# Integration of Motivational Interviewing and Behavioral Economics Theories to Enhance Measurement of Client Language as a Mechanism of Behavior Change

> **NIH NIH R01** · WASHINGTON STATE UNIVERSITY · 2021 · $396,036

## Abstract

Project Summary
Motivational interviewing (MI) theory posits certain measures of client language serve as key mechanisms of
behavior change. Specifically, increased change talk, or statements supporting movement toward healthy
behavior, and decreased sustain talk, or statement supporting maintenance of unhealthy behavior, should lead
to reductions in risky alcohol use. While findings support aspects of this technical hypothesis of MI, there are a
number of limitations to the current study of client language. Of note, large amounts of in-session language go
unexamined and the current MI model lacks a theory guiding session content, particularly in contexts where
clients are not ready to discuss changes in drinking. Behavioral economics (BE) theory assumes the
reinforcing value of a substance is a function of the benefit/cost ratio of substance use in relation to the
benefit/cost of other available activities; thus BE provides a structure by which to understand the value of
alcohol and other reinforcing behaviors. BE also identifies delayed reward discounting as a critical factor
associated with value appraisal of behavior. The proposed research aims to integrate cutting-edge MI process
research with BE theory with the goal of developing an innovative, theoretically-driven conceptualization of
client language associated with college alcohol use and response to brief intervention. Comprised of BE and
MI experts, the proposed research team will develop and test an enhanced coding system that uses a parallel
decision-making process involving multiple independent choices for each client language utterance: one for
motivational state, another for behavioral target (e.g., talking about an alternative substance-free behavior such
as spending more time studying vs. the identified target behavior of alcohol use reduction), and a third related
to temporal orientation (e.g., discussing future goals vs. present circumstances). During the initial development
stage, MI session recordings from three completed randomized controlled trials will be coded using the novel
client language variables and compared to conventional definitions of change talk and sustain talk to examine
convergent, divergent, and incremental validity. Next, using recordings from another two completed
randomized controlled trials, the novel coding system will examine client language as a predictor of response
to an innovative BE clinical application compared to a traditional MI intervention. Finally, using data from all five
original trials, we will examine conditional models of client language as predictors of treatment response. The
current study has significant potential to enhance efforts to reduce risky young adult drinking and inform clinical
training and practice.

## Key facts

- **NIH application ID:** 10140252
- **Project number:** 5R01AA027209-02
- **Recipient organization:** WASHINGTON STATE UNIVERSITY
- **Principal Investigator:** Benjamin O. Ladd
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $396,036
- **Award type:** 5
- **Project period:** 2020-04-10 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10140252

## Citation

> US National Institutes of Health, RePORTER application 10140252, Integration of Motivational Interviewing and Behavioral Economics Theories to Enhance Measurement of Client Language as a Mechanism of Behavior Change (5R01AA027209-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10140252. Licensed CC0.

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