT) as an explanatory framework, this randomised-controlled study evaluates the effect of a motivational interviewing (MI)-based intervention as an addition to a standard weight loss programme (SWLP) on physical activity (PA) practice in obese adolescents over a six-month period. Fifty-four obese adolescents (mean age?=?13?years, mean BMI?=?29.57?kg/m²) were randomly assigned to an SWLP group (n?=?28) or SWLP?+?MI group (n?=?26). Both groups received two SWLP sessions, supplemented for the SWLP?+?MI group, by six MI sessions. Perceived autonomy support, perceived competence, motivational regulations, PA and BMI were assessed at baseline, three and six months (i.e. the end of the programme). MLM analyses revealed that compared to SWLP, the SWLP?+?MI group had a greater BMI decrease and a greater PA practice increase over time. Moreover, the SWLP?+?MI group reported greater autonomy support from medical staff at the end of the programme, greater increase in integrated and identified regulations and a stronger decrease in amotivation. MI appears as an efficient counselling method as an addition to an SWLP to promote PA in the context of pediatric obesity.     

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.     

A Randomized Controlled Pilot Study of Motivational Interviewing to Change Attitudes about Adherence to Medications for Asthma

The day-to-day management of asthma relies on patient self-care practices; in particular, adherent use of asthma medications is fundamental for asthma management. However, most persons with asthma do not use their medications to clinically acceptable standards. The purpose of this study was to test the efficacy of a brief educational intervention to enhance knowledge and skills relevant to asthma self-care, and the efficacy of motivational interviewing to improve attitudes toward taking medications as prescribed. Twenty-five adults with asthma were randomly assigned to receive a brief educational intervention alone, or education plus motivational interviewing. Over time, all participants improved their knowledge of asthma and skills using a metered dose inhaler. Participants who received education alone showed a decreased level of readiness to adhere with their medications over time, whereas participants who received motivational interviewing were more likely to show a stable or increased level of readiness to adhere over time. Among participants who described themselves as not consistently adhering with their medications at the first evaluation, those who received motivational interviewing endorsed more positive attitudes toward taking medications over time. The results are supportive of the utility of motivational interviewing in enhancing participants' attitudes toward adherent medication use. Future research should test if attitude change is reflected in change in medication use.     

A self-efficacy enhancing intervention for pulmonary rehabilitation based on motivational interviewing for postoperative lung cancers patients: modeling and randomized exploratory trial

The objective of this study was to evaluate the feasibility and preliminary efficacy of a self-efficacy enhancing intervention designed for pulmonary rehabilitation based on motivational interviewing (MI) for postsurgical non-small cell lung cancer (NSCLC) patients. This study was a 2-arm pilot randomized controlled trial and was conducted in two cardiothoracic surgery departments, a tertiary hospital in Fuzhou, China. 28 postsurgical NSCLC patients were randomized to a 3 month (6 session) self-efficacy enhancing intervention based on MI or usual care (UC). Data were measured at baseline and after intervention. The MI based self-efficacy enhancing intervention group was superior to the UC group for reducing anxiety and depression, improving self-efficacy, quality of life, confrontational coping, social support and functional capacity. However, no statistically significant difference was observed in subjective well-being, posttraumatic growth, body mass index and pulmonary function between the two groups. This pilot study demonstrated the feasibility of MI based self-efficacy enhancing intervention for postsurgical NSCLC patients. A larger randomized trial would demonstrate a more rigorous test of efficacy.     

从自我决定论看动机访谈法疗效机理

动机访谈法是以病人为中心、促使病人自己改变问题行为的咨询技术和方法。该文从自我决定论角度,解释了动机访谈法取得疗效的机理:动机访谈法起到满足病人基本心理需要(胜任感、归属感、自主性),推动病人产生自主动机的作用,促使病人提高适应性行为的质量和稳定性,提高心理健康水平,从而取得心理治疗效果。     

Development of a Brief Motivational Enhancement Intervention for Intimate Partner Violence in Alcohol Treatment Settings

The current studies were a manual development study and a small pilot study of a 90-minute motivational enhancement style intervention to address intimate partner violence in alcohol-treatment-seeking men. Analyses of feedback provided during manual development suggest participants (a) liked the intervention, (b) reported behavior change intentions, and (c) found the feedback compelling. Findings from the pilot study suggest the intervention might be superior to referral only in increasing short-term help-seeking and lead to marginally significant enhancements in motivation and self-reported intimacy. Help-seeking and motivation findings were associated with medium-large to large effect sizes. At 3- and 6-month follow-up, both groups showed improvements in self-reported alcohol outcomes, anger, and verbal and physical aggression. These findings support further research on this intervention.     

Motivational Interviewing Versus Cognitive Behavioral Group Therapy in the Treatment of Problem and Pathological Gambling: A Randomized Controlled Trial

Pathological gambling is a widespread problem with major implications for society and the individual. There are effective treatments, but little is known about the relative effectiveness of different treatments. The aim of this study was to test the effectiveness of motivational interviewing, cognitive behavioral group therapy, and a no-treatment control (wait-list) in the treatment of pathological gambling. This was done in a randomized controlled trial at an outpatient dependency clinic at Karolinska Institute (Stockholm, Sweden). A total of 150 primarily self-recruited patients with current gambling problems or pathological gambling according to an NORC DSM-IV screen for gambling problems were randomized to four individual sessions of motivational interviewing (MI), eight sessions of cognitive behavioral group therapy (CBGT), or a no-treatment wait-list control. Gambling-related measures derived from timeline follow-back as well as general levels of anxiety and depression were administered at baseline, termination, and 6 and 12 months posttermination. Treatment showed superiority in some areas over the no-treatment control in the short term, including the primary outcome measure. No differences were found between MI and CBGT at any point in time. Instead, both MI and CBGT produced significant within-group decreases on most outcome measures up to the 12-month follow-up. Both forms of intervention are promising treatments, but there is room for improvement in terms of both outcome and compliance.     

Effects of a Motivational Interviewing–Based Counseling Program on Classroom Behavior of Children in a Disciplinary Alternative Education Program

A multiple single‐case research design was used to explore changes in teacher‐reported behaviors of 15 children who completed a motivational interviewing–based counseling program in a disciplinary alternative education school. Findings indicated that 7 children made a moderate to large improvement in their classroom behaviors while participating in the program. Students’ self‐motivational statements and self‐reported readiness to change were related to actual teacher‐rated behavioral changes. Implications for future research and counseling practice were discussed.     

An emerging research agenda for investigative interviewing: hypotheses from the narrative action system

The present issue of JIP-OP brings together an intriguing range of papers that cover a wide range of aspects of testimony and aspects of investigative interviewing. They show how the considerations of how testimony is obtained is broadening out from the memory improvement strategies that once dominated this area with attempts to detect deception, to cover many aspects of how testimony is obtained. This draws attention to the need for more careful examination of the variations in testimony eliciting processes that will be responsive to differences in context and crime. A research agenda is therefore proposed that draws on developments in the understanding of psychological differences between crimes. This research would study the relationship between the psychological processes underpinning offence actions and the interview behaviour of suspects or witnesses. With regard to suspects, recent developments in the modelling of offence style have indicated a narrative basis (narrative action system model) for understanding the patterns of offence actions and the perpetrator's psychological background and characteristics that can be inferred from these. It is therefore suggested that the Hero's Quest, Professional's Adventure, Revenger's Tragedy, and Victim's Irony offending narratives and the Object, Vehicle, and Person victim roles assigned within these, may provide a fruitful link to different patterns of interview behaviour, with consequent implications for approaches to interviewing. Copyright © 2009 John Wiley & Sons, Ltd.     

来访者动机:心理咨询与治疗理论与实践的整合

来访者动机是影响行为改变和治疗结果的重要因素,是贯穿心理咨询与治疗过程的关键问题。自我决定理论(SDT)是关于动机行为的一种宽泛理论,将动机看成一个随自主水平变化的连续体,认为来访者自主水平越高,治疗效果越好,并强调治疗师的自主支持对来访者参与和坚持改变的重要性;动机访谈(MI)则是在成瘾行为治疗中发展起来的一种临床技术和策略,遵循来访者中心的原则激发和增强来访者动机。在健康行为领域两种治疗模型有不同的起点、焦点和发展路径,研究者却发现两者可以系统而有机地整合,促进了有实证支持的实践发展。     

Big Five Personality and Creativity: The Moderating Effect of Motivational Goal Orientation

This study examined the association between the big five personality dimensions and creativity through the moderation of motivational goal orientation. One hundred and ninety students engaged in full‐time employment completed questionnaires, which were used to assess the variables of interest. Regression moderation analyses supported some of the expected hypotheses. The associations between the big five dimensions and creativity were moderated by learning motivational goal orientation. Individuals high in extroversion, emotional stability, and low in conscientiousness, are most creative when they are oriented toward learning. In addition, openness fully predicted creativity, without the moderation of goal orientation. The results are discussed in terms of the interactional nature of personality and goal orientation theory.     

Community Implementation of MI-Enhanced Behavior Therapy for Adolescent ADHD: Linking Fidelity to Effectiveness

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N = 114; Motivational Interviewing [MI]-enhanced parent-teen behavior therapy) of a community-based randomized trial of adolescent ADHD treatment. Participants received therapy from community clinicians (N = 44) at four agencies in a large, ethnically diverse metropolitan setting. Therapists provided self-report of session-by-session adherence to content fidelity checklists and audio recordings of sample sessions that were coded for MI integrity. Parents provided report of ADHD symptoms and family impairment at baseline, posttreatment, and follow-up, while academic records were obtained directly from the local school district. Results indicated that content fidelity significantly waned across the 10 manualized sessions (d = -1.23); these trends were steepest when therapy was delivered outside the office-setting and parent attendance was low. Community therapist self-report of content fidelity predicted significantly greater improvements in academic impairment from baseline to follow-up. MI delivery quality was not associated with improved outcomes; contrary to hypotheses, lower MI relational scores predicted significantly greater improvements in family impairment over time. Findings indicate that community-based outcomes for evidence-based ADHD treatment are enhanced when treatment is implemented with fidelity. Future work should revise community-based implementation strategies for adolescent ADHD treatment to prevent declines in fidelity over time, thereby improving outcomes.     

Applying Motivational Interviewing in a Domestic Violence Shelter: A Pilot Study Evaluating the Training of Shelter Staff

ABSTRACT

This pilot study examined the use of motivational interviewing (MI) with 20 women receiving services at a domestic violence shelter. The experimental group (n = 10) received regular treatment services (RTS) from shelter counselors who were trained in MI; the control group (n = 10) received RTS only. Fisher's exact test showed that participants who received MI-enhanced RTS were significantly more motivated for change (p = .029), as measured through a dichotomous readiness for change motivational variable on the University of Rhode Island Change Assessment (URICA; Center on Alcoholism, Substance Abuse, &; Addiction Research Division, 1996 Center on Alcoholism, Substance Abuse, &; Addiction Research Division. 1996. University of Rhode Island Change Instrument (URICA) Scale, Albuquerque, NM: Author.  [Google Scholar]). Findings suggest that MI can be helpful in increasing the readiness for change in domestic violence survivors who contemplate leaving abusive relationships.     

Primary Care Treatment Integrating Motivation and Exposure for PTSD Symptoms and Hazardous Alcohol Use: A Case Series

Symptoms of posttraumatic stress disorder (PTSD) and hazardous alcohol use are highly comorbid. Research on integrated interventions to address PTSD symptoms and hazardous alcohol use concurrently has demonstrated efficacy, yet integrated treatments are underutilized. Both patient (e.g., stigma, scheduling/logistics) and clinician (e.g., concern about symptom exacerbation and/or treatment dropout) barriers may impede utilization of integrated interventions among those with comorbid PTSD symptoms and hazardous alcohol use. Primary care behavioral health models (PCBH), in which embedded behavioral health providers deliver treatment to individuals with mild or moderate behavioral health symptoms in primary care, may help address treatment barriers by offering accessible behavioral health interventions in a destigmatizing setting. This paper presents two case examples from a randomized controlled trial testing the efficacy of an integrated intervention for PTSD symptoms and hazardous alcohol use developed for and delivered in primary care. Outcome data and session-by-session content for two participants are included, along with discussion of barriers encountered during the course of treatment. Clinician-suggested strategies for navigating barriers to facilitate utilization of integrated interventions for PTSD symptoms and hazardous alcohol use are also discussed.     

Assessment and validation of diagnostic interviewing skills for the mental health professions

A behavioral test was developed to assess the quality of diagnostic interviewing skills of (future) mental health professionals. Two aspects of diagnostic interviewing ability are distinguished: process skills, reflecting the interpersonal and communication skills; and content skills, referring to the information-gathering ability of the interviewer. It was found that diagnostic interviewing can be reliably measured with respect to interrater reliability. However, interviewer performance on one case proved to be a poor predictor of performance on other cases. It was concluded that a large number of cases is required to obtain reliable scores of general diagnostic interviewing ability. Validity was supported by the correlational analyses. Process skills were strongly related to patient satisfaction, whereas content skills were related to the amount of relevant information given by the patient and the accuracy of the diagnostic formulation and treatment plan.