Client Retrospective Accounts of Corrective Experiences in Motivational Interviewing Integrated With Cognitive Behavioral Therapy for Generalized Anxiety Disorder

Abstract

A corrective experience (CE) is one "in which a person comes to understand or experience affectively an event or relationship in a different and unexpected way" (Castonguay & Hill, 2012, p. 5). CEs disconfirm clients' expectations based on past problematic experiences, and can be emotional, relational, behavioral, and/or cognitive. This qualitative study explored corrective shifts among recovered participants (N = 8) who had received motivational interviewing (MI) integrated with cognitive behavioral therapy (CBT) in a randomized controlled trial comparing CBT alone to MI-CBT for generalized anxiety disorder (Westra, Constantino, & Antony, 2016). We administered a posttherapy interview querying their experience of, and explanations for, any shifts in therapy. Grounded theory analysis yielded three core themes: in command of the worry train, experiencing myself in new ways in therapy, and oriented toward change. Findings are discussed in terms of MI theory, and clinical implications for therapists are provided.

Using interpersonal process recall to compare patients’ accounts of resistance in two psychotherapies for generalized anxiety disorder

“…In the context of GAD formulation, they may have felt safer to assert themselves in varied ways (verbally and behaviorally), which was indeed the intention of assimilating MI into CBT specifically to address the markers of patient ambivalence, resistance, or disagreement. To the extent that being given, and taking, such autonomy reflected novel and corrective experiences, the patient narratives further support the previously‐cited quantitative and qualitative work pointing to well‐timed MI as a mechanism of improved CBT for GAD (Constantino et al., ; Khattra et al., ; Macaulay et al., ).…”

“…The importance of shifting toward a heightened sense of control and self‐efficacy, as fostered by the therapist's integrative use of MI strategy and stance, was corroborated in another posttreatment interview study of eight MI‐CBT patients who met recovery status in the Westra et al. trial (Macaulay, Angus, Khattra, Westra, & Ip, ).…”

“…Consistent with aforementioned interpretation, the MI-CBT patient reported a heightened sense of selfconfidence in her own agency, which resulted in more confidence in maintaining therapy gains now that treatment had ended. The importance of shifting toward a heightened sense of control and self-efficacy, as fostered by the therapist's integrative use of MI strategy and stance, was corroborated in another posttreatment interview study of eight MI-CBT patients who met recovery status in the Westra et al trial (Macaulay, Angus, Khattra, Westra, & Ip, 2017).…”

Integrating responsive motivational interviewing with cognitive–behavioral therapy (CBT) for generalized anxiety disorder: Direct and indirect effects on interpersonal outcomes.

“…Doing so would represent a reduction in interpersonal vulnerabilities that can promote and sustain GAD; thus, it is unsurprising that across multiple studies from the Westra et al (2016) trial, the distinct constructs of interpersonal problems and worry reduced in a similar manner over the follow-up period, with resistance management now established as a prime candidate mechanism of the effect of treatment on all of these outcomes. And, in an important triangulation of method and data, qualitative interviews with the patients from Westra et al's (2016) trial have also supported this corrective experience notion (e.g., Macaulay, Angus, Khattra, Westra, & Ip, 2017).…”

How Do Emotions during Goal Pursuit in Weight Change over Time? Retrospective Computational Text Analysis of Goal Setting and Striving Conversations with a Coach during a Mobile Weight Loss Program

“…Coaches contact individuals at least once a week. Coaches use goal setting, motivational interviewing, and cognitive behavioral therapy techniques to help individuals to mutually set incremental goals, express their emotions during goal striving, and cope with their emotions and barriers to their goals [ 17 , 54 ]. Goal setting and striving interactions are offered from the beginning to the end of the program.…”