Extending Motivational Interviewing to the Treatment of Major Mental Health Problems: Current Directions and Evidence

Abstract

Motivational interviewing (MI) was originally developed for the treatment of substance abuse but is rapidly expanding to other major mental health populations beyond addictions. This brief review considers the use of MI and related motivational enhancement therapies (METs) in the treatment of anxiety, depression, and eating disorders, and concurrent psychosis and substance use disorders. MI-MET has been added and (or) integrated into treatment for these problems in a wide variety of ways, most commonly as a pretreatment to other therapies (psychosocial treatments and pharmacotherapy) or integrated into standard assessment procedures. In each problem domain, the bulk of the current evidence supports the value of adding MI to existing therapies in increasing engagement with treatment and in improving clinical outcomes. This is particularly encouraging in that many of the populations included in these investigations represent severe and treatment-recalcitrant populations. However, research on the application of MI to other major mental health problems beyond addictions is in the early stages, with existing studies having numerous limitations (for example, small uncontrolled studies or lack of adequate control groups, and failure to establish both MI treatment integrity and the unique contribution of MI in integrated treatments). In short, the substantial body of promising preliminary findings strongly support the continued investigation of MI and related methods for these populations in well-designed clinical trials that examine not only the additive value of MI but also mechanisms underlying these effects and individual differences (moderators) indicating the need for MI.

Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: A review and meta-analysis

“…An electronic database search of PsycINFO, Embase, Web of Science, Sage, Scopus, ProQuest Dissertations and Theses, and Google Scholar was conducted using the following keywords: motivational interviewing, motivational enhancement therapy, brief intervention, mechanisms of action, mediator, moderator, and therapy process. Hand-searches of the online MI bibliography posted on the MI website (http://www.motivationalinterview.org) were also conducted, as well as hand-searches of relevant commentaries, review, and meta-analytic papers (Apodaca & Longabaugh, 2009;Burke, 2011;Flynn, 2011;Geller & Dunn, 2011;Simpson & Zuckoff, 2011;Westra et al, 2011). Database searches were conducted up until March 2013.…”

“…However, in the treatment of psychological disorders such as anxiety and eating disorders, MI is primarily used as an adjunctive treatment with an aim to enhance treatment gains as a result of another treatment. In these areas, employing MI is thought to facilitate patient motivation and engagement in other treatment (e.g., cognitive behavioural treatment; CBT), thereby potentially yielding more positive outcomes (Westra, Aviram, & Doell, 2011). Given that the focus of MI may differ across populations it is possible that the mechanisms of change in MI for substance use disorders may not apply when MI is used for other disorders.…”

Taking a Timeout to Ensure Well-Being: Social Work Involvement in College Sports

“…Motivational Interviewing is an established practice model, with mounting evidence in research for its effective improvement of psychosocial risks, especially mental health (Brody, 2009;Westra, 2004;Zerler, 2009), substance abuse (Gingerich & Peterson, 2013;Johnson, Sacks, & Edmonds, 2010;Simpson & Zuckoff, 2011;Westra, Aviram, & Odell, 2011), alcohol abuse (Branscum & Sharma, 2010;Feldstein & Forcehimes, 2007;Harris, Aldea, & Kirkley, 2006;Martens, Smith, & Murphy, 2013), and eating disorders (Knowles, Anokhina, & Serpell, 2013;Macdonald, Hibbs, Corfield, & Treasure, 2012;Weiss, Mills, Westra, & Carter, 2013). Gingerich and Peterson (2013) found that MI is also cost-effective, requires fewer therapeutic sessions, and is adaptable to a variety of environments more so than other intervention solutions.…”

Behavioral Interventions for Individuals Dually Diagnosed with a Severe Mental Illness and a Substance Use Disorder

“…Given that effective use of MI with dually diagnosed individuals likely requires an especially high level of therapeutic skill (Martino & Moyers, 2008), it is essential that future research remedy this omission. Second, when MI is combined with CBT, it is unclear whether the integration is being implemented in a manner that preserves MI's efficacy for increasing motivation to change (Westra et al, 2011). For instance, relying on a protocol that calls for the initiation of CBT after one or two introductory sessions of MI, regardless of the individual's response to MI, risks a premature focus on how to change when some patients are still deciding whether to change (Moyers & Houck, 2011).…”

“…The most frequently studied of these behavioral interventions have been motivational interviewing (MI; W.R. Miller & Rollnick, 2013), cognitive-behavioral therapy (CBT; Marlatt & Gordon, 1985), contingency management (CM; Higgins, Silverman, & Heil, 2008) and combinations of these interventions (e.g., MI + CBT). Motivational interventions with SMI individuals focus on engaging patients in a dialogue that is intended to increase their motivation and commitment to changing substance use (Martino, 2007; Westra, Aviram, & Doell, 2011). Cognitive-behavioral treatments emphasize teaching of skills to overcome deficits in interpersonal and intrapersonal life areas that are seen as functionally related to substance abuse, thus improving individuals’ ability to cope with high-risk situations and relapse precipitants (e.g., Kadden et al, 1994).…”