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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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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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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In my view, organisations are playing an ever-larger role with and in these changes. This is why we need organisations that are not afraid to express and give concrete meaning to their innovative views on economic and social themes. These are organisations that dare to break out of the old thought and behavioural patterns in order to create room for change and renewal. They are guided by an innovative philosophy and mode of thinking, and show this leadership by translating this body of thought into concrete actions and results. This is why, in the professorship, we call these organisations ‘thought leaders in a society of change’.
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Habitual behavior is often hard to change because of a lack of self-monitoring skills. Digital technologies offer an unprecedented chance to facilitate self-monitoring by delivering feedback on undesired habitual behavior. This review analyzed the results of 72 studies in which feedback from digital technology attempted to disrupt and change undesired habits. A vast majority of these studies found that feedback through digital technology is an effective way to disrupt habits, regardless of target behavior or feedback technology used.
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Results: We observed a variation of factors which seemed to contribute to the active ingredients. Most prevalent was (eliciting) ‘change talk’, but also factors such as ‘experiencing competency’ and ‘changing sense making’. Since mechanisms of change refer to psychological processes within the patient’s mind, it is impossible to observe these. But we recognised clues for mechanisms of change, the most prevalent mechanism was ‘arguing oneself into change’. The most important conversational techniques are reflections and questions addressing medication adherent behaviour or intentions, which was often (in 74% and 69% of the time respectively) followed by change talk. Conclusions: Active ingredients of MI seem to consist of a sufficient combination of factors, to which both patient and therapist contribute. This combination may act as an active ingredient and can trigger mechanisms of change. Our study suggests that in particular the patient factors are a pool of factors from which, after proper activation by therapist factors, different combinations can form active ingredients.
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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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To improve people’s lives, human-computer interaction researchers are increasingly designing technological solutions based on behavior change theory, such as social comparison theory (SCT). However, how researchers operationalize such a theory as a design remains largely unclear. One way to clarify this methodological step is to clearly state which functional elements of a design are aimed at operationalizing a specific behavior change theory construct to evaluate if such aims were successful. In this article, we investigate how the operationalization of functional elements of theories and designs can be more easily conveyed. First, we present a scoping review of the literature to determine the state of operationalizations of SCT as behavior change designs. Second, we introduce a new tool to facilitate the operationalization process. We term the tool blueprints. A blueprint explicates essential functional elements of a behavior change theory by describing it in relation to necessary and sufficient building blocks incorporated in a design. We describe the process of developing a blueprint for SCT. Last, we illustrate how the blueprint can be used during the design refinement and reflection process.
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Climate change is now considered more than just an environmental issue, with far-reaching effects for society at large. While the exact implications of climate change for policing practice are still unknown, over the past two decades criminologists have anticipated that climate change will have a number of effects that will result in compromised safety and security. This article is informed by the outcome of a co-creation workshop with 16 practitioners and scholars of diverse backgrounds based in The Netherlands, who sought to conceptualize and systematize the existing knowledge on how climate change will most likely impact the professional practice of the Dutch (or any other) police. These challenges, with varying degrees of intensity, are observable at three main levels: the societal, organizational, and individual level. These levels cannot be separated neatly in practice but we use them as a structuring device, and to illustrate how dynamics on one level impact the others. This article aims to establish the precepts necessary to consider when exploring the intersection between climate change and policing. We conclude that much still needs to be done to ensure that the implications of climate change and the subject of policing are better aligned, and that climate change is recognized as an immediate challenge experienced on the ground and not treated as a distant, intangible phenomenon with possible future impacts. This starts with creating awareness about the possible ways in which it is already impacting the functioning of policing organizations, as well as their longer-term repercussions.
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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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