Susan W Krigel1, James E Grobe2, Kathy Goggin3, Kari Jo Harris4, Jose L Moreno5, Delwyn Catley6. 1. Midwest Cancer Alliance, University of Kansas Cancer Center, 4350 Shawnee Mission Parkway, Fairway, KS 66205, United States. Electronic address: skrigel@kumc.edu. 2. JEGrobe Consulting, 9209 Heatherdale Drive, Dallas, TX 75243, United States. Electronic address: jamesegrobe@gmail.com. 3. Division of Health Services and Outcomes Research, Children's Mercy Hospitals and Clinics, Schools of Medicine and Pharmacy, University of Missouri - Kansas City, 2401 Gillham Road, Kansas City, MO 64108, United States. Electronic address: kgoggin@cmh.edu. 4. School of Public and Community Health Sciences, The University of Montana, 32 Campus Drive, Skaggs Rm 352, Missoula, MT 59812, United States. Electronic address: kari.harris@mso.umt.edu. 5. Department of Psychiatry, University of Texas Health Science Center at San Antonio, 7550 Interstate 10 Frontage Rd #1325, San Antonio, TX 78229, United States. Electronic address: morenojlm@gmail.com. 6. Center for Children's Healthy Lifestyles & Nutrition, Children's Mercy Hospitals and Clinics, Department of Pediatrics, University of Missouri-Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO 64108, United States. Electronic address: dcatley@cmh.edu.
Abstract
INTRODUCTION: The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS:College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE). Assessments were obtained at baseline, immediately post-treatment, 1week, and 4weeks. RESULTS: Compared to HE, the MIDB sessions scored significantly higher on the Motivational Interviewing Treatment Integrity (MITI) scale (all standardized differences d>1, p<0.001). Unexpectedly, self-report Pros of smoking scores increased for MIDB but decreased for HE (MIDB vs HE standardized difference d=0.5; 95%CI 0.1 to 1.0, p=0.021). Both groups showed significant reductions in smoking rates and increases in motivation to quit, quit attempts, and self-reported abstinence, with no significant group differences. Changes in the Pros of smoking were correlated with MITI scores, but not with cessation outcomes. In contrast, increases in the Cons of smoking and therapeutic alliance were predictive of better cessation outcomes. CONCLUSIONS: The decisional balance exercise as formulated by earlier versions of MI may be counter-productive and cautions around its use are warranted. Instead, improved cessation outcomes appear associated with increasing perceived benefits of quitting and positive therapeutic alliance.
RCT Entities:
INTRODUCTION: The decisional balance (DB) procedure examines the pros and cons of behavior change and was considered a component in early formulations of Motivational Interviewing (MI). However, there is controversy and conflicting findings regarding the use of a DB exercise within the treatment of addictions and a need to clarify the role of DB as a component of MI. METHODS: College tobacco smokers (N=82) with no intentions on quitting were randomly assigned to receive a single counseling session of either Motivational Interviewing using only the decisional balance component (MIDB), or health education around smoking cessation (HE). Assessments were obtained at baseline, immediately post-treatment, 1week, and 4weeks. RESULTS: Compared to HE, the MIDB sessions scored significantly higher on the Motivational Interviewing Treatment Integrity (MITI) scale (all standardized differences d>1, p<0.001). Unexpectedly, self-report Pros of smoking scores increased for MIDB but decreased for HE (MIDB vs HE standardized difference d=0.5; 95%CI 0.1 to 1.0, p=0.021). Both groups showed significant reductions in smoking rates and increases in motivation to quit, quit attempts, and self-reported abstinence, with no significant group differences. Changes in the Pros of smoking were correlated with MITI scores, but not with cessation outcomes. In contrast, increases in the Cons of smoking and therapeutic alliance were predictive of better cessation outcomes. CONCLUSIONS: The decisional balance exercise as formulated by earlier versions of MI may be counter-productive and cautions around its use are warranted. Instead, improved cessation outcomes appear associated with increasing perceived benefits of quitting and positive therapeutic alliance.
Authors: Andrea C Villanti; Julia C West; Elias M Klemperer; Amanda L Graham; Darren Mays; Robin J Mermelstein; Stephen T Higgins Journal: Am J Prev Med Date: 2020-05-14 Impact factor: 5.043
Authors: Natascha Büchele; Lucas Keller; Anja C Zeller; Freya Schrietter; Julia Treiber; Peter M Gollwitzer; Michael Odenwald Journal: PLoS One Date: 2020-09-17 Impact factor: 3.240