Test of a new motivational intervention for alcohol misuse, incorporating mobile phone reminders

Alcohol misuse is endemic and has significant impact. This proposal refines and tests an innovative motivational treatment (‘Functional Imagery Training’), 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. The proposal develops a mobile phone app that cues commitment and coping when alcohol control is under threat, using pictures, icons and brief descriptions. This study is an uncontrolled pilot with 12 participants, following them over 6 months, and collecting alcohol-related outcomes and qualitative responses. Participants attend 2 face-to-face treatment sessions at QUT, within one week of each other. Session 1 runs for 1.5 to 2 hours and provides normative assessment feedback, explores reasons for change and hypothetical goals, and introduces imagery training. Session 2 runs for 1.5 hours and provides further training in imagery, consolidates goal commitment and instructs participants in the use of the FIT mobile app which they begin using in their usual environment. Participants receive four 10-minute phone calls 1, 5, 11 and 23 weeks after session 2. Calls review and refine use of imagery and of the app. At each contact, participants are given general encouragement to continue using the app regularly. To monitor adherence, participants are asked specifically about their use of the app and its various functions during each phone session. 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 face-to face sessions, and uses a mobile phone app to cue functional motivations and related behaviours in the natural environment.