Beyond words: investigating emotional expression and change talk in motivational interviewing for substance use treatment

Background: Motivational Interviewing (MI) is an evidence-based counseling approach for substance use treatment that emphasizes client-centered dialogue and the resolution of ambivalence. While prior research has extensively examined verbal content—particularly "change talk"—the role of emotional expression, especially as conveyed nonverbally through facial behavior, remains underexplored. Objective: This study investigated the temporal relationship between client emotional expressions and subsequent change talk in MI sessions with emerging adults engaged in substance use treatment. Specifically, it examined whether facial expressions coded as positive, negative, or ambivalent predicted varying levels of change talk intensity. Methods: Nineteen audio-video recorded MI sessions were analyzed using the Facial Action Coding System (FACS) to classify client emotional expressions and the Motivational Interviewing Skill Code (MISC) to assess motivational language. Emotional expressions were coded during therapist speaking turns, and client utterances were categorized into low, medium, or high change talk. Sequential analysis techniques were employed to evaluate lag +1 transitions from emotional display to motivational speech. Results: Ambivalent expressions were the most commonly observed, followed by negative and then positive expressions. Positive facial expressions—particularly Duchenne smiles (AU6+12)—were significantly more likely to precede high-intensity change talk. In contrast, negative expressions were most frequently followed by low-intensity change talk. Ambivalent expressions tended to precede medium-intensity change talk, suggesting a motivational tension reflective of internal conflict. Conclusions: These findings highlight the relevance of nonverbal emotional expression in MI and suggest that emotion may serve as a dynamic and observable precursor to motivational engagement. Clinicians may benefit from greater attention to client affective cues—particularly facial expressions—as signals of readiness to change. Implications for emotion-informed MI practice, therapist training, and future research on the integration of affect in behavior change models are discussed.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Social Work

Grantor

University of Illinois Urbana-Champaign

Year dc:date

2025

Author dc:creator

• Campbell, Corey

Contributors dc:contributor

• Smith, Douglas C.
• Smith, Douglas C
• Liechty, Janet
• Fairbarin, Catharine
• Houck, Jon

• Motivational Interviewing
• Facial Action Coding System
• Change Talk
• Emotion Expression
• Ambivalence
• Emerging Adults
• Substance Use
• Sequential Analysis

Statement dc:rights

• Copyright 2025 Corey Campbell

Language dc:language

en, eng

Handle dc:identifier

https://hdl.handle.net/2142/129883

OAI record oai:identifier

https://www.ideals.illinois.edu/oai-pmh?verb=GetRecord&metadataPrefix=etdms&identifier=oai%3Awww.ideals.illinois.edu%3A2142%2F129883