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

Abstract

Responsively adding motivational interviewing (MI) to cognitive-behavioral therapy (CBT) for generalized anxiety disorder (GAD) has outperformed CBT alone on follow-up worry reduction , with this long-term effect on the cardinal feature of worry being mediated by less patient midtreatment resistance in MI-CBT (Constantino, Westra, Antony, & Coyne, 2019). Insofar as GAD can also be marked by interpersonal problems of nonassertiveness and over accommodation, we tested these same direct and indirect effects on these diagnostically salient interpersonal outcomes. Eightyfive patients with GAD were randomly assigned to brief MI-CBT or CBT. Patients completed a measure of interpersonal problems throughout treatment and across 12-month follow-up. Coders rated patient resistance at a midtreatment session. As expected, and consistent with the previously tested worry outcome, structural equation models showed comparable reductions in the interpersonal problems across active-phase MI-CBT and CBT. Also as predicted, MI-CBT versus CBT promoted greater reduction in over accommodation over follow-up. For problematic nonassertiveness, the effect was directionally consistent, but only approached significance. Finally, as predicted, the treatment effect on both interpersonal problem levels at 12 months following treatment was mediated by less midtreatment resistance in MI-CBT versus CBT. Results support that the benefit of adding MI to CBT for GAD extends to long-term interpersonal changes, and they implicate resistance management as a candidate mechanism of this effect.

A pilot study on the efficacy of motivational interviewing groups in alcohol use disorders

“…However, patient engagement is very challenging within this approach since ambivalence is common in alcohol treatment. CBT requires a strong initial motivation and engagement from the patients, since it does not address specific techniques for reinforcing motivation or resolving ambivalence (Muir et al, 2021; Raistrick et al, 2006; Westra & Norouzian, 2018). Motivational issues are now recognized as central to effective alcohol use disorder management, including increasing adherence to treatment by decreasing resistance to change and ambivalence (Raistrick et al, 2006; Westra & Norouzian, 2018).…”

“…Because of frequent ambivalence in addictions, CBT does not always produce the desired results and dropout rates can be high. Indeed, this approach requires strong motivation on the part of patients, and there is no specific strategy for strengthening motivation or resolving ambivalence (Muir et al, 2021; Raistrick et al, 2006; Westra & Norouzian, 2018). Very recently, Santa Ana et al (2021) evaluated the efficacy of MI in groups relative to control treatment condition (CTC) consisting of cognitive behavioral skills, including relapse prevention and 12‐step facilitation in improving engagement in therapy and decreasing substance use.…”

Training on context-responsive psychotherapy integration: An evidence-informed framework.

“…On the other hand, when applicable, clinicians need to be able to identify and understand their patients' resistance, both in general and within the context of a patient's pathology. For example, patients with GAD are often overly deferent in interpersonal relationships (Gomez Penedo et al, 2017); thus, for them to demonstrate resistance in therapy (perhaps because of their ambivalence about relinquishing their worries that help them feel responsible and in control) would require a type of unfamiliar, but arguably adaptive, relational risk-taking stance (Muir et al, 2021). Were a therapist to attempt to override such resistance by persisting with a heavy worry-reduction-focused treatment plan, it is possible that the patient would relent, thereby invalidating one side of their ambivalence, reinforcing a core relational element of their pathology, and negating an opportunity for interpersonal change.…”

“…Using the current marker as an example, such resolution (i.e., when a patient's momentary resistance is attenuated or eliminated) could be assessed verbally, with a patient self-report measure, and/or through independent observation. Moreover, in the case of the patient with GAD, such resolution could represent a theory-consistent corrective relational experience (see Muir et al, 2021).…”

Developing the Technology-based Parenting Young Children Check-Up Intervention for Disruptive Behavior Problems in Early Childhood

“…Notably, self-administered BPT in healthcare settings (i.e., giving parents packets outlining evidence-based parenting skills) shows promise for responding to elevated DBPs in young children (Berkovtis et al, 2010). Second, the efficacy of motivational approaches as a precursor to more intensive treatments has shown promise in other areas (e.g., Muir, Constantino, Westra, & Antony, 2021) and may also be a way to facilitate engagement and retention in BPT programs. For example, Chaffin et al (2009) found that use of a Motivational Interviewing session at the outset of a home visiting program reduced program dropout.…”