Have you ever had a conversation with a friend and been persuaded to make a positive change?
Think back now. What was it they said that helped you make a decision? Or was it perhaps how they said it that had an impact? Did you notice anything about their style?
Without knowing it, you were probably exposed to motivational interviewing (MI) techniques, which are used in a specific style of communication. Motivational interviewing makes use of a myriad of discreet strategies to elicit change.
When used in therapy, MI can help your clients create change by actioning goals and mastering techniques. This article will investigate the effectiveness of MI and provide exercises that are detailed and based on science.
Before you continue, we thought you might like to download our three Goal Achievement Exercises for free. These detailed, science-based exercises will help you or your clients create actionable goals and master techniques to create lasting behavior change.
This Article Contains:
Effectiveness of MI: 6 Evidence-Based Findings
A Look at 5 Benefits and Common Criticisms
10 Pros and Cons of Motivational Interviewing
A Take-Home Message
Effectiveness of MI: 6 Evidence-Based Findings
Motivational interviewing is a skilled technique. It has specific key qualities, such as a guided communication style, which is used while following (effectively listening) and directing (providing advice and information). It helps to empower people by eliciting their narratives of meaning, pertinence, and capacity to change.
This technique is based on a manner that is both respectful of and curious about people. It supports the process of change naturally and respects the client’s autonomy (Miller & Rollnick, 2013).
MI is evidence based. There is a magnitude of research from clinical trials and other studies that points to MI’s effectiveness. So, let’s look at what the evidence says about using MI to make necessary behavior transformations.
Smoking is a global problem that leads to preventable illness and deaths (Peto, López, & Boreham, 1992).
MI versus anti-smoking advice
Soria, Legido, Escolano, Yeste, and Montoya (2006) found that MI can be used effectively to encourage a client to give up smoking and is more effective than anti-smoking advice.
The randomized experimental study provided 114 participants with MI. The control group of 86 participants received anti-smoking advice. They were all interviewed 6 and 12 months after the intervention.
The MI group was more effective at giving up smoking (18.4%) than the anti-smoking advice group (3.4%). MI may be more effective at encouraging quitting smoking than just giving straightforward advice.
Smokers with cardiac disease
In another study, MI was used to help patients with cardiac disease stop smoking (Okasha et al., 2017).
Smokers with cardiac diseases at a clinic received MI sessions and were monitored before, after, and in follow-up sessions. The MI treatment group had fewer heart attacks than the control group by at least 50%. They were much more likely to want to quit smoking (at least over 90% more), and they reported a much lower level of nicotine dependence (between 82% and 85%).
The most exciting finding is that nearly 92% of the experimental group stopped smoking successfully compared to the control group (45%). MI can potentially help patients quit smoking with less stress and more self-efficacy.
Alcohol and illicit drug reduction and abstinence
People who develop dysfunctional alcohol and drug use issues are often found to be ambivalent about their destructive behaviors. MI evolved from a treatment for alcohol abuse as first described by Miller (1983).
When addicts can no longer control their alcohol or drug use, despite the negative impact upon their lives, they experience distress when they are not drinking (National Institute on Alcohol Abuse and Alcoholism, 2018), and they need help.
A fascinating study by Satre et al. (2016) examined the use of MI to reduce hazardous drinking in 307 adults assigned to receive MI, printed literature, or routine outpatient care. These patients were also being treated for depression as outpatients before the commencement of the study.
Participants assigned to the MI group were more effective at reducing hazardous drinking, especially for those also using cannabis. In addition, depression improved for these hazardous drinkers who were also using drugs.
Alcohol abuse in the military
Motivational interviewing has also proven effective in reducing alcohol abuse within the military, especially if the drinking is classified as hazardous. Brown (2010) investigated the effectiveness of individual and group MI and used a randomized control trial to probe this issue.
Personnel in the Air Force Alcohol and Drug Abuse Prevention and Treatment program because of an alcohol incident were self-referred and consented to one of three interventions: group MI, individual MI, or a substance abuse awareness seminar.
There were follow-up sessions with all groups after 3, 6, and 12 months. The results showed that individual MI was most effective at reducing alcohol use, allowing participants to remain in their jobs and not give up their military career.
Weight loss and obesity
Obesity affects more than a third of U.S. adults (Ogden, Carroll, Kit, & Flegal, 2014). There are further costs to society, such as medical costs (Finkelstein, Trogdon, Cohen, & Dietz, 2009) and the quality of life that the person can lead.
MI versus nutrition education
MI was studied as an effective technique to improve weight loss in 100 overweight women (Mirkarimi et al., 2017). Participants attended a nutrition clinic where they were randomly assigned to either five sessions of group MI or four sessions of group nutrition education.
MI was more successful at eliciting positive weight efficacy and lifestyle among the participants than nutritional education, such as literature related to controlling weight.
Preventing obesity in childhood
MI is effective at preventing obesity in children and adults. In large study in Sweden, families with infants were randomly assigned to either a MI group (of both individual and group sessions) or a standard group with usual care (Doring et al., 2016). Evidence pointed toward healthier food habits among both mothers and children in the MI group.
A Look at 5 Benefits and Common Criticisms
What then are the benefits of motivational interviewing?
Let us look at these here and, to be fair, evaluate some criticisms.
1. Increases participation in treatment
MI is a practical and user-friendly technique, making it straightforward to engage with clients, who are then more receptive to their treatment.
MI seems to elicit greater adherence to treatments than alternative therapies. A study by Westra, Constantino, and Antony (2016) explored the benefits of MI as opposed to Cognitive-Behavioral Therapy (CBT) alone for severe generalized anxiety disorder. Twice as many people in the CBT group dropped out of treatment as the MI group.
2. Changes high-risk lifestyle behaviors
MI has been shown to be effective for people who have alcohol and substance use problems. Many people with alcohol and drug problems experience difficulty with their habits. They often view alcohol and drug rehabilitation programs negatively.
Giving up alcohol entirely may seem unrealistic. They may, deep down, know that using these substances is ruining their lives, yet they find it hard to admit that they need to change.
MI can help high-risk clients build motivation for their treatment. A review of studies by Lundahl and Burke (2009) found that MI was 10% to 20% more effective at reducing risky behaviors and increasing engagement than no treatment at all.
3. Builds self-confidence
Many people who want to make changes experience lowered self-esteem and confidence, which is an obstacle to making the relevant changes needed.
MI allows these people to build confidence as they take on the responsibility to make the changes. As they see their desired result through behavior change, such as weight loss from healthier eating, this brings about a greater sense of confidence in themselves, with longer lasting results. Clients can visualize and see a future free of negative health-related behaviors.
4. People become more self-reliant and responsible for the change
MI allows people to take on the responsibility and rely on themselves to make changes – a healthier approach in the long term.
Rather than relying on medication alone to control diabetes, for instance, people learn that lifestyle changes, such as following a specific diet and exercising, can help regulate their blood sugar levels. They no longer have to rely solely on the medication to do this for them.
5. Increases confidence of health professionals in their communication with patients
MI is beneficial not only for the recipient, but also for the professional providing the technique. When health professionals communicated with patients using MI, they had increased confidence when teaching and educating patients.
After learning MI techniques, nurses who educate patients about diabetes showed a significant improvement in confidence (Stoffers & Hatler, 2017), which also improves job satisfaction.
1. Needs time to build a relationship
MI requires a considerable time investment to engage clients and build rapport. It cannot be undertaken in a hurry, and so the practitioner and the client need to have the time and resources available to make the intervention effective.
2. Needs a certain degree of cognitive clarity and motivation
Some clients do not have the mental resources or cognitive clarity to focus on the advantages and disadvantages of mental illness (such as bipolar condition or schizophrenia) to formulate a plan. They may not benefit from MI, and a different approach may be necessary.
Clients who have been diagnosed with depression often lack motivation. This is an essential requirement for MI. This technique may not work for them, especially if they have clinical depression and are heavily sedated.
3. One size does not fit all
All individuals have differing narratives, obstacles, levels of motivation, and lifestyles. MI is not an approach that can be used for everyone (Hogden, Short, Taylor, & Dugdale, 2012).
4. Follow-up is crucial
Unless you follow up with clients after using MI techniques, you cannot track their changes or see the effectiveness of the approach. A one-off meeting with a client is not an effective way to implement MI. You need to follow up at differing points, such as 6 weeks, 3 months, 6 months, and even 12 months after the first meeting.
5. Requires patient engagement and awareness
Although MI improves engagement, initial engagement from the client is necessary to make it work. If the client does not engage or isn’t aware of their problem, then it won’t be easy to move forward with this approach. There may be obstacles that are hindering their engagement and awareness. These can be time limitations, motivation, lack of cognitive clarity, and even denial.
10 Pros and Cons of Motivational Interviewing
To establish whether MI is an effective technique to use, consider the following pros and cons.
It is effective for clients with addiction behaviors and for managing physical health conditions such as diabetes, hypertension, and obesity.
It helps clients manage their own health and be less reliant on medications and medical appointments.
It avoids confrontation and promotes positivity and optimism for clients and practitioners alike.
It allows clients to find their own solutions for longer lasting results.
It allows clients to feel listened to and understood, an important aspect to enable change.
It will not work well for clients with trauma or depression, as motivation may be limited.
It can be a dangerous approach for clients with bipolar conditions and schizophrenia.
It will not work for a client already highly motivated to make a change.
It will not work for clients without a problem.
It is time consuming and requires a time and cost investment.
PositivePsychology.com has several excellent and relevant resources available to help your clients.
The Motivation & Goal Achievement Masterclass© comes highly recommended to help you understand different types of motivation. By completing this masterclass, you will be able to teach your clients how to enhance their motivation in order to achieve their goals.
For even more resources to support your motivational interviewing, check out the following worksheets, tools, and further reading from our blog:
Motivational Interviewing in Social Work
This template presents five questions based on Prochaska and DiClemente’s (1986) Stages of Change model to help practitioners assess clients’ readiness for change.
Motivational Interviewing: Querying Extremes Worksheet
This worksheet helps clients exhibiting reluctance to change their behaviors explore best- and worst-case scenarios surrounding the change.
18 Motivational Interviewing Worksheets, Examples, and Techniques
This article presents even more in-depth advice on motivational interviewing and includes links to many more free worksheets.
17 Motivation & Goal-Achievement Exercises
If you’re looking for more science-based ways to help others reach their goals, this collection contains 17 validated motivation & goals-achievement tools for practitioners. Use them to help others turn their dreams into reality by applying the latest science-based behavioral change techniques
Additional articles not to miss are our well-researched Motivational Interviewing Quotes, useful for inspiring clients, and a list of Motivational Interviewing Books to strengthen your skills in motivational interviewing.
A Take-Home Message
MI is a process that can work wonders in helping clients make healthy changes in their behavior for the long term.
It is also a beneficial tool for clinicians and practitioners and enables them to increase their confidence.
There are many benefits to this tool. Many clients experience the necessary behavior changes regarding their health and wellbeing in a positive manner.
But, and there is always a but, it is not ideal for all clients; therefore, it is essential to understand the considerations that need to be made before deciding on its use for a particular client.
However, when used appropriately, research has proven that it will provide excellent long-term benefits for the client.
It just shows you, words can change the world, and the right conversation in the right way can turn someone’s life around.
We hope you enjoyed reading this article. Don’t forget to download our three Goal Achievement Exercises for free.
Brown, J. M. (2010). Motivational interventions to reduce alcohol use in a military population. U.S. Army Medical Research and Materiel Command.
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Finkelstein, E. A., Trogdon, J. G., Cohen, J. W., & Dietz, W. (2009). Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs, 28(5), 822–831.
Hogden, A., Short, A. E., Taylor, R., & Dugdale, P. (2012). Health coaching and motivational interviewing: Evaluating the chronic disease self-management toolbox as a tool for person-centered healthcare. Journal of Medicine and the Person, 2(3), 520–530.
Lundahl, B., & Burke, B. L. (2009). The effectiveness and applicability of motivational interviewing: A practice-friendly review of four meta-analyses. Journal of Clinical Psychology, 65(11), 1232–1245.
Miller, W. R. (1983). Motivational interviewing with problem drinkers. Behavioural and Cognitive Psychotherapy, 11(2), 147–172.
Miller, W. R., & Rollnick, S. (2013). Motivational interviewing: Helping people to change (3rd ed.). Guilford Press.
Mirkarimi, K., Mosttafavi, F., Eshghinia, S., Vakili, M. A., Ozouni-Davaki, R. B., & Aryaie, M. (2017). Effect of motivational interviewing on weight efficacy lifestyle among women with overweight and obesity: A randomized controlled trial. Iranian Journal of Medical Sciences, 42(2), 187–193.
National Institute on Alcohol Abuse and Alcoholism. (2018). Understanding alcohol use disorder. Retrieved May 2, 2021, from https://www.niaaa.nih.gov/publications/brochures-and-fact-sheets/understanding-alcohol-use-disorder
Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2104). Prevalence of childhood and adult obesity in the United States, 2011–2012. The Journal of the American Medical Association, 311(8), 806–814.
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Peto, P. R, López, A. D., & Boreham, J. (1992). Mortality from tobacco in developed countries: Indirect estimation from national vital statistics. Lancet, 339(8804), 1268–1278.
Prochaska, J. O., & DiClemente, C. C. (1986). Toward a comprehensive model of change. In W. Miller & N. Heather (Eds.), Treating addictive behaviors: Processes of change (pp. 3-27). Plenum.
Satre, D. D., Leibowitz, A., Sterling, S. A., Lu, Y., Travis, A., & Weisner, C. (2016). A randomized clinical trial of motivational interviewing to reduce alcohol and drug use among patients with depression. Journal of Consulting and Clinical Psychology, 84(7), 571–579.
Soria, R., Legido, A., Escolano, C., Yeste, A. L., & Montoya, J. (2006). A randomized controlled trial of motivational interviewing for smoking cessation. British Journal of General Practice, 56(531), 768–774.
Stoffers, P. J., & Hatler, C. (2017). Increasing nurse confidence in patient teaching using motivational interviewing. Journal for Nurses in Professional Development, 33(4), 189–195.
Westra, H. A., Constantino, M. J., & Antony, M. M. (2016). Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial. Journal of Consulting Clinical Psychology, 84(9), 278–782.