***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Counselor behaviors that mediate the efficacy of  motivational interviewing ( MI ) are not well understood , especially when applied to health behavior promotion . We hypothesized that client change talk mediates the relationship between counselor variables and subsequent client behavior change . Methods Purpose ful sampling identified individuals from a prospect i ve r and omized worksite trial using an MI intervention to promote firefighters ’ healthy diet and regular exercise that increased dietary intake of fruits and vegetables ( n = 21 ) or did not increase intake of fruits and vegetables ( n = 22 ) . MI interactions were coded using the Motivational Interviewing Skill Code ( MISC 2.1 ) to categorize counselor and firefighter verbal utterances . Both Bayesian and frequentist mediation analyses were used to investigate whether client change talk mediated the relationship between counselor skills and behavior change . Results Counselors ’ global spirit , empathy , and direction and MI-consistent behavioral counts ( e.g. , reflections , open questions , affirmations , emphasize control ) significantly correlated with firefighters ’ total client change talk utterances ( rs = 0.42 , 0.40 , 0.30 , and 0.61 , respectively ) , which correlated significantly with their fruit and vegetable intake increase ( r = 0.33 ) . Both Bayesian and frequentist mediation analyses demonstrated that findings were consistent with hypotheses , such that total client change talk mediated the relationship between counselor ’s skills — MI-consistent behaviors [ Bayesian mediated effect : αβ = .06 ( .03 ) , 95 % CI = .02 , .12 ] and MI spirit [ Bayesian mediated effect : αβ = .06 ( .03 ) , 95 % CI = .01 , .13]— and increased fruit and vegetable consumption . Conclusion Motivational interviewing is a re source - and time-intensive intervention , and is currently being applied in many arenas . Previous research has identified the importance of counselor behaviors and client change talk in the treatment of substance use disorders . Our results indicate that similar mechanisms may underlie the effects of MI for dietary change . These results inform MI training and application by identifying those processes critical for MI success in health promotion domains Few studies have investigated the impact of  adolescent change language on substance use treatment outcomes and even fewer have examined how adolescents respond to normative feedback . The purpose of this study was to underst and the influence normative feedback has on adolescent  change language and subsequent alcohol and cannabis use 3months later . We examined how percent change talk ( PCT ) was associated with subsequent alcohol and drug use outcomes . Adolescents ( N=48 ) were r and omly assigned to receive brief motivational interviewing ( MI ) or MI plus normative feedback ( NF ) . Audio recordings were coded with high interrater reliability . Adolescents with high PCT who received MI+NF had significantly fewer days of alcohol and binge drinking at follow up . There were no differences between groups on cannabis use or treatment engagement . Findings indicate that NF may be useful for adolescents with higher amount of change talk during sessions and may be detrimental for individuals with higher sustain talk Motivational interviewing ( MI ) is an effective treatment for substance use disorders ( SUDs ) that focuses on resolving ambivalence and increasing commitment to positive behavior change . Although MI has a well-developed clinical theory , research findings have been mixed in supporting its view of how change occurs . The primary aim of this pilot study was to test hypothesized MI active ingredients and mechanisms of change in reducing drinking during the initiation of a behavior change episode . Problem drinkers ( N = 89 ) seeking treatment were r and omly assigned to MI , relational MI without directive elements ( spirit-only MI [ SOMI ] ) , or a self-change ( SC ) control condition . Participants were followed during an 8-week treatment period . The first 2 of 4 treatment sessions were videotaped and coded for fidelity , discriminability , and change talk . Overall , conditions demonstrated high fidelity . As predicted , change talk significantly increased in MI relative to the SOMI condition . Drinking was significantly reduced at end treatment , but the reduction was equivalent across conditions . Post hoc analyses found that  MI reduced drinking more rapidly than SOMI and SC and that increased change talk mediated the effects of MI relative to SOMI during the week immediately following the first session . Findings are discussed in the context of the pilot nature of the study and the relative absence of experimental tests of mechanisms of behavior change in SUD treatment research BACKGROUND The exact link between the process engaged in during Motivational Interviewing based interventions , such as Motivational Enhancement Therapy ( MET ) , and outcome is yet to be fully understood . AIMS This preliminary study examined Client Language during MET and outcome . METHOD A modified Motivational Interviewing Skills Code Version 2.0 was used to code 106 audiotaped MET sessions from 28 participants who received 3 - 4 sessions of MET within the context of a r and omized controlled trial for mild-moderate alcohol dependence . Client Language was analyzed within sessions ( categorized into Early , Mid , or End Intervals ) and across sessions , and in relation to six month drinking outcome ( drinking within/over national drinking guidelines , i.e. Remitted/Unremitted Drinkers ) . RESULTS Unremitted Drinkers uttered a significantly higher frequency of Sustain Talk , lower Ability Language strength ( over all MET and during End Intervals ) , and lower Commitment Language strength ( during Session 2 and 4 , and change over MET ) . CONCLUSIONS Notwithst and ing limitations , this exploratory study was unique in examining the strength of Client Language within and across sessions . It produced potentially valuable findings that warrant further investigation including supporting the clinical benefit of monitoring Client Language to predict outcome Background Behavioral interventions such as psychotherapy are leading , evidence -based practice s for a variety of problems ( e.g. , substance abuse ) , but the evaluation of provider fidelity to behavioral interventions is limited by the need for human judgment . The current study evaluated the accuracy of statistical text classification in replicating human-based judgments of provider fidelity in one specific psychotherapy— motivational interviewing ( MI ) . Method Participants ( n = 148 ) came from five previously conducted r and omized trials and were either primary care patients at a safety-net hospital or university students . To be eligible for the original studies , participants met criteria for either problematic drug or alcohol use . All participants received a type of brief motivational interview , an evidence -based intervention for alcohol and substance use disorders . The Motivational Interviewing Skills Code is a st and ard measure of MI provider fidelity based on human ratings that was used to evaluate all therapy sessions . A text classification approach called a labeled topic model was used to learn associations between human-based fidelity ratings and MI session transcripts . It was then used to generate codes for new sessions . The primary comparison was the accuracy of model-based codes with human-based codes . Results Receiver operating characteristic ( ROC ) analyses of model-based codes showed reasonably strong sensitivity and specificity with those from human raters ( range of area under ROC curve ( AUC ) scores : 0.62 – 0.81 ; average AUC : 0.72 ) . Agreement with human raters was evaluated based on talk turns as well as code tallies for an entire session . Generated codes had higher reliability with human codes for session tallies and also varied strongly by individual code . Conclusion To scale up the evaluation of behavioral interventions , technological solutions will be required . The current study demonstrated preliminary , encouraging findings regarding the utility of statistical text classification in bridging this method ological gap AIMS To investigate empirically the hypothesized relationship between counsellor motivational interviewing ( MI ) skills and patient change talk ( CT ) by analysing the articulation between counsellor behaviours and patient language during brief motivational interventions ( BMI ) addressing at-risk alcohol consumption . DESIGN Sequential analysis of psycholinguistic codes obtained by two independent raters using the Motivational Interviewing Skill Code ( MISC ) , version 2.0 . SETTING Secondary analysis of data from a r and omized controlled trial evaluating the effectiveness of  BMI  in an emergency department . PARTICIPANTS A total of 97 patients tape-recorded when receiving BMI .  MEASUREMENTS MISC variables were categorized into three counsellor behaviours ( MI-consistent , MI-inconsistent and ' other ' ) and three kinds of patient language ( CT , counter-CT ( CCT ) and utterances not linked with the alcohol topic ) . Observed transition frequencies , conditional probabilities and significance levels based on odds ratios were computed using sequential analysis software . FINDINGS MI-consistent behaviours were the only counsellor behaviours that were significantly more likely to be followed by patient  CT . Those behaviours were significantly more likely to be followed by patient change exploration ( CT and CCT ) while MI-inconsistent behaviours and ' other ' counsellor behaviours were significantly more likely to be followed by utterances not linked with the alcohol topic and significantly less likely to be followed by  CT . MI-consistent behaviours were more likely after change exploration , whereas ' other ' counsellor behaviours were more likely only after utterances not linked with the alcohol topic . CONCLUSIONS Findings lend support to the hypothesized relationship between MI-consistent behaviours and CT , highlight the importance of patient influence on counsellor behaviour and emphasize the usefulness of MI techniques and spirit during brief interventions targeting change enhancement Motivational interviewing ( MI ) is an efficacious treatment for alcohol use disorders .  MI is thought to enhance motivation via a combination of 2 therapeutic strategies or active ingredients : 1 relational and 1 directional . The primary aim of this study was to examine MI ’s hypothesized active ingredients using a dismantling design . Problem drinkers ( N = 139 ) seeking treatment were r and omized to 1 of 3 conditions : MI , relational MI without the directional elements labeled spirit-only MI ( SOMI ) , or a nontherapy control condition and followed for 8 weeks . Those assigned to MI or SOMI received 4 sessions of treatment over 8 weeks . All participants significantly reduced their drinking by Week 8 , but reductions were equivalent across conditions . The hypothesis that baseline motivation would significantly moderate condition effects on outcome was generally not supported . Failure to find support for MI ’s hypothesized active ingredients is discussed in the context of the strengths and limitations of the study design Motivational interviewing ( MI ) is a directive , client-centered therapeutic method employed in the treatment of substance abuse , with strong evidence of effectiveness . To date , the sole mechanism of action in MI with any consistent empirical support is " change talk " ( CT ) , which is generally defined as client within-session speech in support of a behavior change . " Sustain talk " ( ST ) incorporates speech in support of the status quo . MI maintains that during treatment , clients essentially talk themselves into change . Multiple studies have now supported this theory , linking within-session speech to substance use outcomes . Although a causal chain has been established linking therapist behavior , client CT , and substance use outcome , the neural substrate of CT has been largely uncharted . We addressed this gap by measuring neural responses to clients ' own CT using magnetoencephalography ( MEG ) , a noninvasive neuroimaging technique with excellent spatial and temporal resolution . Following a recorded MI session , MEG was used to measure brain activity while participants heard multiple repetitions of their CT and ST utterances from that session , intermingled and presented in a r and om order . Results suggest that CT processing occurs in a right-hemisphere network that includes the inferior frontal gyrus , insula , and superior temporal cortex . These results support a representation of CT at the neural level , consistent with the role of these structures in self-perception . This suggests that during treatment sessions , clinicians who are able to evoke this special kind of language are tapping into neural circuitry that may be essential to behavior change OBJECTIVE Each year , thous and s of college students receive m and ated intervention  as a sanction for alcohol use or alcohol-related behavior . For these m and ated students , brief motivational interventions ( BMI s ) are currently the most efficacious individual intervention . However , little is known about how the technical ( therapist behaviors ) and relational ( e.g. , global ratings of therapist empathy ) components of BMI s influence client language as well as subsequent change in alcohol use and consequences . METHOD This study used the Motivational Interviewing Skills Code ( MISC 2.0 ; Miller , Moyers , Ernst , & Amrhein , 2003 ) to code  BMI sessions  from 2 r and omized clinical trials that facilitated significant reductions in alcohol use ( Study 1 , n = 91 ) and alcohol-related consequences ( Study 2 , n = 158 ) in m and ated students . RESULTS There were significant relationships among therapist behaviors , global scores , and client language both for and against change , yet there were no links between in-session client language and subsequent changes in alcohol use or problems . In contrast , relational aspects of motivational interviewing ( MI ; global ratings of therapist MI Spirit and client self-exploration ) were most predictive of postsession alcohol use . Mediation models incorporating both technical and relational components revealed that higher levels of client self-exploration mediated the relationship between higher therapist ratings of MI Spirit and reduced drinking at follow-up . CONCLUSIONS Findings highlight the importance of considering how both technical and relational components of MI may influence alcohol use in m and ated college students and also suggest more exact analyses to better underst and this complex relationship 
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RESULTS For frequency measures , more sustain talk related to reason , desire , ability , and other were associated with more addictive behavior at follow up .
Other change talk was associated with MI outcomes but in an unexpected direction ( i.e. , more addictive behavior ) .
Proportion measures showed more proportion change talk-reason and -other statements were associated with less addictive behavior at follow up .
This preliminary meta- analysis suggests that aggregate measures of change and sustain talk are comprised of statement subtypes that are not equally meaningful in predicting outcome following MI for addictive behavior change