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A University of Virginia Health System researcher and colleagues have just published findings showing that just a few targeted counseling sessions had a notably positive impact on women at high risk for binge drinking, unplanned pregnancy, and exposure to alcohol during pregnancy. The counseling technique, called motivational interviewing (MI), has proven effective after just four counseling sessions. In addition, Karen Ingersoll, Ph.D., has won a grant for $1.9 million from the National Institutes of Health to study how this effective counseling technique works.
Ingersoll, a lead researcher in the UVa Department of Psychiatry and Neurobehavioral Sciences, and her colleagues found that a few nonjudgmental counseling sessions prompted women both to scale back risky drinking and practice more effective contraception. This study, called Project CHOICES, was designed to reduce the risk of alcohol-exposed pregnancy before conception, and was funded by the Centers for Disease Control and Prevention. The study took place at six sites in Virginia, Texas and Florida and enrolled 830 women from many different backgrounds.
The motivational intervention doubled the odds that binge-drinking women who were at risk for pregnancy would be successful in moving from the category of at-risk to low-risk for alcohol-exposed pregnancy. These findings, published in the American Journal of the Preventive Medicine, are noteworthy because it can be difficult for some women to reduce binge drinking, which can cause harm to their fetuses should they become pregnant.
We demonstrated that using motivational counseling can have a major impact, even on behaviors that are considered difficult to change, such as binge drinking, Ingersoll said. While our main goal was to reduce the risk of alcohol-exposed pregnancy, ours was the first multi-site study to show that motivational counseling can be effective when targeting more than one health behavior, in this case, both drinking and contraception habits, among women who were not seeking help to change.
The women, who were binge drinkers or frequent drinkers, volunteered to be in the study. All of the women were sexually active but not using reliable means to prevent pregnancy. They came from two high-risk samples in each of three cities, including Richmond, Va. During this randomized, controlled trial, the trained counselors used MI to express empathy with the individuals who come for counseling, manage resistance without confrontation, and support the self-confidence of the individual. They used counseling techniques such as open-ended questioning, reflective listening, summarizing, and affirming. Although the study targeted both behaviors (binge drinking and poor contraception use) associated with alcohol-exposed pregnancy, counselors were allowed to emphasize the target behavior favored by the participant.
Now Dr. Ingersoll and colleagues will use the new grant money to answer the question of why this form of counseling, brief as it is, can be so effective. To date, motivational interviewing research has found few links between the characteristics of the people being counseled (clients) and their outcomes.
Thus, the UVa team will look at other aspects of MI, using Project CHOICES' audiotapes of therapy sessions and its outcomes dataset. The researchers will rate audiotapes to capture therapist and client behaviors and interpersonal interactions, and merge this process data with the existing dataset. They then will test a number of hypothesized mechanisms of action during motivational interviewing. The team plans to examine therapist behaviors, client behaviors, and interpersonal interactions; and evaluate their inter-relationships and their relationships to outcomes to unlock the secrets of MI.
Our hope is to identify which aspects of this effective counseling style are most important and linked to the positive outcomes, so that we can create even more effective therapies to help people make healthy changes in problematic habits, Ingersoll said.
This project could have an impact on public health if the researchers do uncover the components of MI that will have the best impact on clinical practice. Once these components are identified, new, scientifically sound interventions could be developed for a range of health-threatening behaviors for people with chronic illnesses, including addictive disorders.
Reflection Exercise #8