Intermittent Motivational Interviewing and Transdiagnostic CBT for Anxiety: A Randomized Controlled Trial

Recent meta-analytic findings suggest that Motivational Interviewing (MI) used as an adjunct to Cognitive Behavior Therapy (CBT) for anxiety disorders improves overall treatment outcomes (Marker & Norton, 2018). However, when used as a prelude to CBT, MI significantly increases the length of treatment and numerous studies note that the effectiveness of pre-treatment MI subsides over time. The current study adapted an already established 12-session transdiagnostic CBT protocol (tCBT, Norton, 2012) to include one hour of MI spread across four sessions of tCBT (sessions 1, 3, 8, and 10) at 15 minutes each, with the option of including additional MI if resistance arose in therapy. Thirty-six treatment seeking adults with principal anxiety disorder diagnosis were randomly assigned to receive intermittent MI and tCBT (iMI + tCBT) or tCBT and psychoeducation. Results indicated that the iMI + tCBT condition significantly outperformed the tCBT condition on several primary outcome variables. While no significant difference was found between the two groups on clinician rated scores of participant principal anxiety disorder, differences were found on a composite index of participants’ self-report measures of symptom improvement, and on clinician rated scores of global psychiatric functioning. These effects were not moderated by baseline motivation or baseline ambivalence. The study also found that the iMI + tCBT condition showed significantly greater improvement to comorbid conditions and greater reduction in self-report depressive symptoms. The inclusion of MI did not impact participant drop out. This study provides further support for integrating MI and tCBT and highlights that even small doses of MI can improve treatment outcomes, without increasing length of usual therapy. Limitations and future research options are also discussed.     

Tailoring a Fruit and Vegetable Intervention on Novel Motivational Constructs: Results of a Randomized Study

Background Tailored health communications to date have been based on a rather narrow set of theoretical constructs. Purpose This study was designed to test whether tailoring a print-based fruit and vegetable (F & V) intervention on relatively novel constructs from self-determination theory (SDT) and motivational interviewing (MI) increases intervention impact, perceived relevance, and program satisfaction. The study also aimed to explore possible user characteristics that may moderate intervention response. Methods African American adults were recruited from two integrated health care delivery systems, one based in the Detroit Metro area and the other in the Atlanta Metro area, and then randomized to receive three tailored newsletters over 3 months. One set of newsletters was tailored only on demographic and social cognitive variables (control condition), whereas the other (experimental condition) was tailored on SDT and MI principles and strategies. The primary focus of the newsletters and the primary outcome for the study was fruit and vegetable intake assessed with two brief self-report measures. Preference for autonomy support was assessed at baseline with a single item: “In general, when it comes to my health I would rather an expert just tell me what I should do”. Most between-group differences were examined using change scores. Results A total of 512 (31%) eligible participants, of 1,650 invited, were enrolled, of which 423 provided complete 3-month follow-up data. Considering the entire sample, there were no significant between-group differences in daily F & V intake at 3 month follow-up. Both groups showed similar increases of around one serving per day of F & V on the short form and half a serving per day on the long form. There were, however, significant interactions of intervention group with preference for autonomy-supportive communication as well as with age. Specifically, individuals in the experimental intervention who, at baseline, preferred an autonomy-supportive style of communication increased their F & V intake by 1.07 servings compared to 0.43 servings among controls. Among younger controls, there was a larger change in F & V intake, 0.59 servings, than their experimental group counterparts, 0.29 servings. Conversely, older experimental group participants showed a larger change in F & V, 1.09 servings, than older controls, 0.48. Conclusion Our study confirms the importance of assessing individual differences as potential moderators of tailored health interventions. For those who prefer an autonomy-supportive style of communication, tailoring on values and other motivational constructs can enhance message impact and perceived relevance.     

Tailored Print Communication and Telephone Motivational Interviewing Are Equally Successful in Improving Multiple Lifestyle Behaviors in a Randomized Controlled Trial

Background  

Computer tailoring and motivational interviewing show promise in promoting lifestyle change, despite few head-to-head comparative studies.     

Impact of a Combined Resistance and Aerobic Exercise Program on Motivational Variables in Breast Cancer Survivors: A Randomized Controlled Trial

Background  Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed. Purpose  To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory (SDT). Method  Sixty breast cancer survivors were randomized in a cross-over design to either an immediate exercise group (IEG; n = 30) that exercised from baseline to week 12 or a delayed exercise group (DEG; n = 30) that exercised from week 12 to 24. SDT variables were assessed at baseline, 6, 12, 18 and 24 weeks using the Behavioral Regulation for Exercise Questionniare-2 and the Basic Psychological Needs Satisfaction Scale. Results  Fifty-eight participants completed the follow-up assessments and achieved a 61.3% adherence rate. Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods. For example, autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points (mean group difference = 2.0, p < 0.001). The cross-over results further supported the main findings. Conclusion  Supervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence. Authors’ Notes: Kerry S. Courneya is supported by the Canada Research Chairs Program and a Research Team Grant from the National Cancer Institute of Canada with funds from the Canadian Cancer Society and the NCIC/CCS Sociobehavioral Cancer Research Network.     

Monetary Incentive Interventions Can Enhance Psychological Factors Related to Fruit and Vegetable Consumption

Background

Incentive interventions have gained popularity to motivate health behavior change, but some psychological theorists caution that they may have deleterious effects on factors that potentiate behavior maintenance. Importantly, no empirical study has tested whether incentives indeed have iatrogenic effects on key psychological constructs associated with health behavior change and maintenance.

Purpose

The study aims to explore the effects of monetary incentives on theoretically informed psychological constructs and fruit and vegetable consumption.

Methods

Individuals reporting insufficient fruit and vegetable consumption were randomly assigned to receive either daily monetary incentives, delayed monetary incentives, or no incentives for their fruit and vegetable consumption during a 3-week intervention period. Behavior engagement and psychological factors were measured at baseline, at the end of the intervention, and 2 weeks following the cessation of the intervention.

Results

Participants in the daily incentive condition demonstrated the greatest increase in self-reported consumption during the intervention and at the follow-up. Moreover, increases in consumption during the intervention period were associated with increases in attitudes and self-efficacy, which, in turn, predicted behavior maintenance at follow-up. Intrinsic motivation to consume fruits and vegetables increased over time across the entire sample but did not differ between groups.

Conclusions

Monetary incentives can alter health behavior engagement without decreasing intrinsic motivation or other relevant cognitive and motivational constructs. Further, although incentives may serve as a vehicle to initiate behavior change, increased experience with the behavior may then lead to enhancements in key psychological constructs that serve as mechanisms to potentiate behavior maintenance following the cessation of incentives.

Trial Registration Number

The trial was registered with the ClinicalTrials.gov database (NCT02594319) https://www.clinicaltrials.gov/ct2/show/NCT02594319.

     

A Randomized Controlled Trial of a Tailored Interactive Computer-Delivered Intervention to Promote Colorectal Cancer Screening: Sometimes More is Just the Same

Background

There have been few studies of tailored interventions to promote colorectal cancer (CRC) screening.

Purpose

We conducted a randomized trial of a tailored, interactive intervention to increase CRC screening.

Methods

Patients 50–70 years completed a baseline survey, were randomized to one of three groups, and attended a wellness exam after being exposed to a tailored intervention about CRC screening (tailored group), a public web site about CRC screening (web site group), or no intervention (survey-only group). The primary outcome was completion of any recommended CRC screening by 6 months.

Results

There was no statistically significant difference in screening by 6 months: 30%, 31%, and 28% of the survey-only, web site, and tailored groups were screened. Exposure to the tailored intervention was associated with increased knowledge and CRC screening self-efficacy at 2 weeks and 6 months. Family history, prior screening, stage of change, and physician recommendation moderated the intervention effects.

Conclusions

A tailored intervention was not more effective at increasing screening than a public web site or only being surveyed.     

A Self-Regulatory Intervention for Patients with Head and Neck Cancer: Pilot Randomized Trial

Background

Research is yet to investigate whether psychological interventions delivered early after diagnosis can benefit patients with head and neck cancer (HNC).

Purpose

The aim of this study was to investigate the effectiveness of a brief self-regulatory intervention (targeting illness perceptions and coping) at improving HNC patient health-related quality of life (HRQL).

Methods

A pilot randomized controlled trial was conducted, in which 64 patients were assigned to receive three sessions with a health psychologist in addition to standard care or standard care alone. Participants completed questionnaires assessing HRQL, general distress, and illness perceptions at baseline and again 3 and 6 months later.

Results

Compared to the control group, patients who received the intervention had increased treatment control perceptions at 3 months (p = .01), and increased social quality of life at 6 months (p = .01). The intervention was particularly helpful for patients exhibiting distress at baseline.

Conclusion

A brief psychological intervention following HNC diagnosis can improve patient perceptions of treatment and social quality of life over time. Such interventions could be targeted to patients who are distressed in order to confer the greatest benefit.

Trial Registration Number

12614000813684.

     

Aggression Prevention Training for Individuals With Dementia and Their Caregivers: A Randomized Controlled Trial

ObjectiveInternational appeals call for interventions to prevent aggression and other behavioral problems in individuals with dementia (IWD). Aggression Prevention Training (APT), based on intervening in three contributors to development of aggression (IWD pain, IWD depression, and caregiver–IWD relationship problems) aims to reduce incidence of aggression in IWD over 1 year.DesignRandomized, controlled trial.SettingThree clinics that assess, diagnose, and treat dementia.ParticipantsTwo hundred twenty-eight caregiver–IWD dyads who screened positive for IWD pain, IWD depression, or caregiver–IWD relationship problems randomized to APT or Enhanced Usual Primary Care (EU-PC).InterventionAPT, a skills-based intervention delivered over 3 months to address pain/depression/caregiver–IWD relationship issues. EU-PC included printed material on dementia and community resources; and eight brief, weekly support calls.MeasurementsThe primary outcome was incidence of aggression over 1 year, determined by the Cohen Mansfield Agitation Inventory-Aggression Subscale. Secondary outcomes included pain, depression, caregiver–IWD relationship, caregiver burden, positive caregiving, behavior problems, and anxiety.ResultsAggression incidence and secondary outcomes did not differ between groups. However, in those screening positive for IWD depression or caregiver–IWD relationship problems, those receiving EU-PC had significant increases in depression and significant decreases in quality of the caregiver–IWD relationship, whereas those receiving APT showed no changes in these outcomes over time.ConclusionThe cost to patients, family, and society of behavioral problems in IWD, along with modest efficacy of most pharmacologic and nonpharmacologic interventions, calls for more study of novel preventive approaches.     

Mediation of Adult Fruit and Vegetable Consumption in the National 5 A Day for Better Health Community Studies

Background The 5 A Day for Better Health community studies demonstrated in randomized trials the efficacy of population-based strategies to increase fruit and vegetable consumption in diverse geographic areas and settings. Purpose Mediation analysis can help to elucidate the theoretical basis of changing dietary habits. This is important for informing more powerful cancer prevention and control interventions to achieve broad public health impact. Methods Five sites that focused on adults were included in mediation analyses to determine whether theoretically derived constructs assessed at baseline and follow-up contributed to explaining change in fruit and vegetable (F&V) consumption. These variables were knowledge, self-efficacy, and autonomy/responsibility. Stage of change also was considered as a potential moderating variable. Results Self-efficacy and knowledge of the 5 A Day recommendation increased in those who received the interventions and were positively associated with higher F&V. Mediation of intervention effect was demonstrated for these variables. Autonomy/responsibility did not meet the criteria for mediation. There was no evidence of differential effect of mediators according to baseline stage. Conclusions The present study findings provide strong support for mediation of F&V consumption by two variables: self-efficacy and knowledge. The authors discuss the findings in relation to study limitations and future research directions.     

Motivational Interviewing to prevent dropout from an education and employment program for young adults: A randomized controlled trial

This study tested the efficacy of Motivational Interviewing for improving retention at a “second chance” program in the United States for unemployed young adults who had not graduated high school (ages 18–24; 60% male). We investigated how Motivational Interviewing effects might be mediated by change talk (i.e., arguments for change) and moderated by preference for consistency (PFC). Participants (N = 100) were randomly assigned to (1) Motivational Interviewing designed to elicit change talk, (2) placebo counseling designed not to elicit change talk, or (3) no additional treatment. Motivational Interviewing sessions increased change talk, but did not increase program retention or diploma earning. PFC was a significant moderator of Motivational Interviewing's impact on program retention; Motivational Interviewing was most effective at increasing 8 week retention for high PFC participants, and least effective for low PFC participants. These results suggest that Motivational Interviewing could be a useful tool for improving retention in education and employment programs, but clinicians should be attentive to how participant characteristics might enhance or diminish Motivational Interviewing effects.     

A Randomized Trial of Generic Versus Tailored Interventions to Increase Colorectal Cancer Screening Among Intermediate Risk Siblings

Background  Individuals with a sibling who has had colorectal cancer diagnosed before age 61 are at increased risk for colorectal cancer and may derive particular benefit from screening. Tailored interventions may increase participation in appropriate colorectal cancer screening. Purpose  This study evaluated the efficacy of two tailored interventions and a generic print intervention. Methods  Participant siblings (N = 412) who were not up-to-date with colorectal cancer screening were randomly assigned to receive either a generic print pamphlet, a tailored print pamphlet, or a tailored print pamphlet and tailored counseling call. Colorectal cancer screening 6 months after the baseline interview was the outcome measure. Results  Results indicated that colorectal cancer screening adherence increased among intermediate risk siblings enrolled in all three intervention groups. Participants in both tailored intervention groups reported having colorectal cancer screening at significantly higher rates than participants in the generic print group. The increase in colorectal cancer screening in the tailored print and counseling call group was not significantly higher than that achieved by the tailored print alone. Decisional balance partially mediated treatment effects. Tailored behavioral interventions are effective methods for increasing screening adherence but telephone counseling did not add significantly to treatment effects.     

The Motivational Interviewing Navigation Guide: a process for enhancing teachers' motivation to adopt and implement school-based interventions

There is a critical need to engage theory-driven research related to the deployment of mental health promotion initiatives and student outcomes. A growing body of research supporting the use of motivational interviewing and engagement strategies in education suggests that this approach may be promising to better understand mechanisms through which coaches, mentors or consultants influence the change in behaviour and improve the implementation of effective practices. Motivational interviewing is a specific approach to engagement that works to raise motivation for fostering change, and may also serve as a useful approach for maximizing teachers' roles within school-based mental health promotion efforts. In this article, we describe the Motivational Interviewing Navigation Guide (MING), which consists of a five-step process to motivate teachers to implement critical features of an intervention with fidelity. In addition, the potential barriers to implement the MING approach, as well as recommendations for future research were discussed.     

A Randomized Controlled Trial of Relapse Prevention Therapy for First-Episode Psychosis Patients: Outcome at 30-Month Follow-Up

The effectiveness of a novel 7-month psychosocial treatment designed to prevent the second episode of psychosis was evaluated in a randomized controlled trial at 2 specialist first-episode psychosis (FEP) programs. An individual and family cognitive behavior therapy for relapse prevention was compared with specialist FEP care. Forty-one FEP patients were randomized to the relapse prevention therapy (RPT) and 40 to specialist FEP care. Participants were assessed on an array of measures at baseline, 7- (end of therapy), 12-, 18-, 24-, and 30-month follow-up. At 12-month follow-up, the relapse rate was significantly lower in the therapy condition compared with specialized treatment alone (P = .039), and time to relapse was significantly delayed for those in the relapse therapy condition (P = .038); however, such differences were not maintained. Unexpectedly, psychosocial functioning deteriorated over time in the experimental but not in the control group; these differences were no longer statistically significant when between-group differences in medication adherence were included in the model. Further research is required to ascertain if the initial treatment effect of the RPT can be sustained. Further research is needed to investigate if medication adherence contributes to negative outcomes in functioning in FEP patients who have reached remission, or, alternatively, if a component of RPT is detrimental.     

Randomized Trial of Anger Control Training for Adolescents With Tourette's Syndrome and Disruptive Behavior

ObjectiveTo evaluate the efficacy of a 10-session individually administered anger control training (ACT) for adolescents with Tourette's syndrome (TS) and disruptive behavior.MethodTwenty-six subjects (24 boys and 2 girls; mean age 12.7 years, SD 0.88) with TS and high levels of disruptive behavior were randomly assigned to ACT or treatment-as-usual (TAU). The parent-rated Disruptive Behavior Rating Scale and the Clinical Global Impression—Improvement Scale rated by the independent evaluator were used as primary outcome measures.ResultsAll randomized subjects completed end-point evaluation, and all subjects in the ACT group completed 3-month follow-up evaluation. The Disruptive Behavior Rating Scale score decreased by 52% in the ACT group compared with a decrease of 11% in the TAU control group (p < .001). On the Clinical Global Impression—Improvement Scale, the independent evaluator rated 9 (69%) of 13 subjects in the ACT condition as much improved or very much improved compared with 2 (15%) of 13 in the TAU condition (p < .01). This reduction of disruptive behavior in the ACT group was well maintained at 3-month follow-up.ConclusionsAnger control training seems to reduce disruptive behavior in adolescents with TS. Larger trials are needed to confirm these results.