The impact of therapists’ words on the adolescent brain: In the context of addiction treatment

Abstract

Despite foundational work, we still do not know how therapist behaviors influence brain response and related treatment outcomes for alcohol-using adolescents. Therefore, we examined this question with 17 binge drinking youth (mean age = 16.62 years; 64.3% female; 42.9% Hispanic; 28.6% bi-/multi-racial). In this within-subjects design, all youth completed a baseline assessment, two therapy sessions, an fMRI scan, and were re-evaluated for behavior change at one-month post-treatment. During the fMRI session, youth were presented with two types of therapist responses from their treating therapist: higher-skill therapeutic statements prescribed in an empirically-supported addiction treatment (complex reflections) versus language standard within addiction treatment more broadly (closed questions). In terms of behavior change, at the one-month follow-up, youth showed significant reductions in their number of drinking days and binge drinking days post-treatment. Further, we found main effects for complex reflections and closed questions across the superior middle temporal gyrus and middle temporal gyrus (FWE-corrected, p<.05). Complex questions showed a relatively stronger response than closed questions within the bilateral anterior cingulate gyrus. Additionally, greater BOLD response in the parietal lobe during closed questions was significantly associated with less post-treatment drinking. Finally, lower BOLD responses during both complex reflections and closed questions in the precuneus were associated with greater post-treatment ratings of importance of changing drinking. This study represents a first step in understanding how certain therapist behaviors influence the developing adolescent brain and how that neural response may be associated with youth treatment outcomes in the context of addiction treatment.

Uniting adolescent neuroimaging and treatment research: Recommendations in pursuit of improved integration

“…Here, Feldstein Ewing and colleagues have found that for substance-using youth, activation of brain networks involved in introspection and contemplation predicted adolescents’ successful treatment response (ages 14–19) (Feldstein Ewing et al, 2013, 2015a). Therefore, for this model, one might expect an increase in self-reflection across both neural metrics of self-reflection (e.g., greater network activation), as well as in behavioral estimates of self-reflection (e.g., self-report ratings of self-reflection and contemplation).…”

“…Here, the research team must select which factors they believe may be fundamental to an adolescent’s positive treatment response (or lack thereof). For example, both behavioral and neuroimaging work by Feldstein Ewing and colleagues has found that certain in-session therapist behaviors positively predict youth treatment response (ages 13–19) (Feldstein Ewing et al, in press, 2015a). Thus, for this step, one proposed modifiable target could be “in-session therapist behaviors”.…”

Orbitofrontal cortex connectivity as a mechanism of adolescent behavior change

“…For this evaluation, 45 unique adolescent substance users (ages 14–19; n = 30 in the cannabis sample, and n = 15 in the alcohol sample) were recruited through community and/or high-risk (justice) centers in the Southwestern United States 33,38 . For sample demographics, see Table 1.…”

“…Throughout the past decade, this task has demonstrated the ability to extract relevant regional brain activation during client language across three different age groups (adolescents, young adults, and adults) and across two different substances of abuse (alcohol and cannabis) 33, 38, 45,46 . For this task, we extracted 5 client “change talk” statements (CT; “I need to cut back my use”) and 5 client “sustain talk” statements (ST; “I like using - it’s fun!”) from participants’ therapy sessions.…”

Does mental status impact therapist and patient communication in emergency department brief interventions addressing alcohol use?

“…In work with adolescents, increases in activity in the posterior cingulate gyrus and precuneous have been observed when participants listen to personal change talk from a previous session (Feldstein Ewing et al, 2013), and greater brain response in the bilateral anterior cingulate gyrus has observed when presented with complex reflections versus closed questions (Feldstein Ewing et al, 2016). Therefore, we propose that neurosychological impairment in any or all of these networks may behaviorally manifest itself in confusion and/or distress during the session, even following the use of skillful MI techniques which reflect the patient’s self-stated reasons for change or consequences of drinking, which in turn will behaviorally manifest itself as sustain talk (preserving the status quo, “I don’t desire/want/need to quit drinking”).…”