Brief online motivational interviewing pre-treatment intervention for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial

Abstract

While the efficacy of therapist-guided internet-delivered cognitive behaviour therapy (iCBT) for anxiety and depression is well-established, a significant proportion of clients show little to no improvement with this approach. Given that motivational interviewing (MI) is found to enhance face-to-face treatment of anxiety, the current trial examined potential benefits of a brief online MI intervention prior to therapist-guided iCBT. Clients applying to transdiagnostic therapist-guided iCBT in routine care were randomly assigned to receive iCBT with ( n = 231) or without ( n = 249) the online MI pre-treatment. Clients rated motivation at screening and pre-iCBT and anxiety and depression at pre- and post-treatment and at 13- and 25-week follow-up after enrollment. Clients in the MI plus iCBT group made more motivational statements in their emails and were enrolled in the course for a greater number of days compared to clients who received iCBT only, but did not demonstrate higher motivation after completing the MI intervention or have higher course completion. Clients in both groups, at screening and pre-iCBT, reported high levels of motivation. No statistically significant group differences were found in the rate of primary symptom change over time, with both groups reporting large reductions in anxiety and depression pre- to post-treatment (Hedges' g range = 0.96–1.11). During follow-up, clients in the iCBT only group reported additional small reductions in anxiety, whereas clients in the MI plus iCBT group did not. The MI plus iCBT group also showed small increases in depression during follow-up, whereas improvement was sustained for the iCBT only group. It is concluded that online MI does not appear to enhance client outcomes when motivation at pre-treatment is high.

A randomized factorial trial of internet-delivered cognitive behavioural therapy: An 8-week program with or without extended support and booster lesson

“…The reality exists that 50% of patients had a desire for an extension and the question remains how to best address the needs of these patients. Other options to be explored in the future include focussing more on the nature of therapeutic support rather than on offering more support; for example using motivational interviewing earlier in treatment to assist with treatment engagement ( Soucy et al, 2021 ). The booster also did not improve outcomes, but nevertheless was used by patients – perhaps offering this as self-directed manner would meet potential demand for this from consumers, but not increase costs.…”

Alcohol and drug use among clients receiving internet-delivered cognitive behavior therapy for anxiety and depression in a routine care clinic – Demographics, use patterns, and prediction of treatment completion and outcomes

“…The trials received ethics board approval from the University of Regina, were registered ( ClinicalTrials.gov Identifier: NCT03304392 ; NCT03684434 ), and conducted between 2017 and 2019. Details on the design of the trials are available elsewhere ( Hadjistavropoulos et al, 2020 ; Soucy et al, 2021 ). In brief, the first trial ( Hadjistavropoulos et al, 2020 ) compared the benefits of therapists providing support once-weekly versus therapists providing support once-weekly supplemented with a one-business-day response to all client emails with no significant differences found in treatment completion or outcomes ( Hadjistavropoulos et al, 2020 ); whereas the second ( Soucy et al, 2021 ) compared the benefits of clients receiving ICBT with and without a preceding online motivational interviewing lesson and similarly found no significant group differences in treatment completion or outcomes ( Soucy et al, 2021 ).…”

“…Details on the design of the trials are available elsewhere ( Hadjistavropoulos et al, 2020 ; Soucy et al, 2021 ). In brief, the first trial ( Hadjistavropoulos et al, 2020 ) compared the benefits of therapists providing support once-weekly versus therapists providing support once-weekly supplemented with a one-business-day response to all client emails with no significant differences found in treatment completion or outcomes ( Hadjistavropoulos et al, 2020 ); whereas the second ( Soucy et al, 2021 ) compared the benefits of clients receiving ICBT with and without a preceding online motivational interviewing lesson and similarly found no significant group differences in treatment completion or outcomes ( Soucy et al, 2021 ). As no differences were found between experimental groups in these two trials and both trials involved the same treatment program, data was combined to maximize power in the current analysis.…”

Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review

“…In all, 2 studies assessed slight variations in the same intervention [ 52 , 87 ]; however, we did not segregate these studies because they only reflected minor variations in what was essentially the same intervention. Furthermore, 3 sets of 2 studies in the sample analyzed the same interventions: [ 66 , 69 ], [ 54 , 58 ], and [ 51 , 89 ]; therefore, we grouped them together. The final list of 48 interventions is analyzed in this section and the subsequent one.…”