Motivational Interviewing in the Prevention and Treatment of Depression William R. Miller, PhD. The University of New Mexico
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, 590-601.
Therapist Empathy Miller, Taylor & West (1980)
Therapist Empathy 60 Miller, Taylor & West (1980)
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: 441-448
Client Relapse Rates 40 35 30 25 20 15 10 5 0 35 38 29 23 24 20 19 13 15 11 18 5 6 Months 12 Months 18 Months 24 Months Follow-up Points Low Medium High
1982 - Norway
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, 147-172.
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, 251-268. doi: 10.1017/S0141347300014129
Counselor Style (Random Assignment) and Client Response 45 43.6 40 35 Client Behavior Counts 30 25 20 21.3 21.6 Change Talk 15 10 12.7 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, 455-461.
What is MI? 1989 Sydney
1991 2002 2013
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(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
The Underlying Spirit of MI
Collaboration Compassion MI Spirit Acceptance Evocation
Absolute Worth Accurate Empathy Acceptance Autonomy Support Affirmation
The apple has not fallen very far from the tree
Four Fundamental Processes in Motivational Interviewing
Four Planning Foundational Processes Evoking Focusing Engaging
70000 60000 50000 40000 30000 20000 10000 0 1983 1987 1991 1995 1999 2003 2007 2011 2015 Annual Cumulative 24
Opposite Sides of a Coin Preparatory (DARN) Desire Ability Reasons Need Mobilizing (CATs) Commitment Activation Taking Steps
How Motivational Interviewing is Directional PS Carl Rogers also responded selectively
What MI Research Tells Us?
0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 0.77 0.31 0.3 End of Treatment 4-6 Months 7-12 Months Hettema et al. 2005, Annual Review of Clinical Psychology, 1, 91-111.
60 40 20 0.8 0.6 0.4 0.2 0 80 60 40 20 0 Directive Empathic 0 MI1 FA1 MI2 FA2
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), 389-396.
70 65 60 55 62.5 65 50 45 40 35 30 25 20 42.9 OR=2.62 OR=2.95 % Patients Drinking Heavily MET NDRL Control
MI Training Feedback + Coaching Increased MI Fidelity Change Client Change Talk
A few early examples of randomized trials:
BDI-II Score 40 35 30 25 20 15 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), 378-388.
Intervention: 6 MI-based telephone calls after discharge from inpatient care for TBI 75 70 65 60 Control Intervention 55 50 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), 230-238.
57 56 55 54 53 52 51 50 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), 422-428.
PHQ-9 Score 17 16 15 14 13 12 11 10 9 8 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), 993-1007.
Remission Rate (%) 24 22 20 18 16 14 12 10 8 6 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), 993-1007.
60 50 40 30 20 Usual Care MI 10 0 % Normal Mood % Deceased OR=1.66 (1.08-2.55) OR=2.15 (1.06-4.38) 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), 1956-1961
and still we re just getting started
www.motivationalinterviewing.org