Preliminary Results of a New Instrument to Assess Patient Motivation For Treatment in Cognitive-Behaviour Therapy

Abstract

The Nijmegen Motivation List 2 (NML2) is a new instrument to assess patient motivation for psychotherapy. A previous version of the instrument was associated with positive treatment outcome in cognitive-behaviour therapy in several studies but its psychometric properties were poor. The present study investigated the NML2’s factorial structure, psychometric properties, and predictive value for treatment outcome. The NML2 was completed by 133 outpatients. Three factors were found: preparedness, distress, and doubt. Internal consistencies and re-test reliabilities of the factors were reasonable. The NML2 total score and preparedness were associated with proximal treatment helpfulness and with treatment drop-out. Distress and doubt were not. These findings corroborate those found with the earlier NML version. Rather than assuming that the relationship between motivation factors and treatment outcome is mediated by the amount or quality of treatment or homework compliance, it is proposed that motivation for treatment is the first step in the patient’s change process itself.

Comparing the predictive capacity of observed in-session resistance to self-reported motivation in cognitive behavioral therapy

“…Future studies should examine the predictive capacity of observed resistance relative to other measures in other anxiety populations. Moreover, a number of other self-report measures of motivation for changing anxiety are available (e.g., The University of Rhode Island Change Assessment, URICA, McConnaughy, Prochaska & Velicer, 1983; The Nijmegen Motivation List 2, Keijsers et al, 1999) but were not used in the present study secondary to previous research suggesting inconsistent and weak relationships with CBT outcomes. It is unclear how well observed resistance would compare to these other measures in terms of predictive capacity.…”

“…Consequently, despite the widespread recognition of the importance of motivation to CBT outcomes for anxiety, adequate self-report measures of motivation that would prove clinically useful in differentiating treatment response are lacking. In addition to definitional problems (e.g., Keijsers et al, 1999), self-report measures of motivation may be prone to social desirability bias (i.e., ceiling effects) and therefore may not accurately reflect client motivation and lack sufficient variability to predict outcomes.…”

The relative efficacy of two brief treatments for sleep problems in young learning disabled (mentally retarded) children: a randomised controlled trial

“…Motivation is often thought to affect success of cognitive behavioural treatments. 20 These families may have been highly motivated, having responded to the screening letter. However, this did not offer treatment, but simply asked for details of their child's sleep problem.…”

Predictors of outcome for telephone and face-to-face administered cognitive behavioral therapy for depression

“…This semi-structured diagnostic interview diagnosed any DSM-IV-TR co-morbid conditions (APA, 2000). Baseline data included in the CART analysis included age, sex, ethnicity, race, marital status, education, employment status, household income, antidepressant medication status, trauma and abuse history (Wolfe & Kimberling, 1997), presence of a co-morbid anxiety disorder from the MINI (Sheehan et al 1997; Stiles-Shields et al 2014 a ), the HAMD total score, the PHQ-9 total score, the Insomnia Severity Index total score (ISI; Doghramji, 2006), the Life Experiences Survey total score (LES; Sarason et al 1978), the Generalized Anxiety Disorder-7 total score (GAD-7; Spitzer et al 2006), the Alcohol Use Disorders Identification Test total score (AUDIT; Babor et al 1992), the Positive and Negative Affect Scale total score (PANAS; Watson et al 1988), Medical Outcomes Study 36 total and subscale (Vitality, Physical Functioning, Bodily Pain, General Health Perceptions, Physical Role Functioning, Emotional Role Functioning, Social Role Functioning, Mental Health) scores (SF-36; Brazier et al 1992), the Brief Symptom Inventory total and subscale (Somatization, Obsessive-Compulsive, Interpersonal Sensitivity, Depression, Anxiety, Anger-Hostility, Phobic Anxiety, Paranoid Ideation, Psychoticism) scores (Lehman et al 2012), the Coping Self-Efficacy Scale total score (CSE; Chesney et al 2006), the Life Stressors and Social Resources total score (LISRES-A; Moos et al 1988), the Nijmegen Motivation Questionnaire-2 total score (NML-2; Keijsers et al 1999), Outcome Expectations Questionnaire – Patient Version, Perceived Barriers to Psychotherapy total score (PBP; Mohr et al 2006), Social Provisions Scale total score (SPS; Russell & Cutrona, 1984), Scale for Interpersonal Behavior total score (SIBS; Arrindell & van der Ende, 1985), Perceived Stress Scale total score (PSS; Cohen et al 1983), and Apathy Evaluation Scale total score (AES; Marin et al 1991). Treatment assignment was also included to explore whether predictors would vary as a function of treatment delivery medium.…”