Brown University, Center for Alcohol and Addiction Studies.
College of Community and Public Affairs, Binghamton University.
Behav Ther. 2019 Jul;50(4):732-742. doi: 10.1016/j.beth.2018.11.003. Epub 2018 Nov 29.
This study examined sequential relationships between clinician skills and client statements about behavior change in a randomized clinical trial comparing a brief motivational intervention (BMI) to a relaxation training control condition (REL) in a sample of heavy drinking young adults. Clinician and client interactions (N = 167) were assessed according to two established observational rating systems. Sequential analyses examined the transitional associations between clinicians' use of MI-eliciting skills (i.e., questions and reflections), MI-supportive skills (e.g., affirmations, emphasize client autonomy, statements of support), MI-inconsistent skills (e.g., confrontations, unsolicited advice), and subsequent client statements about behavior change (i.e., change talk or sustain talk). In both conditions, clinicians' use of MI-elicitation skills operated in a manner that was largely consistent (100% in BMI; 84% in REL) with the directional relationships proposed by MI theory (i.e., The Technical Hypothesis). More detailed analyses of the BMI condition showed clinician skills were related to statements about behavior change somewhat differently in drinking compared to coping discussions. While elicitations of change talk were associated with increased odds of their intended response (i.e., distal drinking and proximal coping change talk), elicitations of proximal coping sustain talk were associated with higher odds of proximal change talk. MI-supportive skills were also associated with increased odds of proximal change talk, and instances of proximal sustain talk were rare in the sample. This fine-grained analysis presents sequential transitions to client change and sustain talk with greater classification specificity than has been previously reported. Such efforts have the potential to advance our understanding of the function of MI skills in promoting client discussions about drinking (i.e., evoking) and coping (i.e., planning) behavior change.
本研究在一项随机临床试验中考察了临床医生技能与客户关于行为改变的陈述之间的序列关系，该试验比较了一种简短的动机性干预（BMI）与放松训练对照条件（REL）在大量饮酒的年轻成年人样本中的效果。根据两个已建立的观察性评分系统评估了临床医生和客户的互动（N=167）。序列分析考察了临床医生使用 MI 诱发技能（即问题和反思）、MI 支持技能（例如肯定、强调客户自主权、支持性陈述）、MI 不一致技能（例如对抗、未经请求的建议）与随后客户关于行为改变的陈述（即改变谈话或维持谈话）之间的过渡关联。在两种情况下，临床医生使用 MI 诱发技能的方式在很大程度上与 MI 理论提出的方向关系一致（BMI 中为 100%，REL 中为 84%）（即技术假设）。对 BMI 条件的更详细分析表明，临床医生的技能与行为改变的陈述之间的关系在饮酒和应对讨论方面略有不同。虽然改变谈话的引出与增加其预期反应的可能性相关（即远端饮酒和近端应对变化的谈话），但近端应对维持谈话的引出与近端变化谈话的可能性更高相关。MI 支持技能也与近端变化谈话的可能性增加相关，并且在样本中近端维持谈话的情况很少。这种细粒度的分析呈现了客户变化和维持谈话的序列转换，比以前报告的分类特异性更高。这种努力有可能增进我们对 MI 技能在促进客户讨论饮酒（即唤起）和应对（即计划）行为改变方面的功能的理解。
