Testing the Efficacy of Narrator Empathy, Self-Disclosure, Gender, and Use of Brief Motivational Interviewing Techniques in a Brief Internet-Based Intervention for Alcohol Use

Objective: Nonspecific relational factors, such as therapist empathy, play an important role in therapy effectiveness. Building on this literature, some researchers have attempted to incorporate relational factors into electronic brief interventions (e-BIs) by using interactive narrators to guide participants through the intervention. However, few studies have examined which characteristics of these interactive narrators increase intervention acceptability and efficacy. The present study sought to systematically manipulate animated narrator characteristics in an e-BI and to examine their effects on respondents' alcohol use and subjective reactions. Method: Participants (N = 348) were randomly assigned to 1-16 possible combinations of four narrator-level characteristics in a 2 × 2 × 2 × 2 factorial trial evaluating narrator empathy, self-disclosure, gender, and the use of brief motivational interviewing (BMI) techniques. We measured main and interaction effects of these characteristics on the primary outcome of typical drinks per week at 1-month follow-up. Secondary outcomes included maximum drinks, alcohol consequences, and subjective reactions to the intervention, with additional secondary analyses evaluating moderation by participant gender. Results: Participants showed reductions in all alcohol outcomes. These reductions were stronger for participants exposed to either narrator disclosure or BMI techniques (vs. neither). Participants in the high empathy condition rated the intervention as more supportive, while those exposed to BMI techniques reported feeling more criticized by the intervention. Conclusions: Specific narrator-level characteristics, such as narrator self-disclosure and empathy, may improve the efficacy or acceptability of e-BIs. Public Health Significance Statement The present study is the first to systematically manipulate narrator-level characteristics in the context of an electronic brief intervention (e-BI) for alcohol use. Results indicate that the presence of a narrator backstory may increase e-BI efficacy, and that narrator gender and empathy may influence intervention acceptability.