Adding the newer therapeutic approach called “motivational interviewing” (MI) to standard cognitive behavioral therapy (CBT) improved long-term symptoms in severe generalized anxiety disorder (GAD) compared to CBT alone, according to a new clinical trial published in the Journal of Consulting and Clinical Psychology.
MI is a client-centered type of counseling that helps the therapist express empathy toward the patient, particularly regarding any fearful resistance and mixed feelings the patient might have upon giving up their worries and anxieties. The approach helps therapists validate the patients’ ambivalent feelings, thus reducing the chance of a clash of wills between patient and therapist.
“People can come into therapy both wanting to change and being reluctant to change,” said psychotherapy researcher Dr. Michael Constantino at the University of Massachusetts Amherst.
“They may be reluctant to let go of something that is so familiar, something that serves as an adaptive tool. That is, the worry is useful to them if they feel it helps keep them on track and functioning responsibly, for example.”
Said Constantino, “Generalized anxiety disorder is a very stubborn condition, and even with a full course of CBT, which is the long-time gold standard of treatment, less than half of patients respond. We wanted to do something about improving mental health treatment outcomes for this very commonly encountered disorder.”
Constantino said the idea is to add MI during the patient’s ambivalent stage to help address any resistance to the therapist or intervention.
“Rather than telling you to change, it is helping you to understand why it’s hard for you to change,” Constantino said. “Patients tend to get better when MI strategies are used in the face of resistance; they get more out of the therapy.”
For the study, researchers recruited 85 GAD patients in Toronto to attend 15 therapy sessions. A total of 43 patients were randomly assigned to receive CBT alone from therapists trained only in CBT, and 42 were assigned to receive CBT plus MI from therapists trained in both.
“Interestingly, for the main outcomes of worry and of global distress, when assessed immediately after treatment ended, there was no significant effect of treatment condition,” said Constantino.
However, he said, “Over a one year post-treatment follow-up period, we saw patients who received the combined MI-CBT therapy do significantly better on both of these outcome variables. They did much better than the CBT-only patients, who either stayed the same or got worse in their worry and distress. So it was a sleeper effect, they got better but we didn’t see it until later.”
Since MI is more patient-centered, the researchers hypothesize that the MI patients were better equipped to resolve their own struggles and challenges after therapy ended, even though they didn’t have the help of a therapist anymore. In other words, the MI strategies gave them more autonomy, and may have helped them help themselves over the long term, they said.