Chasing change talk: The clinician's role in evoking client language about change

Glynn, Lisa H.; Moyers, Theresa B.

doi:10.1016/j.jsat.2010.03.012

Cited by 123 publications

(77 citation statements)

References 25 publications

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“…The model explained 27.6% of the variance in PDC (Table 3). 14,15,[31][32][33] In contrast to previous studies, we report an association between empathy and the behavioral outcome of PDC. While clinician MIAs seemed to positively influence primary adherence and patient CT, there was a small yet significant negative effect on PDC after adjustment for CT, which may reflect clinician support for patient decision-making autonomy regarding antidepressant use.…”

Section: Multivariate Model Of Pdccontrasting

confidence: 99%

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

Kaplan

Keeley²,

Engel³

et al. 2013

The Journal of the American Board of Family Medicine

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Objective: High-quality patient-clinician communication is associated with better medication adherence, but the specific language components associated with adherence are poorly understood. We examined how patient and clinician language may influence adherence.Methods: We audio-recorded primary care encounters from 63 patients newly diagnosed with depression and prescribed an antidepressant medication. We rated clinicians' language (motivational interviewing-adherent statements [MIAs], reflections, and global ratings of empathy and "motivational interviewing spirit") along with patients' "change talk" (CT) demonstrating motivation to take medication. Filling a first prescription and an estimate of overall adherence, the proportion of >180 days covered (PDC) (primary outcome), were measured based on pharmacy records.Results: Fifty-six patients (88.8%) filled an initial prescription, and mean (standard deviation) PDC across all subjects was 45.2% (33.6%). MIAs, complex reflections, and empathy were associated with more CT (for all: r s >0.27; P < .05). Two or more and 0 or 1 CT statements were associated with 63.0% and 36.6% PDC, respectively. Empathy, motivational interviewing spirit, and CT were associated with filling the first prescription (for all: r s >0.25; P < .05). In an adjusted analysis, empathy (t ‫؍‬ 2.3; P ‫؍‬ .027) and >2 CT statements (t ‫؍‬ 2.3; P ‫؍‬ .024) were associated with higher PDC. Nonadherence to antidepressant medication is one of a few potentially modifiable predictors of a poor clinical outcome for people with depression, 1-3 and up to 50% of adults treated for depression in primary care experience clinically significant nonadherence due to side effects, delay in symptom relief, perceived harm of antidepressant medications, and other factors. 4,5 Up to 10% experience primary nonadherence due to not picking up the initial prescription. 6,7 Despite decades of research, there is currently a lack of knowledge about simple, effective interventions to improve medication adherence, and a Cochrane review concluded that most adherence interventions failed to achieve enduring medication adherence or improve patient outcomes.8 Meta-analytical evidence identifies the patient-clinician communication process as a critical and modifiable determinant of subsequent antidepressant adherence, and novel interventions targeting aspects of communication hold promise for positive effects. 9 -11 Yet which aspects of the clinician's or patient's communication are specifically associated with better or worse adherence are unclear.Researchers in the field of motivational interviewing (MI), a patient-centered style of communication intended to help patients resolve ambivalence and work toward improving a targeted maladaptive behavior, 12 have developed instru-

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Section: Multivariate Model Of Pdccontrasting

confidence: 99%

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

Kaplan

Keeley²,

Engel³

et al. 2013

The Journal of the American Board of Family Medicine

View full text Add to dashboard Cite

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“…Data indicate that when these statements are affi rmed and, importantly, are refl ected by an effective therapist, clients generate more change talk (Glynn and Moyers, 2010;Moyers et al, 2009). Consistent with clinical approaches (Miller and Rollnick, 2002) and empirical research (Amrhein et al, 2003), once the client has expressed substantial change talk, the therapist explores plans for changing, relying on the client's expertise for what may be possible in his or her world.…”

Section: Within-session Processesmentioning

confidence: 96%

“…MI seeks to promote positive post-session behavior change through eliciting client speech in favor of change, a construct that can be, and has been, objectively measured (i.e., change talk). Second, in MI, therapist behaviors have been found to successfully lead to clients' generation of change talk (Glynn and Moyers, 2010;Moyers and Martin, 2006;Moyers et al, 2009). Third, MI is one of the most widely studied and widely disseminated interventions for substance use disorders (SUDs; e.g., Hodgins, 2000;Marlatt and Witkiewitz, 2005), and research on the neurobiological mechanisms underlying the success of MI may have important clinical and research implications.…”

Section: Advancing a Translational Model With Motivational Interviewingmentioning

confidence: 99%

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

Ewing¹,

Filbey²,

Hendershot³

et al. 2011

J. Stud. Alcohol Drugs

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ABSTRACT. Objective: Despite the prevalence and profound consequences of alcohol use disorders, psychosocial alcohol interventions have widely varying outcomes. The range of behavior following psychosocial alcohol treatment indicates the need to gain a better understanding of active ingredients and how they may operate. Although this is an area of great interest, at this time there is a limited understanding of how in-session behaviors may catalyze changes in the brain and subsequent alcohol use behavior. Thus, in this review, we aim to identify the neurobiological routes through which psychosocial alcohol interventions may lead to post-session behavior change as well as offer an approach to conceptualize and evaluate these translational relationships. Method: PubMed and PsycINFO searches identifi ed studies that successfully integrated functional magnetic resonance imaging and psychosocial interventions. Results: Based on this research, we identifi ed potential neurobiological substrates through which behavioral alcohol interventions may initiate and sustain behavior change. In addition, we proposed a testable model linking within-session active ingredients to outside-ofsession behavior change. Conclusions: Through this review, we present a testable translational model. Additionally, we illustrate how the proposed model can help facilitate empirical evaluations of psychotherapeutic factors and their underlying neural mechanisms, both in the context of motivational interviewing and in the treatment of alcohol use disorders. (J. Stud. Alcohol Drugs, 72, 903-916, 2011)

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“…Post-test assessments and recorded practice sessions showed that guides were able to learn the MI skills. When compared to the recommended proficiency and competency thresholds (Glynn & Moyers, 2010), guides demonstrated MI proficiency in all categories (competency in some categories), with the exception of the percentage of MI adherence. Because of the brief nature of the practice calls, enough data may not have been captured to demonstrate that proficiency.…”

Section: Discussionmentioning

confidence: 94%

Two Lives Intertwined

Czaplicki¹

2012

Clinical Journal of Oncology Nursing

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Chasing change talk: The clinician's role in evoking client language about change

Cited by 123 publications

References 25 publications

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

Aspects of Patient and Clinician Language Predict Adherence to Antidepressant Medication

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

Two Lives Intertwined

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