Behavioural Interventions and Motivational Interviewing

MI Outcome Studies

The evidence base for motivational interviewing is strong and compelling. Since the 1980s the number of research and clinical articles has doubled every three years, with over 1000 publications and over 200 randomized clinical trials (Miller and Rollnick, 2009; Miller and Rollnick 2013).

Two recent meta - analyses (Lundahl et al., 2010; Lundahl and Burke, 2009) support the efficacy of MI in addictions and in other health behaviour change areas (such as mental health problems, diabetes, obesity, hypertension, criminal justice, homelessness, HIV/AIDS, and more). In particular, research supports the use of MI to enhance treatment engagement and retention, client goal - setting and behaviour change, enhanced motivation, and durable treatment.

When MI has been compared with other interventions (treatment as usual, TAU), outcomes in the MI condition were found to be effective 75% of the time, with 50% of clients gaining small but meaningful effects and 25% gaining moderate to strong effects (Lundahl et al., 2010).

These results are consistent with research findings for other clinical interventions. However, an added benefit of MI over other treatments is that a smaller dose of treatment may be needed; on average, studies find that MI treatments take an average of 100 less minutes yet produce equal effects (Lundahl et al., 2010).

References

• Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. L. (2010). A Meta-Analysis of Motivational Interviewing: Twenty-Five Years of Empirical Studies. Research on Social Work Practice, 20(2), 137-160.
• Lundahl, B. W., & Burke, B. L. (2009). The effectiveness and applicability of Motivational Interviewing: A practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65(11), 1232-1245.
• Miller, W. R., & Rollnick, S. (2009). Ten Things That Motivational Interviewing Is Not. Behavioural and Cognitive Psychotherapy, 37(2), 129-140.
• Miller, W. R., & Rollnick, S. (2013). Motivational Interviewing: Helping People Change. (3rd ed.). New York, NY: Guilford Press.

The Four Key Strategies to MI can be recalled as OARS:

• OPEN questions to elicit change talk (e.g. “So what makes you think it may be time for a change?”)
• AFFIRM the client appropriately (support, emphasize personal control)
• REFLECT (try for complex reflections that paraphrase what you heard – not just parrot back the client’s response)
• SUMMARIZE ambivalence, offer double - sided reflection – (e.g. "Let me stop and summarize what we've just talked about. You’re not sure that you want to be here today and you really only came because your partner insisted on it. At the same time, you've had some nagging thoughts of your own about what's been happening, including how much you've been using recently, the change in your physical health and your missed work. Did I miss anything? I'm wondering what you make of all those things.")

OARS: Foundation Skills

The goal in using OARS is to move the person forward by eliciting change talk, or self - motivational statements. Change talk involves statements or affective communications that indicate the client may be considering the possibility of change. Miller and Rollnick organize this talk into four categories: problem recognition, concern about the problem, commitment to change and belief that change is possible.

The take home message – is not that you have to add these new techniques, but if you remember to listen more and talk less.

There is some evidence that eliminating responses that act as roadblocks such as confrontations, advice without permission, directing, threatening, and raising concern without permission is MORE important than just adding MI consistent responses. Recall that the client should be doing most of the talking – about 70%.