Brad Lundahl

A Meta-Analysis of Motivational Interviewing: Twenty-Five Years of Empirical Studies.

Objective: The authors investigated the unique contribution motivational interviewing (MI) has on counseling outcomes and how MI compares with other interventions. Method: A total of 119 studies were subjected to a meta-analysis. Targeted outcomes included substance use (tobacco, alcohol, drugs, marijuana), health-related behaviors (diet, exercise, safe sex), gambling, and engagement in treatment variables. Results: Judged against weak comparison groups, MI produced statistically significant, durable results in the small effect range (average g = 0.28). Judged against specific treatments, MI produced nonsignificant results (average g = 0.09). MI was robust across many moderators, although feedback (Motivational Enhancement Therapy [MET]), delivery time, manualization, delivery mode (group vs. individual), and ethnicity moderated outcomes. Conclusions: MI contributes to counseling efforts, and results are influenced by participant and delivery factors.

Animal-Assisted Therapy: A Meta-Analysis

ABSTRACT Animal-assisted therapy (AAT) has been practiced for many years and there is now increasing interest in demonstrating its efficacy through research. To date, no known quantitative review of AAT studies has been published; our study sought to fill this gap. We conducted a comprehensive search of articles reporting on AAT in which we reviewed 250 studies, 49 of which met our inclusion criteria and were submitted to meta-analytic procedures. Overall, AAT was associated with moderate effect sizes in improving outcomes in four areas: Autism-spectrum symptoms, medical difficulties, behavioral problems, and emotional well-being. Contrary to expectations, characteristics of participants and studies did not produce differential outcomes. AAT shows promise as an additive to established interventions and future research should investigate the conditions under which AAT can be most helpful.

The effectiveness and applicability of motivational interviewing: a practice-friendly review of four meta-analyses

This article reviews the research support for Motivational interviewing (MI) so that practitioners can make informed decisions about the value and applicability of MI in their clinical work. We highlight the evidence from the three published meta-analyses of MI and a recent meta-analysis that we completed. MI is significantly (10%-20%) more effective than no treatment and generally equal to other viable treatments for a wide variety of problems ranging from substance use (alcohol, marijuana, tobacco, and other drugs) to reducing risky behaviors and increasing client engagement in treatment. Although most client-related variables are unrelated to outcomes (e.g., age, gender, severity), some decisions about treatment format (e.g., individual vs. group) are important. For example, relying solely on group-delivered MI appears to be less effective than one-on-one MI, whereas delivering MI with problem feedback is likely to generate better outcomes for some problems than MI alone.

Motivational interviewing in medical care settings: A systematic review and meta-analysis of randomized controlled trials

OBJECTIVE Motivational Interviewing (MI) is a method for encouraging people to make behavioral changes to improve health outcomes. We used systematic review and meta-analysis to investigate MIs efficacy in medical care settings. METHODS Database searches located randomized clinical trials that compared MI to comparison conditions and isolated the unique effect of MI within medical care settings. RESULTS Forty-eight studies (9618 participants) were included. The overall effect showed a statistically significant, modest advantage for MI: Odd ratio=1.55 (CI: 1.40-1.71), z=8.67, p<.001. MI showed particular promise in areas such as HIV viral load, dental outcomes, death rate, body weight, alcohol and tobacco use, sedentary behavior, self-monitoring, confidence in change, and approach to treatment. MI was not particularly effective with eating disorder or self-care behaviors or some medical outcomes such as heart rate. CONCLUSION MI was robust across moderators such as delivery location and patient characteristics, and appears efficacious when delivered in brief consultations. PRACTICE IMPLICATIONS The emerging evidence for MI in medical care settings suggests it provides a moderate advantage over comparison interventions and could be used for a wide range of behavioral issues in health care.

Preventing Child Abuse: A Meta-Analysis of Parent Training Programs:

Objective: A meta-analysis was conducted to evaluate the ability of parent training programs to reduce parents’ risk of abusing a child. Method: A total of 23 studies were submitted to a meta-analysis. Outcomes of interest included parents’ attitudes toward abuse, emotional adjustment, child-rearing skills, and actual abuse. Conclusions: Immediately following treatment and prior to moderator analyses, effect sizes for all outcomes were in the moderate range (d = 0.45-0.60). Moderator analyses suggest inclusion of home visitors and conducting parent training in both a home and office setting significantly enhanced the effectiveness. In addition, inclusion of a behavioral component and delivering some of the parent training in an individual setting, as opposed to group only, enhanced outcomes significantly.

A Meta-Analysis of Father Involvement in Parent Training

Objective: Investigate (a) whether including fathers in parent training enhances outcomes and (b) whether mothers and fathers benefit equally from parent training. Method: Using traditional meta-analysis methodology, 26 studies that could answer the research questions were identified and meta-analyzed. Results: Studies that included fathers, compared with those that did not, reported significantly more positive changes in childrens behavior and desirable parenting practices, but not in perceptions toward parenting. Compared with mothers, fathers reported fewer desirable gains from parent training. Conclusions: Fathers should not be excluded from parent training and should be encouraged to attend. Further research should seek to understand how parent-training programs might better meet the needs of fathers.

Process-Based Forgiveness Interventions: A Meta-Analytic Review

Objective: To investigate the impact of forgiveness interventions designed to help individuals who have suffered because of betrayals, offenses, or victimization. Forgiveness is believed to be a mechanism through which individuals can experience increases in hope and positive emotions and relief from negative emotions, cognitions, and behaviors. Method: Fourteen published reports of process-based forgiveness interventions that included a comparison group are meta-analyzed. Results/Conclusions: Samples that received forgiveness interventions forgave more (effect size [ES] = .82) and enjoyed increased positive affect (ES = .81) and self-esteem (ES = .60) and less negative affect (ES = .54). Such gains were largely maintained at follow-up periods. Individually delivered programs are superior to group delivery, and some forgiveness programs are superior to others. Further moderators are discussed.

Prison Privatization: A Meta-analysis of Cost and Quality of Confinement Indicators

Objective: To examine the results of prison privatization. Method: In an effort to provide an empirical base from which decisions about privatization might be made, we conducted a meta-analysis of reports on head-to-head comparisons between an identifiable privately managed and publicly managed prison(s). Results: Our search identified 12 studies. Indicators of cost of confinement and confinement quality were assessed. Results suggest privately managed prisons provide no clear benefit or detriment. Conclusion: Cost savings from privatizing prisons are not guaranteed and appear minimal. Quality of confinement is similar across privately and publicly managed systems, with publicly managed prisons delivering slightly better skills training and having slightly fewer inmate grievances.

Interpretations of child compliance in individuals at high- and low-risk for child physical abuse

OBJECTIVE Our studies compared individuals at high- and low-risk for child physical abuse on measures of social information processing. METHOD Two studies were conducted using similar methods. Twenty-eight childless women in Study 1 and 36 mothers in Study 2 read vignettes of parent-child interactions in which the childs level of compliance was difficult to interpret. Participants were asked a series of questions about the childs behavior and their own reactions. RESULTS Accuracy and bias in identifying compliant behavior were assessed using a signal detection paradigm. In both samples, high- and low-risk participants did not differ in their overall accuracy in identifying childrens behaviors. However, they used different evaluation standards such that high-risk participants were biased toward seeing more noncompliance and low-risk participants were biased toward seeing more compliance. High- and low-risk participants also made different types of errors in interpreting childrens behavior. Low-risk participants were more likely to misinterpret noncompliant behavior as compliant, and there was a trend for high-risk participants to not perceive compliant behavior when it occurred. There were no differences in reported disciplinary responses in either study and the results for affective reactions were mixed. CONCLUSIONS Specific differences in social information processing between high- and low-risk individuals replicated across samples, suggesting a reliable association between evaluation standards and risk of child physical abuse. However, the absence of differences in reported discipline and inconsistent findings on affective reactions indicate the need to identify the mechanism through which cognition influences parenting behavior.

Use of Meta-Analysis in Social Work and Allied Disciplines

Abstract Meta-analysis is rapidly becoming the gold-standard for conducting integrative literature reviews. To better understand the role of meta-analysis scholarship in social work, we analyzed publication patterns of meta-analysis across five disciplines: family studies, nursing, psychology, psychiatry, and social work. The frequency and proportion of published meta-analytic studies, critiques of particular meta-analytic studies, and articles discussing meta-analysis methodology were calculated by coding articles from the 10 highest impact journals within each discipline across a 24-year period. All disciplines are increasingly publishing meta-analysis scholarship, though social work lags behind in publishing and commenting on published meta-analyses. Implications are discussed for promoting and strengthening social works ability to effectively produce and benefit from meta-analytic research.