Adolescent change language within a brief motivational intervention and substance use outcomes.

Abstract

The notion that client language about change is related to actual behavioral change is central to the practice of motivational interviewing (MI), but has not been examined in adolescent clients. In this study homeless adolescents who used alcohol or illicit substances but were not seeking treatment (n = 54) were recorded during brief motivational interventions. Adolescent language during sessions was coded based on MI concepts, and ratings were tested as predictors of rates of substance use over time. Types of adolescent speech included global ratings of engagement and affect, as well as counts of commitment to change, statements about reasons for change, and statements about desire or ability to change. Results of multivariate linear regression indicate that statements about desire or ability against change, although infrequent (M = 0.61 per 5 minutes), were strongly and negatively predictive of changes in substance use rates (days of abstinence over the prior month) at both 1-and 3-months post baseline assessment (p < .001). In contrast, statements about reasons for change were associated with greater reductions in days substance use at 1-month assessment (p < .05). Commitment language was not associated with outcomes. Results suggest that specific aspects of adolescent speech in brief interventions may be important in the prediction of change in substance use. Future studies are needed to test the observed relationships in larger samples and other clinical contexts, and assess if youth language about change mediates effects of clinical interventions.Motivational interviewing (MI;Miller & Rollnick, 2002) is a popular, empirically-based counseling method for a range of health-related problems. Defined as a "client-centered, directive method for facilitating intrinsic motivation to change by exploring and resolving ambivalence," (Rollnick & Miller, 1995), MI emphasizes formation of collaborative therapeutic relationships with clients through which client language about change may be strategically elicited and reinforced. "Change language" is defined as client expressions of problems with the current state, benefits of change, and hope and optimism about future change (Miller & Rollnick, 2002). In articulating a theory for MI, Miller and colleagues have stated that "1) The practice of MI should elicit increased levels of change and decreased levels of resistance from clients, 2) The extent to which clients verbalize arguments against change (resistance) during MI will be inversely related to the degree of subsequent behavior change, and 3) The extent to which clients verbalize change talk (arguments for change) during MI will be directly related to the degree of subsequent behavior change" Hettema, Steele, & Miller, 2005, p. 106).

Dynamics of Resistance to Change: A Sequential Analysis of Change Agents in Action

“…However, findings from the therapeutic context underscore the predictive nature of change talk for future actions (Aharonovich et al, 2008;Amrhein et al, 2003;Baer et al, 2008;Gaume et al, 2008;Hodgins, Ching, & McEwen, 2009). Future research should explore whether employee change talk similarly predicts behavioural change in organizational settings.…”

“…The original language categorization into desire and ability originates from psycholinguistic laboratory studies using quasi-performative verbs (Amrhein, 1992). This categorization has been extended in therapy field research integrating commitment (Mahrer, Gagnon, Fairweather, Boulet, & Herring, 1994), reasons, need, and taking steps (Aharonovich et al, 2008;Amrhein et al, 2003;Baer et al, 2008) and is incorporated within the observation coding manuals for MI (Martin, Moyers, Houck, Christopher, & Miller, 2005;Miller & Mount, 2001;Miller et al, 2008). Whereas earlier MI coding manuals could only predict the lack of behaviour change based on resistance language (i.e.…”

Proposed Model of the Neurobiological Mechanisms Underlying Psychosocial Alcohol Interventions: The Example of Motivational Interviewing

“…In terms of candidates for within-session active ingredients, in contrast with other putative mechanisms (Apodaca and Longabaugh, 2009;Longabaugh and Wirtz, 2001), change talk (client statements in favor of change) has gained the most consistent support for its relationship with substance use outcomes across MI (Amrhein et al, 2003;Apodaca and Longabaugh, 2009;Baer et al, 2008;Daeppen et al, 2010;Gaume et al, 2008;Martin et al, 2011;Moyers et al, 2007Moyers et al, , 2009Strang and McCambridge, 2004;Vader et al, 2010;Walker et al, 2011), as well as across other psychosocial interventions (Aharonovich et al, 2008;Hodgins et al, 2009;Karno et al, 2010;Moyers et al, 2007). Together, these data suggest that change talk is the most relevant target for mechanism research in MI (Miller and Rose, 2009), and it therefore serves as the focus of this review.…”

Tinnitus in Patients with Sensorineural Hearing Loss : Management, Quality of Life and Treatment Strategies

“…Research has shown a correlation between change talk and improved patient outcomes (Baer et al, 2008, Gaume et al, 2008.…”