Empirical studies in the creative arts therapies (CATs; i.e., art therapy, dance/movement therapy, drama therapy, music therapy, psychodrama, and poetry/bibliotherapy) have grown rapidly in the last 10 years, documenting their positive impact on a wide range of psychological and physiological outcomes (e.g., stress, trauma, depression, anxiety, and pain). However, it remains unclear how and why the CATs have positive effects, and which therapeutic factors account for these changes. Research that specifically focuses on the therapeutic factors and/or mechanisms of change in CATs is only beginning to emerge. To gain more insight into how and why the CATs influence outcomes, we conducted a scoping review (Nstudies = 67) to pinpoint therapeutic factors specific to each CATs discipline, joint factors of CATs, and more generic common factors across all psychotherapy approaches. This review therefore provides an overview of empirical CATs studies dealing with therapeutic factors and/or mechanisms of change, and a detailed analysis of these therapeutic factors which are grouped into domains. A framework of 19 domains of CATs therapeutic factors is proposed, of which the three domains are composed solely of factors unique to the CATs: “embodiment,” “concretization,” and “symbolism and metaphors.” The terminology used in change process research is clarified, and the implications for future research, clinical practice, and CATs education are discussed.
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Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event. Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation. Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”
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Artikel proefschrift Jos Dobber verschenen in Frontiers in Psychiatry 24 maart 2020: Background: Trials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms. Methods: First, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk. Results: We found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change. Conclusions: Mechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
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AIM: To contribute to the knowledge and understanding of the active ingredients and mechanisms of change in Motivational Interviewing (MI), to enable MI-counsellors to optimise their MI-strategies in daily practice.METHOD: The body of this dissertation are two multiple case studies, one in 14 patients with schizophrenia receiving MI for medication adherence; another in 24 patients with a coronary artery disease receiving MI for smoking cessation.FINDINGS: We found that the active ingredients of MI consist of combinations of clinician factors and patient factors, mostly built up during longer interactions. ‘Arguing oneself into change’ was the most frequently observed mechanism of change.DISCUSSION AND CONCLUSION: Active ingredients in MI consist off combinations of factors contributed by the clinician and factors contributed by the patient. These factors can be employed in a person-centred MI-strategy to trigger a mechanism of change in the patient.This dissertation adds to the understanding of MI since it provides an explanation of how MI may work. It offers a general idea how counsellors can effectively execute MI. This ‘how-possibly’ explanation may be a building block in the development of a ‘how-actually’ explanation of the interactions leading to the active ingredients and mechanisms of change in MI.--De vraagstelling van het proefschrift is hoe MGv werkt: wat zijn de actieve ingrediënten en de verandermechanismen van motiverende gespreksvoering? De twee patiëntengroepen laten zien dat de actieve ingrediënten van MGv bestaan uit een wisselende combinatie van zorgverlener- en patiëntfactoren. Actieve ingrediënten ontstaan gedurende een langer lopende interactie tussen patiënt en professional.
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Background: For patients with coronary artery disease (CAD), smoking is an important risk factor for the recurrence of a cardiovascular event. Motivational interviewing (MI) may increase the motivation of the smokers to stop smoking. Data on MI for smoking cessation in patients with CAD are limited, and the active ingredients and working mechanisms of MI in smoking cessation are largely unknown. Therefore, this study was designed to explore active ingredients and working mechanisms of MI for smoking cessation in smokers with CAD, shortly after a cardiovascular event.Methods: We conducted a qualitative multiple case study of 24 patients with CAD who participated in a randomized trial on lifestyle change. One hundred and nine audio-recorded MI sessions were coded with a combination of the sequential code for observing process exchanges (SCOPE) and the motivational interviewing skill code (MISC). The analysis of the cases consisted of three phases: single case analysis, cross-case analysis, and cross-case synthesis. In a quantitative sequential analysis, we calculated the transition probabilities between the use of MI techniques by the coaches and the subsequent patient statements concerning smoking cessation.Results: In 12 cases, we observed ingredients that appeared to activate the mechanisms of change. Active ingredients were compositions of behaviors of the coaches (e.g., supporting self-efficacy and supporting autonomy) and patient reactions (e.g., in-depth self-exploration and change talk), interacting over large parts of an MI session. The composition of active ingredients differed among cases, as the patient process and the MI-coaching strategy differed. Particularly, change talk and self-efficacy appeared to stimulate the mechanisms of change “arguing oneself into change” and “increasing self-efficacy/confidence.”Conclusion: Harnessing active ingredients that target the mechanisms of change “increasing self-efficacy” and “arguing oneself into change” is a good MI strategy for smoking cessation, because it addresses the ambivalence of a patient toward his/her ability to quit, while, after the actual cessation, maintaining the feeling of urgency to persist in not smoking in the patient.
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Background Communication between people with aphasia and their healthcare professionals (HCPs) can be greatly improved when HCPs are trained in using supportive conversation techniques and tools. Communication partner training (CPT) is an umbrella term that covers a range of interventions that train the conversation partners of people with aphasia. Several CPT interventions for HCPs have been developed and used to support HCPs to interact successfully with people with aphasia. Aims The objective of this study was to identify the mechanisms of change as a result of a Dutch CPT intervention, named CommuniCare, in order to evaluate and optimise the intervention. Methods & procedures A total of 254 HCPs from five different healthcare centres received CommuniCare. An explorative qualitative research design was chosen. Two interviews were conducted with 24 HCPs directly after and 4 months after receiving the training that was part of CommuniCare. Two conceptual frameworks were used to deductively code the interviews. HCPs’ perspectives were coded into a four-part sequence following CIMO logic: the self-reported use of supportive conversation techniques or tools pre-intervention (Context), the intervention elements (Intervention) that evoked certain mechanisms (Mechanisms), resulting in the self-reported use of supportive conversation techniques and tools post-intervention (Outcomes). The Capabilities Opportunities Motivation–Behaviour (COM-B) model was used to fill in the Mechanisms component. Outcomes & results Three themes were identified to describe the mechanisms of change that led to an increase in the use of supportive conversation techniques and tools. According to HCPs, (i) information, videos, e-learning modules, role-play, feedback during training and coaching on the job increased their psychological capabilities; (ii) information and role-play increased their automatic motivations; and (iii) information, videos and role-play increased their reflective motivations. Remaining findings show HCPs’ perspectives on various barriers to use supportive conversation techniques and tools. Conclusions & implications HCPs in this study identified elements in our CPT intervention that positively influenced their behaviour change. Of these, role-play and coaching on the job were particularly important. HCPs suggested this last element should be better implemented. Therefore, healthcare settings wishing to enhance HCPs’ communication skills should first consider enhancing HCPs’ opportunities for experiential learning. Second, healthcare settings should determine which HCPs are suitable to have a role as implementation support practitioners, to support their colleagues in the use of supportive conversation techniques and tools.
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Due to the variegated nature of the teaching profession system, different actors operating in this system (teachers, school leaders, policy makers) are inevitably intertwined and assumably influence each other’s sensemaking processes, especially when system-wide educational change occurs. Gaining insight into how different actors in the teacher profession system make sense of educational change is important, as it might hamper or enable the system's adaptive capacity. That is why we stretched Coburn’s model of collective sensemaking from a teacher-team lens to include different actors and focus on their interpersonal dynamics during sensemaking processes. Performing a conceptual review, we synthesized 87 articles which focus on collective sensemaking of the following actor groups: (1) teachers (micro), (2) school leaders (meso), and/or (3) district/state/national leaders, policy makers, professional development providers, curriculum developers, researchers, community members, and parents (macro). In the results we describe how actors’ involvement varied due to different role distributions and role perceptions of actors. In addition, four contextual factors influencing the interpersonal dynamics were distinguished that were closely related to leadership practices that enable actors to compare the change with their own beliefs and (organizational) practices. We describe three mechanisms which explain how actors valuate a change (valuating), how they are owning this change (owning), and which is shaped by gatekeeping of sensegivers in their social context (gatekeeping).
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Though there are different interpretations in the scholarly literature of what a social learning is: whether it is an individual, organisational, or collective process. For example, Freeman (2007), in his study on policy change in the public health sector, conceptualised collective learning of public officials as a process of epistemological bricolage. In his interpretation, the new policy ideas are the result of this bricolage process, when the “acquired second-hand” ideas are transformed into “something new”. The literature on (democratic) governance points opens another perspective to the policy change, emphasising the importance of public engagement in the policy-making process. Following this school of thought the new policy is the result of a deliberative act that involves different participants. In other words, the ideas about policy are not borrowed, but are born in social deliberation. Combining the insights gained from both literatures – social learning and governance – the policy change is interpreted, as a result of a broad social interaction process, which is also the social learning for all participants.The paper will focus on further development of the conceptualisation of policy change through social deliberation and social learning and will attempt to define the involved micro mechanisms. The exploratory case study of policy change that was preceded by a broad public debate will help to describe and establish the mechanisms. Specifically, the paper will focus on the decision of the Dutch government to cease the exploration of natural gas from the Groningen gas field. The radical change in national policy regarding gas exploration is seen as a result of a broader public debate, which was an act of social deliberation and social learning at the same time.
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Innovation is crucial for higher education to ensure high-quality curricula that address the changing needs of students, labor markets, and society as a whole. Substantial amounts of resources and enthusiasm are devoted to innovations, but often they do not yield the desired changes. This may be due to unworkable goals, too much complexity, and a lack of resources to institutionalize the innovation. In many cases, innovations end up being less sustainable than expected or hoped for. In the long term, the disappointing revenues of innovations hamper the ability of higher education to remain future proof. Against the background of this need to increase the success of educational innovations, our colleague Klaartje van Genugten has explored the literature on innovations to reveal mechanisms that contribute to the sustainability of innovations. Her findings are synthesized in this report. They are particularly meaningful for directors of education programs, curriculum committees, educational consultants, and policy makers, who are generally in charge of defining the scope and set up of innovations. Her report offers a comprehensive view and provides food for thought on how we can strive for future-proof and sustainable innovations. I therefore recommend reading this report.
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BackgroundTrials studying Motivational Interviewing (MI) to improve medication adherence in patients with schizophrenia showed mixed results. Moreover, it is unknown which active MI-ingredients are associated with mechanisms of change in patients with schizophrenia. To enhance the effect of MI for patients with schizophrenia, we studied MI's active ingredients and its working mechanisms.MethodsFirst, based on MI literature, we developed a model of potential active ingredients and mechanisms of change of MI in patients with schizophrenia. We used this model in a qualitative multiple case study to analyze the application of the active ingredients and the occurrence of mechanisms of change. We studied the cases of fourteen patients with schizophrenia who participated in a study on the effect of MI on medication adherence. Second, we used the Generalized Sequential Querier (GSEQ 5.1) to perform a sequential analysis of the MI-conversations aiming to assess the transitional probabilities between therapist use of MI-techniques and subsequent patient reactions in terms of change talk and sustain talk.ResultsWe found the therapist factor “a trusting relationship and empathy” important to enable sufficient depth in the conversation to allow for the opportunity of triggering mechanisms of change. The most important conversational techniques we observed that shape the hypothesized active ingredients are reflections and questions addressing medication adherent behavior or intentions, which approximately 70% of the time was followed by “patient change talk”. Surprisingly, sequential MI-consistent therapist behavior like “affirmation” and “emphasizing control” was only about 6% of the time followed by patient change talk. If the active ingredients were embedded in more comprehensive MI-strategies they had more impact on the mechanisms of change.ConclusionsMechanisms of change mostly occurred after an interaction of active ingredients contributed by both therapist and patient. Our model of active ingredients and mechanisms of change enabled us to see “MI at work” in the MI-sessions under study, and this model may help practitioners to shape their MI-strategies to a potentially more effective MI.
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