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Mechanisms of Change and Active Ingredients of Motivational Interviewing  Timothy R. Apodaca International Conference on Motivational Interviewing June, 2010 ~ Stockholm, Sweden
Overview ,[object Object],[object Object],[object Object]
What is a “mechanism”? ,[object Object],[object Object],T M O (Treatment) (Mechanism) (Outcome)
Context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mechanisms Review Apodaca & Longabaugh (2009).  Addiction
Method ,[object Object],[object Object],[object Object],[object Object]
Steps in the model Therapist MI Client Outcome (Alcohol/Drug) Link 1a Link 2 Main effect Link 1b Link 3a Link 3b
Effect Size Calculation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Therapist ,[object Object],[object Object],[object Object],[object Object]
Therapist  MI Spirit MI Spirit MI Client Outcome .22 .36 .13
Therapist  MI-Consistent MICO MI .64 Client Outcome Guame et al. 2008 and Moyers et al., 2009;   reported MICO    CT and CCT;  Houck & Moyers 2008: MICO    CT;
Therapist  MI-Inconsistent MIIN MI Client .30 .49 .43 Outcome
Therapist  Specific Components Specific Components MI Client .52 .19* Outcome *Larger effect sizes for Feedback and Decisional Balance
Client ,[object Object],[object Object],[object Object],[object Object],[object Object]
Client  Change Talk/Intention Therapist MI Change Talk .29 * Outcome *Guame et al., 2008; Baer et al., 2008; Moyers et al., 2009 provide additional evidence for this link .25 (Longshore)
Client  Readiness Therapist MI Readiness Outcome
Client  Engagement/Involvement Therapist MI .31 Engagement/ Involvement Outcome .15 (Baird)
Client  Resistance Therapist MI Resistance Outcome .58 (Miller) .12 (Miller)
Client  Confidence Therapist MI .25 Confidence Outcome *Barnett (2010) adds suggestive evidence for this link *
Client  Experience Discrepancy Therapist MI .18 Experience Discrepancy Outcome *Walters (2009) adds suggestive evidence for this link .20* (McNally)
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Predictors of Change Plan Completion Magill, Apodaca, Barnett, Monti (2010).  Journal of Substance Abuse Treatment
Predictors of Change Plan ,[object Object],[object Object],[object Object]
Language Measurement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Predictors of Change Plan ,[object Object],[object Object],[object Object],[object Object],[object Object]
Results: Therapist General Behavior ,[object Object],[object Object]
Results: Therapist General Behavior ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results: Therapist Specific Behavior ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Results: Patient General Behavior ,[object Object],[object Object]
Results: Patient Specific Behavior ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Change  Plan
Change  Plan No Change  Plan
Effect of a Significant-Other  on Client Change Talk Apodaca, Magill, Longabaugh, Jackson, &  Monti.  Under Review
Effect of Significant Other ,[object Object],[object Object],[object Object]
Language Measurement ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Methods ,[object Object],[object Object],[object Object],Change Talk (CT + CCT + FN) Ex. Proportion  change talk =
Methods Decile 1 Decile 2 Decile 3 Therapist  Significant Other Therapist  Significant Other Therapist  Significant Other Patient Change Talk (& CCT) Patient Change Talk (& CCT)
Methods Decile 1 Decile 2 Decile 3 Therapist  Significant Other Therapist  Significant Other Therapist  Significant Other Patient Change Talk (& CCT) Patient Change Talk (& CCT)
Results Predicting Change Talk MICO MIIN SO Support SO Against Predicting Counter-Change Talk MICO MIIN SO Support SO Against
Results Predicting Change Talk MICO ns MIIN ns SO Support p < .001 SO Against ns Predicting Counter-Change Talk MICO ns MIIN ns SO Support p < .001 SO Against ns
 
 
 
Implications ,[object Object],[object Object],[object Object]
Next Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Next Steps ,[object Object],[object Object],[object Object],[object Object]
Next Steps ,[object Object],[object Object],[object Object],[object Object],Alex Pentland,  Honest Signals: How They Shape our World.  2008. MIT Press
What do you think? I’ll do it.
What do you think? I’ll do it.
Acknowledgements ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Supported in part by grant K23AA015595 from the National Institute on Alcohol Abuse and Alcoholism Thank you to the patients and therapists.
Thank You! ,[object Object]
Thank You! ,[object Object]
Multiple Mediators of MI Barnett, Apodaca, Magill, Colby, Gwaltney, Rohsenow, Monti (2010).  Addiction
Mediators of MI ,[object Object],[object Object],[object Object]
Mediators of MI ,[object Object],[object Object],[object Object],[object Object]
Mediators Examined ,[object Object],[object Object],[object Object],[object Object]
The Original Study MI Vs. Feedback Alcohol use at 12-months
Mediator study MI Vs. Feedback Readiness Alcohol use at 12-months Risk/Benefit Self-efficacy Treatment Seeking
Results MI Vs. Feedback Readiness Alcohol use at 12-months Risk/Benefit Self-efficacy Treatment Seeking
Implications ,[object Object],[object Object],[object Object]
Context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Context ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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2010 icmi presenation apodaca june6

  • 1. Mechanisms of Change and Active Ingredients of Motivational Interviewing Timothy R. Apodaca International Conference on Motivational Interviewing June, 2010 ~ Stockholm, Sweden
  • 2.
  • 3.
  • 4.
  • 5. Mechanisms Review Apodaca & Longabaugh (2009). Addiction
  • 6.
  • 7. Steps in the model Therapist MI Client Outcome (Alcohol/Drug) Link 1a Link 2 Main effect Link 1b Link 3a Link 3b
  • 8.
  • 9.
  • 10. Therapist MI Spirit MI Spirit MI Client Outcome .22 .36 .13
  • 11. Therapist MI-Consistent MICO MI .64 Client Outcome Guame et al. 2008 and Moyers et al., 2009; reported MICO  CT and CCT; Houck & Moyers 2008: MICO  CT;
  • 12. Therapist MI-Inconsistent MIIN MI Client .30 .49 .43 Outcome
  • 13. Therapist Specific Components Specific Components MI Client .52 .19* Outcome *Larger effect sizes for Feedback and Decisional Balance
  • 14.
  • 15. Client Change Talk/Intention Therapist MI Change Talk .29 * Outcome *Guame et al., 2008; Baer et al., 2008; Moyers et al., 2009 provide additional evidence for this link .25 (Longshore)
  • 16. Client Readiness Therapist MI Readiness Outcome
  • 17. Client Engagement/Involvement Therapist MI .31 Engagement/ Involvement Outcome .15 (Baird)
  • 18. Client Resistance Therapist MI Resistance Outcome .58 (Miller) .12 (Miller)
  • 19. Client Confidence Therapist MI .25 Confidence Outcome *Barnett (2010) adds suggestive evidence for this link *
  • 20. Client Experience Discrepancy Therapist MI .18 Experience Discrepancy Outcome *Walters (2009) adds suggestive evidence for this link .20* (McNally)
  • 21.
  • 22. Predictors of Change Plan Completion Magill, Apodaca, Barnett, Monti (2010). Journal of Substance Abuse Treatment
  • 23.
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  • 32. Change Plan No Change Plan
  • 33. Effect of a Significant-Other on Client Change Talk Apodaca, Magill, Longabaugh, Jackson, & Monti. Under Review
  • 34.
  • 35.
  • 36.
  • 37. Methods Decile 1 Decile 2 Decile 3 Therapist Significant Other Therapist Significant Other Therapist Significant Other Patient Change Talk (& CCT) Patient Change Talk (& CCT)
  • 38. Methods Decile 1 Decile 2 Decile 3 Therapist Significant Other Therapist Significant Other Therapist Significant Other Patient Change Talk (& CCT) Patient Change Talk (& CCT)
  • 39. Results Predicting Change Talk MICO MIIN SO Support SO Against Predicting Counter-Change Talk MICO MIIN SO Support SO Against
  • 40. Results Predicting Change Talk MICO ns MIIN ns SO Support p < .001 SO Against ns Predicting Counter-Change Talk MICO ns MIIN ns SO Support p < .001 SO Against ns
  • 41.  
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  • 48. What do you think? I’ll do it.
  • 49. What do you think? I’ll do it.
  • 50.
  • 51.
  • 52.
  • 53. Multiple Mediators of MI Barnett, Apodaca, Magill, Colby, Gwaltney, Rohsenow, Monti (2010). Addiction
  • 54.
  • 55.
  • 56.
  • 57. The Original Study MI Vs. Feedback Alcohol use at 12-months
  • 58. Mediator study MI Vs. Feedback Readiness Alcohol use at 12-months Risk/Benefit Self-efficacy Treatment Seeking
  • 59. Results MI Vs. Feedback Readiness Alcohol use at 12-months Risk/Benefit Self-efficacy Treatment Seeking
  • 60.
  • 61.
  • 62.

Editor's Notes

  1. The purpose of the current review is to evaluate the existing evidence regarding potential within-session mechanisms of change in MI with alcohol or other drug use disorders. As conceptualized in the present review, a mechanism of change is a variable temporally intervening between assignment to MI treatment and measured substance abuse outcome and at least partially explaining the relationship. The central question we sought to answer in this review was: Which MI constructs and variables appear to be the most promising candidates for mechanisms of change?
  2. Inclusion Criteria Studies were included if they met the following criteria: (1) clients received a therapeutic intervention for problematic alcohol use or any use of illegal substances; (2) the therapeutic intervention was referred to as 杜 otivational interviewing, � 杜 otivational enhancement, � 杜 otivational intervention, � or 澱 rief intervention � (and was described by the authors as being based upon the principles of motivational interviewing); (3) the intervention was delivered individually, and not in a group setting; (4) the potential mechanism was measured either during the intervention or immediately following.