Skip to main content

Advertisement

SpringerLink
Log in

Preparing Clients for Cognitive Behavioral Therapy: A Randomized Pilot Study of Motivational Interviewing for Anxiety

  • Original Article
  • Published:
Cognitive Therapy and Research Aims and scope Submit manuscript

Abstract

Although CBT is a well-supported treatment for anxiety, recovery rates and compliance with treatment procedures are less than optimal. Using adjunctive brief preparatory interventions may help bolster response rates and engagement with therapy procedures. Motivational Interviewing (MI: Miller, W. R., & Rollnick, S. (1991, 2002). Motivational interviewing: preparing people to change addictive behavior. New York: Guilford) is a client-centered, directive method for enhancing motivation for change and has been demonstrated to be a valuable treatment prelude in the addictions domain. Prior to group cognitive behavioral therapy, 55 individuals with a principal anxiety diagnosis (45% panic disorder, 31% social phobia, and 24% generalized anxiety disorder) were randomly assigned to receive either three sessions of MI adapted for anxiety or no pretreatment (NPT). The MI pretreatment group, compared to NPT, showed significantly higher expectancy for anxiety control and greater homework compliance in CBT. Although both groups demonstrated clinically significant anxiety symptom improvements, the MI pretreatment group had a significantly higher number of CBT responders compared to NPT. At 6-month follow-up, both groups evidenced maintenance of gains. These results provide suggestive evidence that brief pretreatments, such as MI, may enhance engagement with and outcome from CBT. The promising results also justify the future investigation of these effects using more powerful designs which may discern whether the effects are specific to MI or to some type of pretreatment.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Notes

  1. Treatment manual available by email from hwestra@yorku.ca

References

  • American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: American Psychiatric Association.

    Google Scholar 

  • Arkowitz, H. (2002a). An integrative approach to psychotherapy based on common processes of change. In F. Kaslow (Ed.), Comprehensive handbook of psychotherapy, volume 4, integrative and eclectic therapies, J. Lebow (Ed.). (pp. 317–337). New York: John Wiley and Sons.

  • Arkowitz, H. (2002b). Toward an integrative perspective on resistance to change in psychotherapy. Journal of Clinical Psychology, 58, 219–227.

    Article  PubMed  Google Scholar 

  • Arkowitz, H., & Westra, H. A. (2004). Motivational interviewing as an adjunct to cognitive behavioral therapy for depression and anxiety. Journal of Cognitive Psychotherapy, 18, 337–350.

    Article  Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory manual (2nd Ed.). San Antonio: Psychological Corporation.

    Google Scholar 

  • Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257–260.

    Article  Google Scholar 

  • Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25–30.

    Article  PubMed  Google Scholar 

  • Brown, T. A., Antony, M. M., & Barlow, D. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behavior Research and Therapy, 30, 33–37.

    Article  Google Scholar 

  • Burns, D. B., & Spangler, D. L. (2000). Does psychotherapy homework lead to improvements in depression in cognitive-behavioral therapy or does improvement lead to increased homework compliance? Journal of Consulting and Clinical Psychology, 68, 46–56.

    Article  PubMed  Google Scholar 

  • Burns, D. D., & Nolen-Hoeksema, S. (1991). Coping styles, homework compliance and the effectiveness of cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 59, 305–311.

    Article  PubMed  Google Scholar 

  • Burke, B. L., Arkowitz, H., & Menchola, M. (2003). The efficacy of motivational interviewing: A meta-analysis of controlled clinical trials. Journal of Consulting and Clinical Psychology, 71, 843–861.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., & Gillis, M. M. (1993). Cognitive therapy of anxiety disorders. Journal of Consulting and Clinical Psychology, 61(2), 248–260.

    Article  PubMed  Google Scholar 

  • Chambless, D. L., Sanderson, W. C., Shohma, V., Johnson, S. B., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies. The Clinical Psychologist, 49, 5–18.

    Google Scholar 

  • Chambless, D. L., Tran, G. Q., & Glass, C. R. (1997). Predictors of response to cognitive-behavioral group therapy for social phobia. Journal of Anxiety Disorders, 11, 221–240.

    Article  PubMed  Google Scholar 

  • Colesa, M. E., Turk, C. L., Jindra, L., & Heimberg, R. G. (2002). The path from initial inquiry to initiation of treatment for social anxiety. Journal of Anxiety Disorders, 18, 371–383.

    Article  Google Scholar 

  • Collins, K., Westra, H. A., Dozois, D. J. A., & Burns, D. D. (2004). Reducing gaps in service provision for anxiety and mood disorders. Clinical Psychology Review, 24, 583–616.

    Article  PubMed  Google Scholar 

  • Collins, K. A., Westra, H. A., Dozois, D. J. A., & Stewart, S. H. (2005). The validity of the brief version of the Fear of Negative Evaluation Scale. Journal of Anxiety Disorders, 19, 345–359.

    Article  PubMed  Google Scholar 

  • Connors, G. J., Walitzer, K., & Dermen, K. H. (2002). Preparing clients for alcoholism treatment: Effects on treatment participation and outcomes. Journal of Consulting and Clinical Psychology, 70, 1161–1169.

    Article  PubMed  Google Scholar 

  • Craske, M. G., & Barlow, D. H. (2000). Mastery of your anxiety and panic III. Colorado: Graywind Publications.

    Google Scholar 

  • Craske, M. G., Barlow, D. H., & O’Leary, T. (1992). Mastery of your anxiety and worry. Colorado: Graywind Publications.

    Google Scholar 

  • Detweiler, J. B., & Whisman, M. A. (1999). The role of homework assignments in cognitive therapy for depression: Potential methods for enhancing adherence. Clinical Psychology: Science and Practice, 6, 267–282.

    Article  Google Scholar 

  • Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory—II. Psychological Assessment, 10, 83–89.

    Article  Google Scholar 

  • Dozois, D. J. A., & Westra, H. A. (2005). Development of the Anxiety Change Expectancy Scale (ACES) and validation in college, community, and clinical samples. Behaviour Research and Therapy, 43, 1655–1672.

    Article  PubMed  Google Scholar 

  • Dozois, D. J. A., Westra, H. A., Collins, K. A., Fung, T. S., & Garry, J. K. F. (2004). Stages of change in anxiety: Psychometric properties of the University of Rhode Island Change Assessment Scale. Behavior Research and Therapy, 42, 711–729.

    Article  Google Scholar 

  • Dugas, M. J., Ladouceur, R., Léger, E., Freeston, M., Langlois, F., Provencher, M. D., et al. (2003). Group cognitive-behavioral therapy for generalized anxiety disorder: Treatment outcome and long-term follow-up. Journal of Consulting and Clinical Psychology, 71, 821–825.

    Article  PubMed  Google Scholar 

  • Engle, D. E., & Arkowitz, H. (2006). Ambivalence in psychotherapy: Facilitating readiness to change. New York: Guilford.

    Google Scholar 

  • Frank, J. D. (1974). Therapeutic components of psychotherapy: A 25-year progress report of research. Journal of Nervous and Mental Disease, 159, 325–342.

    Article  PubMed  Google Scholar 

  • Franklin, M. E., & Foa, E. B. (2002). Cognitive behavioral treatments for obsessive–compulsive disorder. In P. E. Nathan & J. M. Gorman (Eds.), A guide to treatments that work (2nd ed., pp. 367–386). London: Oxford University Press.

    Google Scholar 

  • Garfield, S. L. (1994). Research on client variables in psychotherapy. In A. E. Bergin & S. L. Garfield (Eds.), Handbook of psychotherapy and behavior change (pp. 190–228). New York: Wiley.

    Google Scholar 

  • Hoehn-Saric, R., Frank, J. D., & Imber, S. D. (1964). Systematic preparation of patients for psychotherapy: I. Effects on therapy behavior and outcome. Journal of Psychiatric Research, 2, 267–281.

    Article  Google Scholar 

  • Humfress, H., Igel, V., Lamont, A., Tanner, M., Morgan, J., & Schmidt, U. (2002). The effect of a brief motivational intervention on community psychiatric patients’ attitudes to their care, motivation to change, compliance and outcome: A case control study. Journal of Mental Health, 11, 155–166.

    Article  Google Scholar 

  • Huppert, J. D., & Baker-Morissette, S. L. (2003). Beyond the manual: The insider’s guide to panic control treatment. Cognitive and Behavioral Practice, 10, 2–13.

    Article  Google Scholar 

  • Huppert, J. D., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (in press). The interaction of motivation and therapist adherence predict outcome in cognitive behavioral therapy for panic disorder: Preliminary findings. Cognitive and Behavioural Practice.

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

    Article  PubMed  Google Scholar 

  • Kazantzis, N., Deane, F. P., & Ronan, K. R. (2004). Assessing compliance with homework assignments: Review and recommendations for clinical practice. Journal of Clinical Psychology, 60, 627–641.

    Article  PubMed  Google Scholar 

  • Kemp, R., Hayward, P., Applehaite, G., Everitt, B., & David, A. (1996). Compliance therapy in psychotic patients. British Medical Journal, 312, 345–349.

    PubMed  Google Scholar 

  • Kemp, R., Kirov, G., Everitt, B., Hayward, P., & David, A. (1998). A randomised controlled trial of compliance therapy. British Journal of Psychiatry, 172, 413–419.

    Article  PubMed  Google Scholar 

  • Leahy, R. L. (2001). Overcoming resistance in cognitive therapy. New York: Guilford.

    Google Scholar 

  • Leary, M. R. (1983). A brief version of the fear of negative evaluation scale. Personality and Social Psychology Bulletin, 9, 371–375.

    Google Scholar 

  • Léger, E., Dugas, M. J., Langlois, F., & Ladouceur, R. (1998). Motivation, expectations and therapeutic relationship as predictors of outcome in the treatment of GAD. Poster presented at the annual convention of the Association for Advancement of Behavior Therapy, Washington, DC.

  • Maller, R. G., & Reiss, S. (1992). Anxiety sensitivity in 1984 and panic attacks in 1987. Journal of Anxiety Disorders, 6, 241–247.

    Article  Google Scholar 

  • Maltby, N., Tolin, D. F., & Diefenbach, G. J. (2003). A brief readiness intervention for treatment-ambivalent patients with obsessive–compulsive disorder. Poster presented at the annual convention of the Association for Advancement of Behavior Therapy, Boston, MA.

  • Martino, S., Carroll, K. M., O’Malley, S. S., & Rounsaville, B. J. (1999). Motivational interviewing with psychiatrically ill substance abusing patients. American Journal on Addictions, 9, 89–91.

    Google Scholar 

  • Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behavior Research and Therapy, 28, 487–495.

    Article  Google Scholar 

  • Miller, W. R., & Rollnick, S. (1991). Motivational interviewing: Preparing people to change addictive behavior. New York: Guilford.

    Google Scholar 

  • Miller, W. R., & Rollnick, S. (2002). Motivational interviewing: Preparing people for change. New York: Guilford.

    Google Scholar 

  • Murphy, R. T. (in press). Enhancing combat veterans’ motivation to change PTSD symptoms and other problem behaviors. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational interviewing and mental health. New York: Guilford.

    Google Scholar 

  • Murphy, R. T., Rosen, C. S., Cameron, R. P., & Thompson, D. E. (2002). Development of a group treatment for enhancing motivation to change PTSD symptoms. Cognitive and Behavioral Practice, 9, 308–316.

    Article  Google Scholar 

  • O’Hare, T. (1996). Readiness for change: Variation by intensity and domain of client distress. Social Work Research, 20, 13–17.

    Google Scholar 

  • Orne, M., & Wender, P. (1968). Anticipatory socialization for psychotherapy: Method and rationale. American Journal of Psychiatry, 124, 1202–1212.

    PubMed  Google Scholar 

  • Peterson, R. A., & Reiss, S. (1992). Anxiety sensitivity index manual (2nd ed.) Worthington: International Diagnostic Systems.

    Google Scholar 

  • Safren, S. A., Heimberg, R. G., & Juster, H. R. (1997). Clients’ expectancies and their relationship to pretreatment symptomatology and outcome of cognitive-behavioral group treatment for social phobia. Journal of Consulting and Clinical Psychology, 65, 694–698.

    Article  PubMed  Google Scholar 

  • Schmidt, N. B., & Wollaway-Bickel, K. (2000). The effects of treatment compliance on outcome in cognitive-behavioral therapy for panic disorder: quality versus quantity. Journal of Consulting and Clinical Psychology, 68, 13–18.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1994). Structured clinical interview for DSM IV. New York: New York State Psychiatric Institute, Biometrics Research Department.

    Google Scholar 

  • Swanson, A. J., Pantalon, M. V., & Cohen, K. R. (1999). Motivational interviewing and treatment adherence among psychiatric and dually diagnosed patients. Journal of Nervous and Mental Disease, 187, 630–635.

    Article  PubMed  Google Scholar 

  • Tolin, D. F., & Maltby, N. (in press). Motivating treatment-refusing patients with obsessive–compulsive disorder. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational interviewing and mental health. New York: Guilford.

    Google Scholar 

  • Walitzer, K. S., Dermen, K. H., & Connors, G. J. (1999). Strategies for preparing clients for treatment. Behavior Modification, 23, 129–151.

    PubMed  Google Scholar 

  • Watson, D., & Friend, R. (1969). Measurement of social-evaluative anxiety. Journal of Consulting and Clinical Psychology, 33, 448–457.

    Article  PubMed  Google Scholar 

  • Westen, D., & Morrisson, K. (2001). A multidimensional meta-analysis of treatments for depression, panic, and generalized anxiety disorder: An empirical examination of the status of empirically supported therapies. Journal of Consulting and Clinical Psychology, 69, 875–899.

    Article  PubMed  Google Scholar 

  • Westra, H. A. (1998). Managing anxiety and panic. Unpublished treatment manual.

  • Westra, H. A. (2004). Managing resistance in cognitive behavioral therapy: Applications of motivational interviewing to mixed anxiety and depression. Cognitive Behavior Therapy, 33, 161–175.

    Article  Google Scholar 

  • Westra, H. A., & Dozois, D. J. A. (2003). Motivational interviewing adapted for anxiety/depression. Unpublished treatment manual.

  • Westra, H. A., & Dozois, D. J. A. (in submission). Expectancy for Change, Homework Compliance and Outcomes in Cognitive Behavioral Therapy for Anxiety.

  • Westra, H. A., & Dozois, D. J. A. (in press). Integrating motivational interviewing in to the treatment of anxiety. In H. Arkowitz, H. A. Westra, W. R. Miller, & S. Rollnick (Eds.), Motivational interviewing and mental health. New York: Guilford.

    Google Scholar 

  • Westra, H. A., & Phoenix, E. (2003). Motivational enhancement therapy in two cases of anxiety disorder. Clinical Case Studies, 2, 306–322.

    Article  Google Scholar 

  • Westra, H. A., & Stewart, S. H. (1998). Cognitive behavioural therapy and pharmacotherapy: Complementary or contradictory approaches to the treatment of anxiety? Clinical Psychology Review, 18(3), 307–340.

    Article  PubMed  Google Scholar 

  • Westra, H. A., Stewart, S. H., & Conrad, B. E. (2002). Naturalistic manner of benzodiazepine use and cognitive behavioral therapy outcome in panic disorder with agoraphobia. Journal of Anxiety Disorders, 36, 1–14.

    Google Scholar 

Download references

Acknowledgments

This study was supported by an Academic Development Fund grant from the University of Western Ontario to both authors. We wish to thank Dr. Michelle Duwyn for her excellent provision of the Motivational Interviewing in this study and the treatment team of the Anxiety and Affective Disorders Service at the London Health Sciences Centre for their outstanding provision of CBT.

Author information

Authors and Affiliations

  1. Department of Psychology, York University, 239 BSB, 4700 Keele Street, Toronto, Ontario, Canada, M3J 1P3

    Henny A. Westra

  2. University of Western Ontario, Toronto, Canada

    David J. A. Dozois

Authors
  1. Henny A. Westra
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David J. A. Dozois
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Henny A. Westra.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Westra, H.A., Dozois, D.J.A. Preparing Clients for Cognitive Behavioral Therapy: A Randomized Pilot Study of Motivational Interviewing for Anxiety. Cogn Ther Res 30, 481–498 (2006). https://doi.org/10.1007/s10608-006-9016-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10608-006-9016-y

Keywords

Search

Navigation