Motivational Interviewing in the Prevention and Treatment of Depression. William R. Miller, PhD. The University of New Mexico

Transcription

1 Motivational Interviewing in the Prevention and Treatment of Depression William R. Miller, PhD. The University of New Mexico

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4 All Nine Counselors: Miller, W. R., Taylor, C. A., & West, J. C. (1980). Focused versus broad spectrum behavior therapy for problem drinkers. Journal of Consulting and Clinical Psychology, 48,

5 Therapist Empathy Miller, Taylor & West (1980)

6 Therapist Empathy 60 Miller, Taylor & West (1980)

7 Client Drinking Outcomes Accounted for by Therapist Empathy 6 months 1 year 2 years r =.82 r =.71 r =.51 67% 52% 26% Miller & Baca (1983) Behavior Therapy 14:

8 Client Relapse Rates Months 12 Months 18 Months 24 Months Follow-up Points Low Medium High

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10 Called it motivational interviewing Conceived of MI as preparation for treatment A discussion paper Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural Psychotherapy, 11,

11 Miller, W. R., Sovereign, R. G., & Krege, B. (1988). Motivational interviewing with problem drinkers: II. The Drinker's Check-up as a preventive intervention. Behavioural Psychotherapy, 16, doi: /S

12 Counselor Style (Random Assignment) and Client Response Client Behavior Counts Change Talk Resistance 5 0 Directive Empathic Miller, W. R., Benefield, R. G., & Tonigan, J. S. (1993). Enhancing motivation for change in problem drinking: A controlled comparison of two therapist styles. Journal of Consulting and Clinical Psychology, 61,

13 What is MI? 1989 Sydney

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17 (What s it for?) Practitioner s definition (How would I use it?) Motivational interviewing is a person-centered counseling style for addressing the common problem of ambivalence about change

18 The Underlying Spirit of MI

19 Collaboration Compassion MI Spirit Acceptance Evocation

20 Absolute Worth Accurate Empathy Acceptance Autonomy Support Affirmation

21 The apple has not fallen very far from the tree

22 Four Fundamental Processes in Motivational Interviewing

23 Four Planning Foundational Processes Evoking Focusing Engaging

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25 Opposite Sides of a Coin Preparatory (DARN) Desire Ability Reasons Need Mobilizing (CATs) Commitment Activation Taking Steps

26 How Motivational Interviewing is Directional PS Carl Rogers also responded selectively

27 What MI Research Tells Us?

28 End of Treatment 4-6 Months 7-12 Months Hettema et al. 2005, Annual Review of Clinical Psychology, 1,

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33 Directive Empathic 0 MI1 FA1 MI2 FA2

34 Is MI Just Client-Centered Counseling? Sellman, J. D., Sullivan, P. F., Dore, G. M., Adamson, S. J., & MacEwan, I. (2001). A randomized controlled trial of motivational enhancement therapy (MET) for mild to moderate alcohol dependence. Journal of Studies on Alcohol, 62(3),

35 OR=2.62 OR=2.95 % Patients Drinking Heavily MET NDRL Control

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40 MI Training Feedback + Coaching Increased MI Fidelity Change Client Change Talk

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42 A few early examples of randomized trials:

43 BDI-II Score BI(MI) Therapy 10 Baseline 3 Months 6 Months 12 Months BI = One session brief intervention with MI Therapy = 10 sessions with therapist trained in MI Kay-Lambkin, F. J., Baker, A. L., Lewin, T. J., & Carr, V. J. (2009). Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy. Addiction, 104(3),

44 Intervention: 6 MI-based telephone calls after discharge from inpatient care for TBI Control Intervention Baseline Posttreatment Bombardier, C. H., Bell, K. R., Temkin, N. R., Fann, J. R., Hoffman, J. M., & Dikmen, S. (2009). The efficacy of a scheduled telephone intervention for ameliorating depressive symptoms during the first year after traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(4),

45 Baseline d =.3 Posttreatment Control MET Naar-King, S., Parsons, J. T., Murphy, D., Kolmodin, K., & Harris, D. R. (2010). A multisite randomized trial of a motivational intervention targeting multiple risks in youth living with HIV: Initial effects on motivation, self-efficacy, and depression. Journal of Adolescent Health, 46(5),

46 PHQ-9 Score Baseline 6 weeks 12 weeks 36 weeks TAU TAU+MI TAU = Standard care TAU+MI = Standard care delivered by practitioners trained in MI Keeley, R. D., Brody, D. S., Engel, M., Burke, B. L., Nordstrom, K., Moralez, E.,... Emsermann, C. (2016). Motivational interviewing improves depression outcome in primary care: A cluster randomized trial. Journal of Consulting and Clinical Psychology, 84(11),

47 Remission Rate (%) Baseline 6 weeks 12 weeks 36 weeks TAU TAU+MI TAU = Standard care TAU+MI = Standard care delivered by practitioners trained in MI Keeley, R. D., Brody, D. S., Engel, M., Burke, B. L., Nordstrom, K., Moralez, E.,... Emsermann, C. (2016). Motivational interviewing improves depression outcome in primary care: A cluster randomized trial. Journal of Consulting and Clinical Psychology, 84(11),

48 Usual Care MI 10 0 % Normal Mood % Deceased OR=1.66 ( ) OR=2.15 ( ) Watkins, C. L., Wathan, J. V., Leathley, M. J., Auton, M. F., Deans, C. F., Dickinson, H. A.,... Lightbody, C. E. (2011). The 12-month effects of early motivational interviewing after acute stroke: a randomized controlled trial. Stroke, 42(7),

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50 and still we re just getting started

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