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Lundahl final icmi motivational interviewing 25 years


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Lundahl final icmi motivational interviewing 25 years

  1. 1. Motivational Interviewing: A meta-analysis of 25 years of researchInternational Conference on Motivational Interviewing Sweden – 2010 Brad Lundahl, PhDUniversity of UtahUSA<br />
  2. 2. Acknowledgements<br />Co-authors<br />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. <br />Dr. William Miller – List of published articles<br />
  3. 3. Context: Growth of MI Research <br />PsycINFO (May 2010) “Motivational Interviewing” <br />
  4. 4. Consolidating Findings<br />Meta-analysis statistically combines data from empirical studies to provide:<br />An estimate of the overall effect <br />An estimate of variability<br />Indications of moderator effects – conditions which may alter effects<br />
  5. 5. Study Objective<br />Examine the unique effect of MI by<br />Including studies with designs that isolated MI’s contribution<br />Including studies that compared MI to another treatment <br />
  6. 6. Method<br />Study Selection Criteria<br />Employed a comparison group<br />Design that isolated MI’s unique effect (i.e., not combined w/ other treatment) or compared MI to another treatment<br />Published in peer reviewed source<br />Published in English<br />119 studies met selection criteria<br />11 databases, grossed 1,128 possible studies <br />
  7. 7. Method<br />Dependent Variable Examples<br />Substance abuse<br />Health-related behaviors<br />Risky behaviors<br />Emotional wellbeing<br />Engagement in treatment<br />Independent Variable Examples (Moderators)<br />Study design features<br />Participant characteristics<br />Delivery, role<br />
  8. 8. Reporting Results<br />Effect size: Hedge’s g which is similar to Cohen’s d<br />For this presentation, converted effect size to Binomial Effect Size Display (BESD)<br />BESD = % advantage / disadvantage relative to comparison group <br /><ul><li>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. </li></li></ul><li>
  9. 9. % Advantage for MI<br />TAU= Treatment as Usual<br />
  10. 10. MI vs. Strong & Weak Comparisons <br />
  11. 11. Does 14% or 4% matter?<br />If your take home salary went up or down by 14% … would you notice? <br />If the number of missed appointments went down by 14% would it matter?<br />If the number of people helped went up by 14% would it matter? <br />
  12. 12. Is MI Efficient? <br />
  13. 13. Reach: Targeted Behaviors*<br />Alcohol (68)<br />Marijuana (17)<br />Tobacco (24)<br />Misc drugs (27)<br />Increase healthy beh (11)<br />Decrease risky beh (10)<br />Drinking safe water (1) <br />Gambling (3)<br />Emotional wellbeing (7)<br />Eating problems (1)<br />Parenting practices (2)<br />Engagement (34)<br />Intention to change (23)<br />Confidence (11)<br />*Number in ( ) is number of studies contributing effect size data<br />
  14. 14. Reach of MI <br />Compared to WEAK comparison groups: <br />On 11 of 14 targeted behaviors, MI showed statistically significant advantage<br />3 of 14 were positive, not statistically significant: <br />Confidence (n = 7)<br />Eating problems (n = 1)<br />Emotional wellbeing (n = 11)<br />
  15. 15. Reach of MI<br />Compared to STRONG comparison groups:<br />MI was NOT statistically better or worse on 14 of 14 targeted behaviors<br />2 of 14 targeted behaviors showed a negative, nonsignificantvalence <br />Tobacco <br />Misc. Drugs<br />
  16. 16. Target Behaviors x Comparison Type<br />Superior = Statistically Significant at p < .05<br />
  17. 17. Target Behaviors x Comparison Type<br />Superior = Statistically Significant at p < .05<br />
  18. 18. Is MI Reserved for Simple Situations?<br />
  19. 19. Durability: Do Effects Last?<br />
  20. 20. MI or MET? It Depends<br />
  21. 21. Group Delivered MICaution …. Few Studies <br />
  22. 22. MI Delivered via Group<br />Only 8 studies…. Limited inference making<br />Weak Comparison Groups: Do not simply rely on group-based MI – include individual<br />Strong Comparison Groups: Too early to tell<br />
  23. 23. Is More MI Better?<br />Probably … especially when MI was compared to WEAK comparison groups<br />Positive correlation between minutes spent and time<br />
  24. 24. Quick Questions / Answers<br />Does degree of person delivering MI matter?<br />NO<br />Does MI’s role influence outcome? <br />Prelude, Additive, Head-to-Head<br />Does NOT matter<br />
  25. 25. Quick Questions / Answers<br />Does age matter?<br />Mixed … probably a lower limit based on cognitive processing skills<br />Is MI better suited to males or females?<br />Neither<br />
  26. 26. Summary<br />Robust: Reach & Moderators<br />Equivalent to other active treatments<br />Superior, in most cases, to no treatment or weak treatment<br />Efficient <br />Not a silver bullet … our results show a smaller effect than previous meta-analyses investigating MI<br />
  27. 27. Future Directions<br />Investigate moderator effects within targeted behavior areas<br />Empirically investigate why MI works<br />Assess cost-effectiveness of implementing MI into practice at individual and system level<br />
  28. 28. Thank you for having me!<br /><br />
  29. 29. Meta-Analyses Examining MI<br />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.<br />Hettema, J., Steele, J., & Miller, W. (2005). Motivational Interviewing. Annual Review of Clinical Psychology, (1), 91-111. <br />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.<br />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.<br />
  30. 30. Motivational Interviewing: A meta-analysis of 25 years of researchBrad Lundahl, PhDUniversity of Utah College of Social <br />