Motivational interviewing and the decisional balance procedure for cessation induction in smokers not intending to quit.
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.



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.



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.



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.
Midwest Cancer Alliance, University of Kansas Cancer Center, 4350 Shawnee Mission Parkway, Fairway, KS 66205, United States. Electronic address: skrigel@kumc.edu.
Susan W
SW
Krigel
JEGrobe Consulting, 9209 Heatherdale Drive, Dallas, TX 75243, United States. Electronic address: jamesegrobe@gmail.com.
James E
JE
Grobe
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.
Kathy
K
Goggin
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.
Kari Jo
KJ
Harris
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.
Jose L
JL
Moreno
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.
Delwyn
D
Catley
D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D033182:Intention; D008297:Male; D062405:Motivational Interviewing; D000074285:Smokers / Q000523:psychology* / Q000706:statistics & numerical data; D012907:Smoking / Q000523:psychology* / Q000628:therapy; D016540:Smoking Cessation / Q000379:methods*; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D014495:Universities
Cessation; Decisional balance; Motivational interviewing; Tobacco