Motivational Interviewing with Individuals In Recovery: Effects On Hope, Meaning, Empowerment and Service Participation

Service engagement continues to challenge providers working with individuals with serious mental illness and substance abuse disorders. Motivational Interviewing (MI), an intervention aligned with recovery-oriented principles in its emphasis on empathy, empowerment, and self-directed change, directly addresses this problem. Its effects on service engagement, however, have been inconsistent with dually diagnosed populations. To explore underlying processes that may influence engagement, the present mixed methods, single case experiment studied the effects of MI on key recovery constructs: hope, meaning, and empowerment. Participants were 6 consumers enrolled in an intensive outpatient program for co-occurring disorders. Results showed statistically significant increases for half the sample on a brief hope, meaning, and empowerment survey. Grounded theory analysis also identified positive change in identity, self-efficacy, and relationships as major recovery themes discussed in MI. It also revealed positive affect associated with spirit and method of MI. Implications for attention to personal narratives, supporting persistence in change, and satisfying psychological needs proposed by self-determination theory (SDT) are discussed

Motivating Change in High-Risk Adolescents: An Intervention Focus on the Deviant Friendship Process

134 pagesThe purpose of the following literature review is not to exhaustively survey the current state of delinquency intervention science. Rather, the goal is to clearly delineate the developmental and peer social processes that reinforce and exacerbate adolescent problem behavior. Reviewed literature focuses on the developmental impact of family of origin, detailing how coercive family dynamics negatively impact social skills development. Consideration is then given to the difficulties children from coercive families have with school transitions. Reviewed research suggests that children who remain reliant on coercive interpersonal processes can commonly be directed by both punishments and interventions towards delinquent peer clustering, inadvertently creating environments that reinforce and exacerbate pre-delinquent social dynamics. Focus is then turned to the unique social and reinforcement dynamics inherent in these delinquent peer groups, identifying language and verbal dynamics as being a special risk factors and predictors of later problem behavior. This review, although necessarily limited in scope, argues that for the highest risk adolescents, delinquent talk and the behavioral reinforcement that it generates within the delinquent peer group is a powerful primer for later delinquent action. I also argue that high-risk adolescents' verbal behaviors are both visible and viable targets for intervention efforts.This investigation was supported in part by a Grant from the U.S. Department of Education, Office of Special Education Programs, Student Initiated Research Contest, Competition 84.324B, and an award from the Claire Wilkins Chamberlin Memorial Graduate Research Foundation

Use of automated coding methods to assess motivational behaviour in education

Teachers’ motivational behaviour is related to important student outcomes. Assessing teachers’ motivational behaviour has been helpful to improve teaching quality and enhance student outcomes. However, researchers in educational psychology have relied on self-report or observer ratings. These methods face limitations on accurately and reliably assessing teachers’ motivational behaviour; thus restricting the pace and scale of conducting research. One potential method to overcome these restrictions is automated coding methods. These methods are capable of analysing behaviour at a large scale with less time and at low costs. In this thesis, I conducted three studies to examine the applications of an automated coding method to assess teacher motivational behaviours. First, I systematically reviewed the applications of automated coding methods used to analyse helping professionals’ interpersonal interactions using their verbal behaviour. The findings showed that automated coding methods were used in psychotherapy to predict the codes of a well-developed behavioural coding measure, in medical settings to predict conversation patterns or topics, and in education to predict simple concepts, such as the number of open/closed questions or class activity type (e.g., group work or teacher lecturing). In certain circumstances, these models achieved near human level performance. However, few studies adhered to best-practice machine learning guidelines. Second, I developed a dictionary of teachers’ motivational phrases and used it to automatically assess teachers’ motivating and de-motivating behaviours. Results showed that the dictionary ratings of teacher need support achieved a strong correlation with observer ratings of need support (rfull dictionary = .73). Third, I developed a classification of teachers’ motivational behaviour that would enable more advanced automated coding of teacher behaviours at each utterance level. In this study, I created a classification that includes 57 teacher motivating and de-motivating behaviours that are consistent with self-determination theory. Automatically assessing teachers’ motivational behaviour with automatic coding methods can provide accurate, fast pace, and large scale analysis of teacher motivational behaviour. This could allow for immediate feedback and also development of theoretical frameworks. The findings in this thesis can lead to the improvement of student motivation and other consequent student outcomes

Increasing the Awareness of Trauma Informed Care in the School Setting: Giving Practitioners the Tools to Actively Participate in Trauma Related Care

Of the approximately 15 million children and adolescents who have a mental health disorders that are interfering with their functioning, a mere 25% seek medical advice or treatment (Melnyk, Kelly, & Lusk, 2014). Furthermore, two thirds of youth report experience at least one traumatic event by age 16 (Suarez, Belcher, Briggs, & Titus, 2012). School health practitioners have regular contact with children and adolescents as they typically attend school five days a week, nine months out of the year. The consistent presence of the relationship between the practitioner and student creates an ideal environment for discussing the sensitive topics necessary to engage in trauma informed care modalities. The goal of this project was to increase the awareness of trauma-informed definitions, techniques and resources for nurses in the school setting. The Sonoma County School Nurse Association partnered with a University of San Francisco (USF) Doctor of Nursing Practice (DNP) student to receive a two-hour presentation about trauma and its associated interventions. Participating school nurses subsequently received an evidenced-based module that reinforces the recognition and effective resource management for trauma informed care, in order to reduce the risk of trauma on the growth, development, and success of adolescents. Motivational Interviewing (MI) was used as the primary intervention reviewed for practitioners to implement into their own practices. Play therapy and cognitive restructuring were also presented to the 13 school nurses in attendance. Data was collected immediately before and after the presentation as well as six-weeks later. In both data sets, participating nurses noted an increase in their confidence but did not report a significant utilization of motivational interviewing, play therapy, or cognitive restructuring. A lack of appropriate clinical scenarios was cited most frequently as the reason for not utilizing the presented techniques

Testing the Context Responsivity Hypothesis: Managing Resistance in Cognitive Behavioural Therapy

Despite growing recognition of the importance of context-responsivity in psychotherapy, and recommendations to develop context-responsive models through identification of clinical markers to which therapists need to be responsive, the notion of context-responsivity in relation to key markers such as resistance remains largely understudied. The current study sought to examine therapist responsiveness during identified moments of resistance (i.e., client disagreement with therapist direction) in the context of cognitive-behavioural therapy (CBT) for generalized anxiety disorder (Westra et al., 2015). There were two ways in which context-responsivity was investigated. The first was to examine whether differences in therapist style (i.e., more supportive and less directive behaviour) in the presence of disagreement go on to predict proximal (i.e., level of subsequent resistance in the session following therapist management of resistance) and distal (i.e., pre-to-post worry reduction) therapy outcomes. To this end, the present study utilized the Manual for Rating Interpersonal Resistance (Westra et al., 2009) to identify moments of client disagreement with therapist direction. In turn, the Motivational Interviewing Treatment Integrity (MITI; Moyers et al., 2010) was used to rate therapist use of theoretically indicated motivational interviewing (MI) skills (e.g., level of empathy, collaboration, evocation, and support of client autonomy) during identified moments of disagreement. The second approach to investigating context-responsivity was through comparing variations in therapist MI adherence in the presence of disagreement, with variations in therapist general MI adherence during randomly selected moments in therapy, in order to examine whether the timing of therapist use of MI principles differentially impacts treatment outcomes. Results indicated that clients whose therapists displayed higher levels of MI relational conditions in the context of disagreement had substantially lower levels of subsequent resistance and post-treatment worry. Furthermore, while variations in therapist MI adherence in the context of disagreement were consistently and substantially related to CBT outcomes, variations in therapist general MI adherence were not. These findings provide support for the context-responsivity hypothesis, and serve to suggest that systematic incorporation of the client-centered relational conditions advanced in MI to the responsive management of resistance in CBT is a valuable clinical endeavor which should become a priority for clinical training

Narrative-Emotion Process Markers in Cognitive Behavioural Therapy For Generalized Anxiety Disorder: A Process-Outcome Study

According to a narrative-emotion informed approach to psychotherapy, individuals enter psychotherapy when their narratives lack flexibility, emotional coherence and fail to integrate important lived experiences. Effective psychotherapy provides clients with an opportunity to integrate emotionally salient life experiences, as a told story or self narrative that enables new meaning-making and a more adaptive view of self. The Narrative-Emotion Process Coding System Version 2.0 (NEPCS; Angus Narrative-emotion Marker Lab, 2015) is a standardized measure that consists of a set of 10 clinically-derived markers that capture a client's capacity to disclose, emotionally re-experience, and reflect on salient personal stories in videotaped psychotherapy sessions. These 10 markers are classified into three subgroups: Problem (Same Old, Empty, Unstoried Emotion, and Superficial Storytelling), Transition (Reflective, Inchoate, Experiential, and Competing Plotlines Storytelling), and Change Markers (Unexpected Outcome, and Discovery Storytelling). The present study applied the NEPCS Version 2.0 to a sample of clients (N = 6; 36 therapy sessions) engaging in cognitive behavioural therapy (CBT) for generalized anxiety disorder (GAD). The NEPCS Version 2.0 was applied to two early, two middle, and two late-stage videotaped therapy sessions for each of the six clients (three recovered, and three unchanged outcome status), who were drawn from a randomized controlled trial comparing the efficacy of CBT and motivational interviewing integrated with CBT for GAD (Westra, Constantino, & Antony, 2016). Multilevel modeling analyses demonstrated significantly higher proportions of Reflective Storytelling (p < .001), Unexpected Outcome Storytelling (p = .023), as well as the Transition (p = .003), and Change (p = .021) markers subgroups, for recovered versus unchanged CBT clients. Additionally, there was a significant stage effect for individual markers, Competing Plotlines Storytelling (p = .006), Unexpected Outcome Storytelling (p < .001; p = .031; p = .036), No Client Marker (p = .014), and for overall Transition (p = .001; p = .034) and Change (p = .001) markers subgroups. Findings will be discussed in the context of current CBT research literature on GAD as well as research examining NEPCS marker patterns in other diagnostic populations, and treatment modalities

CoachMotivation: Developing Transformational Leadership by Increasing Effective Communication Skills in the Workplace

Communication is an intrinsic part of the human experience and has been widely studied empirically and practically within organizations. It is the bedrock for many workplace behaviors and outcomes such as employee trust, engagement, job satisfaction, and transformational leadership. Nonetheless, effective communication continues to be a challenge for organizations across a variety of sectors. The current study examined whether a communications training, CoachMotivation (CM), increased perceived effective communication. CM is derived from clinical psychology skills for behavior change, namely, the Motivational Interviewing concepts of open-ended questions, affirmations, reflections, and summary statements. This study also considered the Big Five personality traits (extraversion, agreeableness, openness, conscientiousness, and neuroticism) as predictors of baseline perceived effective communication and whether personality predicted residual change in perceived effective communication after participating in CM training. Findings include: (a) CM training increased self-perceptions of effective communication on the total communication scale (N = 153; t [152] = -8.19, p \u3c.001, d =.66) as well as subscales of clarity (t [152] = -6.83, p \u3c.001, d =.55), responsiveness (t [152] = -6.56, p\u3c.001, d =.53), and comfort (t [152] = -7.13, p \u3c.001, d =.58); (b) Extraversion predicted perceived effective communication at baseline for the total communication scale and comfort scale (B = .19; SE = .06; p \u3c.001 and B = .14; SE = .03; p \u3c.001, respectively); (c) Openness predicted residual change in perceived effective communication on the total communication scale and comfort scale (B = .09; SE = .04; p = .043 and B = .06; SE = .03; p = .034, respectively). This research provides practical implications for using CM to enhance communication and lays the groundwork for further study of CM\u27s effects on more distal outcomes of communication as they relate to transformational leadership

EXPERIENCES OF INDIVIDUALS WHO MAINTAIN ABSTINENCE FROM MOOD ALTERING SUBSTANCES USING SELF-DIRECTED, COGNITIVE-BASED RECOVERY SUPPORT GROUPS

The purpose of this study was to examine how individuals who utilize self- directed recovery support groups perceive the recovery process and how the described experiences of participants compare to 12-step recovery as reported in existing academic literature. Six individuals who have maintained sobriety for a minimum of one year participated in this qualitative study. The individuals also participated in SMART Recovery, Secular Organizations for Sobriety or Women for Sobriety within the past year, and did not participate in 12-step support groups for at least one year prior to the study’s approval date. Data collection included a demographic form and one 60-90 minute, audio-recorded interview, during which participants were asked primarily open questions about their respective experiences in sobriety. Data analysis consisted of a phenomenological procedure adapted from Moustakas (1994). The procedure revealed that participants perceive the recovery process as beginning with freedom and individual choice, continuing into a sense of community and belonging, proceeding with a journey of self-discovery, and culminating in the development of recovery maintenance tools. Participant experiences relate to 12-step recovery in terms of community and fellowship within recovery support groups. Participant experiences diverge from 12-step recovery in terms of spirituality and adherence to sequential steps or perceived programmatic rigidity. Participants maintain that sobriety is a “separate issue” and not necessarily related to spiritual/religious issues or to the attendance of recovery support group meetings. The findings suggest that individuals who use support groups such as SMART Recovery, Secular Organizations for Sobriety, and Women for Sobriety maintain abstinence through face-to-face or online support group meetings and by utilizing a variety of self-directed relapse prevention methods. Counselors are recommended to consider self-directed recovery support groups as a viable referral option for clients dealing with substance use issues. Further research is needed to gain more insight into how individuals use self-directed support groups and online recovery resources to maintain abstinence from mood altering substances

Social workers\u27 perceptions of the effectiveness of animal assisted therapy within social work practice

The purpose of this study was to examine social workers\u27 perceptions of the effectiveness of animal assisted therapy (AAT) within social work practice throughout Riverside and San Bernardino Counties. This study focused on AAT and the therapeutic contribution animals have offered to individuals suffering from a mental health illness, such as depression. The interventions used for depression or other mental illness rarely entail AAT because of lack of education and traning