title: How psychosocial alcohol interventions work: a preliminary look at what FMRI can tell us.
abstract: BACKGROUND
  Current work in motivational interviewing (MI) has supported the role of in-session client and therapist language in predicting postintervention substance use outcomes. In particular, a relationship has been found between specific therapist language (e.g., MI-consistent behaviors), specific types of client speech (e.g., change talk; CT and counterchange talk; CCT), and subsequent drinking outcomes. One hypothesis to explain this phenomenon is that CT is an indication of a neurocognitive shift that happens during the course of a psychosocial intervention. And, it is possible that this shift is responsible for catalyzing and maintaining changes in drinking behaviors following MI interventions. To investigate this question, the effect of CT on blood oxygen level-dependent (BOLD) response during the presentation of alcohol cues was evaluated using functional magnetic resonance imaging.
  
  
  METHODS
  To examine changes in neural response to alcohol cues following client language, 10 adults with alcohol dependence (50% men; 40% Caucasian; 40% Hispanic; M age = 42.6; M years of education = 13.3) were presented with CT and CCT derived from their prescan MI session during the presentation of alcohol cues.
  
  
  RESULTS
  Following CCT, there was significant neural response to alcohol cues in several key reward areas (cluster-corrected p < 0.05, z > 2.3; orbitofrontal cortex, nucleus accumbens, anterior insula, posterior insula, caudate, and putamen). On the contrary, there were no areas of significant reward activation following CT.
  
  
  CONCLUSIONS
  These results indicate that CT may be effectively inhibiting activation in brain regions that respond to the salience of alcohol cues. These findings provide preliminary biological support of the psychosocial literature findings, highlighting the critical importance of change talk during psychosocial interventions.
authors.affiliation: Translational Neuroscience, The Mind Research Network, Pete & Nancy Domenici Hall, 1101 Yale Blvd NE, Albuquerque, NM 87106, USA. sfeldstein@mrn.org
authors.forename: Sarah W
authors.initials: SW
authors.lastname: Feldstein Ewing
authors.forename: Francesca M
authors.initials: FM
authors.lastname: Filbey
authors.forename: Amithrupa
authors.initials: A
authors.lastname: Sabbineni
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Chandler
authors.forename: Kent E
authors.initials: KE
authors.lastname: Hutchison
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology* / Q000628:therapy; D016739:Behavior, Addictive / Q000523:psychology*; D001921:Brain / Q000502:physiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003376:Counseling; D003463:Cues; D000431:Ethanol; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011369:Professional-Patient Relations; D011569:Psychiatric Status Rating Scales; D011614:Psychotherapy, Brief / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000431:Ethanol