The Search for Mechanisms of Behavior Change in Evidence‐Based Behavioral Treatments for Alcohol Use Disorders: Overview

Huebner, Robert B.; Tonigan, J. Scott

doi:10.1111/j.1530-0277.2007.00487.x

Cited by 35 publications

(30 citation statements)

References 11 publications

(11 reference statements)

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“…The current meta-analysis includes brief motivational interventions targeting a range of behavioral outcomes, such as alcohol use, other drug use, gambling, sexual risk behavior, diet and exercise, and medication adherence. Evidence-based knowledge on what makes existing treatments work has the potential to enhance their efficacy and efficiency (Huebner & Tonigan, 2007; Longabaugh & Magill, 2011; Magill, 2006; Magill & Longabaugh, 2013; Morgenstern & McKay, 2007). In fact, MI process research has already impacted implementation and delivery, with revisions to the MI clinical textbook (Miller & Rollnick, 2013) and to the fidelity rating manual (Moyers, Rowell, Manuel, Ernst, & Houck, 2016).…”

Section: Discussionmentioning

confidence: 99%

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

Magill¹,

Apodaca²,

Borsari³

et al. 2018

Journal of Consulting and Clinical Psychology

246

163

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Objective In the present meta-analysis, we test the technical and relational hypotheses of Motivational Interviewing (MI) efficacy. We also propose an a priori conditional process model where heterogeneity of technical path effect sizes should be explained by interpersonal/relational (i.e., empathy, MI Spirit) and intrapersonal (i.e., client treatment seeking status) moderators. Method A systematic review identified k = 58 reports, describing 36 primary studies and 40 effect sizes (N = 3025 participants). Statistical methods calculated the inverse variance-weighted pooled correlation coefficient for the therapist to client and the client to outcome paths across multiple target behaviors (i.e., alcohol use, other drug use, other behavior change). Results Therapist MI-consistent skills were correlated with more client change talk (r = .55, p < .001) as well as more sustain talk (r = .40, p < .001). MI-inconsistent skills were correlated with more sustain talk (r = .16, p < .001), but not change talk. When these indicators were combined into proportions, as recommended in the Motivational Interviewing Skill Code, the overall technical hypothesis was supported. Specifically, proportion MI consistency was related to higher proportion change talk (r = .11, p = .004) and higher proportion change talk was related to reductions in risk behavior at follow up (r = −.16, p < .001). When tested as two independent effects, client change talk was not significant, but sustain talk was positively associated with worse outcome (r = .19, p < .001). Finally, the relational hypothesis was not supported, but heterogeneity in technical hypothesis path effect sizes was partially explained by inter- and intra-personal moderators. Conclusions This meta-analysis provides additional support for the technical hypothesis of MI efficacy; future research on the relational hypothesis should occur in the field rather than in the context of clinical trials.

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Section: Discussionmentioning

confidence: 99%

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

Magill¹,

Apodaca²,

Borsari³

et al. 2018

Journal of Consulting and Clinical Psychology

246

163

View full text Add to dashboard Cite

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“…Each should be used in seeking to identify the active ingredients of treatment that embody or lead to mechanisms of change [13]. It is not enough that treatments are found to be effective in meta-analytical reviews.…”

mentioning

confidence: 99%

Commentary on Kiluk et al. (2010): The emperor has some new clothes – coping is a mediator of cognitive–behavioral therapy's effectiveness

Longabaugh¹

2010

Addiction

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“…As all evidencebased treatments for alcohol use disorders do not include change plans, this suggests that the change plan may be a distinctive ingredient of BMI that partially accounts for its effectiveness. Because identifi cation of active ingredients of behavioral treatments is a high priority for mechanisms-of-change research in alcohol (Huebner and Tonigan, 2007) and other psychiatric disorders (Kazdin and Nock, 2003), the present fi ndings suggest a signifi cant step toward identifying a mechanism of change.…”

Section: Discussionmentioning

confidence: 97%

Change Plan as an Active Ingredient of Brief Motivational Interventions for Reducing Negative Consequences of Drinking in Hazardous Drinking Emergency-Department Patients

Lee¹,

Baird²,

Longabaugh³

et al. 2010

J. Stud. Alcohol Drugs

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ABSTRACT. Objective:Few studies have examined the effects of brief motivational intervention components, such as change-plan completion, on treatment outcomes. This secondary analysis of an opportunistically recruited emergency-department sample of hazardous injured drinkers examines the potential predictive role of an alcohol-related change plan on treatment outcomes after accounting for pretreatment readiness. Written change plans were independently rated. Method: A mediational analysis framework tested directional hypotheses between pretreatment readiness, change plan, and treatment outcomes using linear regressions. The baseline total Drinker Inventory of Consequences (DrInC) score was covaried on 12-month DrInC total score, in all analyses. Participants who completed a brief motivational intervention and a change plan were included (N = 333). Results: Pretreatment readiness was negatively associated with alcohol consequences at 12 months, = -.09, t(254) = -2.07, p < .05, and good-quality change plans, = .18, t(320) = 4.37, p < .001. With change plan and readiness in the same model, the relationship between readiness and treatment outcomes became nonsignifi cant, but change plan remained a signifi cant predictor of treatment outcomes in the expected direction, = -.17, t(254) = -2.89, p < .01. Follow-up generalized linear modeling including an interaction term (change plan and pretreatment readiness) revealed that those with high readiness and a good-quality change plan versus those with low readiness and a poor-quality change plan had better-than-predicted outcomes for either readiness or change plan alone. Conclusions: Study fi ndings suggest that the change plan in brief motivational intervention may be an active ingredient of treatment associated with better outcomes over and above the infl uence of pretreatment readiness. (J. Stud. Alcohol Drugs, 71, 726-733, 2010) (Burke et al., 2003;Hettema et al., 2005) and in diverse health care settings, including primary care and emergency departments (EDs;Gentilello et al., 1999;Longabaugh et al., 2001;Monti et al., 1999). The underlying principles of MI-valuing patient autonomy, collaboration, eliciting the patient's perspectives, building intrinsic motivation to change, and highlighting the discrepancy between where the patient is and where he or she wants to go-are key to its successful implementation, such that in their absence it is unlikely that MI is being delivered (Miller, 1996;Miller and Rollnick, 2002). Brief motivational interventions (BMIs) are an adaptation of MI and its principles and are predominantly used in medical or health care settings targeting a non-treatment-seeking population (Moyer et al., 2002;Rollnick et al., 1992;Saunders et al., 1995). Although BMIs are informed by MI principles, they are distinct from MI because they are more time limited (usually single session) and may include structured strategies, or treatment components, such as the use of personal feedback reports, discussion of pros and cons of use, and change-plan compl...

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The Search for Mechanisms of Behavior Change in Evidence‐Based Behavioral Treatments for Alcohol Use Disorders: Overview

Cited by 35 publications

References 11 publications

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

A meta-analysis of motivational interviewing process: Technical, relational, and conditional process models of change.

Commentary on Kiluk et al. (2010): The emperor has some new clothes – coping is a mediator of cognitive–behavioral therapy's effectiveness

Change Plan as an Active Ingredient of Brief Motivational Interventions for Reducing Negative Consequences of Drinking in Hazardous Drinking Emergency-Department Patients

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