Test of a phone-delivered motivational intervention for alcohol misuse, incorporating use of electronic devices to set reminders.

Alcohol misuse is endemic and has significant impact. This proposal refines and tests an innovative motivational treatment (‘Functional Imagery Training’, or ‘FIT’), based on the applicants’ Elaborated Intrusion Theory of desire. A key focus is on individually tailored imagery to consolidate motivation, interfere with craving, rehearse coping strategies and enhance self-efficacy. This study is an uncontrolled pilot that tests a phone-delivered version of FIT with 30 participants, following them over a 6-month period, and collecting alcohol-related outcomes and qualitative responses. Results underpin a planned NHMRC Project Grant application for 2014. Participants receive 3 phone sessions each spaced one week apart. Session 1 runs for 45 minutes and elicits motivation for change and previous self-control achievements and introduces imagery training. Session 2 runs for 45 minutes and consolidates their goal and assists them to develop a plan, using imagery to reinforce each step. Session 3 runs for 30 minutes and prepare for rehearsal of imagery at home. An additional 4 support phone calls lasting 15 minutes each are delivered in weeks 7, 13, 19 and 25. These calls reinforce achievements and imagery rehearsal. SMSs in weeks 5, 11 and 15 remind participants to think about their goals, rehearse imagery and review their session summaries. All sessions are conducted by clinically trained and registered Psychologists. Critical to successfully addressing any dysfunctional behaviour is enlistment of motivation. So important is this factor that brief advice for addictive behaviors can be as effective as more extensive counselling (Kaner et al., 2009). The most highly developed approach to eliciting change is motivational interviewing (MI, Miller & Rollnick, 2002). Rather than trying to convince people to adopt new behaviours, MI provides an empathic context where they consider options. It encourages them to explore competing motivations and concerns, amplifying inconsistencies between their behaviours and valued goals. MI has strong empirical support (Ruba et al., 2005), not only as a prelude to other treatment, but as a stand-alone intervention (Miller & Wilbourne, 2002). However, effect sizes still have substantial room for improvement: A recent trial on alcohol misuse and depressive mood on which the current investigators collaborated, found a within-group reduction of only 0.25 SD in weekly alcohol intake to 18 weeks from a session of MI (Baker et al., 2010). Our recent internet-based trial on a similar sample obtained a fall in weekly consumption of 0.69 SD to 6 weeks from the motivational module (Kavanagh et al., in preparation). The Elaborated Intrusion (EI) Theory of desire (Kavanagh, Andrade & May, 2005) provides a roadmap for enhancing MI. EI theory emphasises the roles of intrusive thoughts and cognitive elaboration, especially involving imagery, in motivation generally and craving specifically. Intensity of craving is greater when sensory imagery is more vivid and salient (Kavanagh, May, & Andrade, 2009). Goals and motivation to attain them, are sustained by imagery (Andrade, May, & Kavanagh, 2012). Conversely, craving is reduced when a concurrent task (such as other novel or episodic imagery) competes for the same limited working memory resources (May, Andrade, Panabokke & Kavanagh, 2010). Enhancing functional motivation therefore requires: (i) increasing the salience of cues and strengthening the link between cues and the functional goal to boost thoughts about the goal, (ii) increasing the salience of these thoughts to increase the likelihood that they are elaborated, and (iii) enhancing the vividness of imagery about the functional goal and awareness of associated affect. This positive imagery is the critical goal of our innovation: it strengthens motivation towards the functional goal and simultaneously interferes with imagery about the dysfunctional target. Functional Imagery Training (FIT) implements these theoretical and empirical advances in our understanding of motivation, and how it is maintained (Andrade et al., 2012). It retains the spirit and typical elements of MI, but employs imagery throughout phone-delivered sessions, allowing greater potential reach, and employing the use of any available technology to take pictures and set reminders to cue functional motivations and related behaviours in the natural environment.