Dismantling motivational interviewing: Effects on initiation of behavior change among problem drinkers seeking treatment.

Abstract

Motivational Interviewing (MI) is an efficacious treatment for alcohol use disorders (AUD). MI is thought to enhance motivation via a combination of two therapeutic strategies or active ingredients: one relational and one directional. The primary aim of this study was to examine MI’s hypothesized active ingredients using a dismantling design. Problem drinkers (N=139) seeking treatment were randomized to one of three conditions: MI, relational MI without the directional elements labeled spirit-only MI (SOMI) or a non-therapy control (NTC) condition and followed for eight weeks. Those assigned to MI or SOMI received four sessions of treatment over eight weeks. All participants significantly reduced their drinking by week 8, but reductions were equivalent across conditions. The hypothesis that baseline motivation would significantly moderate condition effects on outcome was generally not supported. Failure to find support for MI𠄉s hypothesized active ingredients is discussed in the context of the strengths and limitations of the study design.

Exploration of treatment matching of problem drinker characteristics to motivational interviewing and non-directive client-centered psychotherapy

“…This study used data collected during two randomized controlled trials, a pilot study (Motion 1, Morgenstern et al, 2012) and a larger, replication study (Motion 2, Morgenstern et al, in press; Morgenstern et al, 2016), both of which sought to test the hypothesized active ingredients and mechanisms of change within MI when used to reduce drinking among problem drinkers. Complete procedures for the parent studies are described elsewhere (Morgenstern et al, 2012; Morgenstern et al, 2016).…”

“…Given this assumption, we replicated the study using a larger sample (N=139) (Morgenstern et al, in press; Morgenstern et al, 2016). We again found significant differences in the expected direction related to CT, but all condition differences related to drinking were absent across the treatment period.…”

“…In a previous analysis (Morgenstern et al, in press), we examined the moderating impact of motivation across conditions within the replication study, which yielded null findings. Therefore, based on the limited existing literature, the context of this specific randomized controlled trial, and the theory about MI’s mechanisms of action, we identified four additional potential moderators of MI: 1) severity of baseline drinking, 2) severe AUD (met 6 or more criteria), 3) baseline self-efficacy to moderate drinking and 4) mean daily confidence to resist heavy drinking in the week prior to treatment initiation.…”

Do what you say and say what you are going to do : A preliminary meta-analysis of client change and sustain talk subtypes in motivational interviewing

“…In this meta-analysis, we examined the frequency of sustain talk and its subtypes, but we did not prioritize one portion of the session over another. A few process studies have highlighted the value of making a temporal distinction between client language that arises during engaging and focusing and talk that arises during MI planning (Amrhein et al, 2003;Kahler et al, 2016;Morgenstern et al, 2017). A question to consider in the future is whether greater sustain talk represents a prognostic patient factor (e.g., a defensive or reactant trait) occurring early in the session, a resistance marker that emerges later via the MI process (i.e., a relational state), or both?…”

Development and differentiability of three brief interventions for risky alcohol use that include varying doses of motivational interviewing

“…Here, findings are mixed, with some studies supporting the use of specific MI structure and content, and others not. For example, Morgenstern and colleagues attempted to dismantle the active components of MI treatment by prospectively comparing 4-sessions of MI, to non-directional MI, to a no treatment control condition and found similar outcomes across condition [ 21 ]. On the other hand, Field and colleagues compared brief advice, brief MI, and brief MI plus a feedback based telephone booster among trauma center patients who recently consumed alcohol and found that the BMI plus booster condition outperformed other treatments [ 22 ].…”