Motivational interviewing: a systematic review and meta-analysis

Sune Rubak

Annelli Sandbæk

Torsten Lauritzen

Bo Christensen

Department and Research Unit of General Practice, University of Aarhus, Denmark

Department of General Practice, University of Aarhus, Denmark

Address for correspondence Sune Rubak, Institute of Public Health, Department of General Practice, University of Aarhus, Vennelyst Boulevard 6, DK-8000 Aarhus C, Denmark. E-mail: kd.ua.mla@rs

Received 2004 Mar 3; Revised 2004 May 2; Accepted 2004 Jul 1.

Abstract

Background

Motivational Interviewing is a well-known, scientifically tested method of counselling clients developed by Miller and Rollnick and viewed as a useful intervention strategy in the treatment of lifestyle problems and disease.

Aim

To evaluate the effectiveness of motivational interviewing in different areas of disease and to identify factors shaping outcomes.

Design of study

A systematic review and meta-analysis of randomised controlled trials using motivational interviewing as the intervention.

Method

After selection criteria a systematic literature search in 16 databases produced 72 randomised controlled trials the first of which was published in 1991. A quality assessment was made with a validated scale. A meta-analysis was performed as a generic inverse variance meta-analysis.

Results

Meta-analysis showed a significant effect (95% confidence interval) for motivational interviewing for combined effect estimates for body mass index, total blood cholesterol, systolic blood pressure, blood alcohol concentration and standard ethanol content, while combined effect estimates for cigarettes per day and for HbA_1c were not significant. Motivational interviewing had a significant and clinically relevant effect in approximately three out of four studies, with an equal effect on physiological (72%) and psychological (75%) diseases. Psychologists and physicians obtained an effect in approximately 80% of the studies, while other healthcare providers obtained an effect in 46% of the studies. When using motivational interviewing in brief encounters of 15 minutes, 64% of the studies showed an effect. More than one encounter with the patient ensures the effectiveness of motivational interviewing.

Conclusion

Motivational interviewing in a scientific setting outperforms traditional advice giving in the treatment of a broad range of behavioural problems and diseases. Large-scale studies are now needed to prove that motivational interviewing can be implemented into daily clinical work in primary and secondary health care.

Keywords: body mass index, interview, psychological, meta-analysis, motivation, randomised controlled trials, review, systematic

Abstract

Acknowledgments

Thanks to Professor Carl Erik Mabeck for sharing his profound knowledge on the area of motivational interviewing and for all his support in writing this review. Thanks also Morten Frydenberg, Associate Professor at the Department of Biostatistics, Aarhus University, for his statistical advice.

Acknowledgments

Notes

Additional information

A reference to this paper was reported in URBAN of 21 September 2004. The authors and editor have agreed that the extent of the report does not amount to prior publication of data.

Supplementary information

Additional information accompanies this article at: http://www.rcgp.org.uk/journal/index.asp

Funding body

This work was funded by the Danish Research Foundation for General Practice

Competing interests

None

Notes

REFERENCES

References

1. Miller WRMotivational interviewing with problem drinkers. Behavioural Psychotherapy. 1983;11:147–172.[PubMed][Google Scholar]
2. Miller WR, Rollnick S Motivational interviewing, preparing people to change addictive behavior. New York: The Guildford Press; 1991. [PubMed][Google Scholar]
3. Rogers CR Client-centred therapy. Its current practice, implications, and theory. Boston: Houghton Mifflin; 1951. [PubMed][Google Scholar]
4. Miller WR, Rollnick S Motivational interviewing, preparing people to change addictive behavior. New York: The Guildford Press; 2002. [PubMed][Google Scholar]
5. Anderson RM, Funnell MM, Butler PM, et al. Patient empowerment. Results of a randomised controlled trial. Diabetes Care. 1995;18:943–949.[PubMed]
6. Chick JEarly intervention for hazardous drinking in the general hospital. Alcohol Alcohol Suppl. 1991;1:477–479.[PubMed][Google Scholar]
7. Sanchez-Craig M, Davila R, Cooper GA self-help approach for high-risk drinking: effect of an initial assessment. J Consult Clin Psychol. 1996;64:694–700.[PubMed][Google Scholar]
8. Baker A, Kochan N, Dixon J, et al Controlled evaluation of a brief intervention for HIV prevention among injecting drug users not in treatment. AIDS Care. 1994;6:559–570.[PubMed][Google Scholar]
9. Baker A, Heather N, Wodak A, et al Evaluation of a cognitive-behavioural intervention for HIV prevention among injecting drug users. AIDS. 1993;7:247–256.[PubMed][Google Scholar]
10. Handmaker NS, Miller WR, Manicke MFindings of a pilot study of motivational interviewing with pregnant drinkers. J Stud Alcohol. 1999;60:285–287.[PubMed][Google Scholar]
11. Colby SM, Monti PM, Barnett NP, et al Brief motivational interviewing in a hospital setting for adolescent smoking: a preliminary study. J Consult Clin Psychol. 1998;66:574–578.[PubMed][Google Scholar]
12. Beresford SA, Curry SJ, Kristal AR, et al A dietary intervention in primary care practice: the Eating Patterns Study. Am J Public Health. 1997;87:610–616.[Google Scholar]
13. Monti PM, Colby SM, Barnett NP, et al Brief intervention for harm reduction with alcohol-positive older adolescents in a hospital emergency department. J Consult Clin Psychol. 1999;67:989–994.[PubMed][Google Scholar]
14. Berg-Smith SM, Stevens VJ, Brown KM, et al. A brief motivational intervention to improve dietary adherence in adolescents. The Dietary Intervention Study in Children (DISC) Research Group. Health Educ Res. 1999;14:399–410.[PubMed]
15. Swanson AJ, Pantalon MV, Cohen KRMotivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. J Nerv Ment Dis. 1999;187:630–635.[PubMed][Google Scholar]
16. Harland J, White M, Drinkwater C, et al The Newcastle exercise project: a randomised controlled trial of methods to promote physical activity in primary care. BMJ. 1999;319:828–832.[Google Scholar]
17. Stotts AL, Schmitz JM, Rhoades HM, Grabowski JMotivational interviewing with cocaine-dependent patients: a pilot study. J Consult Clin Psychol. 2001;69:858–862.[PubMed][Google Scholar]
18. Baker A, Boggs TG, Lewin TJRandomised controlled trial of brief cognitive-behavioural interventions among regular users of amphetamine. Addiction. 2001;96:1279–1287.[PubMed][Google Scholar]
19. Tappin DM, Lumsden MA, McIntyre D, et al A pilot study to establish a randomised trial methodology to test the efficacy of a behavioural intervention. Health Educ Res. 2000;15:491–502.[PubMed][Google Scholar]
20. Kuchipudi V, Hobein K, Flickinger A, Iber FLFailure of a 2-hour motivational intervention to alter recurrent drinking behavior in alcoholics with gastrointestinal disease. J Stud Alcohol. 1990;51:356–360.[PubMed][Google Scholar]
21. Carroll KM, Libby B, Sheehan J, Hyland NMotivational interviewing to enhance treatment initiation in substance abusers: an effectiveness study. Am J Addict. 2001;10:335–339.[Google Scholar]
22. Emmons KM, Hammond SK, Fava JL, et al A randomised trial to reduce passive smoke exposure in low-income households with young children. Pediatrics. 2001;108:18–24.[PubMed][Google Scholar]
23. Kelly AB, Halford WK, Young RMMaritally distressed women with alcohol problems: the impact of a short-term alcohol-focused intervention on drinking behaviour and marital satisfaction. Addiction. 2000;95:1537–1549.[PubMed][Google Scholar]
24. Ershoff DH, Quinn VP, Boyd NR, et al The Kaiser Permanente prenatal smoking-cessation trial: when more isn't better, what is enough? Am J Prev Med. 1999;17:161–168.[PubMed][Google Scholar]
25. Longshore D, Grills C, Annon KEffects of a culturally congruent intervention on cognitive factors related to drug-use recovery. Subst Use Misuse. 1999;34:1223–1241.[PubMed][Google Scholar]
26. Booth RE, Kwiatkowski C, Iguchi MY, et al Facilitating treatment entry among out-of-treatment injection drug users. Public Health Rep. 1998;113(Suppl 1):116–128.[Google Scholar]
27. Mhurchu CN, Margetts BM, Speller VRandomised clinical trial comparing the effectiveness of two dietary interventions for patients with hyperlipidaemia. Clin Sci (Lond) 1998;95:479–487.[PubMed][Google Scholar]
28. Rollnick S, Butler CC, Stott NHelping smokers make decisions: the enhancement of brief intervention for general medical practice. Patient Educ Couns. 1997;31:191–203.[PubMed][Google Scholar]
29. Smith DE, Heckemeyer CM, Kratt PP, Mason DA. Motivational interviewing to improve adherence to a behavioral weight-control program for older obese women with NIDDM. A pilot study. Diabetes Care. 1997;20:52–54.[PubMed]
30. Woollard J, Beilin L, Lord T, et al A controlled trial of nurse counselling on lifestyle change for hypertensives treated in general practice: preliminary results. Clin Exp Pharmacol Physiol. 1995;22:466–468.[PubMed][Google Scholar]
31. Saunders B, Wilkinson C, Phillips MThe impact of a brief motivational intervention with opiate users attending a methadone programme. Addiction. 1995;90:415–424.[PubMed][Google Scholar]
32. Pinto BM, Lynn H, Marcus BH, et al Physician-based activity counseling: intervention effects on mediators of motivational readiness for physical activity. Ann Behav Med. 2001;23:2–10.[PubMed][Google Scholar]
33. Bien TH, Miller WR, Boroughs JMMotivational interviewing with alcohol outpatients. Behavioural and Cognitive Psychotherapy. 1993;21:347–356.[PubMed][Google Scholar]
34. Brown JM, Miller WRImpact of motivational interviewing on participation and outcome in residential alcoholism treatment. Psychol Addict Behav. 1993;7:211–218.[PubMed][Google Scholar]
35. Pill R, Stott NC, Rollnick SR, Rees MA randomised controlled trial of an intervention designed to improve the care given in general practice to type II diabetic patients: patient outcomes and professional ability to change behaviour. Fam Pract. 1998;15:229–235.[PubMed][Google Scholar]
36. Ockene JK, Kristeller J, Pbert L, et al The physician-delivered smoking intervention project: can short-term interventions produce long-term effects for a general outpatient population? Health Psychol. 1994;13:278–281.[PubMed][Google Scholar]
37. Ockene IS, Hebert JR, Ockene JK, et al Effect of physician-delivered nutrition counseling training and an office-support program on saturated fat intake, weight, and serum lipid measurements in a hyperlipidemic population: Worcester Area Trial for Counseling in Hyperlipidemia (WATCH) Arch Intern Med. 1999;159:725–731.[PubMed][Google Scholar]
38. Fleming MF, Barry KL, Manwell LB, et al. Brief physician advice for problem alcohol drinkers. A randomised controlled trial in community-based primary care practices. JAMA. 1997;277:1039–1045.[PubMed]
39. Gentilello LM, Rivara FP, Donovan DM, et al Alcohol interventions in a trauma center as a means of reducing the risk of injury recurrence. Ann Surg. 1999;230:473–480.[Google Scholar]
40. Miller WR, Benefield RG, Tonigan JSEnhancing motivation for change in problem drinking: a controlled comparison of two therapist styles. J Consult Clin Psychol. 1993;61:455–461.[PubMed][Google Scholar]
41. Miller WR, Meyers RJ, Tonigan JSEngaging the unmotivated in treatment for alcohol problems: a comparison of three strategies for intervention through family members. J Consult Clin Psychol. 1999;67:688–697.[PubMed][Google Scholar]
42. Rosal MC, Ockene JK, Ma Y, et al Coronary Artery Smoking Intervention Study (CASIS): 5-year follow-up. Health Psychol. 1998;17:476–478.[PubMed][Google Scholar]
43. O'Neill K, Baker A, Cooke M, et al Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection. Addiction. 1996;91:1115–1125.[PubMed][Google Scholar]
44. Fleming MF, Mundt MP, French MT, et al Brief physician advice for problem drinkers: long-term efficacy and benefit-cost analysis. Alcohol Clin Exp Res. 2002;26:36–43.[PubMed][Google Scholar]
45. Fleming MF, Manwell LB, Barry KL, et al Brief physician advice for alcohol problems in older adults: a randomised community-based trial. J Fam Pract. 1999;48:378–384.[PubMed][Google Scholar]
46. Greene GW, Rossi SRStages of change for reducing dietary fat intake over 18 months. J Am Diet Assoc. 1998;98:529–534.[PubMed][Google Scholar]
47. Stotts AL, DiClemente CC, Dolan-Mullen POne-to-one: a motivational intervention for resistant pregnant smokers. Addict Behav. 2002;27:275–292.[PubMed][Google Scholar]
48. Maisto SA, Conigliaro J, McNeil M, et al Effects of two types of brief intervention and readiness to change on alcohol use in hazardous drinkers. J Stud Alcohol. 2001;62:605–614.[PubMed][Google Scholar]
49. Murphy JG, Duchnick JJ, Vuchinich RE, et al Relative efficacy of a brief motivational intervention for college student drinkers. Psychol Addict Behav. 2001;15:373–379.[PubMed][Google Scholar]
50. Sellman JD, Sullivan PF, Dore GM, et al A randomised controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. J Stud Alcohol. 2001;62:389–396.[PubMed][Google Scholar]
51. Borsari B, Carey KBEffects of a brief motivational intervention with college student drinkers. J Consult Clin Psychol. 2000;68:728–733.[PubMed][Google Scholar]
52. Holder HD, Cisler RA, Longabaugh R, et al Alcoholism treatment and medical care costs from Project MATCH. Addiction. 2000;95:999–1013.[PubMed][Google Scholar]
53. Walters ST, Bennett ME, Miller JHReducing alcohol use in college students: a controlled trial of two brief interventions. J Drug Educ. 2000;30:361–372.[PubMed][Google Scholar]
54. Kemp R, Kirov G, Everitt B, et al. Randomised controlled trial of compliance therapy. 18-month follow-up. Br J Psychiatry. 1998;172:413–419.[PubMed]
55. Butler CC, Rollnick S, Cohen D, et al Motivational consulting versus brief advice for smokers in general practice: a randomised trial. Br J Gen Pract. 1999;49:611–616.[PubMed][Google Scholar]
56. Walters ST, Martin JE, Noto JA controlled trial of two feedback-based interventions for heavy-drinking college students. Alcohol Clin ExpRes. 1999;23(Suppl):45A.[PubMed][Google Scholar]
57. Tappin DM, Mckay C, McIntyre D, et al A practical instrument to document the process of motivational interviewing. Behavioural and Cognitive Psychotherapy. 2000;28:17–32.[PubMed][Google Scholar]
58. Schmaling KB, Blume AW, Afari NA randomised controlled pilot study of motivational interviewing to change attitudes about adherence to medications for asthma. J Clin Psychol Med Settings. 2001;8:167–172.[PubMed][Google Scholar]
59. Lennox AS, Bain N, Taylor RJ, et al. Stages of change training for opportunistic smoking intervention by the primary health care team. Part I: randomised controlled trial of the effect of training on patient smoking outcomes and health professional behaviour as recalled by patients. Health Educ J. 1998;57:140–149.[PubMed]
60. Kenardy J, Mensch M, Bowen K, et al Group therapy for binge eating in type 2 diabetes: a randomised trial. Diabet Med. 2002;19:234–239.[PubMed][Google Scholar]
61. Connors GJ, Walitzer KS, Dermen KHPreparing clients for alcoholism treatment: effects on treatment participation and outcomes. J Consult Clin Psychol. 2002;70:1161–1169.[PubMed][Google Scholar]
62. Baker A, Lewin T, Reichler H, et al Evaluation of a motivational interview for substance use within psychiatric in-patient services. Addiction. 2002;97:1329–1337.[PubMed][Google Scholar]
63. Lincourt P, Kuettel TJ, Bombardier CHMotivational interviewing in a group setting with mandated clients: a pilot study. Addict Behav. 2002;27:381–391.[PubMed][Google Scholar]
64. Beich A, Gannik D, Malterud KScreening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. 2002;325:870.[Google Scholar]
65. DiIorio C, Resnicow K, McDonnell M, et al Using motivational interviewing to promote adherence to antiretroviral medications: a pilot study. J Assoc Nurses AIDS Care. 2003;14:52–62.[PubMed][Google Scholar]
66. Blanchard KA, Morgenstern J, Morgan TJ, et al Motivational subtypes and continuous measures of readiness for change: concurrent and predictive validity. Psychol Addict Behav. 2003;17:56–65.[PubMed][Google Scholar]
67. Curry SJ, Ludman EJ, Graham E, et al Pediatric-based smoking cessation intervention for low-income women: a randomised trial. Arch Pediatr Adolesc Med. 2003;157:295–302.[PubMed][Google Scholar]
68. Davis TM, Baer JS, Saxon AJ, Kivlahan DRBrief motivational feedback improves post-incarceration treatment contact among veterans with substance use disorders. Drug Alcohol Depend. 2003;69:197–203.[PubMed][Google Scholar]
69. Miller WR, Yahne CE, Tonigan JSMotivational interviewing in drug abuse services: a randomised trial. J Consult Clin Psychol. 2003;71:754–763.[PubMed][Google Scholar]
70. Baer JS, Kivlahan DR, Blume AW, et al Brief intervention for heavy-drinking college students: 4-year follow-up and natural history. Am J Public Health. 2001;91:1310–1316.[Google Scholar]
71. Carey MP, Maisto SA, Kalichman SC, et al Enhancing motivation to reduce the risk of HIV infection for economically disadvantaged urban women. J Consult Clin Psychol. 1997;65:531–541.[Google Scholar]
72. Marlatt GA, Baer JS, Kivlahan DR, et al Screening and brief intervention for high-risk college student drinkers: results from a 2-year follow-up assessment. J Consult Clin Psychol. 1998;66:604–615.[PubMed][Google Scholar]
73. Stephens RS, Roffman RA, Curtin LComparison of extended versus brief treatments for marijuana use. J Consult Clin Psychol. 2000;68:898–908.[PubMed][Google Scholar]
74. Treasure JL, Katzman M, Schmidt U, et al Engagement and outcome in the treatment of bulimia nervosa: first phase of a sequential design comparing motivation enhancement therapy and cognitive behavioural therapy. Behav Res Ther. 1999;37:405–418.[PubMed][Google Scholar]
75. Project MATCH Research Group. Mattson ME, Del Boca FK, Carroll KM, et al. Matching Alcoholism Treatments to Client Heterogeneity: project MATCH three-year drinking outcomes. Alcohol Clin Exp Res. 1998;22:1301–1311.[PubMed]
76. Miller WR, Sovereign RG, Krege B. Motivational Interviewing with problem drinkers: II. The drinker's check-up as a preventive intervention. Behavioural Psychotherapy. 1988;16:251–268.[PubMed]
77. Wertz J. Virginia: Virginia Polytechnic Institute and State University; 1994. The effect of motivational interviewing on treatment participation, self-efficacy, and alcohol use at follow-up in inpatient alcohol dependent adults; pp. 1–178. [Thesis/Dissertation.] [PubMed]
78. Alderson P, Green S, Higgins JPT Cochrane reviewers' handbook 4.2.1. Chichester: John Wiley & Sons Ltd; 2004. Updated December 2003. [PubMed][Google Scholar]
79. Jadad AR, Moore RA, Carroll D, et al Assessing the quality of reports of randomised clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.[PubMed][Google Scholar]
80. Moher D, Pham B, Jones A, et al Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet. 1998;352:609–613.[PubMed][Google Scholar]
81. Schulz KF, Chalmers I, Hayes RJ, Altman DG. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA. 1995;273:408–412.[PubMed]