The Motivational Interviewing Treatment Integrity Code has been revised to address new evidence-based elements of motivational interviewing (MI). This new version (MITI 4) includes new global ratings to assess clinician’s attention to client language, increased rigor in assessing autonomy support and client choice, and items to evaluate the use of persuasion when giving information and advice. Method: Four undergraduate, non-professional raters were trained in the MITI and used it to review 50 audiotapes of clinicians conducting MI in actual treatments sessions. Both kappa and intraclass correlation indices were calculated for all coders, for the best rater pair and for a 20% randomly selected sample from the best rater pair. Results: Reliability across raters, with the exception of Emphasize Autonomy and % Complex Reflections, were in the good to excellent range. Reliability estimates decrease when smaller samples are used and when fewer raters contribute. Conclusion: The advantages and drawbacks of this revision are discussed including implications for research and clinical applications. The MITI 4.0 represents a reliable method for assessing the integrity of MI including both the technical and relational components of the method.

This study examined differences between Asians and non-Hispanic Whites (Whites) in pain sensitivity, and its relationship to mean arterial pressure (MAP) and heart rate (HR). In 30 Whites (50% female) and 30 Asians (50% female), experimental pain sensitivity was assessed with a hand cold pressor task, yielding measures of pain threshold, tolerance, intensity, and unpleasantness. Mean arterial pressure and HR measurements taken at rest and in response to speech stress were assessed. Perceived stress, anxiety, perfectionism, parental criticism, parental expectations and depressive symptoms were also measured. The results indicated that for the cold pain test, Asians demonstrated significantly lower pain threshold and tolerance levels than Whites. Although no ethnic differences were seen for MAP or HR responses to stress, for whites higher stress MAP levels were correlated with reduced pain sensitivity, while for Asians higher baseline and stress HR levels were correlated with reduced pain sensitivity. Asians reported higher parental expectations and greater parental criticism than Whites. For Asians only, higher levels of perfectionism were related to more depressive symptoms, anxiety and perceived stress. These results indicate that Asian Americans are more sensitive to experimental pain than Whites and suggest ethnic differences in endogenous pain regulatory mechanisms (e.g. MAP and HR). The results may also have implications for understanding ethnic differences in clinical pain.

More standardized protocols for measuring pain across varying research and clinical settings should be developed.

Few studies have investigated the impact of adolescent change language on substance use treatment outcomes and even fewer have examined how adolescents respond to normative feedback. The purpose of this study was to understand the influence normative feedback has on adolescent change language and subsequent alcohol and cannabis use 3 months later. We examined how percent change talk (PCT) was associated with subsequent alcohol and drug use outcomes. Adolescents (N = 48) were randomly assigned to receive brief motivational interviewing (MI) or MI plus normative feedback (NF). Audio recordings were coded with high interrater reliability. Adolescents with high PCT who received MI + NF had significantly fewer days of alcohol and binge drinking at follow up. There were no differences between groups on cannabis use or treatment engagement. Findings indicate that NF may be useful for adolescents with higher amount of change talk during sessions and may be detrimental for individuals with higher sustain talk.

Motivational Interviewing (MI) is an evidence-based approach shown to be helpful for a variety of behaviors across many populations. Treatment fidelity is an important tool for understanding how and with whom MI may be most helpful. The Motivational Interviewing Treatment Integrity coding system was recently updated to incorporate new developments in the research and theory of MI, including the relational and technical hypotheses of MI (MITI 4.2). To date, no studies have examined the MITI 4.2 with forensic populations. In this project, twenty-two brief MI interventions with jail inmates were evaluated to test the reliability of the MITI 4.2. Validity of the instrument was explored using regression models to examine the associations between global scores (Empathy, Partnership, Cultivating Change Talk and Softening Sustain Talk) and outcomes. Reliability of this coding system with these data was strong. We found that therapists had lower ratings of Empathy with participants who had more extensive criminal histories. Both Relational and Technical global scores were associated with criminal histories as well as post-intervention ratings of motivation to decrease drug use. Findings indicate that the MITI 4.2 was reliable for coding sessions with jail inmates. Additionally, results provided information related to the relational and technical hypotheses of MI. Future studies can use the MITI 4.2 to better understand the mechanisms behind how MI works with this high-risk group.

This is the first study to examine how both structural and functional components of individuals’ social networks may moderate the association between biological sex and experimental pain sensitivity. One hundred and fifty-two healthy adults (mean age = 22yrs., 53% males) were measured for cold pressor task (CPT) pain sensitivity (i.e., intensity ratings) and core aspects of social networks (e.g., proportion of friends vs. family, affection, affirmation, and aid). Results showed consistent sex differences in how social network structures and intimate relationship functioning modulated pain sensitivity. Females showed higher pain sensitivity when their social networks consisted of a higher proportion of intimate types of relationship partners (e.g., kin vs. non kin), when they had known their network partners for a longer period of time, and when they reported higher levels of logistical support from their significant other (e.g., romantic partner). Conversely, males showed distinct patterns in the opposite direction, including an association between higher levels of logistical support from one’s significant other and lower CPT pain intensity. These findings show for the first time that the direction of sex differences in exogenous pain sensitivity is likely dependent on fundamental components of the individual’s social environment. The utility of a social-signaling perspective of pain behaviors for examining, comparing, and interpreting individual and group differences in experimental and clinical pain reports is discussed.

There is considerable evidence for Motivational interviewing (MI) in changing problematic behaviors. Research on the causal chain for MI suggests influence of facilitator speech on client speech. This association has been examined using macro (session-level) and micro (utterance-level) measures; however, effects across sessions have largely been unexplored, particularly with groups. We evaluated a sample of 129 adolescent group MI sessions, using a behavioral coding system and timing information to generate information on facilitator and client speech (CT: change talk) within 5 successive segments (quintiles) of each group session. We hypothesized that facilitator speech (open-ended questions and reflections of CT) would be related to subsequent CT. Repeated measures analysis indicated significant quadratic and cubic trends for facilitator and client speech across quintiles. Across quintiles, cross-lagged panel analysis using a zero-inflated negative binomial model showed minimal evidence of facilitator speech on client CT, but did indicate several effects of client CT on facilitator speech, and of client CT on subsequent client CT. Results suggest that session-level effects of facilitator speech on client speech do not arise from long-duration effects of facilitator speech; instead, we detected effects of facilitator speech on client speech only at the beginning and end of sessions, when open questions respectively suppressed and enhanced client expressions of CT. Findings suggest that clinicians must remain vigilant to client CT throughout the group session, reinforcing it when it arises spontaneously and selectively employing open-ended questions to elicit it when it does not, particularly towards the end of the session.

Larger investigations of the psychophysiological relationships among sexual orientation, gender expression and pain sensitivity are warranted. These findings may have implications for differences in clinical pain sensitivity of lesbian and bisexual women compared with heterosexual women.