Rhode Island Change Assessment Scale Research Articles

The Impact and Relevance of Sensory Modulation-Related Occupational Therapy Interventions on Emotional Regulation in Preparation for Readiness to Change for Individuals Who Are Incarcerated and Have Experienced Trauma

This study investigated the effects that sensory modulation-related occupational therapy interventions can have on emotional regulation in preparation for readiness to change among individuals who are incarcerated. Assessments used included the PTSD Checklist (PCL-5), University of Rhode Island Change Assessment Scale 32-item (URICA), and a semi-structured interview. Results quantitatively demonstrated emotional regulation in relation to traumatic experiences was impacted through statistically significant changes in PCL-5 scores. The change in URICA scores was minimal, yet positive. Qualitative data supported positive effects on emotional regulation and readiness to change. This project provided evidence regarding sensory modulation-related occupational therapy interventions within justice-based settings.

Improving motivation and treatment uptake behaviors of patients with eating disorders using patient narrative videos: study protocol of a pilot randomized controlled trial

BackgroundPatients with eating disorders (ED) typically report delays between the onset of symptoms and engagement with treatment services. Personal barriers including stigma, shame, and guilt, as well as the availability of social support may influence patients’ decisions to engage with treatment services. Patient narratives are personalized stories discussing the illness and recovery of previously affected persons. Such narratives can reduce self-stigma and provide current patients with hope for their own recovery.MethodThis pilot study will examine the effects of patient narrative videos on the treatment motivation and uptake of treatment services for patients with ED. Three narrative videos were developed from the perspectives of (a) a former patient with an ED, (b) an ED specialist, and (c) the same former patient discussing a somatic condition unrelated to ED. Patients will be randomized into three video viewing and one treatment-as-usual group. Effects on treatment motivation will be assessed using the University of Rhode Island Change Assessment Scale (URICA-S) immediately after viewing the videos, as well as one-week and three-month follow-ups. Treatment uptake will be assessed during follow-up using a questionnaire listing possible treatment interactions. A post-intervention questionnaire and semi-structured interviews will be used to assess the feasibility and acceptability of patient narrative videos for this population.DiscussionThere is an urgent need to encourage patients with ED to engage with specialized treatments as soon as possible. Patient narratives may be a pivotal approach to implementing cost effective and easy to disseminate early intervention programs to future patients with ED.

The role of ethnicity in the admission process of male juvenile released offenders: Examining risk and readiness to change in the Israeli Shushan centers.

Disparities in evaluating readiness to change and recidivism risk across diverse cultural groups can profoundly affect rehabilitation program efficacy. This study examines readiness to change and recidivism risk disparities between Israeli-Arabs and Israeli-Jews entering a re-entry program by the Prisoner Rehabilitation Authority postrelease. The University of Rhode Island Change Assessment Scale questionnaire gauged readiness to change, whereas the Ohio Youth Assessment System-Residential tool assessed recidivism risk. The sample included 151 participants: 98 Israeli-Arabs and 53 Israeli-Jews. Mean differences in change readiness and recidivism risk were statistically assessed through t tests. Significant differences emerged in change readiness levels between Israeli-Arabs and Jews upon rehabilitation program entry, with Israeli-Jews exhibiting higher readiness. Additionally, a noteworthy divergence in recidivism risk was noted, indicating elevated average risk for Israeli-Jews. Findings underscore the vital need for cultural sensitivity during admission. Bias potential in assessing risk for Arab participants emphasizes the necessity of a comprehensive culturally sensitive approach. While focusing on admission, the Risk-Need-Responsivity model application could enhance risk evaluation and guide culturally tailored treatments.

Thematic group activities: accommodating the individual needs of clients undergoing therapeutic community approach in Indonesia

PurposeTherapeutic community (TC) is a primary approach that has been used in all Indonesian National Narcotics Board residential treatment centers since 2012. In TC, all daily activities are strengthened into habits and routines without strong therapeutic or educational reasons. But recently, the TC members become more critical and have growing individual needs. Thus, the Indonesian National Narcotics Board (INNB) tried to combine the TC approach with thematic group activities (TGA) intervention using an integrated individual approach to improve the outcomes. This study aims to evaluate the client’s behavioral changes after undergoing a TC approach added with TGA intervention for two months.Design/methodology/approachA mixed-methods study with the pre-post design was applied to 122 participants from six INNB rehabilitation centers. Pre-post behavioral changes were measured by using Client Evaluation of Self Treatment, University Rhode Island Change Assessment Scale, modified-Addiction Severity Index 3.0 and World Health Organization-Quality of Life instruments. Analysis was done by using univariate and bivariate on quantitative data, focus group discussion, and medical record review.FindingsThe participants’ mean age was 30.57 years, majority male, 50% graduated from senior high schools and were employed. Bivariate analysis resulted statistically significant (p-value < 0.05) in tendencies to seek treatment, participate more actively, maintain a good relationship with counselors during the program, and decrease the psychological problems of participants. The client’s social state, as well as adaptation to the program, were also amended.Originality/valueTGA-added TC approach was proven to improve clients’ behavioral changes, particularly in social functioning, program involvement and psychological conditions, in people with substance use disorders.

Social phobia and evasiveness: trial protocol for a randomized controlled feasibility and superiority trial of the effect of Modified Collaborative Assessment vs. standard assessment on patients’ readiness for psychotherapy (CO-ASSM-RCT)

BackgroundEvasive personality disorder (AvPD) and social phobia (SP) have substantial costs for patients and their families and great economic costs to the society. While psychotherapy can be an efficacious treatment, many patients drop out during treatment. Increased knowledge on how to decrease dropout from psychotherapy is warranted, including how to increase a patient’s readiness for psychotherapy.MethodsWe describe a randomized controlled feasibility and superiority trial of 42 individuals with a clinical diagnosis of either SP or AvPD, who are to initiate psychotherapeutic treatment in Danish outpatient mental health services. They will be randomized in a 1:1 ratio to either assessment-as-usual and receive no further assessment or to a Modified Collaborative Assessment (MCA) provided as a pre-treatment intervention before psychotherapy initiation. MCA will include a battery of psychological tests designed to thoroughly assess the patients’ psychopathology. The tests are administered in collaboration with the patient, including detailed oral and written feedback. We hypothesize that the intervention is feasible regarding patient’s acceptance and adherence. We further hypothesize that patients randomized to MCA will reach higher levels of readiness for psychotherapy as assessed with the University of Rhode Island Change Assessment Scale (URICA).DiscussionThis protocol assesses the feasibility, efficacy, acceptability, and safety of an intervention aimed at changing the readiness for participation in psychotherapy of patients with SP and AvPD. Results from this feasibility study could guide the development of future large-scale trials of MCA and procedures for MCA treatment fidelity assessment.Trial registrationNCT2021001.

Stages of psychological change among patients with non-alcoholic fatty liver disease in China: a national cross-sectional study

ObjectivesNon-alcoholic fatty liver disease (NAFLD) is becoming the leading cause of chronic liver disease worldwide. However, treatment of NAFLD is potentially influenced by psychological conditions. Using the simplified version of...

Measuring Readiness to Change Substance Use, Alcohol Use, and Cannabis Use: An Experimental Manipulation of Cognitive Effort

Background: The Transtheoretical Model supports that readiness to change should predict actual substance-related behavior change. This relationship is surprisingly modest. Across several behavioral domains, individuals tend to have unrealistic expectations regarding the amount of effort and time required to successfully change one’s behaviors, dubbed the False Hope Syndrome. Objectives: Based on False Hope Syndrome, we expect the standard method of measuring self-reported readiness to change is overestimated. To test this hypothesis, we experimentally manipulated level of cognitive effort prior to completing readiness to change measures. College students from a large southwestern university who reported using substances in the past 30 days (n = 345) were recruited from a psychology department participant pool and randomized to one of three conditions: 1) standard, low effort condition, 2) medium effort condition (selected likes/dislikes of substance use and negative consequences of changing one’s use), and 3) high effort condition (also provided written responses to how they would handle difficult situations related to changing their substance use). We conducted one-way ANOVAs with Tukey post-hoc comparisons to examine differences on three measures of readiness to change: the University of Rhode Island Change Assessment (URICA) scale as well as readiness and motivation rulers. Results: Contrary to our hypothesis, all significant statistical tests supported higher cognitive effort conditions reporting higher readiness to change. Although effect sizes were modest, higher cognitive effort appeared to increase self-reported readiness to change substance use. Conclusions: Additional work is needed to test how self-reported readiness to change relates to actual behavior change when assessed under the different effort conditions.

Assessing owners' readiness to change their behaviour to address their companion animal's obesity.

Owner behaviour change in relation to management is critical for successful pet weight loss. The stages of change (SOC) can be used to conceptualise the process of intentional behaviour change. Clients may be more likely to make successful changes when practitioners use communication techniques appropriate for a client's current stage. The objective of this cross-sectional study was to assess pet owners' SOC in relation to managing the weight of their overweight or obese pet. An online questionnaire targeting dog and cat owners was distributed via snowball sampling. A total of 532 questionnaires were included in the analysis. Of these, 153 participants (28.8%) self-identified their pet's body condition score (BCS) as greater than 5 (on a nine-point scale). An adapted University of Rhode Island Change Assessment scale was completed by 119 of these participants (77.8%) to assess their readiness to change related to managing their overweight or obese pet. Most participants were scored in the precontemplation (52.1%) and contemplation (42%) stages, where readiness to change is low. Owner assessments likely resulted in underestimation of pets' BCS. The results offer preliminary insight into the SOC of owners who identify their pets as overweight or obese. Developing tools to assess and understand owners' readiness to change may be useful in informing veterinary professionals' communication approaches when engaging in weight management conversations.

A study to eveluate the outcome of psychosocial intervention on motivation and readiness to change among individuals with alcohol use disorder at Dharwad institute of mental health and neurosciences (DIMHANS) Dharwad

Background of the study and objectives: The aim of the study was to evaluate the outcome of psychosocial intervention on Motivation and Readiness to change among individuals with Alcohol use disorder at DIMHANS, Dharwad. The study was conducted with following objectives: (1) To assess the motivation and readiness to change among individuals with Alcohol Use Disorder. (2) To evaluate the effectiveness of psychosocial intervention by comparing post-intervention motivation and readiness to change scores of experimental and control group subjects. (3) To find out the correlation between motivation and readiness to change (4) To find out association between motivation and readiness to change with selected demographic and clinical characteristics of individuals with alcohol use disorder.Research methodology: For the present study, quasi experimental non-equivalent control group pre-test post-test design was adopted. The independent variable was psychosocial intervention and dependent variable was Motivation and Readiness to change scores of alcohol use disorder patients. By using convenient sampling technique 60 alcohol use disorder patients were selected from psychiatric wards of DIMHANS Dharwad, based on the convenience first 30 subjects were taken to control group and next 30 subjects were taken to experimental group.The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) and University of Rhode Island Change Assessment Scale – URICA was used to collect the data on assessing Motivation and Readiness to change among individuals with alcohol use disorder. The pre-test was conducted for both experimental and control group subjects. Psychosocial intervention was administered to experimental group subjects in 4 sessions for 10 days. Post-test was conducted on 11th day after the intervention for both the groups.Results: Majority (70%) were in the age group 18-40yrs. 60% of the subjects were having secondary education. 28.33% of the subjects were farmers and private workers. 81.67% of the subjects were married. Largest proportions of participants were residing in rural area. In terms of clinical characteristics, 93.33% of the subjects were having the family history of substance abuse, 63.33% of the subjects were started to consume alcohol above the age of 18 years, among them 80% of the subjects were having peer pressure.Subjects in experimental group improved in motivation and readiness to change scores compared to control group subjects at post-tests level. There was a significant positive correlation between motivation and readiness to change scores among alcohol subjects.Interpretation and conclusion: The present study implies that nurse should involve in conducting psycho social intervention programme to improve the Motivation and readiness to change behaviour of alcohol dependents and help them to have a balanced lifestyle.

Measurement invariance of the University of Rhode Island Change Assessment Scale in Project MATCH: An exploratory structural equation modeling approach.

Progression through the stages of change is a proposed mechanism underlying the effects of treatment for alcohol use disorder (AUD). However, examining stages of change as a mechanism of treatment effects requires that the measure be invariant across patient subgroups, treatment conditions, and time. In this study, we examined measurement invariance of the University of Rhode Island Change Assessment Scale (URICA) in Project MATCH using an exploratory structural equation modeling (ESEM) approach. We conducted a secondary analysis of data from Project MATCH (N=1726; Mage =40.2, SD=10.9; 75.7% male; 80% non-Hispanic white), a multisite randomized clinical trial that tested three AUD treatments: Motivational Enhancement Therapy, Cognitive-Behavioral Therapy, or Twelve-Step Facilitation. Participants completed the 24-item URICA for assessing the stages of change in relation to drinking at baseline and post-treatment (3months after baseline). A 4-factor ESEM provided a good fit to the data and a better fit to the data than a conventional 4-factor confirmatory factor analysis model. Further, the URICA demonstrated scalar invariance across each patient subgroup at baseline (sex, ethnicity, marital status, education, and parental history of AUD) and treatment condition at follow-up. However, the URICA was not longitudinally invariant as the metric model resulted in a significant decrement in model fit. Measurement invariance of the URICA over time was not supported. Longitudinally invariant measures of the stages of change are needed to test the proposal that progression through the stages explains treatment effects.

Denial and Diagnosis of Methamphetamine Dependence Severity.

Denial, or lack of awareness of problems related to substance misuse, is a common feature of drug use disorders and can affect engagement in treatment and recovery. This study tested for association of denial with severity of symptoms used in the diagnosis of Methamphetamine Dependence. This secondary analysis used data from 69 participants (52.2% male) who met criteria for the diagnosis of Methamphetamine Dependence on the Structured Clinical Interview for DSM-IV (SCID). The association between diagnostic severity, determined from a SCID summary score (8 items), and denial, measured by the University of Rhode Island Change Assessment Scale (URICA) Precontemplation score, was tested by Pearson correlation. In post hoc t-tests, participants who differed on individual SCID items were compared on the Precontemplation score. The additional URICA subscales (Contemplation, Maintenance, Action) were also tested on a secondary basis. SCID summary scores were negatively correlated with URICA Precontemplation scores (P = .003). Post-hoc tests revealed that participants who denied continued methamphetamine use despite persistent or recurrent problems (SCID item 6) had significantly higher Precontemplation scores than those who endorsed these problems (t = 3.066, P = .003). In contrast, positive correlations were observed between diagnostic severity and greater openness/willingness to change on the URICA (eg, Maintenance, r = .26; P = .01). The findings highlight the importance of a patient's insight regarding their addiction in clinical diagnosis. Because minimizing the impact of methamphetamine use may preclude or delay treatment, it is advised that self-report be supplemented to improve accuracy of diagnosis.

Attachment and Therapeutic Alliance in Substance Use Disorders: Initial Findings for Treatment in the Therapeutic Community.

Background: There is convincing evidence that individuals suffering from Substance Use Disorder (SUD) often present insecure attachment patterns. In contrast, a strong therapeutic alliance in treatment of SUD has been found to lead to a more positive treatment outcome. However, insecure attachment has been observed to be linked with weaker therapeutic alliance strength. The primary aim of this explorative study was to gain initial insights regarding the influence of attachment and personality characteristics on therapeutic alliance and therapy motivation in SUD patients undergoing treatment at a therapeutic community. Furthermore, SUD patients were compared to healthy controls regarding attachment, personality and mood pathology.Methods: A total sample of 68 participants, 34 inpatients in SUD treatment and 34 age-gender and education adjusted controls, were investigated. Both groups filled in the Adult Attachment Scale (AAS), the Inventory of Personality Organization (IPO-16), and the Brief Symptom Inventory (BSI-18) questionnaires. Additionally, SUD patients filled in the Working Alliance Inventory (WAI-SR) and the adapted German version of the University of Rhode Island Change Assessment scale (FEVER).Results: In line with our assumptions, SUD patients exhibited a decreased amount of attachment security (AAS) which was related to higher personality (IPO-16) and mood pathology (BSI-18). Furthermore, correlational analysis revealed the WAI-SR dimension Bond being positively associated with more secure attachment. A strong task alliance was linked to the Action stage of change (FEVER) and decreased mood but not personality pathology.Conclusion: Our findings confirm the putative negative effect of attachment and personality pathology on therapy motivation and therapeutic alliance in addiction therapy as well as more specifically in therapeutic community treatment. Future research in enhanced samples might focus more on the long-term effects of the interaction of attachment, personality and therapeutic alliance variables.

Validation d’une version francophone de l’Anorexia Nervosa Stages of Change Questionnaire

BackgroundNumerous authors regard motivation to change as a key feature in the treatment of individuals with anorexia nervosa. Although several questionnaires are available to assess motivation to change, most of them were not intended for adolescents nor individuals with anorexia nervosa. The Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) was developed to assess motivation to change specifically in individuals with anorexia nervosa. This study aimed to validate a French translation of the ANSOCQ based on the three-factor model identified elsewhere. MethodologyEighty adolescents suffering from anorexia nervosa and two from an eating disorder not otherwise specified were recruited at their arrival in a specialized eating disorder inpatient treatment program. Fifty-two adolescents participated again at the time of their discharge. Respondents completed the ANSOCQ, the University of Rhode Island Change Assessment Scale, a single item derived from the Motivation Stages of Change for Adolescents Recovering from an Eating Disorder, and the Eating Disorder Inventory-3. Cronbach's Alpha, Pearson's and Spearman's correlations, ANOVA and multiple regressions were performed. ResultsThe global scale and subscales of the ANSOCQ demonstrated excellent internal consistency (α≥0.82). The global scale was significantly correlated with both the URICA (r=0.46) and the MSCARED (rs=0.68). Participants’ scores on the three subscales of the ANSOCQ were significantly higher at the end of their hospitalization (ps<0.05), especially for the Ego-Alien Aspects subscale. Youths’ scores on the Weight Gain subscale were significantly lower than their scores on both Eating, Shape, and Weight Concerns and Ego-Alien Aspects subscales (ps<0.05). The ANSOCQ subscales significantly explained 52% and 41% of variance on the Eating Disorder Risk Composite Scale and the General Psychological Maladjustment Composite Scale, respectively. Furthermore, while the Weight Gain subscale was uniquely related to the former scale (β=−0.38), the Eating, Shape, and Weight Concerns subscale was uniquely associated with the latter scale (β=−0.39). ConclusionThese results support the psychometric qualities of this French translation of the ANSOCQ. Given the differences observed in the present study, the use of the ANSOCQ subscales also seems promising. It is possible that adolescents report higher motivation to change aspects of their difficulties that they recognize more, that are associated with fewer secondary benefits, and that entails greater unwanted repercussions. However, further studies are needed to confirm the factorial structure of the ANSOCQ.

Cognitive and affective empathy in men with alcohol dependence: Relation with clinical profile, abstinence, and motivation.

Background:Empathy plays a role not only in pathophysiology but also in planning management strategies for alcohol dependence; however, few studies have looked into it. No data are available regarding the variation of empathy with abstinence and motivation. Assessment based on cognitive and affective dimensions of empathy is needed.Aim:This study aimed to assess cognitive and affective empathy in men with alcohol dependence and compared it with normal controls. Association of empathy with disease-specific variables, motivation, and abstinence was also done.Methods:This was a cross-sectional observational study conducted in the outpatient department of a tertiary care center. Sixty men with alcohol dependence and 60 healthy controls were recruited and assessed using the Basic Empathy Scale for cognitive and affective empathy. The University of Rhode Island Change Assessment Scale was used to assess motivation. Other variables were assessed using a semi-structured pro forma. Comparative analysis was done using unpaired t-test and one-way ANOVA. Correlation was done using Pearson's correlation test.Results:Cases with alcohol dependence showed lower levels of cognitive, affective, and total empathy as compared to controls. Affective and total empathy were higher in abstinent men. Empathy varied across various stages of motivation, with a significant difference seen between precontemplation and action stages. Empathy correlated negatively with number of relapses and positively with family history of addiction.Conclusions:Empathy (both cognitive and affective) is significantly reduced in alcohol dependence. Higher empathy correlates with lesser relapses. Abstinence and progression in motivation cycle is associated with remission in empathic deficits.

Impact of patient motivation on compliance and outcomes for incontinence

ObjectivesPhysiotherapeutic treatment of pelvic floor dysfunction in women has variable outcomes, and identification of the predictors of outcomes is important in developing service provision and treatment planning. This study explored whether patient motivation affects treatment compliance and outcomes of physiotherapeutic treatment in a cohort of patients with pelvic floor dysfunction. Design, setting and participantsA prospective observational study of 141 adult female patients referred consecutively to the physiotherapy clinic of an urogynaecological outpatients unit at a UK hospital. InterventionA 6-month (one group session per month) pelvic floor muscle training programme, which included a home exercise programme. Main outcome measuresModified Oxford Grading System and Queensland Pelvic Floor Questionnaire ratings of pelvic floor function were taken pre- and post-intervention, and the University of Rhode Island Change Assessment Scale assessed patient motivation to change pre-intervention. ResultsMotivation to change predicted attendance at the intervention sessions and patient-rated improvements in function. Patients with higher baseline motivation to change also reported greater improvements in pelvic symptoms, given the same pelvic floor muscle strength improvement. ConclusionsPatient motivation affects physiotherapeutic treatment adherence and outcomes, and should be considered as part of future assessment/screening procedures. Clinical Trial RegistrationNCT02549157.

Relapse in involuntary substance treatment: a transversal study

ObjectiveTo evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. MethodsThis is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. ResultsRelapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. ConclusionsIn this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.

0476 Readiness and Stages of Change in a Behavioral Sleep Medicine Clinical Sample: From Pre-Contemplation to Struggling to Maintain Change

Abstract Introduction Stages of change in the transtheoretical model are used to assess a patient’s readiness to change, which may help providers tailor behavioral treatment (BT). As research has focused on substance abuse, there is a significant lack of data in individuals presenting for behavioral sleep medicine (BSM) treatment. Methods 146 consecutive patients (46.1±16.0 years, 61.6% female, 19.9% minority) who were evaluated at the BSM program of Penn State Hershey Sleep Research &amp; Treatment Center completed the University of Rhode Island Change Assessment Scale (URICA) assessing readiness to change (RtC) and pre-contemplation (P), contemplation (C), preparation/action (A) and struggling to maintain (M) stages of change. Subjects also completed the Insomnia Treatment Acceptability Scale (ITAS) and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). Results The average RtC score was 9.4, with 21.9% of the sample in stage P, 56.2% in C and 21.9% in A. The average P (53.2±7.6), C (49.1±10.1), A (48.8±12.3) and M (37.7±9.1) scores suggested an overall “contemplation cluster profile”. Higher RtC (r=0.37), C (r=0.31) and A (r=0.24) scores were associated with greater acceptability of BT, while higher P scores were associated with lower acceptability of BT (r=-0.22). In contrast, higher M scores were associated with greater acceptability of pharmacological treatment (r=0.21) as well as higher DBAS scores, including sleep medication expectations (r=0.23). Conclusion Patients attending a BSM program typically present at a contemplation stage, which indicates intention to start changing sleep behaviors within the next few months with some ambivalence in regards to pros/cons of such change. A significant proportion of patients struggle to maintain change and present with higher acceptability for pharmacological interventions, which may hinder the effectiveness of BT and may require specific therapeutic approaches. Support Department of Psychiatry, Penn State College of Medicine

Les caractéristiques personnelles d’adolescentes placées en centre éducatif qui sont associées à la qualité de l’alliance de travail précoce

BackgroundThe working alliance is an important predictor of the outcomes of intervention with adults and adolescents. Establishing the working alliance with adolescents involves some specific challenges. Indeed, the consultation among this population is often initiated by a third party, who is usually a parent or an authority figure. The intervention may even be imposed on the youth if his behaviour involves significant risks to himself or others, as is the case in rehabilitation centres. In addition, it is also important to note that their motivation to change is often low at the beginning of the intervention, which makes the development of the working alliance even more complex. Therefore, it seems relevant to identify factors that may influence the quality of the working alliance, especially when it is a coercive intervention such as in rehabilitation centres. This study aims to examine the links between some personal characteristics and the quality of the early working alliance among adolescent girls placed in rehabilitation centres. The four personal characteristics investigated are: motivation to change, self-efficacy, attitude towards authority figures and behavioural difficulties. MethodsForty-six adolescent girls (12–17 years old) were recruited at the time of their admission to one of the rehabilitation centres located in Montreal. They all completed five self-reported questionnaires: the Working Alliance Inventory Short, the University of Rhode Island Change Assessment Scale, the Self-Efficacy Questionnaire for Children, the Attitudes to Formal Authority Questionnaire, and the Youth Self Report. ResultsThe results indicated that motivation for change (β=.55) and sense of self-efficacy (β=.36) are the variables most closely related to the quality of the perceived working alliance at the beginning of the intervention. Motivation to change and self-efficacy explained 39.5% (p<.01) of the variance of the perceived quality of the working alliance. Attitude towards authority and behavioural problems were not significantly associated with the quality of the working alliance. These findings are consistent with those of other studies conducted with adults or young people in other contexts. ConclusionOur results suggest that motivation to change and self-efficacy are therapeutic targets to consider in order to promote the establishment of a positive working alliance at the beginning of an intervention with adolescent girls placed in rehabilitation centres.

The neural interface between negative emotion regulation and motivation for change in cocaine dependent individuals under treatment

BackgroundEmotion regulation is important for cocaine addiction treatment success, particularly during early abstinence. In addition, the neural underpinnings of emotion processing overlap with those of motivation and goal-directed behavior. We examined if the neural underpinnings of emotion maintenance and its regulation correlate with cocaine treatment motivation. MethodsForty-five cocaine dependent individuals (CDIs) starting outpatient treatment in a public specialized addiction treatment clinic in Granada (Spain) underwent fMRI scans while performing a Reappraisal task, and completed the University of Rhode Island Change Assessment Scale (URICA), to measure treatment motivation. We conducted correlation analyses to examine the association between emotion maintenance and regulation related brain activation and URICA’s Readiness to Change scores. We also explored links between Emotional reports during the fMRI reappraisal task, duration of abstinence, and anxiety and depression symptoms. ResultsReadiness to Change scores were positively correlated with activations in the right dorsolateral prefrontal and right parietal cortices, the midbrain (p ≤ 0.001, cluster extents ≥109 voxels), and basolateral amygdala (PFWE-SVC<0.05), while negatively with emotion maintenance related activation in the same cortical areas and activations in the dorsomedial frontal cortex, the nucleus accumbens and the left fusiform gyrus. Emotional reactivity negatively correlated with right dorsolateral prefrontal cortex reappraisal related activation (r= -0.40, p = 0.007), and the Regulate score positively correlated with the left fusiform gyrus emotion maintenance related activation (r = 0.31, p = 0.04). ConclusionsEmotional related activation in frontoparietal, accumbens, fusiform, amygdala and midbrain regions engaged during emotion regulation and its maintenance correlate with early treatment motivation in CDIs.

Relapse in involuntary substance treatment: a transversal study

ObjectiveTo evaluate the associations between relapse and admissions (voluntary and involuntary) in a sample of patients with substance dependence. MethodsThis is a cross-sectional study undertaken at a private medical therapeutic community specialised in treating addiction, located in a rural area of São Paulo, Brazil. Sociodemographic characteristics, the University of Rhode Island Change Assessment Scale (URICA), Stages Readiness and Treatment Eagerness Scale (SOCRATES), Beck Anxiety Inventory (BAI) and Beck Depression Inventory (BDI) and Structured Clinical Interview for DSM-IV-SCID were used. ResultsRelapse was associated with low family income (P=.006) and contemplation motivational stage (P<0.05). Nevertheless, no significant differences between individuals who were admitted involuntarily (64%) and voluntarily (54%) were observed (P=0.683) in terms of relapses. ConclusionsIn this sample, the relapse outcome in involuntary admissions was no different from the voluntary ones.