A Pilot Trial of Gender-Based Motivational Interviewing for Help-Seeking and Internalizing Symptoms in Men.

Only 15–27% of men with a mental health disorder seek formal help such as psychotherapy or psychotropic medication (Oliver, Pearson, Coe, & Gunnell, 2005). Men are also less likely to seek informal help (e.g. family and friends; Forchuk et al., 2009). Theorists posit that conformity to traditional masculine norms (e.g. emotional control and self-reliance) militate against help-seeking (Addis & Mahalik, 2003). Empirical evidence indicates that men who conform to traditional masculine norms report more negative attitudes towards help-seeking, more stigma, less intention to seek help, and lower rates of formal and informal help-seeking (Good, Dell, & Mintz, 1989; Good & Wood, 1995; Lane & Addis, 2005; Pederson & Vogel, 2007; Smith, Tran, & Thompson, 2008). One approach to addressing men’s low rates of service utilization is developing interventions that increase use of existing mental health services. Another approach is developing alternative interventions for improving mental health functioning that are less stigmatized and more palatable to “traditional” men (i.e. Men that adhere to traditional masculine norms). For example, McKelley and Rochlen (2010) found that alternative interventions such as executive coaching are less stigmatizing than psychotherapy for men. Currently, there are no empirically supported interventions using either approach to influence men’s help-seeking. This article describes the development and initial evaluation of a gender-sensitive motivational intervention for men with internalizing symptoms (i.e. depression and anxiety disorders) that incorporates both approaches. We called this intervention gender-based motivational interviewing (GBMI). GBMI integrates principles of motivational interviewing with gender-based principles derived from social scientific research on the psychology of men and related models of men’s help-seeking (Addis & Mahalik, 2003). We drew on motivational interviewing as it is an effective non-confrontational approach to enhancing motivation and reducing resistance (Miller & Rollnick, 2002). Motivational interviewing frequently includes brief assessment and personalized feedback on a targeted health behavior (Hettema, Steele, & Miller, 2005). Empirical support for motivational interviewing has expanded to include numerous health behaviors (Hettema, Steele, &Miller, 2005). The goal of gender-based strategies is to mitigate gendered barriers that interfere with ambivalence and contemplation so that motivational strategies can be more effective at bringing about behavior change. We organized gender-based strategies into three domains according the type of gendered barrier: interpersonal, cognitive, and linguistic. In order to reduce interpersonal barriers, GBMI incorporates an interpersonal style that is designed to rapidly develop an alliance with potentially reactant men. This interpersonal style is characterized by transparency, curiosity, and respect in order to lessen masculine posturing and competition in the room. GBMI works on cognitive barriers by presenting information about the prevalence of mental health disorders and treatment seeking in men. GBMI introduces alternative conceptions of mental disorders using a cognitive-behavioral model, which has been shown to be less stigmatizing than the medical model (Deacon & Lickel, 2009). Both interpersonal and cognitive barriers are addressed while taking into account potential linguistic barriers. Colloquial language is used when describing the interview (e.g “Personalized feedback” as opposed to psychotherapy)and when labeling a man’s distress (e.g. stress as opposed to anxiety) in order to be less stigmatizing. Internalizing disorders and help-seeking are framed using language that is consistent with masculine norms (e.g. Help-seeking can be framed as “regaining control over one’s problems.”) The stage model of behavioral therapies recommends a pilot trial in order to demonstrate clinically-meaningful outcomes in at least one domain and to estimate the likely effect size of the treatment (Onken, Blaine, & Battjes, 1997; Rounsaville, Carroll, & Onken, 2001). In the present study, we conducted a pilot randomized-controlled trial of GBMI in order to evaluate its efficacy for improving men’s help-seeking behaviors and mental health functioning. Our primary research questions were as follows: What is the effect of GBMI on mental health functioning? What is the effect of GBMI on stigma about internalizing disorders? What is the effect of GBMI on help-seeking behaviors, attitudes, and intentions?