Silberman School of Social Work, Hunter College, City University of New York, 2180 Third Avenue, New York, NY 10035, United States.
Northwell Health, 1010 Northern Blvd. Suite 311, Great Neck, NY 11021, United States.
J Subst Abuse Treat. 2018 Aug;91:69-75. doi: 10.1016/j.jsat.2018.06.003. Epub 2018 Jun 6.
Motivational interviewing is hypothesized to operate by enhancing a client's internal motivation to change. Past research operationalizes this process by measuring in-session statements for change (i.e., change talk), yet relationships between change talk and other measures of motivation have yet to be substantiated. This study tested whether in-session change talk predicted subsequent reports of commitment to abstain or moderate drinking assessed via ecological momentary assessment (EMA), and explored each of their contributions to drinking outcomes.
Secondary data analysis was performed on data from 48 study participants who received therapy within a randomized controlled trial testing mechanisms of actions of MI. Multilevel models were used to test whether in-session commitment statements (strength, frequency, and slope of strength) made in two therapy sessions predicted subsequent daily reports of commitment to abstain or not drink heavily and drinking (21 days of data) in the weeks following each respective session.
A weak, negative relationship between in-session commitment and average daily commitment to abstain emerged. No relationship between in-session statements and average daily commitment to not drink heavily emerged. Only EMA commitment predicted drinking outcome. Post hoc analyses demonstrate a moderating impact of EMA commitment to abstain on in-session commitment strength: low pre-treatment commitment to abstain and increasing commitment strength across a session yielded the greatest drink reduction.
In-session change talk and EMA commitment may represent distinct aspects of motivation, yet their interaction appears important to treatment prognoses. Commitment to abstain may be important for treatment selection and successful drink reduction.
动机性访谈被假设通过增强客户改变的内在动机起作用。过去的研究通过测量会话中的改变陈述（即改变谈话）来实现这一过程，但改变谈话与其他动机测量之间的关系尚未得到证实。本研究检验了会话中的改变谈话是否可以预测通过生态瞬时评估（EMA）评估的随后对戒酒或适度饮酒的承诺报告，并且探讨了它们各自对饮酒结果的贡献。
对在一项测试 MI 作用机制的随机对照试验中接受治疗的 48 名研究参与者的数据进行了二次数据分析。使用多层次模型来检验在两个治疗会议中做出的会话承诺陈述（强度、频率和强度斜率）是否可以预测随后在各自会议后的数周内每天报告的戒酒或不大量饮酒以及饮酒（21 天的数据）。
会话承诺与平均每日戒酒承诺之间存在微弱的负相关关系。会话中的陈述与平均每日不大量饮酒的承诺之间没有关系。只有 EMA 承诺预测了饮酒结果。事后分析表明，EMA 对戒酒的承诺对会话承诺强度有调节作用：低治疗前戒酒承诺和在一个会话中承诺强度的增加会产生最大的饮酒减少。
会话中的改变谈话和 EMA 承诺可能代表了动机的不同方面，但它们的相互作用对治疗预后很重要。对戒酒的承诺可能对治疗选择和成功减少饮酒很重要。
