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

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DOI: 10.1016/j.addbeh.2016.08.036


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

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.

Journal Title

Addictive behaviors



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MeSH Keywords

Adult; Decision Making; Female; Humans; Intention; Male; Motivational Interviewing; Smokers; Smoking; Smoking Cessation; Students; Universities


Cessation; Decisional balance; Motivational interviewing; Tobacco; Smoking

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