Integrating motivational interviewing with cognitive-behavioral therapy for severe generalized anxiety disorder: An allegiance-controlled randomized clinical trial.

Henny Alice Westra, Michael J. Constantino, Martin M. Antony

2016-01-01articleJournal of Consulting and Clinical Psychology254 citationsclosed

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Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes Psychotherapy Techniques and Applications Psychological Treatments and Assessments

Abstract

OBJECTIVE: Although integrating motivational interviewing (MI) and cognitive-behavioral therapy (CBT) has been recommended for treating anxiety, few well-controlled tests of such integration exist. METHOD: In the present randomized trial for severe generalized anxiety disorder (GAD), we compared the efficacy of 15 sessions of CBT alone (N = 43) versus 4 MI sessions followed by 11 CBT sessions integrated with MI to address client resistance/ambivalence (N = 42). Clients were adults, predominantly female and Caucasian, with a high rate of diagnostic comorbidity. To control for allegiance, therapists were nested within treatment group and supervised separately by experts in the respective treatments. RESULTS: Piecewise multilevel models revealed no between-groups differences in outcomes from pre- to posttreatment; however, there were treatment effects over the follow-up period with MI-CBT clients demonstrating a steeper rate of worry decline (γ = -0.13, p = .03) and general distress reduction (γ = -0.12, p = .01) than CBT alone clients. Also, the odds of no longer meeting GAD diagnostic criteria were ∼5 times higher at 12-months for clients receiving MI-CBT compared with CBT alone. There were also twice as many dropouts in CBT alone compared with MI-CBT (23% vs. 10%); a difference that approached significance (p = .09). The treatments were competently delivered, and intraclass correlations revealed negligible between-therapist effects on the outcomes. CONCLUSIONS: The findings support the integration of MI with CBT for severe GAD and point to the importance of training therapists in appropriate responsivity to in-session markers of resistance and ambivalence. (PsycINFO Database Record

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References

2014Diagnostic and Statistical Manual of Mental Disorders, 5th ed.

1995The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories

1991Clinical significance: A statistical approach to defining meaningful change in psychotherapy research.

2005The short‐form version of the Depression Anxiety Stress Scales (DASS‐21): Construct validity and normative data in a large non‐clinical sample

1990Development and validation of the penn state worry questionnaire

1998Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.

2001The Revised CONSORT Statement for Reporting Randomized Trials: Explanation and Elaboration

2003Motivational Interviewing: Preparing People for Change, 2nd ed.

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