The Person in Distress: On the Biosocial Dynamics of Adaptation

Abstract

The application of Motivational Interviewing (MI) principles in Modified Interpersonal Group Therapy (MIGT) addresses two gaps in the literature. First, it explicitly extends MIGT to non-abstinent, addicted patients who are in the precontemplative and contemplative stages of change in contrast to most MIGT models where abstinence is usually required. Second, it provides a novel, process-oriented group intervention for MI, in contrast to current applications of group-based MI which are more structured in their format. The main modification in technique was to prioritize the horizontal exploration of substance use disclosures with a focus on the here-and-now experience of disclosure and the interpersonal impact on the group, in order to: 1) encourage members to openly discuss their ambivalence and shifting motivational states, 2) harness the evocative impact of substance use disclosures between members to elicit change talk (self-motivational statements), and 3) selectively reinforce change talk when it emerges from these exchanges. The authors illustrate these concepts with a case report of an open-ended MIGT group with comorbid mental illness and addiction.     

The motivational value of listening during intimate and difficult conversations

Outcomes of conversations, including those dealing with controversial, deeply personal, or threatening disclosures, result not only from what is said but also from how listeners receive these messages. This article integrates the motivational framework of self-determination theory (SDT) and the expanding literature on interpersonal listening to explore the reasons why high-quality listening is so impactful during these conversations. We describe why high-quality listening is a specific and distinguishable autonomy-supportive motivational strategy, and argue that there is much to gain by considering that listening can satisfy basic psychological needs, in particular for autonomy and relatedness. We argue that SDT can help explain why high-quality listening is effective, especially in reducing defensiveness, bridging divides, and motivating change. The discussion focuses on ways motivation science can build more effective interventions for behavioral change by harnessing listening as an interpersonal strategy.     

A Sequential Analysis of Clinician Skills and Client Change Statements in a Brief Motivational Intervention for Young Adult Heavy Drinking

This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians’ use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians’ use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.     

A Brief,Hospital-Initiated Motivational Interviewing and Acceptance and Commitment Therapy Intervention to Link Postpartum Mothers Who Use Illicit Drugs With Treatment and Reproductive Care: A Case Report

Maternal substance use during the prenatal period often results in infants with compromised health outcomes. The American College of Obstetrics and Gynecology recommends screening, brief motivational interviewing, and referral to existing treatment for women who use illicit substances prenatally. However, many of these women do not present for prenatal care and are not identified as using substances until delivery of their infants, many of whom are admitted to the neonatal intensive care unit (ICU). We describe a case from a novel, hospital-initiated intervention study, Moms in ACTion (MIACT) that combines motivational interviewing (MI) and acceptance and commitment therapy (ACT) to target new mothers with an infant in the neonatal ICU who screen positive for illicit substance use prenatally or at delivery. The MIACT program consists of an adaptive intervention that includes up to three sessions. Initiation of substance use treatment and reproductive care via a gynecological visit are the primary targets of the intervention. Urine samples were collected at 2- and 6-month follow-up visits. The participant successfully completed the program, achieved both treatment outcomes, and had negative urine drug screens at follow-up visits. Improvements in readiness to change and psychological flexibility were also observed. The present case report of a new mother who used substances demonstrated feasibility for combining MI and ACT treatments and the potential for MIACT to increase treatment and contraception initiation, ultimately preventing future substance-exposed pregnancies.     

Interpersonal and emotional processes in generalized anxiety disorder analogues during social interaction tasks

Persons with chronic worry and generalized anxiety disorder (GAD) report maladaptive social cognitions, interpersonal behaviors, and emotional regulation. Because research has neither investigated these processes in actual social situations nor explored whether they take heterogeneous forms, the present study provides the first attempt to do so in a laboratory investigation. GAD analogue participants and nonanxious controls interacted with confederates in an unstructured collaborative story construction task and an emotional disclosure task with standardized confederate behavior. In both tasks, relative to controls, some GAD analogues highly overestimated, whereas others markedly underestimated, their negative (Hostile-Submissive) interpersonal impact on confederates. Although GAD analogues, as a group, exhibited greater sad affect during disclosures than controls, their openness during disclosures and liking by confederates varied with their level of misestimation of negative interpersonal impact. Results underscore the need to further explore interpersonal processes in chronic worriers and how they may exacerbate or maintain dysfunction.     

Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men

Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.     

Self-Determination Theory and Motivational Interviewing: Complementary Models to Elicit Voluntary Engagement by Partner-Abusive Men

Research examining intimate partner violence (IPV) has lacked a comprehensive theoretical framework for understanding and treating behavior. The authors propose two complementary models, a treatment approach (Motivational Interviewing, MI) informed by a theory (Self-Determination Theory; SDT), as a way of integrating existing knowledge and suggesting new directions in intervening early with IPV perpetrators. MI is a client-centered clinical intervention intended to assist in strengthening motivation to change and has been widely implemented in the substance abuse literature. SDT is a theory that focuses on internal versus external motivation and considers elements that impact optimal functioning and psychological well-being. These elements include psychological needs, integration of behavioral regulations, and contextual influences on motivation. Each of these aspects of SDT is described in detail and in the context of IPV etiology and intervention using motivational interviewing.     

Clinically useful assessments: substance use and comorbid psychiatric disorders

This review addresses the assessment of substance use and related constructs with persons having severe and persistent mental illness. The review contains two major sections. The first section focuses on issues particular to the assessment of substance use and abuse in the context of major mental illness; these include the social and motivational context of assessment, the impact of mental status and acute symptoms, limitations associated with acute and chronic cognitive impairment, and the psychosocial relevance of assessment items. The second section highlights a selected set of substance assessment tools for use with this population; evidence for the reliability, validity, and/or feasibility of these tools is summarized. Each instrument meets the criteria of being: (a). relatively brief; (b). easy to administer and interpret; and (c). useful for treatment planning, motivational feedback, and/or monitoring change.     

L’entretien motivationnel,une nouvelle « panacée » dans la prise en charge de patients toxicodépendants ? Une revue de littérature

Motivational Interviewing (MI) is a therapeutic style well established in the field of treatment of substance disorders. It is defined as “a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving client ambivalence” (Miller, W.R., Rollnick, S., 2002. Motivational interviewing: preparing people for change. The Guilford Press, New York, p. 25). After a brief theoretical introduction, this article proposes a review of efficacy and efficiency studies on motivational interviewing for substance abuse. Despite the growing evidence indicating that MI is effective, few studies have examined how MI exerts its effects (search for “active ingredients”). Some hypotheses about its mode of action are reviewed.     

Cognitive models of stereotype change (4): Motivational and cognitive influences

Three experiments investigating the effects of cognitive and motivational factors on stereotype change are reported. Trait ratings in all three experiments showed there to be greater stereotype-change when stereotype-inconsistent information was dispersed across many group members than when it was concentrated in only a few. A sorting task (Experiment 1) indicated that, in the concentrated conditions the stereotype disconfirmers were more strongly isolated from the rest of the group than in the dispersed conditions. Free recall protocols (Experiment 2) showed greater memory for the target exemplars when subjects anticipated interaction with a group member than when no interaction was anticipated. The questions subject chose to ask target group exemplars were also influenced by anticlpated future interaction. Subjects chose more stereotype-inconsistent questions when interactian was anticipated than when no interaction was anticipated. Experment 3 showed the impact of stereotype-inconsistent information to be greater when expectancies for the stereotyped group are weaker A cued-recall task yielded evidence of spontaneous subtyping. All these studies support the subtyping model, even in the presence of cognitive and motivational factors that might be expected to impede stereotype change.     

What makes for a pleasant social interaction? Motivational dynamics of interpersonal relations

The authors used an event-contingent daily recording strategy, the Rochester Interaction Record (RIR), to examine the motivational dynamics of interpersonal relations. Using hierarchical linear modeling, the authors demonstrated that social interactions were more pleasant when participants felt autonomous, competent, and related. Autonomy, competence, and relatedness consistently predicted interaction quality, regardless of (a) the length of the interaction; (b) whether it was dyadic or in a group; and (c) whether it was an interaction with family, friends, or acquaintances. However, participants were more likely to report feeling autonomous and related when they were interacting either with family members and friends or in a dyadic situation. These results suggest that experiences of autonomy, competence, and relatedness may make a good day partly because they produce satisfying interpersonal experiences.     

Dialectical Behavior Therapy and Motivational Interviewing: Conceptual Convergence,Compatibility, and Strategies for Integration

Dialectical behavior therapy (DBT) and motivational interviewing (MI) are two widely used and efficacious psychosocial interventions. An immense and growing number of studies examine DBT, MI, or adaptations of these approaches across diverse treatment contexts and across various clinical populations. Because DBT and MI are in high demand, it is probable that trainees and established practitioners will encounter one or both treatments over the course of their careers. Although MI and DBT initially evolved in distinct contexts for different populations, these approaches share a number of common fundamental principles. Each provides distinct and complementary strategies for enhancing clients’ motivation and ability to change. For some, an integrative or sequenced application of MI and DBT may enhance client care. The present article highlights areas of divergence, convergence, and opportunities for integration, and offers practical tips for applying DBT and MI in conjunction.     

Mental illness, criminal risk factors and parole release decisions

Research has not examined whether higher rates of parole denial among inmates with mental illness (MI) are the result of the increased presence of criminal risk factors among this population. Employing a representative sample of inmates with (n = 219) and without (n = 184) MI receiving parole release decisions in 2007, this study tested whether the central eight risk factors for recidivism considered in parole release decisions intervened in the relationship between MI and parole release. MI was associated with possession of a substance use disorder, antisocial personality disorder and violent charges while incarcerated; however, these factors were not related to release decisions. MI was found to have neither a direct nor an indirect effect on release decisions. While results indicate that release decisions appear, to some extent, to be evidence-based, they also suggest considerable discretion is being implemented by parole board members in release decisions above and beyond consideration of criminal risk factors.     

Development and Initial Validation of the Assessment of Motivational Interviewing Groups – Observer Scales (AMIGOS)

This article documents the development and initial validation of a global observer instrument, the Assessment of Motivational Interviewing Groups – Observer Scales (AMIGOS). The AMIGOS includes three scales composed of 18 items documenting group processes, client-centered style, and motivational interviewing (MI) change focus. Three experienced coders independently rated 18 sessions of various group approaches. The AMIGOS showed high inter-rater intraclass correlation coefficient (ICC) and Cronbach’s alpha, strong convergent and discriminant validity with the MI Treatment Integrity scales (MITI), the Therapist Empathy Scale (TES), and the Group Climate Questionnaire (GCQ). The AMIGOS shows promise as a reliable and valid measure of MI group leadership and group processes, and could be useful measuring other group therapies as well.     

Implicit achievement motive limits the impact of task difficulty on effort-related cardiovascular response

In contrast to the motive literature, motivational intensity theory predicts that the implicit achievement motive (nAch) should only exert an indirect impact on effort by limiting the impact of task difficulty. To contrast these two views, sixty-eight participants with a low or high nAch performed an easy or difficult arithmetic task. Effort was assessed using cardiac pre-ejection period (PEP). Supporting motivational intensity theory’s view, PEP response was low in both easy-task conditions but stronger in the high-nAch group than in the low-nAch group in the difficult task. These findings suggest that nAch exerts an indirect effect on effort investment by setting the maximally justified effort instead of directly determining the amount of effort that is invested to satisfy the motive.     

Therapeutic Factors Experienced by Members of an Out-Patient Therapy Group for Older Women

The Yalom curative factors Q-sort was administered to eight members of an out-patient therapy group for older women (average age 55 years), who were also interviewed on the group experiences they had viewed as helpful. Results indicated that Existential Awareness was seen as the most important curative or therapeutic mechanism by members of this group. This finding stands in contrast to other studies of out-patient groups, in which interpersonal factors have been widely reported as most helpful. The reasons for this distinctive finding are examined. Results also exhibited striking individual differences between members of the group in terms of the group processes they each found most therapeutic. The significance of these findings is discussed, both in relation to working with older women, and also with respect to methodological issues concerned with the use of the Yalom Q-sort technique.     

Group Membership as a ‘Frame of Reference’ for Interpersonal Comparison

Although individuals may view themselves as part of a group (e.g., couple, a family, or a nationality) when comparing to others, most contemporary theory and research in psychology focuses on the interpersonal comparisons that individuals make to other individuals. The prevailing view is quite individually oriented as it emphasizes the closeness between individuals as the most important basis of interpersonal comparison. However, membership in a meaningful ‘reference group’ typically frames interpersonal comparison, even where individuals do not consciously attend to the group. This makes individuals especially likely to make interpersonal comparisons to other members of their reference group and for these comparisons to be especially affecting psychologically. These are the central tenets of reference group theory ( Hyman, 1942 ; Merton, 1957 ). In this paper, we use reference group theory to highlight the role of group membership in what otherwise appear to be individually oriented interpersonal comparisons.     

Motivational interviewing for employment: An exploration of practitioner skill and client change talk

Motivational interviewing (MI) is an evidenced-based approach for building and strengthening motivation for change. The effect of MI training on practitioner conversations with unemployed clients within a government work and income service was evaluated using a mixed-method approach, comprising a multiple-baseline across practitioner (n = 5) design and a pre/post quasi-experimental design. After workshop MI training, practitioners demonstrated greater MI skills in conversations with clients, and MI skills were maintained during the period of post-workshop feedback and coaching. There was also more change talk spoken by clients in conversations that occurred post-MI workshop training compared to pre-training, suggesting increased motivation for change.     

Developing Norms of Argumentation: Metacognitive,Epistemological, and Social Dimensions of Developing Argumentive Competence

We examine how extended engagement in argumentation with peers leads to enhanced metalevel understanding of argumentive discourse. Following such engagement, young adolescents demonstrated enhanced understanding of counterargument and use of evidence as objectives of skilled argumentation, relative to a nonparticipating comparison group. Among the participating group, analysis of metatalk (talk about the discourse, distinguished from talk about the topic) during electronic peer dialogs proved revealing regarding participants’ evolving awareness of and adherence to discourse norms. Metatalk became more reciprocal and sustained with time and revealed an increasing focus on the argumentation process and engagement in talk that seeks to direct it. Implications are considered for understanding and studying argumentation as a social practice that encompasses not only individual skills but also the less visible norms that govern it and that members of a social group come to share.