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    Lundahl final icmi motivational interviewing 25 years Lundahl final icmi motivational interviewing 25 years Presentation Transcript

    • Motivational Interviewing: A meta-analysis of 25 years of researchInternational Conference on Motivational Interviewing Sweden – 2010 Brad Lundahl, PhDUniversity of UtahUSA
    • Acknowledgements
      Lundahl, B. W., Kunz, C., Brownell, C., Tollefson, D., & Burke, B. (2010). A meta-Analysis of Motivational Interviewing: Twenty-five years of Empirical Studies. Research on Social Work Practice, 20, 137-160.
      Dr. William Miller – List of published articles
    • Context: Growth of MI Research
      PsycINFO (May 2010) “Motivational Interviewing”
    • Consolidating Findings
      Meta-analysis statistically combines data from empirical studies to provide:
      An estimate of the overall effect
      An estimate of variability
      Indications of moderator effects – conditions which may alter effects
    • Study Objective
      Examine the unique effect of MI by
      Including studies with designs that isolated MI’s contribution
      Including studies that compared MI to another treatment
    • Method
      Study Selection Criteria
      Employed a comparison group
      Design that isolated MI’s unique effect (i.e., not combined w/ other treatment) or compared MI to another treatment
      Published in peer reviewed source
      Published in English
      119 studies met selection criteria
      11 databases, grossed 1,128 possible studies
    • Method
      Dependent Variable Examples
      Substance abuse
      Health-related behaviors
      Risky behaviors
      Emotional wellbeing
      Engagement in treatment
      Independent Variable Examples (Moderators)
      Study design features
      Participant characteristics
      Delivery, role
    • Reporting Results
      Effect size: Hedge’s g which is similar to Cohen’s d
      For this presentation, converted effect size to Binomial Effect Size Display (BESD)
      BESD = % advantage / disadvantage relative to comparison group
      • Randolph, J. J. & Edmondson, R. S. (2005). Using the BESD to present magnitude of effect sizes to the evaluation audience. Practical Assessment, Research & Evaluation, 10, 1 – 7.
    • % Advantage for MI
      TAU= Treatment as Usual
    • MI vs. Strong & Weak Comparisons
    • Does 14% or 4% matter?
      If your take home salary went up or down by 14% … would you notice?
      If the number of missed appointments went down by 14% would it matter?
      If the number of people helped went up by 14% would it matter?
    • Is MI Efficient?
    • Reach: Targeted Behaviors*
      Alcohol (68)
      Marijuana (17)
      Tobacco (24)
      Misc drugs (27)
      Increase healthy beh (11)
      Decrease risky beh (10)
      Drinking safe water (1)
      Gambling (3)
      Emotional wellbeing (7)
      Eating problems (1)
      Parenting practices (2)
      Engagement (34)
      Intention to change (23)
      Confidence (11)
      *Number in ( ) is number of studies contributing effect size data
    • Reach of MI
      Compared to WEAK comparison groups:
      On 11 of 14 targeted behaviors, MI showed statistically significant advantage
      3 of 14 were positive, not statistically significant:
      Confidence (n = 7)
      Eating problems (n = 1)
      Emotional wellbeing (n = 11)
    • Reach of MI
      Compared to STRONG comparison groups:
      MI was NOT statistically better or worse on 14 of 14 targeted behaviors
      2 of 14 targeted behaviors showed a negative, nonsignificantvalence
      Misc. Drugs
    • Target Behaviors x Comparison Type
      Superior = Statistically Significant at p < .05
    • Target Behaviors x Comparison Type
      Superior = Statistically Significant at p < .05
    • Is MI Reserved for Simple Situations?
    • Durability: Do Effects Last?
    • MI or MET? It Depends
    • Group Delivered MICaution …. Few Studies
    • MI Delivered via Group
      Only 8 studies…. Limited inference making
      Weak Comparison Groups: Do not simply rely on group-based MI – include individual
      Strong Comparison Groups: Too early to tell
    • Is More MI Better?
      Probably … especially when MI was compared to WEAK comparison groups
      Positive correlation between minutes spent and time
    • Quick Questions / Answers
      Does degree of person delivering MI matter?
      Does MI’s role influence outcome?
      Prelude, Additive, Head-to-Head
      Does NOT matter
    • Quick Questions / Answers
      Does age matter?
      Mixed … probably a lower limit based on cognitive processing skills
      Is MI better suited to males or females?
    • Summary
      Robust: Reach & Moderators
      Equivalent to other active treatments
      Superior, in most cases, to no treatment or weak treatment
      Not a silver bullet … our results show a smaller effect than previous meta-analyses investigating MI
    • Future Directions
      Investigate moderator effects within targeted behavior areas
      Empirically investigate why MI works
      Assess cost-effectiveness of implementing MI into practice at individual and system level
    • Thank you for having me!
    • Meta-Analyses Examining MI
      Burke, B., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843-861.
      Hettema, J., Steele, J., & Miller, W. (2005). Motivational Interviewing. Annual Review of Clinical Psychology, (1), 91-111.
      Vasilaki, E., Hosier, S., & Cox, W. (2006). The efficacy of motivational interviewing as a brief intervention for excessive drinking: A meta-analytic review. Alcohol and Alcoholism, 41, 328-335.
      Lundahl, B. W., Tollefson, D., Kunz, C., Brownell, C., & Burke, B. (2010). Meta-analysis of Motivational interviewing: Twenty Five years of research. Research on Social Work Practice.
    • Motivational Interviewing: A meta-analysis of 25 years of researchBrad Lundahl, PhDUniversity of Utah College of Social Workwww.socwk.utah.edu