Brian L. Burke

The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials.

A meta-analysis was conducted on controlled clinical trials investigating adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs were equivalent to other active treatments and yielded moderate effects (from .25 to .57) compared with no treatment and/or placebo for problems involving alcohol, drugs, and diet and exercise. Results did not support the efficacy of AMIs for smoking or HIV-risk behaviors. AMIs showed clinical impact, with 51% improvement rates, a 56% reduction in client drinking, and moderate effect sizes on social impact measures (d=0.47). Potential moderators (comparative dose, AMI format, and problem area) were identified using both homogeneity analyses and exploratory multiple regression. Results are compared with other review results and suggestions for future research are offered.

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.

Two Decades of Terror Management Theory: A Meta-Analysis of Mortality Salience Research

A meta-analysis was conducted on empirical trials investigating the mortality salience (MS) hypothesis of terror management theory (TMT). TMT postulates that investment in cultural worldviews and self-esteem serves to buffer the potential for death anxiety; the MS hypothesis states that, as a consequence, accessibility of death-related thought (MS) should instigate increased worldview and self-esteem defense and striving. Overall, 164 articles with 277 experiments were included. MS yielded moderate effects (r = .35) on a range of worldview- and self-esteem-related dependent variables (DVs), with effects increased for experiments using (a) American participants, (b) college students, (c) a longer delay between MS and the DV, and (d) people-related attitudes as the DV. Gender and self-esteem may moderate MS effects differently than previously thought. Results are compared to other reviews and examined with regard to alternative explanations of TMT. Finally, suggestions for future research are offered.

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.

THE EMERGING EVIDENCE BASE FOR MOTIVATIONAL INTERVIEWING: A META-ANALYTIC AND QUALITATIVE INQUIRY

This article offers a meta-analytic, qualitative, and process review of the empirical literature for adaptations of motivational interviewing (AMIs), a promising approach to treating problem behaviors. AMIs are equivalent to other active treatments and yield moderate effects (from 0.35 to 0.56) compared to no-treatment/placebo for problems involving alcohol, drugs, and diet and exercise. Results do not support the efficacy of AMIs for smoking or HIV-risk behaviors. Conclusions regarding the mechanisms of action for AMIs are limited by methodological problems: confounding motivational interviewing with feedback, unclear definitions of the AMI interventions used, difficulties in therapist training, and limited use of treatment integrity rating scales. Extant research suggests that AMIs are equivalent in efficacy to and briefer than cognitive behavioral skills training (CBST) approaches. Since AMIs focus on readiness to change while CBST targets the change process, AMIs may be useful as preludes or additions to CBST.

Efficacy of Self-Administered Treatments for Depression and Anxiety

Self-administered treatments (SATs) are widely used by the general public and mental health professionals. Previous reviews of the efficacy of SATs have included under this category interventions for nonclinical problems, group interventions, and interventions involving significant amounts of therapist contact. The efficacy of SATs for clinical levels of depression and anxiety with minimal therapeutic contact was examined by meta-analyzing 24 studies. The results show large effects for SATs when compared with no-treatment control groups (d 1.00). However, unlike previous meta-analyses that found nonsignificant differences between SATs and therapist-administered treatments, in this sample SATs resulted in significantly poorer outcomes (d –0.31). Some differences in effect size were observed between the clinical targets of depression and anxiety. However, there were high correlations between clinical target, methodological quality of the study, and amount of contact. This makes it impossible to determine whether the observed differences could be explained by the nature of the disorders, methodological quality, or the amount of contact with a member of the research team. The implications of the findings for the clinical use of SATs and for future research are discussed.

Critical Analysis A Comparison of Critical Thinking Changes in Psychology and Philosophy Classes

This study compared changes in psychology and philosophy classes in two distinct components of critical thinking (CT): general skills and personal beliefs. Participants were 128 undergraduates enrolled in CT in psychology, other psychology courses, or philosophy courses. CT and philosophy students significantly reduced beliefs in paranormal phenomena at the end of the semester compared to other psychology students. Only philosophy students improved on the Watson–Glaser Critical Thinking Appraisal. The Watson–Glaser may not fully measure CT emphasized in psychology, but psychology instructors can still effectively teach students to examine their own beliefs and think differently in their daily lives. Differentiated assessment of CT is important as instructors evaluate student learning against specific goals.

Toward an Emerging Role for Motivational Interviewing in Primary Care

Purpose of ReviewImplementing Motivational Interviewing (MI) in primary care settings has been problematic due in part to persistent gaps in knowledge. Examples include poor understanding of how to effectively train persons to conduct MI, or of which aspects of MI-related communication are associated with better outcomes for patients. This review describes how recent research findings addressing the knowledge gaps support a growing role for MI in primary care.Recent FindingsTwo trials of MI training combined classroom time with ongoing coaching and feedback, resulting in enhanced MI ability relative to a control arm where PCPs received minimal or no MI training. A third MI training trial excluded coaching and feedback, failing to increase use of MI. Adding to a growing list of behavioral health-related problems for which MI training has shown some effectiveness, a trial of training PCPs to use MI with depressed patients was associated with significantly improved depressive symptoms. Moreover, aspects of the PCPs’ MI-related language and patients’ arguments for positive behavior changes, “change talk,” appeared to explain the positive effects of MI training on depression outcome.SummaryMI-training approaches have improved such that PCPs and possibly other clinic staff may want to consider MI training as a way to more effectively support their patients as they address behavioral health-related problems (e.g., tobacco use). MI training should focus on eliciting “change talk” from patients. Researchers and funding agencies might collaborate to continue closing knowledge gaps in the MI literature.

Still Crazy About Teaching After All These Years: An Interview With Dick Gorman

Richard Gorman received his BA in philosophy from the University of Notre Dame and his PhD in educational psychology from Fordham University. Over the years, he has taught at several colleges and universities—both in the east and west—and is currently a member of the Psychology Department at Central New Mexico Community College. He has taught courses in developmental, educational, and cognitive psychology, but is currently concentrating on the introductory psychology course. His publications include a text in the psychology of classroom learning, an introduction to Piagets theory for teachers, and, more recently, an introductory psychology text. He has given presentations and workshops on discovery learning to various audiences including the National Institute on the Teaching of Psychology (NITOP). Brian L. Burke is an Assistant Professor of Psychology at Fort Lewis College, a public liberal arts college in Durango, Colorado. He is a licensed clinical psychologist whose principal academic interests include motivational interviewing and college teaching. He regularly attends teaching conferences, twice winning the Doug Bernstein Award for innovative teaching ideas (NITOP 2004, 2005). He also won the New Faculty Teaching Award at Fort Lewis College in 2005. He teaches a wide variety of courses, including introductory psychology, personality, abnormal, counseling, research methods, history of psychology (via a European trip), and forensic psychology. Brian hails originally from Montreal, Canada, and received his PhD from the University of Arizona in 2003.