The thesis is theoretical and deals with the using of motivational interviewing with a clint addicted to psychoactive substances. It discusses the type of addiction and the psychological, somatic and social consequences. It outlines how the therapist can work with client?s motivation. The thesis describes the model of the cycle of the change by Prochaska and DiClemente. It also marginally mentiones model of changes by Buisman ? Kok. The thesis describes the elements, techniques, principles and strategies of motivational interviewing.

Falls are the primary cause of injuries among older adults, and accidents that result from falls can lead to personal suffering and extensive societal burdens. The overall aims of this thesis were to explore and describe falls and fall prevention strategies in community-dwelling older adults and to evaluate a fall prevention home exercise program, the Otago Exercise Program (OEP), with or without motivational interviewing (MI). Methods: Qualitative and quantitative research methods were uses. The designs were as follows: a cross-sectional, descriptive and comparative study (study I); a descriptive feasibility investigation (study II) and a randomized controlled trial (RCT) with two interventions, the OEP and OEP+MI, as well as a control group, with a 12-month follow-up (study III); and a prospective and descriptive study (study IV). The four studies comprised community-dwelling individuals aged 75 years or older. Study I included 262 individuals and studies II-IV had 175 participants who needed walking aids or home support. Study II also included 12 physical therapists.  Data collection was performed via self-reported questionnaires, fall calendars, exercise diaries, physical performance tests and a semi-structured questionnaire.  Results and conclusions: Suggested actions to prevent falls significantly differed between high and low active older adults (study I). Support for self-directed behavioral strategies could be important for preventing falls in older adults who have low physical activity levels. The study protocol for the RCT had acceptable feasibility (study II), and only minor changes of the protocol were needed. There were no benefits for OEP or OEP+MI with personal support implemented nine times over the 12-month period. However, all groups maintained physical functioning and activity (study III). To increase physical functioning and reduce falls in this sub-group of older adults, more frequent personal support and/or an alternative delivery format may be required for efficient intensity and challenge in home exercises. Over 12 months, falls and fall-related injuries in the RCT sample were the most common when moving around within the home and transitioning from sitting to standing (study IV). Special attention to these activities might be important for preventing falls in community-dwelling older adults who need walking aids or home support.

Background: In Canada, women aged 15-24 report the highest rate of depression, an age group which represents a significant proportion of undergraduate students (Hanlon, 2012). Although pharmacology remains the primary treatment for depression, it may not be the most sufficient (Stanton et al., 2014). Physical activity has been demonstrated to have a large and significant antidepressant effect in individuals with depression (Schuch et al., 2016), though what remains challenging is identifying the most effective way to activate this population. Physical Activity Counselling (PAC) has been shown in research to effectively increase levels of physical activity (Fortier et al., 2011). However, the effects of PAC have not been considered in a population of female students with depression specifically. Purpose: To investigate the effects of PAC on depressive symptoms, affect and physical activity in female undergraduate students with depression. Methods: Five female undergraduate students with depression received two months of PAC from a registered Kinesiologist. The study followed a multiple baseline, single-subject design in which measures were taken during four study phases: baseline, intervention, end point and follow-up. Data was collected, including daily objective measures of physical activity, using accelerometers, and self-reported measures of depressive symptoms, positive affect, negative affect and physical activity, using online surveys administered every second day. Results: Visual analyses revealed that depressive symptoms decreased and self-reported physical activity increased from baseline throughout subsequent study phases in all five participants, as hypothesized. Statistical analyses supported these results. Estimated effect sizes of grouped averages indicated that decreases in depressive symptoms from baseline throughout each study phase ranged from small to large, while increases in self-reported physical activity were in the medium to large range. Conclusions: Findings of this study provide initial support for Physical Activity Counselling as a potential strategy to increase physical activity levels and reduce depression among female undergraduate students with depression. Future research is recommended on this important topic.

Bakgrund Kardiovaskulära sjukdomar är en av de stora folksjukdomarna i Sverige som bidrar till lidande och dödsfall. Sjukdomstillståndet är delvis kopplat till levnadsvanor såsom ohälsosamma matvanor och fysisk inaktivitet. Motiverande samtal är en av många åtgärdsmetoder i primärvården som erbjuds patienter med kardiovaskulära sjukdomar för att förhindra ohälsa och motivera till livsstilsförändring. Syfte Syftet var att beskriva motiverande samtal som intervention i vård av patienter med kardiovaskulära sjukdomar inom primärvården. Metod En litteraturöversikt där 15 artiklar valdes ut och granskades. Sökningarna gjordes via databaserna PubMed/Medline, CINAHL Complete, SveMed +, PsychINFO samt Cochrane Library. Sökorden som användes i databaserna var: Nursing, Cardiovascular diseases, Motivational interviewing, Health promotion, Lifestyle, Person-centered, Primary Care, Primary Health Care, Lifestyle Counselling och Experiences. Resultat Majoriteten av studierna påvisade en god effekt av motiverande samtal vid förändring av levnadsvanor hos patienter med kardiovaskulära sjukdomar, i jämförelse med traditionell rådgivning. Slutsats MI är en övervägande effektiv metod för livsstilsförändring av ohälsosamma matvanor och otillräcklig fysisk aktivitet hos patienter med kardiovaskulära sjukdomar i primärvården i jämförelse med traditionell rådgivning. Det råder även en övervägande positiv inställning till MI från patientens och sjuksköterskans perspektiv. Effekten av metoden och dess funktion är dock kopplade till flera faktorer som bör överensstämma för att MI ska fungera i praktiken. Dessa faktorer kan sammanfattas som: sjuksköterskans utbildning och attityd till MI, patientens motivation till förändring samt ledningens satsning på implementering och uppföljning.

There is a great deal of empirical evidence to support the efficacy and effectiveness of cognitive therapeutic approaches such as cognitive behaviour therapy (CBT) and motivational interviewing (MI). In addition to this, research has identified several mechanisms of change thought to underlie these approaches. However, there has been little exploration of the specific cognitive and emotional processes that may underlie change in CBT and MI, or indeed their interactions. This thesis specifically explored the role of reasoning and emotion in relation to MI and CBT.In the first paper, the initial sections provided a narrative review whereby the roles of reasoning and emotion in CBT and MI were critically evaluated in context of existing empirical evidence. Further to this, the literature examining the effects of emotion on deductive reasoning was systematically reviewed. A total of 19 papers were identified and the implications of the studies’ findings discussed in relation to the clinical practice of CBT and MI. The studies varied noticeably in terms of the quality of the methodologies employed. Overall the studies considered, suggested that the effects of emotion on reasoning were complex, and yet to be well understood. However, through extrapolating the findings from the experimental study of cognition and emotion to the clinical practice of CBT and MI, the review demonstrated the potential relevance of such findings, and indicated the need for research exploring the role of reasoning and emotion in these approaches.The second, empirical paper examined the extent to which statements reflecting informal reasoning and the emotional state of the client affected the generation of positive behaviour change statements and positive behaviour change in the context of MI with individuals with psychosis and alcohol use disorders. Participants (n=26) were clients selected from a large randomised controlled trial of integrated MI and CBT for psychosis and substance use. One audio recorded therapy session was selected for each participant. Reasoning and emotion statements were subsequently identified and categorised for each therapy session. It was found that the total number of reasoning statements generated positively predicted the total number of positive behaviour change statements generated. It was also found that negative emotional statements relating to the present, positively predicted the total number of reasoning statements generated. The results suggested that informal reasoning may be a specific cognitive process underpinning the production of behaviour change statements in MI with individuals with psychosis and alcohol use disorders, and provided support for the central role of discrepancy in producing change in MI. The final section provided a critical reflection of the research process. This included a rationale for the development of the literature review and the empirical paper, followed by a critical reflection on the study context and its’ implication to the study methodology. Finally the theoretical and future implications for research in this area were discussed along with the implications to clinical practice.

Motivational interviewing (MI) is a counselling approach developed in part by clinicalpsychologists William R. Miller and Stephen Rollnick. It is a directive, client-centredcounselling style for eliciting behaviour change by helping clients to explore andresolve ambivalence. The method has grown in popularity during the last years and has spreadoutside the therapy room and into new fields where it is being applied such as healthcare, socialservice and the police. The usage of MI in therapeutic and healthcare settings is well researchedbut MI has recently emerged in a new field where the research is scarce: leadership. In thisstudy we are exploring the experiences of Swedish social workers that are trained in MI whichhas a manager that is also trained in the method and applies MI in leadership. Our results showthat the social workers are generally positive to their managers using the method; MI is seen asa factor that influences the manager to listen and be more empathetic. Our study also showsthat MI has become a general tool for interactions; the social workers are using the methodoutside client meetings and in interactions with colleagues and managers to facilitate a goodrelationship. However, there are also concerns among some of the respondents that MI couldbe used by their manager to manipulate and create behaviour changes that only benefits theorganisation. This explorative study shows that MI has the potential to impact management andleadership approaches and warrants further investigation to develop this growing field ofinterest.

The aim of the study is to gain an understanding of how the preventive work of crime relapse practically appears in the Swedish prisons. The aim of the study is also to gain an understanding of the difficulties with the preventive crime relapse work in Swedish prisons. Staff from the field of the Swedish prisons and former prisoners have been the informants of the study. The study is qualitative study and the empiricism has been generated from semi structured interviews. The study shows that the staff is working with preventive work of crime relapse through programmes that focus on the specific crime the prisoners been involved in. One difficulty with this is that prisoners are not are forced to go to the programmes. In the case of short imprisonment it is also hard for the staff to get time to implement programs for the prisoners. The staff at the prisons get educated in motivational interviewing and are supposed to work with motivational interviewing in the everyday meeting with the prisoners. This work is insufficient and does not work in a desirable way. The study also present that the environment at the prisons may have significance for studied subjects, but the budget for the prisons is not enough to frame the environment in a desirabl e way.

The aim of the study is to gain an understanding of how the preventive work of crime relapse practically appears in the Swedish prisons. The aim of the study is also to gain an understanding of the difficulties with the preventive crime relapse work in Swedish prisons. Staff from the field of the Swedish prisons and former prisoners have been the informants of the study. The study is qualitative study and the empiricism has been generated from semi structured interviews. The study shows that the staff is working with preventive work of crime relapse through programmes that focus on the specific crime the prisoners been involved in. One difficulty with this is that prisoners are not are forced to go to the programmes. In the case of short imprisonment it is also hard for the staff to get time to implement programs for the prisoners. The staff at the prisons get educated in motivational interviewing and are supposed to work with motivational interviewing in the everyday meeting with the prisoners. This work is insufficient and does not work in a desirable way. The study also present that the environment at the prisons may have significance for studied subjects, but the budget for the prisons is not enough to frame the environment in a desirabl e way.

Change-talk (CT), or self-arguments for change, has been associated with favorable patient outcomes, while counter change-talk (CCT), or self-arguments against change, has been associated with poorer outcomes. Most studies on change language have focused on the prediction of distal posttreatment outcomes, while the prediction of more proximal outcomes has remained largely untested. Addressing this gap, we examined early treatment CT and CCT as predictors of worry change trajectories, “hazard” of clinically significant response, and time to response (i.e., outcome efficiency) in CBT and CBT integrated with MI (MI-CBT) for generalized anxiety disorder (GAD). We also explored whether treatment type moderated these associations. Data derived from a randomized controlled trial comparing CBT (n = 43) and MI-CBT (n = 42) for GAD. Independent observers reliably coded CT/CCT during session 1. Patients rated their worry after every session. Multilevel modeling revealed that, across both treatments, more CT associated with lower midtreatment worry level (p = .03), whereas more CCT associated with a slower rate of worry reduction at midtreatment (p = .04). However, treatment moderated the associations between CT and both midtreatment worry level (p = .004) and rate of change (p = .03). In CBT, patients with higher vs. lower CT had less worry and a faster rate of worry reduction; in MI-CBT, CT was unrelated to midtreatment worry level and the rate of worry change. Treatment did not moderate the CCT-worry relations. Survival analyses revealed that, across both treatments, more CT associated with a greater hazard of response (p = .004) and approached a faster time to response (p = .05), and more CCT associated with a lower hazard of response (p = .002) and approached a slower time to response (p = .06). Patient motivational language predicts proximal outcomes, and may be useful in differential treatment selection.

Aim: A randomized clinical trial demonstrated that responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) outperformed CBT alone on long-term worry reduction (Westra et al., 2016). Consistent with MI’s additive aim, this effect was mediated by less patient midtreatment resistance in the integrative treatment (Constantino et al., 2019). Insofar as GAD is marked by interpersonal styles of excessive nonassertiveness and over accommodation, I tested here whether MI-CBT also outperformed CBT, across acute treatment and long-term follow up, on reducing these characteristic interpersonal problems. Moreover, as patient resistance is an interpersonal event for which person-centered MI should, according to theory, be more helpful than directive CBT, I tested if resistance also mediated the expected effect of treatment on the long-term interpersonal outcomes. Method: Eighty-five patients with severe GAD were randomly assigned to 15 sessions of MI-CBT or CBT. Patients completed a measure of interpersonal problems repeatedly through treatment and 12 months of follow up. Independent observers rated patient resistance at a midtreatment session. Results: As expected, structural equation models revealed comparable reductions in nonassertiveness and over accommodation across acute MI-CBT and CBT. Also as predicted, MI-CBT vs. CBT promoted significantly greater reduction in over accommodation problems over long-term follow up; however, this differential effect was only marginally significant for nonassertiveness problems. Finally, as predicted, the treatment effect on the level of both interpersonal problems at 12-month follow up was mediated by less midtreatment resistance in MI-CBT vs. CBT. Discussion: Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal change, and they implicate resistance management as a candidate mechanism of this additive effect.