MI-based Interventions Research Articles

A Review of Motivational Interviewing-Based Interventions Targeting Problematic Drinking Among College Students

This article reviews motivational interviewing (MI) -based interventions targeting heavy drinking college students published between 2003 and 2008. A total of 11 MI-based interventions were included in this study. Students receiving the interventions were generally heavy drinkers or adjudicated students. Based on this review MI-based interventions appear to be consistently effective at reducing alcohol use and drinking problems. Most of the interventions focused on enhancing motivation for decreasing alcohol consumption. Many studies did not explicitly identify a behavioral theory, and antecedents of behaviors were rarely reported. Very few studies utilized randomized controlled design. Recommendations for future interventions are presented.

Public Speaking Apprehension (PSA), Motivation, and Affect among Accounting Majors: A Proof-of-Concept Intervention

ABSTRACT: The importance of public speaking (PS) skills to professional accounting success motivates improving students' self-perceptions of these skills. In addition, evidence of higher levels of public speaking apprehension (PSA) among accounting majors makes understanding and working with students' affective (emotive) reactions to PS critical to their future success. In three studies, we design and implement an intervention based on principles from self-determination theory (SDT) and motivational interviewing (MI). Its purpose is to improve students' PSA and PS motivation; it includes substantive PS instruction, dialogues, nonjudgmental feedback, and interpersonal support. The results of the three “proof-of-concept” interventions (Study 1, n = 23; Study 2, n = 14; Study 3, n = 36) suggest improvements in students' perceptions of their PS cognition, motivation, and affect. Despite the limitations of self'reported measures and exclusively graduate participants, the results suggest that (1) the interventions, described in appendices, may merit replication and extension, and (2) SDT- and MI-based interventions may prove useful in addressing aspects of accountancy pedagogy that induce student apprehension.

Strengths-Oriented Referrals for Teens (SORT): Giving Balanced Feedback to Teens and Families

Despite the great advances in the development of assessment procedures for adolescent substance abuse (Dennis, 1998; Rahdert, 1991; Winters, 1992), very little literature exists that informs clinicians about how to best deliver clinical feedback from substance abuse evaluations to teens and families. We address this gap in the literature by describing a strengths-based protocol called Strengths-Oriented Referral for Teens (SORT). Following is a look at the theoretical basis for SORT, a description of the intervention, and a discussion of quality assurance procedures used in training therapists. SORT was developed through a project funded by the Substance Abuse and Mental Health Services Administration, which sought to expand and enhance adolescent substance abuse treatment. It is a clinical feedback session that occurs after an initial substance abuse evaluation at our comprehensive assessment center. Modeled after Dembo's Juvenile Assessment Center concept (Dembo & Brown, 1994), this one-stop assessment program is structured specifically to help teens navigate the fragmented service delivery system, reduce duplication in assessment across the system of care, and provide targeted referrals. MOTIVATIONAL INTERVIEWING A major component of SORT is motivational interviewing (MI), which combines elements of client-centered therapy with behavioral principles (Miller & Rollnick, 2002). The major concepts underpinning this approach include empathic listening, rolling with resistance, providing feedback, and offering a menu of options. This model can be contrasted with the Minnesota Model of substance abuse (Winters, Stinchfield, Opland, Weller, & Latimer, 2000), which emphasizes clients' acceptance of their substance abuse as a disease. In the Minnesota Model, which was heavily influenced by 12-step philosophy, abstinence from chemicals was the only viable goal. One of the major strategies in treatment was confronting clients' denial related to their substance use. In MI the emphasis is on getting the client to elicit self-change statements through careful questioning and active listening. Thus, mutually developed and appropriate treatment goals emerge and facilitate behavior change. MI has only recently been applied to adolescent populations. Some adaptations exist, including a five- and 12-session intervention (that is, the Motivational Enhancement Therapy/Cognitive Behavioral Therapy [MET/CBT5, MET/CBT12]) developed in the Cannabis Youth Treatment study (Dennis, Titus, Diamond, et al., 2002; Diamond et al., 2002). These two MI-based interventions are cost-effective and were found to reduce substance use and abuse or dependency problems in a large randomized trial (Dennis et al., 2004). Our application of MI elements in SORT is designed to increase an adolescent's motivation to use services (particularly drug treatment) beyond the initial assessment. SOLUTION-FOCUSED THERAPY In solution-focused therapy (Berg & Miller, 1992; deShazer, 1988), therapists use carefully constructed questions that presuppose action and active problem solving. It is inherently present focused and action oriented. Techniques in solution-focused therapy include asking scaling questions, exception-finding questions, and other questions designed to elicit the clients' goals. A scaling question used in our intervention is, On a scale of one to 10 where one is 'not willing at all' and 10 is 'completely ready,' how ready are you to follow through with this referral? This question can be followed up with a question to gauge what would make the client more willing to use a service. For example, if a client responds that he or she is a three on this scale, a therapist might ask, What would have to be different for you to move up to a four or a five? In this way, barriers to going to treatment are explored in greater depth. Exception-finding questions are designed to elicit the client's strengths by asking what they have done to prevent their problems from becoming worse. …

Readiness to change smoking behavior in adolescents with psychiatric disorders

There has been recent increased interest in utilizing motivational interviewing (MI) to increase adolescent readiness to quit smoking, but attempts to impact quit rates have thus far been discouraging. A better understanding of factors associated with adolescent readiness to quit smoking prior to receiving any intervention may provide guidance when tailoring future MI interventions in order to increase their effectiveness with this population. Adolescent smokers ( N = 191) who had been admitted to a psychiatric hospital and enrolled in a clinical trial evaluating MI completed questionnaires that assessed smoking behavior and variables thought to be related to smoking. Confidence to quit smoking and negative beliefs about smoking were significant predictors of adolescents' baseline readiness to quit smoking. The failure to demonstrate relationships between health consequences and readiness suggest that caution may be warranted in the use of feedback, a common component of MI-based interventions. Such feedback tends to focus on health consequences, which was unrelated to adolescent baseline readiness to change smoking behavior in the current study. Parallels between current results and the Theory of Planned Behavior are discussed in consideration of developing more effective MI-based interventions for adolescent smokers.

Motivational interviewing to support antiretroviral therapy adherence: The role of quality counseling

Objective Although research linking motivational interviewing (MI) to behavior change exists, few studies report on MI's quality or explore how it may influence effectiveness. We studied MI quality and adherence to antiretroviral therapy (ART) in the context of a randomized, controlled trial. Methods We used a structured instrument to code MI sessions and then correlated ART adherence (measured by electronic bottle cap monitor and pill count data at study exit) with specific counseling behaviors and the proportion of interactions that achieved quality benchmarks. Results The sample ( n = 47) was predominantly male (79%), minority (90%), had a mean age of 40, and averaged 79% adherence at exit. On three of five benchmarks, most MI sessions achieved the targeted quality level: 100% achieved them for MI-consistent statements; 85% for complex reflections; 63% for reflections to questions ratio; 44% for global therapist rating; 19% for using open-ended questions. ART adherence was positively associated with the ratio of reflections to questions ( r = .39, p = .02), affirming statements ( r = .38, p = .02), and negatively associated with closed-ended questions ( r = −.33, p = .04). Discussion Good quality MI can be conducted within the structure of a controlled trial but was generally not associated with ART adherence. Conclusion Documenting treatment fidelity is critical to judging the efficacy of MI-based interventions. Practice implications Regular feedback and close monitoring are needed to maintain MI quality.