Curriculum; Psychotherapy; Motivational Interviewing; Psychiatry and Psychology
Psychiatry: Addictions, Division of | Division of Substance Abuse | Mental Health Services Research, Division of | Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center | Psychology Section | Psychotherapy Development Center
The driving force behind my research and related scholarly activities has been my dedication to promoting the use of evidence-based treatments in clinical settings. My major contributions have been:
- Modifying an approach called motivational interviewing for patients who have both psychiatric and substance abuse problems;
- Studying the degree to which community program clinicians use motivational interviewing with skill;
- Researching different strategies for training clinicians in evidence-based treatments.
This latter work has involved examining expert and train-the-trainer approaches, a stepwise approach for offering training to only those who demonstrate a need for it, and use of standardized patient instructors. I am currently conducting a multi-site randomized clinical trial testing the effectiveness of supervising motivational interviewing on both clinicians' ability to use it and on their clients' treatment outcomes. I also am studying the effectiveness of motivational interviewing delivered by medical practitioners compared to a computer-based version of this treatment approach. Finally, I have developed performance rating systems to measure how much and how well clinicians use motivational interviewing in practice and have modified these materials for use as clinical supervision toolkit.
Specialized Terms: Motivation interviewing (MI); Clinician training strategies; Implementation science; Technology-based treatment approaches; Curriculum evaluation
Extensive Research Description
The driving force behind my research and related scholarly activities has been my dedication to promoting the use of evidence-based psychosocial treatments in clinical settings. In the early 1990s, I began to apply motivational interviewing (MI) in the treatment of patients with severe mental illness and addictions. I engaged in a series of studies to develop this adaptation and empirically examined its treatment effects in a randomized clinical trial. At the time, few investigators had published about how to specifically apply MI to this dual diagnosis population and to test how well it worked. To my surprise, I found that MI was differentially effective with psychotically ill patients who abused cocaine, but not with those who abused marijuana. My work highlighted the complexities of enhancing motivation in patients with severe co-occurring mental illness and addiction. From these efforts to tailor MI, I became more interested in studying how to effectively train clinicians in evidence-based practices. I was impressed by the disciplined methods used to teach clinicians behavioral treatments in clinical trials (use of manuals, recording sessions, integrity rating, supervisory feedback and coaching, ongoing close monitoring of performance) and, ironically, how uncommon this careful training approach was employed in real world educational and practice settings. This simple observation led me to shift my research toward dissemination and implementation science, and I became increasingly involved in the NIDA Clinical Trials Network. Specifically, I assisted in the conduct of several national multi-site effectiveness trials involving MI. I had primary responsibility for serving as the local, and then national trainer, and developing an integrity rating scale and system to be used for supervision and independent observer treatment validation in the trials. I took the lead in psychometrically validating the scale and developing a NIDA-SAMHSA national dissemination product called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency – a manual that details methods for supervising MI in community treatment programs. Subsequently, I became the national trainer-of-trainers for MIA: STEP and played a key role in its dissemination nationally and internationally. As a Principal Investigator, I am currently conducting a multi-site trial testing the effectiveness of MIA: STEP supervision on improving client outcomes and the extent to which clinician MI adherence and competence mediates this process. To my knowledge, this will be the first clinical trial directly testing the impact of any form of psychotherapy supervision on client outcomes. In addition, I have studied other strategies for training clinicians in evidence-based practices. I have published studies that have examined the effectiveness and cost effectiveness of a train-the-trainer approach for teaching community program clinicians behavioral treatments. I also have piloted an innovative stepwise approach in which clinicians only receive more intensive treatment training if they fail to meet a criterion performance threshold. The study showed the promise of more adaptive training program designs and suggested that future training trials screen participants to exclude those who already have the targeted skills and little room for improvement. In a recent publication, I reviewed the clinician training strategies literature and identify key areas that need more research.
Unintended effects of training on clinicians’ interest, confidence, and commitment in using motivational interviewing
Decker, S.E., & Martino, S. (2013). Unintended effects of training on clinicians’ interest, confidence, and commitment in using motivational interviewing. Drug and Alcohol Dependence, 132, 681-687.
Correspondence of motivational interviewing adherence and competence ratings in real and role-played sessions
Decker, S.E., Carroll, K.M., Nich, C., Canning-Ball, M., & Martino, S. (2013). Correspondence of motivational interviewing adherence and competence ratings in real and role-played sessions. Psychological Assessment, 25, 306-312.
Cost and cost-effectiveness of three strategies for training clinicians in motivational interviewing
Olmstead, T., Canning-Ball, M., Carroll, K.M., & Martino, S. (2011). Cost and cost-effectiveness of three strategies for training clinicians in motivational interviewing. Drug and Alcohol Dependence, 116, 195–202.
A criterion-based stepwise approach for training counselors in motivational interviewing
Martino, S., Canning-Ball, M., Carroll, K.M., & Rounsaville, B.J. (2011). A criterion-based stepwise approach for training counselors in motivational interviewing. Journal of Substance Abuse Treatment, 40, 357-365.
Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies
Martino, S., Ball, S.A., Nich, C., Canning-Ball, M., Rounsaville, B.J., & Carroll, K.M. (2011). Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction, 106, 428-441.
Informal discussions in substance abuse treatment sessions
Martino, S., Ball, S.A., Nich, C., Frankforter, T.L., & Carroll, K.M. (2009). Informal discussions in substance abuse treatment sessions. Journal of Substance Abuse Treatment, 36, 366-375.
Correspondence of motivational enhancement treatment integrity ratings among therapists, supervisors, and observers
Martino S, Ball S, Nich C, Frankforter TL, Carroll KM. Correspondence of motivational enhancement treatment integrity ratings among therapists, supervisors, and observers. Psychother Res. 2009 Mar;19(2):181-93.
Full List of PubMed Publications
- Papas RK, Gakinya BN, Mwaniki MM, Lee H, Kiarie SW, Martino S, Loxley MP, Keter AK, Klein DA, Sidle JE, Baliddawa JB, Maisto SA: Rates and Covariates of Recent Sexual and Physical Violence Against HIV-Infected Outpatient Drinkers in Western Kenya. AIDS Behav. 2017 Aug. PMID: 28097617
- MacLean RR, Martino S, Carroll KM, Smyth JM, Pincus AL, Wilson SJ: Momentary Associations Between Reported Craving and Valuing Health in Daily Smokers. Nicotine Tob Res. 2017 Jun 1. PMID: 28486711
- Ondersma SJ, Martino S, Svikis DS, Yonkers KA: Commentary on Kim et al. (2017): Staying focused on non-treatment seekers. Addiction. 2017 May. PMID: 28378329
- Turban JL, Potenza MN, Hoff RA, Martino S, Kraus SW: Psychiatric disorders, suicidal ideation, and sexually transmitted infections among post-deployment veterans who utilize digital social media for sexual partner seeking. Addict Behav. 2017 Mar; 2016 Nov 17. PMID: 27902944
- Martino S, Paris M Jr, Añez L, Nich C, Canning-Ball M, Hunkele K, Olmstead TA, Carroll KM: The Effectiveness and Cost of Clinical Supervision for Motivational Interviewing: A Randomized Controlled Trial. J Subst Abuse Treat. 2016 Sep; 2016 May 8. PMID: 27431042
- Papas RK, Gakinya BN, Mwaniki MM, Keter AK, Lee H, Loxley MP, Klein DA, Sidle JE, Martino S, Baliddawa JB, Schlaudt KL, Maisto SA: Associations Between the Phosphatidylethanol Alcohol Biomarker and Self-Reported Alcohol Use in a Sample of HIV-Infected Outpatient Drinkers in Western Kenya. Alcohol Clin Exp Res. 2016 Aug; 2016 Jul 18. PMID: 27426424
- Kraus SW, Martino S, Potenza MN: Clinical Characteristics of Men Interested in Seeking Treatment for Use of Pornography. J Behav Addict. 2016 Jun; 2016 Jun 27. PMID: 27348557
- Madson MB, Schumacher JA, Baer JS, Martino S: Motivational Interviewing for Substance Use: Mapping Out the Next Generation of Research. J Subst Abuse Treat. 2016 Jun; 2016 Feb 15. PMID: 26971078
- Fiszdon JM, Kurtz MM, Choi J, Bell MD, Martino S: Motivational Interviewing to Increase Cognitive Rehabilitation Adherence in Schizophrenia. Schizophr Bull. 2016 Mar; 2015 Sep 29. PMID: 26420905
- Kraus SW, Meshberg-Cohen S, Martino S, Quinones LJ, Potenza MN: Treatment of Compulsive Pornography Use With Naltrexone: A Case Report. Am J Psychiatry. 2015 Dec. PMID: 26619775
- Martino S, Zimbrean P, Forray A, Kaufman J, Desan P, Olmstead TA, Gueorguieva R, Howell H, McCaherty A, Yonkers KA: See One, Do One, Order One: a study protocol for cluster randomized controlled trial testing three strategies for implementing motivational interviewing on medical inpatient units. Implement Sci. 2015 Sep 29; 2015 Sep 29. PMID: 26420671
- Toll BA, Martino S, O'Malley SS, Fucito LM, McKee SA, Kahler CW, Rojewski AM, Mahoney MC, Wu R, Celestino P, Seshadri S, Koutsky J, Hyland A, Cummings KM: A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. J Consult Clin Psychol. 2015 Jun; 2014 Nov 24. PMID: 25419583
- Kraus SW, Potenza MN, Martino S, Grant JE: Examining the psychometric properties of the Yale-Brown Obsessive-Compulsive Scale in a sample of compulsive pornography users. Compr Psychiatry. 2015 May; 2015 Feb 17. PMID: 25732412
- Shorey RC, Martino S, Lamb KE, LaRowe SD, Santa Ana EJ: Change talk and relatedness in group motivational interviewing: a pilot study. J Subst Abuse Treat. 2015 Apr; 2014 Nov 20. PMID: 25488505
- Barnes RD, White MA, Martino S, Grilo CM: A randomized controlled trial comparing scalable weight loss treatments in primary care. Obesity (Silver Spring). 2014 Dec; 2014 Oct 9. PMID: 25298016
- Rosen MI, Ablondi K, Black AC, Mueller L, Serowik KL, Martino S, Mobo BH, Rosenheck RA: Work outcomes after benefits counseling among veterans applying for service connection for a psychiatric condition. Psychiatr Serv. 2014 Dec 1; 2014 Oct 31. PMID: 25082304
- Decker SE, Nich C, Carroll KM, Martino S: Development of the Therapist Empathy Scale. Behav Cogn Psychother. 2014 May; 2013 Mar 12. PMID: 23481373
- Decker SE, Martino S: Unintended effects of training on clinicians' interest, confidence, and commitment in using motivational interviewing. Drug Alcohol Depend. 2013 Oct 1; 2013 May 16. PMID: 23684633
- Martino S: Credibility and treatment fidelity may matter in twelve-step treatment. Am J Drug Alcohol Abuse. 2013 Sep. PMID: 23968168
- Decker SE, Carroll KM, Nich C, Canning-Ball M, Martino S: Correspondence of motivational interviewing adherence and competence ratings in real and role-played client sessions. Psychol Assess. 2013 Mar; 2012 Dec 3. PMID: 23205626
- Pantalon MV, Martino S, Dziura J, Li FY, Owens PH, Fiellin DA, O'Connor PG, D'Onofrio G: Development of a scale to measure practitioner adherence to a brief intervention in the emergency department. J Subst Abuse Treat. 2012 Dec; 2012 Sep 26. PMID: 23021098
- Ryan SA, Martel S, Pantalon M, Martino S, Tetrault J, Thung SF, Bernstein SL, Auinger P, Green ML, Fiellin DA, O'Connor PG, D'Onofrio G: Screening, brief intervention, and referral to treatment (SBIRT) for alcohol and other drug use among adolescents: evaluation of a pediatric residency curriculum. Subst Abus. 2012. PMID: 22738002
- Tetrault JM, Green ML, Martino S, Thung SF, Degutis LC, Ryan SA, Martel S, Pantalon MV, Bernstein SL, O'Connor PG, Fiellin DA, D'Onofrio G: Developing and implementing a multispecialty graduate medical education curriculum on Screening, Brief Intervention, and Referral to Treatment (SBIRT). Subst Abus. 2012. PMID: 22489589
- Carroll KM, Ball SA, Jackson R, Martino S, Petry NM, Stitzer ML, Wells EA, Weiss RD: Ten take home lessons from the first 10 years of the CTN and 10 recommendations for the future. Am J Drug Alcohol Abuse. 2011 Sep. PMID: 21854269
- Kiluk BD, Sugarman DE, Nich C, Gibbons CJ, Martino S, Rounsaville BJ, Carroll KM: A methodological analysis of randomized clinical trials of computer-assisted therapies for psychiatric disorders: toward improved standards for an emerging field. Am J Psychiatry. 2011 Aug; 2011 May 2. PMID: 21536689
- Haeseler F, Fortin AH 6th, Pfeiffer C, Walters C, Martino S: Assessment of a motivational interviewing curriculum for year 3 medical students using a standardized patient case. Patient Educ Couns. 2011 Jul; 2010 Nov 30. PMID: 21123019
- Martino S, Canning-Ball M, Carroll KM, Rounsaville BJ: A criterion-based stepwise approach for training counselors in motivational interviewing. J Subst Abuse Treat. 2011 Jun; 2011 Feb 11. PMID: 21316183
- Martino S, Ball SA, Nich C, Canning-Ball M, Rounsaville BJ, Carroll KM: Teaching community program clinicians motivational interviewing using expert and train-the-trainer strategies. Addiction. 2011 Feb; 2010 Oct 6. PMID: 20925684
- Martino S: Motivational interviewing to engage patients in chronic kidney disease management. Blood Purif. 2011; 2011 Jan 10. PMID: 21228571
- Carroll KM, Kiluk BD, Nich C, Babuscio TA, Brewer JA, Potenza MN, Ball SA, Martino S, Rounsaville BJ, Lejuez CW: Cognitive function and treatment response in a randomized clinical trial of computer-based training in cognitive-behavioral therapy. Subst Use Misuse. 2011. PMID: 21190403
- Martino S: Strategies for training counselors in evidence-based treatments. Addict Sci Clin Pract. 2010 Dec. PMID: 22002451
- Bamatter W, Carroll KM, Añez LM, Paris M Jr, Ball SA, Nich C, Frankforter TL, Suarez-Morales L, Szapocznik J, Martino S: Informal discussions in substance abuse treatment sessions with Spanish-speaking clients. J Subst Abuse Treat. 2010 Dec. PMID: 20817381
- Gibbons CJ, Carroll KM, Ball SA, Nich C, Frankforter TL, Martino S: Community program therapist adherence and competence in a motivational interviewing assessment intake session. Am J Drug Alcohol Abuse. 2010 Nov; 2010 Oct 14. PMID: 20942726
- Papas RK, Sidle JE, Martino S, Baliddawa JB, Songole R, Omolo OE, Gakinya BN, Mwaniki MM, Adina JO, Nafula T, Owino-Ong'or WD, Bryant KJ, Carroll KM, Goulet JL, Justice AC, Maisto SA: Systematic cultural adaptation of cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in western Kenya. AIDS Behav. 2010 Jun. PMID: 19967441
- Martino S, Brigham GS, Higgins C, Gallon S, Freese TE, Albright LM, Hulsey EG, Krom L, Storti SA, Perl H, Nugent CD, Pintello D, Condon TP: Partnerships and pathways of dissemination: the National Institute on Drug Abuse-Substance Abuse and Mental Health Services Administration Blending Initiative in the Clinical Trials Network. J Subst Abuse Treat. 2010 Jun. PMID: 20307793
- Toll BA, Martino S, Latimer A, Salovey P, O'Malley S, Carlin-Menter S, Hopkins J, Wu R, Celestino P, Cummings KM: Randomized trial: Quitline specialist training in gain-framed vs standard-care messages for smoking cessation. J Natl Cancer Inst. 2010 Jan 20; 2010 Jan 7. PMID: 20056957
- Carroll KM, Martino S, Ball SA, Nich C, Frankforter T, Anez LM, Paris M, Suarez-Morales L, Szapocznik J, Miller WR, Rosa C, Matthews J, Farentinos C: A multisite randomized effectiveness trial of motivational enhancement therapy for Spanish-speaking substance users. J Consult Clin Psychol. 2009 Oct. PMID: 19803579
- Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM: Informal discussions in substance abuse treatment sessions. J Subst Abuse Treat. 2009 Jun; 2008 Oct 5. PMID: 18835679
- Martino S, Ball S, Nich C, Frankforter TL, Carroll KM: Correspondence of motivational enhancement treatment integrity ratings among therapists, supervisors, and observers. Psychother Res. 2009 Mar. PMID: 19396649
- Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Rounsaville BJ: Enduring effects of a computer-assisted training program for cognitive behavioral therapy: a 6-month follow-up of CBT4CBT. Drug Alcohol Depend. 2009 Feb 1; 2008 Nov 28. PMID: 19041197
- Santa Ana EJ, Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM: What is usual about "treatment-as-usual"? Data from two multisite effectiveness trials. J Subst Abuse Treat. 2008 Dec; 2008 Mar 12. PMID: 18337053
- Carroll KM, Ball SA, Martino S, Nich C, Babuscio TA, Nuro KF, Gordon MA, Portnoy GA, Rounsaville BJ: Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT. Am J Psychiatry. 2008 Jul; 2008 May 1. PMID: 18450927
- Martino S, Ball SA, Nich C, Frankforter TL, Carroll KM: Community program therapist adherence and competence in motivational enhancement therapy. Drug Alcohol Depend. 2008 Jul 1; 2008 Mar 6. PMID: 18328638
- Ball SA, Martino S, Nich C, Frankforter TL, Van Horn D, Crits-Christoph P, Woody GE, Obert JL, Farentinos C, Carroll KM, National Institute on Drug Abuse Clinical Trials Network.: Site matters: multisite randomized trial of motivational enhancement therapy in community drug abuse clinics. J Consult Clin Psychol. 2007 Aug. PMID: 17663610
- Martino S, Haeseler F, Belitsky R, Pantalon M, Fortin AH 4th: Teaching brief motivational interviewing to Year three medical students. Med Educ. 2007 Feb. PMID: 17269949
- Martino S, Carroll KM, Nich C, Rounsaville BJ: A randomized controlled pilot study of motivational interviewing for patients with psychotic and drug use disorders. Addiction. 2006 Oct. PMID: 16968350
- Carroll KM, Ball SA, Nich C, Martino S, Frankforter TL, Farentinos C, Kunkel LE, Mikulich-Gilbertson SK, Morgenstern J, Obert JL, Polcin D, Snead N, Woody GE, National Institute on Drug Abuse Clinical Trials Network.: Motivational interviewing to improve treatment engagement and outcome in individuals seeking treatment for substance abuse: a multisite effectiveness study. Drug Alcohol Depend. 2006 Feb 28; 2005 Sep 28. PMID: 16169159
- Martino S, Carroll K, Kostas D, Perkins J, Rounsaville B: Dual Diagnosis Motivational Interviewing: a modification of Motivational Interviewing for substance-abusing patients with psychotic disorders. J Subst Abuse Treat. 2002 Dec. PMID: 12495791