Motivational interviewing is a directive, client-centred counselling style for eliciting behaviour change by helping clients to explore and resolve ambivalence. It is most centrally defined not by technique but by its spirit as a facilitative style for interpersonal relationship. This article seeks to define motivational interviewing and to characterize its essential nature, differentiating it from other approaches with which it may be confused. A brief update is also provided regarding (1) evidence for its efficacy and (2) new problem areas and populations to which it is being applied.

In order to test the efficacy of a self-help anxiety management package, sixty-two individuals meeting DSM-III-R criteria for an anxiety disorder were randomly allocated to one of three conditions: Stresspac patients were given a self-help/information package. Advice only patients were offered verbal advice on ways of coping with anxiety. Patients in both conditions were seen on one occasion shortly after referral for assessment and management advice. They were then placed back on the waiting list for a three month period. Patients in the No intervention condition also completed measures during this time. They were not seen until the end of this period when formal assessment took place. All patients were then followed through individual therapy and to 12 month follow-up. Results clearly support the superiority of the Stresspac condition after the waiting period, at post therapy and at follow-up on a range of measures. Possible explanations for the results are discussed.

This paper aims to contribute to the discussion of the ethical issues in motivational interventions which have recently been raised by Miller (1994). Motivational interviewing is typically used when a therapist perceives a need for behaviour change in someone who is ambivalent about such change. Motivational interviewing aims to evoke motivation by making salient the inconsistency of continuing with a problem behaviour and other longer term or wider life goals. Miller (1994) discussed what was manipulative about this approach and considered both a descriptive and evaluative component. The ethics of motivational interviewing are considered here, within the context of psychological therapy in a general sense, and questions whether the ethical issues relevant to motivational interviewing are different from other psychological interventions. A distinction between the goals and the means of obtaining therapeutic goals is suggested as useful.

This study derives from an earlier one (Sutton, 1992) which examined the efficacy of training parents to manage difficult pre-school children via four methods: group, home visit, telephone, and waiting list/delayed intervention control. It is a replication of the telephone method of training; the author has never met any of the parents or children involved. Twenty-three children, seventeen boys and six girls, participated; of these one was aged 8, two were 7, one was 6, two 5 and the rest were under 5. They were randomly allocated to an immediate intervention group and a waiting list/delayed intervention control group.

The present study evaluates a multifaceted cognitive-behavioral group treatment in a routine clinical setting. The program consists of directly sleep related strategies such as sleep education, sleep restriction, stimulus control, relaxation, and cognitive restructuring. Also included are techniques that target illness maintaining factors such as stress-management, problem solving skills, and increase of activities. Twenty-eight physician-referred outpatients with chronic primary insomnia according to DSM-III-R criteria attended 11 weekly therapy-sessions. Results were obtained on a subjective and objective level using a sleep diary, questionnaires, and polysomnography, respectively. Pre- and post-treatment comparisons indicated significant changes on all main sleep diary variables, i.e. total sleep time, sleep efficiency, number of awakenings, sleep onset latency and wake after sleep onset, as well as for the global subjective sleep quality. Maximum improvement was reached after the more directly sleep-related part of the program. In addition, the intervention helped patients to reduce the amount and frequency of sleeping aids over time and improved their daytime-functioning. Subjective therapeutic gains were maintained at 3- and 12-month follow-ups. No significant treatment effects could be obtained on polysomnographic measures, taking into account that the baseline values were already in the normative range. After the intervention the patients were able to give a more realistic evaluation of their sleep. These results suggest that a multicomponent psychological treatment is beneficial for the improvement of sleep quality on a subjective level.

Twenty-four DSM-III-R non-depressed obsessive-compulsive (OCD) patients were compared to 21 normal subjects in three lexical decision experiments, to distinguish neutral, obsessive and responsibility words from pseudo-words. Error frequencies were comparable across groups. A significant taboo effect was found in both groups for obsessive and responsibility words. OCD patients did not differ from control subjects in their processing of neutral words and responsibility words. However, OCD patients were significantly slower than controls when processing obsessive words. Furthermore, OCD patients processed pseudo-words slower than controls if these were presented in the same experiment as obsessive words. When mixed with neutral or responsibility words, the performance of OCD patients with pseudo-words was similar to that of control subjects. The level of sub-clinical depression (as appreciated on the HAM-D scale) and psychotropic drugs (such as serotonin reuptake inhibitor) did not modify these results. Lexical decision performances were interpreted in terms of a cognitive disturbance triggered by obsessive stimuli that spreads to a neutral task. These results are compatible with the cognitive model of OCD (Salkovskis, 1985).

Previous researchers have identified disinhibiting agents of restrained eating such as the ingestion of preloads, alcohol consumption, and negative affect. This study investigated worry as a purely cognitive inhibitor of dietary restraint. Seventy-five subjects who were screened as being high worriers and high restrainers were randomly assigned to three groups: eating-related worry; social-evaluative/school-related worry; non-worry. Subjects were induced to either worry or to think pleasant thoughts, and then take part in a bogus taste-test. Food consumption in worry-prone, chronic dieters was found to be triggered more by social-evaluative/school-related worries than by eating-related worries, or pleasant thoughts. Chronic dieting and worrying were found to be substantially related to measures of bulimic tendencies and trait anxiety, respectively. These findings may be germane to behaviour change programmes pertaining to bulimia.

In an earlier edition of this journal (vol. 22, 111–123) William R. Miller persuasively defends his motivational interviewing approach (Miller, 1983) against the claim that it is “manipulative”, at least in the pejorative sense of that term. This critique of Miller's methods and his response to it is explored as a new manifestation of a longstanding conflict between (cognitive) behaviourism and psychoanalysis, a conflict that seems to lie at the very heart of psychological science, restricting the professional development of us all. It is argued that our own discipline could benefit from some form of motivational intervention to enable cognitive-behaviourists and psychodynamicists to communicate genuinely and more fully with each other. Some suggestions for steps in this direction are provided.

This paper describes some of the ways in which ruminative rehearsal and repetitive processing of phobic events may maintain or enhance anxious responding. It focuses on laboratory studies of repetitive rehearsal of potential phobic outcomes and repetitive processing of interoceptive cues. Rehearsal of threatening outcomes whilst in anxious mood has been shown to result in a short term enhancement and resistance to extinction of phobic responses. Increased attention to and discrimination of bodily cues (interoception) has also been shown to result in enhanced phobic responding and increased resistance to extinction. This latter finding appears to result from interoception (1) inflating the threatening nature of the outcome, and (2) leading the individual to reject contradictory information from other sources.

In two separate commentaries, Withers and Seager offer constructive critiques of “The Ethics of Motivational Intervention.” It is difficult to render ethical judgments regarding a method apart from the goals and contexts within which it is to be applied. A clearer and transtheoretical understanding of the mechanisms underlying the efficacy of motivational interviewing may better inform future discussions of these ethical concerns that pertain to psychotherapy more generally.

In an experimental study with panic agoraphobic patients, generalized anxiety patients and normals we operationally defined and measured spatial orientation of the three research groups. The observation, that patients suffering from agoraphobia have a very narrow exploratory activity range, is as important from the point of view of therapy as theory. Our study observed panic agoraphobic patients through their exploratory abilities. We examine panic agoraphobic, generalized anxiety and normal subjects, as they utilized their exploration skills in a complicated maze. We determined that the cognitive maps drawn by the panic agoraphobic patients are inaccurate. They got lost more often and utilized far fewer navigation points during their walk in the maze, compared to the generalized anxiety or normal subjects. The frame of the conceptualization was based on personal attentional strategies, spatial orientation deficit, and exploratory activity abnormalities.

Several empirical studies suggest that exposure in vivo and response prevention have a differential treatment effect on the complaints presented by patients with Obsessive-Compulsive Disorder (OCD). In the present study it was hypothesized that exposure in vivo would result in a greater decrease of obsessional fear, whereas response prevention would result in a greater decrease of rituals. Forty patients, diagnosed with OCD, participated in the study. Half of the patients received exposure in vivo alone, followed by response prevention alone, and half received response prevention alone, followed by exposure in vivo alone. No differential treatment effects between exposure in vivo alone and response prevention alone could be found, although ritualistic behaviour was less strongly affected by exposure in vivo following response prevention.

Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.

Frequent checkers with obsessive-compulsive disorder (OCD; n=24), high checking controls (n=24) and low checking controls (n=48) were instructed to learn action phrases such as “to open the book” by performing the action themselves with imaginary objects (motor encoding), by imagining how one performs the action oneself (motor-imaginal encoding), by imagining seeing somebody else performing the action (visual-imaginal encoding) and by subvocal rehearsal. Compared to low checking controls, OCD checkers showed poorer free recall of motorically encoded actions and poorer reality monitoring, i.e. they confused motor and motor-imaginal encoding more frequently. The results are consistent with a specific motor memory deficit in OCD checkers. Moreover, memory performance of OCD checkers differed from that of high checking controls.

The findings from this study indicate that group cognitive behavioural therapy combined with mood stabilizing medications was effective for some of the participants. Standard measures were used to monitor changes systematically and regularly. Self reports from participants suggested that they found the therapy useful and acceptable. The approach taken seems worth extending to a larger number of participants in a controlled trial, but meanwhile a detailed description of the treatment package is given, for wider dissemination of the methods.

Trauma symptoms, coping and personality were assessed in 44 victims of the Perth flood. The sample was characterized by high levels of intrusions, numbness, arousal and general emotional distress. General levels of symptomatology were predicted by two coping strategies: emotion-focused coping and thought suppression. Overall trauma symptoms and emotion-focused coping were associated with the personality trait of neuroticism. These data are consistent with the Wells and Matthews (1994a) model of affective disorders and stress. The model proposes that certain types of emotion-focused coping tend to lead to greater access to negative self-beliefs, and that thought suppression tends to prime subsequent intruding thoughts. A second personality trait, private self-consciousness, was associated with relatively greater levels of numbing symptoms, and relatively lower levels of arousal symptoms. This patterning of symptoms may result from use of ruminative coping strategies. Hence, intrusions of trauma-related material are not simply a function of automatic activation of a fear network, but are also influenced by the person's voluntary efforts to deal with the aftermath of the event.

Imagery appears to be associated with higher levels of anxiety than does worry. Borkovec has argued that worry could be a way of avoiding distressing imagery and the associated affect. Thus worry could suppress emotional activation, interfere with emotional processing, and contribute to the maintenance of anxiety. This hypothesis suggests that short and long-term effects of worrying after experiencing a distressing stimulus should differ from the effects of engaging in imagery. In the short term, imagery should maintain anxiety while worry should not do so, or should do so less. In the longer term, worry should be a less successful way of reducing anxiety associated with the stimulus than imagery, and should be followed by a greater number of intrusive cognitions (indicating the relative failure of emotional processing). These predictions were tested by asking subjects to worry, engage in imagery or “settle down” after watching a distressing video. The results were broadly consistent with the hypothesis. Other interpretations are also considered.