Non-directive Intervention Research Articles

Age as a moderator of motivational interviewing and nondirective client-centered psychotherapy for alcohol use disorder: An exploratory study.

Motivational interviewing (MI) is a widely used intervention applied to a host of health behaviors, including alcohol consumption among individuals with alcohol use disorder (AUD). Age is an underexplored moderator of MI for treating AUD, with the impact of comparing older individuals with their younger counterparts virtually unexplored. Also unexplored is whether age is associated with distinct mechanisms of change (e.g., motivation and self-efficacy) within treatment. This secondary data analysis utilizes combined data from two previous studies (total N=228) that both aimed to test MI's mechanisms of action in the context of a goal for moderated drinking. Both studies had three conditions: MI, nondirective listening (NDL), and a self-change condition (SC). In the current analyses, the moderating impact of continuous age and age group, <51 (younger adults, YA) versus ≥51 (older adults, OA), on the impact of MI on alcohol use compared to NDL and SC were tested using generalized linear models. Age differences in confidence and commitment to reduce heavy drinking during treatment were also explored. Age group by condition differences emerged, where NDL significantly reduced drinking among YA but not OA (mean -12 vs. -3 standard drinks, respectively). Among OA, MI outperformed NDL but not SC, though the effect was weak. Confidence and commitment during treatment were not significantly different across age-by-condition groups. Findings underscore the importance of understanding the impact of age on treatment effectiveness, as providing a nondirective intervention for OA with AUD could provide suboptimal treatment. Further research is needed to explore these differential effects.

Process Mechanisms in Behavioral Versus Nondirective Guided Self-help for Parents of Children with Externalizing Behavior

The study examined potential mediating effects of therapist behaviors in the per-protocol sample (n = 108) of a randomized controlled trial comparing a behavioral and a nondirective guided self-help intervention for parents of children with externalizing disorders (4–11 years). Additionally, from an exploratory perspective, we analyzed a sequential model with parental adherence as second mediator following therapist behavior. Outcomes were child symptom severity of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder rated by blinded clinicians, and parent-rated child functional impairment. We found a significant indirect effect on the reduction of ADHD and functional impairment through emotion- and relationship-focused therapist behavior in the nondirective intervention. Additionally, we found limited support for an extended sequential mediation effect through therapist behavior and parental adherence in the models for these outcomes. The study proposes potential mediating mechanisms unique to the nondirective intervention and complements previous findings on mediator processes in favor of the behavioral group. Trial registration ClinicalTrials.gov NCT01350986.

Treatment components in behavioral versus nondirective telephone-assisted self-help interventions for parents of children with externalizing behavior problems.

The aim of this study was to analyze treatment differentiation in a behavioral and a nondirective telephone-assisted self-help intervention for parents of children with externalizing behavior problems, including the development and evaluation of a rating scale. In a randomized controlled trial, 149 parents of children aged 4-11 years with externalizing behavior problems were allocated to a behavioral or a nondirective guided self-help intervention. Parents in both conditions received eight self-help booklets and ten telephone consultations. To analyze the content of the interventions, we developed the Therapist Intervention Scale (TIS). In order to evaluate the scale and analyze treatment differentiation, parent booklets and recorded telephone consultations were rated. Item selection and scale development were based on predefined psychometric criteria. The subscales Guidance & Structures and Relationship & Emotions were developed based on exploratory factor analyses. Interrater reliability and internal consistency were found to be acceptable to excellent. Analyses of construct validity demonstrated positive correlations for corresponding and negative correlations for non-corresponding subscales of therapist ratings. Therapists and booklets in the behavioral intervention showed higher scores on the subscale Guidance & Structures, while therapists and booklets in the nondirective intervention showed higher scores on the subscale Relationship & Emotions. The analyses of the TIS support its reliability and validity. The subscale Guidance & Structures contains mainly cognitive-behavioral treatment components, while the subscale Relationship & Emotions contains mainly nondirective treatment components. The implemented telephone-assisted self-help interventions demonstrated distinct treatment profiles which match their intended therapeutic approaches.

THE EFFECTS OF THE NON-DIRECTIVE INTERVENTION (NDI) ON PRESERVICE KINDERGARTEN TEACHERS’ SELF-ESTEEM, SELF-EFFICACY AND PERSONAL GROWTH

Non-Directive Intervention (NDI) is an experiential method of group facilitation, founded by Michel Lobrot. According to this method, the group facilitators intervene in a non-directive way. The aim of this research was to investigate the influence of the NDI on the personal growth, general self-efficacy and self-esteem of pre-service preschool teachers. Ninety-three undergraduate students participated in the research. Results of the present research work showed that students’ personal growth, general self-efficacy and self-esteem were enhanced at the end of the sessions. Results are discussed within the NDI experiential learning framework. Article visualizations:

THE EFFECTS OF THE NON-DIRECTIVE INTERVENTION (NDI) ON PRESERVICE KINDERGARTEN TEACHERS’ SELF-ESTEEM, SELF-EFFICACY AND PERSONAL GROWTH

Non-Directive Intervention (NDI) is an experiential method of group facilitation, founded by Michel Lobrot. According to this method, the group facilitators intervene in a non-directive way. The aim of this research was to investigate the influence of the NDI on the personal growth, general self-efficacy and self-esteem of pre-service preschool teachers. Ninety-three undergraduate students participated in the research. Results of the present research work showed that students’ personal growth, general self-efficacy and self-esteem were enhanced at the end of the sessions. Results are discussed within the NDI experiential learning framework. Article visualizations:

Ethnic differences in response to directive vs. non-directive brief intervention for subsyndromal depression

Objective: Analog research suggests that directive interventions might increase treatment engagement for non-symptomatic Asian American (AA) students; however, no studies have assessed whether directiveness improves therapy processes or clinical outcomes for AAs with mental health symptoms. This study tested the comparative efficacy of brief directive vs. non-directive intervention for AAs and European Americans (EAs) with subsyndromal depression. Method: Participants were randomly assigned directive, non-directive, or cultural values interview conditions, and assessed three times over six months. Directive and non-directive treatment involved meeting with a therapist for a single, 20-minute session to receive psychoeducation and personalized feedback on depressive symptoms and coping strategies. Cultural values participants also met with a therapist. Results: Although results were mixed for the overall sample, directive treatment was generally superior to non-directive treatment and cultural values at addressing depressive symptoms, coping behavior, and working alliance. Ethnicity did moderate treatment effects for some outcomes, but in an unexpected manner. At six-month follow-up, the directive intervention was more effective than cultural values at reducing depressive symptoms for AAs; however, the cultural values condition was more effective than the non-directive intervention at reducing depressive symptoms for EAs. Conclusion: Mixed evidence was found for directiveness as an Asian-specific treatment enhancement.Clinical or methodological significance of this article: This article adds to a complicated body of research and clinical work aiming to inform best practices for ethnic minorities. We found some evidence that a directive therapeutic style may be a “culturally invariant” clinical technique that could be beneficial to Asian American and European American populations alike. Yet, other findings suggest that directiveness might be uniquely advantageous for Asian Americans, particularly for long-term improvement of depressive symptoms.

Behavioral and Nondirective Guided Self-Help for Parents of Children with Externalizing Behavior: Mediating Mechanisms in a Head-To-Head Comparison.

Parent training (PT) delivered as a guided self-help intervention may be a cost- and time-effective intervention in the treatment of children with externalizing disorders. In face-to-face PT, parenting strategies have repeatedly been identified as mediating mechanisms for the decrease of children's problem behavior. Few studies have examined possible mediating effects in guided self-help interventions for parents. The present study aimed to investigate possible mediating variables of a behaviorally oriented guided self-help program for parents of children with externalizing problems compared to a nondirective intervention in a clinical sample. A sample of 110 parents of children with externalizing disorders (80% boys) were randomized to either a behaviorally oriented or a nondirective guided self-help program. Four putative mediating variables were examined simultaneously in a multiple mediation model using structural equation modelling. The outcomes were child symptoms of ADHD and ODD as well as child externalizing problems, assessed at posttreatment. Analyses showed a significant indirect effect for dysfunctional parental attributions in favor of the group receiving the behavioral program, and significant effects of the behavioral program on positive and negative parenting and parental self-efficacy, compared to the nondirective intervention. Our results indicate that a decrease of dysfunctional parental attributions leads to a decrease of child externalizing problems when parents take part in a behaviorally oriented guided self-help program. However, none of the putative mediating variables could explain the decrease in child externalizing behavior problems in the nondirective group. A change in dysfunctional parental attributions should be considered as a possible mediator in the context of PT.

Underutilization of Mental Health Services by Asian American Clients: The Impact of Language and Culture in Clinical Assessment and Intervention

Previous research indicates a disproportionately low service utilization rate and a high dropout rate among Asian Americans receiving mental health services (Sue, 1977). Findings suggest that many of the factors accounting for this problem are related to cultural and linguistic mismatches. This study asked the following questions: Do non-Asian American and Asian American clinicians differ in their (1) style of service delivery, (2) assessment of their Asian American clients, and (3) interventions with them? Clinicians' clinical assessment and intervention strategies are identified components of this study. Eight in-depth interviews were conducted with Asian American and non-Asian American clinicians in the field of social work. A case vignette was developed as the basis for the interviews. Data analysis was based on a content-analysis approach. The findings showed clinicians from the Asian American group as more process-oriented: they placed more emphasis on use of non-directive intervention styles, family dynamics, and level of acculturation. They assessed the case as being less severe, predicting a better prognosis than did the non-Asian American clinicians. Family unity was an identified goal, and there was a strong emphasis on rapport-building in the initial session. In comparison, the non-Asian American clinicians were more content-oriented. They placed more emphasis on individual member's clinical assessments, symptom reduction, individual goal-setting, autonomy, and separation/individual issues. They assessed the case as more severe and predicted a poorer prognosis.