Editor’s note: It’s graduation season, which means a slew of new dissertations! In today’s post, we feature two recent projects on the use of motivational interviewing techniques in recovery settings. These entries are part of an ongoing drug-related dissertation bibliography continuously compiled by Jonathon Erlen, selections of which were formerly published in the Social History of Alcohol and Drugs journal but are now periodically featured on the Points blog. Contact Dr. Erlen through the link above.
Motivational Interviewing Treatment Integrity and Client Change: Using ROC Analysis to Explore the Relationship Between MI Fidelity Level and Drinking Outcome
Author: Fischer, Daniel J.
Abstract: Those engaged in the research and practice of MI have shown interest in treatment adherence as an indicator of effective MI and have expressed curiosity in the threshold at which MI practice could be viewed as “good enough”. The most widely used and often cited of MI integrity measures are the Motivational Interviewing Skills Code (MISC) and the Motivational Interviewing Treatment Integrity code (MITI). These adherence tools share similar descriptive coding systems for therapist in-session behavior. MI fidelity standards are often used as reference points for therapist performance, yet practitioners rarely meet full criteria. Further, substandard ratings have been associated with positive client change. These findings have elicited questions about the necessary levels of therapist treatment adherence to promote client change and suggested the need for empirically-derived fidelity standards. This study analyzed existing data from a sample of Motivational Enhancement Therapy (MET) sessions from Project MATCH (Matching Alcohol Treatments to Client Heterogeneity) that were audio recorded and previously coded with the MISC. MI adherence variables were analyzed along with client drinking outcomes to test the relationship between therapist fidelity and client change. Therapist adherence was determined using behavioral codes common to the MITI and MISC. Client change thresholds were determined using clinically significant change standards developed by Jacobson and Truax. The relationships between therapist adherence level and client change thresholds were examined using Receiver Operating Characteristic (ROC) analysis. Findings showed mixed support for the relationship between therapist adherence level and client drinking outcomes, but yielded levels of therapist MI adherence associated with client changes in drinking outcomes.
Publication year: 2015
Advisor: Moyers, Theresa B.
Committee member: Feldstein Ewing, Sarah; Hettema, Jennifer; Witkiewitz, Katie
University/institution: The University of New Mexico
Fidelity of Motivational Interviewing with Behavioral Interventions for Smokers Who are Not Ready to Quit
Author: Conybeare, Daniel
Abstract: Motivational Interviewing (MI) and behavioral interventions are effective treatments for smoking cessation, and MI is increasingly being integrated into behavioral interventions in smoking cessation programs—especially with smokers who are not ready to quit. Moreover, these programs often utilize bachelor’s-level counselors with minimal training in MI or counseling in general, which may lead to concerns about fidelity of MI. The current study examined whether 15 bachelor’s-level counselors adhered to MI principles and techniques while delivering three smoking cessation interventions: MI, BI, and MI plus BI. Smoker participants were 344 individuals recruited through primary care clinics and enrolled in a larger clinical trial of counseling and nicotine replacement therapies for smokers who were not ready to quit. For each smoker participant, one randomly selected counseling session was coded using the Motivational Interviewing Treatment Integrity Scale (Moyers et al., 2010), a coding system that assesses for global ratings of MI quality (e.g., evocativeness) and specific MI-related counseling behaviors (e.g., complex reflections). Compared to MI only, MI plus BI was associated with lower levels of empathy, but was not associated with lower levels of evocation, collaboration, or support of autonomy, other core characteristics of MI. MI plus BI was also associated with a smaller proportion of complex-to-simple reflections, and a smaller percentage of open-ended (compared to closed-ended) questions, compared to MI only. Lastly, greater empathy and MI fidelity were associated with smoker participants being more likely to report during follow-up that they intend to quit in the future. Limitations and future directions are discussed.
Publication year: 2015
Degree date: 2015
Committee member: Mermelstein, Robin
University/institution: University of Illinois at Chicago