Author: Ngai, Kee Hung
Title: Feasibility study of the motivational interviewing and cognitive-behavioral therapy (MICBT) program for patients with dual diagnosis in relapse prevention
Advisors: Wu, Cynthia (SN)
Degree: DHSc
Year: 2019
Subject: Hong Kong Polytechnic University -- Dissertations
Mental illness -- Relapse -- Prevention
Motivational interviewing
Cognitive therapy
Behavior therapy
Department: Faculty of Health and Social Sciences
Pages: 175, 66, 26 pages : color illustrations
Language: English
Abstract: Motivational Interviewing and Cognitive Behavioral Therapy (MICBT) have been regarded as highly effective strategies for relapse prevention. Motivational Interviewing (MI) assists clients to change their readiness to accept the intensive treatment; while, Cognitive Behavioral Therapy (CBT) assists clients to learn coping techniques to deal with problematic behaviors in substance misuse. The prevalence rate of substance use disorders comorbid with mental health disorder (Dual Diagnosis) was high; little research was done to specifically examine the outcomes of the relapse prevention program for people with Dual Diagnosis. Western research studies reported that people with Dual Diagnosis benefited most from Motivational Interviewing (MI) when it was combined with Cognitive Behavioral Therapy (CBT). These combined approaches have never been adopted in Hong Kong. This feasibility study focused on the acceptability, practicality, implementation and clinical outcomes of the combined relapse prevention program for out-patients with dual-diagnosis. The program consisted of eight out-patient counseling sessions in dealing with high risk situations and coping skills. Self-efficacy and psychiatric symptoms were primary outcomes measured by the Chinese Drug Taking Confidence Questionnaire (CDTCQ-8) and the Chinese Brief Psychiatric Rating Scale (CBPRS-18) respectively; while, relapse tendency was the secondary outcome measured by urine for toxicology. Data were analyzed by using SPSS for Windows (version 23.0). Descriptive analysis to the characteristics of the participants was examined. The repeated measure ANOVA was used to compare mean scores of self-efficacy and psychiatric symptoms for pre-intervention, post-intervention and 3 months after intervention for the same group; urine for toxicology was compared by Crochran's Q test. Focus group interview was conducted at the end for collecting feedback from the participants on the extent, process and efficacy of the intervention. The preliminary findings demonstrated that participants had significant improvement in the mean score of self-efficacy (CDTCQ-8) from 116.67 to 269.52 (p<0.001); psychiatric symptoms (CBPRS-18) was decreased from 35.52 to 30.64 (p<0.001). The level of urine for toxicology indicated the decreasing trend of relapse behavior during the intervention and post-intervention; and tendency of increasing again after 3 months after intervention. The focus group interview identified that four themes by the feedback from participants: 1) factors leading to quit substance use were perseverance support and strive for better life; 2) factors leading to relapse of substance use was lacking of resisting skills to drugs, 3) other factors leading to quit substance use was contact and 4) useful content and skills of the program was self-efficacy supports. It was concluded that the combined MICBT for relapse prevention in out-patient settings was feasible. The findings provided further knowledge and integrated frameworks of implementing the full scale relapse prevention program for patients with dual diagnosis.
Study Aim To examine the acceptability, practicality and clinical outcomes of the implementation of a Motivational Interviewing & Cognitive Behavioral Therapy (MICBT) program for patients with dual diagnosis in relapse prevention in Hong Kong. Study objectives 1. To test the feasibility of the development of nurse-led MICBT program for patients with dual diagnosis in relapse prevention in Hong Kong 2. To evaluate the preliminary effects of the program in terms of self-efficacy, psychiatric symptoms & urine for toxicology. 3. To collect feedback from different stakeholders (participants, therapists, organization) on feasibility towards this program. Design and Methods: This research used a feasibility study design, which divided into two stages of data collection. Stage 1 was conducted to assess the feasibility of MICBT program for patients with dual diagnosis in relapse prevention in Substance Misuse Clinic of Hong Kong. This research design was used to enhance understanding of the suitability and acceptability of the intervention for this group of patients. Outcomes were assessed by the Chinese Drug-Taking Confidence Questionnaire (CDTCQ-8), the Chinese Brief Psychiatric Rating Scale (CBPRS-18) and Urine for toxicology at pre-intervention, post-intervention and 3 months after intervention. While, focus group interview in stage 2 was used to collect feedback from participants, therapists and organizational level on the feasibility. Results: A total of 42 clients participated in the study. Preliminary results indicated that participants had significant improvement in the mean score of self-efficacy (CDTCQ-8) from 116.667 to 269.524 (p<0.001) and psychiatric symptomology (CBPRS-18) was decreased from 35.524 to 30.643 (p<0.001). While, urine for toxicology showed decreasing trends of participant's drug taking behavior during the intervention and post-intervention stages, however, it increased again after 3 months after intervention. The qualitative data was collected from the levels of participants, therapists and organization identified that the program addressed the participants' needs in a specific, appropriate and focused manner. Conclusion: This was a first piece of study to examine the feasibility of nurse led MICBT program for patients with dual diagnosis in relapse prevention in Hong Kong. The results showed that the program was feasible in term of acceptability, practicability and preliminary effects of outcome measures. It demonstrated the program combining with motivational interviewing and cognitive behavior therapy, resulted in significant improvement in primary outcome of self-efficacy and significant reduction in psychiatric symptoms. As the result, clients' relapse tendency was decreased when they decreased in drug taking behavior. This study provided program protocol, training package and implementation plan on the feasibility of the nurse-led relapse prevention program in substance misuse clinic. The knowledge gained in this feasibility study can be used in the design of full scale studies focusing on the implementation, intervention and outcome measures in the settings of out-patient for patients with dual diagnosis. Further studies should be directed toward understanding the factors of long-term abstinence for longer duration of intervention sessions and follow up.
Rights: All rights reserved
Access: restricted access

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