Does motivational Interviewing help people who smoke to quit?

Lai DTC, Cahill K, Qin Y, Tang J-L

Published Online:

October 5, 2011

Motivational interviewing or its variants are widely used to help people stop smoking. It is a counselling technique for helping people to explore and resolve their uncertainties about changing their behaviour. It seeks to avoid an aggressive or confrontational approach. It tries to steer people towards choosing to change their behaviour, and to encourage their self-belief. Our review found that motivational interviewing seems to be effective when given by general practitioners and by trained counsellors. Longer sessions (more than 20 minutes per session) were more effective than shorter ones. Two or more sessions of treatment appeared to be marginally more successful than a single session treatment, but both delivered successful outcomes. The evidence for the value of follow-up telephone support was unclear. Our results should be interpreted with caution, due to variations in how the treatment was delivered, what it included and the completeness of the evidence.

Abstract (click to read)

Background:

Motivational Interviewing (MI) is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It was developed as a treatment for alcohol abuse, but may help smokers to a make a successful attempt to quit.

Objectives:

To determine the effects of motivational interviewing in promoting smoking cessation.

Search strategy:

We searched the Cochrane Tobacco Addiction Group Specialized Register for studies with terms (motivational OR motivation OR motivating OR motivate OR behavi* OR motivat*) and (interview* OR session* OR counsel* OR practi*) in the title or abstract, or as keywords. Date of the most recent search: April 2009.

Selection criteria:

Randomized controlled trials in which motivational interviewing or its variants were offered to smokers to assist smoking cessation.

Data collection and analysis:

We extracted data in duplicate. The main outcome measure was abstinence from smoking after at least six months follow up. We used the most rigorous definition of abstinence in each trial, and biochemically validated rates where available. Subjects lost to follow up were treated as continuing smokers. We performed meta-analysis using a fixed-effect Mantel-Haenszel model.

Main results:

We identified 14 studies published between 1997 and 2008, involving over 10,000 smokers. Trials were conducted in one to four sessions, with the duration of each session ranging from 15 to 45 minutes. All but two of the trials used supportive telephone contacts, and supplemented the counselling with self-help materials. MI was generally compared with brief advice or usual care in the trials. Interventions were delivered by primary care physicians, hospital clinicians, nurses or counsellors. Our meta-analysis of MI versus brief advice or usual care yielded a modest but significant increase in quitting (RR 1.27; 95% CI 1.14 to 1.42). Subgroup analyses suggested that MI was effective when delivered by primary care physicians (RR 3.49; 95% CI 1.53 to 7.94) and by counsellors (RR 1.27; 95% CI 1.12 to 1.43), and when it was conducted in longer sessions (more than 20 minutes per session) (RR 1.31; 95% CI 1.16 to 1.49). Multiple session treatments may be slightly more effective than single sessions, but both regimens produced positive outcomes. Evidence is unclear at present on the optimal number of follow-up calls.

There was variation across the trials in treatment fidelity. All trials used some variant of motivational interviewing.Critical details in how it was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking from trial reports.

Authors' conclusions:

Motivational interviewing may assist smokers to quit. However, the results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias.

This record should be cited as:

Lai DTC, Cahill K, Qin Y, Tang J-L. Motivational interviewing for smoking cessation. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD006936. DOI: 10.1002/14651858.CD006936.pub2

Assessed as up to date:

July 16, 2009

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Primary Review Group:

Tobacco Addiction Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is motivational interviewing in promoting smoking cessation?

Bottom line:

Motivational interviewing seemed effective when given by GPs and by trained counsellors (NNT* 27, range 21–250). Longer sessions (>20 minutes per session) were more effective than shorter ones. Two or more sessions of treatment appeared to be marginally more successful than a single session treatment, but both delivered successful outcomes. The evidence for the value of follow-up telephone support was unclear. * NNT = number needed to treat to benefit 1 individual.

Caveat:

These results should be interpreted with caution due to variations in study quality, treatment fidelity and the possibility of publication or selective reporting bias. Critical details in how motivational interviewing was modified for the particular study population, the training of therapists and the content of the counselling were sometimes lacking in trial reports.

Context:

Motivational interviewing is a directive patient-centred style of counselling, designed to help people to explore and resolve ambivalence about behaviour change. It seeks to avoid an aggressive or confrontational approach, and tries to steer people towards choosing to change their behaviour, and to encourage their selfbelief. Motivational interviewing was developed as a treatment for alcohol abuse, but may help smokers to quit smoking.

Cochrane Systematic Review:

Lai DTC et al. Motivational interviewing for smoking cessation. Cochrane Reviews 2010, Issue 1. Article No. CD006936. DOI: 10.1002/14651858.CD006936.pub2. This review contains 14 studies involving over 10,000 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Lungs & airways > Smoking cessation > Psychological approaches

Tobacco, drugs, & alcohol dependence > Tobacco > Psychological approaches

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Does motivational Interviewing help people who smoke to quit?

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