Effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: a modified Delphi study

Stephen Barrett^{1

2}, Stephen Begg³, Ashley R Dunford⁴, Paul O'Halloran^{5

6}, Jeff Breckon⁷, Emily Denniss⁸, Kane Rodda⁹, Sarah Hardcastle¹⁰, Paul W Marshall¹¹, Tim Anstiss¹², Dominika Kwasnicka¹³, Benjamin Bohman¹⁴, Cathy Atkinson¹⁵, Nicholas F Taylor^{16

17}, Cameron Randall¹⁸, Colin Greaves¹⁹, Kate Hall²⁰, Brea Kunstler²¹, Jeroen Lakerveld²², Denise Goodwin²¹, Cheryce Harrison²³, Roland Devlieger^{24

25}, Dane Halliwell⁹, Daniel Faustino-Silva²⁶, Michel Kingsley^{27

11}

Affiliations

¹ Research and Innovation, Bendigo Health, Barnard St, Victoria, VIC, 3552, Australia. Sbarrett@bendigohealth.org.au.
² Holsworth Research Initiative, La Trobe University, Bendigo, VIC, 3552, Australia. Sbarrett@bendigohealth.org.au.
³ La Trobe Rural Health School, Bendigo, VIC, Australia.
⁴ Renal Services, Bendigo Health, Victoria, 3552, Australia.
⁵ Centre for Sport and Social Impact, La Trobe University, Melbourne, 3086, Australia.
⁶ School of Psychology and Public Health, La Trobe University Melbourne, 3086, Melbourne, Australia.
⁷ School of Health & Life Sciences, Teesside University, Middlesbrough, TS1 3BA, North Yorkshire, UK.
⁸ Institute for Physical Activity and Nutrition, School of Health and Social Development, Deakin University, Geelong, Australia.
⁹ Outpatient Rehabilitation Services, Bendigo Health, Victoria, 3552, Australia.
¹⁰ School of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK.
¹¹ Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.
¹² Henley Business School, University of Reading, Reading, UK.
¹³ Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
¹⁴ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
¹⁵ University of Manchester, Manchester, UK.
¹⁶ Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3086, 3128, Australia.
¹⁷ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.
¹⁸ Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA.
¹⁹ School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
²⁰ School of Psychology, Deakin University, Burwood, VIC, Australia.
²¹ Monash Sustainable Development Institute, BehaviourWorks Australia, Monash University, Victoria, 3800, Australia.
²² Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
²³ Monash Centre for Health Research & Implementation, Monash University, Melbourne, Australia.
²⁴ Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium.
²⁵ Department of Development and Regeneration, REALIFE Research group, KULeuven, Belgium.
²⁶ Grupo Hospitalar Conceição (GHC), Brazil, Brazil.
²⁷ Holsworth Research Initiative, La Trobe University, Bendigo, VIC, 3552, Australia.

PMID: 41185033
PMCID: PMC12581319
DOI: 10.1186/s12966-025-01816-6

Effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: a modified Delphi study

Stephen Barrett et al. Int J Behav Nutr Phys Act. 2025.

. 2025 Nov 3;22(1):135.

doi: 10.1186/s12966-025-01816-6.

Authors

Affiliations

¹ Research and Innovation, Bendigo Health, Barnard St, Victoria, VIC, 3552, Australia. Sbarrett@bendigohealth.org.au.
² Holsworth Research Initiative, La Trobe University, Bendigo, VIC, 3552, Australia. Sbarrett@bendigohealth.org.au.
³ La Trobe Rural Health School, Bendigo, VIC, Australia.
⁴ Renal Services, Bendigo Health, Victoria, 3552, Australia.
⁵ Centre for Sport and Social Impact, La Trobe University, Melbourne, 3086, Australia.
⁶ School of Psychology and Public Health, La Trobe University Melbourne, 3086, Melbourne, Australia.
⁷ School of Health & Life Sciences, Teesside University, Middlesbrough, TS1 3BA, North Yorkshire, UK.
⁸ Institute for Physical Activity and Nutrition, School of Health and Social Development, Deakin University, Geelong, Australia.
⁹ Outpatient Rehabilitation Services, Bendigo Health, Victoria, 3552, Australia.
¹⁰ School of Sport and Physical Activity, Sheffield Hallam University, Sheffield, UK.
¹¹ Department of Exercise Sciences, University of Auckland, Auckland, New Zealand.
¹² Henley Business School, University of Reading, Reading, UK.
¹³ Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
¹⁴ Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
¹⁵ University of Manchester, Manchester, UK.
¹⁶ Allied Health Clinical Research Office, Eastern Health, Box Hill, VIC, 3086, 3128, Australia.
¹⁷ School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, VIC, Australia.
¹⁸ Department of Oral Health Sciences, University of Washington School of Dentistry, Seattle, WA, USA.
¹⁹ School of Sport, Exercise & Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom.
²⁰ School of Psychology, Deakin University, Burwood, VIC, Australia.
²¹ Monash Sustainable Development Institute, BehaviourWorks Australia, Monash University, Victoria, 3800, Australia.
²² Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081HV, Amsterdam, the Netherlands.
²³ Monash Centre for Health Research & Implementation, Monash University, Melbourne, Australia.
²⁴ Department of Obstetrics and Gynaecology, University Hospital Leuven, Leuven, Belgium.
²⁵ Department of Development and Regeneration, REALIFE Research group, KULeuven, Belgium.
²⁶ Grupo Hospitalar Conceição (GHC), Brazil, Brazil.
²⁷ Holsworth Research Initiative, La Trobe University, Bendigo, VIC, 3552, Australia.

PMID: 41185033
PMCID: PMC12581319
DOI: 10.1186/s12966-025-01816-6

Abstract

Background: There are high levels of ill health across the world, largely due to lifestyle risk factors such as inadequate physical activity, unhealthy diet, and smoking. Behaviour change interventions are widely recommended for addressing many of these risk factors. While integrated motivational interviewing and cognitive behavioural therapy (MI-CBT) is increasingly used to support behaviour change, there is currently no established consensus on its core effective components. The aim of this study was to establish expert consensus on the essential elements of MI-CBT interventions for lifestyle behaviour change.

Methods: A modified Delphi study comprised of three iterative online surveys involving international experts in MI-CBT and lifestyle behaviour change was conducted. Using key literature and practice guides, a list of 63 commonly used components in individually delivered motivational interviewing (MI) and cognitive behavioural therapy (CBT) interventions were developed. In each round, experts rated their agreement with each component using a Likert scale. Components reaching at least 80% agreement in Rounds 2 or 3 were included in the final list of essential MI-CBT components.

Results: Thirty experts with a median of 13 years of experience in behaviour change intervention design and delivery participated in Round 1, with 28 (93%) completing Round 2, and 25 (83%) completing Round 3. Consensus was achieved for 26 components. Of these, eight were relational components which included open-ended questions, affirmations, reflections, summaries, emphasising autonomy and offering emotional support. Sixteen components were based on cognitive behavioural content, and included exploring change expectations, identifying and exploring avoidant behaviour, identifying past successes, and technical strategies such as activity scheduling and relapse prevention. Finally, two process components emphasised the importance of scheduling sessions flexibly based on client needs, and ensuring that the therapist meets recognised standards for MI-CBT training and practice.

Conclusions: Expert consensus was established regarding the essential elements of MI-CBT interventions for lifestyle behaviour change. This consensus provides guidance on essential elements to include in integrated MI-CBT interventions, which may strengthen MI-CBT training, improve intervention fidelity, and enhance real-world and research applications targeting physical activity, dietary intake, and smoking cessation. The proposed consensus framework offers a foundation for future trials assessing the effectiveness and implementation of integrated MI-CBT interventions.

Supplementary Information: The online version contains supplementary material available at 10.1186/s12966-025-01816-6.

Keywords: Behaviour change; Dietary changes; Health promotion; Physical activity; Smoking cessation.

PubMed Disclaimer

Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was granted by the La Trobe University Human Research Ethics Committee (approval number HEC24066). Participants provided informed consent at the start of the first survey. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

**Fig. 1**
Flow diagram presenting the modified Delphi study process

**Fig. 2**
Example of statements and answers and the free text option provided to participants

See this image and copyright information in PMC

References

1. Hacker K. The burden of chronic disease. Mayo Clin Proc Innov Qual Outcomes. 2024;8(1):112–9. - PMC - PubMed
1. Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The global burden of cardiovascular diseases and risk: a compass for future health. In., vol. 80: American College of Cardiology Foundation Washington DC; 2022:2361–2371. - PubMed
1. Ng R, Sutradhar R, Yao Z, Wodchis WP, Rosella LC. Smoking, drinking, diet and physical activity—modifiable lifestyle risk factors and their associations with age to first chronic disease. Int J Epidemiol. 2020;49(1):113–30. - PMC - PubMed
1. Yach D, Hawkes C, Gould CL, Hofman KJ. The global burden of chronic diseases: overcoming impediments to prevention and control. JAMA. 2004;291(21):2616–22. - PubMed
1. Dean E, Söderlund A. What is the role of lifestyle behaviour change associated with non-communicable disease risk in managing musculoskeletal health conditions with special reference to chronic pain? BMC Musculoskelet Disord. 2015;16(1):1–7. - PMC - PubMed

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Effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: a modified Delphi study

Affiliations

Effective components of integrated motivational interviewing and cognitive behavioural therapy for lifestyle behaviour change: a modified Delphi study

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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