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A Meta-Analysis of Motivational Interviewing: Twenty-Five Years of Empirical Studies
Brad W. Lundahl, Chelsea Kunz, Cynthia Brownell, Derrik Tollefson and Brian L. Burke
Research on Social Work Practice 2010 20: 137 originally published online 11 January 2010
DOI: 10.1177/1049731509347850
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http://rsw.sagepub.com/content/20/2/137

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Research Article

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

Research on Social Work Practice
20(2) 137-160
ª The Author(s) 2010
Reprints and permission:
sagepub.com/journalsPermissions.nav
DOI: 10.1177/1049731509347850
rswp.sagepub.com

Brad W. Lundahl,1 Chelsea Kunz,1 Cynthia Brownell,1
Derrik Tollefson,2 and Brian L. Burke3

Abstract
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 ¼ 0.28). Judged against specific treatments,
MI produced nonsignificant results (average g ¼ 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.
Keywords
motivational interviewing; meta-analysis; review

Introduction
Motivational interviewing (MI), which originated in the early
1980s, has become a well-recognized brand of counseling.
A simple literature search using the term ‘‘motivational interviewing’’ as the keyword in one database, PsycInfo, revealed
three references during the 10-year span of 1980 to 1989,
35 references from 1990 to 1999, and 352 from 2000 to December of 2008. Interest in MI continues to grow at a rapid pace
(Prochaska & Norcross, 2007), perhaps because it is shortterm, teachable, and has a humanistic philosophy.
Only a brief definition of MI is given here as many other
sources provide thorough explanations (e.g., Arkowitz, Westra,
Miller, & Rollnick, 2008; Miller, & Rollnick, 2002; Rollnick,
Miller, & Butler, 2008). MI is a counseling approach that is,
at once, a philosophy and a broad collection of techniques
employed to help people explore and resolve ambivalence
about behavioral change. In brief, the philosophy of MI is
that people approach change with varying levels of readiness;
the role of helping professionals is thus to assist clients to
become more aware of the implications of change and/or of not
changing through a nonjudgmental interview in which clients
do most of the talking. A central tenet of MI is that helping
interventions are collaborative in nature and defined by a
strong rapport between the professional and the client. MI is
unmistakably person-centered in nature (cf., Rogers, 1951),

while also being directive in guiding clients toward behavioral
change.
Professionals trained in MI generally gain knowledge and
skills in four areas, consistent with the overall philosophy of
MI: (a) expressing empathy, which serves many goals such
as increasing rapport, helping clients feel understood, reducing
the likelihood of resistance to change, and allowing clients to
explore their inner thoughts and motivations; (b) developing
discrepancy, which essentially means that clients argue, to
themselves, reasons why they should change by seeing the gap
between their values and their current problematic behaviors;
(c) rolling with resistance, which means that clients’ reluctance
to make changes is respected, viewed as normal rather than
pathological, and not furthered by defensive or aggressive counseling techniques; and (d) supporting clients’ self-efficacy,
which means that clients’ confidence in their ability to change
is acknowledged as critical to successful change efforts.

1
2
3

University of Utah
Utah State University
Fort Lewis College

Corresponding Author:
Brad W. Lundahl, 395 South 1500 East, Salt Lake City, UT 84121.
Email: Brad.Lundahl@socwk.utah.edu

137
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meta-analysis is interested in understanding variability around the overall effect size. Arkowitz.g. First.02) in the seven studies that compared MI treatments to other active treatments. MI effects were found to be durable across sustained evaluation periods. literature reviews. Mullen. whereas an effect size of d ¼ 0. Considerable research has been applied to the question of whether MI is effective or efficacious. when compared to no-treatment control 138 Downloaded from rsw. If variability is high. An effect size refers to the magnitude of the effect or the strength of the intervention. For example.57. effect sizes are calculated from primary studies and then statistically combined and analyzed. including primary studies. Burke et al. Results were near zero (0.00 would suggest positive movement of a full standard deviation of clients in the treatment group relative to the comparison group. type of comparison group used). Interestingly. respectively (Cohen. and diet and exercise.g. problem severity. The authors also investigated several possible correlates or moderators of the outcomes. For the current meta-analysis. If variability is low. drugs. treatment length) as potential predictors of the mean effect size (Borenstein.40) than the next largest value (d ¼ 0. Meta-analysis is a method for quantitatively combining and summarizing the quantitative results from independent primary studies that share a similar focus. In meta-analyses. 1998) and several previous meta-analyses on MI have been published (Burke. & Cox.com at Uppsala Universitetsbibliotek on January 5. with effect sizes ranging from d ¼ 0. While we believe these efforts have done much to enhance our understanding of MI’s efficacy. we believe further investigation through meta-analytic techniques is warranted for several reasons. time of follow-up assessment. (2005) published the second meta-analysis that included 72 studies in which the singular impact of MI was assessed or in which MI was a component of another active treatment. the current article examines the degree to which MI is able to help clients change.11 to a high of d ¼ 0..g.. Higgins. which uses continuous variables (e. treatment format. although the MI treatments were shorter than the alternative treatments by an average of 180 min (three or four sessions). Burke et al. Lipsey & Wilson. Second. we use the term ‘‘effectiveness’’ here for consistency. (2003) published the first of these studies. The only significant predictors of effect size for MI were as follows: manualized interventions yielded weaker effects and benefits from MI decreased significantly as follow-up times increased. 2006). Vasilaki. First. 2005. Hettema et al. finding no relationship between outcomes and the following variables: methodological quality.25 to 0. effect sizes ranged from a low of d ¼ 0. There was no support for the efficacy of adaptations of MI in the areas of smoking cessation and HIV-risk behaviors in the two studies available at that time. While only a few studies were included in the moderator analyses. counselor training. a meta-analysis utilizes a metric that can standardize results onto a single scale: an effect size. (Note: Studies included in this metaanalysis included both efficacy and effectiveness trials. which is a measure of group differences expressed in standard deviation units.g. and meta-analyses. 97) across all studies. Hosier. Project Match. 1994. Steele. & Miller. Hettema. gender composition. all outcomes (e. & Menchola. which leads to the third common question in meta-analysis: what predicts the variability. wherein effect size differences are examined based on categorical variables within studies (e.138 Research on Social Work Practice 20(2) Through meta-analysis. 2001. These authors included 30 controlled clinical trials that focused primarily on the implementation of MI principles in face-to-face individual sessions. & Salas. Among groupings with three or more studies. our review attempts to answer three questions that are commonly explored via a metaanalysis (Johnson. metaanalysis investigates the central tendency of the combined effect sizes.) Prior to reviewing previously published meta-analyses. alcohol use. & Rothstein.50 would suggest positive movement of a half of a standard deviation. Lundahl & Yaffe. whereas effect sizes in the ‘‘0. We now turn to a brief review of the three existing metaanalyses in the field of MI. Indeed. an effect size of d ¼ 1. Hedges. In addition to describing the basic characteristics of the empirical studies of MI interventions. 1995). it may have been unduly influenced by a single outlier study that had an effect size that was more than 400% larger (d ¼ 3. this study focused exclusively on studies of interventions that targeted excessive alcohol consumption. To be included. many new primary studies bearing on the effectiveness of MI have been published since the last metaanalysis.20’’ range is small. yet statistically significant. we believe a different approach to conducting a meta-analysis may reveal a ‘‘cleaner’’ picture of the unique contribution of MI as we delineate further below. 1988). The aggregate effect size for the 15 included studies. we briefly review the goals and methods used to conduct these types of studies (see Cooper & Hedges. and all time frames. or problem area.. MI treatments were superior to no-treatment or placebo controls for problems involving alcohol. In a meta-analysis. While an overall effect sizes was provided. 2011 . 1997. comparison group type. Unlike the previous two meta-analyses that examined a wide range of behaviors. As most primary studies vary in the number of people who participated and the measurement tools used to assess outcomes. Second. many gold-standard trials have examined the question of efficacy of MI (e. Vasilaki and colleagues (2006) published the third metaanalysis. studies needed to claim that MI principles were adopted as well as include a comparison group and utilize random assignment. and (b) a weighted multiple regression. 2003.. 2007). and our search yielded several articles not included in previous reviews. then the overall effect size is considered a good estimate of the average magnitude of effect across studies. we used Hedge’s g (a nonbiased estimate of Cohen’s (1988) d) as our effect size. participants’ age. then the overall effect size is not considered a good estimate.80’’ are moderate and large.80 (p.sagepub. treatment compliance). 2005).50’’ and ‘‘0. (2003) found that higher doses of treatment and using MI as a prelude to further treatment were associated with better outcomes for MI in substance abuse studies. In terms of comparative efficacy.80). two types of moderator analyses can be conducted: (a) an analog to the analysis of variance (ANOVA). To predict or understand high variability. convention holds that an effect size around the ‘‘0.

Four search terms were used to identify articles reporting on MI.43. At the time of the literature search (2007). we conducted a broad literature search using various article databases. We then used the Endnote to search within the remaining articles.18 and.’’ To ensure that we did not miss other articles.sagepub. all of which were secured and screened for eligibility. the study design had to isolate the impact of MI on client behavior change or to provide a clear head-to-head comparison of MI to another intervention. Pub Med Academic Search Premier. the remaining 5. or (e) the comparison group included the dissemination of written materials. The two ‘‘brand names’’ most commonly used with MI were used. Method Literature Search Three basic strategies were used to identify possible studies. even when the effects of attention (talk time) were not controlled for (such as by mere dissemination of written materials).931 potential articles. they were subjected to a more rigorous screening using two criteria. Our review only included such studies in an effort to overcome the potential confounds found in prior meta-analyses. (b) a treatment group and a comparison group were included. While it can be argued that ‘‘pure’’ MI is not possible. First. 2011 . this strategy yielded 5.070 articles were screened and discarded if they were published before 1984 or were dissertations. identified intervention 139 Downloaded from rsw. and (d) the study was reported in English. 167 articles were cited in the bibliography. given the likelihood of including other components. Key differences between these three metaanalyses include the fading of MI effects over time (supported by only two of the three reviews) and the moderating variables that emerged. This screening strategy yielded 183 articles that were then retrieved and combined with the 167 articles taken from Miller’s bibliography. was d ¼ 0.128 articles were screened by their source and abstracts. Medline. Considering the converging outcomes across these three previous meta-analyses.288 articles. Articles were retained if the abstract indicated that (a) the main principles of Motivational Enhancement Therapy (MET. PsycARTICLES. namely ‘‘motivational interviewing’’ and ‘‘motivational enhancement. even though this subdivision of MI includes feedback from standardized assessment measures (we used this subdivision as a possible moderator described below). the other terms were ‘‘motivational intervention’’ and ‘‘motivation intervention. references were categorized by author and 861 duplicates were identified and discarded. Studies were excluded from this review if MI was specifically combined with another.Lundahl et al. we utilized a bibliography of outcome research assessing MI that was compiled by the co-founder of MI. These references were exported using Endnote software. (d) the study was published in a peerreviewed journal (Note: This was done to establish a more homogenous sample of studies. Furthermore. (b) an intervention used MI as an additive component and the comparison group also used the same intervention minus MI. Dr. Social Services Abstracts. ERIC. First. or (d) the intervention was MET. it was d ¼ 0. CINHAL. there is sufficient evidence to support MI as a viable and effective treatment method. leaving 1. the primary goal of the current meta-analysis was to investigate the unique effect of MI compared with other treatments or control conditions. even though such interventions may not have used MI proper. see below for description) or MI were used. Second.128 articles that were screened for inclusion. Using Endnote. to facilitate potential replication by other researchers. we sought to address two common shortcomings in the previous meta-analyses: (a) they ran moderator analyses with small numbers of studies and (b) they included studies that could not specifically isolate the unique effect of MI without being confounded by other treatments or problem feedback. In the current meta-analysis. searched no more than four databases. 139 groups. Psychology and Behavior. In total. Business Source Premier. Third. We note that the other three meta-analyses. some studies utilize designs that allow for isolation of the unique contribution of MI or provide a direct comparison of MI to other treatments.’’ These four terms were entered using the connector ‘‘OR’’ so that any one of these terms would generate a hit. (c) MI was compared to a ‘‘treatment as usual’’ (TAU) condition as this represents a head-to-head comparison of MI and other treatments even though the design cannot precisely isolate the impact of MI. and because searching the ‘‘gray’’ literature can introduce systematic sampling error). We then cross-referenced the 167 articles previously ordered from the bibliography with the articles retrieved in the basic literature search. we also included more generic terms that involve motivational interventions. although this difference by comparison group was not statistically significant. our review sought to examine and clarify the possibility of moderator effects. which may account for the larger number of studies included in the current study. we identified articles using the references cited in other meta-analyses and review studies. when compared to other treatment groups. Once the articles were obtained. as far as we can discern. William Miller. The following 11 databases were searched: Psycinfo.com at Uppsala Universitetsbibliotek on January 5. Articles before 1984 were discarded because MI was not introduced until this date. and Sociological Abstracts. (c) the intervention was delivered by humans. the three studies point to a similar picture: outcomes tend to be in the low-to-moderate range of effect sizes and are not homogeneous. A study was therefore included if (a) there was a comparison with waitlist or control groups. Thus. this strategy had the most emphasis. In many respects. Articles were excluded if they did not have the terms ‘‘motivational interviewing’’ or ‘‘motivational enhancement’’ in the keywords. This step removed 85 articles. which produced 1. Screening Articles for Inclusion The 1. In this process. such as an information pamphlet. ranging from dose and format of the treatment to manual guidance and sample ethnicity. as we reasoned that this type of comparison group is likely a hybrid between a waitlist and a TAU comparison group.

eating patterns).. 1988) or a modification of it. Dependent Variables: Outcomes Assessed MI interventions have targeted a wide range of behaviors and.g. participation in treatment). seven addressed observable behaviors: alcohol use. even though they represented head-to-head comparisons. and drinking potable water.86 (Landis & Koch.g.g. number of drinks consumed. when the targeted behaviors were important. MI is usually delivered in one of two methods.. which meant that most of the sample (i.g. (b) treatment as usual (TAU) without a specific treatment mentioned (e. ‘‘standard’’ or ‘‘pure’’ MI involves helping clients change through skills basic to MI as described above. groups received the typical intervention used in an agency). keeping appointments. & Krege.. but the sample likely functioned well (e. (d) written materials given to the comparison group (e.g. A second way to deliver MI is one in which the client (often alcohol or drug addicted) is given feedback based on individual results from standardized assessment measures. the specific dependent measures we identified were multifaceted. In an effort to estimate the degree to which MI works with populations with varying levels of distress. we grouped the multifaceted aspects of a particular outcome into its broader category (e. we identified eight broad outcomes related to health. 1998) were excluded from this review. unprotected sex). If the study explicitly stated that a manual was used. as expected. cocaine. overweight college students). Coding Studies: Reliability Following the screening process. but are not limited to. and selfreported confidence in one’s ability to change. drug use. Within each broad category above. In our review. a wide range of measurement tools have been used to assess outcomes. marijuana use. depression or stress).g.g. all articles were independently coded for participant characteristics and for study characteristics. Coding was conducted by graduate-level research assistants (CK and CB) under the supervision of the primary author. 2002). heroin). then it was coded as such. 2007). exercise. Role in treatment. Prochaska & Norcross. The seven categorical variables were coded as follows.).89 for continuous variables and for categorical variables k ¼ . Clients’ level of distress. First. and/or problems arising from alcohol consumption (e. (c) TAU with a defined or specifically named program (e. Each indicator provides a nuanced perspective of alcohol use patterns. studies were coded as not having used a manual. indicators related to alcohol use include. studies originating from the Project MATCH Research Group (1997. increasing adherence to a medicine or exercise regime or increasing fruit and vegetable intake in an otherwise health sample of participants). 2011 . alcohol use) so that the reader will have a general understanding of the value of MI. or (e) an attention control group wherein the comparison group received nonspecific attention. 1977). etc.. relapse rates. Among the studies included in our review. 12-step program or cognitive behavioral therapy). Hettema et al.com at Uppsala Universitetsbibliotek on January 5. (b) moderate levels of distress. abstinence rates. blood alcohol concentration. alcohol dependency) in a system such as the Diagnostic and Statistical Manual of Mental Disorders (DSM) or the International Classification of Disease (ICD).sagepub.. and gambling. Coded as one of five types: (a) waitlist/ control groups that did not receive any treatment while MI was being delivered. MI type. studies were coded into three groups: (a) significant levels of distress or impairment. if we were to extract effect sizes.g. movement in the Stages of Change model. dependency on alcohol. when a problematic behavior was targeted even though the behavior probably had not caused significant impairment in everyday functioning (e.140 Research on Social Work Practice 20(2) and the comparison group was only a waitlist or control group. Comparison group. this approach is sometimes termed MET (Miller & Rollnick. and different measurement tools may examine slightly different aspects of each perspective. occasional marijuana use. Finally.. Average interrater reliability was high r ¼ . selfreported intention to change (e.g. when MI was integrated with 140 Downloaded from rsw. number of drinking days per week..g.. Use of a manual. drinking and driving). Three other outcomes were also assessed that related more directly to client motivation: engagement in treatment (e. (2005) found that outcomes tended to be weaker when studies used a manual-guided process. Finally. otherwise. three other outcome groups were identified but not included beyond initial results because fewer than three studies contributed to each of the outcome groups: eating disorder behavior (binging/purging).g.g. three of which were coded for this study as follows: (a) additive. Sovereign. above and beyond basic training in MI or MET. Thus. reductions in risk-taking behavior (e. number of binging episodes. parenting practices. Potential Moderators We examined eight categorical variables and seven continuous variables as potential moderators to the effects of MI across these studies. The other category included indicators of emotional or psychological well-being (e. above 50%) would qualify for a diagnosis (e.e.. such as the Drinker’s Check Up (Miller... tobacco use. Of these.g...g. For example. miscellaneous drug use (e.. or (c) community sample.. pamphlet discussing the risks of unprotected sex. because the result sections of these reports most consistently reported interaction effects whereas our meta-analysis required reporting of main effects. MI has been used in a variety of roles/formats in the treatment process. they would not be representative of the entire sample across all Project MATCH sites and participants resulting in systematic sampling bias. increases in physically healthy behavior (e.

Who delivered MI. (c) mental health provider with either a master’s degree or a PhD. often through some form of recording. The following groups were coded whenever sufficient information was provided: (a) medical doctor. 2003).sagepub. and Rothstein (2005). Most of the continuous moderators need little explanation. A random effects model was used for all analyses. outcomes assessed. The seven continuous variables we coded as potential moderators of MI effects can be divided into two broad categories: sample characteristics and study characteristics.75. with interrater reliability being very high (98% agreement). which is more conservative than fixed effects models and assumes that effect sizes are likely to vary across samples and populations (Hunter & Schmidt. multiple measures of a particular construct were averaged within studies to prevent violations of independence. with a qualitative system that did not produce a standardized score. Thus. and the percentage of the sample who were White. when MI was used as the only treatment for that group of participants. (b) fidelity was assessed or monitored. Results Study Characteristics In total. outcomes of interest. Welch et al.40 and the highest was 2. Delivery mode. percentile ranks are reported. or multiple measurements of an outcome across time. which was statistically significant. Across these 132 group comparisons. this large body of literature varied in populations of focus.. Mullen. Continuous variables. often through some form of taping or recording. a software package that was produced by Borenstein. the total dosage of MI in minutes. (c) fidelity was assessed. or (c) stand-alone. 141 another treatment to provide an additive component. This value is consistent with Cohen’s classification of a small but statistically meaningful effect. and prediction (Johnson. Research teams have developed tools to measure fidelity to key principles of MI (e. the MI skill code. except that the MI component came before another intervention. & Salas. (Note that we also coded for other racial groups but too little information existed to support analyses). 2002) that produced a numeric score. Effect sizes in Table 1 are collapsed across dependent variables and moderators. and the effect size for each individual study. the study design needed to be such that the role of MI could be isolated. Effect Size Calculation Effect sizes were calculated and analyzed through Comprehensive Meta-Analysis. 2001). Lipsey & Wilson. 1995). neither of which were outliers. The effect 141 Downloaded from rsw. 2000). or Hispanic. and how MI was presented to clients. MI is traditionally delivered via individual counseling. As MI is being used by a variety of professional groups.17-0. study rigor was also coded using an 18-point methodological quality scale (see Appendix for details). African American. if used in an additive fashion. Hedges.06. we investigated whether educational background influenced outcomes. a total of 132 MI groups were contrasted. Miller. and durability by listing the longest time period in which posttreatment measures were administered.22 (confidence interval [CI] 0. As we expected. a total of 842 effect sizes were computed because almost all of the studies reported on multiple outcomes. the standardized mean difference that uses an unbiased pooled standard deviation similar to Cohen’s d but corrects for bias through calculating the pooled standard deviation in a different manner (Cooper & Hedges. z ¼ 8. 1994. (d) mental health counselor with a bachelor’s degree. Higgins. percentage of participants who were male or female. The lowest effect size for MI was 1. or (e) student status.27). Thirty-one percent of the effect sizes were double coded. Three different characteristics of the sample were coded: participants’ average age. which generally indicates that the student was being supervised by someone with a master’s or PhD degree. To gain a more complete picture of the distribution of effect sizes. Effect size extraction and calculation were performed by the primary and secondary authors. multiple indictors of an outcome. MISC. Among the studies included in our metaanalyses. Confidence that an intervention is linked to outcomes is increased when adherence or fidelity to the intervention can be established. p < . including the number of participants in the study. Table 1 details some of the variability found in the studies. type of MI delivered. Overall Findings We organized our results around the three goals of metaanalytic inquiries: central tendency.Lundahl et al. We used Hedge’s g as our main measure of effect size. 2011 . additive would be coded if two comparison groups examined the value of a nicotine patch and only one group used MI. With the exception of the metaregression analyses (see below). Finally. What is the overall magnitude of effect of MI interventions? The average effect size across the 132 comparisons and all outcomes was g ¼ 0. when MI was used as a prelude to another treatment.001.g.g. For example. Fidelity to MI. variability. Again.. For study characteristics. we coded the number of sessions in which MI was delivered. Of these. though it is occasionally delivered via group format. 119 studies met the inclusionary criteria for this review. The format of prelude treatments was conceptually similar to an additive model. (b) registered nurse or registered dietician. 10 compared two conditions of MI or two different comparison groups within the same study.. three levels of fidelity assessment were coded: (a) no assessment of fidelity.com at Uppsala Universitetsbibliotek on January 5. and one study compared four MI groups to a single comparison group. using a standardized system (e. (b) prelude.

00/0.45 0. (2006) Anton et al.33/0.44 0.38/3.52 0. Iguchi..13 0.57 0. (2005) Baer. Moak. Eng.com at Uppsala Universitetsbibliotek on January 5. Libby.01 0.21 0.45 0.59 0.03 0.22/0. GWB Eng. and Dermen (2002) Connors et al.30 0.32/0. (2002) Baker. Miller.18 0.28/0. (2002) Brodie and Inoue (2005) Brown and Miller (1993) Brown et al.28/0.23 0.56 0. (2005) Bowen et al. and Thase (1998) Davidson.25 0. and Larimer (2006) Elliot et al. Longabaugh.02/0.18 0.56/0. Saxon.70 0. IC/SC Health Health Al.41 0.18 0.16/0. (2006) 6/120 4/1/1/1/75 3/3/4/1/52. IC/SC Cig A/C Al. (1998) Connors.34/0.5 1/45 4/12.41/0. Eng Al Al.18 0. IC/SC.48 0.70/0.15 0. MacKnight. Eng.57 0.37 0.56 0.22/0.18 0. Pinto.26 0. (2002) Curry et al.60 0.20/0. (2005) Bien.40 0. Voronin. Risks Eng Health Cig Cig.06/0.91 0.86 0.19 0.30 0.24/0. Wollersheim. Latham. 2011 . (2005) MI MET MET MET MI MET MET MET MET MI MI MI MI MI MET MI MI MET MET MI MET MET 189/189 39/41 164/164 11/8 25/27 34/25 34/29 80/80 12/13 66/45 70/48 9/12 95/97 283/294 76/96 82/82 22/18 67/64 13/13 202/210 24/22 37/42 Study Name Strong Strong Weak Weak Weak Strong Weak Strong Weak Weak Weak Weak Strong Strong Strong Strong Strong Strong Strong Weak Weak Weak Longest Compare Session/ Follow-up N: Tx/Comp Group MI or MET Minutes (Months) Table 1.38/0. OD Cig.96 0. (1999) Carey et al.49 1.55/0. (2007) Elliot et al. and Mikulich-Gilbertson (2004) Borrelli et al. Neighbors. IC/SC Eng Al.26/0.90 0.47/0. and Marlatt (2001) Baker et al. Walitzer. Al.31 0. Kwiatkowski.11 0. (2005) Bernstein et al.23 0. Gulliver.34 1.80/0. and Holt (1993) Ball et al.48 0.15 0. IC/SC. (2007) Colby et al. Eng.06 0. (2001) Galbraith (1989) Gentilello et al.24 0.86 0. (1999) Golin et al.55 0. Kivlahan.35 0.82 0.05/1.14 0.15 0.09/1.65 0. (2005) Colby et al.14/1.19/0.5 2/150 1/37. Selected Study Characteristics and Average Effect Sizes Cig Al. OD Risks Al Al Al Al Health OD Al Eng Eng Cig Eng Health Al Al.01 0. Wirtz.26 0.16 0.85 0. and Hyland (2001) Channon et al. Salloum.98 0.13 0. Sheehan. Baer.5 2/52.06/1. Eng. (2006) Butler et al. (2007) Emmen. Risks A/C.5 1/60 1/20 1/60 4/4/4/80 3/8/480 1/4/1/60 4/360 1/60 Ahluwalia et al. Schippers.15/0.08 0.24 0.19 0.2 1/45 1/30 2/- 1–3 13–24 4–6 4–6 IM 10–12 10–12 1–3 IM 1–3 IM IM 10–12 10–12 4–6 4–6 10–12 10–12 1–3 7–9 1–3 4 years 10–12 4–6 IM IM 1–3 1–3 7–9 4–6 4–6 IM 1–3 10–12 10–12 4–6 1–3 4–6 4–6 1–3 1–3 Carroll.63 0. and Anton (2007) Beckham (2007) Bennett et al.66 0.61/0.27/1.04/0. Mar. (2007) Ball et al. Wodak. and John (1998) Booth.21/0.sagepub.37/0. and Kivlahan (2003) Dench and Bennett (2000) Dunn.34/1. (2003) Daley.89 0.87 0.03 0.66/0. OD Cig Eng Al AL.18 0.02/0. Mar.04/0.5 1/90 1/90 5/9/4/180 1/57 2/67.62 0. Zuckoff.43/1. OD. OD Targeted Behavior Change 0. GWB. and Swift (2006) Davis.19 0.07 0.67 0.5 4/12.28 0.49 0. Kirisci. (2007) Baros.51 0. and Boroughs (1993) Booth.19 CI Effect Size 142 Research on Social Work Practice 20(2) 142 Downloaded from rsw.31/29 27/20 18/20 43/42 38/38 38/50 156/147 11/12 76/73 Total ¼ 73 27/24 45/45 168/186 168/135 61/62 116/120 12/12 66/307 30/35 Weak Weak Weak Weak Strong Weak Weak Weak Strong Weak Weak Weak Strong Weak Weak Weak Strong Weak Strong MI MI MET MI MET MET MI MET MET MET MI MET MET MET MET MET MI MET MI 1/105 4/250 2/47.55 0.03 0.32 0. IC/SC IC/SC Al. IC/SC ED Bx.56 0. (2000) Carroll et al. Eng.53/0. and Bleijenberg (2005) Emmons et al. Dixon. Heather.21 0.38 0.09 0.36/2. Blume.04/0.09 0. Corsi.

OD Cig Health Gam Gam Gam Al Al IC/SC Al IC/SC.57 0..73 0.17 0. Al. Walters.52 0. El-Guebaly (2001) Hodgins et al.88 0.09 0.00 0.26 0.19 0..01/0.92/1.21 0. Kadden.51/0.75 0. Griffith.58 0.03/1. OD Al Health Cig. and Radi (2006) Juarez et al. (2001) Longshore and Grills (2000) Maisto et al.37 0.20 0. Currie. 143 143 .04 0.53 0.. (continued) Al Al.66 0.85 0.05 0. and Iber (1990) Larimer et al.28/0. Nich. Currie.81 0.04/0. (2007) Handmaker.27 0. Svikis.60 0.20 0. Cig. Eng Al. (2001) Maltby and Tolin (2005) Marijuana tx project (2004) Marsden et al. (2006) Juarez et al. (2004) Kelly and Lapworth (2006) Kidorf et al.56/0.81 0.05/1. Cig. Mar.07 0.58 0. Eng.22 0. OD Al.07/0.56 0.40 0. and Strang (2005) Grenard et al.58/0.36/1. and Copass (2007) Juarez. Daugherty. and Manicke (1999) Harland et al.14 0.47/0.19 0. risks Risks Al Al Al Al Al.19/0. Mar.92 0.03 0.32/0.50 0.19 0. Thorogood. Guajardo.27/0. and Stephens (2005) Longabaugh etal.00 0.56 0. Curtin.23/0. Hutchison. (2005) Jaworksi and Carey (2001) Johnston.15/0. Mar. White.35 0.88 0.17/0..14 0. Margetts.05 0.00 0.09 0. IC/SC.56 0.82 0.5 1/32. and Tonigan (1993) MI MI MI MET – MET MET MET MET MET MI MET MI MET MET MET MI MET MET MET MET MET MI MI MI MI MET MET MET MET MI MET MET MI MET MET MET MI MI MI MI MET 15/13 90/48 11/7 7/7 88/89 30/23 38/29 302/285 28/24 31/34 31/33 47/37 58/62 45/45 94/105 26/26 82/92 21/15 21/18 20/15 20/18 24/24 28/22 98/96 12/12 45/49 64/52 137/128 182/188 169/188 40/41 73/85 73/74 7/5 128/137 166/176 24/20 65/81 84/78 47/50 47/44 14/14 Study Name Strong Weak Weak Weak Weak Weak Strong Weak Weak Weak Weak Weak Weak Weak Weak Strong Weak Weak Weak Strong Strong Weak Weak Strong Weak Weak Weak Weak Weak Weak Weak Weak Strong Strong Weak Weak Strong Weak Weak Weak Weak Weak Longest Compare Session/ Follow-up N: Tx/Comp Group MI or MET Minutes (Months) Table 1.94/0.21/0.94/0.60/1. (2001) Hulse and Tait (2003) Hulse and Tait (2002) Humfress et al.17 0. Eng A/C Eng Health Al Al Eng Al Al Al Al Al Eng Mar.45/0.18/0.5 4/2/120 1/52. and Peden (2004) Hodgins.07 CI Lundahl et al. (2006) Kahler et al. (2001) Maisto et al. OD Health Al Al Targeted Behavior Change 0. Droesch. (2006) Kuchipudi.sagepub. (2006) Juarez et al.47 0.02 0. (2002) Ingersoll et al. (2001) Longabaugh et al.47/1.53 0.52 0.5/72. Flickinger.25 0.20 0.80 0. OD Al. and Bryan (2007) Hillsdon.27/0. Benefield.21/0.com at Uppsala Universitetsbibliotek on January 5. Carroll.96 0.30/0. Cig AL. 2011 (continued) 0.57 0.30/1. 165 Michael.46/0.5 1/72. and Rounsaville (2006) McCambridge and Strang (2004a) McCambridge and Strang (2004b) Mhurchu.34 0.57 0.04 0.69 0.32 0.40 0. Hobein. El-Guebaly. Mar. and Tonigan (2003) Gray McCambridge. Cig.13 0.3/180 1/1/25 1/60 3/4/1/3/48 1/25 1/32.5 2/120 1/60 1/3/1/100 2/180 4–6 1–3 1–3 10–12 10–12 1–3 4–6 10–12 13–24 <1 10–12 4–6 5 years <1 1–3 1–3 4–6 1–3 1–3 1–3 1–3 10–12 4–6 IM 1–3 1–3 10–12 4–6 10–12 10–12 10–12 10–12 10–12 IM 4–6 4–6 1–3 1–3 10–12 1–3 <1 10–12 Graeber.06/0. IC/SC.13/1. Dunn.54 0.5 1/150 1/20 /70 /60 /35 /35 1/60 1/60 1/50 1/35 3/2/120 2/1/50 1/50 1/1.41 0.26/0.05/0.35 Effect Size Downloaded from rsw.63 0.34 0.13 0.28 0.04 0. Kirkley. Miller.01/0.98 0.84 0.68/0.58/2.19/0. and Speller (1998).57/1.91 0.17 0. and Jones (2006) Miller. Moyers.54 0.38 0.64/1. Rivara.04 0.38/1.42 0. (2001) Litt. (1999) Haug.18/1.07 0. and Foster (2002) Hodgins.5 1/45 1/1/1/67.22 0.03 0. (2005) Kreman et al. (2006) Martino. and DiClemente (2004) Helstrom.02 0.16 0. IC/SC.

21/0. (2001) Soria.64/1. Roffman.27/0.20 0. Ginzler.14/0.15 0. and Montoya (2006) Spirito et al. and Anderson (2002) Steinberg. and Grabowski (2004) Stotts. and Kohn (2000) Secades–Villa.02/1.53 0. Colby.71 0. and Grabowski (2001) Stotts.20 0.63 1. et al.73 0.32/1.48/0. Blume. Charuvastra. Mar. (2000) Tappin et al. Krejci.65 0. and Garrett (2006) Picciano et al.00 1. Escolano.29 0. (2000) Tappin. and Curtin (2000) Stephans (2004) Stotts.14 0. Siajunza. (2007) Saunders Wilkinson. Ziedonis.98 0.78 0. Sullivan. DeLaune.09/0. Eng A/C.20 0.20 0. Mahmood. GWB Al. IC/SC. and Mason (1997) Smith et al. and Quick (2000) UKAAT (2005) Valanis et al. and Afari (2001) Schneider. Monti.45 0. Lumsden.61 0. Wells. and Byrne (2007) Monti et al.09 -0.34 0.01/0.66 0.30/1. Lumsden. Potts.21 0.08 0.51 0.02 0. Health Cig Cig Al Al.48 0.32 0. GWB Eng.11/0.79 0. Schmitz.01/0. et al.22 0.15 0.11 0.45 0.18/0.54 0. and Page (2004) Murphy et al. (1999).5/105 10–12 1–3 1–3 4–6 10–12 1–3 7–9 7–9 1–3 IM 1–3 1–3 <1 4–6 1–3 4–6 3 years IM 4–6 4–6 4–6 4–6 4–6 10–12 10–12 10–12 1–3 4–6 1–3 4–6 1–3 4–6 13–24 IM IM 4–6 <1 1–3 <1 1–3 IM 10–12 13–24 Miller et al. Gilmour.96 0. and Bloomfield (2006) Schmaling.97 0.81/1. Maksad. Cleland. Miller.08 0. Miller.37/0. IC/SC Mar. IC/SC.12/0. Rhoades. et al.25 0.02 0.22 0. .89/1. OD A/C.83 0.sagepub. 171 Morgenstern et al.42/0.41 0. Eng.91 0.69 1.1 (2001) Murphy et al. Risks Cig Al.17 0.96 0.49 0. Mar.11 0.com at Uppsala Universitetsbibliotek on January 5. Ondersma.5 4/3/180 1/50 1/50 4/240 6/60 3/135 1/105 2/65 20/1800 1/30 1/60 1/30 1/45 1/60 3/180 4/6/19/6/3/60 1/40 1/60 2/100 2/150 2/100 1/40 2/180 2/180 2/120 4/3/54. Kratt. OD Al. Mar. Ingersoll. Yeste. and MacEwan (2001) Sellman et al. . and Dolan-Mullen (2002) Stotts.5 2/120 1/4/150 3. IC/SC Cig OD Cig Cig Cig WSDP Al. 2011 3/150 – 2/180 1/120 1/1/37. (2005) Thevos.26/0.21/1.46/0. Colby. Dore. risks Eng. (2002) MET MET MI MET MET MI MET MET MET MET MET MET MI MET MI MI MI MET MET MET MET MET MET MI MET MET MI MI MET MI MET MET MET MET MET MET MET MET MI MI MI MET MI 14/14 108/104 12/17 Total ¼ 62 33/74 36/35 14/12 14/14 25/26 39/37 57/67 46/43 43/43 95/91 141/146 52/49 64/62 16/16 30/30 20/20 40/42 40/42 6/10 40/42 114/86 64/60 20/15 45/50 69/61 60/49 32/34 75/79 75/95 25/25 19/19 83/83 17/14 48/49 48/49 351/411 91/93 293/214 127/127 Study Name Strong Weak Weak Weak Weak Strong Weak Strong Weak Strong Weak Weak Strong Strong Weak Weak Weak Weak Strong Weak Strong Strong Strong Weak Weak Weak Strong Weak Strong Weak Strong Weak Strong Weak Weak Weak Weak Strong Weak Weak Strong Strong Weak Longest Compare Session/ Follow-up N: Tx/Comp Group MI or MET Minutes (Months) Table 1. and Brandon (2004) Stephens. Eng.43 0.00 0.23/0. and Friedmann (2002) Stein.09 1.12 Effect Size 0.24/0.31/1. Maksad.48 0.41 CI 144 Research on Social Work Practice 20(2) . and Martin (2006) Tappin.69 0.29 1.27 0.14/0. GWB Eng Targeted Behavior Change 0. (2004) Stein.75 0.144 Downloaded from rsw. Eng Al.76 0. (2007) Mullins.36 1. Charuvastra. (1993) Miller. and Arna´ez-Montaraz (2004) Sellman.89 0. OD Al IC/SC Al. (2001) Smith. Schmitz. Mckay. Anderson.39/0.84 0.20 0.37 0.01 0.10 0. Heckenmeyer. OD IC/SC.20/1.79 0.61 0. Adamson. Magura.88/0..27/0.80 0. Mar.71/0.30 0. Risks. Casey. and Martin (2002) Rosenblum. (2006) Stein. OD Al Al Al.02/2.13/0. (2006) Stein.17/0.06/1.82 0.42/0.09 0.55 0.43 0.27 0. Yahne.47/0. and Kosanke (2005) Saitz et al. GWB. Monti.12 0. OD Eng Al. Baer. (2006) Nock and Kazdin (2005) Peterson.30 0.17/0. Ferna´nde-Hermida. et al.14/0.45 0.59 0. DiClemente. George. Suarez.18/1. Kaona.91 0.32/0.00 0.00/1. (continued) Al Eng OD Al Al Eng.02 0.77 0.60 0.04 0. and Tonigan (2003) Mitcheson. (2001) Rohsenow.2 (2001) Naar-King et al. Al Eng Al.88/0.22/0. and Phillips (1995) Schermer. Moyers. McCambridge.15 0. Legido.57 0.94 0.

Comp ¼ comparison group. Stephens.sagepub.83 CI Note. C.11/0.water—safe drinking practices. and Benton (2004) Westra and Dozois (2006) Wilhelm. Weak indicates the comparison group was one of the following: control. Valanis et al.I. Within a single study. ¼ Confidence Interval. Harrison. Tx ¼ treatment group.21 Effect Size 0. A/C Parenting A/C.31 0. Strong indicates the comparison group was a specific intervention. Health ¼ increase healthy behavior.56 0.22/0. Stephans.41/0.74 0. Gam ¼ gambling. authors often assessed several outcomes and the number of participants often varied.62 0. reading materials. and Gardener (2006) Study Name Table 1. 145 145 Downloaded from rsw. IC/SC ¼ intention to change/stages of change. Eng Parenting Targeted Behavior Change 0. Rodehorst. Ed Bx ¼ eating disorder behavior. Berghuis.54 0. (2003) Walker.05/0.05/0. Eng ¼ engagement or compliance. WSDP .01 0.126/127 47/50 167/172 120/120 25/30 20/20 Weak Weak Weak Weak Weak Weak MI MET MI MI MI MI – 2/90 4/180 7/3/180 6/- 13–24 1–3 1–3 10–12 IM 4–6 Longest Compare Session/ Follow-up N: Tx/Comp Group MI or MET Minutes (Months) Eng Mar.10 0. waitlist. A/C ¼ ability or confidence to change. Cig ¼ cigarettes and tobacco.31 0.20 0. Hertzog.34 0. 2011 . and Kim (2006) Watkins et al. Al ¼ alcohol.com at Uppsala Universitetsbibliotek on January 5. Roffman. IM ¼ immediately after treatment. Effect sizes averaged across measures and outcomes within each study. (2007) Weinstein. Risks ¼ reduce risk taking behavior. OD ¼ other drugs.03/1. (continued) Lundahl et al. we reported on the smallest number of participants in both the treatment and the comparison group. in such cases. or TAU that was not specified. GWB ¼ general well-being.

p ¼ 0.09. exercise. When positioned against a weak comparison group. Next. 2011 .21) and miscellaneous drugs (g ¼ 0. Moderators Among Studies Comparing MI to Weak Comparison Groups.001. tobacco (k ¼ 24). The effect size for reducing risky behaviors. though the small number of studies also made these variables the least stable as evidenced by wide confidence intervals. How representative or homogeneous is the overall MI effect size? The overall effect size contained significant heterogeneity as evidenced by the within-class goodness of fit statistic. which comprised outcomes related to diet.35 for tobacco. k ¼ 39). we need to examine effect size variability. then.72. p < . We first examined the effect comparison group had on outcomes as the meta-analysis by Burke et al. populations targeted.146 Research on Social Work Practice 20(2) size at the 25th percentile was 0. and confidence in being able to succeed in change. Of the 14 outcome groups. k ¼ 88) and compared to those studies that pitted MI against a specific treatment or a ‘‘strong’’ comparison group (g ¼ .90.34. written materials) would depend on the method of delivery—that is. though nonsignificant. p < .g. or written material groups (Qb ¼ 4. significant heterogeneity was found. suggesting that the outcomes across dependent variables were. as it has previously been shown that MI was not equally effective for all problem types (e.16 for miscellaneous drugs to a high of g ¼ 0. Comparison group. Based on findings from previous MI meta-analyses. What variables can account for the observed differences in MI effect sizes across these studies? Step 1: Subdividing effect sizes using potential categorical moderators. In line with the finding that comparison group type moderates outcomes. Thus. Qb ¼ 13. Of the remaining healthrelated behavior outcomes. between group heterogeneity was not significant.12).58. Table 2 presents effect sizes organized across the 14 outcome groups with subdivisions for strong and weak comparisons. MI did not show significant advantage over strong comparison groups for any outcome. Exploratory between group analyses were conducted.001.00.com at Uppsala Universitetsbibliotek on January 5.. and 25% were larger than a medium effect size. and no significant group differences were found. we systematically examined potential moderators until betweengroup variance was eliminated. The presence of heterogeneity suggests that the findings vary based on features of participants and/or study characteristics. p < . p ¼ .75 (4). Among the three different levels of distress. In addition to being interesting in its own right. on the whole.34 (df ¼ 10). which can be further studied via moderator analyses. and at the 75th percentile the effect size was 0. was also small (g ¼ 0.19). effect sizes were in the negative range.e. When positioned against a weak comparison group effect sizes for the three variables that concern clients’ engagement in treatment ranged from a low of g ¼ 0. the same pattern tended to hold where outcomes were not significant if the comparison was made against a specific treatment program.39 (2).15 for confidence to a high of g ¼ 0.39).. p < . The test of heterogeneity across the 11 dependent variable groupings was nonsignificant. Qw ¼ 14. 25% of the effect sizes were either neutral or negative. this finding suggests further analyses should be run separately for those that used a strong comparison group and those that used a weak comparison group. eating problems. For that. nonspecific TAU.67. We next questioned whether clients’ level of distress or impairment would moderate MI effects. specific treatments such as 12-step or cognitive behavioral therapy MI did not produce significant nonzero effect sizes in any outcome.01. which most often comprised outcomes related to sexual behavior and drug use. 12-step or cognitive-behavioral) effects were significantly lower than when compared against a waitlist/comparison group (Qb ¼ 18. Dependent variable. Further analyses (see Table 2) revealed that when MI was compared to a TAU program that involved a specific program (e. a generic TAU without a specific program (Qb ¼ 11. (2003) suggested results varied based on this variable. MI is certainly better than no treatment and not significantly different from other specific treatments with some effects being greater than nil and some being negative. Burke et al. 50% of the effect sizes were greater than Cohen’s classification of a small effect size. Among substance use outcomes. leaving homogeneous effect sizes that can confidently be interpreted. and compliance with medical recommendations. Given the wide variability of outcomes examined. p < . miscellaneous drugs (k ¼ 27).22.001). Qb ¼ 2.sagepub. waitlist control. These values are in the small but significant range. 2003).15).g. MI in its basic form versus MET. when compared to other active. all the ‘‘weak’’ comparison groups were combined (g ¼ 0. Client distress level. As was mentioned. Group difference analyses revealed no other significant differences among or between other types of comparison groups. Next.50. meaning that distress did not moderate MI effectiveness. The preponderance of studies examined outcomes related to substance use. As can be seen in Table 2. we explored whether effect sizes would differ based on the dependent variable. the strongest effect was for gambling (g ¼ 0. all yielded statistically significant positive effects for MI with the exception of emotional or psychological wellbeing. Qb ¼ 11. at the 50th percentile the effect size was 0. outcomes for substance use-related outcomes ranged from a low of g ¼ 0. Studies that compared MI to a weak comparison showed significantly higher effect sizes. Qw (131) ¼ 228. In the case of tobacco (g ¼ 0. was in the small range (g ¼ 0. The next moderator analysis examined whether results for MI compared to weak comparison groups (i.005). The effect for increases in healthy behaviors.05).35 for engagement.28.. the overall effect size is likely too broad to guide clinical or administrative decision making. which adds specific problem feedback to MI as described 146 Downloaded from rsw.95. where MI originated: alcohol (k ¼ 68).71. and marijuana (k ¼ 17). and methods used to deliver and study MI. statistically homogenous.. In fact. p < .

51 (1)/.002* 3. ns 4.39/.001* 1.17/0.27/0.12/.145. ns 3.96 0.19 0.20 0.35 (1)/.000* 2.39 0.002* 1.55 0.095.005* 0.06/0.39 3 7 3 4 1 Not applicable 1 2 Not applicable 2 1 Not applicable 1 0.com at Uppsala Universitetsbibliotek on January 5.38 0.050* 6.001* 2.20 0.658. ns 2.06/0. ns 1.03 (1)/.34 0.000* 1.12/0.87/.26 0.Lundahl et al.48 0. ns 4.11/0.11 0.042* (continued) 147 Downloaded from rsw.002* 9.31 0.87/.04 0.43 0.10/0.48 0.13/0.21 0.22/0.77/. ns 1.16 0.229.39/.01/0.10/.42 0.525.12 0.74 0.17/0.29 0. ns 0.36/.56 (1)/.390.146.21 0.14 0.10/0.15 0.018* 0. ns Not applicable 0.15 0.50 0.60 (1)/.58 (1)/. ns 4.43/.49/.21/0.125.37 0.01* 13.35 0.22/0. ns 2.20/.79 0.000* 1.59 0.10/.20 (1)/.13/0.944.18 0.080.001* 0.01/0.70 (1)/.sagepub.000* 4.674.855.408.473.40/. ns 5.09/0.28 0.25 0. ns 0.07/0.24 0.023* 2. ns 5. ns 2.71 0.04/0.06/0.001* 18.18 68 21 47 17 3 14 24 5 18 27 7 10 11 4 7 10 1 9 3 0.06/0.286.006* 1.03/0. ns 4.68 0. ns 2.08/0.17/.77/.78/. ns 19 5 14 0.13 0.42 0.004** 0.001** 1. ns 0.45/.18 0.15 3.29 0.46/.114.37 0.053.14.73 0.20/.015* 3.09/0.16 0.49 0.73 z Value/p Value 8.39 2.33/.196.020* Heterogeneity Q Value (df)/p Value 228.25 0.02/0.008* 2.09 0. Effect Sizes for Overall Effect and Initial Moderators Variable Overall effectiveness (across studies) Moderator: comparison group type Attention Treatment as usual—nonspecific Treatment as usual—specific Waitlist/control Written material Comparisons: combined weak Comparisons: strong Moderator: dependent variables Health-related behaviors Alcohol-related problems Strong comparison Weak comparison Marijuana-related problems Strong comparison Weak comparison Tobacco-related problems Strong comparison Weak comparison Miscellaneous drug problems Strong comparison Weak comparison Increase healthy behavior Strong comparison Weak comparison Reduce risky behavior Strong comparison Weak comparison Gambling Strong comparison Weak comparison Emotional/psychological well-being Strong comparison Weak comparison Eating problems Strong comparison Weak comparison Parenting practices Strong comparison Weak comparison Drinking safe water Strong comparison Weak comparison Approach to treatment Engagement Strong comparison Weak comparison Intention to change Strong comparison Weak comparison Confidence/ability Strong comparison Weak comparison Moderator: clients’ level of distress Community sample Strong comparison Weak comparison k Effect Size CI 132 0.33 0.23 0.77/.34 0.11 (1)/.53/.31/1.26 0.001** Not applicable 34 14 20 23 6 17 11 2 9 0.000* 3.14 (1)/.25 0.05 0.06/0.36 0.09 0.30 0.80/.58 (13)/. ns 0.15/0.44/.28/.01 0.001* 6.40/.94/.27 0.15 0.04/0.53/0.19/0.50/.76/.000* 1.716.29 0.00/0.08 0.23/0.24 0.06/0.15/.78/.23/0.30 0.30 0.001** 1.03 0.14 0.85/.12 0.28 0.161. ns 1.87/.32 0.000* 1.001* 14. 147 Table 2.31/1.21 0.26 0.64/.41 0.59 0.33 0.35 0.002* 0.35 0. ns 6.83/.927.43/.010* 0.67/.44/0.31/.25 0.35/.71 Not applicable 0.24 0.07 0.13/0.08/0.27/0.19 0.080.24 0.18 0.17/0.001** Not applicable 0.53 0.80/.39 (2)/. ns 6.390.07/.18 0.08/0.18/. ns 10.06/0.03/0.015* Not applicable 0.75/.15/0.597. ns 3.020* 1.09/0.30 0.02/0.01 (1)/.10 0.000* 3.43 4. ns 5.01/0. ns 1.64 0.71 (131)/.97/.072.53 0. 2011 .33/.22 0.90 (1)/.009* 2.75 (4)/.22/0.29/.29 0. ns 2.15 2.146.149.09/.27 1 42 39 35 10 88 39 0. ns 5.66/.30/.

01.35/.70. Note that the meta-regression analyses involved all possible comparisons across studies and all moderator groups.17 0. how fidelity to MI was assessed.00) was associated with significantly smaller outcomes compared to when a manual was not used (k ¼ 11.28 0. Studies Comparing MI to Strong Comparison Groups (Specific TAU). In both subgroups. q value ¼ 17.22 (1.83/. p < . further moderator analyses were collapsed across these two groups.05). By contrast.45. Numbers of studies vary because not all studies examined certain outcomes or reported on certain moderators. Qb (1) ¼ 0. With regard to ethnicity.47 (1)/. between group comparisons were made by subdividing the groups that involved typical MI (k ¼ 33) and those that involved MET (k ¼ 50).12/0. each effect size drawn from a study was entered into the regression analyses.12 0. Four other potential moderators were examined: whether a manual was used. Table 3 presents detailed information. further between group comparisons were not conducted. some studies contributed more data than other studies because they reported on more outcome indicators.729. q value ¼ 6. in studies that used a TAU with a specific program. Thus. Three of the participant characteristics were significantly associated with higher effect sizes. Step 2: Examining potential continuous moderators via metaregression. 152).97 (1). African American.96. we assessed the percentage of the sample who was White. a significant negative relationship was 148 Downloaded from rsw. above. while this does not technically violate assumptions of independence because each effect size was compared independently.com at Uppsala Universitetsbibliotek on January 5.001* 0. and durability (the longest length of time that a follow-up assessment was taken.19 0.05.03. the power to detect moderators was reduced and the confidence intervals thus tended to be wider.03. df ¼ degrees of freedom. * p < . Moderators Among Studies Comparing MI to Strong Comparison Groups (Specific TAU). g ¼ 0. and who delivered MI.03 0. Analyses of continuous moderators were subdivided into those studies that compared MI interventions to a weak versus a strong comparison condition.01/0.35 z Value/p Value 5. Average age. Studies that included older participants were more likely to have positive outcomes.01. Qb ¼ 5. Table 4 presents detailed data. no significant difference was found whether MI was delivered via its typical format or MET. further moderator analyses were divided into those that did and did not use a manual. as with the categorical analyses above.26 CI 0.40 (1)/.43 (1.14/0. (continued) Variable Moderate levels of distress Strong comparison Weak comparison Significant levels of distress Strong comparison Weak comparison k 50 15 35 44 14 30 Effect Size 0. p < .10/0. Only one of the participant characteristics was significantly associated with MI outcomes: Studies that included a higher percentage of African American participants in their sample had significantly better outcomes with MI. or Hispanic.15/0. Qb ¼ 4.16/0. and percentage of White or Hispanic participants did not significantly influence MI outcomes. The use of a training manual (k ¼ 25. Contrary to the previous regression analyses. Thus. format/role of MI in the treatment process. Analyses revealed no significant heterogeneity in any of these four variables. a higher percentage of African American participants was negatively associated with outcomes (q value ¼ 29. Furthermore. q value ¼ 8.23) for the total number of minutes.000* Heterogeneity Q Value (df)/p Value 2. p < . p < .79/. rigor. Moderator analyses for MI compared to specific TAU were run in the same order as those that did not involve a specific intervention above. Moreover. (2005). number of sessions.19). Studies Comparing MI to Weak Comparison Groups.32) was significantly more likely to produce positive change compared to typical MI (g ¼ 0. ns ¼ nonsignificant. ns.55/.25 0.05). These results can be viewed in Table 5. such that longer treatments produced higher effect sizes for MI. Given this difference. 2011 . k ¼ number of studies. which replicates the categorical analysis of time since treatment). Given the relatively smaller number of studies (k ¼ 40). MET (g ¼ 0. With regard to study characteristics. 226).06). p < . the amount of services delivered was positively related to outcomes with a significant effect (z ¼ 4. and durability (measurement interval beyond completion of treatment) were not related to outcomes. the format of MI did not moderate outcomes nor did assessment of fidelity to MI or who delivered the MI intervention (all ps > .302. and three indicators of ethnicity. percentage of male participants.32 0.24 0.08/.001). Because homogeneity was found within these four moderators. ns 5. CI ¼ confidence interval.073.000* 4.90. the number of sessions in which MI was delivered. If the comparison group included a specific intervention.001* 1. Five participant characteristics were submitted to meta-regression: participants’ average age. the percent of male participants within a sample (and by converse female). Table 3 presents these results among MI studies with weak comparison groups. the number of minutes MI was delivered to the sample. z ¼ 2.89 (1. p < . 428). ns 6. Four study characteristics were submitted to metaregression: overall study rigor. which is similar to the finding by Hettema et al. g ¼ 0. suggesting that they did not moderate outcomes (all ps > .27 0. ns 5.sagepub.22/.21 0.01.011* Note.148 Research on Social Work Practice 20(2) Table 2.

54 0.22/0.001* 10 23 0. though this difference did not reach statistical significance. ns Note.05. not scored Assessed.84.23/0.389.25 0.e.022* 2. SD ¼ 3. standardized score Motivational Enhancement Therapy No assessment Assessed.53 (1)/.12/0. SD ¼ 332).11/0. With regard to total time spent with clients (measured in minutes).25/.84/.15 (2)/.33 2. Written Materials.10 0.36 0. k ¼ number of studies. p < .92/.14/0.12/0.891.933.03/0.com at Uppsala Universitetsbibliotek on January 5.80 (1.01/0.28/.003* 3.40 4.01/0.008* 2.12 0. ns 5. ns 1.212.31 0.51/.59/.23 (1)/.09/. p < .59 2. the lower the number of participants from other ethnic groups). and group MI Time in treatment.160. t (30) ¼ 1. Numbers of studies vary because not all studies examined certain outcomes or reported on certain moderators.01. the lower the overall mean MI effect sizes.47/.43 0.10/.09/0. ns 3.001* 4. not scored Assessed. ns 5.21/0.69 (2)/.94/.23 0.37. q value ¼ 8.72 0.36/.97 (1)/.65 0.30 0.43 0.26/.09 (3)/. ns 0. There was a significant negative relationship between study rigor and outcomes.001* 2. df ¼ degrees of freedom.16/0.83 0.24 0.07 (2)/.001* 3.17/0.06/0. Moderators Among Studies Comparing MI to Weak Comparison Groups (Waitlist.39 0.150. SD ¼ 447) tended to meet for a longer time than MI groups (M ¼ 207.56 0.23 0.040* 4.010* 0. 149 Table 3.37 1 5 4 3 0.82/.04/0.001* 0.43/. MI groups (M ¼ 3. ns 7 7 1 3 0.27 0.81).32 0.39 0.001* 3. ns 21 16 12 0.47 (3)/. t (51) ¼ 1.001* 22 6 5 0.001* 14 3 16 0.sagepub.45 3. ns.11/0.32 0.39 0.76/. To investigate whether MI is efficient compared to specific TAU or strong comparison groups.07/0. found for the percentage of White participants (q value ¼ 6. 149 Downloaded from rsw.720.81/.42 0.34 0.16 0. durability.93/. ns 3. p < .01).51 0. specific TAU groups (M ¼ 308.360.33 0.. such that studies with higher rigor ratings yielded lower effect sizes for MI.083.46 0.08/0.11/.26 2.032* 33 50 0.67/.07/0. 253). Thus.24 0.256. ns ¼ nonsignificant.17 0. the higher the relative number of African American or White participants in the study (i.55 0.070. With regard to number of appointments.001* 13 7 31 0.001* 7.53/.41 3. ns 0.12/.218.28 0. 2011 .35 0. ns 2.38.76/.29/.459.34 0. * p < .13/0. SD ¼ 4.Lundahl et al.03 0.27/0.13/0. Only one significant relationship emerged for the study characteristics in this subgroup.38/.08/0.27 0.02 (2)/.24 0.001* 1.19 4.40 0. standardized score Moderator: Who Delivered MI Motivational interviewing Mental health: Bachelors Mental health: Masters/PhD Nurse Student Motivational Enhancement Therapy Mental health: Bachelors Mental health: Masters/PhD Nurse Student Effect Size CI z Value/p Value Heterogeneity Q Value (df)/p Value 4. ns 3.98/.27.23 0. we assessed the number of appointments and total amount of time (minutes) spent in treatment.65/.022* 1. ns 0.19 0. Nonspecific Treatment as Usual) Variable k Moderator: motivational interviewing (MI) or Motivational Enhancement Therapy (MET) MI MET Moderator: use of manual Motivational interviewing Manual not used Manual used Motivational Enhancement Therapy Manual not used Manual used Moderator: role of MI in treatment Motivational interviewing Additive Prelude Head-to-head Motivational Enhancement Therapy Additive Prelude Head-to-head Moderator: fidelity to MI model examined Motivational interviewing No assessment Assessed.001* 6.13/0.350.14/0.82) did not significantly differ from specific TAU groups (M ¼ 4.23/0. Step 3: Three further questions—treatment length.58 0. CI ¼ confidence interval.23 0.040* 2.08.55 0.19 0.70. ns 6.001* 10 39 0.

05 0.16/0.013* 3.24. Our analyses strongly suggest that MI does exert small though 150 Downloaded from rsw.75 (2)/.261.10/0.05 0.10 1.10/0. visual inspection suggests that delivering MI through a group format only may dilute effects compared to when MI is also delivered individually.06/0.36/.02).66/.867. and 25 months or more (g ¼ 0.30 0.24/0.534.69 0. ns Not applicable 2.46/.06 0.09/0. k ¼ 32).806. yet no meta-analysis has investigated delivery mode as a moderator. not scored and assessed.66 0.721.045* 0.96 0.72 0.81 5 2 2 2 0.08/. all effect sizes were significantly greater than zero (all ps < . so we ran this analysis separately from the other moderators. ns 4 3 4 0.09/0.49/1. the question of ‘‘does it work’’ is relevant.14. ns 15 23 0. CI ¼ confidence interval.28/.245. To guide practitioners and researchers. ns 0.049* 0.16/.13/0.62 1. between 4 and 12 months beyond treatment (g ¼ 0.04 0. ns 1. With the exception of the longest time frame.07/0. ns 0. social work.24/.06 0.34 (2)/. standardized score Moderator: who delivered MI Manual used Mental health: Bachelors Mental health: Masters/PhD Nurse Student Manual not used Mental health: Masters/PhD Nurse Student Effect Size CI z Value/p Value Heterogeneity Q Value (df)/p Value 0. a robust literature exists that examines the ability of MI to promote healthy behavior change across a wide variety of problem areas.001* 2. ns 3. standardized score Manual not used No assessment Insufficient studies to make comparisons on: assessed. ns 25 11 0. Does MI Work? To the degree that MI is rooted in health care.12/.03 0.08 0. ns 0.00 0.27/1. up to 2 years beyond treatment (g ¼ 0.05.56/. Whereas no statistically significant differences were found.22 0.989. ns 1. k ¼ 45).07 0. ns 0.001* 5. Interest in group-delivered MI exists.96 (1)/.29/.392.38. Delivery mode.294.56 0.22/0.11/0.17 0.46/.21/0.02 0. ns ¼ nonsignificant.38/.17 0.06 0. p ¼ .056. Discussion From a broad perspective.04/0.767. k ¼ 15).18/1. ns 1.03 0.07 0.01/. Numbers of studies vary because not all studies examined certain outcomes or reported on certain moderators. 2011 . Durability. ns 11 0. df ¼ degrees of freedom.36/. and psychology settings. ns 1.27 (4).08/0. ns 1 1 2 0. ns Note.47/1.29. k ¼ number of studies.19/0. We found very few studies that delivered MI in a group format (see Table 6). Moderator Analyses for Studies Compared to Treatment as Usual Groups With a Specific Treatment Program Variable K Moderator: motivational interviewing (MI) or Motivational Enhancement Therapy Motivational interviewing Motivational Enhancement Therapy Moderator: use of training manual Manual used Manual not used Moderator: role of MI in treatment Manual used Additive Prelude Head-to-head Manual not used Additive Prelude Head-to-head Moderator: fidelity to MI model examined Manual used No assessment Assessed.95 (1)/.14 0.28 0.43/0.24.362.21 0.15.45 0.54 0.511. ns 2.28 (2)/.52 1. Qb ¼ 5. we now pose and answer several practical questions that flow from this meta-analysis below. * p < .01 0.024* 11 6 8 0. k ¼ 3).21 0.com at Uppsala Universitetsbibliotek on January 5. That 119 studies met our inclusion criteria is remarkable and suggests MI is an approach that will be part of the treatment landscape for the foreseeable future.91/. The small number of studies addressing this question certainly warrants caution when making inferences from these results.81 0.667.931. ns 0.62 0.sagepub. ns 1.17 0.204.98/. ns 5.533.115. No significant differences emerged between time frames.01/0.27/. 3 months beyond treatment (g ¼ 0.721. k ¼ 2).76 (3)/.45 0. ns 3. outcomes were grouped into five different time frames: immediately following treatment (g ¼ 0.57/.03 (1)/. To support continuous analyses of durability. not scored Assessed.19 0.09 1.10 0.014* 7 7 11 0.150 Research on Social Work Practice 20(2) Table 4. ns.36 0.624.00 0.715.43/.64/.52/.

Remember. 253) 0.34.12 (.37. ns .02/0.01* .33 0. ns 0.15 (1. ns . 6.002 0.90 0. ns 0.44 (1.04/0. 151 Downloaded from rsw.000 0.07 1.09 (0.51. Numbers of studies vary because not all studies examined certain outcomes or reported on certain moderators. although it is more potent in some situations compared to others.13. ns 0.01* .70. 151 Table 5.06 0.89 (.com at Uppsala Universitetsbibliotek on January 5. 516) 14.22 (1. 0. which means MI was either ineffective or less effective when compared to other interventions or groups about a quarter of the time.001 0.001*) 1 3 29 0. or educational interventions.50 (SD ¼ 0. ns) 2.45 0. with 50% gaining a small but meaningful effect and 25% gaining to a moderate or strong level.17/0.80 (1.001 0.30. Lipsey and Wilson (1993) generated a distribution of mean effect sizes from 302 meta-analyses of psychological.19 2. ns .08 0.18 2.01* . * p < . Degrees of freedom of studies vary because not all studies examined certain outcomes or reported on certain moderators. 152) 133) 213) 130) 80) .76 0. or Combined Delivery Collapsed across weak and strong comparisons Combined Group Individual MI compared to weak comparison groups Combined Group Individual MI compared to strong comparison groups Combined Group Individual N Effect Size CI z Value/p Value 3 5 104 0. a negative effect size does not necessarily suggest that participants receiving MI were directly harmed—just that the comparison group either progressed more or regressed less. the bottom 25% included effect sizes that ranged from zero to highly negative outcomes.76 (.70 (1.27 (1.017 2.Lundahl et al.36 0.05.02/2.64 0.001 0.29).45 0. 0.05 0. ns) 7.sagepub. ns . * p < .007 0.29 (.19/0.001 0. Conversely. TAU. ns) 1.39 6. 403) 0.68 (1.010 0.50 1. a full 75% of participants gained some improvement from MI. ns .001* . reporting the mean and median effect sizes to be around 0.01 (1.77.09 (1.85. Table 6.003 0.89/1.46/1.004* .16 0. 8.97 0. 177) 1.34 0.002 1.33/0. 29.51 5. ns .006 0.003 0. 485) 1. 0.25.20. 2011 . ns .15 0.28 0.23.23 0.38.45. The results of our meta-analysis are generally within one standard deviation of this mean effect size. ns) 2.58 (1.028 0.28 1.43 (1.13 0.28 0.85.30 0. and written materials Participant characteristics Average age % Male % White % African American % Hispanic Study characteristics Rigor Dose: # of sessions Dose: # of minutes Durability: F/U time Comparison groups: TAU with specific treatment Participant characteristics Average age % Male % White % African American % Hispanic Study characteristics Rigor Dose: # of sessions Dose: # of minutes Durability: F/U time Slope z Value q Value (df) p Value 0.20 0.38 (0.05.67 2. 543) . Specially.001* .04*) 8.85 0. Meta-Regression: Continuous Moderator Analyses Comparison groups: waitlist.41 (1.22/0. CI ¼ confidence interval.30 3.09 (1. Our results resemble findings from other meta-analyses of treatment interventions.26 (1.003 0. and it does not work in all cases.09 (0.76 0.49 0.000 0. indicating that MI produces effects consistent with other human change interventions. significant positive effects across a wide range of problem domains.05 (1. ns Note. Mode of Delivery: Group. ns) Note.04 8.63 0. 234) 224) 319) 226) 186) .77. 0.55 0.84 (. Individual. ns) 0.96 (. 260) 0.001 2.001*) 2 2 76 0.53.03 (1. behavioral.82 (1.278) .94. ns . 0.89 0. When examining all the effect sizes in this review.80 (1.40.015 0.

g. our regression analyses showed a nonsignificant relationship across 842 effect sizes where time could be classified. 3 months beyond treatment. While most of the studies included in this analysis were related to substance use problems. MI significantly increased clients’ engagement in treatment and their intention to change. whereas theoretical issues pertain to whether the individual or agency can adopt a client-centered model that emphasizes collaboration with clients over directing and pushing people to change. This holds across a wide range of problem areas.com at Uppsala Universitetsbibliotek on January 5. when compared to other active treatments such as 12-step and cognitive behavioral therapy (CBT). MI was also effective for other addictive problems such as gambling as well as for enhancing general health-promoting behaviors. Our results also suggest MI was durable at the 2-year mark and beyond. Furthermore. then our review suggests that if another specific program is not currently being used. employing MET will produce significantly better results than only using MI. and may require less time to achieve results similar to other specific treatments. MI is likely to lead to client improvement when directed at increasing healthy behaviors and/or decreasing risky or unhealthy behaviors as well increasing client engagement in the treatment process. then basic MI is the best choice. Anton et al. Of interest. the two variables most closely linked to motivation to change. November 2008). the decision to adopt or even consider adopting MI requires considerable thought and is ultimately an individual (or agency) choice. Is MI Only Indicated for Substance Use Problems? No. including usage of alcohol.g. 152 Downloaded from rsw. MI mostly held its own with specific TAU groups. if the main goal of the practitioner is to combine MI with other psychotherapy techniques such as CBT (e. Furthermore. compared to those reporting severity not receiving MI (Hal Arkowitz. MET may be easier to learn/train because it is more focused than basic MI.152 Research on Social Work Practice 20(2) Should I or My Agency Consider Learning or Adopting MI? On the whole.. If MI is as successful as other interventions. where MET produced results equal to CBT and 12-step in considerably less time. adopting MET seems like the right choice to specifically target addictive or other problem behaviors. though so few studies evaluated such longterm outcomes that confidence has to be tempered pending further research. Is MI Successful in Motivating Clients to Change? Yes. This finding mirrors the general ‘‘Dodo bird verdict’’ from psychotherapy reviews and metaanalyses that no one intervention model or theory is clearly superior (see Prochaska & Norcross. then decision making about whether to adopt MI rests more with practical and theoretical considerations. however. Is MI as Successful as Other Interventions? To begin. Finally. groups as judged by the significant positive changes. In fact. a recent study comparing MI to CBT for generalized anxiety disorder revealed that receiving MI was substantively and specifically beneficial for those reporting high worry severity at baseline. Furthermore. This makes theoretical sense because MET is ‘‘MI plus.g. Our results suggest MI is effective for individuals with high levels of distress as well as for individuals with relatively low levels of distress. 2007).. If the goal is to target specific behavior changes. such as number of sessions or amount of time. tobacco. 2008). it was at least as successful except in the case of tobacco use and miscellaneous drug-use problems. 2011 . the data suggest ‘‘yes. and marijuana. Of course. 2006) or use MI as in integrative framework throughout treatment for clinical problems like depression (e. furthermore. if one considers the findings originating from Project MATCH (1997. the MI interventions took over 100 fewer minutes of treatment on average yet produced equal effects. While MI was not significantly better than such groups.. This finding comes from over 97 comparisons with a minimum of 15 for each time frame. as well as possibly boost their confidence in their ability to change. adopting MI is very likely to produce a statistically significant and positive advantage for clients and may do so in less time. Thus. lower stress and depression levels). Should Practitioners Learn ‘‘Basic MI’’ or ‘‘MET?’’ The answer to this question depends on many factors. or up to a year following treatment completion..’’ adding a problem feedback component to the MI paradigm that could constitute an effective treatment in its own right. Although MI originated in substance abuse fields. Note that. in MI fashion. Is MI Only Successful With Very Troubled Clients? No. Furthermore. MI was associated with positive gains in measures of general well-being (e. Arkowitz & Burke. 1998). after they had made successful changes in certain areas of their life.sagepub. it may be that MI increased client well-being indirectly. Ease of learning MI and costs are practical concerns. Results did not significantly differ when participants’ improvements were measured immediately following treatment. First.’’ While we did not perform a cost-benefit analysis. which is interesting because MI is geared toward motivating clients to make some form of change and directly targets clients’ engagement in the change process. such as whether standardized assessment tools exist for the target problem area under consideration and whether another specific intervention is already being used. MI is certainly better than no treatment and weak treatment such as a written materials or nonspecific TAU Are the Effects of MI Durable? Our analyses suggest that they are. MI does not require more resources. personal communication. MI certainly shows potential to enhance client change intentions and treatment engagement. its effectiveness is currently much broader.

very few studies contributed data to this question. as a prelude to another treatment where the assumption is that MI will serve a preparatory role. the combined results of the present metaanalysis as well as those previously published meta-analyses suggest a relatively low risk in implementing MI because it 153 Downloaded from rsw. Thus. That said. On the whole. The data therefore suggest that it cannot hurt to provide more MI and that it is unreasonable to assume that a very short MI intervention will lead to lasting change. MI appears broadly capable of helping across many problem domains ranging from addictive to health-promoting behaviors.. although why results would differ by comparison group type is not clear to us at this juncture. although fidelity also showed no significant correlations with MI outcome. psychology). a pattern similar to that reported by Hettema et al. no primary study has explicitly tested this question in a MI context and we hope future research into the process of MI will do so.’’ However. to express empathy. 2011 . the use of a manual did not matter. visual inspection of Table 6 seems to discourage group-only delivery and may favor a combined approach instead. whereas when MI was compared to a specific TAU. Hispanic Americans for MI outcomes. The overall finding that format of MI does not significantly influence its outcome fits with its basic philosophy. Hettema et al. our interpretation of the data is that relying solely on group-delivered MI would be a mistake. To our knowledge. 153 Is Manual-Guided MI Superior to the Alternative? Our results suggest not. treatment manuals should encourage fidelity to the MI approach. In summary. Does MI Work for Most Clients? We cannot provide a simple response to this important question based on our review. a significant positive correlation was found between percentages of African American participants and. On one hand.sagepub. whereas MET may be optimal as an additive or stand-alone intervention. a significant positive relationship was found. Berman & Norton. However. Yet. where studies with older participants yielded better results for MI. (2005) found the use of a manual detracted from outcomes. our data cannot suggest minimum or maximum levels of MI-related contact. Does MI Work in Group Formats? Limited data can be applied to this question because only eight studies used some form of group delivery. When MI conditions were compared to weak (and shorter) alternatives. Does the Format or Role of MI Influence Outcomes? MI is a versatile approach. MI is conducted within a cognitive medium and requires some degree of abstract reasoning that should be present after the age of 12 years (based on Piaget’s (1962) model) and thus may not be as helpful for preteen children. Regression analyses showed a significant relationship between participants’ average age and outcomes only when MI was compared to specific TAU. a lower percentage of Whites and a lower percentage of African Americans (i. to a lesser degree. social work.. Moreover. visual inspection revealed a fair amount of variability across different conditions. these findings suggest that MI may be particularly effective with clients from minority ethnic groups (but not necessarily African Americans).e.e. MI by definition strives toward a humanistic. Many MI practitioners anecdotally report that MI becomes integrated within much of their treatment. 1985).com at Uppsala Universitetsbibliotek on January 5.g. group. We also looked at two participant characteristics: age and ethnicity. When MI was compared with a weak alternative. suggesting that basic MI may work best as a prelude to further treatment (as in Burke et al. Does Level of Training Influence Success of MI? Our data suggest ‘‘no. it appears that one of the strengths of MI lies in its portability across many different treatment formats or roles. and to build motivation to change while addressing ambivalence about change. nursing.. Does MI Dosage Matter? Our answer is that it likely does. our results suggest that this may be the case only when MI is being compared to a specific TAU. suggesting a dose effect—i. such that it cannot be separated from other interventions. (2005). and as a stand-alone intervention. Considering developmental issues. or combined). which thereby makes the question of dosage less pertinent. December 2006) that what is most important is a helping professional’s ability to empathize with clients and not their training background (e. client-centered approach where a manual may interfere with truly centering on the client by causing practitioners to focus unduly on the manual. MI aims to improve the working alliance with a client. Taken together. the use of a manual was significantly less effective. Of note.Lundahl et al. a higher percentage of other minorities) was significantly related to better MI outcomes. to manage resistance. more treatment time was related to better outcomes for MI. although our data do suggest a few insights in that regard. We conjecture that MI may be particularly attractive to groups who have experienced social rejection and societal pressure because MI adopts a humanistic approach that prizes selfdetermination. 2003).g. William Miller has stated (personal communication. While no statistically significant differences emerged based on delivery mode (individual. research has often suggested that little difference can be attributed to professional training in psychological arenas (e. It has been used as additive to other interventions. and any inferences must be made tentatively. however. Our data suggest that MI format does not matter as judged by homogenous effect sizes. when MI was compared to a strong alternative (specific TAU). Our data also provide a mixed picture with regard to race... These targeted goals seem broadly acceptable to most change efforts and are likely useful at any stage of an intervention process. When MI was compared to a weak comparison group. Furthermore.

control groups. MI has been judged to be an evidenced-based practice by organizations such as SAMHSA (Substance Abuse and Mental Health Service Administration). When compared to weaker alternatives—such as waitlist.. therefore.org). Ryan. Indeed. CB) for this project. Tobin. health-promoting behaviors).g. and included more than 20 participants in the intervention and comparison groups. Thus.sagepub.. The results of our meta-analysis suggest several potentially fruitful avenues for future MI research.g. 25 years of MI research has generated broad scientific inquiry and deep scrutiny.g. or written material—MI provides a small yet significant advantage for a diverse array of clients regardless of symptom severity. Further. Studies earned 2 points if measurement of outcomes came from at least two sources (e. cost-effectiveness research would certainly add significantly to the MI literature and would be of special interest to policy makers and clinical administrators alike. MI may also work through therapist interpersonal skills (such as accurate empathy as measured by the MISC. 2008. thanks to the J. Lastly. practice.. Studies earned 2 points if fidelity was assessed and considered high.com at Uppsala Universitetsbibliotek on January 5. Miller. To control for this bias we explicitly instructed our research team that positive and negative findings were welcomed and expected. 1 point if collateral only. Palmer. & Hendrickson et al. MI was equally effective in our review and shorter in length. Arkowitz & Miller. records. Markland. a rather large body of training materials and trainers for MI has emerged along with mounting research addressing training effectiveness (e. with possibly an even stronger advantage for minority clients.. & Fulcher et al. Consistent with its client-centered background. Lastly. both of which minimize client resistance. age. we have likely not yet found the limits of the types of problems and symptoms to which MI can be profitably applied. Miller & Rollnick. 2002). Dunn. nonspecific TAU. it has shown positive and significant effects. physiological indicators) instead of relying solely on client self-report. Furthermore. we consciously determined to present the results regardless of whether they supported or undermined MI’s effectiveness. Compared to other active and specific treatments. 2005). studies earned 3 points if true randomization was used. funded two research assistants (CK. and gender.. 2004). there may be two specific active components underlying the MI mechanism: a relational component focused on empathy and the interpersonal spirit of MI. collected data at a follow-up period beyond immediate completion of the study. Finally. reported data from all dependent variables they assessed. 1 point if the 154 Downloaded from rsw. Miller. and expression of affect (Moyers. utilized objective measurement tools (e. and no point if fidelity was not measured. 2008). 2003). and the MI approach has clearly passed the initial test. be biased. Acknowledgments Thanks to the Utah Criminal Center who paid for the RAs. Willard Marriott Library. 2002). and research has already been devoted to MI. & Rollnick. MI may work via increasing a specific type of client change talk—what they say in session about their commitment to making behavioral changes—and decreasing client speech that defends the status quo (Amrhein. and/or numbers of participants (percentages). Miller. Vansteenkiste & Sheldon. utilized a manual to direct training or standardized delivery. 2011 . Appendix Rating Study Rigor Studies received 1-point if they did the following: reported on three or more demographic indicators of the sample. 2 points if matched groups were used. Studies earned up to 2 points if the data used to calculate effect sizes came from means. we strove to clearly detail our methodology to be transparent and to encourage possible replication. t test). see Burke. In sum. November 2008) and efforts to assess fidelity to MI are well underway (e. utilized coders who were ‘‘blind’’ to participants’ group assignment. While only a handful of MI studies have examined this important variable to date. reported on dropouts.. participant and collateral source).. Authors’ Note The first and last authors are affiliated with the MINT group and may. Yahne..g. disclosure. Funding The Utah Criminal Justice Center. 1 point if an exact statistic was used (e.154 Research on Social Work Practice 20(2) works across a wide range of problem behaviors/types and is unlikely to harm clients. Moreover. 2004. MI researchers are also investing much time and energy into best practices in training MI (Teresa Moyers. we still do not understand the precise links between its processes and outcomes (Burke et al. Declaration of Conflicting Interests The authors declared no potential conflicts of interests with respect to the authorship and/or publication of this article. 2002). 2009). we made the point that MI may well be more cost-effective than viable alternative treatments even if they are not more clinically effective.. which are positively associated with client involvement as defined by cooperation. & Phelps. a considerable body of theory and research suggests that MI may be effective for clinical areas beyond the addictions. 2006). Furthermore. and no point if participant only. standard deviations.. although a substantial amount of thought. included more than one site. Miller. 1 point if fidelity was assessed but not scored. and a technical component involving the differential evocation and reinforcement of client change talk (Miller & Rose. Our review is supportive of such an assertion because virtually anytime MI has been tested empirically in new areas (e.g. 2005.g.g. resulting in a rather standardized training approach (see motivationalinterviewing. personal communication. and no point if effect sizes were derived from p values. Thus. In this review.. It is our sense that MI enjoys a clear and articulate theoretical frame accompanied by specific techniques that can readily be learned (e. Atkins. housed within the University of Utah. such as for depression and anxiety disorders (Arkowitz et al.

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