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Sustainability Goes Change Talk: Can Motivational Interviewing Be Used to Increase Pro-Environmental behavior?

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Sustainability Goes Change Talk: Can Motivational Interviewing Be Used to Increase Pro-Environmental behavior?

Abstract and Figures

Motivational Interviewing (MI) is an interviewing style that has been used extensively in the field of addiction as a treatment intervention for clients that are either resistant to or ambivalent about change [11]. Since its origins in the field of addiction treatment, the use of MI has also been extended to health psychology, clinical psychology [6] and to a minor extent also coaching psychology [13]. This study explores the feasibility and efficacy of motivational interviewing in the field of ecological psychology. Specifically, we compared the effects of an MI with those of a Non-MI control interview on client change and sustain talk language about pro-environmental behavior. Interviewers in the intervention condition were trained in MI to talk with participants about their ecological behavior and to increase pro-environmental behavior. Seventy-one interviews were videotaped, and data was analyzed using a combination of two behavioral coding schemes: the German version of the motivational interviewing treatment integrity [5] and the motivational skill code for client language [10]. Results on client change talk show that clients in the MI condition uttered significantly more reasons for change and ability to change. It is suggested that MI may offer a method to increase pro-environmental behavior by means of increasing client change language.
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Sustainability Goes Change Talk: Can Motivational Interviewing Be Used to
Increase Pro-Environmental behavior?
F. E. Klonek1, S. Kauffeld1
1Institute of Psychology, Technical University Braunschweig, Braunschweig, Germany. f.klonek@tu-bs.de
Abstract
Motivational Interviewing (MI) is an interviewing style that has been used extensively in the field of addiction as
a treatment intervention for clients that are either resistant to or ambivalent about change [11]. Since its origins
in the field of addiction treatment, the use of MI has also been extended to health psychology, clinical
psychology [6] and to a minor extent also coaching psychology [13]. This study explores the feasibility and
efficacy of motivational interviewing in the field of ecological psychology. Specifically, we compared the effects
of an MI with those of a Non-MI control interview on client change and sustain talk language about pro-
environmental behavior. Interviewers in the intervention condition were trained in MI to talk with participants
about their ecological behavior and to increase pro-environmental behavior. Seventy-one interviews were
videotaped, and data was analyzed using a combination of two behavioral coding schemes: the German version
of the motivational interviewing treatment integrity [5] and the motivational skill code for client language [10].
Results on client change talk show that clients in the MI condition uttered significantly more reasons for change
and ability to change. It is suggested that MI may offer a method to increase pro-environmental behavior by
means of increasing client change language.
Introduction
The negative impact humans have on the ecological environment constitutes a major problem to our society [6].
Specifically, human behavior has effects on global warming, air and water pollution, depletion of environmental
and energy shortages. A challenging task for researchers and policy makers is to develop methods that can
reduce the negative human impact on the environment. As most of the respective effects are rooted in human
behavior, psychology can contribute to the solution of this problem by developing methods that increase pro-
environmental behavior [15]. Pro-environmental behavior consists of all behavioral efforts made not to harm the
environment or even to protect and safe environmental resources [15]. MI offers an innovative and promising
approach for communicating the severity of environmental problems, increasing actions to conserve
environmental resources and also reducing environmentally harmful behavior. MI originates in the treatment of
difficult patients in drug therapy, especially the treatment of alcohol problems [11]. Its major aim is to increase a
client’s intrinsic motivation for change. Over the last two decades the method has increasingly been used in a
variety of behavioral domains, for example for reducing risk behaviors, for the treatment of psychological
problems [6] and also as a method to increase healthy behavior [cf., 8]. In the most recent meta-analysis on MI,
the authors claim that they “have likely not yet found the limits of the types of problems (...) to which MI can be
profitably applied" [8, p. 154] . A key skill of MI is to listen for and prompt change talk. Change talk (CT) is any
client language that is directed towards changing a target behavior (in this case: pro-environmental behavior).
This can include reasons, desires, needs, abilities or commitments by the client to demonstrate the specific target
behavior. In contrast, sustain talk (ST) constitutes any client language against changing. This would include
benefits of the current behavior or resistance to change. Previous research using MI in a drug population has
demonstrated that CT and ST can predict outcomes of a target behavior, such as abstinent rates [1]. This line of
reasoning suggests that MI can also be implemented as a method to increase CT about pro-environmental
behavior. This is what the present study seeks to investigate. Specifically, we are interested in whether
participants who talk about their ecological behavior with an interviewer trained in MI show higher levels of CT
than participants who talk about their ecological behavior with an untrained interviewer.
Proceedings of Measuring Behavior 2012 (Utrecht, The Netherlands, August 28-31, 2012)
Eds. A.J. Spink, F. Grieco, O.E. Krips, L.W.S. Loijens, L.P.J.J. Noldus, and P.H. Zimmerman
297
Methods
Sample. Seventy-one participants (interviewees) received feedback on their environmental behavior.
Interviewees were allocated to one of two different groups of interviewers: i) an interviewer that conducted
feedback about ecological behavior in an MI style or ii) a control interviewer. All dyadic interactions were
videotaped and analyzed by means of the German version of the motivational interviewing treatment integrity
[MITI-d, 5] and the motivational skill code for client language [MISC 2.1, 10].
Intervention condition. MI has two aims: the first is to increase clients intrinsic motivation for change; the
second aim is to set goals for the new target behavior in collaboration with the client and develop measures for
how to achieve them. The interviewing style is based on four principles: 1) expressing empathy, 2) rolling with
resistance, 3) developing discrepancies, and 4) supporting self-efficacy. Within the MI style, specific techniques
are used, such as asking evocative questions (e.g., “What is a good reason for you to act pro-environmentally?”)
that aim to prompt client CT. Also, reflecting client utterances is considered a key method of active listening
skills.
Reflection
Client: “I don’t want to pay 100 € for my electric bill!”
Interviewer: ”You see better way spending 100 €, and saving energy is an easy method for you to achieve
that.”
Training for interviewers in the intervention condition. Interviewers in the intervention group received
training in MI. The interviewers were thirteen bachelor students of Psychology, one master student in Human
Resource Development and one PhD Psychology student. The author of the present study, who is certified in MI,
conducted the training of interviewers. Training took place from November 2011 until January 2012 and lasted
for a total of about 21 hours. It contained exercises aimed at improving MI performance using an active,
empathic listening style that minimizes confrontation. Additionally, interviewers took part in bi-weekly peer
coaching sessions to increase their communication skills. Supervision was included at the end of training by
means of tape recordings of these peer coachings. Control interviewers did not receive MI training. They were
given the task to convince their conversational partner to increase their pro-environmental behavior.
Procedure. To exclude the recruitment of clients who are already motivated to talk about their environmental
behavior, clients were kept blind about the topic of the interview until the interview started. Beforehand, they
received a questionnaire about their ecological behavior. They were told that it was a questionnaire to determine
their ecological footprint. Interviewers were given enough time to assess their respective client’s ecological
behavior prior the interview by means of this questionnaire. Interviewers in both groups were given a short
written agenda that listed the topics which needed to be covered during the conversation. These topics were: 1)
Setting the agenda, 2) Asking current environmental behavior, 3) Giving feedback about environmental behavior
to clients, 4) Asking for measures for increasing pro-environmental behavior, 5) Planning measures and giving
advice.
Instruments. Two instruments were combined to code the dyadic interaction: for analyzing the interviewer
behavior, the German Motivational Interviewing Treatment integrity, MITI-d, was used [5]. This instrument is a
reduced version of the MISC and has specifically been designed to code interviewer behavior only. It includes
seven different codes that are intended to capture behavioral micro-skills in MI (see left side of Figure 1). In
order to have a mutually exclusive and exhaustive coding scheme, an eighth category “Other behavior” was
added. This allowed coding every utterance of the conversation. Client behavior was analyzed by means of a
German version of the Motivational Interviewing Skill Code, MISC 2.1, for client language [10]. The MISC
includes 16 different codes that can be differentiated by their valence: client utterances with a positive
inclination towards change are termed “change talk”, whereas utterances that have a negative inclination toward
change are termed “sustain talk”. Coding was performed using INTERACT software [9], see Figure 2.
Proceedings of Measuring Behavior 2012 (Utrecht, The Netherlands, August 28-31, 2012)
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Eds. A.J. Spink, F. Grieco, O.E. Krips, L.W.S. Loijens, L.P.J.J. Noldus, and P.H. Zimmerman
Interviewer (MITI-d) Client (MISC)
MI Adherent (M)
a. Asking permission before giving advice or
information
b. Affirming the client
c. Emphasizing the client’s control,
d. Supporting the client
Open question (o)
Simple reflexion (e)
Complex reflexion (k)
Change Talk (+) /
Sustain Talk (-)
Reasons (G/g)
“I should”; “I must”; arguments for and against change
Desire (W/w)
“I want to…”; “I’d like to…”; “I love to…”
Ability (F/f)
“I can”; “I am able to…”
MI Non-adherent (m)
a. Giving advise without permission
b. Confronting
c. Directing the client by giving orders,
commands or imperatives.
Need (N/n)
“I need”; “I must”
Other (A/a)
Client movement towards or away from change that is not
captured by the other categories
Neutral
Giving Information (I)
a. Providing feedback from assessment
instruments
b. Personal feedback about the client that is not
already available
c. Explaining ideas or concepts relevant to the
intervention
d. Educating about a topic
Closed Question (c)
Taking steps (S/s)
Concrete and specific steps towards or away from the
target behavior
Commitment Language (V/v)
Agreements; intention to change; obligations
Follow Neutral (O)
No inclination towards or away from change
Figure 1. Coding Schemes: the left side shows MITI-d codes for interviewer behavior; the right side shows MISC codes for
client codes. Keyboard codes for each code are given in brackets.
To date, a subset of 28 dyads has been rated by two raters who had received 30 hours of training in the MITI-d
and MISC. Within this subset, 17 subjects belonged to the intervention group (MI-interview), and 11 subjects
belonged to the control group. To assess inter-rater agreement, a convenience sample of three dyads was double-
coded by both raters. Interact-time-event sequential data files were converted into Sequential Data interchange
standard (SDIS) using ActSds [3]. Interrater agreement (Time-unit kappa and event alignment kappa) was
determined using GSEQ [3]. Time-unit kappa was K=.77-.78 (80-82% agreement) and event alignment Kappa
was K =.66 (71 % agreement).
Proceedings of Measuring Behavior 2012 (Utrecht, The Netherlands, August 28-31, 2012)
Eds. A.J. Spink, F. Grieco, O.E. Krips, L.W.S. Loijens, L.P.J.J. Noldus, and P.H. Zimmerman
299
Figure 2. Coding of interviewer (left person) and client (right person) by means of Mangold Interact Software.
Preliminary Results
Interviewer language. In order to adjust for time differences in the interview length between both groups, we
calculated rates for separate codes (i.e., frequency of a code per 60 minutes). Interviewers that received training
in MI asked significantly more open questions and significantly fewer closed questions in comparison to
interviewers in the control group. The MI group interviewers also showed significantly higher levels in active
listening skills (rate of reflections) and less MI non-adherent behavior in comparison to the control group. We
compared behavioral summary scores of the MI interviewer sample with indicators of good MI [12]. Using these
benchmarks, the MI group can be classified within the beginning proficiency level (see Table 1).
Client language. Independent t-tests on client variables revealed that clients in the MI condition uttered
significantly more reasons to change (t(26) = 3.03, p<0.005) and showed significantly more language indicating
ability to change (t(16) = 2.60, p<0.019). Overall, clients in the MI group had more utterances of CT than of ST
(t(26) = 2.02, p= 0.054) although this was only nearly significant.
Table 1: MI quality benchmarks for competency and beginning proficiency: Means and standard deviations (in brackets) for
the MI and the control group.
Behavioral measure
Expert
level
Beginning
proficiency
Mean values
f
or MI group
Mean values
for control
group
Percentage of open questions
70 %
50%
52% (17.8)
23 % (9.6)
Percentage of complex reflexions
5
0%
40%
65% (14.8)
69% (19.8)
Reflections to
questions ratio
2:1
1:1
1
.2: 1
0
.46:1
Rate of
reflections in 10 min.
>15
>10
10
.6 (2.2)
4
.7 (2.2)
Percentage of MI-adherent
statements
100%
90%
95% (9
.2)
68% (24
.7)
Percent
age of talk time
< 50%
< 60%
42% (0.5)
46% (0.4)
Proceedings of Measuring Behavior 2012 (Utrecht, The Netherlands, August 28-31, 2012)
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Eds. A.J. Spink, F. Grieco, O.E. Krips, L.W.S. Loijens, L.P.J.J. Noldus, and P.H. Zimmerman
Discussion
Our results show that interviewers in the MI group demonstrated proficiency in MI as measured by the MITI-d,
whereas interviewers in the control group perform below the MI quality performance threshold. More
interestingly, clients in the MI condition had more reasons to change and showed higher ability to change as
captured by their natural language. These effects are in line with principles of MI that opt to increase clients’
reasons to change and support their self-efficacy [11].
Preliminary Conclusions
Our study reveals that MI can be easily adapted to an ecological psychology framework. Further, the MI style
effected client language in terms of increasing their reasons and ability to change. A previous study of MI in a
drug population sample showed that reasons and ability to change can have a significant effect on outcome
variables, such as abstinent rates [1]. Further analyses are needed to demonstrate whether this link can also be
supported for environmental behavior. When the final coding is completed, sequential analysis [2] will be carried
out to investigate sequential hypotheses from MI theory, and recurrence analysis will be used to detect specific
interaction patterns [14].
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This [textbook] helps establish important new links between environmental science and behavioral science. It develops a framework for addressing key questions about human behaviors that harm the environment, summarizes knowledge from psychology and related fields about these behaviors, and uses that knowledge to point the way to realistic solutions. This book develops a framework for addressing these questions, drawing on behavioral theory, real world case studies, field experiments, and other evidence. Because its central focus is individual behavior, it draws most heavily on concepts from social, cognitive, and behavioral psychology. However, it puts behavior in the context of the economic, institutional, and policy forces that shape it and emphasizes arenas where individual action makes a real difference to the natural environment. The result is an interdisciplinary treatment, rooted in behavioral science but addressing practical issues of environmental policy. The book is written at a level suitable for undergraduate students in psychology, social science, and environmental studies and science. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Client ambivalence is a key stumbling block to therapeutic efforts toward constructive change. Motivational interviewing—a nonauthoritative approach to helping people to free up their own motivations and resources—is a powerful technique for overcoming ambivalence and helping clients to get "unstuck." The first full presentation of this powerful technique for practitioners, this volume is written by the psychologists who introduced and have been developing motivational interviewing since the early 1980s. In Part I, the authors review the conceptual and research background from which motivational interviewing was derived. The concept of ambivalence, or dilemma of change, is examined and the critical conditions necessary for change are delineated. Other features include concise summaries of research on successful strategies for motivating change and on the impact of brief but well-executed interventions for addictive behaviors. Part II constitutes a practical introduction to the what, why, and how of motivational interviewing. . . . Chapters define the guiding principles of motivational interviewing and examine specific strategies for building motivation and strengthening commitment for change. Rounding out the volume, Part III brings together contributions from international experts describing their work with motivational interviewing in a broad range of populations from general medical patients, couples, and young people, to heroin addicts, alcoholics, sex offenders, and people at risk for HIV [human immunodeficiency virus] infection. Their programs span the spectrum from community prevention to the treatment of chronic dependence. All professionals whose work involves therapeutic engagement with such individuals—psychologists, addictions counselors, social workers, probations officers, physicians, and nurses—will find both enlightenment and proven strategies for effecting therapeutic change. (PsycINFO Database Record (c) 2012 APA, all rights reserved)