Connecticut and Texas researchers working together to advance testing of the effectiveness of group motivational interviewing for youths struggling with addiction.
Sarah Feldstein Ewing is professor of psychiatry, vice chair for research, and Health Net Inc. Chair in Alcohol and Substance Abuse at UConn School of Medicine (Tina Encarnacion/UConn Health photo).
UConn School of Medicine's Department of Psychiatry and The University of Texas at Dallas' Center for BrainHealth are researching together how therapy can be enhanced to be more successful for teenagers battling addiction such as with alcohol.
Co-principal investigators are Francesca Filbey, Ph.D., the Bert Moore Chair in BrainHealth and professor of psychology in the School of Behavioral and Brain Sciences at UT Dallas and frequent collaborator, Sarah Feldstein Ewing, Ph.D., professor of psychiatry, vice chair for research, and Health Net Inc. Chair in Alcohol and Substance Abuse at UConn School of Medicine.
The research team is performing simultaneous brain scans on pairs of young adult subjects to examine activity patterns for signs that indicate strong social interactions during group intervention. The collaboration pairs Filbey's neuroimaging expertise in Texas with Feldstein Ewing's expertise in clinical behavioral interventions with young people in Connecticut.
The project will analyze the effectiveness of a therapy called group motivational interviewing (group MI) for youths struggling with alcohol use to help bolster and support behavior change, reducing their alcohol use. The research is supported by a five-year, $1.17 million grant (5R01AA030678) from the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health.
Filbey and her team will take advantage of the resources of the Sammons BrainHealth Imaging Center to conduct the hyperscanning experiments, which allow researchers to collect simultaneously the neurological activity of two people while they interact.
"When our imaging center was mapped out, hyperscanning capability was one purpose they had in mind, placing a control room in the middle of two bays for scanners," Filbey said. "This novel project will use functional MRI (fMRI) to examine group therapy in ways that can teach us what therapeutic tactics work best and why."
Hyperscanning has in the past been used primarily to study social cooperation or team effectiveness using electroencephalography, which measures electrical activity in the brain, or functional near-infrared spectroscopy, which monitors blood oxygenation in the brain. Filbey said that only a few facilities in the nation can perform hyperscanning, and combining it with fMRI is a rare approach.
"Hyperscanning is a great tool for looking at real-time, dynamic interactions between individuals," she said. "I think we can learn a great deal by applying it in this manner and asking the right questions."
Group Therapy Benefits
UConn's Feldstein Ewing said that group therapy is the most widely used format in alcohol- and other substance-use settings for teens because of both the cost-effectiveness of the group-based format and how it mirrors other group settings that teens find themselves in, like school and sports.
"Group MI recognizes that there are real-world reasons why people are drinking. Through it, we try to help young people identify both why they might be drinking and what role drinking might be playing in their lives, and also how drinking might get in the way or cost them opportunities," Feldstein Ewing said. "Given that teens might be a resource for one another, the group MI session is designed to encourage teens to say positive things to help support each other by talking about why the other teen might want to change and how the other teen could change if they wanted to."
Feldstein Ewing's mentor, Dr. William Miller, emeritus distinguished professor of psychology and psychiatry at the University of New Mexico, was the originator of group MI.
"With drinking, knowledge doesn't change behavior. People know drinking is bad; it does not matter," Feldstein Ewing said. "With group MI, the therapist is there in a supportive role; group MI therapists don't tell people what to do. It all comes from the group MI teens themselves."
Behavioral Predictors
The UT Dallas team will seek predictors of changes in behavior from tandem brain responses from fMRI hyperscanning measuring both positive, prosocial and negative exchanges between 124 pairs of 18- and 19-year-old peers. This longitudinal project will check in on participants at three months, six months and one year after imaging to gauge effectiveness and the degree of behavioral change.
Rising drinking rates among this age group greatly affect both physical safety and neurodevelopment.
"Adolescents are unlikely to seek, receive or complete help with hazardous alcohol use," Feldstein Ewing said. "Existing interventions, which were almost all designed for adults, are about 30% effective for teens, who are very different, even at a neurodevelopmental level. We need to rework how we're measuring addiction in teens, then find a brief, effective intervention for this vulnerable age group in which peer feedback holds great influence."
Filbey is seeking to locate and quantify social connectedness in a group setting - the degree to which a participant is vibing with others. She hopes her team can find the first evidence of what connectedness looks like in the brain both in terms of location of activity and temporal synchronization.
"If there is a brain circuit that appears synchronized in terms of fluctuations in brain response, should we expect a greater chance of behavior change and treatment success?" Filbey said. "When two brains are in harmony, does that represent connectedness that we can then learn to maximize? What individual factors make some pairings more connected than others? These are the questions we're taking on as we hope to determine both who is most responsive to group MI and how to maximize its efficacy."
Filbey said that how language is used is as critical as who that language comes from, especially in adolescent peers, who are highly influential.
"Across all types of MI, client language in favor of change - 'I can,' 'I want to' or 'I will' - and in this study of group MI - 'You can,' 'You want to' or 'You will' - is the best driver of behavioral change," Filbey said. "Using natural language processing, we're examining what kinds of language - tone and word choices - make people more connected. If we can isolate fundamental ingredients of effective language, maybe we can help providers and interventionists working with young people be more impactful in any setting."
