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OBJECTIVE: To test the effectiveness of group motivational interviewing (GMI) and school/parent intervention (SP) in reducing drinking among public high school students in Denmark, a region with high rates of hazardous alcohol use. METHOD: This was a 3-arm, cluster-randomized controlled trial in 16 public high schools block-randomized to the following: (1) 2-session, manualized GMI coupled with SP; (2) SP-only; or (3) assessment-only control. A total of 2,766 students (65.53% female; mean age = 16.77 years, range = 15-19 years) completed online surveys during class periods at baseline and at 2, 6, 9, and 12 months. The primary outcome was past-month peak drinks per occasion at 12-month follow-up. Mixed models estimated change from baseline for each condition and mean change difference across conditions. RESULTS: Students in the control condition significantly increased peak drinks over time at 2.5 times the rate of the other conditions (Δmean = 1.13 [95% CI = 0.62, 1.64] vs 0.48 [95% CI = 0.03, 0.93] for GMI+SP and 0.47 [95% CI = 0.06, 0.88] for SP-only). The mean change difference in peak drinks for each GMI+SP and SP-only vs control was significant (Δmean = -0.65 [95% CI = -1.28, -0.02] and -0.66 [95% CI = -1.27, -0.04], respectively), although significance did not persist after p value correction. More robust effects were observed for the secondary outcome of past-month total drinks. CONCLUSION: GMI coupled with school-based alcohol policies and parental education represents a promising approach to mitigating drinking among high school students. This study supports the crucial roles of developmentally salient relationships (eg, peers, parents/guardians) and contexts (eg, school, home) in developing and delivering intervention programs to adolescents. CLINICAL TRIAL REGISTRATION INFORMATION: Prevention of Hazardous Use of Alcohol with Danish High School Students (Our Choice); https://clinicaltrials.gov/study/NCT06018389?cond=NCT06018389.

Veterinary medicine fundamentally revolves around working with people to positively influence how they care for their animals. Veterinarians have traditionally used directive advice-giving when providing clients with recommendations, which can inadvertently push clients further away from change despite good intentions by evoking resistance and leaving the underlying motivational and contextual barriers to change unaddressed. Motivational interviewing (MI), a collaborative communication approach originally developed for addiction counselling, has been widely adapted across many fields because of its proven effectiveness in strengthening intrinsic motivation to change. MI was first applied in veterinary medicine approximately a decade ago with a small but growing evidence base. This review introduces the theoretical foundations of MI, how it can be applied within different types of clinical consultations, as well as the challenges of developing and sustaining competency in practice and ethical implications specific to the veterinarian-client-animal relationship, including the proxy motivation problem where clients bear the costs of behaviour change for benefits experienced primarily by their animal. This review then critically appraises the veterinary MI literature, which has largely focused on communication training outcomes with limited research on the downstream effects on client behaviour or animal welfare, highlighting important research gaps to promote an increased uptake of MI in clinical practice.

contextually relevant motivational interviewing counselling training program for lay counsellors in South Africa

There is an urgent need for innovative approaches to pediatric obesity treatment. There is also a demand for targeted strategies that reduce attrition and improve treatment adherence. Intervening exclusively with parents of overweight children is a novel approach with demonstrated efficacy in reducing child body mass index (BMI) percentile. Motivational interviewing (MI), a brief communication style for exploring and resolving ambivalence about behavior change, might enhance treatment engagement when implemented as part of obesity interventions. The aim of this report is to provide the rationale and methods for a novel study of MI with parents in the treatment of their children’s overweight. We designed and are currently implementing NOURISH+MI, a randomized controlled trial examining the feasibility and efficacy of an adjunct values-based MI intervention, implemented within a culturally-tailored parent intervention for overweight children ages 5-11 years, NOURISH+ (Nourishing Our Understanding of Role modeling to Improve Support and Health). Specifically, we are randomly assigning 60 parents to this adjunctive treatment, and investigating if adding two MI sessions prior to the NOURISH+ group intervention will enhance treatment effects. We will be able to compare NOURISH+MI participants with those from the two NOURISH+ treatment conditions (NOURISH+ and control). We hypothesize that children whose parents participate in NOURISH+MI will demonstrate lower attrition and greater adherence with NOURISH+, ultimately leading to greater treatment effects, compared with children whose parents are randomized to NOURISH+ or a control group. Findings will contribute to the emerging literature examining the efficacy of MI within pediatric obesity interventions.

Motivational Interviewing (MI) and Cognitive Behaviour Therapy (CBT) are both evidence based psychosocial interventions. Motivational interviewing has not sought to develop its own comprehensive theory (Miller & Rollnick, 2012) although it has developed hypotheses on why MI works. This project has looks at what an integration of these two approaches can tell us about motivational interviewing’s theory, hypothesised mechanisms of action and efficacy. It has set out to examine and explore existing theory through qualitative research. This included Semi structured interviews with researchers and practitioners who are experts in the integration of MI and CBT (MICBT). Their views and existing literature were used develop understanding about MI efficacy. A critical realist philosophical framework and Theoretical Thematic analysis was used to explore and test MI theory. A number of themes around hypothesised mechanisms and MI theory emerged from both sets of participants. These included psychological safety, alliance, responding to resistance, acceptance, compassion and positive emotion. A relational rather than a technical practice was emphasised and the theory relating to that observed. Theory around Power, its negative and positive operation in people’s lives arose frequently; as did hypothesised mechanisms relating to power differentials and MI as a ‘power yielding’ approach. Building on insights from evolutionary theory, links were made to a more detailed consideration of the effects of social context on research, practice and the ability of individuals to make change. This project challenges a narrow-individualised approach to research and intervention, emphasising the need to take into account the effects of social inequality and individual social circumstances. The project has illustrated some of the reality of translating theory into real-world practice and suggests expanding MI theory so that it is more contextualised. The centrality of understanding power and power structures may be a useful addition to an understanding of why MI works. An increased awareness of social context and its impacts raise questions about how individual and societal level interventions could work together to improve health behaviour change. Finally, a number of suggestions for future research are made, including that individualised interventions need to be evaluated in real-world services, with direct consultation of and involvement of service users.

The aim of this study was to investigate the feasibility of conducting a randomised controlled trial (RCT) on the effect of motivational interviewing (MI) in facilitating hearing aid use. Methods used and their results are presented in the 3 sections below: (1) A cross-sectional survey where a questionnaire, including the International Outcome Inventory for Hearing Aids was posted to all patients fitted with hearing aids at the Royal Surrey County Hospital, Guildford, between 2011 and 2012 (N=1874). 1023 questionnaires were completed and returned (response rate of 55%). 29% of responders did not use their hearing aids on a regular basis (i.e., used them less than 4 hours per day). (2) 220 patients who reported using their hearing aid(s) less than 4 hours per day in the above survey were invited to take part in a pilot single-blind RCT. 37 were enrolled and randomised to MI combined with hearing aid adjustments (n=20) or hearing aid adjustments only (n=17). The results showed that it was feasible to deliver MI for facilitating hearing aid use. Hearing aid use as measured via data logging 1 month after interventions favoured the MI group. (3) A qualitative enquiry embedded in the above pilot RCT was conducted. 34 out of 37 participants underwent in-depth interviews. Interviews were transcribed and thematically analysed. Five themes were identified in relation to participants’ perspectives about the key components of the research programme which influenced their decision about using their hearing aids. Conclusion: Conducting an RCT on the effect of MI in facilitating hearing aid use in people who do not use their hearing aids is feasible and that MI combined with audiology standard care may have positive effects on hearing aid use.

This study evaluated the effectiveness, for smoking cessation, of the Values Card Sort intervention based on the theoretical therapeutic model of Motivational Interviewing. Veterans at the New Mexico Veteran Affairs Healthcare System who elected to participate were randomly assigned to either one session of the MI-based Values Card Sort or one session of an education-based intervention called Preskills Training, which was designed specifically for this research study. All veterans who participated in the study then went through three sessions of the standard smoking cessation psychoeducational group at the VA. It was predicted that veterans who received one session of Values-Based MI would be smoking significantly fewer cigarettes per day at one-month and three-month follow-ups than veterans who received one session of Preskills Training. According to several analyses investigating differences between veterans in the Values-Based MI condition and veterans in the Preskills Training condition, there were no significant differences between the two groups on measures of cigarettes smoked per day, scores on the Fagerstrom Test of Nicotine Dependence, or on the subscale scores of the SOCRATES. However, it is important to note that there were significant decreases in smoking behaviors for all veterans in the study, regardless of the condition to which they were randomly assigned. Finally, the Values-Based MI condition was found to result in significantly greater decreases in smoking for those veterans who did not initially perceive their smoking to be discrepant with their values as opposed to those who did initially recognize a discrepancy.

Equity is an important principle of health care in Australia, and redesigning health services to meet the needs of culturally marginalised groups has the potential to improve accessibility to psychotherapy. This paper describes the collaborative efforts of an ethno-specific service and a specialist treatment service to provide an evidence-informed intervention to treat Vietnamese Australian individuals experiencing gambling problems. Employing a clinical case audit tool and drawing on the evidence of 33 participants, the study identified which features of therapeutic practice had the most impact on retention and treatment completion. Moderate but influential adjustments to the delivery of a standard behavioural treatment program improved access, treatment adherence, and success for Vietnamese Australians experiencing gambling problems. These findings have significant implications for health care provision in a culturally diverse nation. Results highlight the importance of service adaptation to address under-utilisation and under-representation of psychotherapy services by culturally marginalised groups due to language and cultural barriers.

Abstract Empathic reflections are used to communicate understanding of client communications and experiences. This chapter first presents definitions and subtypes of empathic reflections. It distinguishes between the response mode empathic reflection and the relational quality of empathy. The chapter discusses how empathic reflections are assessed and presents examples of successful and unsuccessful empathic reflections. The chapter presents a meta-analysis of 43 samples, which found virtually no relation between empathic reflection and effectiveness, both overall and separately for each of six effectiveness criteria. Weak support for reflections of change talk and summary reflections was found. Good and poor reflections may cancel each other, indicating the need to examine more carefully the quality of empathy sequences in response to empathic opportunities offered by clients and sensitively adjusted in response to client confirmation/disconfirmation. The chapter concludes with diversity considerations and implications for research, training, and practice.