Assessing fidelity to integrated motivational interviewing and CBT therapy for psychosis and substance use: the MI-CBT fidelity scale (MI-CTS).

BACKGROUND: Guidelines for the psychological treatment of psychosis and substance use suggest integrated treatments to address both problems are necessary. One such treatment combines cognitive-behaviour therapy (CBT) and motivational interviewing (MI). While there are a number of scales to assess treatment fidelity to CBT and MI separately, none, to date, assess fidelity to integrated MI and CBT (MI-CBT) for psychosis and substance use. AIMS: This study aimed to develop a reliable and valid scale to assess fidelity to MI-CBT for people with psychosis and problematic substance use. METHOD: Items for a new scale (the MI-CTS fidelity scale) were selected from multiple relevant sources. Inter-rater reliability and validity (against the CTS-Psy and Motivational Interviewing Treatment Integrity (MITI)) scales were investigated. RESULTS: The scale had good inter-rater reliability when used to rate adherence versus non-adherence. In relation to validity, the scale related well to CBT and MI scales (the CTS-Psy and MITI). CONCLUSIONS: The MI-CTS is useful for assessing adherence to integrated MI-CBT for psychosis and substance misuse and could aid training and implementation of the approach.

Integrated motivational interviewing and cognitive-behavioural therapy for bipolar disorder with comorbid substance use.

Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.

Toward a Universal Maintenance Intervention: Integrating Cognitive-Behavioral Treatment With Motivational Interviewing for Maintenance of Behavior Change.

Improvements in behavior following active interventions diminish over time across a broad spectrum of behaviors. Motivational interviewing (MI) has been found to increase intrinsic motivation for initial behavior change, but there has been little discussion on how to integrate MI and the cognitive-behavioral treatments (CBTs) commonly used to maintain change. A prominent CBT approach to relapse prevention that has been tested in multiple behavioral domains includes the following maintenance strategies: managing the goal violation effect, flexible goal setting, identifying triggers and developing coping skills, and increasing self-efficacy and social support. Using a model of integration where MI is the foundation for CBT delivery, the integration of specific relational and technical components of MI and CBT strategies for maintenance of change are described. A universal maintenance intervention that uses MI as an integrative framework to deliver CBT may address maintenance of behavior change across multiple behavioral domains. Further research is necessary to confirm whether delivering MI with fidelity adds to the effectiveness of CBT maintenance interventions.