Motivational Interviewing as an Adjunct to Cognitive Behavior Therapy for Anxiety Disorders: A Critical Review of the Literature

Abstract

Cognitive behavior therapy (CBT) is efficaciously and effectively used in the treatment of anxiety disorders; however, as CBT for anxiety routinely utilizes exposure components, clients often experience ambivalence about treatment and their clinicians often must deal with resistance. Motivational Interviewing (MI) is a therapeutic strategy that addresses ambivalence about change in clinical interventions. MI has been applied as an adjunct for treatments such as CBT in order to increase motivation for and commitment to the intervention, especially when components of the treatment may be challenging (e.g., exposure, cognitive restructuring). Though researchers have commented specifically on the use of MI as a supplement to CBT for anxiety disorders, no comprehensive review has systematically assessed the strengths and limitations of extant literature on the topic, nor across anxiety disorders. Findings are summarized from 6 case studies and uncontrolled trials and 11 randomized controlled trials published through March 2016. An integrated critique of this literature also is offered. Limitations and the preliminary nature of the work in this area notwithstanding, it appears that it is feasible to supplement or integrate CBT with MI and that doing so has the potential to improve treatment initiation and engagement, as well as clinical outcomes. A number of directions for future research are addressed, such as determining which MI approaches to implement, with whom, when, and in what contexts.

Talking about trauma in therapy: Perspectives from young people with post‐traumatic stress symptoms and first episode psychosis

“…MI is designed to explore and resolve ambivalence about behavioural change, and its effectiveness in the treatment of substance abuse is well known (Smedslund et al, 2011). A recent review found some improvement in treatment initiation and engagement following the addition of MI as an adjunct for CBT for anxiety disorders (Randall & McNeil, 2017). To date, MI approaches in PTSD have focused on ambivalence regarding changing PTSD symptoms or associated coping strategies in veterans (Murphy, Thompson, Murray, Rainey, & Uddo, 2009;Seal et al, 2012).…”

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

“…Notably, client motivation, as assessed by self-report measures as well as by qualitatively coding client motivational language in session, is related to CBT outcomes and adherence (e.g., Bados et al, 2007 ; de Haan et al, 1997 ; Sijercic et al, 2016 ; Wergeland et al, 2005 ). Results from systematic reviews reveal MI enhances CBT response and completion rates for anxiety relative to CBT alone ( Ekelund, 2016 ; Randall and McNeil, 2016 ).…”

Computerized Clinical Training Simulations with Virtual Clients Abusing Alcohol: Initial Feasibility, Acceptability, and Effectiveness

“…The second and third simulations focused on CBT with the second simulation targeting the introduction of CBT to a client, and the third simulation targeting the conducting of a CBT functional analysis. The authors chose simulations focused on MI and CBT because they are among the most versatile and empirically validated psychosocial treatments (Hofmann et al 2012;Randall and McNeil 2017). Moreover, the Brief MI and Introducing CBT simulations were recently examined and found to be efficacious (when delivered and evaluated under ideal research conditions) at enhancing clinical skills (Mastroleo et al 2020;Putney et al 2019a, b).…”