Wednesday, November 7, 2012

Testing Motivational Calls

A Veterans Administration’s study published in “General Hospital Psychiatry” found that a brief therapeutic phone conversation called motivational interviewing is more effective than a simple “check-in” call to convince Iraq and Afghanistan veterans diagnosed with mental health problems to seek treatment. The study was led by Dr. Karen Seal, Director of the Integrated Care Clinic at the San Francisco VA Medical Center.

“Fifty two percent of the half million Iraq and Afghanistan veterans currently being seen by the VA have one or more mental health issues,” Seal reports. “These diagnoses include PTSD, depression, and anxiety.”

“We have gone to great lengths to provide these veterans with state-of-the-art mental health treatment, but the problem is that they are not always engaging in the treatment. Our study was designed to try to connect our veterans with the treatments that are available to them. A simple telephone conversation, if done correctly seems to go a long way in getting these veterans into treatment.”

Motivational interviewing happens when counselors encourage their clients to explore and talk about discrepancies between their core values and how they actually behave. It’s a psychotherapeutic intervention that has been used successfully in other settings, according to Seal. Explaining to a counselor how you want to change your behavior can motivate you to actually make some behavioral changes. The counselor can then support and encourage your intention to make changes.

The study used 73 veterans who screened positive for one or more mental health issues, but were not currently in treatment. Than the 73 veterans were randomly assigned either to Group A or Group B. Members of Group A received four motivational interviewing sessions. Group B, the control group, received four neutral check-in sessions over a period of eight weeks.

All of the sessions were done by phone. By the end of the study, 62 percent of the motivational interviewing group had begun treatment while only 26 percent of the control group received treatment.

The counselors who helped conduct this study were not licensed clinicians, but people with master’s degrees who trained for about eight hours. This can mean that the expense for personnel to do motivational interviewing will not be huge if this form of interviewing becomes routine.

Seal emphasized that the study while encouraging was simply an initial pilot trial designed to assess the potential effectiveness of motivational interviewing that occurs over the phone. More research is needed to test the technique with larger groups of veterans so the VA is planning a follow-up study involving veterans at VA outpatient clinics in rural communities.