Relational Skills and Client Language Predict Outcome in Smoking Cessation Treatment

ABSTRACT

Background: We currently lack insight into the predictive processes of Motivational Interviewing (MI) in smoking cessation treatment. More knowledge is necessary to be able to further enhance the treatment effect in smoking cessation interventions. Objectives: To examine certain hypothesized active components of MI in smoking cessation treatment delivered in an ordinary clinical setting. Methods: Audio-recordings of 106 smoking cessation treatment sessions were analyzed using the Motivational Interviewing Sequential Code for Observing Process Exchanges (MI-SCOPE) Coder's Manual and the Motivational Interviewing Treatment Integrity code (MITI) Manual, version 3.1. The outcome measure was self-reported 6-month continuous abstinence at 12-month follow-up. Results: Client Activation utterances in favor of change were positively associated with smoking cessation at follow-up. The combined category of client language expressing a Desire or a Need to continue to smoke was negatively predictive of smoking cessation. In addition, we found preliminary support for a negative interaction effect between counselors' demonstration of the spirit of MI and clients Activation utterances in favor of change. Conclusions/Importance: Our data suggest that if smoking cessation counselors cultivate client Activation utterances in favor of abstinence and softening client utterances expressing desire or perceived need to smoke, this could contribute to higher rates of treatment success. In addition, counselors' demonstration of the spirit of MI was a statistically significant predictor of outcome when the negative interaction effect between Activation utterances in favor of change and MI spirit was taken into account. These findings should be evaluated in larger studies in the future.

KEYWORDS:

• Smoking cessation
• telephone counseling
• motivational interviewing
• therapeutic process
• MI spirit
• change talk
• sustain talk
• interaction effect

Acknowledgments

We would especially like to thank Dr. Wolfgang Hannöver and Carola Blaut who trained the coders in MI-SCOPE. Moreover, the constructive suggestions, support and generosity of Dr. Wolfgang Hannöver are greatly appreciated. We are also grateful to the contribution of Carola Hellberg and Nina Lindroos, most notably for their work in parsing and coding the audio-recorded sessions. The authors would like to thank all the counselors working at the Swedish National Tobacco Quitline, and the assistance of Maria Rankka, Mats Taftgård and Ásgeir Helgason is gratefully acknowledged. We would also like to thank Isra Black for the careful editing of the manuscript drafts.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Funding

This work was funded by the Swedish Cancer Society, Stockholm County Council, the Swedish Heart and Lung Association, the Swedish Research Council, the Swedish Council for Working Life and Social Research and the Public Health Agency of Sweden (previously the Swedish National Institute of Public Health).