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Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis.

ABSTRACT: BACKGROUND:Down Your Drink (DYD) is a widely used unguided web-based alcohol moderation program for the general public based on cognitive behavioral therapy (CBT) and motivational interviewing (MI); it provides users with many opportunities to enter free-text responses. OBJECTIVE:The aim of this study was to assess participants' use of key CBT and MI components, the presence of change talk and sustain talk within their responses, and whether these data are associated with drinking outcomes after 3 months. METHODS:An exploratory secondary data analysis was conducted on data collected in 2008 from the definitive randomized trial of DYD (N=503). Past week alcohol use at baseline and 3-month follow-up were measured with the TOT-AL. Covariates included baseline alcohol use, age, gender, education level, and word count of the responses. Use of MI and CBT components and presence of change talk and sustain talk were coded by two independent coders (Cohen ? range 0.91-1). Linear model regressions on the subsample of active users (n=410) are presented along with a negative binomial regression. RESULTS:The most commonly used component was the listing of pros and cons of drinking. The number of listed high-risk situations was associated with lower alcohol use at 3-month follow-up (Badj -2.15, 95% CI -3.92 to -0.38, P=.02). Findings on the effects of the percentage of change talk and the number of listed strategies to deal with high-risk situations were inconsistent. CONCLUSIONS:An unguided web-based alcohol moderation program can elicit change talk and sustain talk. This secondary analysis suggests that the number of listed high-risk situations can predict alcohol use at 3-month follow-up. Other components show inconsistent findings and should be studied further.

SUBMITTER: Mujcic A

PROVIDER: S-EPMC7492976 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis.

Mujcic Ajla A Linke Stuart S Hamilton Fiona F Phillips Alexandria A Khadjesari Zarnie Z

Journal of medical Internet research 20200901 9

<h4>Background</h4>Down Your Drink (DYD) is a widely used unguided web-based alcohol moderation program for the general public based on cognitive behavioral therapy (CBT) and motivational interviewing (MI); it provides users with many opportunities to enter free-text responses.<h4>Objective</h4>The aim of this study was to assess participants' use of key CBT and MI components, the presence of change talk and sustain talk within their responses, and whether these data are associated with drinking ...[more]

PMID: 32870162

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Project description:BACKGROUNDMorbidity arising from unprepared bereavement is a problem that affects close personal relations of individuals at the end-of-life. The bereavement studies literature demonstrates that a lack of preparedness for a loved one's death is a risk factor for secondary psychological morbidity among survivors. Short awareness time of death negatively correlates to preparedness for bereavement. The absence of disclosure of end-of-life diagnosis and prognosis to close personal relations ('death talk') between patients and loved ones, or health professionals and loved ones, may contribute to short awareness time of death. To increase awareness time of death, we might attempt to increase patient first-personal disclosure of end-of-life diagnosis and prognosis to loved-ones, and/or patient consent to health professional disclosure of the same.MAIN TEXTInterventions based on motivational interviewing in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient's consent, may offer a part solution to the problem of unprepared bereavement. This paper evaluates the ethical permissibility of such interventions. We consider two ethical objections to using motivational interviewing in this way: first, that it is inappropriate for practitioners to seek disclosure as an outcome in this setting; second, that aiming at disclosure risks manipulating individuals into death talk. While it need not be impermissible to direct individuals toward disclosure of end-of-life diagnosis/prognosis, the objection from manipulation implies that it is pro tanto ethically preferable to use motivational interviewing in a non-directive mode in death talk conversations. However, insofar as non-directive motivational interviewing requires more advanced skills, and thus may be more difficult to learn and to practise, we advance that it may be ethically permissible, all things considered, to employ directional, or specific outcome-oriented, motivational interviewing.CONCLUSIONMotivational interviewing interventions in end-of-life care whose aim is to facilitate death talk, either by the patient directly, or by a health professional with the patient's consent may be ethically permissible, all things considered.

Project description:BackgroundSelf-paced internet interventions for gambling problems offer cost-effective, accessible, and private alternatives to traditional psychotherapy for a population that rarely seeks help. However, these interventions have been relatively slow to develop, evaluate, and deploy at scale relative to those for other addictive behaviors. Moreover, user engagement remains low despite the high interest. Motivational interviews have improved the effectiveness gambling bibliotherapy but have not been augmented with an analogous web-based self-guided program.ObjectivesThis trial aimed to replicate and extend prior work by translating a paperback workbook to the internet and pairing it with a single motivational interview. It was hypothesized that the motivational interview would enhance program engagement and gambling outcomes.MethodsA two-arm randomised controlled trial was conducted. Treatment-seeking Canadian adults recruited solely via social media received one year of access to a web-based self-guided program, either alone (N = 158) or in combination with a virtual motivational interview completed upon enrolment (N = 155). The program was based on principles of cognitive-behavioral therapy and motivational interviewing. Gambling severity, expenditures, frequency, and duration were assessed via online questionnaires at baseline and 3-, 6-, and 12-months post-baseline, along with secondary outcomes (i.e., depression, anxiety, nonspecific psychological distress, alcohol consumption).ResultsBaseline characteristics were indicative of severe gambling problems and concurrent mental health problems but not problematic alcohol consumption in this sample. Both treatment groups demonstrated roughly equal improvements across all gambling outcomes and most secondary outcomes over time, except alcohol consumption, which did not meaningfully change. Changes were most prominent by 3 months, followed by more gradual change by 6 and 12 months. Only 57 % of gamblers who were assigned to receive a motivational interview completed that interview. About 40 % of users did not complete any program modules and 11 % completed all four. No group differences in program engagement were observed, although the number of modules completed was associated with greater reductions in gambling behaviors in both groups.DiscussionThe problem of user engagement with web-based self-help programs remains. There is a dose-response relationship between engagement and outcomes when engagement is measured in terms of therapeutic content completed.ConclusionsThe addition of a motivational interview to a web-based self-help program for gambling problems was unsuccessful in improving engagement or outcomes. Future work should aim to make self-guided programs more engaging rather than solely making users more engaged.Trial registrationRegistered on 7 July 2020 (ISRCTN13009468).

Project description:Current veterinary communication skills training often focuses on the strategies necessary to successfully transfer information and promote shared decision making rather than inspiring client motivation to engage in behaviour change(s). One evidence-based communication methodology with a specific focus on enhancing conversations about change is Motivational Interviewing (MI), which is perceived by veterinarians to be highly relevant to their profession. We examined whether veterinarians who experienced brief (4-5 hours) MI training (BMIT) were able to change their communication behaviours to be more MI consistent. Fourteen veterinarians recorded 31 veterinary herd health consultations before (n = 15) and after (n = 16) BMIT to allow pre-post intervention analysis of veterinarian and farmer verbal behaviour. Additionally, using a sequential linguistic analysis of 3885 veterinarian-farmer communication events within these consultations, the influence of veterinarians' verbal behaviours on farmers' response language was explored. Analysis of veterinary consultations undertaken before and after BMIT revealed that veterinarians changed their communication style to be more consistent with the MI methodology, including more use of reflection statements, a more empathic and partnership-oriented consultation style and greater emphasis on clients' own language in favour of change goals. In response, farmers contributed more to the conversation and discussed more herd health-related changes. Sequential linguistic analysis suggested that following a veterinarian emphasising something positive about the farmer (e.g. efforts, strengths), seeking collaboration or emphasising farmer choice, farmers were subsequently more likely to express arguments in favour of change ('Change Talk'), especially phrases indicative of commitment. This study offers the first evidence of the potential value of a BMIT experience to enhance veterinary communication skills, although conscious and disciplined use of MI principles, strategies and Spirit-an ethos of compassion, acceptance, partnership and evocation-requires longer and more complex training. Further studies examining the longevity and consistency of these verbal behaviour changes following BMIT are required.

Project description:ImportanceThere is a tension between clinician-led approaches to engagement in advance care planning (ACP), which are effective but resource-intensive, and self-administered tools, which are more easily disseminated but rely on ability and willingness to complete.ObjectiveTo examine the efficacy of computer-tailored print feedback (CTPF), motivational interviewing (MI), and motivational enhancement therapy (MET) on completion of a set of ACP activities, each as compared with usual care.Design, setting, and participantsThis randomized clinical trial was conducted from October 2017 to December 2020 via telephone contact with primary care patients at a single VA facility; 483 veterans aged 55 years or older were randomly selected from a list of patients with a primary care visit in the prior 12 months, with oversampling of women and people from minoritized racial and ethnic groups. Statistical analysis was performed from January to June 2022.InterventionsMailed CTPF generated in response to a brief telephone assessment of readiness to engage in and attitudes toward ACP; MI, an interview exploring ambivalence to change and developing a change plan; and MET, MI plus print feedback, delivered by telephone at baseline, 2, and 4 months.Main outcome and measuresSelf-reported completion of 4 ACP activities: communicating about views on quality vs quantity of life, assignment of a health care agent, completion of a living will, and submitting documents for inclusion in the electronic health record at 6 months.ResultsThe study included 483 persons, mean (SD) age 68.3 (8.0) years, 18.2% women and 31.1% who were people from minoritized racial and ethnic groups. Adjusting for age, education, race, gender, and baseline stage of change for each ACP, predicted probabilities for completing the ACP activities were: usual care 5.7% (95% CI, 2.8%-11.1%) for usual care, 17.7% (95% CI, 11.8%-25.9%; P = .003) for MET, 15.8% (95% CI, 10.2%-23.6%; P = .01) for MI, P = .01, and 10.0% (95% CI, 5.9%-16.7%; P = .18) for CTPF.Conclusions and relevanceThis randomized clinical trial found that a series of 3 MI and MET counseling sessions significantly increased the proportion of middle-aged and older veterans completing a set of ACP activities, while print feedback did not. These findings suggest the importance of clinical interaction for ACP engagement.Trial registrationClinicalTrials.gov Identifier: NCT03103828.

Dataset Information

Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis.

Publications

Engagement With Motivational Interviewing and Cognitive Behavioral Therapy Components of a Web-Based Alcohol Intervention, Elicitation of Change Talk and Sustain Talk, and Impact on Drinking Outcomes: Secondary Data Analysis.

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