The widely disseminated clinical method of motivational interviewing (MI) arose through a convergence of science and practice. Beyond a large base of clinical trials, advances have been made toward ..."looking under the hood" of MI to understand the underlying mechanisms by which it affects behavior change. Such specification of outcome-relevant aspects of practice is vital to theory development and can inform both treatment delivery and clinical training. An emergent theory of MI is proposed that emphasizes two specific active components: a relational component focused on empathy and the interpersonal spirit of MI, and a technical component involving the differential evocation and reinforcement of client change talk. A resulting causal chain model links therapist training, therapist and client responses during treatment sessions, and posttreatment outcomes.
Multidrug-resistant (MDR) enterococci are important nosocomial pathogens and a growing clinical challenge. These organisms have developed resistance to virtually all antimicrobials currently used in ...clinical practice using a diverse number of genetic strategies. Due to this ability to recruit antibiotic resistance determinants, MDR enterococci display a wide repertoire of antibiotic resistance mechanisms including modification of drug targets, inactivation of therapeutic agents, overexpression of efflux pumps and a sophisticated cell envelope adaptive response that promotes survival in the human host and the nosocomial environment. MDR enterococci are well adapted to survive in the gastrointestinal tract and can become the dominant flora under antibiotic pressure, predisposing the severely ill and immunocompromised patient to invasive infections. A thorough understanding of the mechanisms underlying antibiotic resistance in enterococci is the first step for devising strategies to control the spread of these organisms and potentially establish novel therapeutic approaches.
This review traces the development of motivational interviewing (MI) from its happenstance beginnings and the first description published in this journal in 1983, to its continuing evolution as a ...method that is now in widespread practice in many professions, nations and languages. The efficacy of MI has been documented in hundreds of controlled clinical trials, and extensive process research sheds light on why and how it works. Developing proficiency in MI is facilitated by feedback and coaching based on observed practice after initial training. The author reflects on parallels between MI core processes and the characteristics found in 70 years of psychotherapy research to distinguish more effective therapists. This suggests that MI offers an evidence-based therapeutic style for delivering other treatments more effectively. The most common use of MI now is indeed in combination with other treatment methods such as cognitive behaviour therapies.
Hal Arkowitz (1941-2019) Miller, William R.
The American psychologist,
02/2021, Letnik:
76, Številka:
2
Journal Article
Recenzirano
Memorializes Hal Arkowitz (1941-2019). Arkowitz was an integrator, with a contagious curi osity for merging seemingly disparate ideas like science and practice. He joined the faculty at the ...University of Oregon, later moving to the University of Arizona in 1977. He studied self-help treatment as well as resistance and impasses in psychotherapy, and he worked to humanize conditions and reduce violence in prisons. Arkowitz was fascinated by integrating concepts and methods from various theoretical orientations and was involved in forming the Society for the Exploration of Psychotherapy Integra tion, becoming the founding editor of the society's
. He also enjoyed writing for general audiences about the science of clinical psychology and myths of mental illness, witness his 2017 book with Scott Lilienfeld
. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Abstract There is often wide variability in the reported effects of complex behavioral interventions. Effectiveness can vary across studies, sites, and providers. A factor that has been ...insufficiently considered is the fidelity of the behavioral treatment that was provided. Low quality practice could be likened to partial doses of a vaccine or antibiotic: the right idea but insufficient strength. Using motivational interviewing (MI) as an example, the authors describe three quality conditions that should be present for a study to be regarded as a trial of a complex behavioral intervention: (1) The treatment should clearly contain the components that are theoretically or empirically related to its efficacy; (2) providers should be trained to an adequate and specified criterion of proficiency before treating trial patients; and (3) the fidelity of treatment should be documented by reliable coding of practice throughout the study and reported in a manner that permits comparison with skill levels in other trials. The authors also discuss bona fide intervention failures despite strong clinical trial methodology, offering recommendations for future outcome research.
In the 26 years since it was first introduced in this journal, motivational interviewing (MI) has become confused with various other ideas and approaches, owing in part to its rapid international ...diffusion.
Based on confusions that have arisen in publications and presentations regarding MI, the authors compiled a list of 10 concepts and procedures with which MI should not be addled.
This article discusses 10 things that MI is not: (1) the transtheoretical model of change; (2) a way of tricking people into doing what you want them to do; (3) a technique; (4) decisional balance; (5) assessment feedback; (6) cognitive-behavior therapy; (7) client-centered therapy; (8) easy to learn; (9) practice as usual; and (10) a panacea.
Clarity about what does (and does not) constitute MI promotes quality assurance in scientific research, clinical practice, and training.
The clinical method of motivational interviewing (MI) evolved from the person-centered approach of Carl Rogers, maintaining his pioneering commitment to the scientific study of therapeutic processes ...and outcomes. The development of MI pertains to all 3 of the 125th anniversary themes explored in this special issue. Applications of MI have spread far beyond clinical psychology into fields including health care, rehabilitation, public health, social work, dentistry, corrections, coaching, and education, directly impacting the lives of many people. The public relevance and impact of clinical psychology are illustrated in the similarity of MI processes and outcomes across such diverse fields and the inseparability of human services from the person who provides them, in that both relational and technical elements of MI predict client outcomes. Within the history of clinical psychology MI is a clear product of clinical science, arising from the seminal work of Carl Rogers whose own research grounded clinical practice in empirical science. As with Rogers' work 70 years ago, MI began as an inductive empirical approach, observing clinical practice to develop and test hypotheses about what actually promotes change. Research on MI bridges the current divide between evidence-based practice and the well-established importance of therapeutic relationship. Research on training and learning of MI further questions the current model of continuing professional education through self-study and workshops as a way of improving practice behavior and client outcomes.
What is the public health significance of this article?
The person-centered approach of motivational interviewing (MI) can effectively change health behaviors that influence the prevention, course, treatment, and outcomes of a broad range of health problems. Research on MI bridges the current divide between evidence-based practice and the well-established importance of therapeutic relationship. Treatments of this kind are inseparable from the person who provides them.
The survival and persistence of Mycobacterium tuberculosis depends on its capacity to manipulate multiple host defense pathways, including the ability to actively inhibit the death by apoptosis of ...infected host cells. The genetic basis for this anti-apoptotic activity and its implication for mycobacterial virulence have not been demonstrated or elucidated. Using a novel gain-of-function genetic screen, we demonstrated that inhibition of infection-induced apoptosis of macrophages is controlled by multiple genetic loci in M. tuberculosis. Characterization of one of these loci in detail revealed that the anti-apoptosis activity was attributable to the type I NADH-dehydrogenase of M. tuberculosis, and was mainly due to the subunit of this multicomponent complex encoded by the nuoG gene. Expression of M. tuberculosis nuoG in nonpathogenic mycobacteria endowed them with the ability to inhibit apoptosis of infected human or mouse macrophages, and increased their virulence in a SCID mouse model. Conversely, deletion of nuoG in M. tuberculosis ablated its ability to inhibit macrophage apoptosis and significantly reduced its virulence in mice. These results identify a key component of the genetic basis for an important virulence trait of M. tuberculosis and support a direct causal relationship between virulence of pathogenic mycobacteria and their ability to inhibit macrophage apoptosis.
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