Reducing Depression and Anxiety through Increased Self-Efficacy in a Motivational Interviewing-Based Intervention for the Prevention of Alcohol-Exposed Pregnancy

Background and Purpose: Mental health and psychological functioning are critical to overall health. Depression and anxiety are extremely common mental health disorders in the United States with a twelve-month prevalence of depression of 9.2% and prevalence of anxiety of 19.1%. Greater self-efficacy to control threats or behavior in risk situations has been shown to play a central role in reducing depression and mitigating anxiety. A primary goal of Motivational Interviewing is to increase self-efficacy. Counselors support self-efficacy by focusing on previous successes and highlighting skills and strengths that the client already has. CHOICES, a motivational interviewing-based intervention, was found to reduce the risk of an alcohol-exposed pregnancy and has been associated with reduction in psychological distress. The current study examines self-efficacy to abstain from alcohol consumption as a mediator of the CHOICES intervention in reducing depression and anxiety. It was hypothesized that the CHOICES intervention would be related to increased abstinence self-efficacy for alcohol which would subsequently be related to decreased depression and anxiety.

Methods: The present study involved secondary data analysis from CHOICES Plus, a randomized clinical trial to test the efficacy of a motivational interviewing-based intervention on reducing the risk of alcohol-exposed pregnancy (AEP) and tobacco-exposed pregnancy (TEP). Women were recruited from 12 primary care clinics in a large Texas public healthcare system. Participants were women who were fertile, not pregnant, aged 18–44 years, drinking more than three drinks per day or more than seven drinks per week, sexually active, and not using effective contraception. Women at-risk for AEP were randomized to CHOICES Plus (n=131) or Brief Advice (n=130). The current study examined abstinence self-efficacy for alcohol as a mediator of the CHOICES Plus intervention on reductions in depression and anxiety. Specifically, this study, using SPSS 26 PROCESS macro (Hayes, 2018), examined indirect paths from intervention condition to abstinence self-efficacy for alcohol at 3-months to depression and anxiety at 9-months . Abstinence self-efficacy for alcohol was measured using the Brief Situational Confidence Questionnaire. Depression and generalized anxiety were measured using the Brief Symptom Inventory-18.

Results: There was not a direct effect of the CHOICES Plus intervention on reductions of depression or anxiety at 9-months. However, as hypothesized, the study found an indirect association with decreased depression at 9-months through abstinence self-efficacy for alcohol at 3-months (indirect effect = -.0643, 95% CI = -.1347, -.0148) and an indirect association of decreased anxiety at 9-months through abstinence self-efficacy for alcohol at 3-months (indirect effect = -.0511, 95% CI = -.1105, -.0101). The intervention was associated with an increase in abstinence self-efficacy for alcohol at 3-months (b=.42, t=3.23, p<.01), which was in turn associated with decreased depression (b=-.15, t=-3.42, p=<.001) and anxiety (b=-.12, t=-2.86, p=<.01) at 9 months.

Conclusions and Implications: Increasing confidence to change a behavior can have the additional benefit of reducing psychological distress. Since alcohol and other substance use disorders are highly comorbid with depression and anxiety, the present study indicates that motivational interviewing-based interventions may be especially useful and practical in addressing internalizing disorders.