Paul C. Amrhein

Providing Live Supervision Via Teleconferencing Improves Acquisition of Motivational Interviewing Skills After Workshop Attendance

Teleconferencing Supervision is a method for training community-based substance abuse clinicians in Motivational Interviewing (MI). Following a 2-day workshop, 13 clinicians received live supervision via telephone during 5 counseling sessions conducted at their community treatment facilities. Clinicians were assessed for skill level at post-workshop, at post-training, and 3 months later; learning was assessed using the MI Treatment Integrity instrument. All summary scores and therapist behavior frequency counts improved by post-training or by the 3 month follow-up, although some gains were not statistically significant. Teleconferencing Supervision may help facilitate the proficient use of MI community clinicians following workshop instruction.

Motivational Interviewing: A Pilot Test of Active Ingredients and Mechanisms of Change

Motivational interviewing (MI) is an effective treatment for substance use disorders (SUDs) that focuses on resolving ambivalence and increasing commitment to positive behavior change. Although MI has a well-developed clinical theory, research findings have been mixed in supporting its view of how change occurs. The primary aim of this pilot study was to test hypothesized MI active ingredients and mechanisms of change in reducing drinking during the initiation of a behavior change episode. Problem drinkers (N = 89) seeking treatment were randomly assigned to MI, relational MI without directive elements (spirit-only MI [SOMI]), or a self-change (SC) control condition. Participants were followed during an 8-week treatment period. The first 2 of 4 treatment sessions were videotaped and coded for fidelity, discriminability, and change talk. Overall, conditions demonstrated high fidelity. As predicted, change talk significantly increased in MI relative to the SOMI condition. Drinking was significantly reduced at end treatment, but the reduction was equivalent across conditions. Post hoc analyses found that MI reduced drinking more rapidly than SOMI and SC and that increased change talk mediated the effects of MI relative to SOMI during the week immediately following the first session. Findings are discussed in the context of the pilot nature of the study and the relative absence of experimental tests of mechanisms of behavior change in SUD treatment research.

Old dogs and new skills: how clinician characteristics relate to motivational interviewing skills before, during, and after training.

OBJECTIVE The relationships between the occupational, educational, and verbal-cognitive characteristics of health care professionals and their motivational interviewing (MI) skills before, during, and after training were investigated. METHOD Fifty-eight community-based addiction clinicians (M = 42.1 years, SD = 10.0; 66% Female) were assessed prior to enrolling in a 2-day MI training workshop and being randomized to one of three post-workshop supervision programs: live supervision via tele-conferencing (TCS), standard tape-based supervision (Tape), or workshop training alone. Audiotaped sessions with clients were rated for MI skillfulness with the Motivational Interviewing Treatment Integrity (MITI) coding system v 2.0 at pre-workshop and 1, 8, and 20 weeks post-workshop. Correlation coefficients and generalized linear models were used to test the relationships between clinician characteristics and MI skill at each assessment point. RESULTS Baseline MI skill levels were the most robust predictors of pre- and post-supervision performances. Clinician characteristics were associated with MI Spirit and reflective listening skill throughout training and moderated the effect of post-workshop supervision method on MI skill. TCS, which provided immediate feedback during practice sessions, was most effective for increasing MI Spirit and reflective listening among clinicians with no graduate degree and stronger vocabulary performances. Tape supervision was more effective for increasing these skills among clinicians with a graduate degree. Further, TCS and Tape were most likely to enhance MI Spirit among clinicians with low average to average verbal and abstract reasoning performances. CONCLUSIONS Clinician attributes influence the effectiveness of methods used to promote the acquisition of evidence-based practices among community-based practitioners.

Training substance abuse clinicians in motivational interviewing using live supervision via teleconferencing.

OBJECTIVE Training through traditional workshops is relatively ineffective for changing counseling practices. Teleconferencing supervision (TCS) was developed to provide remote, live supervision for training motivational interviewing (MI). METHOD Ninety-seven drug treatment counselors completed a 2-day MI workshop and were randomized to live supervision via teleconferencing (TCS; n = 32), standard tape-based supervision (tape; n = 32), or workshop alone (workshop; n = 33). Supervision conditions received 5 weekly supervision sessions at their sites using actors as standard patients. Sessions with clients were rated for MI skill with the Motivational Interviewing Treatment Integrity (MITI) Coding System pre-workshop and 1, 8, and 20 weeks post-workshop. Mixed-effects linear models were used to test training condition on MI skill at 8 and 20 weeks. RESULTS TCS scored better than workshop on the MITI for spirit (mean difference = 0.76; p < .0001; d = 1.01) and empathy (mean difference = 0.68; p < .001; d = 0.74). TCS was superior to workshop in reducing MI non-adherence and was superior to workshop and tape in increasing reflection to question ratio. Tape was superior to TCS in increasing complex reflections. Percentage of counselors meeting proficiency differed significantly between training conditions for the most stringent threshold (spirit and empathy scores ≥ 6). CONCLUSIONS TCS shows promise for promoting new counseling behaviors following participation in workshop training. However, further work is needed to improve supervision methods to bring more clinicians to high levels of proficiency and facilitate dissemination of evidence-based practices.

A Pilot Study of Bibliotherapy to Reduce Alcohol Problems among Patients in a Hospital Trauma Center

&NA; Because alcohol use plays a major role in many injuries that require hospital care, there is increasing interest in developing interventions to address alcohol problems among emergency department and trauma center patients. The aim of the current study was to extend past research on brief interventions by investigating the use of a self‐help manual to treat problem drinkers in a hospital trauma center. Forty injured patients who were either intoxicated at the time of injury or screened positive for harmful drinking were randomly assigned to receive either a brief assessment and a self‐help booklet with no more than 5 minutes clinician contact (bibliotherapy) or brief assessment only. Follow‐up data obtained five months after hospital discharge indicated that patients in both conditions made significant reductions in drinking and associated negative consequences. There was a trend toward further treatment‐seeking among those in the bibliotherapy condition (40% versus 13%). Results suggest that the provision of self‐help materials to treat problem drinkers identified in a hospital trauma setting may not bring about behavior change beyond that observed following hospitalization and an assessment of drinking. Caution in the interpretation of results is warranted due to the small sample size.

Phonological facilitation through translation in a bilingual picture-naming task

We present a critical examination of phonological effects in a picture–word interference task. Using a methodology minimizing stimulus repetition, English/Spanish and Spanish/English bilinguals named pictures in either L1 or L2 (blocked contexts) or in both (mixed contexts) while ignoring word distractors in L1 or L2. Distractors were either phonologically related to the picture name (direct; FISH–fist), or related through translation to the picture name (TT; LEG–milk–leche), or they were unrelated (bear–peach). Results demonstrate robust activation of phonological representations by translation equivalents of word distractors. Although both direct and TT distractors facilitated naming, TT facilitation was more consistent in L2 naming and under mixed contexts.

Dismantling motivational interviewing: Effects on initiation of behavior change among problem drinkers seeking treatment.

Motivational interviewing (MI) is an efficacious treatment for alcohol use disorders. MI is thought to enhance motivation via a combination of 2 therapeutic strategies or active ingredients: 1 relational and 1 directional. The primary aim of this study was to examine MI’s hypothesized active ingredients using a dismantling design. Problem drinkers (N = 139) seeking treatment were randomized to 1 of 3 conditions: MI, relational MI without the directional elements labeled spirit-only MI (SOMI), or a nontherapy control condition and followed for 8 weeks. Those assigned to MI or SOMI received 4 sessions of treatment over 8 weeks. All participants significantly reduced their drinking by Week 8, but reductions were equivalent across conditions. The hypothesis that baseline motivation would significantly moderate condition effects on outcome was generally not supported. Failure to find support for MI’s hypothesized active ingredients is discussed in the context of the strengths and limitations of the study design.

The relationship between in-session commitment language and daily self-reported commitment to reduce or abstain from drinking

BACKGROUND Motivational interviewing is hypothesized to operate by enhancing a clients internal motivation to change. Past research operationalizes this process by measuring in-session statements for change (i.e., change talk), yet relationships between change talk and other measures of motivation have yet to be substantiated. This study tested whether in-session change talk predicted subsequent reports of commitment to abstain or moderate drinking assessed via ecological momentary assessment (EMA), and explored each of their contributions to drinking outcomes. METHOD Secondary data analysis was performed on data from 48 study participants who received therapy within a randomized controlled trial testing mechanisms of actions of MI. Multilevel models were used to test whether in-session commitment statements (strength, frequency, and slope of strength) made in two therapy sessions predicted subsequent daily reports of commitment to abstain or not drink heavily and drinking (21 days of data) in the weeks following each respective session. RESULTS A weak, negative relationship between in-session commitment and average daily commitment to abstain emerged. No relationship between in-session statements and average daily commitment to not drink heavily emerged. Only EMA commitment predicted drinking outcome. Post hoc analyses demonstrate a moderating impact of EMA commitment to abstain on in-session commitment strength: low pre-treatment commitment to abstain and increasing commitment strength across a session yielded the greatest drink reduction. CONCLUSION In-session change talk and EMA commitment may represent distinct aspects of motivation, yet their interaction appears important to treatment prognoses. Commitment to abstain may be important for treatment selection and successful drink reduction.