Jon M. Houck, Ph.D. - US grants

DESCRIPTION (provided by applicant): Motivational interviewing (MI) is a directive, client-centered therapeutic method employed in the treatment of substance abuse, with strong evidence of effectiveness. To date, the sole mechanism of action in MI with any consistent empirical support is change talk (CT), which is generally defined as in-session verbal commitments by clients to change their problem behavior. Sustain talk (ST) incorporates verbal commitments to maintain the status quo. MI maintains that during addiction treatment clients essentially talk themselves into change. Multiple studies have supported this theory, revealing that the frequency and strength of these change talk utterances from MI treatment sessions predict substance use outcomes. Although a causal chain has now been established linking therapist speech, client change talk, and substance use outcomes, the neural substrate of change talk remains largely uncharted. This K01 proposal is designed to explore that neural substrate. Building upon the results of studies of causal mechanisms in motivational interviewing, this application represents an effort to identify biologically-based processes that underlie client change talk during treatment sessions, with the long-term goal of understanding how it might be more efficiently and powerfully elicited to improve substance abuse outcomes. Furthermore, this study is designed to provide important training to prepare me for a career as an independent clinical scientist. My immediate career goals are to: (1) acquire expert-level knowledge about endophenotypes in alcohol use disorders, (2) deepen my knowledge about advanced analysis methodologies including network- level functional neuroimaging analysis and longitudinal data analysis, and (3) develop my scientific and grant writing skills. My overarching goal is to become an independent clinical scientist and a leader in the application of neuroimaging methodologies to study mechanisms of behavior change in substance abuse treatment. Under the guidance of a mentoring team led by Dr. Barbara McCrady and including Dr. Vince Calhoun, Dr. Theresa Moyers, and Dr. Claudia Tesche, I will explore the neural substrate of change talk during an actual MI session using magnetoencephalography (MEG) in a sample of ambivalent alcohol users. In subsequent measurement sessions I will use MEG to measure brain responses to brief utterances of the client's own change talk and sustain talk recorded from that MI session. In this way I can explore differences between brain activity measured when change talk is originally expressed within an MI session, and that measured in follow- up measurements using recordings of the client's change talk. I will also examine differences in brain activity between change talk and sustain talk using independent component analysis, and test for relationships between brain activity and substance use outcomes. In the long term this information could be used to develop refinements to motivational interviewing, targeting the salient brain regions and processes more precisely in order to achieve the most efficient and powerful expressions of change talk, which could ultimately lead to improved substance abuse outcomes.

DESCRIPTION (provided by applicant): This submission is designed in response to NIDA PAR-10-021 AIDS-Science Track Award for Research Transition (R03), titled The effects of client change language on adolescent risky sexual behavior. People under age 25, and those involved with the justice system in particular, are at heightened risk for sexually transmitted infections including HIV. Approaches to reduce sexual risk this population have had limited success, and it remains unclear whether adolescents can benefit from interventions that have been proven effective in adults. One approach that has shown promise is motivational interviewing (MI), a directive, client- centered method employed in the treatment of problematic health behaviors. The mechanism of action with the most empirical support in MI is change talk, spontaneous within-session commitments by clients to change their problem behavior. Clinicians trained in MI employ specific tactics to acknowledge, elicit, and strengthen this change talk, with the goal of increasing its frequency and strength. A causal chain has been established linking therapist speech, client change talk, and subsequent health outcomes in adults. This study will use the Motivational Interviewing Skill Code to quantify client change language from an ongoing study of criminally- involved adolescents. Participants in the parent study are randomized to either MI or a behavioral skills training (BST) condition, both of which have two intervention sessions one week apart, with follow-up assessments at three and six months. Coding client language in this study presents the opportunity to measure change language from a randomized controlled trial of two treatments: MI and BST. We will quantify client language in a sample of 196 treatment sessions, 98 from each condition. Outcome measures in the parent study include a time-line follow-back querying sexual behavior and substance use over the previous 30 days. Effects will be evaluated from both the 3- and 6-month follow-ups, with the maximal effect of treatment expected at 3 months. No previous study has successfully applied client language coding to the study of adolescent sexual risk. This secondary analysis will test a causal chain developed in adult populations by using an adolescent sample and comparing those effects in two treatment conditions, an approach that will guide clinical practice by either corroborating or challenging the effects of client change language in adolescents.

? DESCRIPTION (provided by applicant): Hispanic Americans in general and Hispanic youth in particular, carry a disproportionate share of the burden of substance use in the United States. Hispanic youth are also less likely than are Caucasian youth to benefit from treatment for alcohol and other drug (AOD) use. It remains unknown why this disparity persists after treatment. Two potential factors in this disparity are therapist behaviors and communication patterns during treatment sessions for AOD use. Previous research in adults has demonstrated a causal chain between therapist behavior, client behavior, and AOD outcomes. If therapists behave differently with Hispanic and Caucasian youth, then supervisors, trainers, and educators would have concrete behavioral targets to measure and change therapist behavior to improve these disparate outcomes for Hispanic youth. The proposed secondary analysis relies upon Eco developmental theory (Szapocznik & Coatsworth, 1999) to make specific predictions about within-session behaviors and processes. This study will use an advanced psychotherapy process research technique, sequential coding, to measure within-session behaviors of therapists and clients to test these hypotheses about how communication patterns and therapist behaviors may vary between Hispanic and Caucasian youth in an existing sample of 506 recorded psychotherapy sessions with adjudicated youth, and to link these behaviors to AOD outcomes. Using this large, existing sample of audio recordings from Project AMICA, a large randomized controlled trial to assess health disparities, complete with demographics, psychosocial assessments, and outcome data, will provide an unusual opportunity for a large, low-cost and high-impact study to examine health disparities effects. Evaluating client and therapist language in this study presents a unique opportunity to measure communication patterns from a randomized controlled trial of motivational interviewing with justice- involved youth. The proposed 4-year analysis of existing recordings will test a causal chain developed in adult populations, using an adolescent sample and comparing those effects for Hispanic and Caucasian youth, an approach that will guide clinical practice by either corroborating or challenging current approaches to psychotherapy for AOD use with Hispanic youth.