Aspects Of Motivational Interviewing Research Articles

Supporting college student self-determination through motivational interviewing

PurposeThis study was intended to investigate a small-scale School-based Motivational Interviewing (SBMI) pilot with first-year college students. This approach honors student autonomy, supports self-determination and has the potential to impact educational outcomes in higher education. Motivational Interviewing (MI) is an evidence based conversational skill set, defined as “a collaborative conversational style for strengthening a person's own motivation and commitment to change” (Miller and Rollnick, 2013, p. 12). Student perceptions of satisfaction with the faculty-student mentoring intervention were sought. Relational aspects of MI (partnership, empathy and alliance) were also explored.Design/methodology/approachA mixed-method approach was used for the SBMI study, focused on college students with recent academic setbacks (N = 19).FindingsThe intervention was deployed with high levels of MI technical fidelity and relational quality. Participants reported high satisfaction with the intervention. The relational aspects and participant perceived alliance with their faculty were highly correlated across the intervention, adding to the discussion of the mechanisms of MI that contribute to its effectiveness.Research limitations/implicationsThis work is formative, yet at this point is not generalizable given the scope of the study.Practical implicationsFindings are encouraging for further development of this innovative pedagogical approach. Possible future applications of research are provided.Social implicationsDiscussed herein, SBMI has the potential to meet the needs of traditionally underrepresented student groups.Originality/valueThe reported study is the initial portion of a larger intervention development project.

Gait rehabilitation for foot and ankle impairments in early rheumatoid arthritis: a feasibility study of a new gait rehabilitation programme (GREAT Strides)

BackgroundFoot impairments in early rheumatoid arthritis are common and lead to progressive deterioration of lower limb function. A gait rehabilitation programme underpinned by psychological techniques to improve adherence, may preserve gait and lower limb function. This study evaluated the feasibility of a novel gait rehabilitation intervention (GREAT Strides) and a future trial.MethodsThis was a mixed methods feasibility study with embedded qualitative components. People with early (< 2 years) rheumatoid arthritis (RA) and foot pain were eligible. Intervention acceptability was evaluated using a questionnaire. Adherence was evaluated using the Exercise Adherence Rating Scale (EARS). Safety was monitored using case report forms. Participants and therapists were interviewed to explore intervention acceptability. Deductive thematic analysis was applied using the Theoretical Framework of Acceptability. For fidelity, audio recordings of interventions sessions were assessed using the Motivational Interviewing Treatment Integrity (MITI) scale. Measurement properties of four candidate primary outcomes, rates of recruitment, attrition, and data completeness were evaluated.ResultsThirty-five participants (68.6% female) with median age (inter-quartile range [IQR]) 60.1 [49.4–68.4] years and disease duration 9.1 [4.0–16.2] months), were recruited and 23 (65.7%) completed 12-week follow-up. Intervention acceptability was excellent; 21/23 were confident that it could help and would recommend it; 22/23 indicated it made sense to them. Adherence was good, with a median [IQR] EARS score of 17/24 [12.5–22.5]. One serious adverse event that was unrelated to the study was reported. Twelve participants’ and 9 therapists’ interviews confirmed intervention acceptability, identified perceptions of benefit, but also highlighted some barriers to completion. Mean MITI scores for relational (4.38) and technical (4.19) aspects of motivational interviewing demonstrated good fidelity. The Foot Function Index disability subscale performed best in terms of theoretical consistency and was deemed most practical.ConclusionGREAT Strides was viewed as acceptable by patients and therapists, and we observed high intervention fidelity, good patient adherence, and no safety concerns. A future trial to test the additional benefit of GREAT Strides to usual care will benefit from amended eligibility criteria, refinement of the intervention and strategies to ensure higher follow-up rates. The Foot Function Index disability subscale was identified as the primary outcome for the future trial.Trial registrationISRCTN14277030

Dissemination Of Motivational Interviewing Training: Use In Extension Outreach And School Health Programming

PURPOSE: Motivational interviewing (MI) is a popular conversational strategy used to evoke intrinsic motivation for behavior change. Although a number of training programs have been described to build MI skills, there are few that evaluate the fidelity of training. The present study evaluated MI fidelity following a brief online training. METHODS: This study was conducted as an ancillary component of a school wellness training initiative (SWITCH) that focused on building capacity for schools to plan and lead school wellness programming. A quasi-experimental design was used to evaluate the impact of brief MI training on a sample of 16 extension field specialists (EFS) that facilitated the SWITCH implementation process. EFS were provided guidelines and suggestions for using MI to elicit change talk and promote goal setting by school leaders. A subsample of 8 EFS voluntarily agreed to participate in supplemental MI training prior to interacting with the schools. All EFS recorded phone calls with the schools as part of the standard practice in the SWITCH project, and a trained assistant blinded from group allocation coded them for MI proficiency levels using the Motivational Interviewing Treatment Integrity Coding Manual 4.2.1. RESULTS: A one-way ANOVA followed by Bonferroni post-hoc corrections were conducted to examine differences in MI techniques between trained and untrained EFS. No statistically significant results were found. However, differences between groups for technical global scores (F (1, 14) = 8.9, p = 0.05, d = 1.5) and reflection-to-question ratios (F (1, 14) = 5.3, p = 0.19, d = 1.15) were approaching statistical significance with large effect sizes. Relational global components (d = 0.76) and total adherence (d = 0.38) demonstrated moderate group differences. CONCLUSIONS: This study indicates that a brief MI training protocol is effective for teaching the spirit and relational components of MI. Although proficiency levels were not achieved by the majority of EFS, trained individuals were better at using technical and relational aspects of MI than untrained individuals. Future work should focus on ways to enhance skill acquisition with this type of distributed online training model as well as testing applications with other professionals and diverse settings.

P221 Treatment fidelity in the Gait Rehabilitation in Early Rheumatoid Arthritis Trial (GREAT) feasibility study

Abstract Background Many people with early rheumatoid arthritis (RA) report foot pain and walking disability. Self-reported walking disability two years post-diagnosis is the main predictor of persistent disability. A psychologically informed gait rehabilitation intervention (Great Strides) for early RA was developed to address this, consisting of two compulsory sessions and up to four optional sessions delivered over three months. Physiotherapists and podiatrists received bespoke training to deliver Great Strides, incorporating motivational interviewing (MI) and behaviour change techniques (BCTs), to help patients to complete their walking exercises at home. The aim of this study was to assess fidelity of delivery within the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study. Methods Four physiotherapists and two podiatrists delivered 78 Great Strides sessions across three centres in the UK. All sessions were audio recorded and double coded. The Motivational Interviewing Treatment Integrity (MITI) Rating Scale (scoring ≥4 represents good proficiency) and tailored treatment fidelity measures of the six core elements and 17 BCTs delivered in session 1, five core elements delivered in session 2, and 12 BCTs in session 2-6, were developed to examine fidelity of delivery. Two trained, independent assessors rated audio recordings of Great Strides and assessed the extent to which core elements, aspects of MI and BCTs were delivered across sessions. Results Data from 28 (80%) adult participants across a total of 64 sessions were rated for core components and BCTs and 37 (50%) of sessions were analysed for MI. Relational (score=4.4) and technical (score=4.2) aspects of MI were delivered with good fidelity across the whole sample. The 6 core elements and 7 BCTs in Session 1 were conveyed with high (over 80%) treatment fidelity, but 10 further BCTs were not consistently delivered (range 23-69%). In session 2, the 5 core elements and 3 BCTs were provided with high fidelity, but another 9 BCTs were not reliably delivered (range 11-56%). Sessions 3 and 4 reliably delivered 3 out of 12 BCTs and only one session 5 and 6 was delivered. Inter-rater reliability showed agreement of over 80% was reached between raters for all sessions (range 82-87%). Conclusion Physiotherapists and podiatrists were able to deliver the core elements of GREAT sessions with high fidelity and fidelity assessment methods were appropriate. Results showed a maximum of 4 sessions was sufficient. However, treatment fidelity might be enhanced with further training or greater on-going support, as findings suggested clinicians (physiotherapists) with previous MI experience were more proficient at offering key elements of MI. Additionally, the Great Strides intervention could be amended to improve delivery, as research shows complex interventions should consider mandatory BCTs alongside optional ones, depending on the needs of individual participants. Disclosures E. Godfrey None. M. Sekhon None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

P105 Therapists acceptability of delivering a psychologically informed gait rehabilitation intervention in early rheumatoid arthritis (GREAT): a qualitative interview study

Abstract Background Great Strides is a brief psychologically informed gait rehabilitation intervention (two compulsory face-to-face sessions and up to four optional sessions delivered over 3 months) aimed at improving lower limb function for adults with early rheumatoid arthritis (RA). As part of the Gait Rehabilitation in Early Arthritis Trial (GREAT) feasibility study, physiotherapists and podiatrists received two days of bespoke training delivered by psychologists, physiotherapists and podiatrists on i) the gait rehabilitation exercise programme (six walking exercises) ii) aspects of motivational interviewing (MI) and iii) delivery of key behaviour change techniques (BCTs) to facilitate motivation and adherence to the Great Strides intervention. The training was supported by a bespoke therapist manual and session checklists. The aim of this study was to explore therapists’ acceptability of: (1) the bespoke training received and (2) delivering the intervention within the GREAT feasibility study. Methods All 10 therapists who received training were invited to complete semi-structured interviews. The topic guide was informed by the Theoretical Framework of Acceptability (TFA). Interviews were audio recorded, professionally transcribed and a deductive thematic analysis was applied. Data were coded into six TFA constructs (Affective Attitude; Burden; Intervention Coherence; Opportunity Costs; Perceived Effectiveness; Self-efficacy). Results Nine out of ten therapists (four physiotherapists, five podiatrists) participated in the semi-structured interviews. Five therapists (four physiotherapists, one podiatrist) delivered the Great Strides intervention. Key barriers and enablers with regards to the acceptability of the bespoke training and intervention delivery were identified. Training: Therapists liked the supportive training environment (affective attitude), understood the purpose of the training sessions (intervention coherence), reported that the role play exercises aided their confidence in applying MI and BCTs (self-efficacy) and found that the training sessions were vital preparation for delivering the intervention (perceived effectiveness). Aspects of training which were considered unacceptable included the lack of time to attend the training sessions (opportunity costs). Delivery: All therapists enjoyed applying MI and BCTs to encourage participants to complete the gait exercises (affective attitude) and valued the opportunity to provide individualised care (intervention coherence). Barriers associated with acceptability included the use of trial-related materials (e.g. checklist) during intervention delivery (burden), interference of intervention delivery with routine clinical workload (opportunity costs) and the time delay between receiving training and initial intervention delivery (perceived effectiveness). Conclusion Both GREAT intervention training and delivery were considered acceptable to most therapists. The results have guided key refinements for training and intervention delivery for the GREAT internal pilot and full trial (e.g. remote access to training, timing of training in relation to intervention delivery). These refinements have the potential to improve the bespoke training and enhance the delivery of the Great Strides intervention maximising efficiency and potential for effectiveness. Disclosures M. Sekhon None. E. Godfrey None. G. Hendry None. N.E. Foster None. S. Hider None. M. van der Leeden None. H. Mason None. A. McConnachie None. I. McInnes None. A. Patience None. C. Sackley None. M. Steultjens None. A. Williams None. J. Woodburn None. L. Bearne None.

Perceptions of Motivational Interviewing

The practice of motivational interviewing (MI) has gained acceptance as an effective approach to support behavior change in various therapeutic contexts. In recent years, MI has been extended to clients within less traditional therapeutic settings including prisons and probation departments. Despite the known strengths of MI for positively affecting behavioral change in therapeutic contexts, the extent to which probation officers are able to effectively utilize MI remains unknown. The current study utilizes self-report responses from 485 probationers to assess the internal consistency and factor structure of the Client Evaluation of Motivational Interviewing (CEMI) as a tool for gathering feedback on MI fidelity in probation. Confirmatory factor analysis found two distinct MI factors to exist among this client base—technical and relational aspects of MI. Results suggest the CEMI is an effective tool to determine community corrections clients’ self-perceptions of probation officer’s use of MI-consistent techniques.

Changing orientations to corporal punishment: A randomized, control trial of the efficacy of a motivational approach to psycho-education.

OBJECTIVE: To evaluate the efficacy of a motivational interviewing (MI) approach in changing positive attitudes toward corporal punishment (CP), behavioral intentions, and behavior. CP has been linked to a variety of negative outcomes for children, and parents' attitudes toward CP strongly predicts its use. Five brief interventions have been reported in the literature designed to target CP attitudes. The current study adopts a novel approach by evaluating the effects of a brief, psycho-educational intervention incorporating aspects of MI. METHOD: Forty-three mothers of children ages 3 to 5 completed 1 motivational psycho-education session. Participants were randomly assigned to intervention or waitlist, completing assessments at baseline, postintervention, and 1-month follow-up. After follow-up, the waitlist condition crossed over, completing the intervention and further assessments. RESULTS: The intervention was associated with greater reductions in CP attitudes and intentions versus the waitlist; these effects were replicated in the crossover group. Further, participants' in-session change-talk predicted greater changes in CP attitudes. The effect size of the current approach was stronger than the prior interventions. CONCLUSIONS: MI is a promising approach to address parental use of CP, though this approach needs replication with a larger sample. Several ways of incorporating this approach on a wider scale are considered. ©2016 American Psychological Association Language: en

Primary care nurses' performance in motivational interviewing: a quantitative descriptive study.

BackgroundMotivational interviewing is a collaborative conversational style intended to strengthen motivation to change. It has been shown to be effective in addressing many different lifestyle problems as well as in chronic disease management, and many disease prevention guidelines promote use of motivational interviewing. The aim of the present study was twofold: to assess to what extent the primary care nurses in the study perform motivational interviewing according to the Motivational Interviewing Treatment Integrity Code and to investigate how the participating primary care nurses rated their own performance in motivational interviewing.MethodThe study was based on twelve primary care nurses’ audio-recorded motivational interviewing sessions with patients (total 32 sessions). After each session, the nurses completed a questionnaire regarding their experience of their own performance in motivational interviewing. The audio-recorded sessions were analyzed using Motivational Interviewing Integrity Code 3.1.1.ResultsNone of the nurses achieved beginning proficiency in all parts of any motivational interviewing sessions and two nurses did not achieve beginning proficiency in any parts or sessions. Making more complex than simple reflections was the specific verbal behavior/summary score that most nurses achieved. Beginning proficiency/competency in “percent open questions” was the summary score that fewest achieved.ConclusionPrimary care nurses did not achieve beginning proficiency/competency in all aspects of motivational interviewing in their recorded sessions with patients, where lifestyle change was discussed. This indicates a need for improvement and thus additional training, feedback and supervision in clinical practice with motivational interviewing.

SY28-4 * CLINICAL APPLICATION OF MOTIVATIONAL INTERVIEWING AT OKAYAMA PSYCHIATRIC MEDICAL CENTER

Although research has proven motivational interviewing (MI) to be effective in addiction treatment, MI is not yet wildly used in Japan. When I started the treatment of addiction in 2006, MI was not used in our psychiatric medical center. I thought MI would solve the problems I had had in clinical interviewing with people with addiction. I studied the methods of MI during seminars and workshops including one by William R. Miller. In our psychiatric medical center, over the past 4 years, my colleagues and I have regularly held meetings where we role play therapist/client aspects of MI once a month, as well as workshops by Japanese MINT (the Motivational Interviewing Network of Trainers) members once a year. MI can be used in outpatient and inpatient clinical settings, as well as group therapy. I think that MI is essential in treatment, not only for substance use disorders, but also process addiction–in which we currently do not have many programs dealing with this type of disorder. In addition, MI is very compatible with the trans-theoretical model and harm reduction approach. In this presentation, I will introduce a case of an alcohol dependent patient who, at this time, had not achieved abstinence from alcohol, but through positive engagement has been moving forward in treatment.

Motivational Interviewing in Art Therapy

This viewpoint describes motivational interviewing techniques as adapted to art therapy with adult psychiatric patients. Three important aspects of motivational interviewing are explored: resistance, ambivalence, and readiness. Art therapy applications of motivational interviewing are provided.

Motivational Pharmacotherapy: Combining Motivational Interviewing and Antidepressant Therapy to Improve Treatment Adherence

Treatment non-adherence in psycho-pharmacotherapy remains a significant challenge to the effective clinical management of psychiatric disorders, especially among underserved racial/ethnic groups. This article introduces motivational pharmacotherapy, an approach that integrates motivational interviewing into psycho-pharmacotherapy sessions in order to increase treatment adherence. We describe what aspects of motivational interviewing were incorporated into motivational pharmacotherapy and how we tailored the intervention to the clinical and cultural characteristics of monolingual Spanish-speaking immigrants with major depressive disorder. Transcriptions of the interactions between psychiatrists and patients help illustrate this approach. In our experience, motivational pharmacotherapy differs substantially from standard pharmacotherapy in how it recasts clinicians and patients as equal experts, prioritizes patients' motivation to engage in treatment rather than clinicians' multiple inquiries about symptoms, encourages patients' self-efficacy to overcome barriers, and attends to the momentum of patients' language about commitment to change. We also found that motivational pharmacotherapy can be feasibly incorporated into medication treatment, can be tailored to patients' culture and disorder, and may help increase adherence to psycho-pharmacotherapy.

A systematic review of motivational interviewing training for general health care practitioners

ObjectiveThis article systematically reviews empirical studies that have evaluated different aspects of motivational interviewing (MI) training for general health care professionals. MethodsStudies were obtained from several databases. To be included, the MI training had to be provided specifically for general health care practitioners for use in their regular face-to-face counselling. The training outcomes had to be linked to the MI training. ResultsTen studies were found. The median length of the training was 9h. The most commonly addressed training elements were basic MI skills, the MI spirit, recognizing and reinforcing change talk, and rolling with resistance. Most studies involved follow-up training sessions. The study quality varied considerably. Five studies assessed training outcomes at a single point in time, which yields low internal validity. Four studies used random assignment of practitioners to the MI training and comparison conditions. The training generated positive outcomes overall and had a significant effect on many aspects of the participants’ daily practice, but the results must be interpreted with caution due to the inconsistent study quality. ConclusionsThe generally favourable training outcomes suggest that MI can be used to improve client communication and counselling concerning lifestyle-related issues in general health care. However, the results must be interpreted with caution due to inconsistent methodological quality of the studies. Practice implicationsThis review suggests that MI training outcomes are generally favourable, but more high-quality research is needed to help identify the best practices for training in MI.

Law Enforcement Officers Involved in Domestic Violence as Batterers

This article offers an integrative model of treatment for law enforcement officers involved in mutual violence as batterers in domestic violence. The model draws on aspects of motivational interviewing, solution-focused and cognitive behavioral therapy. The integration of these aspects enhances the inherent strength of each approach and utilizes a technical eclecticism of each perspective while allowing for flexibility and achieving change.