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A multivariate meta-analysis of motivational interviewing process and outcome - PubMed

Meta-Analysis

. 2017 Aug;31(5):524-533.

doi: 10.1037/adb0000280. Epub 2017 Jun 22.

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Meta-Analysis

A multivariate meta-analysis of motivational interviewing process and outcome

Brian T Pace et al. Psychol Addict Behav. 2017 Aug.

Abstract

Motivational interviewing (MI) theory proposes a process whereby a set of therapist behaviors has direct effects on client outcomes and indirect effects through in-session processes (e.g., client change talk). Despite clear empirical support for the efficacy of MI across settings, the results of studies evaluating proposed links between MI process and outcome have been less clear. In the present study, we used a series of multivariate meta-analyses to test whether there are differential relationships between specific MI-consistent and MI-inconsistent therapist behaviors, MI therapist global ratings, client change language, and clinical outcomes. Based on 19 primary studies (N = 2,614), we found a significant relationship between MI-consistent therapist behaviors and greater client change talk, as well as greater client sustain talk. Higher therapist global ratings (empathy and MI spirit) were significantly related to increased MI-consistent behaviors, decreased MI-inconsistent behaviors, increased client change talk, yet also increased client sustain talk. Therapist global ratings were not significantly related to clinical outcomes. Client sustain talk was a significant predictor of worse clinical outcomes, while client change talk was unrelated to outcome. Variability within the correlations indicated that MI-consistent and MI-inconsistent therapist behaviors were differentially related to therapist global ratings of empathy and MI spirit. Similar to past research, present findings provide equivocal support for hypothesized MI process outcome relationships. Clinical implications and future areas of MI mechanism research are discussed. (PsycINFO Database Record

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Figures

Figure 1
Figure 1

Hypothesized pathways that facilitate behavior change in MI. Figure adapted from Miller, W. R., & Rose, G. S. (2009). Toward a theory of motivational interviewing. American Psychologist, 64(6), 527–537.

Figure 2
Figure 2

Structure of the six separate MI comparisons and the 18 correlation types. Models 1a-f including a fixed effect at the correlation type level and a random effect at the study level. Models 2a-f including an additional random effect at the correlation type level. MICO = MI-consistent behavior; MIIN = MI-inconsistent behavior; CT = client change language; ST = client sustain language; OUT = outcome; EMP = therapist empathy; MIS = therapist MI spirit.

Figure 3
Figure 3

Effect sizes in the MI causal model. Note: emp = therapist empathy and mis = MI spirit. * p < .05. ** p < .001.

Figure 4
Figure 4

Correlations between individual MI therapist behaviors and empathy and MI spirit ratings. The point estimated shows the aggregated correlation and error bars represent 95% confidence intervals. The plots depict MI-consistent (left) and MI-inconsistent (right) therapist behaviors.

Figure 2
Figure 2

A primary study inclusion flowchart.

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