Toward a Universal Maintenance Intervention: Integrating Cognitive-Behavioral Treatment With Motivational Interviewing for Maintenance of Behavior Change

Abstract

Improvements in behavior following active interventions diminish over time across a broad spectrum of behaviors. Motivational interviewing (MI) has been found to increase intrinsic motivation for initial behavior change, but there has been little discussion on how to integrate MI and the cognitive-behavioral treatments (CBTs) commonly used to maintain change. A prominent CBT approach to relapse prevention that has been tested in multiple behavioral domains includes the following maintenance strategies: managing the goal violation effect, flexible goal setting, identifying triggers and developing coping skills, and increasing self-efficacy and social support. Using a model of integration where MI is the foundation for CBT delivery, the integration of specific relational and technical components of MI and CBT strategies for maintenance of change are described. A universal maintenance intervention that uses MI as an integrative framework to deliver CBT may address maintenance of behavior change across multiple behavioral domains. Further research is necessary to confirm whether delivering MI with fidelity adds to the effectiveness of CBT maintenance interventions.

A phenomenological exploration of exercise mental toughness: perceptions of exercise leaders and regular exercisers

“…For example, the identified importance of focus and an awareness of self as components of EMT indicates that approaches such as 'Mindfulness' (see Bishop et al, 2004) Developing effective maintenance strategies were reflected by participant descriptions of needing a rapid re-focus, reinforcement, tenacity and remaining positive in tough times. Integrating approaches such as MI with Cognitive-Behavioural (CB) interventions can be helpful in managing the risk of relapse and has found support in many other health behaviour contexts (Naar-King, et al 2013).…”

“…Increased levels of physical activity following active interventions tend to diminish over time across a broad spectrum of behaviours, including exercise (Biddle & Mutrie, 2008). Exercise interventions have often focussed solely on developing intrinsic motivation for initial behaviour change, with little consideration of how to integrate and implement programmes to understand mechanisms and processes used to maintain change (Naar-King et al 2013). For those beginning formal exercise programmes, studies typically report high rates of attrition and relapse, with few managing to maintain exercise for six months or longer (Hillsdon et al, 2005;Hutchison et al, 2013).…”

Integrated motivational interviewing and cognitive behaviour therapy for lifestyle mediators of overweight and obesity in community-dwelling adults: a systematic review and meta-analyses

“…The principles and methods of MI address issues associated with ambivalence about behaviour change, including decreased confidence and low self-efficacy [ 14 ]. MI has well established efficacy for initiating health behaviour change [ 8 , 14 , 15 ], but is less effective in goal-oriented action planning, which can lead to behaviour change relapse [ 12 , 16 ]. Not surprisingly, therefore, it has shown to be more effective and longer lasting when combined with other active treatments, rather than delivered alone [ 17 ].…”

A randomised controlled trial and cost-effectiveness evaluation of ‘booster’ interventions to sustain increases in physical activity in middle-aged adults in deprived urban neighbourhoods

“…57,58 Although physical activity counselling based on MI has been rolled out across the UK through the Let's Get Moving education programme, 59 it remains unclear whether those delivering the training and those delivering the intervention to patients are doing so according to the approach intended. This failure to embed assessments of competence has raised questions over the value of short-term workshops with little or no ongoing supervision and professional practice reflection.…”